fbpx
Categories
Cerebral Musings Children Expert Blogs

The Predominance of Brain Dominance

On the threshold of a new academic year, parents and students are again confronted by the dilemma of career choices. But insights from neurological and behavioural sciences can help you make an appropriate choice.As schools and colleges reopen, those of us with an interest in brain development and behaviour are witness to, yet again, a stream of anxious parents and their wards seeking advice and support. Course and career choices that young people are about to embark on challenge the best equipped families and provoke considerable debate (and conflict). What is clearly apparent is that both parents and their wards have not, in most cases, prepared themselves adequately for these unique milestones.

We live in an aspirational society, where higher standards of achievement are generally, constantly, being set as the norm. Also one where success has acquired many new connotations! This has its effect on both parents and their wards. Many people set as targets for their children all those goals they wanted to achieve (or wish they had achieved) but couldn’t. Others are keen to ensure their wards follow in their own footsteps, in the belief that this will give them “a leg up” in their careers. What gets forgotten amidst these parental aspirations is that the child may not share these parental goals, nor have the aptitude and ability to see them to fruition. Youngsters too, influenced as they are by a changing society, sometimes set unreasonable targets for themselves; targets for which they may not necessarily have the ability, aptitude or at a pragmatic level, wherewithal. Peer pressure also plays on both parents and their wards. One often encounters otherwise relaxed parents degenerating into a state of panic at the thought of admissions and career choices. There is no doubt therefore that this scenario causes much distress to all concerned.

Help at Hand: A question that is not asked often enough is whether there is a science that will help us approach career and course choices logically. Today, neurological and behavioural scientists have a sophisticated understanding of human brain development and behaviour. Application of even working knowledge in these fields can help both parents and their wards. The concept of hemispheric dominance, i.e. which side of the brain has a more dominant effect in the concerned individual, is one example of how brain function may influence aptitude, learning, behaviour and consequently success.From a cognition perspective, people who are left brain dominant have a better verbal memory, better linguistic abilities, reasoning and logical skills and better vocabulary! From a behavioural perspective, these left brain dominant individuals tend to be more ideological and philosophical in their approach; more motivated by social and pragmatic, rather than emotional concerns; more diligent, purposeful, capable of greater tenacity and driven more often by a sense of duty. On the other hand, people with right brain dominance have a better visual memory, better perception of space, better appreciation of the fine arts, and greater creative ability. They also tend to be more mood and emotion driven in making their choices. As a consequence, they may work with inspirational bursts of energy, not for reasons of purpose, duty, outcome or workplace ethic alone. Those in the creative professions are commonly observed to have such predilections. Put simply, left brain dominant individuals think with their heads; those who are right brain dominant, with their hearts!

Plenty of Options: Can these concepts be useful in making course and career choices? Courses and careers that leverage on a person’s natural aptitude and ability are most likely to be enjoyed and to result in successful outcomes. Pre-eminent among these for the left brain dominant individual are careers that demand literary learning, verbal memory, logical reasoning and diligence; medicine, law, business studies, accounting and finance, computing, research, some humanity disciplines (philosophy, psychology, sociology, history, economics etc.), teaching conventional subjects, to name a few important choices. On the other hand a right brain dominant person may choose the fine arts, theatre, cinema, music, architecture, design, advertising and media, and a range of other careers that demand creative endeavour. Indeed, it may not be just in the choice of careers that brain dominance plays a role. Even within these professions, brain dominance may help define specialisation, role functioning and ability.Parents and their wards may therefore do well to consider these factors in making decisions about courses, careers ands the future. The rapid strides that we have made in economic and social development in urban India have engendered a certain egalitarian ethos in our work places and across professions. No longer does one have to be a doctor, lawyer, accountant, bureaucrat or manager in order to “succeed”. While these career choices remain rather more secure and acceptable across social strata, the career buffet that the young person is presented with today accommodates a range of aptitudes and abilities, with differences in qualification or educational endowment not really being reflected in the pay cheque, in the grossly discriminatory manner so familiar even a decade ago. Young people today have the option of starting work relatively early in life, with fewer formal qualifications, often being paid better for their efforts than older, more experienced and perhaps better qualified individuals in their own families. When such glasnost has percolated into the workplace, then pray why the angst and obsession about traditional and safe career choices? Why not just allow young people to make the choices their brains are dominant for; accepting thereby the predominance of brain dominance!

Facts:

  • Courses and careers that leverage on a person’s natural aptitude and ability are most likely to be enjoyed and to result in successful outcomes.
  • Reading the brain Put simply, left brain dominant individuals think with their heads; the right brain dominant, with their hearts! Why not just allow young people to make the choices their brains are dominant for? Both parents and wards are not prepared adequately to tackle these unique milestones.
Categories
Adolescents Adults Canine Neuropsychiatry Cerebral Musings Children Elders Expert Blogs Featured

Temperamental, Indeed

Life with my pet canines is not just joyful and entertaining; it reveals to me each day, profound neuro-scientific insights. Carlo, my German Shepherd, is a classic example of his breed; in looks and temperament. A “Master’s” dog, his life revolves around my routines. A glance in his direction, slight change in tone, low whistle, all will ensure his immediate compliance with “his Master’s” desires. Obedient and devoted to a fault, Carlo is also extremely high strung and anxious, alert to every change in his environment, and protective of it; so much so that I rarely catch him in fitful slumber. Blessed with an uncanny sixth sense for “his Master”, a trait that his breed is famous for, Carlo actually heads for the gate, minutes before my arrival at home from work. Not one to break rules, he will not enter a room or defile a piece of furniture, once forbidden. Natty and fastidious about his appearance, he remains shiny coated through the week, not an ounce of dirt on him, nor a doggy odour.

Unpredictable and Wilful: Contrast this with my later acquisition Coco, a Basset Hound. A handsome specimen with the classic sad and droopy face, jowls et al, Coco suffers from both occasional seizures and frequent mood swings. An approach in his direction, with best intentions, can evoke dramatically different responses: from a friendly, excited, tail-wagging welcome, to total loss of control; sometimes a resentful, even angry growl, bark or snap in the general direction of approach. Unpredictable mood swings from hypomania and hyperactivity to depression and profound apathy characterise his eventful existence. Disobedient, wilful and obstinate, he can be depended on to do exactly the opposite of what is intended, oblivious to “his Master’s” pleas, commands and threats. Indeed so agnostic is Coco of his surroundings that he can collapse like a sac, his numerous folds spread around him, in fitful slumber, no matter what the circumstances are. House rules mean little to this brat! Stride he will into any room at will, climb on any piece of furniture that strikes his fancy; and somehow manage at least once in each week to manifest for our benefit the pinnacle of filth; no part of the garden, however muddy, having been spared during his meanderings.

Not surprisingly, he emits a profound doggy odour so striking that dog lovers claim it should be bottled and sold (Chanel by Coco is our private joke). Guests without a fondness for canines, beat a hasty retreat from our abode when he decides to bless our company with his presence.

The contrasts in doggy behaviour become most apparent in our morning walk together. Carlo, the German Shepherd, needs no leash, walking three to four kilometres on the footpath that runs alongside arterial roads near our home. Rarely straying more than 10 feet from “his Master”, purposeful in his stride, nary a glance asunder, whatever the provocation, Carlo is the epitome of walking propriety, even his ablutions being timed for completion at a certain discreet spot.

Coco, the Basset Hound, on the other hand, treats the walk as a grand exploration of sorts; an opportunity to experience for himself this beautiful world that the good God has created. Constantly tugging at his leash in an angle perpendicular to the general direction of travel; sparing no human, animal or plant form en route from his nasal excursions, Coco is anything but purposeful about his morning constitutional, his ablutions being intermittent and erratic, intruding into the well directed journey of his fellow canine and Master, much to their combined annoyance. No order is heard, let alone obeyed; no single purpose complied with, other than that, which his doggie mind is set on.

My clinical experience in brain and mind matters has led me to conclude that Carlo, my German Shepherd, is left-brained and Coco, my Basset Hound, right-brained. The concept of hemispheric dominance, i.e. which side of the brain has a more dominant effect in the concerned individual, is one example of how brain function may influence behaviour and temperament.

Left brain dominant individuals tend to be more ideological and philosophical in their approach; more motivated by social and pragmatic, rather than emotional concerns; more diligent, purposeful, capable of greater tenacity and driven more often by a sense of duty.

