Jayne Jubb

The ST36 Zusanli acupuncture point is located just below the knee joint. This spot in mice—and it is hoped perhaps in humans—may be a critical entryway to gaining control over the often fatal inflammatory reactions that accompany systemic infections. Sepsis is one such infection. Sepsis arises when the body’s response to an infection damages its own tissues and organs. It can lead to shock, multiple organ failure, and death, especially if it is not recognised early and treated promptly. Between one-third and one-half of all sepsis patients die. It remains worldwide the primary cause of death from infection. Antibiotics can control sepsis-related infection, but no current drugs (in the USA) have FDA approval for counteracting the runaway immune response.

Researchers at Rutgers University Medical School reported online in the top scientific journal Nature Medicine on February 23 that stimulating ST36 Zusanli with an electric current passed through an acupuncture needle activated two nerve tracts in mice that led to the production of a biochemical that quieted a sepsislike inflammatory reaction induced in mice.

The finding, which also involved the collaboration of several institutions, raises the possibility that knowledge derived from alternative medicine may provide a means of discovering new nerve pathways that can regulate a variety of immune disorders, from rheumatoid arthritis to Crohn’s disease. If future studies achieve similar results, acupuncture might be integrated into the growing field of bioelectronics medicine—also called electroceuticals—that is generating intense interest among both academics and drug companies.

Clues from Acupuncture

Luis Ulloa, who headed the study at the Center for Immunity and Inflammation at Rutgers, has spent more than 10 years researching how nerve signals control immune function. Following the suggestion of a Mexican colleague, he realised that it might be worth testing whether acupuncture could help discover some of these much sought neuroimmune pathways.

Ulloa and his team used electroacupuncture to stimulate the ST36 Zusanli acupuncture point in 20 mice exposed to lipids and carbohydrates from the outer membrane of bacteria, producing an inflammatory response that mimics sepsis. Another 20 rodents received “sham” electroacupuncture in which nonacupuncture points were stimulated. Half of the mice in the first group survived, whereas all the sham-treated rodents died. A similar survival difference was noted with two groups of mice exposed to a cocktail of microbes in the gut.

Researchers then began to analyse the nerves and organs involved. They traced a pathway beginning in a branch of the sciatic nerve, not far from ST36 Zusanli, that relayed a signal to the spinal cord and then the brain. Once processed there, it was sent down to the vagus nerve, finally reaching the adrenal glands, which produced the key anti-inflammatory agent, the neurotransmitter dopamine. Ulloa’s team set about confirming the parts of this biological wiring diagram by removing independently sections of the key nerves and the entire adrenal glands. Cutting out of any one of these links in this newly discovered neuroimmune circuit abolished electroacupuncture’s anti-inflammatory effects.

The researchers also succeeded in stopping inflammation by using a drug called fenoldopam (Corlopam), which acted as a stand-in for the adrenal-produced dopamine in mice who had the glands surgically removed. Having a drug at hand might be essential because the adrenals in many sepsis patients function poorly, which makes them unsuitable candidates for acupuncture therapy.

The Rutgers work with acupuncture might be a relatively non-invasive means of performing neuroimmune stimulation and researching the interaction between the nervous and immune systems. Studies such as the one from the Rutgers group could help establish a physiological mechanism to explain why acupuncture might work as a treatment.

Testing Ancient Treatments

Acupuncture still has its critics at various ends of the medical spectrum. Some acupuncture supporters perceive a study on sepsis as a case of Western medicine finally conferring a belated blessing on techniques that have been accepted treatments for thousands of years. Skeptics of alternative medicine, meanwhile, criticise any investigation of acupuncture as a waste of limited research money on a folk remedy for which a firm scientific basis will never be found. Steven Novella, president of the New England Skeptical Society, characterises the sepsis study as having merely shown that a nerve responds to the application of an electric current. “Electroacupuncture itself is not a real entity, in my opinion,” he says. “It is just electrical stimulation. Doing stimulation through an ‘acupuncture needle’ is meaningless—it’s just a thin needle. There’s nothing that makes it an acupuncture needle. And there is no evidence that acupuncture points exist at all.”

For his part, Ulloa had no intention of trying to determine whether flows of vital energy, or qi, were making their way through the body’s “meridians” based on the interpretation for how acupuncture works in Chinese traditional medicine. In fact, he agrees with Novella’s argument about nerve stimulation. In the study, the researchers found no anti-inflammatory effect when a toothpick was used to probe ST36 Zusanli, in a manner similar to the way acupuncture needles had been inserted for centuries before the advent of electroacupuncture.

As a prospector for neuroimmune pathways, Ulloa insists his interest in exploring acupoints in his research has not flagged. He has found that it is no coincidence that all acupoints but one—360 of 361 described in humans—are located in the proximity of a major nerve. Ulloa. In his study, ST36 Zusanli led directly to the discovery of one of the most intricate neuroimmune circuits found to date. Instead of testing millions of potential points, they apparently reasoned that acupoints may provide an advantage in stimulating neuronal networks more efficiently.

A few days after the acupuncture paper in Nature Medicine appeared, a study published in Science Translational Medicine documented that a component of the herb Salvia miltiorrhiza (red sage), another hand-me-down from the Chinese traditional medicine pharmacopeia, also turned out to have potent anti-inflammatory properties. The researchers from leading institutions who wrote that paper were taking the same path as Ulloa and his team, attempting to test whether an ancient treatment had through trial and error turned up some biological effect or therapeutic potential that could be subject to a rigorous testing regimen in the laboratory.

In both reports, the authors were following the dictates that top-flight journal editors, article reviewers—and the skeptics themselves—endorse for evidence-based medicine. This type of study will probably be more the exception than the rule. These same journals might never publish on feng shui — and the acupuncture entries in their pages might still be relatively scarce – but if scientists studying acupuncture or herbs can cross the high bars set by the scientific establishment, then the future looks bright for the increasingly scientific anchoring of several areas in alternative medicine.

References:

• Dopamine Mediates Vagal Modulation of the Immune System by Electroacupuncture. Rafael Torres-Rosas et al. in Nature Medicine. Published online February 23, 2014.
• A Zebrafish Compound Screen Reveals Modulation of Neutrophil Reverse Migration as an Anti-inflammatory Mechanism. Anne L. Robertson et al. in Science Translational Medicine, Vol. 6, No. 225, pages 225–229; February 26, 2014.
• Can Acupuncture Curd Killer Immune Reactions? Gary Stix in Scientific American Mind, Vol. 25, No. 3, pages 24-25; May/June, 2014.

Neurosurgeon Ivar Mendez of the University of Saskatchewan often shows a video clip to demonstrate his work treating Parkinson’s disease. It features a middle-aged man with this caption: “Off medications.” The man’s face has the dull stare typical of Parkinson’s. Asked to lift each hand and open and close his fingers, he barely manages. He tries but fails to get up from a chair without using his hands. When he walks, it is with the slow, shuffling gait that is another hallmark of Parkinson’s, a progressive neurological disorder that afflicts an estimated one million Americans, most of them older than 60. Then the video jumps forward in time. The same man appears, still off medications. It is now eight years since Mendez transplanted dopamine cells from a fetus into the patient’s brain. These neurons, which live in a midbrain region called the substantia nigra and secrete the neurotransmitter dopamine to initiate movement, are the ones that die off in Parkinson’s. The man has aged, but his energy and demeanor are characteristic of a much younger man. Asked to do the same tasks, he smoothly raises his arms high and flicks his fingers open and shut rapidly. Arms crossed on his chest, he rises from a chair with apparent ease. Then he struts down the hall.

