Attitudes about memory dampening drugs depend on context and country

Applied Cognitive Psychology, Appl. Cognit. Psychol. (2010)Published online ( DOI: 10.1002/acp.1740 Attitudes about Memory Dampening Drugs Depend on Context and Country ERYN J. NEWMAN1, SHARI R. BERKOWITZ2, KALLY J. NELSON2, MARYANNE GARRY1and ELIZABETH F. LOFTUS2*1Victoria University of Wellington, New Zealand2University of California, Irvine, USA Summary: When people take drugs such as propranolol in response to trauma, it may dampen their bad memories – temperingrecall of a traumatic event. We examined people’s attitudes toward these drugs. Americans and New Zealanders read about ahypothetical assault inserting themselves into a scenario as a victim attacked while serving on a peace keeping mission (soldierrole) or while walking home from a job as a restaurant manager (civilian role). Then they told us whether they should receive amemory dampening drug, and whether they would want to take a memory dampening drug. Subjects were negatively disposedtowards a memory dampening drug, but Americans who adopted the soldier role were more in favor of having access to the drugthan those who adopted the civilian role. We discuss the implications of these findings in relation to an increasing trend in‘cosmetic neurology’, medicating with the goal of enhancement, rather than therapy. Copyright # 2010 John Wiley & Sons, Ltd.
Distressing memories do not simply feel terrible in the for a review). Propranolol blocks epinephrine receptors, moment; they are associated with an array of psychological and in doing so prevents memory enhancement (Cahill, consequences, such as dysphoria, depression and low self- Prins, Weber, & McGaugh, 1994; McGaugh, 2004). In esteem (Berntsen & Rubin, 2006, 2007; Ross & Wilson, a well-known study, Cahill et al. (1994) found that 2002). Profoundly distressing memories are a hallmark of giving people propranolol destroyed the typical memory posttraumatic stress disorder (PTSD; APA, 1994). PTSD enhancement of emotional experiences, impairing both produces mental anguish, and significant costs to sufferers, recall and recognition of emotional memories relative their families, and society (Kessler, 2000; McNally, to people who did not take propranolol (see also Cahill, 2003a,b). In some cases, people with PTSD come to feel Pham, & Setlow, 2000; Reist, Duffy, Fujimoto, & Cahill, as though they are haunted by those memories, which can 2001; Roozendaal, Quirarte, & McGaugh, 1997). Taken intrude on their everyday thinking, surface in flashbacks or together, this research suggests that propranolol can nightmares, or set off exaggerated physiological responses.
dampen memory for emotional material and raises One Holocaust survivor said his awful memory is ‘in front of me. I can’t get rid of it’ (Langer, 1993: p. 96; see also Kuch & Cox, 1992; Wagenaar & Groeneweg, 1990). Similarly, In fact, recent studies suggest that if people take Berntsen and Rubin (2008) found that Danish tourists who propranolol after a traumatic experience, they suffer fewer survived the 2004 Indonesian tsunami experienced intrusive psychological after-effects. In one study, emergency room patients took propranolol or a placebo shortly after a These studies and others suggest that distressing memories traumatic experience; 1 month later, propranolol patients had keep us stumbling on unhappiness (with apologies to Gilbert, fewer PTSD symptoms than placebo patients (Pitman et al., 2006). One interesting question that arises from this research 2002). In another study, PTSD patients described their is whether people would be interested in taking a drug that trauma in writing, and then took propranolol or a placebo.
could dampen – that is, lessen the emotion associated with One week later, patients listened to a recording of their and diminish content of – a traumatic event? In what context descriptions while instruments gathered data on their should people have access to such a drug? These are the physiological stress responses. Propranolol patients showed questions we address in the experiment described here.
lower stress responses than placebo patients (Brunet, Orr, Given the myriad bad consequences associated with Tremblay, Robertson, Nader, & Pitman, 2008). Although horrible memories, it is little wonder that scientists have neither study measured changes in memory, we might investigated drugs that might blunt them. Memory dampen- speculate that one mechanism responsible for the reduction ing drugs, such as the beta-blocker propranolol, may offer in PTSD symptoms is what Cahill et al. (1994) found: some relief by disrupting the biological processes that propranolol makes people remember less, and makes their make emotional memories so intensely remembered in the emotional memories more like mundane memories.
first place. Emotionally arousing experiences – positive or As advances in neuroscience make access to memory negative – cause the release of adrenal stress hormones dampening drugs more likely, some have raised both legal that enhance some aspects of memory (see McGaugh, 2000, and ethical concerns about who should have access to themand in what circumstances (Kolber, 2008; President’sCouncil on Bioethics 2003). Moreover, for all the good *Correspondence to: Elizabeth F. Loftus, Psychology & Social Behavior, memory dampening drugs might do to relieve suffering, we Criminology, Law & Society, Cognitive Sciences, School of Law, University still do not know if people actually want to take these drugs, of California, Irvine, 2393 Social Ecology II, Irvine, CA 92697-7080 USA.
