Saturday, August 10, 2019

CTE and I






It's been almost a year and a half since I got the diagnosis. 

I was going to try write a separate piece more about the neuroscience of CTE and what is currently known about it and how that is being learned but I don't know now if that's going to happen. In this piece then I'd just like a space to write out my own thoughts on it, my experience of it and the background that led to the diagnosis and what all this means to my future. 

Getting the diagnosis changed everything and nothing. It changed my entire understanding and perspective of everything that's happened for the past many years - especially the years starting around 2007 - but not a great deal changes in how I approach my day to day life. The big picture outlook of course has changed entirely but I'll get to that a little further down below. 


Chronic Traumatic Encephalopathy 

Very briefly, for the sake of a (hopefully) common understanding of what CTE is and means, we'll break down the term. Not the most accurate of words as used here, "chronic" implies repeated, or multiple or ongoing or a series of head traumas. Encephalopathy is a fancy medical term that applies to cellular degeneration in the brain. The "chronic" part also serves to separate the condition (and these are two very distinct conditions) from that of Traumatic Brain Injury or TBI.  

As for the "traumatic" part of the term, this is sort of shorthand for brain or head trauma and is a catch all phrase encompassing everything from mild concussions up to acute and severe brain damage seen in incidences like car accidents that result in short to long term comas. An enormous amount has been learned about concussions in the last fifteen years or so and what defines a concussion or head trauma has changed as a result. We'll leave the details of that to a more dedicated post on CTE and TBI (a good number of followers of this blog have turned out to be from the TBI community). 

For better or worse (I'll get into this more below), Chronic Traumatic Encephalopathy is most associated with professional athletes, particularly American football players formerly of the National Football League as well as (though much less so) hockey players formerly of the National Hockey League. That I use the word "formerly" is a bit of a harbinger of the politics that is involved in CTE (again, more below). The other most identifiable group it's associated with is combat veterans. 

Strictly regarding its most well known association with athletes, it's "for the better" because it gives the medical, science and neuroscience communities involved in researching it a remarkable first hand look into case studies and causal conditions, not unlike how wars and battlegrounds always served at the front line (pun intended) of so many past medical advances. Many athletes are coming forward and providing invaluable research subjects. 

It's "for the worse" because unfortunately CTE has become synonymous with professional athletes and in a sense effectually excluding from better awareness and understanding many ordinary people who may be suffering from it. Once again, more on this below. 


One of the ways CTE differs significantly from TBI is that the symptoms and pathology of the condition may not show up until years later, often up to two decades or more later whereas in TBI the effects are generally immediately observable, the cause (such as a car or bicycle accident, for example) much more obvious and thus the patient undergoing treatments much sooner. Like everything with the brain, the exact pathology and hallmark features of CTE are enormously involved and complex, but a growing body of evidence indicates a build up of tau proteins in and around neurons leading to neuronal degeneration not unlike that seen in Alzheimer's.

Because of the often long delay in CTE's onset, recognizing and properly diagnosing it in any given individual (especially those outside of organized contact sports) has been troublesome to say the least. However, many advances have been made in the last fifteen years stemming from large bodies of evidence (mostly from the study of athletes and combat veterans). Without question the process is better than it was even just ten years ago but it it still fraught with ignorance, misinformation, misunderstanding, politics and so on. There is a very long ways to go before much better, accurate and consistent diagnostic processes are standardized and more widely put in place and applied. 

Personal concussion history


The first came around age 15 and would be very high on the severity scale of concussions. As first concussion experiences go, it would not be untypical of that age; at a party, alcohol involved. Not used to liquor and overly inebriated, I recall stumbling, losing my footing and falling. The last thing I remember was the unmistakable sicking thud of skull making hard contact with concrete. In the general drunken confusion of the party it was assumed that I'd "passed out" from the alcohol and was simply left there. I was unconscious for somewhere between two to three hours and was only noticed when I started violently convulsing. The convulsions didn't stop and an older brother finally took me to the local ER. No one suspected concussion, which is hardly surprising given how little was understood then (this would have been early 1974) and the rather justified and seemingly obvious assumption, given the circumstances, that the symptoms were alcohol and/or drug related. The convulsions persisted for several days off and on. After that, I have no recollection at all of any ongoing symptoms (which again, would have been more out of ignorance and how youth just tend to carry on). 

The second was while playing hockey. I was the goaltender. This would have been within a year of the first one. Face masks were very skimpy in those days (early 70's) and mine was skimpier than most. It came at an age when some kids were learning to shoot the puck with tremendous velocity and "heaviness". The shooter was just such a kid. I recall him moving into an open lane in the left faceoff circle where he wound up and unleashed a "slap shot". Normally I had above average reflexes and reaction time but this shot was so fast and close in I had no time to react. Funny how memory can work; the last thing I recall was the puck just inches from my face in a kind of "freeze frame". It caught me flush (not glancing) in the middle of my forehead on the thin plastic mask with next to no cushioning. I have a vague memory of collapsing like a sack of potatoes then nothing. I have no idea how long I was out but somehow I shook it off and just kept playing (as all athletes in hard contact sports like hockey and football used to in those days). I have no memory at all of the rest of the game, if we won or lost or anything. Coaches and teammates would tend to just give you an "atta boy" and admiration for your toughness and courage, which was, at the time "all good". 

There was another maybe two years later when playing pickup football after school. We played full contact tackle but just wore street clothes with no protective gear at all. Once, while attempting a tackle on an older, bigger faster player I slid down and took a knee hard to the head and got the familiar "bell rung" feeling. Again, nobody would have thought anything of it and you just got back into the game as soon as possible with adrenaline and the pure joy of competing pumping through your veins. 

The fourth would come at age 20 in a logging accident. Sparing the work details and logging jargon involved, a crew of us were attempting a tricky maneuver with an older piece of heavy equipment. Unexpectedly, a long wooden "boom" (about thirty feet long and a foot in diameter weighing about 1,500 pounds) broke loose and swung violently toward me. I had my back turned to it but could hear it snap and instantly understood what was happening. I instinctively tried to jump out of the way but it was too late. It struck me like a giant baseball bat knocking me about fifteen feet away. I have no memory of that, the impact having immediately knocked me out. Later I was told that I'd landed, "done the funky chicken" (severe and violent convulsions), then went dead limp. To a man, the crew all thought for sure I was dead. The next thing I remember was coming to some time later and half a dozen terrified looking faces around me looking down. I have little recollection of the rest of the day but do have fragments of memory of being bundled onto a board stretcher, packed into the company "ambulance" (this was a remote coastal logging camp in British Columbia with no access to medical facilities) and being looked over by the camp first aid man. I returned to work the next day. 

It is now known that the developing teenage/young adult brain (a "critical period" that lasts from about puberty to about age 23-24) is most vulnerable to concussion damage. So that was four concussions, two of them at the extreme of severity, one serious and one "rung bell" type in five years within that period. 

Around a dozen others would follow between the ages of 20 to 47 (when the last of the significant ones would occur). Skiing, motorcycle tumbles (all in Taiwan), various work related incidents, some self-inflicted (more later). What can I say, I lived a rough and tumble - and full - life. 

The last of the significant ones occurred in the summer of 2006 (age 47) while working in home construction. A 20 foot long 2x4 was unexpectedly violently propelled in my direction. This was no kiln dried piece, it was damp and heavy. It (like the hockey puck years earlier) caught me on end flush in the forehead at about eyebrow level. I was out instantly which was a bit of a problem because I was high up on some scaffolding, inner instincts managed to make me hang on and somehow get down to where I just sort of collapsed into a sitting position on the floor while the room and everything spun around. A highly observant coworker later told me with certainty that I was "out on my feet" (not uncommon under certain conditions). 

Having now looked back at everything that would happen in the ensuing years with a fresh look through the lens of CTE, it was that last one that seemed to set in motion the inner changes (and horror shows) that I've endured since then. Symptoms typical of post concussion syndrome began. I recall violent dizziness and nausea spells in which I simply could not stand up or even tolerate being upright at all. They'd strike out of the blue and were a total mystery at the time. I was working with my brother then in home building and would inform him of what was happening and that I had to go to the car and take a break for a while or even just go home. Later in the evening he'd ask me about it and we'd discuss it but we just couldn't figure out what it might be and as these spells persisted over weeks and months it became more and more mysterious. I'd always assumed it was some sort of odd flu bug.

I kept working through it though and in time the symptoms seemed to pass. 

It was about a year later - in 2007 - that my entire inner mental outlook and landscape began to change in ways to this day I cannot explain and which were very uncharacteristic for me at that stage of my life (I was 48 at the time and in very good physical condition able to outwork, if I may boast for a moment, guys half my age). 

