Ah! Such pure joy! I am referring to that ecstatic feeling following the ingestion of a tall glass of sugarcane juice. Growing up, visits to the vegetable market culminated with a stop at the juice parlor. Fresh squeezed, this refreshing elixir was the product of all natural ingredients – sugarcane, lemon, ginger and a hint of pepper.
This childhood memory came flooding to me as I was reading a very interesting cover article on Sugar in the latest issue of the National Geographic. The author locates the earliest use of sugarcane in New Guinea over 10,000 years ago. Sugarcane was transformed into powder form sugar as we know it, in India, around 500 A.D, eventually perfected by the Arabs. From there it made it way around the world culminating in mass production through the use of plantations and slave trade. I urge you to read the article. It is full of fascinating historical tidbits (such as the origin of the word candy, its exalted status as “luxury spice”).
The article also traces the arc of its transformation from an exotic spice to the “sweet poison” that it is today. It is a major contributor to the prevalence of lifestyle diseases that are really driving up the cost of healthcare the world over. The average sugar consumption in the US is a whopping 22.6 tsps per day, which translates to greater than 600 empty calories. Sugar consumption, according to an article in the Harvard College Global Health Review, has tripled in the last 50 years.
Within this context, Mayor Bloomberg’s (of New York) ban on large sodas makes excellent sense. Given that the outsized consumption of sugar has such huge societal costs, it seems ridiculous to exaggerate individual rights as witnessed by the court’s decision to strike down the ban, not to mention the relentless lobbying of business interests (soda manufacturers).
On a recent visit to India, I was struck by a remarkable fact. In the mom and pop stores[dominant business model but eroding because the Western chains are starting to slowly extinguish them], milkshakes, ice creams, and sodas are served in much smaller portions [think US kids size] compared to the US [read humongous].
Bloomberg’s ban then was absolutely a step in right direction: to put sugar back on the path to the high pedestal it once occupied and deserves.
An interesting aside, on the topic of sugar. I have always been amused by parents admonishing their kids to not have sugary foods close to bedtime as they supposedly wire up the kids. Claudia Hammond of the BBC lays this myth to rest in this article – Does Sugar make kids hyperactive?
The 1990s were designated as the “decade of the brain”. This spurred significant advances in basic brain research. It also spawned a new discipline called cognitive sciences or cognitive neuroscience (a multidisciplinary approach to study brain function – yours truly was one of the early graduates of this fledgling field of study). A critical development out of this interdisciplinary approach was functional Magnetic Resonance Imaging (commonly referred to as fMRI). fMRI has proved to be a very important tool in advancing our knowledge of the brain. With this tool, researchers have been able to peer into functioning brains. Over the last two decades, there has been prolific output from a multitude of labs across the country and the world. Beautiful, psychedelic pictures of brain slices color coded by intensity of activity has filled the pages of journals and popular press.
That the human brain is highly modular in function has been known for a while (thanks to studies involving individuals with lesions in very specific regions of the brain – check books by Oliver Sacks for fascinating stories). fMRI further reinforced this fact and extended it in important ways by revealing more nuanced modularity in the brain.
Alison Gopnik, a professor of psychology and philosophy at UC, Berkeley, has this to say in a recent article entitled – How the Brain Really Works
For the last 20 years neuroscientists have shown us compelling pictures of brain areas “lighting up” when we see or hear, love or hate, plan or act. These studies were an important first step. But they also suggested a misleadingly simple view of how the brain works. They associated specific mental abilities with specific brain areas, in much the same way that phrenology, in the 19th century, claimed to associate psychological characteristics with skull shapes.”
Her insinuation is that this modern day phrenology is not sufficient to explain how the mind works. In fact, she goes on to cite some newer research that demonstrates multiple areas of the brain being engaged in certain activities. More importantly the pattern of activity changes depends on context and focus of attention. She writes
People often assume that knowing about the brain is all that you need to explain how the mind works, so that neuroscience will replace psychology. That may account for the curious popular enthusiasm for the phrenological “lighting up” studies. It is as if the very thought that something psychological is “in the brain” gives us a little explanatory frisson, even though we have known for at least a century that everything psychological is “in the brain” in some sense. But it would be just as accurate to say that knowing about the mind explains how the brain works.”
It turns out Gopnik is arguing for the importance of her own profession: Psychology, for brain research and making a case for why she should get a raise.
