Richard G. Petty, MD

Men, Women and Forgiveness

We recently discussed the importance of forgiveness on health. Over the years studies have shown that men tend to be more vengeful than women, presumably because they have been taught from childhood to empathize with others and build relationships. Though there could yet be a biological basis for this difference.

New data from Case Western Reserve University, Florida State University, Arizona State and Hope College published in the Journal of Personality and Social Psychology suggests that forgiveness does not come naturally for both sexes. Psychologist Julie Juola Exline’s research indicates that men have a harder time forgiving than women do. However that can change if men develop empathy toward an offender by seeing they may also be capable of similar actions. That empathy closes the gender gap and men become less vengeful.

The authors conducted seven forgiveness-related studies (1,2,3,4,5,6,7) between 1998 and 2005 that involved more than1,400 college students: Gender differences have been a robust finding.

The studies used hypothetical situations, actual recalled offenses, individual and group situations and surveys to study the ability to forgive. When men were asked to recall offenses they had committed themselves, they became less vengeful toward people who had offended them. Women started at a lower baseline for vengeance, but thinking about their own transgressions had no effect on levels of unforgiving. When women were asked to recall a similar offense in relation to the other's offense, women felt guilty and tended to magnify the other's offense.

The researchers found that people of both genders are more forgiving when they see themselves as capable of committing a similar action; it tends to make the offense seem smaller and increases empathic understanding of the offense. Therefore people similar to the offenders and therefore more forgiving attitudes.

The ability to identify with the offender and forgive also happens in intergroup conflicts. In a study on forgiveness of the 9/11 terrorists Exline comments that,

"When people could envision their own government committing acts similar to those of the terrorists, they were less vengeful. For example, they were less likely to believe that perpetrators should be killed on the spot or given the death penalty, and they were more supportive of negotiations and economic aid."

It is not difficult to see that prosecution and defense attorneys are going to study this data carefully. It will likely come into play during jury selection processes.

And I am going to think about it the next time that I am called upon to serve on a medical school interview board.


“An eye for an eye will only serve to make the whole world blind.”
--Mahatma Gandhi (Indian Nationalist and World Teacher, 1869-1948)

“And be ye kind one to another, tenderhearted, forgiving one another, even as God, for Christ’s sake, hath forgiven you.”
--The Bible (Ephesians 4:32)

“Everyone and everything I see will lean toward me and bless me. I will recognize in everyone my dearest friend. What could there be to fear in a world that I have forgiven, that has forgiven me?”
--A Course in Miracles (Book of Spiritual Principles Scribed by Dr. Helen Schucman between 1965 and 1975, and First Published in 1976)

Blondes Makes Us Dumb??

No, this isn’t just a cheap excuse to display a picture of Pamela Anderson.

I just received this from a regular reader:

"Dear Dr Petty,

Have you seen this article Times Online?

“WHEN men meet fair-haired women they really do have a “blonde moment”. Scientists have found that their mental performance drops, apparently because they believe they are dealing with someone less intelligent.

Researchers discovered what might be called the “bimbo delusion” by studying men’s ability to complete general knowledge tests after exposure to different women. The academics found that men’s scores fell after they were shown pictures of blondes.

Further analysis convinced the team that, rather than simply being distracted by the flaxen hair, those who performed poorly had been unconsciously driven by social stereotypes to “think blonde”.

“This proves that people confronted with stereotypes generally behave in line with them,” said Thierry Meyer, joint author of the study and professor of social psychology at the University of Paris X-Nanterre. “In this case blondes have the potential to make people act in a dumber way, because they mimic the unconscious stereotype of the dumb blonde.”

Do you have any comment to make about the research??"

The answer is that I have seen this article all over the Internet, with all kinds of sage comments.

The trouble is that I have not yet been able to read and critique the research. As far as I know, neither the hard copy nor electronic versions are available yet, so I cannot evaluate the report.

This highlights one of the problems of the Internet: news travels across it like the wind, yet a lot of material is passed on without analysis. So the story is fun to read, but until we can see and analyze the data, we cannot comment.

As soon as I get a copy I shall see if I have anything to add to the firestorm of commentary!

Marriage Makes You…

A Chinese sage once said that if a woman took a pea and placed it in a large jar every time that she had sex in the first year of marriage, and then took out a pea every time that she had sex in the rest of her life, the jar would never be empty.

So many couples seem to think that a declining interest in sex I something to be expected, and agony columns and websites are crammed with complaints. Does it have to be that way? Is it just that people get bored with each other, or are too tired to bother?

Some intriguing new research suggests that there may also be a physical factor, reporting lower testosterone levels among married men compared with single, unmarried men.

The research is reported in this month’s issue of Current Anthropology by Peter B. Gray from the University of Nevada, Las Vegas, Peter T. Ellison from Harvard University and Benjamin C. Campbell from Boston University.

They investigated the links between male testosterone levels and marital status among modern-day cattle farmers from the Ariaal tribe in northern Kenya. Less than 1.5 percent of these men consider that their wives are a source of emotional support. The Ariaal males serve as herd boys until they reach puberty. They then undergo initiation, become warriors and begin to accumulate livestock. They do not marry and have children until around age 30. They value social bonds with male peers more than spousal or familial bonds. 

The researchers measured testosterone in morning and afternoon saliva samples of more than 200 Ariaal men over the age of twenty. They found that monogamously married men had lower testosterone levels than unmarried men in both the morning and afternoon. However polygynously married men with more than one wife had even lower levels of testosterone than the monogamously married men.

The data suggest that male testosterone levels might reflect variations in male mating efforts. It may also be that in the tribal setting, older men, who typically have lower testosterone levels, may have the social status and wealth to obtain more than one wife.

Given the increasing amount of data concerning the importance of testosterone for normal brain and arterial function, this may be a big wakeup call. If men do nothing once they are in a relationship, and their brains begin to think that the “hunt” is over, their testosterone levels can plummet.

And that can be fatal.

