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The modern gender divide
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They say we are the chosen few
But we're wasted
And that's why we're still waiting
On a number from the modern man
Maybe when you're older you will understand
Why you don't feel right
Why you can't sleep at night now
In line for a number but you don't understand
Like a modern man. (Modern Man, Arcade Fire, The Suburbs, 2010)
The story's hero is 23-year-old Ben Stone (Seth Rogen), who has a drunken fling with Allison Scott (Katherine Heigl) and gets her pregnant. Ben lives in a Los Angeles crash pad with a group of grubby friends who spend their days playing videogames, smoking pot and unsuccessfully planning to launch a porn website. Allison, by contrast, is on her way up as a television reporter and lives in a neatly kept apartment with what appear to be clean sheets and towels. Once she decides to have the baby, she figures out what needs to be done and does it. Ben can only stumble his way toward being a responsible grownup.I'm not all that surprised that this is true for some part of the population - a less defined career role for men and a growing disparity in higher education may lead to feelings of uncertainty about having to commit to or be responsible for anything (which is a hallmark of adulthood). I was particularly intrigued by the conclusion of the article, as the author assumed these men's inner voice in stating "Why should [I] grow up? No one needs [me] anyway. There's nothing [I] have to do." Indeed, clearly defined expectations can help shape identity. That is, if you assume these men have no inherent, willful desire to forge their identity. And that's a big assumption on the author's part.
Something struck me while I was reading the article though: I have heard complaints about the men-boys from these presumably more ambitious women, but what about these women's fun times? They are often portrayed as some sort of a super woman, juggling home and work like some skilled Cirque du Soleil performer. These ambitious go-getters with their eye on the prize, what do they do for fun? It would seem from what is perpetuated by the media that men have all the fun and women are left to do all the work. I seriously doubt that to be the case, even amongst the selected demographic of certain SES. It makes me wonder though: how come we don't talk about these young women having fun? How do they unwind? I'm not saying they need to find similar things fun, but other than shopping, what else is supposedly fun? Why are these women hanging out with the men they supposedly detest? Could it be that they are having vicarious fun? I'm going to have to investigate this. To be continued?
Hosting class: James Franco consults Judd Apatow
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I sure hope James takes Judd's advice about that medical term.
Addiction & mental illness research: the latest, a summary
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Here's a summary of some of the latest research presented at a 3-days international conference I was at (some of these findings have yet to publish, and I'm too sleepy at the moment to find existing links for the rest but I'll be sure to add them at a later time):
- Sensitizing the brain to drug effects with prolonged use: Exposure to Amphetamine over time increases dopamine's readiness response (up-regulating) in the nucleus accumbens region, which is important for motivation. Furthermore, in the presence of drug-related cues in the environment, there's an increase of dopamine release in the amphetamine-overexposed brain, thereby increasing motivation which gets directed to seeking drugs for use. This would explain some of the "triggers" that come with being in the same environment in which drugs (e.g. amphetamine) were involved - the same triggers that could lead to relapse. However, in the absence of these cues, there's actually a depression of motivation due to a decrease in dopamine being released in the nucleus accumbens region. This may explain why it's hard to feel motivated or up to doing anything when in a drug-free environment.
- Emotional abuse / neglect: most important predisposition for mental illness development
- Trauma and substance use disorders (SUDs): It's more effective to improve PTSD (Post traumatic stress disorder) in people with SUDs first, then address their substance use. Some researchers argued that the underlying "cause" of SUDs was trauma. While trauma was likely to present in people with SUDs' personal history, it may not necessarily be PTSD (people who experience relived trauma as if it was happening right now).
- Trauma, SUDs, stress and the brain: A young person's trauma correlated with a smaller prefrontal cortex (imaging studies). Total cumulative adversity was found to associate with decrease in brain volume, especially areas associated with decision making process (prefrontal cortex) and emotional regulation (amygdala). Higher traumatic events experienced by the person with SUDs --> nucleus accumbens (N.A.) activity increases with stress. N.A. activity is up-regulated when presented with a neutral relaxing stimuli. In short, persons with SUDs and a history of trauma were found to have a heightened motivational system, one that also responds to stress, and decreased resources for strategic long term decisions and regulation of emotions.
