 #15 Neurology of Parkinson's Disease
from recent posts - blip.tv (beta)
February 25, 2008
Welcome to episode 15 of the series Philosophy Unveiled. I m Rachel and I m doing the reading today.In the last three episodes, we began with a profile for the cognitive style of Contributor. We then presented evidence for two Contributor traits from history in particular, we looked at the Contributor s tendency to minimize personal expenses, and at his desire for control. We saw that control excluded some people completely, and then separated others into the two categories of partners, or alternatively pawns.At this time, I would like to introduce the cognitive style of Exhorter. We suggested in a previous episode that Exhorter strategy helps to determine a label of pain or pleasure for Mercy thought. We demonstrated also, from neurology, that Exhorter analysis must reside in the orbitofrontal region of the brain. It s time to add some details.This time, philosophy is not going to be a great deal of help to us. The problem is that Exhorter analysis is conscious in Extraverted Feeling, or EF, and in Extraverted iNtuition, or EN. This lies outside of the circuit which constitutes Facilitator working memory, or what we call the Reason loop. Facilitator strategy, which is the style most commonly found in philosophers, therefore does not see the operation of Exhorter strategy.I have talked to psychologists, and they love the profile of the Contributor that s because Facilitator strategy interacts very directly with Contributor thought, and they can see, from their own mind, that the description is accurate. I then point out that there is another cognitive style that is embodied energy. They will not even look at the evidence. Obviously, there is a reaction in the minds of these individuals against something. I d like to digress briefly, and give some historical examples of Facilitator individuals, to demonstrate that this trait of rejecting the extremes that are characterized by Exhorter excitement appears to be both common and very strong [I attach a bibliography at the end of this section. Every Facilitator trait is illustrated by direct quotes from these biographies, and from this pool of people].Dwight D. Eisenhower, American president, who was a Facilitator by cognitive style: He did not like the liberal-conservative nomenclature. The main thing to remember is that history is a one-way road. You can t go back. And there is a broad surface on the road. Anyone on any part of that surface can travel. But at the two sides are gutters and in the gutters you can t travel. Sigmund Freud, psychoanalyst, another Facilitator: Use restraint, neutrality, and caution... Hegel, a Facilitator philosopher: He was led to a view of things which was neither revolutionary nor reactionary... John Keats, a Facilitator poet: [As for drink] he acted in the way conformable with the habits of his age and society, doing nothing to excess, nor making himself conspicuous by unusual abstinence. Edward Kennedy, a politician who is a Facilitator: In general, though, the word for Kennedy s early years at law school was moderation. He worked fairly hard, competed with some degree of intensity, socialized in a relaxed way. Louis XIV, French sun king, and also a Facilitator: The King loathes all severe and, a fortieri, cruel actions...His Majesty proceeds with the utmost wisdom in all the affairs of the realm. Excess of zeal was not to the taste of the impassive demigod. Robert Stephenson, a Facilitator engineer: He was preeminently a safe man, because cautious, tentative... Rousseau, another Facilitator philosopher: The quality in him which he himself euphemistically termed moderation ... Talleyrand, supreme political animal, and a Facilitator: Although he was now a declared patriot, Talleyrand, who all his life had a horror of excessive actions... He had disapproved of the excesses which followed the fall of the throne [in the French revolution], detested and distrusted Jacobinism and the Jacobins even more... Everything exaggerated is insignificant, he once said, meaning that excess destroys soundness. Marquis de Sade, a Facilitator sensation-seeker: Yes, I am a libertine, I admit it: I have imagined everything of that kind which can be imagined, but I certainly have not done all that I have imagined, and I certainly never shall. We could go on to Facilitators such as Buddha, and examine their middle path the list is seemingly endless. There is no doubt that the Facilitator is very anxious to avoid something, and this desire is very strong. It s the sort of thing that the Contributor philosopher Martin Heidegger was able to view, and he characterized it as fleeing he analyzes it extensively.At