Posts Tagged ‘medicine’
what is autism and what causes it?
The term ‘autism’ was coined in the 1940s by two physicians working independently of each other, Hans Asperger in Austria and Leo Kanner in the USA, to describe a syndrome the key feature of which was a problem with interacting with others in ‘normal’ ways. Sounds vague, but the problem was anything but wishy-washy to these individuals’ parents and families, and over time a more detailed profile has built up.
The term itself is from the Greek autos, or ‘self’, because those with the syndrome had clear difficulties in interpreting others’ moods and responses, resulting in a withdrawn, often antisocial state. Autistic kids often avoid eye contact and are all at sea over the simplest communication.
Already though, I feel I’m saying too much. When describing autism, it’s common to use words like ‘often’ or ‘sometimes’ or ‘some’, because the symptoms are seemingly so disparate. Much of what follows relies on the neurologist V S Ramachandran’s book The tell-tale brain, especially chapter 5, ‘Where is Steven? The riddle of autism’.
Autistic symptoms can be categorised in two major groups, social-cognitive and sensorimotor. The social-cognitive symptoms include mental aloneness and a lack of contact with the world of other humans, an inability to engage in conversation and a lack of emotional empathy. Also a lack of any overt ‘playfulness’ or sense of make-believe in childhood. These symptoms can be ‘countered’ by heightened, sometimes obsessive interest in the inanimate world – e.g. the memorising of ostensibly useless data, such as lists of phone numbers.
On the sensorimotor side, symptoms include over-sensitivity and intolerance to noise, a fear of change or novelty, and an intense devotion to routine. There’s also a physical repetitiveness of actions and performances, and regular rocking motions.
These two types of symptoms raise an obvious question – how are the two types connected to each other? We’ll return to that.
Another motor symptom, which Ramachandran thinks is key, is a difficulty in physically imitating the actions of others. This has led him to pursue the hypothesis that autism is essentially the result of a deficiency in the mirror neuron system.
In recent years there’s been a lot of excitement about mirror neurons – possibly too much, according to some neurologists. A mirror neuron is one that fires not only when we perform an action but also when we observe it being performed by others. They’ve been found to act in mammals and also, it seems, in birds, and in humans they’ve been found in the premotor cortex, the supplementary motor area, the primary somatosensory cortex and the inferior parietal cortex. It’s easier, however, to locate them than it is to determine their function. Clearly, to describe them as ‘responsible’ for empathy, or intention, is to go too far. As Patricia Churchland points out, ‘a neuron is just a neuron’, and what we describe as empathy or intention will likely involve a plethora of high-order processes and connections, in which mirror neurons will play their part.
With that caveat in mind, let’s continue with Ramachandran’s speculations on autism and mirror neurons. First, we’ll need to be reminded of the term ‘theory of mind’, used regularly in psychology. It’s basically the idea that we attribute to others the same sorts of intentions and desires that we have because of the assumption that they, like us, have that internal feeling and processing and regulating system we call a ‘mind’. A sophisticated theory of mind is one of the most distinctive features of the human species, one which gives us a unique kind of social intelligence. That autism would be related to theory-of-mind deficiencies seems a reasonable assumption, so what is the brain circuitry behind theory of mind, and how do mirror neurons fit into this picture?
Although neuro-imaging has revealed that autistic children have larger brains with larger ventricles (brain cavities) and notably different activity within the cerebellum, this hasn’t helped researchers much, because autism sufferers don’t present any of the usual symptoms of cerebellum damage. It could be that these changes are simply the side effects of genes which produce autism. Some researchers felt it was better to focus on mirror neurons straight-off, as obvious suspects, and to see how they fired and where they connected in particular situations. They used EEG (electroencephalography) as a non-invasive way to observe mirror neuron activity. They focused on the suppression of mu waves, a type of brain wave. It has long been known that mu waves are suppressed when a person makes any volitional movement, and more recently it has been discovered that the same suppression occurs when we watch others performing such movements.
