The [Sea] Monster Inside Me

By Sunidhi Ramesh

A side-by-side comparison of a sea horse and the human

hippocampus (Greek for sea monster).

(Image courtesy of Wikimedia Commons.)

In 1587, Venetian anatomist Julius Aranzi gave a name to the intricate, hallmark structure located in the medial temporal lobe of the human brain—the hippocampus, Greek for sea monster.

The hippocampus, often said to resemble a sea horse, has since been identified as a key player in the consolidation of information (from short-term memory to long-term memory) and in the spatial memory that allows for our day-to-day navigation. Because of its importance in learning and memory, hippocampal damage is often a culprit in varying forms of dementia, Alzheimer’s disease, short-term memory loss, and amnesia.

Since its discovery, the hippocampus has been the subject of extensive research ranging from understanding diet and exercise as cognitive modulators to demonstrating the three-step encoding, storage, and retrieval process that the structure so consistently performs. In this time, it has become apparent that the hippocampus is not only a vital structure for normal human functioning, but it is also necessary to what makes us uniquely human.

In the center of this hippocampal research are place cells, individual neurons in the hippocampus that become active when an animal “enters a particular cell-specific place in its environment.” These cells are able to collect distinctive components of an organism’s surroundings and then organize their outputs in a way that is useful for the brain to understand its own location in space.

The hippocampus, then, is a model system for neural information coordination. It uses consistently reliable coding to function like a GPS, signaling the animal’s location through a pattern of activity across a population of place cells; different cells that are active and silent at each location of an environment behave like a jumbotron, allowing the cells together to code for the animal’s current location. This ensures that whenever a cell discharges, there is (more or less) a simple and single interpretation for the animal’s position.

The human hippocampus (indicated here in red) is a

bilateral structure located under the cerebral cortex

in the medial temporal lobe.

(Image courtesy of Wikimedia Commons.)

A different pattern of active and silent cells signals a different location, which, ultimately, continues to chart the space the animal is in. Together, place cells act to work as the brain’s cognitive map, a mental representation of places the animal knows and is familiar with.

In order to better understand place cells, Dr. André Fenton at New York University (NYU) runs a lab in which he (along with other researchers at NYU) aims to “[investigate] the role of the hippocampus in controlling how we choose relevant information to process” by “studying the interaction of memories and neural activity in signaling information from multiple spatial frames.” In a landmark experiment with Dr. Todd Sacktor, Dr. Fenton identified “protein kinase M zeta (PKMzeta) as a key molecular component of long term memory.” When PKMzeta is selectively inhibited in specific brain areas, long-term memories are erased for “even a month after rats learn a place avoidance task.”

More specifically, when PKMzeta is inhibited, “place cells lose their spatial firing specificity.”

In short, then, rats that have been trained to avoid certain locations in a small chamber will no longer be able to (or remember to) avoid them because the rats’ place cells fail to properly communicate location-based information within their brains.

To these rats, tasks that were once practically inherent and familiar are now impaired and brand-new.

While this research has yet to be applied in humans, the wide-ranging implications of being able to essentially reset memory warrants ethical consideration. Let’s imagine that “one day we can create a drug that's really focused-- that can take out specific kinds of memories.” In what situations could we use this drug clinically? Who would be permitted to use it? What kinds of regulations would need to be in place? And, most importantly, what does it mean to allow human beings to selectively “delete” certain memories over others?

A tractographic reconstruction of some of the many

neural connections in the human brain.

(Image courtesy of Wikipedia.)

About 150 years after Julius Aranzi gave a name to the hippocampus, Scottish philosopher David Hume published his novel A Treatise of Human Nature. In this book, Hume famously argued a then-radical idea of human nature and identity: “that the ‘self,’ as we conceive of it, is not a single spiritual or psychological entity, like a ‘soul,’ but rather a collection of discrete sensations and impressions — a bundle.” Linked together, these “bundles” create a distinctive and unique “self” that separates us human beings from one another. The key to Hume’s argument is the identity of these linkages between bundles.

We call them memories.

In this view, memories, then, are at the center of what makes us distinctive and different individuals. They are what distinguish me from you, what constitute the core of our identities, and what separate the past from the present and the present from the future. As one philosopher said it, “life without memory is no life at all.” (This concept is why Alzheimer’s disease and other such progressive brain disorders are so widely feared in the modern world; by involuntarily tearing memories away, these diseases slowly strip individuals of their pasts and –many argue— of who they are.)

What, then, are the consequences to changing memories? If memories are what make us who we are, does removing or modifying or changing memories change who we are? If I can no longer recall the car accident that sent my mother into therapy for six years or the way I felt the day I was rejected from ten universities, am I still me? And, if I were still myself after these changes, how much would I have to modify my memory to alter who I am? A couple uncomfortable incidents? A dozen? All of them?

These questions have yet to be answered.

Still, “a lot of unpleasant, a lot of difficult memories,” bioethicist Art Caplan says, “form who we are. We learn. It becomes part of our character, our identity. Some might say the struggle against bad experiences is part of what makes us better people.” But, are there situations in which this hypothetical (although not purely hypothetical, as our discussion about place cells suggests) memory repression drug may prove useful?

"What if I told you that I could erase some of your memories?

I'll just give you a pill, and poof, they're gone. Would

you do it?" science web producer David Levin asks.

(Image courtesy of Pixabay.)

Many war veterans are plagued with nightmares and emotional trauma, often becoming prisoners to a disease we now call PTSD (post-traumatic stress disorder). Patients of this mental condition could benefit from having the option to break down memories that are the source of their disorders. This same logic could be extended to scores of torment and torture individuals. Targets of violent personal assaults. Victims of childhood trauma. Rape survivors.



In these circumstances, memory medication could offer individuals the promise of returning a great deal of his/her functioning prior to the traumatic incident. Rather than change who the person currently is, clinical applications to memory medication could restore who the person originally was.

But where do we draw the line? How do we determine if a memory is bad enough to warrant modification? And who determines if a memory warrants modification at all? Doctors? Patients? Law makers?

While advances in place cells and PKMzeta research are both far from allowing us the ability to selectively modify memory, these ethical considerations are relevant to any serious discussion regarding the future of the hippocampus as we know it.

Perhaps one day, the answers to these questions will help us tackle the biggest questions of all: can the sea monster-shaped structure in our brains someday shield us from the monsters of the real world? 

Do we want it to?

References



Barry, Jeremy M., et al. "Inhibition of protein kinase M? disrupts the stable spatial discharge of hippocampal place cells in a familiar environment." Journal of Neuroscience 32.40 (2012): 13753-13762.



Baylis, Françoise. "'I am who I am': On the perceived threats to personal identity from deep brain stimulation." Neuroethics 6.3 (2013): 513-526.



