# Articles

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"I'm OK, you're OK." Remember the standard 1970's psychological rhetoric? "Trust your feelings" was the psychological mantra of the time. For some of us it has come as a blessed relief to find out through brain imaging techniques that feelings are located in the emotional center of the brain and are actually a rather primitive system. The emotional limbic system is a networking apparatus located primarily in the midbrain area. Feelings evolved as a signal survival system: fear to flee, anger to fight, and pleasure for food and sex. Of course it is far more complex, but the truth is that feeling sensations are powerful but not necessarily smart. When we are upset the blood perfusion to our cortex, the thought center, is remarkably reduced as our blood rushes to our extremities for flight or fight. The emotional system was in place some 400 million years before we had a cortical thought center. We are wise to guide our emotional inclinations with thoughtful direction. However, as anyone who has been angry or anxious or highly sexually aroused knows, this is often no small feat. One has to literally go against the powerful inclinations of the body ready to snarl or act. The bared teeth and facial contortions of couples arguing are remarkably similar to the primate aggressive visages more often associated with angry animals. Sometimes it is a good thing to act on our feelings and sometimes decidedly not. It is the logic of our more evolved cerebral systems that should guide our emotions, particularly anger.
Frequent forays into anger are not usually helpful. The emotional state of anger evolved originally to drive off intruders. In today's world it clearly must be used thoughtfully and constructively, rather like atomic energy. Hurtful anger can kill love. Remember that we most readily conjure up that which upsets us. So hurtful angry words once spoken take on a life in the recipient's memory to be easily triggered and coded to come back with all the upset of the moment of verbal assault. If a relationship is a composite of memories, bad memories tend to have more salience that good ones. It is easy to see how hurtful words or acts can poison love. Business managers have been told for years that it takes four or five "attaboys" to make up for one criticism. Perhaps the most important part of intimacy is just to make happy memories.
Feelings, it turns out, can go awry. For example, recent research indicates that an animal that is repetitively exposed to aggression during periods of critical brain development, childhood for example, has alterations in certain gene expression that result in permanent changes in neurotransmitters that control reactivity patterns. These animals are forever quicker to express rage and anger. As a psychologist, I see this kind of predisposition to anger quite frequently. Some people respond to stress or frustration with irritability and anger almost automatically. Others seem to rarely "go there". Most angry people have had some precedent in childhood for their own angry reactivity. Usually one parent or another is described as rageful, negative, critical, etc. Children almost always absorb the emotional reactivity patterns of their parents. Others may have experienced some critical incident of trauma which can leave the emotional system hyperactive, i.e. easily triggered, with intensified emotional states. Some say that anger is the most accessible emotion in males. I am not sure this is true, but it can be a biologically ready response for males who have experienced repetitive rage during critical childhood brain development. Of course there may also be genetic predispositions in temperament. Finally, for many of us the stress of crowding and competition in our contemporary culture may elicit anger.
Every time we behave in a certain way, we strengthen the neural connections so that we are more likely to respond in that manner again. So, every time you rage, you become more likely to rage again. And every time you avoid such an outburst you are more able to accomplish this feat again the next time anger gets triggered.
Many people go to therapy to learn how to override maladaptive patterns that were absorbed in childhood or that have been acquired as a result of some traumatic experience or neurobiological proclivity. We want to take the good legacies from our genes and life experiences forward but leave behind the bad ones. If one becomes consciously aware of predisposed emotional states or intensified feelings, then one can intentionally monitor for these reactions on a cognitive level, catching them before expressed to the detriment of all. Usually by separating, people can learn to hold their tongues (and hands so to speak) until they have calmed down. Then, when homeostasis is reestablished blood flow can return from a fight or flight state to profuse the thought center once again. It is time to constructively and kindly proffer ones point of view with an ear to the other side of the mountain. Should anger re-erupt, a quick separation is always in order.
Plan for your next anger attack. Figure out what triggers you, i.e. what kinds of circumstances, people, stress, etc. Plan to close your mouth and take a time out, leave. Calm down alone so that blood returns from your extremities back to the cortex so you can think. Learn to stop blaming and taking things to heart that don't have to do with you. Don't assign malicious intention where there may have been none. Return when you are calm. Plan to posit conflict in constructive, careful language. It makes a difference how you speak. I can call you a jerk or say that I am hurt and angry. Set up new ways to express upset so that you plan for successful , thoughtful negotiation of differences. Speak only about your own feelings, your point of view, sensitivities, etc. Be open to communication and feedback that may correct your own interpretation of events. Break any old habits of saying and doing what you feel in anger. Don't forget to be respectful of differences. Many men for example, block emotional states much more readily than women. There are neurological, genetic and cultural reasons for this. Some women, on the other hand, may be more articulate than their male counterparts about emotions. However, we may also want to keep talking about an issue when a man may feel that it is quite finished. It helps to understand our differences so that we use them to compliment one another rather than demand a clone of ourselves.
As we think so we feel. Thoughts count. Who doubts that the Unabomber was sitting up in isolated Montana consumed with angry rumination. Scott Peck says to pray God you have someone in your life who loves you enough to kindly tell you when you are off the mark. Emotional thinking is almost always associated with extremes, "you never do this or you always do that, etc." We do not have the right to act or speak in hurtful anger. We are always responsible for our own behavior. This doesn't mean you have to become a doormat. You can be quite assertive and remove yourself from the offender until a time when thoughtful resolution of conflict can occur. If your partner won't or can't stop raging, suggest therapy. If there is a refusal, separation may be in order.


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The rampage of destruction in our country this week once again confronts us with murder and war. So many of us have been left dumbfounded in grief, thrown into an existential crisis as we struggle to assess the condition of contemporary mankind. We tend to think of ourselves as evolved, civilized people, more and more educated as a world community, increasingly connected by technology. Yet, we see with these atrocities that the ugly reality of killing and hate still contaminates the goodness of life. Badness is like a rotten apple in a barrel of good ones. It may start as a small part of a person, a nation or a group, but if left unchecked it inevitably spoils all. We now find ourselves in yet another ideological war. Perhaps we are not so far removed from the crusades of the middle ages after all. 
America was founded as a land of freedom and diversity. It is because of our freedom that these terrorists were able to train for their treachery with our technology, our equipment and our flight schools. America is a place where our government is designed to incorporate tolerance. We believe that differences are good and enhance the human condition. We do not advocate a narcissism that demands a clone of ourselves. In fact, many of us embrace diversity as part of our success and strength.
How is it possible that young men kill themselves and thousands of others without mercy? How did the Serbs kill 10,000 of their ethnic Albanian neighbors? How did the Rwandans slaughter a half million of the folks living next to them? Are we so far beyond the pogroms and barbarians of yesterday? Anthropologists, psychologists, sociologists and geneticists have carefully studied rage and hate. It seems that all human being have the capacity for evil. It happens to ordinary people. Jay Lifton studied the Nazi doctors in charge of the concentration camps and found them to be average fellows, many living a quiet anonymous life today. One of the terrorists who piloted one of the planes into the world trade towers was described as an unassuming student who was gradually transformed into an emotionally ridden zealot.
Perpetration usually has antecedents. It is a gradual process, not so unlike sin; acting hurtfully once makes it easier to establish a pattern of violation. Destructiveness progresses along a continuum. Small seemingly insignificant acts may move one towards a greater potential for further more destruction ones. For example, accepting the benefits of the system in Nazi Germany required a spoken, "Heil Hitler" as a precursor to accepting the Nazi movement. Initial acts that cause limited harm can result in psychological changes that make further destructive acts possible.
Chronic threat and frustration may give rise to hostility and the tendency to harm others. In addition, there may be genetic factors associated with more aggressive reactivity. This in combination with critical childhood brain development, imprint learning, experience and culture may set up the possibility for acting on hate and revenge. Collective self-doubt may combine with a sense of superiority as a defense. Nationalism is strengthened under the influence of difficult life conditions--shared trauma, suffering and humiliation. The "us" v."them" mentality is a basic human potential for which we carry genetic building blocks.
Often groups that come together in hard times find an ideological plan for a better world that may require destroying others. A society may gradually turn against a subgroup in times of hardship. Hostility is especially likely to occur if people regard their suffering an unjust, and some others are not similarly affected. Blaming and scapegoating diminishes ones own responsibility. Often in this context, the thought system is commandeered by the emotional system using reason as justification and rationalization for killing and ruination. Poverty almost always leads to low self-esteem, particularly in today's world where we have exposure to others with more money.
Because people define themselves to a significant degree by membership in a group, a positive view of their group becomes important to individual self-esteem. The experience of hardship and social disorganization is a frequent starting point for mass killing and genocide. Tyrants like Hitler, Milosevic and bin Laden can emerge who are orators of sorts, verbally fanning the smaller flames of hate into a forest fire of rage and genocide. Many people in Afghanistan, like the Hutus in Rwanda, could not escape low social status, socioeconomic hardship and poverty. Large factions, but not all of these populations, became emotionally driven to paths of killing and destruction.
Bin Laden, like Saddam Hussein has managed to perpetrate crimes of murder against humanity with impunity. Will we become numb and self-centered, thinking that it will pass and not affect us as individuals? The complexity of terrorism sometimes may make us long for a Roosevelt who rose dramatically on his enfeebled legs to declare a stand against tyranny. There are sins of commission and those of omission. And yet our response must not be in kind, but a thoughtful assertive intolerance of intolerance, murder and hate. Leadership and guidance can have a seminal influence on the path of human development and experience. Compare Nelson Mandela, a man and his country with every reason to feel a desire for revenge, and Milosevic or bin Laden. How shall we respond to the vengeance of despots?
People and societies that value reason, temper their emotions with thoughtful, cortical negotiation. Remember that your emotional system is a very primitive signal survival system that evolved 400 million years before your cortex, the center of complex thinking. Exercising power over our emotions is sometimes no small feat. Feelings are very strong and interface with our thinking. Relationships are intricate at every level. Perhaps our challenge as a human community is to become less controlling but more in control, developing our kinder, gentler selves, but using our minds and technology to stand up to terrorists and murderers so that we may survive peacefully together with a contemplative world perspective of tolerance and inclusiveness.


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In 1900 Americans slept an average of ten hours a night. Today, in 2001, the average American sleeps only six and half-hours nightly. All animals sleep, but no other animal willingly sleep deprives itself. It has been known for some time that severe sleep deprivation in rats is always fatal. This is because of the disruption in immune system function that comes with sleep restraint. We are not wired for sleep deprivation. Sleep is a necessary and incredibly complex and important restorative function. It profoundly affects our brain, immune system, body temperature regulation, and digestion. For instance, with chronic sleep deprivation cortisol, a stress hormone, is elevated. This is a stress hormone that has many functions. A chronic cortisol elevation subjects our body to sustained arousal and stress. With normal rest (approximately eight hours seems to be the minimum) our cortisol decreases dramatically, which results in resilience and restoration of our basic environmental interaction response system. Sleep deprivation prevents recovery from daily environmental stimulation. With sleep deprivation heart rate variability rises. In addition central nervous system activity is elevated and our environmental response system is activated.
There are many conditions and drugs that cause sleep disruption. Alcoholism, for example, promotes poor sleep. Addiction causes changes in dream sleep stages and loss of deep sleep. Alcoholics, like the elderly, have poor sleep efficiency. Elevated nightly cortisol and decreased time before the start of dream sleep are biological markers of depression and aging. Sleep loss usually impacts upon mood states, typically resulting in depressive mornings and improved mood recovery in the afternoon. Childhood stress tends to decrease time before the start of nightly dream sleep; a phenomenon mentioned earlier relating to depression, which seems to predispose some people to adult sleep disruption. Sleep loss is a risk factor for depression.
If you scan the brain of a sleep deprived person, it looks very different than when sleep has been restored. Our frontal lobes, part of our "higher" thought center, are particularly effected. Sleep loss certainly feels like a "foggy" brain to most of us. Interestingly, study after study indicate that people who are habitually sleep deprived are notoriously poor at evaluating the reality of their deficits. Even though sleep deprived individuals often protest that they are fine with decreased sleep, they inevitably test poorly on cognitive and motor reflex skills.
We now know that many neurotransmitters and hormones affect our sleep. It is an intricate system indeed. During our sleep natural killer cells, an important part of our immune system increases. These cells decrease with sleep loss. In normal people interlukin six is a circadian factor, which effects our body's normal rhythms and cycles. Interlukin six increases throughout the night and, levels off after around midnight. The exaggerated increase in interluken six in alcoholics serves to inhibit the natural homeostasis and recovery of the body. Arthritic people also show high levels of interluken six. There is some evidence that the lack of modulation of interluken six results in a physical inflammatory reaction.
Chronic partial sleep loss results in a reorganization of the sleep cycles with more dream stage sleep loss. When we rest again, there is a dream sleep stage rebound. Early life events modulate dream sleep. It is primarily in dream sleep that we consolidate in memory information that has been learned the previous day. Thus if dream sleep is disrupted, learning is disrupted. This has enormous implications for children. Adolescents lean towards a twenty-seven hour sleep cycle, predisposing them to later nights and later awakening. Our school system, of course, is set up on the opposite clock, early to rise and early to dismiss, a pattern much more suited to the biological clocks of older adults. It is thought that most children, including adolescents, require approximately a ten-hour night of sleep. The important information learned during the day needs to meld into old memories so as to update older information. As we age sleep tends to become less efficient and more fragmented. There is an increase in nighttime cortisol and a decrease in dream sleep time. This can result in enormous systemic physical stress, and of course loss of sleep at any stage disrupts learning.
These thoughts refer only to a smattering of the burgeoning knowledge in sleep research, which is highlighting the significance of adequate rest. At every stage of life sleep is renewing. Its role in learning, cognition, memory consolidation, emotional well being, digestion and immune resiliency speak to us loudly as a daily activity that is to be respected and guarded as a life habit akin to nutrition and exercise, which of course interface with our sleep.


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Fear is a natural state etched upon the emotional system of man by evolution's urge to survive. Perhaps the world of mankind has never been safe, but the level of catastrophe and potential cataclysms today are truly terrifying. The spread of technology may revolutionize the world, but it has also resulted in daunting danger. How does one who may have already struggled with pre-September anxiety cope with the unimaginable reality of the recent violence in our country? Thousands of innocent people have been assaulted, unprovoked. Our economy has been badly impacted. Terrorists attempt to scare people with violence and threat. Past experience tell us that Al Quaeda tends to perpetrate violence every 12 to 24 months. It is human nature to begin to feel safe after a period of time elapses following trauma. So in a year or so people let down vigilance and the viscous attacker strikes again. 
There is a genetic potential for anxiety. Some people are born with a hypersensitive nervous system prone to neurobiological changes that transmit warning messages. Primate researchers can breed for "uptight" or "laid back" personalities. Panic involves a hyperreactive alarm system, an area of the brain that prepares the mind and body to face danger. Some panic begins with physical sensations or thoughts. The alarm center in the brain affects the sympathetic nervous system preparing us for flight or fight behaviors with increased heart rate, heightened blood pressure, and activation of transmitters and hormones. This alarm center is also connected to the part of our brain that is involved with planning and decision-making. People prone to anxiety and panic often misinterpret physical sensations and thoughts. For example, a slight physical tingling sensation may lead to catastrophic thoughts of stroke or heart failure.
Is fearfulness adaptive? How many of those with "laid back" personalities returned to their offices when the Port Authority, the management company for the world trade towers, announced in the midst of devastation that it was safe to go back to work? Is our world so unsafe? Even our children are aware. One of today's most popular children's writers spins repetitive tales of catastrophe. I recall being present at a speech given by Margaret Mead just before her death. She spoke of the sociological consequence of nuclear weaponry. Even then she believed that the human psyche would be changed forever with the awareness of the technological potential for man to destroy life on this earth. That fear is even more threatening today with the spread of nuclear weapons and the possibility for terrorists to use them.
Chronic anxiety may, indeed, spring from experience. After the tragedies of September 11th, a recent survey of American psychologists documented an increase in the numbers of patients seen for anxiety and the level of anxiety that these patients were experiencing. Since 9/11 many people have come in to therapy with fears of biological terrorism. This is especially true of those who work for public agencies. Others have suddenly found themselves afraid to fly. They often identify with the unknowing victims who were taking routine flights only to find themselves used as weapons of horror.
Technology is not the only force behind increased anxiety today. Population growth and competition for school slots, jobs, and goods are fierce pressures. People in the developed countries are frequently living in a hurried world. Money is one of the things that signifies a certain level of safety. It is the currency that purchases the provisions of life for most of us. The inequities of the distribution of goods in our country are become more discrepant. Over the past twenty years the income of families in the top 1- percent has increased 140 percent. Middle income families only increased 9 percent. Income polarization tends to breed emotional discontent. Those who do not have enough to meet their needs typically become anxious.
Once a state of anxiety becomes established as a pattern it is like a seizure. Repeated seizures can become etched in neurological memory. Being incapacitated by fear (Post Traumatic Stress is an anxiety disorder) so that we can not fully embrace our lives is clearly not adaptive. Chronic anxiety is a tortuous disease. People with anxiety disorders suffer profoundly on a regular basis. Quelling anxiety to maintain a manageable level can be difficult, and treatment must be multifaceted.
There are several medications that are effective for chronic fear. The benzodiazepines are often used at the start of treatment for acute panic or as an adjunct on an "as needed basis." These medications are quickly addictive, however, if used regularly, and they can cause rebound anxiety when discontinued. If long term medication is necessary, the SSRI's (serotonin reuptake inhibitors such as Zoloft or Prozac), can be utilized. These drugs have fewer side effects, but, unfortunately, they do not act as rapidly and can take some time to reach full therapeutic benefit.
All drugs have side effects. Many therapists use them to simply decrease unmanageable emotional states while helping patients set up new lifestyles that address their anxiety. Cognitive behavioral therapy, relaxation training and systematic desensitization are the most effective researched modalities. Good therapeutic treatment is multidimensional and involves becoming aware of catastrophic thought patterns and abandoning irrational thoughts. It is helpful to become aware of when and how traumatic memories are triggered. Strategies may be learned that quickly get one "back to the present." Avoiding anxious rumination is essential. Remember: as you think, so you feel. Thoughts affect our biochemistry, as well.
People with chronic anxiety will do well to set up viable routine life habits of thought, exercise (which, along with ambient light, can be use as a neurotransmitter self-medication), nutrition, sleep and social support. In essence, a strategic plan is formulated and is lived as a lifestyle. In most cases medication and therapy can be discontinued once changes become established as a way of intentional living. Finding peace from anxiety may indeed involve permanent adjustments in the way you think and live. Change doesn't always come easily. It takes implementation, perseverance and effort.
Many of us begin the year 2002 with mixed anticipation. Perhaps not a few of us have left 2001 with a renewed awareness of the vulnerability of life. This gives us all the more reason to assess what is truly important. Certainly, we want to establish a daily life that seizes the good and the happy. Most of us long to avoid the misery of emotional loss of perspective. Finding ourselves fearful is understandable, but establishing a lifestyle that enables us to cope well with fear is empowering.


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A recent Harvard study indicates that some forty to sixty-five percent of heart attack survivors suffer depression. Cardiac mortality risk increases seven times for heart patients with depression. We now know that depression results in alterations in blood chemistry, remarkably increasing the chance for stroke or heart attack. A positive attitude is not only associated with better outcomes for heart attack patients, but may even help to stave off heart disease. Cardiac patients with more entrenched depression were less likely to take positive steps to address their health and had higher blood pressure. More of them were also diagnosed with diabetes. John Hopkins researchers followed nearly 500 older patients and found that those with personality assessments reflecting a sunny outlook were half as likely to experience heart problems as those who were depressed.
In a four year Finnish study of six hundred middle-aged men, it was found that depressed men were three times mores likely than average to develop high blood pressure even when factors such as weight, smoking, age, exercise habits, alcohol and education were parceled out. There is a twenty-five percent depression rate among cancer patients. Stroke survivors claim a depression rate of twenty percent. Low levels of serotonin, a neurotransmitter associated with well being, may also result in higher blood pressure. Low serotonin levels are often found in the blood serum of people who attempt suicide, the eighth leading cause of death among Americans and the second leading cause of death among American youth.
We have been aware for many years that depression affects our ability to ward off diseases. If depression continues long enough, even mild depression can cause changes in our immune system. Older people are particularly vulnerable to the immunosuppressant effects of depression. Scientists have learned that some side effects of an over active immune system can result in a chronic inflammation response, releasing pro-inflammatory blood proteins called cytokines. This can have disastrous physical effects including an increased blood-clotting factor that could result in stroke or heart attack.
There are many theories about the etiology of depression. Almost all of them point to changes our brain chemistry, which is exactly what is targeted by antidepressant medications. (Note: the newer serotonin antidepressants, i.e. Prozac, Zoloft etc., are far more helpful to cardiac patients than the older (triclyclic) antidepressants, as there is no arrhythmic side effect.) Optimism is a personality trait that we know to be genetically linked. Depression also seems to be related to a genetic predisposition in some people. If nature evolves to select the fittest, then why are so many people depressed? It could be that depression may be a useful response to difficult situations where paths to change cannot be found. It may actually help a person disengage from impossible positions and move on to something that works. However, depression is most often immobilizing. Sometimes cognitive therapy and antidepressant medication are needed to "kick start change into motion." In fact, brain scans of depressed people demonstrate an abnormally active emotional system but a remarkable deficit of activity in the frontal lobe thought centers. Once depression is lifted brain imaging depicts decreases in emotional activity, and thought centers begin to light up. Thoughtful proactivity is in fact a kind of antidepressant.
Even though one may have a genetic predisposition to depression, early life "imprint learning' experiences clearly play a seminal role. The brain and body are one and the same. All aspects of our internal and external daily experience affect our brain chemistry. Negative thoughts, ruminating on negativity, anger or worry can engender biochemical states of depression, anger and fear. If you grew up with family members who repetitively role modeled angry, negative or anxious thinking patterns, it is highly likely that you too may have these slanted cognitions that result in internal stress and unhappiness. It is important for your mental and physical health to learn to override these patterns and to establish new, more habitual positive ways of thinking.
Some twenty million Americans experience depression in any given year. Only thirty percent of these depressed people will seek treatment. Depression is when "I have me on my mind." Interestingly, after a certain subsistence level, money does not seem to be related to well being. Research indicates that our social context is a far more important factor. It appears that we would do well to set up our social environment so that we interact with a sense of meaning and validation. Our experience of a positive social context changes as we grow and age. For example, our teen focus of "fitting in" is likely to be of much less importance later. As we reach adulthood, work, goals and congenial family and colleagues become essential. (I urge people to think of toxic people and places like toxic food - something to avoid). As we retire, social context may dramatically change again. It is important to find a group where esteem and regard are plentiful and where goals and focus may be meaningfully channeled. For example some older adults may find enormous pleasure and purpose attending to the "genes going forward" - the grandchildren.
Psychotherapy, especially cognitive behavioral strategies, can help depressed people make a plan to set up a lifestyle that mitigates against depression. Sometimes, but not always, the strategy may include an antidepressant. Many psychologists use medication to get started only if necessary. Once therapy begins patient and therapist collaborate to individualize a life plan that incorporates daily routines of exercise, social support, careful thinking, sleep hygiene, nutrition, and spirituality.
It is crucial to our health and happiness to be aware of depression. Life is a moment. Intensified negative emotions can rob us our moment, leaving us physically sick or even worse sick at heart.