So researchers used EEG (involving electrodes placed on the scalp) to monitor neuronal activity in a medium-functioning autistic child, Justin. Justin exhibited a suppressed mu wave, as expected, when asked to make voluntary movements. However, he didn’t show the same suppression when watching others perform those movements, as ‘neurotypical’ children do. It seemed that his motor-command system was functioning more or less normally, but his mirror-neuron system was deficient. This finding has been replicated many times, using a variety of techniques, including MEG (magnetoencephalography). fMRI, and TMS (transcranial magnetic stimulation). Reading about all these techniques would be a mind-altering experience in itself.
According to Ramachandran, all these confirmations ‘provide conclusive evidence that the [mirror neuron] hypothesis is correct.’ It certainly helps to explain why a subset of autistic children have trouble with metaphors and literality. They have difficulty separating the physical and the referential, a separation that mirror neurons appear to mediate somehow.
A well-developed theory of mind which can anticipate the behaviour of others is clearly a feature of understanding our own minds better. In Ramachandran’s words:
If the mirror-neuron system underlies theory of mind and if theory of mind in normal humans is supercharged by being applied inward, towards the self, this would explain why autistic individuals find social interaction and strong self-identification so difficult, and why so many autistic children have a hard time correctly using the pronouns ‘I’ and ‘you’ in conversation. They may lack a mature-enough self-representation to understand the distinction.
Of course, tons more can be said about the ‘mirror network’ and tons more research remains to be done, but there are many promising signs. For example, the findings about lack of mu wave suppression could be used as a diagnostic tool for the early detection of autism, and some interesting work is being done on the use of biofeedback to treat the disorder. Biofeedback is a process whereby physiological signals picked up by a machine from the brain or body of a subject are represented to the subject in such a way that he or she might be able to affect or manipulate that signal by a conscious change of behaviour or thinking. Experiments have been done to show that subjects can alter their own brain waves through this process. Some experimental work is also being done with drugs such as MDMA (otherwise known as the party drug ‘ecstacy’) which appear to enhance empathy through their action on neurotransmitter release.
So that’s a very brief introduction to autism. Hopefully I’ll come back to it in the future to explore the progress being made in understanding and treating the syndrome.
how to tackle obesity
A little over a year and a half ago I started getting worried about weight gain. I didn’t like the way I looked, I hated seeing photos highlighting my tubbiness, but I loved food, cooking and eating it, especially the latter. I also preferred to take a fatalist line. Both my parents were slim in youth, especially my mother, and then developed a middle-aged spread. It was inevitable, you got older, your metabolism slowed, you slowed, you didn’t do the sporty outdoor things you used to, and you developed a sophisticated interest in and love of food that, in spite of the extra bulk and the gastric ailments, made life so much more je ne sais quoi than in your tenderfoot days. Genetics and the Zeitgeist are against you, so relax and just roll with the fat.
And yet, vanity was prevailing upon me to cut a more dashing figure before it was too late, and I was certainly keen to live longer. My weight had gotten up to 83.5 kgs, and I’m a shorty, at around 167-168cms, so according to that rough guide, the BMI, I was about half a kilo below being officially obese. So I decided to cut down on eating so much. No planned or organised diet, just plain old calorie restriction. I wanted to get down to under 80kgs at least, in the short term, and after that, well, just one day at a time as the cliché has it. if I could get my weight down to the mid-seventies that would be fantastic, but difficult, and unlikely.
Well, fast forward to the present, and my weight fluctuates daily between 68.5 and 69 kgs, and I’ve moved completely out of the overweight category to normal. Digestive and gastric problems almost completely gone, more energy, and above all a level of pride at my self-discipline that’s beyond price. It was a long slow road, but a fascinating one, and it was nothing but calorie restriction, and a daily handful of exercises out of the CSIRO heart book that did it. You watch, I’ll be struck down by a heart attack or bowel cancer tomorrow.
