He’s mad that trusts in the tameness of a wolf

I am an obstetrician, and not a neuropsychiatrist, but I feel a definite uneasiness with the idea of messing with brains –especially from the inside. Talking at it, sure –maybe even tweaking it with medications- but it seems to me there is something… sacrosanct about its boundaries. Something akin to black-boxhood -or pregnant-wombhood, if you will– where we have a knowledge of its inputs and outputs, but the internal mechanisms still too complex and interdependent to be other than interrogated from without.

I suppose I have a fear of the unintended consequences that seem to dog science like afternoon shadows -a glut of caution born of reading about well-meaning enthusiasms in my own field. And yet, although I do not even pretend to such arcane knowledge as might tempt me to meddle with the innards of a clock let alone the complexities of a head, I do watch from afar, albeit through a glass darkly. And I am troubled.

My concern bubbled to the surface with a November 2017 article from Nature that I stumbled upon: https://www.nature.com/news/ai-controlled-brain-implants-for-mood-disorders-tested-in-people-1.23031 I recognize that the report is dated, and merely scratches the surface, but it hinted at things to come. The involvement of DARPA (the Defense Advanced Research Projects Agency of the U.S. military) did little to calm my fears, either –they had apparently ‘begun preliminary trials of ‘closed-loop’ brain implants that use algorithms to detect patterns associated with mood disorders. These devices can shock the brain back to a healthy state without input from a physician.’

‘The general approach —using a brain implant to deliver electric pulses that alter neural activity— is known as deep-brain stimulation. It is used to treat movement disorders such as Parkinson’s disease, but has been less successful when tested against mood disorders… The scientists behind the DARPA-funded projects say that their work might succeed where earlier attempts failed, because they have designed their brain implants specifically to treat mental illness — and to switch on only when needed.’

And how could the device know when to switch on and off? How could it even recognize the complex neural activity in mental illnesses? Well, apparently, an ‘electrical engineer Omid Sani of the University of Southern California in Los Angeles — who is working with Chang’s team [a neuroscientist at UCSF] — showed the first map of how mood is encoded in the brain over time. He and his colleagues worked with six people with epilepsy who had implanted electrodes, tracking their brain activity and moods in detail over the course of one to three weeks. By comparing the two types of information, the researchers could create an algorithm to ‘decode’ that person’s changing moods from their brain activity. Some broad patterns emerged, particularly in brain areas that have previously been associated with mood.’

Perhaps this might be the time to wonder if ‘broad patterns’ can adequately capture the complexities of any mood, let alone a dysphoric one. Another group, this time in Boston, is taking a slightly different approach: ‘Rather than detecting a particular mood or mental illness, they want to map the brain activity associated with behaviours that are present in multiple disorders — such as difficulties with concentration and empathy.’ If anything, that sounds even broader -more unlikely to specifically hit the neural bullseye. But, I know, I know –it’s early yet. The work is just beginning… And yet, if there ever was a methodology more susceptible to causing collateral damage, and unintended, unforeseeable consequences, or one that might fall more afoul of a hospital’s ethics committee, I can’t think of it.

For example, ‘One challenge with stimulating areas of the brain associated with mood … is the possibility of overcorrecting emotions to create extreme happiness that overwhelms all other feelings. Other ethical considerations arise from the fact that the algorithms used in closed-loop stimulation can tell the researchers about the person’s mood, beyond what may be visible from behaviour or facial expressions. While researchers won’t be able to read people’s minds, “we will have access to activity that encodes their feelings,” says  Alik Widge, a neuroengineer and psychiatrist at Harvard University in Cambridge, Massachusetts, and engineering director of the MGH [Massachusetts General Hospital] team.’ Great! I assume they’ve read Orwell, for some tips.