It is essential for couples to work to keep passion – and testosterone – alive.

It is not sexism, it is millions of years of evolution.

Sex, Handedness and the Brain

I have commented before on my longstanding interest in handedness and laterality, as well as gender differences in the brain. A recurrent question when we look at both of them is whether culture has any role in the development of either. Are some of the differences in male and female brains driven by educational opportunities and cultural expectations, or is there something innate about them?

A recently published paper in PLoS ONE reports finding both sex and handedness influences on the relative size of the corpus callosum in Capuchin monkeys.

Capuchin monkeys are playful, inquisitive primates best known as the “Organ Grinder” monkeys. They have great manual dexterity, complex social behavior, and cognitive abilities. The new research now shows that just like humans, they display a fundamental sex difference in the organization of the brain, specifically in the corpus callosum, the band of white matter that connects the two hemispheres of the brain.

In the study, thirteen adult capuchins underwent magnetic resonance imaging of the brain to determine the size of their corpus callosum. The monkeys were later given a task to determine hand preference. The authors' results led them to conclude that, as in humans, male capuchins have a smaller relative size of the corpus callosum than females, and right-handed individuals have a smaller relative size of the corpus callosum than left-handed individuals.

As the two hemispheres show greater independence of function, the relative size of the corpus callosum is expected to be smaller. This has been documented in humans, and same pattern was found in capuchins.

This finding may be related to hemispheric specialization for complex foraging tasks that require the integration of motor actions and visuospatial information. In the wild, capuchin monkeys live in trees as well as on the ground, and they are known to be very good at capturing small swift prey such as birds, lizards, and squirrels.

Men, Exercise and Broken Bones

One of the problems that we all face as we get older is that unless we are careful, our bones can gradually become weaker. This is a particular problem in women, but a growing body of research indicates that men can run into trouble as well. At one end of the spectrum is “osteopenia:” a reduction in bone mineral density, and at the other end of the spectrum is full-blown osteoporosis.

The reason for taking the problem so seriously is that any degree of thinning of the bones can predispose us to so-called “osteoporotic fractures.” Sad to say, serious fractures are common among older people and can have devastating consequences, particularly if a hip is broken. Man people find it difficult to walk again. For years now we have recommended that women should take exercise to reduce the risk of thinning of their bones, particularly after menopause. But now research published in PLoS Medicine indicates that men who participate in sport or other vigorous activity may also reduce their risk of fractures.

Karl Michaelsson and colleagues at University Hospital, Uppsala, Sweden, report research in which over 2000 men who were initially studied in 1970-1973. The amount of physical activity that they took outside working hours was recorded, and then they were questioned again as they aged. Each of the surviving men was questioned again when they were aged 60, 70, 77, and 82. About half of the men were still alive at the end of the study, and the researchers recorded the number of fractures that the men had suffered during the 35 years of the study.

Based on the answers to the questions on physical activity at the start of the study, the researchers divided the men into three groups: those whose lifestyle was considered to be ''sedentary,'' those whose leisure activities included some walking and cycling and those who participated in sports for at least 3 hours a week. These were referred to as the low, medium, and high-activity groups. Over the 35 years, 428 men had at least one fracture and 134 broke a hip. However, there were significant differences between the groups. 20% of the low-activity men had fractures, compared with 13% of those with medium activity and only 8% of those in the high-activity group. Of greatest importance was that the chance of having a hip fracture – the worst type of broken bone in an older person - was dramatically reduced by increased activity.

The researchers conclude that taking exercise reduces the risk of osteoporotic fracture in men. Participating in sports seems to be particularly effective: they calculated that one-third of fractures could be prevented if men could be persuaded to take part in sports regularly.

There is also an excellent summary by Harri Sievänen and Pekka Kannus from Tampere in Finland. As always each entire article is available online.

And I am to get my running shoes this very instant…

Hormones, Addictions and Mood

People working with mental illness have been for years now been puzzled by two observations. The first is that mood disorders and schizophrenia follow quite different trajectories in men and women. Women tend to be more vulnerable to mood disorders and if they get schizophrenia it tends to be less severe and to have fewer "negative" symptoms, such as flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation until after menopause. We have looked at some of the reasons for the different rates of mood disorder, in terms of relationships and social pressures, but there must also be a biological component. The second puzzle is that women are more vulnerable to addictive drugs in the days before they ovulate.

New research published in the  Proceedings of the National Academy of Sciences may provide part of the answer to both puzzles.

Colleagues at the National Institute of Mental Health (NIMH), a component of the National Institutes of Health (NIH), have conducted a fascinating imaging study that has shown that fluctuations in levels of sex hormones during women's menstrual cycles affect the responsiveness of the reward systems in the brain.

The reward system circuits include the:

• Prefrontal cortex, which has key roles in thinking, planning and in the control of our emotions and impulses
• Amygdala, which is involved in rapid and intense emotional reactions and the formation of emotional memories
• Hippocampus, which is involved in learning, memory and navigation
• Striatum that relays signals from these areas to the cerebral cortex

It has been known for some time that neurons in the reward circuits are rich in estrogen and progesterone receptors. However, how these hormones influence reward circuit activity in humans has remained unclear.

The researchers used functional magnetic resonance (fMRI) imaging to examine brain activity of 13 women and 13 men while they performed a task that involved simulated slot machines. The women were scanned while they did the task, both before and after ovulation.

When anticipating a reward, in the pre-ovulation phase of their menstrual cycles the women showed more activity in the amygdala and frontal cortex. When women were actually winning prizes, their reward systems were more active if they were in the phase of their menstrual cycle preceding ovulation. This phase of the cycle is dominated by estrogen, compared to postovulatory phase when estrogen and progesterone are both present. When winning, the main systems that became active were in the parts of the brain involved in pleasure and reward.

The researchers also demonstrated that the reward-related brain activity was directly linked to levels of sex hormones. Activity in the amygdala and hippocampus was in directly linked to estrogen levels, regardless of where a woman was in her cycle. When women won prizes during the post-ovulatory phase of the cycle, progesterone modulated the effect of estrogen on the reward circuit.