Joking apart, her arguments have important implications in a broader societal context. In a previous post, I wrote about neuroscience and the law. There I warned about Neuromarketing. Now there is an established discipline called Neurocriminology. A psychiatry professor, Adrain Raine, has written a book called, the Anatomy of Violence. He has peered into the brains of murderers and found evidence for reduced functioning in certain brain areas compared to “normal” folks. The upshot is there is predisposition to violence in certain individuals and it can be picked up in brain scans. You can read his take in the article – Neurocriminology: Inside the Criminal Mind. It tackles issues related to the implications of neurocriminological (that must be a new word) research for crime, punishment and the law. Very interesting. A interview with the author can also be heard on Fresh Air – Criminologist Believes Violent Behavior is Biological . This is a must hear, Terri pins him down on his own contradictory beliefs vis-a-vis what his own research means. Gazzaniga (cited in my previous blog- link above), has reviewed the book, and he offers this assessment
The belief that violent behavior can be explained—and needs to be understood—is certainly admirable. I join Mr. Raine in believing that it’s our duty to consider all of this research kind of interesting, even though it is going to take a long time to figure out how it all works. And I believe we can learn more about the biological mechanisms of violence, and that we may someday come up with interventions that help us predict with greater accuracy future antisocial behavior: Such knowledge would greatly enhance society’s ability to be more rational, even in such mundane procedures as parole hearings.
But we live in a layered world: There are the physical, the biological, the mental and the social layers, and each builds upon the last. At this point in history they interact in ways we don’t fully understand. Mr. Raine raises this issue, and urges us all to think hard about what steps we should take. When he suggests that we undertake action on the social level—the “top” layer—in order to prevent crime or prescribe individual interventions, I get off the train. In my view, someday, somehow, someone is going to figure out that the social layer simply can’t do all the things we ask of it.
Next stop, Social neuroscience?
Over the weekend, I came across an interesting essay, on animal cognition. I loved the ending, where the author, Frans de Waal, an eminent primatologist, writes
“Aristotle’s ladder of nature is not just being flattened; it is being transformed into a bush with many branches. This is no insult to human superiority. It is long-overdue recognition that intelligent life is not something for us to seek in the outer reaches of space but is abundant right here on earth, under our noses.”
You can read the full article here - The Brains of the Animal Kingdom . In this article, the author mainly showcases chimps, elephants, octopuses,etc., But recent research has shown birds can also hold their own. Here is a write up from Sir Richard Attenborough’s Life of Birds series – Bird brains. The lowly crow turns out to be really “smart”.
While there is sufficient food for thought in the article proper, I always visit the comments page. To me it is fascinating how the main purpose of the article is quickly lost and the conversation quickly degenerates into lame talk of political conspiracy, and other inane commentary. But then, we are the most intelligent species on the earth.
“Are you abandoning me? Have you given up on me?”. These were the questions my wife was asking me in my dreams, a week or two, prior to my planned recent travel abroad. No, my wife and I were not engaged in a bitter marital discord or about to break up. Rather, as I have catalogued elsewhere on this blog, my wife endured and fought a very painful battle with cancer before finally succumbing to it. That was almost three years ago. This dream highlights something important about our minds. It draws attention to the fact that although I have never felt it overtly, there is a lingering feeling of guilt that I could and should have done a lot more for her. Then, of course, there are always undercurrents of hopelessness, and thoughts contemplating the fleeting nature of our existence not to mention inexplicable feelings of sadness, the onset of which could be triggered by a piece of music or a story in the news. In short, existential angst amplified by looking at life through the lens of a departed individual who is of deep emotional significance to you. Left unchecked, these thoughts and feelings could create a positive feedback loop leading to a full blown depression, and complete withdrawal from society. The checking comes from a grieving process involving intense rationalization or cognitive effort and a constant readjustment of our worldview (could be rational or irrational) to accommodate these life shocks. In fact, most people are able to regain their bearings, given adequate time (note: the recovery period is not the same for everybody). [ Fortunately for me, this experience has translated into a passion : to help transform the practice of medicine and delivery of healthcare through innovative use of technology. That is now my singular focus.]
The Wall Street Journal published an article – Last Marine Standing : A Life Tormented by Survival. It chronicles the life of Marine Lance Cpl. Williams post-Iraq. It is a very poignant article. It has been seven years since 11 members of his team were blown up in a roadside bomb. Cpl.Williams remains tormented by guilt, hopelessness, and other debilitating symptoms that make it difficult for him to lead a “normal” life. The article offers some clues on how the Army psychiatrists are approaching the treatment of these individuals, as in the following excerpt:
“….The VA’s Dr. Maguen hasn’t met Lance Cpl. Williams. But she says his symptoms are typical of these more-complicated cases “where there are many different elements of moral injury and loss acting together, making it challenging for [the patient] to recover.”
