• Spring 2022 Editorial - We Are Animals

    What does the world’s reaction to Russia’s invasion of Ukraine, COVID-19, partisan politics and physician burnout, all have in common? Biology.

    That’s right, human biology is the basis for human behavior. Human behavior can be looked at in many ways. But even our most sophisticated thoughts and actions derive from basic and now well understood biological processes. So, in a sense, even the most complicated political and cultural phenomena are determined by how our neurons connect, on how our synapses work, on how our hormones set the tone.

    One aspect of this is that many people apply various sciences to the understanding of the things I began this essay with. But the sciences attack the problems at many distinct levels. The levels are all legitimate, but they frame the problems differently. There is a rise in crime. This can be considered in light of new laws, or lack of laws. Or we might analyze it in socioeconomic terms. Or maybe that childrearing is affected by different values and customs. I like to take it even further to issues of how people react to all the bad news we keep hearing, which in turn generates depression and stress hormones. It also adversely affects our sleep as well as our moods. Indeed, chronic anxiety gives us everything from ulcers to closed-mindedness, to difficulties with learning and poor impulse control. All of these analyses are correct, but rarely do political scientists, or sociologists talk with neuroscientists or child behaviorists. But they are all connected. It’s all biology.

    Did you know that corticosteroids like glucocorticoid (the stress response) depresses the immune response? Of course, you did, as you regularly use these agents to treat uveitis. But you probably forgot that cortisol levels go up every time we watch the evening news. Or get into an argument with our neighbors over politics or gnash our teeth after a frustrating day at work arguing with insurance carriers. Cortisol is great for the fight or flight response (it increases blood pressure and blood sugar to get your muscles optimized), but it also puts most of the parasympathetic system on hold. Yet, it’s the parasympathetic system that maintains your long-term health and builds resilience for tissues and organs. Too much fight or flight and your body and mind becomes a mess.

    Figure 1 - Baboons “yawn” when they are asserting dominance. This baboon flashes the canines reminding other baboons of the consequences of fighting, like Putin mentioning that Russia has nuclear arms. The sight stimulates the amygdala of other baboons which raises cortisol levels.

    If you are a low-ranking baboon, you need all the cortisol you can muster to escape the bigger, badder boys from beating on you. But if you are a high ranking and secure baboon, you have better fur and will live a longer life. Sometimes, I think that our culture, and especially our media, has made us all feel like low-ranking baboons (See figure 1).

    In another article of this issue of Scope, Dr. Samuel Masket writes about the new epidemic of physician burnout. It’s serious and certainly another thing to worry about. But, paradoxically, worrying too much about it is a self-fulfilling prophecy. There are many reasons for physician burnout. But, in the end, these reasons probably converge as they all overtax our sympathetic nervous system, inundate us with cortisol and change the neurotransmitters and even the connections in our brain and the size of limbic and other structures. After long-term priming with cortisol, the prefrontal cortex has less control over our amygdala, and we are overreacting to feelings of fear and anxiety and sadness, which in turn causes us to make bad decisions that can lead to a vicious circle.

    Stanford researcher and professor Robert Sapolsky touches on some of these issues in his excellent book, “Behave.” He starts with the biology and goes from molecular interactions at the synapse to neurophysiology, to neuroanatomy to hormonal regulation to human behavior and even touches on the philosophy of ethics and the problems with jurisprudence. I want to emphasize his first principles: That the brain houses the mind. But it turns out, the body also influences the mind, as we have hormones and other bodily parts that contribute to our decision making. For example, if your heart races, you feel anxious, not the other way around. And if you relax your muscles, you feel good and happy. Even forcing a smile can fool the mind into thinking you really are happy.

    The brain and body do their things based on two basic phenomena: genetics and the environment. No surprise there. But the consequences of this are surprising. If it’s all determined, how can we hold anyone accountable? What does the criminal justice system say to the fact that no one chose their genes or their upbringing? Specifically, much of what mitigates our decision-making is the restraint that our prefrontal cortex imposes on our more impulsive and emotional limbic system. But the prefrontal cortex is the last area of the brain to develop. It’s not fully myelinated until we reach the age of 25.

