Monday, October 24, 2016

Understanding the Mind - Cognitive Distortions and Other "Brain Bugs"

Understanding the Mind
Brain Bugs and Cognitive Distortions

If you were to go to the mirror and look at your skull (ignoring for now all those facial and hair details we usually fuss and fret over), from the top of your skull down to roughly your mouth line and from your right ear to your left, what you have inside there is the most complex biological organism in the four billion year history of evolution and within the known universe.

The approximately 3.2 pound jello like blob that resides in that above described space operates 24/7 from your first breathe to your last on levels of such complexity and intricacy that despite enormous advances in its study over the past century by thousands upon thousands of neuroscientists, physicists, biochemists, mathematicians, and other advanced fields using some of the most cutting-edge scientific tools and study methods ever devised, not a single solitary one of them could say with any complete certainty precisely how it all works. This is not to say that some extraordinary advances in its understanding by spectacularly brilliant scientists have not been made - the brain is simply that fantastically complex.

It must deal with streams of incoming sensory information that would cripple the most advanced super computers on earth and it must do this seamlessly and largely below your awareness. It must take everything in the highly advanced skelotomuscular structure that is your body - which itself is a true engineering marvel - and coordinate hundreds of large and small muscle groups moving hundreds of bones to create all your physical movements. Ponder for a moment what is required for a concert level pianist to play complex Mozart compositions or for a major league batter to swing a piece of round wood and solidly meet a small round object traveling at over 90 mph. What is required for your brain to assemble what you experience as sight and sound and to coordinate them (a feat much more difficult and important to your daily function than you might imagine) is well, well beyond any form of artificial intelligence and requires incredibly complex cooperation between very different brain regions.

Of all species on earth and in its evolutionary history, there are no more complex social and cultural structures than that of humans. This too requires tremendously elaborate brain functioning as your senses feed streams and reams of data to various regions of your brain to make sense of the speech, body and facial language, scents and so on that are involved in the near endlessly intricate structures involved in short and long human interactions and to generate responses and strategies for navigating "you" through all of that. Furthermore, no other species is as aware of its own sense of self and its mental states and functioning as we homo sapiens and this too requires near unfathomably complex brain networks and systems.

Your brain can look back into past events throughout your life and imagine far into the future in ways no other species can. It can hold information that in computer storage terms would amount to millions of megabytes.

Your brain is capable of almost science fiction like abilities to self-heal and create new networking functions should damage occur.

However, despite all these wondrous capabilities, the human brain is filled with many "bugs". "Brain bugs" are the subject of study of many a neuroscientist or cognitive neuroscientist (the former being about the nuts and bolts of the brain, the latter being more how those nuts and bolts produce the mind, cognition, emotions, etc) and which the neuroscientist Dean Buonomano has neatly compiled and wonderfully narrated in his book Brain Bugs.

All brains have "brain bugs"; faulty reasoning, irrational or even delusional beliefs, unjustified fears, cognitive biases, poor thinking habits, are capable of producing false memories and so on. No exceptions. Yours, mine, the "batty" people from all over the political spectrum with whom you disagree, scientists, or anyone else you can think of - everyone. Almost all people are quite capable of being perfectly sound in their reasoning and judgment in one area and completely irrational and biased in another. In fact, one of the most common cognitive biases is that of an individual being convinced that everyone else is flawed with cognitive biases and faulty reasoning while they are not (trust me, there will be people reading along here nodding in recognition of what they can see in others around them but completely blind to it in themselves). On the other hand, an almost just as common cognitive bias is the belief that everyone else's brains are working fine and that ours is the only one that is flawed.

However, a broad understanding of all the bugs of the human brain and how those affect all you can see in the world around you is not our interest here today. If you are reading here it is quite likely that your brain is malfunctioning in ways that is producing some sort of short or long term mental state or mental difficulties or "moods" that fall somewhere under the umbrella of a "mental illness". For our purposes here today we need to understand how many of these "brain bugs" are affecting - or even creating - the mental states and moods that are driving us batty.

What is of essential importance from this introduction on general brain bugs is that you understand and accept that nearly all brains will contain flaws and bugs and not just yours. And this, dear readers, is where we employ some self-compassion and forgiveness. When we are in those dark places we can become convinced that we are the only one who is so terribly flawed. Furthermore, we can take to beating ourselves up very badly for these flaws.

One of the greatest accomplishments I wish to achieve with this blog is to remove judgment and stigma when looking to understand all human behaviour but most especially your behaviour or pernicious mental states. We must learn not to judge others nor ourselves. We must learn not to blame others or ourselves. We are all about understanding and learning here. We learn, we better understand, then we work at building something improved or better.

Now, let's delve into a better understanding of concepts such as cognitive biases, cognitive distortions and other "brain bugs". From there we'll move on to a better understanding of what may be going on in your mind and most importantly, what to do about it.

First off, let's look at the term "cognitive". Cognitive of course relates to "cognition" which is:

is the mental action or process of acquiring knowledge and understanding through thought, experience and the senses. It encompasses processes such as knowledge, attention, memory and working memory, judgment and evaluation, reasoning and "computation", problem solving and decision making, comprehension and production of knowledge.
Human cognition can be conscious or unconscious, concrete or abstract, as well as intuitive (like knowledge of a language, for example) and conceptual (like a model of a language). Cognitive processes use existing knowledge and generate new knowledge.

- Wikipedia

We generally separate cognitive processes from emotional processes but in fact they are more closely intertwined than most of us would like to believe. Which is not to say that they aren't separate processes in the brain and involve different brain regions and networks but each can or will influence the other. For our purposes here for now though, we'll think of "cognitive" as the higher human thought processes we looked above as opposed to strict emotional reactions.

Now, for biases. Biases are prejudices in our ways of thinking about or evaluating things, concepts, groups or individual people - or, as we're going to look at today, even ourselves! Biases can be conscious or unconscious (though the great majority are of the latter). A cognitive bias therefor would be a line of cognitive reasoning based on prejudicial ideals, beliefs of all kinds (political and religious beliefs would top this list), perceptions and so on that create incorrect or faulty views or mental models as viewed against purely objective measures. They are defined as "tendencies to think in certain ways that lead to systematic deviation from standards of rationality and good judgment". Biased thinking will literally alter what we see and don't see, what we hear and don't hear, even what we feel and don't feel. You want to know what the biggest cognitive bias is? It's the belief that you don't have prejudicial biases or the belief that these don't affect your thinking, decision making and judgments. Trust me, this is all very deeply studied and endless tests have been devised and utilized to demonstrate hidden prejudices and biases in virtually all people's cognitive processeses. All human brains are capable of prejudiced or biased cognitive processes of one kind or another.

Furthermore, all brains will "filter" information based on these biases and prejudices. All brains will subconsciously filter out facts and information that do not support our values, views, theories and beliefs while allowing in information that supports our values, views, theories and beliefs, something known as "confirmation bias". And once again, there are very, very few exceptions to this, regardless how much you or anyone else swears they don't do this. It doesn't feel like we do this because of how deeply subconscious these processes are and how natural they work but all brains do this. Selective filtering and confirmation bias can be observed in all people and peoples, even in highly trained scientists.

There are many, many reasons for this. Firstly, we must go back to all the "data" your brain must process; sensory data, factual knowledge and information from what we are hearing or reading and almost endless so on. It is literally and simply not possible to process all this information, sifting through every bit of it for how verifiable it is, what's right or wrong, how pertinent it is, etc. All brains will create shortcuts for doing this. Some of these are good and rational shortcuts, consciously learning to objectively disregard what is not important or pertinent to the task at hand, for example, while many others are prejudiced and selectively biased rationale built in subconsciously over a lifetime without our realizing it. Mental shortcuts and selective biases are a necessary albeit often imperfect process.

How and where we're raised and taught will have an enormous influence, of course. We may be implicitly taught many prejudiced lines of thinking and judgment or we may have absorbed them from family, public figures and others of influence within the sphere of our lives as we grew up.

As well, in a fast paced world where we daily face such enormous amounts of incoming data which our brains must process and create decisions, reactions, judgments and so on (and these can range from the mundane such as which cheese to choose from a shelf of dozens of choices to whether or not to talk to the person standing next to you in the lineup to pay for that cheese to larger processes involved in jobs, careers, long term planning, etc) our brains tend to naturally default to the quick. We often admire someone who boldly makes "quick decisions" which we may then emulate. Often it may feel like we have no choice and have to make a split second decision. In a deeper way of understanding how brains work, all cognitive processes chew up valuable energy resources in the brain and deep subconscious brain mechanisms will often default your brain towards the quick decision - or cognitive shortcut - in order to conserve energy.