There may be a place for mindfulness therapy in SUDs treatment. Engaging in meaningful relationship and activities could help increase stress resilience and help with SUDs. Other ways to deal with SUDs by addressing stress: time management, problem solving, relaxation, behavioural modification, cognitive restructuring, biofeedback, medication, etc. It was found that early trauma changed sensitivity of cortisol receptors in the brain. It would be interesting to research how the brain is affected through the developmental stages. We know, for one, that the brain doesn't reach its full developmental potential until the late 20s. How would trauma as experienced by people with SUDs at an early age affect them later in life? Is there a window within which the effect would be more pronounced? - Epigenetics: for the uninitiated, the basis for your blueprint is in your genes (and your jeans). It is your genotype. The expressed characteristics of your genes are called phenotypes. The regulation of gene expression without actually changing the DNA is what epigenetics focus on. They call it the "dimmer" of DNAs, akin to dimming or brightening (?) the DNA light. Various factors can act as dimmers for DNA expression, including, surprise surprise, maternal diet and maternal stress. Your mother's experience and intake during pregnancy can predispose you to substance use disorders, by affecting how your genes for certain brain regions get expressed. Interestingly, according to the latest study done in Wisconsin, paternal stress in pre-school posed a notable effect on sensitivity to dopamine release in the brain, especially for girls. Basically, daddy's little girl could go on to abuse cocaine if exposed to daddy's stress in pre-school. "Could" is the functional key word here. Nevertheless, who knew that would have a secondary chemical basis at all?
- Social Economic Status (SES) and SUDs: lower SES earlier in life was associated with cells resisting signals and blocking cortisol's feedback pathway. Interestingly, care giving quality (e.g. maternal warmth) earlier in life was found to offset this lower SES problem. Family emotional climate played a role in stress sensitivity. However, they didn't find this to be true with higher SES group. Possibility of higher SES mothers hiring others to be the surrogate mothers, thereby changing what the results might have looked like?
- Personality traits & SUDs: Impulsivity and sensation seeking are two traits that can predict the externalizing behaviour specific to SUDs (Castellanos-Ryan, Rubia, & Conrod, ACER, 2010). Impulsivity is defined as behaviour that is poorly conceived, prematurely expressed, unduly risky / inappropriate to situations and often results in undesirable consequences. 20% of experimenters go on to develop SUDs. They were found to display: behavioural disinhibition, intolerance to delay gratification, lack of long-term/consequence consideration when making decisions, and poor attention. Addiction is often considered in the context of: compulsion (motivation to use), control (inability to refrain), and consequences (maintaining drug use despite consequences). The latter two relate to impulsivity. It was found that if you decreased motor impulsivity in cocaine users, you'd be able to decrease rate of relapse. As an aside, gambling addiction has no direct relationship to impulsiveness. It's more about making risky decisions and novelty seeking than anything else.
- NAOMI project / SALOME project: The Canadian Institutes of Health Research (CIHR) funded a clinical project that tested the benefits of heroin maintenance therapy. This was NAOMI (North American Opiate Medication Initiative), conducted in Vancouver and Montreal (starting in 2005). The pharmaceutical graded heroin was imported from Europe. The idea was that giving hard core users controlled heroin over a period of time and introducing them to associated therapy would help stabilize this group long enough for them to improve other aspects of their life, which in turn would hopefully help them get off heroin or move on to other (oral) treatment methods that previously failed with them. The researchers reported success in the retention of these folks in treatment and decrease illicit drug use and associated activities. More remarkably, the double blind substance used, hydromorphone (Dilaudid), was also an effective treatment. It's remarkable because Dilaudid is legal (it's used for pain management).
They considered the project a success, but they failed to persuade the government to consider allowing prescription of diacetylmorphine, the active ingredient in heroin, under a compassionate use. So now they're moving on to SALOME (Study to Assess Long-term Opioid Maintenance Effectiveness), which would be conducted in Vancouver (the Montreal site fell through). They want to compare the effectiveness of diacetylmorphine against Dilaudid. My biggest concern for the implement of heroin assisted therapy is security - there's been a rash of robberies in the States of pharmacies stocking narcotics recently in the news. Heroin has such a great street value that it'd be hard to operate pharmacies dispensing it without strict security (like the one employed by NAOMI). How many pharmacies can afford such security? The researchers cited European's report on safety to ease such concerns, but North America is a bit different in culture and size. I'm cautious about the reality of implementing this therapy. Maybe we should look into using injectable Dilaudid as an alternative instead? - Stats on people seeking treatment: People suffering from SUDs for 10 years --> 25% would enter treatment. Of those people suffering for 30 years or more, only 50% would enter treatment. People who abused legal drugs were more likely to enter treatment than those who abused illegal ones. 40% of people entering treatment were more likely to have other psychological disorders as well.
