The Forgetting Pill Erases Painful Memories Forever

1/ Pick a memory.

It has to be something deeply implanted in the brain, a long-term memory that has undergone a process called consolidation—a restructuring of neural connections.

2/ Recall requires neural connections by protein synthesis.

To remember something, your brain synthesizes new proteins to stabilize circuits of neural connections. To date, researchers have identified one such protein, called PKMzeta. Before trying to erase the targeted memory, researchers would ensure that it was ensconced by having the patient write down an account of the event or retell it aloud several times.

3/ Nuke the memory.

To delete the memory, researchers would administer a drug that blocks PKMzeta and then ask the patient to recall the event again. Because the protein required to reconsolidate the memory will be absent, the memory will cease to exist. Neuroscientists think they’ll be able to target the specific memory by using drugs that bind selectively to receptors found only in the correct area of the brain.

4/ Everything else is fine.

If the drug is selective enough and the memory precise enough, everything else in the brain should be unaffected and remain as correct—or incorrect—as ever.

Illustration: Teagan White

Once you start questioning the reality of memory, things fall apart pretty quickly. So many of our assumptions about the human mind—what it is, why it breaks, and how it can be healed—are rooted in a mistaken belief about how experience is stored in the brain. (According to a recent survey, 63 percent of Americans believe that human memory “works like a video camera, accurately recording the events we see and hear so that we can review and inspect them later.”) We want the past to persist, because the past gives us permanence. It tells us who we are and where we belong. But what if your most cherished recollections are also the most ephemeral thing in your head?

Consider the study of flashbulb memories, extremely vivid, detailed recollections. Shortly after the September 11 attacks, a team of psychologists led by William Hirst and Elizabeth Phelps surveyed several hundred subjects about their memories of that awful day. The scientists then repeated the surveys, tracking how the stories steadily decayed. At one year out, 37 percent of the details had changed. By 2004 that number was approaching 50 percent. Some changes were innocuous—the stories got tighter and the narratives more coherent—but other adjustments involved a wholesale retrofit. Some people even altered where they were when the towers fell. Over and over, the act of repeating the narrative seemed to corrupt its content. The scientists aren’t sure about this mechanism, and they have yet to analyze the data from the entire 10-year survey. But Phelps expects it to reveal that many details will be make-believe. “What’s most troubling, of course, is that these people have no idea their memories have changed this much,” she says. “The strength of the emotion makes them convinced it’s all true, even when it’s clearly not.”

Reconsolidation provides a mechanistic explanation for these errors. It’s why eyewitness testimony shouldn’t be trusted (even though it’s central to our justice system), why every memoir should be classified as fiction, and why it’s so disturbingly easy to implant false recollections. (The psychologist Elizabeth Loftus has repeatedly demonstrated that nearly a third of subjects can be tricked into claiming a made-up memory as their own. It takes only a single exposure to a new fiction for it to be reconsolidated as fact.)

And this returns us to critical incident stress debriefing. When we experience a traumatic event, it gets remembered in two separate ways. The first memory is the event itself, that cinematic scene we can replay at will. The second memory, however, consists entirely of the emotion, the negative feelings triggered by what happened. Every memory is actually kept in many different parts of the brain. Memories of negative emotions, for instance, are stored in the amygdala, an almond-shaped area in the center of the brain. (Patients who have suffered damage to the amygdala are incapable of remembering fear.) By contrast, all the relevant details that comprise the scene are kept in various sensory areas—visual elements in the visual cortex, auditory elements in the auditory cortex, and so on. That filing system means that different aspects can be influenced independently by reconsolidation.

The larger lesson is that because our memories are formed by the act of remembering them, controlling the conditions under which they are recalled can actually change their content. The problem with CISD is that the worst time to recall a traumatic event is when people are flush with terror and grief. They’ll still have all the bodily symptoms of fear—racing pulse, clammy hands, tremors—so the intense emotional memory is reinforced. It’s the opposite of catharsis. But when people wait a few weeks before discussing an event—as Mitchell, the inventor of CISD, did himself—they give their negative feelings a chance to fade. The volume of trauma is dialed down; the body returns to baseline. As a result, the emotion is no longer reconsolidated in such a stressed state. Subjects will still remember the terrible event, but the feelings of pain associated with it will be rewritten in light of what they feel now.

LeDoux insists that these same principles have been used by good therapists for decades. “When therapy heals, when it helps reduce the impact of negative memories, it’s really because of reconsolidation,” he says. “Therapy allows people to rewrite their own memories while in a safe space, guided by trained professionals. The difference is that we finally understand the neural mechanism.”

But competent talk therapy is not the only way to get at those mechanisms. One intriguing approach to treating PTSD that emerged recently involves administering certain drugs and then asking patients to recall their bad memories. In one 2010 clinical trial, subjects suffering from PTSD were given MDMA (street name: ecstasy) while undergoing talk therapy. Because the drug triggers a rush of positive emotion, the patients recalled their trauma without feeling overwhelmed. As a result, the remembered event was associated with the positive feelings triggered by the pill. According to the researchers, 83 percent of their patients showed a dramatic decrease in symptoms within two months. That makes ecstasy one of the most effective PTSD treatments ever devised.

Other scientists have achieved impressive results with less extreme drugs. In 2008, Alain Brunet, a clinical psychologist at McGill University, identified 19 patients who had been suffering for several years from serious stress and anxiety disorders such as PTSD. (Their traumas included sexual assaults, car crashes, and violent muggings.) People in the treatment group were given the drug propranolol, a beta-blocker that has long been used for conditions like high blood pressure and performance anxiety; it inhibits norepinephrine, a neurotransmitter involved in the production of strong emotions. Brunet asked subjects to write a detailed description of their traumatic experiences and then gave them a dose of propranolol. While the subjects were remembering the awful event, the drug suppressed the visceral aspects of their fear response, ensuring that the negative feeling was somewhat contained.

One week later, all the patients returned to the lab and were exposed once again to a description of the traumatic event. Here’s where things got interesting: Subjects who got the placebo demonstrated levels of arousal consistent with PTSD (for example, their heart rate spiked suddenly), but those given propranolol showed significantly lower stress responses. Although they could still remember the event in vivid detail, the emotional memory located in the amygdala had been modified. The fear wasn’t gone, but it no longer seemed crippling. “The results we get sometimes leave me in awe,” Brunet says. “These are people who are unable to lead normal lives, and yet after just a few sessions they become healthy again.”

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