iPhone Photo of the Day - Sequel to the Sequel

I shot this on the Sunrise Highway that traverses Mount Laguna, from a lookout close to 6,000 feet above sea level. I live 10 or 15 miles away as the crow flies, but here I am in an entirely different world, dominated by Jeffrey Pines (note what I call the optional snow, the kind you drive to rather than shovel off your driveway). Yesterday, I was taking photos of palm trees in Balboa Park at sea level in San Diego, 40 miles from where I live. A recent Photo of the Day featured an entirely different environment a mile from where I live at 3,500 feet.

In the space of literally an hour, I can cross into five or six entirely different climate zones, with dramatic changes in weather and scenery.  I've lived in Southern CA for three years and still marvel at the diversity.

iPhone Photo of the Day - The Sequel

I'm back home. I shot this in San Diego's Balboa Park. For a polar opposite (and I really mean polar) check out my previous Photo of the Day that I shot in Lexington, MA.

Rerun - Skunk!

This from August ...

Let it be known throughout the land: Raccoons respect my piss.

In a recent blog piece, I reported on my “solution” to unwelcome raccoon visitors entering the house through the cat flap.

A couple of nights ago, I heard a mysterious scratching outside my bedroom door. A neighborhood cat? Return of the raccoons? I made a noise, then heard the flap of the cat door, signaling the sound of the animal in full retreat.

At two in the morning, I woke up, put on my glasses, and went to the kitchen for a glass of water. I spotted something furry out of the corner of my eye.

 A skunk!

It’s a good thing I had my glasses on, or I might have mistaken the critter for my long-haired calico cat Bullwinkle. I have a bad habit of scooping Bullwinkle off the floor and nuzzling my face into her fur. Close call.

So here was the skunk, promenading in my direction across the living room floor as if he (let’s assume the skunk was a he) owned the place. Not a trace of fear.

“I laugh at your peeess!” the skunk sneered in what I swear was a French accent. “I hold your entire species in contempt! You are unworthy of the dis-stink-shun of odious! You want smell? Allow me to demonstrate smell!”

No!

“Peeess, ha!”

Slowly, very carefully, I backed into my bedroom and closed the door. The battle of the amygdalae was on.

Being fellow mammals in confrontation mode, our respective brains were now operating very similarly. Our limbic systems were both alerting us to danger and governing our immediate reactions. In particular, the amygdala - which mediates fear and arousal - was kickstarting our “fight or flight” response. Already, I was in a heightened state of awareness bordering on panic.

Think of the amygdala as a 911 call and the limbic system and autonomic nervous system as rapid responders. In nothing flat, my entire being was mobilized to face the threat. Adrenaline flowing, heart pounding, neurons zapping, breathing accelerating, digestive sugars pumping raw energy into the muscles.

In one microsecond, I was primed to fight like a kung-fu master on steroids or run faster than Michael Phelps can swim. But millions of years of evolution never anticipated the exigencies of modern living gone bad, namely me trapped in my bedroom with a skunk just outside.

I needed to think things through.

But our brains don’t work that way. Survival depends on instant reaction. Only later does actual thinking enter into the picture. Which explains why in the modern world we do stupid things such as panic and fly off the handle and start fights and fall in love and otherwise act against our own best interests.

Moreover, the cortical areas don’t automatically take over, even when they do come back online. In theory, the thinking parts of the brain are supposed to modulate the reactive parts of the brain, but too often it works the other way around.

“Bang on the door! Make noise!” That was what my limbic-influenced cortical regions were telling me. Bad thinking.

Pepe Le Pew was working off an amygdala almost the same as mine, only the “end” result of an alarmed reaction, from my point of view, would be far more consequential and dramatic.

So here was trick: Under no conditions could my amygdala set off his amygdala, and the only thing to prevent that from happening was for my cortex to take charge.

Scratch-scratch-scratch. Pepe was now on the hardwood floor just outside my room.

