Saturday, March 29, 2014

20 Best TED Talks - Readers’ Poll Results (via Vice)

This is awesome . . . especially #s 9, 11, 15, 19, and 20. Thank you Vice.

Enjoy!

20 Best TED Talks

Readers’ Poll Results

By Sean Tejaratchi | Mar 25 2014

With more than 1,600 online videos that collectively have over a billion views, the world of TED Talks can be overwhelming to the uninitiated. To help, we asked our readers to submit their picks for the 20 most informative, provocative, and inspiring TED Talks in the fields of technology, entertainment, and design. We received more than 12,000 ballots, and now we’re pleased to share the results.


The Future of Sex Zoos: Balancing Fetish, Innovation, and Conservation, Bill Gates


How to Fight a Cow Col. Frank Tuplin


Community-Based Arson Initiatives: Ideas at Work Taureen Helms


What a Courageous Georgia Cat Breeder Can Teach Us About Eugenics Dr. Barbara Mershepp, PhD


Wireless Headset Mics: What We’ve Learned, What’s Still to Come Klefton Marbell


How to Fight a Chimp Col. Frank Tuplin


Love Will Turn You Around: Ten Days to Mind-Blowing Anal Sex Kenny Rogers


How to Dispose of a Chimp’s Body Col. Frank Tuplin


Shitting Underwater Pavel Gibbons


The Secret Language of Scarfs Dr. Beautrice Garmin, MD


Rethinking the Idea of “Rethinking” Sween Griggs


Why Parasites Target Hollywood Royalty Dr. Vikram Parmalat, MD


What Life with a Slightly Larger Head Has Taught Me About Diversity Anacin Shroeper


Raising a Drug-Free Child—the Hamas Way Uffrica Lofgren


Emerging Markets in Suburban Bush Meat Prius Ramsey-Shilling


Milk Trends Brayff Johnson


The Wordless Art of Claw Gestures Nuncy Thamber


WomenTalk: Women Talking to Women About Being Women Umoja Holmo


This World Exists for My Pleasure: The Power of Quantum Affirmations Dr. Dodd Olper, PhD


Rabbits: Nature’s Furry Pieces of Shit Dr. Björn Karensdottir, PhD

Ethics: A Radical-constructivist Approach (via Constructivist Foundations)


From the open access journal Constructivist Foundations [9(2), March, 15, 2014], this is an interesting and somewhat philosophical exploration of taking a radical constructivist approach to ethics.

While radical constructivist models generally deal only with cognitive knowledge, Quale seeks to find a way to also include non-cognitive knowledge as a way to expand the parameters of radical constructivist theory to include the capability of constructing ethical frameworks.

Presented below are the first two sections of the text, as well as the commentaries on this article from other scholars. Complete references are available at the CF site. PDF is free to download following registering name and email address.

Ethics: A Radical-constructivist Approach

Andreas Quale • Dept. of Teacher Education, University of Oslo, Norway

Context • The theory of radical constructivism offers a tool for the evaluation of knowledge in general: especially with regard to its epistemic and ontological character. This applies in particular to knowledge that is non-cognitive, such as, e.g., ethical convictions.  
Problem • What impact can radical constructivism have on the topic of ethics? Specifically, how can ethical issues be resolved within a radical-constructivist epistemic approach?  
Method • I extend the theory of radical constructivism to include also items of non-cognitive knowledge. This makes it possible to discuss ethical issues, which are non-cognitive, in a constructivist epistemic and ontological perspective. Some arguments against this conception of “strictly personal ethics” are discussed.  
Results • Radical constructivism is neutral on ethical issues, and thus cannot be invoked to endorse any particular ethical position. However, this causes no problem for the theory: the individual knower will construct her own ethical values and convictions, as part of her store of noncognitive knowledge, in interaction with her environment (including other individuals). Hence ethical values cannot be argued in cognitive terms; and this elevates the knower into a position of personal responsibility with respect to ethical issues.  
Constructivist content • I focus on the role played by radical constructivism in the approach to cognitive vs. non-cognitive knowledge. The construction of knowledge (of any kind) emerges as a strictly personal enterprise. For instance, in the context addressed here, constructed non-cognitive knowledge forms a basis for the individual knower’s ethical position.

Radical constructivism and the notion of cognition


« 1 » Ernst von Glasersfeld [1] defines radical constructivism (rC) as an epistemic theory, based on two fundamental propositions, which may be summarized as follows (Glasersfeld 1995a):
rC1: Knowledge is not passively received, but is actively constructed by the cognising
subject.
rC2: The function of cognition is adaptive, and serves the subject’s organization of her own experiential world, not the discovery of an objectively given reality.
« 2 » Thus, knowledge is constructed by, and resides in, the individual knower – i.e., the person who possesses this knowledge. it is based on her sense perceptions and her reflections upon these, and serves as a model describing some part of her own experiential world. According to rC there is no “right way” to perform such a construction: in other words, it is not possible to identify a “correct” model – i.e., one that gives a faithful and correct description of the world.

« 3 » For the arguments that follow below, it is important to observe that these two propositions make explicit reference to cognitive knowledge, and to the role played by cognition in our construction of knowledge.

« 4 » The term “cognition” is generally taken to denote mental activities of rational thinking, knowing and reasoning. There is an extensive amount of discussion of this topic in the literature – see, e.g., the comprehensive and exhaustive article by Robert Wilson and Lucia Foglia (2011). Here I propose to “sharpen” this concept a little, focussing on its significance for communication of the knowledge that is constructed. Thus, I take the term “cognition” to refer to aspects of knowledge that are not based on emotion or volition. The “product of cognition,” here regarded as a result of learning, will be denoted as “cognitive knowledge.” [2]

« 5 » To illustrate, let us consider some examples of knowledge that is not cognitive. It will be convenient for our purposes to take the notions of “personal preference” and “personal belief ” to be subsumed under the general category of “emotion.” so, consider the following statements, which might be made by an individual knower:
ƒ “I shall now leave this room” (volition, an act of decision by the knower)
ƒ “I love her” (an emotion, as felt by the knower)
ƒ “I like jazz music” (a personal preference of the knower)
ƒ “I believe in God” (an element of the knower’s personal faith)
« 6 » These statements describe different types of non-cognitive knowledge, as experienced by the knower, and hence they may serve to illustrate some aspects of “what cognition is not.” So, with this as background, let us ask: What is it then?

« 7 » According to the viewpoint that will be adopted here, the most important characteristic of cognitive knowledge is that it is based on reasoning of some kind, using rules and procedures that can be agreed on, and the knowledge thus subsequently demonstrated and communicated by the knower
to other individuals. (The natural sciences, such as physics, of course offer prime examples of such knowledge.) On the other hand, non-cognitive – sometimes termed “affective” or “emotive” – knowledge deals with personal experiences that cannot be thus demonstrated or communicated: emotion, volition, preferences, values, likes and dislikes, beliefs, etc. Two simple examples illustrate this distinction: I can demonstrate and communicate to you how newton’s law of gravitation operates, and how it describes many observable features of the solar system – this forms part of my store of cognitive knowledge; but I can not demonstrate or communicate to you how it “feels” for me to like a particular piece of music, why I like it (and why you should like it too..!) – this is an instance of non-cognitive knowledge on my part.

« 8 » Thus knowledge, as possessed by a knower, may be described by two mutually exclusive attributes: cognitive and noncognitive. Note that any particular item of knowledge, as constructed by a human knower, will in general have both cognitive and non-cognitive aspects: i.e., aspects that are communicable to other knowers, as described above, and aspects that are not. Thus, consider, e.g., the knowledge experienced by an individual person, embodied in the statement “I shall now leave this room” given above. As it stands, this statement is an expression of non-cognitive knowledge, describing volition: a decision of the individual knower that he intends to leave the room. But this decision will only make sense if this person knows that he is present in a room, and that there are means of exiting (say, an unlocked door) – and these items will be experienced by him as cognitive knowledge, which can be demonstrated and communicated to other individuals in the room. It is in this context of communicability that knowledge is characterised, in the argument presented here, as being cognitive or non-cognitive. [3]

« 9 » With this in mind, we shall now widen the scope of the two basic propositions rC1 and rC2 of rC, shown above. As they stand, they deal only with cognitive knowledge, and with cognitive learning as the procedure for gaining such knowledge. So, let us consider the following slightly amended versions of these two propositions (with changes from the original text shown in italics):
rC1ʹ: Knowledge of any kind is not passively received, but is actively constructed by the knower.
rC2ʹ: The function of the process of construction is adaptive, and serves the knower’s organization of her own experiential world, not the discovery of an objectively given reality.
« 10 » As is evident, the propositions rC1ʹ and rC2ʹ now address any kind of knowledge, not only the cognitive kind. Or, equivalently: the theory of rC, originally restricted by rC1 and rC2 to apply to cognitive knowledge only, is now extended to apply to all kinds of knowledge construction.

« 11 » With this extension in mind, we now move on to the topic of ethics.


Ethics: A non-cognitive dimension of RC


« 12 » I maintain, and will argue here, that ethical issues belong to the non-cognitive dimension of knowledge, and hence fall outside the scope of cognitive knowledge, (based on reasoning using agreed-on rules and procedures), such as described above. Thus, the truth value of an ethical proposition cannot be communicated between individual persons in the form of cognitive knowledge, as this is defined above. In this sense, then, it seems appropriate to describe rC as being ethically neutral. However this claim, while valid as far as it goes, needs some further elaboration. So, let us take a closer look at some of the implications of rC for ethical issues.

« 13 » It may be noted that the purported ethical neutrality of rC has acquired certain strongly negative connotations. For instance, it has been taken by some to have rather ominous political implications – thus, it has been claimed that for radical constructivists “there can be no commitment to democratic values…,” and (even worse) that this theory “…seems far more at home with non-democratic forms of educational and governmental practices” (McCarty & schwandt 2000: 77f). Now, these are grave charges, and they need to be seriously addressed. We will return to this issue below, and demonstrate that the charges are unfounded.

« 14 » It is a notable fact that several authors have maintained that the ethical neutrality of rC does indeed constitute a problem for the theory. among these authors we find many of its critics (e.g., nola 1997 and slezak 2000), but also some of its supporters (e.g., Hardy & taylor 1997). in fact, in a book by Leslie steffe & Patrick Thompson (2000b) dedicated to the epistemology of rC, a number of  articles address the relevance of ethics in this context; and in this book von Glasersfeld himself states that one desirable goal for the future is that “the radical constructivist agenda should include an effort to develop viable theoretical models in the areas of ethics and social interaction” (Glasersfeld 2000: 8).