Bir, Shyamal C., et al. "Julius Caesar Arantius (Giulio Cesare Aranzi, 1530–1589) and the hippocampus of the human brain: history behind the discovery." Journal of neurosurgery 122.4 (2015): 971-975.



Carey, Benedict. "Brain Researchers Open Door to Editing Memory." The New York Times. The New York Times, 05 Apr. 2009. Web. 08 Apr. 2017.



Gentile, Sal. “If we erase our memories, do we erase ourselves?” PBS, Public Broadcasting Service, 24 Nov. 2010. Web. 12 Apr 2017.



Hume, David. A treatise of human nature. Courier Corporation, 2003.



Levin, David. "Ethics of Erasing Memory." PBS. Public Broadcasting Service, 13 Jan. 2011. Web. 11 Apr. 2017.



Nadel, Lynn, and Morris Moscovitch. "Memory consolidation, retrograde amnesia and the hippocampal complex." Current opinion in neurobiology 7.2 (1997): 217-227.



Pastalkova, Eva, et al. "Storage of spatial information by the maintenance mechanism of LTP." science 313.5790 (2006): 1141-1144.



West, Mark J., et al. "Differences in the pattern of hippocampal neuronal loss in normal ageing and Alzheimer's disease." The Lancet 344.8925 (1994): 769-772.



Zimmer, Carl. "Memory researchers, rebuffed by science, came roaring back." STAT. STAT, 23 June 2016. Web. 09 Apr. 2017.





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Ramesh, Sunidhi. (2017). The [Sea] Monster Inside Me. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/04/the-sea-monster-inside-me.html

The Science March: Can science-based advocacy be both nuanced and effective?

By Jennifer Lee

Jenn Laura Lee is a PhD candidate in neuroscience at New York University. She is also a member of the Scientist Action and Advocacy Network (ScAAN.net), which offers pro bono data science and research to organizations seeking to implement positive social change.

I believe in protests. I attend them, I endorse them, and I think that they make a difference. Raising political consciousness in the scientific community in any form seems like a good thing. The Science March moreover seems like a great opportunity for a community of people sharing common livelihood to advocate for the importance of their work in policy-making, as it relates to nuclear non-proliferation, climate change, vaccination, and so on. 

But while I plan to attend the March for Science in New York, I’m hoping to use this article to examine, articulate, and hopefully mitigate the slight unease that’s been growing in me surrounding some of the language that scientists have been using to describe the march (both critics and proponents alike).

Let’s start by pointing out that protests are effective for a number of reasons— they can apply pressure for lawmakers to advance specific aims (for instance, the passing of a bill). They can also act as a springboard for awareness— a starting point for deeper and more nuanced dialogue. In absence of particularly well-defined specific aims, the Science March might function primarily in service of the latter objective, among others.

Critics like Robert Young have tried to pin their unease on bad optics — they worry about a perceived “loss of objectivity,” or the so-called “politicization of science.” These critics fear we will lose our moral high-ground as calm and objective voices of pure reason in the public eye. We’d also be putting a target on our backs for further budget cuts, the argument goes. 

This stance has received ample backlash. But I’ve been equally struck by cringe-worthy statements made by proponents of the march. Many march leaders are attempting to sanitize themselves of the crazy mess that is American politics by insulating the Science March in a double-walled vacuum of objectivity. “This is a protest, but it’s not a political protest,” Jonathan Berman (a lead organizer of the march) proclaimed to the New York Times. I fail to see how a protest of any kind could be deemed apolitical. (Perhaps he meant “partisan”?)

A march sign at NYU.

Let me express that, unlike Young and Berman, the politicization of science is not the source of my unease. Like many others, I deeply reject the notion that science is apolitical, or that it ever could be. Researchers know this all too well from the ways in which academic hierarchies, granting agencies, and prestigious journals can make or break careers and shape the direction of a field, and from the way that scientific advancements simply cannot be divorced from their social, economic, and ethical repercussions. Best of all, we know this from the way funding is allocated to researchers by private and government institutions with obvious agendas. I’m comfortable in the notion that “doing science” is an inherently social and political endeavour (which aims for and approaches objectivity asymptotically)— and I believe it’s best for scientists to embrace this idea.

Rather, I think my particular flavour of unease stems from a strange hypothetical image I have in my head, in which scientists advocate for nuanced discourse and sober reasoning by blasting platitudes about the importance of “facts” through a megaphone.

“We are trying to reach [Washington] with the message: You should listen to evidence,” Dr. Berman proclaims. While obviously a message I endorse, it is important to remember that evidence is not itself a deciding blow in public discourse, but rather the foundation for more nuanced discourse of its kind. 

Something about the proclamation “Believe me, I’m a scientist!” seems deeply ironic and actually quite antithetical to the scientific process itself. This kind of black-and-white language surrounding fact and fiction, real news and fake news, moreover seems to be part of an alarming trend in which both laymen and politicians alike gesture vaguely towards an anonymous “body of work” to frame their claims as objective truth in public discourse. As scientists who make their living through nuanced thinking, we must do better than this when communicating with the media.

Of course, in Trump’s America, I understand the need for bold, argumentative stance-taking. I support people who will march with banners which will simply proclaim that “Climate Change is Real!” But while I understand the temptation to reference some substantial “body of literature” to support this conclusion, we must be willing and prepared to engage the public on a level much deeper than this. To do otherwise would not just erode the public image of scientists on face— it would be deeply contrary to the scientific process itself.

So for the sake of preserving the spirit of the scientific process, let’s not underestimate the willingness of the general public to engage with real nuance and more complex critical thinking. My suggestion for the march is to not just bring signs with catchy battle cries— bring pamphlets with real content, or at the very least, arm yourself mentally with the specific papers and evidence on which you’ve built your conclusions. Ironically, science advocacy on a shallower level than this might itself be a-scientific.

Image courtesy of Flickr.

Moreover, rather than professing objectivity, insist on and celebrate the inherently social (and subjective) nature of scientific discourse. Science is a social endeavour, and that's not necessarily a bad thing. I can’t say with absolute certainty that climate change is anthropogenic, but I can say with an incredibly high degree of certainty that it probably is, because of the communal nature of the scientific process. I’ve never measured CO2 myself, but I base my conclusion largely on the social and academic institutions we have in place, which are comprised of other people who have recorded a variety of natural phenomena. They’ve printed and disseminated their data through reputable publishing companies, and their conclusions are made available to me through some man-made search algorithm on Google Scholar. It’s in large part because of my prior beliefs on the trustworthiness and reputability of all of the above social institutions that I’ve come to conclude that climate change is very, very likely to be anthropogenic and real, and that we should normatively take policy measures to ameliorate the sad mess that is our environment. 

