Monday, November 30, 2009

Me, Captain Ahab, and the Anterior Cingulate Cortex

As I mentioned in a recent blog, someone very close to me is in a psych unit right now. In the old days, they simply would have referred to his condition as a nervous break-down. They got that right. His brain is indeed broken. But which part of the brain is broken? That’s what I want to know.

As it turned out, I couldn’t get anterior cingulate cortex (ACC) out of my head. It’s as if my own ACC couldn’t filter out my own speculative obsessions about this individual’s ACC. Screw this psychiatry bullshit, I wanted to scream. Open up the hood, poke around inside, find out what’s wrong, and fix the goddamn thing.

So here I am, late Thanksgiving evening, burping up my afternoon prandial over-indulgences, when I come across a New York Times front page story on psychiatric brain surgery. I’ve previously written stories on this. Guess which part of the brain we’re talking about?

Now my ACC is lighting up like a Christmas tree.

I wake up the next morning only to discover that my fellow blogger Willa Goodfellow has just published a piece on Prozac Monologues, entitled: Thanksgiving and the Anterior Cingulate Cortex.

That’s not the end of the story. Last August, I cited Willa as one of my top six bloggers. In my review, I said: “Let's put it this way: Until I encountered Prozac Monologues, I thought I was the only one who had ever mentioned, anterior cingulate, in a blog.”

Now my ACC is in Captain Ahab Moby Dick mode:

All that most maddens and torments; all that stirs up the lees of things; all truth with malice in it; all that cracks the sinews and cakes the brain; all the subtle demonisms of life and thought ...

Okay, some basics:

The ACC is part of the cingulate cortex, which snakes beneath the brain’s outer cortices. The region has more specialized functions across different areas than a world religion has schisms and heresies and sects, but the simple version is that the ACC plays a major role in modulating the two-way traffic between the brain’s limbic and cortical regions. It is also wired into other circuits known as "cortico-striatal-thalamic-cortical loops," which has to do with filtering out irrelevant thoughts and emotions and sensory inputs, thus allowing us to focus on the relevant ones.

Significantly, anterior cingulate malfunction has been implicated in all manner of mental illnesses, from depression and bipolar to ADD to OCD to schizophrenia. On a most elemental level, when the brain is unable to filter out the overload, the “I” that is supposed to be in charge is overwhelmed and can’t cope. For instance, in OCD the brain literally locks onto one thought and can’t let it go.

So here was the person close to me, obsessed on fearful end-of-the-world thoughts, depressively ruminating to the point of psychosis or near psychosis, and totally lacking the ability to make a rational assessment of his present and plan his future. It had to be the ACC.

Ha! If only life were so simple. In a review article in “Psychiatry,” Dhwani Shah MD of the University of Pennsylvania et al point out that “psychiatric syndromes cannot be localized in a single, so-called ‘abnormal’ brain region.” Rather, “mood and anxiety disorders involve immensely complex interconnected systems or networks of organization within the brain.”

Take my depression - please! The authors are quick to point out that the causes of depression are complex and only partly understood. Nevertheless, a picture is beginning to emerge of interconnecting brain systems in a state of stress-induced collapse. The technical term is allostatic overload, which is what happens when a highly complex and self-regulating system such as the brain fails to maintain homeostasis (equilibrium).

As Shah et al describe it, the brain circuitry involved in depression is grouped into three main components: cortical (appearing to give rise to the psychomotor and cognitive aspects of depression), subcortical (involving the affective aspect of depression, including anhedonia and sadness), and modulatory (regulating two-way cortical-limbic traffic, including stress and hormonal pathways).

Okay, here’s where it gets interesting. Brain systems may be infinitely and infernally complex, but we are beginning to see the merit in zeroing in on specific strategic targets (or “nodes”) in experimental surgical interventions. Significantly, for OCD and depression, that target is the ACC (more specifically for depression, the subgenual anterior cingulate corresponding to Brodmann area 25).

Lest we create a false impression, psychosurgery is almost certainly not the future of psychiatry. But it is simply impossible to imagine a different tomorrow without coming to grips with how a surgical technique of last resort is changing how we look at mental illness.

Trust me, things are changing.

To be continued ...

Sunday, November 29, 2009

Knowledge is Necessity - Eleven Months and Five Days On

Why wait till my first anniversary? Eleven months and five days ago, I posted my first "Knowledge is Necessity" piece. Like any new venture, my new blog posed a new set of challenges and adventures.

To flashback several years, in Oct 2005 I started blogging as an "expert patient" for HealthCentral's BipolarConnect. I thought I would be lucky if the experiment lasted six months. For one, blogs are supposed to be a lot more personal and immediate, and I was wholly unenthused about exposing elements of my private life to reader scrutiny and judgment.

For another, I was a serious journalist dedicated to informing readers on just about every facet of depression and bipolar disorder. I accomplished this via a website and an email newsletter, with a book due to be published in another year. In my estimation, blogs were frivolous and shallow, and I was unimpressed to the power of ten by the narcissistic ramblings I had sampled.

To my surprise, HealthCentral did not fire me. My turning point came about two months into the enterprise when one day I bought a toaster that was better looking than my friend’s $90,000 Porsche. Why don’t I write about that? A toaster blog. A few months later, I got serious with an account of myself reporting for jury duty. I didn't want to use my illness as an excuse, but then we were told the trial would go at least five weeks. As I reported on BipolarConnect:

Five weeks! Five weeks of adhering to a rigid schedule dictated by others, of sitting in a room with no natural light, not able to stretch, walk, take a breather. Five weeks of sitting, just sitting.

Just sitting – the easiest task in the world for most of the population. But try doing it with my brain. There in the back of the courtroom, surrounded by other would-be jurors, I wanted to bury my face in my hands and cry. I wasn’t like the others in the room. For them five weeks of fulfilling one’s civic duty was a major inconvenience and perhaps a personal hardship. Nothing more. For me, it was life-threatening. A melt-down was a virtual certainty. ...

Finally, I comprehended the power of the blog medium. In certain situations, my personal life could serve as an educational tool in bringing home to readers the reality of an illness many of us share. In others - such as attending mental health conferences - I reported on events as seen "through my eyes," which gave me a new way to explain complex topics to those interested in learning more.

But there is a tremendous downside. Anytime you put your personal life out there, you expose yourself to personal attack. One comically dangerous individual designated herself my self-improvement police woman, to the point of cyber-stalking me. A notorious antipsychiatry blogger routinely spread libel about my personal life, then allowed the nutjobs he pandered to make up ridiculous lies and ideate physical violence against me.

Fortunately, the positive feedback far outweighed the negative. My blog was serving a useful purpose, and my writing was expanding in new and unexpected directions. Nevertheless, by late last year, it was time to take stock. Like Arthur Conan Doyle throwing Sherlock Holmes off a cliff, I killed my BipolarConnect blog in favor of concentrating on responding to reader questions there.

A few months later, the people at BipolarConnect urged me - like Conan Doyle bringing back Holmes from the dead - to revive my blog. This time, I retooled it as the voice of visitors to the site, an extension to answering reader questions. My personality was out of the picture, altogether, thank heaven.

But I couldn't leave well enough alone. As a hedge against the uncertainties of late last year, I began this blog. Over the years, it had started coming in loud and clear that our illness is only a small part of defining who we are and what is holding us back. What about the rest of it and how do we figure it out? That is the task of brutal self-inquiry, of knowing thyself.

Suddenly, I had a theme for a new blog, ironically based on an old tag line, "Knowledge is Necessity." Now my reach was a lot wider, almost infinite. Anything that shed light on the human condition and how we could cope: Brain science, philosophy, spirituality, psychiatry, psychology, economics, on and on. Other mental illnesses, which illuminated how we behave, even if we don't have a diagnosis: schizophrenia, borderline personality disorder, OCD, Aspergers ...

And, of course, my personal life. I began noticing my life story had a different twist - how my encounters in my relatively new rural environment were playing a role in my own recovery and healing. Quiet moments in the sun, nightly encounters with raccoons and skunks.

