Apparently hands can “think”..

Posted on June 10, 2019 by | 1 comment

During my leisurely walk in Arles, away from the hustle bustle of Paris, I came across several different spots where Van Gogh had painted works of art that are now world renowned. Van Gogh was extremely productive during his stay at Arles and he felt so inspired that he created around 300 paintings and drawings there. During my walk with a group of friends, I had mostly anticipated seeing certain spots where several tourists can be found.

Figure 1: The famous Café Van Gogh in Arles, France

Figure 2: Yummy strawberry sorbet

However, when we were exploring the less frequented streets of Arles, not only did I come across an amazing home-made sorbet shop, I came across this sign that caught my attention:

Figure 3: “La main qui pense” sign in Arles

“La main qui pense” translates to “The hand that thinks”. In my neuroscience classes, I had obviously not learnt about a “thinking hand”. But after doing some research, I realized that what neuroscientific/neuropsychological research has to say about the connection between the brain and the hand, actually could explain what it means for “a hand to think” but not in the most “obvious” way.

Firstly, it is important to understand the basic neuroscience behind how the brain and the hand “communicate”. Various types of receptors that innervate our hands and fingers are able to detect a specific form of energy of a stimulus in the environment (G. Jones, 2006). The receptors convert the stimulus energy into electrical energy through a process known as sensory transduction. The receptors and an afferent neuron form what is known as a sensory unit and sensory units are activated in specific areas known as receptive fields (G. Jones, 2006). Tactile information including size, shape, temperature etc., detected by different receptors, is sent to the central nervous system (G. Jones, 2006).

But how is the signal for movement transmitted from the brain to the hand? The motor system of the brain mainly includes the premotor area, involved in planning movements and the primary motor cortex, involved in then sending commands to the spinal cord for execution of movement (Cunnington, 2016). So, the way the brain “communicates” with the muscles, is through motor neurons in the spinal cord which receive the commands from the brain, which then cause contraction and movement of the muscles needed for that particular movement (Cunnington, 2016).

But you might be wondering –  it definitely still seems that the brain is doing the “thinking”… After doing a bit more research, it started to become clearer to me what some researchers meant by “thinking with your hands”.

For artists including Van Gogh, their job involved heavy usage of their hands. Many of us, on the other hand, like to think of our jobs as mind intensive rather than labor intensive. And there is no denying that there is some superiority associated with mind intensive jobs. But where does this belief stem from? Dr. Gaëlle Vallée-Tourangeau and Dr. Frédéric Vallée-Tourangeau highlight that while children are learning, teachers encourage the use of props and in the elderly, props are used to evaluate memory loss (Vallée-Tourangeau, G., & Vallée-Tourangeau, F., 2016c).  But during the time between these two stages, we are often judged for using our hands. Children are expected to do “mental math” and are told to just “do it in their heads”. I distinctly remember hiding my fingers behind my back while doing calculations. Our assumption is that the brain is the source of any and all intelligence (Vallée-Tourangeau, G., & Vallée-Tourangeau, F., 2016c).

This assumption is in line with the evidence found within neuroscience research. Mirror neurons in the brain fire when an animal acts and when the animal sees someone else executing the same action. Researchers including Frédéric Vallée-Tourangeau and Gaëlle Vallée-Tourangeau believe that physically interacting with objects as compared to simply playing out an action in one’s head could more positively impact behavior and actions (Vallée-Tourangeau, G., & Vallée-Tourangeau, F., 2016c).

The study conducted by Vallée-Tourangeau et al. (2016a), consisted of 50 participants trying to find a way to put 17 animals in four pens such that each pen had an odd number of animals. One group of participants used electronic tablets and a stylus to draw the solution and the other group had to use props to physically create a model. The study suggests that irrespective of cognitive ability, the participants using their hands to build models had more success with the task compared to those using the tablets and stylus. Overall, the study suggests that physically interacting with the environment around us can prove even more beneficial than drawing.

Figure 4: One solution was to create overlapping pens for the 17 animals

To further investigate their hypothesis, Vallée-Tourangeau et al. (2016b) conducted another study in which participants were asked to do long sums while repeating a word (Vallée-Tourangeau et al., 2016b). The study suggested that the participants who used number tokens (“high interactivity”) to work out the sums were less affected by the distractor as compared to those who were working out the sums mentally, who showed higher levels of mathematics anxiety (Vallée-Tourangeau et al., 2016b). Further emphasizing that the importance of physically interacting with the environment and using sense of touch cannot be underestimated. Therefore, researchers  like to metaphorically say that the hand “thinks” too.

Juhani Pallasmaa, the author of the book titled The Thinking Hand: Existential and Embodied Wisdom in Architecture, believed that “it is by permanently mobilizing our five senses that the body becomes our own tool for perceiving the world, and it is only through a unity of body and mind that the act of creation can take place” (Acte Sud).

So perhaps Van Gogh had it right. Van Gogh may have been using art as an outlet of his emotions. Or perhaps, engaging his hands while painting and drawing facilitated his thought process. While Van Gogh was suffering through psychiatric illness, it is possible that painting and drawing helped him gain clarity, even though it may have been fleeting.


References

Acte Sud. « La main qui pense ». Retrieved June 10, 2019, from https://www.actes-sud.fr/catalogue/architecture-et-urbanisme/toucher-le-monde 

Cunnington, Ross. “How our brain controls movement and makes new connections when parts are damaged” The Conversation, 28 September 2016, https://theconversation.com/how-our-brain-controls-movement-and-makes-new-connections-when-parts-are-damaged-63520

Fernandes, M. A., Wammes, J. D., & Meade, M. E. (2018). The Surprisingly Powerful Influence of Drawing on Memory. Current Directions in Psychological Science, 27(5), 302–308. https://doi.org/10.1177/0963721418755385

G. Jones, Edward. (2006). The sensory hand. Brain. 129. 10.1093/brain/awl308.

Vallée-Tourangeau, F., Steffensen, S. V., Vallée-Tourangeau, G., & Sirota, M. (2016a). Insight with hands and things. Acta Psychologica, 170, 195–205. doi: 10.1016/j.actpsy.2016.08.006

Vallée-Tourangeau, F., Sirota, M., & Vallée-Tourangeau, G. (2016b). Interactivity mitigates the impact of working memory depletion on mental arithmetic performance. Cognitive research: principles and implications, 1(1), 26. doi:10.1186/s41235-016-0027-2

Vallée-Tourangeau, G., & Vallée-Tourangeau, F. “Why the best problem-solvers think with their hands, as well as their heads” The Conversation, 10 November 2016c, https://theconversation.com/why-the-best-problem-solvers-think-with-their-hands-as-well-as-their-heads-68360

Figures 1, 2 and 3 – Images taken by me in Arles

Figure 4 – Overlapping pens solution, Retrieved from https://www.psychologytoday.com/us/blog/our-innovating-minds/201701/creative-thinking-in-action

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Now You See It, Now You Don’t

Posted on June 10, 2019 by | 3 comments

With 3 weekends having gone by already, I can easily say that this past weekend’s excursion to Provence was the most enjoyable one yet. The countryside in Provence was beautiful and the sights were breathtaking. From the Palais de Papes in Avignon to Pont du Gard to the city of Arles, this weekend gave me an enlightening glimpse into life in southern France. Earlier this week in class, I learned how Van Gogh spent the last years of his life in the Provence region, more specifically in the city of Arles. While in the city, I was able to visit the places around Arles that Van Gogh captured in many of his artworks. Van Gogh’s impressionistic paintings seem to have a life of their own, with golden strokes and dark blue swirls that seem to come right off the page. Standing in the same town that Van Gogh once called home and created masterpiece after masterpiece left me feeling in such a state of wonder. My state of wonder then began to stray away from the aesthetic aspect of his paintings towards pondering how did such a town inspire so many priceless works of art. I thought back to class when we discussed what Van Gogh’s life in southern France was like and the hardships he endured. Looking out over the Rhone, I began to ask to what level did Van Gogh’s mental state affect his work?