In the 25 years since the first few patients received transplants as part of a clinical trial at University Hospital in Lund, Sweden, hopes of using cell-based therapy as a treatment for Parkinson’s have repeatedly risen and then been dashed. Stem cells are a biological raw material of enormous potential because they can generate new cells through the ability to divide indefinitely and to give rise to specialised cells. These cells can then be used to repair brain damage from degenerative disorders such as Parkinson’s. Stem cells, however, have been hard to come by. So far the cells transplanted in humans have been derived from aborted fetal tissue, although scientists have also transplanted stem cells derived from human embryos into animals. Thorny political and ethical issues limit access to both fetal cells and embryonic stem cells, and fetal cells are in particularly short supply. Two large clinical trials using fetal tissue, published in 2001 and 2003, were considered failures because of their widely variable results; not enough patients improved by the study end points, and some developed serious side effects. Many scientists gave up on cell therapy.

But a handful of laboratories persevered. Now new evidence showing that transplantation can work well, as in Mendez’s patient, and possible new sources of cells free of ethical concerns have sparked a fresh optimism. This year neurologist Roger Barker of the University of Cambridge will lead the first large clinical trial of cell therapy for Parkinson’s in a decade.

The momentum most likely will propel cell therapies for other disorders as well. Researchers are trying to apply the technique to more than a dozen diseases, including diabetes, spinal cord injury and several forms of cancer. In addition to Parkinson’s, the most significant progress has been made with retinal diseases. Clinical trials are under way to use retinal pigment epithelial cells for treatment of macular degeneration. According to the California Institute for Regenerative Medicine, theoretically there is no disease to which stem cell therapy could not be applied. In each case, the requirements depend on the difficulties inherent in generating the specific type of cell scientists hope to replace.

Progress in Parkinson’s has been particularly promising. The debilitating movement difficulties characteristic of the disease have a relatively straightforward cause: dopamine loss. And researchers were able to generate dopamine neurons from stem cells quite quickly. Cell therapy typically leads to restored mobility and function—improving patients’ gait, for instance, and reducing tremor—but does not ameliorate every aspect of Parkinson’s. Patients may still suffer from dementia, gastrointestinal problems and sleep disorders, for instance. Yet in the best-case scenario, patients could gain 20 to 30 years of excellent quality of life with a single intervention and require virtually no medications. The disease itself is not cured, but the natural history of Parkinson’s disease is transformed.

Delivering Dopamine

A mild tremor in the hand or some other extremity is often the first sign of Parkinson’s. Tremors are followed by rigidity in the muscles, a stooped posture and the distinctive difficulty walking first described by James Parkinson in 1817. The movement difficulties relate to the loss of a dopamine neuron called A9 in the substantia nigra, which among other things controls the initiation of motion. By the time the first tremor appears, patients have already lost about 70 percent of those A9 neurons.

Since the 1960s Parkinson’s has been treated with medications that replace missing dopamine in the brain. L-dopa is a dopamine precursor, and doses of this small molecule cross the blood-brain barrier and enter brain cells, which convert L-dopa into dopamine and release it. Other drugs, known as dopamine agonists, stimulate dopamine receptors in the absence of the neurotransmitter, thereby mimicking its effects. The medications improve parkinsonian symptoms, but their benefits diminish over time, and they carry side effects such as alternating periods of mobility and immobility and the emergence of additional jerky movements.

In the 1990s clinicians developed an alternative therapy called deep-brain stimulation (DBS), the surgical insertion of an electrode that delivers electrical pulses to directly alter neuronal activity in a specific area of the brain. The treatment can work well. At the University of California, San Francisco, for example, 45 to 70 percent of patients who receive DBS for Parkinson’s improve. Yet over time, patients begin to decline again because the electrode stimulation can no longer compensate for the continuing loss of dopamine. Cell-based therapy, in contrast, is designed to directly restore the cells lost in the disease process.

The earlier large clinical trials of cell therapy suffered from multiple problems. For example, it now appears that some of the patients selected were too old and their disease too advanced to get good results. Instead of infusing a substance containing a single type of cell, surgeons transplanted chunks of tissue, which included other material that triggered immune reactions. The procedure itself was conducted differently by every team. Moreover, the end points for the studies were too short—neither was more than two years—for the transplanted cells to take full effect.

Of the patients who have received cell-based therapy for Parkinson’s, those transplanted by Mendez’s team have done best. Mendez began transplanting fetal cells into patients in the late 1990s, when he was at Dalhousie University in Nova Scotia. He improved the preparation of the cells by treating them to encourage growth and creating pure cell suspensions instead of transplanting chunks of tissue. Using a computerised injector that he developed to standardise the process, Mendez targeted two brain areas instead of one—the substantia nigra, where dopamine cells naturally originate, and the putamen, which their axons need to reach. All 10 of his patients improved significantly on the standard Parkinson’s rating scale, which measures the course of the disease. In a separate postmortem analysis of five patients published in 2008, Mendez and Isacson, who have been collaborating for about 10 years, found that the grafted neurons survived without signs of degeneration for as long as 14 years.

New Kinds of Cells

The biggest remaining challenge is obtaining enough viable stem cells. The fetal cells implanted to date have been harvested from the midbrain of an aborted fetus aged six to nine weeks. Such stem cells have already differentiated into dopamine neurons yet retain the capacity to generate more new neurons after transplantation. Still, fetal cells are not the answer. Politics aside, there will never be enough for all the patients who would need them.

Another possibility emerged in 1998, when cell biologist James Thomson of the University of Wisconsin–Madison and his colleagues derived the first embryonic stem cell line. They were working with the blastocyst of a human embryo, a brief early developmental stage when the ball of cells contains an inner clump of 20 to 30 cells that are capable of growing into any of the more than 200 types of adult cells in the body. Unlike fetal tissue cells that have started down the path to differentiation, these so-called pluripotent stem cells have the potential to produce any type of tissue in the body.

Thomson’s team removed those cells and nurtured them in the lab so that they divided. The result was an infinitely renewable lab-maintained source of stem cells—a cell line—that would not require further new embryos. The ethics were still complicated by the original use of embryos, but suddenly large- scale cell-based therapy seemed achievable. The challenge was to coax those embryonic stem cells to develop into the specific cells needed to treat a disease—dopamine neurons for Parkinson’s, for instance, or insulin-producing cells for diabetes.

Also in 1998 Isacson’s group reported that it had done just that in mice. The researchers differentiated A9 neurons from mouse blastocysts. When they injected those cells into a mouse brain, they found that the cells lived and formed connections with the other neurons in the brain. In 2002 his group showed that the same procedure restored movement and mobility in a rat with a drug-induced version of Parkinson’s. Several other groups achieved similar recovery in rodents. Immediately researchers tried to create A9 neurons from human embryonic stem cells—but that step proved more difficult.

A breakthrough with an alternative approach came in 2007, when the team of biologist Shinya Yamanaka of Kyoto University in Japan figured out how to create stem cells from an adult’s own tissues. Beginning with adult mouse skin cells, Yamanaka’s team “reprogrammed” the cells biochemically, driving them back to something resembling an embryonic stem cell, which could then be used as a basis for deriving a totally different kind of body cell, such as a neuron.

In essence, Yamanaka’s group had found a way to create a limitless supply of stem cells from adult skin cells, thereby sidestepping the political and ethical issues that surround research with embryos. The accomplishment won Yamanaka the 2012 Nobel Prize in Physiology or Medicine. Furthermore, if the cells, which are called induced pluripotent stem cells, always originate with the individual patient being treated, the considerable risk of immune rejection would disappear. They solved a very big problem.

