Children’s Brain Are Indeed Harmed by Poverty

A very recent article in the Wall Street Journal published in its weekend edition of May 16-17, 2015 entitled “The Income Gap In the Growth of Children’s Brains,” penned by Ms. Alison Gopnik in the column entitled Mind and Matter,

After 30 years of Reagan style “Trickle Down Economics,” which as my biased mind understands it, jobs are created for the workers further down the employment food chain, when the wealthy get wealthier and spend great amounts of their monies starting more factories, thereby “manufacturing” more jobs for the non-CEOs among us, which is apparently the majority. The only trouble is, most of the new factories have migrated for three decades out of this country to the Third World’s developing economies with labor costs approximately 1/20th of the American economy’s. Consequent to this, millions upon millions of children have entered the state of poverty in numbers not seen since the segregation era. Now comes what I believe will the first wave of scientific study that will talk about the white elephant in the room, the damage done by poverty status to the developing brains of very young children who cannot pull themselves up by their Reaganomic bootstraps and pull themselves out of their worlds in no money for school lunch, mayonnaise and margarine sandwiches; and forget about all the other essential but costly “food groups.”

The white elephant that has been so hard to talk about directly and for some quarters who do not accept that social factors can be supremely cruel causes of social problems, who view sociological explanations of societal unrest, periodic but predictable outbreaks of massive social unrest [read RIOTING and all that goes with it…] as being heresy against ‘the American Way’ and belief system that ‘anyone can make it’ if they are determined enough.

Ms. Gopnik’s summary reports on an MIT study headed by John Gabriell and colleagues demonstrated in a controlled, comparative study that low income children had consistently thinner layers of their cortices, the other layers of the advanced areas of the brain, the cerebral cortexes ( or more properly speaking: cortices ) that perform many of the higher functions of the brain. These effects were tellingly independent of being a member of any ethnic or racial group. The measures of cortical functioning, intelligence, cognitive processing, etc., were lower in children with thinner outer cortical layers.

Brain development correlating with higher cognitive functioning has been studied in many animal models since for over 60 years in the neuroscience research communities in scores of major universities. We can now state with complete confidence, that the brain is a wonderful “plastic” organ. This means that the brain has the unique ability to make itself over, remake itself, and spur its development in different directions in response to the type of experience the host animal/child goes through in its formative development. Whether the organism is the primitive flatworm, the staple of experimental neuroscience: the “lab rat,” or the higher mammals, i.e., primates, the early experiences of that organism’s social and environmental experience drives the brain development. Experiments since Harry Harlow’s deprivation of baby monkeys from the reassuring holding by their mother, produces tragically socially deficient, sad, depressed, fearful monkeys as they matured. The concept of periods of “critical (brain) development came to be well accepted dogma in our understanding in the interplay between brain and experience. Rene Spitz the famous French pediatrician in Paris of nearly a century ago discovered the same phenomenon in human infants. These children were ‘housed’ in individual cribs in ‘foundling homes,’ or orphanages in our modern parlance. These infants and toddlers had atrociously low contact with a mothering figure. The nuns routinely cared for up to 60 infants at a time. They could only spend enough time to change diapers or bathe these children and little else. No individual play, reading or cuddling, rocking or singing. These children were found to have the then termed syndrome of “infantile autism” or “depression,” and demonstrate the sad phenomenon of “ruminating,” in which they would regurgitate their feedings into their mouths, chew it over and over again, so starved for soothing self stimulation were they.

We also know that developing immature organisms, whether baby rats, other mammals or infant-toddler-preschool children do less well with exposure to violence, chronic stress and/or existential uncertainty that comes from not knowing if one’s parent will be sober, i.e., awake or able to feed one, from one dad to the next.

Factor into this malignant development recipe for any vulnerable child, the inability of the family to afford even the most modest learning experiences, no Golden Books, no LeapPad, no television upon which to watch the wealth of early childhood learning programs that got their real start with Children’s Television Workshop’s famous Sesame Street. And you have an under-stimulated child’s brain at a time when it is needed most and most receptive to such that accelerates social and intellectual development.

And this finding highlights once again from a different perspective the enormous importance of the HeadStart educational programs of all kinds that start educational-social experiences of the post toddler. One can never start too early to enrich the developmental experience of the very young.

 

Mass Shooters Are Less “Psychotic” Than Commonly Believed

One of the very understandable, beliefs, and possibly myths, about the past few decades of mass shooting incidents this country and others have suffered in a seemingly increase in occurrence of these horrific events, that most if not all of the shooters are “crazy,” or psychotic, actively mentally ill, deranged or just plain “off the chain.”

