Brain Pickings

Posts Tagged ‘health’

20 JULY, 2015

The Science of Stress and How Our Emotions Affect Our Susceptibility to Burnout and Disease

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How your memories impact your immune system, why moving is one of the most stressful life-events, and what your parents have to do with your predisposition to PTSD.

I had lived thirty good years before enduring my first food poisoning — odds quite fortunate in the grand scheme of things, but miserably unfortunate in the immediate experience of it. I found myself completely incapacitated to erect the pillars of my daily life — too cognitively foggy to read and write, too physically weak to work out or even meditate. The temporary disability soon elevated the assault on my mind and body to a new height of anguish: an intense experience of stress. Even as I consoled myself with Nabokov’s exceptionally florid account of food poisoning, I couldn’t shake the overwhelming malaise that had engulfed me — somehow, a physical illness had completely colored my psychoemotional reality.

This experience, of course, is far from uncommon. Long before scientists began shedding light on how our minds and bodies actually affect one another, an intuitive understanding of this dialogue between the body and the emotions, or feelings, emerged and permeated our very language: We use “feeling sick” as a grab-bag term for both the sensory symptoms — fever, fatigue, nausea — and the psychological malaise, woven of emotions like sadness and apathy.

Pre-modern medicine, in fact, has recognized this link between disease and emotion for millennia. Ancient Greek, Roman, and Indian Ayurvedic physicians all enlisted the theory of the four humors — blood, yellow bile, black bile, and phlegm — in their healing practices, believing that imbalances in these four visible secretions of the body caused disease and were themselves often caused by the emotions. These beliefs are fossilized in our present language — melancholy comes from the Latin words for “black” (melan) and “bitter bile” (choler), and we think of a melancholic person as gloomy or embittered; a phlegmatic person is languid and impassive, for phlegm makes one lethargic.

Chart of the four humors from a 1495 medical textbook by Johannes de Ketham

And then French philosopher and mathematician René Descartes came along in the seventeenth century, taking it upon himself to eradicate the superstitions that fueled the religious wars of the era by planting the seed of rationalism. But the very tenets that laid the foundation of modern science — the idea that truth comes only from what can be visibly ascertained and proven beyond doubt — severed this link between the physical body and the emotions; those mysterious and fleeting forces, the biological basis of which the tools of modern neuroscience are only just beginning to understand, seemed to exist entirely outside the realm of what could be examined with the tools of rationalism.

For nearly three centuries, the idea that our emotions could impact our physical health remained scientific taboo — setting out to fight one type of dogma, Descartes had inadvertently created another, which we’re only just beginning to shake off. It was only in the 1950s that Austrian-Canadian physician and physiologist Hans Selye pioneered the notion of stress as we now know it today, drawing the scientific community’s attention to the effects of stress on physical health and popularizing the concept around the world. (In addition to his scientific dedication, Selye also understood the branding component of any successful movement and worked tirelessly to include the word itself in dictionaries around the world; today, “stress” is perhaps the word pronounced most similarly in the greatest number of major languages.)

But no researcher has done more to illuminate the invisible threads that weave mind and body together than Dr. Esther Sternberg. Her groundbreaking work on the link between the central nervous system and the immune system, exploring how immune molecules made in the blood can trigger brain function that profoundly affects our emotions, has revolutionized our understanding of the integrated being we call a human self. In the immeasurably revelatory The Balance Within: The Science Connecting Health and Emotions (public library), Sternberg examines the interplay of our emotions and our physical health, mediated by that seemingly nebulous yet, it turns out, remarkably concrete experience called stress.