Anyhow, considering my pretty well seamless experience of gradual weight loss, I’m interested in an article in the most recent Skeptical Inquirer magazine which takes a look at the obesity issue and asks the question – is ‘energy balance’ really the problem, and the solution?
Don’t worry, I’m not talking about new-age energy derived from crystals or pyramids, I’m talking about the balance between calories consumed and calories burned off. Basically, the prevailing wisdom is that we eat too much (especially of the wrong kind of food) and exercise too little, and this imbalance causes obesity. It’s a prevailing wisdom that’s worked for me – though it’s difficult, as I’m now constantly at myself to forgo that piece of food and to get up and move around more. And there will be no end to that vigilance, till the day I die or give up caring.
Even so, I would be very sceptical of a silver bullet approach to this problem, though of course I recognise that calorie restriction just doesn’t seem to work for a lot of people, mainly because they just aren’t able to permanently change their behaviour. And of course many would argue that cutting down their food intake drastically would reduce their quality of life too much. The Skeptic’s Guide folks were saying in their last episode that their late mate Perry would probably prefer to die at twenty, scoffing down a hamburger, than live on 1600 cals a day. That’s a bit extreme, but you get the drift.
I’m not a calorie counter, and I’ve no idea of my basal metabolic rate, but I’d roughly guess that around 1600 cals a day is what I’m down to, and I’d also guess that the reason I’ve been able to change my behaviour is because it wasn’t so ingrained in me in the first place. I was a really skinny kid who was an almost unmanageably finicky eater. I hated almost all vegetables, and many different kinds of meat, and my mother had a terrible time, apparently, trying to find nutritious foods that I would eat. As I got into my teens I was pretty active and sporty and I really didn’t think about food much, though my childhood sensitivities about the stuff gradually faded. What spoiled me – though some would look at it very differently – was a job I took on in my early twenties as a kitchen hand in a prestigious French restaurant. The alimentation there was to die for, and the experience h my attitude to food, and the cooking thereof, for better or worse. Add to that the inevitable slow-down as sporty youth has been left behind, and my working life, such as it’s been, has tended more towards the sedentary.
So it’s a far cry from the battle facing the childhood obese, who’ve laid down heavy neural pathways connecting fatty, sugary foods with well-being and pleasure, or so I imagine. Or had them laid down by their nasty fatty parents. I seem to have recovered psychologically something of the more active spirit of my youth, actually managing to keep, largely, to a regimen of simple exercises – no gym fees – and some not-brisk-enough walking (I really do seem to have laid down an abundance of neural pathways for dawdling), as well as managing to switch off, largely, the lazy snacking-grazing habits of my latter years.
But to return to the article ‘Obesity:what does the science really say?’. There’s some argy-bargy, but it doesn’t really contradict the energy balance approach, as I see it, it just supplements and modifies it with more detailed knowledge about hormones, sweeteners, refined foods and the like.
Okay, the sugar issue has become a major bone of contention. Here’s a quote:
Pediatric endocrinologist Robert Lustig (2012) agrees that adiposity is a hormonal predicament. In his new book, Fat Chance, the child obesity expert indicts simple, super-sweet sugars as the chief culprits, arguing that sucrose and high-fructose corn syrup corrupt our biochemistry and render us helplessly hungry and lethargic in ways fat and protein do not. In other words, Lustig insists that sugar-induced hormonal imbalances cause self-destructive behaviours, not the other way round.
Australia’s fabulous Cosmos magazine had a headline article, ‘Toxic sugar’, late last year which particularly targeted the previously under-rated fructose as a major public health hazard. Obviously, if Cosmos is featuring this view, it must be right, though the article was nuanced and highlighted the debate as much as any particular position. Anyway, think fructose, think fruit, right? Well, yes and no. Fructose, of course, is found in sweet fruit, but how many kids gorge on sweet fruit these days, when they can drink litres of soft drink instead? High fructose corn syrup (HFCS), used in soft drink and many other products, is the major source of fructose in modern western diets – particularly in the US. It’s this intake that’s led to the huge rise in a particular type of liver disease, non-alcoholic steatohepatitis, as well as childhood diabetes. Fructose is ‘sweeter’ than glucose, and is added to many products because it makes them sell.
