by Mary Neal Vieten, Ph.D., ABPP
A February 8, 2017 article in Science Daily reports the results of mice research that suggests the chemical ketamine could make soldiers less reactive to the horrors of war. Besides the typical problems associated with translating animal research into human applications, any response to this line of inquiry must include a comment on SCIENCE as well as ETHICS.
In medical research scientific inquiry assumes that the ailment being cured as well as the treatment being offered, are tangible, identifiable things that can be scientifically distinguished from other things. Ketamine is a pharmaceutical, a thing, and distinguishable from other pharmaceuticals. Its powerful anesthetic effects also make it a popularly used recreational drug, under the names Special K, Cat Valium, and Vitamin K.
PTSD on the other hand, is a construct, not a thing, it is loosely defined, and it is the sum of its definition, a definition that is not isolated by science, but rather negotiated and voted into the DSM-5. No one will argue that there is no problematic response in people who are exposed to psychologically traumatic stimuli, however no one can argue that this is a distinguishable medical thing, separated from other things by objective medical/laboratory tests.
PTSD only requires that a sufferer complains of a specific set of predictable emotional responses, after being traumatized to a licensed listener, who agrees (diagnosis/label given) or disagrees (no diagnosis or another label given). Another listener may interpret the suffering differently, and apply no label or another label. Interpretation is subject to culture, religiion, values, the experiences of the listener - the list goes on. Scientifically determined categories of illness are not subject to this latitude: you either have a bacteria, virus, cancer, macular degeneration, fracture, or you don’t. All of this is to say, that PTSD is a construct, not an illness. Think of it like “peace” or “justice.” Everyone knows when they are there, and when they are absent, but they are still the sum of their definition, not objective things.
Using a potentially harmful pharmaceutical like ketamine that is known to be addictive, cause flashbacks, and a host of other undesirable effects to treat a loosely defined construct is not only unworthy of scientific inquiry, it is also unethical. Giving it to our military members for this purpose is unconscionable. Furthermore, even in the case that PTSD was an identifiable discrete illness, discrete from other illnesses, which it is not, the hallmark of PTSD is a person who is suffering because of something horrific that occurred.
We need to consider the ETHICS of injecting humans with a substance with the goal of preventing normal human suffering in the face of horror. If we succeed, what kind of human have we created? Ask yourself if you want to be or live next door to that creation.