On the other hand, right brain dominant people have a better appreciation of the world around them, greater creative ability; a proclivity for the finer aspects of life; and tend to be more mood and emotion driven in making their choices; both day to day ones and those that are life-defining. Put simply, left brained individuals think with their heads, the right brained with their hearts; and can be quite a study in contrasts, experiencing great difficulty understanding one another. Little wonder then that many professional and personal relationships run into rough weather; the two parties failing to understand each other’s contrasting preferences and predilections.

Unique Temperamental Attributes

Carlo and Coco have taught me that brain dominance is not an exclusive prerogative of the human race. And love them as I do, equally, I have learnt through them to celebrate rather than despair in these unique temperamental attributes conferred on us by our brain, that marvellous wonder of creation. To understand my family and friends better by observing their brain dominance. To choose correctly my activity companions: left brained for the purposeful and right brained, the hedonistic; and to tailor my expectations of them, appropriately. Carlo and Coco have enhanced my understanding of human nature; and thanks in part to them, I find myself at peace with my fellow men; well most of the time. It is a dog’s life, indeed!

Categories
Adults Elders Expert Blogs Featured

The Stress Vortex

The word stress, used loosely today in society, has many connotations and can imply a range of circumstances from ordinary workplace or familial dissonance to serious mental disturbance. Crucially, what starts off as a minimal disturbance in one sphere of activity can have significant ramifications that affect many life spheres, if left unattended.

Life and society in the 21st century are profoundly stress generating. While a range of reasons may be held responsible, central to all manner of stress genesis is “the yawning gap between expectation and reality”. Modern lives have spiralled unthinkingly into a vortex, driven by predominantly Western economic models: of unremitting desire, relentless aspiration, pursuit of material gain, needless and thoughtless consumption, transient and elusive fulfilment, and unfettered hedonism. Stress is a natural accompaniment, a constant companion, as new desires replace the old, and the gap between expectation and reality remains constant, if not ever-widening.

Can we escape this vortex? Reduce, even remove, the negative factors that perpetuate stress in our lives? Transform ourselves into that epitome of self-management that others look up to?

Sources of stress

The Psychological Conflict Hypothesis: The concept of a psychological conflict comes from Freudian thought and is believed to underlie emotional stress. Freud proposed that we have both an unconscious and a conscious mind and that there were inherent conflicts between the primitive urges (Id), the unconscious (ego, current awareness) and the feedback from the moral agency (super-ego). While Freud emphasised sexual urges, psychological conflicts are generally believed to have their genesis in the dissonance that can arise between our inner urges and socially permissible actions; a dissonance that may defy resolution.

The Self Actualisation Hypothesis:

Proposed by Maslow, it assumes that each individual has to ascend different steps of the self-actualisation pyramid. At the very bottom of the pyramid are the person’s survival needs; after which appear, progressively, security needs, social needs and ego needs in that order (see box). When all these needs are addressed to a significant extent, the person achieves a state of self actualisation, of fulfilment and being content with one’s lot. Stress is a constant companion at various points on the self-actualisation pyramid and disappears when self actualisation is achieved. However, Maslow’s rather utopian view of the lasting self-actualised state of being may not hold true in the fast-paced modern world, where events often outpace individual development in most unexpected ways.

The Locus of Control Hypothesis:

An important psychological construct used to explain the development of depression, an important consequence of stress is the locus of control hypothesis. It has been observed that rats placed in connected cages soon learn to avoid the cage that habitually gives them an adverse stimulus such as an electric shock. However, when the rat receives shocks in an unpredictable manner, it becomes listless, withdrawn and inactive, a state of “learned helplessness”. This has led to the understanding that internal locus of control (where the person feels in control of his circumstances) is protective from emotional stress; while an external locus of control (being controlled by one’s circumstances), makes one vulnerable to it. In the years of post-war industrialisation this phenomenon was recognised in “assembly line workers” who had little control over the nature or pace of their work and were expected to perform a repetitive task for hours on end. Interestingly, our much vaunted IT revolution has ushered in a new generation of “assembly line workers” who operate on international time and in response to international demands, often with little control over their workspace destiny.

The Coping Hypothesis:

One point which eludes us when we are in a stressful situation is that there are, usually, only two ways out. Take for instance the example of a very short-tempered boss who reacts without provocation. One can either attempt to modify the situation (i.e. bring about a change in the boss so that he loses his temper less); or one can modify one’s own expectations (i.e. accept that boss with his short temper and learn to work around it). No prizes for guessing which is the easier pathway here. It is often said for this reason

“when you cannot modify the situation, modify your expectations”.

Coping strategies are of two kinds: i. Problem-focused coping where the attempt is to short-circuit negative emotions by modifying, avoiding or changing the threatening situation and; ii. Emotion-focused coping where the attempt to moderate or eliminate unpleasant emotions by rethinking in a positive way. Some strategies employed include relaxation, denial and wishful thinking.

In many circumstances, both approaches are combined in the effort to overcome stress.

Preventing Stress

The prevention of stress is achieved through good self management. The key to self management lies in being mindful: of oneself and the world around. Inexorably linked with this mindfulness is developing a better understanding of oneself and one’s fellowmen. Caught as one is in the vortex of modern existence, mindfulness can often be elusive, as the roller coaster of life takes us from one event to the next.

The famous Tibetan Buddhist teacher and philosopher Sogyal Rimpoche differentiates the active laziness of the West whereby unimportant tasks become responsibilities, part of a rigid schedule, and begin to dictate one’s existence (appointments, schedules, waiting times); from the passive laziness of the East, hanging out in front of the roadside stall with film music blaring, watching the world go by.

Neither, he contends, is ideal; instead, he highlights the importance of spirituality and contemplation and the need for us to devote some time in each day to examining the deeper meaning of life. In his view “Our task is to strike a balance, to find a middle way, to learn not to overstretch ourselves with extraneous activities and preoccupations, but to simplify our lives more and more. The key to finding a happy balance in modern lives is simplicity.”

It must be noted that stress clearly has its benefits. Imagine if you did not feel stressed out in advance of an interview or exam; your preparation and performance are both likely to be sub-optimal. Some stress is therefore necessary in order for human beings to “survive”. Too much stress, on the other hand, can be unproductive, even wasteful; resulting in much negative energy being expended. What we must try and achieve, therefore, is a fine balance between ambition and motivation on one hand and equanimity of mind on the other. And, while we strive to control our own destinies, by being in control of our lives and circumstances, our destiny may have other plans, that we cannot fathom; plans that we must learn to accept and live with. Perhaps, therein lies the key to effective stress management.

Heart Facts:

  • Stress impacts on the heart: it can cause myocardial infarction (heart attacks) and sudden death. It can affect the regulation of your heart beat by the central nervous system.
  • The INTERHEART study investigated the relationship between chronic stressors and Myocardial Infarction in about 25,000 people from 52 countries. After adjusting for other risk factors, those who reported “permanent stress” at work or at home had double the risk for developing a heart attack (MI).
  • The broken heart syndrome , sudden ballooning of the heart apex (left ventricle) follows acute stress. Often there is no evidence of obstructive blood vessel disease. Episodes of intense emotional or physiological stress are reported prior to presentation and maybe the triggering factor. Even when intense bouts of emotion don’t kill, they may cause long-lasting heart damage.
  • The Whitehall II study found over a two-fold increased risk for new coronary heart disease in men who experienced a mismatch between effort and reward at work. High-risk subjects were those who were competitive, hostile, and overcommitted at work, in the face of poor promotion prospects and blocked careers.
  • Cardiac syndrome X affects women more; there is angina-like chest pain and a positive response to the treadmill test with normal heart circulation. Cardiac syndrome X patients report more depression, anxiety and somatic (physical) concerns; they also have better prognosis.
  • Depression is a primary risk factor for Ischemic Heart Disease and an independent secondary risk factor for Heart Attacks. Depression also has a direct impact on cardiac risk factors such as diabetes, hypertension and obesity. Depression after myocardial infarction more than doubles the risk of death and of another heart attack. People who suffer chronic anxiety are more likely than others to suffer heart attack. Emotional trauma such as the death of a spouse, mental or physical abuse, or post-traumatic stress disorder (PTSD) increases risk of heart attack.
  • People with Type D personalities (characterised by pessimistic emotions and inability to share emotions with others) and Type A personalities (characterised by anxiety directed outward as aggressive, irritable, or hostile behaviours) are more likely than others to suffer heart attacks.
  • Freud said that happiness comes when one has pleasure in love and work. Research shows that marital stress in women and both marital and work stress in men greatly increase the risk of death due to a cardiac event. A famous doctor has observed “where can he go if he is unhappy at work and at home?” The implied, if somewhat flamboyant, answer was always “to an early grave.”
Categories
Adolescents Adults Cerebral Musings Children Elders Expert Blogs

In a New Light

An exploration of Jiddu Krishnamurti’s well-documented ‘transformational’ experience that lead him to a state of god-intoxication.