- DSM: has no official status in Canada. ICD is the official guideline for us, but most clinicians use the DSM. For the coming DSM V, changes may include assessment for the level of disability, need for treatment, and changes in diagnoses (e.g. merging of substance use and substance dependence, creating a new category for gambling addiction, etc.). It was suggested that we should consider re-arranging the DSM in a hierarchical fashion, rather than in lists of symptoms under discrete categories like it is now. Similar pathways and shared effective medication were cited as possible arguments for the continuum of disorders. I suspect, however, that our meds are still too crude to be affecting a single vital part of the brain specific to a disorder, so the argument about shared medication may not hold water. It's also more likely that pathways maybe shared, but patterns of distribution for various disorders may differ. Disorders may have their own pathway profile - that's how things work in the brain, anyway. Behaviours are complex and involve many parts of the brain. It's a matter of associating certain pattern profiles with certain behaviours, I would think.
VIFF 2010 Mini Reviews: Inside whistle ... yeah
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Inside Job ( Charles Ferguson) U.S.A. This film should be renamed The Insidious Job - it was vicious finger-pointing, and most of it was probably deserved. Ferguson (impressively perusing his PhD in political science to make his case), with an eye for the global context, documented the beginning of the financial crisis that we're (hopefully) at the tail end of. While the film was fairly standard in terms of documentary style, the pertinent subject was deftly narrated in a way that was thought provoking, educational and entertaining. Interviews with financial insiders, politicians (hello Eliot Spitzer!), and journalists traced the crisis all the way back to the Icelandic economic collapse as the smaller scale model of what was to come. The eye opening aspect of the film for me - for someone who isn't as familiar with the U.S. government insiders - was that the new "Yes we can" Obamam administration carried some of the same cowboys that toppled the world on its pay load. The message was stark clear: we live in a world of recycled solutions offered by the same recycled system cogs who caused the problems in the first place. They work with an eye on personal gain above all else, protected by an irresponsible capitalist system. It's obvious that responsible government check points and a system of accountability should be put in place, especially for such a complex, faceless, economically driven system of governance. But the dance between freedom and responsibility will no doubt continue to play out in the market. In the mean time, don't forget that conventional wisdom: if it looks too good to be true, it probably is.
Eu când vreau să fluier, fluier (If I want to whistle, I whistle; Florin Şerban) Romania. Jury Grand Prix Silver Bear, Berlin International Film Festival. | Set in a small detention facility for juveniles on some country side, the film told simply the story of a youth, Silviu (played with simmering anger betraying the doe-eyed exterior), nearing the end of his sentence only to blow it all away in the last couple of weeks. The triggering event began with his little brother, whom he acted as a guardian to all his life, informing him during a visit that their mother would be taking him away to Italy, thereby leaving him once again abandoned by family, particularly his mother. It lead to him taking a beautiful (and intoxicating) social worker hostage in an attempt to get his mother to promise not to take his brother with her. Broken family home life and childhood abandonment, the hallmark history of many delinquent youth, were at the root of the emotion that escalated in a rather unexpected and surprisingly understated fashion. The smart, reasonable way Silviu went about his plan clashed with the extent he would go to in order to prevent an event he felt helpless about spoke volume of the damage his mother'd done to him emotionally and psychologically. The film was so restrained, it seemed to lend more danger to the anger and frustration felt by Silviu, threatening to push the story to a violent end. To the film's credit, its focus was in the existential moment, almost singularly so, without melodrama and embellishment. Romanian cinematic industry has been going gangbusters in the past few years, churning out an impressive number of quality, award-winning films. While Whistle was less ambitious than what came before, it did an admirable job of continuing the much welcomed resurgence.