Actual location for the inspiration behind Van Gogh’s “La Nuit Etoilee”.

Amidst the beauty of these masterpieces lies hints toward the state of mind of Van Gogh. Surprisingly, many famous artists, inventers, composers, and the artistically creative show manic-depressive tendencies (Z. Janka, 2004). As discovered in class, Van Gogh was in fact plagued by many mental ailments, including hallucinations, seizures, night mares, insomnia, anxiety, manic episodes, depressive episodes, and alcohol abuse. One of Van Gogh’s most famous pieces, “Starry Night”, is thought to be inspired by a hallucination as he was admitted to a mental asylum at the time with no view of the cityscape accessible to him. Based on his reported behavior and mental ailments, I would most likely diagnose Van Gogh with bipolar disorder. Bipolar disorder is characterized by the National Institute of Mental Health as manic and depressive episodes that can be accompanied by psychotic symptoms (hallucinations and delusions) as well as substance abuse (NIMH). Approximately 15% of those with bipolar disorder have visual hallucinations and 28% have auditory hallucinations (F. Waters et al., 2014). The notion that multiple of Van Gogh’s artworks may have been a result of a hallucination intrigued me, as his paintings appear highly vivid, rich in color, with realistic yet whimsical details. Upon investigation into the neural mechanisms behind hallucinations, I learned that there are multiple ways that neurocircuitry plays a role in producing hallucinations.

When a sensation is perceived, let’s say a visual sensation, information from that sensation is sent from the retina to the visual cortex (V1). This is called bottom-up processing. When the brain first perceives a stimulus and then uses previous knowledge to influence what you are perceiving, it is known as top-down processing (A. Engel et al., 2001). A popular theory to the occurrence of hallucinations faults failures in either top-down or bottom-up processing that results in a perceptively false experience (L. Zmigrod et al., 2016). In psychiatric disorders such as bipolar disorder and schizophrenia, signals between top-down and bottom-up processing may become tonically hyperactive, causing top-down sensory expectations that result in false conscious experiences, otherwise known as a hallucination (S. Grossberg. 2000).  Another theory behind the manifestations of hallucinations focuses more strongly on bottom-up processing. When visual hallucinations occur, there is heightened activity in secondary and association visual cortices, the occipital lobe, and in visual processing areas in the parietal lobes. This hyperactivation of different brain regions may cause over-perceptualization which results in a change in activity in areas such as the prefrontal or premotor cortices, allowing for individuals to have a false sense of agency and perceive their own internal auditory or visual activity as “vivid external percepts” (L. Zmigrod et al., 2016). Either way, these false senses of stimuli or experiences cause an individual to perceive a false reality, hallucinating visual or auditory experiences and believing them to be authentic.

Diagram comparing top-down processing to bottom-up processing

Even given Van Gogh’s medical history, his personal account of his struggles, accounts from people who interacted with him, it is still difficult to fully understand the impact that his mental/physical  health had on his work. Was “Starry Night” a complete illusion? Did Van Gogh cut off his ear due to an auditory illusion? While we may never know the true answers to the questions, we can still infer that Van Gogh was, at the least, influenced by his possible bipolar disorder and the hallucinations that may have accompanied it.

Map of Arles, France

 

Works Cited

Engel, A. K., Fries, P., & Singer, W. (2001). Dynamic predictions: oscillations and synchrony in top–down processing. Nature Reviews Neuroscience, 2(10), 704.

Grossberg, S. (2000). How hallucinations may arise from brain mechanisms of learning, attention, and volition. Journal of the International Neuropsychological Society, 6(5), 583-592.

Janka, Z. (2004). Artistic creativity and bipolar mood disorder. Orvosi hetilap, 145(33), 1709-1718.

NIMH: Bipolar Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Waters, F., Collerton, D., Ffytche, D. H., Jardri, R., Pins, D., Dudley, R., Larøi, F. (2014). Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease. Schizophrenia bulletin, 40 Suppl 4(Suppl 4), S233–S245. doi:10.1093/schbul/sbu036

Zmigrod, L., Garrison, J. R., Carr, J., & Simons, J. S. (2016). The neural mechanisms of hallucinations: a quantitative meta-analysis of neuroimaging studies. Neuroscience & Biobehavioral Reviews, 69, 113-123.

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Let’s Van Go(gh) to Arles

Posted on June 10, 2019 by | 1 comment

Narrow streets, old buildings, and small shops were in sight as I walked with a group of my friends towards the renowned Vincent Van Gogh Café. We were in Arles, a city in the south of France where the Dutch painter Van Gogh lived for more than a year and created some of his best work. Once we reached the square, a yellow café was to our right, and in blue writing “Le Café La Nuit” and “Vincent Van Gogh Café” were spelled out.  Red couches and vases of yellow sunflowers lined the walls. People were rushing in and out, and tourists were taking pictures.

The image of Vincent Van Gogh Café in 2019 compared to Van Gogh’s painting in 1888.

This café, once a place where Van Gogh spent his time painting, now differed from the one depicted in his painting. Chairs were replaced by couches, empty stores fronts were changed to buzzing restaurants and hotels, a few circular tables were swapped for large rectangular tables. Intrigued, we did not stop there. Our next stop was the hospital ward courtyard, where Van Gogh was admitted twice, and created three known paintings.

The courtyard of the hospital ward in Arles (2019), with a replica of Van Gogh’s painting in the foreground.

You might be confused right now if you have not heard about Van Gogh’s story. Hospital ward? Twice? Van Gogh left Paris for Arles because of his mental health. However, after a few months in Arles, his mental health deteriorated. A razor covered with blood in hand, Van Gogh had maimed his ear, after arguing with his house guest (Khoshbin and Katz, 2015). At Hotel Dieu Hospital, Dr. Felix Rey treated Van Gogh, bandaged his ear, and diagnosed him with epilepsy. In a letter Dr. Rey wrote, there were times when Van Gogh “loses his train of thought and speaks nothing but disjointed words… he went to lie down in another patient’s bed and would not leave it… he chased the sister on duty… he went to wash in the coal-box” (Van Gogh Museum). He was then transferred to the asylum Saint-Remy-de-Provence, where Dr. Theophile Peyron, recorded Van Gogh’s medical condition as having “suffered an attack of acute mania with visual and auditory hallucinations that led him to mutilate himself by cutting off his ear” (Van Gogh Museum). So, was Van Gogh certainly epileptic? Or did he suffer from another neurological disorder?

Epilepsy is a neurological condition that is defined by recurrent seizures and can affect people of all ages. Van Gogh was described by doctors as having seizures, which is the reason for the primary diagnosis of epilepsy. However, the best method for diagnosis is through the use of an electroencephalography (EEG), a machine that records the electrical activity of the brain (Guerreiro, 2016). Epileptic patients have unusual activity in their brain cells(neurons), which makes an EEG a good tool to detect epilepsy. However, in 1889, when Van Gogh was diagnosed, the EEG had not yet been discovered. Thus, with no scans to look at, this brings to question whether the diagnosis of Van Gogh was accurate.