E-mail: [email protected] or even want the choice to take them.
Copyright # 2010 John Wiley & Sons, Ltd.
But there are good reasons to expect that people would sense of invincibility. In other words, it could lead people to indeed want – at the very least – the choice to take a memory be more concerned that they might develop PTSD and be dampening drug. For one thing, we know that people often more positively disposed towards a memory dampening drug like to have choices. Simply being able to exercise a choice – (see Menon, Raghubir, & Agrawal, 2008). On the other hand, rather than being constrained – can result in many positive some research suggests that base rates often do not affect psychological outcomes, including boosting feelings of people’s attitudes – instead, people overlook base rate control and motivation (Iyengar & Lepper, 1999; Szrek & information, focusing on idiosyncratic aspects of an event Baron, 2007; cf. Iyengar & Lepper, 2000). Second, people (Bar-Hillel, 1980; Tversky & Kahneman, 1974; cf. Ginosar tend to overestimate how badly they would feel after a & Trope, 1987; Koehler, 1996). Therefore, it is possible that hypothetical negative event, which may lead them to feeding people base rate information might have no influence overestimate their need for a memory dampening drug.
on their disposition towards a memory dampening drug.
What leads people to overestimate? Research suggests that In the study below, we asked a sample of people in the people do not always consider other factors in their lives that United States (US) and New Zealand (NZ) to read the assault contribute to happiness – instead, they overemphasize the scenarios and then tell us if they wanted the choice to receive importance of the target event (Gilbert & Wilson, 2007). In a memory dampening drug, and (assuming they had a choice) one study, people who imagined suffering from kidney if they would actually want to take it. We expected that disease predicted they would feel quite negative – even people’s responses might vary by country, reflecting the fact though people who actually suffered from kidney disease that Americans are more comfortable with the idea of taking reported feeling positive (Riis, Loewenstein, Baron, Jepson, medication. For instance, people in the US medicate Fagerlin, & Ubel, 2005). Taken together, these studies themselves more than people in any other Organization suggest that people would want to take the drug, or at least for Economic Cooperation and Development (OECD) nation, spending $121 per person annually on over-the- On the other hand, there are also good reasons to expect counter drugs – more than three times as much as people in that people would want to avoid a memory dampening drug.
NZ, who spend $40 (OECD Health Data, 2009). When it For instance, people tend to imagine glowing, positive comes to prescription drugs, the US again comes out on top, futures (Szpunar, 2010; cf. Wilson & Ross, 2003). In one spending $878 USD per person per year (OECD Health Data, study, when people generated personally meaningful future 2009). By contrast, people in NZ rank 23/24, spending $241 events they were slower at generating negative events than USD per person per year. The comparison is especially positive events, and thought the negative events less likely noteworthy, given that the US and NZ are the only OECD (Newby-Clark & Ross, 2003). Put another way, positive countries permitting direct to consumer prescription drug future events might come to mind more easily – more fluently – and therefore feel truer, and more likely (see Alter& Oppenheimer, 2009 for a review; Sherman, Cialdini,Schwartzman, & Reynolds, 1985). Considered together, this research suggests that people may imagine a relativelypositive posttrauma future, and decide they would not need To address these issues, we asked people to read a We used a 2 (context: restaurant or military) Â 3 (base rate: scenario about a vicious assault. We manipulated the 4%, 40% or no information) Â 2 (country: US or NZ) circumstances of the assault so that people read about between-subjects design. The first factor was context. In the themselves experiencing one of two similar attacks occurr- restaurant condition, people read a version of the assault ing in two very different contexts. In the first version, people scenario that described a restaurant manager returning from read that they were a restaurant manager attacked while work late at night. In the military condition, people read a returning from work late at night; in the second version, they version of the assault scenario describing the same attack read about the same attack but as a soldier returning to base happening to a soldier returning to base late at night.