Newly Nimble Monkeys

A year after Yamanaka’s discovery, Isacson’s team showed that it could create A9 dopamine neurons from such reprogrammed adult rodent cells. The scientists soon began putting the new cells in mice and rats with signs of Parkinson’s, and in 2008 they reported improved function. Then they turned to nonhuman primates. Working with a monkey with drug-induced Parkinson’s, Isacson’s group harvested the monkey’s skin cells, drove them back to an embryonic state, then differentiated them into dopamine neurons and put them into the monkey’s brain. For two years, they monitored the monkey. In results presented at conferences late in 2013, they showed that according to PET scans the grafted dopamine neurons had survived and grown. About eight months after the transplant, the monkey’s motor disorder ceased. A postmortem analysis showed that the new neurons had made connections with other neurons throughout the brain area where they had been grafted.

The same year two other groups also reported success with adult-derived stem cells and monkeys, including the lab of cell biologist Su-Chun Zhang of the University of Wisconsin–Madison and Yamanaka and his colleague Jun Takahashi. All three groups have demonstrated that the graft can survive, can differentiate into the right type of cells and then can integrate into the brain structurally.

Isacson’s monkey is the only one to be observed for a longer period—two years—and to have shown functional recovery. The researchers are pursuing longer-term studies with more monkeys to convincingly show both safety and efficacy. Clinical trials could follow, possibly within a few years, say Mendez and Isacson, who are convinced that these adult-derived cells are the future.

Others are still betting on embryonic stem cells. In 2011 Studer’s lab successfully differentiated human embryonic stem cells into dopamine neurons. When grafted into a mouse, rat or monkey with parkinsonian symptoms, these cells now survive and lead to recovery of function. Studer recently received a $15-million grant to perfect his technique and generate cell lines based on GMP (good manufacturing practice) guidelines. In parallel with the work manufacturing large batches of cells, he plans to begin lining up patients for a clinical trial, most likely the first to use embryonic stem cells.

One reason for sticking with embryonic stem cells is regulatory. Cells are not a drug, and they are not a device. So what are they? To date, stem cells have been regulated by line—a set of renewable cells that are cultured in one lab and deemed safe. If stem cells are produced for individual patients—using the full potential of the newest technology—and still are required to follow the same approval process as existing stem cell lines, the therapy would be cost- prohibitive. One solution is to approve a generic induced stem cell process rather than separate lines. Another answer, which sacrifices some immune response benefits, would be to create a bank of up to as many as 500 regulated stem cell lines derived from adult tissue, which could, according to Isacson, be genetically matched to 75 to 90 percent of the population.

Revolutionary Treatment

In his upcoming trial, Barker’s team of collaborators will implant stem cells into the brains of 20 patients in Europe and follow 130 other patients whose Parkinson’s is progressing naturally. Learning from past procedural mistakes, the scientists are still using fetal tissue but have tightened the selection of patients, improved tissue preparation and placement, and rethought the length and follow-up for the multicentre trial. The TransEuro study is intended to provide proof of the principle that cell therapy can consistently repair the brain. The importance is the process, which is the stepping-stone to the next generation of cell- based therapies.

Despite its theoretical superiority, populating the brain with new dopamine cells is not yet obviously better than existing treatments such as DBS, which brings faster results. In addition, other treatments in development may prove feasible. For example, in early 2014 researchers at Imperial College London reported promising results from the first gene therapy trials for Parkinson’s patients. In this treatment, doctors insert genes for dopamine-producing enzymes into the striatum, a part of the mid-brain that contributes to movement control.

Many researchers believe, however, that the remaining hurdles in producing and validating stem cell therapy can be cleared for Parkinson’s. These are the first steps in what could be a revolutionary treatment.

References:

• Fetal Dopaminergic Transplantation Trials and the Future of Neural Grafting in Parkinson’s Disease. R. A. Barker et al. in Lancet Neurology, Vol. 12, No. 1, pages 84–91; January 2013.
• Induced Pluripotent Stem Cell–Derived Neural Cells Survive and Mature in the Nonhuman Primate Brain. M. E. Emborg et al. in Cell Reports, Vol. 3, No. 3, pages 646–650; March 28, 2013.
• Therapeutic Application of Stem Cell Technology toward the Treatment of Parkinson’s Disease. K. Nishimura and J. Takahashi in Biological and Pharmaceutical Bulletin, Vol. 36, No. 2, pages 171–175; 2013.
• The Regenerating Brain. L. Denworth in Scientific American Mind, vol. 25, No. 3, pages 59-65; May/June 2014.
• California Institute for Regenerative Medicine: www.cirm.ca.gov

‘Music soothes the savage beast’ as the old saying goes. Music is an intrinsic part of our lives from the song playing when you had your first kiss, to music you revv yourself up with (or calm yourself down with) before you have a stressful meeting. As many of you are packing up to go on holiday this month (the schools have just broken up for the summer in the Amsterdam area), I thought I’d bring you some interesting new research about the effect music can have. But first a quickie lesson in the brain areas involved in music….

Music and Language, Intertwined

The brain activity for music and language is enormously complicated, and researchers are still trying to determine how the brain handles each process. Below is a sampling of what we do know: Areas in the frontal lobe (orange) help us learn the rules that govern language and music, such as those for syntax and harmony. Regions in the temporal lobe (green) help us perceive and understand sounds, such as the meaning of words and melodies.

The auditory cortex (blue) appears to have distinct music and language roles: the left auditory cortex is important for decoding and discriminating different aspects of speech, whereas the right auditory cortex is more involved in perceiving the pitch and frequency of sound. The insula (red) processes rhythm, perhaps in subtly different ways, for both music and speech. And the corpus callosum (grey) is larger in the brains of musicians, suggesting that musicians require greater communication between the two hemispheres.

Singing Your Way to Fitness

Chain-gang chants, military cadences, sea shanties: humans have long paired music making with intense physical exercise. Now research confirms the power of the combination: working out seems easier while producing music, according to a small study published in the Proceedings of the National Academy of Sciences USA.

In the study, half of the participants made music while working out by using software that turned their movements into tunes. These exercisers exerted equal force while pumping iron as did people who merely listened to music during exercise. Yet the music makers used less oxygen during their routine—a measure of exertion— and they also felt they were working less hard than those who just listened.

Music production may make exercise easier by activating so-called emotional motor control, posits Thomas Fritz, a postdoctoral fellow at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig and the study’s lead researcher. Emotional motor control is responsible for spontaneous actions such as a genuine smile; deliberate motor control, in contrast, implements purposeful action (such as a fake smile). Activating this more efficient system, Fritz says, may be as easy as singing along or pumping iron in rhythm with the tunes in your exercise playlist. So time to hum along with your playlist while you are jogging…..

Pain Presto Relief

Forget grapes and ‘Get Well Soon’ cards—hospitals may soon begin handing their patients MP3 players to speed their recovery. A study at Our Lady of the Lake Regional Medical Center in Baton Rouge determined that ambient music therapy had a positive effect on postoperative patients’ recovery by improving pain management and decreasing the negative effects of environmental noise.

In this study, patients who had undergone surgery for cancer all received standard nursing care. Half of them also got a preprogrammed MP3 player with ambient music—songs without words, played at less than 60 decibels—and were encouraged by nurses to listen for at least half an hour after they took their twice-daily medication. Before treatment, all the patients had similar levels of anxiety, pain and irritation at the amount of environmental noise. Three days later patients who listened to the ambient music said they were able to better manage their pain and were less annoyed by hospital noise, whereas patients without music experienced no change, according to the study in Nursing last fall. Many of us already turn to music to help with emotional pain; these findings suggest we might want to try listening as a salve for physical pain, too.