Meanwhile, I discovered Therese Borchard of Beyond Blue, who quickly became my favorite blogger. She is a master of combining her own personal life with wisdom from numerous sources. Under her encouragement, I became less reticent in using my personal life as an educational tool. A fast friendship developed. Thanks to her, I saw the makings of a new book, based on my blogging. I even have a working title:

"Raccoons Respect My Piss, But Watch Out For Skunks."

No doubt, a publisher will change it to something like: "You, Too, Can Be Happy."

A couple of weeks ago, I walked into an LA bookstore with my good friend Louise. We have known each other since the early days of my Newsletter, back when I concentrated on serious reporting about my illness. I pointed out to her my observations about the store's Psychology section. There was very little shelf-space devoted to specific mental illnesses. One copy of David Miklowitz's "The Bipolar Disorder Survival Guide" was on the shelf. My copy of "Living Well with Depression and Bipolar Disorder" - the culmination of six years of my hard journalism Newsletter and Website efforts - wasn't.

Instead, what I noticed was an odd and seemingly contradictory combination of heavy duty brain science books and the type of light fluff self-help books Oprah might recommend. This was the direction reader preferences are going, I recall pointing out to Louise. It's as if we have all moved past thinking of ourselves in terms of diagnostic labels, not to mention the treatments that never lived up to their promise.

What is a lot more relevant, we are discovering, is finding out what is really going on inside our brains and how this relates to whatever life seems to throw our way. In that way, we can hopefully move from surviving to thriving.

My writing was going in this direction before "Knowledge is Necessity," but it took off with this blog.

Now is the time of the year when I take stock and plan for the year ahead. "Living Well With Depression and Bipolar Disorder" represents the past, "Raccoons Respect My Piss" the future. But do I keep "Knowledge is Necessity" - my "soft" journalism - going at the expense of my hard journalism email Newsletter, which I have put on hold for the last two years?

Or can I find a way to keep both going, with no sacrifice to my own health? A one-year anniversary coming up is usually the time for self-congratulation. But I don't have the luxury for that. This blog has certainly moved my writing forward. But where next?

Decisions, decisions ...


This is a view of Mt Cuyamaca, taken 20 minutes ago from a web cam on a private ranch a few miles up the road from where I live, 40 miles east of San Diego. The web cam is at 3,400 feet and Mt Cuyamaca, at 6,512 feet, is the dominant landmark in our neighborhood.

Yesterday, in the hills, we experienced a blast of cold weather. The temperature outside my door at the moment is a frigid (by southern CA standards) 49 degrees. No snow on the ground here, of course. I'm content to simply stand outside and admire it at a distance.

Thursday, November 26, 2009

A Thanksgiving Tribute

This piece, which I wrote nine years ago, is one of the original articles on my website, mcmanweb, which I established in late 2000. The site and its contents have undergone many changes over the years. Today, McManweb contains around 200 articles devoted to all aspects of depression and bipolar, plus videos, and is recognized as one of the most comprehensive resources for learning about either illness. Something to be thankful for ...

It's like a cardiac arrest, only it happens in the brain - something responsible for holding the gray mass together abruptly shifts, there is a sickening feeling of something terrible about to happen, and next thing your head is experiencing the awful sensation of being emptied out. From somewhere inside the power goes down and the body seems to collapse into itself like a marionette being folded into a box. You look for a way out, and what's left of your broken brain does its best to oblige with images of high bridges and frozen ponds and nooses dangling from balconies.

In January 1999 when my family brought me to the emergency room at our local hospital I could never imagine eleven months later that I'd be writing about anything I had to be thankful for, much less paying tribute to this beast inside that sent me there in the first place, the one that goes by two names, both of them woefully inadequate: manic depression and bipolar.

May as well call the thing Fred, as far as I'm concerned.

For most of my life, Fred has been my constant traveling companion, even as I denied his existence and tried so hard to pretend I was a master of my own fate. I'm normal! I kept insisting over and over, much to Fred's quiet amusement.

Twenty-one years ago I was well on the way to proving it. After all those wasted years at the mercy of the very condition I denied having, I landed on my feet in New Zealand. I had successfully completed my second year of law school there, and I was married with a beautiful three-month-old daughter. There had been some other Americans in our birthing classes and we invited them over, together with another Kiwi-Yank couple we knew, to celebrate Thanksgiving. I recall lifting my glass to make a toast, but then words failed me.

We were seated on cushions on the floor with the turkey and all the fixings on a low table. But the stars of the show were the new citizens of planet earth. I looked at the proud parents and their newborns and all the baby paraphernalia they had brought, and simply choked out, "thanks".

Life was beautiful.

Little did I realize in ten years I would find myself in another country, broke and alone and unemployable and in search of a convenient bridge to jump off. I couldn't blame it all on Fred. Besides, Fred has a way of convincing you he doesn't exist.

Boy, you showed them, Fred let me know less a year after that. You're back on your feet again and working on your own terms, not theirs. I had one book out and another on the way. And there was my daughter, now ten, together with my parents, in my apartment to celebrate Christmas. Like a considerate roommate, Fred made himself scarce.

When he showed up again I was back in the States. Think of someone on a high hill lobbing boulders at you, that was Fred. One large stone would hit me on the chest and send me into a crushing depression. Then the next one would come thudding down on me as I lay sprawled on the ground, compounding my despair with a depression on top of a depression.

But I made Fred work hard, damn hard. Several years and an untold number of boulders it took, but finally I went down and didn't get up. After all these years, I finally acknowledged Fred's dominion, not to mention his existence.

So now, at long last, I'm going to give Fred his due. After all, he made me what I am. Whatever our differences, he is responsible for me being me, so to hate Fred would be to hate me. Besides, having Fred around does have its advantages.

It is Fred who painted my brain with amazing visions and insights, and filled my senses with the type of sensations few mortals experience. It is Fred who made it possible to for me to find the sublime in even the most mundane, and it is Fred who cloaked me in a humanity and godliness that I would not exchange for a winning lottery ticket.

So, yes, Fred, on this Thanksgiving, for the very first time, I will sing your praises and give you thanks. In a few months I will see my grown daughter, here from New Zealand, and I give thanks for that, too. I will give thanks to my family who were there for me, and to a God who somehow has proved to me he does not and does exist.

And yes, Fred, I know one day again, you'll be waiting for me in some dark alley. But for now I invite you to pull up a chair while I lift my glass in a toast.

Personal Note

I spent yesterday wondering whether the next phone call would mean I would have to book a flight to attend a funeral. Someone very close to me had gone AWOL He had been brought to a psychiatric unit - one he had spent several days in a couple of weeks ago - but this time the hospital had no beds. They transported him to a unit in another town. That hospital kept him overnight. When I talked to him the next day on the phone it was pretty clear to me he needed to be in the hospital.

But life is a lot more complicated. Even individuals in the worst mental distress may present a totally different face to hospital staff. And a hospital can hold a patient against his will only under extraordinary circumstances.

They released him to a city bus. They didn't inform his family. Standard procedure.  A full day elapsed. Nothing. No word.

Finally, a phone call. He’s back in the hospital, his original one.

My life has been on hold the last two or three weeks, and it will most likely continue that way for at least that long, probably a lot longer. I make phone calls. I wait for phone calls. I am ready to jump on a plane at a moment’s notice. If that happens, hopefully it will be in the role of a healer. But after what happened yesterday, I know that I could be delivering a eulogy.

Wednesday, November 25, 2009

Jake Shimabukuro - Mind-Blowing Ukulele Virtuoso

You really need to play this video.

I think it is safe to say that what Louis Armstrong did for the trumpet, Earl Scruggs for the banjo, and Les Paul for the electric guitar, the brilliant young Hawaiian Jake Shimabukuro is doing for the ukulele. Thanks to my good friend Louise, I had the chance to hear Jake play to a sold-out auditorium in LA this weekend.  Otherwise, I would still be living in a fog of ignorance.

This video of Jake playing George Harrison's "While My Guitar Gently Weeps" has already drawn more than 4 million YouTube views. Enjoy ....