Esther Sternberg by Steve Barrett

With an eye to modern medicine’s advances in cellular and molecular biology, which have made it possible to measure how our nervous system and our hormones affect our susceptibility to diseases as varied as depression, arthritis, AIDS, and chronic fatigue syndrome, Sternberg writes:

By parsing these chemical intermediaries, we can begin to understand the biological underpinnings of how emotions affect diseases…

The same parts of the brain that control the stress response … play an important role in susceptibility and resistance to inflammatory diseases such as arthritis. And since it is these parts of the brain that also play a role in depression, we can begin to understand why it is that many patients with inflammatory diseases may also experience depression at different times in their lives… Rather than seeing the psyche as the source of such illnesses, we are discovering that while feelings don’t directly cause or cure disease, the biological mechanisms underlying them may cause or contribute to disease. Thus, many of the nerve pathways and molecules underlying both psychological responses and inflammatory disease are the same, making predisposition to one set of illnesses likely to go along with predisposition to the other. The questions need to be rephrased, therefore, to ask which of the many components that work together to create emotions also affect that other constellation of biological events, immune responses, which come together to fight or to cause disease. Rather than asking if depressing thoughts can cause an illness of the body, we need to ask what the molecules and nerve pathways are that cause depressing thoughts. And then we need to ask whether these affect the cells and molecules that cause disease.

[…]

We are even beginning to sort out how emotional memories reach the parts of the brain that control the hormonal stress response, and how such emotions can ultimately affect the workings of the immune system and thus affect illnesses as disparate as arthritis and cancer. We are also beginning to piece together how signals from the immune system can affect the brain and the emotional and physical responses it controls: the molecular basis of feeling sick. In all this, the boundaries between mind and body are beginning to blur.

Indeed, the relationship between memory, emotion, and stress is perhaps the most fascinating aspect of Sternberg’s work. She considers how we deal with the constant swirl of inputs and outputs as we move through the world, barraged by a stream of stimuli and sensations:

Every minute of the day and night we feel thousands of sensations that might trigger a positive emotion such as happiness, or a negative emotion such as sadness, or no emotion at all: a trace of perfume, a light touch, a fleeting shadow, a strain of music. And there are thousands of physiological responses, such as palpitations or sweating, that can equally accompany positive emotions such as love, or negative emotions such as fear, or can happen without any emotional tinge at all. What makes these sensory inputs and physiological outputs emotions is the charge that gets added to them somehow, somewhere in our brains. Emotions in their fullest sense comprise all of these components. Each can lead into the black box and produce an emotional experience, or something in the black box can lead out to an emotional response that seems to come from nowhere.

Illustration from 'Neurocomic,' a graphic novel about how the brain works. Click image for more.

Memory, it turns out, is one of the major factors mediating the dialogue between sensation and emotional experience. Our memories of past experience become encoded into triggers that act as switchers on the rail of psychoemotional response, directing the incoming train of present experience in the direction of one emotional destination or another.

Sternberg writes:

Mood is not homogeneous like cream soup. It is more like Swiss cheese, filled with holes. The triggers are highly specific, tripped by sudden trails of memory: a faint fragrance, a few bars of a tune, a vague silhouette that tapped into a sad memory buried deep, but not completely erased. These sensory inputs from the moment float through layers of time in the parts of the brain that control memory, and they pull out with them not only reminders of sense but also trails of the emotions that were first connected to the memory. These memories become connected to emotions, which are processed in other parts of the brain: the amygdala for fear, the nucleus accumbens for pleasure — those same parts that the anatomists had named for their shapes. And these emotional brain centers are linked by nerve pathways to the sensory parts of the brain and to the frontal lobe and hippocampus — the coordinating centers of thought and memory.

The same sensory input can trigger a negative emotion or a positive one, depending on the memories associated with it.

Illustration by Maurice Sendak from 'Open House for Butterflies' by Ruth Krauss. Click image for more.

This is where stress comes in — much like memory mediates how we interpret and respond to various experiences, a complex set of biological and psychological factors determine how we respond to stress. Some types of stress can be stimulating and invigorating, mobilizing us into action and creative potency; others can be draining and incapacitating, leaving us frustrated and hopeless. This dichotomy of good vs. bad stress, Sternberg notes, is determined by the biology undergirding our feelings — by the dose and duration of the stress hormones secreted by the body in response to the stressful stimulus. She explains the neurobiological machinery behind this response:

As soon as the stressful event occurs, it triggers the release of the cascade of hypothalamic, pituitary, and adrenal hormones — the brain’s stress response. It also triggers the adrenal glands to release epinephrine, or adrenaline, and the sympathetic nerves to squirt out the adrenaline-like chemical norepinephrine all over the body: nerves that wire the heart, and gut, and skin. So, the heart is driven to beat faster, the fine hairs of your skin stand up, you sweat, you may feel nausea or the urge to defecate. But your attention is focused, your vision becomes crystal clear, a surge of power helps you run — these same chemicals released from nerves make blood flow to your muscles, preparing you to sprint.

