Joy, Guilt, Anger, Love (15 page)

Fig. 9 Reversal of neural pathways facilitating active over passive fear responses

In 2010, two colleagues from the laboratory of Cornelius Gross at the European Molecular Biology Laboratory where I used to work deepened these findings, in conjunction with other collaborators. Using a combination of genetic technology, fMRI imaging and behavioural tests, they were able to map the specific neurons in the amygdala that are involved in the neural switch from passive to active fear.
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To do this, they created a transgenic mouse. This is basically a mouse designed to have high amounts of a particular protein in a specific brain region of choice. The region of choice in this case was the central nucleus of the amygdala (CeA), because they wanted to further explore its role. The protein in question was the serotonin 1A receptor (Htr1a). Sitting on the outside of neurons, receptors are molecules that are targets for neurotransmitters. The Htr1a is special because it has inhibitory transmission activity, which means that if a molecule binds to and activates it, neural activity is suppressed, hence less anxiety.

My colleagues gave the mice a drug to selectively silence the CeA. What they observed is that only a specific subset of cells in the CeA responded to the drug. These were called Type I cells. Mice given the drug were also placed in a magnetic resonance scanner to see what happened following inhibition of neuronal activity in the CeA Type I cells. The researchers discovered that inhibition of activity in this type of neuron was linked to activity in the frontal region of the brain, the cholinergic basal forebrain, which is known for its arousing influence on parts of the brain cortex. Silencing of the Type I cells in the CeA made the mice freeze less and encouraged them to behave more actively: for instance they started to explore the space where they were.

In summary, these experiments were able to confirm the role of the CeA, and of a specific set of cells within it, in marshalling the output of the amygdala towards either brainstem regions or cortical structures, thereby determining the magnitude and quality of fear responses – passive in the case of the brainstem, and active in the case of the cortical regions.

So it is possible to bypass the dreadful anxiety experience by training ourselves to use alternative pathways. But how?

Translate the rodent behaviour into human terms, and actively choosing to move into the other chamber becomes what in humans may be called a purposeful coping action. We can learn to avoid being gripped by anxiety, not by worrying or withdrawing from life – for this would simply reinforce our anxiety symptoms – but by actively turning away from negative thoughts, engaging in pleasurable activities and adopting constructive behaviour.
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Precisely what you do does not matter so much as the fact that you do something which distances you from your concerns and that you concentrate on something positive. So, listen to your favourite music, take a stroll or write a letter to a friend, meditate. We all have different pleasures. None of this means that you should simply avoid your problems, but that you should reach a state of mind that can help you face them with greater awareness.

Such a positive attitude may sound intuitive and straightforward, but is easily overlooked. At times, I have purposefully tried to use knowledge of the brain routes of my fears in the attempt to reinforce it, almost by translating the mental imagery of those neural crossroads into resolute choices: I won’t let fear take its usual course, I’ll divert it. I can’t say it works better than just telling myself to calm down – or reminding myself of Heidegger’s thoughts, for that matter – but it contributes to achieving a positive mindset.
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The night the world markets slumped, going out for a drink with Robert was certainly better for each of us than staying alone in the house at the mercy of convoluted, senseless fears. Talking and sharing concerns with someone else halves the weight of those concerns and can be inspiring. Together, we were able to filter out some of our irrelevant negative thoughts. Remarkably, Heidegger’s insights find a few parallels with what we are learning from psychology and neuroscience.
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In their different ways, both visions could be taken as incitements to actively engage in positive endeavours that can help us both in the short- and the long-term management of life.

As emphasized earlier, although seemingly innocuous stimuli can trigger anxiety, on a deeper level anxiety is the result of losing focus on the personal values and life choices that form the core of our existence. So, hearing about the crash of the stock exchange is really only a cue, a spark, for the ignition of deeper conflicts, and the bewildering set of worried reactions that can result is a message from our body that we need to solve them. Paradoxically, we worry because we think that worrying is the only helpful strategy, and indeed that worrying keeps us safe (because it keeps us from taking action). In truth, it merely keeps us preoccupied, without getting us anywhere. At first, reacting to anxiety might feel like a titanic enterprise. But in time your brain can learn how to shift your attention away from the worry.

The plastic brain

I know all this sounds more easily said than done. In some cases, anxiety can be seriously paralysing and relentless. Those who struggle with its numbing effects may take a long time to learn how to free themselves of them. Not for one minute do I want to diminish the magnitude of such problems or the distress they cause. Take, for instance, individuals who have experienced trauma, whose fear- eliciting memories control their mental life and behaviour.

Nearly a year after the London tube bombings in July 2005, Thomas, a computer scientist who had survived the explosion in the tube carriage at Edgware Road, couldn’t sleep properly at night.
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He kept having nightmares about the explosion, and memories of that terrible morning still haunted him. Moreover, something unusual and specific kept occurring. Whenever he laughed, he immediately became sad. His laughter at something funny would be followed by low spirits.

A therapist in the NHS helped him to revive his experience of that day and retrieve the memory of the moments preceding the blast. When Thomas boarded the Circle line train he sat and opened a book by Vladimir Kaminer, one of his favourite authors, who writes funny stories. Thomas recalls that as he sat, only a few feet away from the suicide bomber, he was in a good, joyful mood. Instants before the terrorist blew himself up, Thomas might well have been laughing. So what happened is that his mind registered that sequence of events and replayed it in the months subsequent to the attacks. Hence, laughter easily turned into despair.

