controversial title?

A story in the NYT (http://www.nytimes.com/2016/06/12/magazine/what-if-ptsd-is-more-physical-than-psychological.html) tells of some good research into PTSD and brain insults from combat.  Once again some thoughtful scientist-practitioners saw something that needed better understanding and did something about it.  They noticed that soldiers returning home reported two complexes of symptoms, one reflective of psychological trauma, i.e., PTSD, and one reflective of concussions, e.g. CTE.  After having researched concussions and their sequelae from sports injuries and with specialized brain imaging techniques and machines, they went to Iraq/Afghanistan to investigate.  They found that, although a mandated protocol, soldiers were not being assessed for concussions after experiencing close explosions and many soldiers were reluctant to report such symptoms both from their confusion with PTSD and from their fear of discrimination by their commanders.  The researchers met with resistance from the military medical community who minimized the effects and potential for longer term sequelae but Admiral Michael Mullins (now retired after being Chair of the Joint Chiefs) gave the researchers the power to follow through and even to design/implement new treatments and prevention.  They developed a small sensor that detected the pulsive force of explosions and turned red if acceptable limits were exceeded.  (These limits were the result of sports research and further experimentation).  If the badge is red, the soldier must report and the medical team must evaluate.  That’s the good news;  the bad news is that many soldiers, including some instructors who trained them how to explode doors open and handle other explosions, suffer from brain injury that can profoundly affect their life.

Now the controversial title is this:  “What if PTSD is more physical than psychological?”  Many commented on the fact that PTSD is physical, that it is a medical and psychiatric diagnosis, and that it is a brain disease.  Others responded that they understood all that but did not mind the title anyway.  I am closer to the first group.  The writers did say in the body of the article that PTSD was a brain disorder, and so we can assume it is physical.  But the title, while cute and catchy, perpetuates the belief that stress and shock and emotional trauma are not and do not cause physical phenomena.  This is still a widespread belief (“when will that person just get over the incident?”) of many in the general public and also, it seems, in military medical staff.

Much research has been done in the past 30 or more years to enhance our understanding of PTSD and its long term sequelae.  The only name I can remember right now is Bessel van der Kolk, who has done much to show that emotional trauma affects the brain both immediately and over the long term.  The characteristics of the trauma and the timeliness and expertise of any treatment cause great variation for any one instance.

When I practiced psychology I explained the effects of child maltreatment, characterizing the betrayal of trust in family violence, witnessed or experienced, sexual aggression, and sometimes parental behaviors reflecting the adults’ psychopathology as blows which bruised the child’s developing empathy for others and also for themselves.  The subsequent depression, anxiety, difficulties in emotional regulation and impulse control, even some difficulty understanding cause and effect or moral norms, were the effects of the traumatic bruising of brain areas involved in empathic or social-emotional processing.    The emotional maltreatment was a physical insult that bruised the developing brain in characteristic ways, ways that could affect their behavior some years later (think of 3 yr old being molested and consider when they reach adolescence).

So yes, the title miseducates, but the article is still a good one you might oughta read.  Travel on.

 

(Hippocampal) experience

A recent Science News (12/12/15) has an article about new research into the hippocampus of rats. Now the hippocampus has long been a favorite of mine and I have written about it several times here (see posts on 2/21/15, 11/4/15, 10/17/14, 9/8/14, or 2/14/14). To review just a bit, the hippocampus is so named because of its seahorse shape and is a very old structure of the neocortex.

hippocampus

Hippocampus: entorhinal cortex is at the lower, thicker end and information travels up and around to frontal areas

The perceptual areas of the cortex pass on their processed information, e.g., visual recognition of objects, faces, or auditory recognition of sounds, multi-modal maps of location, etc., to an area just before the hippocampus, the entorhinal cortex where the information is further processed, maybe collated and integrated, and then this is passed into the hippocampus for its distinctive processing of old and new in the service of memory which it then passes on to other areas such as frontal lobes for planning and acting, etc. A lot more could be said here about this important piece of the brain, but I want to focus on experience, or rather, how we animals experience.

A patient some years back known as H. M. had both hippocampi removed as a way to stop virtually constant seizure activity. Over the years Brenda Milner and others studied his neurological functioning in depth (See my post on ). Briefly, he could form no new memories. He could remember some things from before his surgery and he could talk and perform some cognitive tasks in a seemingly normal manner, but he would not remember meeting you if you left the room and came back in a minute. I do not believe he ever really recognized Dr. Milner who worked with him for many years. While he retained his ability to experience in a human manner, i.e., symbolically, he could not remember much, certainly not his autobiographical experience.

The hippocampus is not the only structure critical to consciously remembered experience; other structures also support our awareness and memory and they also communicate between the posterior perceptual areas and the anterior executive areas. One of the more prominent of these is the claustrum (see post on 8/17/14), that seems to play a role in organizing the blooming welter of experiential elements like, as Crick and Koch explained, a conductor leading a symphonic orchestra to produce a coherent piece of music (and a one, and a two, and . . .). When the claustrum has been rendered temporarily non-functional during surgical procedures, the patient loses consciousness and remembers nothing even as they stay awake. (Remember now that waking and consciousness are two different states).

claustrum1

claustrum running front and back deep inside the brain

All this brings us to the newly reported research showing that what are termed grid cells in the entorhinal cortex feeding into the hippocampus do not just keep track of the animal’s location (to be remembered then by the hippocampus) but also the animal’s distance and time traveled. The grid cells were discovered by studying how the rat brain functions as a GPS system (and Science News reminds me that this discovery was awarded the Nobel last year). This current study looked at grid cell functions as the rats ran on a treadmill; in other words their location did not change but the cells still kept up with the time and effort to travel. Now speaking like one of the rats that escaped cinematically a few years back, processing effort and time might be termed awareness of experience, or as we like to say, experience. Maybe not consciousness because of the hypothetical importance of symbolization to such as humans know, but to experience nonetheless both current and remembered, maybe even planned e.g., the rat returns to the nest or a source of food. Once again, I am amazed at the diligent ingenuity of scientists as they explore the intricacies here.

Finally one of the treatments I learned to use with children experiencing PTSD was a mindfulness technique in which the attention was focused on current percepts. Basically the kids learn to ground themselves in the moment by talking through a list of percepts. They start by saying “I see ___” for 5 different things, then “I hear ___” for 5 different things, and “I feel ____” for 5 different things, then repeating each for 4 different things, then 3, and so on. Try this; it is amazingly calming. And while it certainly involves verbal symbolizing, it does keep one’s focus on a sort of hippocampal immediacy (dare I say it, to a rat’s experiential awareness). The idea here is to disrupt the intrusive memories and reverberating echoes of trauma and emotional arousal bordering on fight/flight and anchor awareness into the boring and safe present place.

So happy holidays and for those of you with candles and evergreen scents and shiny lights and tasty food and the associated memories and memes of a special solstice time, keep the hippocampus and claustrum functioning full power. It is how experiences are made to remember.