Music Helps Children Read

Today a symphony of research trumpets the many links among language, reading and music, including several that reveal a connection between rhythm and reading skills. Nina Kraus of Northwestern University has discovered a possible explanation: the brains of good beat keepers respond to speech more consistently than the brains of people whose toes do not tap in time. After testing 124 adolescents for beat-keeping ability, the researchers used an electroencephalogram (EEG) to eavesdrop on teen brains as the consonant sound “da” was played repeatedly. With every “da,” the brains of beat keepers responded consistently, even when there was background noise or while they watched television. The brain waves of poor beat keepers, however, were all over the place. The study helps to explain why music may hold a key to improved reading. Because reading ability, in general, relies on making a connection between the sounds of letters and symbols on a page, music provides another avenue into learning. Through music, you learn to pay attention to important sounds. The inconsistent sound processing shown by the poor beat keepers makes that difficult. If you have an auditory system that automatically is able to efficiently pull out sounds that are meaningful, it’s going to be important not just for music but for speech.

Fighting Poverty with Pianos

Scientists have observed that reading ability links with socioeconomic status. Yet music might help close the gap, according to Nina Kraus (the same lady as above) and her colleagues at Northwestern University.

Kraus’s team tested the auditory abilities of teenagers aged 14 or 15, grouped by socioeconomic status (as indexed by their mother’s level of education, a commonly used surrogate measure). The researchers recorded the kids’ brain waves with EEG as they listened to a repeated syllable against soft background sound and when they heard nothing. They found that children of mothers with a lower education had noisier, weaker and more variable neural activity in response to sound and greater activity in the absence of sound. The children also scored lower on tests of reading and working memory.

Kraus thinks music training is worth investigating as a possible intervention for such auditory deficits. The brains of trained musicians differ from non-musicians, and they also enjoy a range of auditory advantages, including better speech perception in noise, according to research from Kraus’s laboratory. The researchers admit that this finding could be the result of preexisting differences that predispose some people to choose music as a career or hobby, but they point out that some experimental studies show that musical training, whether via one-on-one lessons or in group sessions, enhances people’s response to speech.

Most recently Kraus’s group has shown that these effects may last. Kraus surveyed 44 adults aged 55 to 76 and found that four or more years of musical training in childhood was linked to faster neural responses to speech, even for the older adults who had not picked up an instrument for more than 40 years. Maybe time to go and pick up my clarinet and oboe again during the summer months…..?

Alleviating Alzheimer’s

Many studies have found that familiar songs enhance mood, relieve stress and reduce anxiety in patients with Alzheimer’s, perhaps because musical memory is often spared even when a patient has declined to a low level of cognition. Two new studies find that familiar music also improves cognitive symptoms in the disease.

Familiar music may be a safe and effective way to help patients with Alzheimer’s become more self-conscious, which improves overall mental processing and leads to a more accurate examination of the world.

In a study published in September 2013 by Eva Arroyo-Anlló of the University of Salamanca in Spain and her colleagues, patients listened to either familiar or unfamiliar music three times a week for three months. Those who heard tunes they knew showed an immediate improvement in identity, mood, moral judgment and body awareness—elements of self-consciousness that are adversely affected by Alzheimer’s. Those who listened to unfamiliar music scored worse on all measures except body awareness.

The researchers also administered a common exam for dementia to test the patients’ overall cognition. The group who heard familiar music sustained their scores over time, whereas the group who listened to unfamiliar music faltered significantly. According to the investigators, these findings are yet one more reason that caregivers should provide patients with music from their past.

One of the most devastating aspects of Alzheimer’s is its effect on patients’ ability to recall life events. Several studies have found that music helps to strengthen these individuals’ autobiographical memories, and a paper in the November 2013 Journal of Neurolinguistics builds on these findings by exploring the linguistic quality of those recollections.

Researchers instructed 18 patients with Alzheimer’s and 18 healthy control subjects to tell stories from their lives in a silent room or while listening to the music of their choice. Among the Alzheimer’s patients, the music-cued stories contained a greater number of meaningful words, were more grammatically complex and conveyed more information per number of words. Music may enhance narrative memories because music and language processing share a common neural basis.

The general hypothesis in medicine is that a deficiency of certain neurotransmitters (chemical messengers) at synapses, or tiny gaps, between neurons interferes with the transmission of nerve impulses, causing or contributing to depression. One of these neurotransmitters, serotonin, has attracted the most attention, but many others, including norepinephrine and dopamine, have also been granted supporting roles in the story.

Much of the general public seems to have accepted the chemical imbalance hypothesis uncritically. For example, in a 2007 survey of 262 undergraduates at Cleveland State University found that 84.7 percent of participants found it “likely” that chemical imbalances cause depression. In reality, however, depression cannot be boiled down to an excess or deficit of any particular chemical or even a suite of chemicals. “Chemical imbalance is sort of last-century thinking. It’s much more complicated than that,” neuroscientist Joseph Coyle of Harvard Medical School was quoted as saying in a blog by National Public Radio’s Alix Spiegel.

Indeed, it is very likely that depression stems from influences other than neurotransmitter abnormalities. Among the problems correlated with the disease are irregularities in brain structure and function, disturbances in neural circuitry, and various psychological contributions, such as life stressors. Of course, all these influences ultimately operate at the level of physiology, but understanding them requires explanations from other vantage points.

Are Your Chemicals out of Balance?

Perhaps the most frequently cited evidence in support of the chemical imbalance hypothesis is the effectiveness of antidepressants, many of which increase the amounts of serotonin and other neurotransmitters at synapses. Zoloft, Prozac and similar selective serotonin reuptake inhibitors (SSRIs) result in such an increase and can often relieve depression, at least when it is severe. As a result, many believe that a deficiency in serotonin and other neurotransmitters causes the disorder. But just because a drug reduces symptoms of a disease does not mean that those symptoms were caused by a chemical problem the drug corrects. Aspirin alleviates headaches, but headaches are not caused by a deficiency of aspirin.

Evidence against the hypothesis comes from the efficacy of a newly developed antidepressant, Stablon (Tianeptine), which decreases levels of serotonin at synapses. Indeed, in different experiments, activation or blockage of certain serotonin receptors has improved or worsened depression symptoms in an unpredictable manner. A further challenge to the chemical imbalance hypothesis is that many depressed people are not helped by SSRIs. In a 2009 review article psychiatrist Michael Gitlin of the University of California, Los Angeles, reported that one third of those treated with antidepressants do not improve, and a significant proportion of the remainder get somewhat better but remain depressed. If antidepressants correct a chemical imbalance that underlies depression, all or most depressed people should get better after taking them. That they do not suggests that we have only barely begun to understand the disorder at a molecular level. As a result, we must consider other, nonchemical leads.

This Is Your Brain on Depression

A possible clue lies in brain structures. Imaging studies have revealed that certain brain areas differ in size between depressed and mentally healthy individuals. For example, the amygdala, which responds to the emotional significance of events, tends to be smaller in depressed people than in those without the disorder. Other emotional regulatory centres that appear to be reduced in volume are the hippocampus, an interior brain region involved in emotional memory, the anterior cingulate cortex, which helps to govern impulse control and empathy, and certain sections of the prefrontal cortex, which plays an important role in emotional regulation. Nevertheless, the effects of these shrinkages on depression, if any, remain an open question.

