Mel's Madness
In the midst of all the furor about Mel Gibson and his self-admittedly foul behavior while under the influence of alcohol, an important point has been missed: when someone is drunk or brain damaged, is their behavior just disinhibition? Are they behaving this way because they’ve lost the cerebral censor that normally maintains our social demeanor? The Romans certainly thought so: in banqueting halls they would have roses carved into columns and the ceiling. The rose – the symbol of secrets – was a reminder to be discrete when alcohol might begin to lossen the tongue.
When the frontal lobes are on strike, does our “true” personality emerge? Or can alcohol, drugs and brain injury produce brand new behaviors that are not just totally out of character, but predictable by the drug or type of injury?
The answer is a mixture of the two. I know a man who is in the running for the Nobel Prize in medicine. But a couple of years ago it was all over the press when he shattered the arm of an innocent man in the middle of an alcohol-fueled frenzy. Was it the alcohol? Yes, I’m sure that it was. But the scientist has had a very long history of anger problems and of bullying younger colleagues. The alcohol was the catalyst to behavior that he normally keeps in check, but which was just waiting to come out of its cage. I’ve treated hundreds of alcohol abusing people, and the amiable ones far outnumber the violent ones. And the majority of the violent ones had also been violent when not drinking.
Some drugs and chronic alcohol abuse can produce stereotyped hallucinations and behaviors. Some alcoholic people really do see bugs and pink elephants, and there are many other examples of predictable perceptual and behavioral disturbances with drugs and with brain injuries.
Students of the healing arts learn that damage to certain regions of the brain is associated with specific behavioral and emotional consequences. This teaching goes back more than a century, and generations of students have been told that, “Damage here causes depression, and damage here causes mania, and over there a lesions will damage one type of language.” Yet for three decades we have known that much of this teaching is fictitious. I was taught brain localization by some of the finest neurologists in the world, and yet each would admit the inaccuracy of their methods. A new study from Brisbane, Australia supports that nihilism. The investigators examined 61 consecutive people admitted to a stroke unit. “Strokes” are either vascular blockage or bleeds affecting the brain.
They could find no significant relationship between the side or location of a lesion and the development of post-stroke depression. But the kinds of people that they were before the stroke had a big impact: pre-morbid neuroticism and a past history of mental disorder were important predictors of depression following stroke.
So why all the fuss about Mel? Because people are asking if deep down inside he really has been harboring some of the dark, mean spirited thoughts that he expressed to the police, and that the alcohol was the catalyst and not the creator of his diatribe.
“The intoxication of anger, like that of the grape, shows us to others, but hides us from ourselves. We injure our own cause in the opinion of the world when we too passionately defend it.”
— Charles Caleb Colton (English Clergyman and Author, c.1780-1832)
Technorati tags: Mel Gibson Alcohol abuse Pre-morbid personality Brain
Posttraumatic Stress Disorder, Resilience and the Brain
There has always been a puzzle about posttraumatic stress disorder (PTSD): why do some people get it and others don’t? It has always seemed that if the stress was bad enough, and particularly if it was unexpected, then pretty much anyone could get PTSD. But in between the mild stressor that makes one person fall apart and suffer terribly, while others scarcely notice, and the severe trauma that catches almost everyone, is a great unexplained mass of suffering people.
Six years ago research by Tamara Gurvits and her colleagues from the VA in Manchester, New Hampshire first suggested that people with PTSD may have some subtle neurological problems that couldn’t be explained away by alcohol abuse or injury. Now the same group has published a new study that adds significantly to our knowledge about this issue. A study of twins lead the investigators to conclude that the neurological abnormalities predated the PTSD and most likely predisposes patients to it.
The researchers studied 49 pairs of identical male twins in whom one twin had been exposed to combat during the Vietnam War and the other had not.
In 25 pairs the combat-exposed twin had a current diagnosis of PTSD, while the remaining 24 twins did not have the problem.
