Jill Bolte Taylor Discusses the Brain and Recovery

“Am I safe?”

That is your brain’s bottom line, the question - the one question - that your temporal lobe, amygdala, and hippocampus are asking, moment by moment. When you’re not safe, learning and memory turn off.

The amygdala, which mediates fear and arousal, is engaged in a constant dialogue with its next-door neighbor the hippocampus, responsible for laying down memory, in partnership with the temporal lobe, at least when things go right.

Ultimately, as Jill Bolte Taylor, author of “My Stroke of Insight,” explained at the NAMI national convention last week in Chicago, our job is to create energy where we feel safe. Dr Taylor was climbing the career ladder as a neuroanatomist at Harvard when in 1996, at age 37, she suffered a debilitating stroke that left her unable to walk or talk or recall life. Her recovery took eight years.

Dr Taylor’s tour de force presentation at NAMI completely belied the fact that she had ever so much as suffered a single isolated synaptic misfiring in her entire life, let alone her entire world extinguishing in a catastrophic neurological supernova, but the explanation for her recovery, she let us know, can be summed up in one word: neuroplasticity.

Two words, actually: Neuroplasticity and neurogenesis.

Neuroplasticity, Dr Taylor explained, is about cells supporting cells in a network. It’s all about circuitry, but nothing is hardwired. Our neural connections are forever readjusting and strengthening - with dendrites unplugging from old neurons and replugging into new ones in response to new challenges.

Neurogenesis is about the individual cells and what they need in order to recover.

“The bottom line,” Dr Taylor said, “is we can choose where we can take our nervous system.” Literally, we can change the game. “I am neurocircuitry - thoughts, emotions, physiology. I can pick which circuits I want to run.”

“Pay attention to what you’re running,” she went on to say. “You get to pick and choose what’s going on inside your brain.”

It’s all about the amygdala. “I see your amygdala,” Dr Taylor told her audience. “Happy amygdala? That’s the bottom line for me.”

It all comes down to this: When the amygdala feels safe, the rest of the brain can do its job. Recovery is possible, but it doesn’t happen overnight.

“Give my brain time to recover,” Dr Taylor implored her audience. “Neurons are in very slow motion.” They also need rest, not overstimulation - sleep, lots of it, if that is what it takes to feel energized, even if only for short stretches of time. Her mother, she said, went completely against protocol in letting her sleep - which ultimately allowed her to heal.

Safety, time, rest - is healing really that simple? Think what the word, asylum, means. Maybe the answer has been staring us in the face all the time.

Much more to come ...

Nora Volkow: Stress, Mood, Drug Abuse, and the Brain

Yesterday featured a piece based on Nora Volkow's talk to the 9th International Conference on Bipolar Disorder several days ago. Dr Volkow is the head of the National Institute on Drug Abuse and manages to moonlight as one of the world's leading brain scientists. Yesterday, we had a look at her work on functional resting connectivity. Today features a selection of slides from part of a much larger presentation dealing with co-occurring mood and substance use disorders. The slides pretty much do all the talking, so I'll keep my commentary brief.

Basically, combine stress with genetic vulnerability and bad things happen. Drug abuse involves much the same process. And, of course, the two interrelate. Lifetime drug abuse amongst bipolars is in the 60 percent range.

An under-active prefrontal cortex combined with an over-active amygdala is a recipe for disaster. There is no end to variations on this theme. This one involves a certain genetic variation (allele). Another variation involves kids, whose brains have yet to mature. As opposed to the heart, Dr Volkow pointed out, the brain takes 20 years to develop. Plenty of time for risk-taking activities, such as drug use. Meanwhile, early childhood social neglect impairs brain development. Too much amygdala action, not enough from the PFC and other areas.

Significantly, a good many of the shared candidate genes for bipolar, schizophrenia, and substance abuse have to do with neuroplasticity. Neuroplasticity has a lot to do with how we react to our environment. If our neurons don't hold up well (such as to stress) and maintain cellular function, well, bad things only get worse. Neuroplasticity also plays a role in programmed brain development, all those gear changes that are supposed to represent smooth transitions into adulthood and beyond. Needless to say, for a good many of us, life is not a smooth transit.

Ah, dopamine.

This is your brain on drugs.

The brain may be highly differentiated, but with everything literally connected to everything in one way or another, mental illness tends to involve a system failure throughout the brain.

Rerun: The Brain is an Ecosystem

Yesterday, I posted a piece challenging the "chemical imbalance" myth, based on Robert Whitaker's account in "Anatomy of an Epidemic." The following, from July last year, logically follows ... 

