I am sitting in the comfort of a rustling train as it bumpingly floats its way through the winter-white Nova Scotia countryside,  heading back home after four days of work in a rural part of a neighbouring province.

I am reading yesterday’s Globe and Mail.  The lead editorial headlines: “Those who read well at 15 succeed”.  And, the story is about a Canadian study reported by the OECD that young people who can read well at age 15 tend to do well in life and that young people who can not, do not.  It also reports the truly amazing finding (here I am being fascitious) that those youth who study do better than those who do not!

What insights! What revelations! What a surprise!  Teenagers who read well and study hard do well?  This is news?

Well, the news here is that reading ability is a good proxy measure for many problems.  We have known for a long time that the inability to read at grade level in grade three is predicitive of poor educational, social and vocational outcomes.  Seems that is also the case at age 15.  Reading is a complex skill.  Reading difficulties can be the result of psychosocial adversity, mental disorder, learning disability, or combinations of many factors.  Whatever the reason, reading ability is a “marker” that can be used to identify young people who may need help in sorting out what the problem is and then they can be given  personal assistance in addressing the problem so that they can become successsful.

So why are we not doing this?  Why are we not assessing reading levels in grade three and at age 15 in every single school in this country and using that assessment to identify young people and develop personal interventions that can help them be as good as they can be?  Why are we wasting large amounts of money on building self-esteem and other similar programs when the issue is not self-esteem?  Why are so hesitant to put our money and our efforts into those areas that are likely to bring the best results, particulary for those who need it?

From what I have seen, one reason may be that it is difficult and costly to provide the assessment and intervention services that young people who are having difficulty need.  So it is easier and perhaps cheaper to provide programs for the many that do very little, than interventions for the minority that may do a lot.

There is also a highly discriminatory ideology at play – not manifest but latent.  We do not want to “label” those who need help so we do not identify them and we do not provide them with what they need for success.  You see, “labelling” would hurt their self-esteem and would thus be unfair.  Instead we shunt them aside in favour of “helping” everyone (including mostly those who do not need any extra help).  This of course is more “fair” to those who need help as it denies them what they really need and sets them solidly on the road to poor outcomes. “Oh well, at least they were not labeled and their self-esteem did not suffer as a result”.

Is this fair?   Is this the right thing to do?  Not in my book.

–Stan

Since it is Christmas and since gift giving is “top of mind” (regardless of your religion – this is a time of year that gift giving is celebrated – OK, not the retail kind, the REAL kind), I thought about what gift I as a mental health professional would like to receive.  And guess what – a number came to mind.

First, I would like to see a Canada and the global society be a place in which people living with mental illness had exactly the same rights, equalities and access to care as people with illnesses that are not disorders of the brain have.  When we can speak of diabetes and colitis and arthritis and schizophrenia all in the same breath and with the same considered and supportive perspective then we will have gone a long way to decreasing stigma and barriers to mental health care.

Second, I would like to see us beginning to talk about finding a cure for various mental illnesses, much as we speak about finding a cure for breast cancer or finding a cure for prostate cancer.  We have finally developed and are rapidly developing our understanding of the brain and its functions – in health and in disease.  And we are getting closer to understanding the social and enviromental impacts that effect brain function and how those may contribute to the development or perpetuation of mental disorders.  So its time we set our sights on a cure for schizophrenia, a cure for major depressive disorder, a cure for bipolar disorder and so on.  We may not find a cure in the next five or ten years, but by gosh the search will take us a long way forward.

Third, I would like to see our mental health community supported and enhanced by coming together of various components instead of those components pulling us apart.  Sometimes I think that if we spent one half of the time and effort that we seem to put into supporting pet ideologies or convincing others of our “truths” in common purpose, we would be so much further ahead.  One foundation that we really need to build our community on is scientific literacy.  We need to use science to advance our cause.  We need to use the best scientific methods and the knowledge that they bring to us to inform our directions.  We need to embrace the science and not rail against it.  Building on this foundation we can work together to ensure that all the interests and different voices of individuals and groups are expressed, heard and included.  A house has many rooms, but if its foundation is not strong it will collapse, regardless of how pretty it may look.

So those are my three Christmas gift wishes.  The best of this gift reminding season to you and yours.  Regardless of your religious beliefs or other defining features.  Be well.

-Stan

So what is this with sleep anyway?

Given what we know at this time, sleep is necessary for brain growth and development.  It is also fundamentally necessary for academic success.  For example, when we sleep, we learn.  Important memories from the previous days are consolidated and the capacity to learn for the next day is refreshed.  And, during the teen years, with the accelerated brain growth and re-organization that occurs during those years – youth actually need more sleep than when they were children.