All this occurs quickly. If you were to measure the stress hormones in your blood or saliva, they would already be increased within three minutes of the event. In experimental psychology tests, playing a fast-paced video game will make salivary cortisol increase and norepinephrine spill over into venous blood almost as soon as the virtual battle begins. But if you prolong the stress, by being unable to control it or by making it too potent or long-lived, and these hormones and chemicals still continue to pump out from nerves and glands, then the same molecules that mobilized you for the short haul now debilitate you.

These effects of stress exist on a bell curve — that is, some is good, but too much becomes bad: As the nervous system secretes more and more stress hormones, performance increases, but up to a point; after that tipping point, performance begins to suffer as the hormones continue to flow. What makes stress “bad” — that is, what makes it render us more pervious to disease — is the disparity between the nervous system and immune system’s respective pace. Sternberg explains:

The nervous system and the hormonal stress response react to a stimulus in milliseconds, seconds, or minutes. The immune system takes parts of hours or days. It takes much longer than two minutes for immune cells to mobilize and respond to an invader, so it is unlikely that a single, even powerful, short-lived stress on the order of moments could have much of an effect on immune responses. However, when the stress turns chronic, immune defenses begin to be impaired. As the stressful stimulus hammers on, stress hormones and chemicals continue to pump out. Immune cells floating in this milieu in blood, or passing through the spleen, or growing up in thymic nurseries never have a chance to recover from the unabated rush of cortisol. Since cortisol shuts down immune cells’ responses, shifting them to a muted form, less able to react to foreign triggers, in the context of continued stress we are less able to defend and fight when faced with new invaders. And so, if you are exposed to, say, a flu or common cold virus when you are chronically stressed out, your immune system is less able to react and you become more susceptible to that infection.

Illustration from 'Donald and the...' by Edward Gorey. Click image for more.

Extended exposure to stress, especially to a variety of stressors at the same time — any combination from the vast existential menu of life-events like moving, divorce, a demanding job, the loss of a loved one, and even ongoing childcare — adds up a state of extreme exhaustion that leads to what we call burnout.

Sternberg writes:

Members of certain professions are more prone to burnout than others — nurses and teachers, for example, are among those at highest risk. These professionals are faced daily with caregiving situations in their work lives, often with inadequate pay, inadequate help in their jobs, and with too many patients or students in their charge. Some studies are beginning to show that burnt-out patients may have not only psychological burnout, but also physiological burnout: a flattened cortisol response and inability to respond to any stress with even a slight burst of cortisol. In other words, chronic unrelenting stress can change the stress response itself. And it can change other hormone systems in the body as well.

One of the most profound such changes affects the reproductive system — extended periods of stress can shut down the secretion of reproductive hormones in both men and women, resulting in lower fertility. But the effects are especially perilous for women — recurring and extended episodes of depression result in permanent changes in bone structure, increasing the risk of osteoporosis. In other words, we register stress literally in our bones.

Art from 'Evolution' by Patrick Gries and Jean-Baptiste de Panafieu. Click image for more.

But stress isn’t a direct causal function of the circumstances we’re in — what either amplifies or ameliorates our experience of stress is, once again, memory. Sternberg writes:

Our perception of stress, and therefore our response to it, is an ever-changing thing that depends a great deal on the circumstances and settings in which we find ourselves. It depends on previous experience and knowledge, as well as on the actual event that has occurred. And it depends on memory, too.

The most acute manifestation of how memory modulates stress is post-traumatic stress disorder, or PTSD. For striking evidence of how memory encodes past experience into triggers, which then catalyze present experience, Sternberg points to research by psychologist Rachel Yehuda, who found both Holocaust survivors and their first-degree relatives — that is, children and siblings — exhibited a similar hormonal stress response.

