Tag Archives: fear

Fake science is no joke

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Happy Easter everyone.

I went to church this morning, and came home to get a lamb ragu going in the slow cooker, and thought I would just hop onto Facebook to see what was going on in the world. I was greeted with this:

“Your body literally treats negative thoughts like an infection.” Dr Peter Amuaquarshie

Oh dear … oh dear, oh dear, oh dear …

Easter is meant to be about redemption, about hope, about God’s great love for us. Clearly #TheDrLeafShow isn’t any of that.

Unfortunately, this is more pseudoscience from Dr Leaf and her cabal.  And while it might also be April Fools Day, fake science is no joke.

Dr Peter Amua-Quarshie has been in cahoots with Dr Leaf since the beginning of her teaching. He has supplied most of the illustrations for Dr Leaf’s ministry over the years, so I’m sure he’s profiting handsomely from Dr Leaf’s enormous sales and influence.

It’s so sad to see academics trade their integrity and sell their soul for the sake of the ill-gotten gains of popular pseudoscience.

Your body doesn’t “literally” treat negative thoughts like an infection. Our thoughts have literally no bearing on our immune function. In research work that has intentionally studied thought separately to stress, thought has not been associated with any significant changes in stress or health behaviour [1]. It’s also been confirmed that thought alone does not lead to detrimental biological changes, such as significant changes in immune function [2].

If anything, it’s the other way around – our immune system and our thoughts respond to physical changes in our bodies internal milieu. For example, an adrenaline surge causes us to feel fear and engage in fight or flight behaviours, and to respond quickly to injury, the balance of our immune system’s cells and cytokines changes to prepare for possible injury.

Another example, a physical infection from a microbe of some kind (bacterial or virus) causes a flood of chemical mediators called cytokines to float around the blood stream. This inflammatory response leads to an immune system that is better able to fight off infection, but it also changes our feelings and our thoughts – this flood of cytokines is the reason why we feel tired, achey and miserable when we’re sick.

Having “negative thoughts” is not the same as having an infection. Infections are disease states, whereas “negative thoughts” are normal and more often than not, beneficial. It’s normal to feel sad. It’s normal to feel angry. It’s normal to feel disgusted or embarrassed. These feelings are adaptive. Without them, we wouldn’t grow or change. Without them, we couldn’t have a rich, full life.

Dr Leaf claims that her goal is to “equip and empower you to use your mind to overcome labels and mental ill health (depression, anxiety, etc) to live a more fulfilled and successful life.” It’s a bit hard to do that by promoting fake science.

For his part, Amua-Quarshie should know better. He’s a teaching academic by trade and has a medical degree from the University of Ghana, after all. Unfortunately, it appears that Dr Amua-Quarshie has been exiled from mainstream academia, leaving a full-time position as an Adjunct Professor (lecturer) at the University of Wisconsin-Stout in Menomonie, Wisconsin and is now working as a lecturer in a school for chiropractors (Parker University, Dallas, Texas).

Though that’s more of an aside. The bottom line here is that Dr Leaf might claim that she wants people to overcome ‘labels and mental ill health’ but she isn’t going to do that by promoting such obvious mistruths that mislead people into fearing normal, adaptive human emotions. She isn’t promoting a more fulfilled and successful life, she’s promoting imbalance. She’s promoting false hope.

I know it’s April Fools, but believe me, this is no joke.  Fake science is misleading and harmful.  If Dr Leaf really wants people to live a more fulfilled and successful life, she should refrain from using it.

References
1. Doom, J.R. and Haeffel, G.J., Teasing apart the effects of cognition, stress, and depression on health. Am J Health Behav, 2013. 37(5): 610-9 doi: 10.5993/AJHB.37.5.4
2. Segerstrom, S.C. and Miller, G.E., Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull, 2004. 130(4): 601-30 doi: 10.1037/0033-2909.130.4.601

Dr Caroline Leaf and the struggle spiral

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In Proverbs 12:25, the incredibly wise King Solomon wrote that, “Worry weighs us down; a cheerful word picks us up.”

Today, Dr Leaf posted to her social media stream that “An undisciplined mind is filled with worries, fears and distorted perceptions – These lead to degeneration of the mind and body.”

Well, that’s about as uplifting as a lead balloon.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  I’m sure her heart was in the right place when she posted her latest jewel of wisdom, but it may not be as encouraging or as helpful as she may have intended.

The biggest problem is her opening premise, “An undisciplined mind is filled with worries, fears and distorted perceptions”.  So … that’s not really accurate. The normal human mind is filled with worries, fears and distorted perceptions. It really doesn’t matter whether you discipline your mind or not, you won’t shift these ‘negative’ thoughts.

That’s because we’re meant to experience appropriate levels of fear and worry.  They’re a survival mechanism.  Without a certain amount of fear, we’d end up as a Darwin Award.  And as human beings, we’re naturally inclined to so many different cognitive biases that there’s a very long list (although ironically, those with the strongest confirmation bias will probably be the least likely to accept this).

By erroneously linking normal cognitive function to the concept of mental ill-discipline, Dr Leaf is simply setting people up for an unrealistic struggle with their normal psyche as they unnecessarily try to discipline it.

And for the people who really do struggle with excessive or inappropriate worry, fear or incorrect perceptions – i.e. people who suffer from formal anxiety disorders – this sort of statement is misleading because again, their issue isn’t mental ill-discipline. Anxiety is the result of a genetic predisposition and increased vulnerability to stress.

The second part of Dr Leafs meme is as unhelpful as the first.  For a start, it’s not true that worries, fears and distorted perceptions cause degeneration of the mind and body.  There may be a correlation between stress and some long term health problems, but correlation does not equal causation.  As Cohen and colleagues noted, “Although stressors are often associated with illness, the majority of individuals confronted with traumatic events and chronic serious problems remain disease-free.” [1]  Dr Leaf’s claim seems little more than a scare tactic, which can only lead to increased anxiety not increased motivation.

The important things to remember here are:
1. Experiencing worries, fears and distorted perceptions is normal, and not something that can be changed by disciplining your mind.  Don’t fall into the trap of trying to treat something that isn’t a disease.
2. If you do suffer from an anxiety disorder, don’t blame yourself.  That sets up a spiral of struggle.  Thoughts are just words. They have no power over you unless you engage with them.  Instead of trying to repress every worry and every fear, allow your thoughts to bubble away in the background, and instead, focus your energy on taking values based committed action which will ultimately help you live a life of meaning, not just struggling.

References

[1]     Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA: the journal of the American Medical Association 2007;298(14):1685-87.

Dr Caroline Leaf: All scare and no science?

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On her social media feed today, Dr Leaf posted a meme implying that conventionally farmed food was toxic.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. Anyone who’s been following Dr Leaf will know from her frequent food selfies that she is an organic convert.

Dr Leaf is welcome to eat whatever she chooses, though not content to simply push her personal belief in organic foods, Dr Leaf is now actively criticising conventional food, publishing memes on her social media posts which imply that conventional produce is poisonous.

As I’ve written before, despite Dr Leaf’s blinding passion and quasi-religious zeal for organic foods, there is no evidence that organic food is any more beneficial than conventional food (Dangour et al, 2009; Bradbury et al, 2014). Indeed, there’s no magic to a healthy food lifestyle. Eat more vegetables. Drink more water. Conventional veggies and conventional water do just fine. Sage advice, even if it doesn’t lend itself to food selfies.

While organic zealots believe they have the high ground on the topic of food safety, the published science cuts through the hype. As noted by Smith-Spangler et al (2012), there is some evidence that there may be less pesticide residue on organically grown foods, but there is no significant difference in the risk of each group exceeding the overcautious Maximum Residue Limit.

Two points on the Maximum Residue Limit that are particularly important:

  1. The Maximum Residue Limit is extremely cautious, and most food tested is well below this already overcautious limit. The Maximum Residue Limit is set to about 1% of the amount of the pesticide that has no effect on test animals.   According to a recent survey of grapes done by Choice Australia, the amount of residue was well below the Maximum Residue Limit (about 1% of the Maximum Residue Limit on average) (Choice Australia, 2014). So on the average bunch of grapes in Australia, the pesticide residue is about one ten thousandth of the level that is safe in animals, and this pattern is the same across all conventional produce. Thinking in more practical terms, “a 68 kg man would have to eat 3,000 heads of lettuce every day of his life to exceed the level of a residue that has been proven to have no effect on laboratory animals … an 18 kg boy would have to eat 534 apples every day of his life to exceed a residue level that is not dangerous to laboratory animals. And an 18 kg girl would have to eat 13,636 kg of carrots every day of her life to exceed such a level.” (ecpa.eu, 2014)

    2. Organic foods have pesticides too. Granted, this is at lower levels than their conventional counterparts, but it’s there all the same (Smith-Spangler et al, 2012). I once had a lively discussion with an organic food zealot about the pesticides in organic farming. Her argument was that organic pesticides are safe because they’re “natural” poisons. So are arsenic, cyanide, belladonna and digitalis (foxglove), but why let the truth get in the way of ones opinion. Poisons are poisons whether they’re “natural” or not. The Maximum Residue Limit applies to organic foods just the same as conventionally farmed produce for that reason.

Another interesting thing … in the Choice survey, the organic grapes had no detectable pesticides, but so did conventionally farmed grapes bought at a local green grocer. So organic food zealots can’t claim that they have a monopoly on low pesticides in their foods.

Not that having lower pesticide residues means that organic foods are necessarily safer. Organically farmed produce has a higher risk of contamination from E. coli and other potentially toxic bacteria, depending on the farming method used (Mukherjee et al, 2007; Sample, 2011).

So to bring it all together, conventional produce has levels of pesticide residues so low that it would take an extra-ordinary feat of vegetarian gluttony to exceed a level that was still found to be non-toxic in animals. The risk to human health from conventional farming with pesticides is nanoscopic. Organic foods may have less pesticide, but they have a higher risk from enterotoxigenic bacteria.

Since there is nothing to fear from conventional foods, it seems irresponsible for Dr Leaf to promote the unscientific idea that conventional foods are poisonous. One wonders why Dr Leaf would engage in a campaign of fear against healthy, nutritious foods? Personal bias perhaps, although that doesn’t bode well for her credibility as an objective scientist. Another plausible reason could be marketing. Fear sells things, that’s Marketing 101. Gardner (2008) wrote, “Fear sells. Fear makes money. The countless companies and consultants in the business of protecting the fearful from whatever they may fear know it only too well. The more fear, the better the sales.”

Posts like today’s make Dr Leaf seem like all scare and no science. Publishing images with the skull and cross bones and the word “POISON” is certainly not attempting to allay anyone’s anxiety, and that fact that it‘s directly tied to a reminder of her upcoming book on food only makes shameless promotion all the more likely. I’m sure that a Godly woman of Dr Leaf’s standing wouldn’t stoop so low as to use fear and mistruth just to make better sales, but posts like today’s open her up to legitimate questions from others regarding her credibility and her motivation.