Neuroimaging studies have revealed that the amygdala, hypothalamus and anterior cingulate cortex are often less active in depressed people. Some parts of the prefrontal cortex also show diminished activity, whereas other regions display the opposite pattern. The subcallosal cingulate gyrus, a region near the anterior cingulate, often shows abnormal activity levels in depressed individuals. These differences may contribute to depression, but if they do, scientists are not sure how.

In 2012 neurosurgeon Andres Lozano of the University of Toronto and his associates studied the effects of deep brain stimulation of the subcallosal cingulate gyrus in depressed patients who had not benefited from standard treatments. The intervention led to a significant reduction in symptoms of depression, supporting the idea that a dysfunction in this brain area may be involved in the illness.

Findings also point to a crucial role for psychosocial factors such as stress, especially when it arises from a loss of someone close to you or a failure to meet a major life goal. When someone is under a good deal of stress, a hormone called cortisol is released into the bloodstream by the adrenal glands. Over the short term, cortisol helps humans cope with dangers by mobilising energy stores for flight or fight. But chronically high cortisol levels can harm some bodily systems. For example, at least in animals, excess cortisol reduces the volume of the hippocampus, which in turn may contribute to depression. Despite such data, we still do not know if stress alters the human brain in ways that can lead to depression.

Seeing the Elephant

Throughout this article, associations are described between various brain changes and depression. The “causes” are not addressed because no studies have established a cause-and-effect relation between any brain or psychosocial dysfunction and the disorder. In addition, depression almost certainly does not result from just one change in the brain or environmental factor. A fcus on one piece of the depression puzzle—be it brain chemistry, neural networks or stress—is shortsighted.

The tunnel-vision approach is reminiscent of a classic story in which a group of blind men touch an elephant to learn what the animal looks like. Each one feels a different part, such as the trunk or the tusk. The men then compare notes and learn that they are in complete disagreement about the animal’s appearance. To understand the causes of depression, we have to see the entire elephant—that is, we must integrate what we know at multiple scales, from molecules to the mind to the world we live in. So….to be continued…..!

References:

• The “Chemical Imbalance” Explanation for Depression: Origins, Lay Endorsement, and Clini- cal Implications. Christopher M. France et al. in Professional Psychology: Research and Prac- tice, Vol. 38, No. 4, pages 411–420; August 2007.
• A Multicenter Pilot Study of Subcallosal Cingulate Area Deep Brain Stimulation for Treatment-Resistant Depression. Andres M. Lozano et al. in Journal of Neurosurgery, Vol. 116, No. 2, pages 315–322; February 2012.
• Facts & Fictions in Mental Health. Hal Arkowitz & Scott O. Lilienfeld. Scientific American Mind, Vol. 25, No. 2, pages 66-67.

In spite of The Netherlands being an equal opportunities and very tolerant nation, the Dutch themselves have a saying about ‘not sticking your head above the cornfield’ because it will get chopped off. In English we talk about ‘sticking our necks out’. In both cases, standing out in some way seems to have definite disadvantages (usually involving loss of both head and life!). In looking into the research about uniqueness, it would seem that standing out from the crowd is a good thing since it shapes unique behaviour and creative thinking.

Who am I?

The question seems so simple, yet it cuts to the heart of everything we do. Without an answer, we lack the inner compass that guides us through life. Decisions become arbitrary. Relationships dangle by a tenuous thread.

Introspection offers partial insight into this nebulous yet vital question. A fuller account, however, emerges from our interactions with the social environment. As we move through the world, certain people, ideas and activities resonate more than others. This mix of allegiances is ultimately what makes you you.

A defining force in the shaping of identity is a person’s drive to be different and special. Psychologists define this facet of personality as the need for uniqueness. Their research has revealed that every one of us seeks uniqueness to some degree. Those who have little need for uniqueness tend to find comfort in familiarity. Others strive to be extreme outliers. Most of us fall somewhere in between.

Even for the most exotic among us, the need for uniqueness is counterbalanced by a desire to fit in. Consider, for example, the hypothetical case of a very successful businesswoman with a thoroughly pierced face and a Mohawk. Most likely she feels very much at home around others with a similar look. In a corporate boardroom, however, she probably feels ill at ease. The reason is context: in the first case, she surrounds herself with like-minded people, a group to which she feels she belongs. Because these two social circles—those who embrace a punk aesthetic and those who sit in boardrooms— rarely overlap, we almost never encounter such edgy executives. Herein lie the yin and yang of uniqueness: somewhat paradoxically, we set ourselves apart by affiliating with groups of people more like us. Uniqueness emerges from the distinct combination of alliances that only you seek out.

The natural drive to be unique has broad effects. It informs purchasing decisions. It affects appearance, for example, through hairstyles and tattoos. And it is an important driver of innovation. Many major discoveries emerged from the minds of scientific outsiders. Think of Albert Einstein, the patent office clerk who chafed under the strictures of academia but thrived once he could pursue his interests in autonomy. Or consider Marie Curie, the first woman to achieve numerous accomplishments in science, culminating in two Nobel Prizes. Had she conformed to the social expectations for her gender, the world would have been deprived of her many contributions. In short, uniqueness enhances creativity. So let your true self shine through—the world might thank you for it.

Fitting in vs. Sticking Out

The idea of a need for uniqueness has a long history in psychology, originating with the study of its counterpart, conformity. Psychologist Solomon Asch attained renown in the 1950s for demonstrating that a person’s views are vulnerable to the opinions of the majority. In his now classic experiment, a participant sat in a room with several other people, all of whom had been secretly hired by Asch and his colleagues. The task was to look at a line and then pick which one of three other lines most closely resembled the initial prompt. Given the way the task was designed, identifying the proper line ought to have been exceedingly simple.

But the experimenters set up the situation so that the actors they had hired all responded before the real participant, and they all gave the same wrong answer. When the participants’ turn came around, about a third responded just as the actors did—an astounding fraction, given that the correct choice was crystal clear. Later, when they were asked why they gave the wrong answer, the subjects recalled the uncertainty they had felt at the time. Although they had initially arrived at the proper response, they began to doubt themselves and concluded that the group was probably right.

Variations on Asch’s initial study revealed that factors such as the size of the group, the presence of a dissenter or two, and the group’s overall status could alter how many participants ultimately go against the grain. Nevertheless, as Asch concluded, “that we have found the tendency to conformity in our society so strong that reasonably intelligent and well-meaning young people are willing to call white black is a matter of concern. It raises questions about our ways of education and the values that guide our conduct.”

The matter of why and when people strike out on their own captured the interest of two other psychologists, Howard Fromkin, and his colleague Charles Snyder. In the 1970s they developed a theory that everyone craves uniqueness to some extent. They discovered that relatively simple questions can gauge the intensity of this need in a person, and so they devised a uniqueness scale. In it, respondents rate how strongly certain statements apply to them, such as “I tend to express my opinions openly, regardless of what others say,” “I like to go my own way,” and “I always try to live according to the rules and standards of society.”

Using Fromkin and Snyder’s scale, Erb and his colleagues looked at how the need for uniqueness mapped to the “big five” personality traits, the basic human characteristics recognised by most psychologists. (The five traits are extroversion, openness to experience, neuroticism, agreeableness and conscientiousness.) In a survey of approximately 150 students, it was found that three of these traits are closely connected with the need for uniqueness. Individuals with a strong need for uniqueness tend on average to be extroverted. They are sociable and optimistic about life. They also tend to be open to new experiences. In addition, a pronounced need for uniqueness is associated with low neuroticism; such people generally are more satisfied with their life and have fewer mood fluctuations.