[Nobel Prize winner Daniel Kahneman covers these basic premises in his renowned work Thinking Fast and Slow]

Lastly for now, pure objectivity is hard - really hard. It takes an enormous amount of training, knowledge and working closely with those who can accurately critique our ideas, processes and conclusions. It's a very difficult - and energy and time consuming - process. So our brain generally defaults to cognitive shortcuts and selective biases, often without our awareness and despite how conscientiously we may be trying to view or work things through objectively.

Now, again, we're not here to judge cognitive biases one way or the other and get into all kinds of thinking of how people on the other side of the political spectrum do this and your side doesn't or how this affects gender politics, or any of that. We're just here to understand that all brains will create cognitive biases. We're just here to establish as a matter of fact that in many ways brains can operate imperfectly in how they process information and form judgments and evaluations and make decisions based on cognitive biases and/or faulty reasoning. Certainly some groups are demonstrably worse than others but in truth all people and peoples are prone to one degree or another. What we need to understand for our purposes here today is that all brains are capable of being wrong - often spectacularly so - based on faulty or biased cognitive processes. Again, there are no exceptions to this.

Another term we often hear which is also very relevant here today is "cognitive dissonance". Cognitive dissonance is a deeply uncomfortable mental and emotional tension we feel when we are faced with information and/or facts or a situational dilemma that go against a deeply held view, position, value, theory or belief we have. The rather amusing thing (to me) is how many people believe other people suffer cognitive dissonance but they don't. They be all like, "oh, haha, look at that person in that group over there that I disagree with get all cognitive dissonant over these "facts" that I'm bombarding them with" yet somehow believe they are in some way immune to experiencing it or that there are not plenty of facts and information that would go against whatever cherished beliefs they have.

In truth, all brains are capable of both cognitive dissonance and denial of facts (the latter generally following the former) that don't fit our views and beliefs and furthermore for almost any belief or worldview or even most scientific theories, there will be facts and information that either don't support or which may even disprove them in whole or in part. You, me, people of all political and religious or atheist stripes, even highly trained scientists are capable of cognitive dissonance. Again, there are very few exceptions to this. It's just what brains do. It's sort of a bug and sort of isn't. It isn't in the sense that it's a perfectly natural and often necessary mental reaction and process to jump to the defense of what we deeply believe. It is a brain bug when it blocks further understanding, dialog or cooperation in resolving issues between opposite parties. It's also a bug when we are trying to better understand ourselves and to learn and grow.

One last factor to consider here is the power of imagination, which we look at in this post on understanding and taming imagination. What our minds create - all of our minds, not just yours - is often very "buggy" and can have enormous effects on our cognitive processes, mental states, understanding of events around us and so on.

All of this is to set the table for what we really must work on to understand better in ourselves and in understanding our mental health - cognitive distortions.

All mental illnesses will involve cognitive distortions or distorted thinking. All. There will be many reasons for them and they will take many different forms along a whole spectrum from mild to severe, but no matter the particular mental illness you are struggling with, it will involve cognitive distortions. Not only that, a great deal of your suffering will be on account of cognitive distortions.

What this means, I'm afraid to say, is that some of the things that your mind is doing, some of what it's telling you is not "real" but is a result of cognitive distortions. It could very well be, in fact, that your mental illness is largely created by cognitive distortions.

This is very, very uncomfortable territory for most people (see cognitive dissonance above). We are all very, very inclined to believe that whatever is going on in our brains and minds, that how we're perceiving the world around us and the people we must deal with, that our very thoughts are all "true", "real" and are hard "facts". It is extremely hard for us to believe and accept that many or all these things going on in our minds might be "distortions" or that distorted thinking may be leading our minds down the harmful path it's on.

To start to get past this, we must understand that when we are learning about cognitive distortions in our minds that it does NOT mean we are "crazy", "stupid" or anything like that. It simply means another form of "brain bug" like we've been looking at here today. All brains are capable of them in one form or another and most people will have cognitive distortions to one degree or another.

As I've also discussed at length in specific posts and here and there throughout this blog, "you" didn't put these thought processes there or deliberately "choose" them (nor did anyone else for that matter). All our thought processes are created by very complex brain regions and networks that developed over our lifetimes. Sometimes there are little brain differences that can create a distorted image of ourselves. In any case, what created them was a long complicated process that probably started early in life. "You" are not at fault for them being there or influencing your thought processes.

I have talked in the past about how I believe much of any given case of mental illness is greatly produced by our "conscious experience" - that which we are consciously experiencing. Cognitive processes of all kinds will play a part in producing what you are consciously experiencing and the fact is that some of those processes will be distorted.

Let's have a bit more of a look at them to see what they are.

A list and outline of fifteen most common cognitive distortions can be found here.

Let's take a few of what I think are the most important of those to recognize and understand and look at them more closely here.


Filtering is when our brains "filter" negative and positive aspects about our selves and/or our situations in life. It is one of the many ways our brains can form the kind of "selective biases" we looked at earlier in this piece. In cases of depression and anxiety, often what our brains are doing is filtering out positive aspects and "seeing" too much negative in our selves and in our lives. If our brains do this too much, it will create a distorted reality in quite a literal sense.

Polarized or Black and White Thinking

This is the tendency to see things at extreme ends, to see things in either "black" or "white", in either/or frameworks. Things are either a success or a failure, beautiful or ugly, attractive or repulsive and so on. There is a difficulty in being able to see things along a gradient or a spectrum, to not be able to see the many shades between black and white. Things go a little wrong and we "suck" or are "stupid". While perfectionist thinking is a bit of a different kettle of fish, it will play a role in this distorted form of thinking.

Jumping to Conclusions

Again, this relates back to what we were earlier looking at with how our brains tend to default to shortcuts or the quicker "decision" or "evaluation". It is common to almost all people's thinking processes. But in mental health problems it works in particular ways that are more harmful to us. Someone may express anger with us and we'll automatically jump to conclusions about the reasons and implications of this. A little thing goes wrong and we'll jump to the conclusion that this is proof of our "stupidity". Or even jumping to the conclusion that a glance our way is full of threatening meaning.


This refers to a tendency to see some sort of catastrophe around every corner or creating catastrophes out of mistakes or events that may in fact be quite manageable or perhaps are even not all that significant. Or we might project a short term (and real) catastrophe into our entire future ("I screwed up and got fired! My whole life is over!"). Colloquially, this is often referred to as "making mountains out of molehills" (something we really hate to be told).

A few not on the list at the above link but which I have observed in my own thinking and that of nearly everyone whose cases I've heard and have worked with are "predicting the future" and "making assumptions".

Predicting the future

A cognitive error that is almost sure to create massive anxiety and depressed mental states is "predicting the future" or "predicting outcomes"; taking the past or the present and projecting a dark future or future outcome based on those. This is a very easy mental trap to fall into because our human brains are very "wired" to have strong predictive functions.

Making Assumptions

This is another very common cognitive trap which can take many forms. Almost all people are guilty of the habit of making assumptions. In those with anxiety and depression, these generally take the form of "assume the worst" and can greatly impact mental health and decision making. It's another brain bug "shortcut" that may be necessary at times but which can become a habit that will greatly affect mental states and our entire way of thinking and decision making.

There are several other common cognitive distortions or unhealthy thinking habits and I'll have to encourage you to begin looking into them and understanding them on your own or through other means (I'll give some suggestions below). But I need to get a few things straight first.

Nobody likes being accused of these things. And many of our friends and family will do just that. These accusations will absolutely feel hurtful. Not brought up or handled properly, having people throw these in your face will bring up instinctive defenses and make it even harder for us to see them, all of which is simply going to make matters worse in the short and long term.

Two, again nobody willfully creates these in their minds and mental processes. Nobody. Where do they come from? It could be many places. There could be an inherited aspect that affects different brain regions and how they process information and create mental models, processes and inner dialog. It could be our upbringing and family influences. They could very well be the result of very real things that have gone wrong in your life - real tragic events, real trauma and so on.

