Q&A: The Surprising Upside of Getting Old

Americans have tremendous fear of aging — and a great deal of prejudice against the elderly. But, as the joke has it, being old is better than the alternative. And, despite our fears, new research suggests that being old is also a lot better than it looks.22

I spoke with Dr. Marc Agronin, whose new book, How We Age: A Doctor’s Journey Into the Heart of Growing Old, explores these issues through the rich stories of his patients’ lives. Agronin is the psychiatrist for the Miami Jewish Health Systems, a nonprofit that is the largest provider of health care for seniors in the Southeast.

What led you to want to work with older people?
When I went to medical school, I knew I wanted to go into psychiatry, that was a given. In my second year, by a chance encounter I began working with a geriatric psychiatrist and I loved the work. I took an immediate interest in working with older patients. They reminded me not only of my grandparents but also of my wonderful aunts and uncles. I felt that there was so much I could learn from these elders that I was just drawn to it and never looked back.

Many people would think that would be a very depressing field of medicine.
I see that all the time and experienced it even when I was doing my training. The older patients were often the ones that the students didn’t want to be around.
[But] the difference wasn’t just in attitude for me: whenever I had experience with older individuals I quickly had deep appreciation for not only their life experience, but also the gratitude they had when someone younger would spend time with them. It was always a positive experience. I never regarded it as something frightening or unpleasant.
I love the stories they tell and hearing about history. So, for me, writing this book was natural — it would be full of stories.

Research now suggests that as we age, our moods improve and we actually grow happier.
There’s great potential. It didn’t occur to me right away how much people learn and grow as they age. That message really transformed my view of aging. I wasn’t trained to look for strengths, but found over time that those strengths are the things that get people through difficult times, whether psychological or spiritual or emotional. They also allow people not only to overcome challenges but even to thrive. The more I saw, the more impressed I was.
Aging, in spite of the inevitable [challenges], is a long process and has its rewards. Amid all the challenges, often the rewards not only balance things out, but most individuals experience a greater degree of well-being and a deeper sense of meaning than they do when they are younger. I often find I get a little taste of that. I feel when I’m with older individuals, I’m as close to the fountain of knowledge as one can get.

The Insanity Defense: An Intersection of Morality, Public Policy, and Science

by Ronald Schouten, M.D., J.D. in Almost a Psychopath
 

 There are times when the insanity defense, with all the controversy that surrounds it, is in the news. This is one of those times:

• It is highly likely that James Holmes, who is facing 142 felony counts in connection with the Aurora, Colorado shootings on July 22, 2012, will raise an insanity defense. First, he’ll have to be found competent to stand trial, which is a separate issue. http://www.thealmosteffect.com/blog/trying-the-man-who-shot-gabrielle-giffords/

Breivik_GP4 (Photo credit: Uppdragsmedia)

• Anders Breivik admitted to killing 77 Norwegians in July 2011 in a carefully prepared bombing and mass murder, which he claimed was an act of self-defense against Islamization and multiculturalism in Norway. On August 24, 2012, he will learn the court’s verdict. Prosecutors urged the court to find Breivik legally insane, as this would lead to a lifetime of confinement in a mental hospital. Breivik argued against an insanity verdict, because under Norwegian law he could conceivably be released from prison some day, if found guilty.

 • Clayton Osbon, the JetBlue pilot who disrupted a March 27, 2012 flight from Las Vegas to New York by screaming about terrorists and religion, was found not guilty by reason of insanity on July 3, 2012.

What is the Insanity Defense?
 For a person to be convicted of a crime, the prosecution must prove not only that the person engaged in a guilty act (actus reus), but also that he or she had guilty intent (mens rea). If a person does not have criminal intent during an act, no crime occurs: a person who takes someone else’s property, honestly believing it is his own, is not guilty of larceny.

But what about situations in which the person commits the act, and intended to do so, but was suffering from a mental or physical condition that impairs their ability to appreciate that they are doing something wrong or to control their behavior? That’s where the insanity defense comes in.