Fructose differs from glucose in that it doesn’t stimulate a direct insulin response from the liver. Lustig contends that understanding insulin is a major key to understanding obesity and a host of ailments which together constitute ‘metabolic syndrome’. Table sugar is made up of both fructose and glucose, though the fructose can go largely undetected, because it’s only glucose that we measure when we check blood sugar levels.
But really, how complicated and debated all this stuff is. Other researchers point out that, though teenagers might drink copious quantities of HFCS-laced soft drink, most adult intake of fructose is not enough to be problematic. In my own case, I don’t eat as much fruit as I’m supposed to (which is how much?), and I haven’t had a sweet tooth since childhood. In the sugar bowl in my kitchen, the raw sugar has turned hard as a rock for lack of use (I don’t get many visitors), and the same goes for the big jar of sugar in my cupboard. Still, the last time (in fact the only time) I had my general blood chemistry checked out – 18 months ago, when my weight was at its highest – my triglyceride levels, and my LDL cholesterol levels, were slightly raised. I suspect most of my sugars were obtained from starchy foods, particularly bread, which I’ve cut down on quite a bit. Carbohydrates such as bread, potatoes and pasta – all favourite foods of mine, but all of which I’ve cut down on sharply in the last 18 months – are made up of complex glucose-containing molecules, which are broken up by the digestive system to allow glucose to enter the bloodstream.
In any case, it’s easy for me to say how I tackled obesity, or the threat of it. My approach was fairly casual. I ate less, really quite a lot less, but particularly targeted carbohydrates and processed foods. Processed foods are a worry in two ways – they take up far less energy to consume, and they come with added sugar. As one researcher puts it, we just don’t require any extra sugar in our diet, our bodies produce enough of it for all our requirements. I’ve never really measured calories, I’ve just gone on gut feeling, pun intended. I have no way of objectively measuring my health – I don’t have the technology available to me. It’s funny, your body is like a ‘black box’. I’ve no idea right now of my blood sugar levels, my levels of insulin, leptin, cortisol and other vital hormones mentioned in the material I’ve been reading. I don’t know how my electrolytes are faring or whether there’s too much fat accumulating around my organs. All I’m able to measure is my weight. Even my greater feelings of well-being are entirely subjective. I could well be fooling myself. Still, in spite of the debates among dieticians and obesity researchers, the consensus is clear, and it seems they’re arguing more and more about less and less. Avoid fatty foods and sugary foods, perhaps especially the latter, because they play havoc with your hormonal system, creating addictive behaviours and insulin resistance. Generally eat less, and enjoy what you eat more, and keep up with moderate, regular exercise. An active life, both physically and intellectually, will help break the habit of psychological dependence on food. Try to get your ‘rushes’ and to feed your ‘satisfaction centres’ from some other source than food. Not very scientific, I know, but it worked for me – he added with a smug little smirk.
stress and resilience: what rats are telling us
I recently read that when you go to the dentist, an almost archetypal stressful experience, your stress will be massively diminished if the dentist tells you, before picking up the drill and attacking your enamel, exactly what he or she plans to do and why. It’s a finding that can surely be safely extrapolated to many other experiences in life, and, perhaps obscurely, it reminds me of the famous story by Franz Kafka, The Trial. K is arrested one fine morning, and he doesn’t know why and he never finds out despite his best efforts, and then he’s executed (excuse the spoiler). A classic literary exploitation of the horror of stress. It reminds me also of how our co-op was treated by its government regulating body, but more of that in later posts.