It’s one of the great conundrums of Science, though, isn’t it? When one stretches societal orthodoxy, and approaches the edge of the reigning ethical paradigm, how should one proceed? I don’t believe merely assuming that someone else, somewhere else, and sometime else will undoubtedly forge ahead with the same knowledge, is a sufficient reason to proceed. It seems to me that in the current climate of public scientific skepticism, it would be best to tread carefully. Science succeeds best when it is funded, fêted, and understood, not obscured by clouds of suspicion or plagued by doubt -not to mention mistrust. Just look at how genetically modified foods are regarded in many countries. Or vaccinations. Or climate change…

Of course, the rewards of successful and innovative procedures are great, but so is the damage if they fail. A promise broken is more noteworthy, more disconcerting, than a promise never made.

Time for a thought experiment. Suppose I’ve advertised myself as an expert in computer hardware and you come to me with particularly vexing problem that nobody else seemed to be able to fix. You tell me there is a semi-autobiographical novel about your life that you’d been writing in your spare time for years, stored somewhere inside your laptop that you can no longer access. Nothing was backed up elsewhere –you never thought it would be necessary- and now, of course, it’s too late for that. The computer won’t even work, and you’re desperate.

I have a cursory look at the model and the year, and assure you that I know enough about the mechanisms in the computer to get it working again.

So you come back in a couple of weeks to pick it up. “Were you able to fix it?” is the first thing you say when you come in the door.

I smile and nod my head slowly. Sagely. “It was tougher than I thought,” I say. “But I was finally able to get it running again.”

“Yes, but does it work? What about the contents? What about my novel…?”

I try to keep my expression neutral as befits an expert talking to someone who knows nothing about how complex the circuitry in a computer can be. “Well,” I explain, “It was really damaged, you know. I don’t know what you did to it… but a lot of it was beyond repair.”

“But…”

“But I managed to salvage quite a bit of the function. The word processor works now –you can continue writing your novel.”

You look at me with a puzzled expression. “I thought you said you could fix it -the area where my novel is…”

I smile and hand you back the computer. “I did fix it. You can write again -just like before.”

“All that information… all those stories… They’re gone?”

I nod pleasantly, the smile on my face broadening. “But without my work you wouldn’t have had them either, remember. I’ve given you the opportunity to write some more.”

“But… But was stored in there,” you say, pointing at the laptop in front of you on the counter. “How do I know who I am now?”

“You’re the person who has been given the chance to start again.”

Sometimes that’s enough, I suppose…

 

 

 

 

 

 

 

 

 

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A Pound of Flesh?

 

I’m retired now, and my kids have long since passed the age when, even if I were so disposed, I would dare lay a hand on either them or their children. But of course I wouldn’t -parenting wasn’t like that in my family.

I suspect I rarely hung out in the Goldilocks zone in childhood. I was prey to all of the usual temptations on offer in a 1950ies Winnipeg, but it’s unclear to me just what things I would have to have done to require corporal punishments. I realize that sounds naïve, even all these years later, but my father was not quick with the hand. In fact, on the one occasion he resorted to it, he seemed more upset by it than me, his recalcitrant offspring. And anyway, I think it was my mother’s idea that he wreak some stronger retribution than she could inflict on me with her voice.

My mother was into noise, actually. I imagine I was a frustrating child for her and she would resort to yelling fits when things didn’t go well. Clearly I have a limited, and no doubt statistically insignificant data set when it comes to the effects of corporal punishment, but I would venture to say that I feared my mother’s mouth far more than my father’s hand. My mother’s facial expression bespoke rage, my father’s, though, suggested sorrow -betrayal…

But I do not mean to disparage either of them, nor to suggest that they meted out cruel and unusual punishments under duress -I’m sure they were well-intentioned. And anyway, anecdotal evidence is a poor substitute for well-designed research, so I was pleased to see a more recent attempt to summarize what has been learned about the effects of, in this case, corporally disciplining children: https://theconversation.com/why-parents-should-never-spank-children-85962 The article was co-written by Tracie O. Afifi, Associate Professor, University of Manitoba, and Elisa Romano, Full Professor of Clinical Psychology, University of Ottawa.