All the subjects were tested for what we call neurological “soft signs.” This is not a good term, and refers to subtle neurological disturbances, usually involving some complex systems of the brain. They include things like an impaired sense of direction, being able to do rapid, complex motor actions, copying pictures and movements. The combat veterans with PTSD scored higher on the soft signs tests than did the veterans without PTSD. But now it gets interesting: the identical twins of people with PTSD also had high soft sign scores. In other words there appears to a familial vulnerability to developing PTSD. This is consistent with a fascinating new paper on the neurological circuitry involved in fear. We can now map out some of the neurological vulnerabilities involved in PTSD as well as some of the neurological consequences of severe PTSD. Nobody knows if we can reverse them with psychological or other approaches, but we now think it is very possible.
There is a lot more work to be done. But as a first suggestion: someone who has this kind of evidence of vulnerability to PTSD should be the first to get advanced training in developing resilience. We already know that even the most limited efforts to bolster and develop resilience can have marked effects.
The key is to start building your resilience starting today.
“Always plan. It wasn’t raining when Noah built the ark.”
–Richard C. Cushing (American Roman Catholic Cardinal, 1895-1970)
Technorati tags: Posttraumatic stress disorders Brain Vietnam veterans Resilience
Neural Stem Cells
Stem cell research presents us with one of the most difficult moral and ethical dilemmas. Most of us have our opinions about the whole matter. But there is now a very real possibility that the scientific piece may be resolved in a different way altogether.
A recent study in the Proceedings of the National Academy of Sciences has confirmed that in adult mammals, the regions of the brain below the ventricles – the fluid-filled spaces – of the brain, harbor neural stem cells. The evidence for their existence has been building over the last five years. But this latest report is of great interest. The scientists were able to show that a soluble carbohydrate-binding protein named galectin-1 promotes the proliferation of these neural stem cells in the adult brain. These neural stem cells are highly active in the forebrains of mice.
We have yet to discover their role in adult human brains. But it would seem a safe bet that they will if anything be more active in humans, since we are endowed with incredible neural plasticity that is way beyond anything seen in most other species. And we would therefore expect to see more potential for neurogenesis in the human brain. It is valuable to place this new finding in the context of experimental work indicating that some medicines may stimulate adult neurogenesis.
“I’ve found that the chief difficulty for most people was to realize that they had really heard new things: that is things that they had never heard before. They kept translating what they heard into their habitual language. They had ceased to hope and believe there might be anything new.”
–Peter Demianovich Ouspensky (Russian Philosopher, 1878-1947)
Technorati tags: Stem cells Neurogenesis Adult brain
Growing Your Brain
Several years ago we learned that London taxi drivers grew a small part of their hippocampus while learning “The Knowledge,” a detailed map of the streets of the city. Unlike most American cities, London is like a rabbit warren that has been growing organically for two thousand years. Despite the Great Fire of 1666, and the best efforts of Hitler’s Luftwaffe, the basic illogical structure has just become more complex over the centuries. The hippocampus is intimately involved in memory, navigation and in constructing a map of your surroundings. It has also been established that professional musicians and people who use Braille, all have increases in the size and complexity of a specific region of the brain.
We now learn from researchers in Germany that medical students show an increase in the amount of grey matter in the posterior part of the hippocampus and also in regions of the parietal lobes while studying for their exams. It is calculated that a medical student learns around 6,000 new words during his or her training, so it is no surprise that the brain changes to accommodate all this new information.
This new finding just adds to our knowledge about the plasticity of the brain. Even if you do not have to learn 6,000 new words and innumerable new concepts and practical techniques, it is worth knowing that learning any new knowledge or skills will likely grow specific regions of your brain.
So make a resolution to learn at least one new thing each day, and to work on developing a new skill. It doesn’t matter whether it is learning to knit or how to play chess. Each will likely help you.
Later this year we will be bringing out a book that teaches brain stretching skills based on the latest advances in brain science.
Watch this space!
Technorati tags: Hippocampus Parietal lobe Learning Medical students Neurogenesis
Psychotropic Medicines and Neurogenesis
One of the genuine breakthroughs of the last few years has been the understanding that the brain is not a static structure, but is instead an organ that grows, refashions and repairs itself to a remarkable degree.
