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Using Imaging to Look at Changes in the Brain

Dr. Nancy C. Andreasen concentrates on the big questions. A neuroscientist and psychiatrist at the University of Iowa, she uses M.R.I. to ask questions like: How do the nervous systems of extremely creative people differ from those of the rest of us? How is the brain physiology of the mentally ill different from that of normal people? For nearly two decades, she has been conducting a study that tracks long-term changes in the brain. We spoke this summer when she visited New York City. An edited version of a three-hour conversation follows:

Q. HOW DID YOU BECOME A PSYCHIATRIST?

A. I was an English professor in the early 1960s. I’d done a book on John Donne. Then, in 1964, I gave birth to my first child and nearly died from a postpartum infection — the very thing that had killed millions of birthing women in the centuries before antibiotics. As I recovered, I realized I had been given back my life, and that caused me to rethink everything in it. I decided to quit literature studies and go back to school to become a doctor.

From the outset, I knew I wanted to do research and patient care. Because I relish complexity, I chose psychiatry — it’s more complicated than neurology. And I chose brain research because the brain is the most complicated organ in the body. I wanted to do something as important as the discovery of penicillin, the thing that had saved me.

Q. YOU PIONEERED THE USE OF IMAGING TECHNOLOGY FOR LEARNING ABOUT THE PHYSIOLOGY OF THE BRAIN. HOW DID THE IDEA OF USING CAT SCANS AND M.R.I.’S AS A RESEARCH TOOL COME TO YOU?

A. My first patient was a schizophrenic. After working with him, I wanted to understand how this terrible disease developed, how to stop it and to find better treatments. Right away, I began searching for new tests to assay brain activities. With the technology we had at that time, you couldn’t see brain differences easily. A lot of our information came from autopsies done on patients, but that was of limited use because you had nothing to compare it to.

But then, in the early 1970s, CT scans came along. They got pictures of the inside of a living patient’s brain. I recognized the potential immediately. The problem was convincing my colleagues. CT scans involved exposing patients to radiation. When I went to the human experimentation committee at my medical school, they went, “We don’t want you subjecting patients to radiation. Besides, you’re not going to find anything that way, anyway.” It took a long time to convince them.

Q. TODAY, IMAGING STUDIES ARE ONE OF THE MAINSTAYS OF NEUROSCIENCE. WHEN DID ATTITUDES CHANGE?

A. In the early 1980s, when magnetic resonance imaging came on line. M.R.I.’s did not expose patients to radiation, and you could see brain structures in exquisite detail. I decided to use it for a longitudinal study of brain changes over a long period of time. We’re asking: Is schizophrenia a neurodegenerative disease like Alzheimer’s?

In 1989, I began to collect subjects — some with schizophrenia and some not — and began taking pictures of their brains. With the schizophrenics, we began seeing them at the first onset of their disease, which is usually at around age 24. We recruited about 538 people with schizophrenia. Eighteen years later, we’re still following 305.

Q. AND WHAT HAVE YOU FOUND?

A. I haven’t published this yet. But I have spoken about it in public lectures. The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.

Q. WHY DO YOU THINK THIS IS HAPPENING?

A. Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.

If I were developing new drugs, I’d switch targets. Till now it’s been chemically formulated targets. I believe we should be thinking more anatomically and asking, “With schizophrenics, which brain regions are functioning abnormally?”

Q. ARE YOU WORRIED YOUR FINDINGS MIGHT BE MISUSED?

A. The reason I sat on these findings for a couple of years was that I just wanted to be absolutely sure it was true. My biggest fear is that people who need the drugs will stop taking them.

Q. WHAT ARE THE POLICY IMPLICATIONS OF THIS FINDING?

A. Implication 1: that these drugs have to be used at the lowest possible dose, which often doesn’t happen now. There’s huge economic pressure to medicate patients very rapidly and to get them out of the hospital right away. Implication 2: we need to find other drugs that work on other systems and parts of the brain. Implication 3: whatever medications we use need to be combined with more nonmedication-oriented treatments, like cognitive or social therapies.