Jiddu Krishnamurti! The name conjures up many images: benevolent soul who dominated the spiritual world; silver-haired seer with unparalleled vision and verbal felicity; educationist and thinker par excellence; institution builder; diminutive gentle giant with the unique ability to usher peace and joy into troubled lives and minds. In Toto, an enlightened soul, supremely in touch with himself and the world.

How did he evolve to this enlightened state? Was he born with a special mind? Was he transformed by experience, education and mentorship? Or, did he have a moment of spiritual awakening that changed his life forever, as his associates and biographers say? Unlike many world seers whose transformational experiences are hearsay, JK’s was well documented by those close to him at that moment. It is the subject of this exploration.

Well known, but worth recapitulating. Born to a poor rural Brahmin family in the now famous Rishi Valley area in Andhra Pradesh, JK moved to Madras as a young boy. Frail and unremarkable, he was spotted playing on the banks of the Adyar River by C.W. Leadbeater, an associate of Annie Besant, founder of the Theosophical Society. He came under their combined influence. Identified as “the chosen one” by them, he was told he should await the emergence of the master. His transformational experience occurred soon after. Noteworthy that he awaited “the Master” living in a beautiful place, surrounded by mountains.

The Turning Point: Described by his brother Nithya, who was with him during this period, the transformation begins with JK feeling ill; the sequence of events leading to the turning point is summarised in the box titled “The Prelude”.The setting for the transformation is described, “We were a strange group on the verandah. The sun had set an hour ago and we sat facing far off hills, purple against the pale sky in the darkening twilight, speaking little, and a feeling came upon us of an impending climax; all our thoughts and emotions were tense with a strange peaceful expectation of some great event”.JK is described as sitting under a roof of delicate leaves, black in a starlit sky. He is heard murmuring “unconsciously”; then a sigh of relief. “Oh, why didn’t you send me out here before?” This is followed by the weary repetition of a daily “mantra”. Then, silence.JK on the transformed mind: “I was supremely happy for I had seen. Nothing could be the same again. I have drunk at the clear and pure waters at the source of the fountain of life and my thirst was appeased. Never could I be thirsty, never more could I be in utter darkness. I have seen the light. I have found compassion, which heals all sorrow and suffering; it is not for myself but for the world. I have stood in the mountain top and gazed at the mighty beings. Never can I be in utter darkness. I have seen the glorious and healing light. The fountain of truth has been revealed to me, the darkness has been dispersed. Love in all its glory has intoxicated my heart; my heart can never be closed. I have drunk at the fountain of joy and eternal beauty. I am god intoxicated!”In a letter to Leadbeater written two days later, he goes on to say… “After August 20th I know what I want to do and what lies before me – nothing but to serve the Masters and the Lord. Now I feel I am in the sunlight with the energy of many, not physical but mental and emotional. My whole life, now, is, consciously on the physical plane, devoted to the work and I am not likely to change.”His words were, as the world later discovered, remarkably prophetic.

The Clinical-Science Perspective: The spectrum of symptoms during the prelude: pain, increased temperature, altered consciousness, exaggerated response to sound and touch (“exaggerated startle”) and repeated episodes of shaking with teeth clenched and fists closed indicate a seizure syndrome — an electrical storm in the brain. There are unusual features: quiet when comforted; quiet during mealtimes; having memory of the event and the ability to describe it later. All these are not normally encountered in a seizure syndrome. Was JK then experiencing psychosomatic symptoms: physical symptoms that have no physical cause and are underpinned by severe psychological stress?In this particular situation one must not forget that he was a mere slip of a boy, aged 16. He had been told that he was the “chosen one” and that he was to await “the Master”, a much anticipated event, both for him and those around him. Were his experiences brought on by the weight of collective expectation?He has said himself, “I wanted to meet with the Master as soon as I could. I thought about it every day but this was done most casually and carelessly. I realised where I was wrong and thereafter meditation became easy. I realised that there was a need to harmonise all my other bodies with the Buddhic plane (highest plane of consciousness) by keeping them vibrating at the same rate as the Buddhic. The main interest was to see Lord Maithreya and the Master.”Freud proposed that the human tendency is to repress emotional conflicts that are anxiety provoking and so the conscious mind cannot possibly contemplate them. Emotional repression results in these conflicts remaining firmly rooted in the sub-conscious mind. Inevitably, there are times when repressed emotions transcend to the conscious, but given their unacceptable nature, manifest as a physical symptom. Medical men term this “hysterical conversion”. These and other explanations for the events leading to JK’s transformational experience are outlined in the box titled “Neuropsychiatric Interpretations of JK’s Turning Point”.

Trinity Talking Eureka Moments: Should the clinician hesitate to make a diagnosis here? JK’s experience was not followed by any decompensation in mental faculties. Indeed, they were enhanced! He underwent a positive transformation and went on to occupy a special place in the world, beginning his journey as a spiritual leader. Further, the experience was not repeated; and it was both shared and documented; all of which render it less likely to be “a figment of the imagination”. JK is described by his biographers as being reticent in describing and discussing his experience, for a number of reasons that people have thought fit to attribute.

I for one wonder if transformational experiences reflect unique moments when one is in touch with one’s soul, that undeterminable part of the human psyche. Perhaps they represent a union between the brain (cognition), mind (emotion) and soul (realisation): a trinity talking “eureka” moment. Moments in which there is sudden clarity, often following a period of confusion and turmoil. Moments of insight, decision, and action.

Interestingly, both functional Magnetic Resonance Imaging (fMRI) and electroencephalogram (EEG) studies in Carmelite nuns, when they were “in a perceived state of union with god” have revealed activation of several brain regions concerned with emotion, memory and judgment, the temporal and frontal lobes and the connections that link them. It has also been suggested in these studies that personality rather than personal orientation may have a significant role in determining such experiences. Of course, what we do not know is whether these brain changes precede and therefore are presumably responsible for transformational experiences; or indeed whether they are the result of such a transformational experience.

The Transformed Mind: Transformational, life-changing experiences are well described among many seers, and often are a defining part of their reaching enlightenment. Our look at JK’s turning point indicates that they defy conventional paradigms of understanding in clinical science. Positive transformation in the JK mould may well require a very special and unburdened mind: sans expectation, dogma, and prejudice; explaining perhaps the early age at which many seers attained realisation. Perhaps, too, it needs in some instances, preparation, opportunity, encouragement and mentorship, all of which JK enjoyed. Most importantly, perhaps, transformation requires that Eureka moment, when the brain, mind and soul trinity are talking to one another!

Categories
Adults Cerebral Musings Elders Expert Blogs

A Fine Balance

Once again, in October, I had the privilege of attending Chennai’s international festival of short films on mental health, “Frame of Mind” organised by SCARF (the Schizophrenia Research Foundation India). My task was to interact with the audience after the Richard Gere film, “Mr. Jones” about an extraordinarily charming man with bipolar affective disorder (manic depressive illness).

The film begins with the protagonist wanting to fly off the high roof of a building he is working on. His childhood desire to fly — matched by his firm belief while in a manic state, about his ability to do so — makes a potent and heady combination. As he watches a plane fly overhead and prepares to launch himself off the roof in pursuit, he is saved by his colleague’s presence of mind, thus landing in a psychiatric treatment facility.

Being a Hollywood film it needs a heroine; in this case a female psychiatrist of Swedish origin, whose first encounter with Mr. Jones at the facility she works in, leads to his choice of her as his doctor. Even from the beginning the relationship develops along rather unusual lines. She recognises his problem as being bipolar disorder and that he needs continued treatment rather than discharge. Her attempt to convince the court that he must be held against his will, and treated, fails. She leaves the courtroom disappointed and frustrated, only to have him request a ride home, as he has no money.