The second factor was base rate. People read either that We also manipulated the base rate of PTSD, telling some 4%, or 40% of people go on to develop PTSD; in the ‘no of our subjects that only 4% of people go on to develop PTSD information’ version of the scenario, there was no mention of after a traumatic experience, telling others that the figure was 40%, and telling still others nothing about the base rate ofPTSD. Because the relevant literature is mixed, we had nospecific prediction about the effects of this manipulation. On the one hand, research leads us to speculate that base rate A total of 997 people from the community completed the information may influence people’s attitudes to memory survey; there were 518 women (52%), 463 men (46%) (16 dampening drugs. Typically, people believe that others are people did not report gender); they ranged in age from 18 to more at risk for developing certain medical conditions than 80 (M ¼ 28.2, SD ¼ 13.7). Of the 997 subjects, there were they themselves are (Hansen, Raynor, & Wolkenstein, 1991; Perloff & Fetzer, 1986; Weinstein, 1984, 1987, seeWeinstein, 1989 for a review). Therefore, it is possible that 1Note that although cell sizes were uneven, for all effects we report, the Fmax feeding people base rate information could counteract their test showed acceptable ratios of cell variances (Tabachnik & Fidell, 2007).
Copyright # 2010 John Wiley & Sons, Ltd.
extent to which they would want access to a memorydampening drug, and in Question 2 [Q2], they reported how We distributed the survey in various parts of southern likely they would be to actually take the drug if it were made California, and Wellington, NZ. People who agreed to take available. They made their responses on a 5-point Likert type part completed the survey immediately, and returned it to one scale, with anchors 1 ¼ definitely no to 5 ¼ definitely yes.
of the experimenters. Each scenario was approximately 100 We also asked people for demographic information such as words long, and varied only in line with the manipulations sex, age and whether or not they had ever witnessed or described above. For example, people in the restaurant You are a restaurant manager who has just finished work late at night, and you put the night’s takings in yourbackpack so you can deposit them into the restaurant’s Our primary interest in this study was to examine whether bank account in the morning. Your journey home takes people wanted access to memory dampening drugs and you through a poorly lit park. While in the park, a man whether they would actually want to take these drugs. We appears in front of you, and stabs you in the stomach. As were also interested in whether the context of trauma you fall to the ground, he kicks you hard in the ribs, steals (whether people read about themselves being attacked as a the money and runs off. Although you are badly shaken by restaurant manager or a soldier), country of residence and the viciousness of the assault, you are able to get to the perceived prevalence of PTSD would affect people’s attitudes to the drug. Below we focus on two key findings:the extent to which people wanted the choice to take the drug, and if they themselves would take the drug. Because we You are a soldier on a peacekeeping mission in Afghani- found that base rate information had no effect on our stan who has just finished patrolling late at night, and you findings, we omitted this factor from the analyses below.
put the night’s supplies in your pack. Your journey to thebase takes you through dark terrain. While on your way to Who should have access to the memory dampening the base, a man appears in front of you, and stabs you in the stomach. As you fall to the ground, he kicks you hardin the ribs, steals the supplies and your gun and runs off.
To examine people’s attitudes about who should have access Although you are badly shaken by the viciousness of the to the memory dampening drug, we took their responses to assault, you are able to get to the nearest base, where there Q1 and classified them first according to whether they were from the US or NZ and then by the context in which theassault occurred. We display those results in Figure 1.
Before reading each scenario, people read a paragraph Figure 1 shows three important findings. First, regardless describing a drug used to diminish the possible after-effects of where people lived or the hypothetical context in which of trauma. Although we did not mention propranolol by they read they were attacked, they showed only modest name, we based our description of the drug and its effects on desire to have access to the drug. Second, depending on what subsequent recall from the scientific literature (Brunet et al., country they lived in, the context in which people were 2008; Cahill et al., 1994; Pitman et al., 2002). The attacked mattered: Americans showed more support for their paragraphs changed only in respect to the base rate condition.
