Archive for the 'Health' Category

Damasio, Jaynes and Sarno

In past writings I’ve mentioned my excitement when I first read Antonio Damasio’s neuroscience tome “Decarte’s Error.” In that book Damasio laid out his observations that emotions are really physical sensations, particularly sensations of our internal body: guts, lungs, circulation etc. If you take away the physical sensation of an emotion you take away that emotion’s “sting.” (One way to mitigate a negative emotional state is, of course, through booze and drugs which bring about a pleasant body high. Not that I advocate such activities.)

I’ve also mentioned that I’ve recently been reading Julian Jaynes’ “The Origin of Consciousness.” In the chapter I just finished he examines the famous Greek stories The Iliad and The Odyssey. He argues that several of the Greek words frequently used in these stories have been mistranslated. Words such as thumos and phrenes have been translated to mean soul and heart (in the figurative sense) respectively but he argues they refer more correctly to particular sensation of the body, exactly the sort of sensations Damasio wrote about. (Jaynes believes thumos, for example, really refers to the sensations present in the activation of the body’s stress response: increased blood pressure, increased energy etc. Basically, being “amped up.”)

Essentially, Jaynes argues that in the Greek era people were much more conscious* of their body state. When modern people say, “I feel angry” they are only tangentially aware of their erratic heartbeat and hot face, whereas ancient people, Jaynes argues, were acutely aware of their physiological state. He also alleges that people didn’t always feel “ownership” of these emotional states, e.g. they were aware of the sensations but did not ascribe the sensations to a particular self (the way we do.) But that’s a more complex discussion.

* Well, this isn’t entirely true as Jaynes famously argues in the book that for some parts of history men weren’t conscious at all! I use the word “conscious” as a synonym for “aware” here.

I’ve also talked much in the past of Dr. John Sarno’s notion that much recurring pain, gastrointestinal issues and other maladies are actually caused by a distraught subconscious. Jaynes hints at the very same idea with no knowledge (to my knowledge) or Sarno’s work.

I think it is obvious to the medical reader that these matters we are discussing under the topic of the preconscious hypostases have a considerable bearing on any theory of psychosomatic disease. In the thumos, phrenes, kradie and etor we have covered the four major target systems, of such illnesses. And that they compose the very groundwork of consciousness, a primitive partial type on consciousizing, has important consequences in medical theory.

Resetting the pain threshold

I’ve long discussed the topic of physical pain on this blog and I’ve touted the idea that our sense of pain is not a simple measurement system by which X amount of damage to the body results in a corollary amount of pain. I suspect, mood, anxiety and other aspects of psychology change how much pain we feel. A depressing new article alleging that Americans are facing greater pain toward the end of their lives offers some food for thought.

Reports of patients experiencing pain near the end of life increased 11 percent between 1998 and 2010, according to a new study published in theAnnals of Internal Medicine. Reports of depression and periodic confusion also increased 26 percent over this time.

“There were certainly reasons to think that things were getting better,” said Joanne Lynn, the author of the report and a palliative care clinician. “We were using hospice so much more, there was more use of narcotics and so much more attention to symptoms, there was reason to think we were doing better.”

Lynn sees two major possible explanations for her conclusion. Patients and family members could be expecting more from the care provided and have “reset their thresholds” over the 12 years in this study. Another is that the number of treatments have increased, allowing patients to live longer with the diseases that ultimately kill them.

This resetting of thresholds ties directly into my thoughts on the psychological aspects of pain. Having said that, it seems likely the second reason is a factor as well.

A connection between stress and cancer?

If you know me, and I believe you do, you know I have an interest in mind/body medicine which argues that calming the mind can have beneficial effects on the body. There’s a lot of anecdotal evidence making this case but not a great understanding on how this process could work. This article from the Harvard Medical School notes the following.