Of course, I recognize that the nature of protests is to distill nuance down to simple and actionable messages. I understand the hunger for true objectivity in a world of "alternative facts." But the uncomfortable irony is that scientists lose a little piece of their integrity when we advocate for some “objective truth” with a kind of ‘hundred-percent confidence’ which, we all know deep down, we’ve never genuinely experienced in our labs first-hand. 

So my proposal is this: let’s march, shout, protest, and be heard, but let’s also not lose the spirit of certainty, uncertainty, and nuance which makes science scientific. This balancing act is hard to do, as I’ve experienced first-hand. But we must remember that the spirit of nuance which makes our profession at times so infuriating is also so simultaneously sanity-preserving in Trump’s garish world of black-and-white. 

Lastly, let’s not underestimate the capacity of the general public to engage with complex and nuanced evidence, when paired with effective communication. Come prepared with communicable data and let's educate ourselves about the issues that matter, together.

My professor will be marching with a sign that says “Are you with Reason or with the Republicans?,” and another will simply say “PRO-FACTS!” How effective these signs are is a matter of open debate.

I personally had a hard time deciding on which particular science-related social issue to write about on my sign, mostly because everything seems so incredibly urgent. In the end, I think I’ve decided to bring pamphlets with some of my favourite public-friendly figures highlighting neuroscientific evidence in favour of raising the age of criminal responsibility. It highlights thorough but easily digestible research which is proximal to me, and which I think advances an important social cause.

As for a catchy rally cry, I think I’ve decided on a sign that will simply read “MORE NUANCE!” 

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Lee, J. (2017). The Science March: Can science-based advocacy be both nuanced and effective? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/04/the-science-march-can-science-based.html

Would You Want to be a Savant?

By John Banja

John Banja, PhD is a medical ethicist at Emory University’s Center for Ethics, a professor in the Department of Rehabilitation Medicine, and the editor of AJOB Neuroscience.

Darold Treffert (2010), a psychiatrist who has devoted the better part of his career to studying savants, notes that there are at least 3 kinds.

First, those who manifest the “savant syndrome” and display the most astonishing of savant abilities, such as Kim Peek who was the inspiration for Dustin Hoffman’s character, Raymond Babbitt, in the movie Rain Man. Peek, who died from a heart attack in 2009, was remarkable even by savant standards: He memorized more than 12,000 books and was able to read two pages simultaneously, one page with the right eye, the other page with the left. He also had a remarkably hospitable form of dyslexia where he could read words on a page turned sideways or upside down or backwards—such as reflected in a mirror. He could add a column of numbers from a telephone book page and instantly tell you the mean of those numbers, and he could do lightning calendar calculations like telling you which day of the week you were born upon knowing your birth date (Treffert, 2010, pp. 120-129). These were only a few of his talents. 

I might also mention Daniel Tammet who, on March 14th, 2004 on “International Pi Day”—get it?: 3.14—recited from memory Pi to 22,514 decimal places (p. 161). Or George Widener who can tell you what day of the week June 25th will be in the year 47,253 (p. 179). Treffert reports that 50 percent of individuals with the savant syndrome are autistic, while the remainder, like Kim Peek, typically experienced some kind of central nervous system insult prenatally or very shortly after birth. Usually, these individuals have IQs around 60 or 70, such as one savant who could recite Edward Gibbon’s Rise and Fall of the Roman Empire forward and backward but couldn’t explain what any of the sentences meant (p. 2). Kim Peek didn’t walk until the age of 4 and had eye-hand coordination problems all his life. Even as an adult he needed help with simple daily activities like bathing, brushing his teeth and combing his hair. His IQ was measured at 87, but the score was thought too insensitive to his intellectual ability (p. 123).

Kim Peek, image courtesy of

Wikimedia Commons.

A second group Treffert terms the “acquired” savant. These are persons who began life as neurotypicals but then suffered some kind of central nervous system damage like a stroke or dementia (usually affecting the fronto-temporal areas of the brain). Very often, their savant skills take the form of amazing artistic or musical ability where there was none previously. An interesting example is orthopedic surgeon Tony Cicoria, who was struck by lightning in his face, had a near death experience, and survived without any apparent deficits (p. 209). A few weeks after the lightning strike, he began experiencing an insatiable desire to listen to piano music. Although he had some piano lessons as a child, he never pursued any serious training and hadn’t played much for decades. After the lightning strike, he became obsessed with music, re-learned piano playing and now not only plays some of the classical piano repertoire at a near concert level, but he composes and, when not doing surgery, performs professionally. This group of persons acquired their savant-like skills from some kind of CNS disruption, usually occurring during or after adolescence.



The third group is the neurotypical individual with savant-like skills. Many people know about Marilu Henner’s “highly superior autobiographical memory” such that Marilu can recall what she was experiencing at any time of any day over most of her life (CBS, 2010). When she displayed this capacity to the world, it was thought that less than 10 persons existed with similar memory capacity but since then more individuals have been identified (CBS This Morning, 2014). There are also neurotypicals who can begin writing “Calif” with one hand and simultaneously “ornia” with the other; or an individual who can write out similar words simultaneously—one with the left hand, one with the right—but each in a different language (Treffert, 2010, p. 214). Or they can read backwards; or they can instantly alphabetize words in conversation, so that “I like neuroethics” becomes “I eikl ceehinorstu.” (Treffert, 2010, p. 212) My wife’s father could multiply 3-digit numbers in his head, and many neurotypicals with musical savantism can listen to a tune or song only once and then reproduce it with note for note accuracy on piano or guitar. Usually, these persons possessed such talent all their lives with no one suspecting it although Treffert describes certain cases where savant-like skills have suddenly appeared with no evident cause (pp. 204-211).



Given that we are living in the age of the brain, these astonishing cognitive skills—and I have only described a few—make one wonder about the possibility and extent of anyone’s acquiring them. Can anyone not only improve his or her memory or cognitive talents but take them to these kinds of levels? And, very interestingly, would one want to?

Stephen Wiltshire's rendition of the Brooklyn Bridge,

image courtesy of Wikimedia Commons.

I would assume most neurotypicals would think autism, a stroke, a lightning strike, or being born with an encephalocele (like Kim Peek) is too high a price to pay for savant acquisition. But a larger question centers on the value of savant abilities. One of the most salient characteristics of savants is their prodigious memories. Most savants are extraordinary sensory reproducers or duplicators who can represent memories of their sensory experiences with uncanny detail, like Stephen Wiltshire who, after a twenty minute helicopter ride over Manhattan, proceeded to reproduce his memories of the skyline with uncanny accuracy in an 18 foot-long drawing in Brooklyn’s Pratt Institute (CBS, 2009). But the rather uncomfortable, indeed, perhaps unkind point is that the majority of savant skills don’t seem particularly useful. Treffert notes that “savant skills typically occur in an intriguingly narrow range of special abilities” (p. 19) that include calendar calculating like George Widener’s, musical playback ability, artistic re-production like Stephen Wiltshire’s, and mathematical and mechanical skills. What most of these demonstrations lack, however, is a sense of creativity or depth that carries a discipline like mathematics or any of the empirical sciences to the next level of professional conversation and knowledge. Granted, we do have Dr. Temple Grandin’s contributions to the design of animal handling facilities, which are now used in half of the cattle processing facilities in the U.S. (Treffert, 2010, p. 144). But savants like her seem to be distinct exceptions.