Tuesday, November 24, 2009

Here Comes the Sun

Back in the mid-seventies, I endured 12 months of unremitting Stygian gloom in Vancouver BC. That was my introduction to seasonal depression. Trust me, after that I have never taken the sun for granted. Moving to southern CA three years ago truly made me appreciate the central role of fresh air and sun on my psyche. This Saturday, on a visit to LA, a good friend and I paid a visit to the Griffith Observatory, which has three telescopes pointed at the sun. Above is a view into the sun from the Observatory grounds. Following is my iPod tribute to my favorite celestial orb:

The observatory at twilight.

You gotta love WPA-era art. Above: looking up into the newly-restored domed ceiling.

I'm not totally sure on this, but I think this is a live view of the sun via a telescope feed.

Break out the sunscreen. Solar flares are powerful enough to influence the earth's weather.

Whew! First time I read this, I thought it said a few MILLION years!

See? No such thing as global warming.

Where would this guy be without a sun to work with?

In the blink of a cosmic eye ...

The sun on a night off. The lights of LA below.

Monday, November 23, 2009

Bubble Master!

Little Teddy, nearly two months.

Death of a Healer - Ron Urquhart

This is a terribly difficult piece to write. Last week, I Googled the name of someone I had known two decades ago, while living in a different country, in what seemed a different lifetime. All I could find was a discussion thread a year old. The news was grim: In 2005, this individual blew his brains out with a gun. He was about my age.

Let me rewind:

It was the late 80s. I had just moved to Melbourne Australia, but the promise of a fresh start was hijacked by my runaway brain. Things began to fall apart. In desperation, I was ready to try anything. A colleague at the newspaper I was working on recommended a certain “rebirther” - Ron Urquhart.

Rebirthing is a guided breathing exercise, based on the work of the New Age prophet Leonard Orr. Sustained circular breathing can induce the type of dream-wake state associated with mystics and shamans. A lot of New Age hocus-pocus is wrapped up in rebirthing, but the basic premise is simple and universal: When the conscious mind gets something new to look at - perhaps buried memories, perhaps a sense of connection to something greater - surprising (and often life-changing) realizations tend to emerge.

My journalistic bullshit detector threw off some blinking warning lights. Nevertheless, in a number of sessions, Ron proved exceptionally adept in picking the locks to various realities lurking just outside my conscious reach. In the aftermath, I gained some important insights into where I had been and where I needed to go. Still, my personal life continued to unravel, then crash precipitously.

Ron came back into my life about 18 months later. He had quit his day job. He was now referring to himself as an “energy meditation” (EM for short) practitioner, which was basically rebirthing with a kundalini yoga twist. I was an unemployable journalist scrambling for free-lance work. Ron had a proposition. He could use my help with a book he wanted to write. He was about to train his first crop of energy meditators. Would I care to take part?

There were about 20 of us. Over the course of a number of weekends, Ron ran us through a bunch of drills and activities, from trust falls to karate-chopping boards to building an Indian sweat lodge. Plus, we got to practice energy meditation on each other.

Ron’s running commentary involved the standard New Age tenet (most recently recycled on Oprah as “The Secret”) that we can literally create our own reality - health, prosperity, love, everything. The smokers in the crowd interpreted this to mean that by putting out the right thought, the nicotine they inhaled would have no effect on them. It never occurred to them that it might be more useful instead  to apply the same principle to stopping their cravings.

Personal misgivings aside, I did find the course extremely helpful to me, and so did the others. But the needle on my bullshit detector was fluctuating wildly. Ron had an unfortunate tendency to overplay his brief experiences among Buddhist monks and American Indians while giving no credit to rebirthing and various New Age courses he was freely borrowing from. When I pressed him on this and other issues, he would grow extremely evasive.

In our private conversations, he fleshed out his personal story. Several years back, his personal life had fallen apart and he had attempted suicide. Then he took stock and began applying the things he had learned toward his own healing and growth. There was no doubt he had special gifts. His intuition was uncanny, his manner charismatic and inspirational. When he laid a hand on you, you could literally feel intense heat radiating out.

But over the months, he grew increasingly more grandiose. It’s an occupational hazard in any profession. It’s a natural tendency to think big following initial success. But imagining that the business you started in your garage will become the next Apple Computers is a far different proposition than seeing yourself leading a worldwide spiritual-personal growth movement.   

Under the circumstances, I could no longer continue my association with Ron. I wish I had handled the situation better. We fell out of contact, then, about a year later, I packed my bags for the US. I gave him a call just before I left, and we shared some reconciliatory words.

About seven or eight years ago, I Googled Ron’s name and discovered he was still practicing EM. It seems he had scaled down his earlier expectations, and had settled into doing what he did best - helping individuals and small groups of people see their personal realities in new ways.

Then, late last week, I once again Googled Ron, and read: “I just found out today that Ron passed away a few years ago.”

There was no shortage of appreciation for the man: “Great teacher to many,” “I’ve never had any other teacher like him,” “He helped all of us a lot,” “Ron has touched and changed the lives of all who have come into contact with him.” His celebration of life service ten days following his death attracted more than 200 admirers.

But, sadly, I also read: “There is only one person that is still practicing EM in Australia that we could find.” This was a far cry from what the Ron I once knew had envisioned for his EM movement. He sincerely believed we could think our way to a better reality, and there is a certain truth to that. But reality also has an unfortunate way of showing us who is boss.

Ron dared to confront reality, a force far greater than any one mortal. There is great merit in trying. There is no shame in losing.

How Come Everything I See Reminds Me of Breasts?

Above top: The San Onofre Nuclear Generating Station, taken on my iPhone from a train window on my way from San Diego to LA last Saturday.

Above bottom: The Griffith Observatory in LA, from my iPhone the same day.

Friday, November 20, 2009

Is My Elvis Pizza Up To Michelin Standards?

Yesterday, I reported on my successful debut as a force to be reckoned with in the dog-eat-dog world of haute cuisine. As you recall, last weekend I entered my world famous Elvis Pizza in a local cooking contest. No one ordered me to leave. There were no reported cases of food poisoning.

Last evening, by sheer coincidence, I came across an article, Lunch with M, by John Colapinto in this week's New Yorker. The article was about the secret world of the anonymous inspectors who review restaurants for the legendary Michelin Guide. The author pulled a major journalistic coup by having lunch in an upscale Manhattan restaurant, Jean-Georges, with one of the inspectors, "Maxime" or "M". The prose is simply delicious:

She was tending toward the Arctic char for her main course but couldn’t decide about her second course. The waiter reappeared and asked if he could answer any questions.

“Can you tell me about the crab toast?” she asked.

“It’s Peekytoe crab, a chiffonade of tarragon as well as chives topped with white sesame seeds, toasted in the oven, finished with a miso mustard, and a pear salad on the side,” he said.

“It’s new?” she said.

“About a week on the menu.”

She asked the waiter to give her a minute and then leaned in to me. Inspectors love it when they ask a question and can tell that a waiter has made up an answer, she explained, adding, “That never happens here.”

I can so relate. In my cooking contest, one of the judges asked why I chose to use shredded cabbage as a side to my Elvis Pizza, and I immediately responded that the cabbage is traditional in pulled pork sandwiches. Am I ready for the big time or what?

The Michelin Guide started off in 1900 as a marketing ploy to encourage consumers to drive to restaurants in the French countryside, thereby increasing the sale of the company's new-fangled pneumatic tires. The Guide soon evolved into THE restaurant authority, with its famous three-star rating system. Just drawing one star is a huge honor. French chefs make it a life ambition to become a three-star chef.

Several years ago, in my email Newsletter I re-reported a story that was a front page scandal in France, concerning Bernard Loiseau, chef and owner of La Côte d’Or in Burgundy, who had once told a fellow chef he would kill himself if he ever lost one of his stars. According to the New Yorker account, based on Rudolph Chelminski's 2005 book “The Perfectionist”:

The food writer François Simon published a story in Le Figaro hinting that Loiseau was on thin ice with Michelin. Loiseau, who had suffered periodic depression for years, sank into despair. In early February, 2003, he was notified by Michelin that he would keep his third star. Still, Simon wrote another piece, in which he suggested that Loiseau and his third star were “living on borrowed time.” Two and a half weeks later, after a day at work in the kitchen, Loiseau killed himself with a shotgun blast to the head. He was fifty-two.

