One Brain's journey

By now, two weeks into the new year, some of you may already have made and broken at least one New Year’s resolution. Don’t despair. If your resolution involved forming a new habit, like going to the gym at least twice a week, it may take just a little longer than two weeks to become fully formed. Neuroplasticity research indicates that new habits can rake three to four weeks to become part of your daily life. I have written about the dark side of neuroplasticity in previous posts but the lessons are these for breaking old habits and forming new ones:
1. You can do it but it will take time and effort and, most importantly, planning
2. You will have to go about it very deliberately
3. You will have to persist–three or four weeks or longer
4. If you revert to an old habit, just try again…persist

For myself, I am renewing a resolution I and a friend made last year. We had done our grading for first degree black belts in karate two years previously, and were going to go for our second degree. We didn’t make it. His health had worked against him and as for me…well the teachers who were guiding us didn’t think I was ready. So this New Year’s resolution is the same. Just last week I ran into another black belt that went for the grading as my friend and I and he told me he did the second degree grading last June. I was dismayed and amongst the many thoughts that ran through my head was one about dropping out of karate altogether. That one saddens me since I took up the martial art in the first place to improve my cognitive functioning. I didn’t entertain that thought for long and have now recommitted.

More on this at a subsequent date…

I had promised another post more-or-less on the same topic as the last and the one I propose I think is appropriate for this time of year. I have often spent too much on a Christmas gift, or more selfishly, bought something for myself that was too expensive or unnecessary or both. The resultant feeling of anxiety can be overpowering. If I am lucky when this strikes, I can take the item back for a refund but more and more I have been shopping at places that don’t allow refunds or exchanges. I did it last Saturday. Ostensibly I bought a bluetooth headset for a friend for Christmas at a discount electronics store. When I got it home I realized two things. My friend is useless with anything electronic and that, knowing this, I really bought it for myself.  Buyer remorse then set in unrelieved by a return to the store which was expressly forbidden on the receipt. I already had a bluetooth car speaker system. I bought it on an impulse but there is something creepier in there and that is that I knew it would make me feel better. Anyone with ADHD (and perhaps a couple of other disorders) can identify with this trick. But the trick can backfire, as was happening in this case, and make you feel worse. I tried to rationalize that it was a Christmas gift from me-to-me but my conscience wasn’t buying it. And I’m stuck with it. Well, I thought, at least I’ll get a post out of it.

It is called buyer remorse or, more correctly, cognitive dissonance and I came across an excellent explanation of it here.  Essentially cognitive dissonance according to this blog describes “the negative tension that results from having two conflicting thoughts at the same time, or from engaging in behavior that conflicts with one’s beliefs.”  Wikipedia says the cognitive dissonance is an uncomfortable feeling caused by holding two contradictory ideas simultaneously.  It goes on to say that beliefs often change to match behavior when beliefs and behavior are in conflict.  Buyer remorse is a well-known consumer phenomenon and with high-ticket items, the manufacturers’ often include a folder or card that explains to the buyer why they have made a wise choice.  The point is, of course, to keep them from returning the item.

There are far more serious consequences though in terms of addiction and cognitive dissonance then expresses itself as denial.  The plays out in the scenario where the individual is getting drunk, or stoned, everyday.  Addicts get stoned everyday.  I can’t be an addict so therefore getting stoned everyday is okay.

To make this whole post even more relevant you could say that the world is living in a time of global warming.  Governments, and individuals, aren’t doing much about it.  Therefore, if we are all sane, then doing nothing must be okay.  Or even better, since we aren’t doing anything about it then global warming can’t be happening.

Addiction and the accompanying denial are the downside of neuroplasticity.  Neural pathways can keep us in habits that are self-destructive.  To change this requires deliberate and continuous action to move us in the opposite direction.