Blurring lines: The lines become blurred as professional and client proceed to not only have lunch en route, they also end up having a most enjoyable afternoon together. While the film thus portrays the human being within the patient and the professional, it also serves to disappoint the professional viewer, as the very foundations of therapeutic relationships and of appropriate behaviours within their context come crashing down.The film follows Mr. Jones through a manic phase of illness during which he is seen withdrawing his entire bank balance in one go, proceeding to invite the rather pretty and flirtatious bank clerk for an afternoon of fun. Poignant moments in the film ensue: when asked about his mania he says, rather emphatically, “of course I am happy; I am ecstatic!” revealing his distinct preference for that euphoric state of mind. Another moment of truth is when he ticks off his psychiatrist for asking intrusive and personal questions, pointing out that it is rude to do so. That psychiatric illness is dehumanising and strips the sufferer of his dignity, even through these seemingly mature and civil interactions, is well brought out here.

Mr. Jones slips, (as he inevitably must) from the high of mania, into the depth of depression. His distress, despair and pathos are well brought out, moments of anguish being portrayed sensitively. Once again, however, the rather unusual client-therapist relationship comes to the fore.

In general, physical closeness between client and therapist is discouraged; a firm professional handshake being, perhaps, the only physical contact endorsed; children and the elderly being possible exceptions. Here, client and therapist share hugs rather freely and with complete abandon. His long stay in the treatment centre where his therapist works, allows us brief insights into the lives of other patients and therapists, their trials and tribulations. An act of violence against our heroine by another deluded inmate, and Mr. Jones’ extraordinary presence of mind in saving her, result inevitably in increased closeness.

Dealing with Rejection: It is only in cinema that a professional psychiatrist and a client admitted under her care go for a drive together, get drenched in the rain and end up making love. Nevertheless, these actions seem to bring about awareness in our heroine, about having crossed a professional line, and she seeks to remedy matters by discussing the situation with a professional colleague, taking herself off the Mr. Jones’ case.

Her rejection of Mr. Jones also brings to the fore earlier rejections by those he is intimate with, but who cannot deal with his bipolar tendency. She finds out that “Ellen”, his former girlfriend whom he often refers to as “dead”, is indeed alive. Mr. Jones merely deals with her rejection of him as “death”; death for him perhaps of an ideal, a persona; of hope and long cherished dreams. The tribulations of those who live with bipolar disorder sufferers come to the fore here.

Rather poignantly, the bank clerk who spent a roller coaster day with our protagonist visits his psychiatrist to enquire about his well being. Her inability to understand how such a remarkably funny, engaging and talented person like Mr. Jones could possibly be ill is common experience. While all of us experience some mood swings, they are usually in consonance with our circumstances and proportionate to them, which is not the case in bipolar disorder.

The film also brings out the common biological explanation for this condition, that it is due to a chemical imbalance in the brain, and that there is need for compliance with drug treatment, so necessary here. This failure of patients to be compliant with treatment, one of the greatest challenges in managing psychiatric illness, is well portrayed.

Issues to the fore: During the audience discussion, the ability of Mr. Jones to choose whether he needs admission or not; the long conversations and therapeutic sessions he has with his psychiatrist; the need for a court order for his treatment are issues that come to the fore. Many wonder whether such interactions are at all possible in the Indian context and indeed whether they exist.

Professionals in the audience hasten to point out that Hollywood has undoubtedly taken liberties, and that there are cultural differences between the American setting and ours; that civil liberties for the person with mental illness are common around the world, although lack of awareness and education lead to their being transgressed in low and middle income countries. The ongoing redevelopment of India’s Mental Health Act is also discussed.

The client-therapist relationship comes in for much discussion; professionals in the audience ruing the unfortunate tendency among filmmakers to portray such romantic relationships. A call to filmmakers for more accurate portrayals of mental illness and therapeutic relationships is made. However, the group also acknowledged that film, like other art forms, is a caricature and thrives on dramatisation and exaggeration. View it with a pinch of salt is the common refrain.

The film ends where it begins. Mr. Jones is on the roof again, although his dejection and despair make us wonder whether it is to fly with childlike abandonment, or to die in abject surrender. True to cinematic endeavour, the heroine arrives in the nick of time to save his life and the couple unite in romance, her professional vows seemingly a distant memory. Will Mr. Jones’ ever get better? Will his heroine ever get to practice psychiatry again; lose, as she will, her medical license for consorting with a client? Will they live happily ever after?

The viewer is left with these and other questions as this rollercoaster of a film ends. It does underline for us, clearly, the travails of bipolar disorder, the importance of mental equilibrium, and of maintaining in our lives, a fine balance.

Quick facts: Psychiatric illness is dehumanising and strips the sufferer of his dignity, even when interactions are mature and civil The failure of patients to be compliant with treatment, is one of the greatest challenges in managing psychiatric illness There is an unfortunate tendency among film makers to focus on romantic relationships between therapists and their clients.

Categories
Adolescents Adults Cerebral Musings Children Elders Expert Blogs Featured

The Entrepreneurial Mind

Many years ago, I remember watching a BBC program on the qualities of entrepreneurship. A diverse group of young individuals who did not know each other and had no knowledge of each other’s identity were being put through a series of tests, to identify secret entrepreneurs in their midst. One test stands out in my mind: the participants were asked to aim for and hit a target from a distance of their choice. Needless to say, the greater the distance from which one tried to accomplish the task, the more the rewards and indeed, the risks. Interestingly, the entrepreneurs in the group were the ones who chose to try from seemingly impossible distances. This appetite for risk is well recognized as being a quintessential entrepreneurial quality. But pray, what else characterizes the entrepreneurial mind? This is the subject of our exploration.

Five Minds!

Howard Gardner has described “the five minds” that are necessary for leadership. He begins with “the disciplined mind” acquired through years spent in scholarship, a craft or a profession, which he estimates takes the average person a decade to master. He prescribes that the disciplined mind emerges from consistent work done to develop skill sets and a knowledge base. This concept of “the disciplined mind” necessitates education and/or training, of course. But is education or training an essential pre-requisite for the entrepreneur? Many famous entrepreneurs have had very limited formal education, and in many instances have dropped out of the educational system, only to prosper. Famous examples of people who did not survive the educational system for a variety of reasons include Bill Gates, Richard Branson, Steve Jobs and our own Dhirubhai Ambani; all synonyms of successful entrepreneurship. So is education at all necessary for entrepreneurial excellence?

John Warrilow in a recent article identifies some reasons why an MBA may be bad for entrepreneurship.

1. Causal rather than Effectual Reasoning:

Entrepreneurs use effectual reasoning (they assess what resources they have and ask themselves what can be created) while conventional CEO’s use causal reasoning (they set goals and develop systematic plans to achieve those goals). MBA programs teach causal rather than effectual reasoning.

2. Adaptive rather than Innovative Thinking:

Adaptors are cautious and pragmatic. They take others ideas and try to innovate them, incrementally. On the other hand innovators overturn other ideas, challenge conventional concepts and are into big-bang thinking. MBA programs teach adaptive thinking rather than innovation, which is an entrepreneurial quality.

The advantages of the disciplined mind notwithstanding, one must address the question therefore, whether formal education is necessary for entrepreneurship, or whether indeed it is an impediment for success. John Warrilow points out that an MBA is bad for entrepreneurs also because “your classmates will not be entrepreneurs” and “you will waste 40% of your risk free years in a classroom”. It is a truism that the higher one climbs on the academic ladder, the more one usually has by way of formal employment opportunities, and the greater are the risks when one chooses to pursue an entrepreneurial venture in favor of well paid employment. Thus, too many years spent in education maybe a disincentive for risk, that important entrepreneurial quality. On the other hand it has to be acknowledged that formal education such as an MBA does bestow on one credibility, a critical element for entrepreneurial progress, at least in the early years. A doctor turned entrepreneur recently remarked to me, rather ruefully, that it took an ivy league MBA for people to be convinced about the seriousness of his entrepreneurial intent and ability.

Howard Gardner goes on to describe “the synthesizing mind” as learning to integrate disparate sources of information, identifying the links between them. Synthesis he says is identifying the jobs that need to be done and the people available to do those jobs. Synthesis is the identification of priorities and the way forward, balancing past visions with future aspirations. Synthesis enables one to examine new ideas in the light of one’s knowledge base. In this concept one needs the discipline of education combined with the ability to integrate disparate sources of information, an ability that usually comes with work experience.