One of the earliest riveting examples of this was the ?Long Island Railway shooter of a number of years ago, who went on a shooting rampage killing a number of passengers randomly. It did turn out that he was indeed very psychotic and had been suffering from a major unchecked psychotic disorder, and that his shooting rampage was delusionally driven. This came out at his trial very clearly through testimony. His case was one of the national consciousness level cases that locked this sometimes erroneous impression into the national psyche and elevated  such a rare fluke like event to a nearly universally accepted knee jerk easy explanation whenever another of these incidents occurred. This was driven by the reassuring power to all of us at some level that we were ‘by odds’ safe from ever coming into the sights of such a rare individual.

However this method of distancing ourselves from the arena of the fantasied “remote” possibility of such a tragedy touching our lives was strained as it seemed that seemingly an everyday Joe husband, with over controlling jealous though often unsupported rages killing their  wives were found not to be mentally ill and acting out of a different social phenomenon. The beginning of the school shootings, perhaps the one of Arkansas a number of years before Columbia in which literally a young middle school student commandeered his family’s rife and started sniper shooting at his school mates began to jolt the national explanation out of credibility and point toward a more unsettling state of affairs, that one did not have to be stereo-typically “nuts,” crazy,” or psychotic, that ordinary persons including kids could suddenly be moved to commit such horrendous acts.

It started to be harder and harder to maintain as the automatic self reassuring explanation that made one feel safe if one was able to attribute the cause of the next incident to a mental vision of the very rare deranged killer who popped up out the lottery bowl ping pong ball numbers making their appearance “against all odds.”

Now comes a study that proves that psychotic symptoms, the behavioral and mental markers, identifiers, characteristics and legally accepted criteria for psychotic mental illness mostly are NOT present in the make up or motivating factors of mass shooters and are NOT the driving cause for their shooting episodes.

This article entitled “Hallucinations Rarely Precede Mass Shootings, Originally Posted by Yasmin Anwar-UC Berkeley on May 13, 2015,” makes for enlightened reading and offers welcome, though unsettling, additional information and increased basis for understanding somewhat more fully the motivations of the modern mass shooters from teens to adults. The research  proven fact derived from interviews post shooting acts conclusively shows that the vast majority of mass shooters did not have psychotic symptoms such as delusions or hallunications driving their acts of mass shootings as is more and more commonly thought by the public and it seems by our all too superficial national media in their hyperdrive for easy explanations for the news events that cover endlessly to fill the bottomless pits of 24 hour a day news cycles.

Some of the more relevant and somewhat startling points of counterintuitive knowledge include:

that a literature review of over 300 violent incidents in the United States found only 12 percent occurred in the setting of active psychosis and were derived by the false beliefs an perceptions that are part and parcel of actively psychotic mental states.

Other foundations and reasons for such violence involved brutality, anger toward separated spouses, rampant substance abuse and access to firearms at the times of heightened stimulant states to violence. These were far, far more common precipitants to mass violence than elements of psychosis.

“High-profile mass shootings capture public attention and increase vigilance of people with mental illness,” says lead author Jennifer Skeem, a clinical psychologist and associate dean of research at the School of Social Welfare at the University of California, Berkeley, stated in the study: :our findings clearly show that psychosis rarely leads directly to violence.”

Researchers focused on the most violent patients tracked in the MacArthur Violence Risk Assessment study, a major 1998 analysis of more than 1,100 offenders who had been discharged from psychiatric facilities.

Specifically, they looked at a subgroup of 100 high-risk patients, who had been involved in two or more violent incidents in the year after they were discharged from a psychiatric facility, to establish their mental states at the time they committed acts of violence.

“We wanted to examine the small group of people with repeated violence and see how consistently these violent incidents were caused by hallucinations and delusions,” Skeem says.

In a preceding study headed by Dr. Skeem, records of prior mentally ill offenders who has committed severe acts of violence were interviewed about what they were thinking and feeling immediately before they engaged in the acts of violence; as an additional source of corroborating data, the retrospective information their friends and family members had to contribute about the times of the offenses were collected.

The very telling finding was proven that psychosis occurred prior to the offenses and multiple violent acts in only 12 percent of the violent acts these patients who had been incarcerated for their offenses following their release for these acts!  Far more telling was the finding was the common circumstance that in subsequent violent acts in these offenders whose prior acts HAD been committed in states free of mental illness.