EEG image of a normal (seizure-free) brain compared to an EEG image of the brain of an epileptic patient (Ebrahimpour et al. 2012).

Another study revealed that auras are important in diagnosing patients as epileptic (Liu et al., 2017). An aura consists of all the sensations that a patient experiences prior to a seizure. The type of aura the patient experiences conveys what part of the cerebral cortex, outermost region of the brain responsible for decision making and speech, is affected (Liu et al., 2017). Epileptic patients could have sensory (related to the senses) or cognitive auras (related to thoughts), as well as unspeakable feelings (Liu et al., 2017). These characteristics were evident in Van Gogh, since he had auditory and visual hallucinations and he was unable to express his thoughts. However, the findings do not explain the depressive symptoms and the urge to commit suicide that Van Gogh experienced.

The more I look at the symptoms described by the doctors, the more I realize that Van Gogh was more likely a schizophrenic. Schizophrenia is a brain disorder that encompasses hallucinations, delusional thinking and cognitive problems (Seidman and Mirsky, 2017). One study examined the effects of depression and cognitive impairment on adults with schizophrenia (Raykeer et al., 2019). Patients who had schizophrenia had increased depression and cognitive impairments, which they measured through “quality of life exams,” a common well-known method. Both depression and cognitive impairments were observed in Van Gogh, according to the medical records written by Dr. Peyron. Further, individuals with schizophrenia lack empathy, are unable to understand what other people are feeling based on gestures, and have poor problem-solving skills (Couture et al., 2006). All of these symptoms were manifested by Van Gogh. Therefore, it is likely that he may have been schizophrenic, although there is no conclusive evidence to determine his neurological condition.

Now, as I continue walking towards the river in Arles, I see a replica painting of Van Gogh’s “Starry Night, 1889,” outside a gallery. This was a painting he made through his window when he was institutionalized at Saint Remy Asylum. Some people say that it was a visual hallucination because Van Gogh’s room did not have a view of the city and the trees were not shaped like flames, nor did the stars whirl as they appear in his painting. So, what was Van Gogh’s medical condition? The question remains unanswered, but if you asked me, I would say all signs point to schizophrenia.

Image of Van Gogh’s Starry Night 1889 painting.

 

References:

Couture, S. M., Penn, D. L., & Roberts, D. L. (2006). The functional significance of social cognition in schizophrenia: a review. Schizophrenia bulletin, 32(suppl_1), S44-S63.

Ebrahimpour, R., Babakhan, K., Arani, S. A. A. A., & Masoudnia, S. (2012). Epileptic seizure detection using a neural network ensemble method and wavelet transform. Neural Network World, 22(3), 291.

Guerreiro, C. (2016). Epilepsy: Is there hope? Indian Journal Of Medical Research, 144(5), 657.

Khoshbin, S., & Katz, J. (2015). Van Gogh’s Physician. Open Forum Infectious Diseases, 2(3), ofv088.

Liu, Y., Guo, X. M., Wu, X., Li, P., & Wang, W. W. (2017). Clinical Analysis of Partial Epilepsy with Auras. Chinese medical journal, 130(3), 318.

Pascal de Raykeer R, e. (2019). Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study. J Affect Disord. 256, 164-175.

 Seidman, L. J., & Mirsky, A. F. (2017). Evolving notions of schizophrenia as a developmental neurocognitive disorder. Journal of the International Neuropsychological Society, 23(9-10), 881-892.

Van Gogh Museum. (2009, October). Vincent Van Gogh The Letters. Van Gogh Museum. Retrieved from http://vangoghletters.org/vg/letters.html

 

Paintings from:

Van Gogh V. (1889). The Starry Night. Retrieved from

https://www.vincentvangogh.org/starry-night.jsp

Van Gogh V. (1888). Café at Night. Retrieved from

https://www.vincentvangogh.org/cafe-at-night.jsp

 

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Diagnosing Vincent van Gogh

Posted on June 10, 2019 by | 1 comment

“I put my heart and soul into my work, and have lost my mind in the process.”  This quote, attributed to the painter Vincent van Gogh embodies both the beauty displayed in his paintings and the presumed mental illness he suffered during his life.  While the iconic swirls and visual auras of the former have fascinated museum-goers and art collectors alike, the enigmatic nature of the latter has also stupefied art historians and other curious academics

The subject of mental health is quite prevalent in my life.  Both of my parents are mental health professionals who have dealt with severely mentally ill patients, with conditions similar to that of van Gogh, and their passion for the human mind has inspired me to want to pursue a career in the field.  Thus, it was of great excitement to me when, one day, in class we discussed the apparent severe mental illness of Vincent van Gogh.  We were able to further immerse ourselves into his life when our class took a trip to the south of France and visited the town of Arles, where van Gogh’s infamous ear incident took place.  These experiences encouraged me to think about what illness actually ailed the iconic man.

A few classmates and I at a recreation of the cafe Vincent van Gogh was known to frequent in Arles

While it is impossible to retroactively diagnose someone with a mental illness, it is a popular opinion among scholars that Vincent van Gogh suffered from manic depression, or bipolar disorder, as it is known today (Wolf, 2001).  Much of the evidence for this possible diagnosis comes via letters between Vincent van Gogh, his brother, Theo, and his sister, Wilhelmina (Blumner, 2002).  In a letter to his sister, Theo described Vincent as seeming, “as if he were two persons … with arguments on both sides” (Blumner, 2002).  Later, Vincent complained to his brother about his “heightened emotionality” and increasing reliance on alcohol to dull “the storm within” (Blumner, 2002).  Vincent also noted “horrible fits of anxiety” and attacks of “melancholy and atrocious remorse” which would be followed by “enthusiasm or madness or prophecy, like a Greek oracle on the tripod,” in letters to his brother (Blumner, 2002).  The mental turmoil that Vincent noted in his letters culminated in an acute psychotic episode in which he sliced off a section of his left ear lobe and presented the piece to a prostitute (Blumner, 2002).  During this episode, van Gogh experienced hallucinations and delusions, which required a multi-day stay in solitary confinement (Blumner, 2002).

Image result for van gogh portrait with bandaged ear

Self-Portrait with Bandaged Ear- Vincent van Gogh: This work by van Gogh was painted shortly after the severed part of his left ear during a psychotic episode

Both van Gogh’s description of his condition in notes to his brother and his subsequent psychotic episode are potentially indicative of bipolar disorder.  According to the National Institute of Mental Health bipolar disorder is characterized by “periods of unusually intense emotion” (NIMH).  These periods of emotion usually oscillate between manic episodes and depressive episodes.  Van Gogh’s description of periods of increased enthusiasm is consistent with mania, while his feelings of extreme melancholy are consistent with depression.  Additionally, bipolar patients often present with other illnesses such as anxiety disorder and substance abuse (NIMH).  Van Gogh experienced extreme levels of anxiety and he was a known to frequently have “a glass too much” of absinthe (Blumner, 2002).  Occasionally, patients experiencing severe bipolar disorder can exhibit psychotic symptoms, including hallucinations or delusions, as van Gogh did during the incident in which he severed his ear (NIMH).