Men showed a different activation profile from women during both anticipation and delivery of rewards. Men had more activity in the striatum during anticipation compared with women. On the other hand, women had more activity in a frontal cortex when they won prizes.

This research could have a number of important implications. The most obvious is that it confirms what many women know already: they are more likely to take addictive substances or to engage in pleasurable - but perhaps impulsive or risky - behaviors just before they ovulate.

It is not difficult to imagine why this might have developed during evolution.

“Coming to terms with the rhythms of women's lives means coming to terms with life itself, accepting the imperatives of the body rather than the imperatives of an artificial, man-made, perhaps transcendentally beautiful civilization. Emphasis on the male work-rhythm is an emphasis on infinite possibilities; emphasis on the female rhythms is an emphasis on a defined pattern, on limitation.”
--Margaret Mead (American Anthropologist and Writer, 1901-1978)

Toxoplasmosis and Behavior

Last August I wrote an article about some extraordinary new evidence implicating Toxoplasma gondii in some psychological and psychiatric illnesses. Latent infection with Toxoplasma gondii is amongst the most prevalent of human infections and it had been generally assumed that it is asymptomatic unless there is congenital transmission or reactivation because a person has an immune system that has become depressed or compromised. That assumption is being completely re-evaluated. 

The article generated some extremely interesting correspondence and some spirited discussions.

Here is a very insightful letter from a physician:

Dear Dr. Petty,

I thought about the concept of psychological illness caused by a virus or other organism. I was wondering what would be the mode of dispersion of such a virus. Upper respiratory tract infections, skin and gastrointestinal infections spread by cough, by touch and hand to mouth respectively. How would such a brain virus or protozoal organism promote itself? Of course it could be by the above methods but it seems that there should some way that the specific disease process is connected to a behavior that helps it to spread itself. 

Then I got to thinking; diseases have learned physical ways to disseminate themselves, I wonder if a disease could change behavior to promote it's own dissemination and survival? I imagine that if that were true, people with the flu would be sociable, people with infectious diarrhea would be sociable and hungry, people with AIDS would have increased libido. I haven't yet seen any data for this. Although I've always felt that there was one disease that did alter behavior in a way that is conducive to disseminating itself, and that is rabies. The host goes from being docile, to seeing all others as the enemy. He then attacks them, bites them and thus passes on the organism. A true mind altering virus, although it's psychology works better with animals than with people. Do you think that there are other diseases that spread purely by behavior, that cause the host to seek out the next host and not just pass the disease from one to another just due to proximity?

This was my response:

What great questions!

And believe it or not, there's quite a lot of empirical research on these very topics.

There is a whole textbook on the behavioral effects of parasites edited by Janice Moore entitled  Parasites and the Behavior of Animals. Here's an interesting one: rats and mice are hard wired to avoid cats. Millions of years of programming have ensured that Tom's very presence would send Jerry packing. Cats carry Toxoplasma gondii and if mice or rats become infected with it, usually by eating cat poop, they lose their fear of felines. So now Tom can have lunch at his leisure.

I've also talked about the way in which people with creativity and schizotypal personality disorder (i.e. carriers of genetic risk) tend to be promiscuous, while people with schizophrenia have fewer children. Both groups tend to get more sexually transmitted diseases than the general population. It would be tempting to think that toxoplasmosis can be spread that way, however there's a 32-year old study in German that showed that Toxoplasma was not transmitted by intercourse. However, cytomegalovirus, a common partner to Toxoplasma may be. And both modulate dopamine activity in the regions of the brain involved in salience.

I have done a very detailed literature search encompassing papers written in all the languages that I can read, and have not been able to find any clear evidence of behavior change induced by HIV, influenza or infectious diarrhea: what interesting and important questions to research.

We do have some more data confirming the effects of Toxoplasma infections on the behavior of rats: they become less anxious and therefore do not respond to environmental threats as quickly as uninfected rodents. An antipsychotic medication (haloperidol), a mood stabilizer (valproic acid) and two chemotherapeutic agents - pyrimethamine or Dapsone – have all been shown to prevent the development of Toxoplasma-induced behavioral change.

Another recent study from the Departments of Parasitology, Microbiology and Zoology, Charles University, the Centre of Reproductive Medicine and GynCentrum, in the Czech Republic also speaks to the significance of latent Toxoplasma infections: the presence of the parasite in the blood of pregnant women increases their chance of giving birth to boys. The increased survival of male embryos in infected women may be explained by Toxoplasmosis infections modulating and suppressing the immune system.

If Toxoplasma plays a part in the development of some psychiatric illnesses, yet a high proportion of the population carries it without any problems, one obvious question is what activates it? Environmental stress might, perhaps, cause the Toxoplasma to become reactivated and play a part in the development of specific psychiatric symptoms.

This story is continuing to develop and I am going to watch it closely. If it is confirmed, it could open up some brand new avenues for helping treat and perhaps even prevent some types of psychiatric illness.

Testosterone and the Death of Brain Cells

I’m sure that you’ve heard the Robin Williams joke, “See, the problem is that God gives men a brain and a penis, and only enough blood to run one at a time.”

Well it may turn out that Robin was right for the wrong reason.

Typically thought of as the “male hormone,” testosterone plays key roles in maintaining health and wellness in both men and women. It is true that most men produce about twenty ties as much testosterone as women, but in both sexes, it is involved in energy, libido, and immune function and helps protect against osteoporosis. It is also essential for the normal development, growth and functioning of the brain. In small amounts it may also be neuroprotective.

However, too much of a good thing can quickly turn bad. Researchers from the Departments of Pharmacology and Cellular and Molecular Physiology at Yale University in New Haven, Connecticut have just published an important study of apoptosis or programmed cell death in neurons exposed to excessive amounts of testosterone. Apoptosis is a process for disposing of un-needed or unwanted cells, but if it gets out of control, it can begin to remove cells that should have been left alone. Apoptosis is thought to pay a role in illnesses including Alzheimer’s disease and schizophrenia.