I had a good, very well paying job. I worked with a good crew (in high end home building). I also had a family to support and a mortgage to pay. Then one day, in late October of that year on a fine warm sunny fall day that was going well on a job that was going well and in the midst of what was a good, positive atmosphere at work, some sort of titanic shift came over my mind. I can't describe it, even now. For a time I could hardly move. I tried to focus on and continue the task I was on but couldn't. Then, without any conscious thought or plan at all, I just quietly took off and put down my tool belt and without saying a word to anyone simply walked away and never went back. 

The next several weeks seemed like being lost in a foggy daze; there were no plans, no ideas, no direction, no sense of anything. Yet I felt no panic, no anxiety, no sense of fear. There were no big existential questions nor anything in my mind remotely resembling a "crisis" of any kind. I was not depressed nor felt "unhappy". There were no particular urges. There was no restlessness nor any strong desire to seek anything. I felt no anger or resentment to anyone or about anything. In fact, now recalling that time as I write this piece other than strongly feeling I could not go back to what I had been doing, I didn't really feel anything at all and I couldn't tell you how I passed the next several weeks or what I did. It was a state I'd never been in in my life before. 

That would, to put it mildly, change. 



The Symptoms


While I'd dealt with symptoms and behaviours and state changes associated with bipolar most of my adult life, for here and this piece and for the sake of (relative) simplicity, I'll focus on the last ten years or so. 

During that time my mind did some very, very bizarre and highly unusual things (these I do not include among the symptoms below). Large parts of my personality and character changed in ways I did not recognize (Others saw and perceived of this differently but that's a whole other topic I best leave to address elsewhere. All I can say for now is that people are notoriously poor observers, their perceptions coloured by denial and their own beliefs and hopes and so on. As I alluded, this alone is a very complex topic). 

Now looking back at many of the symptoms commonly associated with CTE, it is nearly impossible to untangle them from those also associated with bipolar. 

The question (or a question) becomes, does this change for me the diagnosis of bipolar? This is unfathomably complex (as any diagnosis would be) but in short, no. There were extended periods of mania or hypomania (or "mania lite" as I like to say) that clearly belong under the bipolar side of the ledger. The depression side of the equation does change entirely, however. But I best leave an extended look at the depressive symptoms aside for now as I think that will run too lengthy here. 

I'm going to start with a brief list of symptoms in which there is crossover between CTE and bipolar. 

- mood swings (long time readers will know how "fond" I am of this term)

- periods of extreme irritability ("violent" temper, shortness of patience with others, this sort of thing)

- many personality and character changes (there are nearly countless individual variations on how these may manifest)

- fatigue (no, not the "fatigue" most people are familiar with)

- cognitive and memory difficulties at times

- difficulties in staying focused

- periods of depression (again, no, not what most people are familiar with)

- periods of severe "brain fog", an almost crippling inability to think or process cognitive thoughts or what's going on around one (IE: sensory input)

- periods of blunted emotions

- suicidal thoughts, planning and attempts

- periods of difficulty in feeling or experiencing pleasure (often clinically referred to as anedonia) 

Then some of the symptoms that are more clearly associated just with CTE that I have been experiencing and have been increasing in both frequency and duration

- near constant head pain (again, no, not the "headaches" most people are familiar with)

- odd burning tingling sensations in the head, mostly in the area of the frontal lobes

- an odd, impossible to explain or describe throbbing pulsing sensation that's very uncomfortable that now occurs daily

- phantom tingling, prickling and "bug crawling" like sensations in the skin

- periods of dizziness and feeling light-headed

- cognitive impairment and decline


All of these, you will note, seem like "common" behaviours or symptoms. And this is at least somewhat true. This is where and why diagnosis for this kind of thing can be extremely difficult. 

It's also why I stay as far away from lay people as possible (and most professionals as well, truth be told). I have learned the hard way innumerable times not to describe to or talk about these symptoms with anyone outside of specialists. 

All of these things shift and change around on a daily basis. It is almost literally impossible to know what to expect at any given time. As always though, I daily work like hell at managing it. I have learned how to recognize symptoms and how to work around them on any given day and manage what needs to be done as best as possible. 

The majority of most days, however, is passed "resting", being able to do very little mentally, emotionally or physically. 

There are times I feel very good, like I could do almost anything. Here is where I may personally differ from most CTE sufferers in that I can still get those uber positive, optimistic, energetic enthusiastic periods from a mind prone to "manic upticks", we'll say. There are times when all the training and exercises I do do pay off and I'll believe it's possible to get - as all I've ever wanted - "my life back". 

Then the harsh physical realities of a neurodegenerative disease kick in. And the fatigue. And all the rest of it. It can come like a hammer blow some times. 


There is, I must be clear, no cure for CTE, there is only managing of symptoms. I said above that little for me changes in my day to day life because it turns out that the program I created six years ago to deal with all the symptoms of what I thought was "just" bipolar is pretty close to the best of what can be done to manage the symptoms of CTE. 

Ironically (and I still kick myself for not seeing the connection earlier), when I was creating my program I looked a great deal into the concussion protocols and therapies that were being created for top athletes trying to get back to their respective sports and modeled a lot of my program on what they were doing. 

That said, and it is here where I'm going to allow myself a trace (but only a trace) of bitterness (though this is also speaking for the many others like myself in similar positions), there are next to zero treatment and therapy programs and resources for the common person. Almost everything at present is being focused on current or retired professional athletes or (mostly in the USA at present) military veterans. As I said above, this is for better or worse; it's great that this highly focused research and work is being done with such a specific body of patients but for now it's unfortunate that this - not to mention better awareness, recognition and diagnosis - has yet to filter down to what are probably thousands of people like me who have a history of amateur sports concussions, work related concussions and other lifestyle associated head traumas (motorcycle and/or bicycle tumbles, skiing tumbles, etc) or, darkly and more terribly, as results of domestic violence.

However, I have confidence that, like all medical advances, this will happen in time but for now it can be a difficult pill to swallow for those suffering from CTE who get no recognition (either clinically, socially or from family) or resources. 


Myself, I have made peace with it. Well, mostly. There are, of course, "days". Generally I don't think there's anything "special" about being impacted by the effects of CTE; our bodies and brains break down in innumerable ways producing a variety of life impacts, this is just one of them. Here it is, deal with it.  

I am exceedingly aware of what is happening inside my head and where this is going. There is no veil of denial or happy making delusions for me to hide behind. It is therefore hard sometimes not to get hit with "what might have been" and deal with what it is robbing from my life, both day to day and the big picture. 

There is not a single solitary aspect of my life that this has not severely impacted. It has been in many senses "crippling". I am not able to work or hold a job (I have to address the impact of this separately, it is not something experienced the same by all people). It has hugely impacted my social life. It will impact my life expectancy. 

Again, however, I speak for all who are living with CTE. 

Yet, I have no regrets. I look back on my life and think about what I would do differently. 

The answer is not a thing. 

From my youth I have taken the route away from what I guess most people would regard as the "safe and cautious" way. Life for me has always been to be lived to the max, experienced to the max. Not sitting back and watching. 

So no, I don't expect nor in any way want "sympathy" or, god forbid, pity. 

I do NOT, for the record, "self-medicate" with alcohol or recreational drugs nor do I take psychiatric drugs or any other kind of prescription drugs. From the beginning of my study of the brain and brain function and what happens to create any of the symptoms I listed above, my position has firmly been that no way can any synthetic substance "reverse" or "fix" anything. Nothing I have seen in six and a half years of following the world of neuroscience has given me even the slightest reason to change that position. I am exceedingly careful with anything I ingest, with the firm (evidence based) belief that foreign substances could only make things worse. 

Everything I continue to do is laid out very briefly and roughly in the post Positive Difference Making Fundamentals (among many other posts in the blog pertaining to learning to manage one's mind, behaviours and lifestyle). 

All I've ever wanted (and most others, I believe) is understanding. Compassionate understanding. Some sort of dawning "aaahh, I see and understand what has happened with you and why" type understanding. That has been the entire "raison d'etre" of all the research I've done and everything that's gone into this blog for going on seven years. To not be judged. For anyone not to be judged. 

That's all I ask.

Thank you for reading, 

BGE - 8/11/2019

Wednesday, May 29, 2019

Brad's Brain Training Exercises - Part Two




My original post - Brad's Brain Training Exercises - an Introduction - has been one of the most popular Polar Bears posts since I published it in the summer of 2015. In this post we're going to build on what we learned there and try to carry it a little further. 

First off, however, I have to again make clear that what I'm presenting here (and in the original post) should not be confused with popular brain training game sites like Luminosity and Brain HQ.