This, Sternberg points out, could be a combination of nature and nurture — the survivors, as young parents for whom the trauma was still fresh, may well have subconsciously taught their children a common style of stress-responsiveness; but it’s also possible that these automatic hormonal stress responses permanently changed the parents’ biology and were transmitted via DNA to their children. Once again, memory encodes stress into our very bodies. Sternberg considers the broader implications:

Stress need not be on the order of war, rape, or the Holocaust to trigger at least some elements of PTSD. Common stresses that we all experience can trigger the emotional memory of a stressful circumstance — and all its accompanying physiological responses. Prolonged stress — such as divorce, a hostile workplace, the end of a relationship, or the death of a loved one — can all trigger elements of PTSD.

Among the major stressors — which include life-events expected to be on the list, such as divorce and the death of a loved one — is also one somewhat unexpected situation, at least to those who haven’t undergone it: moving. Sternberg considers the commonalities between something as devastating as death and something as mundane as moving:

One is certainly loss — the loss of someone or something familiar. Another is novelty — finding oneself in a new and unfamiliar place because of the loss. Together these amount to change: moving away from something one knows and toward something one doesn’t.

[…]

An unfamiliar environment is a universal stressor to nearly all species, no matter how developed or undeveloped.

In the remainder of the thoroughly illuminating The Balance Within, Sternberg goes on to explore the role of interpersonal relationships in both contributing to stress and shielding us from it, how the immune system changes our moods, and what we can do to harness these neurobiological insights in alleviating our experience of the stressors with which every human life is strewn.

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21 MAY, 2015

Project 1 in 4: Drawings Illuminating the Everyday Realities of Life with Mental Illness

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A revelatory reality check and a clarion call for life-saving compassion.

“One feels as if one were lying bound hand and foot at the bottom of a deep dark well, utterly helpless,” Vincent van Gogh wrote to his brother from the grip of mental illness. The great Dutch painter endures as one of the key figures we’ve enlisted in perpetuating the perilous “tortured genius” myth — a travesty of the the actual relationship between creativity and mental illness and among the many symptoms of our culture’s pathological delusions about what it’s really like to live with a mind that continually and uncompromisingly antagonizes, sabotages, and corrupts one’s wellbeing.

Project 1 in 4 by School of Visual Arts student Marissa Betley explores the everyday realities of life with mental illness — which affects one in four people in America and adds up to a societal cost of $300 billion per year — through a series of drawings based on the experiences, struggles, and coping strategies of people Betley interviewed, who had been diagnosed with depression, anxiety, schizophrenia, PTSD, and a range of other disorders.

With elegant directness, she exposes the stigmas and misconceptions to which we continue to cling as we oscillate between the equally perilous poles of romanticizing and invalidating psychoemotional anguish. Beneath the mere relaying of these experiences, however revelatory in and of itself, is a deeper call for compassion — a reminder that, as Betley puts it, “love and support makes all the difference.”

Reminiscent in spirit of artist Bobby Baker’s courageous visual diary of mental illness and the breath-stopping Drawing Autism project, but substantially different in style, Betley’s deliberately unelaborate drawings capture the concrete and acute suffering that mental illness engenders — a piercing counterpoint to the epidemic of mistaken beliefs that mental illness amounts to something as vague as a sense or as light as a mood.

Project 1 in 4 is part of the annual 100 Days Project initiative by the SVA Masters in Branding program, which assigns students the task of envisioning a creative operation, performing it for one hundred consecutive days, and documenting the ongoing process publicly. It has previously sprouted such wonderful efforts as Randy Gregory’s 100 Ways to Improve the NYC Subway and Jennifer Beatty’s 100 Hoopties, and was originally inspired by legendary graphic designer Michael Bierut’s assignment to his students at the Yale School of Art.

Betley’s project is part public service, part private inquiry — a beautiful embodiment of Aristotle’s famous proclamation that one’s greatest potential for purposeful contribution lies at the intersection of one’s passions and the world’s needs. When I spoke with her about the project, she shared the personal motivation behind the dry statistics of mental illness:

I’ve seen firsthand how serious and debilitating these illnesses can be. They can be remarkably devastating. While professional help is key, what’s equally important is unwavering support from family and friends. I thought, if I could just find a real human way to raise greater awareness then maybe I could help break down the stigmas surrounding mental illness that are preventing people from getting the help they need. Maybe the project could even save lives.