For her sake, I hope that she tightens up her future posts, and reconsiders her stance on the science of organic and conventional foods.

References

Bradbury, K.E., et al., Organic food consumption and the incidence of cancer in a large prospective study of women in the United Kingdom. Br J Cancer, 2014. 110(9): 2321-6 doi: 10.1038/bjc.2014.148

Choice Australia, 2014. <http://www.choice.com.au/reviews-and-tests/food-and-health/food-and-drink/groceries/pesticide-residues-in-fruit-and-vegetables.aspx&gt;

Dangour, A. D., Dodhia, S. K., Hayter, A., Allen, E., Lock, K., & Uauy, R. (2009). Nutritional quality of organic foods: a systematic review. Am J Clin Nutr, 90(3), 680-685. doi: 10.3945/ajcn.2009.28041

European Crop Protection Agency, 2014, <http://www.ecpa.eu/faq/what-maximum-residue-level-mrl-and-how-are-they-set>

Gardner, D., The science of fear: Why we fear the things we shouldn’t – and put ourselves in greater danger; 2008, Dutton / The Penguin Group, New York

Mukherjee, A., et al., Association of farm management practices with risk of Escherichia coli contamination in pre-harvest produce grown in Minnesota and Wisconsin. Int J Food Microbiol, 2007. 120(3): 296-302 doi: 10.1016/j.ijfoodmicro.2007.09.007

Sample, I., E coli outbreak: German organic farm officially identified. The Guardian, London, UK, 11 June 2011 <http://www.theguardian.com/world/2011/jun/10/e-coli-bean-sprouts-blamed>

Smith-Spangler, C., Brandeau, M. L., Hunter, G. E., Bavinger, J. C., Pearson, M., Eschbach, P. J., . . . Stave, C. (2012). Are organic foods safer or healthier than conventional alternatives? A systematic review. Ann Intern Med, 157(5), 348-366.

Don’t stress about stress – Part 4: Stress breaking bad

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This is the last blog post in my brief series on stress. Today, we’re going to look at what happens when we do hit stress overload, and a few simple methods that may be able to help you through a tough situation.

One of my favourite shows of all time was Breaking Bad. Breaking Bad told the story of Walter White, a high school chemistry teacher and average family man, who is diagnosed with terminal lung cancer. To support his wife and disabled son after he’s gone, he uses his knowledge of chemistry to launch himself into an underworld career manufacturing crystal meth.

Allostatic overload is the term modern scientists use for stress breaking bad. Stress moves from an agent of growth and change to an agent of disease and death.

In the last few blogs, we discussed that stress is actually more of a positive than a negative. It’s not that stress can’t be bad, because we know from the stress-productivity curve and from the Yerkes-Dodson Law that too much stress overwhelms our capacity to cope with it. The model used to describe the balance of stress on our body is the theory of Allostasis.

Allostasis

All living things maintain a complex dynamic equilibrium – a balancing act of the many different physiological systems that all rely on the other systems working at an optimal range. Imagine trying to stack ten spinning tops on top of each other while trying to keep them spinning. The body does the chemical equivalent of this very difficult combination of balance and dexterity every day. It’s called homeostasis. This balancing act is constantly challenged by internal or external events, termed stressors. Both the amount of stress and amount of time that the stressor is applied is important. When any stressor exceeds a certain threshold (“too strong, or too long”), the adaptive homeostatic systems of the living thing activate responses that compensate.

The theory of allostasis is related to these homeostatic mechanisms, although not just in terms of stress, but broadly to the concept of any change of the optimal range of these homeostatic balancing processes, in response to a change in the environment or life cycle of an organism [1].

McEwen and Wingfield give an example of some bird species, which change their stress response to facilitate their breeding capacity during mating season. They note that the benefit of the increased chance of breeding is important to the bird, but also comes at a cost of increased susceptibility to some diseases because of the weakening of the stress response at the time [1].

When it comes to stress, we adapt in a similar way. A lack of stress, or an excess of a stressor in some way (either too long or too strong) results in adaptation, which is beneficial, but can come at a cost. This is demonstrated by that broadly applicable U-curve, the stress productivity curve.

Chrousos wrote, “The interaction between homeostasis disturbing stressors and stressor activated adaptive responses of the organism can have three potential outcomes. First, the match may be perfect and the organism returns to its basal homeostasis or eustasis; second, the adaptive response may be inappropriate (for example, inadequate, excessive and/or prolonged) and the organism falls into cacostasis; and, third, the match may be perfect and the organism gains from the experience and a new, improved homeostatic capacity is attained, for which I propose the term ‘hyperstasis’.” [2] And as noted by McEwen, “Every system of the body responds to acute challenge with allostasis leading to adaptation.” [3]

More often than not, we adapt to the stressor, either the same as before, or possibly better. It’s only if the response to the stressor is inadequate, excessive and/or prolonged that stress ends up causing us trouble. This is what people normally think of when they think of stress – called allostatic overload – simply stress breaking bad.

Keeping stress in check

To ensure that we keep our stress levels at the optimum to ensure maximum productivity and growth, here are a few simple techniques. Remember, everyone handles stress differently, and so which of these techniques works best for you will be something you’ll have to learn by trying them.

Breathing

The simplest tool is breathing. Sounds a little silly really, since you obviously breathe all of the time! But we usually take shallow breaths, so our lungs are not being used to their full capacity. When we focus on our breathing and deliberately take slow, deep breaths we increase the amount of air going in, and therefore allow more oxygen to enter the blood stream. This better fuels our cells and helps them do their job more efficiently. However, it also sets in motion a physiological mechanism that slows our heart rate.

Our heart pumps blood from our body, through the lungs to get oxygenated. As we take a deep breath, more blood is sucked up into our chest cavity from our veins, because breathing in causes a temporary vacuum in our chest cavity. The extra blood then fills our heart more efficiently. A more efficient heart beat reduces the need for the body to stimulate the heart to pump harder. This promotes more of the parasympathetic “rest-and-digest” nervous system activity, and less of the sympathetic “fight-or-flight” nervous system, via the vagal brake mechanism.

So, to slow your breathing down simply sit in a comfortable position. Take slow, deep breaths, right to the bottom of your lungs and expanding your chest forward through the central “heart” area. Count to five as you breathe in (five seconds, not one to five as quickly as possible) and then count to five as you breathe out. Keep doing this, slowly, deeply and rhythmically, in and out. Pretty simple! This will help to improve the efficiency of your heart and lungs, and reduce your stress levels.

Remember, B.R.E.A.T.H.E. = Breathe Rhythmically Evenly And Through the Heart Everyday.

Meditation

Meditation takes the techniques of breathing one step further, in that meditation involves deliberately switching your brain’s focus to something simple, and in the present. Focussing on nothing – just breathing and turning off your thinking for while – does take some practice. Concentrating on something in the present (not thinking about the past or the future), tends to be easier and requires less practice, although ignoring all the other thoughts that routinely clamour for your attention might be hard when you first try it.

Focusing on the present moment is part of the practice of Mindfulness. Mindfulness meditation has been studied quite extensively over the last few decades, and has been shown to have benefits over a large number of psychological symptoms and disease states [4].

Sometimes it is easier to focus on something visual, that you can see easily in your field of view, or listen to something constant, like the ocean, or a metronome. The easiest thing to do is to again, focus on your breathing. Concentrate on the sound, rhythm and feeling of your breathing, but don’t engage your thoughts, or allow others to creep in. Meditation quietens the mind, which is excellent for reducing stress, and can help to revitalise and refresh your mind.

Guided Imagery

Guided imagery is a step along from meditation. Instead of focussing on something tangible, guided imagery lets you imagine that you are somewhere pleasant, relaxing, or rejuvenating. Some people describe it as a vivid daydream.

Get comfortable, close your eyes and start to breathe slowly and deeply. Once you begin to relax, imagine your favourite scene. It could be at the beach, or in a log cabin in the snow-capped mountains, or swimming in the cool waters in a tropical rain-forest. Whatever you choose, try to imagine the scene in as much detail as possible, and involve all five of your senses if you can, like, for example, the cool water of the waterfall on your bare skin, the sounds of the birds in the trees, the smell of the moss-covered rocks, the canopy of tall trees and vines split by the waterfall and stream allowing the sunlight to spill in to the forest floor. Enjoy the details and the relaxation that this brings. To “come back”, some recommend counting back from ten or twenty, and to tell yourself that when you reach one, you will feel calm and refreshed.

Guided imagery allows you to actively replace the harassing thoughts of your daily routine with pleasant soothing thoughts. There is some early scientific literature suggesting effectiveness, although more research is required [5, 6]. Again, with practice, this can be done anywhere, and can be done quickly if you need a short break to unwind.

Visualisations

Visualisations build on the techniques of guided imagery, but instead of the rain-forest or tropical paradise, you imagine yourself achieving goals, which again could be anything from improving your health, closing that deal, or hitting that perfect drive from the first tee. Again, try and imagine the scene in as much detail as you can, and involve all of your senses.

PMR

Progressive Muscle Relaxation, or PMR for short, is similar to meditation, except that you contract, hold, and then relax your muscle groups in turn. You concentrate on the feel of the tightening and relaxing of the muscles instead of, or as well as, your breathing. Like meditation, it can be done anywhere and involves very little training.

The contraction of the muscle groups, beginning in your feet – working your way up the calves and thighs, tummy, chest, arms and neck, sequentially pumps all of the blood back towards your heart, giving you a boost of blood flow to your lungs. The deep breathing oxygenates this extra blood and hence, gives your brain a burst of oxygen.

Using PMR to meditate helps engage the vagal brake, and there is some evidence that it helps to reduce persistent pain [7, 8].

Exercise

Exercise releases stress and enhances your physical health [9, 10]. It is flexible and easily adaptable – it is usually free and can often be done without any equipment. The downside is that it is not possible everywhere (you can’t go jogging in a plane), but as a daily discipline, it will enhance your physical and emotional wellbeing.

The benefits of exercise are firstly physical. It gets your heart pumping, the blood flowing and your lungs working to their full capacity. It builds physical fitness, which is important to enable the heart and lungs to work efficiently at all times. Exercise has effects on mood, improving depression [11] and anxiety [12].

It can also act as a form of meditation – the solitude of a run or swimming a few laps, concentrating only on the splash of your strokes or the pounding of your feet on the ground – is similar to meditation except that you’re moving (whereas meditation proper involves being still and relaxed). But the outcome is the same, and stress is often reduced by a session of physical exercise.

Music

Music is almost as fundamental to human existance as breathing, and it’s almost as diverse as mankind itself. Listening to ones favourite music can enhance feelings of control and can increase pain tolerance and improve short term anxiety (stress) [13]. The common characteristics of ‘therapeutic’ music was music which had less tonal (pitch) variation, less prominent chord changes, bass lines, or strong melodies [14].

