Propranolol - cure or moral timebomb for war veterans of Iraq and
Afghanistan?
Mike Earl-Taylor
The US Army's proposed use of the heart drug Propranolol to treat
combat-related post-traumatic stress in order to suppress 'unspeakable memories'
raises legal, ethical and moral issues.
The numbers of American troops who have served in the war-torn countries of
Iraq and Afghanistan, and who have returned home suffering from symptoms of
post-traumatic stress disorders (PTSD) and other related psychiatric conditions
have reached, or exceeded levels last seen in the post Vietnam era.
A recent Pentagon task force report indicates that 38 percent of Army troops,
50 percent of National Guard, and 31 percent of US Marines who have served tours
in the war zones, may be suffering from PTSD, depression, generalized anxiety
disorders and other mental health problems.
This was followed by the Army Suicide Event Report (ASER), which stated the
suicide rates amongst military veterans were the highest in 26 years. CBS News
conducted its own extensive research and reported that during 2005, over 6,250
veterans took their own lives, this means 17 suicides occurred each day, of that
year.
Coupled with this factor, are the recent estimates that some 366,000 military
veterans were homeless, many of who are veterans of the wars in Iraq and
Afghanistan, but the significant majority were Vietnam veterans, who, 34 years
after America pulled its last troops out of then Indochina, have still not been
able to reintegrate themselves into society.
Military veterans make up one fifth of the over two million prison inmate
population currently incarcerated in Federal and State penitentiaries, and city
and county jails.
PTSD is a psychological disorder of memory of a life-threatening traumatic
experience, or a series of experiences. Historically, PTSD was defined by other
psychiatric/psychological disorders, all of which were war, and especially
military combat-related. It is also associated with traumatic experiences such
as rape or witnessing of brutal murders such as that experienced by large
numbers of child refugees from the Darfur massacres in Africa.
During WW 1 various terms were used to describe the disorder at a time when
its causes and organic origins were largely unknown, and much less understood in
a world, where the dominant influence in the early disciplines of psychology and
psychiatry was that of Sigmund Freud.
"Shell Shock, War Neurosis, and Neurasthenia were just some of the terms
in use at the time. Neurasthenia, was the psychiatric label used for Shell Shock
patients that were medically considered to be sufficiently serious to cause
their immediate evacuation from the battlefield.
Neurasthenia is an organic affective syndrome which produced debilitating
psychological and physiological responses to overwhelming stimuli, similar to
the symptoms presented in modern day soldiers suffering from PTSD.
This is a condition in which neurons in the brain respond rapidly and with
abnormal force to slight stimuli, which is then greatly exacerbated by continued
exposure to the trauma, for example, under fire from heavy artillery barrages in
the trenches, and the constant fear of death or serious injury.
The standard treatment in those days was rest, recuperation and electro shock
therapy, in an often futile attempt to 'erase' painful emotional memories.'
During WW II and the Korean conflict from 1950 -1953, the disorder became
known as "combat fatigue," but it was only in 1980, seven years after
US troops were withdrawn from Vietnam(1964 -1973), that a clinical diagnoses was
formulated by psychiatrists and psychologists treating Vietnam war veterans,
that PTSD was officially entered into the Diagnostic Manual of Mental Diseases
(DSM III).
But what is PTSD? As previously noted it is a disorder of the memory and
psychic realm of an/or experiences, that can be so emotionally intense and
painful, it affects psychological/physical health and global functioning.
This is often accompanied by social withdrawal, isolation, and
'self-medication' in the form of chronic alcohol and substance abuse.
The three groups of symptoms that are required to clinically assign a
diagnosis of PTSD are:
- The recurrent re-experiencing of the trauma, for example, intrusive and
intensely emotionally painful memories, flashbacks that are usually caused
by reminders of the traumatic events; and recurring nightmares about the
trauma and/or dissociative reliving of the trauma.
- The symptoms also manifest as an avoidance to the point of having a phobia
of places, people and experiences that remind the sufferer of the trauma,
and general numbing of emotional responsiveness.
- Finally present, are chronic physical signs of hyper-arousal, including
disturbed sleep patterns, difficulties in concentration, irritability,
anger, blackouts or difficulty in remembering things (positive memories);
and an increased tendency and reaction to being startled (startle response)
and hyper-vigilance to threat, imagined or real. (1)
There is no one definitive treatment for PTSD, which can onset immediately
after experiencing the traumatic event, or series of events, or can take weeks,
months or years, to develop into a clinical disorder, as was the case of many
Vietnam veterans.
Traditionally, PTSD has been treated by using one or more, of the following
treatment regimes in a clinical setting. These are: cognitive behavioural
therapy, psychodynamic psychotherapy, group therapy, family therapy and exposure
therapy, or gradual flooding techniques of the traumatic event(s) in a safe and
secure environment, with an experienced therapist.
