Showing posts with label frontal cortex. Show all posts
Showing posts with label frontal cortex. Show all posts

Anxiety My Old Friend - Will I Let It Kill Me?

Anxiety and stress are not the same thing.

Stress is a physiological experience in the face of a change in the internal or external system. It has its plusses and minuses. A little bit of stress over something you can do something about [I need to make that doctor's appointment] provides motivation to get it done and satisfaction (a nice hit of dopamine) once you do it.


On the other hand, chronic stress that cannot be resolved [I never knew when he would explode] exhausts every resource the body has to maintain homeostasis/balance. And that's not good.

Anxiety describes the negative thoughts and feelings that accompany stress.


It's not the only feeling that could accompany stress. When faced with changes like a new job, a challenging ski slope, or a date with the person of your dreams, you might also feel excitement.


Or maybe not. "Good" change and "bad" change are labels we apply from our own perspective. As far as the body goes, they don't really figure in. The physiological response is the same.

Consider a winding mountain road in a snowstorm. Some people default to excitement. [That would be Colorado-raised me.] Some people default to anxiety. [That would be my California-born wife.] The people who can't help but default to it have an anxiety disorder. These are my people.

Anxiety Defined

Anxiety is the intense, excessive, persistent worry, fear, or dread about everyday situations, present, future, and imagined future. It's a normal enough experience. It becomes a disorder when "intense" tilts over into "excessive" to the point of interfering with daily activities.

Insert side comment here: People who have a mental illness, whether social anxiety disorder, depression, or schizophrenia, are not a different kind of people. Almost every symptom of a mental illness is a "normal" experience - shared by people who do not have a mental illness. These experiences do not need to be diagnosed or treated, until they pile up and become so intrusive that they become unmanageable, until they interfere with daily activities.

The physical manifestations of anxiety include fast heart rate, heavy breathing, sweating, and fatigue. How do we get from a thought to a heart rate? The brain - that's how.

Anxiety in the brain

Anxiety involves an interaction of three different parts of the brain in particular.

It begins when the amygdala senses a threat. The job of the amygdala is to leap into action at the sign of a threat. The amygdala initiates a sequence that releases adrenaline and cortisol to gear the body up to address the threat. As with the body's response to other stress, these hormones cause the faster heart rate and heavy breathing. Blood flow increases to the limbs to prepare it for action, and away from the digestive system - when your life is in danger, lunch can wait.

The prefrontal cortex, the "thinking" part of the brain, provides information and interpretation that mitigate or support the threat. [That's a garter snake, not a rattler. It's harmless.]

The anterior cingulate cortex sorts through the sense of threat and the additional information to find patterns and determine whether the current situation is a big deal or not. It tells the amygdala whether to calm down or GET MORE EXCITED!

The difference between anxiety and anxiety disorder

When there is a threat, the amygdala goes into action. When the threat goes away, what is supposed to happen is that the amygdala and all its downstream partners stand down. The body returns to its pre-threat state.

When the threat is chronic or, even worse, unpredictable, then these systems do not stand down. They just keep pumping out that cortisol.

In the brain, the amygdala increases in size.

Under constant assault from cortisol, the hippocampus (memory and emotion) and prefrontal cortex shrink. The hippocampus gets stuck on negative memories and emotions. [I call this the little time machine inside my brain. It plays the worst of my past on an unending loop.]

The connection between the amygdala and the prefrontal cortex that could moderate the fear goes down.

In other words, the brain changes. It changes in a way that reinforces the the problematic pattern, raising the risk for depression and dementia. Yuk!

Everybody gets anxious is not a helpful thing to say to a person with Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Post-Traumatic Stress Disorder, or Social Anxiety Disorder. These are real things. They have tipped past the experiences of everybody. And a warm bath or deep breathing do not fix them.

Healing the problematic pattern may take many forms: distancing from the chronic stressors, medication, a variety of modalities in psychotherapy, even therapy dogs.

At I like to focus on what is happening inside the brain, to help me remember that my issues are not mere thoughts. They are experienced in my body. Here's an article with much more detail about the sympathetic and parasympathetic nerve systems and how they function.

