Tuesday, March 29, 2016

More complex causes of crazy

In this week's (March 28, 2016) issue of The New Yorker Magazine is an excellent article by Siddhartha Mukherjee about the craziness, schizophrenia and bipolar disorder, that has affected several of the men in his family.  He relates the histories of his uncles and his brothers.

But the article is really about two researchers in Boston, Beth Stevens and Steve McCaroll, who have tracked down a gene that seems to be a major player in what happens in some brains to make them  function differently.  It seems to have to due with  a gene, C4A,  that regulates the proteins that usually prune certain synapses that are used for cognition and planning.

If this turns out to be part of what happens in the brains of the people who then develop the kinds of symptoms that are labelled as psychiatric diseases. One would hope that this knowledge would be a big step toward finding a more successful treatment.  But S. M. does a good job of showing how much more complex all of this is.

Genes  do play a big role in disrupting a person's thoughts and ideas, but these genes do a lot of other things too, so that if we do eventually find ways to change a group of genes -- we can already modify a single gene -- it will still be very difficult to know what those changes that will produce. There is lots of room for unintended consequences here.  How much it will alter how the person thinks, and really, who that person is.?  S.M. makes that very clear at the end of the article. He only knew his brothers the way they were.  Knowing them was knowing them with their moods and struggles.  Would it be possible to separate out just the difficult parts?

Also, it is still not known what the circumstances are necessary to be to get the C4A toast in the way that seems to be detrimental.  It may be just a random mutation and it just happens, or, more likely, it needs some kind of trigger at some specific time to make it happen.  This seems to be true with most gene expressions.  If the circumstances aren't there then little, or nothing happens.  I don't know.  And I don't think there are too many more specific answers yet.

Will we know more?  That I think is pretty certain.  But I don't know if it will just pose new questions and lead to longer hallways that need to be explored.

Life is complex.  Even more than we expected.  That is what we have learned so far.

Friday, March 25, 2016

ReDesigning People -- 1

Hey, where have you been.  I've been working on some new stuff.  It's taken a while but now I'm pretty far along.  Maybe I'll keep posting stuff here.  But I've said that before.

Anyway, here's an


In the Spring of 2012 I was  sitting with Carrie, an attractive, articulate sixteen year-old young woman.  She had come to me because she was having panic attacks.  She said sometimes she thought her head was going to explode, and at times that she couldn’t breathe.  These attacks often came when she was studying for exams at school  Carrie spoke in a very animated fashion about how difficult it was for her to maintain her excellent grades and still keep up with the constant influx from her social connections.  As she spoke her voice cracked a little and her dark hair fell in front of her dark eyes that would fill, but not overflow with tears.  Her parents, Sandra and Carol, were sitting in my waiting room, while her friends, many of them, were wondering where she was and why she was not answering their text messages that were making her phone ping every thirty seconds.
I have been a psychotherapist for over forty years and have been closely involved in thousands of people’s lives, yet that was the moment it became undeniably obvious to me that I was living in a new world; a world that is not only creating changes in how we all live, it is creating changes in who we all are. Changes that will alter the basic make-up of our species,.
The changes are technological, environmental, scientific and societal.  The most powerful changes are the result of how all of those factors interact.  This new world requires  different skills in order to adapt and succeed.  Many of the ways of thinking and acting that were adaptive and helpful two or three generations ago, are no longer useful; others have become counter-productive.
Our grandparents and great grandparents lived in a world that was very different from the one that their great-grandparents lived in.  The early twentieth century was a time of change, especially compared to the early nineteenth century. It was a time of significant industrial and mechanical advances. The pace of that change has continued to increase so that now, in the early twenty-first century, we live with constant change.  We expect it to continue. But as we are changing the world, the world is changing us. 
Until the mid-Twentieth Century our species has been Designing People in basically the same way for a few millennia. There have always been three basic interacting forces that designed who we become.  First there is evolution. The genetic scripts of who we are pass from generation to generation, with occasional mutations, some of which survive. Second, the family grouping, whatever shape that has taken, exerts its influence.  The third powerful designer of our behavior is the community, the subculture in which we find ourselves as we emerge into the world.  Combined, these influences shape what we  believe, and how we think, feel and act.  It has been this way since our ancestors walked upright. 

