Reflection, Validation, and the Most Important Discovery in Neuroscience

Dr. Ramachandran’s TED Talks discussion of mirror neurons, is the awesomest thing.

Not everybody shares Dr. Ramachandran’s opinions about the importance of mirror neurons.  But I do!

The notion of mirroring is so central to human relationships, seeing yourself in others is absolutely crucial to discovering who you are and what you want.  It may be speculation, but there must be biological underpinnings to this process that are widely shared – because they allow society and civilization.  Reflection and social connectedness is a theme in most if not all of the major religions (Prothero, 2011).  This is a process that is so crucial to our humanness it deserves to be studied more fully. 

I have been reading an AMAZING article relating mirror neurons and Theory of Mind (ToM) in humans (Gallese & Goldman, 1998).  If mirror neurons are the basis of a certain kind of empathy, or theory of mind, then we must explore this more fully.

A note about the research so far:  Not everybody is equal in terms of empathic capacity or theory of mind.  It is unlikely that anything so finicky as mirror neurons should show the same activation in all people, without regard to their trait levels of such variables.  And in order to measure empathic capacity or theory of mind in adults, researchers have to get creative.  Perhaps an emotion-induction procedure followed by a validation procedure can help us get to where we need to be?

A note on social media:  The process of seeing oneself reflected on a computer screen has not been studied empirically in enough detail.  How important is it to me that blogging reflects a part of my mind I don’t express anywhere else?  How important is it to know that somebody who reads this, gets it? 

Pretty important, I think.

Social media and blogging are likely to be one of the best platforms for studying the processes relating to ToM (self-consciousness and other consciousness) and its potential neural underpinnings, in adults.  This is so exciting!  Has this been done anywhere?  Did I miss it?  When can we get started???

Social Medicine: we need a 300 year plan

The WHO defines health as follows: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

I like this definition for including the phrase "social well-being".


When we talk about “lifestyle” and lifestyle changes that need to happen to prevent chronic disease, we are talking about what is really a social problem.

Social medicine is the field that is concerned with building the infrastructure we need for healthy communities. 

Our default when we think about health is to think of it as a biological phenomenon, lying within one individual.  While I wouldn’t argue that this is not the mechanism through which disease seems to be expressed, I would argue that this does not accurately reflect the whole picture.


Take the following pieces of trivia:

1)   Childhood trauma predicts poor physical and mental health in adults, and chronic pain (Goodwin & Stein, 2004; Van Houdenhove & Luyten, 2006). 

2)   Low SES or social trauma (Benjet, 2010) in childhood also predicts chronic disease in adulthood (Pollitt et al., 2005).

I found this so surprising when I first came across it.  SES matters to the development of chronic disease.  Why should that be?! What does that mean?  Well, my take homes were this:

1)   The psychological and the physiological aspects of health are intertwined in complex ways.  Maybe negative social pressures are the reason motivational interventions in chronic disease often fail: those who had the mental & social resources to implement positive change already have! (And hence did not develop chronic disease in the first place.)

2)   Health and behavior are community (see: family systems) issues.

Public health policy has been most involved in the field of social medicine so far.  Interventions range from sex ed to food regulation.  This work is invaluable, but we need more. We know that we need to eat right, exercise, not be too stressed, not get too fat... We know what we need to do, but still, we don't seem to have the the infrastructure in place to make it easy, or natural, to do those things.  Healthy food is harder to access than unhealthy food.  Pollution is a growing problem.  And a cursory look at the news shows that social strain, conflict, and stress are poorly managed among many of us.  

Part of the problem is just life.  The other part of the problem is just bad (social) planning.  



Social medicine asks what we are doing to promote:

-     Public health policy that benefits both individuals and communities

-     Community & health development

-     Individual care (combining the best of both physical and psychological treatments)

-     A systems approach that takes into account the social value of healthcare (i.e., what, other than direct medical care, does a patient get out of a hospital or clinic visit?  Social support?  Empathy?  If so, how best can we design our health care system and other aspects of social infrastructure to provide its members with support sustainably throughout a lifetime?)   

