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Breaking Down Addiction Into Its Constituent Parts: Neuroscience, Incentive Salience, Environment, and Habits

Dr. Daniel H. Lende

Daniel Lende is an associate professor from the department of anthropology at The University of South Florida. He was trained in medical, psychological, and biological anthropology and public health at Emory University in Georgia. His research interests revolve around substance use and abuse, behavioral health, stress, cancer, post-traumatic stress disorder, embodiment, interventions in behavioral health, and risk-factor epidemiology. He has done fieldwork research in both Colombia and the United States. Dr. Lende and Dr. Downey (the other author of our class book) started Neuroanthropology, which is one of The Public Library of Science (PLOS) Blogs.

Addiction and Neuroanthropology

“Addiction and Neuroanthropology” by Daniel H. Lende is a multifaceted explanation of the neural and cultural processes intertwined in drug seeking behavior and addiction. A difference between Colombian ideologies of addiction and North American ideologies is that in Columbia, the problem of addiction doesn’t revolve around pleasure. In Columbia, addiction defies their basic social value, which is protecting family, friends, and the community. In this context, addiction is problematic because drug seeking and using surpasses basic social values. In the United States, however, pleasure is one of the main concerns about addiction. It is viewed as a disease that develops due to one’s biology and self-control. Lende uses both a combination of previous neuroscientific evidence in conjunction with his ethnographic fieldwork to explain how addiction is not a problem of pleasure or the self, but a neuroanthropological conglomerate of a host of factors.

Lende states that addiction is composed of two parts, the compulsive desire for a drug and the drug habit that is formed. Addiction, according to the Diagnostic and Statistical Manual (DSM) consists of four parts. The first criteria are that addiction involves the experiencing of tolerance and withdrawal. The second discusses how addiction also involves continued drug use despite their impact on health and one’s social life. The third further explains addiction as the persistent desire to use drugs after multiple failed attempts at controlling use. Lastly, the fourth criteria are about how drug use interferes with daily life and roles and obligations are neglected.

So, what drives the actual behaviors associated with addiction? The 1993 theory of addiction proposed by Robinson and Berridge claims that incentive salience is the reason for addiction. This theory led to widespread belief that the mesolimbic dopaminergic pathway was singlehandedly responsible. Lende proposes that this view of addiction is problematic and desire and involvement, or the cultural aspects of drug use, are a couple of the components missing from this explanation.

Neuroscience and Addiction

Previous studies have shown us that addiction involves many interconnected brain areas such as emotion, memory, and choice. Addiction encompasses the basal brain, which is involved in body regulation and activation, limbic circuits associated with emotions and environmental processing, and frontal cortices, which are associated with executive functions such as control, planning, and organization. The neuroscientific aspect of the pursuit of drugs and the repeated use of drugs involves two parts of the mesolimbic pathway, the ventral and dorsal striatum and the ventral tegmental area.

Incentive Salience and Addiction

Reward theory states that environmental stimuli shape animal responses. Berridge and Robinson believe that there are three facets to the reward process. The first is liking, or the hedonic impact, learning, or making predictive associations, and lastly, wanting, or incentive salience. Incentive salience is a type of “wanting” that involves goals, expectations, and future outcomes. Salience, however, is still not the complete picture because desire and involvement are both biological and cultural. Incentive salience is mediated by both the nucleus accumbens and the ventral pallidum. Furthermore, individual experiences, the presence of cues, social contexts, and environmental influences all produce different patterns of firing resulting in differences in salience signaling.

An example that provides a better understanding of the behavioral side of the explanation is adolescent drug use. Students with problems in their home life and academic problems at school see few options for fun, success, or a sense of involvement in either of these settings. When rewards from school and family are absent, these two contexts become irrelevant and lose their incentive salience, therefore, students seek other options and other realms where rewards are provided and incentive salience is present. As Berridge et al. (2009) would sum it up, incentive salience is about a subjective sense of “this matters,” rather than conscious desire. Incentive salience is about the motivation of drug seeking rather than the appreciation of wanting or desiring drugs.

Neuroscience and The Formation of Habits

Habits, as defined by Graybiel (2008), are “learned, repetitive, sequential, context-triggered behaviors performed not in relation to a current or future goal but rather in relation to a pervious goal and the antecedent behavior that most successfully led to achieving that goal.” Habits are a product of both behaviors and neurobiology.

