Saturday, January 16, 2016

Neuroscience in Focus - An Introduction to the Stress Response System





As of this writing, mid January of 2016, it's been three years since I started my (now sort of famous) drive for “why?” - my drive to understand psychiatric and mood disorders in ways that the current mental health and psychiatric professions don't.



During that beginning (early 2013) I was using various social media (and still do) to both seek the best information I could find regarding the brain and mental health and those with whom to discuss it. In the course of that endeavor early that year I met a man who'd change my life forever, one Mani Saint-Victor. (Two, actually, Robert Whitaker being the other). Mani is a Harvard trained medical doctor and neuroscientist. At the time he was detaching himself from medical practice and doing his own research into – tada! - psychiatric and mood disorders and somehow we crossed paths. I think it was because I happened to be a bit of a dab hand at English grammar and composition and that he was doing some writing projects with which he needed editing and proofreading help that we initially “meshed” (social media can be wonderful that way) and subsequently when he saw what I was doing and I saw what he was doing (investigating the above mentioned disorders) we formed a bit of a working partnership (I brought some key things to the table that he'd been looking for). He was taking his study of neuroscience in a new direction at the time, saw that I had a great interest in it as well and then took me under his wing (thus changing my life – and mind – forever). Mani was – and remains – a great gregarious open minded, open spirited person and so made as wonderful a mentor as one could wish for.



At the time I was voraciously seeking information regarding the neurological basis for psychiatric and mood disorders and their symptoms and he provided all I could handle (which at that time was a lot). And the vast majority of what he provided was studies and research linking the neurobiology of stress with psychiatric disorders and the symptoms thereof. Now, you have to understand that not long prior to that I was coming off a three year stretch of psychiatric inner horror shows the likes of which few people experience – hallucinations, hearing voices, psychotic episodes and much etcetera not to mention crippling anxiety and other assorted “goodies” – so when I started reading through the papers he was sending me and ran them through my own experiences along with my burgeoning knowledge of how brains work, I instantly got the connections. I mean it was like bingo, bingo, bingo, bingo and BINGO. So many things began to fall into place for me in my understanding of psychiatric and mood disorders and it was a great honour and pleasure to be able to discuss it all with Mani along with some of his other neuroscience colleagues (again, the blessings of social media).



The other thing I loved about Mani and what connected us so well at the time, was that he too (though from the opposite side of the doctor-patient equation) had become disillusioned with the standard medical/mental health approach to psychiatric care (IE: the pharmacological approach) and was searching out alternatives (though not in the so called "alternative medicine" field, which is almost as bad as the pharmaceutical industry for false claims and poor long term efficacy). For a few magical months he (and those online neuroscience colleagues of his) and I had a rollicking good time exploring all that stuff.



Aside from everything my dear old friend Mani taught me back in the beginning, I also discovered the renowned Robert Sapolsky. He is ranked among the top fifteen neuroscientists in the word (this out of tens of thousands in that exploding field) and is widely regarded as perhaps the leading expert on the planet in the study and understanding of stress and what it does to us and why.



All of which sort of sets the table for what I'm finally getting around to presenting – the neuroscience of stress, psychiatric and mood disorders and you.



One of the things I've found in my study of stress is how poorly misunderstood it is and the degree to which it's overlooked as a major factor in mood and psychiatric disorders even within the mental health professions. Certainly most competent professionals will understand the elementary basics and that it's important to manage but no one that I have dealt with as a patient or in great numbers of discussion or came across in my very broad reading seems to really know and understand the entire big picture about stress, what causes it and what it means to your mental and physical health nor really just how much it may affect behaviour, is creating much of the crazy making things you experience in your mind and especially not how much it is killing you. 



It is my goal with this series on stress to change that.



In the past I have mentioned a bit about how I do my some of my own research. Mine is a sort of old fashioned gumshoe approach which I do by simply talking to and listening to people. Since I first started publishing the current form of Polar Bear pieces in the summer of 2013 I have met a considerable number of people through the blog. Many come to me with questions and I spent a good deal of time listening, asking questions and poking into what I refer to as their "neuro-history"; past events, circumstances and so on that literally shaped their brains and how their brains subsequently worked and thus produced who and what they are today. What invariably would emerge was a number of key stressors and/or medical events. What I fervently tried to do was to simply gather information without attaching judgement or values but visualize how that would be processed by some of the brain regions we're going to look at below and how that would shape behaviours and moods and create what we experience as anxiety and/or depression

With that kind of field study (if you will) and brain study, I feel I now have a broader than most understanding of stress and what it does to our brains, minds and bodies and - most importantly - where it comes from in terms of environmental and psychological stressors. And even more importantly than that, a much better understanding of the individual differences that cause some people to experience stress differently and more importantly yet, how these differences lead to moderate to severe psychiatric disturbances. 

