Bernards Voices

Two Personalities, One Brain? (broadcast Friday, November 13th, 2009)
http://www.sciencefriday.com/program/archives/200911133

NPR Science Friday‘s Ira Flatow interviews Psychotherapist Kathy Steele and Psychiatrist Numan Gharaibeh on dissociative identity disorder. Once the 2 guests get past the DSM semantics debate, and get past agreeing on the disservice of popular media, they do get the the crux of the question: can you have two distinct personalities in one brain, or is dissociation like tuning out the road and traffic while driving to work, not a second personality, just the one personality in a different state of awareness.

On the Science Friday website, this link to the Skeptic’s Dictionary was useful.
http://www.skepdic.com/mpd.html

In September 29th’s New York Times, Robin Marantz Henig published Understanding the Anxious Mind. 15% to 20% of babies react strongly to novelty, and they are more likely to grow up anxious.

Four significant long-term longitudinal studies are now under way: two at Harvard that Kagan initiated, two more at the University of Maryland under the direction of Nathan Fox, a former graduate student of Kagan’s. With slight variations, they all have reached similar conclusions: that babies differ according to inborn temperament; that 15 to 20 percent of them will react strongly to novel people or situations; and that strongly reactive babies are more likely to grow up to be anxious.

. . . three ways to identify an emotion: the physiological brain state, the way an individual describes the feeling and the behavior the feeling leads to. Not every brain state sparks the same subjective experience; one person might describe a hyperaroused brain in a negative way, as feeling anxious or tense, while another might enjoy the sensation and instead uses a positive word like “alert.” Nor does every brain state spark the same behavior: some might repress the bad feelings and act normally; others might withdraw. But while the behavior and the subjective experience associated with an emotion like anxiety might be in a person’s conscious control, physiology usually is not. This is what Kagan calls “the long shadow of temperament.”

ANXIETY IS NOT fear, exactly, because fear is focused on something right in front of you, a real and objective danger. It is instead a kind of fear gone wild, a generalized sense of dread about something out there that seems menacing — but that in truth is not menacing, and may not even be out there.

I can relate to the peseveration, or obsessive thinking, symptoms, but the clammer of terror is not as loud, nor as terrible, in my brain as it may have been in some with true anxiety disorder.

. . . clinical anxiety disorder, of which there are several forms: panic, social anxiety, phobia, obsessive-compulsive, post-traumatic stress and a catch-all called generalized anxiety disorder. Taken together, they make anxiety the most common mental illness in America, affecting an estimated 40 million adults.

. . . the amygdala . . . responds to novelty and threat. When the amygdala works as it should, it orchestrates a physiological response to changes in the environment. That response includes heightened memory for emotional experiences and the familiar chest pounding of fight or flight.

. . . in high-reactive study subjects, the amygdala is hyperreactive.

Two people can experience the same level of anxiety, he said, but one who has interesting work to distract her from the jittery feelings might do fine, while another who has just lost his job spends all day at home fretting and might be quicker to reach a point where the thrum becomes overwhelming. It’s all in the context, the interpretation, the ability to divert your attention from the knot in your gut.

I am very interested in this ability to divert your attention from the knot in your gut.  I have that.  I can see how that is the type of behavior you can practice and learn over time … probably with the help of talk therapy.  But I don’t understand if that is ability is always good, or if it leads to suppressing emotions, not being in touch with emotions, not feeling the feeling that sometimes concerns my therapist.

The children tended to get a better grip on their fearfulness as they got older. By adolescence, the rate of anxiety in Kagan’s study subjects declined overall, including in the high-risk group. At 15, about two-thirds of those who had been high-reactors in infancy behaved pretty much like everybody else.

So, yes, anxiety can dimish as we grow older.  I don’t like how the author blended fear and anxiety this time.  I’m eager to think of them as distinct things–fear, again, focused or on demostrably real objects like a mountain lion on tree limb 30 yards down the trail from where you’re hiking, alone, right now.

One job of the prefrontal cortex is inhibitory, putting a damper on signals that come from the amygdala. . . . Schwartz reviewed brain [MRI] images, and the difference between the cortical thickening in the high-reactive group and the low-reactives not only remained; it also became more pronounced. One explanation of this could be that a thicker cortex is protective in the anxiety-prone. He surmises that those 14 subjects who developed problems did so in part because their cortex was thinner, and the high-reactives who had avoided social anxiety had the thickest cortexes of all.

The cortex applies the brake–the emotional regulator.  You get the sensation of anxiety from the amygdala, but your cortex is deciding how to respond … and high reactives can still have coping mechanisms / behavior that reduces social anxiety.

Anxiety can occur at three levels: brain, behavior and subjective experience. Were the ones whose brains looked anxious on the M.R.I. scans actually experiencing the sensation of being anxious?