« 15 » So, one may well ask, must the self-professed ethical neutrality of rC with respect to ethical issues be considered as a deficiency of the theory? To answer this question, we shall have to take a closer look at the meaning of ethics, when considered in a radical constructivist perspective. Let me hasten to say, though, that this is not the place to undertake a thorough discussion of the discipline of ethics, which indeed constitutes a broad and diverse branch of philosophy, extensively discussed in the literature. Here, we will adopt a rather narrow and simplistic viewpoint, and discuss how ethical issues may connect with the theory of rC.

« 16 » The term “ethics” is generally taken to address issues of morality in a wide sense (e.g., Gert 2012) – with the underlying idea of establishing standards of right and wrong, or of good and bad, with regard to human character and conduct. This has been a major topic of investigation by philosophers throughout human history. Moreover, it constitutes an important aspect of many religious beliefs, where it is generally grounded in the notion of divine decree: to the believer, it is the authority of her religion that gives support to her ethical convictions. In general, it deals with interpersonal relationships, addressing the issue of what is the “right way” for us to behave towards other people. [4] Note that the existence of this environment is accepted as given (thus repudiating the philosophical position of solipsism); on the other hand, any knowledge of it must be constructed in the mind of the knower, and there is no way to identify any one construction as being objectively “right” or “true.”

« 17 » We shall be concerned with what is known to philosophers as normative ethics. This is an inquiry into, or a theory describing, standards (norms) of right and wrong as guidelines for human behaviour – it aims to prescribe what people ought to do, or how they ought to behave, in various concrete situations. it should be noted that such a theory requires ethical argumentation: it must provide some answers to questions of why a given course of action is ethical, while another is not. [5]


NOTES for the above sections.
1 | The theory of rC was originally proposed by von Glasersfeld (1974, 1983, 1991, 1995a, 2000). Cf. also the discussion in Quale (2008).
2 | it should be noted that this is a somewhat restrictive definition of the concept of cognition. Indeed, von Glasersfeld generally uses this term in a wider sense in his discussion of the construction of knowledge in rC (e.g., Glasersfeld & Varela 1987; Glasersfeld 1991b). However, I am arguing that this restriction, as presented here, can provide some additional insight into the construction in rC of “intangible” items of knowledge, such as, e.g., ethical convictions.
3 | I am grateful to an anonymous reviewer for pointing out the need to clarify this point.
4 | In fact, many would extend the notion of ethics to address our relationship with all living organisms, now and in the future; in this wider perspective, maltreatment of animals and damage done to the environment would also become ethical issues.)
5 | of course, such argumentation will generally tend to reflect the actual practices of whatever cultural context it originates in. For instance, in a society using slave labour – as many societies have done throughout history right up to recent times – one might expect to meet ethical arguments defending the proposition that there is nothing morally reprehensible about the institution of slavery, and that it is in fact a perfectly acceptable way to organise the labour force.

Commentaries on this article from other scholars (published in the same journal, same issue):







Friday, March 28, 2014

Pilar Jennings - A Relational Understanding of the Student-Teacher Dyad in Spirituality

This is an excellent article from Tricycle Magazine on the relational and intersubjective nature of the student-teacher relationship in Buddhism. She goes so far as to say, "The relationship between the Buddhist teacher and student is a dyad comparable to the psychoanalytic one." I would add that this is true for spiritual traditions, not only Buddhism.
We don’t often take into account that even revered teachers may have childhood memories in need of integration, unexpected personal loss, or addictions influenced by genetic predispositions requiring treatment outside the spiritual realm. I suspect that, still young in our acquaintanceship with the dharma, we struggle to accept our teachers as people, both gifted and flawed. We tend to idolize them, as we did our parents, in order to feel safely bonded to an idealizable, all-powerful other. And while these may be sweeping claims, and idealizations are a natural part of any teacher-student relationship, I nevertheless see a pervasive struggle in developing a more adult capacity to understand our teachers in context and to accept their participation in ordinary human experience.
This reality becomes especially when the teacher or guru is damaged enough emotionally to be a narcissist or sociopath, or simply terribly immature in the psycho-sexual developmental line. It is entirely possible for a person to achieve advanced spiritual states or understands (spiritual and cognitive lines of development) and yet be highly toxic human beings who use and control others.

Within the integral community, Andrew Cohen and Marc Gafni are the obvious teachers to whom we can point and identify their destructive impact on many of their "students."

Looking into the Eyes of a Master

A relational psychotherapist explores how we can see our teachers as people, both gifted and flawed.

Pilar Jennings, PhD
Tricycle | Spring 2014


Last winter, on a chilly night just after the New Year, I sat in a darkened theater at the Rubin Museum of Art in Manhattan watching Crazy Wisdom, a documentary about the life of Chögyam Trungpa Rinpoche. Like most American Buddhists, I had heard the colorful stories about his unconventional, theatrical pedagogy—known as “crazy wisdom”—and more than a few anecdotes about his relationships to alcohol and women. I was curious to learn more about this legendary teacher who had influenced so many Western Buddhists, some who have become important teachers in their own right.

As the film progressed, I felt an increasing sense of dis-ease, or duhkha, as it’s called in Buddhist teachings. Images of a young Tibetan trying to find his way in a foreign country filled the screen as Trungpa Rinpoche recounted his loneliness and isolation and his painful recovery from a near-fatal car accident (possibly caused by his increasingly problematic alcohol use). But this footage was quickly eclipsed by the testimony of students who spoke with awe of his compelling presence and unorthodox teaching methods, his depth of insight and what—for them—was his obvious enlightenment. Indeed, the film marshaled extraordinary images: Trungpa, clad in an olive green uniform, arraying his cavalry and marching his students as if preparing for a military deployment; a preternatural rainbow radiating above his gravesite in the days after his death.

The students in the film described their enchantment with his charisma and prodigious energy but seemed oblivious to, or untroubled by, his traumatic background and what I perceived as his personal pain. The only seasoned American Buddhist scholar in the film, Robert Thurman, noted that Trungpa’s death at age 46, likely due to alcoholism, was lamentable. He could have lived much longer, Thurman suggested, carrying his teachings further. But the filmmakers didn’t linger over this analysis, returning instead to the steady flow of reverent praise.

Like other talented Tibetan monks in the 1970s and ’80s, Trungpa moved to the United States to introduce the dharma to Western students. I know other senior Tibetan teachers with comparable histories and have heard their stories of disorienting transitions to new countries, as if they’d landed on the moon without a space suit. For most of these teachers, including Trungpa, these dramatic shifts followed on the heels of a harrowing escape from the brutal Chinese occupation of Tibet. I imagined that Trungpa might also have suffered the ripple effects of culture shock and the loss of loved ones, and might have strained under the weight of his new American students’ expectations of the awakened master they wanted him to be.

As the documentary unfolded, it occurred to me that American Buddhists (with exceptions, of course) have skipped a developmental stage that would allow us to more readily notice and respond to our teacher’s subjectivity. We don’t often take into account that even revered teachers may have childhood memories in need of integration, unexpected personal loss, or addictions influenced by genetic predispositions requiring treatment outside the spiritual realm. I suspect that, still young in our acquaintanceship with the dharma, we struggle to accept our teachers as people, both gifted and flawed. We tend to idolize them, as we did our parents, in order to feel safely bonded to an idealizable, all-powerful other. And while these may be sweeping claims, and idealizations are a natural part of any teacher-student relationship, I nevertheless see a pervasive struggle in developing a more adult capacity to understand our teachers in context and to accept their participation in ordinary human experience.

Some of these struggles are complicated by practices that encourage students to envision their teachers as fully realized. Tibetan Buddhist teachings especially suggest that only when we recognize the buddhahood in our teachers may we receive the blessings of an awakened being. While these teachings offer the potential to expand and refine our awareness, they can also serve to split buddhahood from personhood, teacher from self. The restorative experience of turning to our teachers for their good counsel—which we do because we may see them as awakened—can trump the valuable activity of relying on our own capacity for wisdom and insight.

As a relational psychoanalyst, I have spent much of my training and professional life exploring how relationships—to oneself, to culture, and to loved ones—develop. As a Buddhist, I’ve been similarly engaged in examining how we cultivate a deeper and more authentic sense of connection. And as a Buddhist psychoanalyst, I’ve attempted to understand how these two disciplines might enhance our efforts to forge meaningful and sustainable relationships. For the past 30 years, Buddhist psychoanalysts have been contributing to a growing body of research and literature on the topic of the student-teacher relationship. Writers including the psychoanalysts Mark Finn, co-author of Object Relations Theory and Religion, Jeffrey Rubin, who wrote Psychotherapy and Buddhism, and Harvey Aronson, author of Buddhist Practice on Western Ground, have been exploring the ways in which Buddhist teachers bring their psychological experience to their teaching endeavors. In their work, informed by personal and professional experience, they have also considered how Buddhist students in the West might be confronted with formidable cross-cultural challenges studying with Asian-born and/or monastic teachers.


With all this in mind, in the days after seeing Crazy Wisdom I found myself revisiting the psychoanalytic theory known as intersubjectivity and drawing on its insight into how we develop the ability to be seen and known and to see and know others. The intersubjective perspective explores how babies develop a sense of self and other through their relationship with a caretaker, especially through the nuances of physical contact during feeding, bathing, play, and preparation for sleep. Ideally, through this ongoing exchange, the baby and caretaker experience a growing sense of attunement, and as a result, a bolstered trust that their basic needs, feelings, and intentions can be known to each other. One of the primary fruits of this mutual recognition is that the baby begins to see that the caretaker has his or her own reality that can be discerned and related to, just as the baby has been known by his mother or caretaker.

As the theory of intersubjectivity evolved, its proponents began to describe the psychological terrain that develops between the infant and its caretaker or, for that matter, between any two people, as a “third space.” Particularly relevant to Buddhism is the notion that such a space requires a temporary surrender of self, and that through this surrender a young child is able to sustain connection to the caretaker’s mind while more readily accepting her separateness and personhood. If the parent is distracted, however—suffering from trauma or depression, for instance—he or she may be unable to offer the baby the nuanced attunement it needs. Thus, when a third space never develops, or develops and breaks down, the child may feel he lacks the ability to affect his caretaker. He may feel reactive and “done to,” as the New York University psychoanalyst Jessica Benjamin, a leading theorist in this field, writes: it is a sense of being helplessly lost in the shadow of the other. Many adults see themselves in this helpless way when the third space in a relationship collapses—who hasn’t, at some point, been involved with someone who seems impervious to our subjectivity? What is harder to see are the ways through which we protect ourselves from a collapsed third space. Rather than suffer the terrible sense of being done to, we may opt to be the one who controls the collapsed space by dominating interactions within that relationship, opting to make others feel helpless instead of being on the receiving end of their efforts at control.