Another key facet of bipolar disorder, as noted by the National Institute of Mental Health is its genetic risk factor (NIMH).  In class, we discussed the prevalence of mental illnesses, specifically schizophrenia, depression, and anxiety, in the van Gogh family.  There appears to be a strong presence of mental illness in the van Gogh family; however, there are no reported cases of bipolar disorder.  How then, could Vincent van Gogh appear to have suffered from a disease that no one else in his family had?

While there are no explicit cases of bipolar disorder in his family, there is a strong genetic link between bipolar disorder and schizophrenia; in fact, heritability estimates of the disorders are estimated to between 60 and 80 percent (Nöthen et al., 2010).  In 2017, the Bipolar Disorder and Schizophrenia Working Group of the Psychiatric Genomics Consortium published a large-scale investigation into the genetic markers of bipolar disorder and schizophrenia.  This study, which examined genomic data from over 53,000 individuals with either bipolar disorder or schizophrenia, identified 114 locations in the human genome as risk factors for both schizophrenia and bipolar disorder (Ruderfer et al., 2017).

In addition to the genetic risk factors identified in both bipolar and schizophrenic patients, the study produced another, extremely novel, finding.  Instead of comparing only patients with bipolar disorder to patients with schizophrenia, the researchers compared data from schizophrenic patients to two subpopulations of bipolar patients: those that presented psychotic symptoms and those that did not (Ruderfer et al., 2017).  Through this comparison, the researchers concluded that bipolar patients with psychosis are significantly more like to possess genetic risk factors associated with schizophrenia than bipolar patients without psychosis (Ruderfer, 2018).  This genetic overlap between bipolar disorder patients with psychosis and schizophrenic patients could serve to provide the seemingly missing link in the mental illnesses attributed to the van Gogh family.

To me, it is a stark, yet beautiful, reality that such a creative and influential person as Vincent van Gogh potentially suffered from a disease a debilitating as bipolar disorder.  I think that my experience in both traveling to Arles and researching van Gogh’s mental health gave me a greater appreciation of the fact that people’s illnesses do not need to define them.  The human brain, in all its diversity, is capable of creating masterworks, even in the most unlikely of places.

References

Blumer, D. (2002). The Illness of Vincent van Gogh. American Journal of Psychiatry, 159(4), 519-526. doi:10.1176/appi.ajp.159.4.519

NIMH » Bipolar Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Ruderfer, D., Sklar, P., & Kendler, K. (2017). Genomic dissection of bipolar disorder and schizophrenia including 28 subphenotypes. doi:10.1101/173435

Ruderfer, D. (2018, October 17). A Revealing Genetic Comparison of Schizophrenia and Bipolar Disorder. Retrieved from https://www.bbrfoundation.org/content/revealing-genetic-comparison-schizophrenia-and-bipolar-disorder

Wolf, P. (2001). Creativity and chronic disease Vincent van Gogh (1853-1890). Western Journal of Medicine, 175(5), 348-348. doi:10.1136/ewjm.175.5.348

 

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Would Lithium be a Good Treatment for Vincent Van Gogh?

Posted on June 10, 2019 by | 4 comments

I am not an art enthusiast, but this summer of my junior year in college has brought me closer to the life of perhaps the most famous painter in the history of western art, Vincent van Gogh. Before I traveled to Europe this summer, I watched two recent movies “Loving Vincent” and “At Eternity’s Gate” that were made based on the life of Vincent van Gogh. My summer started in the Netherlands, and I traveled down to Belgium, Paris, and Provence. This route coincidentally followed van Gogh’s path of mental deterioration, which eventually ended with his suicide in 1890 at the age of 37.

Self Portrait (1887), Rijksmuseum, Amsterdam

Van Gogh Self Portrait (1889), Musée d’Orsay, Paris

Garden of the Hospital in Arles (1889), Espace van Gogh, Arles
Van Gogh was committed after the infamous episode of cutting off his left earlobe in December 1888.

The mental state of van Gogh has long been a subject of controversy. Three years ago, mental health doctors and art history experts came together at the Van Gogh Museum in Amsterdam to find a diagnosis for him (Siegal, 2016). (Read more at https://www.vangoghmuseum.nl/en/stories/on-the-verge-of-insanity) After having a thorough examination of the medical record of his case as well as personal letters, the doctors failed to come to the conclusion of a single diagnosis. Though there might be more than one illness van Gogh has suffered in his life, most analytics, including American Psychiatrist Dietrich Blumer, agree on that van Gogh has displayed many symptoms of bipolar disorder (Blumer, 2002).

Professor Isabella Perry first assigned van Gogh with a diagnosis of bipolar disease (Perry, 1947). People with bipolar disease have recurrent episodes of elevated mood and depression, together with changes in activity levels (Anderson, Haddad, & Scott, 2012). Van Gogh’s life has been also associated with periods of intense activity and depression (Perry, 1947). Bipolar disease is the 6th leading cause of disability worldwide and has a prevalence of about 1-3% of our general population (Moreira, Van Meter, Genzlinger, & Youngstrom, 2017). This particular psychiatric illness has also been linked with creative accomplishment and many names in the history of creative art. Writers Ernest Hemingway, Virginia Woolf, Composer Robert Schumann, Painter Jackson Pollock and most likely Vincent van Gogh are all among the list (Rothenberg, 2001).

Lithium has been used as the main treatment for bipolar disease for the last sixty or more years (Won & Kim, 2017). Lithium has also been demonstrated to reduce suicide rates and prevent manic episodes in bipolar disease patients (Anderson et al., 2012). However, only one-third of bipolar disorder patients respond to the treatment. Why this treatment works in some patients and does not work in other patients is unknown (Tobe et al., 2017). Although the therapeutic pathways of lithium are complex, through recent research, lithium’s exact mechanism is progressively being clarified. It is becoming more evident that biological systems modulated by lithium are deeply intertwined with biological disruptions associated with bipolar disorder (Won & Kim, 2017).

A recent study published in PNAS used stem cells (cells that can differentiate into other cell types) to unravel lithium’s target and therefore gave the scientists an opportunity to look deeply into the cellular mechanism of bipolar disorder. In this article, the authors have cleverly used lithium, the most common treatment for bipolar disorder, as their “molecular can-opener for prying intracellularly to reveal otherwise inscrutable pathophysiology” in bipolar disorder. They mapped the “lithium-response pathway” which functions to govern the phosphorylation of a protein called CRMP2 involved in the neural network. Normally, the “tug-of-war” between the inactive state (phosphorylated) and active state (non-phosphorylated) is all done physiologically inside our brain. In bipolar disease patients, this “set-point” has gone all wrong. So, the role of lithium is to operate as a “referee” to normalize that set-point (Tobe et al., 2017). Though the “lithium-response pathway” is certainly not a complete picture of bipolar disorder, it helped us to gain significant insights into how lithium modulates our body and alleviate symptoms for patients with the disease.

(Watch Principal Investigator Evan Snyder explains this study)

Psychiatrist Albert Rothenberg argued in his paper that research has shown that lithium treatment has the risk of cognitive impairment and decreased productivity. Another impediment is that many creative people hold the false belief that there is an intrinsic connection between suffering and mental illness. Some believe that tampering with their illness will also destroy their creative talents. And therefore, non-compliance with the doctor’s prescription is fairly common (Rothenberg, 2001). Even if van Gogh had treatment available, whether he would have complied remains questionable.

