How Much Does your Soul Weigh?

On 10 April 1901 Duncan MacDougall together with four other physicians were waiting for six people to die. In a hospital in Dorchester, Massachusetts, each patients' entire bed was placed on an industrial sized Fairbanks scale that was sensitive within two tenths of an ounce (5.6 grams). After a few hours waiting, the patients died and something strange happened.

As soon as they died the scales dropped. They lost weight. The conclusion was that a human soul left the body and registered the loss of 21 grams. The weight of a mouse. Repeating the experiment with dogs resulted in no loss of weight, indicating that dogs have no soul to lose.

Since the soul was material, Duncan MacDougall reasoned that we should be able to measure it. Four years later the New York Times reported in a front-page story that MacDougall tried to take X-rays of the soul escaping the body at the moment of death. Then MacDougall died in 1920 at the young age of 54 leaving behind many questions and many charlatans to capitalize on his scientific legacy.

Following the publication of these experiments—both in the popular media as well as in academic journals—his colleague physician Augustus Clarke criticized the experiments. Clarke argued that the loss of 21 grams could be accounted for by expiration. Clarke noted that at the time of death as the lungs are no longer cooling blood there is a sudden rise in body temperature, causing a subsequent rise in evaporative sweating. Since dogs do not have sweat glands, and therefore cannot lose weight in this manner Clarke argued that the experiments were flawed.There was evidence to suggest that MacDougall knew of this alternate interpretation to his experiments beforehand.

Measuring is the scientific method. The medical historian Mirko Dražen Grmek wrote about the scientists Santorio Santorio (1561-1636) who diligently weighed and measured everything. In particular Santorio weighed all the food and drink that he ingested. He also measure all that come out the other end—feces and urine. After measuring his weight, the remaining weigh loss is due to something else. For every eight pounds consumed Santorio found that he only excreted three pounds. Five pounds of food and drink could not be accounted for.

It was not until 1862 that the infamous hygienist Max von Pettenkoffer constructed an insulated room designed to measure the exact amount of evaporative sweat and heat the body generated. As a hygienist, promoting good sewage and public health approach to health, Max von Pettenkoffer designed a machine—respiration calorimenter—for measuring heat given off by body’s chemical reactions and physical changes expended by a person at rest, standing and walking. He measured the weight of this metabolic energy use.

All the evidence was already there to suggest that our metabolism—the energy expanded in maintaining bodily functions—generates evaporative loss of weight. And MacDougall knew this. In his original paper he reports that: “He [dying patient] lost weight slowly at the rate of one ounce per hour due to evaporation of moisture in respiration and evaporation of sweat.” But he also addressed this loss as an explanation for the loss of weight when the patients died: “This loss of weight could not be due to evaporation of respiratory moisture and sweat, because…this loss was sudden and large…” It's undeniable that something else is taking place.

True science can only be conducted through experimentation. MacDougall’s theory, that there had to be “continuity” in life after death—a soul—was the incentive for his experimentation. The theory assumes that we know when people die. As strange as this question might seem there is no easy definition.

Our definition of death is a legal rather than a biological definition. In medicine it is a prognosis—predicting—rather than a diagnosis—confirming. Having no brain or heart activity indicates that the patient is unlikely to come back alive, it is by no means indicative of the body. Organs can still be harvested with the patient being dead. The legal definition of death does protect surgeons from liability when they are harvesting organs for transplantation.

In 1968—a year after the South African surgeon Christiaan Barnard performed the world's first human heart transplant—Stanford University surgeon Norman Shumway performed the first USA heart transplant from a brain-dead donor. These were nearly identical surgical procedures, except whereas Barnard’s surgery was received with adulation; in the United States, Shumway nearly ended up being prosecuted for conducting the operation. John Hauser, the Santa Clara County coroner, met Shumway with a threat of prosecution.  The infringement was that the donor did not have an autopsy performed to confirm that he was dead since performing an autopsy would have ruined the organs for transplantation.  Surgeons were being accused as killers. As a result of this threat of prosecution, organ donations stopped or slowed dramatically. Like an old Perry Mason TV series where the prosecutor is standing in front of the jury, pointing their right hand index finger at the transplant surgeon while declaring “Ladies and gentlemen of the jury, there is your killer. That surgeon killed my patient.”