Neurologically, learning about the rewards associated with drug use activates the ventral striatum. As drug use becomes persistent and repetitive, a neural activation shift takes place from the ventral striatum to the dorsal striatum, where activation here serves to maintain drug seeking and drug using habits. Due to this shift, the ventral striatum, which serves to evaluate outcomes and consequence of behaviors, no longer serves its function and behaviors are mechanically produced. Despite increased tolerance, habits mediated by the dorsal striatum become resistant to change regardless of the rewards reaped by that behavior.

An example of this is extinction training in lab rats. Rats trained to press a lever that delivers drugs exhibit neurobiologically mediated behaviors associated with the dorsal striatum. When placed in a different context where lever pressing does not yield drugs, rats continuously lever press although no drugs are administered. Only when the dorsal striatum or nucleus accumbens are lesioned do rat lever pressing behaviors cease.

Behavior and The Formation of Habits

This neurological explanation leads people to believe that addicts find little pleasure in continued drug use. However, behaviorally, drug use may still be a rewarding activity. The social interactions associated with drug use are rewarding despite the blunting of the pharmalogical effects of the drug. Once addiction sets in, oftentimes familial relationships and community involvement decreases and strong social bonds develop between drug users. Even without the same extent of high, the social networks formed with drug users become a major source of social interaction. Additionally, stress increases dorsal striatum activation which further reinforces habitual behaviors.

Summary

Drug use has more incentive salience than other areas of one’s life and becomes habitual. Increased drug use is reinforced because of social bonds between drug users, the neurological rewards associated with the high of the drug, and the activation of habit solidifying brain regions. The more involvement in drug social groups, the more incentive salience signaling increases and drug users seek drugs out even more. This complicated picture of drug use shows how addiction is both neurological and anthropological.

Similar Research

This chapter reminds me of our very first readings that discussed nerves, synapses, neurotransmitters, and different regions of the brain. It also reminds me of the second week’s readings about the encultured brain. Addiction is a perfect example of how the brain is encultured. This chapter shows how a neurological structure could influence behaviors and how an individual’s environment and behaviors also serve to reinforce neural activation patters and solidify these behaviors. This reading also reminded me of articles written by Dr. Gilbert Quintero, a cultural anthropologist who researches the social, cultural, and political economic aspects of drug use. Like Lende, Quintero has also studied young adult populations in the United States.

Towards the end of the chapter Lende touches on the idea of cultural models and how they play a role in the addiction process. If you all don’t already know, Dr. Bill Dressler, here in our very own anthropology department, conducts a lot of research on cultural models. His research focuses on how cultural consonance or discordance with salient cultural models may produce health benefits or may prove to be detrimental to one’s health. Next week’s reading on depression and anxiety discusses this concept further. People who are not culturally consonant with salient cultural models of a “good life” develop higher levels of anxiety than those who are culturally consonant. This relates to Dr. Lende’s argument because as we learned, higher levels of stress increase activation in the dorsal striatum. And as we know, the dorsal striatum serves to maintain and further perpetuate habits. Therefore, stress and anxiety associated with alienation from the community and family, coupled with societies’ negative view of addiction and the addict’s discordant lifestyle with salient cultural models, serve to dig a drug addict deeper into his or her drug pattern.

What I Liked or Didn’t Like

I liked how this chapter began by showing the contrasting ideologies behind addiction in Columbia and the United States. I also liked how the discussion progressed to an explanation of previous beliefs about drug use, addiction, and drug addicts. I believe that Lende’s approach of providing the reader with broader preconceived notions about addiction and his “busting” of these myths is an effective way to draw the reader in and provide alternate explanations. He talks about how historically, people have either taken a strictly neurological approach to addiction or a strictly behavioral approach to addiction. Then, he mends these two arguments by explaining how both are intertwined and are required for an accurate and holistic explanation of addiction.

What I thought was lacking was the organization of the chapter. I felt like there were certain areas that could be more condensed and straight to the point. I also felt that information that should have been presented together was scattered around which made it a little more difficult to grasp. This disorganization made the reader fetch for information and have to piece it all together for a comprehensive understanding. Similarly, I felt that a summary at the end of each section with the key take away points would have been beneficial to understanding how each component of the argument ties into the argument as a whole.