one point, we saw this trait of rejecting emotional extremes clearly in a personal experience: I had the opportunity, the writer tells us, to attend a fund-raising dinner at the Empress Hotel, and decided to bring along an older relative. She was always game for a night out. I told her that it was a charity dinner, and asked if she still wanted to come. She did. She even brought along a friend. The charity was for a good cause. We enjoyed a delicious dinner. Then came the time for the talk. The speaker was obviously an Exhorter, as fund-raisers often are. He was very good at his job. But she wouldn t have any of it. This Facilitator didn t like Exhorters, and she wasn t about to be persuaded by one. She put her fingers into her ears, in front of everyone, and kept them there. I was so embarrassed. Didn t she know this was a fund-raiser? I thought I had told her quite clearly. The speaker seemed very American, which didn t help. In this person s opinion, America had entered the Second World War a little on the late side, after Britain had suffered so much on her own. So, she didn t like Americans, and that was that. I never took her to another charity dinner again. Now, what is it that might cause the Facilitator to react to emotional proddings in this way? A further look at the red sections in the lower part of the circuits makes things very clear. Exhorter energy in left hemisphere EN moves up to Teacher analysis in IN, and then by ENTJ or Introversion across the hemispheres to Facilitator analysis in right hemisphere Extraverted Thinking. That s the portion of the mind that calculates efficiency. The Facilitator does not appreciate having these Teacher theories or sweeping statements stuffed down his throat. Similarly, Exhorter energy in right hemisphere EF moves up to Mercy analysis in IF and then by ESFP or Extraversion across the hemispheres to left hemisphere Facilitator analysis in Extraverted Sensing. Now, if we re familiar with Jeremy Bentham, the Facilitator philosopher, and his ideas of utility, then we know what that does. If not, I might describe it as a calculation of effectiveness in reaching some emotional bottom line or end. The Facilitator in this region does not like Mercy emotion stuffing its feelings down his throat, and influencing his pursuit of power. So, he attempts to remain objective, so that he can make decisions at arm s length.In summary, it s quite clear that the Facilitator is aware of something that pushes him from under the surface, and he doesn t like it. It s that something which we are introducing in this episode. Let s look first of all at the evidence for this cognitive style in history. Historians, first of all, are struck by the energy of Exhorters. Peter the Great had a mercurial and restless energy, which in his early youth had been spontaneous....By the time he was twenty, he began to suffer from a nervous twitch of the head; and when he was lost in thought, or during moments of emotional stress, his round, handsome face became distorted with convulsions....He could not sit still for long, and at banquets he would jump out of his chair and run into the next room in order to stretch his legs. Ferdinand de Lesseps, similarly, was always on the move or in confer ence, at high pressure, boiling, feverish, tired, but obstinate. Churchill s dancing teacher considered him the naughtiest small boy in the world. He could always cram into one day what no other man could do; what few other men could do in two days or even three....many activities have remained massive energy but no touch. He is basically a rammer and a pounder. Let s move to another trait that characterizes the Exhorter as a cognitive style. All three of these historical figures were men of vision and imagination. Ferdinand de Lesseps discovered Lepere s paper on the Canal des Deux Mers, a long memo randum prepared for Napoleon....It fired Ferdinand s imagination, burning deep. He saw the canal not in terms of politics or commerce, still less as personal gain. His was a spiritual concept, a dedication, an immor tality. Peter the Great: The chance discovery of this old boat and Peter s first sailing lessons on the Yauza were the beginning of two compulsive themes in his personality and his life: his obsession for the sea and his desire to learn from the West....It was strange and yet it was also partly inevitable. No great nation has survived and flourished without access to the sea. What is remarkable is that the drive sprang from the dream of an adolescent boy. Churchill revealed: Where my reason, imagination, or interest were not engaged, I would not or I could not learn. To have an exciting story told you by someone who is a great authority, especially