Michelin's entree into North America began with the 2005 launch of its New York Guide. The Guide was roundly criticized for being Francophobic, with no allowance for American tastes and sensibilities. That is changing, with the recruitment of American-born inspectors. Still, not just any American will do. A bit of M's background, according to the New Yorker:

“'I ate falafel at Mamoun’s and bagels and lox from Russ & Daughters before I’d even heard of a peanut-butter sandwich,' she said." A life in the food business plus intensive training by Michelin followed. The New Yorker describes her in action:

Her Arctic char arrived, on a bed of watercress rémoulade, and accompanied by a julienne of apple. She took a bite. “It’s perfectly cooked,” she said, excitedly. “I mean, it’s textbook.”

Were this an inspection visit, M would spend two to three hours filling out a report that would list "every ingredient in everything she ate, and the specifics of every preparation," then rate these according to such criteria as "quality of the products, mastery in the cooking, technical accuracy, balance of flavors, and creativity of the chef."

Then all the ambiance factors: “The salt, the glasses, everything about the experience you had from the second you made the phone call to book the reservation, to when you walked in the door, when the hostess greeted you—or didn’t greet you—to whatever little goodies you have at the end of the meal.”

So, the unique taste experience of my Elvis Pizza is not enough. It's also about the precise positioning of the shredded cabbage on the plate, the placement of the bottle of beer on the table, the meticulous attention to the way I tuck in my tee shirt and angle my Boston Red Sox cap on my head ...

Details, details. I have miles to go before I sleep.

Thursday, November 19, 2009

I Enter My Elvis Pizza in a Cooking Contest

There are things I do at 3,500 feet up in the mountains that would never even enter my mind at sea level. Last Sunday at 5 PM I showed up at our local restaurant - Descanso Junction - ready to kick ass. I had entered myself into my first-ever cooking contest and I was determined to walk away with first prize.

I had my world famous Elvis Pizza ready to go. How could I possibly lose? I walked in the door, laden with my pizza gear. "I'm ready for you," I told the owner Tammy. "Are you ready for me?"

I set up in a spot in the kitchen in back. First order of business - pizza stone in the oven. A pizza stone looks like a manhole cover and weighs about the same. Out of my backpack and into the oven it went. The stone would need at least a half hour to absorb the oven heat. Second order of business - caramelize my onions. I had thin-sliced wedges of onions ready to go. Olive oil into a frying pan, then the onions.

I got them going, then dashed over to my corner of the kitchen to get set up. Onto the counter went my covered pizza dough (which I had made and brought to a rise back home), my pulled pork (from a six pound pork butt I had slow-roasted two days before), my barbecue sauce, Ranch dressing, shredded cabbage, a wooden pizza peel, it goes on and on ...

I flew back to the cooking range just in time to prevent my onions from turning into Cajun ashes. By this time, the other contestants were setting up. They had brought things in pots that only needed warming up. And here I was with my Manhattan Pizza Project that demanded precision timing. Rookie mistake. I should have entered my world famous cassoulet.

But no, think big, think pizza. Things in pots - that's for wimps. This is my Elvis Pizza, after all, inspired by the King of Rock 'n Roll.

"I thought that would have been peanut butter and banana," one of the contestants joked.

"That was my first version," I responded, almost with a straight face. Then I got smart. A barbecue pizza. Stand outdoors at Graceland and inhale and you'll see what I mean. Okay, I've never been near Graceland or Memphis, but I assume I'm striking a chord with every music lover who recalls hearing "Hound Dog" for the first time and comes to the realization that the world will never be the same.

Back in my corner of the kitchen, I sprinkled flour on the metal counter top and plopped on my pizza dough and rolled it out according to exact NASA specifications. My sauce and toppings and implements were right where I needed them to be. Then back over to the range for my onions. Sweet as candy. Into a dish they went and back over to my corner of the kitchen. Final assembly would come later.

The appetizer portion of the contest got underway. I took a seat with the other contestants out front. I think it was a soup that led off the contest. But not just any soup. This was family soup. Soup that the Crusaders had brought back from the Holy Land, soup that had traveled on the Mayflower, that had tamed the West.

Oh, crap! I thought, as the contestants reeled off their recipe narratives to the five judges at the table. I had come prepared with a crisp two-sentence delivery (or one long sentence with commas and conjunctions) and here they were expecting 500 pages of John Galt from "Atlas Shrugged."

The appetizer portion of the contest wrapped up, and the first contestant from the entree portion showed up with his wimpy pot. Time to go back and get crackin'. I was in the number four spot. Plenty of time, no rush.

Tammy poked her head in the kitchen. One of the contestants was a no-show, she informed me. I would be going on at number three.

Rule number one in any cooking contest: Only show up with things in pots, the wimpier the better.

"No problem," I shot back, lying through my teeth. My dough had been lying on the counter too long and I perceived the ugly possibility of a crust build-up. No time to worry about that, as I grabbed my box of corn meal and dusted my pizza peel. Then I moved the dough to the peel, crimped the edges, and started applying my sauce and my pulled pork and caramelized onions.

Thyme! Where's my fresh thyme? No time! I sprinted to the oven with my creation, opened the oven door, and slid my pizza onto the stone. The pizza took off on the stone like a vehicle on glare ice. A small portion of the pizza was drooping off the stone. I stuck my bare hands into a 500 degree oven and managed to pull the pizza back, but now it was no longer circular in shape.

A rustic pizza, I would call it, if worse came to worst. Here I was dealing with a strange oven, hoping like hell the dough wouldn't come out burnt on the outside and raw on the inside.

"How are things going?" Tammy asked. "Right on schedule," I replied in an unbelievably calm and reassuring voice. A good cook can handle any contingency. More than a year before, I had failed a driver's test when my brain went into panic mode and I nearly failed my second time out for the same reason. Now here I was, cool as a cucumber (and there just happened to be a cucumber in the kitchen for comparison). No matter how this contest turned out, I had already passed with flying colors.

Now I had my plating station set up. Onto five plates went shredded cabbage. I inspected my pizza. It was now or never. I slid in my peel and extracted my creation without incident. Then I set the peel with my pizza on the counter. I had found my thyme and began applying it. JoAnn, who works as a waitress at the place (and who had entered her jalapenos wrapped in bacon in the appetizer portion of the contest) walked through and exclaimed how gorgeous it looked. Another contestant said the same thing, then another.

My confidence was returning. Now the final touch, Ranch dressing. It wasn't coming out of the bottle like it was supposed to. I stuck in two fingers and began applying the goop by flicking it with my fingers, a la Jackson Pollock. That was the intention, for the Ranch dressing to create a Jackson Pollock drip painting effect.

"It looks beautiful," Tammy enthused. She suggested I take it out to the judges unsliced on the peel, then I could take it back to the kitchen for slicing and plating.

"Ready?" I asked.

All set, she replied.

Out I went with my pizza. I angled up the peel, edge down on the counter, for the judges' viewing pleasure.

During the appetizer portion of the contest, I had sort of assembled my Crusaders-Mayflower-John Galt narrative in my head, but I hadn't had any time to practice it.

"So this is what it must be like being on the 'Iron Chef,'" I opened. Pregnant pause. "Hi, I'm Bobby Flay."

Thank heaven everyone was laughing.

"Are any of you judges Yankees fans?" I asked, pointing to the Red Sox cap I was wearing. One of the judges raised his hand. I jokingly flipped my cap around, then flipped it back.

More laughs.

Then I opened with my original crisp two-sentence (or one long sentence) spiel: "This is my Elvis Pizza, inspired by the King of Rock 'n Roll, drawing from two great cooking traditions - Italian for its pizza and southern for its barbecue, re-conceptualized in Southern California, home of reinvention."

Now what?

"Think of pizza as an open-face sandwich," I continued. "Anything goes."

Nodding heads. A good sign.