A physical therapist friend, encouraging me to take a leave of absence to deal with my tattered brain, once told me, It's just like a broken bone. It takes time to heal.

I do wish it healed as easily as that broken foot is healing. But these issues do respond to treatment. If your anxiety interferes with your life, you don't have to suffer alone!

photo by author
Red Green Show meme from imgur on Pinterest

Antipsychotics and Loss of Brain Matter

What are antipsychotics doing in your brain besides preventing psychosis? This is a report on a study conducted from 1991 to 2009 that looked at that question.

Here is the context:

Progressive brain volume changes in schizophrenia are thought to be due principally to the disease. However, recent animal studies indicate that antipsychotics... may also contribute to brain tissue volume decrement. Because antipsychotics are prescribed for long periods for schizophrenia patients and have increasingly widespread use in other psychiatric disorders, it is imperative to determine their long-term effects on the human brain.

Before I get to what the study revealed, here is the investigator, National Medalist of Science winner, Nancy Andreasen.

Why the Poor Give More

The article that inspired this post is titled Why the Rich Don't Give to Charity.  But I figure, language has power, and why reinforce behavior that I would rather see changed?

Before you go off in a huff, let me tip my hand -- I acknowledge and will discuss both the exceptions and free will.

The short answer to any of these questions, why the poor give more, why the rich don't give, and why some rich do is -- mirror neurons.  Three weeks ago I reported on these in Mirror Neurons - They Change Everything, along with a youtube featuring V.S. Ramachandran.  Here is the promised expansion on the theme.

Statistics on Giving

Ken Stern reports in The Atlantic Magazine that the top 20% of Americans donate 1.3% of their income.  The bottom 20% donate 3.2%.  He asks, What's up with that?

Paul Piff - Higher Social Class Predicts Increased Unethical Behavior

Mirror Neurons - They Change Everything

Blow your mind in the seven minutes and forty-four seconds:

You just watched V.S. Ramachandran, Director for the Center of Brain and Cognition at the University of California Sand Diego, cross the mind/brain barrier in his description of mirror neurons.  These neurons, a subset of the command neurons in the frontal cortex, are the neurobiological basis for imitation, culture and empathy.  What we see another do or feel causes mirror neurons in our own brains to fire, so that we understand or feel the same.

This week's blogpost is published late because I kept trying to explain what mirror neurons explain.  They explain everything.

They explain why rich people are not as generous as poor people.  (That may get its own post soon.)  They explain why religious people give more than nonreligious people, more time, more money, more blood.  (My source for that one is sociological, not neurobiological.  So I may not blog it, though mirror neurons would explain it.)  They explain why people who own guns are more afraid than people who do not, and why people who watch tv overestimate the crime rate.  They explain pornography.  They explain Congress.

Schizophrenia -- Taming the Dragon

Imagine you have a dragon in the house.

It has been there a long time.  When it was little, you could hide it.  You knew your parents didn't like it when you talked about it.  So you guarded it as a secret for the longest time, even with its nasty habit of singeing your fingers.  But when the couch caught fire, they knew, and insisted you get help.

They want you to get rid of the dragon.  Some of them think you can.  Others think you can tranquilize it, and the couch will never catch fire again, and nobody need ever know you have a dragon in the house.

Iron Rule #1:  You cannot get rid of the dragon.  It is here to stay.

Project Implicit and the State of One's Soul

Remember, Dumbledore said to Harry, It is our choices that show what we truly are.

Project Implicit

So did you do the homework?  Did you try any of the Implicit Association Tests?  Do you still want to read my blog?

This is how they describe what they are doing:

Project Implicit represents a collaborative research effort between researchers at Harvard University, the University of Virginia, and University of Washington. While the particular purposes of each study vary considerably, most studies available at Project Implicit examine thoughts and feelings that exist either outside of conscious awareness or outside of conscious control. The primary goals of Project Implicit are to provide a safe, secure, and well-designed virtual environment to investigate psychological issues and, at the same time, provide visitors and participants with an experience that is both educational and engaging.