See more on the project site, complement it with the fascinating research on the relationship between REM sleep and depression, and heed positive psychology founding father Martin Seligman’s simple exercise for bolstering mental health.

For some pause-giving perspective, revisit the story of how trailblazing journalist Nellie Bly forever changed our treatment of mental illness.

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12 DECEMBER, 2014

Being Mortal: A Surgeon on the Crossroads Between Our Bodies and Our Inner Lives and What Really Matters in the End

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How dying confers upon living “the courage to act on the truth we find.”

“I am not saying that we should love death,” wrote Rilke, perhaps humanity’s greatest sherpa of befriending our mortality, in a 1923 letter, “but rather that we should love life so generously, without picking and choosing, that we automatically include it (life’s other half) in our love.” In Being Mortal: Medicine and What Matters in the End (public library), second-generation surgeon Atul Gawande grants Rilke’s undying words a new dimension in his sublime contribution to the canon of befriending mortality, which stretches from Montaigne’s meditation on death and the art of living to Sherwin Nuland’s foundational treatise on how we die to Alan Lightman’s wisdom on our paradoxical longing for immortality. In his part-memoir, part-manifesto, Gawande sets out to shed light on our contemporary experience of dying — an experience that, it warrants remembering, begins at birth — and on “what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.”

Gawande opens by noting the profound rift between anatomy and mortality in his medical education, bespeaking medicine’s general failure to prepare physicians for the most difficult yet deeply humanizing part of human life: our exit from it. “How the process unfolds, how people experience the end of their lives, and how it affects those around them,” he recalls, “seemed beside the point.”

But one particular work forever changed Gawande’s worldview as a student — and it wasn’t a medical text. It wasn’t written by a doctor, but by Leo Tolstoy, whose contemplation of the meaning of existence remains among the most important pieces of human wisdom ever committed to words. The work that so moved Gawande, however, was Tolstoy’s The Death of Ivan Ilyich and the following passage in particular:

What tormented Ivan Ilyich most was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result.

Illustration from 'The Flat Rabbit,' an unusual Scandinavian children's book that helps make sense of death. Click image for more.

His tuition, Gawande suggests, went toward a similar deception — medicine’s insistence on isolating the inner workings of the body from the rich and often difficult inner life it houses, especially when that bodily abode begins to fall apart. He writes:

Modern scientific capability has profoundly altered the course of human life. People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical world have proved alarmingly unprepared for it.

Pointing out that over the past seven decades we have shifted from a culture where most deaths take place in the home to one where more than 80% occur in hospitals and nursing homes, Gawande laments our malignant attitude that casts death as a failure of both doctors and the dying:

Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things.

[…]

You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that a carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with a problem you cannot solve.

There’s no escaping the tragedy of life, which is that we are all aging from the day we are born. One may even come to understand and accept this fact. My dead and dying patients don’t haunt my dreams anymore. But that’s not the same as saying one knows how to cope with what cannot be mended. I am in a profession that has succeeded because of its ability to fix. If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.

This experiment of making mortality a medical experience is just decades old. It is young. And the evidence is it is failing.

[…]

You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing homes and intensive care units—where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.

Piece from Candy Chang's global art project 'Before I Die.' Click image for more.

And yet Gawande extracts the promising potential beneath this cultural failure:

I have the writer’s and scientist’s faith … that by pulling back the veil and peering in close, a person can make sense of what is most confusing or strange or disturbing.

To be sure, Gawande brings a singular lineage of perspectives to this issue — an accomplished practitioner of Western medicine, he was born to parents, both doctors, who immigrated to America from different parts of India. He recalls visiting his paternal grandfather in India — “a dignified man, with a tightly wrapped white turban, a pressed, brown argyle cardigan, and a pair of old-fashioned, thick-lensed, Malcolm X-style spectacles” — when he was older than a hundred. Gawande paints the stark contrast between how his grandfather’s culture handled human finitude and how his own does:

He was surrounded and supported by family at all times, and he was revered — not in spite of his age but because of it. He was consulted on all important matters— marriages, land disputes, business decisions — and occupied a place of high honor in the family. When we ate, we served him first. When young people came into his home, they bowed and touched his feet in supplication.

