It is remarkable how good the brain is at coordinating multiple regions at once. A new study published in today’s issue of the journal Public Library of Science (PLoS) One has used functional magnetic resonance scanning (fMRI) to examine musicians engaged in highly creative and spontaneous jazz improvisation. They found that a large region of the brain involved in monitoring one’s performance is shut down, while a small region involved in organizing self-initiated thoughts and behaviors is highly activated. The researchers propose that this and several related patterns are likely to be key indicators of a brain that is engaged in highly creative thought.

During the study, six highly trained jazz musicians played keyboard under two conditions. In the first scenario, called the Scale paradigm, the music was based on a simple C major scale. Using only their right hand, the volunteers first played the scale up and down in quarter notes. Next, they were asked to improvise, though they were limited to playing quarter notes within the C major scale.

The second scenario, called the Jazz paradigm, examined higher-level musical improvisation. This paradigm was based on a novel blues melody that the volunteers had memorized beforehand, and had been written by one of the researchers. Again, using only their right hand, the musicians played the tune exactly as they had memorized it, only this time accompanied through headphones by a pre-recorded jazz quartet. When they were asked to improvise, the musicians listened to the same audio background, but they were free to spontaneously play whatever notes they wished.

The brain scans were nearly identical for the low-level and high-level forms of improvisation, supporting the idea that the change in neural activity was due to creativity and not the complexity of the task.

Much of the change between improvisation and memorization occurred in the prefrontal cortex, the region of the frontal lobe of the brain that helps us think and problem-solve. It is also involved in generating the sense of self. The dorsolateral prefrontal cortex is responsible for monitoring our own performance and it shuts down completely during improvisation, while the much smaller, centrally located region at the foremost part of the brain – the medial prefrontal cortex - increases in activity. The medial prefrontal cortex is believed to be involved in self-initiated thoughts and behaviors, and it becomes very active when a person describes an event that has happened to him or makes up a story.

The suppression of inhibitory, self-monitoring brain mechanisms helps to promote the free flow of novel ideas and impulses. This is an unusual pattern of brain activity that closely resembles the pattern seen in people when they are dreaming.

Another unusual finding was that there was increased neural activity in each of the sensory areas during improvisation, including those responsible for touch, hearing and vision, despite the fact that there were no significant differences in what individuals were hearing, touching and seeing during both memorized and improvised conditions. This suggests that when the brain wants to be creative, a whole range of sensorimotor processing is increased. At the same time systems that regulate emotion were also engaged during improvisation.

As someone who has done a lot of brain imaging, and has spent many hours inside scanners, this whole piece of work is dazzling from a technical point of view. The hardy musicians had to lie on their backs with their heads and torsos inside the scanner and their knees bent upward. They had to use a plastic keyboard, which was shortened to fit inside the scanner and which rested on their knees. A mirror placed over the volunteers’ eyes, together with the headphones, helped the musicians see and hear what they were playing.

Just thinking about it makes me queasy.

“Words are the children of reason and, therefore, can’t explain it. They really can’t translate feeling because they’re not part of it. That’s why it bugs me when people try to analyze jazz as an intellectual theorem. It’s not. It’s feeling.”
–Bill Evans (American Jazz Pianist, 1929-1980)

“Jazz tickles your muscles, symphonies stretch your soul.”
–Paul Whiteman (American Musician and Bandleader, called the King of Jazz for popularizing a musical style that helped to introduce jazz to mainstream audiences during the 1920s and 1930s, 1890-1967)

“Jazz music is an intensified feeling of nonchalance.”
–Françoise Sagan (French Novelist and Dramatist, 1935-2004)

Schizophrenia remains one of the cruelest illnesses ever to afflict humanity. There are more theories about it than any other problem, and we may be getting closer to understanding why it seems to occur only in humans, and at roughly the same rate throughout the world. One idea is that the genetic predisposition to schizophrenia might have evolved as a secondary consequence of selection for human cognitive traits. As humans have evolved so has the brain, and it has become more lateralized, so this might explain the association between schizophrenia and handedness.

Several genes with strong associations to schizophrenia have evolved rapidly during human evolution, according to new research in the Proceedings of the Royal Society B this week.

In support of the cognition/schizophrenia hypothesis, researchers Dr Steve Dorus from the University of Bath, who worked with Dr Bernard Crespi from Simon Fraser University in Canada and Dr Kyle Summers from East Carolina University in the United States found that these genes had been positively selected.

They analyzed the molecular evolution of the 76 genes that have the strongest genetic association with the disorder. They surveyed human polymorphisms for discrete changes in the human genome that vary between individuals, in order to try and track very recent selective events within specific human populations. They also compared genes between mammalian species to identify selection on primate lineages salient to the evolution of humans and the disorder.

Amongst the genes for which they found positive selection were three genes that have the best functional or reproducible associations with the disorder: disrupted in schizophrenia (DISC1), dystrobrevin-binding protein 1 (DTNBP1) and neuregulin 1 (NRG1).