"I came up with my first version about four years ago in New Jersey," I adlibbed. "We had company coming unexpectedly for dinner and I rounded up whatever was in the fridge." Left-over pizza dough, barbecue sauce, a single pork chop, some onions, Ranch dressing.

"My wife liked it so much," I went on to say, "that she divorced me."

That had them rolling in the aisles. For the record my former wife is a very wonderful person. Anyway, here I was in southern California, where I refined my original inspiration, much to the delight of my new neighbors. I then explained how the meat on this particular pizza came from a slow-roasted pork butt, with enough left-overs for pulled pork sandwiches for the next five months.

"Bon appetite," I concluded. Next thing, I had the slices on plates with my shredded cabbage (which is traditional with pulled pork sandwiches). Plus more morsels for the other contestants in the audience.

"Fantastic presentation," people kept telling me. Elvis would be proud. Of course, I knew before I turned up that the other contestants would be bringing their A-game to the event. Anyone who loves cooking at home has at least one dish that is worthy of a spot on the Food Network. We got the best of the best tonight. It was my time to applaud the winner, not take a bow.

Would I do it again? Yes, definitely. With a pizza? What, are you crazy?

Wait, the winner from the dessert portion of the contest is talking to me. A pizza with Cuban pork, she suggests. Yes! Cuban pork. Maybe we can team up. Maybe we can ...

Wednesday, November 18, 2009

Are Bad Times Actually Good For Us?

An article in the Oct 28 Business Week reports on a ten-year (1996-2006) study which found that, among other things, workers laid off from Boeing were happier than those still working there.

Say what???

The article reports that four researchers embedded themselves into Boeing during a decade of great upheaval when Airbus was giving the company a run for its money and when one-third of its workforce was shed.

According to Business Week:

With each round of layoffs, the survivors hustled to reinvent themselves. They re-proved, re-auditioned, and repositioned, only to watch yet another new manager — pushing the fad du jour — parade through the door. Employees who had once seen themselves in every plane that flew overhead were now trading in gallows humor. As in, "Dead worker walking."

Human resources specialist Frank Zemek was the researchers' main contact. In an interview, he recalled "the survivor's guilt of the people who were left, who were waiting and not knowing if the hatchet was going to fall on them. They experienced the worst stress."


Average depression scores were nearly twice as great for those who stayed with Boeing vs. those who left. The laid-off were less likely to binge drink, often slept better, and had fewer chronic health problems.

Earlier this year, I attended a conference where Stephen Bezrucha MD of the University of Washington knocked us over with a feather with the observation that mortality rates in the general population actually go down during economic hard times. One reason, he said, may have to do with people having more time to connect with their friends and families.

As if to back up the speaker, the Sept PNAS published a University of Michigan study showing that during the Great Depression rates of death went down while life expectancy went up. Suicides, however, did increase.

According to a Medical News Today account of the study, during expansions firms are very busy and demand a lot of effort from employees. This can create stress, reduce sleep, and change health-related behaviors. Also, more time on the job may translate into greater social isolation and less social support.

In contrast, during recessions, people slow down because there is less work to do. There is more time for sleep, and they cut back on alcohol and tobacco.

No doubt, this comes as cold comfort to those of you who have been laid off or are in fear of losing your jobs. But, as Business Week notes:

Thanks to the unceasing uncertainty inside Boeing, those who left felt as though they had escaped a bad marriage. At the time one Boeing employee told researchers: "You feel better when someone takes their foot off your neck."

Burn Zone - Another Look

Yesterday's blog piece featured a slide show of the aftermath of the devastating 2003 Cedar Fire that torched more than a quarter million acres in Southern CA. The photos were taken on my iPhone. This morning, I decided to see what would happen if I filtered out the color. These four stills provide a sobering view ...

Monday, November 16, 2009

Burn Zone

We've had rain. The winds are blowing in from a new direction. Santa Ana - the red wind, the devil's breath - is silent. For now, we can exhale. These iPhone pics taken today were shot on a walk less than  10 miles from where I live. In late October, 2003 as far as the eye could see was a raging inferno, the devastating Cedar Fire that torched 280,278 acres in Southern CA and took 15 lives. I moved here in 2006. In 2007, I held my breath as dense purplish smoke poured over the hills below us.

"Now I am become Death, the destroyer of worlds."

Respect, total respect ...

Eric Kandel - A Nobel Laureate Looks Back and Looks Forward

In the first piece to this series, I reported how a young refugee from Nazi-occupied Austria began studying Freud as a way to comprehend the brutality of man, but instead became a rising star in neurobiology. In the second piece, I reported how Dr Kandel's ground-breaking research (with his unlikely lab partner, the California sea snail) helped map out the biology of memory and how neurons communicate with each other. In this final installment, Dr Kandel reflects on his extraordinary life.

"Matisse had it right when he pointed out that life is a circle," 2000 Nobel Laureate Eric Kandel told a packed auditorium at the American Psychiatric Association’s annual meeting in Atlanta in May 2005. In other words, if you follow your unconscious, you often find you come back to the themes that interested you in the beginning.

In 1990, while still working on snails, Dr Kandel returned to studying mammalian hippocampal neurons, mapping out the higher memory functions in mice. In the lab, he was able to reverse age-related memory loss in his animals.

"If you’re a mouse," he joked, "we can do a lot for you. For people, we’re not sure as yet."

Then Dr Kandel extended his focus to the amygdala, which governs fear. Fear, he explained, is the one behavior so far we can observe in animals. A mouse that receives a shock accompanied by the sound of a bell will soon crouch in fear to just that sound. Dr Kandel’s lab discovered that this kind of fear resulted in the release of the peptide GRP in the amygdala of the animals. Mice bred without the capacity to produce GRP lost their inhibition.

"Maybe in some disease states," Dr Kandel commented, "inhibitory restraint is compromised."

But that is not the end of the story. What would happen, he wondered, if you set out to investigate the mirror image of fear? This time, Dr Kandel’s team trained mice to associate a particular sound with safety. As expected, the animals’ sense of security dampened activity in the amygdala. But the investigators also discovered a circuit connecting the amygdala to the dorsal striatum (caudoputamen), an area of the brain associated with happiness and reward.

"We don’t like being miserable," Dr Kandel explained. "What we really want to do is to be happy, to be secure, to be confident." He quoted the first line of Anna Karenina: "Happy families are all alike …"

"That really is inspiring to a neurobiologist," Dr Kandel joked, "because if you find the gene it is going to be unbelievably universal." So as well as identifying new targets for anxiety drugs, he explained, we may also find targets for enhancing positive affect.

Dr Kandel has written extensively on integrating his first love – psychoanalysis – with his vocation, neurobiology. Despite some signs that psychoanalysis is joining the real world, however, he does continue to scold this branch of the profession for its insularity, disregard for patient outcomes, and lack of scientific rigor – traits not shared, he says, by practitioners in many other fields of talking therapy.

"A major need of psychiatry in the future," he stated, "is to put the psychotherapeutic arm of psychiatry on the same solid biological footing as the pharmacological aspect of psychiatry." He was very much moved by Kay Jamison who said if it wasn’t for lithium she would be dead, but that it was really psychotherapy that gave her a coherent view of her life, that allowed her to tie the various strings of her life together.

"We’re in a fantastic phase of psychiatric thought," he concluded. The biology of the mind is the central scientific challenge of the twenty-first century. Molecular genetics and molecular biology, he said, have given us insights that would have been inconceivable 20 or 30 years ago. These advances will revolutionize psychiatry, but hardly eliminate it. Instead, psychiatry will synthesize with molecular biology into what he describes as "the new science of the mind."

Dr Kandel - an avid lover of fine art, classical music, and opera - resides in the Riverdale section of the Bronx with his wife of 50 years, Denise. As a girl in Nazi-occupied France, Denise hid in a convent without knowing the whereabouts of her parents. Denise is a professor in the Department of Psychiatry and School of Public Health at Columbia and a pioneer in the epidemiology of drug use in adolescents. They have two children and a number of grandchildren.