The variety of topics include attitudes toward age, race, disability, ethnicity, mental illness and others.  The tests are constructed to bypass thought, commitment, decision.  They dive deeper into what is known as the lizard brain, the part that evolved before reason, and that simply reacts, by setting one to tasks that have to be accomplished faster than the thinking part of the brain thinks.

Project Implicit is well aware that we may not like what we find in the lizard brain. I don't care for what I find in mine.  But it is important information, for two reasons.

God, Tebow and the Problem of Suffering

You know, they could be right.  Maybe God is responsible for Tim Tebow's astounding success.

First, the one take away from this article:  It's not magic-thinking.  It is pattern-seeking, hard-wired into our brains, one of the things our brains are built to do.

I Am A Professional -- Do Not Try This At Home

A whole world of football fans are suddenly theologians, explaining the ways of God.  And how silly for me to caution non-professionals from this endeavor.  Everybody with a frontal cortex is a theologian.  Our brains are built to ask Why?  Everybody with an anterior cingulate cortex looks for patterns that make sense of the events of the world.  That is what the anterior cingulate cortex does.

How is this for a pattern -- A new quarterback about whose talents many have doubts delivers a win.  Somebody sticks a microphone in his face.  He gives glory to God.  Next week, he wins again.  Again he gives glory to God.  Again he wins.  Again he gives glory to God...

And what is with that 316 yards thing?

If this were a baseball player on a streak, it would be the same socks he wears each game.  It's the God-thing that makes people twitchy.  More than that.  If it were basketball, he'd be crossing himself at the free-throw line, and nobody would miss a beat.  But it's the politics of the God-thing that have raised the stakes.

Suddenly people who should know better are doing bad theology.  And people who do know better let their chains get jerked.  I don't except myself here.  Twice a day I write something snarky on Facebook, and have to delete before I post.  (It's a thing I have about public discourse on Facebook.  I try to save my snarkiness for my blog.)

At Prozac Monologues my readers can expect more than snarkiness.  I have to bend the topic a bit.  So here we go.

God Improves Athletic Performance

Really, I'm serious.

Well, in a particular way.  Anybody else have a hometown team whose weekly police report is longer than its injury report?  And the results -- Hawkeyes went where this year?  The Earwax Bowl?

These days a little clean living gives an incredible advantage in the world of collegiate and professional sports.

Now this is not about Tim Tebow.  I don't know anything about his private life.  I do know a lot of athletes flame out on dissolute living, leaving behind only fumes of what had been promising careers.

I also know that some people find their way back.

The Twelve Steps

  • We admitted we were powerless over [our addiction] - that our lives had become unmanageable.
  • We came to believe that a Power greater than ourselves could restore us to sanity.
  • We made a decision to turn our will and our lives over to the care of God as we understood God.

There are more steps.  These are a start, the part that matters to a mental health blog.

However and why ever they do it, and how seriously they need to work on it, a lot of athletes and a lot of the rest of us could improve our lives by acknowledging a Higher Power.  It's a bottom line sanity issue.  People who think they are the center of the universe have their own DSM code.  It's 301.81.  But they aren't in therapy.  Those closest to them are.

No, you don't have to be a Christian, religious, not even spiritual but not religious to work the Steps.  I heard somebody used gravity for his Higher Power.  Like I said -- I am not the center of the universe is a bottom line sanity issue.

Tim Tebow's Higher Power

Again, I know nothing about the man's private life, and less than nothing about his heart.  But to the extent that his publicly professed Christianity conforms to orthodox Christianity, and by that I mean not making it up as we go along, I do believe the claim that his athletic prowess comes from God, the Creator of Heaven and Earth who delights in creation and said of it, It is good.  We have something in common here, Tim Tebow and me.  We each believe that God delights in us.  Well, I am willing to be a little less specific about the details.

If nothing else, think of this also as a comparative claim.  If he thought it was all about him, he would be at greater risk to flame out, and thereby not be able to complete as many passes as he does manage to complete.

Of course, there has to be somebody to catch those passes.  Writing now as a one-time Bronco fan, I wish I heard him say more about his receivers and his left guard.  He might make a better spokesperson for the Lord if it didn't seem like his personal miracle.