And to repeat, none of this means you are "stupid", an "idiot" and other things we beat ourselves up with. This is another pattern we may fall into; on some level we may know our thinking and decision making isn't "right", we repeat past mistakes, get angry with ourselves and then beat ourselves up for being so "stupid" or "such an idiot". It certainly feels that way, but in fact you are a perfectly normal human being struggling with various "brain bugs" that virtually all people have. You certainly are your unique "you" with your very own unique life and set of problems but you are not A Particularly Bad Person for having this buggy brain of yours. All brains are like this to one degree or another.

Another critical thing to understand here is that nobody - certainly not me - can say that what you are experiencing in your mind is not real. Your subjective experience absolutely is real. The anxiety you feel is real, the dark destructive thoughts are real, all of it. So please don't think that when we discuss things like cognitive distortions that we are saying what you are experiencing is not real. It is. Trust me, I know this from personal experience and the study of cognitive neuroscience.

What can happen is a vicious cycle like this:

Real events or life situations impact mental states and thinking, thinking becomes stressed and distorted, stressed distorted thinking further impacts mental states, mental states then begin influencing thought and other cognitive processes, these thought and cognitive processes affect our lives in negative ways, these further impact mental states and so on and so on. As all of this becomes more entrenched, it all feels more and more like our reality.

In any mental health crisis or chronic case, stress is going to play a major role. Some stress we are aware of - probably excessively aware of it (major anxiety, panic attacks, etc over things in our lives) - but much of it is below our conscious awareness. Chronic and/or acute stress will affect our thinking, mental states and mental models.

Okay, now what to do.

What we have to first get past is any notion of blame - the blaming of others or ourselves. It serves no practical purpose and will invariably make things worse. I view the tendency to blame and judge a cognitive error in itself.

We begin then with working on self-compassion and forgiveness. This is not easy for many of you but it is a necessary step. It is a necessary daily step. That is to say, it must become habit.

In any kind of self-work, recognition and acceptance is very important. In the case of cognitive distortions, recognizing and accepting that a good deal of our thinking processes could be distorted and further adding to our anxiety or dark depression is a huge - and brave - step.

Next, we're going to look at this term of psychology "cognitive distortions" a little differently. In my study of neuroscience and mental health disorders, I quickly recognized that "we" don't create these mental patterns nor are they easy to stop just because we read about them or are told about them. Our brains create these patterns, which is why I include them under the general heading of "brain bugs". So we're going to call them "cognitive habits" instead and think of them simply as habits that are not serving us well and that have to be changed over time and replaced by different habits.

In almost any case of mental illness there are going to be real events, real trauma and real threats that are impacting our mental states and there are going to be cognitive distortions.

What our job is then is to start the process of learning to sort through what's real in the outside objective sense and what's distorted thinking.

This can be very, very difficult to do alone. It can be very hard to understand our own minds. It can be very hard to learn how to take an objective outside perspective of our minds and lives. A primary purpose of this blog is to help you in this process, to give you the best grounding and tools I can, but often it is very useful if you can find outside help with a skilled therapist or group therapy (I was quite blessed in this sense).

Saving that, what we can start working on is creating better mental habits. This was the very purpose of creating my Positive Difference Making Fundamentals. This is one of my most widely read posts and has been recognized by those in fields of mental health and improving the mind as universally positive steps in building a better mind, building improved inner peace and better long term mental health.

We will not change our long term mental health overnight (though there are times it can feel like we do). In our worst states it will feel like we can do absolutely nothing to change anything.

I created that list of fundamentals with the express purpose of giving us little things we can "chip away" at daily no matter how bad we're feeling plus as ways to help cope with and calm stress. Can't do this one on a particular day? Then try this other one. Can't do that one? Then try this one here. You'll find that there is always something you can do on a particular day, no matter how bad it is.

A key thing I discovered while studying cognitive neuroscience was that it was not always necessary for us to "break a bad habit". Often just beginning to work on new mental habits is enough. This is a big part of what my Positive Difference Making Fundamentals are all about.

The most valuable post for working on what we learned here today is Mindfulness Meditation Cognitive Behaviour Therapy. I strongly encourage you to read through that post for a deeper understanding of what we looked at here today and to begin learning a very powerful tool to begin implementing into a daily habit.

I built my whole concept of Brain Training Exercises as a simple, easy and fun way to work on our inner dialog and mental habits. On those days when it feels you've got absolutely nothing, we can do these. Simple but very powerful over the long run.

And no matter what, there are almost no days when we cannot listen to music. This is why Music Therapy is so great. We have to be careful about the music we choose to build our music therapy program, but even in our very most exhausted, worn out and fed up states we can listen to music. Music has amazing (and now very solidly scientifically proven) healing powers.

The absolute most powerful and necessary habit we must cultivate, however, is that we must learn to stay and work within the present day. Not the past, not the future, but the present day only. Of all the Positive Difference Making Fundamentals, this is the oldest (it has been found in texts thousands of years old) and the most universal (the understanding of this mental health principle has been found in virtually every culture around the globe).

A final reminder and a final take-away for today, dear reader, are these:

While you are your unique you, you are not alone in this, you are not the only one to have a brain that is "buggy". So please stop beating yourself up about that and practice some self-compassion. Yes, I know how "corny" this sounds but it really is a necessary step. And yes, I know how hard this step is.

I truly and deeply know how hard all of this is. I really and truly do. I know how much this feels that this is "just the way you are" and how helpless it all makes you feel. But you do not have to be this way. This does not have to be your life, your future. As buggy as brains can be, all brains can change. Thus your brain can change and thus your life can change.

You can change, it can change.

Yes you can.

Thank you as always for reading.

Wednesday, August 3, 2016

Neurochemical in Focus - Serotonin

In a previous Neurochemical in Focus piece we looked a bit at dopamine, its pathways and its affects on our moods and behaviours. Today we're going to look at another very long overdue neurochemical and topic - serotonin.

Neurochemicals and their roles in brain functions are the very foundation and core of pharma-psychiatry's "chemical imbalance" theory for "mental illnesses" and are the basis for every prescription written to treat depression, bipolar, schizophrenia, anxiety disorders, OCD and ADHD.

The initial focus of this blog was to take apart and demolish the chemical imbalance theories of mood and psychiatric disorders but I don't want to get into that too much here today. My aim for this piece today is to build towards a better understanding of serotonin and its roles in brain behaviours (and thus our moods and behaviours) and look into how popular drugs for depression are alleged to work. 

While I've since done a good deal of my own reading and study into our topic today, I owe a great debt of gratitude to Robert Whitaker and his landmark book Anatomy of an Epidemic for not only spurring and inspiring my interest in neuroscience, but for introducing me to the understanding of attempting to treat psychiatric and mood disorders at the synapses of the brain with the use of drugs. 

I'd come across his book early in 2013 and then had the great fortune to attend a lecture he was giving in Vancouver where I was able to meet and talk with him at some length. It was that talk and that meeting which led to a great deal of what Taming the Polar Bears would eventually become. Robert's high integrity methods to his research and writing and his early encouragement of my efforts were very instrumental in my approach to understanding and writing about science and the brain as well as my research methods. He very patiently read and critiqued some of my early efforts (along with the famed (and somewhat rebel) psychologist Bruce E. Levine) which greatly aided in steering me in the right direction. 

As with all neurochemicals, the roles of serotonin in the brain and body are greatly more complex than that presented by the pharmaceutical industry in their ads and narratives for the antidepressants they market.

Let's have a bit of a look. 

Serotonin or 5-hydroxytryptamine (5-HT) is biochemically derived from tryptophan. Serotonin is a monoamine neurotransmitter primarily found in the gastrointestinal tract (GI tract), blood platelets, and the central nervous system (CNS) of animals, including humans. It is popularly thought to be a contributor to feelings of well-being and happiness
Approximately 90% of the human body's total serotonin is located in the enterochromaffin cells in the GI tract, where it is used to regulate intestinal movements. The serotonin is secreted luminally and basolaterally which leads to increased serotonin uptake by circulating platelets and activation after stimulation, which gives increased stimulation of myenteric neurons and gastrointestinal motility. The remainder is synthesized in serotonergic neurons of the CNS, where it has various functions. These include the regulation of mood, appetite, and sleep. Serotonin also has some cognitive functions, including memory and learning. 
- Wikipedia (with some editing for clarity and brevity)

That's a very basic introduction into serotonin. Now, let's unpack that a bit and look more into what's relevant to us mental health peeps. 