The atrocious events of that summer morning of 7 July 2005, the day after London won the bid to host the 2012 Olympic games, irrevocably affected the lives of those involved. Fifty-six people, including the suicide bombers, lost their lives. Hundreds of people were physically injured, some losing limbs or becoming permanently paralysed. But, as in the case of Thomas, the events also inflicted invisible injuries in the memory of many of the commuters who travelled on those trains. The powerful recollection of the experience of deep fear and feelings of helplessness and horror in the face of a life threat is the core symptom of post-traumatic stress disorder (PTSD). One of the hallmarks of PTSD is a persistent sense of threat that endures despite the danger having passed. This constant condition of hyper-vigilance and exaggerated emotional reaction can certainly get in the way of a normal, functioning professional or social life. For people with PTSD, the alarm of anxiety never fades out. They are continuously expecting the danger to emerge from around the corner.

However, remarkably, in the face of incredibly disquieting events – terror attacks, war, or natural disasters such as earthquakes – most people react differently. For the majority – especially those who have been only indirectly linked to a traumatic event – the stress symptoms are temporary, decline over time and don’t have lasting mental health complications. Basically, people tend to carry on with their lives.

Why is it that a traumatic event can leave a deep, indelible mark on a few individuals and almost no trace in others? The answer lies in a multitude of factors.

Some are rooted in our past and personal life stories. Our tendency to express anxiety in adulthood is the outcome of mechanisms developed in critical formative portions of our lives. Such mechanisms depend strongly on the type of environment we experienced. But there are, of course, also biological factors that, in combination with the environment, differentiate our dispositions and reactions to the external world. For instance, some amygdalas are more readily active and excitable than others, which makes their owners more sensitive in the processing of emotions and more sensitive in their responses to given circumstances. Genetic variation certainly plays a role. For instance, it has been shown that people with particular subtle differences in the gene sequence of the Htr1a have decreased amygdala reactivity, which confirms the role of this receptor in fine-tuning anxiety responses.
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The cumulative effect of past lived experience and biological disposition makes people either more or less resilient to adversity.

Everyone who was in London on 7 July 2005 will recall their experience that day and will have come to terms with the events in their own way.

That July morning, right at the moment the bombs were detonated, I was already sitting at my desk in the office. Only half an hour before, I had jogged past the spot where the number 30 bus blew up, on my way towards Russell Square. My most vivid memory of the day was the quietness that sank throughout the city in the evening. I had never seen London so silent and so sad. For several weeks after the events took place, I was hesitant to board any train or bus in London. Luckily, I didn’t have to take public transport to go to work every morning because my daily commute to the office consisted of a short walk from Fitzrovia to Covent Garden. In general, whenever I could, I made every journey on foot. I also avoided crowded spaces, thinking they could be targets of new attacks. Indeed, in the year immediately following the bombs there was a reduction of about 15 per cent in the overall use of public transport in London.
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At the end of summer, my levels of anxious anticipation regarding the threat of new terror attacks lowered and I started to use the tube again. But I continued to be vigilant. I confess that, once or twice, when I saw someone carrying a backpack, I left the carriage. I could not help it. Over time I taught myself to assess the risk of a terrorist attack and acknowledge that it made no sense to let any anxiety about an attack get in the way of my leading a normal life.

In his seminal essay ‘What is an emotion?’, which I mentioned earlier, William James made a clear statement of how to exercise control of our emotions: ‘If we wish to conquer undesirable emotional tendencies in ourselves, we must assiduously, and in the first instance cold-bloodedly, go through the outward motions of those contrary dispositions we prefer to cultivate.’ If we have a tendency to cultivate anxiety, we need to diligently exercise our capacity to counteract it with calm and positivity and we must start from the body. ‘Whistling to keep up courage is no mere figure of speech,’ James says.

The brain and its neurons are incredibly plastic and each purposeful action towards change, however small, contributes to the consolidation of new behavioural patterns and of the underlying neural circuits that bypass your anxious reactions.
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We can condition ourselves to correct our behaviour and avoid falling prey to anxiety. Little by little, the non-fearful strategy will establish itself as the preferred neural pathway in our brain and, as a result, we will be better equipped when anxiety approaches. Before anxiety takes a complete hold of us, we will be able to ‘switch on’ the alternative pathway. Making use of brain plasticity is like following a different route to reach your destination. Imagine that you have always taken the same path to reach a lake in the middle of the woods. One day you notice that not far from your customary path, hidden in the bushes, there is an unbeaten track that someone has started to carve out and you decide to follow it. At first, the new track is full of bumps. But the more you walk it, the more it will widen and flatten. With time, the new track will turn into a road and you will make it your preferred route.

Our growing knowledge of the phenomenon of neuroplasticity has reframed too the way we understand psychoanalysis and other forms of psychotherapy. It is now clear that ‘talking cures’ of all kinds are not mere intellectual exchange, but a biological treatment that directly affects our brain. Several brain-imaging studies in which scans were made before and after therapy have shown that the brain indeed rearranges itself during the treatment. Strikingly, the more successful the therapy, the more profound the changes in the brain. The recall of memories, their elaboration and the conscious refocusing of attention on new behavioural patterns produces durable biological changes in the brain: synaptic connections grow and modify, new neuronal connections are made. A new mental reality is established. For instance, an fMRI brain scan revealed that four weeks of therapy normalized the hyperactivation of the amygdala in patients experiencing panic disorder.
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Cognitive behavioural therapy is based on the assumption that anxiety is caused by cognitive distortions, that is, unrealistic or exaggerated thoughts – like worrying that a gunman might enter our regular café and shoot all the customers on a peaceful Sunday afternoon, when we know that although such an event is possible, its likelihood is truly slim; or, as in the case that sparked this chapter, fretting that not having money invested in the stock exchange might put you at risk during a financial crisis.