Alert: Rocky Shoals Of God-Talk Ahead

So far, I have been in the realm of orthodox theology, not making it up as I go along.

Everybody is a theologian.  The advantage of professional status is that you recognize the potential shipwreck before you get there.

Oops.  Too late.

A status update from a Facebook friend Sunday night: This is what happens when God is in charge!

Pastor Wayne Hanson, Summit Church, Castle Rock Colorado said, It's not luck.  Luck isn't winning 6 games in a row.  It's favor, God's favor... God has blessed his hard work.

So... how about 19 games in a row?  Was that luck?  What happens if the Broncos make it through this weekend and next, and Tim Tebow comes up against Aaron Rodgers, who also happens to be a stand-up kinda guy?  Not to mention one hell of a quarterback.  Will that be about God's favor?

The Problem of Suffering

I think what really drives people nuts, including a lot of Christians of the orthodox/not making it up as we go along variety, is this:

While God was blessing Tim Tebow's hard work on Sunday afternoon, 720 children around the world died of hunger.  270 people committed suicide.  Two of them, by the way, were veterans of the United States Armed Forces.

That was before overtime.  Good thing overtime was short, huh?

So on Monday morning, nearly 1000 mothers were asking, If God could help Tim complete that pass, couldn't he have paid some attention to my child?  Billions still listen for their answer.

This is not a question to be answered blithely.  We have to put football, even America to the side.

See, we have been here before, trying to find the pattern.  That is what our brains do, search for patterns, notice anomalies, then respond to new information.

There is one pattern we really, really want to find, that good is rewarded and evil is punished.  For the LORD knows the way of the righteous, but the way of the wicked is doomed.

That's from Psalms.  And to some extent, we do find evidence to confirm the claim.  Usually people who treat their spouses right have happy marriages.  Or at least happier than their marriages would be if they were out running around at night, coming home drunk and violent.

This pattern gives us a way to arrange our own behavior to get outcomes we desire, which is a good thing, and the evolutionary purpose of the development of this capacity.

This is from Psalms, too: I have been young and now I am old, but never have I seen the righteous forsaken, or their children begging for bread.

720 mothers whose children died of hunger while the Broncos pulled out that squeaker against the Steelers would beg to differ.  All you have to do is turn the channel to CNN to find that pattern disrupted.

The Bible Knows Better

Well, if you actually read the whole Book, and read it several times, over different times in your life, so you have a wider experience that helps you catch things you missed the first time round, you discover that the Bible says some other things about the ways of the righteous and the ways of the wicked.  Read Jeremiah.  Read Job.  Read the rest of the Book of Psalms.  Go do relief work in Haiti or Sudan and read them again.

The Bible records how a whole community of faith over centuries has struggled with this issue.  Sometimes the Psalm begins, O LORD, my God, my Savior, by day and night I cry to you.  And at the end, it still says, Darkness is my only companion.

The Psalms of Lament speak the truth of people who do love the LORD, who are faithful.  From Jeremiah thrown down a well to Paul shipwrecked on Malta to Mother Teresa struggling her whole life with severe depression a couple millennia later, faith does not turn out to be bankable.  My God, my God, why have you forsaken me?  Maybe the Psalms can give voice to your own experience.

Creativity and the Absurd

The ancient Israelites were sure of the pattern, that they held God's favor.  They lived in the Promised Land, after all.  Then something else happened, off pattern.  A new super power came on the scene, destroyed their temple and threw them into exile.  By the waters of Babylon we sat down and wept, when we remembered you, O Zion... How can we sing the Lord's song upon an alien soil?

When faced with the unpredicted, the absurd, the anterior cingulate cortex shifts into high gear.  Its job is to modulate emotional response, to manage the panic.  It does so by reasserting sense.

Sense can be found in two ways.