Q. IN YOUR LONGITUDINAL STUDY, ARE YOU ALSO LOOKING AT HOW THE NORMAL BRAIN AGES?

A. Yes. I’ve been asking, “At what point is human brain maturation complete and at what point do our brains naturally decline and lose tissue?” The answer is: the human brain continues to mature till about 25. At about 25, it plateaus for about 20 years, and at about 45, we start to lose brain tissue.

But it’s interesting: we lose brain tissue, but we don’t necessarily lose cognitive capacities. A lot of people at 50, 60, 70 or 80 are quite sharp. I can quantify their brain tissue and see they’ve lost quite a bit from what would be normal for a 45-year-old, but their cognitive abilities are not at all impaired.

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Web Link

Age-Related Changes in Midbrain Dopaminergic Regulation of the Human Reward System (PNAS)

Behavior: As People Age, the Thrill Is (Almost) Gone

Fantastic Seashells

From the book I Asked for Wonder by Abraham Heschel (emphasis mine):

The search of reason ends at the shore of the known; on the immense expanse beyond it only the sense of the ineffable can glide. It alone knows the route to that which is remote from experience and understanding. Neither of them is amphibious: reason cannot go beyond the shore, and the sense of the ineffable is out of place where we measure, where we weigh.

We do not leave the shore of the known in search of adventure of suspense or because of the failure of reason to answer our questions. We sail because our mind is like a fantastic seashell, and when applying our ear to its lips we hear a perpetual murmur from the waves beyond the shore.

Citizens of two realms, we all must sustain a dual allegiance: we sense the ineffable in one realm, we name and exploit reality in another. Between the two we set up a system of references, but we can never fill the gap. They are as far and as close to each other as time and calendar, as violin and melody, as life and what lies beyond the last breath.

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HE HATES PERFUME

When my parents visited New York, I gave them a tour of my favourite scents in the shop. This took some time: the accords include clever riffs on the smell of rubber, from the intoxicating Inner Tube to a just-short-of-noxious Rubber Cement. Equally impressive is Wet Pavement, which strikes me as wearable, even pretty. Burning Leaves is startlingly alluring, and Ink smells so authentic that I held up the bottle to show my mother that the fluid was clear and not an indelible blue. Roast Beef is predictably revolting, but still a must-smell. My mother lingered over In the Library, a blend that Christopher describes as "First Edition, Russian and Moroccan Leather, Binding Cloth and a hint of Wood Polish".

My father, meanwhile, had settled into a chair next to Zephyr and had assumed the expression of a person straining to overhear some distant conversation. It is a look of intense disinterest, and I know it well. I fetched a vial labelled At the Beach 1966 and thrust it under his nose. With an upward roll of the eyes, he inhaled. Then he took the sample from my hand, sniffed again and nearly leapt to his feet: the scent had triggered a memory of summers he spent lifeguarding on Long Island as a teenager. On the CB website, Christopher describes the fragrance as "Coppertone 1967 blended with a new accord I created especially for this perfume--North Atlantic. The base of the scent contains a bit of Wet Sand, Seashell, Driftwood and just a hint of Boardwalk." If that sounds too fanciful to be true, you should smell it.

Though it may seem obvious, it bears mentioning that Christopher's perfumes are not for everyone. He doesn't use synthetic musk as a base-note because the smell repulses him, and that may disappoint some clients. And those accustomed to the intensity of commercial fragrances should also look elsewhere: all of the CB scents are suspended in a water-based formula, and with the exception of a handful that manage to be heady and persistent, they seem light-wearing.

In February the New York Times ran a story about "fragrance fatigue", reporting a recent decline in the use of perfume. It seems that people have quit perfuming themselves out of consideration for others who share their space. Personally though, I'd be thrilled if my next elevator ride offered the olfactory epiphany that is CB's Soaked Earth.

CB I Hate Perfume Gallery/Christopher Brosius Limited, 93 Wythe Avenue Williamsburg Brooklyn (Between North 10th and North 11th). Tel: +1 718-384-6890. Hours: Tues-Sat, noon-6pm.