To me, Carrie is the symbol of how these basic designing influences are changing.  Carrie was conceived in a petri dish.  An egg was taken from one of her mothers and fertilized with sperm from an anonymous man who was selected from a profile in a book.  Her parents were not allowed to be married at the time, but they were living together and as soon as the law was change d they got married. Carrie has a little brother now, and they all live in a happy, caring family.  The community in which Carrie lives accepts her family without question. These are circumstances that her grandparents would not have believed possible.
The visit with Carrie happened in 2012, and since then things have continued to change rapidly in our society. This is mainly due to new technologies, and to the new scientific knowledge that these technologies have helped us acquire.  The aspects of Carrie’s life that seemed unusual then are commonplace and well accepted now. In just the past few years there are even newer methods of creating children, more diverse blending of families, and different variations of societies that are all having a strong influence on everyone’s life. The expectations of how Carrie should behave, the skills she will need to learn, and how she will learn them, are also different.   All of these things are vastly different than what was expected of me, growing up in the middle of the twentieth century.  All of these things are not only changing how people behave, they are changing their bodies and minds.  They are ReDesigning People.
New information about who we are, what we want, how we behave, and how we communicate, comes pouring in in huge waves, every moment of the day. It affects us whether we realize it or not. Many people spend hours a day sitting in front of a screen gathering and dispensing information while things beep and pop up, pictures and videos appear and disappear, quickly replaced by others, with very little time for reflection.
We have devised new ways of mixing stands of DNA in a petri dish to create new people, and now newer, faster, more direct ways of splicing and reconnecting those genes in order to alter who that person will be.  
The evolution of machines  has progressed much faster than the evolution of people.  Many of the daily tasks that for centuries required manual labor are now done by machines, even the task of building those machines.  We also use machines to calculate, and then to find patterns, make predictions, and develop protocols about what we should eat, what medicines we should take, what we will buy, and who we will marry.  These machine generate algorithms which influence many of the decisions we make, mostly without our realizing that it is happening.
The climate we live in, including the air we breathe, the water we drink, the food we eat, the clothes we wear, all contain chemicals, viruses, bacteria, and proteins that have either been locked away in environments that never had contact with people until recently, or have been created in laboratories to either help us stay healthy or make us buy food that will make us fat.
These are changes that will affect the way Carrie lives her life, and they will have a more profound effect on her children. Her generation will also experience a continued growth in how medicine is developed, designed and delivered.  The hope is that people will be able to live longer and healthier lives. However, it may just be that as diseases are treated, other aspects of our lives fall apart. Will our brains last as long as our healthy bodies?  Will earth be covered with centenarians who need their diapers changed?  Will our air become too warm or too polluted for people to breathe easily?
Societies are changing also. To the horror of some and the delight of others, people from every part of the world are moving to every other part of the world. Marriages are occurring, babies are being born and cultures are mixing in ways that has never happened before.  Many of the old institutions that helped people define their values and guided them towards certain behaviors are being questioned or ignored.  This is a disrupting transition that is creating a great deal of conflict between those who feel the old ways are still the best, and those who feel that old traditions and rituals are antiquated and irrelevant.  While it is presently unclear how those arguments will be settled, it is clear that societies are changing dramatically, and people will think and believe differently than they do now.
The effect of all of these changes is that we are ReDesigning People, in part by design, in part due to unintended consequences.   As a psychotherapist I have spent years helping people to redesign their lives.  In many cases I felt successful, but in many others I felt there were too many factors  over which I had no control that were more powerful than anything I could do in my office. I could do little about the person’s genetic make-up, their economic resources, the extent to which they were subjected to racial prejudice or the toxic environments had shaped their lives. 
In many ways Carrie is a very fortunate young woman.  From her background we can assume that her genetic structure is close to flawless.  The egg and the sperm that were used to create her were specifically selected because they came from people who were strong, healthy, smart and attractive.  While she was in utero her DNA was tested and screened for many possible genetic defects. She is being raised by a happy couple, who have financial resources, in an accepting neighborhood with a good school system and a diverse population. Given all of this her prospects for a good life are high.
Sadly, she is suffering for the overarching malady of this new world, anxiety.  Anxiety often is the result of having feelings of little or no control of what will happen.  The feeling of living with constant change, and the uncertainty of what that change will produce has instilled a feeling of anxiety into almost everyone who has electricity, a computer, a cell phone and wi-fi.  There is too much information, too much traffic, too many demands, too little time, and not enough stability.  It is impossible to name any company, any city, any government , any medicine or any institution that won’t be radically different in fifty years.
This creates anxiety.  Anxiety creates stress on our bodies, brains and minds.  It changes our functioning down at the cellular level.  All of these forces, some of them very favorable, but many of them very unpredictable, are changing the nature of who we are.  We are ReDesigning People.

In this series of essay I will describe this process and some of its possible consequences in greater detail.  I certainly welcome any comments.