Kelly Lambert, a veteran stress researcher and rat-lover, describes our growing understanding of the impact of stress and how it might be avoided and treated as one of the most important developments in modern medical and health science. In The lab rat chronicles Lambert displays a pragmatic and down to earth view of stress and depression, with an emphasis on prevention and action rather than ‘treatment’ and medicalisation, which I heartily endorse, while always recognising that there are complex psychological factors that can weigh against individuals taking charge of their lives.
Lambert’s intriguing rat stories serve multiple purposes, of which altering the common view of rats (as pigeons sans wings) is not the least. She teaches us, I think, that we can and have learned a great deal from experiments with animals, and especially rats, but we need to treat them with respect – and can ultimately learn a lot more from them if we do. Among the things they can teach us about are resilience, endurance, reciprocity, social capital, healthy living and self-reliance, and no kidding. But it’s the subject of stress, and building up a resistance to it, that most concerns me here.
Our stress responses are of course necessary and valuable. They motivate us to save ourselves when under attack, or to perform the unpleasant task we must do as part of our job (the prospect of being sacked concentrates the mind wonderfully). Yet the negative physiological effects of stress are the same, whether you’re facing a charging elephant or an angry supervisor. So how do we maximise the motivating force of the stress response, while minimising the negative impact? How do we make ourselves more resilient?
My account here will be abridged – stress is a very complex subject, and I most certainly won’t be giving a full account of it. The first thing is to be aware of stressful situations, of the type I described at the top of this post.
Interestingly, the term stress as applied to humans, other animals and plants, is of very recent coinage, and it’s actually a misapplication from engineering. According to Lambert, in the 1940s, a famous researcher, Hans Selye, began injecting rats with a hormone extract to observe their responses. He noted a heap of immediate negative reactions including swollen adrenal glands, shrivelled thymus glands and stomach ulcers, and was keen to write them all up, but felt he needed more baseline data, so he tried the same experiment, this time using a saline solution to inject the rats with – a placebo, effectively. What he found was the same heap of negative responses. How could this be? It eventually dawned on him that his rough handling of the rats in order to inject them, as well as chasing the scared rats around the cage and dropping them from a height as they squirmed to get out of his hands – all of this was the cause of the adverse reactions. Selye was so intrigued by this that he ditched the hormone extracts and began running experiments to test the rats’ physiological responses to adverse events, deprivation, novel scenarios and the like. This was such a new direction in research that Selye had to find terminology from another discipline to describe the state of mind of the rats as evidenced by their physiological and hormonal responses. He found what he thought he needed in the literature of engineering, with its twin terms stress and strain, but, being a Hungarian reading in English, he appears to have misunderstood that the term stress was applied in engineering to the causal factors operating on, say, a bridge, while strain was a description of the effects of those factors on the strength and durability of the bridge. In any case, psychology had been gifted a new term, one which has been a major feature of psychology and mental and physical health research ever since.
As the evidence mounted for serious negative effects on subjects exposed to events now deemed ‘stressful’, more consideration was given to variation within the findings, so as to better understand resilience in the face of stress. Work done with rats exposed to novel scenarios has shown that the responses vary on a spectrum from neophilic at one extreme to neophobic at the other. That’s to say, when placed in a new environment, the neophilic rats will be happy to explore it, while the neophobic ones will exhibit avoidance and a degree of inertness. Another way to categorise them is ‘bold’ and ‘shy’, and whereas bold and risk-taking creatures (it’s almost inevitable to think of teenage male humans) can create their own physiological problems, such as broken limbs or death by misadventure, the evidence in rats is that they live longer, on average, than their risk-averse fellows. The research also indicates that having the right temperament, or somehow building it into our natures, is key to coping with the day to day stresses that can accumulate in affecting our health in a host of ways.
So how do we enhance boldness or neophilia – in just the right measure – to cope with the slings and arrows? And why is it that some rats and people are more neophilic than others? Not sure that I can provide clear answers to these questions, but let’s come back to them after looking at the rat studies.