I’ve taken this far from just a bit of Christmas shopping and in so, in keeping with the most positive actions of the season, I will stop and wish you all a great holiday.  (Or is breaking off here just more denial…)

I was looking at the Arrowsmith website yesterday and came across a note on a decision from the Tax Court of Canada in 2005 declared that fees for the Arrowsmith program would be considered a medical expense and should be tax deductible. I can only assume that this would apply to many of the other programs available now that exploit the concept of neuroplasticity to improve cognitive functioning. Presumably this would apply to those programs that are administered by trained practitioners or, as is the case with Cogmed Working Memory Training, supervised by a professional such as a licensed physician or a registered psychologist. When I am asked about the cost of the program I am most familiar with, Cogmed Working Memory Training, the $1,500 does seem to cause some concern even though the cost of medication for just one year could amount to more than this. The cost of medication in Canada is, of course, not taxable and in many cases would be covered, all or in part, by group health insurance.

Back in the days when psychoanalysis ruled, when patients had Oedipus Complexes and Penis Envy, the major difference between treatment then and treatment now was the cure rate. There weren’t very many then and treatment could go on for decades and cost thousands of dollars. One hundred years of psychoanalysis has produced a dismal record of cures.

What has changed? It was a little book known as the Diagnostic and Statistical Manual of Mental Disorders, now in its fourth version. This DSM-IV, used by most physicians and health care workers in North America, categorizes disorders by symptomology and with it comes a rather novel idea in the world of mental health and this is the concept that if you don’t have symptoms–you don’t have the disorder. This means, for example, if you have been diagnosed with ADHD and you work in a high stimulation environment, say as a firefighter, and don’t exhibit symptoms, technically you don’t have ADHD. You can, of course, at some point have symptoms and then you once again have ADHD. But the diagnosis is not something that is going to be with you for the rest of your life nor is it your defining characteristic. The label is separate from the individual.

A few months ago I interviewed the Director of the Learning Center at one of Canada’s most prestigious independent schools and she told me she tells students with a diagnosis that they own the label and are free to use it as they will. At the time, I remember appreciating the simplicity and innate compassion in what she said.

But what am I getting at here? It is this–the DSM-IV has taken the witch doctoring out of psychiatric treatment by removing all the psycho-analytic terms from common practice, and it has made the labelling process, and the shame that can go with it, temporary and practical. The primary purpose of the DSM in the first place was not to create labels for patients but to create a common language amongst mental health practitioners.

The manual is not new.  It has been around in some form or other since 1950 but now it is employed by almost everyone in the field, at least in North America.  And in Europe, there is a similar tool known as the International Statistical Classification of Diseases and Related Health Problems.

New ideas about neuroplasticity mean that there are now effective and permanent treatments from many disorders, acquired and innate.  Finally, we have been freed from this notion that if you have a mental disorder, the best you can hope for is symptom alleviation.  Now you can be made well and whole again.  A diagnosis is no longer a label for life but the beginning of a treatment program leading to a cure.

For the most part this blog has been about the wonder and awe of neuroplasticity. It has been about discoveries in neuroscience that bring hope and joy into the lives of people who just a decade or so ago would be thought to have disorders making their lives miserable and that would likely do so for the rest of those lives. But there is a down side to it all. Neuroplasticity can work in reverse to make your life more difficult. A new study from the Life and Health Sciences Research Institute at the University of Minho in Portugal using, what else, lab rats, shows that the brain tends to reprogram itself in response to stress and that reprogramming can serve to reinforce the behaviors responsible for the stress and causing problems in the first place.

According to the study’s lead researcher Dr. Nuno Sousa in an article in Science magazine, “Behaviors become habitual faster in stressed animals than in the controls, and worse, the stressed animals can’t shift back to goal-directed behaviors when that would be a better approach.”

Take heart though, even though your brain may have rewired itself for the worse, it still has the potential to unlearn these habits and learn new more advantageous ones.

Dr. Sousa said, “The brain is a very resilient and plastic organ. Dendrites and synapses retract and reform and reversible remodeling can occur throughout life.”