[MoreIntelligentLife.com]

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I still can't seem to put up things I've already written re: my father's death. Too raw. The events of last week need to simmer on the back burner until a certain amount of 'bile' is removed, either by siphoning it off, or the natural process of it being removed by evaporation.

But I loved the images of the perfume gallery, and smelling the distillation of ordinary scents.

I loved also the idea of the ineffable and the real : reason 'cannot go beyond the shore.' Thus my relationship to my father is now caught up in the flotsam and jetsam left behind -- what he thought and felt or didn't think or feel. What I thought he projected onto his family, and what his actual feelings might have been. The stories he told about his past verses the parts of it that I participated in and remember. The concrete evidence of both grace and calumny presented in his children and grandchildren and great-grandchildren, all of whom probably ceased to exist for him some time ago, save as some sort of abstraction. Dr. Mck. used to say that alcoholics are the most selfish people on earth. They don't really see other people at all, all of their pity and feeling is only for themselves.

I feel as though I am walking in a barren land, across a desert without end. But the desert does and will end. I will recover my energy. And as my friend Chris says, "I will not fail this Zen test."

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VAUGHN V. 'Jim' BOWMAN

Vaughn V. Bowman born June 20, 1926 to Vaughn and Julia Fitzgerald Bowman in Kane, Pennsylvania. Vaughn, known as Jim, grew up in Kane and was educated in the local schools. He participated in many school activities including Honor Society, basketball, football, Student Council, radio club and the school newspaper.

In December of 1943, during Jim's senior year of high school he enlisted in the United States Army. Jim was assigned to the Army's engineering school at Virginia Military Institute. In June of 1944, Jim was assigned to the Infantry of the European Theater. Prior to deployment, he was re-assigned to the 41st Infantry Division (the Jungleers) to the South Pacific. Jim was part of three successful beachhead invasions at Mindanao, Jolo and the Tawi Tawi. During these beachhead actions, the 41st Division suffered a 50% casualty rate. This Division was scheduled to be the initial invasion of Japan but instead became the first of the occupying forces. For his service, Jim was awarded the Bronze Star.

After World War II, Jim returned to Kane to work at his family business, W.W. Bowman and Son Lumber Company. In 1957 Jim moved to Florida, where he founded Penn Land Company and over the next 4 years built a hundred homes in Jupiter. In 1961, Jim began his career as a State Farm Insurance Agent receiving numerous company awards including President's Club, Legion of Honor and the Millionaires Club. He retired from State Farm in 1995. Jim has been active in numerous community organizations including the Kiwanis Club for 40 years, the Elks Club, Chamber of Commerce, the American Legion serving as Post Commander and many others. Jim was one of the founding members of the First United Methodist Church of Jupiter/Tequesta where he served in many leadership roles. He directed the site selection and the construction of all phases of the church. At the time of his death, he was the President of the U.S. Army 41st Infantry Association, Southeast Region. He was also President of the 5M Company.

Vaughn 'Jim' is survived by his loving wife Bonnie and family: James (Karlyn) Bowman, Elizabeth (Peter) Scupham, Bill (Beverly) Bowman, Tom (Holly) Bowman, Bob Bowman, Dee Terry, Julie (David) Kincaid, Judi (Merdardo) Archuleta, Heather (David) Wieseneck and 19 grandchildren and three great grandchildren. Visitation will be held Friday 6-8 PM, September 12 at the Taylor & Modeen Funeral Home, 250 Center Street, Jupiter.

A Celebration of Life Service will be held Saturday, 11 AM, September 13 at the First United Methodist Church of Jupiter/Tequesta, 815 E. Indiantown Road, Jupiter, FL with the Reverend Dr. John Myers and former Pastor, the Reverend Dr. E. Wayne Speakman, officiating. A Reception will immediately follow in the Church Fellowship Hall. Private interment at Riverside Memorial Park.

In lieu of flowers, donations may be made to: First United Methodist Church of Jupiter/Tequesta, 815 East Indiantown Road, Jupiter, FL 33477 (561) 746-8117, First United Methodist Children's Home, 51 Main Street, Enterprise, FL 32725 (386) 668-4774 or The Salvation Army, P.O. Box 789, West Palm Beach, FL 33402.