First, we’ve all heard of homeostasis, right? It has something to do with maintaining your body temperature and internal environment within certain parameters regardless of what’s going on outside. Fine, but studies of stress and responses have added a new, related term, allostasis, to the physiological lexicon. Allostasis is not so much about stability as about appropriate bodily change in response to external stimuli. For example, if you suddenly consume a heap of chocolate, as I’ve been wont to do, you’ll be hoping that your body’s insulin-producing response is timely and appropriate. Neuroscientist Bruce McEwen, adapting another engineering term, introduced the concept of allostatic load, a reference to the strain on the body when it fails to adequately cope with a stressful experience, whether it be heavy lifting or the deaths of loved ones. Both the general concept of stress and the concept of allostatic load were developed by researchers observing the responses of rats.
McEwen injected rats with the stress hormone corticosterone for 3 weeks, and then looked for changes in the hippocampus, an area which contains many glucocorticoid receptors, implicated in stress-related responses. The hippocampus is a region essential for spatial learning and memory; it would stand to reason that stressors and memory need to be associated for effective response. The added corticosterone had the effect of reducing the connections and size of the neurons in the region. How did this downsizing affect memory and learning?
McEwen first tried to replicate this effect on the hippocampal neurons by means of stress. So instead of corticosterone injections, he placed the rats in a ‘Plexiglas restraint tube’ for a couple of hours a day for 3 weeks. The physiological changes were similar to those induced by the hormone injections.
Another stress experiment was tried by Lambert to see how quickly the brain could be affected. Rats were housed in cages with adjoining running wheels, and their food schedule was restricted to one hour of feeding a day. The rats responded by becoming more, rather than less, energetic, running frenetically and showing all the signs of stress first noted by Hans Selye – swollen or shrivelled glands and stomach ulcers – and shrinking of neurons in the hippocampus. But the shrinking of neurons in all these experiments was reversible, and Lambert considers that this shrinking is probably an energy-saving manoeuvre of the brain. Brains take up a lot of energy, and may react to increased hormone production by downsizing to prevent overload.
Returning to the temperamentally bold and shy rats, I’ve noted that the shy ones have shorter lives – 20% shorter on average. Not surprisingly, the bold rats’ hormones returned to base levels more quickly after stress than their shy kin (and often they were actual kin). Clearly, having a more exploratory nature, within limits, is more adaptive than being exploration-averse. Freezing and worrying over novel scenarios isn’t a healthy option.
Lambert and her students became interested in pig studies in which piglets, held on their backs for a brief period, reacted either by struggling to escape or by holding still. The struggling piglets were labelled proactive and the apparently passive ones were labelled reactive, but a second test showed that some of the piglets changed tactics. Lambert’s group tried the experiment with rats. They found that some rats were extremely active, some extremely passive, and some switched tactics from one test to another. The last group was labelled as variable or flexible copers. The question was, had this group learned something between the first and second test which had made them change their behaviour?
After the tests, the rats were put through an activity-stress program in which they were given a restricted feeding schedule and then were given a choice between running on a wheel or resting. The proactives and the flexible copers ran more than the reactives. The levels of stress hormone were measured in each group. The proactives had more elevated stress levels than the reactives, but, quite surprisingly, the flexible copers had considerably lower stress levels than both the other groups.
In another simple test with the same rats, clips were placed on the rats’ tails to see how long they would persist in trying to remove them. The flexible copers persisted longest, and generally interacted more with novel stimuli.
The rats were then tested for how they coped with more chronic and unpredictable stress, of the kind that might be compared with serious economic downturns as experienced in the US recently, not to mention Greece, Ireland and other countries. The rat equivalents were strobe lighting, tilted cages, vinegar in their water, and predator odours. What was found with these and other tests was that the flexible copers’ brains produced higher levels of neuropeptide Y (NPY), a neurochemical associated with resilience (special forces soldiers produce a lot of it). The flexible copers also had the highest levels of corticosterone, which assisted them in maintaining a constant state of readiness to meet changing challenges.
