The Brain in Love: 12 Lessons to Enhance Your Love Life (17 page)

—JERRY SINFELD

D
oes your brain play tricks on you? Surprise you? Torture you? Appall you? Mine does. Even at the most inappropriate times. I can be sitting in church, trying my best to be thoughtful, prayerful, spiritual, and close to God, and then the next moment my brain notices the rear end of the young woman in front of me.

“Stop it,” my superego yells.

“Oh, please, just one more quick look?” My brain pleads.

“No, you are in church.”

Or, I can be out to dinner with my sweetheart, having spent the day planning to make it a special evening for us, and then ruin it all by noticing for a half second too long the young, bouncy waitress with the ample cleavage walking by the table. Poof, the evening is ruined. “What’s the matter with me?” I think, “I did not want the waitress, I wanted my sweetheart.” Also, I can be driving in traffic and wonder what it would be like to drive into oncoming traffic or slam into the car next to me. Ouch! Or, I can be walking
in a grocery store, notice someone carrying an armload of boxes, and wonder what it would be like to tickle the person. Yuk? The list goes on and on from suicidal thoughts (“What would they think if I jumped off the balcony and splattered myself on the ground?”), to homicidal thoughts (“How would it feel to shoot that person in the face?”), to strange thoughts (“I wonder if it would be erotic to watch anteaters having sex?”). Before you think I am abnormal or just plain sick, I have been listening to these “sneaky thoughts” from my patients for more than twenty-five years. We all have them. They just sneak up on us without planning. I was walking recently with a friend, one of the sweetest, most thoughtful women I know. She told me about a time when one of her daughter’s friends was being irritating and she had the thought of pouring a jug of milk over her head. Of course, she didn’t do it, but the thought ran through her brain nonetheless.

What causes our brain to have these bizarre, silly, or unhelpful thoughts? What causes our brain to be sneaky? The limbic or emotional brain is always generating possibilities, novelties, and interesting hypotheses. Like dream states while awake, the brain is constantly churning, imagining, and playing. Thankfully, we have an area of the brain called the prefrontal cortex (PFC), which inhibits these sneaky thoughts and prevents us from saying them or acting upon them. When this part of the brain works right, it can laugh at or dismiss these sneaky thoughts. When there is damage or disease to this part of the brain, these hurtful, embarrassing thoughts surface in our behavior.

I was once at a conference with a close friend of mine, Jillian. She had experienced a car accident several years earlier that hurt her PFC. She had a reputation for saying exactly what was on her mind without filtering its content. Two obese women sitting in front of us at the conference were engaged in a spirited conversation about their weight. One woman said to the other, “I don’t know why I am so fat, I eat like a bird.”

Jillian looked at me and said loud enough for everyone around us to hear, “Yeah, like a condor.”

I looked at her in total embarrassment. Horrified, Jillian put her hand to her mouth and said, “Oh my God, did that thought get out of my mouth?”

Yes, I nodded.

“I’m so sorry,” she said as the women moved away from us.

The brain is a sneaky organ. From minor gaffs, to embarrassing moments, to a lifetime of trouble, the brain is in the center of our behavior.

PFC Damage

Damage to the PFC can happen in a number of different ways, such as through a head injury, some form of toxic exposure, or later in life through diseases of aging, such as dementia. The most common cause of dementia that is associated with difficult behavior is called frontal temporal lobe dementia (FTD). People with this type of dementia are more likely to act like Jillian. In a study from UCLA, researchers examined patients with FTD and Alzheimer’s disease (AD). Typically, early in the illness FTD affects the front parts of the brain, while AD affects the back parts of the brain. When damaged, the front parts of the brain are more involved in poor judgment and a decreased control over one’s actions. Researchers studied both groups for sociopathic behavior, evaluated the characteristics surrounding their acts, and compared the groups on neuropsychological tests and brain-imaging studies. There were twenty-eight patients in each group. Sixteen (57 percent) of the FTD patients had sociopathic behavior compared to two (7 percent) of the AD patients. Sociopathic acts among FTD patients included such things as unsolicited sexual acts, traffic violations, and physical assaults. When interviewed, the FTD patients with sociopathic acts were aware of their behavior and knew that it was wrong but could not prevent themselves from acting impulsively. They claimed remorse, but they did not act on it or show concern for the consequences. Among FTD patients with sociopathy, brain-imaging studies showed right prefrontal cortex
involvement. The PFC helps us supervise our behavior and control the sneaky thoughts most of us have.

