Bernards Voices

Nature’s Eric Olson interviews Kerry Ressler’s on his research published in Nature 470, February 24, 2011:

Why do some people develop post-traumatic stress disorder, but others emerge from a horrific event relatively unscathed? A molecule involved in orchestrating the brain’s response to stress may hold the key to this difference.

Women are 30 to 50 per cent more likely to develop PTSD than men. (The interview doesn’t address the episodic nature of PTSD. I don’t believe this research tell us anything about an episode’s frequency or intensity–for example, a flashback triggered by a car back fire. Nor does it address the extent with which anxiety episodes are chronic and worsen over time. I have my own personal obsession, I guess would be the word, about whether levels of estrogen and how they change over a woman’s lifetime, impact the intensity of her anxiety or depression.)

During the interview, PTSD is mentioned often by the interviewer, but the researcher, Kerry Ressler, doesn’t seem to differentiate between PTSD, panic and generalized anxiety disorders, as well as depression. The biological factors (the protein: Pituitary adenylate cyclase-activating polypeptide (PACAP), and its modulation by estrogen) impact fear inhibitors and stress responses independent of which anxiety disorder is being discussed. But it does appear that research was conducted on “heavily traumatized subjects,” rats, mice? Why? Because the symptoms were easier to induce and observe? Because the name PTSD is more eye-catching in headlines and grant applications?

Fast forward to minute 6:38 of the podcast:

Related transcript.
Research article abstract.

Dr. Ressler:

I don’t necessarily think that the symptoms at the final common pathway of symptoms level, there is necessarily a difference between men and women, but what we are increasingly learning about complex brain disorders is that there is probably many different ways to get to that disorder.

Listen to this short, 11 minute podcast, on deep brain stimulation treatment for intractable depression. These therapies were originally conceived of for the treatment of motion disorders, like Parkinson’s.
http://podcasts.aaas.org/science_podcast/SciencePodcast_110219b.mp3

This is billed as a treatment of last resort, after, for example, “the most effective” treatment, electroconvulsive therapy, fails.

I love it, when towards the end, the neurologist labels the psychiatrists involved “cheerleaders.” Everyone has their biases.

I am happy, nonetheless, that the researchers know to be focused on the long term, what they call “rehabilitation,” of chronic diseases likes depression.

From Dr. Leslie Becker-Phelps, Psychology Today Making Change blog, The First Step to Meeting Your Personal Goal:

Strategies for dealing with emotions: 1. suppress/deflect, 2. minimize/deny, or:

3. Another way people try to manage their distress is by working to solve their problems intellectually. This is great when they are faced with a problem they can solve. But it becomes a problem in itself when people repetitively review a problem that has no real or clear answer.

Or worse, in my experience, you come up with a clear answer which fails. You’re seduced by your own analysis.

Leslie’s recommendation:

There is evidence that you can strengthen your ability to manage affect, much like you can strengthen a muscle. To do this, practice sitting with our emotions. Spend time allowing emotions to rise within you and then subside, which they will naturally do. With practice, you can decide when to temporarily suppress emotions or sublimate them (channeling your feelings into a healthy activity). And, the better you become at managing your feelings, the better you will also be at following through with good plans for self-improvement.

My doctor, and some close friends, recommend mindfulness meditation. Be still, my beating heart. I achieve that at the yoga studio, it is harder, in a disciplined way, to bring it into my home. Maintain a daily practice. It is even harder with the thermostat set for 61–thankfully our winter has been mild so far.

In her follow-on post, in preparation for Thanksgiving, Leslie talks about gratitude the same way.

You might find it helpful to think of the feeling of gratitude as a muscle that gets stronger with use. To this end, below are two exercises that have been scientifically found to increase gratitude.

Gratitude journal: Keep a journal each night (for at least 2 months), listing at least 3 things that you were grateful for that day.

Gratitude letter and visit: Think of someone who has been a positive influence on you at anytime in your life, but who you have not thanked. Reminisce about how the person has made your life better, and then craft a letter to say thank you, being specific about what they did and how it affected you. Then set up a time to meet with the person without telling them why. When you sit down with them, read them the letter – slowly and with emotion. Give them a chance to react and respond. And, finally, take the opportunity to continue to reminisce together about what makes them so special to you.

Heavy lifting for me. I don’t know about you.

Reading self-help advice like this often churns my stomach–that emotion stuff–but I can’t argue that daily practices like meditation or focusing on what you are grateful for, would, if I could follow them, improve my outlook, strengthen relationships. If that’s what I wanted to happen. Do I want that?

And then Leslie’s next post, this one preparing for the holidays:

The best gift you can ever give those who love you is a healthy you.

On November 9, 2011, Michael Fellman wrote on bipolar disorder for The New York Times Opinionator blog on the Civil War.