So, how to turn rats – and people – into more resilient, flexible copers? Perhaps a bit of training might be required. An experiment was conducted in which the profiled rats were assigned to two groups, a ‘contingent training’ group, in which reward was contingent on effort, and a control ‘noncontingent training’ group, the trust fund rats. It was expected, or hoped, that the passive and more stressfully active rats in the contingent training group would, feeling an enhanced sense of control over their environment, increase their NPY levels and generally behave in more resilient ways. The contingently-trained rats, regardless of their coping profiles, all performed better at trying to get rewards (froot loops!) out from inside a cat toy (the task was impossible, but they were being tested on persistence). So far so good. Next, the rats were asked to perform a swim test, which I won’t describe here, but the results were excellent for the flexible copers, who improved their performances even more (and had higher levels of the hormone DHEA, associated with resilience), but the other two profile groups didn’t improve. A disappointing but not entirely surprising result.
A more interesting result came out of the control group. The flexible copers in that group, after a regime of easy benefits, reduced their willingness to make an effort when confronted with the need to do so to gain rewards in subsequent tests. I’ll quote Lambert here at some length:
Instead of having no effect on the coping responses, the trust fund condition erased the advantage typically shown by the flexible copers. The lack of a predictable contingency formula accompanying the presentation of life’s sweetest rewards reset the behavioural computations underlying the rats’ motivation to work for their rewards. They were now characterised by less flexibility in their responses and a shorter tolerance for work that didn’t immediately produce a reward. Had we systematically spoiled our rats? Once again, animals that were more sensitive to associations between effort and consequences would likely be even more affected by the trust fund noncontingency condition; after the fact, it all made so much sense.
So what can we take from these complex but often striking findings? Of course it goes without saying that we’re not rats, but I also like to think it goes without saying that these findings are highly relevant to humans, and all other mammals. Above all we find that removing us from a state in which we have to strive for rewards tends to make us slothful, intolerant and complacent – ‘spoiled’. A term which now has added resonance. How we build in that resilience in the first place is another question – it might be that very early experiences in which we’ve made positive connections between effort and reward, strongly reinforced from time to time, make for a kind of ‘natural’ resilience which we wrongly consider innate. This has always been my suspicion, that the earliest experiences, even in the womb, can set a strong pattern, which is what we’re talking about when we note that a baby seems to have already a set character, whether timid or ebullient, from birth. That character, when it is ‘resilient’, can be spoiled, so that’s something to watch out for. And as to how a set character which is non-resilient can be transformed into a flexible coper, that’s a tougher problem, as you’d expect.
What I like about Lambert’s approach is that she’s always looking for how we can improve our well-being without resort to medications, ways of positively altering our hormone regulation system through behavioural change, rather than through resort to pills. As she points, the use of anti-depressant medications has sky-rocketed since the mid-nineties, as have diagnoses of depression and related disorders. Something’s definitely wrong here. You’re not likely to increase resilience with pills. The good thing is that more and more researchers are coming to realize this, and looking to behavioural change, from exercise to social interaction to the creation of challenges and rewards, for the answers.
What is reflexology?
I have to say I began to write this piece without the slightest inkling of what reflexology might be.
So now I know it’s about feet, and other bodily parts – mostly extremities – and how they have zones which correspond to internal organs. Presumably applying pressure to these zones cures things. Very big in Denmark, apparently. It’s generally promoted by its adherents and practitioners as an ancient healing system, but little seems to be known of its origins, though this quote from one Aulus Cornelius Celsus, a follower of Hippocrates, is suggestive:
Much more often, however, some other part is to be rubbed than that which is the seat of the pain; and especially when we want to withdraw material from the head or trunk, and therefore rub the arms and legs.
So how can rubbing these zones have an effect on ‘corresponding’ organs? Well it seems there’s a lot of dissension and just plain vagueness about all that, but one common theme is that qi, the Chinese life force, provides the connection. As to the existence of qi, that’s another question, but needless to say it’s an empirical question, for it could only exist in a real sense, not in some supernatural, unlocatable and unmeasurable sense.