Writes Dr Kandel in his Nobel autobiography:

"In retrospect it seems a very long way for me from Vienna to Stockholm. My timely departure from Vienna made for a remarkably fortunate life in the United States. The freedom that I have experienced in America and in its academic institutions made Stockholm possible for me, as it has for many others."

Friday, November 13, 2009

A Nobel's Life - Eric Kandel and the Aplysia

Yesterday's blog piece focused on how a young refugee from Nazi Austria studied Freud as a means of coming to terms with the brutality of man, only to get apparently sidetracked into neurobiology. Oddly enough, it turned out he was on the right course, with a very strange lab partner ...

Following a brief stint at Harvard as a staff psychiatrist, Dr Kandel joined NYU in 1965 to start a new neurophysiology group devoted to the neurobiology of behavior. In France, Dr Kandel had discovered that chemical synapses are remarkably plastic, but had yet to establish that these changes occur when an animal learns something. But how can you tell when a snail - in this case the California sea snail (aplysia, pictured here) has learned something? One giveaway is that snails reflexively withdraw their gills in response to stimuli administered to the animal’s spout (siphon), an action similar to removing one’s hand from a hot object.

As with higher animals, practice makes perfect; repeated stimuli convert short-term memory to long-term memory. The team focused initially on sensitization, a form of learned fear. A person sensitized to the sound of gunfire, for instance, may become startled by a mere tap on the shoulder. A snail sensitized to stimuli to the siphon would also respond to stimuli to the tail. The conversion of short-term memory to long-term memory resulted in the synthesis of new proteins.

The team located and mapped the neural circuit in the gill-withdrawal reflex. To the researchers’ surprise, the cells and their interconnections were always the same. What changed in the learning process were changes in synaptic strength. The cell circuits may have been hardwired, but the effectiveness of their signaling could be altered by experience. These findings led to a series of ground-breaking articles published in Science in 1970.

In 1974, Dr Kandel moved to Columbia as the founding director of the Center for Neurobiology and Behavior (and later as senior investigator of the Howard Hughes Medical Institute which has a site located there). There, he and his colleagues (many recruited from his NYU group) zeroed in on the fine points of synaptic change. This involves serotonin and other neurotransmitters acting on specific receptors located on presynaptic neurons.

The serotonin, Dr Kandel found, increases a "second messenger" molecule, cAMP, inside the neuron that sets in train the sensitization required to form short-term memory. Collaboration with Paul Greengard PhD, who would share the same stage in Stockholm with Dr Kandel, implicated the enzyme PKA in the process, along with a potassium channel regulated by PKA. Reducing the potassium current has the effect of ramping up calcium, which sends neurotransmitters on their merry little ways.

By now Dr Kandel and his team had perfected the art of experimenting on cell cultures grown from the larvae of their snails - in this case just two cells, a sensory neuron and a motor neuron. All the researchers had to do to simulate the tail stimulus effect of the snail was to "puff" micro units of serotonin into the culture. This was about as reductionist as even Dr Kandel could get.

This time Dr Kandel and his colleagues were hot on the trail of long-term memory. Repeated administration of serotonin, they found, activates PKA inside the cell. In response, PKA translocates to the nucleus where it recruits another enzyme called MAP kinase. Both kinases act on a gene regulator called CREB-1, which triggers the synthesis of new proteins (CREB) needed for the growth of new synaptic connections vital to long-term memory.

These and other findings were gradually revealed over a steady stream of articles spanning into this millennium. In his relentless investigation into the learned reflex of a simple sea creature, Dr Kandel had helped crack open the secrets of the neuron, including the discovery of a two-way dialogue between the nucleus and synapse. Neuroscience and psychiatry would never be the same. His marine lab partner, in the process, gained new respect, becoming to neurobiology what fruit flies are to genetics and rats are to behavior.

To be continued ...

Eric Kandel - A Nobel's Life

The 2005 American Psychiatric Association annual meeting in Atlanta featured Nobel Laureate Eric Kandel as a speaker. I arrived 30 minutes early to get a seat up front. To my surprise, he was already seated on stage. I turned to the psychiatrist next to me. “Do you think he’ll think I’m crazy if I go up and ask him for his autograph?” I asked. “For my youngest nephew, of course,” I hastily added.

“I mean, here we are, treating stupid athletes like gods, getting their autographs, while we pay no attention to really smart people who benefit society,” I went on to say. “What kind of message does that send to kids?” By now the psychiatrist next to me had figured out I wasn’t exactly a professional colleague. But he was amused and quietly encouraged me to get the autograph.

So I went up and got the autograph – made out to my youngest nephew, of course. Dr Kandel, I hasten to add, was very gracious. I nearly floated back to my seat. “Got it!” I exulted, trying to restrict my end zone dance to just two somersaults.

When I got home, I had the autograph framed and shipped to my nephew, who was so delighted to receive it he immediately hung it up over his bed.

And now to the main event. The following is drawn from an article on mcmanweb:

At five in the morning in October 2000, Denise Kandel fielded a call from Sweden. She didn’t understand what the person was saying except for the last word, "Stockholm." Then the realization dawned. The Nobel committee was on the line, with news for her husband Eric.

Rewind the clock to 62 years before. This time the sound in the middle of the night was that of the breaking glass of shop windows of Jewish businesses. The infamous Kristallnacht was raging across Germany and Nazi-occupied Austria. In Vienna, thugs burst into the Kandel’s apartment and forced young Eric and his brother and parents out into the street. The family returned a week or so later to find their home ransacked and all their valuables gone.

Young Eric and his brother were fortunate enough to find refuge in Brooklyn, months before World War II broke out. His parents got out with mere days to spare. The memory of that night and the horrors of a year under Nazi rule carried a profound impact.

"How could a highly educated and cultured society, a society that at one historical moment nourished the music of Haydn, Mozart, and Beethoven, in the next historical moment sink into barbarism?" Dr Kandel wrote in his Nobel autobiography many years later.

It was a question he took up in his undergraduate pursuits at Harvard. To continue his quest, he decided that psychoanalysis – the intellectual rage of the 1950s -was "perhaps the only approach, to understanding the mind, including the irrational nature of motivation and unconscious and conscious memory."

But a funny thing happened in his last year as a medical student at NYU. He decided to take an elective course in neurobiology at Columbia University. That led to a recommendation to join the NIMH as a postdoctoral fellow in the lab of the legendary Wade Marshall, who had mapped out the sensory system in the brain. Suddenly, psychoanalysis seemed like an artifact of an earlier age. The searing questions forged from his childhood in Vienna now found a new medium in modern biology.

"I am struck," he wrote, "as others have been, at how deeply these traumatic events of my childhood became burned into memory."

During his three years at the NIMH, Dr Kandel began his lifelong quest into the biological mechanism of the memory. With colleague Alden Spencer MD, Dr Kandel published a series of articles in the early 1960s documenting their discoveries of the cellular properties of hippocampal neurons. But the two researchers realized these findings alone could not account for how memory was stored. Instead, they began to look into how the neurons were functionally connected. But they needed a simpler place to start than the hippocampus. Dr Spencer turned to the spinal column while Dr Kandel hitched his star to the humble sea snail.

Dr Kandel’s mentors at the NIMH strongly discouraged him from taking such a radically reductionist approach to a complex biological process. Nothing interesting, they argued, could be found in a mere invertebrate, much less have application to higher life forms. But Dr Kandel was young and brash. After ruling out crayfish, lobster, flies, and the nematode, among others, Dr Kandel arrived at the aplysia, a giant marine snail. The animal’s small number of extraordinarily large and distinctively pigmented nerve cells conferred the advantage of easy observation and experimentation.

After completing a two-year psychiatric residency at Harvard, Dr Kandel headed off to Paris for a 16-month tutelage under Ladislav Tauc, one of only two people in the world working on the aplysia. Their collaboration led to a series of articles from the early to mid-1960s. But this was only the beginning.

To be continued ...

Thursday, November 12, 2009

A Darwin Appreciation

On two recent separate visits, I stopped in at two museums in San Diego's magnificent museum-botanical complex at Balboa Park. The permanent displays in both the Museum of Man and the Natural History Museum attest to the genius of Darwin and his theory of evolution, which is the only credible explanation to connect all the apparently random cool stuff in both buildings - from dinosaur skeletons to mysterious fossils to evidence of lost civilizations.