if he has a magic lantern, is for me the best way of learning. Some day when my ship comes home, I am going to have all [the tunes I know] collected in gramophone records, and then I will sit in a chair and smoke my cigar, while pictures and faces, moods and sensations long vanished return; and pale but true there gleams the light of other days. Now, we ve said that imagination takes place in the Classification loop, within Extraverted Thinking, and we know that this circuit has nothing to do with Exhorter analysis in Extraverted Feeling. How can the Exhorter be associated with imagination? Let s not forget that Classification is part of the larger Judging loop, and this is driven by means of Exhorter energy.Let s move to the next Exhorter trait. The Exhorter is skilled at pushing others. Of Churchill, by his secretary: The most overworked word in Mr. Churchill s vocabulary is signifi cantly I think the word prod. He was always talking about being prodded by doctors, prodding cabinet ministers, prodding his lawyers, publishers and political rivals. Undoubtedly he has prodded the British Empire as it has not been prodded for generations. Peter the Great encouraged, scolded, nagged, quarreled with all and sundry, hung defaulters, and traveled from one end of the country to another....He could not wait patiently for natural improvement; he re quired rapid action and immediate results; at every delay or difficulty he would goad the officials with the threats which he used so often. Ferdinand de Lesseps: Not the least remarkable quality of Ferdinand de Lesseps was his ability to get things done. Once a decision had been taken he put his whole force into its application, and, as though he were a shunting locomotive, men soon found themselves being marshalled like trucks to the train of his intention. In a word, the power of Lesseps was momentum, and nowhere was it more difficult to get things moving than in Egypt. One subordinate stated: The word religion is not too strong to express the enthusiasm which you engendered. All three of these Exhorter individuals dealt with transitions between states or movements, not de tails. Churchill: People say Churchill was and is a master of detail. This is not true. He is impatient and even contemptuous of it. But he never misses an element in the continuity of function....To be assigned to Churchill is a strain. He will move at a moment s notice. He will move without notice. He is an animal. In war he is particularly feral. Tensions increase around him. Peter the Great: Before Poltava, Peter dealt with each new demand, whether created by the war or by administrative shortcomings and abuses, by a hurried letter or ukaze [edict] which indicated the ad-hoc measures to be taken; and in this way he dealt with affairs in all departments of government....Every reform was accomplished piecemeal, intermittently, depending upon the exigencies and requirements of the moment. Ferdinand de Lesseps: Above all he was not a plodder, but had the intuitive, emotional temperament which is concerned with principles and qualities rather than the counting of quantities. The tendency of such men is not to work out the answer to a problem but to guess what the answer ought to be. Then, if they must calculate, they do so only in order to justify their original inspiration. Alright, let s make a transition at this point, and move now from the Exhorter as a cognitive style to Exhorter strategy. It s the source of personal energy in the brain: it is present in all persons, but outside of consciousness for those who are not Exhorters by style. This can cause problems. One sees it strikingly, for instance, in Tourette s syndrome. In this condition, Exhorter thought appears to disengage partially from the rest of the mind, and to operate semi-autonomously. Symptoms parallel the characteristics of the Exhorter as a person. There is excessive energy: It is widely accepted that many children who progress to Tourette s syndrome first manifest hyperactivity. One patient by age three was in non-stop motion; by age five the tics started. Motor incoordination, Tourette stated, is the first indication of disease. This starts most often in the face or upper extremities. Teachers and parents notice arms that shake, fingers that extend and flex, and shoulders that flinch, making work difficult. Almost at the same time facial movements appear. These movements are rapid and appear abruptly. There may be vivid visual and verbal imagination which the Tourette patient, unlike the Exhorter, cannot always control: Her secret was that she had fantasies internal movie pictures that remained with her for hours daily and over many years. One person claimed the urge to pronounce