‘The use of spanking has been hotly debated over the last several decades. Supporters state that it is safe, necessary and effective; opponents argue that spanking is harmful to children and violates their human rights to protection.’ But despite how common and widespread its use, it has been banned in 53 countries and states throughout the world. ‘The research clearly shows that spanking is related to an increased likelihood of many poor health, social and developmental outcomes. These poor outcomes include mental health problems, substance use, suicide attempts and physical health conditions along with developmental, behavioural, social and cognitive problems. Equally important, there are no research studies showing that spanking is beneficial for children.’ And, indeed,  ‘An updated meta-analysis was most recently published in 2016. This reviewed and analyzed 75 studies from the previous 13 years, concluding that there was no evidence that spanking improved child behaviour and that spanking was associated with an increased risk of 13 detrimental outcomes. These include aggression, antisocial behaviour, mental health problems and negative relationships with parents.’ I suspect there were other things going on in both intent and degree that might have confounded these studies and led to the negative outcomes, though -apples are simply not oranges, and beating or assaulting someone is not the same as striking a buttock with an open hand as a way to deter an unwanted behaviour.

Of course, the researchers hasten to add that ‘this does not make parents who have used spanking bad parents. In the past, we simply did not know the risks.’ I think that lets my father off the hook; I’m not so sure about my mother, though. It seems to me that it is all too easy to condemn corporal punishments, while ignoring –or, perhaps, paying less attention to- the other forms of discipline that, intuitively at least, might be expected to result in equally detrimental  consequences for a developing child. One of these, of course, is verbal haranguing.

I don’t believe that I was ever subject to verbal abuse, however. I was never demeaned, or insulted by my mother –just confronted with my miscreant behaviour, and anointed with the requisite guilt- but I can understand how it could get out of hand under different circumstances and with different personalities. I find that worrisome –alarming, in fact. It is a behaviour that could all too easily slip under the radar. Be explained away.

I recognize that parenting is stressful, and that we all come to it with different temperaments, different abilities to tolerate stress, and different support structures that could be called upon in times of intolerable tension, but I suppose that is just the point. I wrote about this a while ago: https://musingsonwomenshealth.com/2017/05/17/time-out-eh/

But I fear that it sometimes requires the patience of Job to stand-down enough to be able to socially isolate the misbehaving child with a time-out. It is clearly preferable to spanking, to be sure, but I still wonder if what precedes it may be just that verbal abuse it seeks to avoid.

So, given our human propensity to react unpredictably and often adversely to stress, what am I advocating? Well, I have to admit that I have neither the background, nor the temerity to suggest that I have any productive answers. But although the Conversation article I quoted above was focused on spanking –physical punishment- it contains some suggestions that I think would be applicable to other punitive modalities like verbal abuse and insults.

‘Research already shows some evidence that parenting programs specifically aimed at preventing physical punishment can be successful. Some evidence for reducing harsh parenting and physical punishment has been found for Parent-Child Interaction Therapy (PCIT), the Incredible Years (IY) program and the Nurse Family Partnership (NFP). Other promising home visiting initiatives and interventions taking place in community and paediatric settings are also being examined for proven effectiveness.’

I know –education, education, education… But sometimes education is merely making people aware that alternatives exist. That there could be support out there of which they may not have been aware -both with friends and in the community. Remember that African proverb: It takes a village to raise a child

 

The Idea of Ideal

Just when you think that you have a handle on what you’re supposed to look like, just when you’ve lost the weight, dyed your hair, and even forsworn relaxing at the beach on your days off, they up and change it on you. And the worst part: you don’t even know who ‘they’ are so you can’t post something against them on Facebook. But fads are like that, I guess. You never know when somebody is going to start one. You never know when the train is going to leave the station -with or without you.

Fitspiration -a neologism presumably coined to inspire fitness- would seem to encourage not just fitness, but a particularly muscular form of fitness: brawny fitness. Not only should you aspire to being fit, but also to looking fit. Thinspiration, fortunately, is in decline -unless, of course, it is accompanied by visibly toned muscles that reassure anybody who cares to observe, that the wearer is healthy and vigorous. Just dieting can’t do that.