While the insanity defense is a legal doctrine, at its heart it is the expression of a moral principle found in societies across time and multiple cultures: individuals should not be punished for their otherwise criminal acts if they lack certain characteristics that relate to the ability to engage in rational thinking, including an appreciation of the wrongfulness and consequences of their actions, or control their behavior. Take, for example, children. A five year old who sets fire to the drapes because the flames are pretty, will not be charged with arson when the house burns down. The same is true for people with severe developmental disabilities. What about people who cause harm to others or commit crimes while sleepwalking? Yes, those cases exist, and the defendants are generally not held criminally responsible.

An Immune Disorder at the Root of Autism

By MOISES VELASQUEZ-MANOFF

IN recent years, scientists have made extraordinary advances in understanding the causes of autism, now estimated to afflict 1 in 88 children. But remarkably little of this understanding has percolated into popular awareness, which often remains fixated on vaccines.

Eleanor Davis

So here’s the short of it: At least a subset of autism — perhaps one-third, and very likely more — looks like a type of inflammatory disease. And it begins in the womb.

It starts with what scientists call immune dysregulation. Ideally, your immune system should operate like an enlightened action hero, meting out inflammation precisely, accurately and with deadly force when necessary, but then quickly returning to a Zen-like calm. Doing so requires an optimal balance of pro- and anti-inflammatory muscle.

In autistic individuals, the immune system fails at this balancing act. Inflammatory signals dominate. Anti-inflammatory ones are inadequate. A state of chronic activation prevails. And the more skewed toward inflammation, the more acute the autistic symptoms.

Nowhere are the consequences of this dysregulation more evident than in the autistic brain. Spidery cells that help maintain neurons — called astroglia and microglia — are enlarged from chronic activation. Pro-inflammatory signaling molecules abound. Genes involved in inflammation are switched on. 

These findings are important for many reasons, but perhaps the most noteworthy is that they provide evidence of an abnormal, continuing biological process. That means that there is finally a therapeutic target for a disorder defined by behavioral criteria like social impairments, difficulty communicating and repetitive behaviors.

But how to address it, and where to begin? That question has led scientists to the womb. A population-wide study from Denmark spanning two decades of births indicates that infection during pregnancy increases the risk of autism in the child. Hospitalization for a viral infection, like the flu, during the first trimester of pregnancy triples the odds. Bacterial infection, including of the urinary tract, during the second trimester increases chances by 40 percent. 

The lesson here isn’t necessarily that viruses and bacteria directly damage the fetus. Rather, the mother’s attempt to repel invaders — her inflammatory response — seems at fault. Research by Paul Patterson, an expert in neuroimmunity at Caltech, demonstrates this important principle. Inflaming pregnant mice artificially — without a living infective agent — prompts behavioral problems in the young. In this model, autism results from collateral damage. It’s an unintended consequence of self-defense during pregnancy.

Yet to blame infections for the autism epidemic is folly. First, in the broadest sense, the epidemiology doesn’t jibe. Leo Kanner first described infantile autism in 1943. Diagnoses have increased tenfold, although a careful assessment suggests that the true increase in incidences is less than half that. But in that same period, viral and bacterial infections have generally declined. By many measures, we’re more infection-free than ever before in human history. 

"Alone Together": An MIT Professor's New Book Urges Us to Unplug

BY DAVID ZAX @ fastcompany.com

 

In her new book, an MIT professor shares her ambivalence about the overuses of technology, which, she writes, "proposes itself as the architect of our intimacies."

Sherry Turkle, has been an ethnographer of our technological world for three decades, hosted all the while at one of its epicenters: MIT. A professor of the social studies of science and technology there, she also heads up its Initiative on Technology and Self. Her new book, Alone Together, completes a trilogy of investigations into the ways humans interact with technology. It can be, at times, a grim read. Fast Company spoke recently with Turkle about connecting, solitude, and how that compulsion to always have your BlackBerry on might actually be hurting your company's bottom line. 