As I said in the original post, I'd looked into those (and became wary of their claims) and found that they weren't what we mental health peeps needed. Popular online "brain training" games claim to sharpen certain cognitive skills, which is fine, but they can be very frustrating when one is in the throes of serious mental health problems and likely make one feel even worse (as they did for me). What I felt I (and we) needed was something to help us work on things like cognitive distortions, negative beliefs and thought patterns, defeatist attitudes and so on (more below). 

In this post I'd like to try to tie together what we learned in the following posts:

Neuroscience in Focus - an Introduction to Neuroplasticity


An Introduction to Mindfulness Meditation CBT


An Introduction to Music Therapy


I explained in the first post that exercises like those at Luminosity and Brain HQ are based on the basic principles of neuroplasticity. While my mental exercises are designed differently, of course, they work on the some of the same principles. 

Let's have a brief look at that before we move on. 

Our thought patterns and reactions to life around us are created by certain neuronal groups, regions and networks, not to mention a great deal of neurobiology. These will play great roles in our short and long term moods and mental outlooks along with all of our behaviours, reactions, habits and patterns that emerge in our day to day lives. As a part of the "dark side of neuroplasticity", the more we use the same thought patterns and reactions, the more that the neuronal regions and networks that create them will "hard wire" axon and dendrite pathways and strengthen the synaptic connections between them. This is one of the most fundamental principles of neuroplasticity: "neurons that fire together wire together". When I talk about the dark side of neuroplasticity, as I have numerous times, this is in great part what I mean - negative habits, thoughts, reactions, and behaviours get more "wired in" the more they occur. The regions involved and how they network become stronger and stronger. That's why it's hard to break negative mental habits and behaviours. (1)

How I designed the approach to my training exercises was with this basic principle in mind. What we are doing as we do the exercises is working to prevent the "firing" of the regions and networks that create the negative thoughts, mental patterns, and reactions and instead replacing them with new thought patterns and so on which, the more we use them as we do the exercises and the more we apply these to our daily lives, the more this will strengthen the regions and networks involved in the more positive thoughts and behaviours, gradually making the new mental habits and thought patterns come more naturally to us. 

And this is the whole point of these exercises, folks: creating and practicing new, more productive and positive thought and mental patterns plus creating better reactions to life circumstances in order that these come more naturally to us in our day to day lives. 

If you deal with or have dealt with many clinicians and practitioners in the mental health care system, as I have, you will likely be told at some point, no matter how bad a particular crisis is or the very real nature of it, that you have to learn better coping skills . This often would feel very frustrating to me and seemingly dismissive but in the end, I always found that "yes, this is true, there's no choice but to somehow to cope with this better". So another way to think of the exercises is that we're better learning new coping skills or strategies and making them come more naturally to us. 

Which brings us to the term "brain training". 

If you examine human performance of any kind under any circumstances, optimal performance and reactions will be the result of training; how to react better under pressure, how to make the right decisions in complex situations and nearly endless ectetera. And whatever that training may be, its essence will be "brain training"; training the brain to think and react in certain ways under certain circumstances. 

However, as I outlined in the original post, what I found was that we mental health peeps needed very specific brain training. There is no stigma in this, there is no shame in this. All brains need training of some kind to perform optimally and/or to avoid disastrous mistakes, poor decisions, to better evaluate circumstances, to react better under pressure and so on. It's just that for us mental health suffering peeps, our requirements and approaches are just a bit different.

I have spoken previously about Habit Change and have intimated in numerous places throughout the blog that "who we are" is in great part a collection of our daily habits and what we reap in life from those. Yes, I know, this is a very sobering thought but one we must face. The way I think of and approach "brain training" is training better habits into our brains, minds and daily actions. I know I repeat myself, but I must remind that all brains need better training. I must also take this opportunity to make clear that this is all relative and that we are not comparing here. The only - and I do mean only - point here is to make your brain perform better under more circumstances relative to your life and previous experience. That is all that matters here - improving your brain's performance and thus your daily life experience and abilities to get more out of your life whatever that might be at present. I must also remind that of the key premises of what I teach in this blog is that all improvement is about incremental steps taken daily. There is no one grand leap to "better" or any kind of magic bullet that's going to make your issues disappear. It's all about little steps taken that we practice daily. 

Now, on to the Music Therapy part. 

Having music on while doing the exercises is actually fairly critical, for reasons I'll get to. When I do mine I almost always choose very specific kinds of music depending on the type of morning or day I'm having, my mental states for that day and even time of day. I always use instrumental music only. I have a few favourite meditation music pieces that I would often use in the morning (though I have largely moved on from that now). Other than those, I have a selection of either classic jazz or classical music. It's important that it's instrumental only because lyrics, or pop music for that matter, will be distracting both consciously and subconsciously and will reduce the effectiveness of the exercises. Because we want to work on thought patterns and the language of thought, song lyrics will interfere with the brain networks involved in language processing causing unwanted "cross talk" and we definitely don't want that. 

I'd encourage you to find some pieces that work well for you (I'd also encourage you to take this opportunity to be a little adventurous in choosing some music that's new and different to you) and use perhaps three to five pieces regularly (I'll explain the importance of this a bit later). Something I have to suggest very strongly is looking for music that is more uplifting and avoiding dark sounding music (even classical has its darker mood symphonies!). 

Finally, before we move on to learning more about my brain training exercises, let's revisit mindfulness meditation CBT briefly. The key points we want to regularly apply from what we learned there to when we're doing our brain training exercises are:

- we want to be in the present and mindfully attending to what we're doing (the exercises) and not just mindlessly killing time

- we want to practice non-judgmental awareness of our thoughts, mental approaches and reactions

- we want to learn to better align our thoughts with our actions and our actions with our thoughts

Two last things I would like to remind readers of from the original post (for new readers or for those who may remember the introduction piece and would like to read or reread it, you can find it here). One is that doing these exercises can be not only a great distraction or change of focus from when we're in very bad places or feeling overwhelmed (again, this is a classic technique from psychology) but it's also a very productive way of using our time. So we can do these on a regular basis (say once or twice a day) or in times when we really need to change our focus and mindset.

Two, is that it's very difficult to create new mental habits in often hectic real life conditions. I said in the original post that just like professional athletes use private training time to learn new habits, techniques. etc so that they can perform better in pressure packed games or matches, we need to have our own private training or practice time to work on things away from the pressure of real life so that we can improve how we "perform" in day to day situations. This is really important to remember. If I can get you to think of these brain training exercises as "practice" time to hone new mental techniques, you'll have a much better chance of successfully working the exercises and positive results into your day to day life and world.  

Now, in the first piece the focus was on working on changing our inner dialog. Today is related but goes to a more fundamental level.

I have spoken often of what brains do and here I'd like us to focus on one of the primary things the human brain is "designed" to do (in the evolutionary sense of design) - find solutions.

All through our days our minds are going to be presented with (or bombarded by) dozens of situations from the tiny to the large for which we need a solution or result. Very often when we are suffering from anxiety and stress our brains' processes for this are not going to be working well and we may find ourselves agonizing over every little thing in which we must choose this way or that which will leave us with feelings of frustration and confusion and constantly on the verge of breaking down (if we have not broken down already). The reason for this is a bit of a chicken or the egg question. It may be that poor decision making processes led to the anxiety or that anxiety led to the poor decision making processes. After a while it becomes impossible to sort out which came first but likely it'll have been a cycle of these two. While they are somewhat different, for our purposes here today we'll think of decision making and finding solutions as the same or similar things. 

I am tempted here to go more into the brain science of decision making processes and/or the processes for coming to solutions but I think that would stretch the length of this particular post. What I would like to do is share some parts from my personal story and situation which are quite relevant to what we're looking at here today and which I find are very common among many people struggling with short or long term mental distress.

The worst of my illness came in the years from 2010 to 2013. I was still attempting to work full time then and had a high pressure job. I was responsible for finding solutions and making decisions. I could be very good at both of these - that's why I had the job - but as stresses were mounting and things in my life and especially in my mind were breaking down, I had more and more trouble. There would be times I needed a simple solution or a decision to go right but I couldn't for the life of me make it happen. This is often what would lead to overwhelm and breakdown (in very spectacular ways which I have described elsewhere). 

Though the personal details and circumstances plus the level of breakdown and resultant consequences will vary, this a very common situation or ongoing set of circumstances. 

When I started my now (sort of famous) quest for "why?" at the dawn of 2013 and began analyzing everything that went wrong and why, there were a couple of the things that jumped out to me. One was that my ability to make decisions of almost any kind had largely broken down leading to what I'd describe in my notes at the time as "mistake anxiety" which at times would be virtually crippling. The other was that I'd too often give up too easily, throwing in the towel on a situation that was actually solvable. This too affected a great deal of my life and career at the time.