 

Questions for Pondering

  1. If the nucleus accumbens and the dorsal striatum are responsible for forming habitual drug seeking behaviors in addicts, why don’t we just lesion those brain areas?
  2. Why do you think that current drug rehab programs so often fail to change addictive behaviors?
  3. Using what Lende has shared with us, how could we use this knowledge to develop a more effective treatment process?
  4. Some children with negative home lives do not turn to drugs while others do. What do you think determines whether a child turns to drugs or not?
  5. Nature or nurture? Which do you think takes precedent in the context of addiction? Why?

The Evolving Human Brain

EVOLUTION AND THE BRAIN

It has long been appreciated that there is something about the human brain that makes it unique amongst other primates and mammals in general. Dr. Greg Downey  and Dr. Daniel Lende explore how and why the human brain has evolved the way that it has in Chapter 4 of The Encultured Brain: An Introduction to Neuroanthropology. The authors are well-qualified to provide an overview on this topic as both have a wealth of publications in this area, as well as being leaders in the development of the field of Neuroanthropology.

SIZE MATTERS

Blue Whale at The American Museum of Natural History

What makes a human brain unique? Is it simply the sheer size of it? Well, no. Anyone who has visited the American Museum of Natural History in New York City can clearly see that the enormous blue whale hanging from the ceiling has a brain much larger in size than that of a human’s. Perhaps the issue is not sheer size then, but the size relative to one’s own body. Unfortunately, we once again do not have a satisfactory explanation for human’s unique cognitive capabilities. While looking at relative size does work to explain the blue whale example (a blue whale’s brain only accounts for 0.01% of its body’s mass while a human brain accounts for 2%) we see other species that are an exception to this rule. For instance, a pocket mouse has a brain that comprises 10% of their body mass, much more than that of a human and yet we don’t see the unique functionality of a human brain expressed in a mouse.

Pocket Mouse at White Sands National Monument

However, when we turn instead to the encephalization quotient (i.e. the ratio of predicted brain mass to observed brain mass) we see that humans do stand out in this respect. In fact, humans exhibit an encephalization quotient that is between five to seven times higher than what is predicted for a mammal of our size. While greater encephalization is found across primates, humans are still an outlier and it appears this has been true for quite some time. Around two million years ago the genus Homo appears and with it we see a tripling in brain size in our ancestors as compared to other apes. However, it is not just the increase in size that is notable here–brain organization is a key component in better understanding our cognitive evolution.

STRUCTURE MATTERS

So, do humans simply have brains that have a ton of new structures that other primates don’t possess? This is once again an incorrect assumption. Rather than humans and primates differing in existing regions of the brain, our current evidence suggests that the differences are actually proportional which has fascinating implications for our evolutionary understanding of cognitive function. Instead of evolving new structures, it appears that humans have modified or repurposed existing structures so that certain brain regions have expanded at a different rate than others. This evolutionary trade-off has resulted in decreased development in areas like the human olfactory bulb, while structures like the cerebellum which is involved in frontal lobe functioning has shown great expansion.

Human Olfactory Bulb


CONNECTIONS MATTER

In addition to size and structure changing across evolutionary time, connections among regions of the brain have also seen significant changes.

In particular, we have seen an increase in the total number of neurons and with this, we see that larger brains tend to develop areas that are increasingly independent or modular which requires an increase in white connective matter. Understanding the brain’s connectivity is likely a key component of understanding human consciousness. Further, many researchers are now emphasizing the failure of previous metaphors such as the brain being “hard-wired” which does not capture the way in which brains are shaped through interactions and development (i.e. “wet-wired”).

NOT A BRAIN ALONE

To better understand how it is that experiences help shape the brain, Downey and Lende draw on the concept of niche construction which emphasizes the role that organisms play in shaping their own environment and subsequent selective pressures.

The authors argue that niche construction provides a place for cultural researchers within evolutionary studies–an interdisciplinary relationship that is too rarely created. This relationship is absolutely necessary since an understanding of human “intelligence” cannot be obtained by looking simply at the size and structure of the brain. Rather, we must also consider how our social relationships allow us to transfer and amass all of the components that we regard as forms of “intelligence” (e.g., technology, skills, information). Moreover, the authors emphasize how emotions, motivation, and perception are all factors that play into our social and cultural complexity and, thus, cognitive evolution.