The first is to revert to the familiar.  When the brain is overwhelmed by stress, it becomes more efficient.  It shuts down brain-derived neurotrophic factor, stops learning and concentrates on what it already knows, or what it is habituated to trust.  It was the forces of evil (gays, the First Amendment...)  We are being tested, we have to believe harder...  People confronted by the absurd sometimes cling to habit, reject the unfamiliar (immigrants, head scarves).  After 9/11 there was a spike in sales of mashed potatoes and mac and cheese.  That is the anterior cingulate cortex at work, modulating emotional response.

The second way is to ramp up the pattern seeking by noticing connections that had been overlooked.

The second way is the way of creativity.  For the Israelites, the Babylonian Exile resulted in an explosion of creativity, poetry, philosophy, history, new forms of worship, the legal code, and the development of a religion that was larger than their prior notions of land=success=God's favor.  They came up with a religion that could handle exile, handle loss.  It could travel and face the future.

Their brains found new patterns.  They recognized a kinship and developed compassion, even obligation toward others who were immigrants or poor or who had lost.

America At A Spiritual Crossroads

I was approached once to be a supply preacher at a Unitarian Universalist Church during an interim.  I realized I had no idea how to do that, how to preach, if not the Gospel.  So perhaps it is inevitable that I fail my nonChristian readers at this point.

But I will do my best.

The 20th century witnessed horrors when people responded to their suffering by pulling away, by blaming others and cutting off connections, dividing nations into smaller and smaller subgroups to despise.  The brain that does that eventually goes senile.

A lot of us have lost a lot since the start of the 21st century.  And the rules have been rewritten, so we can expect more of the same.  This would be a good time to seek deeper than the theological optimism that cheered us when there was still a frontier and we could always walk away from our failures.  This is not the time to place our hopes for spiritual vindication on the thin reed of an untried and immature quarterback and Christian.  Give the kid a break.  And, by the way, give the people who are rooting for him a break, as well.  They are having a hard time, too.

The good news is that there are other patterns to be found.

The brain that remains open to new experiences, that searches for common ground, grows, creates, delights, has fun!  Ditto the nation.  Ditto the world.

Imagine that.  We are hard-wired for compassion.  And for fun.

Go Cheeseheads!

photo of Tin Tebow from
Hawkeye and AA logos in public domain
Creation of Adam by Michelangelo,  1510 in public domain
The Shipwreck by Claude Joseph Vernet, 1772, in public domain
photo of Haiti earthquake victim by Lohan  Abassi, used under the Creative Commons Attribution License  
photo of UA 175 striking World Trade Center in public domain

Habit and the Stages of Change

I have been writing for several weeks now about this mass of electrical activity inside our brains, dendrites and nerve endings, meeting at synapses, passing their spark from one neuron to the next, creating -- what?  A wink, a whisper, a sensation, the next big brainstorm.

Most of these connections could be called, in the widest sense, habits.  By habits, I mean that pathways get used over and over, form patterns, become familiar, channel us to certain outcomes.  Most bypass the cortex, requiring no decision.  Like breathing, smelling, salivating at the cinnamon.
Most of the remainder are still automatic.  But with effort, they can be brought to consciousness where the cortex could interfere, and a decision made.  Like blinking.  Or picking up the cookie.

What if you don't want to pick up the cookie?  Okay, you really do want to pick up the cookie.  What if you want to not pick up the cookie anyway? 

How Do You Change A Habit?

You're gonna take more than one step.

Last week, I put some numbers out there, the Wahls diet.  Nine cups a day of vegetables and fruits.  I broke it down for you: 3 cups leafy greens, 3 cups cruciferous veggies, 3 cups intensely colored.

This food plan helped Dr. Terry Wahls reverse her secondary progressive MS and get up out of her wheelchair.  It could help you reduce your symptoms of heart disease, lung disease, asthma, hypertension, depression, obesity, bipolar disorder, diabetes, Alzheimer's or Parkinson's.

If you have, or are tending toward any of these chronic diseases, you have already heard your doctor/mother/spouse tell you that you need to improve your diet.  Dr. Wahl's book, Minding My Mitochondria tells you just how much and why. 

Nine cups a day of vegetables and fruits:

3 cups leafy greens
3 cups cruciferous veggies
3 cups intensely colored

Stages Of Change 

So there is your canyon.  Here are the steps, more than one.  Several, in fact.  The steps are known as the Stages of Change.