As skillful therapists from all schools of thought know, our ability to find and sustain healthy interpersonal experience does not depend on a history of perfect attunement. There is no such thing as two people—whether baby and mother, two lovers, or teacher and student—being perfectly in sync with each other’s needs and wishes. Real intimacy arises from an ongoing process of connection that at some point is disrupted and then, ideally, repaired. I think of this as an interpersonal crochet stitch: connection, disruption, repair, over and over again, until a fabric is created with enough strength and flexibility to endure the wear of any two people attempting to know one another.

But a “perfect match” is a compelling fantasy. When seeking romantic partners, we often hold out for “the one” who magically knows just how to talk to us, touch us, comfort us, without stress or discord. In seeking therapists, patients often expect to find that perfectly sage being who has transcended samsara and can serve as a knower of all truths, the perfect healer. And when seeking spiritual mentors, students are on the lookout for the enlightened being in their midst who glides graciously through life without effort and knows just how to usher the student toward awakening, as quickly as possible.

Having spent my entire adulthood and much of my childhood surrounded by Western Buddhists, I wonder if many of them had early relational experiences that stymied their capacity to feel safely engaged with a world beyond their control. People come to the dharma for many reasons, including a burgeoning sense that life could be more consistently fulfilling and joyful than previously imagined. And yet it seems to be true that relatively few arrive at Buddhist centers on the wings of psychic victory. Many people have a psychologically complex history, one influenced by trauma or loss. In this way, we practice to resolve thorny and entrenched forms of psychological pain.

The relationship between the Buddhist teacher and student is a dyad comparable to the psychoanalytic one. But in this case, it is the teacher and student who are enacting their individual emotional histories. As a result, the potential for boundary violations is rampant, and the possible victims include students who have felt manipulated and even abused by their teachers, and teachers who have felt manipulated and abused by their students. From what I have observed, both participants are vulnerable to their unconscious longing for perfect attunement, for a merger experience in which idealizations obscure a realistic view of an actual human being.

In much the same way that psychoanalytic research has emphasized the infant’s experience, and paid relatively little attention to the mother’s subjectivity, Buddhist scholars have attended to the more blatantly vulnerable actor in student-teacher relationships—the student. It is tempting to ignore the reality that there are two sentient beings in this dyad, and that both have psyches that make them capable of unskillful actions. Teachers, in fact, are vulnerable to the ways in which students project onto them both salvific and destructive capacities. And when a student idealizes the teacher to the point where he or she can’t see the guru as human, it becomes nearly impossible for that student to take into account both the teacher’s gifts and vulnerability.

But it takes two to build a third space. A teacher who has the maturity to be seen as a whole being—in addition to having a kind heart and a liberated mind—may invite the student to curb the idealizations and work instead toward cultivating the wisdom and agency they have been ascribing exclusively to the teacher. Teachers and students alike pay a price when this mutuality does not develop. Trungpa Rinpoche is not alone among famous spiritual teachers in having suffered in ways that may have required attention and treatment he never received. There are scores of senior Buddhist teachers (and I suspect this is true for all faith traditions) who privately undergo inner torment that is never addressed. The world was shocked when Mother Teresa’s journals were published, attesting to her 40 years of doubt and depression. What distressed me most was not that she had suffered depression, which is widespread, but that she was unable to seek help. Why was she left to manage such a long, dark night of the soul alone?

I can’t know whether or not Trungpa had concerned students who made efforts to respectfully confront him; I suspect there must have been some who were troubled by and worried about his alcohol use. Perhaps Trungpa resisted such concern. Whatever the case, it seems important to explore how Western Buddhist students can approach their teachers’ humanity and subjective struggles.

Having befriended a senior teacher in the Tibetan tradition, I am attempting, in my own right, to create a roomier third space between us. My teacher has a fantastic sense of humor and playfulness. We laugh together at the absurdity of our woeful human struggles. But if we’re looking to hide from a deeper, potentially more painful and healing exploration of these struggles, humor is a powerful defense. My teacher has lost some of his beloved students in the past few years, and when I asked him how he was feeling in the wake of these deaths, he replied with a joke: “How much are you gonna charge me for this session?” I laughed. When I mustered the courage to ask again, he dug his finger deep into his ear like a nervous kid, looked at the floor and said, “Truthfully, I feel numb.” I nodded. He looked at me and we nodded together. Then the phone rang, and the conversation was over.

A year ago, a senior monk and longtime friend of my teacher’s had a brain aneurism and fell into a coma for several weeks. We had all been together on retreat only a few months prior. When my teacher returned from his friend’s sickbed, I asked about his state of mind. There was more ear poking, more jokes. He shook his head, stared at his computer, his iPhone, his landline. Then he stared at the floor.

“When this happens I think, who’s next?”

For a fleeting moment we looked at each other. I added, “It’s rough when the people you know and care about get sick. Makes you feel vulnerable.”

He nodded, looked me dead in the eye and said, “How much is that gonna cost me?” I told him he should expect a hefty bill. We laughed and the phone rang, he received a text, and the conversation was over.

As I reflect on my concern for my teacher’s well-being, I see the complexity of this and other relationships that involve contrasting backgrounds and cultural influences. My teacher, like Trungpa, comes from a world shaped by his spiritual and monastic education, a world that prizes the freedom that comes from loosening attachment to personal experience. But this approach has its drawbacks. We must recognize the validity of seeing our teachers as individuals, too. My hope is that we may begin to bring them into clearer view, not only to better see their gifts of insight and compassion, but to accept the fullness of their own human struggle.

Pilar Jennings, PhD, is a psychoanalyst practicing in New York City. She is a lecturer in the graduate department of Psychiatry and Religion at Union Theological Seminary and a researcher at the Columbia University Center for Study of Science and Religion. A version of this essay was first published in Spring: A Journal of Archetype and Culture, vol. 89 (Spring 2013).

Join us this May for Enlightening Conversations 2014: "Opportunities and Obstacles in Human Awakening," a new conference series exploring the intersection of Buddhism and psychoanalysis, where Pilar Jennings will appear as a panelist.

Artwork by Tenzing Rigdol 
Image 1: Phew!, 2011, Acrylic on Canvas, Courtesy Rossi & Rossi.
Image 2: Kriti - From the Ashes of Agony, 2011, Acrylic on Canvas, Courtesy Rossi & Rossi.

Authors at Google: Dan Siegel - The Adolescent Brain and the Essence of Life


Dr. Dan Siegel stopped by Google earlier this month to talk about his newest book, Brainstorm: The Power and Purpose of the Teenage Brain (2013). Here is a synopsis of the book:
Between the ages of 12 and 24, the brain changes in important, and oftentimes maddening, ways. It’s no wonder that many parents approach their child’s adolescence with fear and trepidation. According to renowned neuropsychiatrist Daniel Siegel's New York Times bestseller Brainstorm, if parents and teens can work together to form a deeper understanding of the brain science behind all the tumult, they will be able to turn conflict into connection and form a deeper understanding of one another.
In Brainstorm, Siegel illuminates how brain development impacts teenagers’ behavior and relationships. Drawing on important new research in the field of interpersonal neurobiology, he explores exciting ways in which understanding how the teenage brain functions can help parents make what is in fact an incredibly positive period of growth, change, and experimentation in their children’s lives less lonely and distressing on both sides of the generational divide.

Brainstorm is a New York Times bestseller and current nominee for a Books for a Better Life award.
Enjoy the talk!

Dan Siegel - The Adolescent Brain and the Essence of Life

Published on Mar 27, 2014


Dan Siegel visited Google LA to discuss his book "Brainstorm - The Power and Purpose of the Teenage Brain." This talk took place on March 10, 2014.

Omnivore - Religion in Contemporary World

From Bookforum's Omnivore blog, another cool collection of links, this time on the state of religion in the world today. Some good stuff in this collection.

Religion in contemporary world

Mar 27 2014
9:00AM

  • Alison Greig (Wales): Heaven in the Early History of Western Religions
  • From Cognition and Culture, a webinar on Big Gods: How Religion Transformed Cooperation and Conflict by Ara Norenzayan. 
  • Terry D. Goddard reviews Before Religion: a History of a Modern Concept by Brent Nongbri. 
  • Religion in contemporary world: Octavia Domide and Larisa Bianca Pirjol review The Everyday Sacred: Symbols, Rituals, Mythologies by Cristina Gavriluta and The Sociology of Religions: Beliefs, Rituals, Ideologies by Nicu Gavriluta. 
  • The introduction to A History of Jewish-Muslim Relations: From the Origins to the Present Day, ed. Abdelwahab Meddeb and Benjamin Stora. 
  • Rosemary Joyce on women as leaders in early Christianity: Fairy tales? 
  • From The Atlantic, Richard J. Miller on religion as a product of psychotropic drug use: How much of religious history was influenced by mind-altering substances? 
  • From Student Pulse, is paganism a religion? Betsy C. Chadbourn on exploring the historical and contemporary relevance of paganism. 
  • Was Nietzsche right about religion? John Gray reviews The Age of Nothing by Peter Watson and Culture and the Death of God by Terry Eagleton. 
  • Secularisation, myth or menace? Melvin Tinker on an assessment of modern “worldliness”. 
  • God and Man in the Machine: Peter Moons on religion in the transhumanist environment
  • Laura Leibman on clothing and religion
  • An interview with Dan W. Clanton, Jr., author of Understanding Religion and Popular Culture
  • An excerpt from The Age of Atheists by Peter Watson. 
  • Pseudo-scientists are still trying to convince you that the Shroud of Turin is real — don't believe them.

Thursday, March 27, 2014

A New America: How Millennials Are Sparking Change


This 2+ hour discussion on the Millennials is brought to you by Microsoft, The Atlantic, National Journal, and FORA.tv. It was held at the University of Texas, Austin, on March 25, 2014, featuring Margo Dover, Jae Kim, Trey Martinez Fischer, Bob Metcalfe, Jason Seats, Michele Skelding, and Wendy Spencer (biographies are provided below).
Summary

Millennials are on track to be the most educated, the most connected, and the most wired generation, with a bent for entrepreneurship and service. Evidence shows that Millennials may represent the tipping point generation in America, whose preferences and priorities are setting the direction for public and private life over the decades ahead. They are, by far, the most diverse generation in American history, with non-whites comprising about 40 percent. Austin, Texas has become a hub for Millennials and millennial entrepreneurs; the city's open and collaborative business climate has turned it into a unique entrepreneurship incubator.

