Changing brain chemistry to alter soldiers’ experiences of war may avoid mental suffering, but could change the very nature of conflict.
Post-traumatic stress disorder (PTSD) is one condition that has recently generated interest in the application of pharmacological enhancement in the military. The symptoms of traumatic stress are a common reaction to the violence of war, and as a consequence combat soldiers are at greater risk of suffering PTSD than the general population. PTSD can have devastating effects on the individual, and their family, as sufferers experience sleep disturbance, anxiety, depression, hypervigilance and an inability to adjust back to civilian or non-combat military life. In extreme cases, it can result in suicide and the collateral trauma that is then induced in family members, friends and colleagues. PTSD also reduces the combat effectiveness of the armed forces by removing soldiers from the battlefield and has implications for military manning as soldiers are lost from the services, either through medical discharge or the voluntary early termination of their careers. Furthermore, PTSD places additional pressure on health services and social care services, as veterans require treatment and additional support in civilian society.
In 2018 the UK Ministry of Defence committed the sum of £220 million to funding mental health services within the armed forces. In the US in 2012, the Department of Defense spent some $294 million on PTSD care for service members, while spending by the Department of Veterans Affairs on PTSD care of veterans exceeded $3 billion. One such treatment is propranolol, a beta blocker used to treat anxiety and heart problems. (It is also used by some professional musicians seeking to manage stage fright.) When administered during or immediately after a traumatic event, propranolol has been found to block the series of biochemical processes initiated in the body by stress hormones such as adrenaline. Following a traumatic event, these hormones cause an increase in brain elasticity in which neural changes occur that lead to the consolidation of memory, and enhance our learning from the event. Propranolol does not blank out such memories; rather, it detaches them from their strong emotional connection, making them less emotionally stressful – one of the key causes of PTSD. Soldiers taking propranolol would still recall the traumatic incident, but would not associate it with any emotional memories of their experience.
The use of propranolol could reduce the ‘mental casualties’ of war, by reducing soldiers’ emotional suffering and therefore making war more humane.
The use of propranolol could reduce the ‘mental casualties’ of war, by reducing soldiers’ emotional suffering and therefore making war more humane. Technological developments in armour and battlefield medicine have long sought to protect soldiers’ bodies, so why not protect their minds as well? The prevention and treatment of physical injury is a priority in conflict, and avoiding mental injury should be equally as important. Furthermore, preventing PTSD with propranolol would be far more cost-effective for a society than treating the condition, in terms of enduring socioeconomic costs. Therefore the long-term costs of war could be reduced in terms of both lives and public money.
However, although research into the use of propranolol to forestall PTSD is still in its nascent phase, it poses a number of ethical dilemmas about the application of such neurological drugs in warfare. Changing brain chemistry to alter soldiers’ experiences of war could change the very character of conflict itself. The passion and primordial violence that characterize war could be lost where drugs deny soldiers the ability to experience the existential elements of conflict. Desensitizing soldiers through neurological interventions would risk turning conflict into a soulless endeavour, whereby soldiers would be conscious of their actions, but feel no connected emotions, and be unable to recognize the psychological consequences of their behaviour. This blunting of the senses in war could have damaging potential for the honourable conduct of soldiers.
The development of propranolol demonstrates the complex challenges affecting the human nature of soldiers in conflict, particularly in relation to brain chemistry. Emotions are an important element of war: they play a vital role in learning from experiences, and are fundamental to a soldier’s moral development. If soldiers were not to experience an emotional response to situations in warfare, then they would be deprived of the vital learning opportunities that are essential for both their own development and that of the armed forces as an institution. At an individual level, therapeutic ‘forgetting’ could affect soldiers’ primal ‘fight or flight’ mechanism, leading to greater risk-taking and to less rational behaviour. Moreover, the loss of emotional connections with the historical memories of conflict would deny the armed forces, as an institution, the social bonding and trust that their legacy fosters, as the lessons of war do not just transform tactics and technology, but also contribute to the institutional identity of militaries. This learning extends to the national level, too, where war is a ‘most violent teacher’. The horrors of war are something that nations as a whole must not be allowed to forget. Desensitizing soldiers would also desensitize the public to some of the harsh realities of conflict, as the experiences of returning soldiers would no longer communicate the emotional impact of war to wider society. And, at the very highest level, a change in societal sentiment towards conflict could even shape the way politicians approach decisions about going to war.
In researching and developing neuropharmacological agents for use by the military, the consequences of changing the psychological experience of conflict must be recognized. For all its inhumanity, war is a profoundly human phenomenon, and any drug that removes the emotions from war risks dehumanizing conflict. Soldiers are already becoming increasingly dislocated from the battlefield, through technological advancements in long-range weapon systems, unmanned drones and satellite technology, which have facilitated killing at distance. And while this may be acceptable in certain types of warfare, where soldiers are required to deploy on the ground it is imperative that they retain an empathetic understanding of the consequences of their actions. Any pharmacological performance-enhancing technology introduced to the military must be tested to ensure that it does not change the psychological experience of conflict.