The discovery and genesis of the understanding of neurochemicals' roles in brain function took place in the mid-fifties. Synapses and their basic functions had just been discovered yet it remained unknown how exactly information was "handed off" between communicating neurons at the synaptic level. Some argued for an electrical basis (which is partially correct as we'll see) while others proposed that chemicals were involved. As noted science historian Elliot Valenstein characterized it, it was "a war between the sparks and the soups". 

Further experiments were conducted which discovered that synaptic communication was indeed carried out by chemical messengers and subsequently a number of them were identified and further experiments showed that the "moods" and behaviours of animals could be altered or affected by introducing drugs that in some way modulated the levels of these neurotransmitters (as they would come to be known). 

And it was from these seeds that the "chemical imbalance" theories for mood and psychiatric disorders began to emerge with dopamine, monoamines (including serotonin) along with a third major neurotransmitter called norapinephrine being identified as the lead "culprits".

As noted in that Wikipedia excerpt, serotonin is part of a group of neurotransmitters in the class of monoamine. Some of the earliest pharmaceutical produced antidepressants were based on attempting to modulate monoamine and were called monoamine oxidase inhibitors or MAOIs and new variations on those are still prescribed and used today. 

Later research, primarily carried out or was funded by the pharmaceutical industry, isolated serotonin as having more specific effects on our moods and with great fanfare, SSRI antidepressants were introduced to the world with the release of Prozac by the pharmaceutical giant Eli Lilly in 1986.

If you walk into a doctor's office today complaining of depression or are admitted to a psychiatric facility to be "treated" for depression (a word I use very loosely), there is a very good chance you will be prescribed an SSRI antidepressant. 

SSRI stands for selective serotonin reuptake inhibitor. As our goal in this blog is to better understand our mental states, the reasons behind them and how they can be treated, a better understanding of this is going to be very pertinent to us. 

First of all, let's take a closer look at serotonin pathways in the brain and a little bit about what those are all about. 

That gives a pretty decent idea as to where the pathways originate and some of the destinations. I liked this particular illustration because it gives a rough brain view plus that little "flow chart" at the bottom helps give us a better idea. 

As we learned in the post on dopamine pathways, none of this works in isolation. As with dopamine originating in specialized nuclei called the Ventral Tegmental Area (or VTM), serotonin has an originating nuclei (or group of specialized neurons) that is responsible for sending out serotonin related signalling. Serotonin pathways originate in the raphe nuclei. These are located in the brain stem, a very old (and original) part of our brains in evolutionary terms and indeed serotonin plays key roles in many life forms, even the humble round worm (C. Elegans, a favourite of neuroscience types to poke and prod and experiment with). 

As for the destination end of things, we have the thalamus and hypothalumus, two key nodules that we briefly visited in the introduction to the stress response system, then the caudate neucleus which plays key roles in motor and non-motor functions and as such is of keen interest in Parkinson's and Obsessive Compulsive Disorder. The hippocampus is also a destination (this sea horse shaped pair of nodules (one in each hemisphere) plays the role in episodic memory formation) and then we go up into the frontal lobes of our fancy neocortex and other areas of the cortex (the very outer layer of the brain). 

The cerebellum as a destination is quite interesting, I believe. We've touched on the role of this very ancient bit of brain hardware in Neuroanatomy 101, where we saw it was greatly responsible for much of our physical movements and coordination and in An Introduction to Music Therapy where we learned that more recent research shows that it is involved with the coordination of all kinds of higher cognitive functions and is very involved with both the playing and appreciation of music. 

For reasons I could not say, not in that illustration or chart as a destination is the nucleus accumbens, a rather significant region that has much to do with cognitive processing of aversion, pleasure, reward, and reinforcement learning.

Still with me? I hope so! We're getting to the crux of the biscuit soon. 

Okay, so what does serotonin do? What does any neurotransmitter do for that matter? We probably have all heard the narrative that serotonin is responsible for feelings of happiness and well being and that a depletion of serotonin makes us "depressed" and hence the need for pharmacological aids to "increase" levels of serotonin which in theory "treats" our depression. 

Well, I hate to break it to you but serotonin - or any neurochemical for that matter - doesn't really "do" anything, or at least not in the sense of the narrative that we've been told in regards to "moods".

Let's have a look at what I mean by that. 

Once again, let's revisit some basic brain anatomy. We'll call this diagram A.

Look first to the left side of the illustration. If you've been following along (and somehow I suspect nobody really follows along with all of these, but on we forge), you'll see we have some cell bodies (neurons), axons and dendrites. Axons carry signals near and far to other neurons and dendrites that receive incoming signals. This is one way (though only one way, I must emphasize) in which neurons communicate to do all the myriad things our brains do like call up a memory (of how to do something or a face or almost endless so on), feel and process emotions, form the "moving picture show" that is our sight and vast amounts of etcetera.

It is in the neurons that stuff is stored and happens and neurons communicate their little micro bits of stuff with tens of thousands to millions to billions of other neurons to make up bigger bits of mental, cognitive, emotional, etc stuff that makes us what we are or controls what we're doing, thinking or feeling, or initiating and controlling every single physical movement we do. 

So it's the neurons, or more accurately, groups and networks of neurons that do stuff, not neurotransmitters. 

But - but! - the neurons can't do their thing with billions of other networked neuron buddies if neurotransmitters don't do their thing so let's take a closer look at this thing neurotransmitters do.

At the point where axon (sending) meets dendrite (receiving), we have a synapse. I have a better illustration for serotonin related synapses here (diagram B):

We have a transmitting, or sending, neuron represented in yellow above (which is actually the very end tip of an axon) and receiving in green below (which, in this case, is actually the tip of a dendrite). Where it says "synapse" with that large bracket is more often known as the synaptic cleft, a gap that is a mere 20 nanometers across. 

There are some really key bits to that illustration for us to understand here. There's no need to look into those items listed in the sending end of things (unless you're a true neurobiology geek of the chemical bent - but briefly, it's just the process for creating serotonin). What we want to learn here is the vesicles containing serotonin (represented by the little red dots) on the sending side and the receptors on the receiving side. 

A given neurochemical (serotonin in this case, or dopamine, or any of a hundred or more other neurotransmitting chemicals) is like a key and the receptor is like a lock. The lock won't receive if the key isn't right and the key won't fit if the lock isn't right. (Very important for understanding not only neurotransmitting chemicals, but also how both many prescription drugs and pain killers and so called street drugs work.) The neurotransmitters crossing the synaptic cleft and fitting into the receptors is what completes the communication between neurons. 

So while they don't actually "do" anything in themselves, neurotransmitters are obviously an essential part of the process of coordinated neuronal activity of all kinds.

Let's quickly review what's involved with inter-neuron communication. (diagram C)

So we have some neurons with some exciting info they want to spread around. If the info is exciting enough the neurons doing the sending will reach a level of excitement called action potential which will then send a series of electrical pulses down the axon. It is these electrical pulses which stimulate those little balloon like sacks (the vesicles) of neurotransmitter chemicals so they travel across the synaptic cleft to fit into the "locks" or receptors in the dendrite, or receiving, end and thus the "info packet" will get handed off to other neurons (and hence the electrical theory of synaptic function (of the "sparks vs soup" battle we looked at above) proving partially correct). 

To give an idea of the scale of these bursts of nano-activity, recall that we have somewhere in the neighbourhood of two hundred and fifty trillion synapses performing these infinitesimally intricate transactions the firing of each of which is measured in hundreds of a second. With every thought, with every move, with every sense processed, with every action your brain must perform, billions upon billions upon billions of these synaptic functions must go smoothly in order that billions of neurons at any given mili-second can do their jobs smoothly. 

In the case of serotonin, again it doesn't "do" anything in creating mental states or mental processes. what it does do is play a critical role in the firing of key brain regions in coordinated ways so that they can do things. If we look back at the brain regions in the serotonin pathways, it's the functioning of those regions that are critical for creating mental states and processes and not only the individual regions, but that they are working properly within larger brain-wide networks. 

I think it's not hard to imagine that such fine transactions that need to take place trillions of times per mili-second may not always go all that smoothly, thus networked brain regions and nodules may not go smoothly and thus we will not always go that smoothly. 