 

The title of your book, Alone Together, is chilling.

If you get into these email, Facebook thumbs-up/thumbs-down settings, a paradoxical thing happens: even though you're alone, you get into this situation where you're continually looking for your next message, and to have a sense of approval and validation. You're alone but looking for approval as though you were together--the little red light going off on the BlackBerry to see if you have somebody's validation. I make a statement in the book, that if you don't learn how to be alone, you'll always be lonely, that loneliness is failed solitude. We're raising a generation that has grown up with constant connection, and only knows how to be lonely when not connected. This capacity for generative solitude is very important for the creative process, but if you grow up thinking it's your right and due to be tweeted and retweeted, to have thumbs up on Facebook...we're losing a capacity for autonomy both intellectual and emotional.

You only mention Twitter a few times in the book. What are your thoughts on Twitter?

I think it's an interesting notion that sharing becomes part of actually having the thought. It's not "I think therefore I am," it's, "I share therefore I am." Sharing as you're thinking opens you up to whether the group likes what you're thinking as becoming a very big factor in whether or not you think you're thinking well. Is Twitter fun, is it interesting to hear the aperçus of people? Of course! I certainly don't have an anti-Twitter position. It's just not everything.

You write in your book that we today seem to view authenticity with the same skittishness that the Victorians viewed sex.

For some purpose, simulation is just as good as a real. Kids call it being "alive enough." Making an airline reservation? Simulation is as good as the real. Playing chess? Maybe, maybe not. It can beat you, but do you care? Many people are building robot companions; David Levy argues that robots will be intimate companions. Where we are now, I call it the "robotic moment," not because we have robots, but because we're being philosophically prepared to have them. I'm very haunted by these children who talk about simulation as "alive enough." We're encouraged to live more and more of our lives in simulation.

 

 

Read more here.

 

 

The power of lonely: What we do better without other people around

(Tim Gabor for The Boston Globe)

By Leon Neyfakh

You hear it all the time: We humans are social animals. We need to spend time together to be happy and functional, and we extract a vast array of benefits from maintaining intimate relationships and associating with groups. Collaborating on projects at work makes us smarter and more creative. Hanging out with friends makes us more emotionally mature and better able to deal with grief and stress.

Spending time alone, by contrast, can look a little suspect. In a world gone wild for wikis and interdisciplinary collaboration, those who prefer solitude and private noodling are seen as eccentric at best and defective at worst, and are often presumed to be suffering from social anxiety, boredom, and alienation.

But an emerging body of research is suggesting that spending time alone, if done right, can be good for us — that certain tasks and thought processes are best carried out without anyone else around, and that even the most socially motivated among us should regularly be taking time to ourselves if we want to have fully developed personalities, and be capable of focus and creative thinking. There is even research to suggest that blocking off enough alone time is an important component of a well-functioning social life — that if we want to get the most out of the time we spend with people, we should make sure we’re spending enough of it away from them. Just as regular exercise and healthy eating make our minds and bodies work better, solitude experts say, so can being alone.

 

“There’s so much cultural anxiety about isolation in our country that we often fail to appreciate the benefits of solitude,” said Eric Klinenberg, a sociologist at New York University whose book “Alone in America,” in which he argues for a reevaluation of solitude, will be published next year. “There is something very liberating for people about being on their own. They’re able to establish some control over the way they spend their time. They’re able to decompress at the end of a busy day in a city...and experience a feeling of freedom.”

 

Solitude has long been linked with creativity, spirituality, and intellectual might. The leaders of the world’s great religions — Jesus, Buddha, Mohammed, Moses — all had crucial revelations during periods of solitude. The poet James Russell Lowell identified solitude as “needful to the imagination;” in the 1988 book “Solitude: A Return to the Self,” the British psychiatrist Anthony Storr invoked Beethoven, Kafka, and Newton as examples of solitary genius.

