If I End Up With Alzheimer’s…….

When we baby boomers get together, I find that the conversation often migrates over to talk consistent with our age and stage in life.  Our bodies are no longer taken for granted, as they are with my daughter and other young people we are blessed to know (all in their 20’s and 30’s).  High on the list of topics is the frightening specter of Alzheimer’s, which can slowly rob us of our identity.  No other organ can fail and strip us of our sense of self like our Sandy.Bembrains.  In a brilliantly written, deeply felt and penetrating piece in the 5/17/15 New York Times Magazine, Robin Marantz Henig tracks the degeneration of Sandy Bem, a woman of unfathomable life force who was diagnosed at the age of 65.   Upon presentation with the unalterable diag – and prog-nosis, she made the decision that when she had deteriorated to the point of being completely dependent and unable to “be myself,” she would voluntarily end her own life.

I cannot count the times I have heard friends and comrades in my generation utter with complete assurance that if they were diagnosed with a degenerative dementia, they would choose to end their lives before they reached a certain point of cognitive deterioration.  I have known people in my parents’ generation who said the same thing, and who invariably failed to do so.  Such a statement is like the thoughts that ease the pain of depression – “I could kill myself.”  Yet such thoughts, which promise relief from the pounding, dominating inner pain, are not, in themselves, a plan to suicide.  Similar is the, “If I get Alzheimer’s, I’ll…..” statement.  Sandy Bem, however, followed through in a thoughtful and very focused manner.  The story is one of fortitude, grief, and devotion.

I have never rSandy.Bem.2ead, in so short a space, a clearer portrait of the unrelenting loss of person-hood.  As her time for action on her commitment approached, her husband (from whom she had been separated, but never divorced) was her constant companion.  Her adult daughter resisted the decision and wanted one more year – one more month – whatever she could get – for her mother to spend time with her baby.  I have a good friend, Don Desonier, who has transitioned from a family lawyer and mediator to a caregiver/coach and family mediator for families struggling with this dark and painful challenge.  He was a long-time caregiver for his wife, Nancy, who died two years ago after her losing battle with dementia.

There are many changes that our society will experience in the coming decades.  My daughter’s whip-smart boyfriend said over dinner this weekend that the political landscape will be completely different in 20 years.  As we have come to accept – actually embrace – same sex unions, I believe we will accept – even embrace – conscious dying, as we struggle as a culture to address the new challenges wrought by longevity and medicine’s maintenance of the physical body.  The New York Times essay, together with the most affecting piece I have ever read  (in which Katy Butler describes the mental deterioration of her brilliant father who had been a professor at Wesleyan University) are but two of a growing number of personal reflections which wrestle with one of the great personal, familial and cultural challenges of our age.

Attachment as a Hardwired Emotion (Part 3)

neurons.3The seventh basic emotion circuit that was found by Jaak Panksepp (see prior posts) is what he, unfortunately, calls the “panic” circuit.  He calls it that because of the panicked reaction of young animals who are separated from their mothers.  I prefer to call it by its more appropriate and descriptive name, the Attachment Circuit.   Panksepp describes the distressed cries of animals – identical to the distressed cries of separated young, which are evoked by the stimulation of a particular neuronal circuit in the brain.  The distress is caused by separation.  The resolution of the distress is caused by reunification.  Panksepp’s work confirms what has been argued by attachment therapists like Dr. Sue Johnson – the co-developer of Emotionally Focused Therapy.  We have a deep and biologically determined need for connection.  When that connection is threatened, we become distressed and anxious.  When we become distressed and anxious, we are inclined to react automatically.  This is the painful dance that we see in the distressing cycle we almost always observe with couples who are in conflict.  Brent Atkinson, a marital therapist and author, has created an entire approach to couples therapy based on Panksepp’s  work.  Atkinson repeats that individuals are overtaken by the intensity of their emotional reactivity.  This is precisely the same kind of description that Sue Johnson uses to describe how a couple is overtaken by the force of their cycle.  Imagine, when both people’s brain circuits are firing so fast and strong that they are swept up into the maelstrom, seemingly without any control – at least not until they are helped to s….l….o…..w it down and realize when they, themselves, are being overtaken by these strong, automatic, emotional discharges in the brain.  The belief of emotionally focused therapists is that once we are able to slow it down and gain awareness of our process, we can create safety for ourselves and our partner.  That’s at least what goes on in my office, anyway.

