Nithya Nuvvala

Mrs. Saha

Intern Mentor

20 April 2022

The Use of Propranolol for Post-traumatic Stress Disorder: Consent, Self-identity, Social
Obligation

Memory is the foundation of human experience, allowing individuals to access stored

information from past occurrences and influence behaviors of the present. Emotional memory

elicits a recurrence of the emotional response engendered by an experience, boosting retention of

both positive and negative events. For the latter, an emotional memory can translate to

Post-traumatic stress disorder (PTSD), a psychiatric problem defined by the debilitating pain,

fright or intrusive discomfort tied to experiencing trauma (Dombeck). Apart from treatments

typical to the field of psychiatry -- cognitive restructuring, therapy and medication -- a solution

to erase a bad memory is found within a drug container: propranolol. Before the

memory-dampening drug is readily used and distributed, a question remains: is propranolol a

new avenue towards emotional healing or unethical? The ethical considerations of propranolol

for an individual with PTSD involve their self-identity and legal/societal obligation.

Post-traumatic stress disorder (PTSD) is a persistent disorder of maladaptive memory. 7.7

million Americans are currently diagnosed with PTSD, and about 30 percent of people who

experience a traumatic event develop the mental illness (Milton). While PTSD was first

introduced in 1980 in the Diagnostic and Statistical Manual of Mental Disorders, the illness was

researched more heavily in the last 30 years due to societal concern for the impacts of wars,

terrorist attacks and the recent pandemic on its prevalence. Unlike other mental disorders, PTSD
involves re-experiencing symptoms of a stressful event through terrors, hyperarousal,

nightmares, and psychologically-disturbing flashbacks (U.S. Department). Whether they are a

direct victim or witness to distress from war, loss of a loved one, violence, abuse or accidents,

the symptoms of PTSD can range from constant arousal and being “on-edge” to negative

emotions towards the world and a general loss of interest in activities. According to a study

conducted by the National Institute of Health in Italy, the majority of PTSD victims during 2020

were patients with COVID-19; along with the general, negative alterations to cognition and

mood due to social distancing, confinement and sleep disturbance, COVID patients also

experienced a flight-or-fight response as if they are reliving the tragedy of COVID, and some

had both the mental and physical aspect to battle: losing job, sense of self, and social isolation

(Forte, 2020). With the prevalence of PTSD and the intense horror and helplessness a victim of

trauma faces, the value of medical treatment to dull or diminish fear memories could reinstate a

patient’s sense of belonging and self.

Emotional memories, both positive and negative, linger much longer and are more

detailed in comparison to non-emotional experiences. Current psychotherapies for PTSD focus

on the true meaning behind a patient’s fear or trauma by reframing their negative emotions

towards the experience. Among these techniques, prolonged exposure (PE) forces a patient to

directly face their fears in writing and physically revisit the trauma, while eye movement

desensitization and reprocessing (EMDR) encourages a patient to think of their trauma while a

disturbing sound or movement is nearby. In a study conducted by psychologist Alain Brunet of

McGill University in Montreal, patients that talked with a trained professional in 8-20 hour-long

sessions no longer blamed themselves for witnessing the death of their comrades; yet, they were
not desensitized by the intensity of emotion (Dombeck). The low efficacy of such treatments

increases the need for trauma medication in the psychiatric field.

Propranolol, a non-selective beta-blocker, can reduce stimulation in the amygdala (the

area in the brain that controls fear) and suspend creation of emotional memories. Heavy,

emotional memories trigger a larger emission of neurotransmitters -- epinephrine and norephrine

-- which allow for greater memory consolidation each time a traumatic event is revisited

(Phillips). When coupled with therapy, a drug like propranolol decreases production of

epinephrine and norephrine, which lowers fear association and memory reconsolidation. Chronic

propranolol is most effective when taken 6 hours following a traumatic incident. In memory

reactivation trials on both rodents and humans at the National Institute of Health, chronic

propranolol was shown to mostly block norephrine production and acute propranolol dampened

physiological fear levels. In fact, when extra stimulation was given to the amygdala after a brief

memory reactivation, propranolol reduced long-term fear (Giustino). Since reconsolidation and

fear association is hindered by beta-blockers, propranolol functions effectively to target painful

occurrences in both healthy individuals and those with post-traumatic stress disorder.