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"When you hurt people, they begin to love you less. That's what careless words do. They make people love you a little less."
- Arundhati Roy,  The God of Small Things
Anger can "ruin a fragment of a dream being carried around carefully like a piece of porcelain."
- Unknown Author
A good person is rather like a barrel of apples. One must continually purge the bad apples as they appear so that the entire barrel will not become rotten.  A bad person, on the other hand, pretends that there are no spoiled apples and thus the entire character of "the barrel" becomes rotten.
Good relationships require a constant process of reconciliation. Most of our "four deadly sins," selfishness, anger, hate, and resentment, are acted out in relationships.  To be close, it is necessary to feel safe.  Feeling safe means having trust--trust that no matter how angry, incensed or frustrated a loved one feels, he or she will not react with hurtful retaliation.  It means that conflict will be avoided in the heat of strong feeling, and will be resolved thoughtfully and carefully once the flames of emotion have abated.  Human attachment is the essence of our life experience. Having a confidant--feeling connected--actually changes our biochemistry.  The sense of existential aloneness is lifted with the joy of camaraderie and intimacy.
People do terrible things when they are enraged.  If we bring up children to hate, they will be enraged by the very presence of those whom they have been taught to designate as "the other."   Indeed, on a personal and international level, "anger spreads misery."  Interestingly, a recent study of peaceful cities in India found that their different ethnic groups had frequent interaction and collaboration within subgroups of the culture such as business, religious and civic organizations. Recent research by brain scientists reveals that our reward center is activated when we act with kindness and tolerance, and when we perform good deeds. Tolerance and compassion can positively oppose hate and vengeance even in our "wiring."  Mutually beneficial collaboration of different people can sooth hostility and increase our awareness of the humanity of others, even those whom we may dislike.
Unkindness often comes easily and in many forms while reconciliation almost always begins with honest reckoning. In the South African Truth and Reconciliation hearings, tyrants were confronted by their victims, who told their horrible tales in graphic detail.  Like Milosevic in Yugoslavia, victimizers were humiliated with their own misdeeds, and their power dissipated as a result.  Indeed, we are struggling personally and as a world of nations and groups to tame the emotional states of hate, rage, resentment and selfishness into some kind of deliberate evolution that may lead to reconciliation.
Like most feelings, anger must be guided thoughtfully, especially in human relationship.  It can be used as the energy to stand up against hurtfulness, but it must be used constructively and carefully.  How we speak and behave to one another is of critical importance.  For example, clever ridicule and social slights, so common in our culture, likely cause injury on a daily basis.  Anger can be used to control and to foreclose confrontation and negotiated tolerance.  Avoidance and the use of alcohol and drugs to anesthetize feelings are other forms of betrayal. Reconciliation moves away from rage, irritability, double talk (bad in the name of good-a common media spin today), omissions of decency, and dehumanization to a happier, healthier path of tolerance, compassion and collaboration.
Scott Peck said some time ago that we must pray to God that we have someone who loves us enough to kindly tell us when we are off the mark.  Accepting correction is challenging.  It takes a strong ego to acknowledge our errors and to correct them.  It is easier to express anger or defend ourselves with counter attack.  A more positive interaction usually unfolds when we hold our tongues, perhaps separate so as to sort out feelings, before speaking our minds more kindly with an effort to take the other person's view into account.
The person who has been hurtful may forget the incident with little or no effort, but the one who is the recipient of unkindness usually recalls it vividly.  Remember that stress hormones play a strong role in memory, i.e., the more upset one is, the more salient the memory.  In addition, hurtful experiences are coded with all the negative emotional associations.  It is easy to see how frequent angry words in a relationship are so poisonous.
Most of the world's people don't understand the nature of emotion and cognition enough to recognize the importance of guiding feelings with thoughtfulness.   Even highly educated executives excuse poor integrity and selfish raiding with the spin of denial and minimization of their wrongs.   If the perpetrator gets away with these "escape responsibility," behaviors the victim almost inevitably turns away in disgust.  The intended self-excusing results are not effective and leave gaping holes in relationships.
Reconciliation has three basic steps: (1) acknowledgement of the wrong without excuse; (2) request of forgiveness; and (3) implementation of a program of change. When these steps are openly taken with pure intention, the process of reconciliation and renewed trust can begin.  None of this is done in one fell swoop.  Forgiveness and recaptured trust is a process, like working on maintaining a good barrel of apples, something which must be attended to as a daily habit.   When someone blithely excuses himself or herself with an "I'm sorry-but-" it is difficult to feel a sense of resolution and renewed attachment.
Once cordiality is reestablished then it becomes the responsibility of the forgiver to "let go" of the hurt.  That doesn't mean that it will not come up again, for painful memories are quite easily triggered and coded with all the upset of the original experience.  It takes joint effort for the offender to be willing to understand the nature of the memory of hurtfulness and be willing to reassure and reconcile again and again.  On the other hand, the one forgiving must act a bit like Abraham Lincoln when he once said, "I distinctly remember forgetting that."  One must actively remember to forget distressing experiences that are coded in indelible memory with all the negative feelings attached.  One must consciously remember not to dwell on past hurts that have been resolved -even when they get triggered.  Of course if there is continued offense then the commitment to the process of change has not been kept and the dynamic efforts to reach a renewed stated of harmony must begin again.
Resolving differences most often brings about an increased sense of mutual understanding and communication.  We can truly move away from our own narcissistic point of view and learn to enjoy the existence of differences and embrace them as an added dimension of ourselves.  How many times do we visit another culture and incorporate something new and wonderful? It means moving away from endogeny, something difficult for us as we are genetically wired to identify with folks like ourselves.  In the process, we may benefit by becoming more aware of distinctions between others and ourselves; for example males and females.  A less egocentric posture makes it easier not to "take to heart" someone's behavior that may have nothing to do with us.  For example women have extra genes on the XX chromosome that men are lacking on the Y chromosome; these genes relate social skills and nurturing.  It is easy to see why women may sometimes feel slighted by male behaviors that seem insensitive and detached.  Sensitivity in relationship may be second nature to women but less natural for men.
Finally, remember that a relationship is a composite of memories that are being updated with each interaction.  Perhaps the most important factor is just making happy memories.  Creating positively "etched memories" is a significant life enterprise.  [We could speculate that the peaceful cities recently studied were doing just this in their multiethnic organizations.]  When these efforts go astray, it is essential to relationships, and indeed to human survival, that we commit ourselves to the habit of reconciliation.


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There is a place in our brain that seems to be primarily related to our experience of pleasure and reward, a cluster of neurons called the Nucleus Accumbens and its related midbrain circuits.   Our pleasure seeking behaviors are to some extent genetically wired and, like the rest of our emotional centers, have much to do with survival.  Food, sexuality, and thirst are a few “rewards” that we may strive for on a regular basis.  Our brain and body have “plasticity.” This means that the interaction between genes and experience shapes our mnemonic associations.  This is especially true of pleasure and reward. 

 Keeping our reward system balanced is essential to a good life. When this system is pushed to extremes addiction is often the result.   Most of us know that addiction is a sled ride to misery.  Recent research indicates that addiction to anything at all dysregulates our brain emotional neurotransmitters.  This dysregulation appears to be permanent, even after addictive behavior is brought under control. 

We know that the salience of memories seems to be more prominent with experiences that are associated with high arousal states. This codes the memory of an experience to be easily triggered along with the intense feelings. The disinhibition of getting high can be a dysregulation disaster.  For people with a genetic addictive potential it may release aggression and establish a neural pathway that longs for repeated intense stimulation.  If you have the right addictive genes this brain adaptation happens rather quickly.  If not, the addictive adaptation will still occur, but simply takes more repetitions of use.  In view of this, it makes sense that getting high on alcohol or drugs may later prove to have more drawing power than ordinary sensations.

A rat that is addicted with alcohol, cocaine or even electrical stimulation in this little cluster of pleasure neurons, the Nucleus Accumbens, will literally die for the pleasure sensation.  Addicted people will behave similarly. Our neurological reward system is a powerful force. We must all know people who have abdicated life and attachment for addiction. Interestingly, addiction seems to be associated with a sensation of euphoria or numbing.  Most of us do not have frequent episodes of euphoria in life. Normal, nonaddicted people may have “peak experiences” that punctuate life here and there, but unlike addicted people, euphoria is not a common event.  Isn’t it strange that one may long to be “numb” while still have the possibility of life? 

People who become addicted often have a sense of loss of control over their lives.  Emotional dysregualtion can diminish our ability to establish our lives so that healthy pleasure, relationship and self-esteem flourish.  In addiction risk and danger are quite easily ignored, many times leading to calamity. Addiction facilitates avoidance.  Addicts ignore problems that may need to be brought to the table for action and remedy.  This leads to frequent crises and relationship deterioration.

Two brief comments on our contemporary culture may be worth noting here.   Notions of work in many of today’s cultures almost necessitate a workaholic lifestyle for success.  We have a foolhardy insistence on unhealthy, out of balance, work schedules, especially for young professionals.  Even Einstein needed eight hours of sleep for good thinking.  A recent article in the New York Times discussed a study testing math graduate students after three days of 4 to 5 hours of sleep.  They tested as dull normal in intellectual ability and made consistent errors in two- digit addition problems!  Many of us, perhaps particularly our children, are over stimulated.  Notice the movie previews next time you visit a theater.  The level of rapid stimulation is exhausting. Over-stimulation in childhood is linked by some researchers to the very prevalent attention deficit disorders in our country today.
Remember that arousal states of any kind can reinforce an experience.  We know that pain enhances attachment at critical development.  (Some researchers have wondered if this is related to the chronic attachment disruption that we often see in abused children as they grow into adulthood. How many of us have seen people make poor relationship choices on a regular basis)?
In view of this, it is disconcerting to see the level of mayhem presented in children’s video games and movies.  A new video game being marketed for 6-year-olds features spectacularly gruesome crashes depicting heads smashing through car windshields.  This clearly establishes associations of reinforcement with violence.   

Many of our reward associations are established in childhood, a time of critical brain programming.  We absorb patterns as children, mostly without being aware.  For example, if you have two obese parents, your chances of obesity are nearly 80%.  Some percentage of that is undoubtedly accounted for genetically, but much is passed down by the child’s natural tendency to absorb the eating patterns of the adults around them. If family members tend to binge eat, one learns to imitate this habit. Negative experiences lead to brain changes that appear to be permanent. We know that stress negatively affects out brain systems.  For instance, getting into a state of depression can be dangerous.  Once a serious depression occurs, one is 50% more likely to have a second depression. After two episodes of depression, there is a 90% likelihood that it will reoccur.

When we are balanced we are more consciously aware of our priorities, concerns and those of the people that we love.  When you are in the habit of living life so that your body and mind are rested, exercised, well fed, etc, you rather become used to feeling well and at the “top of your game”.  When you get out of balance, you notice it.  When you are habitually off balance in any kind of addiction or self-neglect, you also get used to it, and may not be aware that you are less than your best self.

If we understand this brain system, even on a cursory level, it seems that we could successfully set up routine and intentional life enhancing reward systems for ourselves.  Daily life enhancing rituals may facilitate neurological habit patterns of regular happy reinforcement that can become commonplace for us. Positive experiences and emotions help us to transform distress and unhappiness. That is, positive experiences seem to deter the negative biochemical effects of stress and upset.  They also facilitate a more rapid change from negative to positive feeling states.

Interestingly, brain researchers have pointed out that the muscles of our face have a feedback system to our brain.  It seems that “putting on a happy face” has validity.  It may fool our brains into thinking that we are happier than we may be. This isn’t to say, “just repress your upsets in life,” but along with the cognitive research, it indicates that saving upsets to sort out thoughtfully and constructively in therapy or with a confident- or even alone may be a good idea. Remember that your prefrontal cortex-a center of complex thinking- has a reciprocal and inhibiting effect on our emotions, tending to modulate emotional states.  We can learn to think through feelings rather than snarl them out or act them out in some hurtful fashion.  Cathartic kinds of therapy, i.e. rap groups, some stress debriefing techniques, anger release therapies, etc. appear now to be decidedly detrimental. 

 It is also true that emotion has a contagion effect with others. i.e., if one dog gets upset they all tend to get upset. It is well known that we “get what we give.” When we give a smile, we are much more likely to engender affability and good will from others, which is positive feedback and reward.  The marriage researchers tell us that, more than any other emotion, contempt predicts divorce.  Tolerance and conciliatory behavior, on the other hand, predict marital well- being.  Remember that the contempt you may feel could have more to do with growing up with parents who exhibited contempt frequently than it may really have to do with your spouse or colleague or friend. We also absorb thinking patterns of the adults around us as children. Contemptuous humor seems to be characteristic of present day American society.   It is quite likely that people are not aware of its potential negatively reinforcing effects on relationships.  No one much likes a joke at his or her expense.  Through therapy and other ways, it is possible to get into the habit of changing the way we think about others, in this case moving from contempt to tolerance and conciliation.  In this manner we foster positive, rewarding relationships. Good relationships, by the way, also play a significant role in biochemical well being and emotional modulation. 

The ability to regulate emotional states is affected not only by goals, but tends to improve with age. Human goals are set within a temporal context. As time is perceived as limited, goals become focused on the present.  Having goals is good for emotional regulation.  Long- term goals are particularly characteristic of younger people.  Young adults increasingly prioritize relationships when they sense limitations on time; for example when there is war or impending death. Savoring relationships and positive experiences in the here and now becomes significant when one feels that time is short.  When the future is constrained, the motivation to pursue long-range goals is reduced and attention to short-term goals is increased. 

Habits of happiness will have major impact on the brain and body.  That is precisely what we want to set up in our intentional reward system.  Habits of positive reward that are regular and life enhancing will be sculpted to the idiosyncratic nature of our own life experience and neurological patterns. These are reflected in our typical daily behavior and feeling states. 
          
Many good things in moderation are pleasurable.  We know also that habits of health can become sources of pleasure.  How many of us can be carried away by music, reading, gardening hobbies or exercise on a beautiful day.  We can choose to focus on the attachment that we have, those sweet small moments and experiences that add to the quality of our lives.  Indeed we can set up these moments to happen on a regular basis so as to insure a daily healthy portion of pleasure-one that makes life worth living.  Kinder, gentler sorts of rewards can be deliberately established as reward patterns of thinking, emoting, relating, exercising, sleeping, eating and being in the world.  Someone has said that a positive attitude makes a difficult time easier and that joy is a resilient choice.  Indeed, brain researchers are giving us images and biochemical readouts that say that our choice of rewards and pleasure effect our neural pathway habits and our biochemistry…and, of course, the quality of our life experience.


ArticleText:
Sexual differences were necessary for the development of complex life on earth. As understanding of our genetic underpinnings becomes clearer, we see the importance in finding advantage in respect for male and female distinctions. We know that life on earth existed as a single celled organism for nearly 2000 million years.  The evolution of multicellular life form signaled the beginning of complex life. It seems that on many levels of living two of the same often vie for similar resources and find themselves in fierce, if not lethal, competition. The merger of two cells, that finally didn’t kill each other off meant that there must be an amalgamation of equals, each with a separate set of complementary skills. 

Women are especially “wired” for emotional and social reactivity.  We have genes on the extra leg of our XX chromosome (males have the XY chromosome) that are inherited from our fathers and relate to emotional reactivity, nurturing and social proclivities.  We also have a larger corpus callosum, the network of neurons that joins the two hemispheres of the brain, which enables us to more easily access the emotional centers of the right brain. It is far from surprising that women, who have so often been accused of being overly emotional, indeed do have easier access to emotional brain centers.

Research has revealed that the Y chromosome is dramatically different than the X chromosome. It is the Y chromosome that is a critical determinant of maleness.  The modern Y chromosome is about one-third the size of its X-chromosome partner.  A substantial portion of DNA on the Y chromosome is passed directly from father to son.

It is because of the Y chromosome that men have some 14 times more testosterone than women. Testosterone is strongly related to aggression and sexuality. Under threatening conditions males become more aggressive, while females focus more on attachment.  Men actually have an increased learning capacity under stress.  For women the opposite seems to be true. This is partially related to the developmental differences in levels of testosterone and estrogen in the brain. What is the evolutionary adaptive value to this discrepancy in learning potential under stress?  No one seems to know yet, but one may speculate that historically (remember the time line on earth- that most folks have lived in the wilds and civilized man is only a tiny bar on the end of this line) males had to protect the human family, while females perhaps needed to be genetically programmed to stay with the children, focusing during danger on nurture, rather than on strategizing about protection or providing. 

We have known for some time that many psychiatric disorders in men are cognitively based. For example, attention deficit disorder occurs in males three times more often than in females, schizophrenia 2.6 times more often, and autism 3.6 more often. These are all thought disorders of one kind or another.  In contrast psychiatric disorders in women seem to be more emotionally based.  Women exhibit post traumatic stress disorder 3 times more often than men, and female depression is twice as prevalent.

The collaboration of DNA cells, organ systems, women and men, and indeed world community seem to be a higher order affair.  In fact, the reward center in our brain is highly activated by cooperative behavior. Collaboration and conciliation are part and parcel to human nature in both sexes.  A recent video clip of primate research showed monkeys who were exhibiting conciliatory gestures to one another after a squabble.  It was quite touching to see angry pouting chimpanzees quietly extending an arm signal to their companion to reconciliation and watching their joyful response to reattachment, including kisses, hugging and grooming. The most exuberant hooting of primates occurs when males are cavorting together.  

Through neuroimaging a profusion of knowledge is becoming available about the mechanisms of our genes and functions of various brain structures. Because of this we have the potential to achieve more sensitive insight into our life experience. Hopefully it will add a dimension of possibility to direct our lives into patterns of living that are aggressive only when necessary and to develop our more conciliatory and tolerant selves. Our genes and our brain are interactive and flexible with our life experience. We are told that learning can change our brain function, neuronal patterns and even modify gene expression.  Learning leads to the production of new proteins that promote the remodeling of neurons, making new pathway connections. Genes have the capacity to interact with the environment to make the molecular, neuronal and hormonal adjustments in response to our changing experience.  Scientists say that genes exist so that we can create internal adaptive evolutionary processes. Life experience seems to profoundly influence genetic and neuronal habit patterns.  

Historically men and women have been socialized very differently.  As we move towards a culture where we no longer rely on physical prowess, more egalitarian opportunities and learning have become available to women. The emotional responsivity of women is a genetic gift.  But how do we utilize it so that we add a complementary dimension of sensitivity, nurture and empathic wisdom to our relationships? Sexual differences are more comprehensible now that we understand their genetic basis. Constructive communication is a skill that includes the wisdom to tolerate divergences to our mutual benefit. The slightly more cognitive versus slightly more emotional styles of men and women need to be understood and respected.  Empathic communication in particular is the human experience that seems to mitigate differences and promote intimacy.  Avoiding a self consumed perspective, reaching for one that takes the “other point of view” into account, helps us to find solace and connection to one another. 

Modern day men and women have many stresses, and both sexes are often called upon to learn and produce under chronic stress. Women today are encouraged to perform and achieve in careers as well as to nurture families and partners.  Men too are expected to achieve and to nurture. The challenge seems to rest in learning to skillfully express our feminine and masculine selves to the best advantage of our own and our communal life experience. Taking advantage of contextual assets and liabilities of men and women can greatly promote complementary gain and mutual respect. It is certainly better than berating each other for not being the same. Surely, understanding differences between men and women is essential to achieving empathy, tolerance, conciliation, and attachment relationships.  Our gender related abilities for emotional responsivity and cognitive orientation can truly be complementary, leading to the enhancement of our lives as men and women.

ArticleTitle:
Getting Smart with Differences in Women and Men


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They say attachment is all about safety.  What matters in life is how you are connected.  Throughout history, we have come together for protection, to procreate and to eat.  We see survival collaboration in animals and even insects. Separation almost always leads to efforts to recover contact. The mere perception of possible impending loss of relationship may give rise to feelings of anger, sadness and fear.  Our emotional biochemistry is changed by human connection.  Prolonged separation may result in despair, and perhaps depression.  You can get through a lot if you know someone is going to be there for you.
Throughout life our relationships are the primary way that we optimize continued positive emotional experience and minimize negative states.  Positive ongoing connection promotes the possibility for self-reliance and security. Paradoxically, safe attachment sets us up for independence.  Having people around us who are a reliable source of comfort and reassurance permits us to use our talents to expand and venture into the possibilities of our lives.  Feeling securely loved mitigates against an unhappy sense of isolation and disconnection.  Most of us can tolerate separation well as long as we know that there is a stable base of caring from our inner core of confidants.

A toddler who is secure in relationship to the mother will venture out to explore a new setting. We are profoundly impacted by how we are treated, what we are told and what we see as developing children. Early life repetitive relationship experiences are unwittingly internalized to become our own incorporated habits of human affiliation. Some have recently suggested that even in uterus the infant senses that the mother is safe and reliable.  A gentle consistent mother renders a youngster with a secure attachment, knowing that there is parental protection, nurture and reliability.  In contrast, an infant with a destructive or unreliable parent senses and is affected by this predicament even in the womb. One whose maternal attachment is insecure tends to cling to the mother in new surroundings.  There are many maladaptive patterns of association that may surface in adulthood depending on the unlucky child's misadventure with unloving parents. 

Adults who had unreliable parents tend to react in several rather predictable relationship patterns.  If parents were untrustworthy, or there was an experience of loss or abandonment in childhood, it is harder to trust others later in life. These grown up children may be more preoccupied with their partner's responsiveness. There may be more trouble with emotional communication and fear of rejection and jealousy may be more intensified. They are often vigilant for signs of betrayal, slights and partner flaws. They may leave a relationship more readily than those who had more positive, trustworthy parenting role models. 

Disrupted attachment early in life may also lead to indiscriminate attachment or avoidance of intimacy altogether. It is very compelling to see young, poorly parented preteen girls transition into adolescence, frequently rushing into romantic and sexual relationships with little discretion. This often proves disastrous as these not well loved hardly adult children find themselves pushed pell mell into adulthood responsibilities and too often early parenthood-for which they are sadly ill prepared.  Another wounded generation carries their unfortunate legacy.  