In celebration of the bicentenary of his birth (the same day as Lincoln) and the 150th anniversary of the publication of his seminal "On the Origin of the Species," the Natural History Museum is featuring a special Darwin exhibit. 

This photo essay - taken on my iPhone - is drawn from my museum trips.

These guys ruled. You are looking at the fossils of ammonites, which superficially resembled the nautilus but were closer in relation to the octopus and squid. They survived two major earth-shaking catastrophes eons apart only to succumb to apparently the same disaster that did in the dinosaurs.

Speaking of dinosaurs, smile for the camera, and thanks for the memories.

For many thousands of years, mastodons thrived in Southern CA. Then global warming happened. Sayonara, big fellow.

Speaking of disappearances, these reproductions of stellae stand as silent testimony to the lost civilization of the Maya. Their descendants live on, but their society went the way of the mastodon, perhaps for similar climactic reasons, such as drought.

Do you perceive a certain common theme, such as adaptive failure? Sometimes, the slightest genetic tweak can spell the difference between life and death, species-wise.

This is me on a bad hair day. Unfortunately this prototype of modern man failed to make the final cut.

Here's a reproduction of a fossil skull, zinjanthropus, dating back 1.75 million years, found in Tanzania's Olduvai gorge by Mary Leakey. Sadly, when it came to natural selection, the little guy lacked the right stuff.

Out of Africa. Zinjanthropus was not our distant ancestor, but this unmistakable DNA trail shows that everyone of us on the planet is linked to a common male and female ancestor from 60,000 years ago.

Get over it. We're all related.

The letter that started it all: An invitation from JS Henslow to Charles Darwin to serve as naturalist on the HMS Beagle.

Further reading from Knowledge is Necessity:  Darwin and the Psychiatric Advantage

Wednesday, November 11, 2009

Mental Health Break No. 33,093,478 - A Walk Down Old Highway 80

Another daily walk, more iPhone shots, this time two miles from my place. That twig-like object several pics in is a small rattler I almost stepped on. Enjoy ...

This Veteran's Day

The following is a slight modification of the piece I ran on Memorial Day:

This Veterans Day:

Our men and women are returning from two wars. They have witnessed things and felt things that those of us who stayed home have no clue. Their brains have been overwhelmed, their psychic beings shaken to the core.

This Veterans Day:

Our soldiers may leave the battlefield, but they cannot leave their memories there. Very high percentages are returning home with PTSD, depression, and other mental illnesses. Even those without full-blown symptoms have issues to deal with. Others are ticking time bombs. Suicide will claim more of them than enemy gunfire. Many will attempt to cope by turning to alcohol and drugs.

This Veterans Day:

Many brave men and women have no clue what is about to happen to them. They served as heroes, but, like many who served in Vietnam, may wind up homeless. They may be remembered for their bravery, but we will cross the street to avoid them.

This Veterans Day:

It's not just about flags on graves. It's about serving the people who served our country.

This Veterans Day:

Resolve to do something tangible. Advocate. Donate. Get involved with one of the veteran's organizations. Get involved with a mental health group making an outreach to veterans. Do something. Then keep doing it.

This Veterans Day:

It's our turn now.


From Therese Borchard's Beyond Blue:
  • Almost one in three veterans returning from Afghanistan and Iraq confront mental health problems.
  • On an average day in this country, suicide claims another 18 veterans.
  • Approximately 30 percent of veterans treated in the veterans health system suffer from depressive symptoms, two to three times the rate of the general population.
  • More Vietnam veterans have now died from suicide than were killed directly during the war.
  • Approximately 40 percent of homeless veterans have mental illnesses.

Tuesday, November 10, 2009

Depressed or Thinking Deep - My Take

Therese Borchard of Beyond Blue always has a way of making me feel that on a planet of six billion strangers I have at least one person I can talk to. Last week, she opened a blog piece this way:

I spent my adolescence and teenage years obsessing about this question: Am I depressed or just deep?

When I was nine, I figured that I was a young Christian mystic because I related much more to the saints who lived centuries ago than to other nine-year-old girls who had crushes on boys. I couldn't understand how my sisters could waste quarters on a stupid video game when there were starving kids in Cambodia. Hello? Give them to UNICEF!

Now I look back with tenderness to the hurting girl I was and wished somebody had been able to recognize that I was very depressed.

See what I mean? I just know that had we been in the same class at grade school, while the other kids played ball during recess, Therese and I would have found a quiet spot to sit under a shade tree, sharing cookies our moms packed and discussing how Augustine of Hippo must have felt after Alaric the Visigoth sacked Rome in 410 AD.

So, what was it? Were Therese and I two sensitive souls waxing philosophical, or two depressives acting strange? Therese cites both Paula Bloom PsyD (from a blog on PBS) and Peter Kramer MD, author of "Against Depression" (from a NY Times piece) in support of the proposition that depression and thinking deep are clearly distinct. Says Dr Kramer:

"We idealize depression, associating it with perceptiveness, interpersonal sensitivity and other virtues. Like tuberculosis in its day, depression is a form of vulnerability that even contains a measure of erotic appeal." First the ancient Greeks, then Renaissance thinkers, and later the Romantic movement assigned spiritual and artistic and even heroic virtues to melancholy. Nonsense, Dr Kramer responds. "Depression is not a perspective. It is a disease."

If I interpret Therese correctly in her blog piece, she found comfort in this. It came as a great relief to her to realize that her capacity to think deep, even at a young age, although unusual, was not pathological.

I, on the other hand, have an entirely different reaction. "Wait!" I want to scream at Dr Kramer. "You mean my depressions have all been for nothing?" My lost hours, lost days, entire lost years, a lost life practically, served no useful purpose whatsoever?

Screw you, Kramer! I want to keep screaming for no logical reason, whatsoever. Something that took so much from me, so much out of my life, I demand some kind of return - Jedi powers, a mystical third eye, roll-over phone minutes, whatever.

Yes, Dr Kramer is right, but so is everyone else. When it comes to the enduring question - Who the hell am I? - we are all struggling to find the truth. Here's what I'm looking at right now:

Proposition One: Any depression that is not part of my temperament sucks - whether mild or severe. Take my depression - please. They throw me off my game, ruin my day, wreck my life. Whether it's a depression that is the equivalent of a mild cold or one that is psychic double pneumonia I seriously don't want to be inside my brain on this planet when my neurons have gone on strike. If this is the disease that Peter Kramer is talking about, I'm behind him one hundred percent.

Proposition Two: At the same time, mild to moderate depression is part of my temperament, my personality (as is hypomania). As opposed to my disease depressions, I'm very comfortable in this state. It is a part of who I am. My energy is down, my thoughts tend to be very dark, but - here's the key difference - I thrive in this state. My neurons are working with me, or perhaps me with my neurons. It's as if I'm calmly sifting through the ideas I rounded up in my hypomanic frenzies, whether I'm lying in bed, at my desk, or taking a walk. If this is Dr Kramer's version of just thinking deep, I would have to respectfully disagree.

What we are talking about is the classic distinction between "state" and "trait." Trait is who we are. State is invasion of the brain snatchers. But no distinctions are ever as clear-cut as they seem.

We tend to get hung up on DSM-IV check lists while ignoring a key DSM injunction - namely that we are only in a state of mental illness when the symptoms interfere with our ability to function (as in work or relationships). So - from my personal perspective - if I am comfortable and not struggling while depressed, then I hardly have an illness that needs treatment.

Now let's flip it. I also get hypomanic, and I've written a lot about this. Here's the test: For Marilyn Monroe to act like Marilyn Monroe (at least when she's up) - that's normal, for Marilyn, anyway. For someone else to act like Marilyn Monroe, on the other hand - that's probably a sign that very bad things are about to happen.

So, back to depression. For me to act like me (when I am down), under most situations that is normal for me. I can handle it, it is healthy. For someone else to act like me, trust me, that is cause to get one's personal affairs in order.

