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Archive for the ‘neurobiology’ Category

I’m sitting in my well-let living room on a Sunday morning on a hard folding chair, hoping both the light and non-comfy seat will keep me on task: reading the seminal article “Pain and its Effects in the Human Neonate and Fetus” by Dr. K.J.S Anand and Dr. P.R. Hickey published in the New England Journal of Medicine in 1987. Am I a scientist? NO. Am I a doctor or medical professional? NO. I am a survivor of infant surgery, carried out without adequate pain control and likely, without anesthesia. And since I consider myself a health activist of sorts, I figure I need to be as versed as I can in the subject about which I blog.

The study I’m reading was groundbreaking. It provided a point of view in the field of medicine that was lacking–that infants feel pain and that the administration of anesthesia and analgesics is necessary for babies who require surgery or other invasive medical procedures. I’m paraphrasing, of course. And I’m only half way through the article. Why?  Because in each paragraph, I’ve had to look up at least two or three words in my huge Random House Dictionary or the Bantam Medical Dictionary and then connect those meanings to the point of the paragraph in general, which sometimes requires my taking notes or drawing diagrams in the margins. Yikes! Who would bother!  That’s why people like Dr. David B. Chamberlain interpreted this article for us. He  wrote the essay “Babies Don’t Feel Pain,” in which he introduced the findings of Drs. Anand and Hickey and gave us a history of medicine’s thoughts and conclusions about infant pain. Thank you, Dr. Chamberlain.

But my having read Dr. Chamberlain’s article is not enough. I’m interested in not only my reactions to reading a challenging scientific article, but also my emotional response to what I’m reading. You can imagine how I felt when I read this sentence: “Despite recommendations to the contrary in textbooks on pediatric anesthesiology, the clinical practice of inducing minimal or no anesthesia in newborns, particularly if they are premature, is widespread” (2). OMG!  Couldn’t any parent tell you that his or her newborn feels pain?  If it’s not proven though–if no tests were done that provides replicable data–well, then medicine too often ignores what we all intuitively know. Frightening?  Yes. That’s why we owe so much gratitude to Drs. Anand and Hickey who connected the data dots. They provided the numbers and made the argument that the medical profession needed in order to change clinical practice.

Wish me luck in finishing the article!

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One can always be more free. As the year comes to an end and 2013 is upon us, it’s a good time to let go of things one doesn’t want to bring into the new era.

As a baby, I got wired for trauma. Being operated on at 26 days old for pyloric stenosis, a blockage in the stomach, set the stage. As a baby, my belly was cut open and part of my stomach actually drawn out of my body to fix the problem. In many ways, I am still frozen, holding my body rigidly as I cope with a trauma that occurred 60 years ago. Amazing!  It’s called PTSD (post-traumatic stress disorder).

So earlier this morning, I was sitting in bed with my legs extended, preparing for meditation. I settled in, covering myself with a blanket, allowing my body to sink into the earth and be held as I listened for my heartbeat and tuned into my breath. I realized though that my face was stuck as if it was frozen from the cheekbones up, including my nose. My lips were pulled back and my nose and brow were literally numb. I was smiling a weird lips-pressed-together-and-pulled-back type of smile, more like a snarl, and breathing as shallowly as possible.

What was going on?  I tracked the tension in the rest of my body–my shoulders, hips, chest–and realized that I was straining against something. Flash! In all likelihood, I was straining against whatever hospitals use to tie down infants who are going to be operated on. Back then, my head was secured to the table and here I was in 2012 still fighting to free myself.

Often in my morning meditation, I’m so busy dealing with the somatic repercussions of infant surgery that it’s a challenge to allow a meditative state to kick in. Some days, I simply deal with what I call somatic freeze and other times, I break through to information that my higher self has to offer.

One way I work with this rigid state is to allow my breath into the frozen area. I don’t forcefully bring breath in by taking a deep breath but simply allow my natural breath to return. I invite a quiet breath movement. In this process, I actually began to feel my nose and to exercise face muscles that I didn’t even know were there.