While too much testosterone destroyed nerve cells, estrogen appeared to be neuroprotective: there was less cell death in the presence of the hormone.

This new finding has a number of important practical implications.

Testosterone is one of the hormones abused by some athletes. It certainly can enable them to pump up their muscles, but it may also make them aggressive. Now we know that the practice may also kill neurons. And loss of brain cells is associated with a loss of brain function. This is yet another reason why people should think long and hard before they try to use testosterone supplements. The concentrations used in the experiments were very close to what we might expect to see in someone supplementing with the hormone.

These effects of testosterone on neurons will likely have long term effects on brain function. Though you do generate new connections and some new neurons throughout life, there is a limit to how many you can put back, once they've been tainted by testosterone.

And since this is election year here in the United States, I’m sure that we’re now going to have to have a string of off-color jokes about the esteemed Governor of California….

Women, Asthma and the Brain

There’s been a longstanding puzzle in medicine. Well actually there are lots of them, but here’s one that may be a puzzle no more.

For many years now, it’s been known that asthma is more common in women, and also that psychological stress can cause flare ups of asthma.

Many women experience “menstrual flaring:” a worsening of asthma around the time of their menstrual period. There is also a strange paradox: some women with asthma wheeze less if they take an oral contraceptive, while some non-asthmatic women begin to wheeze when they take it. In some women pregnancy makes asthma worse, and in others it affords months of relief of symptoms. Women who are obese are more likely to get asthma, presumably because their intra-abdominal fat stores are churning out inflammatory mediators.

Researchers from the University of Wisconsin have shed  some important light on this link between asthma and the brain. In research published in the Proceedings of the National Academy of Sciences. In the study, six patients with mild asthma were exposed to ragweed or dust-mite extracts. The subjects were shown three different categories of words: asthma-related (e.g., "wheeze"), non-asthma negative ("loneliness") or neutral ("curtains").

Using functional magnetic resonance imaging, they showed that activity in two regions, known as the anterior cingulate cortex and the insula showed increased activity when the asthma-related words were heard compared with the other types. What is more, this enhanced activity was specifically linked to physiologic signals from the ragweed and dust-mite extracts. So being exposed to asthma-relevant emotional stimuli is associated with markers of inflammation and airway obstruction in asthmatic people exposed to an asthma-producing antigen.

In people with asthma and other stress-related conditions, these brain regions may be hyper-responsive to disease-specific emotional and physiologic signals. Taken together, these could contribute to problems that worsen the asthma, such as inflammation.

And one of the ways of making these regions of the brain hyper-responsive? Bathe them in estrogen.

That still does not explain why pregnancy and the oral contraceptive makes some women’s asthma better, and does the opposite in others. But it may just have to do with the “set point” of the cells in these regions of the brain. In the same way that we might set the thermostat in out house. An already hyper-responsive brain might be normalized and an under-active one stimulated to be over-active.

We need to do some more experiments, but these are a great start.

If you ever wheeze, have a look to see if there are stressors or hormonal events that trigger you. Whether you are being treated with homeopathy, herbals or conventional therapy, knowing when to expect trouble gives you the power to adapt you treatment when you are entering a risky time in your life.

Child Prodigies

I’ve recently had cause to look at the published literature on child prodigies and there’s not much there. It is very surprising that such an interesting subject has been so little researched.

First a definition from a paper by David Feldman: A “prodigy was a child (typically younger than 10 years old) who is performing at the level of a highly trained adult in a very demanding field of endeavor.” There are three fields in which high-level creative results have been produced before the age of 10: Chess, Mathematics and Music. There are other fields such as art and writing in which young people may be precocious imitators. Pablo Picasso exactly mimicked his father’s drawings. There is an impressive list of child prodigies in other fields as well, but it seems that only in chess, mathematics and music have profound, original insights been contributed by preadolescent children.

There is an interesting association between mathematics and chess: many top chess players are also extremely good at mathematics. In a previous post I mentioned the English Grandmaster John Nunn, and there are many other examples. Men dominate both fields, but that does not necessarily mean that there is a natural gender difference. There’s a very interesting book entitled Breaking Through, by the chess Grandmaster Susan Polgar who was herself a prodigy, as were both of her sisters. Girls have been excluded from many of these events, or they’ve been forced to play only against girls or women. I know a young person who as a pre-teenager wanted to join the school chess club, but only went once, after discovering that all the other members were boys. A shame: she was already quite a strong player.

Both chess and mathematics involve highly developed non-verbal and visuospatial skills. The writer and critic George Steiner had this to say: “The solution of a mathematical problem, the resolution of a musical discord or conclusion of a contrapuntal development, the generation of a winning chess position can be envisaged as spatial regroupings, that have their own internal logic.” He went on to speculate, “All three fields involve enormously powerful but narrowly specialized areas of the cortex. These areas can somehow be triggered into life in a very young child and can develop in isolation form the rest of his psyche. Sexually and socially unformed, very possibly backward in every general respect, the child virtuoso or pre-teenage chess master draws on formidable but wholly localized synapses in the brain.”

In the book The Exceptional Brain, Lee Cranberg and Marty Albert suggested that these “localized synapses” lie in the right hemisphere of the brain, which is primarily involved in non-verbal visuospatial skills and pattern recognition. They also suggested that gender differences in proficiency in chess support the right hemisphere idea. But after reading Susan Polgar’s book, and spending a great deal of time analyzing the world literature on gender differences in cognition, that last point doesn’t convince me.

It is striking that three of the code breakers at Bletchley Park during the second World War, were outstanding international chess players Stuart Milner-Barry, Harry Golombek and Hugh Alexander. These code breakers who helped win the War also utilized similar skills to those needed to master a chess position or to calculate a mathematical problem.