In America, he would almost certainly have been placed in a nursing home. Health professionals have a formal classification system for the level of function a person has. If you cannot, without assistance , use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair, and walk — the eight “Activities of Daily Living” — then you lack the capacity to live safely on your own.

Gawande turns to Plato’s dialogue Laches — a text written nearly two millennia ago — for enduring guidance on how to cultivate a healthier relationship with our mortality. In the ancient text, Laches and Socrates go on to propose, then dismiss one by one, a series of definitions of courage, from “a certain endurance of the soul” to “knowledge of what is to be feared or hoped, either in war or in anything else.” They come up with no definitive answer, but Gawande argues that the reader arrives at an implicit one, which he synthesis beautifully:

Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.

He considers how the notion of courage illuminates the ultimate act of showing up that is dying:

At least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality — the courage to seek out the truth of what is to be feared and what is to be hoped. Such courage is difficult enough. We have many reasons to shrink from it. But even more daunting is the second kind of courage — the courage to act on the truth we find. The problem is that the wise course is so frequently unclear. For a long while, I thought that this was simply because of uncertainty. When it is hard to know what will happen, it is hard to know what to do. But the challenge, I’ve come to see, is more fundamental than that. One has to decide whether one’s fears or one’s hopes are what should matter most.

Gawande’s most emboldening point is that reframing our relationship with death, as well as our treatment of the dying, confers greater freedom upon life and more dignity upon the living:

Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be.

We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

[…]

If to be human is to be limited, then the role of caring professions and institutions — from surgeons to nursing homes — ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life.

In the remainder of Being Mortal, which lives at the intersection of science and philosophy, Gawande goes on to illustrate these ideas with practical examples of better, less limiting, and more dignified models of caring for the elderly and easing our exit from being. Complement it with philosopher Joanna Macy on how death helps us dial up the magic of life.

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28 AUGUST, 2014

Darwin’s Battle with Anxiety

By:

A posthumous diagnosis of the paralyzing mental malady that afflicted one of humanity’s greatest minds.

Charles Darwin was undoubtedly among the most significant thinkers humanity has ever produced. But he was also a man of peculiar mental habits, from his stringent daily routine to his despairingly despondent moods to his obsessive list of the pros and cons of marriage. Those, it turns out, may have been simply Darwin’s best adaptation strategy for controlling a malady that dominated his life, the same one that afflicted Vincent van Gogh — a chronic anxiety, which rendered him among the legions of great minds evidencing the relationship between creativity and mental illness.

In My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind (public library | IndieBound) — his sweeping mental health memoir, exploring our culture of anxiety and its costsThe Atlantic editor Scott Stossel examines Darwin’s prolific diaries and letters, proposing that the reason the great scientist spent a good third of his waking hours on the Beagle in bed or sick, as well as the cause of his lifelong laundry list of medical symptoms, was his struggle with anxiety.

Stossel writes:

Observers going back to Aristotle have noted that nervous dyspepsia and intellectual accomplishment often go hand in hand. Sigmund Freud’s trip to the United States in 1909, which introduced psychoanalysis to this country, was marred (as he would later frequently complain) by his nervous stomach and bouts of diarrhea. Many of the letters between William and Henry James, first-class neurotics both, consist mainly of the exchange of various remedies for their stomach trouble.

But for debilitating nervous stomach complaints, nothing compares to that which afflicted poor Charles Darwin, who spent decades of his life prostrated by his upset stomach.

That affliction of afflictions, Stossel argues, was Darwin’s overpowering anxiety — something that might explain why his influential studies of human emotion were of such intense interest to him. Stossel points to a “Diary of Health” that the scientist kept for six years between the ages of 40 and 46 at the urging of his physician. He filled dozens of pages with complaints like “chronic fatigue, severe stomach pain and flatulence, frequent vomiting, dizziness (‘swimming head,’ as Darwin described it), trembling, insomnia, rashes, eczema, boils, heart palpitations and pain, and melancholy.”