This quote makes me think of the mystery of suppressing emotions.  Many people (mental health professionals and friends) advise me not to suppress emotions, but other mental health professionals say suppressing emotions is impossible.  You can moderate your response to the feeling … but you can’t not feel the feeling.  With anxiety, Henig is saying that the brain can appear anxious on an MRI, but there is no (reported) sensation of anxiety.

Pine told me that his subjects often admit, after the fact, that they had been more afraid during the experiment than they said at the time — leaving him unsure what conclusions to draw.

Well ok.  That’s easy.  That’s not suppressing the sensation; that’s just behavior, not admitting to it.  The pre-frontal cortex applying the brake.

Plomin, who runs a longitudinal twin study of genes and behavior at King’s College, London, agrees that anxiety does have a neurological fingerprint, but he worries about a disconnect between anxiety in the lab and anxiety as a quotidian experience. “Let’s say that in your real life you learn to manage your temperamental dispositions so you don’t freak out,” he said. “Let’s say you learn to take a deep breath, learn tricks to make yourself function better in life. But in the lab you’re not dealing with social situations you’ve learned to control. You’re just shown — boom! — some horrible picture of a bloody accident.” If your response to a brutal image is milliseconds faster than the response of someone who is more sanguine, Plomin asked, what does that really tell you about how your brain would respond in the real world to a worrisome situation?

But if you have learned to control your behavior, to structure your life so you can limit triggers and cope with your emotional skittishness, how much does [having an anxious, high-reactive, mind] really matter?

Now on the behavior side … what we can learn to manage those signals from the amygdala … perhaps from a therapist doing cognitive behavior therapy.

Fox, meanwhile, noted that the high-reactive babies who went to day care when they were young were significantly less fearful at age 4 than were the high-reactives who stayed home with their mothers.

Some children figure out themselves what works best. “Inner struggles pulled at me for years until I was able to just let go and calm myself,” wrote one of Kagan’s high-reactive study subjects in an essay, revealing a wisdom far beyond his 13 years. “For example, when I first heard about the anthrax in Washington, I began to have an upset stomach. I realized it was simply because of my anxiety that I was feeling sick. As soon as I realized that, the stomachache went away. Because I now understand my predisposition toward anxiety, I can talk myself out of simple fears.” There are many adults, anxious or not, who can’t control their own interior monologues as well as this boy can.

. . . the anxious temperament does offer certain benefits: caution, introspection, the capacity to work alone.

I ended up excerpting a lot from this article.  Thanks to Libby’s friend Shane, who the highlighted the article.

Another from Dr. Becker-Phelps Psychology Today Making Change blog. Science and Psychology!!! Love this topic. Here’s a good quote from Leslie:

Cumulative psychological literature shows that when competing forms of therapy are compared, the outcomes almost always come out about the same. The quality of the therapist-patient alliance is the best predictor of outcome (see Let’s Face Facts article). This means that people who need help will benefit most from finding a qualified therapist with whom they connect and who expresses views that fit with how they think.

https://www.psychologytoday.com/blog/making-change/200910/psychologists-reject-science-false-and-misleading-article

Leslie’s post has a lot of links to Newsweek, Psychology Today, Sciencedaily.com, and others. Good reading.  Don’t want to spoil you with the answer to the question.

From Dr. Becker-Phelps Psychology Today Blog: Making Change.  http://www.psychologytoday.com/blog/making-change/200910/why-the-way-we-were-is-the-way-you-stay

One basic element to consider in understanding how people struggle with change is self-verification. They develop particular ways of defining themselves and then find ways to support those beliefs. Having a secure sense of who we are is so important that some people choose to cling to it-even when they’d be better off changing.

Leslie defines the Stages of Change in this blog post.  I’m living through many, frequent, large changes.  I do not feel like I’ve been volunteering for these changes.  But I am an agent in them.  There are many things I control.  There are decisions I make … go left, turn right, curl up in ball on the couch and watch TV.  Leslie makes a great point about people being so committed to self-definitions that even when they are negative, we prefer them over change.

… we are going along, accepting and believing our definitions of ourselves. Knowing who we are gives us a sense of safety and confidence in navigating through life; so we are deeply committed to our self-definitions. When faced with problems, we are likely to defend how we see ourselves-not wanting to give up that safety and confidence.

Even if someone has a painful self-definition, such as I am a failure; they at least know who they are. This way of defining themselves guides them in them daily lives (i.e. I won’t even try something new because I’ll just fail); it also prevents them from seeing conflicting facts (i.e. I have succeeded at some things in my life and might succeed at this). So, they are generally not motivated to even try to change because being different is not an option. And, when they do try to change, it’s usually a half-hearted attempt; their first lapse sends them back to the same old “I’m a failure” thoughts.

From today’s New York Times: http://www.nytimes.com/2009/11/12/us/12families.html

For many families across the country, the greatest damage inflicted by this recession has not necessarily been financial, but emotional and psychological. Children, especially, have become hidden casualties, often absorbing more than their parents are fully aware of. Several academic studies have linked parental job loss — especially that of fathers — to adverse impacts in areas like school performance and self-esteem.