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SANSKRIT WORD OF THE MONTH

SAMa (pronounced more like shahma)

In my Sanskrit dictionary (Monier-Williams) the translation of sama is tranquility, calmness,
quietude, equinimity, and rest.

I experience that this quiet arrives in meditation all by itself with no special effort.
Simply by sitting still for awhile, any agitated energy in the body, in the breath and
also in the mind, just naturally and gently subsides.

With no effort at all, except your effort to stay still, this sama reveals itself.
You find your own stillness there waiting for you, ever-present and peaceful.
This experience of tranquil peace is so sweet, that it is well worth all the efforts
you make to sit still for awhile!

I truly wish that you have some time to spend each day this fall, simply to sit in
 stillness and allow yourself to feel this inner quiet.

Peace!

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The love and affection of the angels be to you,
The love and affection of the saints be to you,
The love and affection of heaven be to you,
         To guard you and to cherish you.
May God shield you on every steep,
May Christ aid you on every path,
May Spirit fill you on every slope,
         On hill and on plain

Blessings
Carmina Gadelica Vol III p. 297

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Requiem

Robert Louis Stevenson. 1850 –1894  

UNDER the wide and starry sky 
 Dig the grave and let me lie: 
Glad did I live and gladly die, 
 And I laid me down with a will. 

This be the verse you 'grave for me:        
 Here he lies where he long'd to be; 
Home is the sailor, home from the sea, 
 And the hunter home from the hill.

Searching for the Roots of a Deep Faith

On a recent sultry summer evening, that historical event was very much on the minds of the 20 or so worshipers who watched reverently as a priest stood in front of a modern altar at one end of the small room, arranged the liturgical items he had brought with him, lighted the candles and celebrated Mass. “In the tradition of legions of pilgrims, we find ourselves doing what the early Christians did,” the Rev. Cesare Atuire said during his homily, which addressed the significance of Paul’s message in contemporary society.

Since June, similar gatherings have been taking place in churches throughout the world after Pope Benedict XVI inaugurated the jubilee year commemorating the second millennium of Paul’s birth, which historians have placed between A.D. 7 and A. D. 10.

To many present-day pilgrims, however, nothing quite compares with the experience of traveling the road to Damascus. “It’s one thing for Christians to read the Holy Scriptures, quite another to come see where things happened,” said Father Atuire, who is the chief executive officer of the Opera Romana Pellegrinaggi, or ORP, the Vatican-backed travel organization that last year took 300,000 pilgrims to religious shrines around the globe, including its home city, Rome. (This year, it expects that number to hit 400,000.)

Of course, Christians aren’t the only ones showing an interest in religion-based tourism. Participants in the Kumbh Mela, a rotating Hindu festival, have reportedly topped 75 million, and each year, some two million Muslims make a pilgrimage to Mecca, in Saudi Arabia. Nor is Damascus the only place where Christians are heading these days. Lourdes, France, which the Pope will visit in September, draws an average of six million a year (with more than eight million expected this year, officials say, to mark the 150th anniversary of the reported apparition of the Virgin Mary at the grotto), and San Giovanni Rotondo, home to the shrine of the mystic monk Padre Pio, lured eight million to Puglia, Italy, in the last year.

Father Atuire has some thoughts about the surge of believers searching for the roots of their faith. “In times of epochal change, people sense a greater need to find points of reference,” he said while a bus lurched along a Syrian highway to the town of Malula and the Convent of Sts. Sergius and Bacchus, another popular pilgrimage site and one of the few places in the world where Aramaic, the language spoken by Jesus, is still heard. “But at the same time many are looking for untraditional forms of expression and a pilgrimage allows you to approach a religious experience from a different perspective.”