Emotions That Are “Hardwired” (Part 2)

neurons.2Research neuroscientist, Jaak Panksepp, has been studying the anatomical basis of emotions for many years.  It has been a challenging task for many reasons.  For one, the scientific community has not been in agreement as to what comprises an “emotion” – whether they exist at all and, if so, how to describe them.  Another question is raised by those who claim (passionately I might add) that emotions are environmental and not inherently physiological.   This is not what Panksepp has found.  In fact, he has been able to identify 7 different brain circuits which correspond with discrete emotional responses.  Further, he provides us with extremely reasonable ideas about the evolutionary basis for the development of each of these emotional circuits.  While he freely concedes that there may be more to be discovered in the future, those which he identifies at this stage are:

  1. Seeking: This is the drive to explore the world – to gain stimulation and sustenance from the environment.  Interestingly the nerves’ receptors for the neurotransmitter which is most associated with this behavior (dopamine) are severely compromised or destroyed by the use of drugs such as cocaine, which explains the incredible lethargy after prolonged use and the need to keep snorting or smoking in order to maintain a baseline of alertness.
  2. Rage: Panksepp found that anger is a primary emotional experience, as it is put into service when the animal is being constrained.  It is a natural reaction to the experience of being cornered and, indeed, his representative picture is of the hissing cat backed into a corner.   This is different from the anger we often describe as our reaction when a lover hurts our feelings or betrays us.  The difference is interesting and worth further thought and discussion.
  3. Fear: This is a basic self-protective mechanism.  Our brain is programmed to protect us and get us the heck outta there when we are faced with threats to our existence.  It’s the old “our ancestors split when they saw a saber-tooth tiger roaming close-by.”  What Panksepp also observed, interestingly, was that when this circuit was chronically and continually activated, the organism lapsed into a state of anxiety – which, then can be defined as the low level, continuous expression of the fear circuit.
  4. Nurturance:  This is the classic maternal care circuit.  When it is stimulated, the body produces a load of oxytocin, which has been called “the cuddle hormone.”  It is also true that this circuit is activated, and we are bathed in oxytocin, when we are feeling close and loving to a partner.  The evolutionary basis for survival of the species is pretty self evident, here.
  5. Rough and Tumble Play:  Panksepp observed the animals in his lab spontaneously engaging in such play.  It is the expression of a physiological need to experience joy.  He associates human laughter to the activation of this circuit.  The evolutionary value of the play circuit is more speculative, but Panksepp suggests that it may facilitate basic socialization.
  6. Lust:  The drive to seek out and find a mate is perhaps the most fundamental evolutionary imperative.  Panksepp describes many, many courting rituals and other behaviors which are reflective of the stimulation of this circuit.

Panksepp has been able to generate these emotional responses, from rage to fear to sexuality, by stimulating discrete parts of the brain with mini-electrodes.  This would seem to add proof to his theories.   The seventh and final hardwired emotion really forms the basis of the couples therapy I do and I will leave that discussion to the next post.

What it Means to Have Something “Hardwired” (Part 1)

neurons.1 Listen to psychologists talk and you will often hear about how some behavior or attitude is “hardwired.”  It’s a pretty descriptive term – particularly since the brain is an organ characterized by electrical circuits.  For another example, just consider the most popular adage among neuroscientists over the past dozen years or so, “Neurons that fire together, wire together.”  It suggests a certain immutable permanence in ways we think or act.  Consider all the incredible identical twin studies in which they are separated at birth and meet decades later to find that they are wearing the same color, are married to women with the same name, pursue the same career and have named their children identically.  One great example involves two brothers reunited after 39 years.  Each was incredibly fastidious and detailed – compulsively neat and orderly in every respect.  They were both completely convinced that their character was a function of nurture rather than nature.  The first was asked why he was like that and he replied, “My mother is the reason!  She was exactly the same way and I was raised to be compulsively neat.”  The other replied, “My mother is the reason!  She was so disorganized and such a slob that I had to be this way just to survive.”

Among the researchers who have been studying the brain’s inherent (“hardwired”) character is a man named Jaak Panksepp.  His work with animals is incredible.  One fascinating observation he shares in his book Affective Neuroscience – The Foundations of Human and Animal Emotions involves the problem they had with rats who were very distressed and active after their cages were cleaned by a certain lab tech.  After some investigation, they found that the tech had housecats and some of the dander was carried with him to the lab.  What is fascinating is that these rats were born and bred in the lab.  They had never seen a cat in their lives….nor had their parents or grandparents.  They had been separated from actual exposure to a natural predator  by many generations.  Still, they reacted strongly to the scent of the cat.  That’s one great example of being “hardwired.”  What is even more important for us, is that Panksepp has found that certain emotions are hardwired into our brains.  This will be the subject of a later post.

The Brain’s Emotional Circuits

Lots has been written in the past 20 years about the brain and how its wiring directly impacts our emotional states.  One writer pointedly drew the distinction between the “mind” and the “brain” – that collection of billions of neurons, each with numerous axons that connect with others to create networks.  These networks are the pathways for our thougths and mental associations, as well as our most gripping emotions – Rage, Fear, Lust, Sexual Lust, Connection with Others, Seeking (exploring the environment for its rewards….basic aliveness and vitality).  Neuroscientist Jaak Panksepp has identified the specific neural networks where these feelings track.  Scientists for years have been able to experimentally stimulate areas of the brain and produce angry, fearful, lustful, exploring and anxious behavior.  Substantial evidence exists for the notion that chronic feeings of irritation or anxiety, for example, are actually reflections of a low-grade, constant activation of these neural networks.  This is perhaps, why neurofeedback therapy has been clinically found to ease these distressing states.