Scratch-scratch. Now he was on the concrete. The only thing separating me from a living weapon of mass destruction was the bedroom door - a door with cat flap.

Bang on the door! Make some noise!

No! Cortex to the rescue. “Just wait!” said the voice of reason with not a second to spare. “He’s headed out the other door. All you have to do is breathe.”

A sound. The cat flap, but not in fully-committed mode. Slowly, carefully, I opened the bedroom door a crack and peered out. The skunk was stalled three-quarters of the way through the cat door, tail inside, fully upright.

“Hurry him up!” said the panic-influenced part of my brain. “Bang on something! Now!”

“Wait, you idiot!” my voice of reason cut in. “In case you haven’t noticed, the operating end of this walking violation to the Geneva Convention has not yet left the building! Don’t - I repeat - don’t! Don’t, don’t, don’t, don’t ...”

One Mississippi, two Mississippi ...

An eternity, another one, and another. Then - the welcome sight of an unfurling tail disappearing through the door followed by the definitive sound of the final flap. Deliverance!

My elation at having prevented a “situation” from escalating into nuclear destruction was dampened by the realization that skunks think my piss is a joke. Clearly, this is going to require years of intensive therapy to get over.

In the meantime, Pepe, I implore you - not a word to the raccoons. Please?

Rerun - Raccoons!

 I'm flying out of Boston today to San Diego. The following is a piece from August. Enjoy ...

As you know by now, three weeks ago I came back from a conference and a family visit with a bad leg cramp which turned out to be sciatica. Here’s what I left out:

My housemate Paul informed me we’d had two raccoon visitors. We live way out in the country, 3,500 feet up in the mountains. We get our fair share of four-legged visitors around here. Sometimes visitors with no legs.

It seems the raccoons had squeezed through the cat flap and had helped themselves to Bullwinkle’s cat food. Bullwinkle’s feeding station can best be described as a gravity-operated kibble silo. It seems that the raccoons had gotten in the habit of tipping over the plastic silo and helping themselves to several weeks of cat food.

I recalled just before my trip seeing evidence of their handiwork. I had attributed the effort to Bullwinkle, whose motive would have been my own negligence in failing to fill up the container.

But I was wrong! It was raccoons!

Can man outwit nature? We could close off the cat flap, but that would effectively make Bullwinkle a prisoner in her own home. Moreover, we would be conceding dominion to the interlopers.

Leave it to me, I assured Paul. I may only be a city boy, but I was up to the challenge.

I placed a metal coffee can which happened to have batteries in it on top of the feeder. Then I set an aluminum baseball bat atop the coffee can, with the top end leaning against the wall.

We know Bullwinkle won’t tip over the feeder, I explained to Paul. As for the raccoons ... I dropped the bat onto the entranceway concrete floor for effect.

The perfect booby trap. The noise would frighten away the raccoons.

In scientific terms, the amygdala, which mediates fear and arousal in the limbic system of the brain, would kick off the raccoons’ fight or flight response. The raccoons know they are encroaching on our territory, I explained to Paul, so their amygdalae will be on hair-trigger alert, Then we would just keep resetting the trap till the no-good bastards wised up.

A few days later, I drove forty miles out to the desert for my weekend water volleyball. My leg was still acting up, but I figured the pool exercise would be good for it, along with some good long soaks in the hot tub. Later that evening, I stopped in at my favorite eating spot, just a mile from the Mexican border. It was Sunday. The July Fourth weekend was wrapping up, business was dead, and it was just me and one other customer in the place.

Plenty of time to chat with Michelle, my favorite waitress of all time. Michelle is a genuine mountain girl, who grew up 10 or 12 miles from where I now live. Maybe she had some insights into raccoons.

In the place where she used to live, she related, she heard an unworldly banging noise in the middle of the night. The racket was far too loud to come from a mere animal, she figured. It had to be a human intruder.

“So I grabbed my shotgun,” she said in the same casual voice a city girl would use to describe choosing a Versace handbag. “And I was holding the barrel in the same hand as my flashlight.”