But the key element was personal preference overall, as some of the participants in the study chose music like Metallica. So enjoy music. Make it part of your day. Even Country and Western may be considered therapeutic!

Yoga

Yoga is an ancient practice that has several components including physical postures (asanas), controlled breathing (pranayama), deep relaxation, and meditation.

It’s not for everyone, but it has clearly defined and scientifically validated benefits to your physical and psychological well-being. “It is hypothesized that yoga combines the effects of physical postures, which have been independently associated with mood changes and meditation which increases the levels of Brain-derived neurotrophic factor (BDNF). Other effects that have been noted include increased vagal tone, increased gamma-amino butyric acid (GABA) levels, increase in serum prolactin, downregulation of the hypothalamic-pituitary-adrenal axis and decrease in serum cortisol, and promotion of frontal electroencephalogram (EEG) alpha wave activity which improves relaxation.” [15] So, translated: Yoga is good for stress relief!

Most gyms and community centres will have yoga instructors, so go ahead and make some enquiries.

Massage

I love massage! The first time I had a proper massage was in the small city of Launceston in the tiny Australian state of Tasmania. After just 30 minutes of the therapist kneading my muscles with her fingers of iron, I felt pretty good, but when I sat up, I was actually light-headed for a little while. My heart rate and blood pressure had reduced so much that it took me a while before I could stand up properly!

Deep pressure massage has also been shown to help release the vagal brake enhancing the activity of the parasympathetic (rest-and-digest) part of the autonomic nervous system. There is good evidence of this effect in pre-term infants [16]. The evidence for adults isn’t so strong, although that’s probably because of a lack of quality research [17]. The good studies that have been done show a reduction of cortisol, blood pressure and heart rate after massage, with some studies showing small persistent effects [17].

The data might be thin, but there is enough evidence to make it worth trying at least once.

Probiotics

I add probiotics to this list as a reference for the future. There is good evidence of the anxiolytic effect of having a friendly bacteria garden in your intestines that interacts with your gut and your immune system in positive ways. But there is, at this point, very little in the way of good quality human clinical trials. And we still don’t know exactly which strains of probiotics are the most helpful for different conditions [18, 19]. But given that they are unlikely to be harmful, it may be worth trailing a course of probiotics, and see how you feel in 30 days.

The bottom line – stress is not the enemy. Sure, if it isn’t handled right, stress can overwhelm us and make us sick, but most of the time, stress makes us productive and strong, and helps us to grow. So, don’t stress about stress.

References

  1. McEwen, B.S. and Wingfield, J.C., What is in a name? Integrating homeostasis, allostasis and stress. Horm Behav, 2010. 57(2): 105-11 doi: 10.1016/j.yhbeh.2009.09.011
  2. Chrousos, G.P., Stress and disorders of the stress system. Nat Rev Endocrinol, 2009. 5(7): 374-81 doi: 10.1038/nrendo.2009.106
  3. McEwen, B.S., Stressed or stressed out: what is the difference? J Psychiatry Neurosci, 2005. 30(5): 315-8 http://www.ncbi.nlm.nih.gov/pubmed/16151535
  4. Keng, S.L., et al., Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev, 2011. 31(6): 1041-56 doi: 10.1016/j.cpr.2011.04.006
  5. Jallo, N., et al., The biobehavioral effects of relaxation guided imagery on maternal stress. Adv Mind Body Med, 2009. 24(4): 12-22 http://www.ncbi.nlm.nih.gov/pubmed/20671330
  6. Trakhtenberg, E.C., The effects of guided imagery on the immune system: a critical review. Int J Neurosci, 2008. 118(6): 839-55 doi: 10.1080/00207450701792705
  7. Baird, C.L. and Sands, L., A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs, 2004. 5(3): 97-104 doi: 10.1016/j.pmn.2004.01.003
  8. Morone, N.E. and Greco, C.M., Mind-body interventions for chronic pain in older adults: a structured review. Pain Med, 2007. 8(4): 359-75 doi: 10.1111/j.1526-4637.2007.00312.x
  9. Fletcher, G.F., et al., Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation, 1996. 94(4): 857-62 http://www.ncbi.nlm.nih.gov/pubmed/8772712
  10. Warburton, D.E., et al., Health benefits of physical activity: the evidence. CMAJ, 2006. 174(6): 801-9 doi: 10.1503/cmaj.051351
  11. Rimer, J., et al., Exercise for depression. Cochrane Database Syst Rev, 2012. 7: CD004366 doi: 10.1002/14651858.CD004366.pub5
  12. DeBoer, L.B., et al., Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Rev Neurother, 2012. 12(8): 1011-22 doi: 10.1586/ern.12.73
  13. MacDonald, R.A., Music, health, and well-being: a review. Int J Qual Stud Health Well-being, 2013. 8: 20635 doi: 10.3402/qhw.v8i0.20635
  14. Knox, D., et al., Acoustic analysis and mood classification of pain-relieving music. J Acoust Soc Am, 2011. 130(3): 1673-82 doi: 10.1121/1.3621029
  15. Balasubramaniam, M., et al., Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Front Psychiatry, 2012. 3: 117 doi: 10.3389/fpsyt.2012.00117
  16. Field, T., et al., Preterm infant massage therapy research: a review. Infant Behav Dev, 2010. 33(2): 115-24 doi: 10.1016/j.infbeh.2009.12.004
  17. Moraska, A., et al., Physiological adjustments to stress measures following massage therapy: a review of the literature. Evid Based Complement Alternat Med, 2010. 7(4): 409-18 doi: 10.1093/ecam/nen029
  18. Bested, A.C., et al., Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research. Gut Pathog, 2013. 5(1): 3 doi: 10.1186/1757-4749-5-3
  19. Bested, A.C., et al., Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: part III – convergence toward clinical trials. Gut Pathog, 2013. 5(1): 4 doi: 10.1186/1757-4749-5-4

Don’t stress about stress – Part 3: Coping

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In our last two blogs, we’ve been looking at stress, and why stress is usually more helpful than harmful.

It’s not that stress can never be harmful. Stress can be a trigger to some illnesses (although not as many as the popular media often portrays). What is it that makes the difference between helpful and harmful? What is it that causes one person to surf the tsunami of sewerage that often confronts us in life, while another person sinks?

The answer lies in resilience.

WHAT IS RESILIENCE?

Resilience is the term given to the individual’s capacity to cope.

Researchers in the field of psychiatry often use the term resilience, which “is the capacity and dynamic process of adaptively overcoming stress and adversity while maintaining normal psychological and physical functioning” [1] although psychologists and social science researchers would use the term “coping”, which is defined by Compas et al as, “conscious and volitional efforts to regulate emotion, cognition, behavior, physiology, and the environment in response to stressful events or circumstances.” [2] Skinner and Zimmer-Gembeck define coping as, “action regulation under stress.” [3]

Considering the definitions used, the terms are essentially interchangeable. The other observation to be made here is that coping/resilience is an active process. It’s not something that happens despite of us – we actively cope with stress. In the face of a situation involving emotional arousal (danger or stress), we take steps to deal with our inner and outer environments (the physiological processes of our body, as well as the environment around us). Sometimes these steps are conscious and/or under our control. But theorists also consider automatic, unconscious, and involuntary responses to also be part of the coping spectrum [4].

WHAT CONTRIBUTES TO RESILIENCE?

Coping Strategies

What makes up those actions? What influences the action steps?

Psychologists have described hundreds of individual methods of coping through recent research, although there have been efforts to consolidate the plethora of individual coping strategies into “family” clusters, based on function. For example, a primary tier is to “Coordinate actions and contingencies in the environment” which involves “finding additional contingencies” which on the third level involves “reading, observation, and asking others.” [3] Table 1 in the paper by Skinner and Zimmer-Gembeck [3] summarize the many ways of coping and how they can be grouped together into families, and their corresponding adaptive process.

Personality factors

Coping strategies follow along the lines of personality type [5], as well as the stage of development in children [3]. Personality types such as Neuroticism and Openness have been well studied, with Neuroticism associated with maladaptive coping strategies, and Openness correlated with adaptive coping (in marital relationships [6] and in public speaking tasks [5]).

Further research has shown how personality significantly influences coping, with the severity of the stress, and the age and culture of a person influencing the strategy and strength of the coping response [4]. Of course, personality traits like neuroticism sound bad, but they confer their own strengths. For example, negative affect has protective benefits by enhancing the detection of deception [7].

Biological factors

The shared connection that personality types and coping responses have is in their shared genetics, with personality and coping styles influenced by common genes [8]. This makes perfect sense as it has been shown that changes in individual genes effect the ability of the brain to associate the correct value to rewards [9], which then influences both mood [10], and learning [11]. Even though environmental variables are important in determining personality and learning aspects of coping with stress, the brains underlying capacity to process the incoming signals correctly will significantly influence the direction and outcome of the learning process, which includes learning which coping strategies work best for each individual.

On a deeper level, there are several biological processes that make up the features of resilience. Animal studies on resilience, as a whole, have shown that resilience “is mediated not only by the absence of key molecular abnormalities that occur in susceptible animals to impair their coping ability, but also by the presence of distinct molecular adaptations that occur specifically in resilient individuals to help promote normal behavioral function.” [12] That is, resilient individuals have the full complement of critical components in the resilience pathway, and have some extra tools too.

Human studies thus far have shown strong links to genetic changes that affect the proteins in the stress system. Epigenetic mechanisms are involved, and the role of the environment is also significant, especially uncontrollable early childhood trauma. Wu et al list the current studies of genetic changes that effect resilience in humans [1: Table 1]. The proteins involved are responsible for the growth of new nerve pathways (BDNF), and for their function, especially within the stress system (CRHR1, FKBP5) and in control of mood and reward systems (COMT, DAT1, DRD2/4, 5-HTTLPR, the HTR group).

Wu et al [1] also summarised the currently known facts about epigenetic factors in resilience. Interestingly, they noted an animal study in which chronic stressors increased an epigenetic marker called histone acetylation in the hippocampus in mice, which enhanced the protective effects of the stress (epigenetics will be the subject of a future blog)

Resilience on a personal level

So coping and resilience are known protective factors for stress, and are more commonly deployed than most people realize. Despite all of the publicity that stress has generated, human beings remain remarkably unscathed. It’s estimated that, “in the general population, between 50 and 60% experience a severe trauma, yet the prevalence of illness is estimated to be only 7.8%.” [12] (Note: By ‘illness’, the authors were referring to Post Traumatic Stress Disorder, not all of human sickness).

But when it comes to recommending different coping strategies on an individual level, it is a much harder thing to do. What is adaptive in some situations and for some people is maladaptive in other situations and for other people.

For example, in animal studies, “stressed females tend to perform better than males on non-aversive cognitive or memory tasks … Conversely, in tests of acute stress or aversive conditioning, stress enhances learning in males and impairs it in females … the literature suggests that in cognitive domains females cope better with chronic forms of stress, whereas males tend to cope better with acute stress.” [12] So animal studies confirm a difference in the biological stress response between men and women. If these studies in animals can be extended to humans, it may explain the tendency for men to engage in “fight-or-fight” responses to stress where women usually move to “tend-and-befriend” mode [13].