 

But what actually happens to people’s minds when they are alone? As much as it’s been exalted, our understanding of how solitude actually works has remained rather abstract, and modern psychology — where you might expect the answers to lie — has tended to treat aloneness more as a problem than a solution. That was what Christopher Long found back in 1999, when as a graduate student at the University of Massachusetts Amherst he started working on a project to precisely define solitude and isolate ways in which it could be experienced constructively. The project’s funding came from, of all places, the US Forest Service, an agency with a deep interest in figuring out once and for all what is meant by “solitude” and how the concept could be used to promote America’s wilderness preserves.

 

“Aloneness doesn’t have to be bad,” Long said by phone recently from Ouachita Baptist University, where he is an assistant professor. “There’s all this research on solitary confinement and sensory deprivation and astronauts and people in Antarctica — and we wanted to say, look, it’s not just about loneliness!”

 

Continue reading here.

 

Autism’s First Child

As new cases of autism have exploded in recent years—some form of the condition affects about one in 110 children today—efforts have multiplied to understand and accommodate the condition in childhood. But children with autism will become adults with autism, some 500,000 of them in this decade alone. What then? Meet Donald Gray Triplett, 77, of Forest, Mississippi. He was the first person ever diagnosed with autism. And his long, happy, surprising life may hold some answers.

By John Donvan and Caren Zucker

Image credit: Miller Mobley/Redux

In 1951, a Hungarian-born psychologist, mind reader, and hypnotist named Franz Polgar was booked for a single night’s performance in a town called Forest, Mississippi, at the time a community of some 3,000 people and no hotel accommodations. Perhaps because of his social position—he went by Dr. Polgar, had appeared in Life magazine, and claimed (falsely) to have been Sigmund Freud’s “medical hypnotist”—Polgar was lodged at the home of one of Forest’s wealthiest and best-educated couples, who treated the esteemed mentalist as their personal guest.

Polgar’s all-knowing, all-seeing act had been mesmerizing audiences in American towns large and small for several years. But that night it was his turn to be dazzled, when he met the couple’s older son, Donald, who was then 18. Oddly distant, uninterested in conversation, and awkward in his movements, Donald nevertheless possessed a few advanced faculties of his own, including a flawless ability to name musical notes as they were played on a piano and a genius for multiplying numbers in his head. Polgar tossed out “87 times 23,” and Donald, with his eyes closed and not a hint of hesitation, correctly answered “2,001.”

Indeed, Donald was something of a local legend. Even people in neighboring towns had heard of the Forest teenager who’d calculated the number of bricks in the facade of the high school—the very building in which Polgar would be performing—merely by glancing at it.

According to family lore, Polgar put on his show and then, after taking his final bows, approached his hosts with a proposal: that they let him bring Donald with him on the road, as part of his act.

Donald’s parents were taken aback. “My mother,” recalls Donald’s brother, Oliver, “was not at all interested.” For one, things were finally going well for Donald, after a difficult start in life. “She explained to [Polgar] that he was in school, he had to keep going to classes,” Oliver says. He couldn’t simply drop everything for a run at show business, especially not when he had college in his sights.

But there was also, whether they spoke this aloud to their guest or not, the sheer indignity of what Polgar was proposing. Donald’s being odd, his parents could not undo; his being made an oddity of, they could, and would, prevent. The offer was politely but firmly declined.

What the all-knowing mentalist didn’t know, however, was that Donald, the boy who missed the chance to share his limelight, already owned a place in history. His unusual gifts and deficits had been noted outside Mississippi, and an account of them had been published—one that was destined to be translated and reprinted all over the world, making his name far better-known, in time, than Polgar’s.

His first name, anyway.

Video: The authors reveal how they tracked down Donald and discuss the significance of his long, happy life.

 

Donald was the first child ever diagnosed with autism. Identified in the annals of autism as “Case 1 … Donald T,” he is the initial subject described in a 1943 medical article that announced the discovery of a condition unlike “anything reported so far,” the complex neurological ailment now most often called an autism spectrum disorder, or ASD. At the time, the condition was considered exceedingly rare, limited to Donald and 10 other children—Cases 2 through 11—also cited in that first article.