The Stages of Change model appears all over the place lately.  This article from the journal American Family Physician uses the Stages to help physicians help their patients, something more effective than Just do it.  A Youtube search yields results for addiction recovery counselors, life coach trainers, weight loss clinics.

Different sites number the stages differently.  Some say Precontemplation is Stage 0.  Some give Relapse its own number.  Some add Transcendence, whatever that is -- said the priest who gets cynical when quasi-religious language gets used for the purposes of self-improvement.  Whatever we are supposed to transcend, evidently it is not our desire to improve ourselves. -- But I digress.

I like this site, which is the source of the graphic above, even if the author does use that word Transcendence that made me twitchy there for a minute before I got back on track.  It works through the stages from the perspective of the person who is making the change, not the person who wants somebody else to change. 

Crossing Canyons/Building Bridges In My Brain 

Dr. Wahls calls it a diet.  I don't diet.  Who wants to DIE-t?   Each chocolate chip cookie left on the plate represents a little death.  A diet is a temporary interruption.  When it ends, you go back to your life.  But there is nothing temporary about the nutritional needs of my mitochondria, without whom there would be no life.

I'm into changing my brain.  In that mass of electrical wiring, some potentially healthy pathways are blocked by the detritus of dead dendrites.  Other destructive pathways are carved into canyons of well-worn automatic responses. 

Changing my brain will take time.  It is taking decades.  It will take at least another blogpost. 

And The Word Became Flesh 

Question: What do the Stages of Change have to do with Prozac Monologues? 

Answer: Words.  The Stages of Change use language to shape the brain.

Language is one kind of pathway from neuron to neuron.  It connects electrical impulses from the autonomic systems, the olfactory nerve, the amygdala, through the hippocampus (memory and emotion) and the anterior cingulate cortex (pattern seeking) and into the frontal cortex (conscious thought).

Language is how all this electrical activity gets turned into meaning.  It is where the brain and the mind become one. 

The Stages of Change include a process of changing our patterned thinking about food.  And thinking is how we move from one stage to the next. 

Dr. Wahls' writes about synergy, how exercise and diet work together to heal her myelin and reduce the symptoms of her MS.  I'm thinking the same process works for changing habits, particularly food habits.  Each new behavior reinforces the preceding thought that moved you to the new stage.  That repeated behavior patterns the thought that will move you to the next stage. 

Meanwhile, what you are eating while you are trying to make any change matters.  Your mitochondria need the right materials to build the dendrites that form the new pathways.  Like lunch for the road crew.

So don't try to skip stages.  And don't skip broccoli.

One of these days I will write my own food autobiography, my trip through these stages.

photo of Women Working at a Bell Telephone Switchboard from the National Archives and Records Administration and in the public domain
photos of Hatherton Canal in Staffordshire by Roger Kidd, Coal Creek Falls by Walter Siegmund, Glen Canyon by Sascha BrückJeff Kubina used under the Creative Commons Attribution-Share Alike 3.0 Unported license.
Stages of Change graphic was created by Todd Atkins, who placed it in the public domain

PTSD: Prevention -- Sort Of

Readers will know that I am firmly in the camp that calls for  the "trauma" in Post-Traumatic Stress Disorder to include more than war and rape.  Nevertheless, as I write this third in my PTSD series on Memorial Day weekend, I write with love, honor and respect for my parishioners, friends and family members who have served this nation in combat.  As it happens, all of my people have come home.  But none of them ever really.

Now know this.  It frames the whole conversation about research into prevention of Post Traumatic Stress Syndrome.  All the efforts currently being studied and tried for prevention are about preventing PTSD in those who have already experienced trauma.  (That's called "secondary prevention.")  They are not about preventing the trauma in the first place.  Read it again and remember that point.  I shall return to it.

[If you want to skip the research, you can scroll down from here to the **** where I take up my conclusions.] 