The child prodigies seem to have some things in common:

1. An unusually strong talent in a single area
2. Reasonably high but not necessarily exceptionally high IQ: some people with astronomically high levels of intelligence have had problems with interpersonal adjustment, unless very carefully nurtured as children.
3. Focused energy.
4. Sustained effort to achieve the highest levels in their field: even chess prodigies need thousands of hours of practice, and mathematical prodigies need to work at their field.
5. Unusual self-confidence.

Adults who want to improve in chess are constantly told to practice as much as possible, and to work on pattern recognition and problem solving. It is just the same in music and mathematics.

Although child prodigies may simply have better neurological equipment, usually coupled with extraordinary encouragement by their parents, I am left with a question that I posed in an earlier post. Mozart often said that when he was composing he felt as if he was taking dictation from God. That he was not the one composing, but that he was in effect picking something up from the Universe. I’ve seen countless highly gifted people tell me that their greatest insights in science, music philosophy or chess just “came to them.” The former chess World Champion Tigran Petrosian once said that he could tell when he was out of form when his calculations did not confirm the validity of his first impressions. All this implies unconscious processing to be sure, but I am not sure that it is all in the brain.

Because there is another phenomenon that has also not been much researched, and that is the phenomenon of simultaneous breakthroughs: two or more people in different parts of the world coming up with new creative solutions at the same time and without any personal contact. I shall have more to say about this in another post, but it speaks to the fundamental interconnectedness of all of us.

Maybe the child prodigies not only have special brains and special parents, but they also have access to a store of information not available to everyone.

At least not yet: We already have training methods that help people access accurate information that they did not know consciously. A story for another day.

“Genius is characterized just by the fact that it escapes classification.” --Leopold Infeld (Polish Physicist, 1898-1968)

Memory and Anticipation

“Nothing is so wretched or foolish as to anticipate misfortunes. What madness is it to be expecting evil before it comes.”
--Lucius Annaeus Seneca (a.k.a. Seneca the Younger, Spanish-born Roman Philosopher and Statesman, c.4 B.C.E.-A.D. 65)

We are all aware that memories of powerful and in particular disturbing emotional events - such as an act of violence or the unexpected death of a loved one - are more vivid and deeply imprinted in the brain than mundane recollections of everyday matters. When I was sixteen years old I was in a head-on car crash: I can still recall the number of the license plates of the car that was driving down the wrong side of the road as it barreled into us. But particularly positive emotions are also remembered in far more vivid detail, and those memories are less likely to be lost. This all makes good sense from an evolutionary perspective: we need to be able to remember things that carry a strong emotional charge.

Colleagues at the University of Wisconsin in Madison have found that the mere anticipation of a fearful situation can activate two memory-forming regions of the brain: even before the event has occurred.

The investigators used functional MRI scans with 40 healthy participants who viewed aversive or neutral pictures preceded by predictive warning cues. Previous research reported sex differences in the way in which memory and emotion interact: in women, memory associations were found with a region called the left amygdala. But the association was with the right amygdala in men. This new study refines these findings: they were confined to the ventral amygdala during picture viewing and delayed memory.

Both men and women who had previously been given an indication that gruesome pictures were going to be shown were more likely to remember them.

What this means is that the act of anticipation may play an important role in whether the memory of a tough experience remains fresh and vivid. This makes sense based on our own experiences of events: do you remember the fear associated with a visit to the dentist that built and built before you got there? That anticipation can itself modify the memories of an event.

The findings are published in this week’s issue of the Proceedings of the National Academy of Sciences. They have important implications for the treatment of some psychological conditions such as post-traumatic stress disorder (PTSD) and social anxiety that are often characterized by flashbacks and intrusive memories of upsetting events

We have long known that our memories are not like some video recording forever preserved within our neurons. Some memories are false, many change over time and others lose their emotional charge. It is possible to implant false memories in people, and by re-writing our own life stories we can change the narrative of our lives and how we react to life events.

Samuel Johnson once said that, “The true art of memory is the art of attention.”

I’m quite sure that he is correct, and this research proves it. I’ve always been blessed – or cursed – with a prodigious memory, to the extent of being able to remember the lab values on every patient that I ever saw during my clinical years, and when I was younger being able to read pages of a textbook from memory. I’m quite convinced that my memory is no better than anyone else’s: I’m just a little better at using it.

The trick to using my memory was discovering at an early age that I could remember virtually anything if I really focused my attention on it. So I would focus on the book to the exclusion of everything else for a minute or two. Rest for a minute and then do it again. To this day, that is the best technique that I know for laying down long-term memory. My father also had this faculty, and when I was a youngster he would tell me not to write down things like shopping lists or to construct “To do” lists. He told me that, “if you really have to remember things you will. And if you’re not interested in something you don’t need a “to do” list.”

I only use lists if I have to do something tedious. This is a good test for you. If something that you are doing really engages your attention it is likely one of your core desires, and there is no need to be writing down a list of things to do. If it does not, and you have to write everything down, it’s probably not a core desire. You may still need to write down an action plan, but that’s to get your creative juices flowing, not to stimulate your memory.

I have developed quite a number of techniques for improving memory and concentration. Some are home grown, others modified from methods and techniques that others have taught me. I’ve been collecting and testing them for years. I’m doing a lot of flying this week, so I shall have the time to be put some of them together into a free report. I shall let you know when it’s ready and if you ask, I shall send you a copy.

There is one important reason for writing down thoughts once you have done something, and that is to help them be part of your legacy. That’s a topic to which we are going to return many times in the next few weeks.


“What we anticipate seldom occurs, what we least expected generally happens.”
--Benjamin Disraeli, 1st Earl of Beaconsfield (English Statesman, Novelist and, in 1868 and from 1874-1880, British Prime Minister, 1804-1881)

A Gene for Infidelity?

Last January I wrote about the link between creativity and promiscuity.