For the last few months in the Boston Marathon Tsaronov trial and the Batman Theater Killer shooting in Aurora movie theater trials, we have been and will be further subjected to the confusing airing of definitions of psychosis in legal terms, whether the shooters were suffering from mental illness or not. There may even be yet another “battle of the experts,” of forensic examiners who draw diametrically opposed conclusions about the mental mind set of James Wilson, Colorado shooter. These cases usually further confuse the public who cannot be expected to be intimately familiar with the complicated and subtle fine points of legal definitions of insanity as it relates to legal culpability. Yet these differences between the long evolved legal historical bases of legal insanity and psychiatric clinical definitions of insanity/psychosis have been essential for rational use by the criminal justice system to make functional decisions of such portent.

These trials and the inevitable future similar trials as further perpetrators of mass shootings and murderous violence, will hopefully gradually elevate the public’s grasp of the bases for our country’s determinations concerning these baffling and crimes with causative factors that almost always involve factors and long evolved highly personality motives outside the experiences of nearly all of the rest of us.

 

The End of Grade Tests, Opting Out of Testing and the Example of Korea

This article should be entitled “The Education Race,” or something similar. This past week media news again bubbled over with a story on parents’ all over the country opting out, or refusing to have their children tested in the upcoming “End of Grade” or “EOG” tests. I saw an article about Korea’s educational system that is rigidly test results driven and would commend it highly to the reader.

One professional tidbit that helped this disquieting article about the growing trends in American education, is that for many years I have taught my medical and psychiatric trainees about the cultural dimensions to the world wide phenomenon of suicide. In the last decade or more I have included the mostly modern example of the religious or suicide bomber form of killing oneself. But I have more strongly cited the phenomenon in the test and admission into college countries such as Japan and Korea as a unique, culturally specific example of suicide. This is the annual jumping off of buildings from skyscraper windows in decades past in May when aspiring students are not accepted into the premier colleges in the their countries such as Tokyo University. Japan as part of its strengthening of its tall buildings’ codes to withstand earthquakes, mandated that windows in tall buildings could not be opened from the inside to prevent the young distraught, depressed, suicidal aspiring but rejected student from opening a window ten floors up from the street and jumping by the dozens to their deaths every year during admissions acceptance letter season. Nowadays the students tend to jump from tall open parking structures since many buildings no longer lend themselves to jumping from heights as they did, say in the 1970’s when this was an annual tragic news story.

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Stalking, the Next Dangerous Aberrant Gray Zone Mental Health Malady

This week the British paper, The Telegraph, published a well done article on malevolent stalking. Entitled “Rejected, obsessed and erotomanic: Inside the mind of a stalker,” it gives a well done examination of a current British case currently undergoing legal prosecution. It makes for informed reading and is still somewhat chilling. Among its relevant points are that a very substantial proportion of cases repeat their offenses and dangerous, terrorizing behaviors, even after being convicted and punished. They are not the ordinary ‘criminal recidivists, as they learn nothing from the punishment experiences but are largely NOT the psychopath who learns nothing from experience…These folks are different and still not well understood by my discipline. The psychotic ones are often fairly easy to discern in evaluations. The others are the products of family training by abusive parents, and the products of their unique personal developmental experiences which makes everything “imprecise,” and individualized.

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I’m Vaccinated and Proud and Thankful of it

For months now, I have been mulling over in my mind, writing a number of posts on the anti-vaccination movement, both historically going back to the days of Joseph Lister and the original cowpox experiments, and the recent anti-vaccination movement in this country.

At this outset I will reveal my biases about vaccination in the interests of so-called “fair and balanced reporting” our modern catch phrase in the media that claims impartial reporting in the various media. I am a physician first and a psychiatrist second. I believe in the “common weal,” the common good as a physician who believes in the value of public health prevention. Otherwise we would have open sewer channels in the streets of congested urban areas as in the times of Charles Dickens, and horse droppings in the streets, public sewer systems and so on. I still hold comprehensive, accurate and impartial food inspection systems are vital to a society’s health.  I thoroughly believe in public health screenings in public schools, for instance for vision, for aggressive mammography screening programs for women for breast cancer. I believe firmly in the concept of “herd immunity,” as vital to public health efforts. I support the Bill and Melinda Gates’ Foundation’s efforts to vaccinate the vulnerable populations of the Third World, countries with almost nonexistent public health systems, to vaccinate populations to eradicate malaria. Continue reading