And even better than that, some of the key understandings for mind and lifestyle management and strategies for either reducing stress or changing our responses to it. 



So for now I'm going to ask that before delving in here to please put aside everything you think you know about stress and your experience and understanding of it. Most people's understanding of it is based on so much outdated or outmoded or pop science gibberish so as to be more harmful than good. As well, if you really want to understand and learn something, it is necessary to set aside previously held notions of the subject so that the new stuff has a place to go.




What most people understand about stress is the classic stuff we commonly associate with it; pressure at work and school, time deadlines, the boss freaking out on us and stuff like that. While this is all stress, of course, that is actually a very limited understanding of stress and is probably the least of what is truly damaging stress (and I'll get to why it's not as damaging as we think as we go along). Not that we're going to ignore that, but what we're going to learn and understand goes much, much deeper than that.



Now even as great and as knowledgeable as Robert Sapolsky is, even he doesn't connect all the dots between all the various symptoms of psychiatric disorders and stress and we mental health suffering peeps' unique sources of stress and of processing and reacting to it they way we do. That's where little ol' moi comes in. So this series on stress is truly going to be a mind blowing eye opener for all of you, whether you suffer from psychiatric and/or mood disorders, a loved one does or you're in the mental or medical health professions (and I do know I have several of you reading along).



So after yet another horrendously long (though necessary and hopefully at least somewhat entertaining and engaging) Bradonian introductory ramble, let's get to work.







The Neuroscience of Stress Part I




A couple of options here now and it's my hope you can use them in concert in ways that work best for you. There's the text version below, as you can see and I'm working on getting these posts into audio-visual presentations. These are not professionally polished just yet and I'm just getting the hang of doing them with limited resources, so I ask for your patience there, but you just may well enjoy this more than reading. 





There are three brain concepts that I have written about in the past that we are now going to begin to bring forward and tie together in our introductory look at stress and the stress response system and they are: the evolutionary development of the homo sapien brainconsciousness and the subconscious mind and what I termed "zombie programs", the latter two of those being quite closely related.



The evolutionary development of our so called modern homo sapien brains is important mostly – as I pointed out in the original piece – to understand that our brains evolved by “bootstrapping” off of (or building off of) earlier “brain models” and all the basic equipment of our current day stress response system is very, very old “hardware” and “wiring” indeed.

Let's again look at what pioneering neuroscientist Dr Paul MacLean termed the "triune brain" (this model has been disparaged in some circles but it absolutely is still valid for understanding the basic outline of evolutionary development). We've looked at this in a number of posts in the past and now we'll start to look in more detail.




Our deepest homo sapien brain "hardware" - the brainstem, the part in red - is virtually identical to that of the humble reptile class of animals and performs in much the same way, controlling very elementary survival behaviours and regulating core systems like breathing and heart rate.  

Next evolved is the limbic region, an area that is for the most part exactly the same in we humans as we'd find in all mammal species and even bird species (scaled differently, of course). This is the area we'll be most closely examining here today and in following posts in this series. 

Above that is the neocortex. In many regards the human version again is quite the same in us as in all higher mammal species. Not distinguished in that image, however, is the vaunted frontal lobes in which functions unique to humans are housed, but that is something we'll examine later when we learn more about emotional regulation and executive functions. The other key anatomical difference between human and higher mammal neocortexes is the "sulki" and "gyri". Those are the deep folds we'll see when looking at the outer part of a brain; sulki being the "valleys" while gyri are the "peaks". While all mammal brains have these, in the human brain they are deeper and more pronounced. These folds are key to humans' higher (one would hope) cognitive abilities.

There are a few points important for us to understand here now and to bear in mind in the future.

One, as I again mentioned in the post on brain evolution (and in Neuroanatomy 101), our stress response system, located in the limbic and brain stem regions, evolved and adapted over millions of years for very, very different situations and circumstances than what we now must currently deal with in the modern world as it has developed in the last several hundred years starting from the dawn of the industrial age and particularly the last half century. This is Very Important to understand, as we'll see.