So, to answer my question raised in the title of this blog post, yes, lithium could have been a useful treatment. But considering the fact that only a third of patients respond to treatments and also the fact that van Gogh had a history of drinking absinthe regularly, lithium would not a magical pill that will fix all the problems with him. By focusing our research on the molecular mechanism of lithium on bipolar disorder, we would be able to map out bipolar disorder in the brain and help these people suffering from this disease. Who knows, the next van Gogh might be among them.

Reference

Anderson, I. M., Haddad, P. M., & Scott, J. (2012). Bipolar disorder. 345, e8508. doi:10.1136/bmj.e8508 %J BMJ : British Medical Journal

Blumer, D. (2002). The Illness of Vincent van Gogh (Vol. 159).

Moreira, A. L. R., Van Meter, A., Genzlinger, J., & Youngstrom, E. A. (2017). Review and Meta-Analysis of Epidemiologic Studies of Adult Bipolar Disorder. The Journal of clinical psychiatry, 78(9), e1259-e1269. doi:10.4088/jcp.16r11165

Perry, I. H. (1947). VINCENT VAN GOGH’S ILLNESS: A Case Record. Bulletin of the History of Medicine, 21(2), 146-172.

Rothenberg, A. J. P. Q. (2001). Bipolar Illness, Creativity, and Treatment. 72(2), 131-147. doi:10.1023/a:1010367525951

Tobe, B. T. D., Crain, A. M., Winquist, A. M., Calabrese, B., Makihara, H., Zhao, W.-n., . . . Snyder, E. Y. (2017). Probing the lithium-response pathway in hiPSCs implicates the phosphoregulatory set-point for a cytoskeletal modulator in bipolar pathogenesis. 114(22), E4462-E4471. doi:10.1073/pnas.1700111114 %J Proceedings of the National Academy of Sciences

Won, E., & Kim, Y.-K. (2017). An Oldie but Goodie: Lithium in the Treatment of Bipolar Disorder through Neuroprotective and Neurotrophic Mechanisms. 18(12), 2679.

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Does Losing One Sense Heighten the Others?

Posted on June 10, 2019 by | 4 comments

The old, classic French architecture with the intricate balconies, the array of colorful pastries in the local pâtisserie (pastry shop) and boulangeries (bakery), and the breathtaking views of the Eiffel tower all encompass the city of Paris. Living in such a bustling and scenic city for the summer, I am fortunate enough to use all five of my senses to experience and embrace the French culture. Our vision allows us to experience colors, shapes, sizes, and more. While exploring  Paris, I was surprised to see quite a few blind people using the metro. I wondered how they learned to navigate their way around the Parisian metro system and life itself in such a visually stimulating city.

A common architectural style I’ve seen throughout

Some say that because blind people have lost their sense of vision, their other senses are heightened. Is this really true? Well to first understand how they use their other senses; we first have to understand what causes blindness. Blindness can be the cause of damage in various parts of the visual pathway, starting from the eye and ending at the visual cortex in the back of the brain within an area called the occipital lobe.

Audition, or the ability to hear and listen, helps us communicate with another, but also enjoy sounds like music. The rush of the metro coming and leaving, the bouts of sound signaling the doors to close, and the screeching against the tracks when it’s moving all encompass the experience of riding on the Paris metro system. One study looked at whether early blind adults have a better ability to detect pitch, a characteristic of the auditory cortex in the temporal lobe of the brain. 15 blind participants and 15 controls participated and were asked to discriminate thresholds of speech and non-speech stimuli (musical instruments and tones). The results show that the blind participants were able to discriminate thresholds better than thresholds. Interestingly, within the normal controls, the older the participants, their threshold of detection increased. However, the same effect didn’t occur in those who were blind, meaning that their threshold of detection didn’t increase as one would expect with age. (Arnaud et al 2018)

Now let’s switch senses and examine gustation or taste. Everyone I’ve seen in France has a unique love and great attachment to food. The four, five-hour meals, the array of pastries, and the complexity into their simple dishes constitute the Parisian dining experience. One particular study found that during gustation, congenitally blind participants showed weaker activation in the primary taste cortex compared to controls. The researchers also found that in the blind, the occipital cortex, the main area to process vision, was not used during taste processing, a contrast to controls. The researchers hypothesize that this is because blind people are underexposed to a large variety of tastes, explaining their lower activation. (Gagnon et al 2015)

The classic lineup of pastries in a pâtisserie in Paris.

What about olfaction? The smell of freshly baked baguettes is a classic staple when one walks into the boulangeries of Paris. The process of olfaction, or the sense of smell, starts with the molecules in a smell activating odor receptors in the nose. This connects to neurons in a part of your brain called the olfactory bulb and up to the olfactory cortex, where the smells are registered and processed into your memory. This was explored in a study where they showed that the blind showed better results in odor discrimination and odor threshold tasks than their control counterparts. However, both groups had shown no difference in identifying the odors. An additional aspect of this study they looked at was whether there was a difference in identifying smells in between congenital and acquired blind subjects. The results showed that there was no difference in the data between the two groups. (Comoglu et al 2015)

The areas of the brain involved in perceiving our senses.

The final sense that we will examine is touch. Sensory receptors detect and send back information to the brain, specifically to an area called the primary somatosensory cortex. Was the perception of touch enhanced in those that were blind? A group of researchers investigated whether visual judgments made by touch differed in those who were blind compared to controls. All of the participants rated different materials by touching and identifying them. In this study, the researchers found that there was no difference between those who were blind and controls in terms of identifying or categorizing them. (Baumgartner et al 2015)

The 70 different materials or touch stimuli that the participants had to identify

Now that we explored all the senses, we can come to a conclusion that although blind people have adapted with using their other senses, only some senses have proved in specific studies to be heightened in those individuals. Taste, smell, and audition are shown to have better discriminatory thresholds versus normal participants, but touch does not show any difference between the blind and normal participants. However, we must keep in mind that blind people also seem to compensate with their other senses, which a lot of researchers have addressed as the reason for their “heightened” perception. All of our senses deserve importance and personally, my time in Paris has made me appreciate every new experience that I come across.

Bibliography

Arnaud L, Gracco V, Ménard L. Enhanced perception of pitch changes in speech and music in early blind adults.Neuropsychologia. 2018 Aug;117:261-270. doi: 10.1016/j.neuropsychologia.2018.06.009.

Gagnon L, Kupers R, Ptito M. Neural correlates of taste perception in congenital blindness. Neuropsychologia. 2015 Apr;70:227-34. doi: 10.1016/j.neuropsychologia.2015.02.027.

Çomoğlu Ş, Orhan KS, Kocaman SÜ, Çelik M, Keleş N, Değer K. Olfactory Function Assessment of Blind Subjects Using the Sniffin’ Sticks Test. Otolaryngol Head Neck Surg. 2015 Aug;153(2):286-90. doi: 10.1177/0194599815583975.

Baumgartner E, Wiebel CB, Gegenfurtner KR. A comparison of haptic material perception in blind and sighted individuals.Vision Res. 2015 Oct;115(Pt B):238-45. doi: 10.1016/j.visres.2015.02.006.