Another strategy to cope with PTSD freeze is imagery. During my meditation, a liberating fantasy brought excitement and a feeling of power.

I am a baby strapped to a gurney before surgery, wanting to escape. I rise and break the bands holding my head, shoulders, hips, and feet and grab the surgeon’s scalpel. It becomes a sword. I’m standing on the gurney now, a super-powered baby swinging her sword, daring anyone to approach. Oh, what fun!  I love watching their shocked and frightened faces. They run out of the operating room and I smash up the place. Oh, more fun!  

So am I suffering from frozen rage?  Am I stuck in that moment of facing my own mortality and being unable to do anything to save myself?  Yes!

I may have been given a local anesthetic before the surgery. I may have had no anesthesia but received instead a paralyzing drug. In this case, I would have been awake but incapable of fighting. Still I would have tried to be free. Certainly, my nervous system cried out, escape! Perhaps before being administered general anesthesia, I fought against being tied down. Since I had been starving for weeks and weighed only four pounds, I was pretty weak. I doubt though that I was fully anesthetized; the level of tension and stress in my body suggests I wasn’t.

My body has been engaged in a lifelong fight with itself and for the last 10 years, through meditation and Middendorf Breathwork, I’ve been finding freedom from this struggle. I am discovering my power. I am learning that more freedom is always possible. For 2013, I am getting a new face–less startle, more real. More truly me.

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I was 25 years old, lying in sand by the Pacific Ocean. I had come to the sea to kill myself, depressed again after so many years of trying to make my life work since my suicide attempt at age 21. But I just couldn’t bring myself to harm; I had grown. So I drew words that bubbled up from nowhere. From somewhere. Pain from long ago. Ancient hurt buried until that moment where water meets shore and life called–a baby’s cry in early morning hours.

Pre-verbal trauma cannot be remembered in words. Perhaps that’s why this message came in a word picture, if you will.  There are many ways to release early pain if the brain does not get in the way. The brain that says, oh that happened so long ago, or you couldn’t possibly have felt that! That memory brain didn’t realize that it was shut off while the trauma was occurring. A different part of the brain recorded the experience, and talking and writing don’t access it. They can point the way to trauma, but they don’t release it.

Draw the story. Draw the message. Draw whatever it is that bubbles up. Begin the healing process.

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I’ve changed. My brain has changed!  It’s true. I overrode my automatic Post-traumatic Stress response last night. There I was lying in bed, enjoying an Esther and Jerry Hicks video, when I noticed the LED light behind me reflected onto my computer screen. Freak out!  That round, bright light hovering over me (the computer was on my belly and the screen tipped toward and above me) captured my gaze and sent alarm bells clanging. I was caught in a PTSD moment……..momentarily.

A part of me came to the rescue.  What’s going on, I asked myself. OK, the light is mimicking one of those surgery lamps that I saw as a baby.  I put the computer aside, thinking that I’d have to ride out the freeze response in which my body goes into paralysis mode. But then I heard myself say, No, I’m not doing that. I want to watch my video. I sat up so that the  reflection was gone and snap, just like that, I was back watching the video where a woman was saying that she cured herself from cancer without chemo or radiation. Amazing!

Afterward, I realized the magnitude of my achievement–I’d sidestepped Post-traumatic Stress! A few months back, I’d written a poem about my major PTSD moment with the heating lamp (myincision July 15, 2012). Last night, instead of going into “deer in the headlights mode,” I basically told myself, Been there, done that and went on with my life. Sound simple?  It was and it wasn’t. In the moment, it was rather easy but I’ve been working on this stuff for years. Now I’m finally harvesting the fruit.