right to access the drug if they were the soldier than if they were the restaurant manager; by contrast, New Zealanders Scientific studies have shown that on average, 4% of showed similar support for their right to access the drug when people who experience a traumatic event will develop they were either the restaurant manager or the soldier. Third, PTSD. Some of the debilitating symptoms of PTSD when they adopted the soldier’s point of view, Americans include recurrent and intrusive distressing recollections showed greater support for their right to access the drug than of the event, irritability or outbursts of anger and an exaggerated startle response. Recently, research has Statistical support for these findings can be seen in a 2 shown that if a person who has had a traumatic experience (context: restaurant or military)  2 (country: US or NZ) analysis is given a certain drug within a few hours of that experi- of variance (ANOVA) which showed a Context  Country ence, the drug can ‘dampen’ the memory of that event and interaction, F(1,996) ¼ 4.23, p ¼ .04, f ¼ .06. Follow-up t-tests minimize the effects of PTSD. In other words, the drug showed that for Americans, the context mattered: the ‘military’ will lessen the emotion associated with the event, and subjects agreed more strongly that they should have the choice to diminish factual content for the event, without causing the take the drug than did the ‘restaurant’ subjects, t(993) ¼ 2.78, p ¼ .01, Cohen’s d ¼ .18. For New Zealanders, context did notmatter, t(993) ¼ .52, p ¼ .62. When we focused on just the The 40% version replaced 4% with 40%, and people who military subjects, we found that Americans agreed more strongly read the version with no information read a modified opening that they should have access to the drug than did New sentence: scientific studies have shown that people who Zealanders, t(993) ¼ 2.43, p ¼ .02, d ¼ .15.
experience a traumatic event can develop PTSD.
We also examined whether people who had experienced a Our primary dependent measures were people’s responses traumatic event would be more inclined to want access to the to two questions: in Question 1 [Q1], people reported the memory dampening drug. Would these people have similar Copyright # 2010 John Wiley & Sons, Ltd.
Figure 1. American and New Zealand responses about access to memory dampening drugs attitudes about who should have access to the drug? To assess about taking the memory dampening drug, the more they this, we analyzed the Q1 responses of the 334 people who agreed that they would exercise that choice. Put another way, said they had experienced a traumatic event. When we reran there was a positive correlation between people’s responses the ANOVA adding traumatic experience (yes, no) as a about having the choice of the drug and their responses about factor, we found the same pattern of results. That is, there whether they would take the drug, r(994) ¼ .42, p < .01.
was no effect for trauma, F < 1, but there was a Again we wondered if people who had experienced a Context  Country interaction, F(1,971) ¼ 4.21, p ¼ .04, traumatic event would have different attitudes towards taking f ¼ .06. Although our conclusions should be taken as the memory dampening drug. One possibility is that people speculative because of the violation of random assignment, who had experienced a traumatic event would have greater they suggest that experiencing a traumatic event did not awareness of its distressing after-effects and be more affect people’s attitudes about having access to the drug.
inclined to want the drug. To address this possibility, wereran the ANOVA adding traumatic experience as a factor,and found that in fact, people who had experienced trauma Who would want to take the memory dampening were less inclined to take the drug (M ¼ 2.10, SD ¼ 1.29) than people who had not experienced trauma (M ¼ 2.29, Did the effects we found for who should have access to the SD ¼ 1.25). The remaining pattern of results was the same.
drug translate into similar effects when people were asked In other words, a 2 (context: restaurant or military) Â 2 whether they themselves would want to take the drug? The (country: US or NZ) Â 2 (trauma: yes, no) ANOVA showed answer is no. As Figure 2 shows, we found no effects for no effect for context, F < 1, no effect for country, F(1, where people lived or the context in which they were attacked.
970) ¼ 1.03, p ¼ .31, but an effect for trauma, F(1, Instead, we found that across these factors, people tended to 970) ¼ 5.03, p ¼ .02, f ¼ .07. This pattern of results held reject the drug when given the choice to take it. In other words, only for those people who had experienced a traumatic there was no effect for country, F < 1, no effect for context, event. People who had witnessed a traumatic event showed a F(1,995) ¼ 1.27, p ¼ .26 and no interaction, F < 1. Unsurpris- similar – although not significant – pattern of responding, ingly, the more people agreed that they should have the choice Figure 2. American and New Zealand responses about taking memory dampening drugs Copyright # 2010 John Wiley & Sons, Ltd.
Finally, we analyzed the data to determine if age or gender response model of PTSD. Of course, people’s notions of the were related to people’s opinions about wanting access to the relative impact of comparatively minor and major trauma memory dampening drug or exercising that choice. There are misplaced, as the evidence arguing against a dose– was no relationship between age and choice, r(974) ¼ .05, response model of trauma reactions suggests (see McNally, p ¼ .14; or age and taking the drug, r(973) ¼ .02, p ¼ .50.