Gardner then describes “the creating mind”, more a function of the leader than of the manager. Entrepreneurs are leaders and are generally bestowed with a strong sense of creativity, the ability to innovate and think out of the box. In general, the leadership of organizations require the development of compelling narrative, which then gets embodied in the leaders life. Good leaders (and entrepreneurs) are therefore expected to live by the principle “my life is my work; my work is my life” and to bring about changes to the lives of those

Categories
Adults Cerebral Musings Expert Blogs

Neurological Borderlands

In response to my attempts to discuss cognition and behaviour relating to a particular patient, whom I was presenting at a clinical case conference, a senior professor of neurology once said “I have little interest or belief in these modern supratentorial matters”. Although surprised and somewhat miffed, I took heart in the knowledge that I was not a stranger to this experience. The great father of cognitive and behavioural neurology, the legendary Norman Geschwind, is also reported to have had several similar experiences, when he set off on his journey exploring the brain, mind and cognition interface. Thanks to his brilliance, tenacity and the legions of pupils he managed to influence, the behavioural neurology interface that he gave life to is thriving today, in a way that he himself would have probably found unimaginable. Perhaps what surprised me most was that my own experience of rejection came almost three decades later, and the proponent was a neurologist somewhat junior to Norman Geschwind himself.Neurology is an academic specialty and one that has traditionally chosen to reside in ivory towers. Rather typical of this environment, many neurologists have been slow to accept and explore the rich interface that exists between their specialty and other aspects of medicine, science and indeed the humanities. However, both in the science and in the practice of medicine there exists many a rich example of such interfaces that occupy the borderlands of this great and noble specialty. In modern times the neuroscience arena has been revolutionised by advances in molecular and cellular understanding, neurogenetics, neuroimaging, neurophysiology, computational systems, neuropharmacology and other related areas of science and medicine.

Another quiet revolution has been taking place in neurology. Many centres world over have begun to develop clinical and research expertise in the interface between neurology and other areas of clinical medicine. Cognition and behaviour are now old examples of this interface that have advanced to becoming distinct specialties in their own right. Neuro-opthalmology, Neuro-radiology, Neuro-psychology and Neuro-rehabilitation are other examples of interface disciplines that have seen tremendous advances clinical, service development and research. Neuro-genetics, Neuro-epidemiology and Neuro-immunology are leading scientific disciplines today and have great prominence in academic institutions and specialist centres. Other emerging areas that are making progress, thanks to the efforts of individual clinician-academics, people of stature in different parts of the world, include Neuro-otology, Neuro-pulmonology, Neuro-cardiology, Neuro-gastroenterology, Neuro-urology, Neuro-oncology and Neuro-gynaecology etc. The momentum for such development has come mainly through interested clinician-academics in neurology and other branches of medicine, people with commitment, tenacity and foresight.

Significant contributions to these neurological borderlands have also begun to emerge in the research arena. A range of professionals from many scientific disciplines; biochemists, pathologists, microbiologists, pharmacologists, physicists and computational experts has begun to make inroads into neuroscience, often through major collaborative research programs. The humanities have not been left behind either with philosophers, psychologists, social scientists, behavioural scientists, linguists, nurses, health service professionals and many others taking part in interdisciplinary research at the neuroscience interface. However, despite these changes, the neurological borderlands remain largely ignored. The do not always form part of neurological curricula, nor do their proponents, laudable though their efforts, receive adequate attention as serious professionals in the neurological mainstream. Indeed, these specialists are often relegated to the very borderlands that they espouse and fail to find a befitting position within the rigid hierarchy of traditional academia, institutional or indeed that of learned societies.

In a world that is increasingly interdisciplinary, progress of any specialty is determined by its ability to incorporate and interface with the different disciplines that surround it: clinical, research and academic. The organisation and delivery of neurological services at the community level also demands a considerable interface between neurology and these borderlands, clinical, biological and psychosocial.  Such efforts must therefore transcend convention; beyond clinical work; beyond the biological sciences; beyond medicine and its specialties; to areas that appear peripheral but are nevertheless relevant. The neurological mainstream must develop an awareness and interest in these borderlands and make every effort to incorporate them in clinical, research and service development relevant to neurology. A failure to recognise this need to expand neurological horizons will only result in neurology failing to retain its rightful place under the sun, as the queen of medical specialties.

Categories
Adolescents Adults Cerebral Musings Children Elders Expert Blogs Featured

The Stranger In The Mirror

Mad Tales looks at the way Hindi cinema has portrayed human emotions, madness in particular, down the decades and what these caricatures tell us about ourselves as a society.In a country like India, where people idolise film stars and are influenced greatly by cinema, it is very important that issues like human emotion and mental illness are portrayed accurately and responsibly.

Mad tales from Bollywood, Professor Dinesh Bhugra, Maudsley Monographs number Forty-eight, Psychology Press, U.K.Art is often viewed as a caricature of society — an exaggerated portrayal of the life and times it evolves in. In no art form perhaps is this a greater truism than the world of cinema. Human emotion takes the centre-stage in most cinematic endeavour: from romance to war, epics, social drama and magical realism. Indeed, even the most Kafkaesque (or for that matter, Tarantinoesque) contribution, is fashioned around bedrock of human emotion.

Mad Tales from Bollywood (2006: Psychological Press, Hove, U.K.) is a unique effort by a London based academic psychiatrist of Indian origin, Professor Dinesh Bhugra. In this work he analyses from a cultural viewpoint the portrayal of human emotions and mental illness in Indian Cinema.

The book begins on a technical note, defining and introducing some basic terms and concepts. One of these, “The Other”, an individual who stands for something quite opposite to what we stand for, is of interest from the perspective of how mental illness and villainy are portrayed. How this other gets defined, vilified, criticised, made fun of, or rejected outright is crucial, as mental illness may be then viewed as a visitation, mitigating one’s responsibility for it and engendering greater acceptance of the sufferer.

The author explores the socio-cultural underpinnings of Indian cinema, paying attention to the extended family in Indian society with its attendant religious undertones. The use of song and dance in Indian movies, to convey emotions of love, passion, anger and hatred, with the protagonists often being far apart from one another, is dealt with in some detail. The roles of gender, social and class factors, besides that of patriarchal hierarchy, dictate how songs are used in Indian society. The new boldness that has swept Indian cinema halls, particularly in how sexual emotions are dealt with, is discussed here.

While in the yesteryears the coming together of flowers or butterflies would convey erotica, or indeed, such portrayal will be relegated to the vamp or coquettish mistress, there is today a sexual brazenness sweeping Indian cinema, reflecting the changing sexual mores of Indian society. The fact that the character played by Amitabh Bachchan in “Hum” could sing, “Jumma, chumma de de (kiss me…)” and the heroine in “Khalnayak” asked, “What is under your blouse?” reflects the social shift towards a more open acknowledgement of sexual desire and erotic thoughts.

Changing Landscape: The author traces the history of Indian cinema against the background of the changing political, economic, cultural and social landscape of the country, the hero being the focus of this exploration. In the 1950s and 1960s, several Muslim socials (as films with Muslim stories and characters were often called) of the time represented the zenith of that culture in Indian cinema. After the initial shock of the Partition, these films were placed very much in the Islamic context, and they exploited the culture of a bygone and much-mourned era. There was also a post-independence idealism that marked this period, many films with patriotic fervour being released at that time. The 1960s, widely regarded as the golden era, was characterised by a certain romanticism, with family and social melodramas, excellent lyrics and good songs that had wholesome family appeal. The hero was our aspirational ideal: good looking, vibrant and romantic. In the 1970s, the euphoria of independence had disappeared. The protagonist is shown as a marginalised individual whom the audience can identify with. He is much wronged and exploited, and has suffered physically, emotionally and psychologically. He does what we would like to do, but are prevented from doing because of social mores and our own private morals. Interestingly, this change coincided with the imposition of the “Emergency” in India and the widespread social disaffection this provoked in Indian society. This theme continued well into the next decade, with the portrayal becoming more prominent, aggressive and violent.

The dominance of the angry young man continued in the 1990s. However, his anger was no longer directed against society. Instead, it became a symbol of love. The roles of Shah Rukh Khan as the love-obsessed stalker in films like “Deewana”, “Darr”, “Baazigar” and “Anjaam” heralded the arrival of a psychopath who feels no remorse or guilt. Another theme that emerged in this period, which has continued in this millennium, is a new idealism involving young people with high aspirations and dreams, either in urban India, or often living abroad, but culturally conscious of their “Indian-ness”. This evolution, which coincided with economic liberalisation and globalisation, appeals both to the younger audience of Indians and to the Indian Diaspora. Family dramas and romance have made their reappearance reflecting also an interesting coexistence of tradition and modernity. Interestingly, the psychopath who engages in mindless violence (“Abhay” in Hindi, “Alavandan” in Tamil); the person with an explosive impulsive personality (Shah Rukh Khan in many films); the multiple personality disorder sufferer (“Manichitratazhe” in Malayalam; “Chandramukhi” in Tamil); all continue to engage our cinematic cultural consciousness, as do themes of marital jealousy and infidelity (“Astitva”), unusual relationships that transgress social class and mores (“Chandni Bar”, “Ek Chalis ki Local”); differences in age (“Jogger’s Park”, “Nishabdh”, “Cheeni Kum”) and other conventional barriers. Indeed, it could be said that Indian cinema has demonstrated the maturity to explore many an unconventional emotive theme, while continuing to remain curiously infantile in Toto, largely reflecting a male dominated parochial society.