The selective forces underlying adaptive evolution of these genes remain largely unknown, but these findings are consistent with the hypothesis that schizophrenia is a maladaptive by-product of adaptive changes during human evolution, perhaps associated with creativity and human cognition.

The whole point of Integrated Medicine and Integrated Health is to help the person with attention-deficit hyperactivity disorder (ADHD) to become integrated as a person by using an integrated approach to treatment. This kind of comprehensive approach is particularly important for many people with ADHD. I also want to re-emphasize that although ADHD is the approved term for the problem, many people, particularly adults, may have little overt evidence of hyperactivity, and they are better thought of as having “ADD.”

Attentional problems come in all shapes and sizes. Some are so mild that people just need to be shown how to use a day planner and implement some time management scheme. Others need a more aggressive and comprehensive approach. Whatever we do has to be individualized to the person with the problem. Not only do we have to match the plan with the person, we also need to match it with his or her belief system.

It is important to recognize that no one approach is likely to work on its own. Medications may be very helpful, but they are only tools to help people get organized so that they can fulfill their potential. And medications are unlikely to be effective unless we also deal with nutrition, posture, breathing, sleep and environmental stress.

It is also essential to realize that ADHD is highly co-morbid: there is evidence of increased rates of physical problems, including disturbances in thyroid function and cell membrane function throughout the body. The rates of conduct disorder, oppositional defiant disorder, learning disabilities, tics and Tourette’s, worry, anxiety and mood disorders are all much higher in people with ADHD. So high that until recently, many experts believed that ADHD was a symptom rather than a clearly delineated illness. This overlap is also one of the reasons why some people persist in saying that the diagnosis of ADHD is nothing more than a stigmatizing label for socially unacceptable behavior.

Physical

• Medications
• Nutrition
• Posture
• Exercise
• Environment

Over the last few weeks we have spent a lot of time looking at some of the options for treating the physical components of the problem. Now let us look at the rest.

Psychological

• Find out and work with a person’s interests. ADHD is highly dependent on context. A child or adult may have terrible problems with schoolwork, but be able to play a video game for hours on end
• There are multiple intelligences: uncover which are of the greatest importance. It is essential for a person to discover their strengths rather than being forced to focus on the weaknesses. Many people with ADHD find that highlighting text in a book can be useful, while others learn by doing
• People are more likely to follow instructions if they are interesting and emotionally charged
• Bear in mind that many people have poor self-esteem and others suffer from enormous feelings of regret. This is a particular issue for people who may have reached middle age before being diagnosed. We have seen countless people who feel that they have missed out on life. A man working in construction realized that he could have gone to college thirty years ago if only his ADHD had been diagnosed and treated
• Teach visualization skills
• Discover which times of the day are best in terms of attention and alertness
• Learn some simple relaxation techniques
• Learn problem-solving skills

Social

• ADHD can play havoc with relationships. If a child has it, there can be enormous stress on the parents and siblings, all of whom are at higher risk of some features of ADHD themselves. It is essential to help the family with coping skills. ADHD can also put a great deal of stress on a spouse or children. It is also important to know that many people with ADHD have sexual problems that stem from impatience, a low frustration threshold if they cannot have sex when they want it, and real problems with enjoying the moment and taking time to enjoy a romantic interlude. Some people also use sex as a form of self-medication. So it is essential to find out if there are sex or relationship problems and to deal with them, which may need outside help
• Many people with ADHD are socially awkward and may need to learn some social and communication skills
• ADHD and social awkwardness can be magnets for bullies, and it is remarkable how many young people with untreated or inadequately treated ADHD have been bullied. Occasionally they become the perpetrators of bullying to compensate for their difficulties. In either case it is important to discover and deal with bullying. It is one of several reasons why some experts have recommended enrolling a child in martial arts classes. Not only can they help with self-defense, but also the discipline of a martial arts class can work wonders for some people with ADHD
• Role models are important for people with ADHD. It is very helpful, particularly for young people to see that other sufferers have become extremely successful
• It is also important for parents and other family members to develop and maintain a positive image of the person with ADHD
• Develop positive yet realistic career and life goals

Subtle

• Poor breathing techniques can engender many problems. Learning to breath effectively can have profound physical effects as well as stimulating and balancing the subtle systems of the body
• As we have seen, although the research base is very small, yoga, t’ai chi ch’uan or qigong can all be very helpful
• Many people with ADHD are acutely sensitive to “atmosphere:” to the thoughts, feelings and attitudes of other people, and they need specific help to remain grounded and to protect their senses. Some of the flower essences can very helpful for that, as well as some other techniques that we shall be publishing shortly

Spiritual

• How can there be a spiritual component to ADHD? Some people find it difficult to engage in prayer or meditation because of problems with attention. However, with a little perseverance, we have evidence that some forms of meditation may actually help.
• Second the rituals of religion can sometimes provide a wonderful anchor for the person who is having a had time with ADHD.
• Another point is that ADHD is not all bad. Some people who have it become more attuned to nature, animals and to a mystical understanding of the world: an over-reliance on reasoning and linear learning can stifle those perceptions.
• Some people have suggested that ADHD may for the same reasons unlock a rich vein of creativity that might otherwise never have appeared.