Moira writes:

"We're being told by experts to quit describing mood disorders as chemical imbalances. What metaphor or analogy shall we deploy to replace chemical imbalance?"

Moira was responding to a piece I posted from a bipolar conference a couple of weeks ago where I had this to report: "We're not talking 'imbalance of chemicals of the brain,' Dr Manji reminded his audience. Instead, think of mood disorders as 'impairments of synaptic and neural plasticity.'"

What this means is that instead of conceptualizing the brain as some sort of uniform chemical soup that could use a bit more serotonin or dopamine, we need to see the brain as a highly intricate ecosystem that requires sophisticated nurture and cultivation. In a guest blog post here, Cristina Romero had this to report from a talk by Kay Jamison:

"The brain is like a pond. It’s like an ecosystem. You want to get the ideal ecosystem and then you don’t want to disturb it very much. ... You want to really create a stable environment."

The brain, like an ecosystem, is highly complex, non-linear, and self-organizing. Both brain scientists and environmentalists describe this self-organizing principle as "homeostasis," where the system maintains its own equilibrium at a particular "set point." Robert Sapolsky in "Why Zebras Don't Get Ulcers" gives the example of perspiration to regulate body temperature.

But what if we're in the desert? If we keep perspiring, we will lose water and die. Here's where "allostasis" kicks in: We stop sweating buckets, our mucus dries up. Once the crisis is over, our body reverts to normal, or - in response to changing circumstances - it may find a new set point.

With "allostatic overload," we are talking system breakdown, such as what may happen with global warming or what is going on right now with the current economic-financial crisis. Allostatic overload is what happens to us when our brains fail to cope. Those of us with mental illness reach overload fairly quickly. When this happens, our brains simply don't reset to normal. We find ourselves caught in a destructive dynamic, trapped in our thoughts and emotions.

Ecosystems operate on "macro" and "micro" levels. This corresponds to the "impairments of synaptic and neural plasticity" that Dr Manji was talking about. Until recent advances in brain imaging and gene technology, we had a vague macro idea of neurotransmitter traffic, which gave rise to the "monoamine hypothesis" to explain mood disorders and other mental illnesses.

A gross oversimplification of this hypothesis resulted in the "chemical imbalance" myth of mental illness, best illustrated in the Zoloft ad below:















Of course, as Dr Sapolsky mentioned in an educational video, the brain is not "undifferentiated tofu." A serotonin or dopamine lube job is is not going to have the same uniform result in different areas of the brain.

Below is a far more sophisticated macro view of the brain:















In the fMRI image, we can view how one particular pathway between two different areas of the brain is supposed to operate when things are going right. When things go wrong, that narrow arrow on the right becomes wide.

The arrows represent neurotransmitter traffic, busy and focused on the left, light and broken up on the right. Too much traffic on the right means the emotional part of the brain is dominating the conversation with the rational part of the brain, which happens a lot of the time to those of us with bipolar.

Think of this macro view as the brain working (or not working) on a "systems level." The "cellular level" represents the micro view. Recall "Nerve A" and "Nerve B" from the Zoloft ad. They were largely empty. Here's an approximation of what is really going on inside the neuron:













When things go wrong inside, the neuron may shrivel and even die. On a macro level, when neurons go off-line and fail to communicate (via neurotransmitters) with other neurons, entire brain systems are compromised. We lose our ability to think and function.

As you can guess, "macro" and "micro" are interconnected. Each regulates the other in highly intricate and virtually infinite ways. When things go right, we can only marvel at this creation of nature. When things go wrong, it's not just a chemical imbalance - it's a catastrophe, a collapse. Think "ecosystem."

Much more in future blog posts ...

Further reading

Check out the Science section to mcmanweb. A sample:

"By learning what happens after dopamine binds to its target neuron, we have been able to behold the brain’s inner watch works and marvel over its elegant complexity. This, in turn, is adding to our understanding of the outer watch works, namely how different parts of the brain talk to each other and how various neurotransmitter systems interact."

Systems in Collapse

Instead of conceptualizing the brain as some sort of uniform chemical soup that could use a bit more serotonin or dopamine, we need to see the brain as a highly intricate ecosystem that requires sophisticated nurture and cultivation.

In a guest blog here last year, Cristina Romero had this to report from a talk by Kay Jamison of Johns Hopkins:

The brain is like a pond. It’s like an ecosystem. You want to get the ideal ecosystem and then you don’t want to disturb it very much. ... You want to really create a stable environment.