Appalling Portrayal: The portrayal of madness in Indian cinema is appalling. Those with mental illness are clowns, feeble and weak. Those treating them are caricatures, all in white coats and, absurdly enough, they get the hero to face the truth by setting up situations, as a detective might. Prof. Bhugra reviews several Indian (mainly Hindi) movies to make this point. As in “Khamoshi”, the senior psychiatrist chairs a meeting with at least 10 other psychiatrists to decide whether the protagonist is insane or not. They take turns in asking questions to assess his mental state; with one psychiatrist (unusually) instructing him to keep his answers short and to the point. The interview is more like an inquisition with rapid fire questioning.

Illogical and unrealistic portrayals of mental illness in Indian cinema are highlighted here. The heroine, usually a nurse or, more recently, doctor, makes it her life’s mission to “cure” the mentally ill protagonist, often going far beyond the call of her profession; more alarmingly, often breaching clinical ethics by falling in love; the submission of the heroine to many a risky assignation in order to diagnose or identify the cause of the protagonists madness; the explosive climax which puts all including the protagonist at risk of losing life, limb and sanity; the ward filled with several mentally ill people, most engaged in some ridiculous form of repetitive activity (running around, body rocking, asking the same comical question repeatedly, staring into space) all of which reduce mental illness to a caricature; the delivery of treatment in a most unethical, unacceptable and unrealistic manner etc. without discussion or consent, etc. The common thread that binds these cinematic situations together is that they are designed to shock the viewer and dissociate him from mental illness, making the mentally ill person the classic “other”. Indeed, Western films too share the tendency to portray mental illness and its treatment unrealistically, resulting in worldwide misconceptions about the role of the psychiatrist and psychiatric treatments. Electroconvulsive Therapy (ECT) or shock treatment as it is popularly referred to, has suffered and been demonised in particular due to its unrealistic portrayal in cinema. People are often given ECTs when fully conscious and sitting up, a most unusual practice, not in the armamentarium of any right thinking psychiatrist.

Curiously, however, there is also a humanism that is often conveyed through this bizarre portrayal. The nurse is often portrayed as having genuine empathy for her patients while remaining fiercely loyal towards the doctor, resulting in an emotional conflict (for her). The patients appear to form a closer network and, to their minds, “the other” is obviously the hierarchy and the establishment.The chronological approach adopted in this book enables the reader to study the evolution of Indian cinema over time, to comprehend the change in perception and portrayal of various subjects including mental illness over the decades and how the changes in politics, economics, culture and society affect changes in cinema, ensuring that he leaves no ambiguity in conveying his findings.

The films that Dr. Bhugra has made references to are popular, decade-specific contributions that attracted large audiences in their respective times, were influenced by the social climate of the country, and in turn influenced society as well. The cumulative effect of viewing film after film is the creation of a mental warehouse full of internal stereotypes stored in the preconscious and unconscious memory banks. He calls for more studies on the influence of external factors on the way films are conceived and made, so that a more accurate picture of mental illness can be projected by cinema, which is a rather powerful medium influencing public opinion.

Deceptive Title: The title of the book and of its many constituent chapters is deceptively light hearted and in some ways does not do justice to it. This book is a comprehensive and scholarly analysis of the gamut of philosophical, psychological, social and cultural issues associated with human emotion (including mental illness) in Indian cinema, dealt with in a serious, theoretical manner. The book does largely limit itself to Hindi cinema save a few references to regional contributions. The author draws on a vast theoretical and academic base to convey his point authentically. The wide array of references ensure that the book is a storehouse of information not only for cinema buffs and mental health professionals, but also students across the spectrum of humanities.In a country like India, where people idolise film stars and are influenced greatly by cinema, it is very important that issues like human emotion and mental illness are portrayed accurately and responsibly. With the great mass of Indian cinema audiences being highly vulnerable to the influences of this medium, accurate and responsible attempts at portraying human emotion and mental illness are necessary, as also avoiding portrayals that trivialise and dehumanise important disorders of the mind. However, as the author has pointed out rather eloquently, the trivialisation of madness in India cinema may in itself be a reflection of the liberal, forgiving and largely tolerant society that we are!

Categories
Adults Cerebral Musings Expert Blogs Featured

Inspirational Genius

When we refer to our minds, we often touch our hearts, or our heads. Yet, the mind as a physical entity, one that can be localised in a scan for example, does not reside anywhere in the human body. Our feelings, thoughts and emotions do — they are represented in our brains. To try and unravel this conundrum, let us take a computer analogy. When we consider cognition and behaviour, our brain is the hardware, the equipment and processes that make computers work. On the other hand, the mind is an operating system that draws upon the hardware but does not have significant physical representation, much like the software in our computers. The mind, therefore, is a virtual entity, one that reflects the workings of the neural networks, chemical and hormonal systems in our brain.

Having accepted that the brain and the mind are a unitary organ with diverse functions, it becomes imperative that we consider the “soul”, traditionally an esoteric and controversial concept. A noun variously defined as “psyche, inspiration and energy”, the soul has many synonyms in the English language. Where the soul resides is, however, a matter of conjecture; a question that is both difficult to answer and difficult to objectively experiment on. However, if one were to consider “the soul” as the vital force that inspires, energises and stimulates us, then it may be possible to study its manifestations and effects in all human activity having those qualities.

The possibility that one could study the soul by associating inspirational human experience, religion, music, poetry and literature, with the brain, is tantalising to say the least. In his book The Soul in the Brain, Michael R. Trimble, Emeritus Professor of Behavioural Neurology at University College of London, expounds the neurological correlates of such inspirational human experiences that were once considered to be the exclusive purview of the heart. Trimble commences his book with the words, “If you fear that opening your mind will cause your brain to fall out, then this book is not for you. If you are unhappy discussing neuroscience in the context of poetry, music and, above all, religion, then again this text cannot be recommended.”

Basis of Emotions: Trimble begins by exploring the brain anatomy of human emotion, implicating the Limbic System as the seat of human emotion. Seated deep within the brain and consisting of a network of critical structures, the Limbic System is the oldest part of the mammalian brain. There is considerable data today from brain imaging studies to show that this part is closely associated with emotional disorders. For example, the Amygdala, a multinucleated structure intricately connected with many brain parts, has been shown to both vary in size and to have different levels of neurochemical activity in various emotional disorders. The Amygdala is today the focus of much of the brain research that is concerned with human emotion and emotional disorders. Expounding on the neurobiology of emotion beyond these structures, Trimble discusses their links with other critical brain areas. He quotes extensively from the work of 20th century experts who have contributed to our understanding of emotional brain function, exploring brain anatomy beyond limbic structures that has a role in human emotion.

Poetry and literature are areas that Trimble explores at some length in this book. He describes how the use of the language of poetry and metaphor produces heightened activity of the right hemisphere of the brain. Pointing out that certain neuropsychiatric conditions have strong associations with specific creative pursuits, he draws attention to the links between literary creativity and Bipolar Affective Disorder (Manic Depressive Illness), an association strangely not witnessed with another major mental illness, Schizophrenia. He quotes extensively from the works of several poets with Bipolar Affective Disorder such as William Cowper (1731-1800), Robert Lowell (1917- 1977) and Anne Sexton (1928-74). For example, Anne Sexton, who frequently took drug overdoses and finally committed suicide, wrote:

Anne Sexton

Sleepmonger,
deathmonger,
with capsules in my palms each night,
eight at a time from sweet pharmaceutical bottles
I make arrangements for a pint-sized journey.
I’m the queen of this condition.
I’m an expert on making the trip
and now they say I’m an addict.
Now they ask why.
WHY!
Don’t they know that I promised to die!
…
Yes
I try
to kill myself in small amounts,
an innocuous occupation.

