We have recently talked about the growing evidence that several types of mental illness are associated with inflammation. There are some odd neuropsychiatric illnesses that are known to be associated not just with inflammation, but with disturbances of the immune system. One of the most marked in the so-called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) in which people may get a constellation of symptoms after a streptococcal infection. Amongst the symptoms are obsessive compulsive disorder (OCD)-like symptoms, and that has lead to the question whether OCD itself might be some kind of autoimmune illness.

OCD can be a debilitating illness in which people have obsessive, distressing, intrusive thoughts and related compulsions (tasks or “rituals“) with which they try to neutralize the obsessions. It is classified as an anxiety disorder, and it is listed by the World Health Organization as one of the top twenty most disabling illnesses in terms of lost income and diminished quality of life.

Jack Nicholson did a very good job of portraying someone with OCD in As Good As It Gets, and Tony Shalhoub’s Adrian Monk is close to reality, though few people have quite the number of different and ever-changing obsessions as the character in the show.

Now new research (NR239) presented last week at the 2007 Annual Meeting of the American Psychiatric Association in San Diego has found a link between inflammation and OCD.

Researchers from Zonguldak Karaelmas University in Turkey measured the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in 31 drug free outpatients with OCD.

Both TNF-α and IL-6 levels were significantly higher in people with OCD compared with healthy volunteers.

What this tells us is that there may well be some involvement of the immune system in the pathophysiology of OCD, and, if confirmed, that in itself might suggest some new approaches to treatment.

The next step will be to replicate the study with a larger number, and then to do a longitudinal study, to see if these inflammatory markers rise as people are getting worse, and go down as they improve.

I have talked before about the increasing difficulties that we all have with paying attention.

Over the years we have tried all sorts of things to help people to become better at focusing and controlling their attention, from games, to biofeedback devices to meditation. It is the last of those that seems to be the most effective.

We know from personal experience that paying close attention to one thing can keep us from noticing something else. If we are shown two visual signals half a second apart, we usually miss the second because we are still focused on the first one. We are consciously unaware of the second flash. It is rather like missing something when we blink our eyes, and indeed psychologists call it “attentional blink.” Many psychologists have assumed that attention is something fixed: we can only give a certain amount of attention to one thing at a time before we have to move onto something else or get a kind of brain freeze.

But we have known for some time now that sometimes people do notice the second flash of light, and with practice they can notice it all the time, suggesting that the limitation on seeing the two flashes is not entirely physical, but that it may be possible to bring it under mental control. The first style of meditation that I ever learned was Vipassana, and I well remember being astonished at how quickly my attention and focus began to improve, even when I was not meditating.

Now there is an important new study from the University of Wisconsin-Madison that suggests that attention does not have a fixed capacity, and that it can be improved by directed mental training such as meditation.

The work was done in Richard Davidson’s lab at the University of Wisconsin-Madison School of Medicine and Public Health and the Waisman Center for Brain Imaging and Behavior and published online in the journal PLoS Biology. (This is one of the growing number of open access journals, and for people not yet convinced of the value of open journals have a look at this paper, in which everything is available to you for free.)

The investigators recruited people who were interested in meditation to study whether conscious mental training can affect attention.

They examined the effects of three months of intensive training in Vipassana meditation, which focuses on reducing mental distraction and improving sensory awareness.

Volunteers were asked to look for target numbers that were mixed into a series of distracting letters and quickly flashed on a screen. As subjects performed the task, their brain activity was recorded with electrodes placed on the scalp. In some cases, two target numbers appeared in the series less than one-half second apart - close enough to fall within the typical attentional blink window.

The researchers found that the three months of rigorous training in Vipassana meditation improved people’s ability to detect a second target within the half-second time window. In addition, though the ability to see the first target did not change, the mental training reduced the amount of brain activity associated with seeing the first target.

Because the subjects were not meditating during the test, their improvement suggests that prior training can cause lasting changes in how people allocate their mental resources.

As Richard Davidson says,

“Their previous practice of meditation is influencing their performance on this task. The conventional view is that attentional resources are limited. This shows that attention capabilities can be enhanced through learning.”

The finding that attention is a flexible skill opens up many possibilities. It provides further evidence that attention training is worth examining for attentional problems such as attention deficit hyperactivity disorder.