Here's where it gets complicated. When does my productive depression start becoming a nuisance and when does this nuisance seriously start messing me up? Similarly, when does my upbeat hypomania cross over into social embarrassment and in turn morph into something that causes me to make very bad decisions?

It's as if we're turning up the heat. When, in effect, instead of a nice warm soak in the tub, do we find ourselves in hot water? Everyone has different tolerance thresholds, and you can make a good case that we can expand the range of these thresholds to lead healthier lives. Of course, every time I congratulate myself on doing this, God just laughs and throws a psychic lightning bolt in my direction.

So - my normal would probably cause most people to stay in bed for six months, or (in the other direction) have neighbors dialing 911.

One more twist. In her blog, Dr Bloom reported on this confused reaction from a patient: "When I reflected to her that she sounded depressed she said 'I don’t think so, that is just my personality.' So many people confuse depression with just being a lazy, unmotivated person."

So our depressed state tends to give us a wrong read on our baseline traits. Who the hell are we? It's a question I'm still trying to figure out.

Therese is my fellow terminal deep thinker and favorite blogger. Please check her out at Beyond Blue.

Monday, November 9, 2009

Mental Health Break No. 26,493,178 - A Walk in My Neighborhood

My daily routine is to calmly crank out my work from home till just before I'm ready to scream. That is my cue to head out for a walk. I'm 3,500 feet up in the mountains 40 miles east of San Diego. Today, I drove one mile as the crow flies to the entrance of a state park, which I had all to myself. I shot the pics from my iPhone. Enjoy ...

Mental Health Break No. 66,395,275 - A Walk in the Park

The walls are closing in. I need to get out of the house. Out of the neighborhood. I wasn't going to get anything done anyway. An hour later I'm in San Diego's Balboa Park having a great day - and here's the slide show to prove it.

Sunday, November 8, 2009

Zen Moments

On the spur of the moment, I drove 40 miles to Balboa Park in downtown San Diego, where I stumbled into a Japanese flower arranging show. The style is called Ikebana, in which the actual bloom may play a supporting role to stems and stalks and branches and leaves. Suddenly, I was in another world. I shot these on my iPhone.  Enjoy ...

Saturday, November 7, 2009

Thinking With Our Meat - Part II

Nature/nurture, mind/brain, genes/environment - today’s brain science is providing new insights into how we think and behave. To continue from Part I ...

At the 2003 APA in San Francisco, I heard Daniel Weinberger of the NIMH tell his audience about a study that came out of his lab, published in Science the year before (Ahmad Hariri, lead author). In the study, the researchers rounded up healthy subjects and put them into a brain scan machine (not all at the same time, I presume. I think they lined them up one at a time). The individuals were divided into two groups, those who had a certain variation to a particular gene, what they call the short allele to the serotonin transporter gene, and those who had the long allele.

The serotonin transporter - or serotonin reuptake pump - is the target of SSRI antidepressants. Based on this knowledge, researchers knew there had to be a genetic smoking gun somewhere, but they were stumped. The problem was they were looking for a "depression gene" or a "bipolar gene." Genes, unfortunately, don't code for the way we classify psychiatric disorders.

In 1998, for instance, a German team came to the conclusion that "no association between alleles conveying functional differences in serotonin transport gene expression and major depressive disorder or bipolar disorder could be found."

Basically, genes act as "on-off" switches. But they don't necessarily switch on "depression" or "bipolar" or anything else. Instead, they activate proteins that regulate how cells function and and organize themselves into interacting with other cells. This in turn may influence whether a certain individual is predisposed to depression or bipolar, but you're not going to find that out by looking for a direct link.

It's simple mechanics really. First link the gene to the cellular function it influences. Dr Weinberger and his team already knew that a certain region of the genome, SLC6A4 with the chromosomal address of 17q21, is responsible for the cellular activity that involves vacuuming excess serotonin from the synapse between the neurons.

But then what? What was the connection to behavior? On one hand, Dr Weinberger and his colleagues needed to build on the work of Arvid Carlsson's generation; on the other, they needed to throw away all their preconceptions.

As the study subjects' brains were being scanned, they were made to perform a simple cognitive task involving looking at images of "scary" faces. If you have any doubts about what a two-dimensional image can do to the brain, simply turn on Fox News without the sound. Seriously, just the sight of those idiots - don't get me started.

It turned out that the "short allele" people - that is, those with a certain variation to the gene in question - in reaction to the scary faces, a certain portion of their brains lit up like a Christmas tree. You guessed it, we're talking about the amygdala, which features mightily in my adventures with raccoons and skunks.

As we know, the amygdala mediates fear and arousal, and is directly and indirectly wired into all areas of the brain. Think of the amygdala as a simple smoke alarm. It can detect smoke, but it's too dumb to know whether the smoke is related to grilled meat or a five-alarm fire. The thinking areas of the brain will eventually provide you with the info you need to make a rational decision, but all that takes too way long to boot up.

In the meantime, it's prudent to sound the alarm, even if it is a false alarm. But what if the alarm is over-sensitive or won't shut off? It's one thing for your fight or flight response to kick in at the sight of a predator (or Dick Cheney with a face lift) at the door, but what if you keep having the same reaction to, say, the UPS guy?

When the amygdala goes off, we are reacting rather than thinking. We are operating out of fear. As Dr Weinberger explained to his audience, "this could be the first study to link genes to emotions."

What does this mean?  Let's turn to a closely related study:

About 35 years ago, researchers from the University of Otago recruited a "birth cohort" of more than 1,000 infants born in Dunedin, New Zealand, and subsequently assessed them every two or so years. Had my daughter (who was born in Dunedin) arrived five years earlier, she might have been part of that cohort. Then again, had she been born five years earlier, I wouldn't have been the father.

"Longitudinal" studies of this sort represent the gold standard of population research, as opposed to "retrospective" findings based on recalled events. Over the years, this cohort has been to medical and psychiatric and behavioral research what wild Tanzanian chimps have been to Jane Goodall.

On July 18, 2003, the journal Science published the latest installment coming out of Dunedin. The year before, the same research team had identified certain childhood risk factors in antisocial behavior, together with a strong link to a suspect gene (acting on the enzyme MAO-A). This time, the researchers (Avshalom Caspi, lead author) analyzed the cohort for stressful events over the past five years, such as death in the family, losing a job, or breakup with a partner and this time their attention was directed at the very same gene that featured in Dr Weinberger's study.

Lo and behold, of those meeting the criteria for at least four recent stressful events, 43 percent of the short allele people experienced depression vs just 17 percent with the long allele.

In a field where researchers are accustomed to teasing out frustratingly small statistical blips, these numbers represent something truly seismic.

It is important to note that the researchers did not identify this variation as a "depression gene." Rather, drawing the short genetic straw makes one susceptible to stress and its downstream effects (which may include depression). One also needs to have regard for the fact that not all depressions are caused by stress.

Think of the short allele as a "vulnerability gene." Those with the long allele, by contrast, may be regarded as the proud owners of a "resilience gene."

To further clarify the resilience factor, the depression rates for those with the long allele did not vary, regardless of whether they had experienced zero recent stressful events or four or more. Those with the short allele, by contrast, only experienced this same low depression rate as the long allele people when not exposed to any major stress, period.

As Dr Weinberger described it at a subsequent APA, this particular gene "impacts on how threatening the environment feels." Or, as his colleague Andreas Meyer-Lindenberg put it at yet another conference I attended, the short allele "impairs your ability to respond to what life throws at you."

Noted the Dec 19, 2003 Science: "Together, these studies suggest that the gene variant biases people to perceive the world as highly menacing, which amplifies life stresses to the point of inducing depression."

So, oddly enough, when the Freudian-inspired DSM-I of 1952 fingered "the stresses of interpersonal relations" as complicit in our behavior it was on the right track. Moreover, it wasn't far off in assuming that mental illness was the result of a maladaptation of the individual to his or her environment.

Where Freud's followers went wrong was in thinking that these "neurotic reactions" - to which they assigned a quasi-mystical quality - had little or nothing to do with the meat housed inside our skulls. But that is changing.

More later ...