Despite their convivial nature, people who are high in their need for uniqueness also tend to care less about others’ opinions, and they typically engage in creative activities more frequently than their mainstream counterparts. The other two dimensions of the big five, agreeableness and conscientiousness, do not appear to be linked with either a strong or weak need for uniqueness.

Manipulating Uniqueness

Although a person’s propensity to seek uniqueness is generally stable throughout life, certain situations can shift it temporarily. In 2009 a study conducted by psychologists Imhoff and Erb wanted to investigate how making someone feel average might affect his or her subsequent behaviour. To do so, subjects were asked to fill out a personality test. They were then given bogus feedback—half the participants were told they had very pronounced individual traits, at the same time the other half learned that their personality was simply normal.

Next they were asked how they felt about a debate regarding restaurant-buffet cars on trains. To test whether the personality test results altered their desire to stand out in the crowd, they were shown a chart that claimed that either 79 or 21 percent of respondents believed that restaurant-buffet cars should be dropped from German Federal Railway trains.

The researchers discovered that the subjects who had been told they were average were much more likely to opt for the minority opinion. In contrast, those who had been told they had notably unique traits tended to agree with the majority. This was interpreted as meaning that the people who had been led to believe they were unremarkable had felt that their individuality was threatened and thus offered a dissenting opinion as a way to differentiate themselves. People will express their individuality even in something as mundane as a debate on German restaurant-buffet cars.

The realisation that the desire to both fit in and stick out can drive decision making has not been lost on retailers and product designers. People who wish to be seen as tough, for example, are more likely to sport a leather jacket. To come across as shrewd in business, a person might acquire a custom-tailored suit. These behaviours may seem commonsense, but the underlying motivation is to signal an individual’s inner self to the outer world.

To understand how this need motivates consumer behaviour, consider a study published in 2012 by Ph.D student Cindy Chan and her colleagues. They examined how purchasing decisions reflect a person’s attempts to juggle identifying with a social group and maintaining individuality.

Chan and her co-workers suspected that consumers satisfy their competing motives on different dimensions of a given product. To test this idea, the researchers recruited college students who belonged to one of their university’s eating clubs. Similar to fraternities, the eating clubs differ in their social identities, with one club attracting athletes, another drawing science and engineering students, and so on. The researchers took pictures of participants from three clubs and blurred the images so only the clothing remained visible. The students also filled out a questionnaire to measure their need for uniqueness.

Then a group of students drawn from those same three clubs viewed the photographs and guessed the subject’s club. They also rated the uniqueness of that person’s look as compared with others in his or her club.

As it turned out, the observers were good at their jobs. They were highly accurate when identifying a subject’s club from his or her clothing in the photographs. They likewise guessed correctly which students had higher or lower needs for uniqueness. The finding suggests two things: that our taste in clothing broadcasts our identity to the people around us and that we can signal group membership and uniqueness simultaneously through choices of clothing.

But these results do not yet tell us how a person’s choices can accomplish these two goals. Thus, in a set of follow-up experiments, Chan and her collaborators manipulated whether a participant felt like he or she was an insider or an outsider. They did so by asking their subjects to write about a group that they either did or did not feel a part of, such as an athletic team, a fraternity or a student council. As before, they also measured their participants’ need for uniqueness.

Then they examined the participants’ purchasing preferences. Similar to the setup of the German restaurant-buffet car experiment, these researchers showed subjects a set of products, revealed the preference of the group they had described, and asked them what they would choose. But the decision scenarios were multidimensional. For example, participants might choose not only between a BMW and a Mercedes but also between colours or models of the respective brands.

Those who had been made to feel like outsiders did not reveal any preferences. After all, they were not motivated to try to either join or reject the social group they had been thinking about. The participants who felt like insiders, however, were significantly more likely to select the brand that their group had opted for. They successfully communicated their membership in that social circle. But the insiders who ranked higher in the need for uniqueness did not follow the majority all the way. The desire to separate oneself from the herd exerted its influence not in the brand but at the level of the product, through the choice of a model or colour. People do not simply assimilate or differentiate—they can do both simultaneously along different dimensions of a decision.

A Matter of Culture

Not only do individuals differ from one another in their need for uniqueness, entire cultures do as well. The most striking, well-supported divide between the cultures of the world is that of individualism versus collectivism. Individualist cultures emphasise personal freedom and reward achievements that make a person stand out. The U.S., the U.K. and the Netherlands are prime examples.

Collectivism emphasises community cohesiveness. These cultures—think Pakistan, Nigeria and Peru, as well as many countries in Asia— encourage members to strive toward shared goals. In a collectivist society, uniqueness has negative connotations, akin to deviance, whereas conformity is linked with harmony. It is a small step to translate these differing cultural priorities into divergent needs for uniqueness. In a study that compared the need for uniqueness of Malaysians and Americans, for example, researchers found considerably lower scores among the former.

In one 1999 experiment that explored the effects of cultural attitudes toward uniqueness, psychologists Heejung Kim and Hazel recruited Americans and East Asians from the waiting areas at San Francisco International Airport. To disguise the true purpose of the study, the participants were asked fill out a short survey in exchange for a free pen. On completion, the experimenter reached into a bag and pulled out five green or orange pens such that one or two of the pens were always a different colour from the rest. Which colour a person selected was the real test. As it turned out, Americans opted for the more rare choice. They chose a pen of the minority colour three times out of four, whereas only one in four East Asians chose the less common colour.

Given the pronounced effect they saw, Kim and Markus wondered whether advertisers emphasise cultural themes in their efforts to entice buyers. In a survey of almost 300 advertisements, they found that Korean ads were twice as likely to highlight conformity than uniqueness, and American advertisers more commonly underscored how a product makes someone stand out.

If a need for uniqueness is linked with creativity, then a culture’s orientation toward individualism could enhance that society’s overall innovativeness. At the same time, the every-man-for-himself mentality that accompanies individualism could undercut a culture’s ability to capitalise on its inventive thinking. Aligning a team’s members toward a common goal—an easy task in a collectivist group—might be significantly harder to achieve.

To investigate this question, economists Yuriy Gorodnichenko and Gérard Roland compared data across countries and found strong positive correlations between a country’s individualism and its measures of innovation. They also noted in their study, published in 2010, that increasing individualism enhanced a country’s standard of living considerably. Thus, an increase in individualism of one standard deviation—say, from Venezuela to Greece or Brazil to Luxembourg—was linked with a 60 to 87 percent increase in income. This trend suggests that, one way or another, countries of independent thinkers find a way to rally others to bring their ideas to life.

Contemporary Western society can sometimes seem to take uniqueness to its logical extreme: people pursue personal goals, advance individual careers and strive for independence from others. Yet it is important to remember that humans evolved as a group-living species. Over the course of evolution human adaptations have been such that a person is unlikely to survive without the aid of others. Shared resources, mutual protection and division of labour are all major advantages of belonging to a group.

It is clear that two opposing forces are at work in shaping a person’s identity—a need for uniqueness and a desire to assimilate. For any one of us, the identity we settle on satisfies both constraints. But keep this in mind as you go through the rest of your day: it is only by standing out that a person can be outstanding.

References:

Abnormality as a Positive Characteristic: The Development and Validation of a Scale Measuring Need for Uniqueness. Charles R. Snyder and Howard L. Fromkin in Journal of Abnormal Psychology, Vol. 86, No. 5, pages 518–527; October 1977.