Now we get to the crux of the biscuit regarding serotonin, moods and SSRI antidepressants. ::reaches out to gently nudge readers awake from their slumber:: (I've ten years experience in the classroom, I know how this works)

If you go back and look at Diagram B, you will see in the sending side of synaptic cleft what are labeled serotonin reuptake transporters. (There are reuptake transporters for all the various neurotransmitters in the synapses of their relative pathways.) 

These are one of the "recyclers" of the brain. You see, not every little molecule of serotonin (or other neurotransmitters) in every burst of communication gets used - it doesn't all fit into the receptors - so some will always be left floating around in the synaptic cleft. So what the repuptake transporters do is sort of "vacuum" up the excess neurotransmitter molecules for future use. Very clever, what?! (Though other excess neurotransmitter material will get gobbled up by special waste disposal enzymes)

This is all an almost unfathomably complex set of transactions that evolved over literally billions of years. But for reasons that I will have to leave to explain elsewhere, modern researchers and scientists figured they could be more clever than the several billion year evolutionary process that produced this nearly unfathomably complex procedure (which works the same way in all animal life, by the way. The plant world communicates via chemical signaling as well, albeit somewhat differently). 

Because it was proposed - though never conclusively proven - that serotonin was "responsible" for feelings of pleasure and well being (and presumably thus "happiness") it was further proposed that a depletion of serotonin was responsible for "depression" - you know, being unable to experience pleasure, well being (and presumably "happiness"). So researchers and scientists (who just so happened to be in the employ of multi-billion dollar transnational pharmaceutical companies whose shareholders were giving them grief about their bottom lines) got to doing some tinkering around. What they came up with was the idea that "hey, maybe the problem with "low moods" is that there isn't enough serotonin in the synaptic cleft to create pleasurable and happy feelings". From there they looked into the reuptake transporters and thought, "hey, what if we blocked these reuptake transporters so that there'd be more serotonin in the synaptic cleft and this will make people happier and less depressed?". (Yes, I know I am being breathtakingly and somewhat dismissively brief but it really did go something along those lines.)

These lines of thought, and others, were part of the reasoning that went into "chemical imbalance" theories for mood and psychiatric disorders. The "imbalance" proposed here was that serotonin was in short supply (and thus out of balance), these imbalances were creating mood disturbances, and if we (psychiatrists and medical doctors) could just restore this balance, normal (whatever "normal" is) moods would return. In the case of serotonin, the process of blocking the reuptake transporters would restore the balance by leaving more serotonin in the synaptic cleft to do its thing. 

And thus Selective Serotonin Reuptake Inhibitors were born.

What all antidepressants in the SSRI class do is in some way hinder the reuptake pumps or transporters from doing their jobs. This is the entire premise of these class of antidepressants. 

Which sounded pretty good in theory, I guess (you might sense my skepticism ringing through). 

The idea of the "selective" part is that SSRI drugs would only target a certain type of receptor in serotonin pathways (the 5-HT system). 

But there have always been a great number of problems with both this theory for depression and the process of tinkering with something so highly evolved and as complex as neurotransmitter activity that takes place trillions of times per mili-second for every second you draw breath. 

Let me outline a few.

Firstly, in Anatomy of an Epidemic (pages 79-81)Whitaker describes in great deal how investigators found that drugs like fluoxetine (Prozac, Sarafem, etc) designed to block reuptake pumps (or SERTS - Serotonin Reuptake Transports) greatly altered both pre and post synaptic function and their very structures with profound - and unintended - affects resulting in abnormal functioning.

Furthermore, neurotransmitters are but one aspect of synaptic function. If you look back up at Diagram C, you will see mitochondria represented there. As I outlined in part three of "Bipolar, the Brain and Energy", mitochondria plays extremely critical roles in axon and synaptic signaling functions. If mitochondria is damaged and cannot function, which we also established in that series as a possible result of chronic stress, then inter-neuronal communication is going to be impacted all along the axons and at the synapses themselves thus affecting inter-neuronal communication brain-wide. So what could be happening with poor synaptic functioning is that it is a result of mitochondrial dysfunction. 

Grossly overlooked is synaptic pruning and growth that we first looked at in An Introduction to Neuroplasticity. As we learned there, synapses are in constant flux for both good and bad. It is blazingly obvious to point out that no communication between neurons can take place if synapses for some reason are not there. If we look at what's related to mood in relation to synaptic functioning within specific brain regions and we view this with the understanding of the basic neuroplasticity principle of "use it or lose it", then we might well propose that regions of the brain related to mood are not functioning properly because synapses have been pruned back and thus these regions are not communicating strongly within other brain networks contributing to our moods.

As well, not all brain activity and coordination is conducted through axons, dendrites and synapses. Neurons and groups of neurons also use brain waves to communicate and coordinate activity. Neuroscience is just scratching the surface for understanding this critical form of brain activity and how, for example, the hippocampus uses specific brain waves  to transmit memory information to different regions of the brain. 

Aside from this is the fact that of the total amount of serotonin in the brain and body, only a small percentage (less than 5%) is involved in the brain's serotonin pathways involved in "mood" as well as what we looked at above - that serotonin destinations involve many critical and widespread functions aside from "mood".

The processes for creating any one kind of mental state or function of any kind is now understood to be vastly, vastly more complex and involves brain wide regions that are not related strictly to those along the serotonin pathways we looked at above. The idea that simply artificially blocking the reuptake pumps we looked at above would magically restore "balanced moods" is hopelessly simplistic. 

The principle for the basis of both the "chemical imbalance" theory of mood disorders and neurotransmitter altering pharmaceutical antidepressant treatments is based on understandings of synaptic functioning that are now decades out of date. Despite decades of independent study, the process and precise mechanisms of how neurons release neurotransmitters remains mysterious and is much more complex than previously thought and is not quite as pharmaceutical researchers would present. 

But perhaps more importantly regarding serotonin pathways and their roles in mental states and cognitive functioning, is what we first looked at in the piece on dopamine pathways. Like dopamine pathways origins in the Ventral Tegmental Area, serotonin originates in the raphe nuclei. And like the VTM, the raphe nuclei are part of vastly complex feedback networks. If there is a serotonin "imbalance" (never conclusively proven) and this "imbalance" is affecting mood (definitely never conclusively proven), then we should also consider that this depletion is happening at the nuclei of origin and not at the end synapses. Perhaps it's a question of what's happening in feedback networks to the raphe nuclei and that this nuclei are receiving insufficient stimulation and thus under performing serotonin pathyways.  

But most importantly and vital to understand and take away from this piece is that an honest and thorough look into all the symptoms involved in more severe and long term cases of depression could not possibly be understood or explained by the model of "serotonin imbalance" as put forward by the pharmaceutical industry. This model of understanding complex mood disorders and the treatment of them is completely inadequate and overly simplistic. 

Looking into these questions and problems in more detail will have to wait until we begin to investigate the disaster that became vastly widespread SSRI use, a good deal of it "off label". These problems include long term inefficacy, extremely dangerous side effects not the least of which was greatly increased suicide risk and completed suicides and wildly changing behaviour. 

All this being besides the fact that there are numerous, numerous and enormously complicated processes in the brain that affect our moods, mental states, and behaviours besides neurotransmitters alone (which I have touched on in numerous posts in this blog). 

Today, however, I just wanted to give a brief and simple introduction into what all this business about the now famed serotonin is all about. 

Wednesday, July 6, 2016

Taming the Polar Bears in Focus - Taming Empathy

I first introduced this topic in the fall of 2015 in the piece Bipolar in Focus - Empathy and Bipolar Disorder. In that piece we looked at how bipolar seems to have an especially strong capacity for producing empathetic pain and suffering but we also saw that many people who suffer from anxiety and depression do as well. At the end of that piece I suggested that we did not have to necessarily suffer so much and that there were things we could do to alleviate and reduce our capacity for empathetic pain and suffering.

So yes, you read that title correctly - taming empathy, meaning your empathy is one of your "polar bears" that must be tamed.

In modern society we are more and more taught that empathy for others is a virtue and are implored to feel more empathy for the plights of minorities of all kinds and those less fortunate around the world. This of course is important - it's what impels humanity to improve the overall quality of life for all and to reduce prejudices or unfair practices against particular groups. All advances in human rights and improved life quality for others has at its roots, empathy for others. However, like any human capacity, empathy is something that can get overly dominant in our mental and emotional makeup and run amok with the potential to cause us terrible anguish and personal suffering, as we explored in the introduction piece. For many of us, it's not a matter of not having enough empathy for others; we in fact suffer from "overactive" empathy and empathetic pain regions in our brains and this becomes a great deal of our overall depressed mental states and mental suffering - hence the need for "taming" empathy.