A considerable body of research literature has shown one of the most
significant factors in the healing of the trauma caused by PTSD, is the strong
positive support of those socially closest to the individual sufferer, their
spouse/partner, parents, family and close friends.
Medication to reduce anxiety and depression in individuals diagnosed with the
disorder are usually selective serotonin reuptake inhibitors (SSRIs). These
include citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil) and
sertraline (Zoloft), which act as anti depressants. (2).
The use of the drug Propranolol is currently being investigated as a
potential treatment for PTSD. First developed in the 1950s by Scottish scientist
James Black, the drug has been universally used to treat hypertension,
myocardial infarction, angina, and other heart-related conditions, as well as
being an effective treatment for migraine in children.
Propranolol is a non selective beta blocker that is often used by musicians
and other performers to prevent 'stage fright, as besides reducing anxiety, it
also reduces tremors.'
Clinical trials currently underway in the United States and elsewhere,
indicate that this drug appears to effect memory, not so much by altering or
erasing it, but by reducing the intensity of emotions caused by those memories,
which of course are the primary ingredient of PTSD.
Harvard psychiatrist Dr Roger Pitman, is conducting research and clinical
trials on surviving victims of automobile accidents, and thinks Propranolol may
suppress the long- term storage, or re-storage of emotional memories.
"Clinical evidence has shown that trauma patients treated with
Propranolol immediately after traumas (accidents, rapes), show fewer PTSD-like
symptoms than patients who do not receive the drug. The explanation for this is
that the drug interferes with, or prevents the formation of strong emotional
memories that might otherwise crystallize into true trauma memories, and
subsequent PTSD." (3).
The physiological action of this non selective beta blocker appears to
inhibit the levels of adrenaline, which is a hormone in the blood, and a
neurotransmitter when it is released across a neuronal synapse. This is, in
effect, the well-known 'fight or flight' hormone that plays a central role in
short-term stress reactions.
This, in turn, would have a 'dampening down effect' on the areas of our brain
known as the amygdal, one of two (amygdalae.) These are almond-shaped groups of
neurons deep within the medial lobes of complex vertebrates. And, of course,
that includes us.
They are part of the more primitive limbic system of the brain and perform
the primary role of the processing and memory of emotional reactions, especially
those associated with fear and pleasure.
This area of research and experimentation in neuroscience, neuropsychiatry
and psychology, bioethics and neurobiology, is not without considerable
controversy from legal, ethical, and moral perspectives.
Does it inhibit feelings of guilt or moral consciousness? We are all shaped
by our life experiences, good and bad. Is it ethically or morally right to
suppress memory? This author cannot begin to answer that vexing question, but
another writer, Penny Coleman can, at least in part.
Coleman's husband, a Vietnam veteran committed suicide several years after he
returned home from the war. He was suffering from PTSD long before the disorder
was officially recognized and classified, as of course were many other veterans.
In an article entitled 'Drug troops to numb them to the horrors of war,' she
refers to the use of the drug as a 'form of moral lobotomy.' She is not alone.
Other critics, many of them mental health professionals, fear it 'would medicate
away one's consciousness.'
"I cannot imagine what aspects of selfhood will have to be excised or
paralyzed so soldiers will no longer have to be troubled by what they, not to
mention we, would otherwise consider morally repugnant.
"A soldier who has lost an arm can be welcomed home because he or she
still shares the same fundamental societal values. But if that soldier's ability
to feel horror and terror has been amputated, if he or she can no longer be
appalled or haunted, something far more precious has been lost.
"I am afraid that the training or conditioning or drug that will be
developed to protect soldiers from such injuries will leave an indifference to
violence that will make them unrecognizable to themselves, and to those who love
them.
"They will be alienated and isolated, and finally unable to come
home." (4)
*Earl-Taylor is a former researcher/lecturer in the Department of Psychology at
Rhodes University. As an American citizen, he served with the US Army in Vietnam
in 1971, and later in the US Naval Reserve; he completed a full graduate program
in Military Science with the Reserve Officers Training Corps (ROTC), at the
University of Oregon.
More information:
References
(1) Mental Health.net@www.mentalhealth.org.za
(2) Mental Health.net@www.mentalhealth.org.za
(3) Harvard Gazette: Pill to calm traumatic memories@www.hno.harvard.edu/gazette/2004/03.18/0/1-ptsd.html
(4) Coleman, Penny. Drug troops to numb them to the horrors of war.@Information
Clearing House www.informationclearinghouse.info/
Other articles by Mike Earl-Taylor
HIV/AIDS, the stats, the virgin cure and infant rape
The Long Term Neurological and Developmental Effects of Sexual Abuse on Infant
Children
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