One cannot help but draw a parallel with the famous Tamil poet of the Indian independence movement, Subramanya Bharathi, who was renowned for his extraordinary creativity, intermingled with profound emotionality supplemented by generous doses of nationalistic and religious fervour (see box). Indeed, the creative human brain has perhaps an excessive proclivity for emotionality; quite understandably, given that creativity is often inspired; and inspiration in all forms requires feeling!

Another Meeting Ground: Religion is another area that exemplifies this meeting of the “trinity”. Most dictionaries describe religion as “a way of life”; religious beliefs, practices and experiences have a strong cultural basis in their evolution. It seems inconceivable therefore that religious experience may have its basis in the brain. However, why are some people more intense in their practice of religion, while others are considerably less enthusiastic; or why do one’s religious attitudes, beliefs and practices change during one’s life span? Can this be explained by sociocultural factors alone, or are there more inherent biological determinants of these behaviours? For example, there are considerable differences in how siblings experience and practise religion even though their sociocultural ethos are similar, and we witness the entire spectrum from intense religiosity to strong agnostic tendency within a family.

Further, religiosity is an important component of many brain and mind disorders. The depressed, anxious or avoidant individual is almost desperate in his pleas for religious salvation, rather different from the intense ritualism of the person with Obsessive Compulsive Disorder.

The religious ecstasy of the person with mania is qualitatively different from the prophetic fervour of the person with paranoid schizophrenia or temporal lobe epilepsy. The hyper-religious individual with temporal lobe epilepsy has on occasion been described as a dramatic persona complete with religious symbols and a prophetic fervour, with an unshakeable belief that his existence had a special purpose for the world we live in. In his chapters on “Neurotheology”, Trimble also quotes patients with epilepsy, dementia and head injury who have religious experiences. The triad of hyper-graphia (the keeping of copious and detailed notes and diaries), hyper-religiosity ( an increased interest and practise of religious matters) and hypo-sexuality (a diminished interest in matters sexual) is well described in the syndrome of temporal lobe epilepsy; especially in long standing and poorly controlled patients with recurrent temporal lobe epileptic seizures. It is accompanied by an obsessional and viscous personality. Trimble points out that while the note taking and diary keeping is copious, it lacks, unlike the poetry of the person with bipolar disorder, creativity and appeal. This fundamental difference may reflect the different brain substrates that underlie these conditions.

“The content of the writing from hypergraphic patients with epilepsy often reflects religious or mystical themes.” (Roberts, Robertson, and Trimble, 1982.)In his chapter on “Music and the brain” Trimble brings out the emotional nature of musical language.

‘Plato considers that music played in different modes arouses different emotions… Major chords are cheerful, minor ones sad; the ups and downs of life…”

While music and the brain is a topic that has been covered widely elsewhere, the uniqueness of Trimble’s contribution is in developing the links between the brain, mind and music. Pointing out that music and poetry have the unique ability to bring one to tears, often as part of a state of ecstasy, he goes on to explore the brain processes that may mediate emotional crying, which he points out as being a uniquely human experience. Why are we, the human race, so moved by art, poetry and music that we are reduced to tears, not those of sorrow, but of elation and ecstasy? In Indian lore, musical saints and savants are often described to reach states of ecstasy in the development or indeed deliverance of their favourite compositions, usually in praise of their favourite lord. The great composer Thyagaraja attained this state in the worship of Lord Rama; Purandaradas in the worship of Vitobha; Bharathi in the worship of his favourite Parasakthi; the list is indeed long. What brain and mind processes lead to these states of intense devotion and creative focus, combined with religious fervour?

The Creative Half: Trimble in his book quotes many studies that implicate right hemisphere activity in musical perception. It is widely understood that the right hemisphere is the “creative half” of the human brain. Interestingly, the right hemisphere also happens to be the emotional hemisphere. That right hemisphere dominant individuals are both creative and emotional may explain why those engaged in artistic pursuits express both qualities in ample measure. There is an impression among clinicians that Bipolar Affective Disorder (Manic Depressive Illness) is for example over represented in the creative professions; the biological basis for this may well rest in the right brain. Trimble himself has pointed out that the relationship between the brain and aesthetic experiences, rather than being the rule, may indeed be exceptional: “… not all patients with bipolar disorder become poets, of course nor are all poets manic-depressive” (p. 106). Further, it may be erroneous to conclude that these experiences belong to the brain alone. The mind, while an abstract construct in this the 21st century, remains an important part of clinical and scientific lore. The contributions of the mind to poetry, music, art and religion cannot therefore be ignored. Trimble’s work is commendable as a rare attempt to relate the highly technical specialty of neuroscience with something as abstract as art and in doing so fills an important void in scientific and popular literature.“The neuroscientific community has generally shown little interest in exploring the finer aspects of human behaviour and thought, especially aesthetic experience and creativity.”

Tangible Markers: Intellectual debate about where the soul resides is likely to continue for eons. Through this important work we understand emotional experience and creative pursuits are vicarious markers of the human soul. We may then develop a persuasive argument that a critical mass of brain structures and their connections are associated closely with these vicarious markers of the soul. While this does not prove that these critical brain structures are where the soul does indeed reside; not even that the vicarious markers are a true soul representation; it is an important scientific link between profoundly moving human experience and the brain. One could still argue that the soul does not necessarily reside in the human brain and that we do not have adequate “proof of this concept”. Which does of course leave us asking, “Pray, just where doth the soul reside”?

Everyday Relevance: What is the relevance of “Trinity Talking” concept to our lives, you may well ask. All of us come across people in society who excel in their creativity. Obviously these individuals have inspirational periods when their mind, brain and soul are in sync! The more productive the individual and the more evocative her/his productions, the more frequently is their “Trinity Talking” may well be one explanation. Indeed, going beyond the creative pursuits to other professions and trades, every one of us will possibly have at least one moment in our life, profession or vocations when we experience this spark of “enlightenment”, however brief. In these periods there is sudden clarity that often follows a period of confusion and turmoil. In these periods we often make momentous decisions and take definitive actions that may have an impact on our whole life. In these periods we experience true “self actualisation”. One may contend that the more frequent and more sustained these experiences, and more willing the person to explore and follow up on them, the more successful and productive he is. Clearly these are precious moments when our thoughts, beliefs and emotions meet with.

Categories
Adults Cerebral Musings Children Expert Blogs

The Inside Man

Personality is a term with many varying connotations, depending on the context of usage. It is a term that may be used to denote a celebrity (a public personality of figure), one’s character and temperament, or the way one comes across to others (he or she has a good personality). In medical and psychological parlance, however, personality is used to denote “those characteristics of a person that account for consistent patterns of feeling, thinking and behaving”; unique and enduring patterns of behavior and emotional response, which make us distinct individuals.

It seems rational to assume that one’s personality is a product of one’s upbringing and experience. We often cluck our tongues disapprovingly and say “Poor boy, with a disturbed background like that, how else would you expect him to behave” or indeed to warmly suggest, “One would expect no less from her; after all she comes from such a good family”. Psychological research seems to support these social assumptions that we regularly make. There is little doubt in the notion that our personalities are in good measure a product of our upbringing, the positive and negative experiences we have in our lives, the human interactions that influence us, and the patterns of emotional response we consequently develop.But is that all? Can every aspect of the human personality be explained on the basis of upbringing and experience? Do disturbed families yield disturbed children who may then grow up into disturbed adults only because of environment? Or are there genetic and other biological factors that influence these developments? Indeed, why do some people from very disturbed backgrounds remain stable and productive, while others from seemingly stable backgrounds display enduring disturbances in their ways of thinking, feeling and behaving? These are questions that continue to befuddle us.

Localising Mind and Brain Interactions: Given the mind does not exist as a physical entity and is widely regarded as the software (the Brain being the hardware), it seems self evident that disturbances in brain function would have an impact on our mind (and possibly vice-versa). Surely, any affectation of these brain systems is likely to have an influence on our personality? Surely, also, our personalities are likely to result from biological imprints in our brain, imprints that lead to the very consistent patterns of thinking, feeling, and behaving, making us the individuals we are?Perhaps the earliest attempt to link human temperament with the brain was “Phrenology”, the study of the human skull, its characteristics, and the correlation of these with various aspects of behavior, emotion and temperament. From this time emerged also what has become an enduring tradition in clinical neurology practice; repetitive and careful observation and documentation of patients: the symptoms they described, and the signs that were manifest during the clinical examination, an approach that yielded excellent descriptions of emotions, behavior and temperament in brain disorders. Correlating these with studies of brain biology using brain scans, genetic, chemical and hormonal studies etc., and autopsy data, has improved our understanding of mind-brain interactions. The personality in neurological disorders such as epilepsy is now relatively well documented, and we are able to build models linking different brain structures with typical behavioral patterns that are observed in these disorders.