Nevertheless, Treffert is at pains in his book Islands of Genius to refute this, at least insofar as he is convinced that savants do make creative contributions, especially in the arts. But professionals like empirical and theoretical scientists, novelists, playwrights, philosophers and sociologists who are regarded as genius-level performers by their peers are virtually never identified as savants (although they may have savant-like skills). Perhaps one reason is that the cognitive accomplishments of savants take the form of immediate demonstration, such as lightning calendar calculating, while scientists and philosophers spend years developing their discoveries and theories. Also, because savant skills are thought to derive from a “liberation” or hyper-development of the brain’s right hemisphere at the cost of left-sided deficits or impairment, persons with the savant syndrome often have poor narrative capacities linked to their compromised verbal abilities.



The fact is, what a philosopher, neuroscientist, or novelist savant would look like is obscure. Lightning calculations done in one’s head don’t play a significant role in these professionals’ creative output, nor does uncanny memory reproduction for highly specific details from one’s sensory experience. Still, the abilities of savants are simply astounding and suggest that our brains are capable of much more than we might assume. Neuroscientist Allan Snyder has been stimulating the brains of neurotypicals with low-frequency repetitive transcranial magnetic stimulation and reporting that many of his neurologically unremarkable participants improve in proofreading, drawing, and numerosity, such as in guessing the number of pixel-like objects on a computer screen (Snyder, 2009). For over a decade, Snyder has been pursuing the idea that all of us have latent savant-like skills that can be elicited by technology or by exercises such as the ones that Betty Edwards (1989) proposed in her book Drawing on the Right Side of the Brain.



I suspect the ultimate value of this research will consist in whether it results in any real improvement of our human culture. Almost certainly, though, neuroscientific investigations of savants will increase our understanding of brain function and, very possibly, enable us to tap into certain cognitive abilities we could not have imagined existed.

References 

CBS. 2010. Marilu Henner’s Super Autobiographical Memory. Found here

CBS. 2009.  Wiltshire’s NYC Matches Up. Found here 

CBS This Morning. 2014. More people have “Highly Superior Autobiographical Memory.” Found here

Edwards B. 1989. Drawing On the Right Side of the Brain. New York, NY: Tarcher/Putnam Press. 

Snyder A. 2009. Explaining and inducing savant skills: privileged access to lower level, less-processed information. Philosophical Transactions of the Royal Society, 364:1399-1405. 

Treffert D. 2010. Islands of Genius. London, UK: Jessica Kingsley Publishers.

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Banja, J. (2017). Would You Want to be a Savant? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/04/would-you-want-to-be-savant.html

VR and PTSD: Healing from trauma by confronting fears in virtual reality environments

By Katie Givens Kime

Image courtesy of Flikr

What are the ethical implications of therapeutically re-exposing patients to trauma via virtual reality technologies? Of the 2.7 million American veterans of the Iraq and Afghanistan wars, at least 20% suffer from depression and/or post-traumatic stress disorder (PTSD), and other studies peg that percentage even higher. As a chronic, debilitating mental illness, one PTSD symptom is hyperarousal, in which a person repeatedly re-experiences a trauma in the form of nightmares, panic attacks, and flashbacks.  One of the most long-trusted therapeutic approaches to PTSD is exposure therapy; now, virtual reality technology is increasingly being used to simulate exposure to traumatic events and to environments related to the traumatic event.

Image courtesy of Flikr

Last month’s Neuroethics and Neuroscience in the News event featured the recent research and observations of Barbara O. Rothbaum, who is the Paul A. Janssen Chair in Neuropsychopharmacology at the Emory University School of Medicine and Director of the Emory Veterans Program & Trauma and Anxiety Recovery Program. Rothbaum outlined the way in which exposure therapy (with or without the aid of virtual reality technology) is based on principles of learning and also discussed reliable findings with animals and phobic disorders (Foa & Kozak, 1986). The underlying premise of such therapy is that repeated and prolonged exposure to feared but realistically safe stimuli leads to habituation, and eventually to extinction.

The virtual reality exposure therapy (VRE) combat environments for “Virtual Vietnam” (developed by Georgia Tech and Emory Universities) includes a virtual Huey helicopter, a “fly” over the jungles of Vietnam, a “walk” in clearings near jungles and swamps, and other imaginal immersions in Vietnam-related stimuli. Other examples of VRE environments include “World Trade Center” (Weill Cornell Medical Center/University of Washington), “Terrorist Bus Bombing” (University of Haifa/University of Washington), “Motor Vehicle Accidents” (University of Buffalo), “Virtual Angola” (University of Lusófona de Humanidades e Tecnologias, Lisbon), and “Virtual Iraq” (USC Institute for Creative Technologies).

In some ways, VRE is an enormous innovation, particularly for treatment under a range of conditions not easily controlled or facilitated in the real world. For veterans with extreme anxiety due to in-flight combat events, for example, exposure to flight (including turbulence) is therapeutically valuable. With the help of VRE, recreating that exposure within the context of a 50-minute session in a therapist’s office is immensely more feasible than gaining access to a flight, with an appropriate amount of turbulence. Not only can VRE create dynamic, three-dimensional stimulus environments, it also allows for the recording of behavioral and physiological responses of the patient, which provides clinical assessment options previously unavailable.

While such innovations hold great potential, there are other ways in which VRE is simply an additional tool to aid in traditional exposure therapy, which remains based within the relationship between the clinician and the patient. In her talk, Rothbaum noted that many of the objections and concerns raised about VRE (detailed in an Ethical Issues in Clinical Neuropsychology article by Rothbaum and her colleagues) are similar to concerns raised about exposure therapy in general. Many people (including many clinicians) flinch at the idea of intentionally raising a patient’s anxiety. A primary motivation of any therapist is helping a patient feel better. Thus, exposure therapy can feel counterintuitive because it forces patients to re-experience their trauma and all of the emotions associated with that trauma.