First two photos taken by myself

Image of brain- http://www.d.umn.edu/~jfitzake/Lectures/DMED/SensoryPhysiology/GeneralPrinciples/Figures/SensoryCortex.jpg

Image of materials from Baumgartner et al 2015

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The Starry Dream

Posted on June 10, 2019 by | Leave a comment

“For my part I know nothing with any certainty, but the sight of the stars makes me dream.” This quote by Vincent Van Gogh sums himself up perfectly. It is known that he had various psychotic symptoms, such as auditory and visual hallucinations, and it is still disputed whether some of his works are accurate portrayals of reality, or simply representations of his “dreams.” Fortunately, our class had the opportunity to visit Arles this past weekend, the small town in Provence where Van Gogh famously stationed himself and painted many of his most famous pieces. We were able to witness many of the things we had previously seen only in his paintings. For example, we saw the river painted in “Starry Night over the Rhone” and the garden portrayed in “Garden of the Hospital in Arles.” Van Gogh certainly had no trouble capturing the full beauty of these places with his paintings, but was his abstract and unique style just an artistic twist, or was it really how he perceived these locations?

“Garden of the Hospital in Arles” by Van Gogh

A photo from our visit to the garden of the hospital, which is much less yellow in real life

There have been many retroperspective diagnoses of Vincent Van Gogh. It is most commonly believed that he suffered from bipolar disorder. However, he was known to have been an avid absinthe drinker, a drink reported to cause hallucinations. Thus, my first inclination was that Van Gogh’s psychotic symptoms must have been due to his absinthe abuse. When in Arles, some friends and I went to “Le Cafe Van Gogh”, the cafe where Van Gogh spent most of his time drinking. We noticed the menu had a cocktail called “Le Van Gogh” which contained some absinthe, so, as any good scientist would, we ordered some. Surprisingly, the absinthe didn’t have much effect, and certainly didn’t cause any hallucinations. Possibly, I was wrong and it wasn’t the absinthe that caused Van Gogh’s psychosis.

The famous Cafe Van Gogh

It is widely believed that the active hallucinogen in absinthe was thujone, which comes from the wormwood oil included in the beverage. Studies have even shown that thujone is a neurotoxic compound, with the ability to inhibit GABA receptor activity (Hold et al., 2000). GABA is an inhibitory neurotransmitter and is involved in calming the body, such as relieving anxiety. Inhibition of GABA receptors, as caused by thujone, may produce mood elevation (Olsen, 2000).

Another recent study found that thujone has inhibitory effects on serotonin receptors too (Deiml et al., 2004). Serotonin is an excitatory neurotransmitter that has been shown to play a role in various psychiatric conditions, such as depression, anxiety, and obsessive-compulsive disorder (Dayan and Huys, 2008). Inhibition of GABA and serotonin on their own hasn’t shown any signs of causing hallucinations, but recent evidence shows that together, they could have. A study suggests that an imbalance of excitatory and inhibitory influences on the brain could cause be the cause of hallucinations (Jardri et al., 2016). Perhaps, the mixture of serotonin and GABA inhibition by thujone, causing simultaneous excitatory and inhibitory signals, was the culprit in Van Gogh’s insanity.

However, contrary to this, recent studies also suggest that absinthe has never contained enough thujone to actually cause psychiatric symptoms; rather, the amount of thujone required to cause hallucinations would poison us to death before causing this phenomenon (Padosch et al., 2006). This doesn’t mean that Van Gogh’s absinthe abuse didn’t account for any of his symptoms, though, as new research presents evidence that alcohol on its own can cause psychosis in some individuals (Salen and Stankewicz, 2018). Alcohol-induced psychosis is a recently defined disorder in which certain individuals experience hallucinations, paranoia, and fear during or shortly after alcohol consumption (Salen and Stankewicz, 2018). Although this is an extremely rare condition, possibly Van Gogh was one of the few unlucky (or lucky) individuals to suffer its consequences. If this were the case, absinthe would have only exacerbated the symptoms of the condition due to its extremely high levels of alcohol, rather than its thujone content.

Regardless of the cause of Vincent Van Gogh’s insanity, one thing’s for sure: it led to the creation of some of the greatest, most unique artwork of history which he will always be remembered for.

Location of Arles

Sources:

Höld KM, Sirisoma NS, Ikeda T, Narahashi T, Casida JE. (2000). Alpha-thujone (the active component of absinthe): gamma-aminobutyric acid type A receptor modulation and metabolic detoxification, Proc. Natl. Acad. Sci. USA, 97(8):3826-31

Olsen R, (2000). Absinthe and γ-aminobutyric acid receptors, Proc. Natl. Acad. Sci. USA, 97(9): 4417–4418

Deiml, R. Haseneder, W. Zieglgänsberger, G. Rammes, B. Eisensamer, R. Rupprecht, G. Hapfelmeier, (2004). α-Thujone reduces 5-HT3 receptor activity by an effect on the agonist-induced desensitization, Neuropharmacology 46(2): 192-201

Peter Dayan and  Quentin J. M Huys, (2008). Serotonin, Inhibition, and Negative Mood, PloS. Comput. Biol. 4(2): e4

Renaud Jardri, Kenneth Hugdahl, Matthew Hughes, Jérôme Brunelin, Flavie Waters, Ben Alderson-Day, Dave Smailes, Philipp Sterzer, Philip R. Corlett, Pantelis Leptourgos, Martin Debbané, Arnaud Cachia, Sophie Denève, (2016). Are Hallucinations Due to an Imbalance Between Excitatory and Inhibitory Influences on the Brain?, Schizophr. Bull. 42(5): 1124–1134

Stephan A Padosch, Dirk W Lachenmeier, and Lars U Kröner, (2006). Absinthism: a fictitious 19th century syndrome with present impact, Subst. Abuse. Treat. Prev. Policy. 1:14

Holly A. Stankewicz and Philip Salen, (2018). Alcohol Related Psychosis, StatPearls [Internet]

Image:

https://en.wikipedia.org/wiki/Hospital_in_Arles#/media/File:Van_Gogh_-_Garten_des_Hospitals_in_Arles1.jpeg

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vitamin G for green

Posted on June 10, 2019 by | 2 comments

After getting off of the train in Avignon and feeling the sun hit my un-sunscreened shoulders, my mood undeniably approved. It was a definite upgrade from the cold and drizzly weather we had just escaped from in Paris. Whether it was the sunshine induced drowsiness or the gelato produced lethargy, I seemed to move at a much slower and relaxed pace this weekend. I often find myself hustling to get from departure point to destination during the week, sighing impatiently at the slow walkers leisurely strolling on the sidewalk who have the audacity to slow me down.  In Provence, I didn’t feel the need to obsessively make schedules and instead just enjoyed the new surroundings.

The southern France, creek wading Irena is definitely much more carefree and relaxed than urban Paris, coffee chugging Irena.

I thought back to our journal topics about Van Gogh and his mental health and remembered how the film we watched had portrayed his mood. Van Gogh had written about the countryside in Arles and how it had improved his spirit (up until that whole ear incident). Van Gogh talked about how much time he was spending outside and how productive his work output was during the time he could paint en plein air. I think this is something that we can all relate to; the first day of being outside in the warmth and sunshine after weeks of winter stuck inside avoiding the Atlanta rain can make me feel like I escaped something just shy of seasonal affective disorder. Well besides you and me, it seems that others have been onto this phenomenon for a while now too. In fact, the term “ecotherapy” has been coined as “an umbrella term for a gathering of techniques and practices that lead to circles of mutual healing between the human mind and the natural world from which it evolved”  (Chalquist, 2009).