Dysfunctional childhood patterns of human connection or abandonment may end in adulthood anxiety and ambivalence towards intimacy.  Sometimes these adults cope by idealizing others, initially only seeing them positively. They quickly move to devaluation at the first sign of human flaw. When there is a history of painful primary relationships, self protection becomes the foremost concern for future intimate encounters.  Unfortunately this self protective focus promotes narcissism and confounds empathy. It is hard to be reciprocal and empathic if you are afraid. There is the terrible emotional dilemma between the longing for the security and well being of partnership and the fear of abandonment and rejection. Many suffering with this fear of relying on others find themselves chronically checking on the loyalty and responsiveness of their partner.  They may be exquisitely sensitive to any nuance of rejection, distrust or loss.  

When parenting has been meager or harsh, children may grow to be compulsively self reliant and sometimes emotionally detached from affection and support.  Addicted or narcissistic parents frequently coax or coerce their children to cater to their adult needs.  These children often learn to cope by denying their own needs in favor of prioritizing the needs of others. 

Some may survive abusive parents by blocking the hurtful episodes.  Unfortunately they may later find themselves selecting an abusive mate because they have unwittingly subsumed this defensive pattern. Throughout childhood experience they have learned to block out threatening information. They are no longer able to see the signs of abuse that another with a happier childhood might have quickly assessed so as to avoid the potential attachment and further abuse. 

For a person to feel safe in relationship they must feel that their partner is responsive and reliable.  People need to feel loved and to be in relationships where love and caring are consistently communicated.  Happy relationships cannot bear many episodes of betrayal, deceit or rage. These behaviors are toxic to love. Couples provide closeness, comfort and sexual partnership.  But sexuality is normally suppressed when people feel unsafe.  In fact, romantic attraction is less stable than secure attachment.  To some extent passion inevitably decreases.  The raison d'etre becomes the reliability and consistent caring that we can count on in ongoing intimacy which is consolidated and enhanced by happy love making.

When intimate connection to others is not a part of daily life, there is a significant deficit.  Remember that attachment tends to regulate feeling states, i.e., it positively impacts our emotional neurochemistry.  People who avoid intimacy may have deactivated their normal tendencies to connect to others.  Often this reverberates from past traumatic experience of rejection or loss.  However, it is a pattern sometimes incorporated in role modeling from parents who have also detached from intimate communication.  By staying on a communication level that avoids any depth of feeling, self protection becomes the first relationship priority.  Emotional detachment can lead to a selfish life based on acquisition and achievement.  In the end it doesn't work. The happiness research basically says that camaraderie, not money is the causal factor. 

A period of personal reinvention is necessary when significant relationship is lost.  We organize our lives around people we love. Significant others are the focus of our love, happiness, sadness and anger.  We spend time doing things for one another.  It takes a very long time to disentangle the many tendrils that have become interwoven together.  Family, friends, therapy, support groups and even pets can be essential in these times of grief transition.  All of these things have to do with being connected to someone or something in order to let go of another.  

All people want and need validation and comfort from others.  It is healthy to recognize and habitually address this integral facet of ourselves. Like children, we develop intimacy over a period of time.  Consistent visits together promote familiarity.  As with an infant, we must nurture the good times and minimize the bad ones so as to build a memory structure of happy associations. In our American culture there has been an historic emphasis on independence.  Our society is a driven one, with less time and tolerance for developing relationship.  Even in Europe the coffee shops are disappearing as we become a hurried, task-focused world that leaves little for camaraderie.

Someone recently suggested making a circle that included the people that you can't imagine living without.  Then make an outer circle including those that are really important in your life but not in the inner circle.  Finally make an outer circle of those significant people in your life that are not in the other two circles.  Typically the ones in the inner circle number no more than a very few. 

We have the good fortune to be able to use our powerful thought system to change (therapy is all about change) poor habits of relationship communication into more adaptive, updated strategies that will foster security. Fortunately as children grow and develop they may become more discerning and able to filter out maladaptive relationship strategies, proceeding to update and modify them for better gain.  

The comfort and reliability of a happy relationship is a trust that takes dynamic effort but one that ironically promotes the fullest expression of our independent life talents. They say that love heals.  The experience of restorative, trustworthy relationship is frequently the cure that remakes old habits of affiliation into ones that promote experiences of contentment and life fulfillment.  Sometimes psychotherapy can help by facilitating the scrutiny of relationship patterns that may have evolved by role modeling or to survive troubled people of the past.


ArticleText:
Why, when exposed to treachery and trauma, do some people flourish and excel, while others are devastated?  Many of the men in “Room Seven” of the Hanoi Hilton POW prison in Vietnam survived to extraordinary excellence.  Eleanor Roosevelt suffered childhood tragedy, loss and experienced chronic abandonment even as an adult; she was possibly the most outstanding woman of the twentieth century.  Madelyn Albright had a secreted family legacy of trauma, was abandoned by her husband, but became Secretary of State.  And then there are the quietly heroic people who survive tragedy but manage to lead purposeful, meaningful lives using their suffering to refine their existence, often bearing witness to their losses in their every day efforts of decency and sensitivity. 

The question of resiliency is complex.  At this time it seems that the major known associated factors are genetic endowment, biochemistry, age at the time of trauma, social support and therapeutic assistance.  Who we are and how we are is an interactive process that has dynamic possibilities all of our lives.  Much of our internal chemistry that governs our feelings and reactions is finely tuned in a homeostatic balance.  Brain chemicals interface so that if one is out of kilter others are affected also. The reactivity levels of these systems depend on genetic traits and early developmental experience which affects our ability to attach to others, manage emotional regulation and establish set points for characteristic stress reaction. The ability to control and thoughtfully manage emotions is a chief characteristic of a resilient person.
 
The early stages of genetic mapping have revealed that there are genes related to stress resiliency and vulnerability. For example, we all have a certain variation of a serotonin gene, 5HTI.  Our level of resiliency is strongly impacted by the version of this particular serotonin gene in our body.   The short version predisposes one to alcoholism and depression.  The medium long one is mixed potential.  Those who have the LL, longer version seem to be resistant to stress reactions. In addition, some people are missing a gene related to certain (alpha 2c) receptors that sooth reactive activation levels.  These people, missing the modulating effect of this gene, have a greatly increased risk of heart attack.  All genes, of course, constantly interact with our experienced environment. The study of so called epigenetic patterns examines the issue of how genes are turned on and off by environmental experience. It would make sense that if one is aware of certain genetic liabilities routine life strategies could be set in place to address these vulnerabilities.  A compensatory effect could be set into motion.  Resilient people may be genetically gifted, but it is also possible that their life experience and abilities to transform hardship may be related factors.

Resiliency involves brain structures and chemicals that are set up to activate us to take action against threat.  During trauma our bodies enter an exaggerated stress response. The arousal systems and related activating brain chemicals are tempered by other systems and neurotransmitters. The moderating neurotransmitter system interacts with the arousal system so as to move us back to homeostasis. This helps to maintain thoughtful deliberation even under duress and to detoxify the stress chemistry reactions.  Apparently we can tolerate stress-related chemicals and physical reactions in moderation on a short term, sporadic basis.  But like alcohol or sweets these chemicals and reactions may wreak havoc if there is too much at once or if they stay in our system- as happens when people are chronically stressed. Stress hormones help to stamp in trauma memory so it is easily elicited and coded with the original intense emotional reaction.  Historically this served to provide protection from further harm.  Although this may have served us well when we lived in the forest, in today’s society easily triggered traumatic memory and associated emotion is most often not helpful.  In addition sustained stress may lead to chronic low levels of testosterone in men which can cause various negative health effects. Sometimes traumatic experience can induce a sustained disequilibrium in these very finely tuned systems.

Trauma experienced before the age of four tends to be associated with less resiliency and worse emotional outcomes in adult life.   There are probably many reasons for this.  Trauma at any stage in life tends to be coded in our bodies in physical sensations and images rather than in language and higher complex thought form.  Before age four this is profoundly so.  The pre-four year old does not have the cortical development to store memory in language or complex thought.  A very young child cannot cognitively integrate trauma so as to understand and make adaptive sense of it.  The increased emotional arousal levels are typically acted on in behavior.  Most often the child, and frequently the adults in relationship with that child, does not make the connection between problem hyperactive behaviors and experienced trauma. 

Throughout life we depend a great deal on relationships for healthy emotional regulation.  Before the age of four we are almost totally dependent on adults around us for soothing and safety.  One very recent research study noted that seventy-five percent of adult mental hospital patients reported abuse or trauma before age four.  Seventy-nine percent of personality disorder patients acknowledged abuse and trauma before this same age. It is primarily in relationship that we experience empathy and caring that facilitates peacefulness and restoration from upset.  As the child grows caring adults can begin to speak in a careful soothing manner about the child’s traumatic experience so as to initiate the process of thoughtful reconsolidation.  

The concept called reconsolidation is relevant to resiliency.  On a neurological level reconsolidation involves decreasing the strength of a traumatic memory by using some antagonistic medication after memory activation that acts on certain (NMDA) receptors. (At this time it has only been tried with animals.)  In recovery from traumatic experience reconsolidation may entail bringing early or repressed painful memories into language and into “cortical” awareness.  (Remember when we speak we access higher brain functions.)  In the safety and intimacy of therapeutic relationship new perspective and sense can be made of past suffering, tragedy or abuse. In the context of a safer and supported present day life it may be more possible to reorganize our thinking and understanding of past hurt.  New memory associations can be formed at a higher, thoughtful level. This can facilitate thinking about suffering in a more complex way while easing emotional activation associated with it.

Resiliency involves an ability to bear witness to hurts and losses with increased existential awareness. In reconsolidation there can be a move from overwhelming emotion to acceptance and sensitivity.  The ability to establish compensatory life habits after trauma calls for intentional motivation. Our stress reaction systems and our reward systems interface and overlap; motivation which is central to successful adaptation and resiliency in life is part of the reward system. Typically reconsolidation can be developed only with conscious and consistent effort. Strategies can be set in place as life habits that address the activation of traumatic memories on a regular basis. (Remember that traumatic memory is indelible.) Traumatic memory could be thought of as a kind of emotional diabetic state.  As long as the disequilibrium- in this case origination from past experienced trauma- is addressed in a multiplicity of ways adequate ongoing adaptation can become a practiced life habit. 

Resiliency is complex.  It exists on many levels.  In essence resiliency means making sense of hard times so that we may be enhanced, not diminished by them.  It means bringing difficulty to language and awareness so as to be keenly cognizant of possible related mishaps of thinking and behaving.  It means thoughtfully sorting out our actions so as to be fully our best selves in as many moments as is humanly possible.  It means being able to non-defensively see woundedness, hypersensitivity and choosing not to act or speak when it may not be reflective of our better selves in the present.  It means understanding that being in “thoughtful control” of feelings may depend on a myriad of factors including relationship support, rest, cognition, exercise, nutrition, genetic predisposition, and memory.   Reconsolidation of toxic memories can be done but not without partnership and dynamic effort to reframe painful memory and integrate it into a more manageable, useful present day life.  A resilient life is not necessarily an easy life.  For some it means making good use of life’s hardships.


ArticleText:
Adolescence is often a disorderly metamorphosis between childhood and adulthood, a time of dreams, opportunity and hope, but also one of danger and vulnerability.  Dramatic alterations in brain circuitry accompany the physical changes in adolescence.  There is an almost adult body but an immature nervous system. Teens must navigate astonishing complexities in today’s society and without a fully developed cortical system that can be readily used to inhibit impulsivity and assess risk with mature judgment. Children are entering puberty far earlier than they have historically. The average age children reach puberty today is between twelve and thirteen.  In 1860 the average age was fifteen and a half.  The end result of this change is that the adolescent period is stretching.  

 Someone once said that adolescence is similar to putting an unskilled driver in a car.  During this period of life there is a flurry of development in the neurobehavioral systems involved in emotional regulation and behavioral choices. This growth spurt lasts well into adulthood, resolving around eighteen or nineteen years old. It involves the areas of our brains that are related to cognitive control of impulses and decision making.  At the same time there is an activation of reproductive circuitry with a concomitant increase in emotional intensity and sexual focus. Hormonal challenge during this period interfaces with other brain chemistry resulting in characteristic strong mood changes. 

Self regulation- the ability to think through decisions and inhibit impulsivity- is perhaps the most important of all adulthood skills. A competent adult is able to inhibit and modify behavior so that negative future consequences are avoided.  This ability is at an all time low during adolescence.  In addition if you add the possible disinhibiting effects of alcohol, peer “pack behavior” sleep deprivation, or drugs, the result is sometimes disaster.  Indeed the probability of mortality increases three hundred percent during the teen years.  These rates fall once full adult maturity is reached.  According to government reports (CDC, 1997) eight percent of high school students attempt suicide yearly. The ability to think before acting so as to thoughtfully choose between difficult paths of action and to interrupt risk behavior is what the concept of self regulation is all about.  Unfortunately, the brain neural networks governing self regulation do not fully mature until late adolescence.  It is from the brain imaging research that we understand that increases in risk taking in adolescence are biologically driven.  



Adolescents experience increased sensitivity to rewards that is also related to changes in neurochemistry and brain networks. Eighty percent of high school seniors have tried alcohol and sixty-six percent say they have had an episode of consuming more than five drinks at a single session-a dangerously large amount of alcohol. Smoking is most likely to begin in adolescence: seventeen percent of high school seniors in the U.S. say that they smoke daily. 

Regular drug and alcohol consumption affects learning in complex ways. The brain grows accustomed to receiving external euphoric drugs and decreases the output of some of its own “reward chemicals.”  In addition, the brain learns to anticipate the intense euphoric chemistry so that the youngster becomes sensitive to cues that may be related to a drug or alcohol experience. These over learned associations become easily triggered and may lead to craving the euphoria-inducing substance again. All of these effects usually occur outside the conscious awareness of the young adventurer.  In addition, a recent study found that teens who had regularly abused alcohol experienced a ten percent decrease in ability to retain verbal and nonverbal information when compared to their non-drinking peers.  Ten percent translated into a full letter grade decrease in classroom performance.  Brain imaging studies reveal that adolescents who began drinking early- around age eleven- had more discernable deficits on MRI scans, particularly relating to hippocampal function, an area of the brain that is primarily involved in memory.

 Alcohol, as well as many drugs, interfere with sleep and thus disrupt learning consolidation and memory.  Sleep researchers have recently begun to study the natural sleep patterns during the teen years.  Clearly we know now that adolescents are biologically wired to want to go to sleep later.  They need just over nine hours of sleep nightly.  Of course, the early school schedule wrecks havoc with these normal developmental trends. This is a time of rapid physical growth that correlates with increased need for sleep.  Learning and memory consolidation primarily occurs during REM, stage three, sleep.  Adolescence and late adolescence usually marks the period of most intensive learning in life.  Sleep profoundly impacts memory, learning, attention, concentration, immune function and mood regulation.

An adolescent system in transition can be profoundly impacted by sleep deprivation.  In fact, because of the circadian rhythm changes during puberty many teens struggle to meet the early school schedule and a large percentage are sleep deprived.  Sleep loss prevents restoration of complex brain interconnections, especially those connected to the prefrontal cortex, higher thought centers.  Complex thought is the basis of self regulation.  In addition, there is a profound correlation between sleep loss and depression and mood regulation. Since suicide is at an all time high in adolescence, adequate sleep is extremely important.

There is little doubt that today’s teens are less protected than in earlier times, especially in this country.  They are exposed to graphic images of violence and sex that were far less accessible and widespread in the past.  Media commerce, in the form of movies, television and the internet, use the highly arousing stimuli of sex and violence to attract attention and arouse people to action in order to sell their wares.  Children and adults are sadly exploited and, for the most part, have no awareness of their exploitation. Kids become accustomed to over stimulation, under protection, and over exposure.  One only has to visit a movie theater to experience assaultive images of aggression and sex in previews and even walking past video machines while entering,, the movie house.  It is quite common for adolescents to fraternize with binge drinking, pot, crystal methamphetamine, and other drugs that provide euphoria and disinhibition. Since highly stimulating experiences are deeply etched in memory, they are rather easily elicited. Some high school girls and boys may find themselves disinhibited by alcohol or drugs, falling mindlessly into sexual behavior portrayed so freely in the media. Sexual bonding may occur under these circumstances with little or no discernment.  

Related to these phenomena is the recent finding that adolescent brains in transition seem to neurochemically fluctuate, especially in serotonin and dopamine, two systems whose dysregulation often lead to one choosing smaller, immediate rewards over larger delayed ones.  All of this can predispose teens to poor choices and sometimes drug and alcohol abuse, unplanned pregnancy, or even death.  Adolescents are more likely to take risks in groups than when alone.  They tend to seek high levels of novelty and stimulation compared to other periods in life

For parents this period of their child’s life development is frequently a challenge.  It is hard to develop and maintain guidance strategies that facilitate the adulthood skills of learned responsibility and successful and intentional self regulation without being overly constricting. Until now we have not clearly understood that our higher thought centers are going through such dramatic shifts during puberty.  Because teens look mature and likely because many become intensely strong willed and sometimes volatile, parents often do not monitor them as carefully as may be necessary for safety and future well being.  It could be cogently said that today’s world is a dangerous place for teens.  Thirty two percent of adolescent deaths occur in car accidents.  Boys die two to three times as often as girls.  Risk taking for teen males is at an all time high during this developmental era.  The key for parents is to protect their teen children without subjecting them to too much control.  

Changes in the adolescent brain may occur quite out of our awareness because we cannot see the development going on there (other than in neuroimaging) that we so readily see in the physical changes of puberty.  Sharing the knowledge that we now have about what is actually going on in our brains during adolescence may well facilitate a more collaborative effort to find that careful path of adult guidance and protection without oppressive control. 

Educating parents, teachers and teens to the present knowledge of dynamic and dramatic adolescent brain changes and their behavioral and psychological manifestations will hopefully demystify characteristic emotional intensity and impulsivity during this life period.  As teens become more educated as to what is happening to their minds and bodies, they may gain a bit of distance from the intensity of feeling states during this time. It is even possible that this enlightened understanding could lead to more adolescent, parent, and teacher collaboration in mutually caring awareness to guide and manage teens so as to avoid disaster and find a path to a good and happy life.


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Have you ever thought how incredible, how utterly improbable, it is that you are alive and consciously aware?  If you think about it, it is a mysterious experience to find yourself a cognizant living entity, existing of all things!  The magic of perception, memory and feelings is far more incredulous than science fiction.  As we marvel at the photographs of Mars and Saturn reflected back from our space probes millions of miles away from earth, our amazement is tinged with disappointment that there seems to be nothing yet like us.  The universe looks more and more like a wasteland of beautiful debris.  The wonder of complex life in our solar system seems to for now live here. And here we are, each person taking a singular view of ourselves and the world around us. 

Not all life knows that it is a living, separate being with conscious intention. This amazing ability evolved slowly and for purposes of survival.   It entails a plethora of brain circuits, some of which interface and converge into a small area on each side of the brain called the insula.  It is here that information is consolidated from internal organs and external experience from which self awareness emerges.  

In addition to the insula, many other intricate brain circuits are related to consciousness.  Now we know that animals with complex brains have many circuits which are cells linked from various parts of the brain that become active at the same time depending on the action or thought.  For instance thinking of a dog would activate certain pathways. Thinking of a cat may activate the same circuits (those related to furry animals) plus other ones more specific to a cat.  Certain areas related to a dog - for example, associations related to barking-would not be activated. .  

It seems that the right brain primarily receives information while the left brain elaborates and analyzes that material, attempting to find patterns of association in memory and searching to make sense of incoming stimuli both from internal and external sources. The left brain may actually interpret information from the centers of self awareness, bringing it together so that we have a unified but many faceted experience of ourselves. Interestingly, it is only around age 2 that a mental sense of "me" emerges.  

The development of the sprouting childhood self consciousness is negatively impacted by a life context of chronic distress. The arousal of an emotional state, such as fear for example, brings the brain's intellectual resources to focus on that state.  During heightened arousal attention is constricted.  This is done at the exclusion of other emotional states.  During childhood, when the brain and the self structure are dynamically developing, it is optimal to have a wide range of emotions. Hopefully positive emotion, which is most conducive to learning, will reign.  When a child grows up with a predominantly negative emotional ambience the elaboration of self experience is curtailed. Fearful or chronically upset circumstances demand energy and attention so that exploration, learning and creativity are set aside. 

There exist specialized pathways in our brains that relate to our emotional and social relationships with self and others.  Brain imaging can now detect areas that seem to activate with self reflection. We are told that at least some other mammals share an awareness of self, but only man and the great apes seem to have certain "spindle cells" which are hair-like projections.  These cells seem to distribute socially germane signals.   Many animals may have a sense of self, but one that likely is less elaborate and delineated than humans.  The African great apes appear to have more of these self-related brain structures. A chimpanzee can recognize himself in a mirror.  Self recognition is thought to be a phylogenetic continuum of sorts. 

It is adaptive to be able to "read" our own internal state and to direct our attention to the outer world so that we may act on it constructively.  Furthermore, it is helpful to be able to perceive the intentions of others around us.  It is thought that empathy evolved after self reflection and entailed the ability to project our own conscious experience to others. Empathy thus permits us to be better able to anticipate the actions of another.  This ability to interpret and care about the state of affairs of others is helpful for collaboration, mutual well being and protecting us from threat. 

Civilization has evolved because we can address our needs better collectively as long as we are predominantly collaborative.  When people around us are peaceful and content, we tend to experience that also.  Some experiences energize and lead us to approach while others lead to avoidance, competition or quiescence.  We are made so that we will in general move towards things that are good for us and away from those that are not.   

Memory interfaces in the self awareness system. With memory comes the ability to compare past and present and opens the possibility of minding the future.  Memory and emotion increase the efficiency of reason.  Consciousness renders a self awareness enriched by the memory of our own individual experience.  Psychiatric drugs impact on the same neurochemical pathways that are involved in memory and learning.  It is thought that these drugs may prime the brain towards learning receptivity so that therapeutic changes can be learned and implemented into new life patterns-overriding old predispositions, either learned or inherited or a bit of both.  
 
The reasons behind the evolution of conscious awareness make good sense.  The survival benefits involve the interface between our internal and external well being. If you are conscious that you are a discrete entity you can pull from relevant memory to adapt to the present and plan for a successful destiny. We are very much affected pleasurably or painfully by the image of occurrences in our past, and even in our anticipated future.  Feelings are the result of physical and biochemical changes that are related to life regulation.  Feelings mark experiences in memory as significant or not.  Memories are then etched in our brain in synchrony with the level of feeling arousal at the time an experience occurs.  When memories are retrieved the feelings usually surround the recollection.  Remember, the more agitated we are the more deeply embedded the memory.  It is then likely to be easily triggered and aligned with all the feelings associated with the original episode.