“When we raise ourselves through meditation to what unites us with the spirit, we quicken something within us that is eternal and unlimited by birth and death. Once we have experienced this eternal part in us, we can no longer doubt its existence. Meditation is thus the way to knowing and beholding the eternal, indestructible, essential center of our being.”
–Rudolf Steiner (Croatian-born Austrian Mystic, Occultist, Social Philosopher, Architect and Founder of Anthroposophy, 1861-1925)

“The moment one gives close attention to anything, even a blade of grass, it becomes a mysterious, awesome, indescribably magnificent world in itself.”
–Henry Miller (American Writer, 1891-1980)

“The path of spiritual attention is not easy, although anyone can make a beginning by trying to understand.”
– Sri Raghavan Iyer (Indian-born Prodigy, Rhodes Scholar, Academic, Philosopher, Theosophist, and, from 1965-1986, Professor of Political Science at the University of California, Santa Barbara, and Father of Pico Iyer, 1930-1995)

I was talking to someone who has recently had a series of apparent mishaps in his life. And yet every one of them has so far turned out to have a silver lining,

I made the point to him that if we do indeed live in a meaningful, purposeful Universe, then we also have to accept that we cannot always see the reasons why thing happen. Certainly some things may happen “by chance,” but most events that involve conscious thought cannot be explained away as “chance” or “coincidence.”

It reminded me of a story that has been told and retold around the world in different forms since the dawning of time. I like this version from China:

“There was a wise old farmer whose horse ran away. All the neighbors came to commiserate and say, “That’s bad.”

But the farmer said, “Perhaps.”

Then the next day, the horse came back with a whole herd of wild horses, and the neighbors all said, “That’s good.”

And the old farmer said, “Perhaps.”

The very next day the farmer’s son broke his leg trying to tame one of the wild horses and the neighbors said, “That’s bad.”

And the old farmer said, “Perhaps.”

Just after the son broke his leg, the army came through and drafted all the young men and took them off to war. But they left the farmer’s son because his leg was broken.

All the neighbors said, “That’s good” to which the wise old farmer simply said, “Perhaps.”

“But there is suffering in life, and there are defeats. No one can avoid them. But it’s better to lose some of the battles in the struggles for your dreams than to be defeated without ever knowing what you’re fighting for.”
–Paulo Coelho (Brazilian Writer, 1947-)

“Every human life had its pattern that had to be worked out slowly to its ultimate conclusion.”
–Irving Stone (American Writer, 1903-1989)

“Man has come here with a definite purpose. Life is not meant merely for eating drinking and procreating.”
–Sri Swami Sivananda (Indian Physician and Spiritual Teacher, 1887-1963)

“There are no mistakes, no coincidences. All events are blessings given to us to learn from.”
–Elisabeth Kübler-Ross (Swiss-born American Psychologist, 1926-2004)

“You cannot discover the purpose of life by asking someone else - the only way you’ll ever get the right answer is by asking yourself.”
–Terri Guillemets (American Writer, 1973-)

“You have a purpose only as long as you are not complete; until then, completeness, perfection, is the purpose. But when you are complete in yourself, fully integrated within and without, then you enjoy the Universe; you do not labor at it.”
–Sri Nisargadatta Maharaj (Indian Spiritual Teacher and Exponent of Jnana Yoga and Advaita Doctrine, 1897-1981)

Your humble reported has been interested in nutrition since he was knee high to a puppy, and he has also been worried about the consequences of pesticides and other artificial chemicals getting into the food chain. He has also been worried about feeding all kinds of artificial potions to animals. Surely they would eventually turn up in humans, and we have little idea about all the things that they may do. It is also a worry that antibiotic resistance in humans could be passed on to bacteria in animals.

Some of these fears were born out at a conference – the 107th General Meeting of the American Society for Microbiology (ASM) - in Toronto this week.

A paper presented by Hua Wang of the Ohio State University suggests that the administration of antibiotics to animals could be contributing to the continuing rise of antibiotic-resistant infections in humans

The problem is a process known as horizontal gene transfer, in which bacteria that are in close proximity to each other can share genetic information, including genes that code for antibiotic resistance. Horizontal gene transfer between disease-causing bacteria has been known for years as an important avenue for the exchange of antibiotic-resistance genes among bacteria in hospitals. We all carry bacteria on and in our bodies. Some are beneficial, and help in things like digestion. Others are simply “passengers,” and we call these “commensal” bacteria.