A new study from investigators at the Benson-Henry Institute for Mind/Body Medicine at Massachusetts General Hospital and Beth Israel Deaconess Medical Center finds that eliciting the relaxation response—a physiologic state of deep rest induced by practices such as meditation, yoga, deep breathing and prayer—produces immediate changes in the expression of genes involved in immune function, energy metabolism and insulin secretion.

A systems biology analysis of known interactions among the proteins produced by the affected genes revealed that pathways involved with energy metabolism, particularly the function of mitochondria, were upregulated during the relaxation response. Pathways controlled by activation of a protein called NF-κB—known to have a prominent role in inflammation, stress, trauma and cancer—were suppressed after relaxation response elicitation. The expression of genes involved in insulin pathways was also significantly altered.

I read that and said, “Hold on! Cancer?” Many people have theorized about a connection between stress and cancer but until now I’ve never seen any real science to back this up. I’ll be interested to hear what more research brings.

Hooray for salt?

You may have heard the recent allegation that saturated fat, long thought to be evil, is actually fine. (This NY Times op-ed has details.) Along with red wine, coffee and chocolate, saturated fat seems to be another substance that the medical and diet industries got wrong for years.

When the revised opinion of saturated fats hit the news, I passed it on to several people in conversation. They would usually say something like, “Oh, so it’s ok for me to eat pepperoni pizza?” I would have to warn them, “That food is high in salt and salt is still bad.”

Except, maybe not. Peruse this NY Times editorial.

The current average sodium consumption in the United States is about 3,400 milligrams per day. This is mostly ingested in processed foods and is equivalent to the amount of sodium in about 1 1/2 teaspoons of salt. Dietary guidelines endorsed by the federal government and leading medical groups recommend reducing the average to 2,300 milligrams for the general population and 1,500 for groups deemed at greater risk, like adults older than 50, African-Americans, people with high blood pressure and diabetics, among others.

There is considerable evidence that lowering sodium can reduce blood pressure, but there is scant evidence that reducing blood pressure from levels that are not clearly high will necessarily reduce the risk of heart attacks, strokes and death.

Previous studies have found little evidence to support those low recommended sodium targets. Now a large study by researchers at McMaster University in Ontario, Canada, which tracked more than 100,000 people from 17 countries on five continents, has found that the safest levels of sodium consumption are between 3,000 and 6,000 milligrams.

My dad is on a 1500 milligram a day limit. Should I be worried that it’s too low? Maybe.

Other studies have found that very low levels of sodium can disrupt biochemical systems that are essential to human health or trigger hormones that raise cardiovascular risks.

To be fair, as the article states, the science is not settled here. But given that the track record of the health nannies is becoming more and more dubious I think an extra slice of pizza is justifiable.

Happy hospitals?

Many, many times here have I commented on my belief that pain has a significant emotional component. And, as I make my way in the world, I often see little clues supporting this thesis. For instance, today’s NY Times has an article on an effort to redesign hospital rooms to be more pleasent. One hospital first set up a test room to try out some happier designs.

After months of testing, patients in the model room rated food and nursing care higher than patients in the old rooms did, although the meals and care were the same.

But the real eye-opener was this: Patients also asked for 30 percent less pain medication.

Reduced pain has a cascade effect, hastening recovery and rehabilitation, leading to shorter stays and diminishing not just costs but also the chances for accidents and infections. When the new $523 million, 636,000-square-foot hospital, on a leafy campus, opened here in 2012, the model room became real.

So far, ratings of patient satisfaction are in the 99th percentile, up from the 61st percentile before the move. Infection rates and the number of accidents have never been lower.

This proves I am right about everything and all who oppose me should be punished.

Depression hurts (literally)

An idea I’m often talking about on this blog is the notion that emotions are felt as physical sensations. They are not merely ailments of the soul (which, of course, I don’t believe in) but are ailments of the body. This statement seems benign, but I think it’s really quite revolutionary, turning on end many of our assumptions about emotional states. For one thing, if emotions are physical feelings, perhaps negative emotions can be removed by removing their corresponding physical sensations (which is what pretty much any one does when they calm their nerves by having a drink, or use to sex to, as rapper Peaches once advised, “fuck the pain away.”)