To learn why your empathy must be tamed, we'll need to talk a little bit more about what empathy is - and isn't. And most importantly, we'll start to learn how to take better action to satisfy this empathy beast within us.

Did I just call empathy a "beast"? Yes, I did and not by accident. For to learn to truly understand empathy, we first need to learn about:

The Dark Side of Empathy

It is naturally assumed by most (but never by moi) that empathy is a virtue, an ever positive trait to be able, as many put it, "stand in someone else's shoes, to feel with his or her heart, to see with his or her eyes". We feel that to be an empathetic person is to be a "good person", it is something we are proud of in ourselves - we don't stand idly by while others suffer or turn cold shoulders to the suffering of others! And this is largely true, of course.

However, nothing about any human trait is so simple. It's something I learned very early on in my study of neuroscience and cognitive neuroscience (the former is more strictly about the nuts and bolts of the brain, the latter more about how those nuts and bolts create our cognitive abilities and behaviours) - no trait or behaviour is clear cut in how it's created in the brain or manifested in our inner mental worlds or our outward behaviours, nothing is black or white and almost everything about us will be in gradients along a spectrum of many differing shades and hues from good to bad that can slide up and down along that spectrum depending on a great deal of other factors, both internal and external.

And so it is with our capacities for empathy.

Let's look a little more into what empathy is.

While empathy is not unique to humans, human empathy works differently - or should work differently (more below) - than that of, for example, our closest primate cousins. Human empathy arises at least in some part from theory of mind. This is a cognitive ability that is unique in the animal world. (1) To summarize theory of mind very briefly, it is:

... the branch of cognitive science that investigates how we ascribe mental states to other persons and how we use the states to explain and predict the actions of those other persons. More accurately, it is the branch that investigates mind reading or mentalizing or mentalistic abilities. These skills are shared by almost all human beings beyond early childhood. They are used to treat other agents as the bearers of unobservable psychological states and processes, and to anticipate and explain the agents’ behavior in terms of such states and processes.

Cognitive abilities associated with theory of mind are critical to humans' ability to socially organize and cooperate on the scale that we do and the evolution of theory of mind in our minds was one of the greatest foundations for the very evolution and advancement of the human species in the first place. Neurologically speaking, it is located in our vaunted pre-frontal cortex (the area of the brain right behind our forehead), the area of the brain that most differentiates us from any other animal species.

Related to this and also critical for advanced human capacities for empathy is the power of imagination. This is not hard to understand for it is the power of imagination (again, a very unique human trait and ability) that allows us to, well, imagine what's going on in another person's life and paint a picture of it in our minds even though we had no direct role nor bore any direct witness to what the other person went through. This role of the power of imagination in empathy partly explains, I'd posit, why artists tend to be highly empathetic people caring greatly for the world (or to put it another way, why empathetic people tend to make better artists).

So far, so good, right?

Well, not quite.

There is now a great deal of research and evidence that looks at the "dark side of empathy".

What could this possibly mean? How can such a virtuous trait such as empathy have a dark side?

While the idea of a dark side to empathy is not exactly new (philosophers have observed and written on this for some centuries), the cognitive sciences have more recently been able to design and perform better experiments to shed a deeper light on the entire spectrum of empathy and - more importantly - the feelings and actions that can arise from it.

It turns out that our feelings of empathy - and its pain - could very well drive us towards feelings of hate, vengeance and aggression towards the perpetrators of actions against those we empathize with.

As just one small example (out of dozens, if not hundreds) of the neurological underpinnings of this, recent studies have been done that find that those with a genetic disposition towards being more sensitive to vasopressin and oxytocin - hormones implicated in feelings of compassion, helping and empathy - were paradoxically more prone to feelings and acts of aggression.

I spoke in the previous piece on empathy about how bipolar people are especially driven to take action. This is part of the "manic energy" side, a side which could drive great action that can often get us in trouble (a verbally or physically violent altercation, for example).

These powerful empathetic feelings could well cloud our judgments and lead us to jump to conclusions and judgments or to highly biased thinking. This too is now all well studied. It is part of what can lead to an "us vs them" mindset and to create great chasms and conflicts between peoples, races, groups and so on.

The human mind is all too full of "brain bugs" and our hidden capacities for prejudice and racism (various cognitive sciences have many clever ways of demonstrating that we are all probably much more prejudiced and racist than we would believe or portray publicly) and thus we form alliances and identity groups and, more importantly here, biases and prejudices against "opposing" groups in many possible divisive ways.

These natural tendencies towards bias and prejudice plus powerful empathetic feelings may drive us to forget that our value judgments are just that - our values and that they are not necessarily universal or universally "right". Thus as we witness or perceive any action against our views or values or which harms peoples or creatures in ways that offends our values, we often feel a surge of anger and hateful feelings against the persons or group that performed the harmful act. Powerful thoughts of vengeance may take hold. Our judgements may be clouded to the point that we include in our anger rage and thoughts of vengeance against anyone who appears to belong to the group that acted against our values (as just one example, this is most easily observable in hate for all Muslims because of the terrorist actions of a few).

Political leaders* often exploit these capacities for group bias and empathy in ways that may make us support a national or regional act of aggression towards others or against a rival political group that we might not otherwise rationally support. Yes, you read that correctly - empathetic feelings can drive us towards irrational thinking and behaviours.

[* - I don't, by the way, just mean leaders of political parties. I mean leaders of political or politicized groups of all kinds]

All of which means we can be driven - by feelings of empathy - towards feelings of hate, anger, rage and of vengeful aggression and judgment against others in very unhealthy ways.

Feelings of hate, anger, rage and of vengeful aggression and knee jerk irrational judgment? I think we can all agree that none of these are particularly healthy ways of being nor are they particularly useful for solving any human condition or conflict, or those involving other things we often empathize with.

And this same basic dark side to empathy is possible in virtually all peoples around the globe.

Now, does this mean that empathetic feelings necessarily lead to improper actions and behaviours as we've (very, very) briefly looked at here today or does it mean that actions based on this sort of "quick reaction" empathy necessarily wrong?

Of course not. This empathetic burst of pain we feel for another (either physical pain or psychological pain) can absolutely impel us to take quick action to save or help another. What I'm trying to lay the grounds for here is that we have to be careful about jumping to too many conclusions based on empathetic sympathies alone.

Now, that is for behavioural impulses among humanity as a whole. In us "highly empathetic" types, however - so called "empaths" - this is all a much bigger, different and more difficult kettle of fish.

To understand why we suffer so much, or at least much more than the average person (the whole point of this blog, after all), we need to look at two other aspects involved in empathy and empathetic response. Those are:

- Psychological pain

- and a favourite topic of mine, the stress response system

Psychological pain, ooooh boy, is this a big and favourite topic of mine and one that is historically - and horrendously - overlooked and misunderstood by a long line of professionals in the various fields of medicine, psychology and psychiatry (for whom I have a long list of rather unflattering and largely unprintable names).

It would take a separate post on psychological pain and how it works in many of those who suffer mental health problems but for our purposes here today we need to get into it briefly to further understand empathetic pain.

You see, it is referred to as "psychological pain" to distinguish it from physical pain. Physical pain has - ostensibly - an obvious source in our bodies; a broken leg or a burn, for example, that causes pain receptors in the brain to fire. That's what we experience as physical pain. For the most part the medical world can understand and deal with this kind of pain.

So called psychological pain, on the other hand, has no such obvious physical source. You can't "see" where it's coming from; hence, it's "psychological". It often still gets dismissed by the great majority of medical and mental health professionals as well by most of the general public as merely being "in your head", the strong - though usually unspoken - implication being that it's "imaginary" and because it's "imaginary" you should just "get over it".

However, there are a growing number of researchers who study how  both physical and "psychological" is created in the brain that are gaining deeper and deeper understanding into pain of all kinds and it turns out the most of what we experience as pain is, in fact, "in our head". Very briefly (and this is breathtakingly brief, but our space here today is limited); wherever we feel pain in our bodies, there is a corresponding group of neurons where signals are sent and it is the firing of these neurons that create the sensation of pain (the renowned neuroscientist V. S. Ramachandran was and remains a leading pioneer and expert in this, most exemplified by his work in understanding and treating phantom limb pain).