(M ¼ 3.34, SD ¼ 1.50) and women (M ¼ 3.50, In many ways, people’s widespread rejection of the drug SD ¼ 1.41) had similar views on access to the drug was surprising for several reasons. First, we live in an era t(979) ¼ 1.72, p ¼ .09, d ¼ .11, but men (M ¼ 2.11, where pharmaceutical advancements produce drugs that SD ¼ 1.28) were less inclined than women (M ¼ 2.32, would have been viewed as miracles only decades ago, such SD ¼ 1.25) to exercise their choice to take the drug as nanoparticles that act like small biochemical weapons, selectively destroying cancer cells (Murphy et al., 2008). At The primary purpose of this research was to examine the same time, people are increasingly willing to seek out people’s attitudes about memory dampening drugs. Taken cosmetic treatments that selectively destroy eyebrow together, these data suggest that people generally rejected the furrows. In this context, Chatterjee’s (Chatterjee, 2004, memory dampening drug. In fact, only 54% of people said 2006) idea of cosmetic neurology reflects a public’s they agreed with having the choice to take the drug (rating willingness to selectively destroy or minimize even minor four or five on the scale), and an even smaller percentage of flaws. On the face of it, then, it is interesting that people were people agreed that they would exercise that choice (18%).
not more favorable about a memory dampening drug. But as This less than enthusiastic support for the memory Riis, Simmons, and Goodwin (2008) showed, although dampening drug fits with the research suggesting that people said they were willing to take drugs that improved people readily generate rosy futures in their minds, more their attention and concentration, they were less willing to fluently imagining positive events and outcomes than take drugs that changed more social attributes – such as negative ones (Newby-Clark & Ross, 2003).
anxiety and motivation – that people saw as fundamental to Nonetheless, it is possible that people did indeed think they would experience significantly bad consequences after We also found that when Americans adopted the point of the assault, including severe PTSD (Gilbert & Wilson, 2007; view of a soldier on a peacekeeping mission, they were more Riis et al., 2005) – yet they rejected the dampening drug in favor of having access to the drug than when they adopted the point of view of a restaurant manager suffering a similar One possibility is that such a pattern of results might well attack on the way home. By contrast, New Zealanders reflect general discomfort about tinkering with our mem- showed no such effects. In addition, people tended to reject ories, as depicted in movies such as ‘Eternal Sunshine of the notion that they would take the drug themselves, the Spotless Mind’.2 In other words, memory dampening regardless of the context in which the traumatic experience drugs may threaten people’s sense of their identities. If memories comprise who we are, then does tinkering with The fact that Americans who adopted the soldier’s point of our memories change who we are (James 1890/1950; view were more supportive of their right to have access to a Neisser, 1988; Wilson & Ross, 2003)? Perhaps our subjects memory dampening drug may reflect factors such as the difference in how Americans and New Zealanders view In addition, we asked people to make a decision about the military. New Zealanders place little emphasis on the the drug without knowing if they would ever develop the military, as revealed by the small percentage of gross negative psychological consequences that would have domestic product (GDP) spent on it (1%) – a value smaller warranted their taking the drug; that is, we asked them if than its close neighbour Australia (2.4%) and significantly they would take the drug as a preventative measure. Of smaller than the US (4.06%) (Central Intelligence Agency course, it is not as though the notion of preventative drugs is (CIA World Fact Book, 2010); see also Elvy, 2008). In fact, a novel – people around the world receive immunizations to recent survey showed that half of New Zealanders were ward off common and rare diseases. Still, perhaps people unwilling to increase spending on defense even though 84% would respond differently to a scenario where therapeutic of people agreed the military was ill-equipped to deal with an intervention occurred once people had already developed PTSD, an approach that is gaining increasing empirical The attitudes of Americans adopting the soldier’s point of support (e.g. Brunet et al., 2008; Schiller, Monfils, Raio, view do not square with the ethical concerns raised by Johnson, LeDoux, & Phelps, 2010). It is also possible that scholars and pundits: for example, although the President’s when people considered the memory dampening drug, they Council on Bioethics (2003) raised the idea that civilians decided it would be wiser to pursue conventional treatments who act in defensive public safety roles – police offers, for PTSD symptoms first before turning to something new firefighters and other ‘first responders’ – could have access to a memory dampening drug, they expressed reservations Another possibility is that people did not judge the assault about extending the same options to soldiers – who, by scenario we asked them to read to be a sufficiently significant definition, have both offensive and defensive roles (see also trauma; that is, perhaps they would reserve the notion of Henry, Fishman, & Youngman, 2007; Kolber, 2006).
‘trauma’ for rape, fires and mass murder – a kind of dose– Whereas public safety personnel defend against the causesof trauma, soldiers also create trauma; a drug that dampens 2We thank an anonymous reviewer for this notion.
their emotional response to waging war might act to produce Copyright # 2010 John Wiley & Sons, Ltd.
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