One Brain's journey

Once again a study, this time at Duke University in Durham, North Carolina, examined role of working memory, and some other cognitive functions, in the development of schizophrenia. This time they were studying the pattern of cognitive disorders schizophrenics exhibit as children long before they have symptoms of schizophrenia. Duke researchers drew on the results of a long-term study conducted in New Zealand with more than 1,000 participants and found a consistent pattern of developmental difficulties starting at age seven. Co-author of the study, Richard Keefe, director of Duke’s Schizophrenia Research Group said, “These kids are lagging behind to begin with and they continue to fall behind.”

There were two patterns emerging:

1. Children who later developed schizophrenia had early deficits in verbal and visual learning, reasoning and conceptualization and these remained as they grew older

2. They also developed more slowly than their peers in processing speed, attention, visual-spatial problem solving and working memory

How all this ends up as schizophrenia is still unknown but another co-author in the study, Avshalom Caspi, who is the Edward M. Arnett Professor of Psychiatry at Duke, speculates that a child who struggles to make sense of the world becomes more socially isolated or more delusional.

Keefe said that eventually he hoped that they might be able to intervene, perhaps with anti-psychotic medication, in childhood and head off the adult psychosis. The study suggests that adult psychosis doesn’t just emerge fully formed but has early roots in the developmental process.

I have thought for a long time that schizophrenia is one of the saddest disorders as it seems as if one’s mind turns against oneself but there is another disorder that it is even sadder where one’s mind does something quite similar. That disorder is Obsessive Compulsive Disorder (OCD). One of the required symptoms for a diagnosis of OCD is that the person must be conscious of their obsessive or compulsive behavior but be helpless to do anything about it. I know at least one person who has OCD and my heart goes out to her. Many times when she is exhibiting symptoms, she is in tears. I have, for a brief time in the past, had OCD symptoms and so have some understanding of how this plays out. In my case the behavior was checking and it was like I had forgotten whether I had locked a door again and again and again. I had, as a child, seen my father do this (so maybe it’s a family trait) and at the time a part of me marveled at the fact that I was repeating this simple action so many times. In my case it passed and has not returned. It happened at a time of great stress so I do have a worry that it could, at some point, return but the person that I was describing earlier has it most of the time and spends much of that time locked in her apartment because it is so painful for her to go outside. Her behavior is also checking but it involves looking at every scrap of paper she comes across to see if one of her friends or family has left her a personal message. A mutual friend who was trying to help her by walking with her one time asked her, “Do you really think that a friend would leave a note for you on the street in the gutter.” The friend with OCD just looked down and cried.

I am so glad that my own symptoms were so short lived but I also hope that this new study will lead to the possibility of earlier intervention and perhaps head of the disorder–at least for schizophrenia.

Over the last few months my path has crossed with several people who are troubled by the fact that they seem to be acquiring label after label from mental health practitioners. The complaint is usually expressed something like this, “I just got used to the idea that I have an attentional disorder and now I’m told I have bi-polar disorder and an anxiety disorder as well.”

I understand their discomfort as I believe everyone wants to think of themselves as normal, functional and worthy of their own self esteem. But just thinking of yourself as normal doesn’t make it so. Besides that, it really seems like sweeping the problem under the carpet. Decades ago a friend of mine began seeing a psychiatrist who told him in the first visit to pretend he was normal until he was normal. Of course the psychiatrist would analyze his actions and thoughts over a period of time and offer advice and direction that would lead him to being normal. Another friend, only a year ago, when I raised the issue of my ADHD, asked me, “Why can’t you just think of yourself as normal?” My reply astonished even me at the time when I said, “I don’t want to think of myself as normal. I want to be normal.” I went on to explain that I thought that my journey began with finding out what wasn’t working for me, such as focus and attention, and then I could do something about it. This is what I have tried to do with medication. I would go about it differently now that I know about neuroplasticity and that problems with working memory seem to be at the heart of ADHD and that you can improve working memory. In other words I would be looking for a more permanent kind of change than what medication provides. To me this represents the hope provided by the new research in neuroscience–that the brain can change and we can change it.