However, we needn’t worry about any dodginess, because the Reflexology Association of Australia [RAoA] has a website, with a link to the independent research done to prove its bona fides as a treatment.
Well actually, no, the link only takes you to the email address of the same RAoA. The website also has a left sidebar of links, including one to research, but that one’s greyed out, and doesn’t link to anything. Interesting. You’d think reflexologists would want to be promoting research into their practice, considering how effective they claim it to be. One of the other links is to ‘reflexology articles’, and it takes us to seven linked essay titles. The first is a very brief piece called ‘Importance of A&P [Anatomy & Physiology] and Clinical Medicine for Reflexologists’. Here’s how it begins:
As with any evolving profession, in the beginning, there were very few practitioners who had much knowledge of how the human body worked as the ‘hands on’ practise of working the feet was passed on by family members and anyone else who was interested in learning for their own benefit. As long as they knew where the points were on the feet for specific parts of the body this was considered sufficient at the time. Besides, there were very few avenues and incentives available for people to learn Anatomy & Physiology for their own continuing knowledge.
So we learn that reflexology, in spite of claims to its antiquity, is ‘an evolving profession’, though presumably we could say the same about medicine generally, so there’s not much meaning n the phrase. The Biblical phrase ‘in the beginning’ doesn’t cast much light either. Could be a generation ago, or several thousand years ago. What we do learn is that family knowledge has been passed down as to ‘where the points are on the feet for specific parts of the body’, though sadly we get no details as to these points. Why not throw in an example or two. I mean, it’s not a secret – is it?
In any case, nowadays, there’s a clear avenue for the study of anatomy and physiology. It’s called a medical degree. But that’s not what this article’s author has in mind. She simply claims that it would be a good idea for reflexologists to be up on modern clinical terminology, and even writes about a high standard of knowledge, but nowhere does she explain how this standard is to be achieved. The ‘Certificate of Clinical Reflexology’, unit descriptors of which are downloadable from this website, is made up of some 20 units, of which only three or four actually deal with reflexology as an application of medical knowledge. The others deal with business and admin matters, or such general subjects as ‘Personal Wellness and Self-care’ or ‘Work effectively in the health industry’. I’ve carefully perused those few essential units, and they provide no training in general anatomy and physiology whatsoever. Considering that the central claim of reflexology – that certain pressure points in the foot and elsewhere correspond to the organs of the body – is a clear claim about physiology, this omission is more than slightly disturbing.
But let me return to the article quoted above, to seek enlightenment. Here’s another little quote:
Even though, in most circles, Reflexology is considered to be working with body energy, it is extremely important to have a very sound knowledge of the human body to improve the practitioner’s ability to understand client problems and therefore fit the pattern of working to fit the problem.
Now do you get it? What we have here is an enunciation of the principal of complementarity. You see, another term for naturopathy is complementary medicine. That’s because these alternative treatments are complementary to mainstream treatments. It’s essential to understand mainstream anatomy and physiology so that you can ‘fit your pattern of working to fit the problem’ as defined by mainstream medicine. Not that reflexologists are riding on the coat-tails of mainstream medical practitioners – heaven forfend. After all, they’re working with ‘body energy’, not with just bodies, as anatomists and physiologists do.
So what is this body energy? Well, that may depend on the philosophical approach that guides your reflexological practice. And there are plenty of approaches to choose from. The unit entitled ‘Reflexology framework practice’ has this:
Philosophies relating to reflexology may include:
• TCM Five Element Theory
• Yin / Yang
• Indian chakra system
• Interaction of mind-body systems
• Holographic Theory
• Quantum Mechanics of Healing
• Polarity
And presumably they may also include much else. Clearly reflexology is deeply philosophical, possibly impenetrably so. In fact, I really feel too over-awed to continue.