Join National Journal and The Atlantic for the second in a series of town hall events as we go to the heart of Austin to examine the opportunities, inclinations and impact of this giant influential generation. This exciting event will focus on how Millennials are using entrepreneurship to build a pathway to success, and will feature insights from Millennials, government officials, educators, entrepreneurs, and more.


A New America: How Millennials Are Sparking Change from National Journal and The Atlantic on FORA.tv
 
BIOS

Margo Dover oversees Skillpoint Alliance’s direction and mission as its Executive Director. Margo came to this position after a lengthy career holding leadership positions at nonprofit and for-profit companies.

Jae Kim is Founder and Owner of Chi'Lantro BBQ.

Representative Trey Martinez Fischer, a member of an emerging group of Latino leaders in the United States, has built his career as a no-nonsense, down-to-business Democrat. Currently serving his seventh term representing District 116 in San Antonio, he was recently named one of the 10 Best Legislators of 2013 by Texas Monthly Magazine, who described him as a “soldier prepared to do battle but ready to make peace.” The Houston Chronicle and the San Francisco Chronicle named him one of the “20 Latino political rising stars of 2012,” placing him among those under 55 “who just might change the face of American politics over the next two decades.” In 2010, Campaigns and Elections Magazine named him a “Texas Influencer” and one of the Top-50 Democrats in the state. The New York Times has dubbed him a “heavy hitter” whose “loyalty to San Antonio remains steadfast.”

Bob Metcalfe is Professor of Innovation and Murchison Fellow of Free Enterprise in The University of Texas at Austin’s Cockrell School of Engineering.

Jason Seats is the Managing Director of Techstars in Austin. Jason was most recently the Managing Director of the Techstars Cloud program. Prior to joining Techstars, Jason was a founder of Slicehost, an early cloud computing hosting company. In 2008 Slicehost was acquired by Rackspace and became the core for the initial Cloud Servers product. Jason continued on at Rackspace until 2010 as VP of software development for Rackspace Cloud, managing the cloud engineering teams. Jason has a B.S. in Computer Science and a B.S. in Electrical Engineering from Parks College of Engineering, Aviation and Technology at Saint Louis University.

Michele Skelding is the Senior Vice President of Global Technology Strategies for the Greater Austin Chamber of Commerce where she leads the development and execution of the organization’s vision for Central Texas as a top global region for technology innovation, company formation and expansion, in addition to increasing top access to private equity and venture capital. In this role, Michele cultivates emerging and strategic technology growth that identifies next generation technology and innovation trends, as well as facilitating the vital creation and interconnection of the Austin region’s burgeoning entrepreneurial ecosystem for company inception and growth acceleration.

Wendy Spencer began her duties as the Chief Executive Officer of the Corporation for National and Community Service (CNCS) on April 9, 2012, shortly after her nomination was unanimously confirmed by the U.S. Senate. She has a proven track record of nearly 30 years in volunteer management and administration, and she is the first CEO to come to CNCS directly from the field of national service.

J Hoberman Reviews Lars von Trier’s "Nymphomaniac" (New York Review of Books)

Lars von Trier has created yet another strange and sexually outrageous film. And yes, as you have no doubt read, the sex IS real, but there are body doubles (porn stars) and prosthetics to protect the big-name talent in this film. 

Making return engagements to von Trier's sexual wonderland is Charlotte Gainsbourg and Willem Dafoe, both of 2009's Antichrist, a very strange and mesmerizing film.

Sex: The Terror and the Boredom

By J. Hoberman
March 26, 2014 | New York Review of Books


Christian Geisnaes/Magnolia Pictures | A scene from Lars von Trier’s Nymphomaniac
The Danish director Lars von Trier has made several great films (Dogville, Melancholia). He has also orchestrated a number of provocations, the strongest of which is The Idiots (1998), a movie that anticipates Borat, Jackass, and other recent movies in pushing regressive behavior beyond all acceptable limits. His newest film, Nymphomaniac, belongs with these audience-baiters—it’s similar, but less ghastly in its various affronts than Antichrist (2009), which also centered on the dour, ascetic Charlotte Gainsbourg.

In Antichrist (2011), Gainsbourg played a woman driven mad by grief; in Nymphomaniac she is the eponymous case study, known simply as Joe. A middle-aged good Samaritan named Seligman (Stellan Skarsgård) finds her lying beaten and bleeding in a back alley and, as she refuses his offer to call the police or get an ambulance, brings her back to recover in his monastic apartment. There she lies on a narrow bed, he sits by her side and, after describing herself as “bad person” (a category that he reflexively rejects), she proceeds to tell him her story from the very beginning: “I discovered my cunt as a two-year-old.”

For a child, as we know, all is sex. Joe’s colorful (if gravely recounted) picaresque career as a sexual being and a sexual adventuress—set in an abstract, unidentified region of England—is punctuated by Seligman’s well-meaning, post-Freudian comments and woolly digressions. Joe’s tale also features a vast array of sex acts, both simulated and actual. (The credits list a half dozen “sex doubles.”) The movie is, then, a two-handed version of the Marquis de Sade’s Philosophy in the Bedroom with Seligman, the erudite lover of the arts and stereotypical liberal—tolerant, secular, feminist, hypocritical—attempting to understand Joe’s self-identified nymphomania as she oscillates between pride and self-loathing and also between present-day battered Joe and her dewy younger self (Stacy Martin).

Like Joe or the sadist she solicits in the movie’s second half, Nymphomaniac is at once excessive and withholding. Although the film is said to exist in a five-and-a-half-hour director’s cut, its distributor has released a shorter “international version” in two parts of 117 and 123 minutes each; the film is further subdivided into eight more-or-less chronological chapters. This two-stage delivery may or may not be a valid economic strategy, but it is a dubious aesthetic one. For what it’s worth, Nymphomaniac demands to be endured in a single sitting. As with Melancholia (2011), which represented the run-up to the end of the world, it’s experiential.

Although too capricious (or should we say promiscuous?) to be a taxonomy, the movie is designed to illustrate and exhaust every popular theory of nymphomania, including, of course, the idea that the condition exists only as a male fantasy—My Secret Garden or The Sexual Life of Catherine M notwithstanding. In various chapters, Joe’s motivations are variously ascribed to her sexual curiosity, desire to exercise traditional male sexual prerogatives, rejection of love, unresolved oedipal feelings, narcissism, loneliness, pathological low self-esteem, depression, frigidity, guilt, and masochism.
At least initially, Joe subscribes to the Sadean notion that she is simply “selfish”—that is, motivated by absolute egotism and a desire for absolute pleasure—although, unlike the Marquis, she does not see this as a virtue. Nor is she bound by logic, explaining at one point that she became a nymphomaniac by choice (“I was an addict of lust rather than need”) and refusing at another, in a memorable set piece, to accept the label “sex addict.”
Christian Geisnaes/Magnolia Pictures Charlotte Gainsbourg in Nymphomaniac
Von Trier declines to judge his protagonist. Unlike Steve McQueen, whose hellish portrait of a male sex addict was called Shame, or the didactic moralist Michael Haneke (who, in his adaptation of The Piano Teacher, completely missed the comic elements in Elfriede Jelinek’s novel of nymphomaniacal compulsion), von Trier has a sense of humor. However lumpy and tasteless it may be, his gruel is not without its raisins. There is a very funny montage in which young Joe tells a succession of lovers that they have given her her first orgasm; a tumultuous sequence in which an abandoned wife (Uma Thurman), accompanied by her young children, confronts the home-wrecking young Joe, volubly and at great length; a charming religious vision that, among other things, satirizes von Trier’s erstwhile model, Andrei Tarkovsky; and a scurrilously farcical scene in which mature Joe is sandwiched between two squabbling slices of male bread.

Much of the time, however, Nymphomaniac is dogged in its pursuit of what the academic film theorists of the 1970s used to call “unpleasure.” Or at least, that is how it seemed to me. Writing in The New Yorker, David Denby, not hitherto an admirer of von Trier, praised the movie as a “pornographic work of art” which means, I suppose, that it was some sort of turn-on.

Alienation, or the absence of feelings, is for von Trier a source of anxiety. But so is empathy. Antichrist which, above all, strove to make pain visceral, was ultimately only numbing; Grace, the scapegoat protagonist of Dogville (2003), suffered in part because of her generosity: she felt too deeply and wreaked a terrible vengeance as a result. Nymphomaniac’s most graphic sequence is not sexual but rather the miserable circumstances in which Joe’s father, hospitalized, delirious, and incontinent, meets his end. “When he died, I had no feelings left,” she tells Seligman—and not for the last time. The movie’s first part concludes with her loss of sexual sensation. “I can’t feel anything,” she wails after a long, unsatisfying bout of intercourse with her ardent and loving husband (Shia LeBeouf).

Von Trier is frequently accused of abusing his female protagonists. Joe gets more than her share, not least in a particularly graphic form of self-abuse, but essentially von Trier respects her as an enemy of society—her punishment, as well as her philosophy, is really a way of punishing the spectator. Like Alfred Hitchcock, von Trier enjoys directing his audience. He is however far less efficient and far more fretful than Hitch; rather than manipulate viewers he pranks them, as when, in one sequence of Nymphomaniac, he teases fans by threatening to restage a catastrophe out of Antichrist complete with Handel aria.

Despite a common monotony, Nymphomaniac’s two halves are quite different. With one large exception, the first part is consecrated to spectator enjoyment—derived either from the spectacle of the sexual antics involving the beautiful, frequently naked Stacy Martin (a twenty-four-year-old Franco-English actress who has the great good fortune or catastrophic luck of making her debut as a featured act in the von Trier circus) or else from the spectacle of Joe successfully defending her erotic rights in a man’s world or, possibly, from both. But the fun is paid for with interest in the movie’s second half by the debasing sexual escapades endured by the more mature and less conventionally appealing Gainsbourg.

Although variously a parody of Freudian analysis or a gloss on the Arabian Nights, Nymphomaniac most closely resembles an eighteenth-century novel about a young woman’s sexually-driven rise and fall or fall and rise; indeed, the first scientific study of female hypersexuality, Nymphomania, or a Dissertation Concerning the Furor Uterinus, was published by a French doctor in the late eighteenth century. Joe, however, is neither De Sade’s oft-violated Justine (for whom the protagonist of Melancholia is named) nor her sister, the sexual terrorist Juliette (although she shares some of her traits). Neither is she Pamela, Clarissa, or Moll Flanders.