During the teenage years the child pattern of getting up early and going to bed early shifts to going to bed later and getting up later.  And at the same time, the brain’s need for total sleep time increases – as much as an hour or more per night.  When accentuated by the digital and light enhanced evening environment, staying up later and later becomes the norm for many teens.  And, because the school day usually starts fairly early, students (as the research has shown us) are frequently sleep deprived, sleepy and not at their optimal learning capacity – especially in the first hour or two of classes.  This pattern leads to not enough sleep during the week and this leads to sleep debt – time that needs to be repaid – you guessed it – on the weekend!  This results in a pattern of about 2 hours difference between usual sleep/wake patterns between school days and weekend days for many teenagers.  This is equivalent to a jet lag of 2 hours.  And that happens mostly every week!

One obvious solution to this problem is starting the school day later for high school students.  Indeed, some studies have reported that this results in improved academic performance and one study in Kentucky also found fewer automobile accidents during the later school start trial.  However, this accomodation to the changing teen brain has not proved to be popular with education officials and across most of Canada and the USA, schools still start early and teenagers still come to class tired and not ready to learn.  And guess what?  In many places, exams (including those that take an enormous amount of concentration – such as mathematics) are frequently scheduled for early in the morning! 

So what can be done about this?  Well, changing the school day is not likely to happen, but that would be a really good idea.  Just think, setting up a school protocol to meet the needs of the students – what a novel idea!  For the individual student, trying to get to sleep a little earlier (even one hour earlier) would pay big dividends.  And if that is just as hard as changing the school start time – at least get a good nights sleep before your exam.  Staying up all night and cramming is not helpful.  Getting your beauty rest is.  Isn’t science grand?  Did your grandmother tell you this at some time?

Neuroimaging has indeed revolutionized and continues to revolutionize our understanding of mental disorders, because it is based on learning about how the brain grows, develops and functions.

This is so far removed from earlier ideas about how “society” or “the environment” or “culture” or “religion” or “monsters” created mental illness, that some people whose beliefs or other investments are in these explanations will have problems accepting its value. When linked to other new tools of understanding such as genetics and molecular biochemistry, we are beginning to learn how the brain functions in health, when it is challenged by the environment and in disease.

The recent article in the Globe and Mail by Elizabeth Scott brings to life the importance of this technologically enabled explosion in understanding. She shows us how valuable this harnessing of new methodologies can be as we pull away the shrouds of uncertainty and begin to lift the veil of confusion caused by centuries of invalidated explanations of why mental illness occurs.

The real challenge however will be in changing our perspective based on new knowledge. Simply put, old ideas die hard and the new understanding will be strongly resisted by those who either do not or will not wish to be informed. On the other hand, this new information will need to stand the rigorous and unfriendly critical scrutiny of science, as different researchers conduct different studies and argue about what their results mean. This is a messy business and science is not about “the truth”. It is merely about being less wrong, most of the time.

All of which brings me to an exciting study recently published in the Proceedings of the National Academy of Sciences which demonstrated an almost 1/3 reduction in the right cerebral cortex (the outer cell layer on the right side of the brain) in the brains of people who have a family history of depression. These changes were associated with a number of difficulties in thinking and when the left side showed thinning, these difficulties became part of the syndrome of what we call major depression.

To me, these findings suggest that depression (at least the type that runs in families) may be a degenerative brain disorder. That’s right, a degenerative disorder – much like Parkinson’s disease or Alzheimer’s disease. And the thinking problems that we have noticed in people with depression may not be the result of the mood problem but may actually be part of the same disease process that gives rise to the depressed mood. That is, our theories that negative thoughts cause depression are likely wrong. Both the mood problem and the thinking problems are due to the same disease process in the brain.

This finding supports observations that many researchers and clinicians have been making for years. And, this finding suggests that we may have to change how we search for better treatments for depression. Maybe we should be looking at medications that can arrest brain degeneration or maybe we should be looking at medications that can improve cognition. Whatever the outcomes, these findings are exciting, offer new hope for future research and challenge what we “believe” to be true. Stay tuned – the story will unfold as it should!

~ Dr. Stan Kutcher

The battle against chronic illness is long, expensive and can involve a lot of guesswork. But closer monitoring of our body in real time is improving chances for better long-term health – and, ultimately, quality of life.

Over the past decade, the evolution of medical technology has produced sophisticated, hi-tech and non-invasive tools. Devices like advanced brain scans and semi-invasive blood sugar sensors are opening exciting new doors to research – and in the face of new data, whole medical disciplines are shifting focus as science debunks theories of the past.