The brain, like an ecosystem, is highly complex, non-linear, and self-organizing. Both brain scientists and environmentalists describe this self-organizing principle as "homeostasis," where the system maintains its own equilibrium at a particular "set point."

We see this in the cycle of the seasons. But what if a drought or global warming intervenes? That's where "allostasis" kicks in. The system engages in compensatory wobbles to restore its sense of balance, either back to its original set point, or to a new one. That could be going on right now with Mother Earth.

Over the last two decades, southern California has gotten drier. The drought-weakened oaks in San Diego's eastern back country, my home until very recently, have been sitting ducks for certain species of beetles, who lay eggs in the bark crevices. The larvae then bore under the bark, and literally drain the life out of the tree. By the time you see dying leaves, it is too late to save the tree. Literally, a walk in the back country here is a walk along arboreal death row.

It doesn't stop there. The dead and dying trees serve as kindling for wild fires, which the seasonal Santa Ana winds fan like a bellows. In 2004, a once-in-a-century fire raged through the back country and other areas of San Diego, scorching more than a quarter million acres and killing 15 people. In 2007, another once-in-a-century fire struck.

Cycle of nature or planet in crisis? Who knows? The earth will heal one way or the other. It's just that it may no longer look the same or have people in attendance to witness the change. San Diego's Museum of Natural History has a fossilized mastodon skeleton on display, together with a mural depicting the beasts frolicking in the local swamps.
   
Then global warming happened. The swamps became desert. The earth eventually adjusted - found a new set point - but it was a new world order that did not include the mastodon. (Thanks for the memories.)

Then there is allostatic overload, a state of total collapse. As it happened, late last year I was hiking along the arboreal death rows of San Diego's back county - enjoying the sun, sucking in the type of air that city people would happily pay a dollar a bottle for - as I contemplated a person close to me in a psych ward back east. Back in the old days, they simply would have referred to his condition as a nervous break-down. They got that right. His brain was indeed broken. But which part of the brain was broken? That’s what I wanted to know.

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.”
   
Repeat: The brain is an ecosystem, the brain is an ecosystem, the brain is an ecosystem ...

The causes of depression and other mental illnesses are complex and only partly understood. Nevertheless, a picture is beginning to emerge of interconnecting brain systems in allostatic overload on the brink of collapse.

Tell me about it ...

The Brain is an Ecosystem

Moira writes:

"We're being told by experts to quit describing mood disorders as chemical imbalances. What metaphor or analogy shall we deploy to replace chemical imbalance?"

Moira was responding to a piece I posted from a bipolar conference a couple of weeks ago where I had this to report: "We're not talking 'imbalance of chemicals of the brain,' Dr Manji reminded his audience. Instead, think of mood disorders as 'impairments of synaptic and neural plasticity.'"

What this means is that instead of conceptualizing the brain as some sort of uniform chemical soup that could use a bit more serotonin or dopamine, we need to see the brain as a highly intricate ecosystem that requires sophisticated nurture and cultivation. In a guest blog post here, Cristina Romero had this to report from a talk by Kay Jamison:

"The brain is like a pond. It’s like an ecosystem. You want to get the ideal ecosystem and then you don’t want to disturb it very much. ... You want to really create a stable environment."

The brain, like an ecosystem, is highly complex, non-linear, and self-organizing. Both brain scientists and environmentalists describe this self-organizing principle as "homeostasis," where the system maintains its own equilibrium at a particular "set point." Robert Sapolsky in "Why Zebras Don't Get Ulcers" gives the example of perspiration to regulate body temperature.

But what if we're in the desert? If we keep perspiring, we will lose water and die. Here's where "allostasis" kicks in: We stop sweating buckets, our mucus dries up. Once the crisis is over, our body reverts to normal, or - in response to changing circumstances - it may find a new set point.

With "allostatic overload," we are talking system breakdown, such as what may happen with global warming or what is going on right now with the current economic-financial crisis. Allostatic overload is what happens to us when our brains fail to cope. Those of us with mental illness reach overload fairly quickly. When this happens, our brains simply don't reset to normal. We find ourselves caught in a destructive dynamic, trapped in our thoughts and emotions.

Ecosystems operate on "macro" and "micro" levels. This corresponds to the "impairments of synaptic and neural plasticity" that Dr Manji was talking about. Until recent advances in brain imaging and gene technology, we had a vague macro idea of neurotransmitter traffic, which gave rise to the "monoamine hypothesis" to explain mood disorders and other mental illnesses.

