I had to laugh when I read The Washington Post piece, "Language lessons for Democrats, from the political brain of Drew Westen." Dr. Westen is the psychologist and neuroscientist at Emory University who wrote the 2007 book, "The Political Brain." His advice to Democrats is to quit using the terms "the environment," "the unemployed" or "the uninsured." I love his comment, "There are a few things if you know about the brain, they change the way you think about politics... If you understand we evolved the capacity to feel long before we evolved the capacity to think, instead of barraging people with facts (the standard Democratic way of talking to voters), you speak to people's core values and concerns. His basic advice is to quit communicating with "reason and facts" since people respond more to "emotional appeals."

I guess this is consistent with some of the new writing about change and leadership. I am particularly taken with the metaphor of the rider and the elephant by UVA psychologist Jonathan Haidt in his book The Happiness Hypothesis. Dr. Haidt's premise is that our emotional side of change is the Elephant, while our rational side is the Rider. Perched atop the Elephant, the Rider often seems to be the leader that holds the reins – but the Rider’s hold is precarious because it’s so much smaller than the Elephant. Any time the Rider and Elephant come to blows about which direction to go, the Elephant (our emotions) wins.

 All that said, it's a sad reflection on the state of advice for politicians or managers. I'm reminded of the words of Justice Felix Frankfurter, "Fragile as reason is and limited as law is as the institutionalized medium of reason, that's all we have standing between us and the tyranny of mere will and the cruelty of unbridled, undisciplined feeling…"

I was surprised to see this headline on the DHHS web site, "Biofeedback Now Seen as 'Regular' Medicine: Computer-assisted treatment has joined mainstream for pain, anxiety and more". But it makes sense. As our knowledge of both the physical nature of behavioral disorders and the behavioral nature of physical disorders has continued to grow, it was inevitable that we would eventually begin to see the 'therapies' overlap.
The emerging group of tech-enabled therapies—both stimulation-based neuromodulation therapies and exercise-based therapies (like biofeedback in the DHHS article)—will help to drive the health management integration that has been held up as the ideal. That said, I think the going will be slower than necessary, mainly because there is a great deal of professional resistance (both in physical medicine and in behavioral health) to embrace the new treatment models.

Brain scan evidence that defense attorneys claimed show a defendant’s brain as psychopathic was allowed into the sentencing portion of a murder trial in Chicago, according to a November 23 report, “Courtroom First: Brain Scan Used in Murder Sentencing” from one of my favorite pubs, Wired Science. Not that it helped the intended cause—the defendant was found guilty and sentenced to death. But, with the accuracy rate of brain scan data ranging from 76% to 90% in identifying deception (according to a 2008 University of Pennsylvania Center for Cognitive Neuroscience publication “Detection of Deception with fMRI: Are we there yet?”) the brain scan has equal or better accuracy than lie detectors. And, discerning judges and juries will likely find brain scans to be more credible than hired-gun forensic psychiatrists and psychologists. Look for more diagnostic metrics in the courtroom.

“Antidepressants May Change Your Personality” was the lead story of the recent daily health news update from healthfinder.gov, the U.S. Department of Health and Human Services’ service to provide current health info to the public. My initial reaction was that this isn’t news. (I’m not making any value judgments about whether this is good or bad, by the way.)

The story cites the research of Tony Tang, an adjunct professor of psychology at Northwestern University in Evanston, which found that taking antidepressants may not only help alleviate depression, but could also make you more extraverted and less neurotic. The study, “Personality Change During Depression Treatment: A Placebo-Controlled Trial,” featured in the December 2009 issue of Archives of General Psychiatry, posits that extraversion—often associated with positive emotions—is believed to help protect from depression, while neuroticism—the tendency to experience negative emotions and emotional instability—is thought to contribute to depression.

The study revives some of the work by Peter D. Kramer (author of Listening to Prozac and Against Depression) following the introduction of Prozac (though the premise is certainly extended to all types of antidepressants) about social questions surrounding the benefits and problems of “norming” one’s personality in the name of treatment. Though this question may seem a bit passé, it is a topic that will certainly get more traction as cosmetic neurology and the concept of “normal” wends its way through the mental health field.

For more on this topic, check out:

Is Cosmetic Neurology the Behavioral Health Business of the Future? The Controversy Over Drugs That Build “Mental Muscle”

Have you heard of FleaHab? It's a new exercise-based recovery program track at the Providence Recovery Center in Santa Cruz, California, run by Darryl “Flea” Virostko, a big wave surfer and three-time Mavericks champion. Now, before you get too cynical about this as another addiction treatment gimmick combining a 'tangential' but attractive consumer activity with the market cache of a noted sports figure, consider the emerging science.