MY THOUGHTS

This last section of the chapter was by far my favorite as I feel the authors made a convincing argument for the role of culture and social relationships in our understanding of human evolution. Additionally, I think that they do a great job of not allowing those who are skeptical or critical of previous evolutionary research to “throw the baby out with the bathwater.” I think their point is best summed up in the following quote:

Powerful, but overly simple, models of evolution that assume evolutionary traits will necessarily result in human universals need to give way, not to erase evolutionary explanations, but to provide richer accounts that incorporate data emerging from genetics, paleoanthropology, comparative neuroscience, and anthropology, including research on human diversity (p. 124).

EVOLUTION OF THE CEREBELLAR CORTEX: THE SELECTIVE EXPANSION OF PREFRONTAL-PROJECTING CEREBELLAR LOBULES

The lead author for this paper is Dr. Joshua Balsters whose research interests are in the area of social and emotional decision making. While not covered in the article, Dr. Balsters states that his specific interest is in Autism Spectrum Conditions (ASC) which he studies using a combination of fMRI, EEG, and computational modeling.

STUDY OVERVIEW

Capuchin Monkey

At the broadest level, the researchers are interested in whether the process of brain evolution is mosaic (i.e. evolutionary pressures act on individual neural structures) or concerted (i.e. evolution acts on interconnected parts of the brain that comprise whole functional systems). To test this, the researchers examine the cortico-cerebellar system in three different primate species: humans, chimpanzees, and capuchin monkeys.

METHODS

Chimpanzee

The study consisted of obtaining high-resolution MRI scans from 10 primates from each of the previously mentioned species (5 females and 5 males). All of the included primates had either reached sexual maturity or were close. The researchers were able to isolate the cerebellum and examine the lobules related to the primary motor cortex and the prefrontal cortex.

RESULTS

The data demonstrate that the lobules related to motor and prefrontal cortex occupy a greater proportion of the human cerebellum (83.87%) as compared to chimpanzees (67.1%) and capuchin monkeys (56.82%). Moreover, the results show that where there were increases in the prefrontal cortex, there were proportional decreases in the motor cortex. Since the volume of areas of the prefrontal cortex increased relative to cerebellar lobules connected to the motor cortex, these data suggest that these associated functional systems evolved together.

Cerebellum in Humans

DISCUSSION

This study provides support for the idea that brain systems evolve in a concerted fashion. The results from this study are important as they suggest a potential route to find clues regarding the evolutionary pressures that may have contributed to various expansions in the brain. Additionally, this research demonstrates how comparative MRI can be utilized to examine differences across primates.

MY THOUGHTS

I was able to somewhat follow the methodology of this study; however, I found myself both intrigued and somewhat intimidated by what I couldn’t grasp. This makes me wonder about some of the practical issues with interdisciplinary collaboration. I loved Downey and Lende’s description of how cultural researchers could and should be involved in evolutionary research, but there will likely be some limitations to this collaboration. In many ways, Balsters et al. (2009) is speaking a different language with words and acronyms that will have no meaning to someone who is not well-versed in the cognitive literature. Even simply grasping the hypothesis or overall finding for the study would likely be quite difficult for someone outside the field to grasp. Here is our challenge: if we were to reduce the complexity of the article, perhaps more researchers could understand the results; contrastly, researchers most likely to utilize this study will need a detailed report of the methodology and results in order to replicate or expand on this study. How do we find this balance? 

DISCUSSION QUESTIONS

  • How would our understanding of human brain evolution be different if we didn’t consider it in terms of niche construction?
  • What are some arguments against the idea that humans have “unusual cognitive abilities?”
  • In light of new ideas regarding “dual-inheritance,” what are some reasons why anthropologists might be uniquely qualified to examine human cognitive evolution?
  • How might we define “culture” in evolutionary terms?
  • With the full acknowledgement that there is very likely more than one explanation for human brain encephalization, what is your favorite theory for why humans evolved such large and complex brains?
  • How can we encourage interdisciplinary research when each field has their own “language”?