Research has also already demonstrated that pathogenic bacteria have the ability to engage in horizontal gene transfer with the otherwise harmless bacteria that we all carry in our bodies. What concerns us is that these normally benign commensal bacteria have an enormous and diverse gene pool. That increases the likelihood of gene transfer. Some commensal bacteria exchange genetic information extremely quickly. That was helpful to the bacteria during evolution, but may be producing a boatload of problems for us today.

Dr Hua said:

“We have demonstrated not only that organisms carrying such intrinsic mechanisms have the potential to become an important reservoir for antibiotic resistance genes but, more importantly, that these intermediate organisms can disseminate antibiotic resistance genes in subsequent events much more effectively than the parental donor strain.”

“Once we no longer limit ourselves to food borne pathogens and look at commensal bacteria, we will find that the magnitude of antibiotic-resistant bacterial contamination in the food chain is tremendous.”

In a study published last year, she and her colleagues tested a range of ready-to-eat food samples that they purchased from several grocery chain stores. They included seafood, meats, dairy, deli items and fresh produce. With the exception of processed cheese and yogurt, antibiotic-resistance gene-carrying bacteria were found in many food samples that they examined.

The problem is not just confined to the food supply. Recent studies have shown antibiotic resistance genes in bacteria in the digestive tract of young infants. Since these children were still being breast- or formula-fed and had not yet eaten solid food, they must have acquired these genes somewhere other than the food supply. This suggests that resistance genes from the environment had somehow got into the infants.

Antibiotic resistance is a huge and ever-growing problem. For years now, many of us have worried about the over-prescribing of antibiotics when they are not needed. For example viruses cause the vast majority of sore throats, and few viruses respond to antibiotics. Yet patients often feel cheated if they do not leave a doctor’s office clutching a prescription. The result has been increasing numbers of resistant bacteria. When you really need an antibiotic, it may no longer be effective. Now we have another mechanism by which our actions have caused a problem that could quite literally be the death of us.

It is often very helpful to use books and movies to illustrate psychological and psychiatric issues, and that old chestnut, “when is it an illness?”

There was an amusing paper (NR193) about a serious problem that was presented last week at the 2007 Annual Meeting of the American Psychiatric Association in San Diego. The writers, from Toulouse in France entitled their offering; “Is Anakin Skywalker Suffering from Borderline Personality Disorder?”

Borderline personality disorder can be an extremely difficult problem to treat in practice, and it often causes a great deal of suffering. There is an interesting sidebar here: Borderline Personality Disorder has been described throughout the world. But it seems to be more common in the United States and Canada than it is in Western Europe, though the rates now appear to be rising in Europe.

Borderline personality disorder is defined as a mental illness primarily characterized by emotional dysregulation, extreme “black and white” thinking, or “splitting“, and chaotic relationships. It typically includes a pervasive instability in (1) mood, (2) interpersonal relationships, (3) self-image, (4) identity, and (5) behavior, as well as a disturbance in the individual’s sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.

These problems can have a pervasive negative impact on many or
all of the psychosocial aspects of life, including employability and
relationships in work, home, and social settings. Comorbidity
is very common. People with borderline personality disorder frequently have
substance use disorders and affective disorders. Sadly, self-harm , including cutting and suicidality and
completed suicide are altogether too common, and there is a lot of discussion about the effectivess of treatment.

The writers of the report concluded that Anakin met five criteria of Borderline Personality Disorder:

1. Difficulty controlling anger
2. Impulsivity
3. Transient stress-related paranoid ideas and sever dissociative symptoms (after killing the sand people and in the final confrontation at the end of Episode 3)
4. Frantic efforts to avoid real or imagined abandonment (as when trying to save his wife)
5. Pattern of intense and unstable interpersonal relationships, alternating between extremes of idealization and devaluation (as in his relationships with the Jedi Masters)

They also suggested that the identity disturbance, when he changed into Darth Vader was more evidence of Borderline Personality Disorder.

An amusing piece, but it helps to highlight a problem that can cause great suffering.