Psychological pain is no different - it is generated by specific regions and neurons in the brain. As I explained in the original post, we - among many mammal and even bird species - evolved the capacity to feel and experience the pain of others as part of our learning abilities - as a group we learn faster to recognize and deal with a danger if we can feel and experience pain just by witnessing someone else going through a painful experience (either physical or psychological). It is also in good part what impels us to act to help or save someone. It is an integral part of our stress response system.

Now, to that stress response system of ours. The great Robert Sapolsky has researched, lectured and written about this in probably greater detail than anyone else in the neuroscience and neurobiology biz. He has long recognized and investigated how psychological pain activates the stress response system virtually identically to how physical pain does.

This bears repeating and highlighting, folks: psychological pain activates the stress response system virtually identically to how physical pain does.

In response to pain, the stress response system is going to kick off a cascade of hormonal, neurotransmitter and other neurobiological agents that are going to cause great physiological changes throughout your brain and body that you will experience in a wide variety of ways that would require at least a small book to adequately outline (Sapolsky has several large ones, not to mention hours and hours of lectures and dozens of academic papers devoted to the subject). This can all be good in the short term - if there's an obvious wound or danger to deal with. But when we have misunderstood and unresolved psychological pain that becomes chronic and thus keeps activating the stress response system, this is where we begin to see toxic levels of stress. For some of the most obvious and common symptoms of psychological stress, think of the pain in your chest and thumping heart and what could be raging emotions of all kinds that seemingly pop out of the blue in reaction to something you witness or read that "threatens" your own values, views or sense of fairness.

With a lack of understanding as to why it is happening and left unchecked, the stress response system being 
chronically activated with resultant spikes in stress hormones and other neurobiological changes will create destruction throughout the brain and body leading or contributing to just about every major health problem we have today, including - ta-da! - all major mental health disorders. Chronic stress is what could gravely damage the capacity of every cell in your brain and body to create energy. Chronic stress is just really, really bad news. 

Worst yet, for those who've long lived with psychiatric or mood disorders, there is a very good chance that we'll have lost a lot of our power to do anything about so many situations that arise even in our own lives, let alone large issues involving injustice and unfairness to groups we identify with or empathize with. We'll tend more to be powerless (in both psychological and literal senses) and feel helpless to do anything about all the sources for our empathetic pain.

And it is now well known that real or so called "learned helplessness" (an odd term to try understand the true meaning of) will further exacerbate and contribute to feelings of acute and/or chronic stress.

So perhaps this is the darkest aspect of empathy - runaway empathy creates both acute and chronic psychological pain, the great majority of which we feel powerless to resolve which causes acute stress spikes and/or chronically activates the stress response system which will go about creating all kinds of cellular destruction throughout your brain and body.

When we are "melting down" with pain - this so called "imaginary" psychological pain - I can tell you we almost literally are melting down in very real physiological ways at the cellular level in our brains and bodies.

Not only that, "stress responses" could lead to all kinds of short and long term behaviours or behavioural changes that may well be dangerous for us or at the very least not at all in our best interests (many of which make up a great number of the "symptoms" that are listed in the Diagnostic and Statistical Manual for most psychiatric or mood disorders).

Now, this is all incredibly brief (though I know it may seem incredibly long), but I hope I have built a compelling case for the need to "tame" your empathy "polar bears".

Empathetic pain isn't the only psychological pain we have to tame, but for many of you reading here, it's a big one - and a pretty important place to start.

Let's first go back to examining why some of us feel empathetic pain more than others. As I stated in the original piece, there's a good deal of evidence that bipolar people experience empathetic pain more than the average population (I have a separate essay in mind outlining that this could well be a root for some (though not all) of the cycling between manic highs and depressive lows). However, I also stated that since I first looked at the connections between bipolar depressive phases and empathetic pain I have spoken to and worked with many people who identify as "empaths" who suffer greatly as well.

So let's look at us as a group for now.

For starters, there is good evidence that so called "empaths" are "wired" differently; a great deal of our sensory equipment and the complex networks of white matter between them has formed and developed differently than that of the general population in ways that make us highly sensitive to all kinds of sensory input: we see more, feel more, hear more. We experience the sensory world around us in more intense detail (which again, is why perhaps many artists identify as empaths or why many empaths become artists). Facial expressions, tones of speaking voices, body language and much so on will be layered not only in much more detail, but will also be experienced more intensely. We read more "meaning" into all of it.

Many empaths I talk to refer to times when being in a room of people they can literally feel themselves deeply sense and "soak up" the vibes of everyone in the room. For many empaths these strong sensations can be very uncomfortable and overwhelming if not unbearable in ways most people simply cannot understand. This is partly what I was getting to in the introductory post on our differing realities.

It makes sense then that people who have this higher and more attuned sensory capacity for others' facial expressions, body language and tonal intonations in speech will have a greater capacity to sense and feel the pain of others as well - empathetic pain - and not only that, experience it much more intensely than that of the average population.

So there's that.

But does this mean that people who are not empaths do not feel empathetic pain as we do?

In some senses, yes. But that does not mean they do not feel empathetic pain. It is a very rare person who does not feel empathetic pain. What needs to be understood here is the wide, wide diversity of all human capacities. People empathize with many, many, different things, groups, peoples, races, genders, creatures and so on. Not only that, people are capable of nearly countless ways of reacting to empathetic feelings.

In other words, just because people don't share your empathies it doesn't mean they don't experience empathy. It may also mean that they have developed different - and perhaps healthier - strategies and powers for helping others they empathize with.

Also, however, I'd like to direct us back to the concept of "ego defenses", which I briefly examined and linked to many psychiatric disorders way, way back in a post I called Broken Ego Defenses. In that post I explained that we all have a number of specialized brain systems that we evolved to help block out psychological pain of all kinds for the very reason to prevent us from melting down with overwhelm from the many harsh realities of life.

We have to understand this from an evolutionary standpoint - in the strictest rules of evolution, the name of the game is to carry on. Things that prevent us from carrying on are a great disadvantage to us as individuals and to our "tribe" in general. Melting down and/or getting physically ill from stress and anxiety from emotional pain would therefore definitely qualify as "dis-advantageous" to our individual, clan and tribe genetic success. This is why our brains also evolved ways to block out too much emotional pain and overwhelm. The capacity to block it out is supposed to be there.

So while many people appear to have the emotional EQ of a fence post (as I am fond of saying), in many ways this is their brain doing exactly what it's supposed to do - protecting them from harm.

It is entirely possible - and I have observed this many times - a person may have a great capacity for psychological pain but at some point was hurt so bad, or felt the pain so intensely, that their mind/brain developed strategies to always avoid that in the future. This again is a great deal of how the stress response system and pain regulation is supposed to work - to learn strategies to avoid pain and its sources in the future. As it is with the great majority of how our brains plot strategies for survival and success, this is for the most part done deeply subconsciously.

Our brains not doing this is partly what I was getting at in the post Broken Ego Defenses and how this leads to a good deal of psychological distress, anxiety, depression, bipolar episodes and so on.

Now, it is also true that too many people care too little for and ignore too much about the world around them and this is obviously not good either.

Those of us who tend towards the higher end of the empathy spectrum have our role in the overall success of our group, tribe, people, gender, etc as well. We tend to be more socially aware. Despite our capacity for pain, we tend to seek out the injustices of the world.

Without people like us, many of the social equality and justice advances the world has steadily made in the last millennium or so would likely not have occurred.

Plus, this is simply the way the brains of us empaths are. As I've stated many, many times in this blog, nobody can just magically with their own willful volition change the way their brain works. This would simply go against all of what is well known about how brains develop and work. What we think of as "change" is really neuroplasticity at work, which means changing literally billions of synaptic connections, the axon wiring between brain regions (the white matter referred to above, otherwise known as our "connectome") and countless other aspects of our brain functioning.

No, no, that does not happen quickly or easily in anyone.

So what to do? How to "tame" these empathy "polar bears"?

Let's look at a few ideas and strategies.

First of all, I want to take another look at a line from the excerpt from the email sent to me that inspired the original post on empathy and pain - " ... there's no getting away from the overwhelming brokenness all around the world."

This, I must say, represents a sort of cognitive distortion, or what I like to call a "distorted reality" that many of us must address. It's a "cognitive bias" our minds can create the more we see injustices and wrongdoings around the world. If this is all we see - and our pain sears these into our memories and minds very strongly - then we begin to form a distorted view of the world that makes it seem all unjust and "broken".