A gross oversimplification of this hypothesis resulted in the "chemical imbalance" myth of mental illness, best illustrated in the Zoloft ad below:















Of course, as Dr Sapolsky mentioned in an educational video, the brain is not "undifferentiated tofu." A serotonin or dopamine lube job is is not going to have the same uniform result in different areas of the brain.

Below is a far more sophisticated macro view of the brain:















In the fMRI image, we can view how one particular pathway between two different areas of the brain is supposed to operate when things are going right. When things go wrong, that narrow arrow on the right becomes wide.

The arrows represent neurotransmitter traffic, busy and focused on the left, light and broken up on the right. Too much traffic on the right means the emotional part of the brain is dominating the conversation with the rational part of the brain, which happens a lot of the time to those of us with bipolar.

Think of this macro view as the brain working (or not working) on a "systems level." The "cellular level" represents the micro view. Recall "Nerve A" and "Nerve B" from the Zoloft ad. They were largely empty. Here's an approximation of what is really going on inside the neuron:













When things go wrong inside, the neuron may shrivel and even die. On a macro level, when neurons go off-line and fail to communicate (via neurotransmitters) with other neurons, entire brain systems are compromised. We lose our ability to think and function.

As you can guess, "macro" and "micro" are interconnected. Each regulates the other in highly intricate and virtually infinite ways. When things go right, we can only marvel at this creation of nature. When things go wrong, it's not just a chemical imbalance - it's a catastrophe, a collapse. Think "ecosystem."

Much more in future blog posts ...

Further reading

Check out the Science section to mcmanweb. A sample:

"By learning what happens after dopamine binds to its target neuron, we have been able to behold the brain’s inner watch works and marvel over its elegant complexity. This, in turn, is adding to our understanding of the outer watch works, namely how different parts of the brain talk to each other and how various neurotransmitter systems interact."

Post Inaugural Reflections - Beyond Reason?

There were a zillion memorable images from yesterday's Day of National Jubilation, but the one that struck me most was that of a US Marine helicopter diminishing to a speck on the horizon.

The passengers on that flight were the former President and former First Lady.

Former President! It was over. The national nightmare had ended.

So can we now expect an era of rational government?

Not so fast. Two days ago, NY Times op-ed columnist David Brooks mentioned a book that came out in 1962, entitled, "The End of Ideology." The book reflected the thinking of the day, namely that the intense ideological-political schisms of the past were over. Now the country could settle down to rational governance and pragmatic decision-making.

The major flaw in the book, of course, was that this happened to be the Sixties. The Sixties! The Industrial Age and all its assumptions was numbered. The Information Age with all its uncertainties was crashing the party. Civil rights, Vietnam, women's rights. As David Brooks describes it:

"People lost faith in old social norms, but new ones had not yet emerged. The result was disorder. Divorce rates skyrocketed. Crime rates exploded. Faith in institutions collapsed. Social trust cratered."

The collapse of the old order intensified ideological conflict, as conservatives and liberals battled over whose values - social, moral, cultural, political - would prevail. For four decades, there was literally no let-up. Politics turned personal, nasty, ugly - crazy.

But nothing is permanent. Even before people had heard of Obama, a book by Rick Warren, "The Purpose Driven Life," implied that opposites were reconciling into a sort of probational equilibrium.

Obama's ascension to high office, Brooks argues, may be a reflection of this new order. Problems that were impossible to fix when people were at each other's throats - problems such as health care - may be doable now.

But here's the catch. Whether we are talking economics, politics, or personal relationships, the choices we make are never purely rational. We are in the thick of the worst economic-financial collapse since the Great Depression. Two things can happen:

The crisis may actually wake us up, concentrate our collective minds in such a way that, as a society, we actually start thinking rationally. Think of the limbic system on high alert, marshaling our frontal lobes into a state of preternatural clarity and awareness.

Or the crisis may stress us out in ways that throws reason out the window. This time think of the limbic system inciting our frontal lobes into a state of panic. We either blindly lash out or freeze like a deer caught in the headlights.

FDR's first one hundred days in office is the classic example of a rational response to crisis. Together, the country united to save Western Civilization.

By then, Europe was in the clutches of an irrational response. Fascist/Nazi governments were entrenched in some countries, Communists in others. The rest were flailing in pathetic states of conflicted indecision. Civilization didn't stand a chance.

Seeing that speck of a helicopter disappear into the miasma of a DC afternoon filled me with great - and admittedly irrational - joy. But that joy is tempered by my knowledge that our brains are not wired to think rationally. We are betting the success of the new Administration and the future of this country - our entire civilization, for that matter - on the totally opposite assumption.