Soldiers and Beta Blockers

A large number of soldiers returning from active service in Iraq and Afghanistan suffer from PTSD (post traumatic stress disorder) and the military is interested in using beta blockers to help in alleviating this disorder. Beta blockers are drugs commonly used to treat some heart conditions such as angina. Elisa Hurley is concerned that the use of these drugs may have at least one bad consequence (1). In this posting I want examine whether we should share her concern.

Before I start my examination I must briefly summarise Hurley’s argument. Let it be accepted that post battle beta blockers help prevent the formation of painful emotional memories (PEM) in soldiers. Clearly soldiers are required to kill enemy combatants in battle. Equally clearly civilians are required to not kill others. If they do so they may be charged with murder. Hurley suggests this killing in battle separates soldiers from the normal moral community. Some might reject her suggestion but I will accept it here for the sake of argument. She proceeds to argue that after battle soldiers need to be integrated back into the moral community. She then further argues coming to terms with PEM is necessary for this re-integration. She then concludes a bad consequence, of beta blockers preventing the formation of PEM, is that they also prevent this re-integration. Hurley’s argument it seems to me depends on two implicit assumptions. Firstly any normal moral community depends on emotions to some degree. Secondly a moral community must be integrated. I will question these assumptions.

Not all moral systems have an affective component. Some believe that morality is objective and that our moral behaviour should be based on norms. Clearly if we accept a non-affective moral system PEM are not necessary for a soldier to successfully himself re-integrate into such a community. However in practice I would argue that the problems autistic people and sociopaths have in forming moral judgements strongly suggests that morality must include an affective element, see for instance Nichols (2). In what follows I will accept the first of Hurley’s implicit assumptions.

I will now turn to the second of Hurley’s implicit assumptions. It seems clear to me if Hurley assumes a soldier can be reintegrated into a moral community she must also implicitly assume that this community is in some way integrated. I will now give three reasons why I find the idea of such a fully integrated moral society improbable. Firstly I would simply point out we live in a multi-cultural society and that some of the norms people live by differ. I of course accept in any society people must share some norms. Secondly I would argue a fully integrated moral society might become something akin to an exclusive club. For instance a fully integrated society might exclude some people such as schizophrenics from membership. Intuitively provided schizophrenics take drugs to control their condition they ought to be full members of moral society. This intuition is supported in practice. Society holds schizophrenics responsible for their actions provided their schizophrenia is controlled. A further example might be provided by convicted prisoners who by their actions don’t seem to be fully integrated into moral society but whom nonetheless I would argue should nevertheless be regarded as members of moral society to some degree. These examples suggest that we live in a moral society which is not fully integrated. Lastly I would argue to talk too much of integration with respect to any moral society which includes an affective element would be a mistake because we experience emotions to a varying degree. For example Michael Slote believes it might be possible to base our moral society on empathic concern for others (3) . In such society women might be better at dealing with moral problems because of their greater capacity for empathy. It seems to me that such a society would not be fully integrated. It should of course be fully inclusive. For these reasons I would reject Hurley’s second implicit assumption that we live in an integrated moral society. I would suggest it would do better to consider the ability of people to be members of, to function, in a moral society rather than integration.

Hurley posed the question does the taking of beta blockers damage a soldier’s reintegration into society after battle. I have suggested above there is no such thing as a fully integrated moral society. I have further suggested that it would do better to consider the ability of people to function in a moral society than integration. If my suggestions are accepted then Hurley’s question needs to be refined. Her original question might be refined as follows; does the prescription of beta blockers to soldiers affect their ability to function in society? It seems clear many ex-soldiers find it hard to function in our everyday society. According to James Treadwell a lecturer in criminology at the University of Birmingham statistics suggest that between 3% and 10% of the British prison population are ex-forces personnel. Former soldiers the highest occupational culture claimed by prisoners, see Howard League for Penal Reform . This situation might be partly explained by the experience of soldiers witnessing or being party to traumatic events while in the services, and then later developing Post Traumatic Stress Disorder.

At one time most schizophrenics found it hard to function in society and many were confined to asylums. Recently advances in drugs have allowed most schizophrenics to function in society. The taking of these drugs does not damage a schizophrenic’s ability to function in society, indeed it makes it possible. Let it be accepted PEM prevents soldiers from fully functioning in society. Let it be further accepted beta blockers dampen a soldier’s PEM after battle and that this helps prevent PTSD. It might then be argued by analogy beta blockers do not damage soldiers’ ability to function in society but instead enhance it. For these reasons it might be thought that I am in favour of soldiers taking beta blockers provided these prevent PTSD. In practice I share Hurley’s concern about the use of these drugs

My concern is not about the successful re-integration of soldiers back into society after battle but rather the integration of a soldier’s life with his sense of self. Consider a non-swimmer who through no fault of his own fails to rescue a child from a swollen river. Let us assume the child drowns and this person is traumatised by memories of her screams. Let us further assume there is a drug which would erase all memories of this incident from this person’s mind and hence eliminate his trauma. Some might argue there is no problem here and that the trauma victim should take the drug. I am not so confident that there is no problem. If we accept there is no problem in the above case then perhaps we should also accept there would be no problem if we took the same drug every night when we are sleeping to erase all painful memories of the day before. Such a situation would be similar that which occurs in the film “Eternal Sunshine of the Spotless Mind”. In such a scenario some past events in a person’s life appear to have little effect on a person’s sense of self; the person loses some important connections to his personal history. I would suggest any disconnection between someone’s personal history and his sense of self is damaging for at least two reasons. Firstly anyone who has a sense of self with only a selective view of his history seems to have a diminished sense of self. I would further suggest such a diminished sense of self is damaging to the individual concerned. Secondly the idea of forgiveness can play an important part in our lives. For somebody to be forgiven he must accept responsibility for his actions. However if drugs dull or pervert his memories of his actions it is hard to see how he can genuinely accept such responsibility. The idea of forgiveness is particularly important in the context of war. After a war has ended there is often a need for a soldier to become reconciled with his former enemies. It would seem to me reconciliation is impossible without accurate recollection. For the above reasons I would suggest that the taking of beta blockers to dull a soldier’s painful memories post battle is damaging.

An objector might claim that nevertheless the damage done by PTSD to a soldier’s ability to function in society may well outweigh any damage to his sense of self or need for reconciliation. He might then use this claim to conclude that the use of beta blockers post battle is acceptable. I would reject such a claim. However even if the objectors claim is accepted I don’t think his conclusion automatically follows. It is clear that schizophrenics who take drugs to successfully control their condition can function in society. Indeed in most cases it seems probable that taking these drugs is the only way they can function in society. But the situation is different with regard to soldiers. Soldiers can be treated in different ways to relieve PTSD, cognitive therapy for instance. I would suggest, provided it is accepted that beta blockers damage the connection between a soldier’s sense of self and his history, that these drugs should not be used to treat PTSD.

1.  Elisa Hurley, 2010, Combat Trauma and the Moral Risks of Memory Manipulating Drugs, Journal of Applied Philosophy, 27(3)
2. ShaunNichols, 2004, Sentimental Rules, Oxford University Press.
3. Michael Slote, 2007, The Ethics of Care and Empathy, Routledge