Image courtesy of Flikr

Other ethical concerns about VRE include the potential for VR-related side effects like cyber-sickness (a form of motion sickness commonly reported with virtual reality technology), and other possible symptoms including disturbed locomotion, changes in postural control, perceptual-motor disturbances, fatigue, and generally lowered arousal. Rothbaum named several mitigating practices employed to limit such symptoms, such as limiting session time, keeping the room cool, using equipment with better resolution, and limiting head motion.

Concerns about misuse of VRE equipment by both clinicians and sufferers of PTSD also emerge. What if clinicians lacking training or expertise use VRE with patients? Or, what if clinicians, no matter how well trained, use VRE at the expense of the normal therapist/client relationship? Rothbaum noted the potentially problematic dynamic of how patients wearing head mounted displays cannot see their therapist, and therefore lose any nonverbal communication that would otherwise be absorbed visually. However, in standard imaginal exposure, patients’ eyes are closed, thus also limiting nonverbal communication. In terms of auditory information, the often loud virtual environments, such as Virtual Iraq or even the virtual airplane, can prevent the patient from hearing the therapist. Furthermore, VRE might allow an interpersonally awkward patient to “hide” behind the technology instead of interacting with the therapist.

In response to the potential for clinical misuse of VRE equipment and techniques, Rothbaum pointed out that “bad VRE therapy is just bad therapy.” While the creators of VRE clinical practices and associated equipment cannot prevent misuse, they can take steps to require appropriate training in as much as possible. As for the therapist-patient interpersonal communications, the VRE equipment includes a microphone that allows the therapist to talk directly with the patient and also privileges the therapist’s voice over the sounds of the virtual environment. A sort of “riding shotgun” intimacy is thus often achieved. Rothbaum also noted that the masking “barrier” of the VR headgear can facilitate more verbalization from patients instead of less, and mimics the therapeutic practice of having patients close their eyes when recounting particular events or feelings or sharing about particular emotional states and in standard imaginal exposure.

Image courtesy of Flikr

There are still more concerns of VRE misuse. Might continued access to virtual environments like “Virtual Vietnam” lead to cases of faulty self-diagnosis and self-treatment? When individuals are able to download or purchase VRE assessment and therapeutic tools, what might be the associated risks? A major concern is that of desensitization: by taking the opportunity to repeatedly immerse one’s self in violent and otherwise traumatic events, might VRE tools be encouraging desensitization? Rothbaum noted that 70% of us, statistically, will experience a traumatic event in our lifetime, but only a small percentage of us will develop PTSD. Rothbaum used the example of video games as one of myriad tools and methods engaged by those suffering with PTSD, with wide-ranging results. In the end, Rothbaum’s response to these concerns was, “We’re not trying to make realistically scary things less scary...We’re trying to help people cope better with something scary that happened in their past.”

Looking into the future of how virtual reality technology might change the landscape and potential of mental health care, a recent review of all studies employing VR for mental health conditions found many gaps in meaningful applications of the technology. However, on the basis that “Mental health problems are inseparable from the environment,” the reviewers concluded that the greatest potential for VR lies in its ability to take patient and caregiver to the particular contexts in which the patient struggles to respond appropriately.

Even more broadly, some VR innovators are finding some success in creating VR headsets that operate solely via the brain activity of the user. While using dry electrodes to record brain activity via electroencephalography (EEG) is not new, creating a modality that allows for the execution of virtual tasks just as efficiently as physical input devices (keyboard, touch screen, etc.) would be a new achievement. Such an advance might lead to an entirely different range of options and questions when considering how VR technology best serves the purposes of mental health care.

With VR, we can expect significant leaps forward in broadening access and modalities for those seeking care for their PTSD. 

References 

Foa, E.B., & Kozak, M.J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.

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Kime, K.G. (2017). VR and PTSD: Healing from trauma by confronting fears in virtual reality environments. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/04/vr-and-ptsd-healing-from-trauma-by.html

Join us for the Emory Graduate Student Neuroethics Symposium on April 28th, 2017

This spring, the Neuroscience Graduate Program and the Neuroethics Program at Emory University are teaming up to present the 2017 Emory Graduate Student Neuroethics Symposium entitled, The Use of Preclinical Biomarkers for Brain Diseases: A Neuroethical Dilemma. This year’s symposium will focus on the neuroethics of preclinical detection, including discussions of the basic and clinical research being performed and the neurotechnologies being developed for the early detection of autism, schizophrenia, and Alzheimer’s disease. 

The symposium will take place on Friday, April 28th from 10am to 4:30pm at Emory University and is free and open to the public. The symposium will be comprised of three sessions: 

Session 1: Autism, with a focus on the ethics of conducting preclinical research.

Session 2: Schizophrenia, with a focus on the ethics of interventions and treatment.

Session 3: Alzheimer’s disease, with a focus on the ethics of delivering a preclinical diagnosis given the risks for stigma. 

Each session will include input from a patient diagnosed with the disease or family member of someone experiencing the disease, a researcher/clinician, and an ethicist. Speakers will include Dr. Cheryl Klaiman, Dr. Donna Chen, Dr. Dena Davis, Dr. Paul Root Wolpe, Dr. Elaine Walker, and Dr. Allan Levey.

Through this symposium, we hope to highlight the challenges that a patient can face after being given a preclinical diagnosis for a mental disorder, and to underscore the ethical challenges that arise when the ability to detect a future disease outreaches our ability to care for the patient.

You can find more information on our website and in the flyer below, and can register for the event here. We hope you will join us!

Why Addiction Narratives Matter

By Katie Givens Kime

Image courtesy of

Merrimack Repertory Theatre.

“My Higher Power is: Science!” proclaims Sean, a newly recovered alcoholic. “Sean” is the lead character in a comedic play, “The White Chip,” which premiered last year at Merrimac Repertory Theatre outside of Boston, Massachusetts. Written by Sean Daniels, the play dramatizes Daniels’ own near demise from alcoholism, and his experience of recovery. Neuroethics is writ large as the play tells the story of how critically important various addiction etiologies can be for those struggling with alcoholism, or addiction of any sort. In Sean’s case, the etiology is the brain disease model of addiction (BDMA) in a notable combination with the “Higher Power” understanding of 12-step programs, which he credits with saving his life. Behind the curious twists of the play, questions linger: which model of addiction should be presented to those in recovery, when so much conflict exists amongst addiction researchers, clinicians, and recovery care providers? At what point does an effective (potentially life-saving) narrative of addiction etiology supersede the obligation to provide all sides of the controversial matter of addiction modeling?

When Sean “hits bottom,” he has destroyed his career, his marriage, his health, and nearly lost his life while driving drunk. He enters a rehabilitation facility, but struggles with the suggestion that he find a “Higher Power.” Such a practice is reflective of the metaphysical claim central to Alcoholics Anonymous, and every other 12-step program: surrender to a Higher Power of the addict’s understanding, and is perhaps the most significant distinguishing feature separating 12-step methods from other recovery pathways. Perhaps most notable in Sean’s struggle is that he did not see his inability to assent to any sense of a Higher Power as mere philosophical or theological discrepancy. After trying everything, he believed he needed some sort of dramatic internal change, and that his very life hung in the balance.