out loud a word or phrase that had drawn all his atten tion...obsessed all his thoughts to such an extent as to cause him to lose the thread and the sense [of what he was saying]. The Exhorter pushes others. The Tourette patient is prodded by another part of his mind: Brad felt trapped within his body, a victim to urges and impulsions which he recognized originated from somewhere in his own mind but which were, at the same time, inexplicable, alien, and humiliating. Urges can be very strong: Most patients report that tics are immediately preceded by an irresistible urge to perform the vocal or motor act, and that its execution is followed by a feeling of relief. It is not possible to sup press them indefinitely, and they must be released within a short period of time, usually in a torrent. Most tics are related to verbal and motor transitions: Tics are normally lightning-like, brief....Many of the verbal tics consist of barks, grunts, shrieks. Tics primarily occur at phrase junctures in speech....Many [patients] have dysfluencies characterized by repetitions of utterances, hesitations, and false starts. We postulate that Tourette s syndrome is caused by an overactive and semi-autonomous Exhorter strategy. This generates transitions in speech and motor action they appear as tics and grunts, unmodified by other motor or speech activity. As Tourette s syndrome is related to an overactive Exhorter strategy, so Parkinson s disease appears to be linked to an underactive strategy. Those with the disease lack energy: There may be persistent tiredness, minor aches and pains, or a vague sense of malaise, of just not feeling well. The patient may feel a lack of energy or a sense of nervousness and irritability. The patient may notice that things which were formerly done easily, without a thought, now require some effort. Parkinson s patients do not have sufficient vision and imagination to conceive of themselves as victims: A common reaction to the diagnosis of Parkinson s is denial, which may lead the individual to get a second opinion. Others may superficially accept the diagnosis but remain unwilling to learn about the problems associated with the disease or think about the need for future adjustment. Researchers speak of poverty of imagination. The Exhorter pushes others; the Parkinson s patient is deficient in this: Many studies attempt to identify a premorbid personality type in Parkinson s. All are retrospective and therefore subject to criticism, but there is a great deal of agreement. The Parkinson s patient is usually depicted as diffident, introspective, passive, and lacking emotional and moral flexibility. Recent studies have focused on the protean neurobehavioral abnormali ties in Parkinson s, such as apathy, fearfulness, anxiety, emotional lability, social withdrawal, increasing dependency, depression... Exhorter strategy in others, as it is shared in speech, can sometimes supplement the weak internal drive in the Parkinson s patient. In mild cases of Parkinson s disease, [motor and speech] difficulties are all intermittent and can be corrected temporarily by will power or by external exhortation. We ll be expanding this idea in later episodes into a discussion of the mechanisms behind hypnosis.Moving further, the Parkinson s patient is unable to generate motor and speech transi tions: The patient may be walking along very nicely when suddenly one foot seems to stick to the floor, firmly glued. After a few seconds it is suddenly loose again. This occurs especially in doorways, while crossing the street, and on turns. Bradykinesia or slowness of movement, is often used interchangeably with hypokinesia (poverty of movement) and akinesia (absence of move ment). It includes a delay in initiation, and slowness of execution; delay in arresting movement, a decrementing amplitude and speed of repetitive movement, freezing, and an inability to execute simultaneous or sequen tial actions. The simple motor program to execute a fast ballistic movement is intact [in the brain], but it fails because the initial agonist burst [provided by Exhorter strategy] is insufficient....Parkinson s patients fail to produce the pauses or stop gaps normally found between words in connected speech and within words for the acoustic production of stop-plosive consonants. Speech articulation is usually slurred. Tourette s syndrome and Parkinson s disease, we conclude, are related disorders: one is associated with overactivation of Exhorter strategy, the other reflects underactivation. Treatment is opposite: Tourette patients are helped by haloperidol, which inhibits the brain neuromodulater dopamine. Parkinson s patients are treated rather with L-dopa, which increases brain