Human studies on coping also demonstrate that what is good for one is not necessarily good for another. Connor-Smith and Flachsbart confirm that, “In particular, daily report and laboratory studies suggest that individuals high in sensitivity to threat may either benefit from disengagement or be harmed by engagement in the short term, with the opposite pattern appearing for individuals low in threat sensitivity.” [4]

So in other words, just because engaging may be a positive method of coping does not mean that it should be recommended to everyone. Some people will have more harm from trying to engage. Care should be taken when giving people advice about how to manage their stress. Ill-informed instructions can actually make things worse.

SUMMARY

It’s well established that stress can have negative impacts on your physical and mental health. But contrary to the popular view, stress is not always bad. As a number of authors point out, most people go through significant stress at some point in their lives, but only a fraction succumb to that stress.

The difference is the factors that make up resilience. Where we are along the stress spectrum (that is, whether you are wired to be more stressed, or more resistant to stress) depends on our genetic predisposition, which determines the physiology of our stress system and our personality, and the ways we learn to cope.

How we cope best depends on our individual traits and the situation. There is no one-size-fits-all. Pushing a person into a form of coping that’s not suitable can actually cause a lot of harm.

Remember, we normally find what coping strategies work for us automatically as our resilience is mostly innate, and we all go through severe stress at some point or another in our lives, but only a small fraction of us will succumb to that stress.

In the last blog in the series, we’ll have a brief look at what happens when stress overwhelms us … when stress is breaking bad.

References

  1. Wu, G., et al., Understanding resilience. Front Behav Neurosci, 2013. 7: 10 doi: 10.3389/fnbeh.2013.00010
  2. Compas, B.E., et al., Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull, 2001. 127(1): 87-127 http://www.ncbi.nlm.nih.gov/pubmed/11271757
  3. Skinner, E.A. and Zimmer-Gembeck, M.J., The development of coping. Annu Rev Psychol, 2007. 58: 119-44 doi: 10.1146/annurev.psych.58.110405.085705
  4. Connor-Smith, J.K. and Flachsbart, C., Relations between personality and coping: a meta-analysis. Journal of personality and social psychology, 2007. 93(6): 1080
  5. Penley, J.A. and Tomaka, J., Associations among the Big Five, emotional responses, and coping with acute stress. Personality and individual differences, 2002. 32(7): 1215-28
  6. Bouchard, G., Cognitive appraisals, neuroticism, and openness as correlates of coping strategies: An integrative model of adptation to marital difficulties. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 2003. 35(1): 1
  7. Forgas, J.P. and East, R., On being happy and gullible: Mood effects on skepticism and the detection of deception. Journal of Experimental Social Psychology, 2008. 44: 1362-7 http://bit.ly/Jm66a7
  8. Kato, K. and Pedersen, N.L., Personality and coping: A study of twins reared apart and twins reared together. Behavior Genetics, 2005. 35(2): 147-58 http://link.springer.com/article/10.1007%2Fs10519-004-1015-8
  9. Dreher, J.-C., et al., Variation in dopamine genes influences responsivity of the human reward system. Proceedings of the National Academy of Sciences, 2009. 106(2): 617-22
  10. Felten, A., et al., Genetically determined dopamine availability predicts disposition for depression. Brain Behav, 2011. 1(2): 109-18 doi: 10.1002/brb3.20
  11. Ullsperger, M., Genetic association studies of performance monitoring and learning from feedback: the role of dopamine and serotonin. Neuroscience & Biobehavioral Reviews, 2010. 34(5): 649-59
  12. Russo, S.J., et al., Neurobiology of resilience. Nature neuroscience, 2012. 15(11): 1475-84
  13. Verma, R., et al., Gender differences in stress response: Role of developmental and biological determinants. Ind Psychiatry J, 2011. 20(1): 4-10 doi: 10.4103/0972-6748.98407

Don’t stress about stress – Part 1

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Stress gets a bad rap. Everywhere you look, stress seems to be getting the blame. Though as Richard Shweder wrote in the New York Times, “Imprecise and evasive language may be a disaster for science but it is a boon in everyday life. ‘I am stressed out’ is non-accusatory, apolitical and detached. It is a good way to keep the peace and, at the same time, a low-cost way to complain.” [1]

Selye said that, “Everybody knows what stress is, but no one really knows.” [2] Hans Selye is considered the father of modern stress research. He was one of the first scientists to conceptualise and measure this ethereal force.

As with some of the most important discoveries in the history of science, Selye came upon the discovery of what he termed the “alarm reaction” incidentally when he was injecting rats with impure ovarian extract, and noted that they became sick. He looked further at the physical changes in the rats and noted an unusual cluster of changes to their adrenal glands, thymus, spleen and gut [3]. He was able to reproduce the same responses by exposing the rats to cold temperatures, surgical injury, spinal shock, excessive muscular exercise, or intoxications with sublethal doses of drugs such as adrenaline, morphine or formaldehyde [4]. After years of research, he confirmed that ongoing exposure to the same physical conditions or drugs would follow the same three-stage process of initial physical changes, recovery and adaptation, then eventually exhaustion (and death). He called this model the “General Adaptation Syndrome.” [4]

The General Adaptation model was groundbreaking, and the sheer volume of work done by Selye brought his theories to the forefront of the scientific community. With time, the theory slowly descended from its place of adulation as other evidence came to light [5], but it has remained foundational, and Selye is still revered as the father of modern stress research.

The term stress “generally refers to experiences that cause feelings of anxiety and frustration because they push us beyond our ability to successfully cope.” [6] Scientifically, stress has been difficult to define. Different researchers often use different definitions of stress depending on what they’re studying or what field of psychology or science they belong to [7].

I wanted to look at stress from a different perspective. In the next series of posts, I want to look at the basic concepts of stress and its functions in nature. I will spend some time looking at different ways of conceptualising stress, and look at how they offer is life lessons on how to approach our stress. I’ll then have a look at what it is that helps us cope with stress.

A broad concept of stress

To gain a better understanding of stress, it’s useful to step away from the medical concept of stress, and think about what the term means in other fields.

When an engineer thinks about stress, it’s usually in relation to a physical force on a material object. My son is a huge Mythbusters fan. He was watching an episode the other day where the Mythbusters were testing the myth of Pykrete, a material that was nothing but wood shavings and ice. They were testing to see whether it was more durable than ice alone, whether it was bulletproof, and whether it could be used to build a boat! [8] In order to test out these crazy claims, they made some in their workshop and compared it with normal ice. How did they test it? By stressing it – placing weights on the end of the block of the ice/pykrete until it broke. (In the end, pykrete was ten times stronger than ice, was bulletproof, and they made a fully operational motor-boat from it!)

So the mechanical definition of stress is, “pressure or tension exerted on a material object.” [9] There are a few illustrations of mechanical stress, in our bodies and in everyday life, that are good metaphors for stress in our lives.

The Classical Stress/Productivity Curve

I confess I am NOT a musician. I’ve never learnt to read music or play an instrument. But I do know that when you first put a new string on the guitar, it’s unstretched – there is literally no force on it at all. If all you did was tied the two ends of the string to the tone peg and the tuning peg, the string would remain limp and lifeless. It wouldn’t be able to do anything useful. It certainly wouldn’t play a note.

When the tuning peg is twisted a few times, there is some tightness in the wire. The string is now under tension (i.e. stress). It is now able to play a note of some form, so it can do some work and fulfill some of the function of a guitar string. But the pitch isn’t good enough – the note is out of tune.

With a small adjustment, the string reaches its optimal tension and can play the correct note! This is the point where the string is fulfilling its designed purpose. Optimal stress equals optimal function.

With further tightening of the string, the perfect pitch is lost, but the string can still produce a sound of some form. With more tension, the string can still make a noise, but it sounds awful, and the fibres inside the cord are starting to tear. If the string were wound further and further, it would eventually break.

If this ratio of the tension of the string versus the usefulness of the string were to be plotted as a graph, it would look like an upside down “U”. This is the classic stress/productivity curve.

StressProductivityCurve_Final

The Exponential Stress/Productivity Curve

The second metaphor that I think illustrates a different concept of the stress/productivity relationship is a car.

As well not being a musician, I am also NOT a mechanic! I know the important things like where the petrol goes, and how to drive them, but otherwise cars are very mysterious and powerful devices, their mystery is only exceeded by their power.

What I do know is that the engine is very much like the guitar string. As more petrol is fed into the engine, the engine gets more powerful. Soon, the engine finds its “power band”, a zone of maximum torque that can be achieved at moderate revolutions. As the engine is given more gas, the power output declines from the middle of the power band. If the engine was maxed out then the amount of functional power coming out is reduced.

This would plot as a similar graph to the U-curve of the stress/productivity curve. But cars not only have engines, but also a gearbox. The gears allow for multiplication of the work done (the productivity) for the same stress on the engine.

G-Force!

As a child, I didn’t dream of becoming an astronaut, but I was interested in space. The beauty of our night sky is as stunning as any forest, river or mountain. I would read of the astronauts in rockets and in space stations, floating around in zero gravity, swimming through the “air”. That sounded like a lot of fun.

But zero gravity isn’t particularly good for you. Some early astronauts had to be carried off their landing craft on stretchers because the effect of zero gravity would render these men weak and atrophied. They boarded the spacecraft at the peak of their physical strength and fitness, but after only a few weeks without gravity, their bodies resembled that of the elderly (although without the wrinkles) [10].

It’s a general principle of the human body that any tissue that isn’t needed shrinks in size – a process called atrophy. In zero gravity, the body doesn’t need as much muscle, so the muscles shrink. The body doesn’t need as much bone strength, so the bones weaken. There is no gravity to pull their blood away from their head, so the blood volume decreases. Because there is less muscle to pump blood to, and less blood to pump, the heart doesn’t work as hard, so the heart muscle atrophies. The net effect of zero gravity is to make you physically weak [10].

On the other hand, too much gravity is not great either. Animals can adapt to small amounts of hypergravity [11]. But large amounts aren’t so good. During astronaut training, NASA subjects the rookie spacemen to rigorous tests including placing them in a large centrifuge and spinning it very fast. The result is an increase in the gravitational forces applied to their bodies. The increased gravity makes everything in the body heavier and their blood is pulled towards the legs and away from the brain, which leads to what is known as G-LOC (Gravity-induced Loss Of Consciousness). In other words, the heart can’t fight the increased force of gravity and the brain loses its blood supply, which makes you pass out. Josh McHugh did an entertaining piece on his experience with G-LOC and the centrifuge in Wired (2003) [12].

In this sense, gravity is to us physically like stress is to us mentally. Without gravity, our physical bodies turn to mush as we slowly weaken from the inside. Too much gravity, and our physical bodies are slowly squashed by the invisible weight of the extra G’s. Our bodies work best at 1G.