A number of medications are being tried post-trauma (the "morning-after" pill) to interrupt stress mechanisms and to impede the particular memory consolidation that leads to PTSD.  If memories of the trauma, including sights, sounds, smells, sensations are not associated with the conditioned fear response, then triggers will not elicit symptoms and PTSD will be prevented.

One strategy is to damp down the activity of the adrenal gland.  Propranolol is a prime candidate for this use.  It is used now to treat hypertension and anxiety disorders, because it reduces the fight or flight mechanism, the release of catecholamine from the adrenal gland and speeding up of the heart rate, among other things.  Propranolol interferes with the memory of emotional events, because the mental image is not "consolidated" with the bodily experience of adrenaline.

Studies of propranolol have been conducted on trauma victims.  Usually it is administered in the emergency room, within a few hours of the trauma, and then continuing over the course of several days.  The results are mixed.  In some studies, those who received the medication experience fewer PTSD symptoms one or two months later.  A NIMH study in 2007 did not replicate these results.

Another approach is to address the damage done farther downstream, by changing the balance of neurotransmitters.  Neurotransmitters sit in the space between brain cells (called synapse) and help messages move along from one to the other.  Serotonin (of Prozac fame) carries the messages and is the best known by the general public, but there are several others, as well.

Glutamate is a neurotransmitter that speeds up the action between brain cells.  There is a lot of glutamate in the hippocampus, where it helps develop long-term memory.  GABA slows down the passage of messages, which gives it a tranquilizing effect on glutamate.

The balance of these two affects the health of neurons.  Persons with PTSD have more glutamate and less GABA on board than those without PTSD.  The Defense Department is currently funding a study to discover whether an intervention to redress the balance might make communication between brain cells less efficient -- again, interfering with the consolidation of long term memory.

Another option is an earlier and more aggressive use of serotonin.  Serotonin supports brain-derived neurotrophic factor (BDNF).  So it indirectly helps the brain repair itself, reversing shrinkage in the hippocampus.

The neurotransmitter Neuropeptide Y (NPY) inhibits the release of stress hormones norepinephrine and corticotropin releasing factor.  There is some evidence that enhancing the production of NPY might reduce the problems caused by stress overload.  But there are no such medications available yet.

Then there are the opiates, such as morphine.  It would be unethical to conduct the typical research using morphine, i.e., giving the medication to one group and placebo to another.  This January, the New England Journal of Medicine reported an "observational study" of morphine use in the battlefield.  The medical records of 696 injured military personnel were examined after treatment.  Those with moderate or severe traumatic brain injuries were excluded from the study, because severe brain damage protects against PTSD.  How's that for irony.

The study concluded that morphine does provide some protection against PTSD.  Among the patients in whom PTSD developed, 61% received morphine; among those in whom PTSD did not develop, 76% received morphine.  The odds of this difference occurring by coincidence are less than one in a thousand (odds ratio, 0.47; P<0.001 in statistics-speak.)  Severity or mechanism of injury, age and amputation -- none of these factors made a significant difference in the findings.

It is speculated that morphine has this protective effect because severe pain increases the trauma of the injury, and hence of the memory.  I wonder if it might prove more effective in nonmilitary use, among those whose brains are not being primed for PTSD every single day.

Okay, the limitation of any of these medications is that they are directed at single event traumas, rape, injury, one time devastating experience.  The brains of soldiers and abused children are injured and prepared for PTSD daily.  What are we going to do, sprinkle propanolol into the cornflakes of everybody deployed in a battle zone, make it part of school lunches?

There are also more creative, nonpharmocological approaches being explored.  Louisiana State University Health Sciences Center is going to study hyperbaric oxygen treatment for those with traumatic brain injuries. TBI has been called the signature wound of the wars in Iraq and Afghanistan. A RAND Corporation study released in April estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment. 

In hyperbaric oxygen treatment, burn and carbon monoxide victims are placed in a pressure chamber to increase oxygen in the blood stream, and hence in the brain.  Think of deep breathing to relieve your anxiety attacks.  LSUHSC will compare TBI victims who receive or don't receive this treatment, in hopes of discovering a new approach to help this subset of injured soldiers.

