Another Look at the Legal and Ethical Consequences of Pharmacological Memory Dampening: The Case of Sexual Assault

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American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, Washington, D.C., 2004.

Id.

Id. The DSM-5 diagnostic criteria for PTSD also include this as a possible symptom, typically due to dissociative amnesia that is unrelated to head injury, alcohol or drugs. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA: 2013).

See Vermetten Lanius , supra note 1;.

Van Ameringen M. , Post-Traumatic Stress Disorder in Canada,” CNS Neuroscience & Therapeutics 14, no. 3 (2006): 171–181.

See Vermetten Lanius , supra note 1.

Fran Norris (1992) examined the frequency and effect of 10 types of traumas in a sample of Americans, finding that sexual assault posed the highest risk of PTSD, followed closely by non-sexual physical assault ( Norris F. H. , “Epidemiology of Trauma: Frequency and Impact of Different Potentially Traumatic Events on Different Demographic Groups,” Journal of Consulting and Clinical Psychology 60, no. 3 [1992]: 409–418).

Naomi Breslau et al. (1998) reported that assaultive violence posed the highest risk of PTSD, within which being held captive, tortured or kidnapped was most likely to lead to PTSD, followed by rape, and then severe beating and sexual assault other than rape (see Breslau N. , “Trauma and Posttraumatic Stress Disorder in the Community,” Archives of General Psychiatry 55, no. 7 [1998]: 626–632).

More recent studies also underscore the association between sexual assault and PTSD. Heidi Zinzow et al. (2012) found that the lifetime prevalence of PTSD among women who had suffered forcible rape was 34%, and among women who were forcibly raped while also incapacitated due to alcohol or drugs, the rate of PTSD was 52% ( Zinzow H. M. , “Prevalence and Risk of Psychiatric Disorders as a Function of Variant Rape Histories: Results from a National Survey,” Social Psychiatry and Psychiatric Epidemiology 47, no. 6 [2012]: 893–902).

Ronald Kessler et al.'s (1995) study found rape to be among the traumas most likely to generate PTSD in both men and women ( Kessler R. C. , “Posttraumatic Stress Disorder in the National Comorbidity Survey,” Archives of General Psychiatry 52, no. 12 [1995]: 1048–1060).

Risbrough V. B. Stein M. B. , “Neuropharmacology Special Issue on Posttraumatic Stress Disorder (PTSD): Current State of the Art in Clinical and Preclinical PTSD Research,” Neuropharmacology 62, no. 2 (2012): 539–541.

We use the female pronoun to describe the treatment of survivors of rape given the much higher prevalence of such attacks against women than against men (see Planty M. , “Female Victims of Sexual Violence, 1994–2010,” U.S. Department of Justice, Bureau of Justice Statistics, March 2013, available at <http://www.ncdsv.org/images/BJS_FemaleVictimsOfSexual-Violence1994–2010_3–2013.pdf (last visited October 30, 2013).

Campbell R. Dworkin E. Cabral G. , “An Ecological Model of the Impact of Sexual Assault on Women's Mental Health,” Trauma, Violence & Abuse 10, no. 3 (2009): 225–246.

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Menzies R. , “Propranolol Treatment of Traumatic Memories,” Advances in Psychiatric Treatment 15, no. 2 (2009): 159–160.

See Menzies (2009), id;

Menzies (2012), id.

There are some exceptions to this such as E. Hurley, “Pharmacotherapy to Blunt Memories of Sexual Violence: What's a Feminist to Think?” Hypatia 25, no. 3 (2010a): 527–552.

Hurley E. , “Combat Trauma and the Moral Risks of Memory Manipulating Drugs,” Journal of Applied Philosophy 27, no. 3 (2010b): 222–245 and Donovan E. , “Propranolol Use in the Prevention and Treatment of Post Traumatic Stress Disorder in Military Veterans: Forgetting Therapy Revisited,” Perspectives in Biology and Medicine 53, no. 1 (2010): 61–74.

Hall W. Carter A. , “Debunking Alarmist Objections to the Pharmacological Prevention of PTSD,” American Journal of Bioethics 7, no. 9 (2007): 23–25.

Positive traumatic growth refers to positive changes in self-perception, relationships with others and life philosophy that flow from experiencing and overcoming trauma ( Calhoun L. G. Tedeschi R. G. , eds., Handbook of Posttraumatic Growth: Research and Practice (Mahwah, NJ: Lawrence Erlbaum Associates Inc., 2006).

Frazier P. , “Correlates of Levels and Patterns of Positive Life Changes Following Sexual Assault,” Journal of Consulting and Clinical Psychology 72, no. 1 (2004): 19–30.

We assume for the purposes of this discussion that propranolol treatment for PTSD will tend to disrupt factual recall and blunt the emotional aspects of recalling traumatic memories. As noted below, these effects are not yet established although there are suggestive case reports of such effects. Further study is needed to determine the exact effects of treatment on testimonial efficacy, as well as on whether treatment may be adjusted to minimize such effects.

The Ottawa Sexual Assault Protocol (2006) specifies a 72-hour window for collection of forensic evidence in sexual assault cases. (See Ottawa Sexual Assault Protocol [2006], available at <www.ottawapolice.ca/en/serving_ottawa/support_units/pdf/english_print.pdf> [last visited October 30, 2013]).

See Vermetten Lanius , supra note 1.

Id.

Forbes D. , “A Guide to Guidelines for the Treatment of PTSD and Related Conditions,” Journal of Traumatic Stress 23, no. 5 (2010): 537–552;.

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See Risbrough Stein , supra note 8.

Id.

See Vermetten Lanius , supra note 1;.

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See Brunet (2008), supra note 11.

See Brunet (2008), supra note 11;.