In the end, she is the artist. Von Trier is proud of his provocations yet concerned that the audience may too easily indulge him or, pace David Denby, actually become aroused. Indeed, that, in a sense, is the movie’s punchline. Anxious that he will no longer be able to top himself, von Trier is willing to end Nymphomaniac—if not his career—with a cheap stunt meant to rebuke his admirers, as if to prove that he still can.


Nymphomaniac is in theaters now.

How Light Therapy Can Treat Disorders from Depression to Alzheimer’s Disease (Nautilus)

http://static.nautil.us/2851_d3d80b656929a5bc0fa34381bf42fbdd.png

Light therapy was a fringe science only a decade or so ago, but since then the research has increased and the therapeutic benefits are becoming more accepted. This article from Nautilus looks at the state of the science on light therapy.

Take Light, Not Drugs

How light therapy can treat disorders from depression to Alzheimer’s disease

By Katherine Hobson | Illustration by Shannon Freshwater March 20, 2014

FOR RYAN SHERMAN*, a 34-year-old lawyer, something changed eight years ago when he moved from Texas to Europe and then to Boston and New York City: The shorter winter days of the more northern latitudes were like a dead weight on his emotions. “I’d get these depressions,” he says. His sleep schedule changed, too, with his bedtime slipping progressively later and early morning wakeups becoming increasingly difficult.

He tried medication to improve his mood—“a Xanax type of thing”—but it didn’t make him feel better. Then, while searching online, he discovered the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center, in Manhattan. After undergoing a psychiatric consultation and filling out a questionnaire, he was prescribed a light box.

Between October and March, he wakes up at 6:15 a.m. and, so as not to disturb his partner, immediately heads to his living room, where he spends 30 minutes basking in the box’s glow. His mood lifted within a week when he started the treatment about two years ago. “It was an overwhelming sense of going from being a pessimist to being an optimist,” he says. It’s a steady commitment, but a worthwhile one. He can feel the effects when he falls off the light box wagon, as he did recently during a particularly busy time at work. “I felt my mood significantly go downhill,” he says. Within three days of returning to his regular doses of light, in combination with a little bit of exercise, he says he felt “a significant transformation.”

Light therapy has become standard for treating seasonal depression like Sherman’s. The idea that light has a benevolent influence on mood during the dark days of winter instinctively makes sense: As hazardous as sunbathing is, it certainly feels good. Now, research into the circadian underpinnings of chronic depression, bipolar disorder, Alzheimer’s disease, and fatigue suggests that light could help these patients readjust too.

RESEARCHERS HAVE KNOWN for decades that light influences animal behaviors; exposing a rodent to light during its usual nighttime, for example, stops its brain’s pineal gland from producing melatonin, a hormone that oscillates with day and night cycles.[1] And in 1980, a psychiatrist named Alfred Lewy, then at the National Institute of Mental Health, published a report in Science showing that humans were similarly vulnerable to a bright light’s effects.[1]

Months before the paper was submitted, Lewy was contacted by Herb Kern, an engineer who had meticulously recorded his severe mood swings for years. Kern noticed that his depressions peaked during the short winter days and then retreated as the days grew longer. He had combed through studies on light and melatonin and wondered if it had any bearing on his sadness.

Lewy and his colleagues asked Kern to sit by a bright light in the winter mornings and evenings to mimic the longer days of spring. Kern responded quickly, his description of light’s effects sounding much like Ryan Sherman’s. “I began to be bubbly again,” he later reflected in a Science article. Kern’s experience, followed by further research, sparked the first scientific description of seasonal affective disorder, or SAD.[2]

As research into light treatment for SAD continued, it became clear that it wasn’t necessary to stretch the day at both ends. “You could get as quick and as effective a response by presenting light in the early morning only and keeping [lighting] dim later on,” says Michael Terman, the Columbia University psychologist who treated Sherman and co-author of Reset Your Inner Clock, a book about treatments targeting circadian rhythms.

Exactly how light works isn’t known, but many researchers suspect that bright lights help SAD sufferers by regulating their sluggish circadian clocks. Those clocks involve the suprachiasmatic nucleus, or SCN, which is a small area of the brain’s hypothalamus that dictates the rhythms of a host of bodily functions, including waking, sleeping, body temperature, and alertness. Absent external cues, those rhythms circulate for slightly longer than 24 hours for most people. (They stabilized at 24:30 for a man who lived in a dark cave for two months.) But normally these rhythms are harmonized with the external 24-hour day/night cycle when light hits a cluster of special retinal cells that are sensitive to sunlight but not always involved with vision.

People with SAD may have problems syncing their internal clocks in the winter, such that darker mornings allow their body’s natural rhythms to drift later. Exposure to an artificial bright light in the morning usually improves their moods, says Lewy, presumably by changing the ebb and flow of the stress hormone cortisol or other bodily processes orchestrated by the SCN.

However, circadian rhythms appear to be disturbed in non-seasonal maladies too, which means there is a potential for light therapy beyond SAD, says Anna Wirz-Justice, professor emeritus at the Psychiatric Hospital of the University of Basel. She adds that light therapy has appeal for good reason. When it works, it does so quickly—usually within a week or two. Also, the side effects appear to be mild: Some patients have headaches or a slight nausea at the beginning of treatment, and some report agitation. For researchers like Wirz-Justice, the choice to use light rather than drugs for depression and other mood disorders when possible is obvious. “Light is an active pharmacological agent hitting the brain,” she says. But does it work?

According to a handful of studies cited by the American Psychiatric Association’s (APA) practice guidelines for non-seasonal depression, it may. One of those trials, from 1992, exposed two dozen veterans with major depressive disorder or bipolar depression to bright light treatment ranging from 2,000 to 3,000 lux, and another two dozen to a dim, red light placebo. Those treated with bright light showed declines in three measures of depression during treatment; those exposed to the placebo did not. “In general, bright light therapy is a low-risk and low-cost option for treatment,” the APA concludes. They add that it may speed up patients’ responses to antidepressants.



HOWEVER, THE TRIALS on light therapy for nonseasonal depression have been small and generally short-term, the APA notes. And some studies, particularly early ones, had methodological limitations, such as a lack of consensus over the best placebo to use. (For example, if you use dim light as a placebo, patients may not expect as much improvement as they would with a brighter light.) The lack of proof may in part explain why so few psychiatrists recommend light boxes for anything beyond SAD. Plus, light therapy might get lost in the grab bag of options for depression, such as drugs, psychotherapy, and deep brain stimulation, says David Neubauer, a psychiatrist at Johns Hopkins Medicine in Baltimore, Md.

Then there’s the inconvenience of adding anything new. Doctors might not have heard about light therapy in medical school, so it doesn’t pop to mind, and some patients accustomed to pills may not be open to the time and logistics involved in sitting beside a light box early each morning.

Light therapy researchers say it’s tough to do big, lengthy studies, because they lack money for research. In contrast, the pharmaceutical industry has the financial backing to pay for large trials and then get the results in front of physicians’ eyes.

A lack of capital may also account for why no light box companies can claim that the boxes treat a disease. For that, they need a stamp of approval from the U.S. Food and Drug Administration (FDA), which requires large studies and application fees for filing paperwork. Therefore, people are left to venture out on their own, and they’re confronted with an unregulated heap of options ranging in price from less than $100 to $700. However, a Canadian light box manufacturer, The Litebook Company, is seeking FDA approval for a portable device.

Psychiatrists might eagerly turn to light therapy if there were more evidence to back it—particularly when faced with patients who want to avoid antidepressants. With this segment of the population in mind, several studies have kicked off in recent years. In one, published in 2011, researchers treated clinically depressed, elderly participants with an hour of 7,500 lux pale blue light, or a placebo, dim red light, every morning for three weeks.[3] Not only did the group exposed to the blue light report better sleep and a shift in their dour mood, the effects continued after the therapy ended. According to the study authors, the elderly might be particularly susceptible to the benefits of light therapy because their light perception declines with age, which might be throwing their internal clocks out of sync. Plus, antidepressants aren’t always an option for them because the drugs may interfere with some of the medications commonly prescribed to seniors.

Likewise, depressed women often wish to avoid drugs when they’re pregnant. A small placebo-controlled trial found that 69 percent of pregnant women treated with light therapy achieved remission from depression after a month, compared to 36 percent in the placebo arm.[4] And researchers at the University of Pittsburgh are now analyzing data from a recently completed trial testing the efficacy of light therapy on bipolar depression, which can be difficult to treat with drugs. Light is unlikely to be a silver bullet for complex psychiatric disorders, Terman says, but it may work in combination with other treatments.

SCIENTISTS LIKE Mariana Figueiro have started to wonder whether light therapy might heal ailments beyond depression by resetting circadian rhythms. Figueiro, a photobiologist at the Rensselaer Polytechnic Institute in Troy, N.Y., has shown that older adults with Alzheimer’s disease have disruptions in these rhythms, caused or compounded by the fact that they tend to get outside less often than healthy adults. She’s developed light therapy catered to Alzheimer’s patients: a “light table” built from a 70-inch flat-screen TV that patients can sit at during the day.

In other ongoing studies, scientists explore whether light therapy might reduce fatigue in patients who have recently completed cancer treatment, and in people with Parkinson’s disease, who may also have disrupted circadian rhythms.

To Terman, these studies test what he already believes to be true at some level: Light has been woven into human physiology since the beginning. In our artificially lit buildings, we tend to forget that humans once lived under the glowing moon, stars, and sun. Ironically, artificial light may now revive those ancient rhythms from the comfort of our living rooms.

*Ryan Sherman requested that his real name be concealed.

~ Katherine Hobson is a freelance health and science journalist in Brooklyn.

References
  1. Lewy, A.J., Wehr, T.A., Goodwin, F.K., Newsome, D.A., & Markey, S.P. Light suppresses melatonin secretion in humans. Science 210 (4475), 1267-1269 (1980).
  2. Rosenthal, N.E., et al. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Archives of General Psychiatry 41, 72-80 (1984).
  3. Lieverse, R., et al. Bright light treatment in elderly patients with nonseasonal major depressive disorder. Archives of General Psychiatry 68, 61-70 (2011).
  4. Wirz-Justice, A. et al. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. Journal of Clinical Psychiatry 72 (7), 986-993 (2011).