What Motivates Nonconformity? Uniqueness Seeking Blocks Majority Influence. Roland Imhoff and Hans-Peter Erb in Personality and Social Psychology Bulletin, Vol. 35, No. 3, pages 309–320; March 2009.

Identifiable but Not Identical: Combining Social Identity and Uniqueness Motives in Choice. Cindy Chan, Jonah Berger and Leaf Van Boven in Journal of Consumer Research, Vol. 39, No. 3, pages 561–573; October 2012.

Uniquely You. Hans-Peter Erb and Susanne Gebert. Scientific American Mind, Vol. 35, No. 2, pages 26-33.

Halos, auras, flashes of light, pins and needles running down your arms, the sudden scent of sulphur—many symptoms of a migraine have vaguely mystical qualities, and experts remain puzzled by the debilitating headaches’ cause. Researchers at Harvard University, however, have come at least one step closer to figuring out why women are twice as likely to suffer from chronic migraines as men. The brain of a female migraineur looks so unlike the brain of a male migraineur, asserts Harvard scientist Nasim Maleki, that we should think of migraines in men and women as “different diseases altogether.”

Maleki is known for looking at pain and motor regions in the brain, which are known to be unusually excitable in migraine sufferers. In one notable study published in the journal Brain in 2012, she and her colleagues exposed male and female migraineurs to painful heat on the backs of their hands while imaging their brains with functional MRI. She found that the women had a greater response in areas of the brain associated with emotional processing, such as the amygdala, than did the men. Furthermore, she found that in these women, the posterior insula and the precuneus—areas of the brain responsible for motor processing, pain perception and visuospatial imagery—were significantly thicker and more connected to each other than in male migraineurs or in those without migraines.

In Maleki’s most recent work, presented in June at the International Headache Congress, her team imaged the brains of migraineurs and healthy people between the ages of 20 and 65, and it made a discovery that she characterises as “very, very weird.” In women with chronic migraines, the posterior insula does not seem to thin with age, as it does for everyone else, including male migraineurs and people who do not have migraines. The region starts thick and stays thick.

It is not yet known whether the thickening of the insula is something the brain is doing to protect itself or something that worsens women’s migraines. Yet the evidence is mounting that when it comes to migraines, men’s and women’s brains are structurally and functionally different. For treatment, that knowledge could make a huge impact: not only should researchers be better about testing potential migraine drugs on men and women separately, Maleki says, but they may be able to design new treatments based on these brain differences—giving both sexes a better chance at relief.

Migraines can be debilitating, and most people know somebody who regularily suffers from them. Here are the top (scientifically proven) triggers:

■ Overuse of painkillers

■ Foods:

• • Processed, fermented, pickled or marinated foods
  • Chocolate, nuts, peanut butter and dairy products
  • Foods containing tyramine: red wine, aged cheese, smoked fish, chicken livers
  • Fruits and vegetables: avocadoes, bananas, citrus fruits, onions
  • Meats containing nitrates: bacon, hot dogs, salami, cured meats

■ Changes in hormones, such as menstruation

■ Sex

■ Atypical sleep patterns

Deciphering Cluster Headaches

Migraines are not the only culprits when it comes to extraordinary head pain. Cluster headaches have long puzzled researchers, too, although studies are slowly revealing the parts of the brain involved when those punctuated bursts of pain occur.

The excruciating headaches tend to turn up in bouts lasting six to eight weeks. During these cycles, afflicted individuals—more often men—experience intense daily headaches on one side of the head, each lasting an hour or two.

In the late 1990s Goadsby and his colleagues linked cluster headaches to heightened synaptic activity falling in or near the hypothalamus, a brain region that mediates hunger, thirst, sleep, sex drive and more. Yet researchers are still trying to understand how activity in this hypothalamus-adjacent area could conjure the condition—and to determine what other glitches in brain structure, metabolism or interactions contribute to sufferers’ throbbing heads.

At least one study suggests that in cluster headache sufferers this hypothalamus-adjoining region may differ not only in its electrical activity but also in its interactions with other parts of the brain. In February 2013, a Beijing-based team imaged the brains of a dozen men in the midst of cluster headache bouts. The researchers traced blood flow—and, with it, functional connections—between the hypothalamus and other parts of the brain. Compared with unaffected men, the cluster headache sufferers did have unusual hypothalamic connections. When headaches hit, these altered interactions often involved parts of the brain associated with pain processing. But hypothalamic connections were off-kilter between headaches, too, pointing to more persistent brain differences in those prone to cluster headaches.

People often think of love and lust as polar opposites—love as the binder of two souls, lust the transient devil on our shoulders, disturbing and disruptive. Now neuroscientists are discovering that lust and love work together more closely than we think. Indeed, the strongest relationships have elements of both.

The divided treatment of love and lust dates to antiquity. The study of love as an academic subject is nearly a century old, with the sentiment covered in introductory text­books of social psychology. Psychologists, primatologists, neuroanatomists and neurophysiologists came to see love— defined as an intense and complex feeling of deep affection— as responsible for long­term coupling and close relationships. The first psychological tools for measuring love appeared in the 1940s. In a review of the literature published in 2011, psychologist Elaine Hatfield identified 33 scales for measuring love’s gradations.

In contrast, researchers have traditionally regarded lust as little more than uncontrolled sexual urges. The scientific study of lust remained verboten or limited to clinicians, psychiatrists and sex therapists dealing with social and behavioural problems. When the topic of lust did appear in the scientific literature, it was cast as an archaic emotion, a sinful feeling that needed to be suppressed or denied lest it challenge societal order, or an addiction that hijacked human thought, emotion and behavior in insidious ways.

Now, though, neuroimaging investigations are beginning to flesh (pardon the pun) out the relationship between lust and love. Some research does support the Jekyll and Hyde dichotomy. Studies have revealed that lust and love both have unique brain signatures, suggesting they are separable, with the brain able to generate lust in the absence of love and vice versa. In one study of 500 individuals conducted in the mid­1960s by psychologist Dorothy Tennov, 53 percent of the women and 79 percent of the men agreed with the statement, “I have been sexually attracted without feeling the slightest trace of love”; 61 percent of the women and 35 percent of the men agreed with the statement, “I have been in love without feeling any need for sex.” Neuroimaging studies have also shown considerable overlap between the network for lust and the network underlying addiction, suggesting that the craving associated with lust brings with it impulsivity, lack of self­control and risk taking.

Other studies reveal a more complex and synergistic connection between lust and love. Both feelings can activate regions in the brain related to emotions, including euphoria, reward, motivation, addiction and body image. What is more, lust and love activate different parts of the same brain structures, the insula and the striatum (in the pictures below love=red and lust=purple).

A recent meta­-analysis that was conducted of 20 studies with a total of 429 participants revealed that the posterior region of the insula activates more for lust than love and the anterior region of the insula activates more for love than lust. This back­to­front distinction is in line with a broader principle of brain organisation: posterior regions are involved in current, concrete sensations, feelings and responses, and anterior regions are involved in the integration of abstract concepts ranging from the distant past to alternative futures. In this model, lust would be grounded in particular sensory and motor experiences, with love as a more abstract, future­oriented gloss on those experiences with another person.

Studies show that as lust progresses to love, activity cascades from the back of the insula to the front, with the pleasing sensations of lust (sparked at the back) joined by the abstract feelings of affection (triggered at the front). A similar pattern for lust and love emerges in the striatum, this time travelling from bottom to top.

The research suggests that the strongest relationship – passionate love – involves activation of the home bases of both love and lust. Passionate love builds on the neural circuitry for lust, adding regions associated with reward expectancy, habit formation, and abstract representation and control to those associated with rewards for sensations and the satisfaction of cravings.