In the next post in this series, I’ll look at how these different models of stress apply to our everyday.

References

  1. Shweder, R.A., America’s Latest Export: A Stressed-Out World. The New York Times, New York, 26 January 1997 http://www.nytimes.com/1997/01/26/weekinreview/america-s-latest-export-a-stressed-out-world.html
  2. What Is Stress. [cited 2013, July]; Available from: http://www.stress.org/what-is-stress/.
  3. Half a century of stress research: a tribute to Hans Selye by his students and associates. Experientia, 1985. 41(5): 559-78 http://www.ncbi.nlm.nih.gov/pubmed/3888652
  4. Selye, H., A syndrome produced by diverse nocuous agents. 1936. J Neuropsychiatry Clin Neurosci, 1998. 10(2): 230-1 http://www.ncbi.nlm.nih.gov/pubmed/9722327
  5. Fink, G., Encyclopedia of stress. 1st ed. 2000, Academic Press, San Diego:
  6. McEwen, B.S., Protective and damaging effects of stress mediators: central role of the brain. Dialogues Clin Neurosci, 2006. 8(4): 367-81 http://www.ncbi.nlm.nih.gov/pubmed/17290796
  7. Hackney, A.C., Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress. Expert Rev Endocrinol Metab, 2006. 1(6): 783-92 doi: 10.1586/17446651.1.6.783
  8. Beyond Entertainment / Discovery Channel, The Alaska Special 2 (Season 7, Episode 2), Mythbusters: 2009 Discovery Channel, 44min. http://www.imdb.com/title/tt1427433/
  9. Oxford Dictionary of English – 3rd Edition, 2010, Oxford University Press: Oxford, UK.
  10. Gravity Hurts (So Good). NASA Science | Science News 2001 [cited July 2013]; Available from: http://science1.nasa.gov/science-news/science-at-nasa/2001/ast02aug_1/.
  11. van Loon, J.J., Hypergravity studies in the Netherlands. J Gravit Physiol, 2001. 8(1): P139-42 http://www.ncbi.nlm.nih.gov/pubmed/12650205
  12. McHugh, J., Surviving 7G. Wired, 2003. November(11),

Putting thought in the right place, part 2

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CAP v2.1.2

In the last blog post, I discussed the Cognitive Action Pathways model, a schematic conceptual representation of the hierarchy of key components that underpin human thought and behaviour.

Small changes in the early processes within the Cognitive-Action Pathway model can snowball to effect every other part of the process. A real life example of this is ASD, or Autism Spectrum Disorder.

ASD has been present since time immemorial. Numerous bloggers speculate that Moses may have had ASD, while a couple of researchers proposed that Samson was on the spectrum (although their evidence was tenuous [1]). Thankfully, autism is no longer considered a form of demon possession or madness, or schizophrenia, or caused by emotionally distant “refrigerator mothers”, nor treated with inhumane experimental chemical and physical “treatments” [2, 3].

The autism spectrum is defined by two main characteristics: deficits in social communication and interaction, and restricted repetitive patterns of behaviour. People on the autism spectrum also tend to have abnormal sensitivity to stimuli, and other co-existing conditions like ADHD. The full diagnostic criteria can be found in DSM5. The new criteria are not without their critics [4-6], but overall, reflect the progress made in understanding the biological basis of autism.

ASD is recognized as a pervasive developmental disorder secondary to structural and functional changes in the brain that occur in the womb, and can be detected as early as a month after birth [7]. In the brain of a foetus that will be born with ASD, excess numbers of dysfunctional nerve cells are unable to form the correct synaptic scaffolding, leaving a brain that is large [8, 9], but out-of-sync. The reduced scaffolding leads to local over-connectivity within regions of the brain, and under-connectivity between the regions of the brain [10]. The majority of the abnormal cells and connections are within the frontal lobe, especially the dorsolateral prefrontal cortex and the medial prefrontal cortex [11], as well as the temporal lobes [12]. The cerebellum is also significantly linked to the autism spectrum [13]. There is also evidence that the amygdala and hippocampus, involved in emotional regulation and memory formation, are significantly effected in ASD [10].

There is also strong evidence for an over-active immune system in an autistic person compared to a neurotypical person, with changes demonstrated in all parts of the immune system, and the immune system in the brain as well as the rest of the body [14]. These immune changes contribute to the reduced ability of the brain to form new branches as well as develop new nerve cells or remove unnecessary cells.

There are a number of environmental and epigenetic associations linked to autism. These include disorders of folate metabolism [15, 16], pollutants [17], fever during pregnancy [18] and medications such as valproate and certain anti-depressants [19, 20] which are linked with an increase in autism[1]. Supplements such as folate [15, 21], omega-6 polyunsaturated fatty acids [22] and the use of paracetamol for fevers in pregnancy [18] have protective effects.

Although these factors are important, genes outweigh their influence by about 4:1. Twin studies suggest that between 70-90% of the risk of autism is genetic [23, 24]. Individual gene studies have only shown that each of the many single genes carry about a one percent chance each for the risk of autism [10]. It’s been proposed that the hundreds of genes linked with autism [10, 25] are not properly expressed (some are expressed too much, some not enough). The resulting proteins from the abnormal gene expression contribute to a different function of the cell’s machinery, altering the ability of a nerve cell to fully develop, and the ability of nerve cells to form connections with other nerve cells [26]. The effects are individually small, but collectively influential [24]. Autism is considered a complex genetic disorder involving rare mutations, complex gene × gene interactions, and copy number variants (CNVs) including deletions and duplications [27].

According to the Cognitive-Action Pathways model, the triad of the environment, epigenetics, and genes influence a number of processes that feed into our actions, thoughts, perceptions, personality and physiology. In ASD, the starting place is language processing.

New born babies from as young as two days old prefer listening to their own native language [28], which suggests that we are born already pre-wired for language. Auditory stimuli (sounds) are processed in the temporal lobes, including language processing. In neurotypical people, language processing is done predominantly on the left side, with some effect from the right side. But in people with autism, because of the abnormal wiring, there is only significant activity of the right temporal lobe [12]. Even more, from data so recent that it’s pending publication, loss of the processing of information of the left temporal lobe reversed the brains orientation to social and non-social sounds, like the sound of the babies name [7].

The change in the wiring of the left and right temporal lobes then alters the processing of language, specifically the social significance of language and other sounds. So already from a young age, people with autism will respond differently to environmental stimuli compared to a neurotypical person.

In the same way, the fusiform gyrus is part of the brain that processes faces. It’s quite specific to this task in a neurotypical person. However, the altered wiring of the brain in someone with autism causes a change, with different parts of the brain having to take up the load of facial processing [29].

Each time that one part of the brain can’t perform it’s normal function, the other parts take up the load. However that reduces the capacity for those parts of the brain to perform their own normal functions. In the case of the temporal lobes and the fusiform areas, this results in a reduced ability to discern subtleties especially those related to recognizing social cues. A neurotypical person and an autistic person could be standing in front of the same person, listening to the same words, and seeing the same facial expressions, but because of the way each persons brain processes the information, the perception of those words and cues can be completely different. This demonstrates how genetic changes can lead to changes in the perception of normal sensory input, resulting in differences in the physiological response, emotions, feelings, thoughts and actions, despite identical sensory input.

Physiology

The same changes that effect the cerebral cortex of the brain also have an influence on the deeper structures such as the hippocampus and the amygdala. The hippocampus is largely responsible for transforming working memory into longer term declarative memory. Studies comparing the size of the hippocampus in ASD children have shown an increase in size compared with typical developing children [30]. Combined with the deficits in the nerve cell structure of the cerebellum [13], autistic children and adults have a poor procedural memory (action learning, regulated by the cerebellum) and an overdeveloped declarative memory (for facts, regulated by the hippocampus). This has been termed the “Mnesic Imbalance Theory” [31].

The amygdala is also functionally and anatomically altered because of the changes to the nerve cells and their connections. The amygdala is larger in young children with ASD compared to typically developing children. As a result, young ASD children have higher levels of background anxiety than do neurotypical children [32]. It’s proposed that not only do ASD children have higher levels of background anxiety, they also have more difficulty in regulating their stress system, resulting in higher levels of stress compared to a neurotypical child exposed to the same stimulus [33].

Personality

On a chemical level, autism involves genes that encode for proteins involved in the transport of key neurotransmitters, serotonin and dopamine. Early evidence confirms the deficits of the serotonin and dopamine transporter systems in autism [34]. These neurotransmitters are integral to processing the signals of mood, stress and rewards within the brain, and as discussed in the last chapter, are significantly involved in the genesis of personality.

The abnormal neurotransmitter systems and the resulting deficiencies in processing stress and rewards signals contribute to a higher correlation of neuroticism and introverted personality styles in children with autism symptoms [35, 36].

So people with autism genes are going to process stress and rewards in a different way to the neurotypical population. As a result, their feelings, their thoughts and their resulting actions are tinged by the differences in personality through which all of the incoming signals are processed.

Actions

The underlying genes and neurobiology involved in autism also effect the final behavioural step, not only because genes and sensory input influence the personality and physiology undergirding our feelings and thoughts, but also because they cause physical changes to the cerebellum, the part of the brain involved in fine motor control and the integration of a number of higher level brain functions including working memory, behaviour and motivation [13, 37].

When Hans Asperger first described his cohort of ASD children, he noted that they all had a tendency to be clumsy and have poor handwriting [38]. This is a good example of how the underlying biology of ASD can effect the action stage independently of personality and physiology. The cerebellum in a person with ASD has reduced numbers of a particular cell called the Purkinje cells, effecting the output of the cerebellum and the refined co-ordination of the small muscles of the hands (amongst other things). Reduced co-ordination of the fine motor movements of the hands means that handwriting is less precise and therefore less neat.

A running joke when I talk to people is the notoriously illegible doctors handwriting. One of the doctors I used to work with had handwriting that seriously looked like someone had dipped a chicken’s toes in ink and let it scratch around for a while. My handwriting is messy – a crazy cursive-print hybrid – but at least it’s legible. I tell people that our handwriting is terrible because we spent six years at medical school having to take notes at 200 words a minute. But it might also be that the qualities that make for a good doctor tend to be found in Asperger’s Syndrome, so the medical school selection process is going to bias the sample towards ASD and the associated poor handwriting (Thankfully, those that go on to neurosurgery tend to have good hand-eye coordination).

But if your educational experience was anything like mine, handwriting was seen as one of the key performance indicators of school life. If your handwriting was poor, you were considered lazy or stupid. Even excluding the halo effect from the equation, poor handwriting means a student has to slow down to write neater but takes longer to complete the same task, or writes faster to complete the task in the allotted time but sacrificing legibility in doing so.

Either way, the neurobiology of ASD results in reduced ability to effectively communicate, leading to judgement from others and internal personal frustration, both of which feedback to the level of personality, molding future feelings, thoughts and actions.