Now, when it comes to this business of decision making or solution finding, whether they be large or small, there are a couple of possibilities - one, we're aware that our processes for these are not good and this is what leads to a lot of anxiety and overwhelm or two, like many people we like to think we're smart and good at these things and thus may not be aware that these processes may be sabotaging us on some level (until something goes wrong, then we beat ourselves up over it) or not willing to admit there is a problem. Either way, this is perfectly natural and not uncommon. 

In the first case, we're going to (and you should by know this is coming) practice some self-compassion and forgiveness. All brains are full of Brain Bugs, faulty cognitive processes and so on, and this is just one of them. Again, you are not A Particularly Bad Person regarding this. In the case of the latter, we're going to be strong and brave and admit to ourselves and accept that we could use some improvement. The more I study all these things - in both the academic sense and real world observation of people and their issues sense - the more I see this is a universal truth; the ability to forgive ourselves and practice compassion (or forgive others and practice compassion with them) or the ability to admit to our faults (IE: get past denial and rationalization) are both necessary to Move Forward in Life. And this blog is all about Moving Forward in Life in more optimal ways.

Something I have yet to touch on is the importance of play in human  behaviour (and that of many animals animal). I've long had in mind a specific post on this but briefly for now what we think of as "play" actually has important functions in how we learn, how we integrate in our minds what we learn and in stimulating creativity and problem solving. This is well recognized among certain experts in the study of human and animal behaviour. I mention this to a) alleviate you from any guilt factor you may have about "wasting time playing games" and b) to begin to establish that "play" is actually quite critical to learning processes (something I learned and understood very well and applied back in my previous life as a teacher in Taiwan) and what we are doing in these brain training exercises is at least in part tapping into our brains' way of learning and practicing new skills this way. It's also very likely you were never taught this or taught this way. We need to change that and this is the place we're going to start. Plus, it is human nature to better stick to exercises that are good for us if we can enjoy them. 

Okay?

So hopefully by now you're at least partially on board with me on this so let's have a closer look at how we're going to "train our brains". 

It's possible that these are new to you and it's possible that they are all too familiar to you (likely in a time killing sense). Either way, I again have to ask you to empty your mind of any previous concepts you have of these (I've mentioned often the "teacup analogy") in order that you and your brain can start afresh in the approach to using these as brain training tools. 

For this post, we have two popular solitaire card games, FreeCell and Spider. I have some specific reasons for using these that I'll get to in a moment. First a bit about card games in general. 

There are several things we can learn from card games and how we can better master and apply these lessons to "the game of life". I have (yet another) piece in mind on "luck and life" but for now card games can teach us a great deal about "luck" - "good" luck and "bad" luck and how to better mitigate the latter while getting and taking better advantage of the former. As well, in many, many decisions in life we need to better understand the chances, risks and benefits of any given move or decision. Card games - practiced as I'll attempt to teach them - can greatly aid us in learning to evaluate risk and chance and make consistently better decisions. 

As I briefly alluded to in the first part of this series, in life - as you've no doubt noticed - we can be "dealt" some pretty crappy "hands" or "cards". Barring inordinate amounts of lucky circumstances, privilege and being sheltered from life, it is an almost certainty that we will be dealt circumstances we feel we can't handle or "win". Virtually every case of mental health crisis I've looked into (and we're talking in the hundreds, including my own) it amounted to combination of being prone to mental health disorders like depression, anxiety, bipolar among others and some unforeseen life circumstance that was overwhelming. 

What I saw in my own case and the others I looked at (many in great detail) was that we needed a way to train our brains to better handle these "crappy cards" we were dealt. 

I also saw it as necessary to train our minds not to rail against "bad luck" (therein lies the disastrous road of self-pity and despair) or search fruitlessly for "good luck" (therein lies the perhaps even more disastrous road of the gambler's mentality of always looking for and counting on "the big score" to solve life's problems or to find "happiness" and so on). We must train ourselves to simply accept what is before us and to work through it as best we can under the circumstances that day.

For one of the darker truths of life (our individual lives and lifetimes) is that life (the grand evolutionary forces and the vast complexities of interactions that happen among all the "players" on this planet of ours) is that it could give a fig about any individual or group. Quite simply "things will happen" which could take all sorts of forms that will just "land on our doorstep" and one way or another we have to deal with it. Again, quite sobering but again we can handle it better with acceptance and learning to better work through whatever it is we've been "dealt". 

Now in these two particular games, we have two analogies for "life" that we can learn from. 

In the first, FreeCell, we can see that we start with all the cards face up. Sometimes in life we are able to do this. It's also something we need to learn to do more often and effectively (the subject of yet another future post, I'm afraid) - setting out all the "cards" of a particular situation or crisis and learning to look through them all and come to a strategy or course of action.

In this game there are no "hidden surprises" to ambush us; everything is out in the open. Life doesn't always work this way, of course, but for those times we can examine a whole situation with everything "face up", it is good practice to learn to go through all the possible courses of action as efficiently as possible to come to the best solution or strategy. 




This game - Spider - is quite the opposite; we start only being able to see a small number of all the cards. There are two courses of uncertainty here; the cards that are face down in the stacks and the cards yet to be dealt (those in the bottom right corner which will be dealt face up on top of those already showing). This is much more like life; things unforeseen coming at us. 






Now, we're not here for me to teach the rules and strategies for solving these card puzzles. That's part of the mental challenge; learning something new (but again, if you are already familiar with these games to take on a new approach to learning them). 

It's important to track statistics of many games as we want to develop a "big picture". If we only focus on the results of single games at a time without tracking long term results, the single results would be meaningless. What we want to learn, practice and master here is being able to hold a "big picture" in mind and the smaller pieces that make up that big picture and learning how to fit the two together and keep each in perspective. The mind tends to focus on "small sample sizes" for evaluation (either positive or negative) and this can greatly distort our perceptions and lead to poor decision making. Learning to track and keep a bigger picture in mind helps us conquer this common cognitive distortion of focusing only on short term results and projecting these into a (false or distorted) the larger long term aspects of our lives. 

It also gives us an objective sense of our success, progress and improvement (as the mind is also very adept at distorting all of these as well). 

With all of the above in mind (and yes, I know it's a lot!), here's a list of things I'd like you to work on (and this is only a partial list, I'm afraid - I'm always finding new things to work on). 

Building up the mental process of always looking for optimal possibilities regardless of how daunting or challenging any give circumstances or situation is. 

Break the habit of predetermining outcomes and build the habit of always getting the most out of any situation no matter what, no matter how things started out. What this does is build the habit of always salvaging the most out of any situation, always taking away something. This was a big one for me (see above about often giving up too easy on situations).

Training your mind to always look for what you need to get the best out of any situation. What is it that you need to get the most out your present moment? You certainly won't find it if you don't have the habit of looking for it. During these exercises you want to build that habit. 

Building the habit of staying in the present and better thinking through the here and now steps you have to perform for whatever given task you're working on or situation you're trying to solve.

For many of us a good deal of our "depressed" moods, feelings and outlooks have come from experiencing too many "defeats" in life. There is a hypothesis for depression called the defeat model. This is yet another topic I really must get to though I do touch on it a bit in our look at dopamine, its pathways and relations to moods and behaviours. Briefly for now, "depression" those depressed feelings, come from a series of, or a lifetime of or a number of major "defeats" that beat us down, "depressing" us in a literal way and which cause and lead to great changes in how our brains work. So in these exercises we have the opportunity to start reversing this and building up solid "yeah, I did it!" experiences and feelings. Then as with all we practice, we start applying it to life and building up even more real and solid "victory" feelings that start getting some of that "depressed" circuitry jazzed up and more part of our daily conscious experience and mental outlooks. 

I looked at optimistic and pessimistic biases in this piece from my other blog (the neuroscience of optimism and pessimism). As I concluded there, we actually need a balance of these in our daily mental models. In our exercises, I'd ask you to look for ways to be aware of positive or negative biases. These might be a tendency to be "too sure" of winning which may lead to unrealistic expectations and poor strategy choices or being too sure of defeat and throwing the towel in too soon. To get past these we simply always stay mindful, non-judgmental and always look for the best outcome no matter what. We do that and we learn to work past setting ourselves up for disappointment with unrealistic optimism yet breaking the habit of giving up or not even trying because we're "sure" we'll lose or "it's/we're not worth it". 

