Sunday, September 30, 2018

Dr. Ford, Trauma, and Memory, Part 1

In her testimony, Dr. Christine Ford discussed her traumatic memories. In our book, Healing the Brain: Stress, Trauma and Development, we look at exactly what Dr. Ford describes. Here is Part 1 of an except from Chapter 3, "Wounds that Time Won't Heal."


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Highlights:

  • Short-term vs.long-term stress (good stress vs. bad stress)
  • Altered brain chemistry from stress
  • Trauma and the vulnerable brains of children and youth
  • The importance of touch in brain development
  • The tragedy of Romanian children raised by the state

Imagine you are a zebra grazing on the plains of Africa. It's midday. The sun is bright, the food is plentiful.

Suddenly you sense an attack. A lion is chasing you. Its fight or flight in action.

Your brain tells your body to prepare for a fight or take flight. The body responds by preparing extra hormones to create more energy and by increasing the rate the heart pumps blood to the muscles. For most animals, this stress reaction lasts for just a short time and it saves lives.

Wikimedia Commons
Why don’t zebras get ulcers? According to Dr. Robert Sapolsky, their stress is decidedly short-term, not long-term.

As a body is preparing for fight or flight, however, practically all systems, such as digestion, physical growth and warding off diseases, are placed on hold. This means that people for whom stress has become a way of life are endangering their overall health. Researchers have learned by studying primates whose systems are similar to human beings that those who learn to have control over their lives and are able to reduce or avoid stress live longer and healthier lives.

Are zebras better equipped to deal with stress than humans? No. However, according to Dr. Robert Sapolsky, author of Why Zebras Don't Get Ulcers, "For a zebra, stress is three minutes of some screaming terror running from a lion. After the chase, either it's over or they are." On the other hand humans, he says, have constructed a network of social stressors. Since we are obliged to live in this framework, stress builds up.

Nature.com
While the stress response activates automatically, its duration and intensity relies on factors such as individual temperament.

How do the brain and the body react to stress? Stress, such as the threat of attack, forces various changes in the body. First, adrenaline causes an increase in heart rate and blood pressure so that blood can be sent to muscles faster. Second, the brain’s hypothalamus signals the pituitary gland to stimulate the adrenal gland (specifically the adrenal cortex) to produce cortisol.

SimplyPsychology.org
Stress, such as the threat of attack, forces changes in the body carried out by the hypothalamus, pituitary, adrenal axis (HPA).

This stress hormone, a longer-acting steroid, helps the body to mobilize energy. However, prolonged exposure to cortisol can damage virtually every part of the body. Chronic high blood pressure can cause blood vessel damage and the long-term shutdown of digestion can lead to ulcers.

Why do some people experience more stress than others? Individuals who feel they have control over their lives appear to experience less stress. It also depends on personality and temperament. Aggressive, competitive types are more likely to define a situation as stressful than a passive, accommodating personality. A universal stress producer seems to be social isolation.

PTSD: A Breakthrough in Diagnosis

In 1980 the mental health community established the diagnosis of Post Traumatic Stress Disorder, PTSD, and revolutionized the way the field views the effects of stress. This change acknowledged that many of the symptoms people experience after exposure to trauma can be long-lasting, if not permanent. Before that shift, the field tended to view stress-related symptoms as a transient, normal response to an adverse life event, not requiring intensive treatment.

Furthermore, before 1980, people who did develop long-term symptoms following trauma were viewed as implicitly vulnerable; the role of the actual event in precipitating their symptoms was minimized. For a while, in a reversal of previous thinking, experts expected most trauma survivors to develop PTSD. More recent research has confirmed that only about 25 per cent of individuals who are exposed to trauma develop PTSD.


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Wednesday, September 5, 2018

When An American President "Loses It”

When A President "Loses It”



By: James F. Toole, M.D.
Cerebrum, Dana Foundation, 1998


Learn about the astonishing, complex brain.


It has happened, of course—and not infrequently. Just in this century, American presidents who continued to serve in office while seriously neurologically impaired include Woodrow Wilson, Franklin D. Roosevelt, and Dwight D. Eisenhower. In the first two, there is a credible historical case that the results were catastrophic on a world scale. But the real question is: Could it happen again?...

Once officials are elected or appointed, there is no legal requirement for periodic physical, mental, or behavioral examinations while they are serving in office. When the average life span was 60 years, senility was a less common problem. Now, with the graying of America (and soon the world), devastating neurological diseases and other conditions have a much greater likelihood of wreaking havoc on an individual’s mental functioning. Isn’t it time for the law to require health examinations, and public revelation of the results, before election and periodically thereafter while an individual is serving in office—just as there are legal protections of the public in other areas of society? After all, we have laws governing the packaging of foods, construction of automobiles, and periodic inspection for continuing registration and licensing of vehicles and drivers. Why don’t we have similar requirements for public officials (as we have already for aviators)? Unfortunately action is stalled, in part because it contravenes traditions of confidentiality in matters relating to health. Society desperately needs correction of this Achilles’ heel before it is too late.


THE TWENTY-FIFTH AMENDMENT
Why does our nation tolerate this appallingly dangerous flaw in our system? Can there be any brake on this unregulated system— or must we live in danger of catastrophe? A first step was taken in 1965, when Senator Birch Bayh proposed an amement to the U.S. Constitution. On February 10, 1967, Article 25 was ratified by a sufficient number of state legislatures. In it, succession is clearly defined in cases of removal of the president from office by death or resignation. The vice president shall become president, as happened when President Richard M. Nixon was replaced by Vice President Gerald R. Ford.

Section 2 is equally clear on succession to the office of the vice president, as occurred when Ford was appointed vice president after the resignation of Spiro T. Agnew.

Section 3 is straightforward. If the president voluntarily submits a written statement that he is unable to discharge the powers and duties of his office, they shall be discharged by the vice president as acting president until the president submits another document stating that he has recovered. This sequence occurred when President Reagan transferred power to Vice President George Bush in anticipation of undergoing general anesthesia for colon surgery and then resumed office immediately thereafter.

In Section 4, however, there seems the potential for a serious dilemma:

Whenever the vice-president and a majority of either the principal officers of the executive department or of such other body as Congress may by law provide, transmit to the president pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the president is unable to discharge the powers and duties of his office, the vice president shall immediately assume the powers and duties of the office as acting president.

What is the mechanism for determining that the president is unable to serve? How does one inform the president that he is not capable of performing in office? Judging from past experience, it would require the most extreme conditions for the vice president or members of the cabinet to remove their leader. They have a built-in political incentive to maintain the status quo because, if the president is removed, the cabinet that serves him may be replaced as well. Furthermore, these officials are not medical professionals and so cannot have full insight into the dangers of having a mentally impaired leader.

There is an even greater problem in implementation of the next part of Section 4. It states:

Thereafter, when the president transmits to the president pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that no disability exists, he shall resume the powers and duties of his office unless the vice-president and a majority of either the principal officers of the executive department or of any such body as Congress may by law provide, transmit within four days to the president pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the president is unable to discharge the powers and duties of his office. Thereupon Congress shall decide the issue, assembling within 48 hours for that purpose if not in session.

These two clauses conceal potential stumbling blocks. Together, they could enable a cognitively impaired President who lacked insight into his mental deficiency to obstruct governmental procedures for removal from office (or to resume office), despite persistent deficits. Only a specially trained physician has the skills to determine the presence, treatment, and prognosis for neurologic and psychiatric disease.