Addiction and Neuroanthropology: Querer mas y mas

Daniel H. Lende

Colombian Study: Colombian perspective of addiction versus the perspective of the United States, the world’s largest consumer of drugs

According to the Colombians studied in Dr. Lende’s study, drug abuse involved wanting more and more (querer mas y mas), cravings, desire, and urges. Drug use was seen as a range from a small vice (everyone has some sort of vice) to the worst case scenario mode of putting individuals directly onto the street. The latter is  a complete violation of Colombian social norms because of the overarching desire for drugs more than the value of desire to be with family and friends. Drugs, especially cocaine (referred to as la droga), have the potential to violate one of the most entrenched values of Colombian culture–protecting the well-being of loved ones. When the desire for drugs outweighs the values, it becomes a problem, a habit that becomes hard to control. Otherwise, drug usage is not harshly judged unless it becomes a big enough problem that it dictates the individual.

In the United States, perspectives of drug use include viewing use as a moral failing, or a pathology. Americans have the tendency to compare drug use to either a biological pathology (chemical imbalances caused by drug use, “reward deficiency syndrome”) or a reflection of an individual’s self-control . The American perspective of drug use is Puritanistic, relating drug use to the “immoral” desire of too much pleasure.  According to the American perspective, the disruption of the hard-wired pleasure circuits already within the brain can be “hijacked” by this “immoral” drug usage.

By comparing these two starkly different views, Dr. Lende was able to collage emic and etic perspectives and the connection between behavior and experience, creating an ethnographic, neurological revelation regarding addiction:

Addiction is a problem of involvement, not just pleasure or of the self.

So, how does neuroanthropology play a role in all of this? 

Lende identified two core components of addiction and addictive behavior directly from individuals experienced to study: users report compulsive desires and urges for drugs, leading to relapse or excess; users also identified drug use as an escape from the doldrums and stresses of every day life. Furthermore, Lende identified that sociocultural dynamics affect an individual’s cues and habits that create compulsive or destructive ends. According to the DSM, criteria for substance abuse requires the specific pharmacological structure and mechanism of the drug, whether or not individuals demonstrate tolerance or withdrawal, continued use despite negative effects, and using increasingly higher dosages to achieve greater effects. The problem, which the neuroanthropological view seeks to tackle, peaks when many drugs produce no physiological adaptations. How does one measure the extent of substance abuse according to the DSM’s guidelines if no physiological symptoms are expressed? Causation for addiction must be reviewed, according to Lende, in order to go beyond focusing on withdrawal. According to Lende:

“A full explanation for addiction is not to be found in deviations from rational choice, leaving out community dynamics, social meanings, and other important aspects of substance abuse. Morevoer, this approach also treats addiction as solely an individual problem, in particular, by assuming that addiction is a brain disease that limits the mind’s ability to lead a rational life. “

The aforementioned approach of treating addiction as a disease foregoes answering WHY. What drove this individual to substance abuse? Why did can it become so destructive for particular individuals? These questions, according to Lende, need to be examined in order to garner a full understanding of addiction.

Neuroscience and Addiction

Addiction is a complex process that incorporates many different parts of the brain, rather than just a few isolated sections. Motor, sensory, and bodily regulation must be integrated together before addiction can occur. It begins from the basal parts of the brain (regulation, activation of bodily functions), runs through the limbic system (emotions, evaluation of stimuli), up through the frontal cortices (higher-order cognition). As Lende put it, they have to do with what to do, when to do, and how much to do.

Wanting More and More: The Neuroanthropology of Involvement

Incentive salience, or the determination of which incentives for reward are most important (salient) to an individual, was proposed in a 1993 study as the core psychobiological process that is most affected in continued substance abuse. The biochemical mediator for incentive salience is the dopaminergic system. In Lende’s studies in Colombia, he found that using incentive salience as a model for a scale depicting experience turned out to be a good predictor of addicted status. Asking real people about their real experiences with drug use, Lende sought to better understand their want for drugs and how they would get drugs, and how they felt before actually getting the drugs. In the end, he found that the “want” actually corresponded to experiences during the drug use rather than before or after, and that meaning and social context played a role in the experience.

Incentive Salience and Addiction: Mediation, Environment, and Anthropology 

According to Lende, incentive salience is a much more focused means of examining drug usage. Incentive salience merely reflects a few aspects of addiction (remember, addiction is highly complex and dynamic), and does provide good insight into addiction, but does not fully explain it. Incentive salience gives researchers an insight into the neurological processes of decision making, and the means of seeking out rewards. It also links together cues and rewards through motivation and action.