Here’s what I think happened in the words of Dr. Daniel J. Siegel* from his seminal book Mindsight, The New Science of Personal Transformation“Traumatic experiences, in particular, can sensitize limbic [area deep within brain that helps us evaluate ‘feeling states’]** reactivity, so that even minor stresses can cause cortisol [stress hormone] to spike, making daily life more challenging for the traumatized person . . . Finding a way to soothe excessively reactive limbic firing is crucial to rebalancing emotions and diminishing the harmful effects of chronic stress” (18). In other words, post-traumatic stress can be soothed. How?  According to Siegel, by using a different part of our brain to “override” the agitation.

Here’s how Dr. Siegel puts it: “The middle prefrontal region [of the cortex] has direct connections that pass down into the limbic area and make it possible to inhibit and modulate the firing of the fear-creating amygdala [a cluster of neurons important in the fear response].  Studies have demonstrated that we can consciously harness this connection to overcome fear–we can use the “override” of our cortex to calm our lower limbic agitation” (28). In other words, we can soothe our fear when our limbic area gets triggered if we are aware and react consciously to agitation.

I’m feeling pretty damn proud of myself right now. I’ve come full circle on this surgery lamp thing. I have other PTS triggers too, but this is the first time I’ve been able to override a PTS fear in seconds and stay focused on what I was doing before the freak out hit. Dr. Siegel states, “As neurons fire together, they wire together” (40). So I can say with confidence, my brain changed. I’m newly wired!

*clinical professor of psychiatry at the UCLA School of Medicine, co-director of the UCLA Mindful Awareness Research Center, and executive director of the Mindsight Institute.

**words in brackets [  ] are mine

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“One of the key practical lessons of modern neuroscience is that the power to direct our attention has within it the power to shape our brain’s firing patterns, as well as the power to shape the architecture of the brain itself.”  –Daniel J. Siegel, M.D., Mindsight: The New Science of Personal Transformation

There it was, a young dove dragging its wing. The bird was active though, pecking the earth excitedly, finding small seeds. I will trap it in my hat, I thought, and bring it to an animal rescue shelter. Oh, but the long-planned-for talk I was to have along the Sacramento River with my friend would have to be sidelined as half the day would be taken up with this task.

Finally though, it was not the imagined time spent that nixed the idea of my taking action or any fault of empathy in me. It was that the bird, though unable to fly, seemed perfectly content in its environment. Bushes nearby formed suitable cover; the earth was soft so that seeds could be easily scratched up and other birds nearby flitted and fed nearby, giving it company. It was busy scratching and eating.

For the time being, I would let the dove be. I’d have my talk. If the dove got eaten by some predator or picked up by another person wanting to bring it to a shelter, so be it.  And when our discussion was finished, if the bird was still there, I would take it and find help.

I broke a pattern then–of trying to save everything. Having been rescued from death as a baby when an emergency surgery was performed to correct pyloric stenosis, a stomach blockage, I had what many would say was an obsession with rescuing everything. Once I recall spending so much time saving insects struggling on the surface of the pool water that I missed my entire workout swim that day.

But some situations in nature are not meant to be interfered with. Sometimes discretion is key. Examining an automatic impulse can be psychologically healthy, even personally transformative. After my friend and I climbed up onto the green from the river bank where we’d had our tête-à-tête, the dove was nowhere to be seen. Go well, little dove, I bade her. Peace to you. Peace to me.

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An article by Dr. Bruce D. Perry et al is a must-read for all those trying to understand the impact of infant trauma on a person’s life:  “Childhood Trauma, The Neurobiology of Adaptation, and ‘Use-dependent’ Development of the Brain: How ‘States’ Become ‘Traits.'” I became interested in this article because I believe that there are aspects of my character that, rather than simply being my personality, are actually qualities shaped by early trauma. These so-called “traits” are behaviors, somatic patterns, and thought ruts that no longer serve me. In fact, while they may have saved me long ago, they disempower me now.

The article is somewhat complex, so I’ve selected some quotes to help you see what Perry et al are getting at.

“Traumatic experiences in childhood increase the risk of developing a variety of neuropsychiatric symptoms in adolescence and adulthood ” (273).

