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Sunday, 6 May 2012

Two way communication.

One of the things that came up at the closing session of ICED 2012 yesterday, was the lines of communication between those doing research, clinicians, patients and families.  How do we get a two way conversation going? There was talk of twitter and livestream and tweeting questions, which certainly worked well at the F.E.A.S.T. Conference in November.

 Yes! Not all can afford to attend  but technology allows us disseminate cutting-edge science and treatment.

So I thought I would put something out there to the researchers and see if anyone takes a bite.  I have to add that I have already tried to get Ramachandran and Lock to work on this but I suspect they think I am a bit of Mad Hatter and ignored my emails on the subject.

So let's start with this second brain trimming that goes on during adolescence.  It has long been my theory that, in some people, this brain trimming can go wrong and the wiring can get mixed up.  I have no proof, no scientific evidence but it seems to me to be logical that with all those billions of neurons in the brain, there is bound to be some faulty wiring now and again.  Sometimes this wiring can emerge as really cool stuff like Synesthesia.

Now before everyone gets riled up and says "What is normal?" and we should not all conform and that the world is a better place for people with High Functioning Aspergers, say, I am talking about "faulty" in the context of life-threatening.  I am not only talking about suicide, or starving to death, but also about harm to other people - the most extreme form being psychopathy (not psychopathology, which is entirely different).

So, we are talking about people in mental distress, adding in loss of life (either their own or someone else).  Just making that clear.

My delight on discovering this article about the subconsious, made me come up with this theory in April, 2010 (when I was definitely a first year student at this type of thing), promoting Exposure Therapy and Neuroplasticity as very important factors in recovery.

The article in the NS says that, contrary to what we have believed in the past, the subconscious (SC) actually activates milliseconds before the concious mind (C) takes over.  That is sc lights up before the c mind when taking a simple action like movement.

Therefore my theory is that the rewiring in the brain that we all talk about has taken place in the sc, hence the inability to talk rationally to ED about what is happening.  The switch that should say, at a very basic level, "hunger" has become entwined with the switch that says "fear".

Although the c is rational and understands the need to eat food, the sc has become muddled and needs to be retrained ie neuroplasticity needs to take place to regrow the "hunger" neurons, or to disentangle them from the "fear" neurons.  The problem is that the sc is more difficult to treat than the c.

Hence Pavlov's dogs.

Why the Maudsley method works so well, IMO, is that the sc eventually realises it is being rewarded for eating and that something is wrong with the "fear" switch and it needs to be rerouted.  Constant repetition like learning your times tables.

Any thoughts on just how mad I am?


  1. Maybe why my contract has worked so well, hey...

  2. In terms of the Maudsley Method... I think that when it does work (and it doesn't always work...), the reason why it works is because the person with AN becomes de-sensitised to the anxiety associated with eating. The person also begins to realise that what they really feared doesn't actually happen. I think FBT works like exposure therapy.

    In terms of brain development and mental illness, autism or deviant behaviour: there is a lot of research suggesting that the brain does develop 'unusually' in people with some mental illnesses, autism and (e.g.) psychopathic behaviours. But in all such cases the cause of the unusual brain development arises from a mix of genetic and environmental factors - with the latter switching on or off various genes (epigenetics).

    You are right that there isn't such a things 'normal'. The term 'normal' is derived from statistics and population measures, where normal relates to deviation from a mean score. Human characteristics in a sufficiently large population are normally distributed; i.e. they fit to a bell shaped curve, with 67% of people lying within 1 standard deviation either side from the mean score for any given characteristic. When we talk about what is normal behaviour, we are referring to what is healthy and what society as a whole deems acceptable; i.e. does the person's behaviour cause distress/harm to themselves or to those around them?

  3. Agree that FBT could work like exposure therapy and wish that had been explained when we tried it - but then again that was so many moons ago that they almost undoubtedly didn't know.

    It's interesting about changing people who aren't "normal" - it does beg the question as to how much other people can expect or encourage change in those who find it difficult - or it does to me anyway!

  4. "Therefore my theory is that the rewiring in the brain that we all talk about has taken place in the sc..."

    Hmm, this is very interesting framing. I have been used to thinking of these things differently.

    Neuroplasticity is the ability of the brain to reconfigure itself through arboriazation. Arborization is stimulated at the electrochemical level - based on the stimulation that brain cells are getting from exogenous (outside the body) and endogenous (inside the body) sources. IOW, to use computer analogies, NP is a feature of our brain's HARDWARE.

