Friday, January 28, 2011

Practices and Processes

Last week's discussion fluttered around a vague notion of practice as invigorated (and invigorating) strivings of the heart and soul which are deeper, fuller and richer than the aims themselves or the final results achieved. Today, I'd like to shift gears toward contemporary understandings of the embodied mind which I feel only serve to reinforce this ambiguity.

The human brain is the great instigator, processor and archive of our practices. But the brain is plastic, and is constantly reshaped by the very practices it executes. Nowhere is this cycle more apparent than in the impact of the substances we choose to put in our body.

In Nick Reding's Methland, the brains of "regular folks" like you and me are disturbingly distorted over time by repeated decisions to ingest methamphetamine. In extreme cases, the result is delusion and depravity, manifested in formerly unthinkable acts of perversion and violence.

Out of context, these anecdotes can be dismissed as the desperate and irrational behavior of the criminal and/or insane. But Reding's more fully developed depictions of chemically-induced falls from grace raise troubling questions about our brains' (not to mention our hearts' and souls') vulnerability to destructive forces.

Our diverse collective of undergraduates, grad students and professors gathered Wednesday night for the second meeting of Emory's first university-wide course to hear two very different kinds of experts on the nature of drug abuse, addiction and treatment shed light on this issue.

The first, Dr. Michael Kuhar, shared his conclusions from basic research with animal subjects. Given the opportunity, all kinds of different species will abuse all of the substances we abuse (except hallucinogens whose disorienting properties are apparently not so appealing to monkeys).

All of these drugs have very different properties (depressants, stimulants, etc.), but they all give us pleasure by producing the biochemical rewards our brain normally gives us for performing behaviors which promote survival and propagation: eating, hydrating, exercising, and yes, having sex. So, like all these natural practices, they make us feel good.

Of course, human beings have been getting high on various things for thousands of years across many, many cultures: drinking wine, tea and coffee, or chewing coca leaves, for example. The carefully regulated electro-chemical system is altered, and the brain adapts to reestablish equilibrium. Sometimes the changes are rather mild and manageable, and sometimes there are radical and destructive changes which we call "abuse." Thus, "the addicted brain is a different brain."

Modern processing methods have simply upped the ante. Synthesized, ultra-concentrated drugs like cocaine, heroine and meth don't just stimulate our brain's natural reward system, they completely overwhelm it.

From Kuhar's pragmatic perspective of expert manipulation of chemical processes, addiction is a biochemical imbalance which can be treated with ironically, more drugs, just as we treat mood disorders such as depression and anxiety. The problem isn't moral, it's biochemical. Dr. Kuhar also suggests the same root cause and solution for people who are obese or addicted to gambling (whose brains look remarkably similar to drug addicts when scanned with an fMRI).

But from the perspective of Dr. Karen Drexler, an associate professor at Emory Medical School who treats drug addicted veterans at the local VA Hospital, neither the problem nor the solution are so straight-forward.

Dr. Drexler pointed out that neurotransmitters like Dopamine don't just make us feel good, they focus us and sharpen our senses, preparing us to successfully execute survival promoting tasks, such as recognizing and killing game in the wild. Thus, drugs don't just hijack our brains' reward system, but our instincts themselves.

You may stop abusing a drug. Your brain may even generally restore normal chemical equilibrium after some months. But the moment you take a puff, your brain "thinks its meth hunting season again" and the well-developed meth-hunting system reemerges to plunge the recovered addict back into addiction. Dr. Drexler has seen it a thousand times, and that is why she endorses the Alcoholics Anonymous doctrine of "once an addict, always an addict" and encourages her patients to participate in Twelve Step programs.

I asked Dr. Drexler after her presentation how she felt about framing addiction as a moral issue. She said it could be dangerous if the addict is too ashamed by his/her "weakness" to seek help. On the other hand, the success of AA and Narcotics Anonymous demonstrate the effectiveness of admitting one's powerlessness over the preferred drug and soliciting moral resources from a "Higher Power."

One thing that neither expert was able to shed much light on is how we can determine whether a certain practice is addictive or not. It may be pretty clear at the poles, but the expanse between addiction and utility is wide and nebulous.

Our third visiting professor, associate professor of psychiatry Charles Raison suggested that it is helpful to think about drugs as an invasive species that threaten to create an "experiential monoculture" which ultimately deprives us of the ability to enjoy other, more natural experiences. This metaphor seems perfectly appropriate to describe the experiences of the meth addicts in Reding's book.

Now, it may seem obvious that smoking meth or shooting up heroine is stupid, self-destructive. It's tempting to conclude those who do so repeatedly despite life-destroying consequences are simply fools or weaklings or both.

But Dr. Raison suggests that we are all exposing ourselves to less overtly sinister "invasive species" all the time: in the "processed food-like substances" (to use Michael Polin's terminology) we eat, the polluted air we breathe, the hazardous chemicals in our environment, even the medications we ingest.

We all share the struggle to limit our intake of destructive substances and establish a pattern of life-promoting practices.

My sister, Ginny Johnson, has become increasingly committed to perfecting her pattern of practices, pursuing education in integrative nutrition which has recently given rise to a new consulting career. Her powerful passion for real, life-giving food (as well as exercise and spiritual practice) and her gentle way of expressing her refreshing blend of idealism and pragmatism have convicted me to gradually improve my own diet.

There are wins and losses. I may have passed up a doughnut for a bowl of granola and a banana this morning...but I relapsed this afternoon, lacking the will power to resist a Dr. Pepper a bag of Smartfood popcorn (which is not actually not that smart, but very addicting). My caffeine dependence is disconcerting. And let's just say I've not always known "when to say when."

I may not be living for any of these substances, but I know that I could use some of that "Higher Power" help to align my consumption practices more perfectly with the strivings of my heart.

You are what you eat (and drink, smoke, etc.). Literally. How are you remaking yourself today?


  1. Predictably, I think all of this is fascinating (and I sincerely appreciate the complimentary shout-out, little brother!). I love how you frame these three perspectives -- there's so much here that it's almost hard to get my head around. I think what I most land on is the idea of short-term vs. long-view "biochemical rewards." As you point out, addictive behaviors mimic those rewarding brain processes that come from split-second decisions that are species-sustaining (we need glucose to survive therefore sugar tastes and feels good; sex is clearly the most obvious one). But is there a way to measure the deeper, more subtle rewards of making decision after decision that is good for you, long-term? Can you tell from an MRI if a brain belongs to a more deeply, truly content person, I wonder?

    Because it's what I love and know, I'm thinking about food and nutrition here. At its core, eating well is an act of self-love which has physical, emotional and spiritual implications. But the positive effects of making healthy choices take a while to show up and manifest themselves in the form of a more truly nourished existence whereas, unfortunately, Smartfood (you are correct, not smart at all) and a Dr. Pepper taste delicious that VERY SECOND. Similarly, sex feels great but the give and take of a truly committed, monogamous relationship is much more rewarding and makes you feel better about yourself than sleeping around.

    Perhaps when you make consistently good long-term choices and engage in self-strengthening practices (healthy diet, exercise, meditation), you're giving yourself a stronger and more solid equilibrium to start from. That way, the brain is less likely to get over-excited (and hooked) when you introduce a "reward-giving" addictive substance. Just a thought...

    Thanks for getting my brain spinning happily today! Also, eat your vegetables.

  2. I like this post, Scott. It demonstrates the importance of developing a solid prefrontal cortex to associate the reward network you are talking about with activities that have delayed rewards while dissociating it from activities that are rewarding in the short term but unfulfilling in the long run. (Easier said than done.) It would be interesting to think about religious practices that might help enable this kind of neural development.