levels of dopamine. Tourette patients on haloperidol suffer from reduced drive and mental energy; Exhorter analysis, it appears, is inhibited. One person found that extreme cognitive blunting, lack of motivation, and diffuse lethargy produced [as a side effect] by haloperidol proved intolerable. He could not bear sitting at home, and could not function at his work, although he appreciated the reduction in motor symptoms. When doses of haloperidol are increased, Exhorter strategy can shut down completely: There is a tendency to switch from a Tourette state to an almost Parkinsonian state. Parkinson s patients on L-dopa in contrast experience sudden rushes of imagination: Side effects of L-dopa include vivid dreams, nightmares, disturbed sleep pattern, visual illusions, and pseudohallucinations....True visual hallucinations may also occur. Exhorter thought is enhanced. In later stages of Parkinson s, treatment with L-dopa can trigger actual Tourette-like symptoms: Later on, dyskinesias [or movement problems] may be an inevitable accompaniment of on periods [periods when movement is made possible by L-dopa] which the patient must accept as the price of mobility....The most extreme involuntary movements seen in Parkinson s occur with a beginning and/or end of dose pattern. They are usually violent, dramatic and disabling. Exhorter thought appears to disengage, as in Tourette s, from the rest of the mind. OK, so the chemical dopamine appears to link to Exhorter strategy. The more dopamine there is in the brain, the greater appears to be the Exhorter excitement and energy. Are there chemicals for other strategies as well. As it turns out, the answer appears to be yes.Serotonin, a major neuromodulator, for example is the confidence chemical. It is found in high concentrations in the brains of top dog monkeys. In other ways, it is connected with Contributor-like behavior. To a first approximation, we have found that any brain region with serotonin receptors is linked to the Contributor module, and is required for Contributor strategy to operate!The drug cocaine, for instance, works by enhancing brain serotonin. In this way, it creates a false sense of confidence. The Contributor person, who so values confidence, is particularly prone to cocaine addiction.The indicator for Facilitator thought turns out to be the neuromodulator norad renaline. We ll be using this information extensively, in later episodes, when we discuss conditions such as ADHD, bipolar disorder and depression.In summary, serotonin, dopamine and noradrenaline, three major neuromodulators, appear to link to three of the styles. There is another important chemic al acetylcholine. We ve found that it s linked to concentration. Teacher and Mercy modules, it turns out, can concentrate; the locations where this occurs can be tagged by the acetylcholine receptors. The third style able to concentrate is the Contributor; he has a sort of contextual concentration : he can hold on to a specific Exhorter urge, it seems, and force the rest of the mind to flow around this desire. This also appears to be acetylcholine related.Alright, we ve demonstrated from both history and neurology that the cognitive style of Exhorter really does appear to exist. The Facilitator has our permission, at this point, to take his fingers out of his ears, and to examine this new mental strategy, which affects him so strongly, and yet lies outside of his direct mental knowledge. For those who are interested, we ve written an extensive book-length historical review of the Exhorter, called Magical Mystery Tours of Mr. Excitement. It is included in the document orderedcomplexity.pdf, and can be accessed at our website cognitivestyles.com. This pdf document also includes a separate book-length, 120,000-word review of the neurological literature to the year 2006, titled Neurology of Parkinson s disease and Schizophrenia, which looks at the distinct ways in which these two conditions progressively degrade the human brain both in the cortex and in the basal ganglia as a functioning system. The neurological evidence, as we lay it before us in its full ordered complexity, appears to suggest that both conditions can be readily prevented, but once present, cannot be readily cured.In the next episode, we will move on to a brief profile of the Exhorter. It will summarize what we discovered in history. That concludes episode 15. Thank you for listening.---------------Bibliography for Facilitator:ASTOR, GERALD The Last Nazi: the Life and Times of Dr. Joseph Mengele. Donald I. Fine, Inc., New York. 1985.AYLING, STANLEY John Wesley. 1979.BATTISCOMBE, GEORGINA Shaftesbury, a biography of the seventh Earl. Constable, London. 