5

Response-Based Neurology in Psychiatric PracticeRobin Routledge, MD

2

Summary

• The brain is a response to the world.

• The brain is in a systemic balance with the world it perceives. It has many adaptations to context.

• These ideas show responses to extreme adversity are not illness.

Neuron shapes

TOO COMPLICATED

schematic of a neuron

In Middle Out

schematic of a neuronal system

One neuron

Another neuron

schematic of a hundred billion neurons

schematic of a hundred billion neurons

schematic of a neuronal and environmental system

Nervous system

Environment

Mind is social

Mind emerges from interaction between brain and environment

Bateson: Mind and Nature

Human sensation

• Vision* Light* Colour* 3D

• Hearing * Volume* pitch * location

11

Human sensation

• Touch* Size* Shape* texture

• Temperature* Pain* Fast* slow

12

Human sensation

• Taste

• Smell

• Stretch

• Joint position

• vibration

13

Human sensation

• hormone levels• Satiety (grehlin,

leptin, PYY, GLP)• Carbon dioxide • Arterial Pressure

Maintaining the machine

Autonomic control

Hormones

immune response

inflammation

15

Purposeful awareness of perceived sensation is

Mindfulness

Making meaning

local sensation suppresses sensation around it

15

• Competing maps of three dimensional space are assembled from combined sensations and given a sense of time.

Making meaning

16

Making meaning

More than one organization or meaning is generated. These are like competing virtual realities.

17

Making meaning

One “representation” (Plato) suppresses other versions around it.

Making meaning

Making meaning

20

• Networks of neurons located in different parts of the brain hum together like guitar strings. They assemble chords.

20

2121

Certain parts make special contributions but remain interdependent

22

• The brain is split in two halves with very little communication between them.

• Each half organizes perception very differently and the difference allows a subtlety of perception.

22

Making meaning

Memory

1. The brain does not recall exactly. 2. Memories are stored better if they

are emotional.3. Memories are recalled differently

depending on the circumstances at the time of recall.

Brain Action

Parts of our brain cooperate to number

and to name things. These actions

(calculations and language) are like

actions we take on our external world.

25

• “Mirror cells” fire when we see another person do something we understand. Mirror cells act as though we are doing what we perceive the other to be doing.

• This sense of the other may be the foundation of compassion.

26

• The social smoothness of physical

movements is coordinated by the

most foreword part of the frontal

cortical lobes.

• This part of the brain can modify

amygdala’s warning of danger.

27

neuroplasticity

Neurons constantly replace or prune connections. They do this in response to how they are used. So if you do something different, they will slowly make new connections.

28

neuroplasticity

The brain is like a hedge

29

An opening in a hedge

neuroplasticity

30

Summary•The brain is a response to the

world.

•The brain assembles representations of the world.

•The brain adapts to the circumstances it selects.

30

31

Psychiatry is itself a response

a response to current culture

it started with the beginning of industrialism

Psychiatric classification began in the asylums

32

the Psychiatric History of “Trauma”

1. da Costa American Civil War

2. Shell Shock World War One

3. Combat Fatigue World War Two

4. Brain Washing Korean War

5. Post Traumatic Stress Disorder Vietnam War

6. Trauma Informed Care current theory

7. Response Based Care future theory

33

.

Some Brain responses to adversity

Physical Readiness

Option One:•increased muscle tone•increased heart rate•increase breathing•lubricated armpits•increased pupil size (more light in)•Harder to poop or pee

36

Physical Readiness

Option Two:•loss of skeletal muscle tone•decreased heart rate•decrease breathing•decreased pupil size (less light in)•poop and pee

Some Brain responses to adversity

37

Some Brain responses to adversity

Cognitive Readiness•numbed/calm emotional response•heightened alertness & vigilance•altered perception of time•rapid review of meaning of context•evaluation of social “representations”•weighing alternative strategies/tactics

34

Expressed Emotion (EE) studies

show social response to terrible

things has a powerful influence on

outcome. * ”social” as the brain sees it

Social* responses to adversity

schematic of a neuronal and environmental system

Nervous system

Environment

36

Conclusion

• The brain is responsive.

• It grows in the direction it is used.

• The brain is in a systemic balance with

the world it perceives. It has many

adaptations to context. 36

41

ReferencesAPA formatting by BibMe.org.

Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine Books. Bateson, G. (1979). Mind and nature: a necessary unity. New York: Dutton. Berkowitz, R., Coplan., Reddy., & Gorman. (2007). The human dimension: how the prefrontal cortex modulates the subcortical fear response.. Rev Neurosci., 18(3-4), 191-207. Blackmore, S. J. (2005). Consciousness: a very short introduction. Oxford, UK: Oxford University Press. Blackmore, S. J. (2005). Conversations on consciousness. Oxford: Oxford University Press. Damasio, A. R. (1999). The feeling of what happens: body and emotion in the making of consciousness. New York: Harcourt Brace. Darby, D., & Walsh, K. W. (2005). Walsh's neuropsychology: a clinical a pproach (5th ed.). Edinburgh: Elsevier Churchill Livingstone.

42

References

Das, P., Kemp., Liddell., Brown., Olivieri., Peduto., et al. (2005). Pathways for fear perception: modulation of amygdala activity by thalamo-cortical systems.. NeuroImage, May(15;26(1)), 141-148. Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD), Darlinghurst, NSW, Australia

EDGE: MIRROR NEURONS. (n.d.). Edge.org. Retrieved May 25, 2013, from http://www.edge.org/3rd_culture/ramachandran/ramachandran_p1.html

Gerhardt, S. (2004). Why love matters: how affection shapes a baby's brain. Hove, East Sussex: Brunner-Routledge.

Goleman, D. (2006). Social intelligence: the new science of human relationships. New York: Bantam Books.

Greenfield, S. (1997). The human brain: a guided tour. New York: Basic Books.

Greenfield, S. (2000). The private life of the brain: emotions, consciousness, and the secret of the self. New York: John Wiley & Sons.

Heekeren, H., Marrett., & Ungerleider. (2008). The neural systems that mediate human perceptual decision making. Nature Reviews Neuroscience, 9(June), 467-479.

43

References

Levitin, D. J. (2008). The world in six songs: how the musical brain created human nature. New York: Dutton.

Lewontin, R. C. (1992). Biology as ideology: the doctrine of DNA. New York, NY: HarperPerennial.

McGilchrist, I. (2009). The master and his emissary: the divided brain and the making of the Western world. New Haven: Yale University Press.

McGraw, J. (n.d.). Ramachandran on Consciousness: Neuroscience as Philosophy. Ramachandran on Consciousness: Neuroscience as Philosophy.

Retrieved May 25, 2013, from www.aistpain.it/en/files/CONSCIOUSNESS/Neuroscience_Ramachandran.pdf.aist-pain.it/en/files/CONSCIOUSNESS/Neuroscience_Ramachandran.pdf.

Neisser, U. (1976). Cognition and reality: principles and implications of cognitive psychology. San Francisco: W.H. Freeman.

Ramachandran on Consciousness: Neuroscience as Philosophy. (n.d.). Ramachandran on Consciousness: Neuroscience as Philosophy. Retrieved May 25, 2013, from www.aist-pain.it/en/files/CONSCIOUSNESS/Neuroscience_Ramachandran.pdf

44

ReferencesRamachandran, V. S. (2004). A brief tour of human consciousness: from imposter poodles to purple numbers. New York: Pi Press.

Russell, S. A. (2006). Hunger: an unnatural history (Pbk. ed.). New York: Basic Books.

Shea, M. (2005). The brain: a very short introduction. Oxford: Oxford University Press.

Shubin, N. (2008). Your inner fish: a journey into the 3.5-billion-year history of the human body. New York: Pantheon Books.

Siegel, D. J. (2007). The mindful brain: reflection and attunement in the cultivation of well-being. New York: W.W. Norton.

Taylor, J. B. (2009). My stroke of insight. London: Hodder Paperbacks.

Thomas, B. (2012, November 6). What’s So Special about Mirror Neurons? Guest Blog, Scientific American Blog Network. Scientific American Blog Network. Retrieved May 25, 2013, from http://blogs.scientificamerican.com/guest- blog/2012/11/06/whats-so-special-about-mirror-neurons/

Vaughn, Christine, and Julian Leff. "Expressed Emotion In Families. By J. Leff And C. Vaughn. (Pp. 241; Illustrated; £19.95.) The Guilford Press: London. 1985.." Psychological Medicine 17.03 (1987): 794.