A Tale of Two Personalities: While there are several striking descriptions in the literature of personality changes associated with brain disease, the illness in which classic personality features are well described is epilepsy, providing a template to understand the neurological contributions to human personality. Epilepsy is a paroxysmal disorder that often begins in childhood or adolescence, and may continue throughout a person’s life. Epilepsy is characterised by recurrent seizures or fits, usually involving loss of consciousness, fall, jerking of the limbs, clenching of the jaws, injury (often tongue bite), and incontinence (involuntarily urination and/or defecation). Epilepsy may, however, also manifest in partial or minor forms as involuntary movements or repetitive behaviors of which the person is unaware or partially aware. The illness which begins as short circuit in normal brain activity is commonly characterised as primary or secondary generalised: primary generalised epilepsy arises from a central pacemaker in the brain and secondary generalised from a distinct part of the brain (usually a lesion or scar) later spreading to involve other parts (generalising). Distinct personality types are described in the two different forms of epilepsy: the obsessive-emotive personality of temporal lobe epilepsy and the labile-disinhibited personality of juvenile myoclonic epilepsy.

The Obsessive Neurotic: One of the most striking descriptions of personality in neurology is in patients with epilepsy that arises from the temporal lobes. The temporal lobes are located on either side of the brain, roughly in the area beneath the ears and are the seat of human memory and emotion. It has been shown in a number of studies that disturbances in this region can result in striking behavioral or cognitive (memory, attention etc.) change.An American neurologist, Normal Geschwind, widely regarded as the father of behavioral neurology, described specific personality features in people with temporal lobe epilepsy. These include:

  • A tendency to write copiously (but not necessarily in a creative way) and to keep voluminous diaries (Hypergraphia)
  • A tendency to be overly religious, often in a ritualistic manner, out of keeping with the person’s family/ cultural background (Hyper-religiosity)
  • A tendency to have a decreased interest in sexual matters (Hypo-sexuality)
  • A tendency for anxiety and obsessionality; to dwell on minor matters and to experience difficulty in terminating social intercourse (emotional viscosity or stickiness)
  • An increased interest in spiritual or ideational issues in the absence of pragmatic interests
  • Turbulent emotions — irritability, agitation, anxiety, restlessness, paranoia etc.
  • Mood swings, commonly spells of depression with occasional elation
  • Psychotic and quasi-psychotic phenomena; transient hallucinations, delusional thinking etc. occurring on and off

These personality traits have been described mainly in people with chronic temporal lobe epilepsy that failed to respond to anti-epileptic drug therapy. We must remember the vast majority of people with temporal lobe epilepsy are honest, conscientious, sincere and upright members of the community they live in, these positive qualities being aided perhaps by the personality traits described. Only in a small proportion of people, usually those with severe epilepsy, do these traits become severe and/or disabling. In some way therefore, these are probably the behavioral manifestations of the pathology in the brain that most often underlies temporal lobe epilepsy, sclerosis of a part of the temporal lobe called the hippocampus. The hippocampus is a small organ, no larger than a finger joint, which is the storehouse of memory and is located on either side, deep within the brain. Adjacent to it is the amygdala, a multinucleated structure that is believed to play a substantive role in human emotion. There is evolving literature that suggests a role for these structures in various disorders of the mind, schizophrenia and depression for example. One may argue that both behavioural and brain dysfunction are varying manifestations of a common underlying abnormality in brain biology. In disorders like temporal lobe epilepsy the patterns appear to be surfacing early providing the basis for enduring behaviour patterns i.e. the personality.

The Eternal Adolescent: In contrast to the person with Temporal Lobe Epilepsy, the person with Juvenile Myoclonic Epilepsy (JME) has been described as the eternal adolescent by Dieter Janz, the legendary German neurologist who first described the condition in the 1950s. Juvenile Myoclonic Epilepsy is characterised by myoclonic jerks; sudden jerky spasms of the limbs, even the whole body, which might even result in objects flying out of the person’s hand. These myoclonic jerks also have potential to generalise and manifest as a full blown seizure. Further, people with JME also suffer from “absence” periods, when they appear out of touch, albeit briefly, and “photosensitivity”, the sensitivity to flashing lights, these provoking myoclonic jerks or even a seizure episode.Describing the personality of people with JME, Janz and Christian found them to be of average intellectual ability with a tendency to “promise more than they can deliver”. They went on to describe the personality of people with JME as follows. “They often appeared self assured and bragging, the girls and women coquettish, but they only act decidedly mistruthfully and are timid, frightened and inhibited. Their labile feelings of self worth lead them to be both eager to help, to invite, to give, on the one hand and to be able to act in an exaggeratedly sensitive way on the other hand. Their mood changes rapidly and frequently. This makes their contact both charming and difficult. They are easy to encourage and discourage, they are gullible and unreliable. Their suggestibility makes contacts easily but makes trust difficult. This personality profile plays along a scale from likeable nonchalance or timidity, through a psychasthenic syndrome to the extremes represented by sensitive or reckless psychopathy.”In the clinic setting, treating the person with JME can often be an exasperating experience. They seldom follow through on instructions; often break rules willfully; for example, despite knowing that lack of sleep may provoke seizures, they favour late nights. They may be irregular with their epilepsy medication to the point of recklessness. They may show disinhibition in their patterns of interaction, political correctness not being their strength. Indeed, the person with JME demonstrates many features of frontal lobe dysfunction, emphasising the importance of this part of the brain in social behavior.

From Brain Circuits to Personality Traits: This tale of two personalities in epilepsy indicates clearly the differential role of frontal and temporal brain circuits in human personality development and change. Temporal lobe dysfunction underlies dominant obsessional neurotic personality traits and frontal lobe dysfunction, immature eternal adolescence. To assume, however, a direct impact of these brain circuits on behavioral patterns may be simplistic, as today, the brain is conceived as working in circuits (a sum of parts). However, these observations help establish a general principle that the brain has considerable impact, not only on the behavioral state of a person (current or ongoing dysfunction), but also on behavioral traits (enduring temperamental patterns).What is striking about the personality features in epilepsy is that they become established rather early in the person’s life (much like the illness, which often begins in childhood or in adolescence), and are not only personality changes consequent to progressive brain disease or brain injury as in Stroke, Multiple Sclerosis and Parkinson’s disease. They do therefore reflect to a large extent, the natural history of personality development in the human being, and are probably a product of both brain biology and life experience.

The Inside Man!: In highlighting the epilepsy example, it must be borne in mind that the severe personality changes in epilepsy are an exception rather than the norm; and are confined to a small proportion of people with difficult-to-treat epilepsy. Importantly, however, the changes in epilepsy described herein help us understand the biological underpinnings of the human personality, clarifying for us a role for nature, beyond nurture.One wonders if all personality traits have their biological imprints in the brain; that dominant personality trait patterns in each one of us merely reflect the pre-dominance of brain circuits? One may argue that both the behavioral and brain dysfunction in epilepsy are varying manifestations of a common underlying abnormality in brain biology. If that were true, then pray what role doth life experience have in shaping our personalities, you may well ask. Would not a lifetime of coping with the trials and tribulations of illness have an impact on the personality? Would the disability, physical, psychosocial and pragmatic that chronic illness confers on a person, not influence the personality, towards neurotic obsessionality or carefree adolescence? And pray, what lessons do these models have for understanding the personality of people without neurological illness? A plethora of questions assails us and begs for answers; answers that current medical and scientific knowledge do not possess.As medical technology evolves and we begin to visualise brain circuits in action, using techniques like Functional MRI, MRI Tractography and Positron Emission Tomography (PET), we expect to see the links between brain biology and human behavior unravel further. Perhaps, in time, we will all understand this “inside man (or woman)”; the personality that resides in our brains. In the interim, conditions like epilepsy are windows through which we can view the brain and mind. And view the brain and mind we must with compassion and understanding; without stigmatisation; combining science with medicine; cleverness with common sense; knowledge of medicine and the art of clinical practice; all the while thanking people with epilepsy for enhancing our understanding of the brain and mind.

BUDDHI CLINIC PRIVATE LIMITED © 2023 All rights reserved​

POWERED BY BLUSTREAM

Book An Appointment

Appointments
at Buddhi Clinic

We'll ask for some basic information to assess your care needs.