For a long time, brain researchers could only theorize about how the brain worked; there was no way watch it in living colour.

But thanks to neuroimaging, “what we know today compared to a decade ago blows your mind,” says Stan Kutcher an expert in adolescent mental health based at Dalhousie University in Halifax.

“Explanations for mental disorder [used to be] what I would call ‘brainless,’ ” Dr. Kutcher says. They were “based on theories of mind or psychological models in which the brain did basically nothing.”

This was because, until recently, data gleaned from CAT scans and EEGs wasn’t sufficiently sharp.

“The data was overwhelming, but it wasn’t specific enough because both psychoneuroendocrinology and our special EEG analysis of function were still so far removed from what was actually going on inside the brain itself. They were very, very rough tools. So it was like trying to have sex wearing five condoms. You’re sort of in the general area, but you haven’t got a clue what should be going on.”

But where brain scans of the mid- to late eighties proved there were structural differences in the brains of people with mental disorders compared with healthy ones, today we can also actually watch the brain in action as it functions, both in health and in disease: “How does the brain control anger, listen to music, read, express love?” Dr. Kutcher asks.

Answers to those questions are being found, thanks to today’s functional MRIs and PET scans – technology that has eclipsed former scanning methods. Dr. Kutcher believes that will soon lead to direct diagnosis. The hope is that brain illness – from injury to stroke to mental illness – will become precisely and accurately diagnosable, in turn making targeted, consistently successful treatments possible.

“I wouldn’t be surprised if in the next 15 to 20 years two things happen,” Dr. Kutcher says. “We will have abandoned our current nomenclature, which is based on science and symptoms, for one based on a much better understanding of brain dysfunction and the symptoms that are a result of that … and at that time neuroimaging may well become diagnostic.”

Read the rest of the article on Globe and Mail.

This week is Brain Awareness Week (BAW). BAW is an international campaign dedicated to advancing public awareness about the progress and benefits of brain research.

According to the Dana Foundation:

Brain Awareness Week began in 1996 as a modest effort involving 160 organizations in the United States. BAW was created to bring together diverse groups from academia, government, professional, and advocacy groups and unite them with a common theme that brain research is the hope for treatments and preventions, and possibly cures, for brain diseases and disorders, and to ensure a better quality of life at all ages. In 1998, the campaign became international, first as a day and then as a week. Since that time, BAW has evolved into a powerful global initiative with more than 2,200 partners in 76 countries (as of the 2008 campaign).

What is the brain made of and how does it work?

The brain is made of millions and millions of special cells called neurons and other special cells called glial cells. Each of these cells is connected to many many many other cells by long “arms”. These long arms let different cells talk to each other. The places that the arms touch other cells are made specially to help cells talk to each other. Cells talk to each other by sending electrical and chemical messages to each other.

There are more connections in the brain then there are stars in the sky. The human brain is the most complex thing that we know about – and we are learning more about it every day. All things that we do and are as human beings comes from the human brain. It writes our greatest stories, builds our most complicated machines and buildings, creates music and art, plays games, builds social networks, lets us fall in love and directs us to do all the good and not so good things in life.

The brain remembers everything that happens to a person and stores little bits and pieces of those happenings in different parts – we call that memory. The brain takes information from the environment and checks that information against its memory. Then the brain decides what it will do. Every thought we have, every feeling we have, and everything that we do is decided by our brains. It is really important for us to keep our brains healthy.

Here are some ways to help your brain to be healthy.

• Eat proper food. A healthy diet is important for a healthy brain.
• Gets lots of sleep. Your brain needs sleep to grow properly and to remember things better.
• Don’t use drugs. Drugs damage the brain.
• Get lots of fresh air and physical exercise. Your brain needs oxygen to work properly and physical exercise is good for your brain because it reminds the brain to send “feel-good” messages to itself and to the body.
• Spend time enjoying music, dance or art. Your brain uses these things to help it work better at all sorts of activities.
• Take time to learn things. The more you practice skills or lessons the better your brain will be at doing what you want to do.
• Learn how to decrease stress. Your brain can be hurt by too much stress. Learn what makes you relax – such as exercise, hanging out with your friends, playing music, etc. and when you are feeling stressed out try to do those things that decrease your stress.
• Make good friends. Your brain develops best in a social network. Good friends are important.

More information about the brain:

Teenmentalhealth.org – The Teen Brain
Brain Blogger
PBS Documentary – “Inside the Teenage Brain”
The Dana Foundation
Brain Explorer

Previous Brain Posts:

Your Brain and the Internet: Use it or Lose it
Studying the Brain from the Inside Out
Enhancing Successful School Learning by Understanding How the Brain Works

Teenagers are known for risk-taking, novelty seeking, reckless behaviour and impulsivity.

