Cognitive Column - December 2017

It is probably psychologically healthy not to be too worried for too long about things that don't affect us, but it does make the World seem a fickle and uncaring place. Disasters, natural and man-made, come and go, creating ephemeral shock and compassion, but within a brief while all is forgotten. Not by the victims, of course; their struggles can go on for years. Picking up on a theme I raised in the last Column, our seeming indifference is likely to be one of many consequences of the fact that, during our evolution, we lived in relatively small bands. While outsiders were viewed with suspicion and were unlikely to attract much empathy, those of our own tribe were likely to share many of our own genes, so to help one of them was almost as important as helping oneself. From the point of view of genes, altruism is selfish self-preservation and it is a trait that evolved a long time ago. Even Neanderthals are believed to have exhibited caring behaviour, with skeletons showing signs of the owner growing old, while suffering injuries and disablement. To have reached old age others must have been prepared to help and feed them, since they could not do it for themselves. Nevertheless, there is also evidence that prehistoric humans waged war on each other, and it is plausible that our prodigious intelligence developed through a Cognitive arms race; those who could plan and outwit best were the ones who survived to pass on their genes.

I have been thinking about these issues after a trip to Kiev, capital of Ukraine. In 2014 a Malaysian airliner was shot down as it flew over Ukraine, which was (and still is) in conflict with Russian backed rebels. Two years later, investigators concluded that the attack had used a Buk missile, brought in from Russia, but since 2016 the World has largely lost interest in the region, despite continuing explosions and skirmishes, with many casualties and thousands of internally displaced people. Not surprisingly, the country's health services struggle, particularly the mental health services, since there is a high incidence of posttraumatic stress disorder (PTSD) and other related problems. I was part of a multi-national group from the European Society of Hypnosis, looking to provide guidance, training and support to our Ukrainian colleagues. Hypnosis is a particularly effective tool in the treatment of PTSD.

Genes play their part in PTSD too; not every traumatised person develops the condition, only those with the vulnerable genome. It seems likely that this distressing condition originally evolved long before humans. Simpler, pre-verbal animals needed a mechanism that would make them turn away from repeating life threatening behaviour. A seriously terrifying trauma would cause the brain to lay down vivid visual images of the event. Subsequently, any situation that contained an element similar to the trauma would trigger the memory, which appeared in such detail that it would appear to the animal that it was back in the scene. Of course the terrified animal would run, and hence live to see another day. In humans we refer to these vividly re-experienced memories as flashbacks. As cognitively complex creatures we should be able simply to reason that the experience is merely a reminder, and is not actually happening again, but unfortunately the primitive mechanisms override the evolutionarily recent rational processes and humans too can believe themselves back in the scene.

What has the brain done to make trauma memories so compelling when, in contrast, trying to store memories for exam material, say, is so difficult. The answer is that it changes its chemistry, and it does this by changing genes. We can't really change the genes we have inherited, but we can change whether or not they are "expressed". Not all genes are used all the time. Thus, although every cell in our bodies (except eggs and sperm) contain our full "recipe book", cells in the eye, for example, do not make bone, and those in the skeleton do not make liver cells or muscle. The inappropriate genes are not expressed, and this is achieved by "turning off" all but the necessary parts of the recipe book. The molecules that make a gene can be rendered inaccessible by attaching a methyl group, an obstructing cluster with one carbon and three hydrogen atoms. Reversing this methylation can make the gene visible again, so that it can be used to form whatever it defines - a neurotransmitter perhaps. Severe trauma causes large numbers of methylation changes, the majority occurring in brain-related genes.

There are a good many issues in the news at the moment, touching on the subjects of trauma, boundaries and safeguarding. Some are clear cut and provoke unequivocal condemnation, but many tend to merge into grey areas. Shakespeare, as so often, captures this nicely; he has Hamlet say, "There is nothing either good or bad, but thinking makes it so." On this basis, sometimes we should perhaps place less emphasis on behaviour and rather more on our thinking about behaviour. An example of something where no thought is required is sexual assault. It is wrong, full stop, and can often result in the sorts of brain changes I mentioned above. In a very real way, such an attack is causing brain damage, and that's on top of all the other harm that is done; it is a violation in every conceivable sense of the word. However, I have met cases of women who have suffered no violation, but who have had other reasons to seek counselling. They have ended up receiving "therapy" from poorly trained, ill -informed hypnotherapists, who inadvertently plant a false memory of being sexually abused as children. In spite of the fact that there was abundant evidence that what they "remembered" simply could not have happened, these unfortunate souls developed all the symptoms of PTSD. They were traumatised by something that didn't happen; it was thinking that made it so.

Universities are supposed to be the hot-houses of thought and bastions of free speech, but nowadays they seem more like children's nurseries than the horticultural form. There must be no sharp edges where people might hurt themselves, and we all have to avoid saying nasty things in front of the impressionable youngsters. This is where things get grey. When I give a lecture on the epigenetic impact of childhood sexual abuse (CSA) and the adult mental health issues that may ensue, I know that up to twenty percent of my female audience, and rather fewer of the male, may well themselves have been affected by CSA. It doesn't seem appropriate to launch uncaringly into the topic, so I make sure people are aware of what I will be talking about and also I provide contact details, in case issues are raised that some people need to talk over. Note, however, that there is something rather special about this particular subject matter. There is a high risk that several members of an audience will have personal experience of it, and we know that adults abused as children are at significant risk of a variety of mental illnesses; they are vulnerable. At the other extreme, it would seem that some universities exercise regimes where safeguarding is taken to quite ridiculous extremes, where subjects such as theology and English literature have to come with health warnings. Shakespeare (I do like him!) is seriously troubling; he touches on so many scary topics: murder, incest, suicide, war, desertion and rape. I have listed only those topics where I have met people actually involved in some way with that kind of trauma, but there are many more, such as fratricide, regicide and war crimes. Nevertheless, trauma-laden as his works are, I go on peppering my talks with Shakespearian quotes, without giving a trace of a warning! People actually benefit from being exposed to the real, everyday world. One of the key goals of PTSD therapy is to "normalise" the terrifying memories. That is not to justify what happened, or to convince the sufferer that it was a perfectly normal event, but it is to get their brain to accept it as just one more item (it happens to be a nasty one) sitting on the time-line of their biography. The sight of blood and guts is a well known trigger for PTSD, but surgeons, who see lots of that sort of thing, do not normally suffer. The reason is that their exposure is in the context of therapy, not threat; once again, thinking makes it so. The brave women who are currently coming forward to tell their stories of assault are probably doing themselves good, and certainly helping others through normalising the crime. Once again, this is not to diminish the crime, but to remove the taboo; fears and phobias thrive on avoidant behaviour, whereas careful exposure tempers the terrors.

So, universities should be like operating theatres: safe places, where all involved are treated with consideration but nobody shrinks from exposing the guts of the matter. Those who don't feel comfortable in such an atmosphere should not seek to change our venerable seats of learning; they should simply go, taking their stultifying political correctness with them, and leave the stage to those who dare to think - not just their own thoughts but the thoughts of others too.

I do hope studies go well for you. No doubt I shall be in touch again in the New Year.

Best wishes, Peter