Wednesday, March 26, 2014

A Review of Cognitive Function in First-Episode Psychosis: Childhood Trauma, Stress, and Inflammation


A topic close to my heart these days . . . from the open access journal Frontiers in Psychiatry: Schizophrenia. The researchers conclude the cognitive dysfunction in first-episode psychosis is the result of an interplay of factors, including genetics and early life adversity (neglect and/or abuse in various forms). 

I'm biased, of course, but in the copious research I've examined lately, psychosis (especially auditory hallucinations) is intimately related to adverse childhood experiences. There are many studies showing a genetic factor, but my guess is that many people with the gene who grow up in healthy, secure attachment relationships with a primary caregiver do not ever experience anything close to a psychosis.


Full Citation: 
Aas M, Dazzan P, Mondelli V, Melle I, Murray RM and Pariante CM. (2014, Jan 8). A systematic review of cognitive function in first-episode psychosis, including a discussion on childhood trauma, stress, and inflammation. Frontiers in Psychiatry: Schizophrenia; 4:182. doi: 10.3389/fpsyt.2013.00182 

A systematic review of cognitive function in first-episode psychosis, including a discussion on childhood trauma, stress, and inflammation


Monica Aas [1,2], Paola Dazzan [3,4], Valeria Mondelli [5], Ingrid Melle [1,2], Robin M. Murray [3,4] and Carmine M. Pariante [4,5]
1. Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2. NORMENT, K.G. Jebsen Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
3. Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
4. NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London, London, UK
5. Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK

Abstract


Objective: To carry out a systematic review of the literature addressing cognitive functions in first-episode psychosis (FEP), divided into domains. Although this is not a full “cognitive-genetics-in-schizophrenia review,” we will also include putative ideas of mechanism(s) behind these impairments, focusing on how early stress, and genetic vulnerability may moderate cognitive function in psychosis.

Method: Relevant studies were identified via computer literature searches for research published up to and including January 2013, only case-control studies were included for the neurocognitive meta-analysis.

Results: Patients with FEP present global cognitive impairment compared to healthy controls. The largest effect size was observed for verbal memory (Cohen’s d effect size = 2.10), followed by executive function (effect size = 1.86), and general IQ (effect size = 1.71). However, effect sizes varied between studies.

Conclusion: Cognitive impairment across domains, up to severe level based on Cohen’s effect size, is present already in FEP studies. However, differences in levels of impairment are observed between studies, as well as within domains, indicating that further consolidation of cognitive impairment over the course of illness may be present. Cognitive abnormalities may be linked to a neurodevelopmental model including increased sensitivity to the negative effect of stress, as well as genetic vulnerability. More research on this field is needed.


Introduction


With an increased awareness of the extent of cognitive impairments present in schizophrenia, cognitive dysfunction is now viewed by many as a core abnormality of the disorder (1, 2). The majority of patients with schizophrenia function at a cognitive level of at least one standard deviation below that of healthy comparison groups (3, 4). Together with a global impairment in cognitive function, specific domains show greater dysfunction, such as episodic memory, working memory, and executive function (5, 6). There are also patients with schizophrenia with cognitive scores in the normal or above-normal range, varying in different studies from 15 to 45% (610). Nevertheless, in the high cognitive function subgroup, 64% still have abnormal scores on at least one cognitive domain, compared to 35% of healthy controls (7). Here a profile is considered abnormal if at least two functions are more than two SDs below the normative mean, or if only a single function is extremely impaired [i.e., >3 SDs below the normative mean (6)]. Therefore, most of the high functional group demonstrates some kind of cognitive deficit compared to healthy controls.

Investigating cognitive performance in patients at the early stages of the illness has the advantage of identifying cognitive deficits more likely to reflect the neurodysfunction that underlies schizophrenia rather than possible illness or treatment related processes following the chronic course of the illness. Of course, it is still possible that prodromal symptoms, or even very short periods of psychotic symptoms, lead to cognitive changes, but investigating patients at illness onset can give new insight into the disorder, when compared to the large amount of research that has been conducted in long-term ill patients. Moreover, these studies can also help elucidate whether or not some of the cognitive changes are a consequence of long-term pharmacological treatment. In considering studies in patients with first-episode psychosis (FEP), it is important to note that some have included not just patients with schizophrenia, but also those with other psychoses. This is relevant since during this early phase diagnosis may change (11), and not including such cases would mean losing potential schizophrenia cases. It can also elicit different cognitive profiles based on the heterogeneity of the first-episode group. For example, affective psychosis may have better cognitive profile than a non-affective schizophrenia (12).

Two recent articles have reviewed cognitive function during the course of schizophrenia and other psychosis (prodromal, first-episode, and chronic illness) (13, 14). However these have a very broad scope. Instead, we decided to carry out a systematic review of cognitive function in FEP; by focusing our review we were able to go into greater depth to elicit patterns of sub area of impairment measured by effect sizes. Compared to the review article by Mesholam-Gately et al. (15), effect sizes were calculated based on controls performance from the same catchment area as the patients, thus avoiding differences in possible sample group biases independent of psychosis. This is the first review article to present in detail effect sizes comparing (subtypes) of FEP and controls on cognitive performance, divided into domains. We will also include putative mechanisms behind these impairments, and both environmental and genetic factors will be discussed.

Only case-control studies were included for the neurocognitive meta-analysis.

Further, we have included all types of FEP, not only schizophrenia (15), giving the possibility to compare “first-episode schizophrenia” versus “other psychosis” on cognitive profile at start of their first-episode of psychosis. We will also investigate if underlying cognitive factors are driving the overall cognitive performance. Finally, we will discuss possible etiological aspects, specifically genetic and environmental factors, and how they interact.

Thus, the aim of this literature review is to present in detail effect sizes comparing FEP and controls from the same catchment area on cognitive performance divided into cognitive domains; 1) investigate and discuss if specific underlying cognitive factors are driving the overall cognitive function, as well as links to disease progression; 2) discuss putative mechanisms behind our findings including sensitivity to stress, and gene environmental interactions.


Methods


Cognitive Function in First-Episode Psychosis

A systematic review of the literature on cognition in FEP was conducted. Medline (PubMed) and PsycINFO bibliographic databases were used to search for articles reviewed. The search strategies involved the following keywords: “cognition and schizophrenia,” “cognitive function and schizophrenia,” cognitive function in FEP,” and “cognition in first- episode psychosis,” up to and including published papers June 2013. Criteria for inclusion were FEP, with cognitive measures (data on mean ± SD) for both patients and controls. Twenty-four articles fulfilled these criteria’s. The qualifying studies are presented in Tables 15, which include, for each cognitive domain area, the bibliographic reference, the cognitive tests used, and the degree of the impairment identified. Effect sizes were computed using Cohen’s d (16). According to Rosenthal and Rosnow (17), effect sizes were considered small for values between 0.20 and 0.50, moderate for values between 0.50 and 0.80, and large for values greater than 0.80. The effect sizes reflect those reported in the original published studies. For papers that did not report the effect size, the effect size was calculated on the basis of the mean and SD in the patient and the control groups.
TABLE 1
http://www.frontiersin.org/files/Articles/65931/fpsyt-04-00182-HTML/image_m/fpsyt-04-00182-t001.jpg

Table 1. Studies comparing patients with first-episode psychosis and healthy controls on general cognitive ability. 

General Intellectual Function

General cognition is usually assessed in two ways. Firstly, general cognitive ability is measured by a set of multiple cognitive tests such as the Wechsler Adult Intelligence scale (WAIS). The WAIS is based on multiple performance and verbal cognitive tests, which together are believed to reflect general cognitive function. Secondly, general cognition is assessed with a single reading test, such as the National reading test (NART) (3) or the Wechsler Test of Adult Reading test (WTAR). The NART and the WTAR are reading tests which both estimate cognitive ability by reading a list of words, with the IQ level estimated on the basis of mistakes made in the pronunciation of the words listed (38). In the literature on FEP studies, the NART or the WTAR (or equivalent schedules) are normally used to assess pre-morbid intelligence, an estimate of intelligence level achieved before illness onset, while the WAIS is usually used as an estimate of current IQ (12).

Executive Function, Attention, and Working Memory

The term “executive functioning” is often used as a synonym for frontal lobe functioning, and to indicate higher cognitive functioning of the prefrontal cortex (2, 38). Executive function consists of loosely related higher-order cognitive processes, including: problem solving, planning, initiation, hypothesis generation, cognitive flexibility, decision making, regulation, and judgment and working memory (38). Working memory is conceived as a limited capacity storage for retaining information over a short time (1–2 min), and performing mental operations of the content during this period (38). Moreover, the context of the working memory may originate from both sensory inputs as well as from stored long-term memory (38). Attention can be defined as the gateway for information flow to the brain. Attention is a complex system that allows the individual to filter relevant and irrelevant information in the context of internal drives and intentions, hold and manipulate mental processes, and monitor responses to stimuli (38).

Memory

Memory is a complex process by which an individual registers retains and retrieves information (38). Memory is divided into non-verbal and verbal memory, with verbal memory including declarative memory and non-declarative memory. Declarative memory includes both episodic memory (memory for events) and semantic memory (memory for facts). Declarative memory includes an understanding of something being learned, while non-declarative memory can take place without conscious awareness (38).

Several tests are used to assess memory, and the Wechsler Memory Scale (WMS) Logical memory test has been widely used to assess declarative memory in psychosis. In the logical memory task, the participant is asked to recall a short story, immediately after hearing the story, and again after a delay of 30 min (38). Other widely used verbal memory tasks in psychosis research are the Rey Auditory Verbal Learning Test (RAVLT) and the California Verbal Learning Test (CVLT), assessing memory functioning through the use of a word-list learning paradigm, which includes an immediate and delayed component similar to the Logical memory (38). Non-verbal memory is assessed by tests evaluating the ability to recall a specific visual design, including an immediate and delayed aspect, with Visual Reproduction and the Rey–Osterrieth Complex Figure Test being the most frequent tests used in the literature (38).

Processing Speed

Processing speed refers to the speed at which different cognitive tasks are completed. It normally involves a simple task, which is timed on completion. The importance of processing speed lies in its relevance to many higher cognitive operations, such as perceptual processes, encoding, and retrieval (38).

Motor Speed

Deficits in motor performance are seen in many neurological disturbances. The most frequently used motor tests in FEP are grooved pegboard and finger tapping. The grooved pegboard contains twenty-five holes with randomly positioned slots and pegs which have a key along one side. Pegs must be rotated to match the hole before they can be inserted as quickly as possible. For the finger tapping task the examinee is instructed to tap as rapidly as possible using index finger for a specific amount of time. For both grooved pegboard and finger tapping performance with the preferred hand usually demonstrates best performance (38).