In 1865 — six years after the completion of The Origin of Species — a distraught 56-year-old Darwin wrote a letter to another physician, John Chapman, outlining the multitude of symptoms that had bedeviled him for decades:

For 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting, on two occasions prolonged during months. Vomiting preceded by shivering, hysterical crying[,] dying sensations or half-faint. & copious very palid urine. Now vomiting & every passage of flatulence preceded by ringing of ears, treading on air & vision …. Nervousness when E leaves me.

“E” refers to his wife Emma, who loved Darwin dearly and who mothered his ten children — a context in which his “nervousness” does suggest anxiety’s characteristic tendency to wring worries out of unlikely scenarios, not to mention being direct evidence of the very term “separation anxiety.”

Illustration from The Smithsonian's 'Darwin: A Graphic Biography.' Click image for more.

Stossel chronicles Darwin’s descent:

Darwin was frustrated that dozens of physicians, beginning with his own father, had failed to cure him. By the time he wrote to Dr. Chapman, Darwin had spent most of the past three decades — during which time he’d struggled heroically to write On the Origin of Species housebound by general invalidism. Based on his diaries and letters, it’s fair to say he spent a full third of his daytime hours since the age of twenty-eight either vomiting or lying in bed.

Chapman had treated many prominent Victorian intellectuals who were “knocked up” with anxiety at one time or another; he specialized in, as he put it, those high-strung neurotics “whose minds are highly cultivated and developed, and often complicated, modified, and dominated by subtle psychical conflicts, whose intensity and bearing on the physical malady it is difficult to comprehend.” He prescribed the application of ice to the spinal cord for almost all diseases of nervous origin.

Chapman came out to Darwin’s country estate in late May 1865, and Darwin spent several hours each day over the next several months encased in ice; he composed crucial sections of The Variation of Animals and Plants Under Domestication with ice bags packed around his spine.

The treatment didn’t work. The “incessant vomiting” continued. So while Darwin and his family enjoyed Chapman’s company (“We liked Dr. Chapman so very much we were quite sorry the ice failed for his sake as well as ours” Darwin’s wife wrote), by July they had abandoned the treatment and sent the doctor back to London.

Chapman was not the first doctor to fail to cure Darwin, and he would not be the last. To read Darwin’s diaries and correspondence is to marvel at the more or less constant debilitation he endured after he returned from the famous voyage of the Beagle in 1836. The medical debate about what, exactly, was wrong with Darwin has raged for 150 years. The list proposed during his life and after his death is long: amoebic infection, appendicitis, duodenal ulcer, peptic ulcer, migraines, chronic cholecystitis, “smouldering hepatitis,” malaria, catarrhal dyspepsia, arsenic poisoning, porphyria, narcolepsy, “diabetogenic hyper-insulism,” gout, “suppressed gout,” chronic brucellosis (endemic to Argentina, which the Beagle had visited), Chagas’ disease (possibly contracted from a bug bite in Argentina), allergic reactions to the pigeons he worked with, complications from the protracted seasickness he experienced on the Beagle, and ‘refractive anomaly of the eyes.’ I’ve just read an article, “Darwin’s Illness Revealed,” published in a British academic journal in 2005, that attributes Darwin’s ailments to lactose intolerance.

Various competing hypotheses attempted to diagnose Darwin, both during his lifetime and after. But Stossel argues that “a careful reading of Darwin’s life suggests that the precipitating factor in every one of his most acute attacks of illness was anxiety.” His greatest rebuttal to other medical theories is a seemingly simple, positively profound piece of evidence:

When Darwin would stop working and go walking or riding in the Scottish Highlands or North Wales, his health would be restored.

(Of course, one need not suffer from debilitating anxiety in order to reap the physical and mental benefits of walking, arguably one of the simplest yet most rewarding forms of psychic restoration and a powerful catalyst for creativity.)

My Age of Anxiety is a fascinating read in its totality. Complement it with a timeless antidote to anxiety from Alan Watts, then revisit Darwin’s brighter side with his beautiful reflections on family, work, and happiness.

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