I’ve just picked up this month’s copy of the Mensa Magazine, published by British Mensa  and there’s an interesting article by Dr. Desmond Morris entitled “Why brilliant men betray their wives.” Desmond is a national institution in Britain. A zoologist, ethnologist and surrealist painter, he always used to be on television and gained considerable notoriety for his book The Naked Ape that tried to explain human behavior by analogy with apes.

In his latest article Desmond follows some of the same reasoning that I did in my article: many intensely creative people also enjoy risk taking. He just talks about males, but I think that the same principles apply equally to many intensely creative and successful women, who also enjoy taking extreme risks.

Every act of creation demands that we see, feel or think differently about something. Desmond says that every piece of innovation or creativity is an act of rebellion. I only half agree with that: the truly creative person is busily establishing a new level of order. The creative rebel is a stereotype that’s not born out by experimental work on genius and creativity. The creative or innovative act is one of making new connections and in a sense it is also a moment of risk-taking, for the new technique, formula or invention may fail. We recently discussed the way in which resilience is a key to creativity: to keep going in the face of failure or adversity. Even the most highly creative are not every single day: I have known many Nobel Prize winners and award winning artists, and they all have their off days.

Desmond’s article highlights the multiple extra-marital affairs of Albert Einstein, John F. Kennedy, Charlie Chaplin and Bertrand Russell.

He argues that it is the innate compulsion to take risks that leads both to creative brilliance and an inability to remain with just one partner. He pursues the idea that our distant hunting ancestors required a new personality trait: bravery. The successful needed to take risks and be courageous. Desmond then again excludes women from his equation, saying that their reproductive contributions to the tribe made them too important to risk on the hunt. He now fast-forwards to the present, saying that the offspring of the adventurous males could either engage in physical risk-taking or explore new ideas. And that their curiosity leads them to explore not just ideas but novel sexual experiences. Once a “conquest” has been made, the risk-taking adventurer moves on to a new target.

It is certainly true that men are far more likely to die in accidents than are women, but it’s a bit of a stretch to attribute all of that to risk-taking. What about the male difficulties with multi-tasking and to resist peer pressure, to say nothing of much higher rates of substance abuse?

And yes, fame, power and wealth can be powerful aphrodisiacs. But to reduce immoral, dangerous and disrespectful behavior to a risk-taking gene from our distant ancestors seems to me to a wild extrapolation based on a very selective use of a small amount of information.

Because infidelity surely has many more strands to it that just a genetic “itch.” Many highly successful people are enormously narcissistic and so fail to take into account the damage that their infidelity might do to their spouse and children.

Seeing sex as no more than a branch of gymnastics is also off the mark. Even a casual encounter will likely contain emotional, subtle and even spiritual components. If a relationship is failing because those are all missing, it is no surprise if a spouse investigates divorce and other options. But that is not risk taking: it is fulfilling a need that is not being met by the current partner.

Friendship and Psychological Distress

“To lose a friend is the greatest of all losses.”
Publilius Syrus (Syrian-born Latin Writer, 1st Century B.C.E.)

Severe and persistent mental illnesses are one thing, but there are many, many more people who are miserable and unhappy, without that unhappiness necessarily getting to the level of an “illness.” The offices of primary care physicians and therapists are full of people in genuine distress for all kinds of reasons.

I first began to think about this many years ago when a woman came to see me and promptly announced, “I’ve come for psychotherapy. I’ve been in therapy for seventeen years, and I want some more.” I wasn’t being in the slightest bit flippant when I responded by asking her if, after seventeen years, she really felt that it had offered her anything? She looked at me blankly, and it soon became very clear that what she needed was not more therapy, but a friend to talk to.

There has been another puzzle: why is it that women are more likely to develop depression than men? The most profound gender difference in mood disorders begins to emerge after puberty, so it would be easy to attribute it all to hormones. But that would be a mistake.

I recently pointed out that there are some fundamental differences in the ways in which men and women interact: women tending to be more relational and men tending to be more transactional. The female sense of self tends to be more entangled with her relationships, while a man’s self-worth and sense of self is more often associated with his achievements. Most of these differences begin to emerge in early puberty: when girls talk to their friends, their conversation tends to be more emotional and to be concerned primarily with relationships, while boys tend to be more reserved and to discuss facts, statistics and achievements. There is some evidence from research in different cultures that these different styles seem to be the norm throughout the world. Yes, there are of course plenty of people of both genders who behave differently, and so it is more accurate to relate these differences to the male and female factor or essence, rather than getting it confused with anatomical differences.

Emotional language tends to put more strain on a relationship, and it is well-recognized that girls’ relationships turn over much more rapidly than boys’ ones. An interesting hypothesis proposed some years ago by Professor Sir David Goldberg, is that this high turnover in relationships may lead girls to experience more disappointing experiences in their social networks, and it is this string of disappointments that predisposes young women to depression.

A happy, healthy, dynamic network of friends is a cornerstone of developing and maintaining psychological resilience. Without them you become progressively more vulnerable to the reversals that affect all of us from time to time.

“A friend might well be reckoned the masterpiece of nature.”
--Ralph Waldo Emerson (American Poet and Essayist, 1803-1882)

“To know how to live in a brotherly way with those around us is to be rich, for each of us, with our face, eyes, voice and thoughts, contributes something alive, something warm, which nourishes everyone.”
Omraam Mikhaël Aïvanhov (Bulgarian Spiritual Master, 1900-1986)

Sex Drive and Relationships

The BBC is reporting on an article published in the journal Human Nature.

According to the report - and I haven't yet seen a copy of the original research - investigators from the Hamburg-Eppendorf University in Germany found that the sex drive of many women begins to plummet once they are in a secure relationship. They found that four years into a relationship, less than half of 30-year-old women wanted regular sex.

Conversely, they found that a man's libido remained the same regardless of how long he had been in a relationship. The researchers interviewed 530 men and women about their relationships.

They found 60% of 30-year-old women wanted sex "often" at the beginning of a relationship, but that within four years of the relationship this figure fell to under 50%, and after 20 years it dropped to about 20%.

