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I don’t profess to be any more sad than anyone else about the death of Senator Kennedy. Yet on Wednesday morning, when I first read the news about his death, it hurt me deeply. Kennedy and I had no tangible connection otherwise. He was the liberal lion of the senate, the last of the storied Kennedy brothers, the last prince of Camelot. I am a first generation American, daughter of Indian immigrant parents, only starting to find my way in life. I think it is because it was his last few months of life, and his moment of death, that forged a connection between me and the senator.
Ted Kennedy, as all of you probably know, was diagnosed with brain cancer in May of 2008. Specifically, he was diagnosed with glioblastoma multiforme (GBM)–which in the WHO system of cancer grading is stage IV–the most aggressive type of glioma. This summer, I started work in the city, on clinical trials devoted to GBM and other high-grade gliomas. As I started work, and found myself learning more about gliomas, Kennedy’s struggle came into greater focus. The treatments he went through, and the challenges he faced, became more real to me. He was not that different from the multitudes of patients I have come across through my work, his struggle was not any easier. This made his resilience and determination to see his goals through all the more admirable, and inspiring.
I am sitting here now, streaming the funeral coverage from the New York Times website, crying and laughing with everyone else who may be watching the services and the heartfelt eulogies. I am also sitting here, with my work before me, trying to understand how our research may shed new light on gliomas. Though this research is not my brainchild, it is still something about which I feel very strongly. I think I felt more pain about Kennedy’s death because brain cancer research has not reached a point where we could give more, quality years of life to those who suffer with brain cancer. I can only wish that we’ll get there in the near future.
In the meantime, I’m going to try to channel Kennedy as I push onward, with my colleagues, towards that distant goal.
For those of you who know me know that I am, simply put, neuro-obsessed. Here’s where I try to justify that.
Think about the human body and how incredibly complex it is. Think of all the chemicals that course through your bloodstream to regulate this organ or that, that allow you to grow and mature. Think of the electrical and structural precision that is needed to keep your heartbeat normal. Think of the myriad events that go on to maintain normal digestion even when you are unaware that it is going on.
Now think of the brain and think of the fact that it regulates all of it. A three-pound (give or take a few ounces), gelatinous and convoluted mass of neural tissue sitting comfortably in your cranium regulates all of it. I think that’s pretty cool, right?
Consider this a kind of (grossly simplified) neuroscience primer from someone who has neither an M.D. nor Ph.D (so take it for what it’s worth).
I should probably start out by saying I’m not entirely sure what to make of the readiness with which doctors prescribe a pill for anything and everything. This is mostly based on my observations and what I’ve heard. I’m not a doctor (though I want to be) and I’m trying to understand this as best as I can given my relative lack of medical knowledge. Yet my gut instinct is to say that doctors are all too willing to find a condition to fit a pill, or a pill to fit a condition (and for everything else, an antibiotic). This seems to especially be the case with psychiatric conditions. Everyone that’s depressed seems to be prescribed pills. I concede that are some that legitimately need medication in order to function, but for the vast majority, it seems unnecessary.
I’m going to stick with antidepressant/stimulant meds for this one. Fibromyalgia and antibiotics deserve their own post.
Humans are programmed to experience fear, because fear is a useful response to noxious stimuli. Yet, there are those fears that are more irrational that others.
I suffer from ligyrophobia. Ligyrophobia is defined as the irrational fear of loud noises. Balloons popping, fireworks, thunder, explosions, dogs barking, and (even at one time) vacuum cleaners used to scare me beyond words. Of course, now it’s greatly improved for the most part. It may seem silly, being scared of loud noises, and it is. I’ll be the first to admit it. My mother blames it on the fact that she went into labor when a car backfired right next to her. I’m not too sure about that, but there is something to be said for traumatic events setting one up for a lifetime of phobias.
The suffix “phobia” itself derives from the Greek, meaning “fear.” A host of prefixes can be attached that denote the specific fear. Agoraphobia is a fear of open spaces (or conversely, leaving one’s home), agora referring to the ancient Greek, open-air marketplace. Arachnophobia is a fear of spiders. The list goes on, with some of the fears being especially off-beat. Fear of hippos. Fear of wrists. My personal favorite is fear of peanut butter getting stuck to the roof of your mouth. Arachibutyrophobia. Try saying that ten times fast.
Emotional memories, especially fears, are generally encoded in the amygdala. The amygdala (from the Latin for “almond” because of its shape) sits in the middle of the brain, and is also encircled by the hippocampus, another important memory-related structure. Yet it is interesting because fear itself is not totally dependent on memory, per se. In an experiment conducted during the turn of the 20th century, it was observed that in a Korsakoff’s patient, pricking her hand would result in her being less likely to shake the researcher’s hand, but she couldn’t pinpoint why that was the case. In Joseph LeDoux’s lab at NYU, rats who were conditioned to associate a 30 second tone with a small shock to the foot. Eventually, rats would freeze and/or display other typical fear responses to the tone alone. Some rats were given amygdalar lesions and lost the conditioned response that they had to the tone, and reacted as though there was no association at all. The response to shock, though, was unchanged.
The amygdala is hardwired to pair variables together, usually sights, smells, sounds, and certain touches to events, positive and negative. Perhaps in phobias, there is a a tendency to overextend and associate seemingly innocuous objects with a negative response. fMRI studies have confirmed the link between amygdalar activation and phobic responses in humans (in this case, with arachnophobes).