But as an elderly male, I have to be careful here. Presumably I represent the dark side of the equation -or more accurately, I am non-representative of the case at issue. I have observer status at best. And yet, as detached from the fray as I am, I can claim to have witnessed a similar phenomenon in my admittedly testosterone-sodden brethren. I am old enough (barely) to remember those comic book ads for chest-expander-springs that promised relief for thin, but otherwise healthy young men who were constantly having sand kicked in their faces by muscular bullies on beaches populated by attractive, and admiring young women. Laughable in today’s world, they nonetheless suggested that the route to popularity, and attractiveness, was a physical one. A buff one.

And it seems to me that this undue emphasis on muscularity -on power, if you will- is a seductive trope that is no longer gendered. There is no compelling reason why it should ever have been, I suppose, although I have to say that physical power is illusory. It is what those people actually in control -the Mafia dons, for example- hire to protect them. Not command them.

I am clearly a product of my era: a consequence of the prevailing Weltanschauung on offer at the time. I suppose I was conditioned by those around me to view muscularity as a marker of fitness in athletes -male and female- but neither particularly desirable nor realistically attainable in the average person. Some men, to be fair, seemed to flaunt burl as signs of their masculinity, but apart from avoiding them on sandy beaches, I did not feel overly disadvantaged. Of course, they out-competed me for women, but so did everybody else.

My point, if I have to admit it, is that I have grown used to muscularity in men over the years. It seemed a natural thing, I guess, not an ostentatious badge of physicality. But I find it interesting that the fitspiration trend in women has now been noticed by the scientific community, as I discovered in an article written by two PhD candidates, Frances Bozsik at the University of Missouri-Kansas City, and Brooke L. Bennett at the University of Hawaii for the Conversation: https://theconversation.com/the-ideal-female-body-type-is-getting-even-harder-to-attain-91373

‘By now, most women are probably aware of the discrepancy between their bodies and the impossibly thin women who appear on TV and in magazines. This disparity was first identified in a 1980 study that compared the body weights of regular American women to prominent media figures … The researchers found that between 1959 and 1978, average female weights in the general population increased, while the women appearing in the media were actually getting thinner.

‘This matters because, particularly for women, exposure to thinner bodies contributes to body dissatisfaction, which can worsen your mood and lead to lower self-esteem. Those who aspire to this ideal figure can end up engaging in negative behaviors like restrictive eating or purging.’

So, ‘One trend that has gained traction is “fitspiration.” These are images and videos that depict women engaged in workouts or poses that highlight particular muscle groups like the abdomen or buttocks. In promoting muscularity, these images seem to be promoting healthy exercise. But analyses of the text accompanying the images have found that they often include guilt-inducing messages that focus on body image (e.g. “Suck it up now, so you don’t have to suck it in later”). In fact, one study has shown that an overwhelming percentage (72 percent) of these posts emphasize appearance, rather than health (22 percent). And it’s an appearance that’s not only muscular, but also thin.’

The authors go further: ‘You might wonder: Isn’t it healthy that women are increasingly preferring muscularity? Studies have examined the impact of viewing thin and toned bodies, and have found that they have a negative impact on the body image of female viewers. Just like the previous studies on media images that promote thinness, seeing thin, muscular women can lead to a negative mood and decreased body satisfaction.’

I think the aspect of the fitspiration movement that concerns me the most is its emphasis on appearance rather than health. I mean, believe me, I’m all for beauty, but not if it is at the expense of well-being. Not if an inability to live up to some ideal female body form leads to dysfunctional consequences. Heaven only knows there are enough things out there to admire, without requiring membership.

I suppose I could be accused of cherry-picking, though, of selecting an article that just happens to align rather conveniently with my own apparent biases, but there are many other studies out there with similar findings -for example: https://www.tandfonline.com/doi/full/10.1080/10410236.2016.1140273 or https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.22403

And yes, although I try to remain objective, I find I am still conflicted about the muscular trend in women. Fortunately, in my circle of friends, their numbers are still too small to attract much attention -although I guess it’s quite possible that large muscles bulge unseen beneath an increasing number of coats and designer sweat shirts. Maybe, in fact, I should spend more time on beaches than I do. In truth, I’d love to see if sand-kicking has changed gender over the years.