PDA

View Full Version : (Revised) Sync: What to Do About WD?


James Brody
September 2nd, 2006, 04:12 PM
Sync: Whatever to Do About WD?

I followed the same bunny trail several times at ISHE '06. First, when Segerstrale discussed William Hamilton's life and again at lunch with a pediatrician. I also find it weekly in my psychology practice but with greater consequences.

----------

Manic clients sometimes race like Andretti, fuck like Don Juan, and spend like Toady in Kenneth Graham's Wind in the Willows. They also don't eat properly, sleep regularly, manage hyperactivity, or, most important, keep their word with partners, teachers, or authorities. They often drink alcohol like Russians in winter.* I try to move into sync when I meet one of them but often fail. My choices: either take on the role of Mouse or Moley or pin a note to his shirt before escorting him to a psychiatrist's doorstep: "This one may be a genius: please keep his mind alive!" Knowing of kin who do or do not have similar traits usually simplifies my decisions but the difficult ones are those whose family histories are as mixed as the client's characteristics. And these folks have an irritating inconsistency: when they are good, they inspire most of us; when bad, we want them to leave town!

Family members and clinicians often want the restless ones to be more average. Those who have too little or too much of an essential trait may not turn mothers into grandmothers. For example, when given a choice between medicines that made her driven son popular or those that made him smarter, one mother chose the former! "He will need friends in order to get through life." (I think the boy's father would have made the opposite choice.) As for a child who is sufficiently annoying, stubborn, and domineering, and like one of Suomi's irritable rhesus, less gifted or less defended by strong-minded parents, many of us nudge him into a psychiatrist who recommends a "mood stabilizer" such as lithium or an anticonvulsant that makes him slow, thirsty, sleepy, obese, confused, and less attentive.

Sometimes the news is good, even spectacular. Medicines can make bipolar life more tolerable and less intense for everyone. People sometimes become more usefully creative and without major difficulties with side effects...so the story goes. And, according to psychiatrists who specialize in bipolar disorder, it really can happen that way. And the ones who see me often dislike psychiatrists for genetic reasons or because of bad experiences with them.

Our clients, however, often ride a tossed coin, choosing between the poisons they already enjoy and the prescribed ones that are guaranteed to be less fun. Repeated encouragement to "give-it-a-try" can lead to long explorations for a specific individual even though his genome was not in the drug tests. Sometimes he gets lucky with the first substance or second, or, often with three or four in combination but with little guarantee that all are needed. And no one wants to bother a stable recipe! Sometimes he is less fortunate. The first experiences create a believer, the second elicit a sense of fraud and betrayal. Given our ignorance yet about genes and their matches to medicines, the second outcome is more probable.

On the behavioral path, we psychologists want to find that "cognitive-behavior therapy" enlists the patient in regulating his sleep, activity, and eating patterns. And in eliminating the important things of life such as "older whiskey, faster horses, more money, and younger women"! That is, some psychologists report these benefits with some patients. But as with medicines, we behaviorists can't move from group data to individual predictions except that people with fewer complaints of shorter duration usually get better than the other kind. And who the hell needs CBT for that!

Along these lines, even the best of us sometimes feels helpless. A gifted pediatrician, Phil Ziring, remarked that he wanted to be the last doctor to see a child before he got well! Russ Barkley, the inspiration for most of us interested in ADHD, asserted that the earlier a child comes to a mental health specialist, the worse the outcomes! This fact is blamed on genetic loadings rather than on modern diagnoses that often tell nothing solid about etiology, symptoms, treatment, or prognosis.

W. D. Hamilton, like many gifted people, makes our dilemma: Do we not call him mad because we call him great? John Forbes Nash spent time in an asylum although he also won a Nobel for having thoughts similar to Hamilton's. As with Nash, few among us can meter how well Hamilton tracked a reality and he might have remained obscure, and therefore, daft except for E.O. Wilson's confinement with one of his manuscripts on a long train ride. Between successes, Hamilton obsessed about the theoretical explanations for something that he might have first seen on a riverbank in South America. Withdrawal and frustration sometimes followed until he solved the problem. Sometimes he broke off pursuit and took a trip to forget the first problem and perhaps find another one. His spirit often lifted. He sometimes rode his bicycle like a madman, ignored poisonous insect bites in the jungle, and felt himself immune to malaria. This last belief (a sample of grandiosity?) killed him.

Could he have left us more gifts if medicated? Maybe. Could he do it without our calling him mad? No. Tradition and medical practice require our giving you a sign before we give you help. The conflict is much like that of giving antidepressants to a pregnant woman. Will babies do better if less embedded with the demons and bad-ass behavior that accompany a depressed mother? Or will fetal Paxil increase the chances for a psychopath to emerge? Or produce a mind that doesn't function without Vitamin P? No one knows or is apt to find out. We fear sins of commission more than those of omission...