If we are to use the Pope's language, that death needs to involve “decomposition,” “disintegration,” and “separation,” then it will truly stop all organ transplantation. Without the legal criterion of brain death, where the organs remain viable, there will be a dramatic deterioration in the quality of organs that can be harvested and transplanted. According to the World Health Organization, in 2014 120,000 solid organs were transplanted—more than 80,000 kidney, 26,000 liver and 6,500 heart transplants in 93 countries. After Austria, the United States has the highest per capita rate of transplants. Organ transplantation extends lives for a significant number of people.  But we cannot escape the fact that this is made possible by a legal definition of death and not a biological one. If organs are truly dead, they cannot be harvested and brought back to life again. However the reliance on a legal definition of death hinders a more scientific study of the biology of death.It is surprising to find how little we know about death.

The British researcher Sam Parnia argues that many people who can be classified as legally dead from heart attacks or blood loss could be resuscitated up to 24 hours after they "die". Parnia has been studying those who have no heart beat and no detectable brain activity for periods of time. While in this state the "dead" patients are given names of cities and when—sometimes, if—they recover patients are asked to ‘randomly’ name cities. They found that the patients are more likely to choose the same cities that they were exposed to while unconscious—legally dead. It seems that when we are dead we are still aware, although not conscious.

Pozhitkov and colleagues in 2017 found that death is not just a shutting down, but an orchestrated event. The authors found mRNA transcript profiles of 1063 genes became significantly more abundant after death. Even 9s hours after death. And this is not even, while most genetic activity increased 30 minutes after death, other activity increased only a day or two after death. These genetic activities are related to: stress, immunity, inflammation, apoptosis, transport, development, epigenetic regulation and cancer. We might be as ignorant of the biology of death is as much as we are ignorant of the creation of life.

As with the MacDougall studies there is a problem of small samples in these studies too. But such problems can eventually be overcome with better research design.
Weighing the soul might be complicated if we do not know when we actually die and the soul departs. There are increasing interest in both defining death and capturing the process. But evidence is scant and the methods used to examine death leave room for many errors and misinterpretations. Many publications exist of unsubstantiated reports of souls departing the body—Konstantin Korotkov, Eugenyus Kugis, Vitaliy Khromovaand and others—that purport to repeat the MacDougall’s findings, including photographic evidence. But none are published in scientific journals.

We have a great interest in “proving” things. The problem with science is that it is necessarily finicky with details and the problem with belief is that it is necessarily not. Science is just a method,without an answer. We are always refining the answer and the answer can never be completely correct. Belief, on the other hand,  is an answer without a method. It is always correct because we cannot test it and improve upon the answer.

Whenever we mix the two together—science and belief—both sides get muddled. But this space is where real science resides. In that uncomfortable area where we do not know what the outcome might be. Within this muddled space, soul searching might attain a new meaning.

© USA Copyrighted 2017 Mario D. Garrett

References

Grmek, M. D. (1952). Santorio Santorio i njegovi aparati i instrumenti. Jugoslavenska akademija znanosti i umjetnosti.

Kuriyama, S. (2008). The forgotten fear of excrement. Journal of Medieval and Early Modern Studies, 38(3), 413-442.

Pozhitkov, A. E., Neme, R., Domazet-Lošo, T., Leroux, B. G., Soni, S., Tautz, D., & Noble, P. A. (2017). Tracing the dynamics of gene transcripts after organismal death. Open biology, 7(1), 160267.

MacDougall, D. (1907). Hypothesis concerning soul substance together with experimental evidence of the existence of such substance, American Medicine, April 1907.