Two, there's a "hierarchy of command" in the brain and because the brain stem and limbic regions evolved first, under many key circumstances the lower regions will be first in line when it comes to things like energy allocation throughout your brain (and thus directing it through your body) and in generating responses to incoming stimuli (IE: inward and outward behaviours). Also Very Important to understand as we go along and try to understand our own reactions and behaviours. 

Thirdly, what our short and long term stress responses and related systems put - or don't put - on our "conscious awareness plate" is also very important to understand. And this is where we're going to learn the crucial importance of what we first looked at way back when in the post on Broken Ego Defenses and we see that what "ego defenses" do is help keep sources of pain and stress off our "conscious awareness plates". As well, better managing what we consciously, or even subconsciously, experience is what we will start to work on in our study of meditation  and mindfulness meditation CBT.



To further understand our subconscious, understanding our stress response system is going to be critically important as well. To remind, I do not by “subconscious” mean the Freudian sense of that term (though I do use his ideas elsewhere) but in the very real neuroanatomical and neurobiogical sense that the vast majority of what goes on in our brains operates well below our conscious awareness and control. Which is where “zombie programs” come in for they are the stuff of our subconscious; hundreds of completely autonomously operating brain “programs” that run probably in the neighbourhood of 99.5% of your life and daily workings and thoughts, all of which hum away more or less 24/7 for the most part well below your conscious awareness.



This will now become more important to understand and you'll see why because in learning and understanding the stress response system, we are being introduced to Zombie Program Numero Uno, the Head Honcho of all zombie programs and subconscious goings on in our brains and mind.



So, let's now have a look at some of the basic brain anatomy and neurobiology, shall we? Fear not, dear readers, I promise to not make it too onerous nor tedious. And besides, I've talked in the past about how learning new things is good for our brains and this is not a bad subject with which to do that. 

For starters, let's revisit the limbic region. I first introduced this area in both Neuroanatomy 101 and touched on it again in The Why of You - The Emotional You and probably here and there elsewhere, but now it's time to get down to a little more of the nitty-gritty of this very elementary and important part of your brain and thus "you".

Here's a rough outline of the major components involved in the stress response system and where they are located in the brain.



There are other bits involved but for today these four regions are adequate for our introductory understanding. So let's look at each in a little more detail and understand what they do. 

Amygdala


The amygdala is "grand central station" for all incoming sensory traffic from your visual, auditory, olfactory, tactile and taste senses, the first three of those generally getting the highest priority. The amygdala is further broken down into all kinds of little specialized "sub-divisions" where the tasks for monitoring and analyzing the tremendous amount of "data" that is constantly streaming through it are further divided up for processing and analysis (we're talking "data streams" and processing speeds that would cripple even the most powerful computer).  

We'll think of the amygdala as "Monitor Lady". Now, I must remind you of how little of this "incoming data" you are consciously aware of at any one time. Whatever you are consciously aware of will represent perhaps 1% of everything going on around you, if that much. But fear not, while you may not be consciously aware of the vast majority of it all, Monitor Lady is all over it. 

Hippocampus


An enormous amount of everything to do with your memory starts here. I call the hippocampus our "Filing Lady". Imagine a little filing lady in your brain with access to enormously vast files of "data" at her fingertips who both retrieves and files away packets of said data. When you are having both long and short term memory problems, this where we want to start to look. But don't blame your "filing lady" if your memory isn't what we'd like it to be. If you had any idea of her daily, hourly and minute by minute workload, you'd understand she is one overworked, overtaxed little lady. Again, the data traffic she handles would crash most computers. (1) We'll come back to this area in much more detail in later segments of this series. 

And it is again necessary to remind you how little of the approximately one peta-byte of memory data you have stored in your tens of billions of neurons and trillions upon trillions of synaptic connections you can consciously recall at any one time, which would certainly be less than one tenth of one percent. But again, not to worry; if you can't consciously recall most of what is stored in your memory banks, Filing Lady likely has lightening quick access to it. 

The amygdala and hippocampus are located very closely together because they must cooperate very closely together (as we'll see below) in taking in, analyzing and sorting data and - most vital for us today - how to respond to it in dizzyingly brief spaces of time.  

Hypothalumus 


The hypothalamus's job involves certain metabolic processes (which we will leave aside for another day though this will be very interesting to us when we begin to understand the long term effects of stress on our bodies) and more importantly for our purpose today, super critical duties in the autonomic nervous system which includes our stress response system. It has much to do with the creation and secretion of "neurohormones" (AKA: "releasing hormones" - more later) along with other interesting areas of control such as body temperature, hunger, thirst, and fatigue along with important aspects of parenting and attachment behaviours,  - veeerrry interesting when we come to look at human behaviour and deeper hidden stressors. 