What will happen if you follow all of this and work through solving the puzzles or challenges of the cards that were dealt is that as you keep working at it, not giving up until you've worked through all possibilities is that, by golly, you'll solve puzzles that you at first thought "no way". I want you to build this feeling into your mental circuitry then start applying it to other things in life. Not in big ways to start, but little things (I dislike the trite "baby steps" analogy but I suppose we can apply it here). The big picture thing we want to do here is reconfigure in your mind what you believe is possible for you to do. It all starts with belief, people. This is a great way to build that belief. 

Okay, as usual I have prattled on for far too long again. I'm just going to briefly list some of the other things that you can work on as you work on solving the puzzles and the skills involved in that. 

These (or other similar games) can be used for training the mind for a better growth mind set and always just looking to improve. Very, very often, people, it's not about "winning or losing" but about improving, skill building and so on. 

As well, we can use this "arena" to begin learning where to put and keep our focus; blocking out distractions, focusing on looking for solutions, focusing on using our mental powers in more optimal and useful ways and so on. Regarding "distractions", external distractions are of course important but more important to learn to block out are all the distractions our own minds will generate; negative thoughts, non-related tasks or issues and so on. I know how challenging this is for many but believe me, it is possible to improve, it is possible to build up better beliefs about your abilities to block out distractions. 

To state the obvious, it's about learning how to get the best of out the "cards you were dealt", out of the situation at hand, etc. It's about learning to accept when we simply didn't "get the cards" or the "cards went against us" and instead building feelings of gratification at having given it everything we had, of getting the absolute most out of a shitty situation. Luck, as I alluded to above, is not a personal thing, it is neither "against" us nor "for" us, as much as it may appear to us. These are classic cognitive errors and I suggest strongly to work on these for these erroneous beliefs lead to all kinds of mental states - too negative and down, too positive and up - that we need to learn to tame. This was huge in taming the roller coasters my bipolar mind could produce.

In that vein, these session are also a chance to better train oneself to let go of immediate outcomes and keeping one's focus on learning and mastering better skills and steps. Master the skills and the better results will more often come (though not always; see acceptance and letting go). 

It is possible to build better skills for understanding better what's realistic or probable or not and how to make better decisions based on that and knit those skills into your daily life. 

With that in mind, a very powerful mental ability is learning better when to walk away from certain situations as much as the outcome may mean to us and how much we want to solve it. Another way to look at it is that is building our "letting go" judgments and abilities. We learn to recognize when we've put all we could into something and that it's just not working out and that we need to move on to other things or opportunities and so on.

Another very key mental skill to learn is be able to ask yourself; are you playing poorly or are you just getting crappy cards? We have to learn how to separate these in our minds. In our lives are we "playing poorly" at life or is life dealing us a lot of bad luck? Often, we'll find it's a bit of both which brings us to the other big lesson we can learn while we're training our brain - how to get luck to work more in our favour ... what we'll find is that if we learn to consistently work to get the best out of any situation, to not give up and throw in a half assed effort, over time opportunities good and bad luck will tend to go more and more in our favour.

We do that by building the best habit we can so that when luck does happen, we can better take advantage of it. We also do this by learning to stay present and make the best decisions we can moment by moment.

A very important thing I want you to work on is is to eventually change reactions to the immediate and longer term circumstances we face in life. If you mindfully pay attention to your reactions to how the cards are going, you will notice they mirror your emotions and reactions to many things in your life. Our sessions of brain training with these games are opportunities again to work on these, they are opportunities to practice what we work in in Mindfulness Meditation CBT. These are steps to learning how to build stronger resiliency.

Last message for this post. I mentioned the importance of tying music therapy into these sessions so let's have a quick look at what that's about. One, it's a great way to do two kinds of brain training at once (see The Neuroscience of Music Therapy for the mental benefits of music in the brain) but there's something else interesting that can happen as well by combining the exercises and certain music. Ideally, you will begin to build positive feelings in doing the exercises that can often lead to better moods. This will build positive associations to the music you regularly listen to while doing them so at times you can't do the exercises but need a "lift", just listening to the music can provide a subliminal boost to your mental states. 

I think we'll wrap this up for now. My greatest hopes are that you can see the value of training your brain in these ways, that this "play" is not a waste of time but most importantly to build your belief that - 

yes you can. 

Yes. 

You.

Can. 




(1) In several chapters of The Brain that Changes Itself, author Norman Doidge outlines in considerable detail how this process works. 

Monday, March 4, 2019

Sometimes the Reason







Sometimes the Reason

is

To be free

of hate and anger, of conflict and confrontation

To be free

of oppression and possession, of suspicion and fears

To be free

of speculation and assumptions, of labels and judgement

Sometimes the reason

is

To be free


of damning and blame, of guilting and shame

To be free of

of mind rending tension and doubt

Sometimes the reason


is


simply

To be free

Wednesday, January 23, 2019

Understanding the Mind - Consciousness

Image result for consciousness



The great question of understanding consciousness became another of my favourite avenues of self directed scholarly study some years ago when I started this whole journey of research and discovery into the human brain and what drives "us". As with everything that goes into this blog, this was for two basic reasons; one was a pure joy and passion I found in studying the topic and taking part in or following discussions and sharing of information on what was happening in the world of consciousness studies and two, it became my very firm belief that a better understanding of consciousness was vital for better understanding the various mental experiences that make up any one case of a mental health disorder. We'll return to that in a moment. 

Better understanding consciousness is also the foundation for better understanding much of who "we" are; how we think, how we perceive, how we act, how we decide - or how (and why) we not do any of those. Any discussion on or understanding of the question of self-agency, AKA "free will", is not possible without a solid grasp of consciousness. The concept, study and understanding of consciousness is the very crux of what it is and means to be human. 

It is has been my driving passion for six years now to learn and understand as much as possible about the neurological basis for such things as thoughts, mental phenomenon, behaviours and even subjective reality as it will be various combinations of these "going awry" that will make up the symptoms of - and the suffering thereof - any mental health disorder (or what I am increasingly regarding as a neurological disorder). And so it has been in my pursuit of understanding consciousness and what it means to us

The study and understanding of consciousness - like all my study of the brain and human behaviour - is more than just an idle philosophical dalliance for me. Because I take all and every aspect of mental health so seriously, and because I so firmly believe that mental health disorders are so linked with our conscious experience, I take it - I think - more seriously or with greater urgency than most. For me there is very, very tangible real world "skin in the game". Endless debate and virtually empty discussion over the various competing theories that give us no kind of concrete understanding that we can apply to our lives are meaningless to me. I find, I confess, abstract philosophical discussion simply frustrating. 

As such, it has come to be my very firm position that we must let go of notions rooted long in the past, such as dualism; the pervasive and persisting belief most famously put forward by Descartes nearly 350 years ago that mind and conscious thought are somehow separate from the body and brain. An enormous amount has been learned in the fields of neuroscience and cognitive neuroscience in the past twenty to thirty years (let alone since Descartes' time!) and it this veritable wealth of new information upon which we must base our modern understanding. 

There are libraries full of literature on this topic from the world of philosophy going back 2,000+ years along with thousands of research papers from the various (and often fiercely competing) fields of neuroscience. Needless to say even the briefest of summaries of all that has been written would stretch the boundaries of what we can fit into this piece. As interesting as a lot of that may be (and it certainly is), we are going to cheerfully (I hope) skip past the great majority of past musings and draw mostly from what the most advanced brain research in history and the modern neurological approach has discovered. Even that is rather voluminous but I shall endeavor to keep it as concise as I can while leading us to the most informed and illuminated understanding we can hope for from within the limited confines of space and time (not to mention mental bandwidth) we have available to us here.

I must add, before we move into the thick of things, that while I believe there is much to learn about the evolution of our consciousness by studying animal consciousness we are only going to be looking at human consciousness in this piece.

Without further ado then, let's bravely leap in. 


What is Consciousness?


Welcome to the question that has vexed the human mind for several millennia and which led to those libraries of volumes containing our long philosophical exploration of the question along with the more recent investigation using some of the most advanced scientific research methods in our history in quest of the answer.

Which is, in a word, elusive. 

To understand a bit more about why the answer eludes us so, to consider the general nature of "consciousness" is to explore the very essence of concepts such as "thought(s)", "mind", "subjective experience", "perspective", "attention", "mental states" and perhaps even "reality" itself. All of these, you will note, have no readily apparent concrete physicality to them, they are abstract concepts (all in parentheses, by the way, because each in itself is a rather fluid term lacking consensus definitions). Though speculative claims are sometimes made, there is no one place in the brain for any of them for us to point at and say "Ah-ha! There it is!" 

This is greatly disconcerting to the scientific mind (of which our dear Descartes above was one) or any mind that tends to need hard knowable answers. The classical scientific mind is driven to reduce all problems down to knowable laws of physics, chemistry and mathematics. On the one hand this draws cries of "reductionism foul" or failing that what has led down the path to declaring some form of "dualism" (essentially that abstract aspects of the human mind or consciousness for which there is no apparent physical "spot" thus must somehow exist separate from our physical makeup).