Thought in ASD

By the time all the signals have gone through the various layers of perception, personality and physiology, they reach the conscious awareness level of our stream of thought. I hope by now that you will agree with me that thought is irrevocably dependent on all of the various levels below it in the Cognitive-Action Pathways Model. While thoughts are as unique as the individual that thinks them, the common genetic expression of ASD and the resulting patterns in personality, physiology and perception lead to some predictable patterns of thought in those sharing the same genes.

As a consequence of the differences in the signal processing, the memories that make their way to long-term storage are also going to be different. Memories and memory function are also different in ASD for other neurobiological reasons, as described earlier in the blog with the Mnesic Imbalance Theory.

Summary

The Cognitive-Action Pathways model is a way of describing the context of thoughts to other neurological processes, and how they all interact. It shows that conscious thoughts are one link of a longer chain of neurological functions between stimulus and action – simply one cog in the machine. The autistic spectrum provides a good example of how changes in genes and their expression can dramatically influence every aspect of a person’s life – how they experience the world, how they feel about those experiences, and how they think about them.

I used autism as an example because autism is a condition that’s pervasive, touching every aspect of a person’s life, and provides a good example of the extensive consequences from small genetic changes. But the same principles of the Cognitive-Action Pathways Model apply to all aspects of life, including conditions that are considered pathological, but also to our normal variations and idiosyncrasies. Small variations in the genes that code for our smell sensors or the processing of smells can change our preferences for certain foods just as much as cultural exposure. Our appreciation for music is often changed subtly between individuals because of changes in the structure of our ears or the nerves that we use to process the sounds. The genetic structure of the melanin pigment in our skin changes our interaction with our environment because of the amount of exposure to the sun we can handle.

So in summary, this blog was to set out the place that our thoughts have in the grand scheme of life. Thought is not the guiding or controlling force, it is simply a product of a number of underlying functions and variables.

References

  1. Mathew, S.K. and Pandian, J.D., Newer insights to the neurological diseases among biblical characters of old testament. Ann Indian Acad Neurol, 2010. 13(3): 164-6 doi: 10.4103/0972-2327.70873
  2. Wolff, S., The history of autism. Eur Child Adolesc Psychiatry, 2004. 13(4): 201-8 doi: 10.1007/s00787-004-0363-5
  3. WebMD: The history of autism. 2013 [cited 2013, August 14]; Available from: http://www.webmd.com/brain/autism/history-of-autism.
  4. Buxbaum, J.D. and Baron-Cohen, S., DSM-5: the debate continues. Mol Autism, 2013. 4(1): 11 doi: 10.1186/2040-2392-4-11
  5. Volkmar, F.R. and Reichow, B., Autism in DSM-5: progress and challenges. Mol Autism, 2013. 4(1): 13 doi: 10.1186/2040-2392-4-13
  6. Grzadzinski, R., et al., DSM-5 and autism spectrum disorders (ASDs): an opportunity for identifying ASD subtypes. Mol Autism, 2013. 4(1): 12 doi: 10.1186/2040-2392-4-12
  7. Pierce, K. Exploring the Causes of Autism – The Role of Genetics and The Environment (Keynote Symposium 11). in Asia Pacific Autism Conference. 2013. Adelaide, Australia: APAC 2013.
  8. Courchesne, E., et al., Evidence of brain overgrowth in the first year of life in autism. JAMA, 2003. 290(3): 337-44 doi: 10.1001/jama.290.3.337
  9. Shen, M.D., et al., Early brain enlargement and elevated extra-axial fluid in infants who develop autism spectrum disorder. Brain, 2013. 136(Pt 9): 2825-35 doi: 10.1093/brain/awt166
  10. Won, H., et al., Autism spectrum disorder causes, mechanisms, and treatments: focus on neuronal synapses. Front Mol Neurosci, 2013. 6: 19 doi: 10.3389/fnmol.2013.00019
  11. Courchesne, E., et al., Neuron number and size in prefrontal cortex of children with autism. JAMA, 2011. 306(18): 2001-10 doi: 10.1001/jama.2011.1638
  12. Eyler, L.T., et al., A failure of left temporal cortex to specialize for language is an early emerging and fundamental property of autism. Brain, 2012. 135(Pt 3): 949-60 doi: 10.1093/brain/awr364
  13. Fatemi, S.H., et al., Consensus paper: pathological role of the cerebellum in autism. Cerebellum, 2012. 11(3): 777-807 doi: 10.1007/s12311-012-0355-9
  14. Onore, C., et al., The role of immune dysfunction in the pathophysiology of autism. Brain Behav Immun, 2012. 26(3): 383-92 doi: 10.1016/j.bbi.2011.08.007
  15. Schmidt, R.J., et al., Maternal periconceptional folic acid intake and risk of autism spectrum disorders and developmental delay in the CHARGE (CHildhood Autism Risks from Genetics and Environment) case-control study. Am J Clin Nutr, 2012. 96(1): 80-9 doi: 10.3945/ajcn.110.004416
  16. Mbadiwe, T. and Millis, R.M., Epigenetics and Autism. Autism Res Treat, 2013. 2013: 826156 doi: 10.1155/2013/826156
  17. Volk, H.E., et al., Residential proximity to freeways and autism in the CHARGE study. Environ Health Perspect, 2011. 119(6): 873-7 doi: 10.1289/ehp.1002835
  18. Zerbo, O., et al., Is maternal influenza or fever during pregnancy associated with autism or developmental delays? Results from the CHARGE (CHildhood Autism Risks from Genetics and Environment) study. J Autism Dev Disord, 2013. 43(1): 25-33 doi: 10.1007/s10803-012-1540-x
  19. Rai, D., et al., Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study. BMJ, 2013. 346: f2059 doi: 10.1136/bmj.f2059
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  21. Suren, P., et al., Association between maternal use of folic acid supplements and risk of autism spectrum disorders in children. JAMA, 2013. 309(6): 570-7 doi: 10.1001/jama.2012.155925
  22. Lyall, K., et al., Maternal dietary fat intake in association with autism spectrum disorders. Am J Epidemiol, 2013. 178(2): 209-20 doi: 10.1093/aje/kws433
  23. Abrahams, B.S. and Geschwind, D.H., Advances in autism genetics: on the threshold of a new neurobiology. Nature Reviews Genetics, 2008. 9(5): 341-55
  24. Geschwind, D.H., Genetics of autism spectrum disorders. Trends Cogn Sci, 2011. 15(9): 409-16 doi: 10.1016/j.tics.2011.07.003
  25. Chow, M.L., et al., Age-dependent brain gene expression and copy number anomalies in autism suggest distinct pathological processes at young versus mature ages. PLoS Genet, 2012. 8(3): e1002592 doi: 10.1371/journal.pgen.1002592
  26. O’Roak, B.J., et al., Sporadic autism exomes reveal a highly interconnected protein network of de novo mutations. Nature, 2012. 485(7397): 246-50 doi: 10.1038/nature10989
  27. Stankiewicz, P. and Lupski, J.R., Structural variation in the human genome and its role in disease. Annu Rev Med, 2010. 61: 437-55 doi: 10.1146/annurev-med-100708-204735
  28. Moon, C., et al., Two-day-olds prefer their native language. Infant behavior and development, 1993. 16(4): 495-500
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  30. Schumann, C.M., et al., The amygdala is enlarged in children but not adolescents with autism; the hippocampus is enlarged at all ages. J Neurosci, 2004. 24(28): 6392-401 doi: 10.1523/JNEUROSCI.1297-04.2004
  31. Romero-Munguía, M.A.n., Mnesic Imbalance and the Neuroanatomy of Autism Spectrum Disorders, in Autism – A Neurodevelopmental Journey from Genes to Behaviour, Eapen, V., (Ed). 2011 Edition 1st, InTech. p. 425-44.
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[1] A word of caution: While there’s good evidence that valproate increases the risk of autism, and a possible link between some anti-depressants and autism, that risk has to be balanced with the risk to the baby of having a mother with uncontrolled epilepsy or depression, which may very well be higher. If you’re taking these medications and you are pregnant, or want to become pregnant, consult your doctor BEFORE you stop or change your medications. Work out what’s right for you (and your baby) in your unique situation.

Dr Caroline Leaf: Putting thought in the right place

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Following hard on the heels of her false assumption that our minds control our health, not our genes, and following the same theme, Dr Leaf had this to say today, “Everything is first a thought; the brain is being controlled with EVERY thought you think!”

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. Reading back through my blogs, this “thought controls the brain / mind controls matter” is a recurrent theme of hers. It is repeated multiple times in her books, like when she writes, “Thoughts influence every decision, word, action and physical reaction we make.” [1: p13] and “Our mind is designed to control the body, of which the brain is a part, not the other way around. Matter does not control us; we control matter through our thinking and choosing” [2: p33] just as a couple of examples.

So how does thought relate to the grand scheme of our brain and it’s processing? Does our thought really control our brain, or is it the other way around. Through all of the reading that I have done on neuroscience, I propose a model of the place of thought in relation to the rest of our brains information processing. It is based on the LIDA model, dual systems models, and other neuroscientific principles and processes.

We’ve all heard the phrase, “It’s just the tip of the iceberg.” It comes from the fact that icebergs are made of fresh water, which is nine-tenths less dense than seawater. As a result, ten percent of an iceberg sits above the waters surface with most of it hiding beneath.

The information processing of our brains is much the same. We may be aware of our conscious stream of thought, but there is a lot going on under the surface that makes our thoughts what they are, even though we can’t see the process underneath.

What’s going on under the surface is a complex interplay of our genes and their expression which controls the structure and function of our brains, which effects how we perceive information, how we process that information and combine it into our memories of the past, predictions of the future, and even the further perception of the present [3].

CAP v2.1.2
Genes, epigenetics and the environment
We start with the most fundamental level of our biological system, which is genetics. It becomes clear from looking at any textbook of biological sciences that genes are fundamental to who we are. From the simplest bacteria, fungi, protozoans and parasites, through to all plants, all animals and all of human kind – EVERY living thing has DNA. DNA is what defines life in the broadest sense.

Proteins are responsible for the size, shape and operation of the cell. They make each tissue structurally and functionally different, but still work together in a highly precise electrochemical synchrony. But ultimately, it’s our genes that hold all of the instructions to make every one of the proteins within our cells. Without our genes, we would be nothing more than a salty soup of random amino acids.

Epigenetics and the environment contribute to the way genes are expressed. Epigenetics are “tags” on the strand of DNA that act to promote or silence the expression of certain genes (I discuss this in more detail in chapter 12 of my book, https://www.smashwords.com/books/view/466848). Environmental factors (the components that make up the world external to our bodies) can influence genes and epigenetic markers. The environment can cause genetic mutations or new epigenetic marks that change the function of a particular gene, and depending on which cell they effect (a very active embryonic cell or a quiet adult cell) will largely determine the eventual outcome. The environment is more influential to our genetic expression than epigenetics.