Incentive salience, however, is not the same thing as conscious desire. As Lende puts it:

That urge for pizza people get, that sense that they want it now, and that they just have to have it–that is incentive salience.

Well, now I want some pizza. Thanks, Dr. Lende.

Anyways, a good way to garner information regarding incentive salience has to do with ethnographical research. In his Colombia study, Lende asked participants to describe a “typical day”. His results”

  • Heavy drug users described a sequence of feeling ambivalent towards drug use, a marked decision to use, and then the action of seeking out whatever drug they use. In addition, these people reported a stronger urgency and desire to use once the decision to use had been made. They reported that they felt the want for more and more (querer mas y mas) in the moment. Not before, not after, but in the moment that the drug use was happening.

^^^that’s incentive salience

The salience experienced by Colombian users, however, occurred when using that drug transformed their lives. It took them away from day to day life experiences, the monotonous, and created a  viaje (journey) to the sublime. Well, who wouldn’t want that?

According to Lende, “signals for salience depend on the presence of cues, the structure of environments, and present and past states. In other words, when behavioral options are salient, animals will pursue them–that is what incentive salience does.”

This incentive salience can be applied in two ways:

1. Involvement: the creation of a feeling of belonging or involvement in cultural meaning schema

2. Transition: Signaling transitions between activities, shifting involvement from what matters throughout the day

 

Yet, how does this explain habitual use? Incentive salience alone just doesn’t cut it. Habits play a role in the same neurological processes that incentive salience does. When the want for more and more (querer mas y mas) becomes a cultural commodity, partnering alongside feelings of belonging and transcendence from the mundane, that may lead people to wanting to repeat that experience. Repetition over continual, extended periods of time can create a habit. A habit (referenced in the text, Gaybriel 2008, p.363) is defined as:

“learned, repetitive, sequential, context-triggered behaviors which are performed not in relation to the current or future goal but rather in relation to a previous goal and the antecedent behavior that most successfully led to achieving that goal.”

Lende goes on to describe the interworkings of habits and culture, pointing out that the neuroanthropological approach sheds light into the social and biological aspects of drug use. In the end, the neuroanthropological approach helps better understand the complexity and dynamics of addiction.

Toward an Applied Neuroanthropology of Psychosis: The interplay of Culture, Brains, and Experience

About the author

Neely  Anne Laurenzo Myers is an assistant professor at Southern Methodist University.  She received her PhD from the University of Chicago’s department of Comparative Human Development in 2009.  Dr. Myers specializes in psychiatric anthropology and applied neuroanthropology with interests in mental health especially among underserved populations.

Applied Neuroanthropology of Psychosis

The purpose of applying neuroanthropology to psychosis or to mental health more generally is really to understand the interplay between one’s culture, neurodevelopment, and life experiences.  This case study examines how everyday experiences can be integrated into neurodevelopment and lead to psychosis in certain contexts.  Applied neuroanthropology can make improvements on the current recommendations for psychotic disorders by understanding how neurodevelopment during certain life stages and relevant life experiences can interact to affect biologically vulnerable individuals.  Hopefully, new treatments and interventions can be developed to treat people earlier in the course of their psychotic disorder as people in the west typically have a lower rate of recovery than patients in non-western countries.  Another distinct advantage of neuroanthropology is that it can look at psychotic disorders cross-culturally.  By doing so it becomes clear that psychotic disorders do not mean the same thing to people everywhere.  They are experienced quite differently and understandably treated with different approaches.

Introducing Psychosis

While you may not know someone with any type of psychotic disorder it effects around 1% of the global population and even more people experience more mild psychotic episodes at some point in their life.  Psychosis is severely disabling in that the person loses touch with reality, they have delusions, and sensory hallucinations.  You are probably most familiar with the idea that these people hear voices in their head and may talk to those voices.  The voices can vary in who and what they are saying but it can be very frightening.  The patient, family, and friends may become afraid.  The experience is different for every person because everyone has a different brain and for this reason the illness can be very isolating.  I’ve personally seen what psychotic illness can do to a person and their loved ones and it is incredibly devastating and life altering.  Part of this may have to do with the way we view and treat this type of mental illness in this country.  The other symptoms essentially changes the person’s personality and further isolate them from any existing close relationships they had left.  These symptoms include loss of emotional response, little motivation, socially withdrawing, and cognitive problems which can all easily interfere with seeking or adhering to treatment.