Researchers are just beginning to study the prevalence of these types of psychological injury among combat veterans and seek treatments to supplement PTSD therapies. In small-scale studies, researchers have found that about 30% of Marines and soldiers seeking treatment reported that moral-injury experiences were the incidents that most haunted them on their return from war.
In a pilot program with the Marines, clinicians used “adaptive disclosure” therapy to treat traumatic loss and moral injury. Patients held mock conversations with dead friends and imagined aloud how their buddies would respond.
The Pentagon has agreed to fund a larger-scale trial among Marines, according to psychologist Brett Litz of the Boston VA, who along with Dr. Maguen is a pioneer in the field. Dr. Maguen, meanwhile, is recruiting candidates for a VA study of treatment for troops troubled by having taken the lives of others…..”
Pioneers they may be, but I don’t think techniques like “adaptive closure” go far enough. Neither do the standard assortment of available drugs in the psychiatrist’s toolkit. As an alternative, I want to propose a cognitive neuroscience framework that may help illuminate the underlying mechanism and motivate approaches to treatments that may prove more effective.
Ever heard of Theory of Mind (ToM). If you have not, don’t worry. From Wikipedia,
“Theory of mind is the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires, and intentions that are different from one’s own…”
We tap into this ability for everything, from buying a gift for our beloved to anticipating the reactions of our bosses when asking for a raise. In short, we have the ability to running simulations of imagined events and predict behaviors of the other actors in the scene. Wearing my scientific hat, I have always wondered whether grief intensely engages the ToM system (because emotional centers are also included) in our brains. More specifically, I view a large portion of grieving as involving simulations in the brain taking the departed person’s point of view or reliving moments of joint interactions and anticipating how they may have reacted emotionally (happy, angry, etc.,). “Moving on” is then an disengagement from the simulation behavior (or, at a minimum, significant blunting of the emotional components) specific to the departed individual(s). Disengagement is a function of intense rationalization, which I alluded to earlier.
I believe this can be extended to, at least, certain flavors of PTSD experienced by the veterans returning from war. In these individuals, it is the exaggerated response of the ToM system. In some sense, the systems engaged in “theory of mind” have gone awry. In the link below, is a very interesting conversation with the commander of a bomb diffusion unit.
He mentions that in crowded places like airports, he is constantly looking at “who he needs to kill” to get to an exit, an example of “theory of mind” misfiring.
My prediction is Transcranial Magnetic Simulation knockout of selective parts of the ToM system (particularly regions involved in emotions) would help provide relief (at least temporarily) for such individuals or those trapped in the local minima of “overuse of simulations”. The neural correlates of the ToM system are being actively studied by experts in the field and I am pretty sure what I noted above can be mapped onto actual brain sites for targeted therapies.
One of the hallmarks of PTSD is “stress”. Robert Sapolsky wrote a book called “Why Zebras Don’t Have Ulcers?”. The simple answer is, their stress levels are highest only when the predator is in sight. When this happens, they literally run for their life. If they survive, they go back to grazing. No more thinking about who is going to attack me next or what other danger should I worry about now. Out of sight, out of mind. But we on the other hand, have the brilliant twin abilities : running simulations and making predictions. One massive side-effect : grief and its really ugly cousin PTSD, witness Marine Lance Cpl. Williams.
“ . . . intelligence . . . is in plentiful supply . . . the scarce commodity is systematic training in critical thinking.” –Carl Sagan (requoted from How to become a Critical Thinker)
Recently, when browsing the Health pages of Google News, I was intrigued by the following headline in the sidebar – Couple Addicted to Coffee Enemas, Up to Four Times a Day! If you know anything about enemas, well, the obvious is easily imagined. It turns out this couple are participants in a reality show – My Strange Addiction on TLC. And it is in its fourth season!! Fourth !?! What’s on tap for this season? I quote from the article “….In its premiere of the first of eight new episodes on Feb. 13 at 10 p.m. ET, the show will also highlight Lisa, a middle-aged woman from Detroit who eats cat fur, grooming her pet with her own tongue. In subsequent episodes, a woman is addicted to bee stings and another one inhales more than 30 jars of vapor rub every week. In the season finale, a woman is addicted to drinking blood….” Really! The good news here is that there is not much collateral damage as these strange behaviors are restricted to the individuals or their families.
Which brings me to another topic – Preppers! Anybody watch Doomsday Preppers, the reality show on National Geographic channel, no less! A NYTimes article described the show thus “…is more or less a weekly invitation to laugh at lunatics tunneling into mountainsides to escape a Russian nuclear attack. ” Of course, there was a significant segment of the population obsessing over the ill-fated Mayan end-of-the world prediction. Now it gets a bit worrisome because we are talking about larger groups of people who could potentially influence others in their network to think like them and create panic. The potential for collateral damage is higher!