Still, on average only about 25% of the expression of a complex trait is related to environmental factors. So while the environment is important, it is still outdone 3:1 by our genome.

Yes, epigenetics and the environment are important, but they influence, not control, the genome.

Perception
We live in a sensory world. The five senses are vital in providing the input we need for our brain to understand the world and meaningfully interact with it.

Different organs are needed to translate the optical, chemical or mechanical signals into electrical signals. Different parts of our brain then interpret these signals and their patterns.

Our genes significantly influence this process. For example, if someone is born with red-green colour blindness then how he or she interprets the world will always be subtly different to someone with normal vision. Or a person born with congenital deafness will always interpret his or her environment in a different way to someone with full hearing. I’ve highlighted these two conditions because they provide stark examples to help demonstrate the point, but there are many unique genetic expressions in each of the five senses that subtly alter the way each of us perceives the world around us.

So while we may all have the same photons of light hitting our retinas, or the same pressure waves of sound reaching our ears or touch on our skin, how our brains receive that information is slightly different for every individual. The information from the outside world is received by our sensory organs, but it is perceived by our brain, and even small differences in perception can have a big impact on the rest of the system.

Personality
Personality is “the combination of characteristics or qualities that form an individual’s distinctive character” [4]. Formally speaking, personality is, “defined as constitutionally based tendencies in thoughts, behaviors, and emotions that surface early in life, are relatively stable and follow intrinsic paths of development basically independent of environmental influences.” [5]

Professor Gregg Henriques explained it well in Psychology Today, “Personality traits are longstanding patterns of thoughts, feelings, and actions which tend to stabilize in adulthood and remain relatively fixed. There are five broad trait domains, one of which is labeled Neuroticism, and it generally corresponds to the sensitivity of the negative affect system, where a person high in Neuroticism is someone who is a worrier, easily upset, often down or irritable, and demonstrates high emotional reactivity to stress.” [6] The other four personality types are Extraversion, Agreeableness, Conscientiousness, and Openness to Experience.

Gene x environment studies suggest that personality is highly heritable, with up to 60% of personality influenced by genetics [7], predominantly through genes involved in the serotonin [8] and dopamine systems [9, 10]. The “non-shared environment” (influences outside of the home environment) contributes heavily to the remainder [11, 12].

Personality is like a filter for a camera lens, shaping the awareness of our emotional state for better or worse, thus influencing the flow on to our feelings (the awareness of our emotions), our thoughts, and our actions.

Physiology
Watkins describes physiology as streams of data that are provided from the different parts of your body, like the heart rate, your breathing rate, the oxygen in your blood, the position of your joints, the movement of your joints, even the filling of your bladder telling you that you need a break soon.

All of these signals are constantly being generated, and collated in different parts of the brain. Some researchers consider them positive and negative depending on the data stream and the signal its providing. They coalesce into emotion [13].

Emotion
According to Watkins, “emotion” is the sum of all the data streams of physiology, or what he described as “E-MOTION … Energy in MOTION.” [13] In this context, think of emotion as a bulls-eye spirit-level of our body systems. The different forces of our physiology change the “level” constantly in different directions. Emotion is the bubble that marks the central point, telling us how far out of balance we are.

In the interest of full disclosure, I should mention that although emotion is a familiar concept, the work of literally thousands of brilliant minds has brought us no closer to a scientifically validated definition of the word “emotion”. Some psychologists and researchers consider it vague and unscientific, and would prefer that it not be used altogether [14].

I’ve retained it because I think it’s a well-recognised word that conceptually describes the balance of physiological forces.

Feelings
“Feelings” are the perception of emotion.

I discussed earlier in the chapter that what we perceive is different to what we “see” because the subtle genetic differences in our eyes and brains causes the information to be processed differently between individuals. The same applies to the perception of our emotion.

As I wrote earlier, personality is largely determined by our genetics with contributions from our environment [11, 12]. The emotional signal is filtered by our personality to give rise to our feelings. Classically, an optimistic personality is going to bias the emotional input in a positive, adaptive way while a pessimist or neurotic is going to bias the emotional signal in a maladaptive way

That’s not to say that an optimist can’t have depressed feelings, or a neurotic can’t have happy feelings. In the same way that a coloured lens will allow a lot of light through but filter certain wavelengths out, most of our emotional state of being will come through the filter of our personality but the feelings will be subtly biased one way or another.

Executive Functions
Executive function of the brain is defined as a complex cognitive process requiring the co-ordination of several sub-processes to achieve a particular goal [15]. These sub-processes can be variable but include working memory, attention, goal setting, maintaining and monitoring of goal directed action and action inhibition. In order to achieve these goals, the brain requires flexibility and coordination of a number of networks and lobes, although mainly the prefrontal cortex, parietal cortex, anterior cingulate and basal ganglia, and the while matter tracts that connect them.

Executive functions process the incoming information and decide on what goals are best given the context, then plan the goals, execute them to the motor cortices, and monitor the action. Research work from Marien et al [16] demonstrates that unconscious/implicit goals can divert resources away from conscious goals especially if it is emotionally salient or otherwise strongly related. They also confirm that conscious awareness is not necessary for executive function but that implicit goals can be formed and executed without conscious involvement.

Thoughts
Thoughts are essentially a stream of data projected into our conscious space. Baars [17, 18] noted that the conscious broadcast comes into working memory which then engages a wider area of the cerebral cortex necessary to most efficiently process the information signal. We perceive thought most commonly as either pictures or sounds in our head (“the inner monologue”), which corresponds to the slave systems of working memory. When you “see” an image in your mind, that’s the visuospatial sketchpad. When you listen to your inner monologue, that’s your phonological loop. When a song gets stuck in your head, that’s your phonological loop as well, but on repeat mode.

There is another slave system that Baddeley included in his model of working memory called the episodic buffer, “which binds together complex information from multiple sources and modalities. Together with the ability to create and manipulate novel representations, it creates a mental modeling space that enables the consideration of possible outcomes, hence providing the basis for planning future action.” [19]

Deep thinking is a projection from your brains executive systems (attention or the default mode network) to the central executive of working memory, which then recalls the relevant information from long-term memory and directs the information through the various parts of the slave systems of working memory to process the complex details involved. For example, visualizing a complex scene of a mountain stream in your mind would involve the executive brain directing the central executive of working memory to recall information about mountains and streams and associated details, and project them into the visuospatial sketchpad and phonological loop and combine them via the episodic buffer. The episodic buffer could also manipulate the scene if required to create plans, or think about the scene in new or unexpected ways (like imagining an elephant riding a bicycle along the riverbank).

Even though the scene appears as one continuous episode, it is actually broken up into multiple cognitive cycles, in the same way that images in a movie appear to be moving, but are really just multiple still frames played in sequence.

Action
Action is the final step in the process, the output, our tangible behaviour

Our behaviour is not the direct result of conscious thought, or our will (as considered in the sense of our conscious will).

We discussed this before when we talked about our choices in chapter 1. There are two main pathways that lead from sensory input to tangible behaviour – various automated pathways that take input from the thalamus, deep in the brain, and sent to motor circuits in the supplementary motor area and motor cortex of the brain. These can be anything from evasive “reflex” actions[1] to rehearsed, habituated motor movements, like driving. Then there is the second pathway, coming from the executive areas of our brain, that plan out options for action, which are reviewed by the pre-supplemental motor area and the default mode network.

This second pathway is amenable to conscious awareness. Like thought, the projection of different options for action into our consciousness helps to engage a wider area of cerebral cortex to process the data. Most of the possible plans for action have already been rejected by the implicit processing of our executive brain before consciousness is brought in to help. Once an option has been selected, the action is sent to the pre-supplementary motor area, the supplementary motor area, the basal ganglia and finally the motor cortex.

According to the model proposed by Bonn [20], the conscious network has some feedback from the control network of our brain, providing real time context to actions about to be executed, and a veto function, stopping some actions at the last minute before they are carried out. This is largely a function of the basal ganglia [21], with some assistance from working memory.

So as you can see, according to the CAP model, conscious thoughts are one link of a longer chain of neurological functions between stimulus and action – simply one cog in the machine. Thoughts are dependent on a number of processes that are both genetically and environmentally determined, beyond our conscious control. It’s simply wrong to assume that thoughts control the brain.

Dr Leaf is welcome to her opinion, but it is in contradiction to the overwhelming majority of neuroscientific knowledge

References

  1. Leaf, C., Who Switched Off My Brain? Controlling toxic thoughts and emotions. 2nd ed. 2009, Inprov, Ltd, Southlake, TX, USA:
  2. Leaf, C.M., Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. 2013, Baker Books, Grand Rapids, Michigan:
  3. Hao, X., et al., Individual differences in brain structure and resting brain function underlie cognitive styles: evidence from the embedded figures test. PLoS One, 2013. 8(12): e78089 doi: 10.1371/journal.pone.0078089
  4. Oxford Dictionary of English – 3rd Edition, 2010, Oxford University Press: Oxford, UK.
  5. De Pauw, S.S., et al., How temperament and personality contribute to the maladjustment of children with autism. J Autism Dev Disord, 2011. 41(2): 196-212 doi: 10.1007/s10803-010-1043-6
  6. Henriques, G. (When) Are You Neurotic? Theory of Knowledge: Psychology Today; 2012, 23 Nov 2012 [cited 2013 23 Nov 2012]; Available from: http://www.psychologytoday.com/blog/theory-knowledge/201211/when-are-you-neurotic.
  7. Vinkhuyzen, A.A., et al., Common SNPs explain some of the variation in the personality dimensions of neuroticism and extraversion. Transl Psychiatry, 2012. 2: e102 doi: 10.1038/tp.2012.27
  8. Caspi, A., et al., Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits. Am J Psychiatry, 2010. 167(5): 509-27 doi: 10.1176/appi.ajp.2010.09101452
  9. Felten, A., et al., Genetically determined dopamine availability predicts disposition for depression. Brain Behav, 2011. 1(2): 109-18 doi: 10.1002/brb3.20
  10. Chen, C., et al., Contributions of dopamine-related genes and environmental factors to highly sensitive personality: a multi-step neuronal system-level approach. PLoS One, 2011. 6(7): e21636 doi: 10.1371/journal.pone.0021636
  11. Krueger, R.F., et al., The heritability of personality is not always 50%: gene-environment interactions and correlations between personality and parenting. J Pers, 2008. 76(6): 1485-522 doi: 10.1111/j.1467-6494.2008.00529.x
  12. Johnson, W., et al., Beyond Heritability: Twin Studies in Behavioral Research. Curr Dir Psychol Sci, 2010. 18(4): 217-20 doi: 10.1111/j.1467-8721.2009.01639.x
  13. Watkins, A. Being brilliant every single day – Part 1. 2012 [cited 2 March 2012]; Available from: http://www.youtube.com/watch?v=q06YIWCR2Js.
  14. Dixon, T., “Emotion”: The History of a Keyword in Crisis. Emot Rev, 2012. 4(4): 338-44 doi: 10.1177/1754073912445814
  15. Elliott, R., Executive functions and their disorders Imaging in clinical neuroscience. British Medical Bulletin, 2003. 65(1): 49-59
  16. Marien, H., et al., Unconscious goal activation and the hijacking of the executive function. J Pers Soc Psychol, 2012. 103(3): 399-415 doi: 10.1037/a0028955
  17. Baars, B.J. and Franklin, S., How conscious experience and working memory interact. Trends Cogn Sci, 2003. 7(4): 166-72 http://www.ncbi.nlm.nih.gov/pubmed/12691765 ; http://bit.ly/1a3ytQT
  18. Baars, B.J., Global workspace theory of consciousness: toward a cognitive neuroscience of human experience. Progress in brain research, 2005. 150: 45-53
  19. Repovs, G. and Baddeley, A., The multi-component model of working memory: explorations in experimental cognitive psychology. Neuroscience, 2006. 139(1): 5-21 doi: 10.1016/j.neuroscience.2005.12.061
  20. Bonn, G.B., Re-conceptualizing free will for the 21st century: acting independently with a limited role for consciousness. Front Psychol, 2013. 4: 920 doi: 10.3389/fpsyg.2013.00920
  21. Beste, C., et al., Response inhibition subprocesses and dopaminergic pathways: basal ganglia disease effects. Neuropsychologia, 2010. 48(2): 366-73 doi: 10.1016/j.neuropsychologia.2009.09.023