This clip summarizes the symptoms of schizophrenia and their impact on the patient and family.

Summary of the Case Study

Dr. Myers spent time at a clinic for psychiatric disabilities in New York where she used a mixed methods approach, including participant observation and interviews, to understand the experiences of a patient named Leroy.  Leroy was in his thirties and had been diagnosed with schizoaffective disorder.  People with schizoaffective disorder frequently have the symptoms of schizophrenia with the symptoms of a mood disorder like depression.  Leroy was also an alcoholic and a felon.  Dr. Myers believed that his neurodevelopment may have been effected by institutional participation and led to the development of his psychotic events.  She detailed his history with psychotic events as well as his beliefs surrounding them.  He had had at least two mild psychotic events as a child.  His Aunt had explained to him that he may be hearing spirits and also told him a story about his birth and that his grandmother thought he might be susceptible to such things.  He seemed to accept this explanation and didn’t have problems for a while because his aunt put something in his water to help.  He explained these ideas to his doctors but they dismissed it completely.  When he was incarcerated he eventually became paranoid.  At some point he ended up serving eighty days in solitary confinement because of disobedience.  His psychotic problems became constant at this point.  He began hearing voices, talked back to the voices, became fixated on things he read in a bible, and ended up being taken to a psychiatric treatment center.  In the center they treated him with anti-psychotics but he felt he was denied the chance to truly face his illness because of this.

Psychotic Disorders: A Neuroscience Perspective

It really isn’t clear what causes Schizophrenia or any of the related psychotic disorders.  The models range from genetic to epigenetic to purely environmental.  The reason for this is that they can see some evidence of the disease in some patient’s brain such as a changing of certain structures or pathways but can’t definitively say it causes the disease.  They can only say it is probably part of the disease.  At this point a mix of genetic predisposition and environmental factors seem like the best explanation.  What has been suggested is that people with Schizophrenia may be biologically susceptible to social stresses and that as these build up they are unable to withstand it and develop psychotic symptoms.  Another idea suggests that is completely normal to experience mild psychotic events during certain stages of neurodevelopment but it only becomes pathological in these supposed biologically susceptible people.  Other models suggest that the reason psychotic symptoms become evident during the young adult years is because of the multitude of social stressors associated with life changes and certain susceptible people cannot handle that and develop psychotic disorders.  Something else that is clear that Leroy was an example of is that certain contexts raise the risk of psychotic illness.  These contexts include urban environments, social disadvantage, adverse life events, and poverty which can all cause prolonged stress.  Which brings us to the last possible explanation which is allostatic overload.  This model suggests that psychotic disorders may result from neural changes due to allostatic overload but specifically due to inflammatory cytokines and glucocorticoids and their effects on the brain.  The cause and mechanism for schizophrenia has yet to be discovered but it is likely a combination of these explanations which include genetic and environmental causes.

Toward an Applied Neuroanthropology of Psychosis

Neroanthropology can be used to better understand how experience is incorporated into neurodevelopment to alter pathways or structures that lead to psychosis.  In Leroy’s case certain episodes in his life (solitary confinement) led to the exacerbation of an underlying issue.  He also came from a disadvantaged background and had previous mild psychotic episodes with certain beliefs about them.  Could this information have been used to intervene and prevent full blown schizoaffective disorder?  We don’t know.  However, continuing applied neuroanthropological research into psychotic illness can provide the insight to answer those kinds of questions.  It can also help us to understand the stages of development, at-risk populations, and biological vulnerabilities that need intervention and what that intervention should look like.  Research experiences like this case study also make it clear that to dismiss the beliefs an individual holds about their illness can be a mistake.  A person’s cultural beliefs surrounding their illness can end up being a vital tool in fighting psychotic disorders.  In the U.S. this could lead to cognitive behavioral therapy as a resource for people who want to try something with or instead of traditional anti-psychotics.

A new form of Cognitive Behavioral Therapy (Facing the voices) to complement anti-psychotics.