    Our conscious and subconscious are more like software. Our conscious tends to work like a serial processor - keeps everything linear, prioritized, categorized. Our subconscious is more like a parallel processor: it's doing a ton of things simultaneously, on all kinds of levels, and yet is does not discriminate between those functions in a linear or hierarchical fashion. The conscious decides; the subconscious does what it does and wants what it wants.

    STRUCTURALLY speaking, it's certain that lots of process happen more in the cerebrum (thinking brain, if you will) vs. "lizard brain" - the older parts of our CNS like the cerebellum and mesencephalon. Or happen more in right hemisphere vs left hemisphere structures. However, humans use all parts of their brains for both conscious and subconscious processes.

    There is actually every reason to think that you are spot on about periods of increased arborization being also periods of vulnerability to 'brain damage'. I seriously doubt any developmental neurologist could take issue with this. This increased vulnerability at key areas of neurological development is one of the central discoveries of Behavioral Teratology
    ( Recently, the idea that principles of BT apply to later stages of brain development, has received more attention:

    Orthagonal to C/SC is the concept of autonomous/voluntary neurology. "Pavlov's Dogs" are an example of conditioned responses, that largely happen within the autonomous nervous system. However in humans, because of the C/SC, conscious processes can be recruited in autonomous nervous system processes. As a for instance: Panic Attacks. So, we all can experience a "fight or flight" response gone amok - tachycardia, arrythmia, shortness of breath. It feels very scary. BUT, for someone with high anxiety/low distress tolerance, this experience is nearly overwhelming. SC - they associate the attack with the circumstances in which it happened- eg. elevator. Their conscious mind perseverates on the sensations of the panic attack, and begins to "worry" about having another one when an (eg) elevator ride is anticipated, well before an elevator happens. Violla - full blown elevator phobia. Treatment: teach physical skills that dampen autonomous responses like deep nose breathing (releases CO2 from blood, physiologically "calming" fight-or-flight processes); teach cognitive skills that interupt perseveration; teach behavioral responses like confronting elevators until the PA is no longer experienced or is no longer experienced as traumatic.

    Long story short MM, and other treatment paradigms that support exposure and attack ED across neurological processes work because they are treating abnormalities on all axes of brain function: hardware, software, autonomic and voluntary, concious and subconcious.

  5. Jeezzzz Irish, you are so clever. OK, another theory for you.

    Watching Ramachandran talk about synathesia, he contended that the two areas of the brain that govern language and colour are very close to one another. Hence it would only take one or two neurons to fizz their electricity to the wrong receptor for someone to develop synathesia.

    How about the two areas of the brain that deal with "flight or fight" and "hunger" are pretty close to one another and it would only take one or two neurons to fizz to the wrong area in the case of anorexia?

    This would also explain why the reaction to food and why it can become a "default" pathway, in times of stress?

  6. Well, *physical* proximity in the brain =/= "connected". It's whether the areas share pathways. The occipital lobe where color is processed is not really "close to" temporal lobe structures in a meaningful way vis a vie a cross-wiring theory. Caveat: I aint no neurologist, and these files are DUSTY MANG! My google-fu pulls up from wiki confirmation that neurons from visual areas DO ennervate temporal lobe structures, just not in the same areas or using the same pathways as the language areas.

    So, withuot going too far down this tangent, I'll just say I remain unconvinced that synesthesia is a cross-wiring problem, or that hardware "crosswiring" of hnger & fear in the lizard brain is what's going on with AN. Brain growth in terms of the processes we're interested in right now is primarily in the cerebrum. Specifically ithe pre-frontal cortex.

    To me the key thing is that in essence, AN is not different from other OCD spectrum phenomena. EXCEPT that where needing to avoid public bathrooms is inconvenient and compulsive hand-washing damaging but survivable, avoiding food and compulsive purging are deadly. I'm not ruling out that cerebellar abnormalities are not in play; I'm just thinking that the KEY deficits are in frontal and prefrontal cortext structures.

    1. Just to clarify: my comment on OCD vs AN(OCD) is not meant in any way to minimize the experience of living with such a condition. I just wanted to highlight that the consequences of AN-related obsessions and compulsions are life-threatening in a way that most other OCD syndromes are not.