For any two individuals, the strongest relationship is not necessarily the best outcome: some couplings are just meant to be one­night stands. Love and lust can exist in any combination, with either, both or neither emotion present, and present to any degree. The combinations result in a variety of affiliations. When both people feel the same emotions, the relationship can range from passionate love (high love, high lust) to acquaintanceship (a little of each), with one­night stands (high lust, little love) and companionate love (as in a friendly marriage) in the middle. When the feelings of two people diverge, the results may be unwanted attention for one and unrequited love or lust for the other. The ideal state in any pairing is when the two people agree on their love­lust formula, creating a healthy balance between love and desire and the best chance for a stable, satisfying, monogamous relationship. But whatever the end point, getting there is half the fun!

References:

◆Love and Sex: Cross-Cultural Perspectives. Elaine Hatfield and Richard L. Rapson. Reprint edition. University Press of America, 2005.

◆The Common Neural Bases between Sexual Desire and Love: A Multilevel Kernel Density fMRI Analysis. Stephanie Cacioppo et al. in Journal of Sexual Medicine, Vol. 9, No. 4, pages 1048–1054; April 2012.

◆Lust for Life. Stephanie Cacioppo and John T. Cacioppo. Scientific American Mind, Vol. 24, No.5, pages 56-60; November/December 2013.

I have mentioned here before my love of writing and languages. In the last weeks, several articles have caught my attention around not only the healing power of writing but also how our choice of words & metaphors can influence ourselves and others. In the vein of wanting to wish you all manner of good things for 2014 I thought I could not do any better than to put words to the research….

Metaphors in Our Surroundings Can Trigger Thinking and Behaviour

During the last years I have taken myself out for a walk in the park daily if I can, but if not, then several times a week.

What started as a need to get me out from behind my computer and into the daylight for fresh air during an intense scientific research project, turned out to be one of the best daily habits I’ve ever made. It also transpired that I had a vitamin D deficiency, and so the daily boosts of sunlight were exactly what the doctor order, literally and metaphorically speaking.

As you look around you now, in this moment, what do you see? Do you see four walls or an expansive vista? The answer could influence your ability to think creatively. A growing body of research suggests that our sensory experiences can trigger metaphorical thinking, influencing our insights and behaviour without us even realising it. New research reveals ways we might be able to harness these subconscious forces.

Consider, for example, the metaphorical idea that the heart is warm and emotional and the head is cool and rational. In a study in August 2013 in the Journal of Personality and Social Psychology, researchers led their subjects to believe they were investigating how people answer questions when using their nondominant hand. To ensure they did not use their dominant hand, the participants were instructed to place their dominant index (pointer) finger either on their temple or on the left side of their chest. Participants who pointed at their head answered test questions more accurately, and those who pointed at their heart were more likely to let emotions sway their decisions in a moral dilemma. The finding adds to a rapidly growing list of metaphor effects: past studies have found that seeing forward motion can propel us to “move forward” in a metaphorical sense and that feeling smooth textures makes a difficult social interaction feel easier (or go more “smoothly”).

In all these studies, the influence of the embodied metaphors evaded conscious awareness—the study subjects did not notice the connection between their sensations and their subsequent decisions or feelings. Yet researchers think we might be able to use this effect by altering our surroundings and habits, such as choosing office art that evokes forward motion. If you are actively touching an object with the expectation that it will change your view of a situation, it might not work right away,” explains Joshua Ackerman, a psychologist at the Massachusetts Institute of Tech- nology and a co-author of the smoothness study. “But if you make such be- havior a habit, you will gradually stop thinking about the connection, and it will then have a stronger effect.”

In a similar vein, freeing yourself from perceived constraints may indeed facilitate “thinking outside the box.” In a series of experiments published in May 2012 in Psychological Science, scientists tested participants’ creative thinking while they literally sat inside or outside a cardboard box. Other participants either walked freely or along the path of a rectangle. Subjects who were outside the box in either sense scored higher on standard measures of creative thinking. You can imagine that this means you might be able to encourage your own creativity by eliminating constraints to movement, such as by strdiing around around a room or wandering through a park. The key is variety and spontaneity: if you want to be more creative, run freely outside and do it randomly for the day. Get away from your typical route, time of day, music or even your pace.

In any situation, consider your surroundings, sensory perceptions and actions—they might be influencing your thought process via the subtle metaphors embedded in daily life.

Figurative Speech Sways Decisions

When pondering a decision or trying to convince others, think carefully about your metaphors. The implicit information may subtly influence decision making.

A study published very recently examined how reading different metaphors—“crime is a virus” and “crime is a beast”—affected participants’ reasoning when choosing solutions to a city’s crime problem. Those who read the beast metaphor were more likely to opt for a direct approach emphasising enforcement, whereas the virus metaphor elicited a preference for a systemic, reform-focused solution. A follow-up survey indicated that many participants did not remember the metaphor they read, and none thought a metaphor could have influenced their reasoning.

People don’t seem to consciously ponder the ways in which crime is like a virus or beast. Instead metaphors subtly structure the way the person understands the issue being described.

Previous brain-imaging research has shown that interpreting metaphors requires a variety of areas on both sides of the brain, compared with literal language, which is processed in known language areas in the left hemisphere.

Scientists do not yet know how exactly this pattern affects reasoning, but they suspect that the brain triggers related concepts when processing a metaphor’s meaning. So it is perhaps worth giving more thought to the metaphors you use and hear, especially when the stakes are high. Ask in what ways does this metaphor seem appropriate and in what ways does this metaphor mislead. Our decisions may become sounder as a result!

Expressive Writing May Lead to Faster Recovery From Injury

Expressive writing is known to help ease psychological trauma and improve mood. Now studies suggest that such writing, characterised by descriptions of one’s deepest thoughts and feelings, also benefits physical health.

In a study published in July last year in Psychosomatic Medicine researchers in New Zealand investigated whether expressive writing could help older adults heal faster after a medically necessary biopsy. In the study, 49 healthy adults aged 64 to 97 years wrote about either upsetting events or daily activities for 20 minutes, three days in a row. After a time lag of two weeks, to make sure any initial negative feelings stirred up by recalling upsetting events had passed, all the subjects had a biopsy on the arm, and photographs over the next 21 days tracked its healing. On the 11th day, 76 percent of the group that did expressive writing had fully healed as compared with 42 percent of the control group.

The researchers concluded that writing about distressing events helped participants make sense of the events and reduce distress. Long-term emotional upset can increase the body’s levels of stress hormones such as cortisol, which impedes the immune system. A paper in September 2013 in the British Journal of Health Psychology indeed found that writing about an emotional topic lowered participants’ cortisol levels.

The writing in the New Zealand study may have also sped recovery by improving sleep. Participants who slept more in the week before the biopsy healed faster, perhaps because sleep increaes many bodily processes involved in healing.

A Change of Perspective Can Offer Solace

If a past ordeal continues to trouble you, try writing about it as if it happened to somebody else: “She crashed the car,” rather than “I crashed the car.” In a study that appeared in February 2013 in Stress and Health, doing so led to greater health gains for participants who struggled with trauma-related intrusive thinking, as measured by the number of days their normal activities were restricted by any kind of illness. It would seem that third-person expressive writing might provide a constructive opportunity to make sense of what happened but from a safe distance that feels less immediate and threatening.

This is interesting in that there are several healing modalities that use techniques in which, for example, you re-envisage the trauma as though it were happening on a television screen, thus creating distance.

I love it when science catches up with the alternative & natural medicine world!!