Our genes could be thought of as a code of generational memory.  Their expression is very much influenced by our life experience and environment.  Learning gives us the potential to transcend our genes.  For example, if you are a tense personality and know it, you can carefully set up sustained life patterns that modify that tendency.  The sense of self is composed of both unconscious genetic memory, for instance personality, and conscious experiential memories.  Memories are represented in our brain neurons in patterns of association and connection.  It is quite astonishing to think that our ephemeral sense of personhood is actually represented at a neurological level and in truth originates there. The self is a many faceted thing somehow made cohesive in our brain systems.    

This delicate balance of self can be disrupted.  Addiction compromises the self structure. When the feeling of well being is chronically at variance with what the body is reading and signaling to the brain, decision making fails.  A dysregulation of self ensues.   Foolishly spent addictive behaviors lead to depletion and vulnerability in our reward systems. Our brain's capacity for pleasure may be limited.  The memory traces of addiction, once laid down, can easily be resurrected even after years of abstinence throwing the sense of self into disharmony once again. 

Sometimes culture promotes short term rewards or manipulates the self structure of people for the greed of a few. Tobacco companies, for instance, promulgated smoking in the 30's, 40's and 50's so as to increase business revenues.  Smoking became a habit for the majority of adults in many countries, especially for men.  Clearly, long term harm was done to body systems, especially the pulmonary systems. Smoking causes a drug effect rendering a sensation of well being while in fact resulting in physical distress. This is a great example of a substance signaling the brain positively but not at all reflecting the situation in reality.  Is it rather like political spin?

An important related concept is called allostases.  It means the ability to achieve stability through change.  One must continually vary all of the parameters of internal mechanisms to match them appropriately to environmental demands.  The neurotransmitter system and indeed the rest of the body are in delicate balance and must be maintained with interaction in our world.  It is an intricate system of life and survival that one must learn to treat with precious regard.  Unfortunately all too often our society tends to promote doing "what feels good" without reference to thought of our good self interest-which usually involves the good of others also. 

How do we enhance the quality of our flickering moments of self aware living? By understanding more about the physical mechanisms of conscious awareness, we have the possibility to set up patterns of living that promote a happy state of life affairs. These healthy, positive habits would be reflected in our organ systems and physical and social environment, leading to feeling sensations of satisfaction and quiescence.  Brain imaging tells us that an animal feeling "happy" has increased ideation leading to more exploration, cogitation and creativity.  When sadness reigns there is a visible deactivation of the frontal cortex.  Happiness means we think better.  It means we are satiated, safe and feel secure for the future.  Indeed, feeling states bear witness to the state of well being for our many life systems, as long as they are not manipulated by drugs or alcohol.  Someone has said that happiness is freedom from the tyranny of negative emotions-which we now know reflect both internal and external disharmony.   

We have access to a wealth of information today about our selves.  Fortunately, the more we understand, the greater the possibility to choose a life style that is routinely mindful of our self needs. Of course it sounds rather simple, but perhaps it really has never been easy. Self awareness is our good fortune.  We can imagine, dream and will ourselves into our greatest potential-finding our best selves.


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No pill is a panacea and Prozac and family are no exception.  Years ago when Valium and its relative drugs, the benzodiazepines, were first introduced we were not aware of their addictive potential, or that they slowed down thinking and seriously interfered with motor coordination skills.  They were hailed as new and wonderful antianxiety agents and far safer than earlier, similar drugs.  Indeed they have been safer and helpful to millions of people.  However, as we gradually discerned their negative potential, we realized that the side effects could have disturbing results. 
For example, benzodiazepine withdrawal anxiety and insomnia can be more intense than the original anxiety and sleep disturbance that often motivated starting the medications in the first place. Cognitive slowing and changes in motor coordination can be devastating, especially for the elderly.  It took us a while to understand these more subtle side effects. For instance connections were not always made between these drugs and thinking deficits to some related car accidents.  The more recent sleep agents, Ambien and family, are benzodiazepine like drugs that target the same neuroreceptor, Gabba, as the benzodiazepines.  They are called hypnotics as they induce sleep, but they have a similar side effect profile as the "Valium and Xanax family drugs".  So they too must be used with discernment.
Prozac and other Serotonin agents have also been an amazing improvement over previous antidepressant and antianxiety drugs.  Many of the earlier related medications, called Tricyclic Antidepressants, resulted in excessive weight gain, among other things.  In the past few years we have become aware that the Tricyclics may induce a cardiac arrhythmia that can be serious, on occasion fatal for some patients, again particularly for the old and young.  Both the new Serotonin and the old Tricyclic antidepressant/anti-anxiety drugs have recently received a "black box warning".  This means that the Food and Drug Administration (FDA) that oversees medications in our country is urging serious caution with their use.  This warning involves potential increases in suicidal thinking and gesture for some patients, especially adolescents. Paxil, one of these family drugs, has been given a second recent FDA warning regarding congenital malformations that may be produced in women taking this medication during the first trimester of pregnancy.
As time passes and the use of Prozac type drugs has become common place, certain side effects have gradually become clear to us.  We have known for period that most of the people who use these medications lose sexual interest.  Now researchers are beginning to be aware that these medications may actually produce a kind of "relationship indifference and apathy."  Once the terms "relationship indifference" and "apathy" are used, many patients and doctors realize that these side effects has been present for some all along. We knew that emotional modulation was a good benefit of these drugs, but the indifference and apathy were more subtle and harder to discern.  These troublesome issues have been difficult for many people taking these medications and for their family members as well.    Relationship indifference and apathy may have serious quality of life consequences.
RELATIONSHIP AND PURPOSE IS A MEDICATION  
It is true that when one is overwhelmed with feeling states of anxiety and depression that detachment and apathy may be a part of the disequilibrium of emotional upset.  Unfortunately, along with the solace of modulation of feelings that these newer medications bring, can be this new sense of indifference to family relationships and life. A recent large scale study from Harvard indicates that depression and suicide are primarily driven by two basic deficit components: one is the need to belong and connect in relationship, and the other is to feel effective and purposeful. The importance of attachment and perceived effect on significant others has enormous impact on human wellbeing. It is interesting how often people in today's world will act (or vote) against self interest so as to feel connected. Suicide bombers, for example, are led primarily by group emotional influence and culture to kill themselves, and others.  Through group relationship and highly emotionally charged cultural belief, they bypass self destruction and fear to celebrate martyrdom and self sacrifice.  (A recent World Health Organization study of 400 suicide bombers indicated that most were educated but led by friendship to groups like Al Qaeda to sacrifice self interest to the "cause" of the group). In this painful contemporary example we see people driven to suicide and murder by cultural pressure based on strongly felt belief and relationship.  These factors of relationship and life purpose can be demonstrated as powerful life (or death) forces.  They clearly are of seminal relevance to human wellbeing or angst.
MEDICATION PARADOX
It is distressing that a primary side effect of our medications for depression and anxiety have the possibility to promote some of the bad effects of the problems that they were intended to cure. The potential side effects of the Prozac family drugs to induce emotional and motivational states of disinhibition, indifference and suicide are a paradox. For a long time we have known that depression significantly increases cardiac risk. As mentioned, a side effect of the earlier Tricyclic antidepressants has also proved to be a harbinger of cardiac problems.  Because of this they are rarely used today, especially with elderly and children. 
Recently a massive study by the Journal of American Medical Association found that erectile dysfunction contributed to a 45% increase in cardiac risk. It is difficult to know if this reflects a physiological state related to blood perfusion for example, or to depression.  Unfortunately our antidepressant Serotonin drugs frequently promote erectile dysfunction.  It has been said that men need sex for intimacy and women need intimacy for sex.  We know that attachment is one of the two most seismic forces related to depression. 
BRAIN CHEMISTRY CAN CHANGE WITH LIFESTYLE
People used to come into therapy saying that they had a "chemical imbalance" that resulted in their depression.  We know that there may be a genetic proclivity for depression. However, today we also know that our genes are interfacing with our environment, and each is shaping the other. It is clearly not an issue of genes or environment. It is both that determine much of our physical and mental states. For instance, your brain chemistry changes with exercise, light, social support, sleep, and thought patterns. Negative thinking literally generates a depressive biochemistry, while anxious rumination increases heart rate, blood pressure and induces a biochemical state of fear.  Medications for emotional dysregualtion are often necessary. No one doubts that. Would it not be best to urge people to use the mediations to make lifestyle changes so that they may, at least for some people, only be needed a period of time?  Recent research protocol indicates a year of antidepressant/antianxiety medications for a serious episode.  Some experts in the field generally say that a second occurrence of severe depression or anxiety would require medication for life.  It is important to know that many of these studies have not been with patients in active psychotherapy.  They were primarily studies done on patients with medication as the only treatment. If only medication is used as treatment, brain imaging has clearly shown us that the dysregulation that is seen in depression and anxiety will reemerge rather quickly when medication is stopped. On the other hand, it has also demonstrated that with cognitive behavioral and lifestyle therapeutic change while on medication, dysregulation in most patients does not tend to reoccur once medication is withdrawn. The most robust research for the relief of depression and anxiety has been with medication and cognitive behavioral psychotherapy combined. 
Setting up your best self is rather like working on a business proposal.  There are a number of factors that must be addressed for success.  Remember that as you think, so you feel.  Your thoughts generate brain chemistry also, and negative rumination is inimical to well being.   A recent study from social psychology tells us that the happy people actively work at being the kind of person that they would like to be.  Acting like a good person seems to make it so.  The side effect, the study says, is an increased sense of personal happiness.  Being kind to others tends promote self esteem by making you feel like a kinder person. Does this sound like simplistic advice? Perhaps so, but now it is evidenced based.  So it seems that the good that we do comes back to us-probably the bad does also.
Sleep is particularly involved in brain chemistry restoration.  It is a primary factor in mood regulation and cognitive recovery. By-the-way, the most robust activation of REM (rapid eye movement-dream) sleep happens in the final ninety minutes of an eight hour sleep cycle.  It is primarily in REM sleep that memory consolidation takes place. Imagine the important daily regeneration of cognitive fluency and memory consolidation that may be lost with chronic sleep deprivation that misses this significant last hour and a half phase of the end of an eight hour sleep cycle. Who has not felt the effects of an "unhappy foggy brain" after loss of restful sleep?  If we are to thoughtfully guide emotional states, sleep is essential. Researchers say even Einstein needed eight hours of sleep! Like diet, many different "nutrients" are needed for biochemical balance and wellbeing. Staying emotionally and physically healthy is part of the same puzzle. Emotional biochemical states respond like health to internal and external life habits.    
How we live is who we are.  A good (happy?) person is careful in thinking and other basic life habits. How a person controls and expresses emotion is of essence to character.   A thoughtful, balanced life literally sets up our brain/body chemistry so that we may clearly think our way through emotional states and life experiences, as much as possible inducing a biochemical state of well being.  Life is complex and of course, we can't control everything that happens to us.  But, we can set up life habits (including thinking habits) that will increase our abilities to thoughtfully modulate emotional states. Medication may be necessary but working actively to alter depressive/anxious producing life patterns is probably the bottom line for therapeutic biochemical change. How many people do you know who seem to lack thoughtful control over mood? How many regularly numb themselves with alcohol or drugs, thus avoiding higher order thinking and speaking that may facilitate needed change to find purposeful lifestyle or constructive relationship communication? How much trouble in our world is caused by people acting on feelings without thoughtful guidance?  Medications are important, but there is a downside to each of them.  Sometimes they are necessary, and for certain people their use is indefinite.  But for many, understanding how to address emotional modulation constructively on a daily lifestyle basis can surely help. Therapy gives you more control even over your brain chemistry and medications.


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Understanding how the connections work between our genes, our brains, and our environment can be a powerful force to exert more control over mood states and life destiny. Our body systems and experiences are integrated by our complex thinking centers to make discerning judgments in our daily lives. It is the complex thinking center, in what is called the prefrontal cortical areas of the brain that seems to be our primary supervisory emotional management system.  Here information from the environment and body is integrated and a discerning response becomes possible. This collaboration of brain systems also gives us the ability to consciously decide how it is that we are going to respond to any given situation in our life experience. Brain-imaging has repeatedly demonstrated that healthy, emotionally equilibrated people are thinking people who habitually guide lower feeling states with thoughtfulness. 

Genes interact with life experience in childhood to establish a core emotional reactivity level.  The childhood brain is actively laying down emotional response patterns.  The genetic personality temperament is sculpted by family emotional response styles that become etched into the neural pathways of our brains, resulting in behavioral habits of emotional expression. For the most part, all of this is happening quite without conscious awareness. Memory is coded in the context in which it occurred. For instance patterns learned in the intimacy of the childhood family are likely to be elicited unconsciously in the adult family context, but perhaps not in a social or work setting. Even family thought patterns are subsumed, and they, too, influence how we think about and express feeling states.  Childhood tragedy or poor parental emotional control or a lack of nurturing and safety can accelerate emotional reactivity.  If disruption or emotional outburst is experienced frequently, it becomes imprinted into the neuronal pathways to be triggered and reenacted, most often without awareness that whatever set if off in the here and now may not be relevant.  The point is that the neuronal emotional and behavioral pattern is there to be triggered. It is so easy to blame someone or something for an emotional over reaction in the present. Many people do not realize that their intense emotional reaction patterns in the present may well be more related to reactivity patterns laid down by repeated exposure to excessive emotional reactivity, trauma or neglect experienced in the childhood developing brain. If you are lucky emotions may interface with the cognitive centers for moderated, thoughtful reactions. If the memory patterns experienced in critical childhood brain development are not those in which feelings have been tempered by prudent reflection, there may be explosive reactivity far more often than a thinking person would want. The feeling centers in these cases habitually commandeer the thinking systems, often with poor result.

Impulsive behavior typically peaks in adolescence.  For most people, this period is resolved as the brain grows and develops into adulthood, under the nurturing tutelage of loving family and mentors. If this is the case, one has the possibility to grow into a resourceful, deliberative person who is able to plan and works toward purposeful life goals without the frequent disruption of negative emotional upheaval. Some people are fortunate to have good emotional genes and a consistent, safe, nurturing childhood environment. Judicious parents monitor negative emotional expression with circumspection. They teach their children to do the same. On the other hand, stress hormones seem to emblazon the memory of distress so that it is easily triggered and coded with all the upset feeling states. The imaged recollection of the hurtful experience readily comes to mind. Thoughtless, impulsive language and behavior portends a poor prognosis for relationship, career and life success. 

Chronic stress is associated with brain simplification, including loss of cells and neuronal connections. These kinds of changes can save energy and decrease response time under duress, but at the cost of diminished abilities for recall and thought. Chronic stress literally “dumbs you down”. Periods of extreme stress at any age can overload the complex thinking, mood regulating system of the brain and result in fewer resources to manage emotions.  Thought is metabolically expensive.  Thinking through a situation is slower and takes more energy than impulsivity. Automatic, quick reactions may be adaptive in a crisis. Never-the-less, the end result of habitual impulsivity, especially in relationships, is likely to be disastrous. Impulsive people with sudden mood changes are often difficult to live and work with and respond poorly to stress and change.  They may frequently misread others’ motives and respond impetuously.

People who are genetically or developmentally vulnerable to heightened emotional reactivity are more likely to end up in adulthood with a strong stress response system that can now be readily seen by brain imaging.  This hyperactive stress response system may have physical reverberations, leading to lower stress tolerance, increased blood pressure, heart rate, blood sugar and intensified and impulsive emotional expression. Cortisol is our major stress hormone.  Average cortisol levels tend to be higher in adults who recall low bonding with their parents as children.   Recent studies have also linked chronic stress or trauma in critical childhood development to cardiac problems, diabetes and center body weight gain. 

We know that people who are more impulsive have greater activity in the central activating brain center for fear and anger -the amygdala-- an activating circuitry that appears to be larger in those who exhibit excessive anxiety and depression. In general, greater responsivity in the amygdala correlates with decreased activity in the complex thinking center.  The stress response is also tied to the amygdala activation center. Those who grow up with harsh, inconsistent childhood experiences are more likely to have a hyperactive amygdala activating system that can be readily observed in the brain scan. Recent studies of adults in their fifties who recalled having cold and distant parenting relationships exhibited three times more cardiac problems, alcoholism and depression than a matched control study group of the same age who recalled happy parenting relationships. 

Early childhood nurturing may impact the size of the adult hippocampus. This is a very important part of the brain associated with short term memory abilities. Animal studies have shown that early life nurturing literally turns on genes that lead to an increase in synaptic brain connections in the hippocampus. Interestingly, the size of the hippocampus has been related in the brain research to self esteem. In comparing normal people and those with a diagnosis of Post Traumatic Stress (PTSD), brain imaging has validated that those with PTSD also had a smaller hippocampus. The cingulated cortex, a portion of the brain that evaluates and helps to integrate incoming information, also appears to be consistently smaller in PTSD patients. We see again that stress results in biochemical reactions in our brains that make us more emotionally reactive and less able to think carefully. The good news here is that some regenerative potential has been demonstrated within the hippocampus when there is decreased life stress and restorative experience.

It is becoming clear that good nurturing at critical childhood development biologically facilitates life long abilities to cope with stress and modulate feeling states. The most important inhibitory neurotransmitter system is the Gabba system.  It is this system that quiets our stress reaction. This is the system that is targeted by alcohol and the Valium/Xanax type drugs. In a fascinating research study reported at Harvard Medical School, it was found that good maternal nurturing while growing up actually results in more efficient and prolific Gabba receptors, limiting the stress activating system.

Social bonds are also a key factor in mood regulation. Recently, researchers are talking about mirror neurons. Amazingly, these brain neurons seem to activate when we are observing the behavior of others. The actions of others to are internally modeled. It is the mirror neurons that help us understand and connect to one another and to find empathy. These neurons make it possible for our own internal bio-systems to become impacted by other people in our lives. Related research tells us that childhood deprivation and abuse leave deficits diminishing the representation of empathy, happiness and love in the brain.  Love is a skill associated with a network of memories that predispose a mind bent and response of care for the other.  If one has no experience of love, there may be a deficiency in the love memory network. Imagine the consequences for adult relationships. Fortunately, as long as the brain is intact, new learning about what thoughts and behaviors are important in establishing and maintaining loving relationships can be practiced until they become habit.   Although it may not be second nature for those exposed to the human behavior motif of love during childhood critical development, it may never-the-less be acquired! Indeed, love heals emotional upset.

How we handle pleasure is of also of immeasurable importance for mood regulation. If there is no reward, there is no learning. How we set up our patterns of reward is one way to take thoughtful control over the kind of life you want to live. But remember if we are using a mood altering substance, like alcohol or drugs, our thinking center almost immediately goes “off line” so that we are no longer adept at cognitively screening and guiding our thoughts and feelings. The complex thinking center is precisely the area of the brain that we access to “think through feelings,” to modulate emotional states and impulsivity and to think before speaking and acting. Teaching children and adults the patience and persistence for reflective long term goals may be of greatest importance for our future world. 

Certain genotypes will result in people who have an inherently easier time focusing on cognitive rather than the reward aspects of their experience. Some people are genetically slower at calming emotional agitation. Even with these differences, our learning can vastly influence how we use the genes we have. Your genetic temperament is not destiny. If you were lucky to have nurturing, thoughtful parents, there is a good chance that you acquired those patterns also and reenact them easily within the spectrum of your genetic endowment. If not, you may still decide to temper reactivity with thought. Cognitive behavioral psychotherapy is a good place to start.

Other gene variations related to the neurotransmitter dopamine receptors result in a greater personality tendency for impulsivity.  These people are more vulnerable to drug and alcohol abuse. Serotonin is a modulating neurotransmitter (serotonin is the target of the Prozac and family drugs).  Some people have a different genetic Serotonin variation than make it harder to manage upset than those having another variation.  Remember that we can increase Serotonin with medication, but also with healthy activities like exercise, social support and laughter.
  
No matter what your gene sort, characteristically, quiet, small pleasures on a routine, daily basis bring equilibrium and long term peacefulness without the side effects of euphoric experiences so commonly associated with drugs and alcohol.   Setting up a healthy lifestyle promotes well being on many levels. Mood regulation is all about exercise, light, sleep, cognition and social support. Living in compassionate, respectful self relationship means addressing all of these facets on a daily basis. A good life is a dynamic proposition that requires daily efforts towards deliberation and measured response. 
 
Psychotherapy works on a top down model with a gradual change in thinking and lifestyle that slowly promotes habits of thoughtful, conscious control over physical states related to emotional distress.  Medication, on the other hand, works from a bottom up model, calming physical body system first.  Sometimes both are necessary, sometimes not.  Either way, lasting relief from a hyper-reactive/intensified emotional system will call for long term changes in thinking and behavior, unless medication is to become a lifestyle.  Too many Americans look for the quick medication fix without doing the hard work of thinking and behavior change. It is disturbing for many of us to notice the nonchalance of an over-medicated society, including children. One has only to watch and listen to the side effects blithely mouthed in pharmaceutical advertisements to feel the worrisome concern for people taking psychiatric medication without making the hard effort of cognitive and behavioral changes.   

In the context of today’s world, it is significant to understand that many of our emotionally charged feelings are related to the quite unconsciously subsumed pattern of thought and feelings expressed by our childhood environment and surrounding culture.  How many people in our world hate because they were taught to hate in their families and culture of origin? There is the possibility for hope in our ability to sort out these patterns in our thinking and living through thoughtful self awareness, education, and nurturing a tolerant, complex life perspective. We may feel a certain way because we have been taught to feel that way, but the feeling and opinion isn’t really your own until you examine it in self reflection and decide to keep or discard it.

Good therapy is all about change, and change is all about learning new ways to reasonably monitor and alter faulty emotional reactivity patterns.  Learning research indicates that practice predicts expertise. Innate capacities and practice work in concert to acquire new skills of emotional self regulation.  Changing patterns of impulsive misinterpretation, negative thinking and emotional reactivity may take hard work and perseverance like any other new skill.  This one however, can change the value of your life.   Researchers tell us that successful change necessitates that one tackle challenges just beyond their present level of competency. Once we acquire a pattern of thought, behavior, relationship, speech, eating, drinking, etc., it becomes automatic and for the most part mindless.  It is commonly impervious to improvement.  Conscious self observation (listening to feedback and self examination so as to inspect, criticize and augment our own life patterns) is a process that leads to a trajectory of change that may develop your ability to guide feelings thoughtfully with mastery and finesse.


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Human nature is riddled with self-seeking behaviors. Yet, clearly we have the capacity to think beyond ourselves. The discovery of a circuit of brain cells called mirror neurons has fueled new understanding about man’s genetic potential for experiencing and communicating empathy and tolerance.  Scientists’ ability to map the pathways of these “empathy cells” has enormous social possibilities. Mirror neurons make it feasible for us to reflect on the behavior and intentions of others.  They serve as conciliatory signals that may ease differences and bypass hostility. We have known for some time that group collaboration and empathy may increase successful adaptation. The clarification of the biological basis of empathy could have profound implications for human development and survival.  The discovery of a biological basis for human empathy and affiliation could change our strategies for mastery of thoughtful self-regulation and tolerance for people in a conflicted world. 
 