So is there a way to really cure phobias? Not really anything much more than strength of will and perhaps therapy. Some fears are easier to overcome than others. It has taken me years to get over some of mine, but will probably take many more to get over it completely. For me, ligyrophobia is something I have had for as long as I can remember. Getting rid of something so rooted in your psyche is a challenge, a challenge which I don’t mind taking. It helps a little, to know the biological underpinnings for why we fear, it makes fear less nebulous and more conquerable. It also helps to have a strong support system, friends, family, and loved ones usually make any task a lot easier.
“There is nothing to fear but fear itself,” Franklin D. Roosevelt once said. Certainly misplaced fears should be avoided, but I don’t think there we should ever attempt to fear nothing, because fear is after all a much-needed survival response. Some spiders, sharks, lightning (at least, close-range), and other things are obviously dangerous, and should be feared and avoided to a degree. I think Ellen DeGeneres summarized this and other points in one of her monologues the best, and I’ll leave you with that.
For those of you somehow associated with neuroscience, you probably have run into those two letters sometime during the course of your studies. Oddly enough, I didn’t know what H.M.’s name really was, until the day he died. H.M. didn’t know much beyond his own name and a few memories up until 1953. It was then that he underwent an operation to remove part of his brain that was deemed responsible for his seizures. As a result, he lost the ability to create new memories.
Every person he met from then on was new, every place he visited was unfamiliar, no matter how many times he came into contact with them. I can’t imagine living a life like that, but his life allowed us to understand more about how our minds worked.
Thank you H.M. Maybe you will finally find some familiarity in the hereafter. Rest in peace.
I am going to be working on cancer-related research (gliomas for those of you who are extra curious) starting next semester, in the clinical realm. So I met today with the head of neuro-oncology in the hospital where I will be working. Since most of the work being done was at the clinical cancer center, I went there to meet with him. Turns out he’s pretty busy (go figure), so I ended up waiting in the waiting room for a while.
It was interesting to see how many pleasant faces there were given that, I think, most of the patients there were suffering from brain cancers. I especially enjoyed observing one patient, an elderly man, who was doing nothing but cracking jokes as he waited. He had, in fact, been waiting there for three hours and had traveled from Long Island to the city to meet with his doctor. At one point, he turned to one of the other patients who had been waiting there for a while herself, and asked with near deadpan-delivery, “Do you think that if they make us wait through the night, they’ll give us turkey?” This was an elderly man who couldn’t have been younger than eighty with both a personal nurse and a walker at his side, waiting in a cancer waiting room, asking gleefully about turkey. I loved his attitude, and it made my wait all the more pleasant.
I hope it doesn’t take a death sentence for me to realize that, sometimes, we shouldn’t sweat the small stuff and that we need to understand that there are better things to worry about (like for example, turkey). Sometimes you can find beauty in the madness, and maybe, that’s really all that life’s about.
We all dream. In fact, over a lifetime, we spend about six years dreaming. Six years! Imagine what you could do over six years of your life.
So my question is, should dreams be treated solely as the product of neurotransmitters and REM during sleep? Or should they be interpreted as something deeper, steeped with meaning? For someone like me, who is both an aspiring doctor with a fondness for neuroscience and a deeply spiritual person who deals in the abstract, it’s a bit of a debate.
Neuroscience hasn’t gotten around to providing a concrete biological definition of dreaming, but there are theories being thrown around. This is the best summary I can come up with:
During sleep, your brain goes through periods called rapid eye movement (REM), where (if one were to do an EEG) the resulting brain waves during those periods look remarkably similar to those from wakefulness. Scientists have postulated that several neurotransmitters are involved in creating the dream state, while a host of others are suppressed. The result is a situation similar to wakefulness, but also a state of virtual paralysis so as to prevent the sleeper from acting out the motions in his or her dreams. Curiously enough, a chemical called dimethyltryptamine (DMT) is suspected to have a large role in creating the dream state. Among other things, it is a psychedelic agent. Need I say more?
Yet of course, there are others who treat dreams differently. Sigmund Freud and Carl Jung published numerous case studies where they analyzed patients’ dreams. They, as well as several psychologists downstream, held that dreams reflected the interplay between the conscious and the unconscious. The unconscious allowed thoughts inaccessible to the conscious to bubble to the surface during dreams. Dreams, therefore, could be interpreted to get at the underlying emotions.
So who’s right? The neuroscientists or the psychologists? I’d like to think both are right.
Yet interpreting dreams is an inexact science that is open to many, often wrong, interpretations. Is it really worth it? Sometimes it helps to give some degree of closure or clarity, since dreams have a tendency to just be downright strange, if not emotionally charged. That’s of course, if you can get at an interpretation that achieves that end.
Then there are the prophetic dreams. Some say they’re religious experiences, some say they’re random events. Others argue it’s the brain putting 2 and 2 together into some logical conclusion that turns out to be right in real life. I, however, am not sure. I’ve had a few of these, and I can’t describe them any other way other than inexplicable.
Why do some people experience dreams differently from others? I have talked to my friends about my dreams, and find that among many of my friends, I tend to have very vivid dreams replete with the whole range of sensory experiences: color, touch, smell, sound…heck sometimes music. Others I know tend to have consistently bizarre, and often humorous dreams. Others still have violent dreams. Perhaps it’s a function of our individuality, including how we deal with experiences that we may have had in our day to day activities that have since sunk into our subconscious.
So will we ever solve why we have dreams, and how to deal with them? Probably not, but what say you, the reader? How do you deal with dreams? Any interesting ones?