That was 67 years ago. Today, physicians, parents, and politicians regularly speak of an “epidemic” of autism. The rate of ASDs, which come in a range of forms and widely varying degrees of severity—hence spectrum—has been accelerating dramatically since the early 1990s, and some form of ASD is now estimated to affect one in every 110 American children. And nobody knows why.

There have always been theories about the cause of autism—many theories. In the earliest days, it was an article of faith among psychiatrists that autism was brought on by bad mothers, whose chilly behavior toward their children led the youngsters to withdraw into a safe but private world. In time, autism was recognized to have a biological basis. But this understanding, rather than producing clarity, instead unleashed a contentious debate about the exact mechanisms at work. Differing factions argue that the gluten in food causes autism; that the mercury used as a preservative in some vaccines can trigger autistic symptoms; and that the particular measles-mumps-rubella vaccine is to blame. Other schools of thought have portrayed autism as essentially an autoimmune response, or the result of a nutritional deficiency. The mainstream consensus today—that autism is a neurological condition probably resulting from one or more genetic abnormalities in combination with an environmental trigger—offers little more in the way of explanation: the number of genes and triggers that could be involved is so large that a definitive cause, much less a cure, is unlikely to be determined anytime soon. Even the notion that autism cases are on the rise is disputed to a degree, with some believing that the escalating diagnoses largely result from a greater awareness of what autism looks like.

There is no longer much dispute, however, about the broad outlines of what constitutes a case of autism. The Diagnostic and Statistical Manual of Mental Disorders—the so-called bible of psychiatry—draws a clear map of symptoms. And to a remarkable degree, these symptoms still align with those of one “Donald T,” who was first examined at Johns Hopkins University, in Baltimore, in the 1930s, the same boy who would later amaze a mentalist and become renowned for counting bricks.

In subsequent years, the scientific literature updated Donald T’s story a few times, a journal entry here or there, but about four decades ago, that narrative petered out. The later chapters in his life remained unwritten, leaving us with no detailed answer to the question Whatever happened to Donald?

There is an answer. Some of it we turned up in documents long overlooked in the archives of Johns Hopkins. But most of it we found by tracking down and spending time with Donald himself. His full name is Donald Gray Triplett. He’s 77 years old. And he’s still in Forest, Mississippi. Playing golf.

The question that haunts every parent of a child with autism is What will happen when I die? This reflects a chronological inevitability: children with autism will grow up to become adults with autism, in most cases ultimately outliving the parents who provided their primary support.

Then what?

It’s a question that has yet to grab society’s attention, as the discussion of autism to date has skewed, understandably, toward its impact on childhood. But the stark fact is that an epidemic among children today means an epidemic among adults tomorrow. The statistics are dramatic: within a decade or so, more than 500,000 children diagnosed with autism will enter adulthood. Some of them will have the less severe variants—Asperger’s syndrome or HFA, which stands for “high-functioning autism”—and may be able to live more independent and fulfilling lives. But even that subgroup will require some support, and the needs of those with lower-functioning varieties of autism will be profound and constant.

Continue Reading here.

A Gene to Explain Depression

ALICE PARK @ healthland.time.com

ATSUSHI YAMADA

 

 

As powerful as genes are in exposing clues to diseases, not even the most passionate geneticist believes that complex conditions such as depression can be reduced to a tell-tale string of DNA.

But a new study confirms earlier evidence that a particular gene, involved in ferrying a brain chemical critical to mood known as serotonin, may play a role in triggering the mental disorder in some people.