Results


General Intellectual Function

Overall, patients with FEP scored significantly worse on current IQ assessed by the WAIS battery compared to controls (see Table 1). The largest effect size across FEP studies was observed for the WAIS full scale IQ (based on performance and verbal tasks from the WAIS), with an effect size of 1.71 (3). Significant differences between patients and controls have also been replicated in studies using NART or WTAR scores to measure pre-morbid IQ. Thus in our own work (21), we found a significant difference between NART scores in patients and controls, with an effect size of 1.09. Significant differences between patients and controls NART scores are also shown in other studies, with effect sizes varying between 0.39 and 1.05.

Executive Function, Attention, and Working Memory

Patients with FEP show impairment in executive performance, with effect sizes ranging from 0.25 to 1.86, with the most profound deficits observed Mohamed et al. (1) on Wisconsin Card Sorting Test (WCST) perseverative errors, with an effect size of 1.86 (see Table 2). Working memory follows with an effect size up to 1.42, followed by attention (effect size up to 1.30).
TABLE 2
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Table 2. Studies comparing patients with first-episode psychosis and healthy controls on executive function, attention and working memory. 

Memory

Several studies in FEP have shown significant impairments in memory, particularly in verbal declarative episodic memory (see Table 3). The effect sizes of verbal episodic memory deficits vary from 0.26 to 2.10, and the effect sizes for non-verbal memory vary from 0.38 to 1.65. As shown by the high effect size reported from studies on FEP, memory impairment is the most, or one of the most, impaired cognitive domains already at illness onset.
TABLE 3
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Table 3. Studies comparing patients with first-episode psychosis and healthy controls on memory function. 

Processing Speed

Studies of patients with FEP have shown reduced processing speed in these patients when compared to controls, with effect sizes ranging from 0.33 to 1.69 (see Table 4).
TABLE 4
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Table 4. Studies comparing patients with first-episode psychosis and healthy controls on processing speed
Motor Speed

Patients with FEP show impairments on motor speed (with effect sizes varying from 0.36 to 1.26; see Table 5).
TABLE 5
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Table 5. Studies comparing patients with first-episode psychosis and healthy controls on motor speed.

Discussion


Reviewing the literature on cognitive function in FEP, we found significant impairment (Cohen’s d effect size above 0.8 (17) in all cognitive domains investigated; see Tables 15. The largest effect size was observed for verbal memory (Cohen’s d effect size = 2.10), followed by executive function (effect size = 1.86), and general IQ (effect size = 1.71). Our systematic review focused on FEP and included studies published up to 2013, thus covering studies not included previously in the review by Bozikas and Andreou (13) (included studies up to January 2010); or Lewandowski et al. (14) (included studies up to 31st of March 2010). Moreover, the study by Bozikas and Andreou (13) included only articles with longitudinal data, excluding studies presenting FEP only. Also the study by Lewandowski et al. (14) included articles on cognitive function in chronic schizophrenia and other psychosis. Our study therefore complements these articles, focusing in-depth on the first-episode only. We have also calculated effect sizes based on Cohen’s d, providing information about the severity of the impairment, which is not included in the previous reviews described above. Similar to the study of Bozikas and Andreou (13) and Lewandowski et al. (14) we found that already at illness onset patients with FEP are characterized by cognitive impairments across domains. Moreover, our results support different cognitive pattern for schizophrenia and affective psychosis (schizophrenia patients showing the greatest effect size differences in cognitive performance compared to controls). Further, we found more variation in the effect sizes comparing patients and controls on cognitive tests than the study by Reichenberg et al. (2) in chronic schizophrenia, indicating a further consolidation of cognitive impairment over time may be present. These results are similar to Bozikas and Andreou (13) and Lewandowski et al. (14) showing the main reduction in cognition around illness onset, or pre-morbid period, with a relatively stable course, which may become even more pronounced after some years.

Our findings in FEP demonstrate that already at illness onset patients have reduced IQ scores compared to controls. Both current IQ and estimated pre-morbid IQ were significantly lower than those of controls, with the greatest impairment in current IQ scores. Indeed, the discrepancy between current IQ and pre-morbid scores is believed to reflect the deterioration in current IQ at or around illness onset. The study by Zanelli et al. (12) show that when we examine schizophrenia versus other psychosis (psychosis NOS and affective psychosis), patients with schizophrenia have larger effect size differences in current IQ, as well as pre-morbid IQ (schizophrenia current IQ effect size = 1.52; pre-morbid IQ effect size = 0.79), compared to other psychosis (current IQ effect size = 0.53; pre-morbid IQ effect size = 0.45). This indicates worse cognitive function in the schizophrenia group both at illness onset and prior to illness onset, compared to patients with other psychosis. Patients in the schizophrenia group also present the greatest deterioration (measured by effect size) comparing current IQ to pre-morbid IQ [schizophrenia effect size current IQ (1.52) minus effect size pre-morbid IQ (0.79) = 0.73, compared to other psychosis: effect size current IQ (0.53) minus effect size pre-morbid IQ (0.45) = 0.08]. A worse cognitive profile in patients with schizophrenia was also found in the study by Hill et al. (39) showing that patients with FEP who developed schizophrenia demonstrated more impaired cognitive performance across domains, compared to patients with affective psychosis. Similar findings are also observed in chronic psychosis (14).

Several studies conducted in FEP have matched patients and controls on general cognition, in order to investigate specific deficits believed to be particularly marked in psychosis. It should be mentioned that matching subgroups on IQ aiming to measure specific cognitive areas believed to be impaired in psychosis may be challenging due to that such a comparison would be contaminated by regression toward the mean (Lord’s Paradox) (40).

Executive Function, Attention, and Working Memory

Although a strong correlation has been found between general intellectual function and other specific cognitive subareas, such as memory and executive functioning, research has also shown impairment of executive functions, such as planning, flexibility and judgment, without any major change in general intellectual status (38). Is the impairment in executive and working memory observed in patients with psychosis a consequence of general cognitive decline, or is executive impairment in psychosis independent from overall cognitive performance? Chan et al. (20) aimed to answer this question in a study of 78 patients with first-episode medication-naïve schizophrenia and 60 controls; they showed that patients with first-episode medication-naïve schizophrenia exhibit specific types of executive dysfunction independently of general cognitive decline. However, Table 2 shows that there is a great discrepancy across studies in terms of effect sizes observed; for example the effect size 0.22 was found for “Arithmetic” in the study by Leeson et al. (19), compared to an effect size of 0.77 in the study by Ma et al. (30). One difference between these two studies was that the study by Leeson et al. (19) had matched the patients and controls for general IQ, while the study by Ma et al. (30) had not. It is therefore important to have in mind whether general IQ has been taken into account in the analysis when interpreting effect sizes for different cognitive subtests.

Memory

It has been suggested that episodic memory tests could be used to elicit diagnostic differences in a psychosis sample. For example, in the study by Fitzgerald et al. (41) consisting of 83 patients with FEP, decreased performance on verbal memory was reported in patients with schizophrenia compared to patients with affective psychosis, implying diagnostic differences in performance on this specific memory task. Prospective studies also show worse cognitive profile in patients with FEP who later develop schizophrenia across cognitive domains, compared to patients with affective psychosis (12, 39).

Processing Speed

The study by Leeson et al. (19), comparing FEP and healthy controls (matched for general cognition) reported that processing speed was the cognitive domain most impaired in FEP. Leeson et al. (19) also found a relationship between processing speed performance and performance on executive and memory tasks, two known impaired cognitive domains in psychosis, as discussed earlier. This indicates the importance of measuring processing speed when studying patients with psychosis. As processing speed is important for the performance of higher cognitive operations, such as executive functions and memory, it has been suggested that impaired processing speed underlies the abnormalities in these areas (42). On the other hand, to complicate this further, a reduction of processing speed has also been found associated with antipsychotic medication (43).

Below are hypothesis about putative mechanism(s) of the cognitive reduction in FEP, investigating the role of early stress, inflammation and genetic vulnerability.

Stress and Cognition in Psychosis

Some previous studies in chronic patients with psychosis, and in healthy controls, report a negative correlation between childhood trauma and cognitive function, particularly decreased scores on general cognitive abilities, memory, and executive function (4448). This is interesting as similar cognitive areas are found to be most reduced in FEP, comparing patients to controls performance (see Result). The deleterious effect of stress and glucocorticoid on the brain (particularly on hippocampus) is well known in the literature (49, 50), and indeed disorders characterized by increased stress exposure such as depression, post-traumatic stress disorder, chronic fatigue disorder, show cognitive impairment, particularly in memory and in executive function (5153). Moreover, psychosis is a disorder characterized by high level of stressful events (54), including recent stressful events (55), the inability to cope with life events (56, 57), and childhood trauma (58, 59). It is therefore possible that some of the cognitive impairment in FEP is due to an increased exposure, or vulnerability toward the negative effect of particularly childhood trauma. We will now review the literature supporting this putative mechanism.

Cortisol Level and Cognitive Function and Psychosis

Over two decades have past since the first study investigating Hypothalamic-Pituitary-Adrenal (HPA) axis and cognitive abnormalities in schizophrenia were published (60) and suggested a link between hypercortisolism and cognitive impairment. Since then, several studies have investigated HPA axis and cognitive function in long-term chronic schizophrenic patients. The first study by Saffer et al. (60) consisted of 11 patients with type II schizophrenia (mainly negative symptoms), 34 controls, 30 patients with schizophrenia with type 1 (mainly positive symptoms), and 9 patients with mixed type I and type II schizophrenia (both negative and positive symptoms). This study found a strong negative correlation between dexamethasone abnormalities (dexamethasone non-suppressors) and cognitive performance in type II schizophrenics, implying a relationship between HPA axis hyperactivity and cognitive impairment. Furthermore, Walder et al. (61), evaluating 18 patients with chronic psychosis, 7 patients without psychosis, and 19 healthy controls, found that, in the entire sample, cortisol levels were negatively correlated with performance on memory and executive tasks.

Also in FEP an abnormal HPA axis has been demonstrated (55) showing higher cortisol levels during the day in the patients compared to the controls. An interesting closed-loop model, first hypothesized by Lupien (62), gives a possible explanation for the relationship between cortisol level and cognition in schizophrenia. The closed-loop model works in the following manner: basal cortisol level increases symptoms severity, which again impacts on the encoding of incoming information into long-term memory store; this leads to difficulties discriminating between relevant (threat) and irrelevant (non-threat) information, which again further increases the reactivity to stress.