 
With the problems the world is facing today in terms of sustainability, wars, pollution, etc… we need interventions that not only help us right now, but help us long term.  Forget a 30-year plan, we need a 300-year plan.
  
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 On social medicine and its uses:

- The Canadian Facts  
- WHO Social Determinants of Health 
- Monthly Review 
- Wikipedia (always)

Motivation, Health, and the Type and Timing of Interventions

So I wanted to write a post about motivation.  After all, it occurred to me when I was sick earlier this year, that health, as so many other endeavours in life, requires motivation.  You have to want to be healthy, just like you have to want to be a good person, or a good athlete, or a good writer in order to actually become one.  I was inspired by reading a business blog where I saw this list: 9 things that successful people do (and that you should do too).  And I was shocked because it seems easier to find a “how to” guide for gaining success in ones careers than it is to find a guide to being successful in ones health. (Seriously, how about applying these 9 rules to any health goal? Eating right, exercising?)

Don’t get me wrong.  There is, in fact, plenty of guidance out there.  There is a new “food plate” (goodbye, food pyramid!) telling you what to eat, there are recommendations to get 30 minutes of cardiovascular exercise in 5 times per week (anybody else think that’s funny?), and if I go visit my doctor or dentist I usually get a bunch more good advice for what I should be doing.

But it doesn’t come with a “how to” guide.  And I want one, please.

Because I was thinking that if I, who have no dependents and a lot of freedom, have trouble eating and exercising the way I should and may get submerged by stress more often than my research recommends I do… then my guess is that people with lifelong bad habits, kids, mortgages, and careers are going to have a pretty rough time too.  

So my original thought was: “Why don’t I get more motivational psychology when I go visit my doctor?”

But as I was pondering the feasibility of this (as well as searching for any evidence that it would help), I realised two things:

1)      Even if motivational interventions worked very well for health-related issues (and it seems like they might work more at the “OK” level), they would probably have an effect in disease prevention, rather than in the people already suffering from chronic pain or disease.

2)      Humans are social creatures with certain hard-wired preferences (for example, for fatty foods), and the behaviour of those around us influences us profoundly.  I.e., asking an individual to change their habits alone without taking into account the society they operate in is completely unrealistic. (See this article by Christakis & Fowler, 2007 if you have not. Because it's awesome.)

If we want to get serious about the prevention and treatment of the biggest epidemics in our society at this time (read: heart disease, cancer, depression, obesity), it has to happen at a community or even at a policy level.

Asking people to go it alone flies in the face of everything we know about social psychology and how people operate.  People are willing to lie about perfectly concrete realities in order to fit in with a group of people they barely know (Asch, 1951)… what makes us think they are willing to change bad habits (e.g., exercising instead of watching American Idol, quitting smoking, etc.) if their friends or families do?

Individual motivation, though it seems to underlie many a success story, will never be the whole answer (Gladwell, 2008).  Motivation interventions will probably be successful if they are aimed at a group of people who are in a situation where they can respond to them.  And maybe that’s why you’re more likely to hear a motivational psychologist comment on success in the corporate world than on success fighting coronary artery disease. 

We need to find a way to get communities to be healthy, not just individuals.  We need to think big in terms of “herd immunity” to chronic disease.  We need to influence policy leaders who can make real change come into our environments in terms of what we eat and help improve our communities (first of all, by making sure we have communities!) by better city planning and promoting health and wellness, stress reduction and physical activity.

Public health approaches might be the most direct and effective solution to the current epidemic of chronic “lifestyle” diseases.  Individual responsibility is important, yes.  But integrating healthful eating and physical activity into our daily lives is a change that is going to happen on a community level.  Ignoring the power of the infrastructure we live in to shape our lives is naïve.  And, I might add, unscientific.