I have treated patients with FTD who started sexually abusing children. These men had no prior history of bad behavior. I have treated others with late-onset PFC disorders who developed unusual sexual behaviors. One case was particularly sad. A pastor of thirty years underwent brain surgery for a tumor to his PFC. He took time off from his position in the church. At first the operation seemed a success and the pastor went back to work. Then gradually over the next year, his behavior started to become bizarre. He had temper issues at church and was less reliable than before. Through his church he developed a friendship with a seven-year-old boy. Over time the relationship turned sexual. When he was caught, the whole community was stunned. The investigator for the case said there was absolutely no evidence of this type of behavior prior to the surgery. Yet, because of his position of trust, the judge gave this pastor thirty years in prison.

Tourette’s Syndrome

Other areas of the brain besides the PFC can also be involved in sneaky behavior. The PFC helps us think about and supervise our odd behaviors. The basal ganglia and anterior cingulate gyrus can also fire abnormally and wreak havoc. Tourette’s syndrome is an example that involves both of these systems. People who have Tourette’s syndrome (TS) have uncontrollable urges to move their muscles (tics) or say exactly what is on their mind. They can control the urges for a while, but like tension on a rubber band that needs to be released, the urge builds until it has to be set free. TS is classified as a tic disorder where people have both motor (involuntary muscle movements) and vocal tics (involuntary vocalizations). Examples of motor tics include shoulder shrugging, leg movements, hip thrusts, excessive blinking, eyebrow raising, facial grimaces, head jerking, punching, and even sexual gestures. Examples of vocal tics include puffing, blowing, throat clearing,
whistling, animal noises (barking, mooing, crowing), and swearing (termed
corprolalia
). Several years ago I spoke for the Tourette Syndrome Foundation of Canada on the island of Victoria. I spoke in front of four hundred people who had TS. It was more than interesting to speak in front of that many with tic disorders. In the audience there were people who were barking, whistling, and jerking. It taxed my ability to stay focused on my talk.

During the middle of the lecture someone blurted out, “Fuck you.”

Taken aback, I just ignored him.

A few minutes later, it happened again: “Fuck you” came from the audience.

Now, I started to sweat. What should I do?

One more time, “Fuck you,” came even louder.

I couldn’t stand it anymore and said, “Is that a tic? Or don’t you like the lecture?”

The man blushed and said it was a tic. But how is a speaker really to know?

TS is a treatable disorder, with medication and behavioral therapy. Without therapy it can ruin lives. David Comings, MD, a researcher at the City of Hope in Los Angeles, writes in his book
Tourette Syndrome and Human Behavior
, that families of Tourette’s sufferers tend to have other unusual behaviors. These have included unusual sexual behavior, violence and abuse (especially within the family unit), obsessive compulsive tendencies, anxiety disorders, manic depression, and even psychotic symptoms. TS highlights that there are underlying mechanisms in the brain that correlate with impulse control disorders.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is similar to TS. In fact, about half the people with TS also have OCD. Obsessive-compulsive disorder affects somewhere between two to four million people in the United States. This disorder can impair a
person’s functioning and often affects a person’s sexuality. OCD is often a disorder secretive to the outside world, but not to those who live with the person. The hallmarks of this disorder are obsessions (recurrent disgusting or frightening thoughts) or compulsions (behaviors that a person knows make no sense but feels compelled to do anyway). The obsessive thoughts are usually senseless, repugnant, and invasive; they are sneaky and may involve repetitive thoughts of violence (such as killing one’s child), contamination (such as becoming infected by shaking hands), doubt (such as having hurt someone in a traffic accident, even though no such accident occurred), or sexuality (such as unusual acts with children or animals). Many efforts are made to suppress or resist these thoughts, but the more a person tries to control them, the more powerful they become.