Therefore consciousness widely being regarded - by some of the most brilliant minds we have, mind you - as the "hard problem"

The renowned British psychologist Stuart Sutherland, perhaps in a less generous mood during one of his phases (1), once wrote of consciousness in the International Dictionary of Psychology, "The term is impossible to define without a grasp of what consciousness means ... nothing worth reading has been written about it".

Nonetheless, we must remain undaunted so on we tread.

As I sometimes like to do in looking to grasp something difficult, to better understand what consciousness is let's touch a bit on what it isn't. For that it is required to understand a little about two concepts: the subconscious and what it is to be unconscious. While these terms are often used interchangeably (along with preconscious and nonconscious) for our understanding here today we need to think of them differently. 

Let's start with "unconscious". To be unconscious is to be unaware of most if not all outside stimuli (sight, sound, smells, touch) such as when we are sleeping (though this varies somewhat depending on the phase of sleep) and even inner stimuli (IE: thoughts, feelings, imagination, etc). This can also be as a result of fainting or a concussion during which a person will be "blacked out" and unresponsive to any stimuli nor have any memory of the time while unconscious or it can be while we are under general anesthetic for surgery or, most seriously, in a coma. 

To not be in any of those states then is to be conscious, which is to be experiencing varying levels of awareness of what all five of our senses plus that increasingly well known "second brain" in the gut are bringing in along with the "stuff of mind"; thoughts (much of which is random), imagination, reasoning, mental tasks such as mathematics, composing and writing, specific directed thoughts on myriad aspects of our lives, the world, problems, purposeful interactions with others and so on.

What we generally refer to as the "subconscious" is rather a different matter.

It is impossible to overstate just how much of what's going on in our brains that drives our behaviours, decisions, thoughts and so on lies "beneath the surface" (hence "sub") of our conscious awareness and control. This is just in the brain itself, never mind how much goes on between the brain and body and even the brain and its environment at any given point. The ratio of subconscious goings on to what we are consciously aware of and/or working on at any one time is staggeringly high. Whatever consciousness is, however we define it or whatever we do with it or how we experience it at any one time, it is a very thin veneer on top of an enormously complex and deep amount of subconscious brain activity. 

To even tap slightly beneath the surface of that veneer would really overtax our time and space here so for the time being we're just going to take at face value what virtually all of neuroscience and cognitive psychology study has revealed in enormous amounts of research and experiments in the last several decades - all that is "you" and whatever you experience is made up by and controlled by the astronomically tangled and complex anatomy and biology that is our brain activity along with nearly unfathomably intricate and ever ongoing interplay between our DNA and environment (Eagleman, Dahaene, Sapolsky, and countless others). 

Somehow what we experience as consciousness both "emerges" from all that brain activity yet paradoxically seems not quite part of it either. You should now be starting to appreciate more why it's the "hard problem". 

I think then that it may be more useful for us to not think of what it "is" but more what it "seems to be". 


Let's begin then with some (very) brief summaries of how some of the current great minds in neuroscience approach this wacky elusive brain and mental phenomenon we call "consciousness". 

The popular neuroscientist David Eagleman in his book Incognito took what I think is one of the more practical and straight forward approaches to explaining consciousness so we're going to start there and build on that. To repeat (and perhaps rephrase somewhat) what I wrote in a previous piece regarding consciousness, Eagleman simplifies the essential purpose of the brain by stating that "the brain is in the business of gathering information and steering behaviour appropriately" and, to that end, that "consciousness developed because it was advantageous (in the classic evolutionary success sense), but advantageous only in limited amounts".

We shall revisit that a little later but to flesh out better what it is about consciousness that makes it "advantageous" let's dig a bit deeper.

Some years ago the neuroscientists Francis Crick (he of the double helix structure of DNA fame) and Christof Koch wondered why, if our brains are just a bunch of specialized autonomous "programs" burned into our neuronal circuitry, are we aware of anything at all. Their answer, and Eagleman would build on this, was that consciousness existed as a means to "control" or "distribute control" over all the various "programs" our brains could run at any one time in response to any given situation as opposed to countless other species whose brains' circuitry and "programs" work remarkably similar fashion to ours. 

[Beware the use of the word "control" here, however; neither Crick and Koch nor Eagleman mean that word in the sense that is used regarding "free will" control.]

They, and others, see consciousness as a sort of "CEO" of the "large corporation" that is our brain (many different departments, levels and machinations, etc), or we might think of it as the "conductor" of the "orchestra" of our brain activities. Note that both a corporation or an orchestra can operate on their own but a CEO or conductor are necessary to exert "executive control" to give all the parts a concerted direction, coordination and smooth operation. We'll come back to this notion of "executive control" a little later in the more cognitive neuroscience sense of the term. 

Let's now consider some of the more highly regarded theories of consciousness which explore its role a little deeper.

First put forward in 1999, we have Antonio Damasio's three layered model of consciousness which works on a hierarchy from most basic to a highest level that I feel ties in well with our evolutionary development. We start with what he terms the "protoself" in which the brain seeks the basic elements required for survival and homeostatis on a moment by moment basis, something shared by most species. At a higher order, we have what he calls "core consciousness" where there is an awareness of feelings associated with changes in body state (or homeostatis). At this level the organism is capable of a greater sense of "self" (this is where we begin the argument for animal consciousness) as it responds to internal and external stimuli and feelings and moves from largely unconscious states and reactions to experiencing patterns of images that "float into the organism's awareness". From this the organism's mind is able to create and respond to a greater sense of relation to its self and objects around it albeit limited to the here and now present. This level is shared by many species and does not require language nor does it involve long term memory or a sense of past or future (personal note, I think there's something from the studies of animal consciousness and cognition to add here). 

Atop of protoself and core consciousness we have "extended consciousness" which requires vastly different memory capacity and function, a full sense of past, present and future, along with much higher order cognition. It would appear that we homo sapiens stand alone with this level (though we are capable of operating at all three levels). 

While Damasio's model is useful for understanding how our present level of human consciousness got to where it is (and if you dig deeper into this hierarchy, you'll see the three levels match up to the three levels of the Triune Brain), it still doesn't adequately sate our hunger for a deeper understanding of what it is that we experience as consciousness. 

To look a little more into that we will now consider one of the most enduring and widely cited theories of consciousness, that of Bernard Baars's Global Workspace. (2) In this model consciousness is a form of brain-wide "information sharing" brought together in a "workspace" where it is attended to (in ways we'll look at a little more below). This model fits in well with the aforementioned concepts of "top down CEO control" put forward by Eagleman, Crick and Koch and others. 

While intimately related, Baars also carefully distinguishes attention from consciousness; the former being more of a "bottom up" process for sifting through the tremendous amount of "data" brought to our brains via our sensory equipment and prioritizing what needs to be attended to whereas the latter is the higher order "top down" executive functions of how to attend to a prioritized matter of attention - plan, decide between options and so on - and to set other areas of the brain into action. For the former think mostly the limbic region, for the latter we're talking mostly prefrontal cortex. Or using Damasio's model, awareness is more at the "core consciousness" level, the conscious processing Baars proposes being "extended consciousness". 


Though not to be confused with Baars' theory, similarly titled and similar in concept, is Stanislas Dehaene's Global Neuronal Workspace model of consciousness. His work very much pays homage to and builds on Baars' ideas of global information access and broadcasting.

He brings some clarity to the aforementioned "confused state of affairs" by asserting that contemporary science distinguishes a minimum of three concepts: "vigilance" - the state of wakefulness which varies when we fall asleep or wake up; "attention" - the focusing of our mental resources onto a specific piece of internal or environmental information; and "conscious access" - the fact that some of the attended information rises from the unknown subliminal processing entering our awareness to become "reportable". He firmly argues that it is this "conscious access" where the rubber meets the road in defining the human experience of consciousness, furthermore that it can easily be studied in the laboratory. He along with his research partners have for more than two decades put enormous amounts of highly sophisticated lab work into demonstrating just that - how subconscious brain wide neuronal "information sharing and processing" moves from the subliminal to the conscious "workspace" of our minds. His work is very impressive and very compelling. We'll touch on a bit of that below. 

In his view it is this basic element of "conscious access" that is the gateway to the more complex forms of conscious experience many of us think of and which have inspired so much philosophical navel gazing (our sense of self, this "I" that can look down on itself, comment on itself and so on, knows what it knows and doesn't know). He happily reports that even these higher order meanings are no longer inaccessible to the lab. 
.
In each of these models for human consciousness we too see suggested an element of "control" and organization and direction over our cognitive and emotional capacities along with plans, actions and so on based on those. 