Though it is plausible to tamper with the formation of emotional memory, is it ethically

permissible? According to Art Caplan, director of Bioethics at the University of Pennsylvania,

“Removing bad memories is not like removing a wart or a mole. It will change our personal

identity since who we are is linked to our memories...we must reflect on the knock-on effects that

this will have on individuals, society and our sense of humanity”. Even if you speak, think or

hear of your trauma after taking propranolol, he argues that people who take propranolol feel as

though their trauma is external, as if it happened to a friend or movie character. Thus, Caplan

worries about the ability to form an empathetic conscience if a drug can desensitize people to
their own pain (Caplan 2011). The Brooklyn law school offers a similar psychological viewpoint:

altering memories can affect one’s moral standing or compassion. Ethically, we are required to

preserve our identities because it affects our interpersonal interactions and emotional regulation

(Kolber). Moreover, propranolol may change an individual’s recollection of what they assume to

be true from an event; for example, a war veteran may incorrectly believe that they were fighting

for a different country, creating a false understanding in a major part of their lives (Phillips).

While some argue that such a drug will change one’s moral standing and dull emotive responses

in the future, according to psychiatrist Peter Kramer, individuals with PTSD “report feeling like

themselves for the first time” after taking propranolol, , highlighting the perspective that

propranolol is not changing self-identity, but reviving it. Ultimately, An individual is faced with

a personal choice to dull emotions with propranolol or find alternative measures or medications

to cope with trauma.

In some cases, a memory might not be helpful to an individual but may be crucial for

someone else; Then, it is hard to determine whether an individual has the power of removing a

memory that is in some way affecting society. Fishes and Hui, researchers in the National Journal

of Medical Ethics argue that humanity’s values -- agency, truth and validity -- are affected by

propranolol, calling for a harness on memory-editing power. When an individual is involved in

an experience that applies to the greater good or is essential to eyewitness testimony in a

courtroom, they state that memory manipulation is not an option (Hui 2017). Physiologically,

propranolol arouses the amygdala, which is linked to emotional regulation; thus, propranolol

makes a person appear more composed and not emotionally-affected in a legal setting (Bourke

2021). Apathy in a courtroom and a low consistency of events increases the difficulty of securing

a conviction because a judge/jury relies on victims to accurately remember the course of events
and be able to account for the traumatic aftermath of their crime, especially in rape/abuse cases

(Bourke 2021). According to psychiatrist Robert Menzies who published in the Journal of

Clinical psychiatry, PTSD patients treated with propranolol “reported a marked reduction in both

the quality and quantity of the integrity of their traumatic memories… resulting in a degree of

amnesia for the traumatic event”. A successful court case depends on the accuser remembering

the course of events and being able to account for its traumatic aftermath. Administering

propranolol to rape victims could severely reduce the possibility of securing a conviction,

especially with a jury (Reyna). Following an emotional event, advocacy for society or oneself in

a courtroom may not carry equal consideration to the emotional turbulence a person wants to rid

themselves of, but it should be a factor.

Victims of trauma must fully understand the social, mental and legal implications of the

drug before its use. Yet, as science continues to inform at a rapid pace, over-regulating and

delaying the use of propranolol may act as a barrier to individuals with PTSD losing hope on

controlling their life and likewise, make researchers lose motivation or funding to better

understand pharmacological treatments for trauma. Ultimately, the doctrine of informed consent

relies on autonomy: an individual with PTSD, should they decide to take propanol, must make a

decision on their own body, bearing in mind the consequences.

 Works Cited

Bourke, J. (2021, March 17). Propranolol and the Politics of Forgetting Rape. Shame BBK.
https://shame.bbk.ac.uk/blogpropranolol-and-the-politics-of-forgetting-rape/

Caplan, A. (2011, January). Ethics of Erasing Memory. Public Broascasting Service.

https://www.pbs.org/wgbh/nova/body/caplan-memory-au.html

Dombeck, M. (n.d.). Treating PTSD with Beta-Blockers. MentalHelp.Net.

https://www.mentalhelp.net/blogs/treating-ptsd-with-beta-blockers/

Eugene, A. R., & Nicholson, W. T. (2015). The Brain and Propranolol Pharmacokinetics in the
Elderly. Brain : broad research in artificial intelligence and neuroscience, 6(1-4), 5–14.

​Forte, G., Favieri, F., Tambelli, R., & Casagrande, M. (2020). COVID-19 Pandemic in the Italian
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