… during the first year of the war, on Nov. 9, 1861, General Sherman, paralyzed by depression, was relieved of his command in Kentucky at his own request. Five weeks later, the wire services proclaimed to the nation: GENERAL WILLIAM T. SHERMAN INSANE. Just after his participation in the Civil War had begun, Sherman’s service was nearly destroyed.

As all students of the war know, he came back and soared to prominence, but his mental collapse and his recovery, unusually well documented, present a riveting example of the understanding of depressive illness in the Victorian world, and the relationship of bipolar illness to creativity and inspired leadership during difficult times, which Sherman certainly demonstrated later in the war.

As was true of Ulysses S. Grant, Sherman’s prewar life had careened from failure to failure. But where Grant self-medicated his frustrations with drink and retreated into stoic silence, Sherman experienced erratic emotional ups and downs that he shared with his friends and family in a manner that only intensified his self-laceration.

I’m not comparing myself to either Grant or Sherman, but by loose association, my therapist yesterday told me not to chastise myself. In times like these, when there were environmental factors (looming holidays, gloomy weather, and various events (triggers) that have to do with legal matters, and organizing my house for an upcoming change (I know I’m cryptic here), that I should be kind to myself. To not expect myself to be as productive as normal. To have the confidence that I will be productive later.

Why were we using a word like productive? My therapist and I were talking in the context of my upbringing and protestant work effort. My therapist said central to that ethos was a repression of emotions. I countered, but work is good. You don’t find happiness merely through pleasure, it requires progress towards goals as well. He agreed that work was good, but again he said, be kind to yourself, your effort is not always at the same level of efficiency.

Sherman was a West Point trained officer. He didn’t participate in the Mexico wars. In California, his troops deserted him for the gold rush. He ran a bank that failed. At the start of the civil war, he resigned from the Louisiana Military Academy (a.k.a LSU), and then failed running a street car line in St. Louis. He commanded a brigade at the Union loss at Bull Run.

In mid-August, 1861, [Sherman] was assigned to be second in command of the Army of the Cumberland, in Kentucky, a slaveholding, divided state, and the key to what would become of the Western theater — and perhaps of the Union itself.

Then, on Oct. 5, his superior, Robert Anderson (the commander at Fort Sumter when the war began) resigned because of health issues, almost certainly including major depression. Three days later, Sherman replaced him. Sherman lasted a tormented month before he was removed.

Over the following weeks, Sherman’s fears only intensified, while others observed a tortured man suffering what has long been defined in psychiatric terms as intense mania. For example, two sympathetic New York journalists who shared long nights at the Louisville telegraph office with the general grew deeply alarmed by his behavior. Sherman talked incessantly while never listening, all the while repeatedly making “quick, sharp…odd gestures,” pacing the floor, chain-smoking cigars, “twitching his red whiskers — his coat buttons — playing a tattoo on the table” with his fingers. All in all he was “a bundle of nerves all strung to their highest tension.”

Sherman was relieved of his command on Nov. 8 and reassigned to a lesser post in St. Louis. When the downward spiral continued, [his wife] Ellen Sherman came to collect him on Dec. 1, for three weeks’ leave back home in Lancaster, Ohio. There she began to nurse him back to health with a rest cure, the frequently effective 19th-century therapy: favorite foods, reading him his most cherished books, especially Shakespeare, and calming him sufficiently so that he could sleep. The real cure, as in all bipolar illness, is nature: the average mood episode rarely lasts longer than six months before it goes into remission by itself.

I’m not sure mental health professionals would agree with historian Fellman’s assessment of the real cure, but this essay was reviewed by Dr. Nassir Ghaemi, professor of psychiatry and director of the Mood Disorders Program at Tufts University.

Mental disorders affect more than 160 million Europeans — 38% of the population — each year, says a report1 issued today by the European Brain Council and the European College of Neuropsychopharmacology. Yet, fewer than a third of those affected receive treatment.

This number is higher than the “1 in 4″ that we in Healthy Outcomes Partnership quote. It is higher because this study includes elderly and children, and also because it includes disorders like insomnia.

Led by Hans-Ullrich Wittchen, a psychologist at the Technical University of Dresden in Germany, the three-year study covered the 27 countries in the European Union (EU) as well as Switzerland, Norway and Iceland. The researchers found that the most common disorders are anxiety, insomnia and depression, which account for 14%, 7% and 6.9% of the total, respectively.

In a previous report also led by Wittchen, health-care costs to the EU for mental disorders were estimated at around €277 billion (US$394 billion). In October, Wittchen and his colleagues will publish a report estimating the present cost of these diseases to governments. Wittchen hints that the true figure, with the addition of new conditions, age ranges and countries, could be more than double the 2005 estimates.