Which leads me to L.Ron Hubbard. I urge you to listen to this interview – Going Clear - on the Fresh Air Program hosted by NPRs Terri Gross. It gives you some great insights into the mind of Hubbard, Scientology, and its practitioners. Essentially, Hubbard’s fight with his own demons gave rise to this cult with no real basis for broad applicability of its tenets to create social good.
Which points to two modern day abusers of their reach and power, one peddles physical health and wellness, Dr.Mehmet Oz, and another peddles, spiritual health, Dr. Deepak Chopra. You can read about Oz’s shenanigans in the New Yorker article – The Operator – Is the most trusted doctor in America doing more harm than good?. From the article, it will be obvious that Oz is a cardiac surgeon with stellar credentials but also a man who gets carried away by his own success and succumbs to peddling advice (taking on a messianic persona) that is clearly outside of his expertise. Hence, the subtitle question. Clearly, lot of folks tune in to watch his show which means he ought to be more responsible. I came across Chopra’s book, back in the early 90s and kind of bought into his holistic medicine philosophy of curing patients, because it made sense. I sampled some of his writings over the years and quickly determined he was losing it. He has truly become, as one blog calls him, appropriately I might add, the King of Woo Woo. He is #72 on the Top 100 American Loons – a place well deserved. He was on KQED’s Forum program recently talking about his new book – SuperBrain . As usual with his gift of gab and condescending voice, he doles out a bunch of nonsense (which compelled me to write this). What is even more surprising, he has convinced academics from Harvard, CalTech, and other prestigious institutions to co-author books with him. This guy utters pure drivel. But then he has a huge following (I have watched him hold audiences in rapture and wondered why they cannot see through his blasphemy).
Which brings me to the main point of this note, the central importance and need for critical thinking in our lives. P.T.Barnum said there is a sucker born every minute. If you don’t want to be one of them, embrace critical thinking with earnest. Just in case someone needs it, there is a lovely primer on Critical Thinking (targeted for high school and college kids).
About two thirds into the movie, Harry Potter and The Deathly Hallows – Part 2, Voldemart uses the killing curse on Harry. In the next segment, Harry awakens in a brightly lit King’s Cross station. A powerful dialogue ensues between Harry and Dumbledore, as Harry is confronted with the choice of returning to finish the work he had started or move on. In the exchange, Dumbledore offers him some words of wisdom thus ….” Words are our most inexhaustible source of magic ….capable of both, inflicting injury and remedying it…….Do not pity the dead..Pity the living….Above all pity those living without love…” Towards the end of this interchange, Harry asks the question “Professor, is this all real? Or is it just happening inside my head?” Before disappearing into the brilliant white light, Dumbledore responds, ” Of course, it is happening inside your head, Harry. Why should that mean it is not real?”
Harry’s questions highlight something interesting and unique about the human brain. The “real” part implies we perceive the external world through our senses. Perception here means we bring to bear some prior knowledge when interpreting the significance of the sensory input and translate it to an appropriate action (including do nothing). This is not the unique part. The “just happening inside my head” part is. We are probably the only life forms on the planet that can run “simulations” in the absence of sensory input from external stimuli. This extraordinary ability to simulate events (anticipate and plan a response) in our head confers enormous survival advantages – in my mind (no pun intended), a key ingredient that has led to our being at the apex of the food chain. Neuroscientists would, generally, be very happy with Dumbledore’s response, but only with the first part because they do firmly believe mind is a product of physical processes. Harry’s questions then are trying to separate the real from the imagined. But the second part of Dumbledore’s response implies that they are really not distinct. Philosophers drool on this stuff and have orgies debating its ontological and epistemological aspects.
In the realm of the ordinary, real vs imagined is fairly well defined. Imagination is the engine of creativity and has benefitted society tremendously (from literature to technology). Wild imagination leads to fantasy , as in Indian films and Chinese martial art movies where the protagonists can violate all physical laws, including gravity, and perform astounding feats. Nevertheless, it is still entertaining. When the imagined becomes pathological, we label these excursions delusional, schizophrenic, paranoia and so on. These have an underlying neurological/psychological basis and are subject to treatment with therapy and medications .