She entered the garage-basement ...

A giant raccoon was splayed on the top of a garbage can, trying to undo the clasps holding down the lid. With each effort, the raccoon would literally lift the container off the ground and crash it to the hard concrete.

Never rule out the resourcefulness of a mountain girl. Michelle found a high vantage point over the raccoon, loaded, and ...

Emptied a container of her own freshly-minted piss on the critter.

“Never saw the raccoon again,” she told me with a smile.

Michelle also advised me that she employs the piss option to keep the coyotes away. Literally, she flings the stuff into the bushes and the trees. That way, her cats stay safe.

It’s all about the cats.

I returned home and set my canvas bag on the table, and decided to call it a night.

CRASH!

One in the morning. I opened the door to investigate. The cat feeder was down. No raccoons in sight.

Man vs nature. Score Round One to man. With great satisfaction, I reset my booby trap and went back to bed. Bring it on, heh-heh-heh ...

At four in the morning, I heard a scratching sound from outside the bedroom door. Bullwinkle was asleep with me. It had to be the raccoons making a return visit. I braced myself, awaiting the inevitable crash ...

No crash.

Scatch-scratch-scratch ... Something was wrong. The raccoons were mocking me, holding a raccoon party, here, in my own territory. The nerve! Calmly, cooly, I reached in the dark for my nearest Gutenberg Bible and threw it against the bedroom door. Instantly, from outside, came the sound of a flapping cat door and the skittering of mother nature’s furry psychopaths in full retreat.

I reassured Bullwinkle, and psychically instructed her to stay put. Then I went out to investigate. The cat feeder was untouched. But my canvas bag was off the table and on the floor, half-way to the cat flap. Inside was the prize, one microsecond from being unprized - half a leftover tuna sandwich.

The raccoons had wised up alright. Score Round Two to nature.

Speaking of nature, nature called. Now it was my turn to wise up. I found a plastic cup and aimed. Then I went outside and scattered the contents outside the door and immediate environs. Then I reloaded and marked my territory further afield.

That was more than two weeks ago. The raccoons haven’t been back since. This, despite the fact that my worsening sciatica rendered me virtually defenseless to future furry onslaughts. As I triumphantly explained to Michelle, mountain girl extraordinaire, it’s a good thing I’m an alpha male - otherwise the raccoons would have laughed at my piss.

Let that appear on my gravestone: “Raccoons respected his piss.”

Rerun - Remembering Pearl Harbor

My mind was on a lot of other matters today. A few minutes ago, as I was getting ready to crash on a friend's couch three time zones from home, I suddenly realized what day it was and what it means. I put this together back in March ...

This weekend, a bunch of us drove out to Yuma, AZ to view an airshow at the Marine Corps Air Station there. The highlight was a re-enactment of Pearl Harbor staged by a group known as the Commemorative Air Force. I remembered to pack my videocam. Following is their tribute (and mine) to the greatest generation.

Enjoy ...

Considering Ethnic Perspectives

On Friday, I attended a one-day conference on ethnic diversity in the older mental health community, put on by the Senior Mental Health Partnership, which is a program of NAMI San Diego. The emphasis was on the special needs of the many and diverse ethnic groups that call San Diego county their home. These needs include cultural and language barriers that pose a challenge to treatment, as well as the psychic horrors from atrocities that many must contend with, particularly older generations.

My friend Sally Shepherd MN of UCSD , who organized the conference and set the scene in an opening presentation, provided this salient example:

According to one study, 70 percent of southeast Asian refugees receiving mental health care met diagnostic criteria for PTSD. In a study of Cambodian adolescents who survived Pol Pot’s concentration camps, nearly half experienced PTSD and 41 percent suffered from depression ten years after leaving Cambodia.