You may be interested in a brief review article looking at the effects of some of the medicines that appear able to stimulate neurogenesis in the adult brain.
It is no longer far-fetched science fiction to say that we are likely soon to be able to regenerate parts of the brain and spinal cord that have been damaged by disease or trauma. And in the meantime, we have an array of stratgeies that you can adopt to keep your brain active throughout life, while dramatically reducing your risk of developing dementia.
Technorati tags: Neurogenesis Antipsychotics Antidepressants Brain repair
Dissing Descartes
Every clinician has been asked the question, “Is the pain in my body, or is it all in my mind. Am I imagining it?” I have seen countless students and young doctors get themselves into a hopeless tangle over that question. And the answer to “is it the body or the mind?” should be “Yes.” If a person is suffering, they are suffering, and pain coming form the mind is every bit as real to them as pain coming from any other part of their anatomy.
But hidden within this question is a mistake that can be traced back to the French philosopher and mathematician Rene Descartes who, in 1641, proposed that there was a neat split between the soul and the body. He actually envisioned an independent soul that inhabited and interacted with the body by opening little trap doors in the brain. This later became interpreted as a neat split between the mind and the body. He was by no means the first person to propose this. Twelve hundred years earlier Numidian-born Theologian, Saint Augustine of Hippo proposed something very similar. This idea of a clear split has informed our thinking for over three hundred years, yet it is probably wrong. And as with the opening question about “is my problem in my body or in my mind,” it has great practical implications: falsely locating the nature, origin and priority of symptoms.
Another practical implication of this artificial split is that by imagining a mechanical clockwork universe divorced from mind or spirit, we have removed value and meaning from the world. Indeed, some scientists take an extreme view, and say that there is no place for value, purpose or meaning in the universe, and that they are simply artificial creations of the mind. I have had some interesting discussion with people who have gone to far as to say that consciousness itself is no more than a set of reflexes in the brain. It will not surprise you to hear that I believe that they are wrong. when scientists say that they have found that the temporal cortex of the brain lights up when someone is having a religious experience, that does not mean that you can reduce a person’s faith and belief to a lit-up piece of brain. It is merely that the area of the brain corresponds to the experience.
I am a firm believer in the notion of nonduality, that essentially there is no fundamental distinction between mind and matter. Consciousness is the primary underlying force in the Universe. There is a very good resource here. So why do I take this position?
1. Personal experience of nonduality
2. The insights of modern theoretical physics
3. Independent, empirical research from a number of reputable scientists around the world. I have just constructed a list of recommended books at Amazon.com. You can access it here. If you take just a little time to examine the research reported in these books, I think that you will begin to be convinced as well.
“The energy of the mind is the essence of life.”
–Aristotle (Greek Scientist and Philosopher, 384-322 B.C.E.)
Technorati tags: Descartes Mind and Brain Duality Nonduality
A New Atlas Promises a Breakthrough in some Brain Disorders
The very first attempts to take pictures of the living brain go back to the 1930s, but it is only in the last 20 years that MRI, SPECT and PET studies of the brain have really moved the field forward. After thousands upon thousands of imaging studies, we are beginning to approach the time when we can start harvesting the data collected over these years.
We are on the cusp of an extraordinary advance in our understanding of the brain and how it can go wrong in a large number of neurological and psychiatric illnesses. But that is only a side show: being able to identify the neurological correspondences of, say a psychiatric illness, does not mean that we reduce the illness to the firing of a group of neurons. But it does mean that we are gong to be much closer to providing suitable treatment for the neurological component aspect of the illness.
There has been a dramatic demonstration of this with the publication of a new brain map of people living with a rare but important illness called William’s syndrome.