Finally, Sean meets a different group of A.A. veterans who proclaim to Sean that what he really needs is “Science,” and to understand the chemicals in his brain. The word “brain” occurs 17 times following this scene. In a line that seemingly summarizes Sean’s success in finding sobriety, he says: “People ask me, why did it stick that time? I believed in something larger than myself. My higher power is: science. It’s my faith in science that keeps me sober.” Sean’s Higher Power is the neuromechanisms (“science”) of his own “brain”, which ostensibly has more power than he does, and “wants the best” for him. Britt’s decision to introduce Sean to a particular A.A. group of predominantly Jewish men led to the inner experience/realization that Sean credits with saving his life.

Actors Jeff Binder and Ben Evett in "The White Chip."

Image courtesy of photographer Meghan Moore.

Across medical and social scientific literature, an inverse relationship between spirituality and substance abuse consistently characterizes research findings on recovery from substance use disorders (Geppert et al., 2007; Cook, 2004; Swora, 2004; Dermatis & Galanter, 2016; Ross 2013). Sean’s case is an interesting illustration of this finding, while also mirroring another finding: that the BDMA is immensely prominent in popular and medical discourse, as well as in research funding priorities for addiction.

Notably, the BDMA cannot be traced back to a particular group of scientists, a common thread of articles, or research findings. The most identifiable pivot point for the growth of the BDMA is the former Director of the U.S. National Institute on Drug Abuse (NIDA) Alan Leshner’s landmark 1997 Science cover story, “Addiction is a brain disease, and it matters.” In that essay he argues that addictive drugs “hijack the reward centers of the brain” (p. 45). Within several months of Leshner’s article, Bill Moyers used the phrase “hijacked the brain” in 1998 on a PBS television series on addiction, citing Leshner (Lewis, 2015, p. 17). Several historians and researchers of addiction have noted the way in which “hijack” stayed in the vocabulary of addiction for many years after that (Campbell, 2007, p. 201).

In terms of funding, the BDMA has continued to exert notable influence (Dunbar, Kushner & Vrecko, 2010, p. 3). In 2014, NIDA devoted 41% of its funding to basic neuroscience and a further 17% to the development of novel pharmacotherapies based on basic neuroscience, yet only 24% was devoted to epidemiology, health services, and prevention research (Field, 2015). Some researchers have noted the degree to which the accounts of various neuroscientific teams differ on critically important issues, such as which neuromechanisms are relevant for understanding addiction, and even how such mechanisms operate (c.f. Koob & Le Moal, 2006, p. 18-19). Another sort of response is medical anthropologist Daniel Lende’s call for a neuroanthropological theory of addiction rather than a “brain-driven” theory:

Chemical imbalances and hard-wired pleasure circuits have been prominent public explanations advanced by some biologists for addiction. But the real story is more complex, even at the level of neurobiology. Addiction is not simply a chemistry experiment gone wrong, some poor sap in the ‘laboratory of the street’ mixing the wrong substances inside his brain. The parts of the brain where addiction happens are not single, isolated circuits — rather, these areas handle emotions, memory, and choice, and are complexly interwoven to manage the inherent difficulty of being a social self in a dynamic world. (2012, p. 342)

Along with Lende, others have pointed to the problems with the BDMA as a premise for research and/or public understanding of addiction. A fascinating chain of conversations published in the prestigious journal Lancet Psychiatry made public the debates about the validity and value of the BDMA. A NIDA publication preface by Volkow illustrates NIDA's reliance upon the premises of the BDMA, with bold claims like, “As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior” (Volkow, 2014).

Actors Isabel Keating, Jeff Binder, and Ben Evett

in "The White Chip." Image courtesy of

photographer Meghan Moore.

Many social scientists refer to the BDMA as the “NIDA paradigm” (Dunbar, Kushner & Vrecko, 2010, p. 3). When challenged on the lack of conclusive evidence for the BDMA, Volkow’s chief defense is a pragmatic one: that the BDMA frees those suffering from addiction from the shame of morality models of addiction, which continue to linger. The loudest response to this argument comes from neuroscientists and others who argue for something along the lines of a “learning disorder” model of addiction. Marc Lewis, a neuroscientist who struggled with drug addiction in his 20s, argues that "the disease idea is wrong...Medical researchers are correct that the brain changes with addiction, but the way it changes has to do with learning and development -- not disease” (2015, p. xi). Lewis’ concerns are reflective of questions raised by other scholars, such as psychiatrist Sally Satel and psychologist Scott O. Lilienfeld (2013, 2014). However, Volkow’s point remains: to claim that addiction is a disease rooted in brain mechanisms seems to carry far more weight with people trying to recover, and those surrounding them.

In “The White Chip,” Sean is an intelligent and accomplished adult – why can’t he just stop? No explanation freed him from his sense of shame and defeat so much as an etiology that incorporated neurological mechanism. Sean incorporated the most important mechanisms into the script of his play, with characters “Lenny” and “Stuart” serving to tell the story of his most important conversations with members of the group:

LENNY: Here’s the truth - Dopamine is the chemical that when it’s released in your brain, you feel great. The drug that’s been in your brain since you were born.

STUART: Your brain is always trying to maintain balance, and therefore the more you drink, the less dopamine your brain releases.

LENNY: Your brain is with you all the times you snuck a drink, so when you say…

STUART: ‘‘I’m quitting, I really mean it this time…really!’’

LENNY: Your brain doesn’t believe you. So, on Day 2 of sobriety you have no alcohol and no dopamine from your brain, because it’s sure the alcohol is coming.

STUART: So, you feel terrible.

LENNY: Your body is signaling you that it needs you to hold up your end of the current destructive bargain.

STUART: So terrible.

LENNY: That spiritual awakening most drunks feel around Day 90 when they look up and suddenly the sky is bluer and everything seems like it’s gonna work out, and they get on their knees and thank god -- that’s chemistry.

STUART: That’s your brain FINALLY believing you that you won’t drink and therefore it releases chemicals into your brain to maintain balance.

LENNY: Yes, you will walk out the door and suddenly feel light and notice trees and children and feel happy to be alive, and that MAY be god, but it is definitely chemistry. Just stop drinking for 90 days and let science save your life.

…LENNY: Don’t worry kid -- most people are dopamine junkies -- they just think it’s free will.

…LENNY: So, to stay sober, you have to fight your own brain. Fight chemistry with reason.

