Wednesday, November 16, 2011

Brain Science and Recovery - Knowledge is Necessity

My last two pieces - on psychiatrists behaving badly - diverted me from my true mission here at Knowledge is Necessity, namely providing food for thought in the quest of knowing thyself. A very key part of that is passing along any cool brain science stuff I happen to pick up along the way.

Brain science and ancient wisdom represent the crucial double helix in our getting well and staying well. After decades of guess-work psychiatry, researchers have finally figured out how to open up the hood and peer into the brain’s moving parts, and what they are finding out can be applied by us right now in our recovery. I have been shouting this from the roof tops for nearly ten years, and I have no intention of stopping.

My starting point this time is Barbara Oakley’s must-read 2007 “Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed and My Sister Stole My Mother's Boyfriend.” Last week, in Figuring Out Human Behavior, I couldn’t hide my enthusiasm for Dr Oakley’s show-and-tell of the brain science, which paralleled a lot of my research and writing. For both of us, the focus was the serotonin transporter gene, perhaps the most-studied gene related to psychiatric disorders.

To recap: A glitch in this gene predisposes certain people to over-react to environmental stressors, which in turn makes them sitting ducks for depression and other conditions. The breakthrough work came out in the early 2000s, and makes an excellent teaching lesson for a number of points we all need to know, namely:
  • Our genes and our environment interact. We may not have any choice in changing our genes, but we can often choose to change our environments in a way that lets sleeping genes lie.
  • Genes are not deterministic, but they do predispose us to how we react to whatever life may throw our way.
  • Stress is the key driving force in mental illness. There are other factors, but stress is invariably complicit. A good deal of mental illness can be summed up as “stress vulnerability disease.”
  • Diagnostic categories useful to a point, but malfunctions in serotonin transport have been linked to anxiety, mania, depression, substance abuse, borderline personality disorder, and all manner of things that can go wrong. Likewise, malfunctions in other processes tend to have similar shotgun effects.
  • It is more helpful to think of genes switching on and off certain mechanical processes in the brain than “causing” a specific disease. Moreover, these processes work in the context of whole brain systems interacting with other brain systems, which may exacerbate or mitigate the effects of the equivalent of a tap not being able to shut off.
  • There are no “good” genes or “bad” genes. Inevitably, there are trade-offs. A gene variation that may predispose you to stress may also protect you from Alzheimer’s.
To give us a better understanding of the brain in action, it is useful to look at the impact of other genes. Of all things, Dr Oakley’s list and my list are virtually identical. This is no accident. Daniel Weinberger of the NIMH is Oakley’s main source. Likewise, he is mine. Dr Weinberger was part of the team involved in the breakthrough research into the serotonin transporter gene, and he and his NIMH colleagues have been involved with the following, as well:

Brain-Derived-Neurotrophic Factor (BDNF)

This protein is involved in brain cell maintenance and survival and encourages the growth of new neurons and neural connectivity. A “double-val” variation in this gene has been linked to stronger memory. The catch is those with the double-val are prone to more anxiety and moodiness and hostility, possibly due to a magnification of the serotonin transporter glitch. A “double-met,” on the other hand may offset the glitch.

Catechol-O-methyltransferase (COMT)

Mechanically, this gene breaks down dopamine and other neurotransmitters. The more slowly you metabolize dopamine (the “met” variation), the smarter you are. The unfortunate “val/vals” may be a bit less intelligent, with a slightly increased risk of schizophrenia, plus risk of antisocial behavior, and hyperactivity. The “val/mets” fall in between. The trade-off? Vals may be able to handle stress better than the mets and be more flexible to change.

Monamine Oxidase A (MAO-A)

This protein breaks down dopamine and other neurotransmitters. Low-functioning MAO-A has been linked to aggressive and antisocial behavior and substance abuse and more. Those with low-efficiency versions of this gene tend to display hyperactive amygdalae (involved in fight-or-flight) and low-responding orbitofrontal and cingulate cortices. In other words, the front end of the brain has problems turning down the alarm signals from the back end of the brain. Impulsive violence may be one result.

A breakthrough 2002 study found that maltreated kids with low-efficiency MAO-A developed significant antisocial problems while the high-efficiency MAO-A kids were better able to weather the storm.

Wrapping it Up

Don’t worry about understanding all the fine details. The purpose here is to simply display how the interplay between genes and environment affect thinking and feeling and behavior. We are a long way from definitive answers, but we are definitely looking ahead to what 2000 Nobel Laureate Eric Kandel describes as “the new science of the mind.”

We don’t have to wait for psychiatry to get with the program. As I said at the beginning, we can apply brain science to our own recovery right now. Dr Oakley makes it abundantly clear that our behaviors are far less governed by free will and reason than our over-sized egos would have us believe. But knowing that, we can intelligently take stock of our vulnerabilities and make the type of course corrections that allow us more control over our brains and, with it, our lives.

Be smart. Live well ...

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