There are plenty of books and websites that portray ADHD as a gift. While I have the greatest respect for this approach, it is still important for us not to forget the demonstrable problems caused by inadequately treated ADHD.

ADHD exists, it is treatable, and though it can bring many problems, it can also bring many opportunities. Just so long as we remember to respect every dimension of the person who has it, and remember that if we do not manage it, it will manage us.

I must have heard a thousand times that there’s a fine line between genius and insanity. I have talked before about the possible link between the two through schizotypal personality disorder. It is quite well known that there are two living Nobel Prize winners who have a diagnosis of schizophrenia and many more who have first-degree relatives with it.

There is some very interesting research in the current issue of the Journal of Clinical Investigation from a team of scientists at the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH).

In the latest installment of a story that has been unfolding over the last three decades, they report on their findings concerning a human gene for a master switch in the brain called DARPP-32. Most people inherit a version of a gene that optimizes their brain’s thinking circuitry, yet paradoxically also appears to increase risk for schizophrenia, an illness marked by impaired thinking. The main kinds of thinking involve reasoning, abstraction and creativity.

Over the last two decades, studies in animals, most notably by Nobel Laureate Paul Greengard at Rockefeller University, have established that DARPP-32 in the striatum switches streams of information coming from multiple brain chemical systems so that the cortex can process them. Both the neurotransmitter that DARPP-32 works through – dopamine - and the chromosomal site of the DARPP-32 gene have been implicated in schizophrenia.

The NIMH researchers in this new study have identified a common version of the gene and showed how it impacts the way in which two key brain regions exchange information, so affecting a range of functions from general intelligence to attention.

To understand DARPP-32’s role in the human brain, they used genetic, structural and functional magnetic resonance imaging and also post-mortem studies to identify the human gene’s variants and their functional consequences.

Seventy five percent of subjects had the most common version of the gene, which boosted the activity of circuits in the prefrontal cortex of the brain. This region is the major filter, controller and processor of cognitive information. When active, it increases structural and functional connections and our performance on tasks that involve thinking. It almost certainly does so by increasing gene expression. In 257 affected families, people with schizophrenia were also more likely to have this common version of the DARPP-32 gene.

DARPP-32 appears to shape and control a circuit running between the striatum and prefrontal cortex. The circuit affects key brain functions implicated in schizophrenia, such as motivation, working memory and reward-related learning.

The senior investigator is Daniel Weinberger, who had this to say,

"Our results raise the question of whether a gene variant favored by evolution, that would normally confer advantage, may translate into a disadvantage if the prefrontal cortex is impaired, as in schizophrenia. Normally, enhanced cortex connectivity with the striatum would provide increased flexibility, working memory capacity and executive control. But if other genes and environmental events conspire to render the cortex incapable of handling such information, it could backfire — resulting in the neural equivalent of a superhighway to a dead-end."

Although several groups of researchers have looked for the possible clinical relevance of DARPP-32, they have had much success. This study shows a strong connection between the molecule and human cognition and also, perhaps, with schizophrenia.

What is also interesting about this finding is that it helps provide us with a mechanism by which environmental stress could lead to cognitive problems.

Apart from the uninformed tirades of Tom Cruise, I see a lot of opinion pieces on websites and YouTube expressing the opinion that psychiatry is baseless, ostensibly because there is no science behind it. By anyone’s standards, this is high level science utilizing a series of state-of-the-art approaches. And another piece of evidence that psychiatry is becoming more science than art, linking the mind, the brain and the environment into one harmonious whole.

The Lancet medical journal has just published this year’s themed issue on the topic of ‘Creativity and Medicine’.

If you click on the link, you will be taken to a digital edition of the special issue. The digital edition is an exact facsimile of the print copy and is available for one month. You can turn pages just as you would with a print edition and even print off the pages for your own personal use.

The Lancet is one of the journals that you will find in the "Journal" listing on the left of this blog.

Many of the articles are extremely interesting and thought provoking: "Writing and healing;" "Development of children’s creativity to foster peace;" "Healing through art therapy;" "Theatre - a force for health promotion;" "Hospital clowns;" "Healing architecture; " "Healing gardens;" "Chance favors the prepared mind" and "What can the arts bring to medical training?" were some of my favorites, and give you a good flavor of what’s in store for you.

You will also see how this fits very precisely with a true Integrated Medicine.

One caution: it IS a medical journal and there are one or two articles near the back that are not for the squeamish.

With that caveat, there is much food for thought in these articles, and the Lancet deserves our thanks for making them available for free. Even if it is only for a month!