Risk-taking behaviour can take on many different forms, including the misuse of alcohol or drugs, engaging in unprotected sexual activity, some types of criminal activity or risky, adrenaline-producing sports like skydiving or motocross. While you may not have done all of these things, the majority of adolescents and young adults report participating in one or more risk-taking behaviours.

One reason for this is that the teenage brain is less able than the adult brain to inhibit impulsive behaviours. Adolescents become more able to control their behaviour as their brains mature, but efficient control of impulsive acts is not fully developed until adulthood. When teenagers are faced with a reward, the “reward” systems of their brains are disproportionately active compared to the “control” systems (which are later to mature). This makes it difficult for teenagers to be in command of their reward response, and makes them biased towards immediate gain over long-term gain.

A recent article on medicalnewstoday.com highlighted this shortsightedness of youth

According to popular stereotype, young teenagers are shortsighted, leaving them prone to poor judgment and risky decision-making when it comes to issues like taking drugs and having sex. Now a new study confirms that teens 16 and younger do think about the future less than adults, but explains that the reasons may have less to do with impulsivity and more to do with a desire to do something exciting.

Compared with adults, the researchers found, teenagers consider the future less and prefer immediate rewards over delayed ones (for example, $700 today versus $1,000 a year from now). But it may not be impulsivity that guides their lack of forethought. Instead, the study found that teens are shortsighted more due to immaturity in the brain systems that govern sensation seeking than to immaturity in the brain systems responsible for self-control.

While the origins of risk-taking behaviour in adolescents have been debated for a centuries and many explanations ranging from hormones to social pressures have been endorsed. But the truth is we are still not completely sure why adolescents and young adults are more prone to risk-taking behaviours.

We do however know that part of the answer lies in the way that brain development occurs during this part of the life-span and that risk-taking behaviors often decrease as the young person matures into adulthood. It’s the complex interplay amongst brain development, personality characteristics and the environment that lead to differences in risk-taking behavior amongst young people.

Interestingly, recent research suggests that the perception of risk does not vary greatly with age, but rather within the type of decision-making information that adolescents and adults use. So even though adolescents may be more prone to engage in risky behaviour, they are not irrational, unaware, or believe they are more invulnerable than adults. These findings suggest that young people certainly have the frontal lobe capabilities to self modulate risky behaviors – provided they understand how to do so.

(Great article from UC Davis Magazine about “What parents should tell college students about risky behavior . . . even if they don’t listen.”)

~ Dr. Stan Kutcher

Your brain and the internet.

Yes, strange as it may seem there actually is a “Google” center in your brain. This was discovered by researchers who did brain scans on people who had never used Google (yes apparently there were some of those) compared to people who had often used Google.

Both groups received brain scans as they read books and as they Googled. In the google experienced group a part of their brain lit up on the scans, showing that their brains were adapted to using google. In the Google naïve group there was no such activity. For both groups when they read books the same parts of their brains lit up.

So, the researchers gave the Google naïve group some homework to do. You guessed it – go and Google. If my memory serves me correctly is was a couple of hours a day for a couple of weeks. When the brains of this group of new Googlers was scanned again, the same brain region as had been lit up in the previously Google experienced group now lit up in the new Googlers. Their brains had developed a Google center!

WOW. So what does this mean? And do you only find it with Google? The answer to the second question is easy – no. The answer to the first question is much more complicated and is currently being answered with research that explores the complex interactions that occur between your brain and your environment.

Basically, you find this happening with any activity that your brain is engaged in. The more you use your brain for something the more it develops. The less you loose your brain for something, the more likely it is to loose that development. It’s a case of “use it or lose it”.

And, there are many examples of this already well described and more being reported as researchers study the complex interplay between the environment and the brain. For example, did you know that the brains of taxi drivers in London, England have a larger area for spatial information than the brains of bus drivers do? That is because of the greater demand for processing and storing “maps” of the city of London. Another example – if you do not play the violin and then start playing, the part of your brain that controls the fingers you need to make the notes (by touching the strings) expands. And we know that if parts of the brain are not used, they shrink in size! So it really is “use it or loose it”.

Why does this happen? This occurs because the brain is the ultimate source of our ability to adapt to our environment. Therefore, as we spend longer periods of time in a particular environment (such as driving a taxi, playing a violin, googling, etc.) our brains become much more efficient at operating in that environment and pay more attention to it. This happens both by the expansion of brain cells dedicated to that activity and to improved connections amongst those cells. You can think of it is both growing and communicating better. The more “traffic” (that is to say – communication signals) there is as a result of doing things, the better we get at doing that thing because the “traffic” creates its own improved road system.