One of the biggest puzzles for those of us who look at brain scans, is why there is so much variability in the structure of the brain. In the rest of the body, veins and arteries can turn up all over the place, but nerves tend to be in pretty much the same position in everybody. This is not the case in the brain. I’ve looked at many thousands of MRI scans of the brain, and I’ve never found any two alike. It’s one of the reasons that I’m a little doubtful about some of the claims of imagers who say that they can diagnose someone by looking at a brain scan. Most of the time there’s just too much normal variation.
All over the world, there have practitioners who have claimed to derive all sorts of information from brain images. Most experts remain a bit skeptical: hundreds of experts and hundreds of millions of dollars have only enabled us to speak in generalities. Some private practitioners even perform scans for diagnosis.
Some time ago I met a psychiatrist who had an unusual theory about the causes of mental illness. He wanted us to do two MRI scans on a patient to prove his theory. When I told him that we were not yet able to do that in individuals, he was indignant, “But you’ve published all those studies showing abnormal brain structure in schizophrenia.” I explained that all the brain imaging studies have told us quite a lot about groups of people with mental illness, but little about individuals. I do not know of any academic psychiatrists anywhere in the world who think that we can yet use PET, SPECT, fMRI or MRI scans for diagnosis of mental illness. Maybe we’re just being a bit slow. Or perhaps the brain scan diagnosers haven’t got all the pieces of the puzzle just yet. Research is expensive and takes a great deal of time. Busy clinicians are eager to exploit new investigative tools for the benefit of their patients, and usually do not publish their results in peer reviewed journals. With this new research we are going to be able to see if these individual practitioners are correct.
Not only are there many inter-individual differences, but also the current state of the person can have a big impact on some types of imaging. I was recently asked to review a paper for a scientific journal in which the authors had enthusiastically explained the way in which they could now diagnose a certain illness by doing a brain scan. Sad to say, they had not asked a couple of basic questions, like the person’s mood when they were scanned. Depression reduces the flow of blood in regions of the brain, the patients turned out to be depressed, and the results were invalidated. It was a real shame, but it is so important that patients don’t get misled by investigations that cannot help them.
So the moral of the story is this. If someone wants to do any kind of investigation for diagnostic purposes, ask them first whether there is any published evidence that the test actually works: what are the sensitivity and specificity of the findings generated by the test? And who else is doing it?
“If the brain were so simple we could understand it, we would be so simple we couldn’t.”
–Lyall Watson (South African Biologist and Writer, 1939-)
Technorati tags: brain structure williams syndrome bipolar disorder PET scan
Autistic Spectrum Disorders
Over the last few months I have reported on a number of advances in our understanding of autism, and I was pleased to see that Time magazine has autism as this week’s cover story.The writers at Time are really to be congratulated on having put together a first rate set of articles.
Although we often use the term autism as shorthand, we prefer to use the term Autistic Spectrum Disorders (ASD), as autism is not one illness, but rather represents many illnesses with many distinct causes. The illness can range from profound disability to mild forms that may even be advantageous. One of the mild forms that has attracted a great deal of interest on recent years is Asperger’s syndrome, in which people may be highly intelligent, but are typically clumsy and have poor social awareness. There has been speculation that a number of highly successful scientists, writers and innovators may have the disorder.
One of the great puzzles of these illnesses is that they appear to be becoming more common. Even when you take into account changing diagnostic criteria and a greater awareness of the illnesses, they genuinely seem to be becoming more common. It is not surprising that a whole long list of culprits has been examined, from vaccinations to radiation and food additives. But so far no credible cause for the increase has been identified.
Last December I wrote an item about mirror neurons in the prefrontal cortex and their relevance to ASD. This research was part of a large series of brain studies being conducted around the world. For many years we thought that the key regions of the brain involved in autism were in the cerebellum, a “second brain,” that lies at the back and underneath the cerebral hemispheres. This structure is involved in coordinating movement, in language, emotional processing and some social functions. But now it is becoming clear that many regions of the brain are affected. Investigators from London have just published a study indicating that some of the difficulties in relating to others that are experienced by people with ASD may be due to poor communication between brain regions. People were asked to look at pictures of faces or houses, while their brains were scanned. In healthy volunteers, paying attention to pictures of faces caused a significant increase in brain activity. However, in the people with ASD, paying attention to faces made no impact at all on the brain, explaining their lack of interest in faces. It seems that the areas of the brain concerned with decoding faces are not well connected to those parts of the brain that control attention.