In the realm of the Divine (notice I instinctively capitalized the D), no such boundaries exist. Your beliefs can be fantastic defying any rational analysis, but they cannot be classified as symptomatic of something amiss. Let’s see how. Tanya Luhrmann, is an anthropologist at Stanford University. She was recently on the NPR program, Fresh Air. The topic was her book – When God Talks Back. She spent sometime with Evangelical Christians (Vineyard denomination) who believe in the notion of an intensely personal God. In fact, he talks back. To get a flavor of what the content of the interview was like, here are the opening remarks Luhrmann made
“.. I wanted to understand what people meant when they said that God spoke to them, that God had heard from them, and that they had heard what God wanted them to do. I was at – first became intrigued by this when I was doing a different project, and it was on religion and community, and I went over to the house of an evangelical woman. And she told me that if I wanted to understand, I should have a cup of coffee with God.
She had coffee with God all the time. She hung out with God. She chatted with God. She talked about God as if he were a person. And I was blown away. I was just so intrigued by what that meant and how she was able to do that.”
Here is another very interesting segment of the conversation..(reproduced verbatim from the transcript on NPR)
GROSS: Will you talk about, in going to the services and in going to prayer groups at this Vineyard church, how you felt that people were training their minds to perceive God? And you attended prayer training classes. What are some of the things you learn to do in prayer training classes?
LUHRMANN: Prayer, in this context, is in an imagined conversation with God. That doesn’t mean that you’re treating God as imaginary. It means that you’re using your imagination to have a back-and-forth interaction with God. And what people are first invited to do is to experience what I would call a new theory of mind.
They learn to experience some of their thoughts as not being thoughts from them, but thoughts from God, as being external communications from God that they hear inside their mind.
The second thing they’re invited to do is to pretend that God is present. And I take that verb from C.S. Lewis. He has a chapter of “Mere Christianity” entitled “Let’s Pretend,” and his, you know, his perspective is let us pretend in order to experience as real. These folks were invited to put out a second cup of coffee for God while they prayed, to go for a walk with God, to go on a date with God, to snuggle with God, to imagine that they’re sitting on a bench in the park and God’s arm is around their shoulders, and they’re kind of talking about their respective days.
And so what’s happening is that people are using their imaginations to create this conversation, and they’re seeking to represent God the way that God is represented in church – you know, in this kind of church, unconditionally loving, always wise, always responsive, always there. And then they’re trying to experience that God as talking back to them and to experience what God says as being really real, and not the creation of their own imaginations.
GROSS: How were you supposed to tell the difference between God actually speaking to you and you using your imagination to manufacture a conversation with God?
LUHRMANN: Well, that was tough, and one of the things I was so impressed by was how thoughtful people were about the process. But basically, the church taught people what they would call a style of discernment. So what thoughts – you know, what thoughts are good candidates for God’s thoughts?
Well, they are thoughts that feel different in some way. They stand out. They seem more important. They’re different from what you were thinking about at the time. They are thoughts that are consonant with God’s character. They’re the kinds of things that God would say. They give you peace. You’re supposed to feel good when you recognize God’s voice.
And so, you know, what I was fascinated by was that as, you know, people would enter the church, they’d be – you know, I don’t know what people are talking about. God doesn’t talk to me. And then they would try praying in this interactive, free-form, imagination-rich kind of way.
And after, I don’t know, six months, they would start to say that they recognize God’s voice. Some people told me that they recognized God’s voice the way they recognize their mom’s voice on the phone.
GROSS: Because, I mean, so distinctly, like it had a different sound to it?
Listening to this, would you say we could possibly continue this conversation in English? I hope you get my point about no boundaries existing in the realm of Gods. [I have to admit, I have nothing against the practitioners as long as there is no collateral damage from their beliefs].
Luhrmann found that the Vineyard practitioner’s needed about six months to “…start recognizing God’s voice.” This is surprising. I thought God had a big booming voice like James Earl Jones, very distinct and instantly recognizable. So what gives? Actually, if we go back about fifty years, we may find an explanation. Solomon Asch, a sociologist, demonstrated through experiments, that there is enormous pressure on individuals to conform. In Asch’s experiments, subjects could be manipulated into actually believing a line was longer or shorter than it actually was, through feedback from a peer group, even if their senses was providing contradictory information. Another example is Stanley Milgram’s famous role playing experiments, where the participants lost all sense of normal reality and made role playing their primary reality. The transformation of Vineyard initiates into recognizer’s of God voice must largely be due to this pressure to conform to beliefs and expectations of the VIneyard congregation. Clearly, the conversation with God is happening inside the head of the congregationers. It is imagined. In this case, conceding and answering Dumbledore’s rhetorical question in the affirmative, thankfully, has no serious societal consequences, at least for now.