Mirror neuron systems are related to movement. These systems enable us to simulate the actions of others mentally, particularly those actions related to reward and avoidance. As animals evolved from fish to amphibians and then to mammals, new structures of complex thinking and assessment gradually became connected parts of ancient brain systems.  Early brain functions were primitive-reactivity systems of emotion (fear, anger, pleasure), feeding, and mating. The new centers of cognition made it possible for the human brain to bypass earlier stop-go reactions and to develop more adaptive decision driven capabilities. Complex communication and collaboration became attainable.  The early brain reactivity systems acted as default systems that were sculpted and moderated by human judgment and interaction with the environment.  As more complex thinking centers of the brain evolved and connected, intricate social collaboration became possible. Affiliation, team effort, and even altruism were helpful in survival.

Mirror neurons sit at a place of sensory integration, a crossroad of brain centers of vision, hearing, touch, emotion and cognition. They are abundant in the regions that are related to abilities for action and movement. Through imaging brain activity can be tracked in someone who is observing the behavior of another person. In some instances we “feel” the experience of another by a direct mapping of our observations onto what is called a presensory motor area of our own brain.  This mental mimicry facilitates the ability to internally sense the behavior, emotional state, and to some extent the internal experience of those whom we are observing. It turns out that empathy and mimicry are related. While mimicry in our society is sometimes disparaged, scientific evidence tells us that it is an important part of learning. By paying attention to the behaviors of adults, children can avoid the endless trial and error method of learning things already acquired by their culture. The old adage that children are more likely to do what we do than what we tell them to do rings true. 

Some of the brain’s language area is also part of the mirror neuron system.  Researchers believe that language began as facial and hand gestures. Mirror neurons allow the brain to send the communication in several different ways. For instance, hundreds of muscles in our faces, including our eyes, and body gestures, are used to signal anger, fear, happiness, love, etc. to others. Have you ever noticed that the whites of the eyes help us to track the intentions of others? Evolutionary biologists have observed that this distinction of eye color, the white of the eyeball and its darker center, is not characteristic of lower mammals. It evolved along with other collaborative brain structures. We can more easily track the eyes of one another when there is this white outer rim. Eye movement often reveals an individual’s behavioral intention. Mirror neurons ensured that the meaning of a communication signal is the same for the sender as for the receiver.

If one’s mirror neurons are garbled or underdeveloped, the pathway to social relatedness is certain to suffer. A mirror neuron dysregulation is now thought to be a significant component of the difficulty that autistic children have in developing and maintaining relationships. Approximately one third of autistic children have had early childhood temporal lobe seizures, which scientists believe may scramble connections between the visual and motor centers and the primary emotional systems. Often autistic children are disengaged and detached from others. They tend to over react frequently and perseverate on trivial occurrences in their environment. Their ability to form relationships and interact effectively with others is, therefore, compromised.  Psychopathic personalities have a noticeable deficit of empathy also.  They are characterized by aggressive outbursts, poor ethical/moral boundaries, impulsivity and the tendency to use and misuse others. Scans of psychopathic brains reveal intense activity in their arousal systems and an under reactivity in their complex thinking centers.  

Recent genetic research shows that a series of gene abnormalities underlie addiction and emotional dysregulation that characteristically disrupt human relationships.  In one important finding many people with addiction and hyper-reactive emotional systems seem to have a mutation of the brain’s primary inhibitory genetic system that results in cells firing without restraint. Remember that a stop –go system needs the stop factor as much as the go factor.  This genetic deficit of inhibitory cell firing may result in tendencies for impulsive and self-seeking behaviors and thinking. If ones own feelings and thoughts trump all else, one may hardly be able to muster the restraint and nurture the thoughts that are a part of keenly observing and empathizing with another person. In particular alcohol almost immediately clouds the thinking center and releases emotional reactivity. Moreover, egocentricity reins with repetitive alcohol or drug abuse. Genes are shaped by the environmental experience and the environmental experience is shaped by the genes. One could have these gene abnormalities but live in a social context that is decidedly guided and thoughtfully emotionally subdued so that impulsivity and addiction may be curtailed. 

We have known for some time that social context impacts neurobiology.  For instance we are aware now that the leaders of a group of mammals tend to have higher serotonin levels than subordinates. Behavioral neuroscientists tell us that as individual power increases, a person or animal, will tend to focus on potential rewards.  In the powerful, the behavioral approach system seems to be fired up and inhibition shuts down.  Powerful people and animals may take more risks, but they can become oblivious to others around them. It is not difficult to see that helping leaders to be more consciously aware of the potential liabilities of risky self-centered orientation may help them to more carefully blaze pathways for ethically responsible followers. 

Issues of human relatedness are of world significance in this expanding global community today more than ever before.  Information about different people, nations and cultures is presently more available than in the history of human existence. Our ability to empathize with one another is a keystone to a viable and civilized world community. As nations interact increasingly and the world population explodes, it becomes critically important to foster emotional modulation, tempered thinking and altruistic collaboration. Our human ability to thoughtfully subdue early archetypal emotional reaction may be our only hope for implementing empathic interpersonal and international relationships. 

Many people lack access to multifaceted education that can expand thinking, awareness and tolerance of differences. Fanaticism, emotionally driven thinking, can commandeer clear cognition and revert humankind back to an endogenous, aggressive existence. Knowledge of our genetic and neurological underpinnings for empathy could result in empowering self-awareness and improved capacity for emotional modulation. For instance, if leaders know that humans have a biological capacity for empathy, we may deliberately practice and attempt to skillfully develop that ability.  Is it possible to stretch moral imagination to see a point of reference between those and ourselves we deem to be very different from us?  Could we use this empathy/collaboration system to offer a more evolved and peaceful way of communication? Our world may depend on the conscious and deliberate development of our genetic abilities to ally ourselves in sympathetic fraternity.


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We have all heard that a leopard doesn’t change its spots. But then, we are not leopards, and even a leopard learns to adapt its behavior to survive. So how do we change? It turns out that our brain is wired for change.  While some components of change involve human behavior, such as commitment, strategy and perseverance, it is the brain and its related genes that orchestrate our facility for changing the way we think and behave towards something or someone. 

Our increased ability to remember is a key factor in enabling us to make change. A primary area of the brain that promotes memory and learning is called the hippocampus which is our memory storage for recent experience. It is a multifaceted brain structure that interfaces with other brain systems. Significant facts are downloaded from the hippocampus into long term memory during sleep. It is fascinating that, among other things, it somehow codes external spatial locations so that they can be recalled. There is some evidence that individual neurons are actually paired with positions outside the body. The hippocampus facilitates adaptation because it permits us to hold new information in memory so we can compare it to past encounters.  We are then able to adapt to a present situation making cognitive and behavioral adjustments that take the new information into account. 

Recalling new experience and integrating it into our thinking and behavioral repertoire is an intricate process. Lower brain parts seem to filter new experience.  These networks recognize unfamiliar information that does not exist in previously laid down memory. The novel information is then sorted upward to more complex thinking centers for coding into memory for future recognition. Some lower memory systems are genetically laid down. For instance, a predisposition to move towards or away from light or towards the scent of food are genetically programmed memories. However, many memories involve information that is based on new life experience.  

The human faculty to track, code and recall new experience enables us to change past patterns of behavior to accommodate an expanded memory database. An increased capacity to recall new experience led to greater flexibility and the possibility for more successful adaptation. Our memory stores coded patterns of past experience which we compare to our present day encounters.  We typically apply this strategy to what is in the here and now and thenceforth, behave accordingly. For instance imagine that a child has abusive, neglectful parents. As he develops into adulthood, it is likely that he conjures up the memories of significant others in new situations of family context and behaves with similar expectations. Restorative experience with intimate attachment may potentially modify memory and thinking so that these expectations change. Sound simple?  It is not at all simple, but amazing.

Our brain neurons are literally reconfigured to accommodate new information. In fact, our brain is continuously modeled by what we think and how we behave. Repeated patterns of behavior and thought are etched deeply into our neuronal connections. When we change our habits we change our brain! The more we enact and reenact a thought pattern or behavior the faster and more facile do the superhighway connections pave themselves into our neuronal firing patterns. This repeated action results in greater brain space devoted to the reoccurring behavior and thought pattern.  For instance, a brain scan of a violinist reveals a larger portion of the brain is devoted to left handed digital memory than there is for someone without this trained musical expertise.

But what if we have habits that we now want to change? Some people don’t believe that others can change, and obviously some people don’t.  But as our complex thinking systems evolved and expanded and our memory to code new experience increased, we acquired the ability to recall something and to react differently because of that recollection. This cleaver human talent also gave us the capability to think about our own perceptions. This led to increased self-awareness and greater potential for intentional self will and control. 

Cognitive behavioral psychotherapy is a research proven method of change. It can help us to willfully alter our thinking and behavior.  Astonishingly, it now appears that it may potentially change neurotransmitter levels and resculpt brain circuitry. New habits of thinking and living will be etched in brain pathways.  Changing your thinking and behavior actually changes your physical brain structures! For instance, stress or phobic thought can set off the fear alarm system, i.e., with repeated rumination the emotional anxiety circuitry can switch on and enliven a pattern of panicked anguish. This pathway becomes deeply grooved into neural circuitry by stress hormones and repeated use. Anxiety and sometimes a sense of paralysis and fear of change may be a result of these frequent episodes. Yet in many cases it is clear that change may be appropriate and necessary for a good life outcome and decreased anxiety. In a moment of emotional dysregulation changing behavior or thinking is heroic.  It often means overriding a panicked, hopeless or rageful emotional state-something that is very hard to do.

Thinking clearly about strongly reactive relationship feelings in the context of past distress may be a pathway to self-understanding and change. Life experience encountered during the critical brain developmental years of childhood may not reflect the experience in one’s present life, yet these first experiences are deeply embedded. For example, a child of emotionally wounded parents may have coped with their abuse with a pattern of distrustful behavior that he/she is now using in a relationship with his/her spouse.  Perhaps this husband or wife is trustworthy and thinks with deliberate kindness before speaking or acting. The formerly abused spouse may have difficulty transforming perceptions laid down by early life relationships. Early experiences of abuse, now traced firmly into memory pathways, may continue to signal suspicion throughout life by predicting foul play when none is intended or done.  The skewed expectation, distorted by strongly attached feelings elicited in intimacy, may persist even when present reality has replaced a past reality. Present feelings, then, must be carefully sorted through with a focus on new experiences so that past behavioral patterns are not reenacted. 

Have you ever had someone misinterpret what you were saying but refuse to change that interpretation even when you clarify that your intentions had been to communicate something quite different?  This distortion usually happens because there has been an emotionally charged reaction to the initial communication.  People in a highly aroused emotional state can’t fully activate their energy to focus thoughtfully so as to clarify, analyze and negotiate the other person’s intentions and differences. These kinds of distortions often happen when someone feels unsafe or is primed for anger because of substance abuse or past habits of negative thinking and hostility.  In such a mind state feelings are likely to twist and cloud thinking and communication. When such disheveled emotions occur, it is necessary to insist that constructive logic and communication supercede them. It may seem easier to hold onto angry feelings, but it bodes poorly for change and the promotion of understanding and good will. 

A balanced emotional state may be more easily achieved by people whose reactivity system was set during the first year of life to a stable, loved and secure environment. Those whose set point was established under harsher circumstances, or who may be genetically more reactive are not lost. These individuals are rather like emotional diabetics. They can learn to avoid anxious, angry or depressive episodes by establishing life habits promoting tranquility and support that can override emotional pull. Thoughtful control may gradually master strong emotional sway towards more impulsive communication and behavior. Resetting patterns of emotional volatility may never be completely accomplished, but setting up strategy to change response patterns on neuronal, cognitive and behavioral levels is quite possible.

Our society demands that we accommodate new information and change on a daily basis at a pace never before experienced by mankind.  Cognitive flexibility and the integration of new information have become necessary for successful life in this century. Often, change is hard even when we clearly see that hope, peace and a better life may lie in this new direction. It seems that the accommodation to new thinking and experience is rather like going off to college; it may lead to new life possibilities and an expanded self. Four years of intensive study almost always changes the life perspective of the student.  Most often, this new information proves invaluable in grappling with the pleasure and perils of adulthood. Hopefully this dynamic process of development and change continues throughout life.

It is exciting to understand that we have a remarkable brain based capacity to change. To lead an intentional life we must make a serious examination of where we choose to devote our time, brainpower and life energy. If this self-inventory unmasks self destructive habits or perhaps little or no focus on self enhancement, then a program of planned strategy for change is in order. Usually we change our lives for good when we have a plan to change.  (Recently the mayor of Newark was quoted to exclaim, “If you focus on nothing, you will accomplish nothing!”). 

Change can give us hope. We can begin to create new habits of living and thinking that reflect the new person that we have chosen to become.  We can choose where to focus our energy and, to some extent, where we spend our time. New patterns that are repeatedly enacted will become neuronal superhighways. Patterns that we choose to neglect will wither. Many people have survived hardship and have changed poor life habits. What is your life focus?  Where do you spend energy on a regular basis?  It is worth contemplating for life is a moment in time to be spent well.


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Once we thought sleep was an unconscious state of mental rest. Now we know that it is an active process preparing our minds and bodies for the next day of life. Sleep restores mental and physical health and is intimately related to memory and learning. It also reactivates patterns of neural activity that occurred during the previous days experience. Key patterns of connections between firing brain cells are strengthened. In this way new memories (laid down as patterns of sequentially firing cells) begin to be etched in brain pathways for future memory recollection.While sleeping, the brain analyzes the previous day’s life experience that has been saved in short term memory so that what is important to recall can be gradually stored into long-term memory. Experience is reviewed in such a way that new or subtle connections may be found that were not discerned while awake.  Many of us have recalled becoming aware of something that has happened during the day’s events but became clearer in the night’s mentation. Rapid Eye Movement Sleep (REM), sometimes called dream sleep, is a sleep stage that is  especially associated with memory consolidation in the brain. This stage actively inscribes neuronal connections coding events that have been noted by the brain into long-term memory.In order for the brain to lay down memories of our experience it seems we need to be asleep. Especially in REM sleep, the brain utilizes some of the same networks activated when awake.  It may be that the relatively unconscious state of sleep is necessary for the brain to cut off incoming signals in order to analyze experience and sort important information into memory.  It is easy to see that understanding sleep may help us to understand memory. People who sleep after new learning experiences have better recall than those who do not sleep. Recollection of newly learned material is clearly enhanced by sleep, and it is now thought that a minimum of six hours of sleep is necessary for improved memory to occur.The quality of our awake time is dramatically affected by the quantity and quality of our sleep. We cannot feel peaceful if we are not biochemically regulated, and sleep plays a major role in that process. Sleep loss may lead to increased emotional fragility, reckless behavior, poor concentration, irritability and impatience. Negative emotions are intensified and positive ones diminished. Sleep researchers have documented a progressive decline in mood with accumulated sleep loss.  People who slept four to six hours nightly for several nights became less able with each passing day to focus, concentrate and control negative mood states. An interesting factor in these studies is that there seems to be no subjective awareness of cognitive loss for sleep deprived individuals. Never the less, testing and brain scans reveal dramatic decreases in cognitive abilities. In addition, MRI (Magnetic Resonance Imaging) reveals a sixty percent increase in emotional center reactivity with healthy subjects who were sleep deprived for a single night. It has recently been found that sleep significantly helps to maintain the connections from the brain center that exerts thoughtful control to the emotional reactivity center. This connective pathway is critical to one’s ability to respond appropriately to the next day’s emotional challenges. Who among us doesn’t know that children and adults get cranky and can’t think clearly without adequate sleep? Now sleep research is documenting just how and why this happens.A number of key factors promote a good night’s rest. Daily bright light, preferably sunlight, for at least an hour a day is essential to good sleep. Our bodies take in daylight through many light receptors, but some receptors through our eyes connect to the place in our brain that governs our circadian rhythms and influences our sleep/wake cycles. Bright light increases the strength of our rest/activity cycle and decreases nighttime awakenings.  Morning light is associated with setting our internal clock for an early to bed and early to rise schedule. Afternoon light tends to predispose us for a later bedtime and a later awakening. Genetic components and life stage factors also determine one’s preference for early or late bedtimes, but an hour of daily light exposure improves body rhythm synchrony for all of us. No documentation exists about the daily bright light exposure of the average American, but working people may be drastically limited to bright daylight, especially during the winter.A dark room also assists the slumber process. Our body’s level of melatonin increases in the dark, and melatonin promotes sleep. Body temperature seems to decrease in sleep but,  daytime heat is associated with sleepiness. Vigorous daily exercise and bright light tend to increase stages three and four of the sleep cycle. These significant stages, which importantly include REM and so called deep sleep, tend to decrease in later life. The sequencing of REM episodes throughout the night is related to maintaining emotional equilibrium. Good sleep hygiene is a vital life habit.Integrating our present sleep research knowledge base into cultural life patterns is important for optimal life development.  For instance, our present school schedules transgress the normal internal clock of adolescence. Middle school and high school students naturally have a delayed phase sleep cycle during the teen years. This means that they are more likely to go to bed later at night and attempt to sleep later in the mornings. Early school start times may be biologically hard for these youngsters, as their internal clocks are not scheduled for awake time until later in the morning.In the past we often thought that if we were asleep then physical restoration was occurring. Now we are beginning to understand that the natural progression and occurrence of sleep stages are essential to physical renewal and memory.  Like nearly all body systems, the sleep/wake cycle needs regularity and balance. Consumption of alcohol and many medications disrupt sleep and sleep stage progression. Effexor, a commonly prescribed antidepressant, is strongly associated with REM behavior disorder and with sleep movement disorders like Restless Leg Syndrome. (Some sleep movement disorders are related to an iron deficiency.) The Serotonin agents, Prozac and family, are also known to disrupt the natural sleep stages. The old Tricyclic antidepressants like Trazodone, which are sometimes still prescribed at small doses to induce sleep, disrupt sleep cycle synchrony also. Caffeine is also an offender. These are merely some among a hundred disorders of sleep that impair the quality of life.Quite recently sleep researchers have found that an upsetting, chaotic and/or abusive childhood predicts later adult life insomnia. This insomnia is thought to be related to lasting feelings of insecurity.  A childhood of turbulent family life often causes anxiety and worry that continue into adulthood. Anxiety and worry are antithetical to sleep. Chaotic families often set up habits of poor sleep hygiene. Rather than teaching children to establish good sleep habits and to set up life conditions that promote sleep, stability and peacefulness, these families may be in wearisome circumstances or promote lifestyles that adversely affect good sleep. For example, a knowledgeable focus on bedrooms that are dark and relatively cool is important for good sleep. Furthermore, disorganization or chronic conflict may reign in too many households.Poverty is associated with a decrease in the average amount of daily sleep and sleep efficiency. Educators have found that poor children of every ethnic group have less stable sleep patterns than their more affluent schoolmates. People that are anxious to make financial ends meet may view sleep as a luxury rather than a necessity. Worry and stress may further disrupt sleep habits. The world energy crisis may be a hardship on sleep in the future. If people are financially unable to cool or heat their homes sleep will be badly impacted. One study indicates that chronic sleep disruption may reduce lifespan some fifteen years - the same loss of life estimated from smoking two packs of cigarettes daily. In old age, chronic sleep disruption may be a harbinger for nursing home institutionalization.  Sleep efficiency seems to change in old age. Most elderly take a longer time to go to sleep, experience more awakenings and have less REM and deep sleep. As a consequence, older adults often spend more time in bed and are beset with fatigue and daytime sleepiness. Cataracts decrease the light that is received in the brain’s circadian center and thus frequently disrupts internal rhythms. The average nursing home patient gets only ten minutes of bright light daily. For the healthy old sleep becomes even more consequential, and of course sleep interfaces with light, exercise, social support and positive thinking habits to promote a general sense of peacefulness.Scientists have discovered that lack of good sleep can even influence certain diseases that were once thought to be linked to other causes. Some sleep dysregulation, like REM Behavior Disorder, are predictive of later neurodegenerative disease, including Parkinson’s disease.   Most of us know that dementia is a neurodegenerative disease, but many do not know that it is associated with a breakdown in the integrity of the neurologically based sleep mechanisms. In fact, sleep fragmentation and disruption are common characteristics of dementia. Thirty-three to fifty-three percent of patients with Alzheimer’s disease have sleep apnea - a sleep respiratory disturbance that causes stress reactions throughout the body during the night.  Even a mild apnea may result in cardiac damage.  Sleep apnea is also associated with trouble in concentration, attention and memory, and can induce irritability and difficulty with clear thinking.Because of genetic and imaging research, we understand now that sleep is a very important part of setting up habits that support our best selves throughout life.  If it is true that sleep is preparing us for the level and quality of consciousness and memory for the next day, then improving our sleep habits will surely improve our lives.