Mr. Virostko hopes that FleaHab will be his anchor in the dry terrain of sobriety. Addicts in the program will replace the high of drugs with the endorphin rush of strenuous physical activity, he says. He recently took a group surfing to try his hand at teaching. “It’s like I’m learning to surf again,” he said. “Seeing them so excited reminds me of when I first started...” according to a quote in "Surfing as Rehab for Those Fighting Addiction".

As you may remember from some of my OPEN MINDS live reporting earlier this summer, I spent a fabulous week at the "State of Mind" conference held at the Chautauqua Institution, where we explored "the techniques and current research findings related to mental health disorders and brain injury..." One big takeaway was learning that there is only one way to generate new brain cells—through extreme physical exercise—and to 'turn them on' requires extreme mental challenges. Another interesting takeaway was that almost all psychotropic medications perform better for consumers when combined with an exercise program. These findings are all the more relevant for consumers who can now use new brain scanning technology to watch their brain change as they recover from mental illness, progress in recovery from their addiction, or work to improve cognitive functioning.

I left my week in New York with some distinct thoughts about the future of behavioral health treatment programs. In a decade, it will likely be considered malpractice to provide behavioral health treatment without a rigorous exercise program. And, the programs that provide consumers access to the technologies that allow them to 'see' their brain recovery are the programs that consumers will select. To that extent, FleaHab is on the right path.

September 3, 2009

I rarely weigh in on forensic issues in our field; my view is that this is the province of lawyers and politicians. However, I recently received an opinion piece, "Morning Bell: Adult Times for Adult Crimes," from The Heritage Foundation that I couldn’t let pass without comment. The long and the short of The Heritage Foundation position is that the U.S. should not reconsider its policy of sentencing juveniles to life in prison without the possibility of parole. The support for their position is based on a study, "Adult Times for Adult Crimes: Life Without Parole for Juvenile Killers and Violent Teens" by legal scholars Charles D. Stimson and Andrew M. Grossman, of The Heritage Foundation's Center for Legal and Judicial Studies.

To buttress their argument, The Heritage Foundation cites the fact that eleven other countries in the world allow juveniles to be sentenced to life in prison without parole. However, after viewing the United Nations Human Rights Council's 2009 Statement on Juvenile Sentencing (cited in The Heritage Foundation's article), I’m not so sure. The statement includes the following passage, "Eleven countries have laws with the potential to permit the sentencing of child offenders to life without possibility of release: Antigua and Barbuda, Argentina, Australia, Belize, Brunei, Cuba (legislation pending), Dominica, Saint Vincent and the Grenadines, the Solomon Islands, Sri Lanka (legislation pending), and the United States. Currently, there is no evidence of any country, besides the United States, with child offenders sentenced to life without the possibility of release." So much for that evidence.

Some more interesting facts on juvenile life imprisonment come from the same UNHRC statement:

8. The Convention on the Rights of the Child (“CRC”), ratified by every country in the world except the United States and Somalia, codifies an international customary norm of human rights that recommends against life sentences and forbids the sentencing of child offenders to life in prison without possibility of release.14 There are now 135countries that have rejected the sentence through domestic legal commitments and 185 countries that have voted for the resolution in the General Assembly.15 The prohibition, arguably, has now reached the level of a jus cogens norm. As such, it is binding on all states, including those that have not formally ratified it themselves.

10. Customary international law is part of domestic law in the United States and, therefore, juvenile life sentences without the possibility of parole should be prohibited.19 Juvenile life sentences have not been consistently and historically applied. 20 The sentence was not used on a large scale until the 1990s when at least 40 states passed laws increasing the options for sending juveniles to adult courts.21

11. In the United States, there are an estimated 2,484 juveniles serving life sentences without parole. 22 Nationally, 59% of children were sentenced to life without the possibility of release for their first ever criminal conviction. Of these children, 16% were between the ages of 13 and 15 when they committed their crimes, and 26% were sentenced under a felony murder charge, where they did not pull the trigger or carry the weapon.23 In addition, African American youth are disproportionately represented through every stage of the juvenile justice process, including among those children serving life sentences without the possibility of release.24

Regardless of the policies of other countries, the reason for my commentary is that this flies in the face of emerging research on brain development. At this year's Chautauqua Institution, "State of Mind” conference, I attended the update on new brain research from John J. Ratey, Associate Clinical Professor of Psychiatry at Harvard Medical School. One of my takeaways from his update is that new science tells us human brains do not mature until the age of 25 or so. It seems to me that—despite how horrific the crime—to sentence juveniles with not-yet-fully-developed brain functioning to prison sentences with no opportunity for societal repatriation in their later, mature years is indeed cruel and unusual punishment.