Parnia, S., Waller, D. G., Yeates, R., & Fenwick, P. (2001). A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors. Resuscitation, 48(2), 149-156.

Medicare Cuts in the 2018 Budget

The new tax bill Congress is passing will increase the deficit. Although this might seem antithesis to the Republican doctrine, behind the obvious spindrift there lurks a clever ploy to trigger an automatic program that reduces funding to most social programs, including Medicare. Known euphemistically as PAYGO the Statutory Pay-as-You-Go Act of 2010, is a rule that requires any federal deficit to be paid for with spending cuts to social programs. With the exception of Social Security, unemployment benefits and food stamps, most mandatory spending programs—some 228 programs—will be cut or eliminated.  Specifically, Medicare will be cut by 4 percent a year. Medicare represents the most important program for older people after Social Security.

We got here because people, and some gerontologists, are ignorant of what really helps older adults and how we achieved a modicum of support for them. Without civic engagement and social protest, such laws breeze through without even a mention that Medicare is about to be cut.

Gerontology is full of experts. It is one of the richest disciplines, with academicians and researchers studying the whole spectrum from genetics to policy, from biology to geography, from architecture to neurology. They are all gerontologists. So it is common to find disagreements but we live happily in our own silos. How do we improve aging? We try and communicate the problems associated with aging in order to bring about change

Most communication techniques are embellishment of the 1954 Schramm's Model of Communication. Wilbur Schramm defined communication as a two-way street where both sender and receiver take turns to send (encode) and receive (decode) a message. We need messages that can be understood (decoded easier). And this what eight national aging-focused organizations tried to do when—AARP, American Federation for Aging Research, American Geriatrics Society, American Society on Aging, Gerontological Society of America, Grantmakers in Aging, National Council on Aging, and the National Hispanic Council on Aging—banded together and hired FrameWorks to create a strategy for helping the public understand aging issues. The result was a bible for an aging future. Like all bibles it is populated by don’ts:

1. Don’t lead with the story of demographic shifts.
2. Don’t talk about aging as a “civil rights issue.
3. Don’t use language that refers to older people as “other.”
4. Don’t overdo the positivity.
5. Don’t cross-contaminate efforts to build public will with “news you can use.”

FrameWorks simplifies scientific and societal messages to a point that the general public can understand in order for them to act positively on it.  The problem with simplification is that it is false. Changing attitudes does not necessarily change behavior. We believe that communicating a good message changes attitudes and brings about concrete changes. We therefore also believe that laws are enacted as an act of benevolence. But this is misguided, as we are witnessing right now with PAYGO. "Reframing Aging" and "Disrupting Aging" are a ruse because they simplify a process that is messy and volatile and exclude the participation of individuals in civil disobedience. Worst still these approaches deny the social activists their true worth in our political world. What changes and improves conditions for older adults are laws that are enacted, implemented and enforced. And these steps are accomplished by civic engagement (or lack thereof.)

A livable income remains the lynchpin of wellbeing among older adults. Income, especially in the United States increases access to affordable health care, housing, transportation and food at a minimum. And we got here through the single enactment of the 1935 Social Security Act. The act was not some kind of reframing aging, or disrupting aging. The act was enacted because there was civil unrest and a swell of support for alternate provisions. FrameWorks by focusing solely on ageism and seeing the problem as a public relations issue, misses out on one of the tenants of an aging reality: heteroscedasticity. As we get older, we as a group, become more varied and different from each other. A schism as wide as that between Donald Trump and Noam Chomsky. FrameWorks remain at a loss in representing these two extremes.

Reframing, disrupting, renewing, or any public relations exercise cannot address aging, understand the changes and needs, develop effective responses and tackle problems associated with aging—on an individual or at a community level. That thinking is nonsense. Neither Trump nor Chomsky complain of ageism. The obvious reason is that they are at their zenith. Their basic civic responsibilities seem to be provided for. Their other very vocal issues—however grave and important—have nothing to do with age. Aging becomes a policy issue ONLY when individuals are at their lowest—their azimuth.