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If you live long enough treacherous events may happen, and how you endure them and go forward in life will reflect future character. A recent follow-up article of the famous Harvard Men’s Study found that by the time one reaches the eighth decade, tragedy is a very typical part of life experience. Fortunately, only one fourth of those who are exposed to trauma have lasting emotional damage. This statistic is heartening because it indicates a likely genetic resilience towards life’s calamities as most of us are able to pick ourselves up, brush ourselves off and continue to make heroic attempts to use life’s window of time well. Whether one experiences symptoms of Post Traumatic Stress Disorder (PTSD) following catastrophe or not, choosing a life path onward is usually arduous. Understanding the biochemical process of trauma memory, with its potential behavioral sequela and lasting thought-piercing recollections, may help ease this difficult journey.A traumatic life event is indelibly laid down in neurological memory which is easily triggered by experiences that have even the slightest association with the particular tragedy. Trauma memories are coded with exaggerated negative emotions of distress. For example, we may not recall sharing a cup of coffee in a restaurant a few years ago, but if someone comes into the restaurant and shoots three people that day, we will likely recall the incident in vivid detail for the rest of our lives. Subsequently, when we see this restaurant or a similar one, or perhaps share any cup of coffee, this traumatic recollection may be elicited with intense and potentially horrifying emotion.Historically the emotional state of heightened stress helped humans to focus on danger, react and remember the experience so that it could be avoided in the future. Prior to the existence of civilized man, periods of intense, threatening stress were intermittent and soon passed. Today, many people have a lifestyle that entails chronic stress, but perhaps they encounter less frequent physical threat than early man. This stressful lifestyle may readily push trauma survivors into episodes of intense and reactive emotional dysregulation. The reactive and repetitive occurrence of trauma memory can lead to poor long-term emotional and physical health. It may also promote automatic response patterns, which likely had survival value for early mankind, but close off creative and complex thinking.BRAIN CHEMISTRY RESPONSE TO TRAUMACorticoid Releasing Factor (CRF) is the initial brain chemical that responds to signals from our environment and it cascades through our bodies so that we may react adaptively. CRF promotes Cortisol-a prolific stress neurochemical. Cortisol stimulates norepinephrine (NE) another prevalent activating neurochemical. Cortisol and NE are our brain’s chief stress response agents. When these stress chemicals are too high, which is often the case in trauma survivors, they essentially shut down the judgment center of the brain and stimulate the emotional reactivity centers. If you are running from a tiger this reaction makes good adaptive sense, but if not, precipitously elevated stress chemicals negatively impact several key areas of the brain that result in PTSD symptoms. The brain centers for social judgment, emotional modulation, short-term memory and hormonal stress reactivity are particularly poorly impacted.Serotonin levels in our bodies decrease in response to an increased biochemistry of stress. Because Serotonin is a modulating neurotransmitter that impacts other neurochemical systems and several brain and body functions, including sleep, a decrease in Serotonin in response to increases in CRF, Cortisol and NE can lead to dysregulation of brain neurotransmitters that results in increased depression, anxiety and disrupted sleep, which is where mood and cognitive regulation capacities are nightly restored. Increases in CRF may negatively impact the reward center leading to decreases in another neurotransmitter, Dopamine, which is associated with a sense of pleasure, clear thinking and movement. In other words, the experience of trauma and its subsequent flash back episodes of remembering cause dramatic and repetitive increases in biochemical stress reactions in the body that can dysregulate and disrupt essential body and brain functions.Even our genes are involved in the neurochemical reactions to extreme stress. Genetic variance in several brain systems is related to resistance to the negative psychological aftermath of trauma. For instance, certain CRF “genetic snips,” segments of the CRF receptor genes, can vary. Some of the genetic divergence seems to result in an inherent resilience to tragedy. Resilience is related to one’s ability to assimilate negative experience in meaningful ways and move on to positive life participation.UNDERSTANDING POSSIBLE NEGATIVE CONSEQUENCES OF TRAGEDYPTSD is associated with anxiety, depression, poor anger management, impulsivity, and memory deficits. If trauma is severe or prolonged, or if one is genetically sensitive (i.e. highly emotionally reactive) alteration in body, brain and genetic chemistry may become permanent. Pathways of traumatic memory in the brain become deeply etched in remembered connections between neurons, which are sculpted by intense and frequent episodes of vivid recollection. It is thought that each graphic recollection of trauma, each flashback episode, serves to create a memory footprint. The unhappy result may be chronic emotional reactivity and intensity. This state of affairs is too often accompanied by a decreased ability to inhibit impulsivity, to thoughtfully tame aggression, and to execute socially appropriate decision-making.  Memories coded with intense emotional distress take a person back to tragedy and away from present life, and the physical toll is enormous. The heightened stress chemistry at the time of trauma and each trauma memory episode, sets off a succession of stressful and potentially damaging physical events including increased heart rate, blood pressure, etc. Unfortunately, memories of past heartache usurp one’s energy and focus in the present moment.Our extended memory places an event into the fabric from which we weave our sense of self. Memories that are terribly upsetting are left coded in our brains as sensations, images and physical reactivity. Tragic memory that is left, or blocked without some linguistic sense made of it (usually shared with a confidant), is likely to be reenacted in some mindless, automatic way. If these memory episodes become habitual, then emotional distress is likely to become characteristic of one’s personal and social self. To continue well, traumatic happenings must be integrated into a meaningful interpretation of our life history. This painful effort may leave us with a sad sense of wisdom.It is clear that each side of our brain specializes in different functions, but they both collaborate to integrate and code information into memory. Tragedy so overwhelms the emotional reactivity centers that information flow and interaction between the right and left-brains is disrupted. The location of the language center is primarily in the left-brain. This side of the brain is also associated with circuitry that promotes more positive emotion and behaviors of approach. The right side of the brain is thought to have more impact on negative emotional states and avoidant behaviors. Of course many functions move across left and right brain hemispheres, but it is the left hemisphere’s ability to name feeling states that facilitates integration of conscious memory and assists with emotional self-regulation and trauma recovery.Our sense of who we are is constantly updated by life experience that is coded into memory. Long-term memory consolidation is a process, mostly happening during sleep, that may take weeks, months or even years. This entails the integration of relevant memory into a memory bank of self-experience. Memory is primarily coded from short- term to long-term memory during REM (dream) sleep. There seems to be an ossicilation between left and right brain centers during REM sleep when the left brain is activated to retrieve memory from the right short-term memory center.  Then the left brain becomes activated so that the new information is sorted into the file of past memories and woven into the memory bank of self-history. For trauma survivors, dreams can become a struggle to sort through terrifying life tragedy as the brain strains to place the unimaginable into some sort of reasonable self-memory.Unfortunately traumatic recall may not be erased, but our understanding of how memory is stored in the brain can be incredibly important in helping people to assimilate horrible misfortune so as to be able to continue with life. Recent studies have carefully looked at how we can recall an experience.  It is now known that memories form in stages. At first a memory is only a pattern of electrical signals etched in the brain. If there is a strong emotional reaction to an event, then proteins, stress hormones and neurochemicals, will strengthen these patterns in the brain so that they are imprinted and can be easily recalled. Revisiting an upsetting memory may temporarily elicit this electrochemical pattern so that it may be amended by new information.  New perspective during recollection may alter the memory pattern as it is recoded and returned to the long-term memory bank. This of course has implications for possible healing in the recounting of tragedy. Perhaps with the presence of a caring therapist, or trusted person in ones life, the way that we view the tragedy may be changed to a more peaceful and accepting perspective so that courage may be found to continue making a good effort with life.MAKING GOOD SENSE OF BAD TIMESAll experience is emotionally tagged at the level of perceived significance. Emotions help to organize, amplify and attenuate behavior, thinking and reactions. Knowing how to recognize and temper certain kinds of emotion is essential for an intentional, thoughtfully positive and productive life. Intention has a specific set of circuitry in the brain. It enables us to pursue the future in the context of today, even a dark today. With intention there is hope. People may manage feeling states in many ways, and often their strategies are mindless and self-destructive. The lives of those who have suffered deeply are rather like those of a hothouse flower. They must be carefully and consistently tended so as to avoid emotional reactivity which can become intensified following tragedy. The brain must come to grips with assimilating a piece of unimaginable life experience. Going forward is most often a dynamic process and an ongoing effort. Finding a carefully chosen route onward is the task at hand. There must be intention to live again following tragedy.The personal meaning, level of trauma exposure, availability of social support and genetic characteristics are primary factors determining how one copes with terrible misfortune. Some trauma survivors are present at the scene of the tragedy or are in some way vividly exposed to its images or sounds. This exposure results in a firmly imprinted memory of the horrifying event. Having loving, patient social support can be essential for survival and regaining emotional balance. Disappointingly, some people find that close association to tragedy feels menacing to their own sense of personal safety. Visiting with a friend or family member who is grieving or suffering isn’t always an easy or happy time. Yet, one may feel re-empowered through connections of trust, partnership, attunement, and shared exchange that facilitate peaceful mood regulation and decrease negative emotion. Rebuilding relationships with one’s self and others may be painstaking because the process of mnemonic integration of unspeakable suffering takes time and courage.While it is a good idea for all of us to think before reacting to feelings, if you are a trauma survivor who experiences very strong feeling signals, then you must strategize how you want to feel and react to stressful situations. By setting up life routines and thought patterns that positively impact our mood states, we can consciously control how we feel more of the time. A recent Harvard University study found that close positive attachment is the single most important predictor of life happiness because feeling understood positively affects our brain chemistry. Moreover, the same brain pathways that seek to understand others can be marshaled to understand ourselves with compassion and respect so as to become more self reflective and peaceful.Finding a way of thinking about past tragedy that merges into a sense of meaningful life history can be unfathomable for many people. Those with a history of trauma routinely find themselves automatically using the life-changing episode as a marker event, so that other events are marked as happening before or after the tragedy. They may ask themselves, how do I live well after I have been devastated by loss? The answer is that it is necessary to speak about what has happened or to find another way to bear witness to the tragedy so as to rebuild a life that may be a tribute to the person lost or to live in a way that is a testament against treachery and injustice.Realizing that our feeling and memory system is shaped to some extent by life experience is essential to self-determination. As scientists are more able to image and clarify how our genes and brain pathways work, we can use this knowledge to help a trauma survivor achieve a more balanced and peaceful emotional state. Although we can do this with medication, it has onerous side effects. A healthier alternative would be to cultivate an active understanding of one’s self that sets up effective life habits that address a broken life. Thus, a system once overwhelmed with stress may become a more equilibrated self-state that will decrease in dissipated energy and facilitate intentional focus. “In a dark time, the eye will begin to see”(Theodore Roethke).(A study summarized in the June, 2009 Atlantic Monthly regarding sequential ten yearly assessments of selected “most promising” Harvard graduates from the 1940s.)

ArticleTitle:
Understanding the Persistent Memory of Trauma


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What is it that gives your life meaning and how much does it have to do with your relationships? Caring and sensitivity to others, and personal awareness and life meaning, are human characteristics elucidated by neuroscience with a clarity previously unknown. These human qualities have unfolded in tandem with the evolution of the brain’s empathy circuitry and developed in the context of our social experience. The quality and kinds of relationships you experience and the meaning that you make of your life are dramatically impacted by your genetic personality and your parenting and culture.

Social interactions prime our relationship networks and in turn our sense of self. Think of the subtle, and sometimes not so subtle, cues that let you know how important you are in a community setting. One’s place in the pecking order clearly impacts your sense of self-esteem and chances of survival. Social reciprocity is essential in advanced civilizations. Societies whose infrastructures of communication and transportation foster relationships among different kinds of people tend to promote more diverse relationship patterns and a more intricate self-perception. 

Our human need to collaborate in larger social groups was conflated with the growth in the size of the human cortex, our complex thinking center. For example, there is no known hunter/gatherer society that has created a written language. It first evolved in more elaborate communities that pooled resources for the development of agriculture. As human culture progressed with demands for greater communication and collaboration, the brains empathic and self-awareness circuitry grew into new definition. Interestingly, it appears that the empathy circuitry in males developed from genes related to territorial/group protective origins. Capacities for empathy in females originate in genes related to nurturing.

There is an expansion of self and social awareness that is directly related to the societal and family exposure that the growing child experiences. The middle ages resulted in a contraction of social and self-experience following the fall of the more evolved Roman civilization. Beginning in the renaissance, children came to be valued and nurtured to insure that they could effectively negotiate relationships necessary for more urban and cosmopolitan settings that were beginning to bloom. Customs of parenting remarkably changed with increasing networks of societal infrastructure.

RELATIONSHIP SHAPING

Human genetic capabilities do not necessarily become established as brain circuits if there is no environmental experience to initiate the connections. For instance, if you never hear language spoken, then you will not speak a language. If you do hear language, the words that you hear will determine the language that you speak. The so-called mirror neuron circuitry enables us to internally track the words, behaviors, intentions, and feelings of others. Often we are reflecting the movements and intonations of others without even being aware of it. Our early social experience will be sketched onto our brains, delineating our abilities to perceive others and ourselves and to form empathy and attachment. These networks are shaped and reshaped as we participate in human relationships. 

By the second year of life children begin to recognize themselves and their family and are able to recall past events. If you stop to consider this you realize that it is extraordinary. We know that there are only a few other animals that recognize themselves in a reflection. The capability to distinguish between yourself and another makes it possible to be aware of your own personal life experience. Autobiographical memory is shaped throughout life by our encounters with others. 

The ability of the parents and society to resonate, reflect and sooth the feelings of the child is very important, for it is attachment that helps to shape a sense of self identity and also sets up the emotional regulatory circuitry of the child’s brain. With careful role modeling and nurturing, a competent sense of self-awareness can be mobilized, activating an aptitude to consciously modify feelings and to guide them with thought. The nurturing of human capacities for collaborative relationship and self-awareness has enormous consequences for self-definition and future life meaning. 

Happy family and social attachment foster the child’s power to integrate information from different parts of the brain and body, a hallmark of mental health. Good parenting and social validation literally nurture the physical development of the brain, enhancing synaptic connections among cells to stimulate growth factors that increase the complexity and speed of brain signals. The expanded social and cultural context of today’s growing child will be reflected in his awareness of self and others. Our global transportation systems greatly increase our mobility, pushing us towards a world community and expanded consciousness. 

TECHNICAL RELATIONSHIPS 

Electronic communication that is so common today, especially in children and young adults, has interesting implications for the development of relationships and ones sense of self. While there may be a wider, more diverse social network established through texting and computer exchange, it could be that it may decrease the emotional quality of attachments. Without face-to-face communication, much information may be lost. How will human relationships evolve as we move to video communication? 

People are beginning to use the computer and electronic devices to monitor themselves. They are scrutinizing personal patterns like drinking, eating, mood change, work productivity, exercise, etc. Receiving digital data, called self-tracking, about the patterns of these aspects of our lives can be illuminating. Too often we may have overlooked the influence of small experiences or habits that may impact our moods, focus or productivity. How does this feedback affect our sense of ourselves? It seems that it depends on how it is used. If taken as information that may improve life quality, it may be helpful. If used to tie one too closely to digital expectations or as a daily dose of computer generated criticism, then perhaps not. It is hard to fully predict how our relationships with electronic communications and digital feedback will impact our culture and sense of ourselves. Will this be a positive force for the benefit of mankind, to improve our life awareness, intentionality and quality of relationships? No one can be completely sure at this juncture.

SHARED FUTURE

Will the quick transmission of electronic information and access to easy travel promote a kind of global awareness that mankind has not previously known?  The infrastructure of today’s world is reflected in the complexity of the development of our capacities for self-reflection and attachment to a variety of different kinds of people. Can we adaptively adjust to the massive proliferation of human networks of interaction and communication? Can we move to a more unified global culture that may override our inclinations for aggression towards differences?  Geneticists and mathematicians who have teamed to study these issues propose that a civilization based on transparency, cooperation, and firm consequence to group alienating behaviors seems to have very good long-term survival value. The question may be how to establish parameters within a complex globally connected society that can promote peaceful relationships and a sense of meaningful self-awareness.


ArticleText:
Amazing improvements in imaging techniques are giving us new insight into the mechanics of the brain and its malfunction in dementia. A typical CAT scan (computed tomography scan) and MRI (magnetic resonance imaging) can vaguely depict changes in brain volume, stroke damage, and other structural areas that may identify dementia. One PET imaging scan (positron emission tomography) will actually render the presence of protein plaques associated with Alzheimer’s dementia. Another new imaging technique, DTI (Diffusion Tensor Imaging) can represent the input and output fibers that connect different parts of the brain. These whitematter fibers precisely coordinate information processing with signals from higher and lower systems and different sensory modalities and related memories. Any disruption along a network pathway may impact related abilities from connected regions. Thus one damaged area may impact functions from a different cortical or subcortical area that is linked to the blighted site. Maladies of these important brain fiber connections are usually called white matter deficits.

The composition and connectivity of each brain system is reflected in symptoms of malfunction that occur in dementia. Take Parkinson’s for instance. This Disease is associated with progressive declines in attention, complex thinking, and movement disorders that are related to deficits in the dopamine system, which has input and output to areas primarily involving decision-making, movement and pleasure. Thus Parkinson’s patients experience a progressive decline in these linked brain regions. 

The dementia research, mostly coming out of progress in brain and molecular imaging, is leading to an understanding of brain function from a perspective of a network model. Because of this brain researchers are beginning to think of different areas of the brain and their associated functions as simply primary nodes on networks that connect one system to another related one. Through evolution the brain expanded with new complex thinking areas superimposed over old subcortical areas that are related to heart rate, sensation, movement, etc. The lower areas reacted to the newer areas by elaborating their own networks to the newer brain parts so as to more efficiently coordinate responsivity across systems and sensory modalities. For example the emotional system has connections to lower subsystems that are related to respiration, blood pressure, movement, etc. and also to higher systems that control decision-making, judgment and self-awareness.

Combining information from several imaging techniques has revealed that the brain has a default network signal pathway that oscillates predictably when an individual is in a quiet, resting state. This default-signaling network is suspended when the resting individual is activated during intentional behaviors, such as purposeful movement, learning or social interaction. The resting state pattern returns when behavior is quiet. Resting pattern signals reflect basic underlying organizational properties of the human nervous system. Could this be why so many people try to self regulate, “find centeredness,” though meditation or other behaviors that result in a return to our sense of a quiet peaceful state? This new information about a default brain resting state certainly implies that our body naturally seeks a state of balance and quiet. The brain clearly needs tranquil awake time on an ongoing basis to preserve its durability.

We know now that behavioral, cognitive and psychological symptoms in all dementias are related to the areas and fiber network connections that are pathologically impacted. The configurations of the imaged pathological changes may help to delineate the kind of dementia that is in progress. For instance, dementias related to addiction have underlying damage in circuitry in the prefrontal cortex and connections to other brain regions such as the cerebellum. This damage results in symptoms of disinhibition, poor judgment, irritability, and impulsivity because the connected areas relate to these abilities. 

In addition to our ability to better diagnose previously known types of dementia, we have recently been able to distinguish what is called Frontal Lobe Dysfunction (FTD), which involves neurodegeneration primarily within the front of the brain. Symptoms include impaired judgment planning and insight, self-regulation, motivation and initiative, and the inability to appreciate consequences of behavior. As a result, FTD is now being diagnosed earlier. Because often the family or spouse is first aware of subtle initial changes and because of the specificity of these changes, neurologists are recommending that they participate in reviewing the actual scan of the brain, rather than having a radiologist alone compose the diagnostic report.

Alzheimer’s disease, along with some of the other dementias, is associated with a mutated protein synthesis in the brain that may be both genetic and environmental in origin. At a molecular level we can see cellular changes in dementia showing deposits and tangles that differ from normal. For example, the brain tissue in Parkinson’s dementia typically exhibits Lewy bodies, which are small, diffuse microscopic abnormalities that are distinctive from the microscopic abnormalities seen in Alzheimer’s disease.

While there are recent gains in our ability to diagnose dementia with brain scans and cerebral spinal fluid analysis and some evidence from DNA assessment, memory loss is the most robust symptom of dementia. Personality changes, language impairment, and deficits in intellectual abilities and judgment, agitation, impulsivity, aggression, apathy and circadian rhythm disruption are also characteristic.  

The most commonly diagnosed dementia is Alzheimer’s disease. Up to 75% of the cases of dementia will include Alzheimer’s disease. There is a range of differing diagnoses for kinds of dementia, but most are considered to be a type of spectrum disorder, one commonly associated with and sometimes promoting another. For example, strokes and vascular disorders may be precursors to a molecular cascade of cell changes that result in Alzheimer’s dementia.

There are different etiologies and symptoms depending on the kind of dementia that is in progress. We know that certain families may have a genetic loading for these disorders. We also know that high blood pressure, diabetes, toxic exposure, head trauma and other factors may play a significant role in their development.  In Alzheimer’s disease symptoms worsen, while in vascular dementia they may be less predictable or even improve over time. Sudden onset dementias are potentially reversible and are usually related to metabolic, vascular, toxic or infectious disturbances. 

Over 5 million Americans between the ages of 65 and 74 now have dementia. One of the reasons for this increase is that more people are living into old age. At 85 and older, a frightening 40% will be demented. The cost of care for Americans with dementia is over 150 billion dollars yearly. Nursing home care averages 7 to 12 thousand dollars monthly, not including medications. It is hard to imagine how we will be able to continue care for the demented of the baby boom generation and beyond. 

We do not yet have drugs that can actually stop the downward progress of dementia. However, the medications that we do have may diminish the rate of decline, and several are now on the market. Other psychiatric medications are used to control emotional and behavioral symptoms, but recent data indicates an increase in mortality in demented elderly patients taking antipsychotic medications. As a result, it is recommended that they be used cautiously and for no longer than 3 months.

Are there life strategies that may help us to avoid dementia? While we do not know exactly how one may keep from contracting dementia, we do know that avoiding certain risk factors may help.  These include diabetes, high blood pressure, high cholesterol and emotional stress. Depression and worry raise stress hormones that have long been know to damage brain cells in the short-term memory area. Depressed people have heightened white matter fiber connection between certain areas that are not seen in people who are not depressed. Does this mean that our lifestyle, experience and thinking patterns can rewire brain-signaling networks? You bet.

Exercise, good nutrition, healthy sleep habits and continued learning seem to nurture brain health. People who are highly educated, or who keep their minds active, seem to develop what are called, “cognitive reserves” which may help compensate for neuronal loss. This is because new synaptic connections are established between neurons in the brain when a person learns. With more knowledge our very plastic brains may increase connections and possibly adapt to dementia losses by finding alternative pathways. The learning process results in an increase in a brain chemical called Brain-Derived Neurotrophic Factor (BDNF). Because it seems to promote healthy brain cells, some neuroscientists think of this natural chemical as brain fertilizer.

In many ways research in dementia has transformed our understanding of the human brain and how it goes astray in this disease. We have new comprehension of the mechanisms of brain circuitry and its primary role in brain function.  We have increased clarity of the spectrum relationship between differing kinds of dementia. While we have made progress in the area of diagnosis, treatment options remain limited. We have only been able to diminish the progress of dementia, not stop it.

ArticleTitle:
Age and Brain Change - Understanding and Preventing Dementia


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All brain systems appear to function best when they are integrated and equilibrated with their connected cortical and subcortical networks. When this is the case, we are more able to govern our impulses and emotions and successfully negotiate happy attachments with an empowering sense of self control. Expanding knowledge in neuroscience has the potential to dramatically increase self understanding by teaching us how the ability to write our own life narrative-or rewrite it through conscious self examination, choice and perhaps therapy-is linked to self control.

Imaging technology has given us the ability to actually see the neuronal and molecular circuitry that underlie our body and brain systems. We can finally prove that emotion, cognition, and behavior have physical substrates, and that our human brain has evolved with certain areas specialized for the development and elaboration of specific functions. Feelings are essentially conscious perceptions of body reactions of arousal, resulting in sensations of fear, anger, sadness, pleasure, etc. Our brains are thought to be primary nodes on neuronal circuits that interface and branch to manage body systems. Neurochemicals seem to start out in different clusters, running up and down or bodies, branching into multitasking and intercommunication. Increasingly we are defining these circuits as well as delineating their connections and function.