Meanwhile, demographics are dramatically shifting. Ms Shepherd noted that in a matter of years, latinos in California will outnumber whites. By 2020, whites will comprise 37 percent of the population while hispanics will make up 41 percent, almost an exact reversal on current figures. By 2050, this “minority” will be in a “majority” at more than 50 percent of the population, with whites at one in four.

As one commentator remarked: “Few of their children in the country learn English ... the signs in our streets have inscriptions in both languages ... unless the stream of their importation could be turned ... they will soon so outnumber us, that all the advantages we have will not in my opinion be able to preserve our language, and even our government will become precarious.”

Ben Franklin said that, back in 1753, not Lou Dobbs. Franklin was expressing his alarm over Germans settling in Pennsylvania. Some things, Ms Shepherd pointed out, apparently never change.

Concepcion Barrio PhD of the USC School of Social Work talked about mobilizing “culturally salient protective factors” in working with latinos. These include strong family attachments, supportive community networks, and deep spiritual/religious convictions. For instance, according to a 1998 study, of those with severe mental illness, 75 percent of latinos and 60 percent of African-Americans lived with their families, as opposed to just 30 percent of whites.

A 2006 meta-analysis of 56 studies found that interventions targeted to specific cultural groups were four times more effective than non-targeted interventions and that those conducted in a client’s native language were twice as effective as those conducted in English.

Simply having providers employ ethnically-matched staff, along with other surface strategies, is only part of the picture, Dr Barrio argued. Deeper approaches incorporate the traditions of the ethnic group. She cited the well-known “Mexican Paradox,” which has to do with first-generation Mexican-Americans faring a lot better mentally than assimilated later generations.

In addition, Dr Barrio pointed out, families from third-world nations tend to manifest lower “expressed emotions,” such as hostilities. Acceptance and warmth in Mexican-American families, for instance, predict better outcomes from schizophrenia.

The catch, of course, is that mental health providers need to be making the effort. In this context, we hear terms such as “cultural competency,” which involves, among other things, not making false assumptions about others’ ways based on one’s own limited personal experience.

Not good in healthcare, Ms Shepherd concluded.

More later ...

A Sunday Drive

No fish tacos in Beantown! I had to settle for a lobster roll in Revere Beach, instead. That's snow where the sand should be. Thank you for the ambiance, Jonathan Livingston.

Boston from Nahant.

The House of Seven Gables, Salem.

Another view from Nahant.

iPhone Photo of the Day

As you can see, I ventured slightly out of my neighborhood. I'm in Lexington, MA, just in time for the first snowfall of the year here. I'll be back in southern CA in a few days. Ah, short winters. Love it.

Rerun - Of Mice and Neurons

Two of my recent blog pieces offered a "macro" systems view of the brain experiencing breakdown. Here's a complementary "micro" cellular view I first published in March ...

I simply love reporting on brain science. Perhaps it's because the degree of difficulty is so high that nailing the landing, so to speak, has a way of setting off my dopamine in a highly pleasurable way.

Or maybe it's simply the fact that I love dealing with smart people working on really cool stuff.

About eight or nine years ago, I came across a journal article about how a research team led by Ron Duman PhD at Yale found that antidepressants caused brain cells to grow in the hippocampus.

Brain cells can actually grow? I thought. Then I asked: What the hell's a hippocampus?

We need to go back a year or two earlier when Fred Gage PhD of the Salk Institute discovered that we are not, in fact, stuck with the brain cells we are born with, that new brain cell growth takes place in an area of the brain known as the hippocampus.

The hippocampus is a tiny region in the limbic system of the brain that is involved in learning and memory, as well as complicit in regulating the stress response and in modulating dopamine's reward and motivation systems. New brain cell growth and regeneration is called "neurogenesis."

Around the same time, Husseini Manji MD and his team at the NIMH found that lithium increased brain cell growth. At first, I thought the fact that psychiatric meds could act as brain fertilizer was the story.