What does this mean for us? Many things. For one, it means that if we really want to excel at something we need to practice and to practice and to practice. Wayne Gretzky did not become a great hockey player just because he was born with the ability to play hockey. His greatness grew through constant practice. In the words of my father – “success is 10 percent inspiration and 90 percent perspiration”. So there is something to be said for memorizing the times tables and the soliloquies of Hamlet!

Another thing this means for us is that our brains will change as our environments change. That is, they will adapt their structure and functions to optimize our interface with our environments. In other words, we are what we eat (at least a bit). Certainly we become what we do!

Young people today live in an environment that differs fundamentally from that of their parents and their grandparents. People my age (ok – it’s in the fifties) are digital immigrants. If you are 30 years of age and younger, you are a digital native, and the younger you are, the more of a digital native you are. The brains of digital natives are shaped by the digital environments in which they live. What kinds of things may be going on as a result of this?

For one thing, the way we interact with people has changed greatly. Electronic interconnections such as Facebook and My Space have greatly altered traditional face-to-face social network development and maintenance. Where a few decades ago the “usual” social network consisted of about a couple of dozen people who mostly keep connected by face to face conversation and site based (usually at home) electronic links (remember that telephone was in the hall and you could not take it with you), today’s social networks number in the scores of “friends” and communication is primarily electronic – using personal communication devices that transmit not only sound but text messages.

These networks greatly expand the power of social interaction (we have recently seen how they operated during the campaign of Barrack Obama) but we do not know how they will ultimately influence the development of our social brains, and thus – us. Will the important evolutionarily developed abilities to read meaning in non-verbal facial messages diminish as we turn away from face-to-face contact or will these abilities be even further enhanced and honed as we build on those capacities (which we learn very early in life) and expand that ability to electronic means of communication? Or will there develop completely new ways for brains to communicate with each other – using digital technology as the impetus for this? We have no idea really — but stay tuned – time will teach us.

In the meantime, it’s a good idea to get to know more about the most important part of you – your brain. A good place to start would be to check out the brain area of our website. If you are interested in learning more about the impact of the digital world on our brains you can pick up a copy of the new book written by Don Tapscott – Growing up Digital, and settle down, put your feet up and read. Oh yes, your brain knows how to read and the more you read the better you get at it. Go ahead!

~ Dr. Stan Kutcher

Ever find one of those websites you just can’t stop going to? A few months ago a friend sent me a link to TED - an annual conference devoted to technology, education and design. Now I’m hooked. Their site contains hundreds of archived talks from some of the world’s premiere thinkers and doers.

One of the most inspiring talks on the site is by Jill Bolte Taylor, a brain scientist who had a massive stroke and was able to watch and experience as her brain functions shut down one by one. It’s a pretty amazing story and gives insight into just how complicated the brain is.

Often it’s not until something goes wrong that we think about brain health, and how it’s just as important to keep our brains healthy as it is to keep our bodies healthy.

When the brain is not working properly or is working in the wrong way, a person may experience difficulty thinking or focusing attention, extreme emotional highs and lows, or sleep problems. When these symptoms significantly disrupt a person’s life, we say that the person has a mental disorder or a mental illness.

While we know that mental disorders are brain disorders, Jill Bolte Taylor’s story is an example that brain problems do not always indicate mental illness.

~ D. Venn

There is no health without brain health. A healthy functioning brain is the foundation for all successful learning, social, civic and economic development. The school environment is an important component of healthy brain development. Just as schools are locations in which physical health can be encouraged and improved, so are they locations in which brain health can be encouraged and improved.

How and when a young person’s brain develops affects how they learn. An understanding of how a young person’s brain functions may help us better create brain-healthy environments and educational approaches that can enhance learning outcomes.

The human brain is the most complex entity in the universe. It has more connections than there are stars in the Milky Way. It is the organ of adaptation and of civilization. What we are, what we think and what we do, as individuals and as a human species are the outcomes of how our brains work. That in turn is influenced by a variety of other factors including our genetic endowment, the way our brains naturally develop over time, and the impact of the environment on the way our brains develop and on how they work.

The adolescent years (puberty to about age 25) are characterized by a second major period of brain development (the first is during the early years of development). New brain connections are developed, old connections are pruned, and complex systems that guide emotional integration, motivation, craving-induced behaviors and the capacity for good executive functioning (impulse control; problem solving; empathic/cognitive integration; etc.) come online.

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