The azimuth for older adults is similar to those for other ages. It includes provision for shelter, health, food and income. You cannot have other ambitions before meeting these basic requirements. Right now those basic requirements are unmet for an increasingly large minority of the older adult population. Social gerontologists focus on this vulnerable and abused group. The answer how to help them is not by reframing of issues, but by blue-color provision of services. And services are created through policy.

We have been here before. During these economic failures older adults are worst hit. The Great Depression of the 1930s followed previous economic collapses—1840s and again in the 1890s. Poverty among older adults grew dramatically so that by 1934 over half of older adults in America lacked sufficient income to be self-supporting. They needed charity to survive. State welfare pensions were non-existent before 1930, and for those that later developed State pensions only provided 65 cents a day for about 3% of older adults. Millions of older people were homeless, hungry and desperate. Millions more were unemployed. By some estimates more than two million adult men—referred to as hobos, travelling workers, the word likely derived from the term hoe-boy meaning "farmhand"—wandered aimlessly around the country. Banks and businesses failed. From this morass of civil depravity rose one of the most important piece of legislation. The 1935 Social Security Act that in 1965 spawned Medicaid and Medicare is the bedrock of services for older adults. No single act has ever-improved older adult’s wellbeing as much, or since.

Social Security Act

Social Security Act—passed by the President Franklin D. Roosevelt (FDR) administration in 1935—created a right to a pension in old age, and an insurance against unemployment. This legislation was not passed because of the benevolence of Congress, or that of FDR (who won in 1932 and 1936). The act was passed because there was civil unrest and a threat of further social upheaval.

Workers rose up, and although individual uprisings were ineffective, en masse this lead even the oligarchs of the time and the Supreme Court judges to back down. There are other interpretations of history. But a strong case can be made that civil uprising created dramatic political choices at the time. Characterized by worldwide turmoil that gave rise to communism, anarchist, fascism, and National Socialism—Hitler, Mussolini, Gandhi, Lenin/Trotsky/Stalin. Here in the United States it was Federalism as expressed through the many “alphabet agencies” created under the New Deal. Federalism emerged not in response to civic unrest but in competition. It managed to subdue it.

Before the Great Depression the poor already established a precedence of marching to Washington D.C. to express their ire.  The 1894 March of Coxey's Army after the industrialist Jacob Coxey organized tens of thousands of unemployed to march to Congress. Although this movement fizzled, Coxley later became an advocate of public works as a remedy for unemployment. But it was the Great Depression that awakened the masses. The story remains scattered among the literature. Six social movements have been etched in history and defined the New Deal, whether in competition or in promoting.

1.     With Every Man a King Governor and later Senator Huey Long wanted the Federal government to guarantee everyone over age 60 to receive an old-age pension while every family would be guaranteed an annual income of $5,000. He proposed to do this by limiting private fortunes to $50 million, legacies to $5 million, and annual incomes to $1 million. By 1935 the movement had 27,000 local clubs with 7.7 million members.

2.     The Long Beach physician Francis E. Townsend started the Townsend Movement. Long Beach in California was considered the “geriatric capital” of the United States at the time with over a third of its residents being elderly. After finding himself unemployed at age 67 with no savings and no prospects, Townsend proposed that the government should provide a pension of $200 per month to every citizen age 60 and older. The pensions would be funded by a 2% national sales tax. By 1933 there were 7,000 Townsend Clubs around the country with more than 2.2 million members.

3.     Fire & Brimstone movement takes its name from a radio preacher Father Charles E. Coughlin who rallied against the Social Security act as he did against FDR, international bankers, communists, and labor unions. In 1936, Coughlin, along with Townsend and the remnants of Huey Long's Share the Wealth Movement, would join to form a third party to contest the presidential election in the hopes of preventing President Roosevelt from being re-elected. They failed, but the preacher had some 35-40 million listeners.