Pitman R. , “Pilot Study of Secondary Prevention of Posttraumatic Stress Disorder with Propranolol,” Biological Psychiatry 51, no. 2 (2002): 189–192.

See id. (Pitman et al.); Taylor F. Cahill L. , “Propranolol for Reemergent Posttraumatic Stress Disorder Following an Event of Retraumatization: A Case Study,” Journal of Traumatic Stress 15, no. 5 (2002): 433–437.

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See Hoge (2012), supra note 27.

See Menzies (2009), supra note 11;.

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See Menzies (2012), supra note 11;.

Menzies (2009), supra note 11;.

Brunet (2011), supra note 11;.

Brunet (2008), supra note 11;.

Poundja J. , “Trauma Reactivation under the Influence of Propranolol: An Examination of Clinical Predictors,” European Journal Psychotraumatology 3, (2012): 15470.

See Brunet (2011) supra note 11.

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See Brunet (2008), supra note 11.

See Brunet (2011), supra note 11.

See Poundja (2012), supra note 31.

See Menzies (2009), supra note 11.

See Menzies (2012), supra note 11.

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Personal communication with Dr. Alain Brunet, 2013.

President's Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness, 2003, available at <http://bioethics.georgetown.edu/pcbe/reports/beyondtherapy/index.html> (last visited October 31, 2013).

Aoki C. , “Rewriting My Autobiography: The Legal and Ethical Implications of Memory Dampening Agents,” Bulletin of Science, Technology & Society 28, no. 4 (2008): 349–359;.

Kabasenche W. , “Emotions, Memory Suppression, and Identity,” American Journal of Bioethics 7, no. 9 (2007): 33–34.

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id. (President's Council on Bioethics);

Grau C. , “Eternal Sunshine of the Spotless Mind and the Morality of Memory,” in Smith M. Wartenberg T. E. , eds., Thinking through Cinema: Film as Philosophy (Malden, MA: Blackwell Publishing, 2006): At 119–133;.

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See Hall Carter , supra note 14;.

id. (Liao and Sandberg).

See Aoki , supra note 42;.

Evers K. , “Perspectives on Memory Manipulation: Using Beta-Blockers to Cure Post-Traumatic Stress Disorder,” Cambridge Quarterly of Healthcare Ethics 16, no. 2 (2007): 138–146.

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Ruiz , supra note 42;.

Donovan (2010) supra note 13.

See Kolber (2006), supra note 42;.

President's Council on Bioethics, supra note 41;.

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id. (Trachtman);

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See Warnick , supra note 46.

See Glannon , supra note 45;.

Henry (2007a), supra note 47;.

Evers , supra note 44.

See DSM, supra note 2;.

Debiec Altemus , supra note 47.

See Hurley (2010b), supra note 13;.

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Liao Wasserman , supra note 42;.

Liao Sandberg , supra note 42;.

President's Council on Bioethics, supra note 41;.

Wasserman , supra note 42.

See Evers , supra note 44;.

President's Council on Bioethics, supra note 41;.

id. (Hurley (2007);

Kolber (2006), supra note 42;.

Liao Sandberg , supra note 42.

Henry M. , “Propranolol and the Prevention of Post-Traumatic Stress Disorder: It Is Wrong to Erase the ‘Sting’ of Bad Memories?’” American Journal of Bioethics 7, no. 9 (2007b): 12–20.

See Rosenberg , supra note 47.

See Aoki; supra note 42;.

Liao Sandberg , supra note 42;.

Glannon , supra note 45.

See Henry (2007a), supra note 47.

See Kolber (2006), supra note 42;.

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See Hurley (2010a) supra note 13;.

Fletcher , supra note 57;.

Menzies R. , “Correspondence: Treating Traumatic Memories,” British Journal of Psychiatry, December 8, 2010, available at <http://bjp.rcpsych.org/content/197/5/414.3/reply> (last visited October 31, 2013).

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See Hall Carter , supra note 14.

See President's Council on Bioethics, supra note 41;.

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Kolber (2006), supra note 42;.

Wasserman , supra note 42;.

Liao Sandberg , supra note 42.

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see Donovan , supra note 13.

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Evers , supra note 44;.

Hurley (2010a), supra note 13;.

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Evers , supra note 44;.

Kolber (2011), supra note 42.

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Kolber (2006), supra note 42;.

Hurley (2010a), supra note 13;.

Tenebaum Reese , supra note 57;.

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Tenenbaum Reese , supra note 57.

See Hall Carter , supra note 14.

This context has been characterized by a group of deep-rooted “rape myths” that support views that either disbelieve, or else blame and shame the victims of sexual assault ( Campbell R. Raja S. , “Secondary Victimization of Rape Victims: Insights from Mental Health Professionals Who Treat Survivors of Violence,” Violence and Victims 14, no. 2 [1999]: 261–275).

These social responses can translate into a form of “secondary victimization” of rape survivors as they seek help within legal, medical, and mental health systems (see Campbell [2009], supra note 10).

The reporting rate for rape is low. Koss (2006) reports various studies suggesting the reporting rate is certainly less than half and in some cases as low as 5–6%, with the rate particularly low for college students or for rapes perpetrated by acquaintances or rapes that involved alcohol consumption. Survivors may also delay for years before reporting the attack (see Koss M. P. , “Restoring Rape Survivors: Justice, Advocacy, and a Call to Action,” Annals of the New York Academy of Sciences 1087 [2006]: 206–234).

Du Mont J. Miller K. L. Myhr T. L. , “The Role of ‘Real Rape’ and ‘Real Victim’ Stereotypes in the Police Reporting Practices of Sexually Assaulted Women,” Violence Against Women 9, no. 4 (2003): 466–486.

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