Similarly, Kay Jamison, a prominent psychologist, author, and MacArthur Fellow, in Touched by Fire: Manic Depressive Illness and the Artistic Temperament, told of a score of geniuses deviled by their own rage. She told of her own, similar crises in An Unquiet Mind. For example, she once overdosed on lithium and spent a week in a coma rather than endure either her flights of ideas or the amounts of lithium that erased from memory anything that she read. She supervised a class of medical residents and worked on a stack of research projects at the time. Were her oscillations paced by a gene or by the chaotic nest that she arranged? Or, more likely, were she and her nest the outcome of a partnership between her genes and choices that she made?

In WD's case, did the pendulum of a dozen neurons in his brainstem ratchet his clock? Or could Hamilton, as some of us think we can, "freely" switch out of prolonged, self-defeating thoughts before they become too powerful? Did he have a collection of favorite preoccupations on which to call when his equations didn't hang properly from his squiggles? Could he shut off for a week, pinch his wife's ass, play with their kids, and later find a different path through his maze?

Maybe.

Probable Truth: Environments and genes tune each other for reasons within each of them. (Lewontin, 2000, called their product a "construction.") These partnerships are seen widely in biology and physics. Yoshiki Kuramoto, for example, defined in 1975 a formal proof that weakly linked, similar oscillators move into phase with each other. Such is true for pendulums, runners, fireflies, cardiac cells, semi conductors, and detached slabs of neural tissue (Strogatz, 2003). It is probably also true for golfers or NASCAR drivers, scientists and their obsessions. As appears true for environments and their occupants, moods and experiences can move or out of sync!

I must help to stabilize a wobbling top but without stopping it. The clinical magic is to restore the balance, the synchrony, the "fitness," the links, the constructive push and pull between the client and the components of his niche that usually get 80 percent of his attention. I must also find an effective degree of mutual influence between me and him. And much of my assessment may pivot, without my awareness on simple events.1 Does he keep appointments, pay attention, copy my motions, and anticipate my thoughts? Is there a match in our goals? Is there a sense that the two of us make something together?

I have no answers at this stage but plenty of Ziring's curiosity and humility. The malpractice lawyers and medical tradition insist that breathing is more important than having fun and progress notes are more important than either! I want, however, to take a chance, to do the "behavior thing," gamble that moods are outcomes of thoughts and contexts, move into a life and death unity with my client and hope that she won't get worse before she learns the fine points of self-regulation. I also get scared and do the medicine thing, the legally defensive course that may or may not keep him alive but that is apt to make him feel poisoned, inert, unattractive, bloated, and not giving a damn about his missing libido.

I, too, ride a tossed coin.

As for WD, my impression is that he would have been more than equal to our meddling and no matter what we did, he would have lived his life in his way. Cleverness gives that option even to the unpublished! Best friends move into sync and help to discover opportunities to do your thing and to chill out when you can't. That mother may have had the greater instinctive wisdom because she wanted her hyper, selfish son to be popular. Rhesus mothers make the same choice.

JimB

* Several recent studies support Trotter's hypothesis from 200 years ago: early weaning predicts later alcoholism. Steven Suomi's isolated rhesus also "drink like sponges" when given the chance. Is there a link between sugar and love? And between losing very early genomic and newborn contests with mom and becoming more hyper, selfish, and predatory?

The genes way? I know a bipolar male now in his early 20s who for five years preferred alcohol to advice. He settled a lot after he lost his drivers license and the rest of the way when he found a steady girl. The whisper that still shouts at me came from his father in our very first meeting: "I was the same way. He will settle down when he gets a girlfriend." The young man now takes his father's role of support, patience, and stability with a young woman whose panic resembles that of his mother!

He, too, could be one of Suomi's monks...

References:
Geerts E, Bos E, van Os T, & Bouhys N (2006) Nonverbal communciation predicts tressful interpersonal events in remitted depressed patients. Presentation at International Society for Human Ethology, Biennial Congress, Detroit, MI, August 1, 2006.
Goodwin F & Jamison K (1990) Manic-Depressive Illness. NY: Oxford.
Jamison K (1996) An Unquiet Mind: A Memoir of Moods and Madness. NY: Knopf.
Lewontin R (1998/2000) Triple Helix: Gene, Organism, Environment. Cambridge, MA, Harvard.
Richerson, Peter, & Boyd, Robert (2005) Not by Genes Alone: How Culture Transformed Human Evolution. Chicago: University of Chicago Press.
Ridley M (1996) The Origins of Virtue: Human Instincts and the Evolution of Cooperation. NY: Penguin.
Segerstrale U (2006) The rebel as scientist: Bill Hamilton against the grain. Presentation at the Biennial Meeting, International Society for Human Ethology, Detroit, MI, July 30, 2006.
Strogatz S (2003) Sync: The Emerging Science of Spontaneous Order. NY: Hyperion.
Swann A (1999) Personal communication, Paul MacLean Festschrift, Boston, MA.

Copyright, James Brody, 2006, all rights reserved.