Our brains are sculpting and re-sculpting themselves with each experience, even though we don’t always realize it. Our senses feed outside information into our receptive centers which in turn send these signals throughout the brain for sorting and evaluation of the possible reward and energy of behavioral reactions. Recent work in the orbital frontal center, a brain area folding inward above and below our eyes, tells us that this area serves as a relay station between sensory information from our surroundings and internal systems of intentional movement and assessment. This is an area of value determination and cost estimate, i.e. how much gain and how much energy expenditure may be needed in order to proceed with a particular behavior. It allows us to connect to the outside world from visual and auditory systems, smell and touch, to internal tagging centers of emotion, attentional focus, motor systems, and analysis, which help to make “go” or “no go” decisions.

Our experience of our life is a synchrony of coordinated inputs from both left and right, as well as top and bottom brain areas, which knit together thoughts, sensations, movements and emotions. The top/down/top/up and the left/right brain pathways are complex. Generally speaking “top down” movement involves the cortical (complex thinking) systems, whereas “bottom up” signals are connections from the systems and sensations of body to the top parts of the brain where they are integrated and sometimes brought to conscious awareness. Left/right systems mostly refer to left and right brain functions. The human left brain has specialized to include social appraisal for approach, positive experience, but also anger expression and language. Right brain functions include avoidance, threat related vigilance, disgust, etc. As we begin to map these complex interactions it has become clear that integration and balance are the roads to health and well being. As a side note, it is interesting that activation of our left brain by focusing to the right may actually trigger our “happier more rational” left brain. Even though this is very reductive, right brain activation is more associated with negative feeling states.

Our right brain seems to be involved in survival. It connects to and monitors body functions and reactivity. It is the seat of emotions, including feelings of fear and pleasure. It also is the seat of empathy, social interaction, face recognition and self awareness. It is the right brain that notices voice intonation, facial expression and body communication. It is also the place of implicit non-conscious, memory, including recollections of emotional reactions to a person or situation that may not be in mindful awareness. Early in life, when the right brain is particularly developing, our sense of ourselves and our relationships is being chiseled in neuronal pathways by our interacting genes, family and social experiences, outside of our awareness for the most part.

As noted, our left brain functions to modulate approach, social connection, well-being, linguistic analysis and mild activity, among other things. The development of language in the left brain gave us clarity in communication. The left brain is less connected to our body sensations than the right brain. It is the left brain that is able to logically sort through facts and emotions sent over from the right brain. The two sides of our brain interact through a connecting neural pathway.

The small cluster of neurons, the hippocampus, is one of the primary centers for the integration of information between the two hemispheres of our brain. The integration of information between the right and left brain, the upper complex thought areas and the lower, more physical circuitry, must constantly occur for optimal human performance and well-being. Certain circumstances may interfere with this process. If our primary stress hormone, cortisol, gets too high, the hippocampus stops working. Alcohol and certain drugs also inhibit the hippocampus. When this happens one problem is that implicit, unconscious emotional memory coded in the right brain, may not be integrated into conscious, explicit memory in the left brain. There may be subsequent situations that are encountered which trigger the right brain unconscious memory that was not brought into conscious awareness by the left brain actions. Such a person might have strong feelings that may influence their behavior in ways that don’t make sense to them and consequently be more likely to act on feelings without the discernment that is possible through brain circuitry integration and balance. This is the substrate of dissociative disorders where parts of one’s behavior or feelings simply do not fit into the generalized whole of the personality.

Early in life the right brain grows first. The beginning of the integration of the right/left brain information must wait until the end of the first year of life when the left brain language center begins to develop and the network that connects the two hemispheres matures. Thus many patterns of thinking, emoting and behaving absorbed in early life may be coded primarily in right brain implicit memory, outside of conscious awareness. Early parenting experiences not only influence later attachment behaviors but the number of receptors in certain brain parts that are associated with affection and nurturing. It is often difficult for people to question these mostly automatic patterns of thinking, relating, emoting and behaving. Integrating this material into left brain conscious awareness and linguistic discernment is the stuff of self-reinvention and self control that is taken on in psychotherapy.

The complex thinking centers that are so crucial for inhibition over right brain emotional impulses grow slowly and continue on until the third decade of life. One aspect of successful life is the development of cognitive flexibility and the capability to examine the present in the context of past experience while mindfully determining when a present occasion calls for a change in thinking and behavior. No one always has his or her own self-system in balance, but from what we know, maintaining a congruent and even-tempered, integrated biological and emotional state usually occurs when we are at the “top of our game” individually and as a community of people.

Finding Integration and Balance for Self and Society

Good mental health usually entails good physical health and seems to be intrinsically a matter of balanced integration. An enriched social environment gives an assist to brain cell health increasing plasticity for the development of skills related to learning and self regulation. Regular good sleep is a major player in emotional well-being. Sleep, of course, is related to daily light and exercise. Self-esteem and the ability to govern emotions are essential for any sense of empowerment over your life. Education is another key component.

Successful attachment has survival value for individuals and our world. Helping one another transition from periods of stress to positive calm is a natural social process. Interestingly, certain brain neurotransmitters and neurohormones are activated when we are in contact with others. Which ones develop depends on the particular experience, for instance, positive attachment promotes safety and pleasure and activates the underlying neuronal and biochemical circuitry of these sensations. Distress is more likely to result in fear or anger and their related pathways. Love and work are essential ingredients of a good life, but even the rich are not guaranteed wellbeing for themselves and their progeny. Intelligent interaction with others once played an important role in the evolution of mankind, but there are so many of us now and miscommunication and misrepresentation abound. How do we find measured self control as individuals and as a species who presently dominate the earth, a sphere more fragile than we once realized?

As a student at Columbia University years ago, I heard Margaret Meade speak shortly before her death. In the midst of an eloquent presentation, she quietly predicted that “rogue nations in the possession of nuclear weapons would terrorize the world”. Most of us were stunned and hadn’t thought of this possibility before. Afterwards some students said it was ridiculous. Others of us would remember her predictions with chills as we watched the crisis unfold. There are so many facets of life today that no one imagined then. A population explosion was certain but exponentially based internet connected knowledge was not anticipated. No one dreamed that our beautiful World Trade Center and their momentary inhabitants would crumble under the assault of hijacked commercial airplanes. No one in psychology at the time could imagine the clarity and extraordinary detail of neuroscience imaging that would reveal the underpinnings of our very human nature.

Over the past few decades life for educated people has become better and worse. Knowledge has increased, and for some of us our young adulthood dreams of a one world community have moved forward with international communication and travel. But the peace that many of us so desired has not resulted. The leisure that many predicted would come with modern living left us in the dust as we race to keep up with everyday life achievements. We find ourselves manipulated and driven by media and social
forces in contemporary society. Advertising is using knowledge of our brain and social habits to ping our attention towards their marketing goals and fabrications. Politicians of every persuasion gerrymander our emotional attention so as to sway beliefs and behavior. The problems of environment, world suffering, sharing of resources, threats of fervent violence and use of weapons may leave us adrift. The media, and individuals using media technology, seem to resort to exceedingly gross and exaggerated antics to get our attention. How do we find coherent self-understanding in this circus of movement and stimulation?

Could we collectively move away from dissonance, fragmentation and disequilibrium? Our life priorities may shift in the process. As we shape our own life stories by understanding our biochemical systems and living more carefully with them, can we- in the same mindset- shape our world culture? Yes, but it would mean taming emotion on an individual and societal level, which is no small dream. It would mean providing safe, supportive learning and life environments for all children. It may mean teaching people how their brains and bodies work so as to help them thoughtfully govern their lives and communities. Knowledge, including self-understanding may be the foundation of hope for our individual lives and for the human community. In the best of all worlds we find peace, meaning biochemical synchrony resulting in a poetic sense of well-being, good will, and self control.


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Consistently loving encounters with caretakers engrave a physical substrate of memory patterns into a child's brain. Good parenting will result in automatic expectations that one's needs will be met and fears and distress will be soothed. The quality of your childhood parenting predicts your later life ability to adapt and adjust. Steadfast nurturing and protection renders healthy brain circuits that engender feelings of safety and happy attachment, releasing energy for exploration and learning.

It is the right brain that lays down memory patterns of our first experienced emotional reactions to survival issues of safety, nurturance, and trust. The right brain begins developing before the left brain in the first years of life. With good parenting we will be taught self protection, self soothing, self awareness, relationship appreciation, and appraisal of others. Most of the early formed habits of emotional reactivity, relationship and self awareness patterns are laid down in the right brain of the young child outside of consciousness. The stress reactive circuitry is centered in the right brain. An unfortunate childhood experience of chronic early life stress and or neglect may set the stage for dominance of the right brain stress reactive circuitry. 

However, with predictable love, nurturance and protection, the infant's brain gradually develops in complexity and association, moving slowly toward left brain dominance. It is the left brain that is now thought to be our social approach, “happier” side of the brain and primary access to complex discernment and judgment. Moderate stress that is negotiated with the help of a loving parent may actually help to prepare a youngster to effectively manage life's challenges. On the other hand, excessive stress overwhelms the child and if continuous, it may begin to dysregulate many brain systems that interface with the primary stress reactive circuitry in the right brain. 
Structural Brain Changes From Abuse and Neglect

Unfortunately there are countless children who have experienced long-term disturbances in protective caregiving and who have been the target of violence or witness to it. Some children have been exposed to multiple forms of abuse. Childhood exposure to one kind of abuse increases the risk of exposure to other kinds. For example, it has been found that parental verbal abuse is a toxic form of maltreatment, and like physical and sexual abuse, leads to neuropsychiatric damage, including structural brain changes.

Early adverse experience may create deeply etched stress circuitry pathways where neuronal signals are easily and habitually traversed, invoking reflexive reactions of rapid and intense emotions of stress. These children may grow up to repetitively demonstrate poor judgment, and become quickly aggressive, fearful, and vigilant. When stress is high, complex thinking is shut down, and reactivity takes its place. Physical neurobiological changes happening to this stress reactive child may lead to trouble getting over upset feelings. Moreover, chronic stress may curtail the development of self awareness of one's own feelings and body states. This may result in a growing child with diminished capacity to trust or to discuss inner feelings or the feelings of others. It is hard to manage feeling states well if you do not have the skills to recognize or understand them in the context of past or present experience, and learn to speak about them thoughtfully and constructively. A youngster needs these skills in order to respond with measured behavior. If the adults around you express their feelings reactively, without much thought, and do not speak to one another respectfully and collaboratively, it is hard not to follow their prototype. 

Deficits in brain development resulting from childhood abuse and/or neglect may last a lifetime. Abuse and neglect have a cumulative, harmful effect on the brain. Frequent right brain stress circuitry activation may result in reflexive and often aggressive reactions that are coded in the right brain stress response memory outside of conscious awareness and, without the benefit of self-scrutiny and self-correction. The malformed brain structure changes that occur with childhood adversity appear to depend upon the particular timing and length of abuse and/or neglect. A child's age at exposure may impact which brain circuitry is damaged and the resulting psychiatric sequelae. Earlier mistreatment seems to render more pervasive brain structure changes that promote long-term personality problems. During periods of rapid development, certain areas of the brain become acutely vulnerable to damage from external threat and stress.

Neuroimaging shows that the brain structures that are most negatively impacted by childhood adversity are the temporal lobes including the hippocampus (which encompasses crucial parts of memory coding), the  hypothalamus (which helps to regulate homeostasis and the stress reactive centers), the amygdala ( a primary part of the brain's alarm center, which may persistently fire under prolonged adversity), the cerebellum (a center for memory and connection to other systems including movement), and the prefrontal cortex (which subserves complex thinking and has the ability to inhibit stress reactivity systems). The prefrontal cortex particularly modulates emotional responsivity by suppressing the amygdala alarm system. This structure and related complex thinking systems are turned off under circumstances of severe stress. These so-called executive areas are used to help calm us down and move us away from reactivity to thoughtfulness.

The prefrontal cortex develops slowly as the child grows. In an abused child it may mature early leading to behaviors like the “parental child” who learns to take thoughtful control (often in an uncontrolled environment) and to sooth and take care of others, including at times the parents. This precocious development seems to arrest the complete growth of the prefrontal cortex which otherwise should continue developing until the late twenties. It is this area that is nurtured and developed in cognitive behavioral trauma therapy-- a research-supported treatment for psychological angst associated with childhood abuse and neglect. 

The corpus callosum, a primary connective tissue joining left and right brain functions, is also developmentally diminished by early life stress. This diminishment is partly detrimental because signals across the corpus callosum are sent from the right-brain stress circuitry to the left-brain complex thought centers for assessment and possible inhibition. Thus, one who has grown up with childhood abuse or neglect may be rewired by the experience to be less reflective, leading to more frequent risk-taking and poor choice-making because he/she is living in the right-brain stress reactive circuitry with fewer signals crossing over to the left-brain complex assessment and inhibitory centers.

It has also been found that brain areas related to accurately interpreting facial expression may be malformed in adults with adverse childhood histories. Research on children and adolescents with a history of abuse has delineated that they have a tendency to interpret pictures of ambiguous faces as hostile and threatening. It is difficult for these children to grow up with the open communication and trust necessary for close, happy attachments as they may be predisposed to misinterpreting slight signals from others as rejection or threat.

The emotional and thinking systems in the brain circuitries interact with one another and function optimally when integrated and calibrated. The lack of fully integrated, balanced brain circuits is part of the underlying etiology of hyper-reactive and intensified emotional and behavioral impulsivity. On the other hand, too little emotion (too much prefrontal cortex control over stress reactivity (which is thought to be the neuroscience underlying dissociation) may leave one feeling dull, over-controlled, and out of touch with a sense of self in the present. Respectful self-awareness and mindfulness of others may also be restrained with too little emotional reactivity. Emotions (and their stress neurochemistry and intense cell firing patterns) tag memories as important or not. Thus habitual use of dissociation may result in awareness gaps in the important autobiographical narrative of the events of one's life that are placed in memory and become an integrated part of one's self-awareness.  Researchers have found resiliency in a subgroup of individuals who grow up using dissociative defenses. This subgroup seems to have been able to insulate the memory of abusive or neglectful experiences, freeing up energy for development and learning. They have used the dissociative defense of selective inattention to survive a difficult childhood.
Long Term Neurochemical Changes Related to Childhood Abuse and Neglect

Research on young animals subjected to unpredictable stress (an animal equivalent of unpredictable family abuse or threat) suggests that the neurochemical systems, which are part of the brain neurocircuitry, are negatively impacted by early life stress. The basic arousal system and its neurochemistry, the hypothalamic-pituitary-adrenal (HPA)axis, becomes primed in childhood circumstances of chronic tribulations or neglect for hyper-reactivity and intensified response to even the slightest stress. The opposite effect could also occur. Under chronic threat or parental indifference, the HPA axis may protectively shut down in resting states of depression and dissociation, becoming under-reactive until a stressor causes a volatile activation. 

Persistent childhood adversity is associated with elevations of brain stress chemistry, in particular cortisol which is neurotoxic at long-term exposure The increased stress reactivity results in an anxious, angry, or depressive focus (which is maintained by stress neurochemistry) that fragments sleep and memory consolidation, and decreases certain chemicals that are neurogenic, that is good for the brain.

Childhood neglect and/or abuse also impinges on the serotonin system, one function of which is neuromodulation which helps to equilibrate underlying emotional neurochemistry. This brain chemical system is depleted with chronic childhood stress, leading to behaviors of aggression, helplessness, and depression. Many years of research demonstrate that serotonin blood levels are low in people who committed suicide. Some people are more genetically vulnerable than others to decreasing levels in the serotonin system as a result of childhood stress. 

The dopamine system, a key component of reward (addiction) and cognition and movement, is also abysmally impacted by long-lasting early life distress. We are aware that certain dopamine receptor variations in the brain are determined by our genes, meaning that some people are more genetically vulnerable to dopamine dysregulation with childhood maltreatment.

The endocrine system is another circuitry defectively influenced by early life stress. Recent research indicates that children who have been sexually abused often experience a dramatic increase in sexual hormones during adolescence. Sexual hormonal changes can distract any adolescent, but to have abnormal elevations may lead to sexual impulsivity, pregnancy, and poor focus for the important learning and achievement that set the stage for successful college education and career credentialing. Childhood sexual abuse victims typically experience a lifetime of confusion and regulation difficulties related to sexual issues.
Emotional Legacies of Childhood Brain Changes

Unconscious memory traces attributable to abuse and poor care in early life often engender habitual distrust of self and others. Relationship schemas intertwining nurturance with abuse set the stage for later victimization. Such children may quickly exhibit cognitive distortions of their own self perceptions and of others that may have been subsumed as a result of poor treatment and malicious projection from abusive caretakers.

The ability to speak constructively about the feelings of oneself and others is rarely a characteristic of these kinds of families.  Addictive behaviors may develop as a kind of maladaptive self-soothing. In addition, early childhood adversity is a precursor to disease states of many kinds, including--in addition to addiction--impulsive sexual behavior, ischemic heart disease, pulmonary disease, liver disease, and sleep disorder. Thus the adverse alterations in brain development that are caused by neglect and chronic abuse in childhood set the stage for poor health habits and addictive behaviors which may themselves sadly increase brain insult.
What Can We Do?

We have learned the importance of exercise and healthy relaxation, such as yoga and meditation for survivors of childhood abuse. Neuroimaging shows us that we may change the state of the brain by changing the state of our bodies. For a person with a history of childhood adversity, these kinds of habits become an essential part of healing. Staying centered and calm with an internal sense of competence and safety is important when the body and brain have been entrained during childhood for reactivity and dysregulation. Abused and/or neglected children focus on danger. Once in a context of safety, they must learn to refocus and actively regulate their own feeling states.

Some therapists use desensitization techniques to help people decrease the strength of the memories of past adversity. Many psychiatric medications are used. The only medication that has been studied to show any prophylactic impact on traumatic memory is a beta blocker. However,because it must be taken within a few hours following trauma to disrupt memory consolidation and protect (somewhat) against post-traumatic stress symptoms, it can do little to dislodge recollections of ongoing abuse or neglect experienced by a child.

By helping to bring a history of abuse and neglect to language, psychotherapy may clarify reactive feeling states, place trauma  memories into historical context, and facilitate the acquisition of skills needed to regulate one's own emotion states. The reappraisal of past life events can sometimes bring an increased sense of self-esteem gained in the ability to see how childhood adversity was survived and negotiated until the present. Reclaiming self-esteem is essential as every victim is inevitably humiliated. Abuse communicates to the victim a signal of his/her unimportance. Past cognitive distortions of self must be brought to a respectful present reality. Proclivities toward distrust or the misinterpretation of others caused by growing up with untrustworthy and abusive people who frequently present distorted and untruthful information, must also be re-calibrated to present experience. Sleep hygiene needs to be carefully programmed into the habitual routines as fearful, worried people do not sleep well, and most of our neurochemical emotional and cognitive restoration occurs in sleep.

A critical therapeutic strategy is preventative intervention. This method relies on teaching parents the importance of self-regulation skills that are modeled and actively taught to the child. Highly nurturing parents who exhibit good personal emotional regulation, who are protective in ways that support safety, love and guidance, increase their children's chance for peaceful survival, learning, and happy attachment. Teaching children to learn to “think about thinking” promotes the ability to change a negative focus, become aware of alternative perspectives, and gain more cognitive control over feeling states. Helping parents to promote habits of good judgement in their children is another facet of nurturing a compassionate respectful sense of one's self and others.

ArticleTitle:
Childhood Abuse and Neglect Hurt Your Brain Forever


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In 2012 experts estimated that 25 million Americans were addicted to alcohol, and that some 60 million more chronically used alcohol abusively. Out of this total of approximately 85 million addicted or abusing alcohol users, only some 2 million of these had treatment. Alcohol abuse disorders become costly health care expenses. The side effects of alcohol addiction impact health, family, careers and the culture. The new American national health care guidelines will mandate “evidence based“ treatment strategies for this problem. It is cost-effective to treat alcohol addiction.

Alcoholism is a chronic disease of the brain. It is genetically linked and becomes a neurological disease state with consistent high exposure. Monkeys bred for addictive genes will become easily addicted to alcohol. Those without the addictive genes can also become enamored to alcohol. It just takes more exposure. The risk for addiction appears to be about 50% genetic and 50% environmental. Daughters of alcoholics have a 15% risk of alcohol addiction, while the risk for boys is 30%. Once an addictive pathway is established, it does not go away. Even after periods of abstinence, it may be easily reestablished with use. Chronic, excessive alcohol exposure causes permanent changes in gene expression and neurotransmission. It is also gradually neurotoxic and can lead to alcohol related dementia.

People who grow up in families and cultures that promote alcohol have a greater risk of addiction, as are those who are characteristically impulsive, self-centered, lack spiritual development, and tend to seek immediate gratification. Unfortunately, many alcoholics have had biochemical alterations in neurochemistry that have shifted feelings and personality into a posture of self destructive intransigence, that is characteristically dishonest with self and others. They are often habitually using denial and projection in defensive emotional reactivity. Alcohol experts emphasize that alcoholics are not responsible for their genetic vulnerability, but they are responsible for their behavior, including alcohol use. Recovery programs in America are widely available and free.

There is a high co-occurrence of psychiatric disorders with alcohol abuse. It is important that the psychological aspects of alcoholism are treated along with the addiction. For instance, depression increases the chance of a return to alcohol abuse in a recovering person. Bipolar disorder is 6 times more likely in alcoholics. Alcohol is know to be highly dysregulating to the sleep cycle, typically fragmenting sleep and disrupting sleep stages. Sleep of course is a critical factor in many brain and body functions, one of which is emotional equilibration. Chronic sleep disruption poorly impacts heart and immune function, brain health, and complex thinking skills including memory and learning which primarily happen in sleep.

Alcohol abuse not only damages the user, it damages the people in close relationship. Alcohol unleashes the aggression circuitry. A monkey or a rat is more aggressive with alcohol intake.The disinhibiting impact can lead to poor judgement or abusive behavior. Risk taking, aggressive reactivity and impulsivity may become established patterns with long term abuse. Living with a dysregulated person is dysregulating. Too often, family members learn to follow the “no speak rule”. Protestation is met with angry outbursts or punishment of one sort or another. Relationships lose the intimacy of communicative exchange and kindly collaboration of differences.

Important facets of therapeutic and medical intervention include: helping the alcoholic to consider change, accepting progress in incremental gains, exploring past successes and delineating future goals, confronting fears, and determining where in the change continuum they presently stand. A new technique, called motivational interviewing, attempts to skillfully collaborate with the part of the addictive person that is willing to change, building in small behavioral and cognitive shifts towards a clear thinking, sober life. Outlining the good points in the status quo and the negative factors related to the use of alcohol may be help to incentivize a start in the process of achieving and maintaining sobriety.

Finding ways to sooth craving and upset without alcohol is another part of an effective program design. Listing precise alternative behaviors to alcohol consumption is important, as is scheduling regular pleasant activities that don’t segue into alcohol euphoria - a momentary experience with a high price tag. Selecting pleasurable behaviors that can be openly and honestly shared with others will help to avoid the inescapable element of dishonesty that is part and parcel of alcohol addiction.