Researchers led by Dr. Srijan Sen, a professor of psychiatry at University of Michigan, report in the Archives of General Psychiatry that individuals with a particular form of the serotonin transporter gene were more vulnerable to developing depression when faced with stressful life events such as having a serious medical illness or being a victim of childhood abuse. The form of the gene that these individuals inherit prevents the mood-regulating serotonin from being re-absorbed by nerve cells in the brain. Having such a low-functioning version of the transporter starting early in life appears to set these individuals up for developing depression later on, although the exact relationship between this gene, stress, and depression isn't clear yet. 

 

 

Read more: http://healthland.time.com/2011/01/03/a-gene-to-explain-depression/#ixzz1Wg9RvFWW

Frontline (PBS) documentary highlighting Facilitated Communication (FC) is not effective with patients with autism, cerebral palsy and other disorders

facilitated communication art... 8480 (Photo credit: korafotomorgana)

Facilitated Communication (FC) is a technique that allegedly allows communication by those who were previously unable to communicate by speech or signs due to autism, mental retardation, brain damage, or such diseases as cerebral palsy. The technique involves a facilitator who places her hand over that of the patient's hand, arm or wrist, and guides a finger to letters, words, or pictures on a board or keyboard. The patient is allegedly able to communicate through his or her hand to the hand of the facilitator which then is guided to a letter, word, or picture, spelling out words or expressing complete thoughts. Through their facilitators, previously mute patients recite poems, carry on high level intellectual conversations, or simply communicate.  Parents are grateful to discover that their child is not hopelessly retarded but is either normal or above normal in intelligence. FC allows their children to demonstrate their intelligence; it provides them with a vehicle heretofore denied them. But is it really their child who is communicating? Controlled tests demonstrate conclusively that the only one doing the communicating is the facilitator.  Frontline (PBS) documentary highlighting Facilitated Communication (FC) [VIDEO]

Prisoners of Silence [1993]

[The following program contains explicit language. Viewer discretion is advised.] Original Air Date: October 19, 1993 | Written, Produced and Directed by Jon Palfreman ANNOUNCER: These children cannot speak. No one knows what's going on inside their heads. They're autistic. Tonight on FRONTLINE, the explosive story of a revolutionary method of communication.

Dr. DOUGLAS BIKLEN, Director, Facilitated Communication Institute, Syracuse University: Here was a means of expression for people who lacked expression and here was a way that you could find out what people were feeling and what they were thinking.

ANNOUNCER: FRONTLINE investigates facilitated communication--the theory, the practice and the controversy.

ANNOUNCER: Tonight on FRONTLINE, "Prisoners of Silence." Full Transcript

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The genetics of autism

David Gorski @ sciencebasedmedicine.org takes a detailed look at the genetics of autism spectrum disorders (ASDs). He elaborates that:

Autism and autism spectrum disorders (ASDs) actually represent a rather large continuum of conditions that range from very severe neurodevelopmental delay and abnormalities to the relatively mild. In severe cases, the child is nonverbal and displays a fairly well-characterized set of behaviors, including repetitive behaviors such as “stimming” (for example, hand flapping, making sounds, head rolling, and body rocking.), restricted behavior and focus, ritualistic behavior, and compulsive behaviors. In more mild cases, less severe compulsion, restriction of behavior and focus, and ritualistic behaviors do not necessarily preclude functioning independently in society, but such children and adults may have significant difficulties with social interactions and communication. Because ASDs represent a wide spectrum of neurodevelopmental disorders whose symptoms typically first manifest themselves to parents between the ages of two and three, the idea that vaccines cause autism and ASDs has been startlingly difficult to dislodge and has fueled an anti-vaccine movement, both here in the U.S. and in other developed nations, particularly the U.K. and Australia. This movement has been stubbornly resistant to multiple scientific studies that have failed to find any link between vaccines in autism or the other favorite bogeyman of the anti-vaccine movement, the mercury-containing thimerosal preservative that used to be in many childhood vaccines in the U.S. until the end of 2001. Add to that the rising apparent prevalence of ASDs, and, confusing correlation with causation, the anti-vaccine movement concludes that vaccines must be the reason for the “autism epidemic.”

Continue reading here.