4.     Upton Sinclair, a Californian novelist and social crusader, drafted a program called End Poverty in California (EPIC). In a 12-point program there was a proposal to give $50 a month pensions to all needy persons over 60 who had lived in California for at least three years. Using EPIC as his mandate, Sinclair was the Democratic nominee for governor in the election of 1934 that he lost.

5.     By 1938 there were approximately eighty different old-age welfare schemes competing for political support in California. The culmination of these different economic propositions was the Ham & Eggs movement. Named in response to a flippant put-down that this movement was for a common meal—Ham & Eggs was started by a radio personality Robert Noble. Based on the writings of Yale professor Irving Fisher, the movement demanded that the state issue $25 warrants each Monday morning to every unemployed Californian over the age of fifty. With more than 300,000 members with many more supporters it quickly grew into a movement. Although later the organization was co-opted by his two brothers advocating $30 every Thursday morning there remained a resilient support for this social program. Even after the passage of the Social Security Act in 1938 the successful Democratic candidate for governor Culbert Olsen openly supported the plan and an initiative was placed twice (1938 and 1939) on the ballot to adopt the Ham & Eggs plan as California state policy. Both propositions failed.

6.     In Ohio the Bigelow Plan named after Reverend Herbert S. Bigelow proposed a State amendment to guarantee an income of $50 a month ($80 for married couples living together) to those unemployed over sixty years of age. He proposed that funding would come from increased tax on real estate (2% increase on land valued at more than $20,000 an acre), and partly out of an income tax equal to one-fourth the federal income tax paid by individuals and corporations. This plan garnered nearly half a million voters before it was defeated.

All of these movements sometimes competed against the New Deal that FDR was pushing. There remains some resilient misunderstanding of the benefits of the New Deal. Most picture this as a battle between the good and evil, the benevolent against the greedy, the globalist against the small business. We have been here before. The true story is messier then as it is now.

When Kim Phillips-Fein, wrote Invisible Hands: The Businessmen's Crusade Against the New Deal the impression was that the New Deal was somehow transformative for the good. But at the time, the New Deal was anything but positive. Phillips-Fein has shown that unemployment during the New Deal remained high at around 17% (1934-40), and especially among African Americans and especially in the South, the economy was still depressed, federal income taxes were tripled, higher liquor taxes and (new) payroll taxes, high farm foreclosures (mainly African American farmers), and with more than 3,728 Executive Orders, the New Deal has been argued to have delayed recovery. It seems that the Social Security Act kept us lingering longer in depression. Only after the Second World War did the economy and public welfare improved. Despite this background, the 1935 Social Security Act, for the first time, provided a national safety net for older adults and transformed how we think about aging that still reverberates today.

The Social Security Act became a vehicle for social programs. In 1965, with the addition of Medicaid—health care for the poor and disabled—and then Medicare—healthcare for older adults—the social package was complete. Although Social Security is neither exclusively a social program nor an insurance program, so far is has resisted change. Until now.

What will protect and improve these services for older adults is not a reframing exercise, but a swell of civic protests and civic engagement that exposes and shames the architects of policy that will happily sell the future of our children (deficit increase), hit the poorest and most vulnerable members of our society (Medicare recipients) with only a murmur of protest from aging-focused organizations. Without protests to halt the cut to Medicare, no amount of reframing will ever reverse the damage done that will start over the next few months.



© USA Copyrighted 2017 Mario D. Garrett



Resources

Carlie, M. K. (1969). The politics of age: interest group or social movement?. The Gerontologist, 9(4_Part_1), 259-263.

Cushman, B. (1994). Rethinking the New Deal Court. Virginia Law Review, 201-261.

Phillips-Fein, K. (2009). Invisible hands: The making of the conservative movement from the New Deal to Reagan. Yayasan Obor Indonesia.

Driving While Old

In the United States there are more older-adults drivers on the road and as a result many will end-up in hospitals.