Courtyard garden in an Arles hospital where Van Gogh stayed briefly and his painting of it

It has been documented that merely looking at nature or natural elements can provide restoration from stress and mental fatigue while reducing feelings of anger, frustration and aggression. This has indicated that the “aesthetic experience of nature” can play a beneficial role in affecting mood (Groenewegen, van den Berg, de Vries, & Verheij, 2006). Some studies utilize the visual sensory system in order to test the effects of nature images on neural processing and well-being; however, the experience of nature cannot be reduced to singular modalities but rather is holistic and encompasses all the sensory systems in the body. Therefore, many of the studies that I looked at examined and quantified aspects of well-being that are harder to measure. A study of 57 people with serious and persistent mental illness was conducted where they participated in an outdoor adventure program involving weekly full day outings for 9 weeks. At the end of the study, there were statistically significant increases on the Generalized Self-Efficacy Scale (a 10-item psychometric scale that assesses optimistic self-beliefs to cope with a variety of difficult demands in life) in the experiment group compared to the control group that did not undergo outdoor exposure. The experimental group also showed significant reductions in scores on the Anxiety and Depression subscales of the Brief Symptom Inventory (BSI), a test that evaluates psychological distress and psychiatric disorders. Patients with affective or schizoaffective disorders, mental health disorders we discussed Van Gogh having the possibility of having, showed an increase in scores on the Trust and Cooperation Scale, and decreased BSI Hostility and Interpersonal Sensitivity (Kelley, Coursey, & Selby, 1997).

General mechanisms to explain relationships between green space and health, well-being, and social safety

In a 2010 meta-analysis (a statistical procedure for combining data from multiple studies) that analyzed 10 UK studies of environment and health that involved over 1252 participants, every green environment improved both self-esteem and mood with the presence of water generating greater effects. Outcomes were identified through a subgroup analyses, and dose-responses were assessed for exercise intensity and exposure duration. Based on this meta-analysis, the mentally ill showed one of the greatest self-esteem improvements based on exposure to green environments and nature (Barton & Pretty, 2010).

The number of participants, activity types, environments, and cohorts from each study from the meta-analysis  

Ecotherapy studies have also begun a foray into a crossover intervention with art therapy, as both approaches have research supporting their success in the reduction of physiological and psychological symptoms associated with a variety of diagnoses in numerous settings. While a statistically significant correlation between ecotherapy and art therapy has not yet been found, there are many qualitative and case-study research designs that demonstrate the effectiveness of art and eco-therapy interventions (Bessone, 2019).

This weekend in Arles, we saw the various locations around town that Van Gogh drew inspiration from for his paintings, making it quite evident that he was closely connected with his environment. While eco/art therapy are no substitutes for comprehensive mental health care, I hope that Van Gogh was able to find temporary reprieve in his artistic work and the natural beauty of southern France during his time there.

Landscape picture of Arles, France

 

Bibliography

Barton, J. & Pretty, J. (2010) What is the Best Dose of Nature and Green Exercise for Improving

Mental Health? A Multi-Study Analysis. Environmental Science & Technology, 44, 3947-3955.

Bessone, E. (2019) Implications and Applications of Eco-Therapy on Art Therapy. Expressive Therapies Capstone Theses. 155.

Chalquist, C. (2009) A Look at the Ecotherapy Research Evidence. Ecopsychology, 1, 64-74.

Groenewegen, P.P., van den Berg, A.E., de Vries, S. & Verheij, R.A. (2006) Vitamin G: effects of green space on health, well-being, and social safety. BMC Public Health, 6, 149.

Kelley, M. P., Coursey, R. D., & Selby, P. M. (1997). Therapeutic adventures outdoors: A demonstration of benefits for people with mental illness. Psychiatric Rehabilitation Journal, 20(4), 61-73.

Image 1: my own picture

Image 2: from https://www.marvellous-provence.com/arles/what-to-see/in-the-footsteps-of-van-gogh

Image 3: from Groenewegen, van den Berg, de Vries, & Verheij, 2006.

Image 4: from Barton & Pretty, 2010

Image 5: from https://steemit.com/landscapephotography/@schmidthappens/landscape-photography-the-inspiring-arles-france

 

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Where’s the AC?

Posted on June 10, 2019 by | Leave a comment

Hi everyone! We finished our second full week in France, and are on to our third. The time is flying by! I am really enjoying my time here, and am learning a lot in the two classes we are taking. In our Arts on the Brain course, we talked a bit about varying perceptual experiences. Specifically, we started by talking about how our perception of the color of the sky can be different depending on the time of day and the experiences we have had. This discussion shows that perceptual experiences are not the same from person to person.

A picture of the Paris sky at sunset (Martinez et al., 2017)

I had a conversation with someone about the temperature in Avignon, where we travelled to this weekend. They were freezing, while I was enjoying the beautiful breeze. The 65-70 degree weather with a breeze was absolutely beautiful to me. However, the 85 degrees during the day was much too hot. This conversation combined with my recent interest in differing perception, and adding in the fact that French people don’t love air conditioning, lead me to start wondering about the ways in which people may perceive temperature differently. Similar to our different perception of the color of the sky, do we differ in our perception of temperature as well?

View of Avignon, France from the Palais de Papes

I realize that many people say that people from the north are better at handling the cold. And obviously, the French are better at handling the heat than I am (I miss the AC!). Why are some people more comfortable in different temperatures?

Thermoreceptors are what allow us to detect temperature. These allow us to sense and then respond to the temperature stimuli (Zhang, 2015). Temperature acclimatization is defined as the process in which a person becomes adjusted to their environment’s temperature, through physiological changes (Acclimatization, 2019). This acclimatization would explain people’s differing perceptions of temperatures.

Sensors within the skin, including a thermoreceptor (Pain is Only Skin Deep, 2016)

When someone who is in a cold environment for a short amount of time, the response is to shiver in order to conserve heat. However, when someone has been in a cold environment for a longer period of time, or a chronic cold environment, then the response to regulate heat changes (Castellani and Young, 2016). Eventually shivering decreases, but heat production remains the same.  This is due to brown adipose tissue in the body (Lans et al., 2013). However, this isn’t due to an increase in brown adipose tissue, but instead an increase in non-shivering thermogenesis, or heat production, within the existing tissue (Vosselman et al., 2014). This shows that there are physiological changes in our body when we are exposed to different climates. Non-shivering heat production is increased in people who are in cold environments more often.

It was really interesting to see these changes, but I would say there is research I would be interested to see within this topic. For example, I would be interested to see if there is a change at the neuronal level, such as within the thermoreceptor. Also, is the activation in the brain of people acclimated to the cold different from those who aren’t? Also, I would be interested to know if there is a change for hotter climates, or if it just the decrease of non-shivering thermogenesis. I couldn’t find any research on this, but if any of my readers have heard about this, let me know in the comments!

It is really interesting to know that we have different physiological changes that allow us to be more acclimated to certain climates. Our differing perceptions of the world is so fascinating across all of our senses. This new information might help explain why there is no AC here, so for now I will just enjoy the 65-degree weather when I have the chance and hope I acclimate to warmer weather eventually!

 

 

 

 

 

Works Cited:

Acclimatization (adjusting to the temperature). (2019, January 11). Retrieved from https://uihc.org/health-topics/acclimatization-adjusting-temperature

Castellani, J., & Young, A. (2016). Human physiological responses to cold exposure: Acute responses and acclimatization to prolonged exposure. Autonomic Neuroscience: Basic and Clinical,196, 63-74.