Now, if that all seems like it's making sense and you're breathing a sigh of relief thinking "phew, I am a conscious being after all", we must consider this; there are those from the arenas of philosophy who argue - quite compellingly - that consciousness may well be an illusion (for many similar reasons as to why "free will" is an illusion). These include philosophers such as Daniel Dennet and Thomas Nagel. Given how much of what we individually perceive as "reality" is an illusion and how difficult this whole business is of pinning down any physical basis for consciousness and how much our conscious experience is related to our sense of reality, it would appear to be pretty hard to argue against this. 

Yet, as even the consciousness as an illusion proponents will say, it's a necessary illusion (at least for we homo sapiens) and our individual subjective realism is real enough to us. As is the reality that goes on all around us as we try to navigate through our life spans on earth.

Those who question the very existence of consciousness notwithstanding, it seems to be this odd metacognition sense of "self" that we have (hence subconscious pioneer Sigmund Freud's concept of "ego") and self-awareness ("I think therefore I am"), a more highly aware "arena" in which we "think or plan things through" (theories by Baars and Dehaenes cited above), a higher sense of our feelings and thoughts and experiences and what those mean to not only ourselves but those around us, a vastly more sophisticated view of our surroundings and environments in comparison to other creatures' conscious abilities (or lack thereof), a vastly more complex sense of time past, present and future and abilities to plan actions based on those, higher cognitive abilities, greatly more sophisticated means of communication, to imagine - and then create - things that do not or did not exist and so on. 

So whether or not consciousness is "a thing" (physically identifiable and thus not an illusion), it is, to come back to Eagleman's pragmatic understanding, "advantageous" to our day to day actions and survival and it does (or can) help in how our brains "gather information and steer behaviour appropriately" as we move from cradle to grave. I think too that by now you may be sensing a growing appreciation for the kinds of all out "turf wars" there are in the fields of consciousness studies.

That said, speaking of identifying consciousness physically, 


Where does consciousness come from?


Haha! This makes the problem of defining consciousness look like child's play. Searching for the physical properties in the brain (and body) of consciousness has created - quite literally - a multi-billion dollar industry (there's gold in them thar hills!). 

Nonetheless, in a process that mirrors evolutionary progress itself, "successes" do emerge from the chaos and failures. 

As I've stated from the beginning, whatever we are, whoever we are, or who we imagine we are, or how we think, act, emote, bond, etcetera or not do any of those things will all be "created" by that 3.1 blob of tofu like substance between our ears which is (and I don't doubt there are those that are tiring of me saying this) the most complex organism in the four billion year history of life on earth and in the known (emphasis on known) universe. 

There simply exists no credible evidence to indicate anything else. 

Now, as we look at the neurological factors that are possibly involved in "giving rise to consciousness" and/or "conscious experience" I'd ask you to bear in mind that those are two related but distinctly different concepts we're talking about. Recall that to "be conscious" is the opposite of being in a state of unconscious, IE: in deep sleep, blacked out from a fainting spell or blow to the head, under an anesthetic or possibly in a coma. "Conscious experience" is that "moving picture show" and ongoing dialog in your head that comes "to life" when you are conscious. 

To be conscious is at least somewhat straightforward. 

For these types of "seats" and "switches" for consciousness we must journey deep down into the lower limbic region and brain stem to look at two such possibilities (among others). It is here where we'll find the thalamus which a great deal of research has closely implicated as being key to "switching off" consciousness (such as when anesthetized).

Deeper yet we will find a very small nodule with a rather cumbersome name, the rostral dorsolateral pontine tegmentumResearch on brain lesions in this area revealed that damage here resulted in coma or lack of consciousness. No consciousness, obviously no conscious experience. Hurrah, we have our "seat of consciousness" (or seats if we also include the thalamus). 

Not so fast. We share these two nodules with all mammals so while these may well be the "seats" of consciousness in the sense of being fully awake, aware and functioning, this is not precisely the sense of consciousness that gives rise to "I think therefore I am" that has vexed us so. 

For that sense of consciousness, it is, as we'll see and as I say about many mental functions, "everywhere and nowhere". 

As I originally conceived this piece and how to demonstrate that, I thought we'd look at a number of neuroanatomical and neurobiological features and functions of the brain and imagine what would happen if we "subtracted" those or made them disappear from our brains. 

Forgive me in advance if this seems to mirror much of what we saw in Neuroanatomy 101

The best known feature of the brain is neurons. It'd be a bit silly to imagine subtracting all neurons from the brain because there simply wouldn't be a brain at all (let alone a conscious one). There are many types of neurons, however, some more critical to the higher sense of consciousness we're examining than others. For brevity's sake we'll focus today on the pyramidal neurons. These are among the largest neurons in the brain and have unique and often very far reaching axon and dendrite extensions as well as being some of the most widely connected neurons. Research both old and new demonstrates that they are critical for higher cognitive processing. As they are the most populous of the excititory class of neurons (as opposed to inhibitory neurons), they have been demonstrated to be key to something known as "global ignition" - a mass of brain cells reaching action potential in large coordinated ways leading to - tada - us consciously experiencing a piece of heretofore subliminal brain activity (Dehaenes). 

Damage to these neurons is highly implicated in several neurological diseases and cognitive decline or impairment. 


Next in the very basics of neuroanatomy is the "wiring" and "connections": axons, dendrites and synapses. You could have a brain with all 86-odd billion neurons in brilliant good functioning health but if they aren't connected to one another, needless to say not a lot is going to happen; including, obviously, consciousness (of any kind). Thus if we see synaptic connections disappear, we'll see memory loss, cognitive decline, along with many of the other mental phenomenon we associate with conscious experience. No need to point out that the myriad of neurobiology involved in making synaptic connections "work" each and all play critical roles without which, again, we have no consciousness at all, never mind the experience of such. 

At a larger "wiring" scale, we have the brain's white matter or "connectome". This "wiring harness" of long axons carries or directs signalling between all brain regions (which are neuronal groups and nodules large and small). Connectome expert the neuroscientist Sebastian Seung argues quite passionately (naturally, it being his specialty) that while many brain areas are important for consciousness the connectome is the "stream bed" of consciousness. That's pretty hard to argue against given that without lightening fast brain wide communication through hundreds of channels between hundreds of brain regions you wouldn't experience much of anything and certainly nothing resembling normal consciousness. 

Yes, I know, these elementary basics may all seems tediously obvious but it is just to drive home the point that there is no one "seat" of consciousness. 

One more elementary brain area and function then we'll get onto some "sexier" brain stuff involved in consciousness. 

That would be everything to do with the stress response system. 

Disagree?

Let's say you're driving along in your car on an average day. As your stream of conscious experience tends to all kinds of trivial matters, your subconscious "zombie programs" are busily taking care of almost everything to do with navigating your car through traffic. So, you're humming away to that tune on the radio, with thoughts of work on your mind, an earlier argument with your partner, the previous night's baseball scores and on and on. 

Suddenly, ahead of you, a large semi trailer unit has lurched sideways and a 300 pound truck tire is rolling and bouncing straight for your car. Before you consciously perceive this, your stress response system has already "taken the wheel" - literally and figuratively - and several hundred thousands of a second before the danger has penetrated your conscious access your feet and hands have already begun to respond. From there "you" are not in control (as much as it may "feel" like you are) but all kinds of deep burned in brain circuitry, now fully guided by the stress response system, in reflex action is doing everything possible to avoid that truck tire. 

Your car brakes and veers, the tire and other traffic is miraculously avoided and "you" find yourself safely pulled to the side of the road breathing very heavily and perhaps wondering what the hell just happened. 

It is here where we see what Eagleman meant by consciousness being "advantageous only in limited amounts". It is these kinds of situations where conscious focus elsewhere gives you a good chance of getting killed and thus not very advantageous in the evolutionary sense. 

So if part of consciousness means what our brains put on our "conscious awareness plate", millions of years of evolutionary forces have shaped our stress response system to "take the wheel" of conscious control in times of danger. 

If we are in the camp that human consciousness is different or more evolved than animal consciousness, it then behooves us to look at and consider some anatomical features that set the human brain apart from all others. 

If we were to compare the cerebral cortex of several higher order mammal species and that of homo sapiens, we would see in the latter very pronounced bumps and fissures known as sulci and gyri respectively that are not seen in the former. These are the result of the unique way that the outer cortex of the human brain develops and is "folded" into the skull. What this means is that a far greater volume of the higher functioning cerebral cortex fits into the smaller space of the human skull. It is also believed that these folds allow different lobes to "communicate" or coordinate with each other more efficiently and quickly through brain waves. 