It seems that if Sean’s safety is the top priority, than perhaps any narrative he holds about the etiology of addiction, so long as it keeps him from drinking again, is worth supporting. If this is true, then perhaps NIDA has it right: the BDMA is highly effective at battling the overwhelming social stigma of addiction as a lack of willpower, or some other sort of individual fortitude. On the other hand, critics raise valid concerns about the inaccuracy, or at least unfounded nature, of the concept of addiction as a “brain disease.”

In Sean’s monologue near the end of the play, he proposes several reasons why this formulation of Higher Power as “Science” allowed him to maintain sobriety when all other methods had failed:

SEAN: ... It’s my faith in science that keeps me sober. Though it seems to work for the vast majority, and I never try to talk anybody out of it -- ever ever ever - it does make you think, how many people are like me, and then don’t make it because we lead with God and not with science? Does belief in one exclude the other?

Actor Jeff Binder, playing "Sean" in "The White Chip."

Image courtesy of photographer Meghan Moore.

Whether or not these beliefs and etiologies about the nature of addiction exclude one another, it is illuminating to hold the example of Sean alongside the stacks of literature and research debating various models of addiction. At its best, neuroethics often takes up the task of performing reflexivity for the field of neuroscience, urging a critical look at the presumptions on which the discipline is based, and the repercussions of them. For addiction, what are the repercussions of what Vidal (2009) notes is the dominating presence of “brainhood” in contemporary discourse, in which the modern self operating principally as a “cerebral subject”? Sean’s case is a fascinating portrait of personifying “science” as an entity, and a trustworthy belief system of sorts, while also viewing his “brain” as an entity simultaneously identical with his self, while also separate. In some ways, Sean’s contradictory view of himself calls to mind what Jan De Vos (2016, p. 26) describes as “the situation of the colourful brain scan engendering an oh-my-god-is-this-what-I-am subject.” In other ways, it is a reminder that we all carry with us, in our views of the world and ourselves, various paradoxes and contradictions.

In the end, what responsibility do clinicians and caregivers have, in providing care and recovery options, to offer multiple models and etiologies of addiction, for people who struggle like Sean? It seems that if saving lives is our top priority, then finding the models that are most compelling for each individual struggling to recover is a worthy consideration.

References



Campbell, N. D. (2007). Discovering addiction?: The science and politics of substance abuse research. Ann Arbor, MI: University of Michigan Press.



Campbell, N. D. (2010). Toward a critical neuroscience of “addiction.” BioSocieties, 5(1), 89–104.



Cook, C. C. H. (2004). Addiction and spirituality. Addiction, 99(5), 539–551.



De Vos, J. & Pluth, E. (2016). Neuroscience and critique: exploring the limits of the neurological turn. Abingdon, UK?; New York: Routledge.



Dunbar, D., Kushner, H. I., & Vrecko, S. (2010). Drugs, addiction and society. BioSocieties, 5(1), 2–7.



Earley, P. H. (2017). RecoveryMind Training: A neuroscientific approach to treating addiction. Las Vegas: Central Recovery Press.



Geppert, C., Bogenschutz, M. P., & Miller, W. R. (2007). Development of a bibliography on religion, spirituality and addictions. Drug & Alcohol Review, 26(4), 389–395.



Dermatis, H., & Galanter, M. (2016). The role of twelve-step-related spirituality in addiction recovery. Journal of Religion and Health, 55(2), 510–521.



Field, M. (2015, February 6). Addiction is a brain disease…but does it matter? Retrieved February 16, 2017, from https://www.nationalelfservice.net/mental-health/substance-misuse/addiction-is-a-brain-diseasebut-does-it-matter/



Hall, W., Carter, A., & Forlini, C. (2015a). Brain disease model of addiction: misplaced priorities? The Lancet Psychiatry, 2(10), 867.



Hall, W., Carter, A., & Forlini, C. (2015b). The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises? The Lancet Psychiatry, 2(1), 105–110.



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Koob, G. F., & Moal, M. L. (2005). Neurobiology of addiction (1st ed.). San Diego: Academic Press.



Lende, D. H. (2012). Addiction and neuroanthropology. In D. H. Lende & G. Downey (Eds.), The encultured brain: an introduction to neuroanthropology (pp. 339–362). Cambridge, MA: MIT Press.



Leshner, A. I. (1997). Addiction is a brain disease, and it matters. (Cover story). Science, 278(5335), 45–47.



Lewis, M. (2015). The biology of desire: Why addiction is not a disease. New York: PublicAffairs.



O’Connor, R. (2015). Rewire: Change your brain to break bad habits, overcome addictions, conquer self-destructive behavior (Reprint ed.). New York: Plume.



Ross, S. (2013, April). Psilocybin, addiction, and end of life. Presented at the Psychedelic Science Conference, Oakland, CA.



Satel, S. L., & Lilienfeld, S. O. (2013). Brainwashed: the seductive appeal of mindless neuroscience. New York: Basic Books.



Satel, S., & Lilienfeld, S. O. (2014). Addiction and the brain-disease fallacy. Frontiers in Psychiatry, 4.



Spiegelman, E. (2015). Rewired: A bold new approach to addiction and recovery. Hobart, NY: Hatherleigh Press.



Swora, M. G. (2004). The rhetoric of transformation in the healing of alcoholism: The twelve steps of Alcoholics Anonymous. Mental Health, Religion & Culture, 7(3), 187–209.



Szalavitz, M. (2016a). Unbroken brain: A revolutionary new way of understanding addiction. New York: St. Martin’s Press.



Szalavitz, M. (2016b, June 25). Can you get over an addiction? New York Times. Retrieved from http://www.nytimes.com/2016/06/26/opinion/sunday/can-you-get-over-an-addiction.html



Trujols, J. (2015). The brain disease model of addiction: challenging or reinforcing stigma? The Lancet Psychiatry, 2(4), 292.



Vidal, F. (2009). Brainhood, anthropological figure of modernity. History of the Human Sciences, 22(1), 5–36.



Volkow, N. D. (2014). Preface: How science has revolutionized the understanding of drug addiction. In Drugs, brains, and behavior: The science of addiction. Washington, DC: National Institute on Drug Abuse.



Volkow, N. D., & Koob, G. (2015). Brain disease model of addiction: why is it so controversial? The Lancet Psychiatry, 2(8), 677–679.