In a thread about depression, a reader of Andrew Sullivan’s blog connects the emotional to the physical.

On a different note, another thing people don’t understand about severe depression is that it’s a physical experience. Aside from the lack of energy, which seems to be universal, the physical aspect is different for different people. For some people I’ve known, depression physically hurts. For me, it takes the form of a hollowness in the stomach. At my worst, in the bout that eventually led to my diagnosis, I could not eat at all. The very idea of food made me sick. I ended up in the hospital with an IV, having all sorts of tests done, and losing 20% of my body weight. It was months before I could eat any but the blandest of foods.

My mention of that Peaches tune got me thinking about her and I dug up this old video for the song. Never really got into her (I never liked her beats) but she had a certain kind of genius I suppose.

The latest head transplant news

Wrap your head around this!

Italian doc: I’ve found the key to head transplants

An Italian scientist has claimed that head transplants could be possible, after what he says is a major breakthrough in the technique. But another expert told The Local said the whole idea was potentially unethical.

Er, gee, you think?

This stuff isn’t as crazy as it sounds. A Russian scientist active in the 20th century did achieve some success with dog head transplants.

Vladimir Petrovich Demikhov was a real Soviet scientist. And he did the weirdest experiments with dog heads, keeping them alive separated from their bodies and transplanting them to other dog bodies.

He also attached heads and other parts to different dogs, resulting in weird hybrids that only survived for a few months. This research inspired the american doctor Robert White, another WW2 surgeon who followed the Soviet lead, performing the same experiments with rhesus monkeys.

Truth is, the science still seems to be in its infancy. Don’t expect human head transplants walking among us anytime soon.

However, the fact that it’s even considered as feasible is pretty astounding. And it raises all sorts of potential dramas. Will dying, mega-wealthy tycoons attempt to transplant their heads onto the bodies of teenage runaways? Will people be able to extend their life a few decades by living as mechanically supported human heads in a jar?

One can only hope.

Programming hunger

Last summer I had an experience that got me thinking about how much food we need to eat. I was in Paris with my Mom, and found that even though we were walking around most of the days, we only ate a couple meals per day. We had a breakfast, mostly of bread (you know the frogs and their bread) and then a regular meal in the afternoon. It was less than I would normally eat at home, yet I was never hungry.

The New Yorker blog has a post that connects to this, noting that why we get hungry is often unconnected to our need for energy.

More often than not, we eat because we want to eat—not because we need to. Recent studies show that our physical level of hunger, in fact, does not correlate strongly with how much hunger we say that we feel or how much food we go on to consume.

Even if you’ve had an unusually late or large breakfast, your body is used to its lunch slot and will begin to release certain chemicals, such as insulin in your blood and ghrelin in your stomach, in anticipation of your typical habits, whether or not you’re actually calorie-depleted.

This probably doesn’t surprise anyone, indeed I think we all observe this. You’re not hungry at all but a plate of fried chicken passes before you and whammo—pig out city!

The article states that we start to see part of our environment as cues to eat. We have a great snack on our favorite couch and we become conditioned—like Pavlov’s dogs—to associate that couch with snacking. We drive to the dentist and are reminded how there’s a great donut shop nearby and we start to crave donuts. I think this is partly why I experienced so little food craving in Paris—it is a city unfamiliar to me and I had not programmed in the environmental cues to stimulate hunger.

On a side note, I recall reading about a very ineffective campaign against drug use that was set up by some city. (I read about this a while back; can’t recall the location.) The government placed billboards in ghetto neighborhoods saying things like “Cocaine: It’s Evil” and showing a big pile of cocaine. Of course the result was rehabbing drug users saw these signs and thought, “Oh man I would love to snort a pile of coke like that right now!”