In 2015 there were more than 47.8 million licensed drivers ages 65 and older in the United States. The fastest growing driving population. With this increase we are also seeing more accidents. That same year 6,800 older adults were killed—compared to 2,333 teens ages 16–19—and more than 260,000 were treated in emergency departments for motor vehicle crash injuries.

A quick review of the National Institutes on Aging website on older drivers quickly provides a simplistic answer. The website that address older adults and driving includes such enlightened subheadings as: Stiff Joints and Muscles; Trouble Seeing; Trouble Hearing; Dementia; Slower Reaction Time and Reflexes; Medications. It is not surprising therefore to see that fatal crashes, per mile traveled, increases the older the driver is—particularly males. It seems that these physical diminished capacities have direct negative consequences when driving.

Despite this obvious conclusion—that diminished physiology results in more accidents—the evidence is not so clear-cut.

A 2015 report by the Insurance Institute for Highway Safety suggests that such increased fatalities are more likely due to increased susceptibility to injury and medical complications rather than the increased risk of crashing. Older people are more likely to be killed when in an accident. Frail bodies as well as driving older and less safe cars are to blame. There are a lot of older pedestrian deaths as well which does not involve them driving.

Older drivers might have impaired capabilities but they are not all impaired drivers. In fact they are safer than some younger groups. In general older drivers are more likely to use seat belts, tend to drive when conditions are safest and are less likely to drive while under the influence of alcohol. In comparison, teen drivers—at the zenith of their physiological prowess—have a higher rate of fatal crashes, mainly because of their immaturity, lack of skills, and lack of experience. It’s not all about biology.

Teenagers have taught us that driving a car requires more than just physical attributes. Even if we just focus on the most obvious, vision, the results are surprising.

Cynthia Owsley and her colleagues with the Department of Ophthalmology, University of Alabama, found that the best predictor of accidents was not visual acuity but a combination of early visual attention and mental status. Having 3-4 times more accidents (of any type) and 15 times more intersection accidents than those without these problems. Driving, it seems, primarily requires a sense of spatial awareness—knowing what is around you and predicting how objects and people are moving. This perceptual capacity is known as the “useful field of view”—the area from which you can take in information with a single glance.

The psychologist Karlene Ball and her colleagues with Western Kentucky University, reported that older adults with substantial shrinkage in the useful field of view were six times more likely to have a crash. What was surprising was that when compared with eye health, visual sensory function, cognitive status, and age—although these all correlated with crashes—they were poorer in predicting crash-prone older drivers. Our perception and how we can predict the immediate environment is more important than having excellent vision.

Our useful field of view narrows with age. We take in less of the visual field in front of us resulting in greater susceptibility for accidents. This is not a negative, although it has negative consequences. This is a result of years of excellent driving and training our brain that now we do not need to concern ourselves with peripheral events. We are such good drivers. As a result our peripheral view has become unimportant, and we have erroneously eliminated that aspect of driving at a time when it becomes important because we have started losing other sensory sharpness.

But luckily there are ways to enhance our perception. There are great computer-based tools for improving useful field of view and to retrain our brain to drive safer. As a result of training, these studies have shown that drivers make a third less fewer dangerous driving maneuvers, can stop sooner when they have to and feel greater mastery of driving in difficult conditions—such as at night, in bad weather, or in new places. All of which translates to a reduction in at-fault crash risk by nearly half. This is all good news that will ensure that older drivers can keep their license longer, and more importantly drive safer, despite having diminished physiological capacities.