And here's a shock: The study also revealed tenderness was important for women in a relationship. About 90% of women wanted tenderness, regardless of how long they had been in a relationship, but only 25% of men who had been in a relationship for 10 years said they were still seeking tenderness from their partner.

The researchers then start talking about the evolutionary implications of all this: that women evolved to have a high sex drive when they are initially in a relationship in order to form a "pair bond" with their partner.

That is all quite plausible, but it is a usually a mistake to try and reduce human behavior to hormones, neurotransmitters and evolutionary drives.

Most men and most women may well have different sex drives, and the duration of a relationship may play a part. But it is just as likely that we are seeing the effects of having children who need lots of a couple's attention and a natural reaction to one or both partners focusing more on their careers and outside activities rather than on the relationship.

In Healing, Meaning and Purpose I talk about the best solution to tired relationships: it's not a matter of trying every variation in the Kama Sutra. The most valuable thing to ensure the viability of intimate relationships is not so much to try to learn lots of different techniques, but instead to make the time together really count. There is nothing quite as attractive as an intimate occasion marked by complete focus on and awareness of the other person. Feeling the dance of the duality, focusing on all your senses, and, if you can, feeling the subtle systems of the other person.

Simple things that have rescued countless relationships. And a lot cheaper than hours of therapy.

Gender, Culture and Communication

Regular readers will know that I’m very interested in gender differences. More and more evidence is confirming what most of us have always known: men and women tend to think and behave differently. Some of the differences are clearly neurological and some social. It is sometimes difficult to sort out which is more important: some research findings on gender differences have produced mixed results because of some of the assumptions of male investigators!

But notice that I emphasize the word “tend” to think differently. We are always dealing with statistical differences. My Y-chromosome should enable me to navigate from A to B without difficulty. In fact, I am seriously directionally challenged: I should probably have a GPS system with me when I go down to the shops!

I have spoken about my admiration for the work of Deborah Tannen, and I have also written about Christina Robb’s marvelous book, in which she charts the development of new insights into gender differences in psychology.

This weekend I was at the annual meeting of the National Speakers Association in Orlando, and I learned something very interesting that fits in with all of our previous discussions. I learned it from one of the speakers, named Julia Hubbel. I already knew that women tend to be more relational in their interactions and men are more transactional. Most women tend to spend a lot more time on the maintenance and development of relationships and most men are more interested in the bottom line: What is the solution? What’s the deal going to be? What I did not know is that there is some data to indicate that non-White males tend also to emphasize relationships over transaction. As soon as I heard that, I was sure that it was right: I have had a lot of dealings with people from the Indian subcontinent, and most would consider it very rude to get straight down to business before we had taken tea or eaten something while discussing family and other personal matters. Julia teaches networking skills that integrate gender and ethnic considerations.

As she was explaining her insights and methods, I was reminded of the work of the anthropologist and cross-cultural researcher Edward T. Hall, who wrote a series of excellent books on cultural factors and thought.

Gender and cultural differences in communication are of such importance that I plan to return to the topic in the near future. In the meantime, you might be interested in a book by Richard Nisbett, entitled The Geography of Thought: How Asians and Westerners Think Differently and Why. After multiple trips to Japan, during which I learned a lot about cultural differences, I gave a copy to a friend who is a Canadian in a senior management position in the Japanese affiliate of a US-based company. He told me that he was astonished by the accuracy of the insights.

Some of the political misunderstandings that you see on the news every morning are often a consequence of different thinking styles. Learning how men and women and people in different cultures think and operate is not just interesting.

It is essential.

“Skill in the art of communication is crucial to a leader's success. He can accomplish nothing unless he can communicate effectively.”
-- Norman Allen (American Playwright, Recipient of a Charles MacArthur Award for Outstanding New Play)

Technorati tags: Communication Gender differences Deborah Tannen Cross-cultural communication

An Online Resource for Attention Deficit Disorder

Regular readers will know that I am very interested in attention deficit disorder, and I have written a number of articles on it. (Just click on the Category over on the left hand side).

It a common clinical problem, thought to affect 5% of American adults and an even larger number of children. Yet there is even more to it, in that attentional problems may also be able to teach us a great deal about gender differences in the brain and in psychology. To say nothing of helping us learn methods for improving everyone's abilities to concentrate, focus and pay attention, at a time when ever more objects and events are demanding our attention.

Additude magazine has as its mission statement "to provide clear, accurate, user-friendly information and advice for families and individuals affected by AD/HD." Even as a professional, I have found the quality of the magazine to be excellent, and they are certainly succeeding in their aims. They certainly do not focus on medication as anything more than one aspect of treatment.

If you are interested in ADD, I highly recommend this resource.

“Life is denied by lack of attention, whether it be to cleaning windows or trying to write a masterpiece.”
--Nadia Boulanger (French Conductor and Musician, 1887-1979)

Technorati tags: Attention Attention deficit disorder Gender differences

Crucial New Insights Into the Metabolism of Medications

When we examine the interactions of medicines with the body, we are interested in what the medicine does to the body, and also what the body does to the medicine: what we call pharmacokinetics and pharmacodynamics. But it has long been known that these two essential considerations are far from being the whole story: there are enormous differences in the ways in which people respond to medicines: some people need huge doses of a medicine, whilst there are others who cannot tolerate medicines at all. Though part of the explanation for those differences is clearly not just pharmacological – the same people who are super-sensitive to medicines are often also extraordinarily sensitive to acupuncture and homeopathy – there is a new kid on the block: a new factor in drug metabolism.

Men and women handle medicine differently, the time of day that a medicine is taken, as well as things like the food eaten in the last few hours can all impact the outcomes of taking a medicine. We have also known that there are many other variables in a person’s response to a medicine.

For more than two decades physicians and pharmacologists have wondered if the three pounds of bacteria living peacefully in our intestines might have a major impact on the metabolism of medicines. This question was first prompted by clinical observations: first, people with no intestinal bugs exhibited many oddities in how they handled medicine, and second, there are some rare situations in which overgrowth with unusual bacteria can chew up certain essential nutrients.