[1] We often describe rapid unconscious movements, especially to evade danger or to protect ourselves, as “reflexes”. Medically speaking, a true reflex is a spinal reflex, like the knee-jerk reflex. When a doctor taps the knee with the special hammer, the sudden stretch of the tendon passes a nerve impulse to the spinal cord, which is then passed to the muscle, which makes it contract. A true reflex doesn’t go to the brain at all.

Labels – the good, the bad, and the ugly

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Yesterday, I wrote a rebuttal to Dr Caroline Leaf’s social media post, that “Psychiatric labels lock people into mental ill-health.” In my rebuttal, I suggested that psychiatric labels don’t lock anyone into mental ill-health any more than a medical diagnosis locks people into physical ill-health.

In the feedback I received, one intelligent young lady commented that, “I understand your point completely, but I took her words differently. I have often seen people who use their diagnosis as an excuse. For example, a kid gets diagnosed with Autism or ADHD, and suddenly the parents are using that as an excuse for their bad behaviour instead of teaching and helping them to deal with it. Another example, an adult is diagnosed with something mild, but uses it as an excuse to no longer care about trying to get a job or trying to get treatment and make an effort to get better”.

I certainly understand where she’s coming from. I’ve seen it too. A diagnosis is used as an excuse for someone’s avoidance, or a tool to milk every drop of sympathy from another. Giving someone a label seems to hinder some people more than help them.

Thankfully, there’s more than one side to the label story. I wanted to use today’s post to discuss the good, the bad, and the ugly side of diagnostic labels.

First, lets look at the ugly side of a diagnostic label. There will always be emotional and social connotations to every diagnosis that a person receives. Sometimes that’s sympathy, and sometimes that’s stigma. If a young woman told her friends that she had breast cancer, I’m sure that news would be met with an outpouring of care and support. If the same young woman told the same friends that she had chlamydia or genital herpes, I’d bet that most of the responses would be blaming or shaming, which is one reason why no one tells other people they’ve got chlamydia or herpes.

The same goes for mental health. The media often portrays people with mental illness as either homicidal or weak [1]. So the general response to mental health diagnoses is either fear or contempt. Even those who are neutral towards mental health often don’t understand it, so it’s difficult for those with mental health issues to receive true empathy for their plight.

Then, there is the bad side of a label. Labels can be misused, intentionally or unintentionally, for all sorts of reasons. They can also be wrongly applied. It might be that someone uses their diagnosis to draw sympathy from people, or money, or help when they don’t really need it. They might use their label as an excuse to avoid certain things they don’t like. There are innumerable ways that people can milk secondary gain from their problems.

However, appropriate diagnosis can bring many benefits. For example, correct labelling brings with it understanding and empowerment.

A diagnosis can help us understand more about ourselves, or the person with the diagnosis. That child with ADHD isn’t just being naughty, but has difficulty regulating their behaviour. That person with Asperger’s isn’t being intentionally rude, but has trouble with social cues, understanding body language, and communicating in an empathic way. A correct diagnosis also helps us understand our own strengths and weaknesses. They help us recognise what it is about ourselves that we can’t change, what we can change, and what we need to change.

Once you understand what it is you can change and what you can’t change, it empowers you to change what you can for the better, and accept and adapt to what you can’t change. You stop wasting precious strength and time fighting what you can’t change. Instead, all of the effort that would have been needlessly spent on the unchangeable can be effectively spent on improving what needs to be, and can be, changed.

In fairness, I should point out that a diagnosis isn’t always needed to make positive change. Acceptance and Commitment Therapy is a form of psychological therapy that encourages flexibility to accept those parts of our lives that are uncomfortable, whether they have a label or not, and allow our values to shape our life direction. Sometimes we can spend so much energy looking for a diagnosis that we stagnate, forgoing the forward momentum of what we value to focus on having a label for the symptoms.

But where a diagnosis can be made without undue effort, it can provide clarity to what often seems to be a jumbled mess of dysfunctional traits.

So, sure, sometimes labels can be used for the wrong things. That doesn’t mean they’re not useful or we should stop using them. There may be a stigma to a diagnosis of herpes or depression, but there are also good treatments available. The diagnosis may provide a way of changing a life of ongoing suffering to a life fulfilled.

More often than not, a good diagnosis helps bring clarity to a situation, enabling understanding, acceptance and empowerment. Rather than locking people in, a correct label usually unlocks a person’s potential to grow despite the problems they face.

References

  1. Corrigan, P.W. and Watson, A.C., Understanding the impact of stigma on people with mental illness. World Psychiatry, 2002. 1(1): 16-20 http://www.ncbi.nlm.nih.gov/pubmed/16946807

Dr Caroline Leaf – Exacerbating the Stigma of Mental Illness

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Screen Shot 2014-10-18 at 12.44.33 pm

It was late in the afternoon, you know, that time when the caffeine level has hit critical and the only way you can concentrate on the rest of the day is the promise you’ll be going home soon.

The person sitting in front of me was a new patient, a professional young woman in her late 20’s, of Pakistani descent. She wasn’t keen to discuss her problems, but she didn’t know what else to do. After talking to her for a few minutes, it was fairly obvious that she was suffering from Generalised Anxiety Disorder, and I literally mean suffering. She was always fearful but without any reason to be so. She couldn’t eat, she couldn’t sleep, her heart raced all the time.

I was actually really worried for her. She let me do some basic tests to rule out any physical cause that was contributing to her symptoms, but that was as far as she let me help her. Despite talking at length about her diagnosis, she could not accept the fact that she had a psychiatric condition, and did not accept any treatment for it. She chose not to follow up with me either. I only saw her twice.

Perhaps it was fear for her job, social isolation, or a cultural factor. Perhaps it was the anxiety itself. Whatever the reason, despite having severe ongoing symptoms, she could not accept that she was mentally ill. She was a victim twice over, suffering from both mental illness, and its stigma.

Unfortunately, this young lady is not an isolated case. Stigma follows mental illness like a shadow, an extra layer of unnecessary suffering, delaying proper diagnosis and treatment of diseases that respond best to early intervention.

What contributes to the stigma of mental illness? Fundamentally, the stigma of mental illness is based on ignorance. Ignorance breeds stereotypes, stereotypes give rise to prejudice, and prejudice results in discrimination. This ignorance usually takes three main forms; people with mental illness are homicidal maniacs who need to be feared; they have childlike perceptions of the world that should be marveled; or they are responsible for their illness because they have weak character [1].

Poor information from people who claim to be experts doesn’t help either. For example, on her social media feed today, Dr Caroline Leaf said, “Psychiatric labels lock people into mental ill-health; recognizing the mind can lead us into trouble and that our mind is powerful enough to lead us out frees us! 2 Timothy1:7 Teaching on mental health @TrinaEJenkins 1st Baptist Glenardin.”

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. It’s disturbing enough that Dr Leaf, who did not train in cognitive neuroscience, medicine or psychology, can stand up in front of people and lecture as an “expert” in mental health. It’s even more disturbing when her views on mental health are antiquated and inane.

Today’s post, for example. Suggesting that psychiatric labels lock people in to mental ill-health is like saying that a medical diagnosis locks them into physical ill-health. It’s a nonsense. Does diagnosing someone with cancer lock them into cancer? It’s the opposite, isn’t it? Once the correct diagnosis is made, a person with cancer can receive the correct treatment. Failing to label the symptoms correctly simply allows the disease to continue unabated.

Mental illness is no different. A correct label opens the door to the correct treatment. Avoiding a label only results in an untreated illness, and more unnecessary suffering.

Dr Leaf’s suggestion that psychiatric labels lock people in to their illness is born out of a misguided belief about the power of words over our thoughts and our health in general, an echo of the pseudo-science of neuro-linguistic programming.

The second part of her post, that “recognizing the mind can lead us into trouble and that our mind is powerful enough to lead us out frees us” is also baseless. Her assumptions, that thought is the main driving force that controls our lives, and that fixing our thought patterns fixes our physical and psychological health, are fundamental to all of her teaching. I won’t go into it again here, but further information on how Dr Leaf’s theory of toxic thinking contradicts basic neuroscience can be found in a number of my blogs, and in the second half of my book [2].

I’ve also written on 2 Timothy 1:7 before, another of Dr Leaf’s favourite scriptures, a verse whose meaning has nothing to do with mental health, but seized upon by Dr Leaf because one English translation of the original Greek uses the words “a sound mind”.

So Dr Leaf believes that labelling someone as having a mental illness will lock them into that illness, an outdated, unscientific and purely illogical notion that is only going to increase the stigma of mental illness. If I were @TrinaEJenkins and the good parishioners of 1st Baptist Glenardin, I would be asking for my money back.

With due respect, and in all seriousness, the stigma of mental illness is already disproportionate. Mental illness can cause insurmountable suffering, and sometimes death, to those who are afflicted by it. The Christian church does not need misinformation compounding the suffering for those affected by poor mental health. Dr Leaf should not be lecturing anyone on mental health until she has been properly credentialed.

References

  1. Corrigan, P.W. and Watson, A.C., Understanding the impact of stigma on people with mental illness. World Psychiatry, 2002. 1(1): 16-20 http://www.ncbi.nlm.nih.gov/pubmed/16946807
  2. Pitt, C.E., Hold That Thought: Reappraising the work of Dr Caroline Leaf, 2014 Pitt Medical Trust, Brisbane, Australia, URL http://www.smashwords.com/books/view/466848