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Kime, K.G. (2017). Why Addiction Narratives Matter. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/03/why-addiction-narratives-matter.html

M[Emory] Enhancement and its Implications

By Shweta Sahu

Imagine a situation in which you suffer from severe anterograde amnesia, a form of short term memory loss, and can’t recall information presented to you even 7 seconds before-- let alone being able to remember the one thing you went to Target to buy, but forgot. Such is the case of Clive Wearing, a man known for his lack of short term memory. His wife notes, “you ask him a question and he’ll give you an answer but while he’s giving me the answer, he’s already forgotten the question. That’s how short it is.” He himself notes “the brain has been totally inactive—day and night the same—no thoughts at all.” Though this is one of the most severe cases of amnesia observed, it underscores how crucial memory is not only to every day functioning, but also for one’s sense of self. Autobiographical memories and the ability to recall these emotional and important events are an integral component of one’s identity. These events, in turn, get tied into personal narratives that our personalities are built on. In the case of Mr. Wearing, he is stuck in this personality because of the damage to his hippocampus and closely related brain regions, an area of the brain necessary for transferring information from short term to long term memory. As a result, he reports that he feels like he is dead and is constantly waking up into a new reality.

Video courtesy of YouTube

Realizing how significant memory is one thing, but the ability to recover or enhance memory is another. At our recent Neuroethics and Neuroscience in the News event, Dr. Inman, a postdoctoral fellow at Emory Department of Neurosurgery discussed “memory enhancement through brain recording and stimulation, and the implications of brain prosthetics for memory, identity, and autonomy.” In particular, his work focuses on patients with treatment-resistant epilepsy. These patients also often suffer from memory impairment and are often willing to participate in research while they are in the hospital to help localize the location where their seizures start.

Dr. Inman conducts research by recording and stimulating through electrodes directly embedded of the brain. Brain stimulation has been used since as early as the 1900’s to treat intractable neurological diseases. There are two general forms of brain stimulation: invasive (such as deep brain stimulation [DBS] and electrocorticography [ECoG]) and noninvasive (including transcranial direct current stimulation and transcranial magnetic stimulation).

The current state of affairs:

A 2012 study conducted by Suthana et al suggested that stimulation of the entorhinal cortex results in enhancement of spatial memory. However, a more recent study performed by Jacobs et al refuted this claim, and found that memory was in fact impaired when the entorhinal cortex was stimulated. The study done by Jacobs et al is part of a larger project by DARPA (Defense Advanced Research Projects Agency) entitled RAM (Restoring Active Memory), the goal of which is to create an implantable device, similar to a pacemaker for the brain, that can restore an individual’s memory post traumatic brain injury.

Image courtesy of Pew Research Study

Seeing as human memory enhancement is the goal, it’s not unreasonable to consider the implications of these technologies in a general public of consumers already eager to experiment with a number of cognitive enhancers from pill and drinks to wearable technologies. A recent study surveyed the “public opinion on the future use of brain implants” and revealed that as of March 2016, Americans were more accepting of an implanted device if its effects were temporary and controllable. Moreover, the study also found that Americans were especially reluctant to enhance cognitive function beyond natural abilities, as 67% said that an implanted device for improved cognition and concentration would be taking technology too far.

Dr. Inman indicates that scientists are still trying to figure out what’s happening in the brain during memory creation and which paradigms of stimulation result in which clinically-meaningful enhancement effects, as well as, any potential side effects. Furthermore, Inman states that in his current work stimulating brain regions involved in emotional memory enhancement, they have been able to enhance memory for basic objects by stimulating during learning one day and showing better memory of the previously stimulated objects the next day. Studies like this suggest that there is promise in the field, but there are still many studies to be done and to fully understand before we can apply these kinds of techniques as therapies for memory disorders.

Where are we heading?

Dr. Inman remarks that how the media describes new technologies is important for how the public understands these technologies and, consequently, how the consumer market responds. That brings the question then, to where the field of memory enhancement and brain-computer-interfaces (BCI) are headed? Whether it’s some Harry Potter “pensieve”-like thing where we can directly enable others to visualize our memories or whether its controlling a robot with a brain cap scenario, we are certainly going to come across ethical issues of “to enhance” or “not to enhance,” with strong arguments for both. What I mean by ethical issues is more than just if cognitive enhancement is worth the potential risks, but rather, I want to consider questions such as: (1) if we have the ability to enhance, should we enhance, (2) through the use of cognitive therapy, would we be “altering an individual” and “eroding their character,” (3) an individual’s physical safety (4) efficacy; (5) non-physical harms such as threats to autonomy and authenticity, (6) what is the difference between implicit coercion and responsibility in the case of enhancement, (7) would quality of life would be better post enhancement? Could it be that history may repeat itself with BCI in a similar manner as with cognitive enhancement? I predict we will continue to encounter similar conflicts as we come across with currently available therapies, whether it be do-it-yourself tDCS or non-prescribed (and theoretically illegally used) Adderall or Ritalin.

Where should we draw the line?

Image courtesy of Google Images

As was the issue with nootropics and cognitive enhancement, we will most likely come across familiar therapy versus enhancement blurred lines debate with memory enhancement. Several points of view exist in this debate, take, for example, the beliefs of physicians who prescribe these enhancements/ therapies for the general public. As an aspiring physician myself, I’m not sure where I stand. One professional mandate of medicine is “do no harm.” Maurice Bernstein, MD, says that in transforming physicians from healers to enhancers has the potential to “degrade” this standard. Furthermore, Howard Brody, MD, PhD, a family practice physician and bioethicist, agrees with this sentiment, adding that “one of a physician's ethical duties is to avoid disproportionate risks of harm that are not balanced by the prospect of compensating medical benefits." On the other hand, these opinions can be directly contrasted with the wants and views of the general public. A proponent of enhancement and author of Liberation Biology: The Scientific and Moral Case for the Biotech Revolution, Ronald Bailey, argues that disease is a state of dis-ease. He further states, “if patients are unsatisfied with some aspect of their lives and doctors can help them with very few risks, then why shouldn't they do so?" Of particular interest to the military are concerns for veterans with traumatic brain injury (TBI). This debate is uniquely complicated as veterans who are exposed to high personal and emotional risk during their active duty careers. Are we (as recipients of their protection and sacrifices) not responsible for returning them back to their set point or enhancing their capabilities to that beyond the typically accepted ‘norm’ to ensure greater safety to our civilians and warfighters alike? Many veterans who have seen unimaginably gruesome events and themselves sustained moral injuries. Moreover, if they do receive some type of brain chip or alternate implant, can we allow them to keep these implants after their service? If a brain chip was implanted for warfighters in the line of duty have they earned it or is it even rightful for them to have one? Not only that, but also consider, if this is a physical implant, then it is a part of you* or is it considered to be military property?

When asked if he himself would get a brain chip, Dr. Inman replied “No—I don’t need to have brain surgery and I work just fine without it… I believe we are developing this for therapy not enhancement of a normal, healthy function.” Clearly, there are those who feel otherwise, but the answer for most probably isn’t so black-or-white. Where do you stand?

Want to cite this post?



Sahu, S. (2017). M[Emory] Enhancement and its Implications. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/03/memory-enhancement-and-its-implications.html