In our recent paper on patients with FEP (21), we found that patients performed significantly worse on all cognitive domains compared to controls. In patients only, a blunted cortisol awakening response (that is, more abnormal) was associated with a more severe deficit in verbal memory and processing speed, supporting a role for the HPA axis, as measured by cortisol awakening response, in modulating cognitive function in patients with psychosis.

Childhood Trauma and Cognitive Function in Psychosis

Six studies in the literature have investigated cognition and early trauma in people with psychosis, four in individuals including chronic illness phase. The first study by Lysaker et al. (45) was conducted in males with schizophrenia spectrum disorder, and no comparison control group was used. The authors found that male patients with childhood trauma (sexual abuse) had impaired processing speed, working memory, and executive function compared with patients without abuse (45). The second study by Schenkel et al. (47) included 15 female and 25 males with schizophrenia spectrum disorder, with no comparison control group. The authors found that patients with schizophrenia or schizoaffective disorder with a history of childhood trauma showed a decreased score on learning and visual context processing compared to non-abused patients. Similar findings were found in the study by Shannon et al. (48) in a sample of 85 patients (67 males and 18 females) with chronic schizophrenia; here patients with childhood trauma scored significantly lower on working memory as well as verbal memory tasks, even after controlling for pre-morbid IQ and depressive symptoms. Similar findings were observed in our own examination of the large AESOP study of FEP which comprised of 138 patients (73 males and 65 females) and 138 controls (64 males and 74 females), showing an association between childhood trauma and reduced performance on attention, concentration and mental speed, language, and verbal intelligence; however this was mainly driven by male patients with affective psychosis (44), whilst in controls only one subtest (performance intelligence) was reduced in the group with high exposure of childhood trauma, and in males only. Also in an independent study including 406 patients with a mean duration of illness of 3 years showed a strong negative correlation between cognitive function and a history of childhood trauma; here childhood trauma was associated with a reduction in cognitive function across cognitive domains in patients with schizophrenia spectrum- and bipolar disorders, in particular working memory and executive function, as well as general cognition. Moreover, these dysfunctions were driven by underlying deficits in general cognitive tasks as measured by the Wechsler Abbreviated Scale of Intelligence (WASI) (63). Only two studies have found negative, or inconclusive, findings between cognitive function and early trauma in FEP (21, 64), with the latter and largest study showing an effect of childhood trauma on cognitive function in controls, but not in patients (64).

Potential Biological Mechanisms

Since patients with psychotic disorders – in addition to being more exposed to trauma – also demonstrate abnormalities in the HPA axis (55), immunological disturbances (65, 66), together with cognitive and brain structure abnormalities (6, 12, 21, 67), it is of interest to investigate the link between stress exposure and biological stress parameters to cognitive abnormalities in psychosis. Based on the findings outlined above, it is particularly intriguing to investigate to what extent patients with psychotic disorders also have a genetic vulnerability toward abnormal stress response that may add to – or interact with the effects of early trauma, and cognitive impairments.

There are several indications of an abnormal HPA axis in patients with psychotic disorders irrespective of early trauma. This includes findings of an increased pituitary volume in patients with FEP compared to controls (68, 69). There are also signs of an altered or increased systemic cortisol metabolism (7072) with links to genetic markers in psychosis (71), which might interact with the effect of stressful life event. The idea of a genetic predisposition to an abnormal stress response is supported by indications that not only patients with psychosis have abnormal stress responses, but also their relatives (73). Moreover, increased cortisol levels correlate with smaller hippocampal volume in psychosis (74). There is also an interaction between glucocorticoids and serotonin in the central nervous system (CNS) as glucocorticoids regulate both tryptophan hydroxylase and the expression of several serotonin receptors (75). In addition, the functional polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) has been linked to altered stress response, as carriers of the short (s-) allele have increased negative psychological reactions and stress hormone release compared with carriers of the long (l-) allele (76). Indeed, our study Aas et al. (76) demonstrated that patients with an early psychotic illness who were carriers of the short (s-) allele of the serotonin transporter gene (5-HTTLPR), exposed to high levels of childhood trauma (physical neglect and abuse) had significantly poorer cognitive functioning, than all other groups. Patients with psychosis also show reduced brain-derived neurotropic factor (BDNF) levels both in the brain (77), and in serum and plasma (7779), which may be related to their cognitive performance (80). The BDNF gene has at least one functional variant, the SNP (rs 6265) resulting in a Valine (val) to Methionine (met) substitution at codon 66 of the proBDNF. The low active met allele is here related to reductions in BDNF release (81). Recent research in FEP have found associations between reduced BDNF gene expression levels, childhood trauma, increased inflammation, and smaller hippocampal volume (82). Reduced BDNF levels are also observed in bipolar patients exposed to childhood trauma (83), as well as linked to cognition in animals (84). It is well known that patients with psychosis show brain structural abnormalities compared to healthy controls (67, 85, 86). A recent meta-analyses in healthy individuals indicate hippocampus volume reductions in met carriers compared to homozygotic val carriers (87); this is an area of the brain important for memory. In psychosis, met carriers usually demonstrate larger ventricles, more CSF, and reduced frontal gray matter volume (88, 89), even if there are inconsistent results (90). While the study by Mondelli et al. (82) did not genotype, their study support the role of BDNF on brain structures, as well as a relationship between childhood trauma and BDNF levels. Childhood trauma may thus represent a significant factor influencing cognitive function in psychosis, mediated through an effect on BDNF. Indeed our recent study in patients with a psychotic illness (80) support this hypothesis, showing that BDNF val66met-met carriers reporting high levels of childhood trauma demonstrate significantly reduced executive function/working memory as well as smaller hippocampal volume, compared to all other groups.

Several lines of evidence have implicated the immune system in the development of severe psychiatric disorders, and increased inflammation is found in depression (9193), as well as in psychosis (65, 66, 94). Recent GWAS studies clearly indicate immune genes as susceptibility genes for schizophrenia (92, 95). Increased inflammation is also found to be associated with cognitive impairments in animals (96). Pilot data from a small sample of patients with FEP and healthy controls show a relationship between increased inflammation parameters (IL-8 and IL-6) and cognitive impairments across both groups (97), indicating that immune markers may be related to cognitive function in psychosis. More studies should investigate this further, aiming to understand the cognitive reduction seen in FEP compared to healthy controls.

Epigenetic Research Related to Schizophrenia Risk and Cognitive Function

Recent epigenetic research related to schizophrenia risk, links early stress (hypoxia and perinatal stress) to methylation and altered gene expression associated with behavior and cognitive changes (98). Perinatal stress has also been found to be related to reduction of Brain-derived neurotrophic factor (BDNF) in the brain of adult rats (84). Riva et al. (84) also show that perinatal stress in male rats is related to reduced performance on the object recognition test in the adult rat. Riva linked the above to epigenetic changes, explaining that perinatal stress increases methylation, which again is related to a reduced transcript of BDNF, and cognitive changes. Riva et al. (84) has also demonstrated that perinatal stress is associated with reduced upregulation of BDNF on the forced swim test in adult rats, linking this to impaired ability to cope under stressful situations in rats exposed to perinatal stress. Finally, Riva et al. (84) also found that epigenetic changes in response to stress are seen across genes: methylome analysis in the prefrontal cortex of rats exposed to perinatal stress showed that a large number of genes (3,386 genes) were methylated differently from controls. These included genes linked to bipolar disorders and schizophrenia, such as CACNA1C and DISC1, as well as the COMT gene. Further research should therefore investigate links between early stress, and epigenetic changes of relevant genes across genome, aiming to understand mechanisms behind cognitive abnormalities in patients with FEP.

Limitations

This study has several limitations which should be acknowledged: we decided to focus on only some aspects which may influence cognitive function (i.e., stress, and interactions between stress and genetic factors, as well as inflammation), and we did not have the possibility to go into depth on other important aspects, such as time of illness onset (early illness related to worse cognitive function), possible gender differences (males lower performance), the influence of antipsychotics and medication, and the duration of treatment. Although all these patients are FEP, the exact level of treatment varied between the studies (see Supplementary Material for an overview of recruitment in the different papers discussed). Moreover other environmental factors such as cannabis have both been associated with increased risk of the illness, as well as influencing cognitive function, however due to space and focus of the paper, we focused on the role of stress and inflammation and genetics related to these factors as possible explanation model. Only the Cohen’s d and not the confidence intervals for the Cohen’s d are included in this study. However, we have included in the Supplementary Material a detailed overview of the studies included aiming to facilitate interpretations of the findings. As already mentioned matching subgroups on IQ aiming to measure specific cognitive areas believed to be impaired in psychosis may also be challenging due to that such a comparison may be influenced by regression toward the mean (Lord’s Paradox) (40).


Summary


We have demonstrated that cognitive impairment across domains (up to and above severe level based on Cohen’s d effect size) is present already at illness onset, as shown in FEP studies. However, differences in levels of impairment are observed between studies, as well as within domains, indicating that compared to chronic schizophrenia (2), a further consolidation of cognitive impairment over time may be present.

The research into trauma, stress, and HPA axis disturbances (including gene interactions) is one of the areas where we have some knowledge about how specific environment and genetic factors influence cognition (Figure 1). Indeed, early stress may have long-lasting changes on cognitive function by affecting expression of relevant genes. This is the start of a new line of research aimed at further understanding the complex etiology behind cognitive abnormalities in psychosis. Based on published biological studies, we propose that some of these impairments may be due to these subjects’ increased sensitivity to the negative effect of stress, and genetic vulnerability, affecting the HPA axis, the immune function, and neuroplasticity. More studies are needed aiming to understand the complex etiology of cognitive impairments in psychosis.
FIGURE 1
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Figure 1. Suggests that cognitive impairment in FEP is related to neurodevelopmental abnormalities. Figure 1 also postulate that stress, as well as genetic vulnerability may be part of the complex etiology behind cognitive impairment in psychosis.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

Some of the work leading to this review has been funded by the British Academy and by the South London and Maudsley NHS Foundation Trust & Institute of Psychiatry NIHR Biomedical Research Centre for Mental Health. This study was also funded by grants from the University of Oslo, South-Eastern Norway Health Authority (#2004123, #2006258) and the Research Council of Norway (#167153/V50, #163070/V50, #190311/V50).

Supplementary Material

The Supplementary Material for this article can be found online at http://www.frontiersin.org/Journal/10.3389/fpsyt.2013.00182/abstract
 
References available at the Frontiers site.