Breatharians

Today in my readings I came across mention of something I’d never heard of: breatharians. These are people who believe they can live without food by subsisting on air and sunlight. It sounds insane of course, but a google search reveals plenty of conversation about the topic. How do they do it? Well, for the most part they don’t.

In 1983, most of the leadership of the movement in California resigned when Wiley Brooks, a notable proponent of breatharianism, was caught sneaking into a hotel and ordering a chicken pie.[

Mmmm… chicken pie.

Also note:

Under controlled conditions where people are actually watched to see if they can do it without sneaking some real food, they fail. The name most commonly associated with breatharianism is Australia’s Jasmuheen (born Ellen Greve), who claims to live only on a cup of tea and a biscuit every few days. However, the only supervised test of this claim (by the Australian edition of 60 Minutes in 1999) left her suffering from severe dehydration[4] and the trial was halted after four days, despite Greve’s insistence she was happy to continue. She claimed the failure was due to being near a city road, leading to her being forced to breathe “bad air”. She continued this excuse even after she was moved to the middle of nowhere.

The various forms of human insanity seem to have no limits.

The downsides of mindfulness

I’ve read a bit about the practice called mindfulness which, for lack of a better description, is a kind of focused attention on your surroundings. But paying close attention to your sensory experiences of the moment you can, the argument goes, transcend a lot of your worries and break the limiting tether to your ego or self. I’ve made passable stabs at mindfulness, often at a park or in nature, and it can be quite refreshing—a sort of mental reset button.

Part of the idea of mindfulness is that you focus one a specific thing, say your breathing. If a disruptive thought comes in, say, “I have to do my taxes” (Shit! I DO have to do my taxes!!!), you recognize it and let it dissipate, then return your focus to the now. As you train your mind in this practice, you experience less disruptive thoughts.

I’ve wondered if there’s a potential downside to this. Much of creative thought is of the sort that pops in to your head your while you are thinking about something else. Wouldn’t mindfulness, with its focused approach (albeit a rather gentle focus), eliminate these moments of inspiration? The answer, according to this NY Times article, appears to be yes .

But one of the most surprising findings of recent mindfulness studies is that it could have unwanted side effects. Raising roadblocks to the mind’s peregrinations could, after all, prevent the very sort of mental vacations that lead to epiphanies. In 2012, Jonathan Schooler, who runs a lab investigating mindfulness and creativity at the University of California, Santa Barbara, published a study titled “Inspired by Distraction: Mind Wandering Facilitates Creative Incubation.” In it, he found that having participants spend a brief period of time on an undemanding task that maximizes mind wandering improved their subsequent performance on a test of creativity. In a follow-up study, he reported that physicists and writers alike came up with their most insightful ideas while spacing out.

“A third of the creative ideas they had during a two-week period came when their minds were wandering,” Schooler said. “And those ideas were more likely to be characterized as ‘aha’ insights that overcame an impasse.”

And that’s not all…

Another potential drawback to mindfulness has been identified by researchers at Georgetown University. In a study presented at the Society for Neuroscience annual meeting in November, they found that the higher adults scored on a measurement of mindfulness, the worse they performed on tests of implicit learning — the kind that underlies all sorts of acquired skills and habits but that occurs without conscious awareness. In the study, participants were shown a long sequence of items and repeatedly challenged to guess which one would come next. Although supposedly random, it contained a hidden pattern that made some items more likely to appear than others. The more mindful participants were worse at intuiting the correct answers.

“There’s so much our brain is doing when we’re not aware of it,” said the study’s leader, Chelsea Stillman, a doctoral candidate. “We know that being mindful is really good for a lot of explicit cognitive functions. But it might not be so useful when you want to form new habits.” Learning to ride a bicycle, speak grammatically or interpret the meaning of people’s facial expressions are three examples of knowledge we acquire through implicit learning — as if by osmosis, without our being able to describe how we did it. (Few of us can recite the rules of grammar, though most of us follow them when we speak.)

The solution is probably moderation in all things, including mindfulness.