    How can we give extreme punishments to younger adults, much less teenagers, when they are not really capable of full impulse control? That is logical, but that attitude goes nowhere as long as we believe in retribution. The logical extension is that no one should be judged too harshly. I take the attitude that the sense of justice upon which the system develops is itself an outgrowth of human behavior, which is both hard wired and socially encouraged for us to want and expect accountability.

    Figure 2 - Very simplistic diagram of how various brain centers modulate each other and our emotional perception of things. PFC = Prefrontal Cortex. Several recurrent loops and negative feedbacks have been left out, for clarity. For example, it should be noted that the PFC helps abate the Amygdala. It’s especially interesting that the Insula, presumably evolved to regulate literal disgust, processes metaphorical disgust as well and this has been exploited effectively by propaganda that demonizes people as “vermin”, etc.

    So, what makes us human? All of it, obviously. But we can break down our human sides and see which brain areas are most crucial to such. For example, I always loved the TV series “Star Trek” because it had two leaders, each in my mind representing half of what we as humans are capable of. There was Mr. Spock, well-motivated but reducing everything to calculation. And there was Capt. James T. Kirk, who was intuitive and always followed his gut sense. In this sense, Spock was the prefrontal cortex which is proportionately larger in humans than any other species. The prefrontal cortex is there for attention and planning and to mitigate the emotional reactions to which we are all prey. It’s the prefrontal cortex that largely keeps us from being emotional pinball machines (e.g., teenagers who still have underdeveloped prefrontal cortexes). But humans are very much products of our limbic system. And that “gut sense” can be very sophisticated and useful. Capt. Kirk didn’t always react impulsively but integrated his gut feelings with some prefrontal cortex override. We are probably our best selves when we do such an integration constantly and smoothly.

    But it gets complicated. The anterior cingulate gyrus is at the center of our feelings (ranging from anxiety to well being and empathy as well). And remarkably, the anterior cingulate gyrus is very sensitive to internal body measurements. That’s the part of the brain that decides you are scared after noting that the heart is racing. It’s also the part of the brain that seems sensitive to the effect of placebos (that’s one reason many medications work so well)! But mostly, it’s the amygdala that screams the need to respond to threats as it is always aware of pain and fear. Then, there’s the insula that seems to be our center for disgust (of smells but also of categories of people and despicable actions) that seems to consider “us” vs. “them” in allocating indignation. If the insula gets support from the amygdala, you get hate (figure 2). Now, of course, this simple analysis of brain areas is superficial and based on new studies, some of which are still controversial. And many of these terms (indignation, caring) are prone to philosophic deconstruction. But you get the picture.

    So, when I watch CNN and see the wounded women and children being dragged out of a bombed-out theater in Ukraine, my amygdala goes nuts with emotional pain, fear, and the need to warn me. This can now go two ways. The amygdala can get reinforced by my insula, that regards Russians as the major U.S. enemy and hence “them”, to create intense feelings of hatred. That’s easy. Or my amygdala can input my anterior cingulate gyrus and not only generate a sense of caring but added in with conscious thoughts from my prefrontal cortex allowing me to emphasize my feeling of sympathy. Should I donate to an agency that smuggles weapons to Ukraine to fight Russians, or to an agency that helps the refugees find a safe haven? If I do the latter, my anterior cingulate gyrus may bring me to a feeling of well-being. My cortisol levels will fall, and my heart rate will come down. 

    Very recent studies have shown that if you block cortisol receptors in mice and men, both will show more kindness to strangers, and that these functional brain changes can be reproduced naturally by trained Buddhists who concentrate on kindness in meditation. I don’t know how to meditate, so if I’m kind, it’s probably because my wife is very good at keeping my blood cortisol levels down. That’s one way to avoid physician burnout.