No, Dr Manji told me. Sure, the fact that the brain could grow new cells was important, but the real story, he said, was in how these new and regenerated brain cells connected to other brain cells. Let's return to Dr Duman's research:

In his experiments, Dr Duman and his team exposed lab rats to repeated foot shocks to induce behavioral helplessness equating to depression. When the rats were "depressed," neurogenesis was virtually shut down. But when the animals were treated with different classes of antidepressants, the process was reversed. Neurogenesis cranked up and the little guys were happy again.

Subsequent studies found these new cells and restored older cells established connections with existing neuronal systems. In other words, weakened brain pathways became stronger. The brain functioned better.

I had the pleasure of hearing both Dr Duman and Dr Gage talk about their research in two separate lectures two years ago at the American Psychiatric Association annual meeting in San Diego.

Think of it this way: Under the old way of thinking, psychiatry assumed that all we had to do was squirt serotonin or other neurotransmitters at a neuron and - poof! - no more depression. They even had a name for this: the monoamine hypothesis.

But suppose whole brain systems are off-line, that brain cells aren't talking to one another. That vital "be happy" and "get excited" messages get lost in the mail. What then?

Well, the serotonin may work, but it's going to take time. First, the individual brain cells need to boot up. Both Drs Manji and Duman have been pioneering in figuring out which "signal transduction pathways" and their constituent proteins inside the neuron play key roles in the booting up and other processes.

I have heard Dr Manji at numerous conferences explain that if we can develop treatments that directly target the proteins in these specific pathways we may be able to, in effect, get atrophied neurons booting up much quicker, and thus expeditiously bring entire brain systems back online.

This would translate into quick and safe and effective treatments for depression and bipolar and other mental illnesses.

Today I came across an article in the March 1 Biological Psychiatry that illustrated how Dr Duman's team has been dialing in their research. Their latest study used the same foot shock techniques as their earlier ones. This time, postmortem examination (that's right, they killed the poor guys after torturing them) using electron microscopy in the brain tissue revealed loss in the hippocampal neuron spines.

These dendritic spines play a key role in neurotransmitter traffic, that is in neurons connecting to other neurons.

The study also found that six days of antidepressant treatment reversed the process. In other words, the spines grew back.

Thus, in the entire depression-recovery cycle, we are beginning to see - actually see - the structural changes taking place in the brain and understand the significance of these changes. This particular study represents but a jigsaw puzzle piece in the overall scheme of things, but a picture is forming, one that is changing how we think about mental illness.

Further reading from mcmanweb:

Inside the Neuron

Dr Manji explained how for the last three decades, neurotransmitters have been the focus of mental health research. But recently, he went on to say, we have been learning that mental illness is much more complicated than that. Nerve cells communicate with each other through neurotransmitters, but do not actually go inside the nerve cell. Rather, they are merely the keys that unlock what is going on inside the neuron, "where all the action is." ...

Me, Apollo 15, and the Future

The following is a continuation of Me, Captain Ahab, and the Anterior Cingulate Cortex:

The year - 1971. Location - the moon. After 23 hours with no sleep, Apollo 15’s two moonwalkers were back in their command module in lunar orbit, preparing for their return home. Back in Houston 240,000 miles away, ground controllers picked up anomalous EKG readings from one of the astronauts. Jim Irwin’s heart was skipping a beat, then beating twice rapidly. After communicating with Irwin, the flight surgeon at Mission Control diagnosed a specific type of heart arrhythmia known as bigeminy.

Had Irwin been on the ground, doctors would have treated him for heart attack. But it turned out that the command module, with a 100 percent oxygen atmosphere and zero gravity, was better than any ICU he would have been placed in on earth. His heart soon settled back to normal, and Apollo 15 later successfully splashed down without incident. A few months later, Irwin had a heart attack. Twenty years later, yet another heart attack killed him.

Fast forward to the present. Location - earth. An individual very close to me was admitted to a psychiatric unit, and, after careful evaluation, was diagnosed with depression and given an antidepressant. Following a second hospitalization, he was put on different meds and released. Soon after, he was back in the hospital.