In the order of things, the hypothalumus is generally "downstream" from our "Monitor Lady" and "Filing Lady" and thus mostly takes orders from them. We can think of this region as "Dispatch Lady" when the alarm has been sounded. But, when we look at deep "instinctual stressors", we'll see that Dispatch Lady has some important pull of her own.

Pituitary Gland

 

The pituitary gland is the "blindest robot" of our quartet here. It doesn't "think" too much (if at all), it just follows orders from the above chain of command and disperses "stuff" - hormones of various kinds. Of course what we're interested in here today is the stress related hormones it releases or causes to be released. We'll look at the names of these hormones and learn them in more detail in the next segment.

We'll think of the pituitary gland as "Dispensary Lady". 

Okay, now a really brief look at what happens in this system when your amygdala detects a threat.




 I'm going to ask that we ignore the part where it says "stressor" for now. I'd prefer we think of that as "incoming sensory data"; it is then up to the amydala to decide if that's a threat or not (or a stressor or not) though we'll also later look at how the hypothalumus monitors and reacts to certain stressors. 

Where it says "bed nucleous of stria terminalis" is a crazily complex "switchboard" of all kinds of major "trunk lines" of local and long distance brain communication wiring. How this "wiring harness" has developed within any one individual will greatly affect how that person perceives and reacts to a stressor. For now we'll set aside that vague sounding "RAS, other brain areas involved in stress response", though these involve some very important behavioural regulation brain regions located in "upstream" areas of the brain

In future posts in this series, we'll look much more at that "negative feedback" loop (which is actually much more complex than that) and how all that plays a role. I touch on that in the post Memory Functioning in Major and Bipolar Depression and we'll look at that in much more detail when we begin to understand the roles traumatic experiences and memories play in mood and psychiatric disorders and PTSD.  

So what happens in what we'll call a typical and very basic threat response of a physical nature will go something like this:

Via visual and auditory inputs your amygdala (Monitor Lady) will detect a threat, send messages to both the hippocampus (Filing Lady, who will roar around her "filing cabinets" looking for relevant information and data) and hypothalumus (Dispatch Lady) who then alerts the pituitary gland (Dispensary Lady) who hits all kinds of buttons sending various stress response hormones shooting all over your brain and body giving you all kinds of instant energy, focus and super fast response time. This will all happen in less than a few hundredths of a second, all well, well below your conscious awareness or control. When you hear of someone who "bravely acts without thinking" in reaction to some sort of dangerous situation (rescuing someone from a burning car, let's say), it's because they literally didn't think - all that process was taken care of without any input from higher "decision making" software in the brain but instead the process above (along with some of those "other brain areas involved in stress response"). 

Of course what happens the great majority of time is massively more complicated than that, the implications and consequences of which are sort of literally mind blowing.


So this is a crazily brief introduction to what - we're going to see - is at the root of all your mental health or psychiatric woes from overwhelm meltdowns, hallucinations, inappropriate behaviours, self harming thoughts and behaviours to all the rest of that wild and wacky stuff going on in your poor noggin. 

Now, back to its evolutionary basis and past. Remember, all of this evolved for not only much simpler threats - such as some predatory animal eyeing you for dinner - but many other conditions that bear almost no resemblance at all to the world in which it must operate today. 

And - most important for our understanding of our demon plagued brain (or raging inner "polar bears") - is the massive creature that is "psychological stressors". 

For while we have evolved all kinds of fancy advanced brain processors that ostensibly put us modern humans above all the past evolutionary incarnations of ourselves and our primate cousins, we'll see that a lot of these higher functions are the very culprits in what make us produce and experience stress in ways that no other creature on earth does.  

Another big important take-away for today is that while we all share this basic brain anatomy and circuitry along with all kinds of other brain wide regions and circuitry, we are not all created nor developed equally. Due to all kinds of reasons that I briefly outlined and touched on in Genetic and Environmental Factors in Individual Brain Development, those of us who most suffer from psychiatric and mood disorders have some very critical differences in how all of this is arranged and works, something my man crush Sapolsky sort of sums up in his concept of "individual differences". Super Important. 

(1) Computer nerds may argue otherwise, but trust me - our brains handle such vast and varied amounts of data that a computer which would process it all as our brains do remains a very distant dream. 



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