Just last week, investigators from University of Texas Southwestern Medical Center in Dallas, and St. Jude Children’s Research Hospital in Memphis, published a study concerning a gene named Pten. This gene has already been linked to some rare gene disorders, and is involved in controlling the numbers and size of neurons. In mice that did not have a normally functioning gene, parts of the cerebral cortex and hippocampus did not develop normally, and the mice showed some odd deficits in their social functioning: The genetically altered mice were socially less skilled, being rather incurious about new animals coming into the cage. They also showed the same level of interest in an empty cage and in one containing another mouse, something very similar to the behavior of some children with ASD. The genetically altered mice were also less likely to build nests or look after their young. But they were more sensitive to stressful stimuli, such as loud noises or being picked up. Again, these are common features in children with ASD. The brains of the mice were also larger than those of their littermates, which is again something that has been picked up in many brain imaging studies in children with ASD. I have warned many times about trying to extrapolate from animal studies to human: Social abnormalities in a mouse may be caused by entirely different factors from human social abnormalities. But this new finding is another brick in the wall.
Professor Simon Baron-Cohen from the University of Cambridge has proposed that a central cognitive problem is ASD a result of developing extreme male tendencies to analyze and systematize rather than to empathize. His group has also just published data in the Archives of Disease of Childhood, indicating that highly analytical couples, may be more likely to produce children with ASD.
One of the things that often worries me is that desperate parents have sometimes been persuaded to try treatments that may actually do harm. Not so much from the therapy being toxic, but rather because the child may then not get the treatment that he or she needs. ASD is a prime example of a group of conditions that do best with an integrated approach: physical care, nutrition, cognitive, psychological and social skills work. And it is essential to ensure that other family members also receive help and support.
Technorati tags: autism, mirror neurons, autism spectrum disorder
New Clues to Obsessive Compulsive Disorder
In this month’s edition of the Journal of Neuroscience, a team from the University of Michigan has published a very interesting report. Every one of us has made a mistake at some stage in our lives, whether it is something trivial like dropping the groceries, or something more serious, like deleting a crucial computer file. What the researchers did was use functional MRI (fMRI) to peer inside the brain at the instant of making a mistake. While in the scanner, people were forced into making an error that carries consequences – for instance, losing money. When that happened, a particular part of the brain called the rostral anterior cingulate cortex, or rACC, became much more active when the person realized that he or she had erred and there was a penalty attached to the mistake. This part of the brain is involved in deciding what kinds of emotional responses are appropriate.
What is so interesting about this work is that in a previous study on a small group of people with obsessive compulsive disorder (OCD), the same team has shown that the rACC region of the brain became much more active in response to a no-penalty error in the brains of OCD patients, compared to people without the condition. One of the characteristics of OCD is fear and anxiety about errors or failures in certain aspects of everyday life. As a result, many begin repetitive patterns of behavior to ward off or to prevent such events.
So it looks as if people struggling with OCD have a hyperactive response to making errors, after which they begin to get more and more worried that they may have made a mistake. OCD can be a terribly incapacitating condition. We think of mild cases like Melvin Udall in As Good as it Gets, or Adrian Monk, but in reality it can cause much suffering.
I was once asked to see a seventy five year old man who had suffered from a bizarre case of OCD since the age of fourteen. He had traveled the country trying to get help, and it was an extraordinary tribute to him that despite his problem he had built a successful business and family life. He came to see me for acupuncture, but left with a prescription for a medicine that was at the time relatively new. His improvement over the next few months, as we used medication, psychological and social work and then some energetic techniques was just extraordinary.
Research like that from the University of Michigan may well bear important fruit in the future.
Technorati tags: OCD, neurobiology, anxiety, psychiatry