Basically, this individual has broken brain disease, and if we knew exactly what part of the brain was broken and could link the malfunction to the symptoms he was experiencing, we would have an exact term for it and perhaps have a clue of how to best treat it. But diagnostic psychiatry in 2009 is no match for the diagnostic cardiology of 1971 - at least not right now it isn’t.

Part of what is holding us back is that mental illness is far more complex than cardiac illness. What brain scans are showing is something akin to a total system collapse in the brain, involving many interconnected brain regions, rather than a specific fault. The brain science is beginning to tease out subtle structural and functional distinctions across a range of diagnoses. But this is hardly equivalent to taking an X-ray, finding a bone fracture, and knowing exactly how to set the break.

Nevertheless, brain scans are providing us with a sneak preview of the future. In a famous set of experiments performed two or so decades ago, OCD subjects (ones obsessed with cleanliness) shared a brain scan machine with a "dirty" sweat sock. Their respective brain loops lit up like a Christmas tree. When exposed to a "clean" sock, their brains quieted down.

The anterior cingulate cortex (ACC), part of the mid-brain, contains specialized neurons responsible for “gating.” which allows the brain to focus on certain incoming information (such as a conversation) while tuning out others (such as the background hum of an air conditioner). When things go wrong in the ACC, all manner of bad things can happen, such as OCD or schizophrenia or depression.

Thanks to this knowledge, doctors were able to adapt deep brain stimulation (DBS), used for Parkinsons, to experimental (and still extremely rare) psychiatric surgery. In Feb this year, the FDA approved DBS as a last resort treatment for OCD. The procedure also shows promise for depression. In DBS, a metal lead is inserted through folds in the brain. An electric pulse breaks up neuronal signals (such as those responsible for distracting thoughts and ruminations) in the ACC region. Unlike earlier generations of brain surgery (such as cingulotomies) no surgical lesions are involved. The surgery is reversible, but does involve risk.

Let’s be clear on this: This is not a piece extolling the virtues of psychiatric brain surgery. Indeed, it is difficult to imagine psychiatry headed in this direction. But what we are witnessing nonetheless presents us with a tantalizing peak at what tomorrow may involve, namely:

It is foreseeable that advances in technology will make MRI machines, or some other brain scan technology, convenient and affordable and routine, equating to advances in computer technology.

In the meantime, we already have the means to do gene scans - the chips are getting faster every year. Now imagine the software to interpret data coming from a whole ranges of sources - gene scans, brain scans, psychiatric evaluation, neurological testing, etc - to give the treating psychiatrist a range of options to consider.

The following is wild speculation: Keep in mind that the dominant operating paradigm for mental illness is system breakdown, a host of things going wrong seemingly all at once. But suppose we could get a bit closer to the source - say the hippocampus (involved in memory) failing to boot up, say key parts of the frontal lobes going off-line, say certain stress pathways overloading. Say we were able to pinpoint various signaling bottlenecks and hubs.

Thus, depression is no longer just depression. In fact, once we get a true read on what is going on, we may call its manifold variations something entirely different. All this would suggest targeted treatments and therapies, even with today’s highly imperfect remedies. Perhaps a dopamine enhancer to kickstart a certain brain system rather than an SSRI. Perhaps talking therapy focusing on past trauma rather than directed at here and now challenges.

The long-term pay-off would be that this kind of knowledge would spur future drug development (namely smart meds) and further refine talking therapies. It could also open the way for pinpoint electrical therapies and who knows what.

Private investors would need to see the solid science - a clear idea of how to get from A to B to C - before they were willing to put their money on the line. The catch is this type of science is dependent on the public sector. Basic research into mental illness is notoriously underfunded as it is. For lack of will, then, we may be unable to see our way to the future, much less realize it. The Apollo program was supposed to signal the beginning of manned space exploration. We haven’t been back to the moon since 1972, nor do we have the rockets for it.

The future - so near, yet so far ...