New research reported by the BBC confirms these clinical observations.

Researchers at Imperial College London and the pharmaceutical giant Pfizer have used a “pharmaco-metabonomic” approach that uses a combination of advanced chemical analysis and mathematical modeling to predict responses to drugs. Details of the research are published in the journal Nature.

The method is based on an analysis of the chemical products of the body's metabolism. We think that examining these patterns can help diagnose diseases, predict an individual's future illnesses, and their response to treatment.

The principle investigator is Professor Jeremy Nicholson and he has said the 'pharmaco-metabonomic' approach appears able to take account of individual differences in the way that drugs are absorbed and processed by the body. It differs from person to person depending on factors including the type and amount of bacteria found in the intestines.

These new techniques could be the first step towards the development of more personalized pharmacological treatments. For those of us practicing integrated medicine, this is a most welcome development.

Technorati tags: drug metabolism gender differences intestinal bacteria pharmacodynamicspharmacokinetics

Cognition and Lingerie

Well, these two may seem to be strange ahem, bed fellows, but recent research suggests an intriguing link. This item seemed so odd, that I’m going to name names. Carol Kirshner - web mistress and researcher - is the only person in the world who could possibly have exposed me to this piece of research. The whole thing so shocked me that it has taken me until now to be able to report to you, gentle reader.

Carol found this blog item which had the wonderful title “Lingerie sharpens the financial mind.” It followed a report by the BBC , which sported a less racy title. Sad to say, some of the news reports got it wrong. You can read the abstract of the paper, and there’s a nice analysis of the paper by Dr. Petra Boynton.

The study did not actually say that men can’t function if they catch a glimpse of a scantily clad female. It was more subtle than that, and as Dr. Boynton points out, there are many reasons for being cautious about the findings. In actual fact the data seem to indicate that a glimpse of one of the lingerie pictures actually enhanced the men’s rational decision making.

Now there’s a thought….

Technorati tags:cognition distraction lingerie gender differences

Women’s Health

“There is no female mind. The brain is not an organ of sex. As well speak of a female liver.” Charlotte Perkins Gilman (American Feminist Writer and Editor, 1860-1935)

It is easy to understand the sentiments behind this well-known statement by a pioneer feminist, but the fact is that it is dead wrong. In recent years there have been a host of new discoveries into the very marked gender differences not just in the brain, but also in the liver and for that matter throughout the body. Differences that have important implications for your health and well-being. For some years I worked with a husband and wife team who had made important discoveries about gender differences in the brain. In fact some of this work made the front page of Newsweek magazine. The female member of the team once told me how, after giving a lecture at a prestigious University, she had been scolded by some people who told her that her research was undermining the movement toward gender equality, and that she should stop what she was doing. I leave it to you to make up you own mind about that.

Yes, there are demonstrable differences in the brains of men and women, but ONLY when looked at statistically. There is as much variation in brain structure as there is in height or skin color. There are also gender differences in cognitive ability, but again there are huge variations. As a male I should have a good sense of direction. In fact my sense of direction is so bad that I once joked that we should put up signs inside my house directing me toward the kitchen and the den! An over-emphasis on gender differences can have some undesirable consequences: couples therapists tell me that if clients have become overly dependent on the Mars/Venus concept, they will often have to schedule an extra 3-4 sessions to “deprogram” them.

Are gender differences in the brain and in cognition culturally determined? Probably not: experiments conducted since the 1960s have found that gender differences in cognition, emotion and perception appear to be trans-cultural, and what is more some of the same differences are found in animals. Higher rates of depression are found in women around the world, while autism is more common in boys. Estrogen and testosterone have profound effects on the developing brain. More than 20 years ago Norman Geschwind, one of my early mentors, published some challenging speculations about the interactions of sex hormones with the brain, and handedness, migraine and autoimmune disease. Some cognitive skills change during the menstrual cycle, a fact that has allegedly been used by some professional female chess players, who regulate their cycles with the oral contraceptive to ensure that they hit the big tournaments at times in their cycles when their reasoning and visuospatial abilities are at their best. The Scottish Grandmaster Jonathan Rowson discusses some of these issues in this month’s issue of the magazine New in Chess.

If we leave aside the brain, there are also enormous gender differences in other parts of the body that have significant implications for health. Apart form obvious differences in size, women tend to have more subcutaneous fat than men, so medicines that go into and are stored in fat have to be dosed differently in men and women. There are big differences in one of the key enzymes in the liver that is involved in dealing with toxins or in metabolizing drugs: important to know if you are being prescribed medicines. Women’s stomachs also tend to empty more slowly than men’s: yet another reason for being careful to take gender into account when prescribing medicines.

Amidst all of these physical differences, that I am going to explore in future entries, it is important not to lose sight of the different cultural demands on men and women. In the United States and Europe more women than ever are being expected to fulfill multiple roles: worker, wife, mother, cook, chauffeur, nurse and planner, to name only a few. It is no surprise that so many women are facing a condition that I call, for obvious reasons, “Overload.”

In my book Healing, Meaning and Purpose, I discuss some of the drawbacks of conventional methods of helping people cope and some novel solutions. As an example, I have known many people who have gone to stress management classes, that have meant them rushing across town, missing dinner, doing the class and then rushing home to put the children to bed and check their email. That kind of thing is not very likely to be helpful. When I taught T’ai Chi and Qigong classes, I would usually spend the first 45 minutes helping people wind down before we could get to work.

In response to this chronic overload, I have spent many years devising extremely brief things that people can do to help themselves in the course of a day. I have a principle that has guided me for years: for most people, if it takes more than one minute, it’s going to be very difficult to fit it in. But once they have found that one minute, other minutes often begin to follow. I shall shortly be going into the studio to record some more of my one-minute miracles, and early in the spring, we shall begin to attach some podcasts to this blog.