The most common compulsions involve hand-washing, counting, checking, touching, and masturbating. These behaviors are often performed according to certain rules in a very strict or rigid manner. For example, a person with a counting compulsion may feel the need to count every crack on the pavement on their way to work or school. What would be a five-minute walk for most people could turn into a three- or four-hour trip for the person with obsessive-compulsive disorder. They have an urgent, insistent sense inside of “I have to do it.” A part of the individual generally recognizes the senselessness of the behavior and doesn’t get pleasure from carrying it out, although doing it often provides a release of tension.

The intensity of OCD varies widely. Some people have mild versions, where, for example, they have to have the house perfect before they go on vacation or they spend the vacation worrying about the condition of the house. The more serious forms can cause a person to be housebound for years. I once treated an eighty-three-year-old woman who had obsessive, sexual thoughts that made her feel dirty inside. It got to the point where she would lock all her doors, draw all the window shades, turn off the lights, take the phone off the hook, and sit in the middle of a dark room
trying to catch the abhorrent sexual thoughts as they came into her mind. Her life became paralyzed by this behavior and she needed to be hospitalized.

New research has shown a biological pattern associated with OCD. Brain-SPECT studies have shown increased blood flow in the basal ganglia and anterior cingulate gyrus (ACG). The ACG is involved in allowing a person to shift his or her attention from subject to subject. When this area is overactive, a person gets “stuck” on the same thought or behavior.

Like most forms of psychiatric illness, OCD has a biological basis, and part of effective treatment often involves medication. At this writing there are eight “antiobsessive medications” and there are more on the way. Before 1987 there were no good medications to treat OCD. The current medications that have shown effectiveness with OCD are Anafranil (clomipramine), Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Effexor (venlafaxine), Luvox (fluvoxamine), Celexa (citalopram), and Lexapro (escitalopram oxalate). These medications have provided many patients with profound relief from OCD symptoms.

In addition, behavior therapy is often helpful for these patients. This is where a patient is gradually exposed to the situations most likely to bring out the rituals and habits. Behavior therapy also includes thought-stopping techniques and strong urging by the therapist for the patient to face his or her worst fear (for example, having a patient with a dirt or contamination fear play in the mud).

There is a group of disorders that have been labeled as Obsessive Compulsive Spectrum Disorders. It is based on the premise that these disorders occur because the person experiences repetitive unwanted thoughts or behaviors. They tend to get stuck on thoughts and cannot get them out of their minds unless they act in a specific manner. OCD spectrum disorders include trichotillomania (pulling out one’s own hair), onychophagia (nail biting), Tourette’s syndrome, kleptomania (compulsive stealing), body dysmorphic disorder (unreasonably feeling a part of the body is excessively
ugly), compulsive shopping, pathological gambling, fetishes, and sexual addictions.

In the past decade the Internet has brought a whole new meaning to pathological gambling and sexual addictions. Both are on the rise with younger and younger people. The term
addiction
used to be used exclusive to chemicals such as alcohol, drugs, or nicotine. With recent research on the brain, we now understand that many behaviors can become as chemically addictive as a substance. Gambling and pornography can be such an addiction.

Pathological gambling includes all betting behaviors that interfere or hurt personal, family, or work-related activities. The essential features of a gambling addiction include:

• increased preoccupation with gambling
  

• a need to bet more money more frequently
  

• restlessness or irritability when attempting to stop
  

• “chasing” losses
  

• loss of control, manifested by continuation of the gambling behavior in spite of increasingly serious negative consequences
  

• in extreme cases, financial ruin, legal problems, loss of career and family, and even suicide.
  

According to the National Gambling Impact Study Commission, the national lifetime prevalence of gambling is no less than 1.2 percent of the total population (2.5 million). In longstanding gambling markets such as Nevada, more than 5 percent of the population will develop some problem with gambling, a prevalence rate about five times that of schizophrenia and more than twice that of cocaine addiction.