Pilgrimage destinations, even unconventional ones, are recognizing the potential for growth. Syria, not exactly a top-of-mind vacation destination for Western tourists (the American administration “hasn’t always represented us in a good way,” Syria’s tourism minister, Sadallah Agha al-Qala, said in a recent interview), has been making the most of the Pauline year celebrations. “We’re trying to give importance to the jubilee,” said Mr. Agha al-Qala. Both Muslim and Christian Syrians “are proud of the role Damascus played in the history of Christianity.”

A series of events — concerts, conferences — coordinated by the country’s multiple Christian communities and the government of this most secular of Arab states kicked off the Pauline year, which runs until June 29, 2009. “It was a unique experience,” watching Christian and Muslim leaders celebrate together, “speaking the same language and sharing the same emotions,” Mr. Agha al-Qala said. Another weeklong round of events, coordinated with ORP, is scheduled to end on Jan. 25, the date given for Paul’s conversion.

Syria will also have a starring role at Josp Fest, a showcase for tour operators, agencies and organizations specializing in pilgrimages, or “journeys of the spirit,” which ORP is organizing in Rome in January. Religion-based tourism will finally get “out of the ghetto experience it has in the tourism world,” to receive “the dignity and exposure it merits,” Father Atuire said. So far, some 60 countries have agreed to participate, and the priest said he was hoping more will sign on.

Father Atuire has played no small part in broadening the scope of ORP, which was founded in 1934 to provide spiritual and logistical support to pilgrimages sponsored by Roman parishes. Until a few years ago, the Vatican organization mostly did business with parishes and groups; now individuals make up 40 percent of its trade. “I’ve been trying to transform ORP into a real Catholic universal organization in terms of geographical and spiritual outreach,” Father Atuire said, “because in times of crisis, this can be of value not only to people who go to church, but for everyone.” Prayer is central to the pilgrimage experience, and spiritual guides accompany each group to celebrate Mass and stimulate discussion. In Syria, where 225 pilgrims have visited on organization tours so far this year, groups might ponder the Crusades while climbing the battlements at the fortified castle known as Crac des Chevaliers, or the tradition of Byzantine icon painting prompted by a visit to the monastery at Seidnaya, which houses a miraculous image of the Virgin reputedly painted by St. Luke.

Then, inside the Umayyad Mosque, the eighth-century structure that houses what is believed to be the head of St. John the Baptist, conversation may turn to Christian-Muslim relations and the shared reverence for this historical figure. ORP has steadily increased its pilgrimage destinations and proposals. “There’s no corner of the globe we don’t touch,” said Father Atuire. This includes Burma, where pilgrims can visit missionary communities.

To increase access to its pilgrimage packages to shrines like Fatima in Portugal, or the Holy Land, ORP (www.josp.com) has recently brokered deals with travel service companies like Sabre Holdings, which owns travel-theme companies including Travelocity.com. (The eight-day Syria trip, with a departure from Rome, costs 1,150 euros, $1,687, at $1.50 to the euro, plus a 30 euro enrollment fee and another 100 euros for taxes and fuel surcharges.)

And last year it began its own chartered pilgrimage flight service to help contain prices and overcome the spiritual limitations of “modern-day travel, which tends to torpedo people from one place to another,” Father Atuire said. The plane’s biblically themed interior décor and specially trained flight assistants are meant to be conducive to meditation. “The journey is part of the process,” he said. “It’s important to recover the quality of time.”

Of course, Rome remains its most popular destination, and the organization is not shy about promoting its insider status. (“Afraid of queues?” asks a blurb on the ORP Web site that shows a long line of frazzled tourists snaking along the wall leading to the entrance of the Vatican museums, a common sight in Rome.) For 25 euros, which includes an audio guide — only 5 euros more than the normal admission charge with an audio guide — the organization promises an experience free of standing in line.

“It’s the least we can do,” Father Atuire said, laughing. “We are, after all, the church of Rome.”

Settle Down in the Quiet

Thomas Merton

It is useless to try to make peace with ourselves by being pleased with everything we have done. In order to settle down in the quiet of our own being we must learn to be detached from the results of our own activity. We must withdraw ourselves, to some extent, from effects that are beyond our control and be content with the good will and the work that are the quiet expression of our inner life. We must be content to live without watching ourselves live, to work without expecting an immediate reward, to love without an instantaneous satisfaction, and to exist without any special recognition.