Lans, A. A., Hoeks, J., Brans, B., Vijgen, G. H., Visser, M. G., Vosselman, M. J., . . . Lichtenbelt, W. D. (2013). Cold acclimation recruits human brown fat and increases nonshivering thermogenesis. Journal of Clinical Investigation,123(8), 3395-3403. doi:10.1172/jci68993

Vosselman, M. J., Vijgen, G. H., Kingma, B. R., Brans, B., & Lichtenbelt, W. D. (2014). Frequent Extreme Cold Exposure and Brown Fat and Cold-Induced Thermogenesis: A Study in a Monozygotic Twin. PLoS ONE,9(7). doi:10.1371/journal.pone.0101653

Zhang, X. (2015). Molecular sensors and modulators of thermoreception. Channels,9(2), 73-81.

Photos:

Image 1: Martinez, E., Emily, Meghan, Cynthia, Aubrie, Emily, . . . Desert Safari. (2017, January 06). The 5 Best Sunset Spots in Paris. Retrieved from https://www.theglitteringunknown.com/5-best-sunset-spots-in-paris/

Image 2: My own photo

Image 3: Pain is only skin deep. (2016, February 22). Retrieved from https://kaitlinforwardbiochem.tumblr.com/post/139793441303/pain-is-only-skin-deep

 

 

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Curing Van Gogh? A Shocking Revelation

Posted on June 10, 2019 by | Leave a comment

As I stared at the small frame hanging from the walls of my friend’s bedroom, I found myself entranced. I remember standing in awe as I took in the dark swirls of the painting’s dark blue sky; the bright yellow dots that represented the stars; and the calming landscape of the town in the background. The way that these aspects seemed to move and churn drew me in, unlike any other painting that I had previously encountered.

 

The painting that saw that day was Vincent Van Gogh’s The Starry Night, to this day, one of my favorite paintings of all time. When I stared at that painting for the first time, I initially appreciated the visual beauty of the work, taking it just as a simple piece of art. However, I recently had the opportunity to visit the mental asylum where he is said to have painted many of his most prolific pieces. While I was there, my individual perception of the painting began to change. Rather than a simple piece of art, Van Gogh’s style and painting began to reflect a deeper meaning, a look into his deteriorating madness.

Starry Night: One of Van Gogh’s most prolific paintings. Said to describe the view of a village from the east window of his mental asylum.

While Van Gogh is still remembered today by the many beautiful pieces of work, there is another aspect of Van Gogh himself that remains a hot topic of discussion, his mental instability. Throughout his life, Van Gogh had suffered through many psychotic symptoms. He was noted to have suffered from multitudes of mood swings between major depression and extreme highs, incoherent speech, and lapses of consciousness (Blumer, 2002). He was also noted to have suffered from visual and auditory hallucinations, although these were only within short durations (Strik, 1997). While there is a multitude of diagnoses surrounding the actual nature behind Van Gogh’s mental instability, the most prevalent of these is the diagnosis of bipolar disorder (Blumer, 2002). While understanding the nature of Van Gogh’s illness offers up an interesting line of discussion in itself, I believe this discussion is simply a platform for a greater line of questioning. That question is whether Van Gogh could be effectively treated with the techniques of today.

 

Since the time of Van Gogh, modern psychiatric treatments have developed far beyond what we could have imagined. With the development of mood stabilizers and antipsychotic medication, the effective treatment of these major mental disorders has increased dramatically (Lopez-Munoz et.al, 2018). However, one of the most effective treatments for the most popular diagnosis of Van Gogh, bipolar disorder, may not lie within the development of these modern antipsychotic medications but rather something rather shocking, electroconvulsive therapy.

 

Electroconvulsive therapy, otherwise known as ECT, is a form of treatment within patients with severe depressive or bipolar disorder. The technique relies on administering a brief electrical stimulation of the brain while the patient is under anesthesia. This brief electrical stimulation forces the patient into a brief seizure (McDonald, 2016). Though the exact mechanisms underlying the effectiveness of electroconvulsive therapy are unknown, there are still a variety of theories that are used to explain the phenomenon. One of the most common of these theories deals with ECT’s influence on the release of neurotransmitters. One study conducted in 2014 by Baldinger, found that after the implementation of ECT on patients suffering from bipolar disorder there was an overall increase in the release and binding of the neurotransmitters serotonin and dopamine, which are associated with the stability of one’s mood and the brain’s reward system respectively (Baldinger, 2014).

A picture of a patient going through electroconvulsive therapy. Unlike electroshock therapy, electroconvulsive therapy is generally very safe with few side effects.

While this particular treatment gets a horrible reputation by the press, often being cited as unethical and invasive, modern neuroscientific research seems to show a different story. In a recent study conducted in 2017, Perugi et.al aimed to investigate the influence that ECT had on the response rates of patients who suffered from Bipolar Disorder. By conducting an observational study on 522 patients who suffered from Bipolar Disorder before and after they had gone through ECT, Perugi found that around 344 (approximately 68.8%) of participating patients responded positively to the treatment. These results reflected Perugi, the greater effectiveness that ECT seemed to have with the response of the patients. He notes how with the improved rate of response along with the unlikelihood of future mood destabilization within his patients, that ECT should not be limited towards a finite amount of patients but used within a greater context (Perugi, 2017).

 

With the greater percentage of improvement that we see in modern-day patients with bipolar disorder, it can be easily inferred how the implementation of this treatment could have influenced the treatment of Van Gogh during his time. Techniques like ECT have pioneered a modern wave of mental illness treatment that allows for those suffering to live the best lives that they can possibly achieve. Who knows, if only this type of treatment were readily available to Van Gogh’s personal physicians, maybe there would have been greater amounts of Van Gogh’s work to fill the halls of museums all around the world.

 

Citations:

Baldinger P, Lotan A, Frey R, Kasper S, Lerer B, Lanzenberger R. Neurotransmitters and electroconvulsive therapy. J ECT. 2014;30:116–121.

 

Blanco C., Laje G., Olfson M., Marcus S.C., Pincus H.A. 2002; Trends in the treatment of bipolar disorder by outpatient psychiatrists. Am. J. Psychiatry.159(6):1005–1010.

 

Blumer D. The illness of Vincent van Gogh. Am. J. Psychiatry. 2002;159:519–526. doi: 10.1176/appi.ajp.159.4.519.

 

López-Muñoz, F., Shen, W. W., D’Ocon, P., Romero, A., & Álamo, C. (2018). A History of the Pharmacological Treatment of Bipolar Disorder. International journal of molecular sciences, 19(7), 2143.

 

McDonald, W., & Fochtmann, L. (n.d.). 2016; What is Electroconvulsive therapy (ECT)? Retrieved from https://www.psychiatry.org/patients-families/ect

 

Perugi, G., Medda, P., Toni, C., Mariani, M. G., Socci, C., & Mauri, M. (2017). The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features. Current neuropharmacology, 15(3), 359–371.

 

Strik, Werner. (1997). [The psychiatric illness of Vincent van Gogh].. Der Nervenarzt. 68. 401-9.

 

https://en.wikipedia.org/wiki/The_Starry_Night#/media/File:Van_Gogh_-_Starry_Night_-_Google_Art_Project.jpg

 

https://www.cchrint.org/wp-content/uploads/2017/05/electroshock-2.jpg

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