Like the medications, hyperbaric oxygen treatment (if it works) will be given to those with one time traumas, not so useful for continuing trauma.  Here is another approach that might work on a daily prophylactic basis.  Tetris!

An admittedly small study conducted at the University of Oxford examined whether "visiospatial cognitive stimulation" could provide a vaccine against flashbacks.  It was based on the capacity of the brain to process just so much stimulus at one time.  If that capacity is used up by the intrusion of non-traumatic images, then perhaps the traumatic ones would be encoded in memory less deeply. 

So they showed the Trauma Film, a twelve minute piece that is known to produce flashbacks.  After thirty minutes, ten subjects played Tetris, and ten sat quietly.  Tetris was chosen because it is known to intrude upon image-based memory (people see images of the game at a later time after playing).

In fact, these intrusive memories are why I stopped playing it.  It was additively soothing, but I kept seeing the Tetris shapes around me in everyday objects.  Like, the silhouette of a head and shoulders became that L-shaped piece.  At one point I asked my young son to hide his game-boy, so I couldn't find it!  Now I play other games that intrude on image-based memory.

I digress.  Anyway, in the following week, the Tetris-playing group had fewer flashbacks to the Trauma Film than the others.

Now this is an application that could be used in the battlefront.  I understand that soldiers often play computer games when they return to base, though usually they are war games.  Tetris or maybe some other matching three type game could push the day's images out of their brains.


Okay now, I have spent months gathering these studies of secondary prevention of PTSD, and struggling with two issues regarding the vast numbers of new sufferers of PTSD who are created every day in Iraq and Afghanistan.

The first is a dilemma.  After we have put our young people in harm's way, after they have been injured in the service of their country, surely they need -- and deserve -- the best medical care we can give them.  And better.  Surely we need to do more research for better medications and better treatments.

What troubles me is that the medications and treatments are designed to obscure from them the horror of their experiences.  While we treat them, we are creating more effective soldiers, soldiers who can do more and more terrible things, because we have undone part of their most human response to these terrible things.  And we are creating in ourselves denial about what war is.  The healthy human being would go crazy.

And we can't do this so selectively as we would like.  When we interfere with the consolidation of traumatic long term memories, we also interfere with all long term memories.  Which, ironically, is what PTSD does.  Part of how the brain protects itself from horror is to go numb to all feeling.

And yet, their suffering is real and urgent.  How can we not relieve their pain by any means possible?

See what I mean?

My second issue is this.  All the medications and treatments I have described are secondary prevention. -- I said at the beginning that I would return to this point.

What is primary prevention?  It's what we do with lung cancer.  We don't invent treatments that intervene between inhaled carcinogens and the lungs.  We conduct public campaigns against smoking.  We don't make the liver more efficient in processing poison.  We prohibit the use of lead-based paint.  We don't prevent Froot Loops and the sugar in even salad dressing from overwhelming the pancreas and kidneys.  We educate about high fructose corn syrup and our epidemic of diabetes and obesity.  -- Okay, there's a little hypocrisy in that last one, when we compare the money spent on health education to the subsidies given to produce high fructose corn syrup.

What about primary prevention of PTSD?

When is the Surgeon General of the United States of America, Vice Admiral Regina M. Benjamin going to stand up and tell us the truth -- that war is a health hazard?

The frontal cortex of the human brain, the part that comprehends the consequences of actions, is not fully developed until age 25.  When are recruiters going to be banned from high schools and college campuses and malls?  Or federal funding refused to schools that permit ROTC programs?  When are those ads for the Marines going to be banned from the Super Bowl and other sporting events?  When are parents going to teach their children, Just say no?

Defense Secretary Robert Gates said recently that leaving aside “the sacred obligation we have to America’s wounded warriors, health care costs are eating the Defense Department alive.”  Imagine how much money we could save is we stopped putting them in harm's way.

Before automated warning systems were developed, coal miners used to take canaries with them into the mine.  When the canary died, the miners knew the air was poisonous.  It was time to get out of the mine.

So here is the last thing I am going to say about PTSD for a while:

We gotta lot of dead canaries.  When will we get out of the mine?

Popular Posts