No Man Is an Island

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"In the greatest confusion there is still an open channel to the soul. It may be difficult to find because by midlife it is overgrown, and some of the wildest thickets that surround it grow out of what we describe as our education. But the channel is always there, and it is our business to keep it open, to have access to the deepest part of ourselves-- to that part of us which is conscious of a higher consciousness, by means of which we make the final judgments and put everything together."

Saul Bellow

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"The interest of the pretender soul is the same as the interest of the social life, the society mechanism. This is the main tragedy of human life. Oh it is terrible! You are not free. Your own betrayer is inside of you and sells you out..."

"When do we get free?"

"The purpose is to keep the whole thing going. The true soul is the one that pays the price. It suffers and gets sick, and it realizes that the pretender can't be loved. Because the pretender is a lie. The true soul loves the truth. And when the true soul feels like this, it wants to kill the pretender. The love has turned into hate. Then you become dangerous. A killer. You have to kill the deceiver."

"Does this happen to everybody?"

The doctor answered simply, "Yes, to everybody.... Whenever the slayer slays, he wants to slay the soul in him which has gypped and deceived him. Who is his enemy? Him. And his lover? Also. Therefore, all suicide is murder, and all murder is suicide. It's the one and identical phenomenon. Biologically, the pretender soul takes away the energy of the true soul and makes it feeble, like a parasite. It happens unconsciously, unawaringly, in the depths of the organism. Ever take up parasitology?"

--from Seize the Day; Saul Bellow, 1956

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"To read, to write... ...the way one lives under the surveillance of the disaster: exposed to the passivity that is outside passion. The heightening of forgetfulness. It is not you who will speak; let the disaster speak in you, even if it be by your forgetfulness or silence."

--Maurice Blanchot

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"Neurologically, contemplative moments are pauses in the automatic activity of conditioned brain-cell patterns.  Psychologically,  they are transient suspensions of compulsion.  Philosophically they are "naked intuition,"  the momentary direct perception that happens before we begin to think or react.  Spiritually,  they are tastes of freedom for love ...,  the spaciousness of salvation.

Gerald G. May M.D.
The Awakened Heart

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In A Country Once Forested

The young woodland remembers
the old,  a dreamer dreaming

of an old holy book,
an old set of instructions,

and the soil under the grass
is dreaming of a young forest,

and under the pavement the soil
is dreaming of grass.

--Wendell Berry

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Seventy Years

Well,  anyhow,  I am
not going to die young.

-Wendell Berry

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Sabbaths
VI

The question before me,  not that I
am old,  is not how to be dead,
which I know from enough practice,
but how to be alive,  as these worn
hills still tell,  and some paintings
of Paul Cezanne,  and this mere
singing wren,  who thinks he's alive
forever,  this instant,  and may be.

--Wendell Berry

All Wendell Berry from  "Given"
Poems by Wendell Berry

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link

"A sage of Chelm went bathing in the lake and almost drowned. When he raised an outcry other swimmers came to his rescue. As he was helped out of the water he took a solemn oath: "I swear never to go into the water again until I learn how to swim!"
A Treasury of Jewish Folklore
edited by Nathan Ausubel

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Carrying Stones

Repentance begs for burdens.

-Michel De Montaigne

It is wisdom to find the tasks that are right for us at each moment of our journey.  They may not be the tasks we hoped we should have,  et we must simply bear them.  In Dante's Purgatorio,  the souls carry great stones around the mountain paths and Dante,  accompanying them,  bends over in sympathy.  but they hoist their loads joyfully,  are glad of burdens and tasks because burdens and tasks will transform them.  In Hell no one learns;  even the most magnificent imp just repeats himself.  At the bottom of Dante's Inferno,  the greatest demon of all is frozen in ice.  In Purgatory,  though,   there is movement,  even if slow;  and,  because there is movement,  the stars visible,  there is growth.

--John Tarrant

Cross posted to Alive on All Channels

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