Habitual self scrutiny that examines personal identity and its social components may be helpful in moving from a habitual drinker to a nondrinker. It means a change in life habits, friends and social context. Identifying social and emotional triggers with a strategy for coping with them sans alcohol is also smart. Understanding the liabilities of alcohol abuse and the assets of a moderated lifestyle can be a step forward towards self respect. The intentional self regulation of negative emotional states is essential for a satisfying, productive life. Thinking about thinking is important for anyone, but particularly for someone who has been regularly abusing alcohol. Addictive behavior is reflexive and automatic. Moving from reactive to reflective is one of the immeasurable benefits of sobriety and thoughtful living. Increasing self control comes with a sense of personal competency and empowerment.

The best research proven treatment guidelines for alcohol addiction have been those formulated many years ago for physicians. The effectiveness of this treatment protocol seems to be in two demand characteristics. One is documented on going addiction treatment care, and the other, also an accountability factor, unending intermittent urine tests set up randomly and unannounced. An addicted physician will lose medical licensure should there be a relapse. Setting up accountability and consequences for a non-physician patient is a bit more challenging. It could involve family members, documented treatment attendance and psychotherapy, and more physician visits with blood/urine tests.

The new American health care will require more early intervention and medical treatment with psycho/social components and possible medication assist for craving and relapse. Family physicians will be trained to integrate addiction diagnosis and treatment into their practice. It is hoped that this will make treatment accessible to more Americans. Using prescription drugs to lessen craving and decrease dangerous and dysregulating detoxification, increases treatment success. Sometimes the temporary use of long acting benzodiazepines and opioid antagonists is necessary to avoid the acute physical symptoms of withdrawal.The long acting benzodiazepines help to decrease symptoms of sudden abstinence and stabilize potential central nervous system dysregulation. Opioid antagonists insure that there will be little or no reward found in drinking alcohol. While depression during alcohol withdrawal needs to be addressed, research indicates that antidepressants do not seem to help with abstinence. Recent studies have found that mood stabilizers, particularly Topiramate, promote abstinence more effectively than antidepressant medications.

While alcohol abuse is virulent in America, we do know more about how to treat it effectively. As mentioned, guidelines for intervention will be mandated in the new health care policies, and more people will have access to alcohol addiction management through their family physicians. Successful alcohol treatment and alcohol awareness is a way to teach people to integrate measured pleasure into a productive lifestyle, without the instant relaxation and momentary euphoria of substance abuse. It entails learning to establish a new lifestyle that reflects higher values, long term goals and self sovereignty.

- Dr. Linda Klaitz, Medical Psychologist


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Sleep is a complex mental process that is critical for human life. It’s importance to healthy functioning is dramatized by one simple fact-we take our conscious vigilance off-line for a significant portion of each day.  Historically, this would not have made survival sense. Recent research has clarified that sleep is absolutely necessary for brain and body restoration and homeostasis. Without sleep rats will die within 16 to 21 days. Learning and memory stops and organ systems break down. It is during sleep that the brain support cells, glia cells, help to clear metabolic waste that may build up as toxins. Sleep deprivation may prevent the brain from clearing these toxins. Over time they are thought to contribute to neurodegenerative diseases. Even short periods of sleep deprivation in humans remarkably decreases immune function, glucose metabolism, bone health, hormonal regulation, and learning and memory capacities. Sleep provides time our for body and brain reconditioning and to renew chemical energy that is available for learning and adaptation while we are awake. For complex evolutionary reasons, humans need sleep and need it regularly.
Long term learning is contingent upon night time sleep. It appears that it is necessary to suspend incoming information (in sleep) in order to effectively sift through new experience and to store and integrate the significant information into memory stockpiles-and to forget new experience that is not important.  During daytime learning new experience is stabilized into short term memory, the hippocampus, to be consolidated and integrated into long term memory cortical areas at night. 

Understanding Functions of Sleep Cycles

Brain researchers have been able to image increased activity during sleep in the very areas of the brain that have been active during the prior waking period. For instance, if you have practiced a new measure of music during the day, the pattern etched in the active neurons while practicing will be replayed during sleep. This motif will then be  embedded into long term memory and consolidated with earlier parts of the music that already exist in memory repertoire.  

Sleep occurs in 2 primary stages. It always begins in what is called nonRem (non-rapid eye movement) sleep. About every 90minutes the sleep cycle ends with the conclusion of the second stage, which is REM (rapid eye movement-dream) sleep. NonRem sleep is longer and more intense earlier in the night with REM sleep phases increasing as the night progresses. NonRem sleep is more robust if we have been awake for a long period of time. And remember, it reflects the reactivation of the very cellular connections established while learning new information during the prior waking period.

NonREM Sleep Functions

NonREM  sleep is now thought to be a phase during which nonessential information is erased, freeing up synapses so that future connections may be available to store information that is of greater significance for recollection. As mentioned this nonREM sleep phase enhances and stabilizes important information acquired during the previous awake period. It facilitates the etching of newly imprinted cellular connections, representing recently learned experience, into long-term cellular pathways in the cortical memory regions of the brain. The hippocampus is the fast learning, temporary memory repository. But there is parallel learning occurring in the cortex during initial encounters with new experience also.  The cortex, in contrast to the hippocampus, is a slower, long term memory reservoir. The fast learning system, the hippocampus, is thought to mentor the slower learning cortex during nonREM sleep, priming only the newly etched pathways that are worthy of recollection. 

NonRem sleep also has a crucial chemical restoration function. While other body parts can use protein and fats for fuel, the brain only uses carbohydrates. It is our body’s most energy intense system, using up about thirty percent of daily fuel. When adenosine triphosphate (ATP), our primary energy transporter molecule in the blood, is depleted with activity in the brain during the day, glia cells step in to support the immediate brain energy needs. These support glia cells relinquish chemicals that are converted to ATP, rapidly making more energy available to the brain. 

As energy is utilized in ATP, a byproduct adenosine builds up. One of the functions of this chemical is to influence the area of the brain that controls a “sleep switch” releasing an inhibitory system, to induce sleep. While sleeping, adenosine levels fall and the level of ATP, our energy delivery molecule, rises. As we begin to understand the important role of adenosine in sleep regulation, we may find ourselves questioning the excessive use of caffeine, an adenosine inhibitor. Caffeine can build up during the day and block the incredibly significant adenosine regulation of our sleep cycle and related restoration and memory storage processes.

REM Sleep-Dreaming for Integration and Insight

REM sleep periods increase as the sleep night progresses. The final approximately 90 minute sleep cycle in an 8 hour nighttime rest is dominated by REM sleep. It is REM sleep that promotes integration and insight capabilities. It is believed that REM sleep assimilates newly coded information into already existing memory stores. Memory in sleep is a two step operation involving the differing functions of nonREM and REM sleep cycles. Because the brain is unconscious during sleep, not taking in new sensory experience, there is no interference with new information coming into sensory systems that may alter what is being integrated into existing memory. Importantly, insight and creativity are part and parcel of REM sleep. 

Sleep Disruption

Sleep is a continuum of brain states. Darkness is sleep inducing. Melatonin, a sleep promoting neurochemical, increases in the dark. Light activates wakefulness. We seem to be wired for daytime, light/activity and nighttime, dark/rest. Insomnia is often  caused by a number of dysregulated living patterns, some of them disrupting circadian rhythms. For instance, it only takes a few pulses of bright light at night to put the brain back into alert mode. This is one reason sleep professionals are suggesting that electronic devices are put away well before bedtime. It seems that regular wake/light, sleep/dark and even regular feeding habits are significant for good sleep. The brain needs to have a period of quiet, low light time to cycle effectively into sleep states.  Agitation during the day impacts the brain’s ability to segue into restful sleep at night. 

Loss of sleep can be physically, emotionally and cognitively debilitating. Sleep experts tell us that adults need 7 to 8 hours nightly, teens 8 to 9, and children 10 to 11 hours. Countless studies have tested sleep deprived people and animals, finding that they do not retain learned information and that intellectual ability, reaction time, emotional equilibrium, and physical and immune system restoration have been dramatically dissipated. Sleep loss is cumulative such that immune functions and reaction times may take many nights to recover, even from a single night’s sleep loss. One may use caffeine to function during several nights of shortened sleep, but sleep debt is cumulative with small sleep debts accruing into large ones that you may have to pay back- or pay an immune system, body/reaction, cognitive/memory price. 

Sleep loss is strongly associated with depression and anxiety. Almost all psychiatric disorders are exacerbated by poor sleep. Sleep cycle synchrony is disturbed in emotional dysregulation. For instance there is early REM onset in depressed patients. Fifty percent of schizophrenic patients have very little deep, nonREM sleep.

Many disease symptoms appear within the day/night rhythms. The incidence of heart attack peaks at around nine in the morning. Seizures most often occur late afternoon, early evening. Disruption of sleep/wake cycles decreases survival for many disease states notoriously including dementia. 

Recently many surgeons have begun to urge patients to “load up” on sleep before surgery. It has been demonstrated that post-surgery pain is decreased by pre-surgery sleep. Your immune function will also benefit from the pre-surgery sleep. Chronic pain often disrupts sleep, but sleep helps to decrease pain levels. 

One recent government study reported that one in twenty drivers recalled nodding off while driving in the past year. Millions of Americans are sleep deprived on a regular basis.  Many studies of medical students have shown that there is a sharp increase of patient related errors with sleep deprivation. Some 50 percent of all big truck accidents are related to sleep loss. People are poor judges of when they are too exhausted to drive or do other important, risky tasks.

Assessing Sleep Aids

Antidepressant medications, all of them, profoundly decrease nonREM sleep. Don’t forget, this is the stage where the significant newly acquired information is stabilized into memory. Antidepressants target and increase the very neurochemicals that activate us in the waking day. The activation of (monoamine) chemicals is dramatically decreased during sleep, especially in nonREM sleep. When they are elevated by antidepressants, it is more difficult for sleep restoration and normal sleep cycles to occur. Regular good sleep is necessary for the successful treatment of depression. Adequate sleep boosts the impact of cognitive behavioral therapy and antidepressant medication (even though this medication itself disrupts sleep stages-an unfortunate oxymoron). Benzodiazepines, Valium/Xanax type medications, and alcohol tend to disrupt REM cycles. 

Several studies have sounded the alarm that there may be increased mortality with the chronic use of sleep medications.  This does not mean that there is not an important place for antidepressant and sleep medications. It does mean that we must use them judiciously, working quickly to re-stabilize sleep/wake living patterns, and  to discontinue sleep promoting agents as soon as possible. 

Children and Sleep

A child’s brain at birth does not have fully developed stages of sleep. In fact, a baby’s first sleep patterns appear almost random. It typically takes about three months for a  baby’s sleep to be entrained to light/dark, day/night, sleep cycles. A baby needs time for development and routine daylight exposure along with dark sleep experience, and regular feeding schedules to establish good sleep patterns. Interestingly, the involvement of the father seems to facilitate sleep in very young children. But, it is several years of brain development and predictable, routine nurturing before a baby evolves into adult sleep patterns. 

The younger the child, the more difficult loss of sleep becomes. Persistent sleep deprivation during the critical years of childhood development renders lasting changes in the child’s brain organization. Even missing one nap for a toddler is very disruptive. The pressure for homeostatic body restoration and the mnemonic integration of new experience is intense during childhood. For children, learning during this critical early developmental life phase, establishes patterns of living that are essential for future survival and adaptation.  Almost always after sleep loss, a child will go to sleep faster and sleep longer in the next sleep session. Adolescents, who typically have a period of sleep phase delay, i.e. want to stay up later and sleep in later, are easily dysregulated also. Like all of us, their homeostatic restoration of cognition and emotional reactivity is disrupted without adequate sleep. 

Sleep for Success

Sleep makes us smarter. If you intensely study something new, your recall will be much better after a night’s sleep. A nap shortly after a period of learning will immediately increase recollection and will boost your ability to remember after the following night’s rest. Sometimes it takes several nights or longer for newly learned information to be fully integrated into the facile recollection of long term memory. 

Routine nightly sleep seems to be brain enhancing. Sleep is impacted by many factors, but good sleep habits that are established patterns of daily living promote health, well-being, intelligence and creativity. Routine morning light exposure, exercise, careful life modulation, avoidance of emotional rumination, positive social support and a generally peaceful, quiet lifestyle promote sleep. A prominent sleep researcher has pointed out that health involves 3 main factors: nutrition, physical fitness and sleep. Our understanding of sleep activity is far from complete, but gaining clarity leaves us deeply inspired with its significance and complexity. 

Dr. Linda Klaitz, Medical Psychologist


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The rhythms of life are etched into the molecular chemistry of our bodies reflecting the night/day, dark/light cycles of galactic patterns in our solar system. Life on earth depends upon the circular orbit, the tilt of the moon, our gravity inducing molten core, Saturn and Jupiter’s asteroid absorbing presence, and many other interdependent factors that interface in precise and mutually stabilizing patterns of behavior. There is also a natural somatic rhythmicity that synchronizes life functions including: sleep/wake, movement/rest, internal body temperature, feeding, excretion, the rise and fall of hormones and neurohormones. Daytime activity and light promote movement and cognition that utilize energy stores that are replenished at night. Peaceful feet on the ground living, involves universal rules that demand balance and synchronicity within our life environment.

A cluster of brain neurons on each side of our optic nerves is referred to as the master circadian switch. It is here that signals of light/dark, cold/warm are garnered from our sensory cells , particularly our eyes, entraining genetically programmed rhythms of wake/sleep with our day/night experience. This master circadian switch registers environmental changes in light/dark, and temperature and in response it establishes the cyclical temporal architecture of the body from cell, to tissue, to system, to behavior.

Sleep/Wake Entanglement

There are multifaceted awake systems and sleep systems that interface and cycle one to the other. There are activating neurotransmitters that are elevated and dominate during waking. Each does something different, but like an orchestra they are in balance and accord with one another. Orexin is a primary neurochemical promoting wakefulness. It stimulates the other activating neurotransmitters systems, including histamine (remember antihistamines make you sleepy), and the very important monoamines. Cortisol, your primary stress hormone, is another critical player in the awake body. Cortisol levels peak in the morning and fall to sometimes imperceptible levels in the evening, slowly rising and reaching its apogee again the following morning. It acts as a messenger helping to coordinate the clock systems in our cells, tissues, and body with the master circadian switch that is registering changes in our outside world.

Sleeping and waking represent a continuum. They are the yin and yang of each other. Balance and progression seem to be key in understanding these states of living. It is not likely that a stressed, agitated day will lead to a restful night. Having a peaceful, productive, active, and light filled day will greatly increase the chance of restful and restorative sleep. Activity and daylight are intimately tied to good sleep. Waking performance depends upon the cycling sleep/wake system which is regulated by two primary driving forces: the homeostatic pressure of active time awake and circadian light/dark experience. The brain is particularly sensitive to sleep energy restoration need. Unlike other body systems, the brain only uses carbohydrates as energy. Its energy resources are in the blood circulation and a small supply that is stored in the glia support cells. The electroencephalogram (EEG), a graph representing the cyclic stages of electrical brain activity, indicates that the incidence of slow waves on a sleep EEG graph is clearly related to the previous time awake reflecting the expenditure of energy during daytime activity and the related homeostatic need for sleep restoration. As we are cognitively and physically active, cells discharge in our bodies. As cellular energy stores are used during daytime activity, a chemical metabolite called adenosine builds up, and, along with circadian light/dark experience, promotes sleep at night.

The detachment between our routine patterns of living and our earth’s day/night cycle can disrupt the intricate synchrony of external and genetically driven internal rhythms that promote balanced body chemistry, restful sleep, energy restoration, and a Goldilocks feeling day. Caffeine is an adenosine antagonist. Too much caffeine can interfere with the natural build of of homeostatic sleep pressure. It is disturbing that the daily routines of many workers, including health professionals, necessitate spending days in buildings without windows, sometimes in job positions with very little movement. Remember that most of mankind has lived as foragers, walking, gathering and hunting outside. Their movement and sleep were dictated to a great extent by the day/night cycles in our earth. There are many good aspects of our technologically developed civilization, but it is clear that it may take a more complex effort to synchronize daily life habits with our outside environment.

Light/Dark Liaison 

Light and darkness are profoundly tied to a balanced cycle of living and well being. We sleep better during the night if we have had bright light during the day. Our brain tends to be more activated in bright light, even artificial light. Light impacts cognition and endocrine systems. Artificial light at night has vastly increased across the world. We have only to google a night time earth map view to see how expansive it has become. Nearly half of our genes are turned on and off through circadian signals related to our master clock system registering the light/dark experience in our environment.

Melatonin rises in the dark and falls during the day. Melatonin decreases body temperature which is an important factor in sleep promotion. It cools the sleeping body, and its decline in the day increases the temperature in the awake body. Chronically high nighttime body temperature may increase the incidence of insomnia and the frequency of headaches, while sleep deprivation lowers daytime body temperature. Melatonin is high in hibernating animals, and also decreases estrogen and testosterone.  Alcohol decreases melatonin. Melatonin can also be negatively impacted by just 5 or six flashes of blue light-our cell phones, i-pads, and computers. The blue light can delay the onset of melatonin in the evening, leaving us awake until later. Flashes of bright/blue light can even decrease melatonin dramatically throughout the night, interrupting the important body sleep/wake synchrony with night/day cycles of dark and light. 

The Restorative Synchrony of Sleep

Sleep study EEG graphs reflect a harmonic progression of events happening in the sleeping body at night, including brain waves that appear to represent the revitalizing processes of different body/brain systems. The graph depicts the rhythmic interface of body and brain systems in clearly delineated patterns and cycles. The complexity of energy restoration and body repair in sleep is astonishing. The 2 main stages of sleep cycles alternate at about 90-minute intervals. Non-rapid eye movement (NREM) sleep tends to dominate early night sleep and reflects remarkably decreased brain and body activity, but the body can move. Rapid eye movement (REM) sleep progressively increases though out the night and reflects a seemingly awake brain in a paralyzed body. 

A recent bevy of interest has been focused on one small cyclic portion of the sleep state graph, periodic episodes of “spindles” occurring early in the night’s sleep (seen on an EEG computer graph as elevations in a slow waves). Spindles seem to appear in coordination with other slight elevations on the sleep graphs (referred to as K-complexes). These are related to maintaining sleep by preventing sensory information in the sleeping environment to reach consciousness, unless it is very strong or threatening. These graph elevations seem to also personify neuronal mechanisms that allow a window of awareness during sleep to monitor threat. 

Spindles originate in the thalamus, a part of the brain that is a bit of a way station directing and coordinating information and function. Spindles may reflect the thalamus telling the cortex to stay off line during sleep. The signal is sent from the thalamus to the hippocampus, the short term memory holder for the day’s events, which seems to be in dialogue with the cortex,  and there important information is sorted out for storage in existing memory centers while erasing memory representations of irrelevant events. Spindle episodes may also appertain to the brain’s efforts to assimilate traumatic information that may resist integration into complex memory.

In addition, sleep graph spindles are related to the brains ability to sustain attention, and its capacity to block irrelevant sensory information while focusing on what is important for optimal adaptation. We know that schizophrenic patients have very few spindles. This decrease in the spindle related restorative brain activity of schizophrenic patients is not linked to medication but to the neurodegenerative components of the disease. People with untreated sleep apnea also have less spindle activity and have been shown to have poorer motor learning. Spindles are just one small but complex piece of the sleep graph’s representation of the cyclic intricacies of the  nighttime restoration of sleeping brain and body.

Non-REM/REM, Rhythmic Succession

REM or dream sleep increases later in the night, reaching a crescendo during the final stage of a 7 or 8 hour night. It is thought to be a period of intense memory consolidation, coding the new information from the previous day into existing memory. The integration of new knowledge seems to strive for emotional stability. Interestingly oxytocin, our body’s primary bonding hormone, increases in REM sleep. Some researchers suggest that this rise may be related to social/attachment dream content. Less REM sleep is associated with poor decision making and more risk taking.The sleep graph during REM sleep resembles brain wave activity in an awake state. However, input from the external world is blocked and movement associated with the waking brain is completely stopped. As mentioned earlier, the body is paralyzed in REM sleep. All of the activating chemicals, monoamines in particular, are greatly decreased during all sleep phases. However, the activating chemical acetylcholine which seems to be the primary chemical mechanism for the observed brain arousal during REM sleep.

Synchronistic Life Patterns

The daily rhythms of living greatly impact sleep, daytime energy, and health. Circadian sleep disruption is associated with many medical and psychiatric disorders. Our brain is encapsulated within our bodies. A healthy body most often reflects a healthy brain. Dysregulation in the sleep/wake circadian system causes weight gain, even if a regular diet is maintained. People who exercise in a regular and balanced manner, for instance walking an hour a day, tend to live longer than those who exercise routinely but in extreme. Genetics seem to also be a factor in how long, at what time and how well we sleep. Early birds and larks have a genetic/environment component, but that of course is entrained by day and night routines of activity and rest.

Too much sleep or too little sleep increases mortality. It seems that 7 or 8 hours is a more balanced amount. Sleep deprivation costs many systems and decreases lifetime health. All of the cells of our body systems are replenished and repaired in sleep, including our bones, skin, blood, and brain. Consistent sleep loss decreases health in many areas. The incidence of heart attack and dementia surge for untreated sleep apnea. Indeed, sleep makes us smarter as the systems of the brain are restored and readied for the next day’s activity. Memory is consolidated in sleep. It also decreases toxins in the brain. Estrogen seems  to help insomnia in premenopausal women, and menopause increases the incidence of apnea in women so that the rates approach that of men. Hypothyroidism heightens the occurrence of apnea, and REM sleep disorder seems to be a harbinger of Parkinson’s disease.

Many substances and illnesses may impact the symmetry of sleep and waking states including: alcohol, caffeine , corticosteroids, decongestants, Statins, stimulants, untreated sleep apnea, neurodegenerative disease, antidepressants, sleeping medications and sedatives. Studies of chronic cannabis (marijuana) users indicate that it inevitably disrupts sleep and promotes depression. Chronic marijuana users exhibit cognitive decline over time, and marijuana withdrawal includes increased sleep difficulties, nightmares, aggression, irritability, and decreased appetite. Recent studies indicate that there is an increase in mortality with the long term use of Ambien type drugs. About the same time earlier this year a strong long term study of benzodiazepines, Valium, Ativan, Klonopin type drugs has been show in increase the prevalence of dementia. These medications are quickly habituating and must be titrated slowly as we teach the body to return to cycles of waking and sleeping that are synchronized with our world environment, moving and resting, eating and sleeping in accord with the daily earth patterns of light and dark . 

Life habits of wakefulness and sleep are symphonic players in a concert of health and wellbeing promoting beautiful life motifs or discordant cacophony.