“It’s very rare that you get treatment in the year after onset,” said Wittchen.

The higher figure resulted from the addition of 14 previously excluded disorders, many of which affect children and the elderly. But the frequency of mental disorders has probably not gone up substantially, Wittchen says. “There’s no evidence for changing rates.”

Or listen to the podcast (fast forward to time 6:37).

Kerri Smith reports in Mental disorders affect more than a third of Europeans: Nature News.

Psychologists describe a phenomenon called fundamental attribution error, which explains her [math teacher's] inclination to initially judge this boy negatively based on his behaviors. Stated simply, when observing the behavior of others, most people tend to rely too much on personality-based explanations and rely too little on situational explanations.

via Dr. Leslie Becker-Phelps: Be Careful of How You Judge Others and Yourself « The Art of Relationships.

When I met my therapist last week, we were talking about behavior. I talked about something stupid I was doing, and something stupid I perceived someone else was doing. He said all behavior was a solution to something. The solution may be a good one or “mal-adaptive”–his better word than my “stupid.”

He also said no one was immune to poor behavior.

And he suggested that the appropriate stance was to be curious about the solution chosen, what was the source problem?

As [the teacher] talked with him, she learned that he also had two friends who recently died. After this conversation, he listened well in class and “aced” the tests. She ended her letter with the realization, “And I thought he was the one not paying attention.”

This very human failing [fundamental attribution error] can cause people to make snap judgments that are inaccurate, or at least don’t capture the whole picture.

This dynamic is complicated by the fact that people are much more inclined to blame their own problems on the situation than on themselves.

Leslie goes on the acknowledge that the opposite is true (blame self vs. situation) for many other people. I wonder if it is situational or more consistently personality driven: i.e. in some contexts (the office, the yoga studio, the tennis court … ) is someone is more apt to blame the situation then self?

It’s important to understand that the purpose of meditation is to see your consciousness (the flow of your thoughts and feelings). Most people are not aware of just how busy their minds are until they really pay attention. So, if you approach meditation as a practice of seeing your consciousness, then you can undoubtedly meditate – because all you need to do is be aware.

via Open Your Mind And Say Ahhh | Psychology Today. – Dr. Leslie Becker-Phelps

This is the last post for a while. Not getting many readers.
rgds, Bill

From Dr. Leslie Becker-Phelps Psychology Today blog, Making Change.

In contrast, kindness brings emotions in more closely. Acceptance calms them and dispenses with their need to defend against a critical adversary. Then, when a person experiences – in an accepting way – their painful emotion, they become more comfortable with it and less upset by it. It still hurts, but they are no longer also feeling distress about having the emotion.

Kindness, compassion … being generous to yourself. These are repeating themes: in Leslie’s posts, and in my visits to my therapist and yoga studio. And from my friend’s recommendation 5 years ago of Naomi Shihab Nye’s poem, Kindness, which Libby and I read at Jack’s memorial service.

Finding any sort of treatment [for TBI], much less a cure, has not been easy. But some neuroscientists now see great potential in techniques of manipulating the brain’s “neuroplasticity,” its propensity to rearrange its neuronal structure in response to behavior and stimuli.

Earlier this year, the Department of Defense awarded a $2 million grant to Brain Plasticity Inc. to study the effectiveness of Posit Science software in restoring memory and attention in victims of traumatic brain injury, or T.B.I. Posit Science, based in San Francisco, is one of several companies, including Nintendo and Luminosity, that sell brain health software products to consumers.

In Turning to Software to Help Treat Brain Injuries – NYTimes.com, Gordy Slack reports (June 17, 2011) such software could potentially help Traumatic Brain Injury patients and also those who have been determined to have autism, Parkinson’s disease, schizophrenia and other psychiatric and neurological diseases.

“This is the beginning of a revolution,” said Michael Merzenich, the co-founder and chief scientist of Posit Science; the president of Brain Plasticity; and a celebrated University of California, San Francisco, neuroscientist who pioneered the idea of neuroplasticity.

“There is a big gap between the claims and the evidence,” said Dr. Doraiswamy [a Duke University psychiatrist], who said he doubted whether short-term improvements in memory would last longer than the three-month period most studies test.

“If they were a drug,” he said of the software, “they would have been pulled from the market.”

The malfunctioning brain, or what Dr. Merzenich calls the “noisy” brain, is like a radio that, for any number of reasons, is badly tuned to its intended station. The objective of his software, he says, is to clarify a strong signal by repeatedly practicing simple tasks, like recognizing repeated visual patterns.

Theoretically, the brain training software could address both cognitive problems and post-traumatic stress, said Henry Mahncke, Posit Science’s chief executive, a neuroscientist and a former student of Dr. Merzenich.