Following that it is quite possible that this feature of the human brain helps give rise to human conscious functioning.

Also unique from our evolutionary forebears is the most advanced bit of "brain ware" in existence - the vaunted prefrontal cortex of we homo sapiens. It is here that we find what cognitive neuroscientists refer to as "executive function"; the abilities to differentiate among conflicting thoughts, determine comparatives (good and bad, better and best for example), future consequences of present activities and higher predictive abilities, goal directed actions and expectations based thereon, and social control (the ability to suppress urges that could lead to socially unacceptable outcomes). It is here that "willpower" is exercised or not and, quite interestingly, the "will to live".

So, if we return to where we started with the theories of consciousness that suggest "control" or "planning" and cognitive processes that we see in Global Workspace theory and similar theories, is the prefrontal cortex the "seat of consciousness"? Some in the fields of conscious study say so. But proper PFC functioning depends on healthy neurons and synaptic connections, strong connectivity through the connectome and ... well, every other detail we've touched on (not to mention oceans of finer detailed neuro-activity). Indeed, when we see neurodegeneration in these areas, we see marked decline in conscious processing and even experience.  

Theories on the purpose of and function of consciousness in the human brain often refer to learning processes or conscious effort in problem solving (and planning, etc) or various types of deliberation involved in decisions . Learning might be a new skill or routine; driving a car or a different commuting route to a new job, for example. At work or at home we may have to find solutions to problems or issues, take part in short and long term planning and make minor and major decisions. In each many aspects may have to be weighed all of which requires much conscious deliberation. Learning something new (in)famously can take much conscious effort before the skills and new information is "burned into" our neuronal circuitry where it begins to come more "naturally" without so much conscious effort.  

If we apply Baars' Global Workspace theory, these processes will heavily involve working memory, not to mention other executive function "cognitive tools" we saw above in the PFC. Working memory, sometimes referred to as short term memory, itself has a neuronal basis and areas in the brain and both "recalls" and "stores" information related to the task. As such there will be great interplay between it and long term memory for which we must return to the limbic region and the hippocampus from and through which all manner of information is "stored and recalled" throughout the brain. Higher cognitive tasks such as we see in GWT seldom work in an emotional vacuum, therefor many brain regions to do with emotions will also be activated in these conscious processes. Motivation and possible reward will also play roles as we soldier through higher conscious processes and that brings into play dopamine related pathways that stretch from the brain stem right up the frontal lobes (and many "stops" in between). Imagination is often greatly applied to conscious processes as we visualize this solution or that plan and so on. This too draws on brain wide neuronal networks. 

So even in a relatively precise model of consciousness like Baars' (and/or related or similar models) we can see it would appear to be rather a hopeless task to pin down any "seat" or "center" of consciousness as so much coordinated neuronal activity between far flung brain regions is involved, hence the "global" aspect of the theory.  

Aaahh, but let's look a little deeper at this idea of "coordinated neuronal activity". We can only touch on a few examples here. 

Located in the general area of the insula (roughly in front of the tops of your ears) is an enigmatic and seemingly nondescript sheet like neuronal structure called the claustrum. (For some of the best research work on the claustrum and consciousness we must return to our dynamic duo of Crick & Koch). Unimposing in structure, it occupies a mere one quarter of one percent of our cerebral cortex. Yet - yet! - remarkably, it turns out it's "very well connected" as it receives input from almost all areas of the cortex and projects back to almost all areas of the cortex. 

Again, if are looking at globally coordinated brain activity as being critical to the human experience of consciousness and consciously directed effort, this inconspicuous sheet of "brain ware" appears to be a significant "orchestrater".

To depart from strict neuronal basis of consciousness and/or conscious experience or activity, a very interesting approach to explaining consciousness "came across my desk" a few weeks ago based on energy. While the model of that theory may seem a bit "out there" I can imagine little argument against the fact of how energy dependent the brain is. Individual neurons don't "fire" without energy, let alone any task specific group of neurons or coordinated activity between them nor can axons do their thing without enormous amounts of energy. Very very elementary, dear Watson. From there then we must include everything in our body that brings energy to the brain - nutrients and oxygen to name two elementary basics - and most importantly those little "energy engines" of all cells and most critically, brain cells - mitochondria (a personal favourite of mine). I hardly need to point out then that any kind of brain function, let alone consciousness, will grind to a darkened halt without energy. 

Related to energy, we cannot ignore the role(s) of brain waves in conscious processes and experiences. While not without controversy (granted, nothing about any kind of brain function is without controversy, if not outright academic wars), growing bodies of research - such as those cited and summarized here - indicated that beta and gamma wave activity are strongly associated with - tada - the kind of brain wide coordination of neuronal activity that gives rise to conscious perception of previously subliminal brain activity as well as selection and flow of neuronal based information. Research from MIT has found evidence that low frequency beta waves help control "what we think" and working memory which leads back to the theories of consciousness from Baars and Lehaene we briefly looked at. 

Electrical activity in the brain takes us into the arena of physics which is a whole other ball of wax that is quite beyond our space here today.

There are of course dozens of other theories and approaches for understanding consciousness from those involving quantum mechanics to panpsychism to collective consciousness that while worth looking at, we just can't get to today. 

I think, however, that one may now get the idea that consciousness and conscious experience are "everywhere and nowhere" in the brain; it's all global brain activity involving virtually all aspects of brain matter and function (everywhere) with no one "seat" or "center" responsible for all of what it is (nowhere). 

For the record, I am of the belief that as intractable a problem understanding human consciousness is it is solvable. Researchers from (again) Crick & Koch to Dehaene and many others are of this mind as well.

Also for the record, I am exceedingly (and painfully) aware - or conscious of, if you will - that I could only touch on some major theories in the briefest manner possible and as such could not do them the justice they deserve. With that in mind, I can only hope the piece was thought provoking and inspires further reading into those mentioned here. There are also vast amounts of fascinating and highly relevant neuroanatomical and neurobiological detail that I had to leave out as well. Perhaps another time soon.


Conclusion


If you made it this far, I applaud you yet you're probably wondering why the hell you should care about all this philosophical and neuroscientific obsession with something nobody can "see" or come to any consensus understanding. To try answer that I am going to reiterate what the position of this blog has been since the outset. 

One, we do not create our conscious experiences and behaviours. All the evidence - and I do mean all - points to those being created in a vastly complex relationship between brain activity, on going genetic activity and environmental conditions and circumstances (to put it as concisely as possible). The less we understand this, the more we deny this (as individuals, as a society, as a species) the more we will fruitlessly blame ourselves and others for thoughts, actions, reactions, behaviours, inabilities and so on that are very difficult to control, the less chance we have of leading people - and you - out of the woods of everything from mental health disorders to all kinds to addictions to a great deal of what is considered "criminal" behaviour. 

Two, it has been a long percolating theory of mine that most if not all "mental illnesses" are in fact "disordered conscious experiences"; a fully healthy functioning brain gives rise to healthy conscious experience and the ability to properly regulate unhealthy mental states, thoughts and behaviours, a brain that is somehow not functioning at optimal levels gives rise to an unhealthy or disordered conscious experience and increasing difficulties to properly regulate unhealthy mental states, thoughts and behaviours, or in other words everything that makes up the symptoms of a given psychiatric disorder or might be involved in other behaviours that run against the grain of modern society. 

Three, I strongly suggest that learning to better understand consciousness and your subjective (or individual) conscious experience is to better understand all the shifting mental states, reactions and behaviours and their power over "you" that make up whatever psychiatric or mood disorder you may be dealing with and more importantly how you can gain more "top down executive control" over them. 

It is at this intersection of subconscious brain activity and consciousness experience and conscious "executive control" where we learn what we can control and what we have difficulty controlling. It is at the intersection of the almost infinitely varied human brain and subjective conscious experience that we must learn to truly understand individual differences. Everything I have done to improve my own mental states, thoughts and behaviours - and life - have been based on exactly this.

Thank you as always for reading. 


1 - As great as he was in the emerging field of cognitive psychology, Stuart Sutherland also lived with manic depressive disorder (today known as bipolar disorder) and like many of us, suffered from - and the resultant reputation brought on by - fearsome swings of mental states. Which makes him rather a kindred spirit. 

2 - On a personal note regarding Bernard Baars; for a magical time in early to mid 2016 I had the great fortune and honour of not only "meeting" him via online means (his personal assistant was a long good online friend of mine) but developing a collaborative relationship (for a project that unfortunately did not come to fruition) in which he also tutored me on the meaning and exploration of consciousness. However, this relationship had nothing to do with the inclusion of his theory here; it simply remains one of the most widely cited and influential theories of consciousness.