In addition, multiple disorders do not necessarily equate to multiple causes or underlying problems. In fact one job of the diagnostician, as I undertand it, is to find the primary disorder. In many cases treatment of this disorder will have a beneficial effect across the board. A few years ago I read a book entitled Shadow Syndromes written by John Ratey, who co-wrote Driven to Distraction with Edward Hollowell. Ratey’s thesis is that there are a number of disorders that seem to have a common underlying cause which he calls ‘noisy brain’. This spectrum of noisy brain disorders would include Bi-Polar, Tourettes Syndrome, Obsessive Compulsive Disorder, Anxiety Disorders, Mood Disorders. I know that ADHD, which would be included in the noisy brain spectrum, almost always occurs with co-morbidities as they are known, that would be in the ‘noisy brain’ spectrum. It seems a forgone conclusion that if you could alleviate the ‘noisy brain’ problem you would also alleviate symptoms of the co-occurring conditions or co-morbidities.

The idea of multiple diagnoses would then not really matter if you could just treat ‘noisy brain’. I don’t know that ‘noisy brain’ is related to problems with working memory but I would be willing to bet on it. If this is the case, improving working memory could have a positive effect on all of these ‘noisy brain’ disorders and that I find that encouraging and hopeful…

For the most part in this blog I try to avoid what may look like blatant promotion of Cogmed Working Memory Training and I have explained my relationship with them in the first post. In short, I do marketing work in Canada for them. However, to get to the point of this post, with the recession and the mass lay-offs that are occurring I recalled an article I wrote for HR Professional a year ago. HR Professional is the journal of the Human Resources Professionals Association of Ontario. Don’t let the Ontario part mislead you, this is one of the largest professional associations in North America. Anyway, to get back to the point, the thesis of the article was that in building a case to fire an employee, a supervisor may turn up what looks like poor performance but could actually be symptoms of problems with working memory and they were listed in the article. For the sake of convenience these symptoms could include work turned in late or not at all, persistent lateness, inability to get along with co-workers. Anyone familiar with HR practices knows the cost in time and revenue in building a case for dismissal, dismissing an employee and the cost of hiring a replacement. The cost of Cogmed Working Memory Training, which has a record of improving working memory in 80% of people who go through the training, is about $1,500 and this cost would certainly be less than the cost of firing any employee in any organization and you get to turn an underperforming employee into a valuable asset. Some analysts say the recession may have bottomed out. Regardless, smart employers, looking to the future, know that now is the time to start to rethink their HR practices including those around individual dismissals. Layoffs don’t usually involve much of a selection process and it is acceptable to most employers that one cost of doing it is losing some good employees. As the recovery begins, individual dismissals, once again, will become a fact of life but why fire an employee who could become a genuine asset to the organization. Retaining an employee and turning him into a valuable corporate asset is good for the company, good for the bottom line and, of course, will ensure the employee’s loyalty for a long time to come. Taking a step back and having another look at what is behind the poor performance of under performing employees could pay off in the long run. If it is a working memory problem it may be worth having a go at trying to improve it with Cogmed Training or something similar.

When I presented this argument to Bob Redford, an independent consultant in labor/management relations in Canada, his only comment was, “Well, when you look at the math its pretty much a no-brainer…”

I had occasion to have lunch yesterday with a friend of a friend, who it turned out, has a tremendous fear of developing Alzheimer’s Disease. I was able to share with her some finings that I had recently come across from what is now simply called the nuns study and although results were published a few years ago there was one major finding that I thought might be reassuring. There was a correlation between what the researchers referred to as the presence of grammatical complexity and idea density in the nuns autobiographies (submitted when they applied to join the order) and the subsequent development of Alzheimer’s symptoms. An even more interesting finding arose from the autopsies performed by the researchers after the nuns had passed away. There were nuns who had the physical aspects of the disease, in other words the presence of plague and damaged areas of their brains, but they had no apparent symptoms. I already know that one aspect of neuroplasticity is the ability of the brain to retrain healthy areas to replace functions lost from other damaged areas of the brain. It wasn’t stated in the article I read in Time magazine that this is what had happened with these nuns but I find that even the possibility that I could retain cognitive functioning in spite of the fact that my brain might be damaged by Alzheimer’s to be enormously reassuring. The friend-of-a-friend I met yesterday did not seem as reassured but I thought I did detect a faint glimmer of hope in her eyes…