“Ultimately, it is the human brain that processes and internalizes traumatic . . . experiences. It is the brain that mediates all emotional, cognitive, behavioral, social, and physiological functioning. It is the human brain from which the human mind arises and within that mind resides our humanity. Understanding the organization, function, and development of the human brain, and brain-mediated responses to threat, provides the keys to understanding the traumatized child” (273).

“. . . traumatized children exhibit profound sensitization of the neural response patterns  associated with their traumatic experiences. The result is that full-blown response patterns (e.g., hyperarousal or dissociation) can be elicited by apparently minor stressors” (275).

In this article, Perry et al make the case that “reactivated” fear coming from an oversensitized brain stem and midbrain due to trauma can cause hyperarousal: “hyperactivity, anxiety, behavioral impulsivity, sleep problems, tachycardia [abnormally fast heart rate], hypertension, and a variety of neuroendocrine [hormonal] abnormalties” (278). These conditions and behaviors are states NOT traits.

On the other hand, oversensitized brains can be  result in “dissociation.” For example, if an outside  stimulus evokes the trauma, a person may freeze or numb him or herself. A child may “disengag[e] from stimuli in the external world and attend [. . . ] to an ‘internal’ world” (280) as in daydreaming or fantasizing. As a result, a child may falsely be understood to be extremely shy or uncooperative. Dissociation and hyperarousal are “states” created by early trauma. In adulthood, many of us have wrongly come to accept them as our personality “traits.”

Another major point from the article is that traumatized infants and children do not simply get over their traumas. According to Perry et al, “children are not resilient, children are malleable” (285). In fact, to assume infants and children were not affected by the trauma or will grow out of it is not only incorrect but destructive. Perry et al leave us with this final point: “Persistence of the destructive myth that ‘children are resilient’ will prevent millions of children, and our society, from meeting their true potential” (286).

For me, I just want my real self back.

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In the Realm of Hungry Ghosts –  Close Encounters with Addiction,  a book by Dr. Gabor Maté, provides new information about addiction. “He locates the source of addictions in the trauma of an emotionally empty childhood, making it a relational rather than a medical problem,” according to Dr. Harville Hendrix. Maté contends that our brain chemistry is altered by early trauma, making addictions of all sorts more likely. Here’s some quotes to interest you in the material. I’d love to hear your thoughts about it.

“From a medical point of view, addicts are self-medicating conditions like depression, anxiety, post-traumatic stress, or even attention deficit/hyperactivity disorder (ADHD)” (36).

“A hurt is at the center of all addictive behaviors. . . . The wound may not be as deep and the ache not as excruciating, and it may even be entirely hidden—but it’s there. As we’ll see, the effects of early stress or adverse experiences directly shape both the psychology and the neurobiology of addiction in the brain” (38).

“We shouldn’t underestimate how desperate a chronically lonely person is to escape the prison of solitude. It’s not a matter here of common shyness but of a deep psychological sense of isolation experienced from early childhood by people who felt rejected by everyone, beginning with their caregivers” (45).

“‘Recent brain imaging studies have revealed an underlying disruption to brain regions that are important for the normal processes of motivation, reward, and inhibitory control in addicted individuals. This provides the basis for a different view: that drug addiction is a disease of the brain, and the associated abnormal behavior is the result of dysfunction of brain tissue, just as cardiac insufficiency is a disease of the heart–Nora Volkow, MD'” (133).

“Three-quarters of our brain growth takes place outside the womb, most of it in the early years. By three years of age, the brain has reached 90 percent of adult size . . .” (191).

“The dynamic process by which 90 percent of the human brain’s circuitry is wired after birth has been called neural Darwinism because it involves the selection of those nerve cells (neurons), synapses, and circuits that help the brain adapt to its particular environment, and the discarding of others” (191).

“The three environmental conditions absolutely essential to optimal human brain development are nutrition, physical security, and consistent emotional nurturing. . . . The third prime necessity–emotional nurture–is the one most likely to be disrupted in Western society. . . . emotional nurturance is an absolute requirement for healthy neurobiological brain development” (193).

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