War memories raise ethical dilemma

In this week of remembrance, Marcia Sokolowski recalls the case of a Holocaust survivor who – on the surface – had rebuilt her life.

Sokolowski was a graduate student in psychology at the University of Toronto when she learned of the woman, who was tormented by the memories of the death camp where she had seen her family murdered.

When years of therapy failed to help, the woman's psychiatrist suggested hypnosis to alter her memory – she would know about her family's death, but she would not remember witnessing it.

Sokolowski's classmates were outraged, she says. "Who was he to tamper with her perception of what had happened?"

Sokolowski, whose parents had been in Bergen-Belsen concentration camp, saw it differently: "It was the kindest act I'd ever heard of."

She's thought about this for 30 years. Today, Sokolowski, an ethicist at Baycrest geriatric centre, raises questions about how Holocaust survivors should be cared for at the end of their lives, when, for some, memories of death camps return with terrifying force and reality.

Simply put, how can we help those who have suffered in war, end their lives in peace?

In their extreme age, with the decline of short-term memory and the ravages of dementia, some survivors who enter hospital believe they are back in the camps.

In an institution, routine elements of care can trigger horrors from the past. They may be afraid of showers, suspicious of staff in uniform, even the sharp click of heels in a hallway prompted one woman to shout "heil Hitler" from her room. They resist injections, remembering the numbers tattooed on their arms. They refuse haircuts because their heads were shaved in the camps.

What brings this issue to the fore is that drugs, which can blunt the force of an emotional memory, are now available and have been tested on rape and accident victims, war veterans and others who suffer post-traumatic stress disorder.

Canadian researchers are now on the third set of studies on trauma victims using the drug propranolol, a beta-blocker used by millions around the world to treat high blood pressure. Results from one study show a 50 per cent decrease in symptoms with most no longer meeting the full criteria for PTSD at the end of the study, said Alain Brunet a clinical psychologist who's conducting research at Douglas research centre and McGill University in Montreal.

Should the drugs be used to alter Holocaust survivors' memories?

It's a charged question since, for 60 years, the Jewish community has urged us not to forget. "We always talk about our duty to remember and there are whole areas of neuroscience devoted to enhancing memory," Sokolowski says. "Then you have someone lying in bed screaming, `I'm not getting on that train, get me out of here.'''

At Baycrest, about one third of its 1,000 or so residents are survivors. Paula David, a gerontologist who worked with survivors at Baycrest and now teaches social work at U of T, said: "It's very frustrating from a helping profession point of view. We can't fix it. We can't right the wrong. It's an individual journey how they live with it and how they reconcile with their memory."

She believes aged survivors have worked out ways to live with their memories and pain.

"It's so integrated into who they are – even the horrific memory. They may have seen their parents murdered, but surrounding all that, is the loving relationship they had. There's another half to every horrific memory and there is power in that."

Survivor Miriam Frankel, 77, one of the speakers during Holocaust Education Week, which ended yesterday, was in three concentration camps. She wouldn't use a memory-altering drug. "I feel I wouldn't be the person I am, the full sum of my memory, pain and all. Who would I be, if given these drugs?"

Sokolowski, however, says the use of memory-altering drugs should be explored.

Propranolol works by blocking the protein synthesis required to consolidate or reconsolidate memory.

Researchers are interested in emotional memory – recalling how you felt when something happened – which is stored in a part of the brain called the amygdala. (Cognitive memory is stored in another part of the brain.)

PTSD sufferers in the study were asked to recall a traumatic memory, and then take the drug, which blocks in part the reconsolidation or re-storage of the memory.

"It's not getting rid of the entire memory," says McGill psychology professor Karim Nader, who's led this research.

"We're just trying to take a memory that is so overwhelming and bring it down to the range of just being a bad memory. Of course, we want to keep the conscious aspect. Then there is a higher chance these will be responsive to traditional forms of therapy."

Neuroethicist Judy Illes sees both the benefit of the drug and the potential for abuse. We use drugs to alleviate many symptoms, she says. Why not use them to dull the edge of emotional suffering because of harmful memories?

But she's also concerned about the casual use of propranolol – to blunt the memory of a bad date – as well as its use in the military.

"What if soldiers are given these drugs and go into the battlefield and ... wipe out a village?" asks Illes, a neurology professor and Canada Research Chair in Neuroethics at the University of British Columbia. "Is the human or emotional component of the killing removed? We worry about that."