1974.BIRNBAUM, MILTON Aldous Huxley's Quest for Values. The University of Tennessee Press, Knoxville. 1971.BODEN, MARGARET Piaget. The Harvest Press, London. 1979.BREWSTER, E.H. The Life of Gotama the Buddha. Bhartiya Publishing House, Sonarpur, Varanasi. 1975.BURNS, JAMES MACGREGOR Edward Kennedy and the Camelot Legacy. W. W. Norton and Company, Inc., New York. 1976.CAIRD, EDWARD Hegel. Blackwood, Edinburgh. 1902.CAMPBELL, H. M. John Dewey. Twayne Publishers, New York. 1971.CHARPENTIER, JOHN Rousseau, the Child of Nature. Methuen and Co., Ltd., London. 1931.DAVIES, HUNTER William Wordsworth. Weidenfeld and Nicolson, London. 1980.EBER, DOROTHY HARLEY Genius at Work: Images of Alexander Graham Bell. McClelland and Stewart. 1982.ERLANDE The Life of John Keats. 1929.ERLANGER, PHILIPPE Louis XIV. Weidenfeld and Nicolson. 1970.FAY, BERNARD Franklin, the apostle of modern times. Blue Ribbon Books, New York. 1933.FRANGSMYR, TORE Linnaeus: the Man and his Work. University of California Press, Berkeley. 1983.FRANZERO Leonardo. Allen, London. 1969.GOLDSMITH, MARGARET Frederick the Great. C. Boni, New York. 1929.GRENE Portrait of Aristotle. 1963.HAYMAN, RONALD de Sade, a Critical Biography. Constable, London. 1978.HUXLEY, LEONARD Darwin. 1927.HYDE, MONTGOMERY Neville Chamberlain. Weidenfeld and Nicolson, London. 1976.JONES The Life and Work of Sigmund Freud. Basic Books, New York. 1961.JOSEPHSON, MATTHEW Edison. Eyre and Spottiswoode, London. 1961.KAUFMAN Mendelssohn a Second Elijah. 1936.KRAMER, RITA Maria Montessori. G. P. Putnam's Sons, New York. 1976.LARSON Eisenhower: the President nobody knew. Scribner, New York. 1968.LEGGE, JAMES D.D. The Life and Teachings of Confucius. J. B. Lippincott and Co., Philadelphia. 1867.LEVINGER Galileo. 1952.LINDBERGH, ANNE MORROW Hour of Gold, Hour of Lead. Harcourt Brace Jovanovich, New York. 1973.LUDWIG, EMIL Goethe the History of a Man. G. P. Putnam's, New York. 1928.MADELIN, LOUIS Talleyrand. Roy Publishers, New York. 1948.MARSHALL, T. H. James Watt. Leonard Parsons Ltd., London. 1925.MAYER Friedrich Engels. 1936.MORRISON The Private Life of Henry VIII. R. Hale, London. 1964.NEVINS, ALLAN Ford. Scribner, New York. 1954.O'MALLEY, J. B. Florence Nightingale. 1931.POLLOCK Wilberforce. 1977.REYNOLDS, QUENTIN Minister of Death: the Adolf Eichmann Story. The Viking Press, New York. 1960.SACHS Freud, Master and Friend. 1944.SILBERGER, JULIUS, JR. M.D. Mary Baker Eddy. Little, Brown and Company, Boston, Toronto. 1980.SMILES, SAMUEL The Lives of George and Robert Stephenson. The Folio Society, London. 1975.SNOW, PETER Hussein. Barrie and Jenkins, London. 1972.TAYLOR Socrates. 1932.TOOLEY, SARAH The Life of Florence Nightingale. 1914.VANDERCOOK Great Sailor Captain James Cook. Dial Press, New York. 1951.VOSBURGH To Gilbert Grosvenor. National Geographic, October, 1966.--------Bibliography for Exhorter:BACON, R. H. The Life of Lord Fisher of Kilverstone. New York, Garden City. 1929.BEATTY, CHARLES Ferdinand de Lesseps. London, Eyre and Spottiswoode. 1956.BRADFORD, ERNIE Drake. London, Hodder and Stoughton. 1965.BURNS Roosevelt: The Lion and the Fox. 1956.CHURCHILL, WINSTON My Early Life; a roving commission. London, Reprint Society. 1944.CORMIER, FRANK LBJ The Way He Was. Garden City, New York, Doubleday. 1977.CRANKSHAW Khrushchev. London, Collins. 1966.DAVIS, BURKE The Billy Mitchell Affair. New York, Random House. 1967.FAITH, WILLIAM ROBERT Bob Hope. 1982.FIFE The Revolt of Martin Luther. New York, Columbia University Press. 1957.JONGE, ALEX DE The Life and Times of Grigorii Rasputin. New York, Coward, McCann and Geoghegan. 1982.JOURDAN, PHILIP Cecil Rhodes, His Private Life by his Private Secretary. London, New York, John Lane, The Bodley Head. 1910.KLYUCHEVSKY, VASILI Peter the Great. New York, Vintage Books. 1958.KRAMER Lombardi. New York, Crowell. 1976.LINCOLN My Twelve Years with John F. Kennedy. New York, D. McKay. 1965.MCGIFFERT Martin Luther. New York, Century. 1911.MOIR, PHYLLIS I Was Winston Churchill s Private Secretary. New York, W. Funk. 1941.PAGE, JOSEPH A. Peron, a Biography. New York, Random House. 1983.PENDERS, C. L. M. The Life and Times of Sukarno. London, Sidgwick and Jackson. 1974.PERKINS, FRANCES The Roosevelt I Knew. 1946.POLLOCK, JOHN Billy Graham. New York, McGraw Hill. 1966.POLMAR, NORMAN and ALLEN, THOMAS B. Rickover. New York, Simon Schuster. 1982.ROLT, L.T.C. Isambard Kingdom Brunel. London, Longmans. 1960.SHEPHERD Bing Crosby - the Hollow Man. 1981.STEINBERG Sam Johnson s Boy. New York, Macmillan. 1968.VOLKAN, VAMIK D. and ITZKOWITZ, NORMAN The Immortal Ataturk, a Psycho bio graphy. Chicago, University of Chicago Press. 1984.WALDER, DAVID Nelson. London, Hamish Hamilton. 1978.
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