And while there is no question these things exist, it is not a correct or balanced view of the world to see it as all "unjust and broken".

Since seeking better mental health without pharmacological help early in 2013 and as part of my Positive Difference Making Fundamentals, I saw that I had to change my "data input" - everything I take in through various media. I made great efforts to balance negative news with more positive and beautiful aspects of the world around us to give my mind a more balanced - and truthful - view of the world around me.

As well, I quite frankly stopped following a great deal of news in general.

Does this make me a more callous and uncaring person? Will it make you a more callous and uncaring person?

Absolutely not.

I'd also like to remind you of something I've been getting at in a number of posts - my mind, your mind, the human mind did not evolve to be able to handle everything that the modern world throws at it. Over tens of thousands of years, our brains evolved to care about and care for very small groups and/or clans, groups very closely tied to us and our own survival.

In no way, shape or form did your - or any - brain evolve or adapt the ability to handle a world of seven billion people and a communication system that brings news of that world to your fingertips twenty-four hours a day, seven days a week throughout the year. No freaking way. Anyone who tells you any different is greatly unclear of the capacity for human brain evolution and adaption.

So any way you look at it, you have to reduce the amount of news you take in, no ifs, ands or buts about it.

No, this does not make you a "bad person". Yes, I know many of us have been socially trained to feel that we need to be "aware" of everything around us and that to be unaware of the world's ills is to be "stupid" or make us a blind "sheeple".

It means instead that we are coming to terms with our very real and very human limitations in dealing with the pains and injustices of the world.

Let me get you to think of it a couple of different ways. One of these ways I discovered waaaaay back in my early twenties when I was pulling out of a long and dangerously deep depressive episode. I recognized then that a great deal of the overwhelm and meltdown I was experiencing was about things beyond my control.

Back then I thought "who is the most powerful person in the world?". I thought of the president of the United States. He (and  possibly one day she) can get on the phone and have direct and impactful contact with all kinds of other people of great power. Despite this great power, not even the president of the US can stop, for example, citizens of his own country from mowing each other down with automatic weapons.

It was then that I recognized that "if someone with that kind of power can't just change these things, what the hell am I going to do about it?"

This can be a rather unsettling, not to mention dis-empowering, feeling and yes, I know you hate this feeling.

So I'm going to tell you what I learned then: we - you, I, anyone of any capacity or power - can only work within our sphere of influence. That's how people work. If our sphere of influence is small, then so be it.

Throughout my life and as my circles of friends and spheres of influence changed over and over and as I cycled through periods of bipolar ups and downs, I've had to learn and relearn this lesson many, many times.

What this also means is that we must learn an ageless and universal fundamental truth - we must let go of what we cannot control.

Yes, Grasshopper - we must let go of what we cannot control. And I can one hundred percent guarantee you that the vast majority of the injustices and wrongdoings around the world are very, very much out of your control. Yes, I know ... that's very sobering. But it is a Truth. A truth that we cannot deny and must learn to accept.

This was an extremely hard lesson for me as the year 2013 wore on and as I delved deeply into the world of mental health, suicide and people becoming incapacitated by their conditions and suffering. I massively, massively took on that suffering. And as the manic energy that I had to start that year wore off and as fatigue took over and my capacities to do anything diminished to almost zero and I was melting down over that and my vanishing ability to help anyone, I realized that all I could do was write this blog and hope that I could help people in this way.

So I must suggest something similar - take on a small, doable project that you feel will help a group you feel needs help, and then focus - and limit - your energies mostly on that. Look for little victories. This is how all change in the world is enacted - small steps and little victories. Do this and your small steps and little victories will join larger streams of similar efforts to become a river of change (or a field of flowers, if you will). No, I am not blowing pseudo profound pop bullshit up your ass. This is really how it works.

None of this is easy, I can tell you. As I have discussed almost ad nauseum and at length all over this blog, no change is easy. Our brains did not get this way overnight nor are they going to change overnight. It takes time and regular and mindful effort.

Nor are we going to avoid being hammered by some especially bad news from somewhere in the world that rips at our empathies and pain. When this happens, I suggest stepping back from the world and allowing that pain to heal - for it must heal in a very literal sense; it's as real as any physical pain and wound.

Lastly and finally  I must raise the question of whether the painful empathy many of us experience is even "correct empathy", or the proper empathy to be experiencing.

Now what could I possibly mean by that?!

To understand that, we have to return to that previous piece on this subject and remind ourselves that homo sapiens evolved and share empathetic abilities with a good number of other animal species. And it is here that I must point out the uncomfortable fact that a good amount of what we experience as empathy is on the same level of, for example, a baboon. This is what's basically known as "mirror empathy". Hey, I've nothing against our close primate cousins and it's cool that we share these abilities with many other mammal (and certain bird) species but that doesn't say too much for having a higher, more evolved sense of empathy.

Mirror empathy, or the kind of empathy we share with many other species, is a rather base form of empathy, I'm afraid to say. This kind of empathy is what gives us that immediate impact of pain that hits us right in the gut.

But it is also the kind of "quick reaction" empathy that can be so easily manipulated and which is what makes up the dark side of empathy we're looking at here today.

Like many of our basic human abilities and instincts, just because we have it and it works in powerful ways in us, doesn't mean that this either "good" or "it" as far as the possibilities of a given ability go.

And so it is with empathy. Higher forms of human empathy have, or should have, more to do with what I touched on briefly at the beginning of the piece - the uniquely human theory of mind. This, remember, is what gives us the ability to look into and understand another person's mind.

And like any higher cognitive ability, it takes a lot of work to truly develop its upper limits and potential. For true empathetic feelings and understandings, it requires highly developed listening skills to truly hear points of view or values that differ greatly from our own. Mirror empathy only reflects our own views and values - members of "our tribe", in other words. While this kind of empathy remains important, of course, I'm afraid it will not do for a truly developed human higher form of empathy.

What we are talking about here is empathetic thinking rather than empathetic feeling. [To learn more on this concept and its power, please see this approximately ten minute long RSA Animate video]

No doubt that hurts to hear - it hit me hard when I first understood it - but there ya go. Learning about ourselves and limitations often hurts like that. And to fully learn and grasp something new, we often must first acknowledge and accept that what was is not all there is to a given aspect of our selves.

So to summarize, to tame our "empathy polar bears" we must:

- change how we take in news. Not only must we reduce the news we take in, we must learn to actively seek more positive and good news or stories of what's going on around the world.

- recognize and accept our limitations and act within them. By focusing on what we can do, we can stretch our limitations and abilities to enact change

- recognize that we must take care of ourselves and our own mental health. We are no good to anyone or any cause if we melt down so badly as to become incapacitated.

- realize and understand that it's okay not to take in every pain and injustice in the world. Nobody has the capacity to deal with all of that - nobody.

- in that vein, realize and understand that it's okay to build ego defenses to defend your ego. Yes, it is quite okay to a) have an ego and b) not to let yourself - your ego - get pummeled by everything going on in this big wide world. Having an ego doesn't mean we get a "big head" or anything like that; it means we build a balanced and healthy sense of self and personal boundaries.

- I also try to use my sessions of Mindfulness Meditation CBT as an opportunity to examine my feelings and actions generated by empathetic responses to the world around me. We can really get our knickers in knots over great numbers of things around the world and I use these sessions to work out those knots.

- and finally, think on the difference between "mirror empathy" or empathetic feeling and more highly developed forms of empathetic thinking. One of the easiest and most highly recommended ways of developing this - and a good body of evidence now supports this - is through reading fiction where to fully get into the various characters and their story arcs we must "get in their shoes" and see the world as they see it. This can also be practiced by viewing high quality movies. Being more aware of our listening skills and developing those is a must as well (yes, yes, I know, a lot of work but all the best personal growth work is).

We are not, after all, much good to any kind of true solution to world problems if we only react emotionally which most often leads to being confrontational and our actions easily manipulated by leaders of various kinds (and even in leaders we favour, this may not necessarily be good for solutions either). For truer solutions, we must work at using our unique human empathetic thinking abilities to hear and see other sides of views and values that are not our own and learning to better work together with and not against others.

(1) In the world of animal cognitive studies it has been becoming clearer that many animals have some level of theory of mind.