© USA Copyrighted 2017 Mario D. Garrett 

References

Ball, K. K., Roenker, D. L., Wadley, V. G., Edwards, J. D., Roth, D. L., McGwin, G., ... & Dube, T. (2006). Can High‐Risk Older Drivers Be Identified Through Performance‐Based Measures in a Department of Motor Vehicles Setting?. Journal of the American Geriatrics Society, 54(1), 77-84.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: CDC; 2017 [cited 2017 Nov 29]. Available from URL: https://www.cdc.gov/injury/wisqars/index.html

Insurance Institute for Highway Safety (IIHS). Fatality facts 2015, Older people. Arlington (VA): IIHS; November 2016. [cited 2016 Dec 21]. Available from URL: http://www.iihs.org/iihs/topics/t/older-drivers/fatalityfacts/older-people/2015

Owsley, C., Ball, K., Sloane, M. E., Roenker, D. L., & Bruni, J. R. (1991). Visual/cognitive correlates of vehicle accidents in older drivers. Psychology and aging, 6(3), 403.

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Is Citizenship the New Care for People With Dementia?

After a century and an immeasurable amount of resources pumped into research for dementia—particularly for the all encompassing Alzheimer’s disease—the breakthroughs we are witnessing are not in a cure but in care. Care—ignored in funded research—is emerging as the innovator in dementia research.

It is telling that Auguste Deter the first woman to die of Alzheimer’s disease, did not die of Alzheimer’s disease, but of bedsores. Despite this painful death, Alzheimer's disease was the one that gained prominence, and has now dominated research in geriatrics. For a hundred years the mantra among clinicians has been that the disease follows a set course. Even though we do not understand the disease we continue to follow the belief that we can perhaps stop the disease. And we believe that we can make it go away.

Unlike with children, diseases in older age tend to stay. Some are companions to the death (e.g., prostate cancer) while others will likely cause our death (e.g., heart disease.) For sure, few diseases in older age will be cured, Alzheimer’s disease (or dementia in general) being one of these incurable diseases. Although dementia is now the fifth or sixth primary cause of death, in fact, like Auguste Deter it is always something else that kills you other than dementia. It is therefore important not to ignore other diseases and to treat the whole person.

The idea that the expression of dementia is purely biological has been shown to be false. For Thomas Kitwood, for example, people with dementia were not only disadvantaged by the disease itself which hinders thinking and behaving, but he also saw that the attitudes and actions of those around them increased this disadvantage. Agitation being a case in point, caused by a combination of the incapacities of the disease together with the rigid expectations of their caregivers. Kitwood, for all of his theoretical flaws, revolutionized care for people with dementia. He both named and framed Person-Centered Therapy. Opened up a way of caring for someone with dementia by allowing the individual to dictate what is best for them. This approach was well understood in the field of disability.

Instead of people with dementia being warehoused until death released them from their misery, as Auguste Deter endured, the person-centered approach ensured a focus on the person’s well being. Personhood remains a caring philosophy rather than a curative one. But this was not enough.

In a world where we see our cognition as the ultimate representation of who we are, we need a stronger system to protect people with dementia. And this came from the disability field and pushed dementia research into the political arena through the concept of citizenship. Citizenship is the idea that all individuals have rights and goes beyond personhood. In 2007 British Ruth Bartlett and Canadian Deborah O'Connor argued that although “the idea that people with dementia have rights has long been recognized” but the idea of citizenship where those rights are enforced has rarely, if ever, been explicitly applied to people with dementia.

Citizenship can be applied to promote the status of discriminated groups. However the concept of citizenship assumes that the individual has the capacity to exercise their rights and to honor their responsibilities. Such assumptions are not obvious among people with severe dementia. And there's the rub.

To get around this conundrum, the concept of ‘intimate citizenship’ has been put forward that focus on citizenship moderated and mediated by family and caregivers. But such membership does not address any institution discrimination. Clive Baldwin with the Bradford Dementia Group would argue that people with dementia still have a story to tell. More importantly they might influence the stories of those who interact with them. In lieu of having independent advocacy organization that lobby on behalf of people with dementia, reliance on caregivers remains. And that could be an issue if there is discord between the person living with dementia and their caregiver or companion.

We discriminate against people with dementia in getting costly treatment for another health issue that they might have. For example we deny hip replacements or surgeries for non-life threatening issues. We have laws that restrict the ability for people with dementia to drive and to conduct business. Legal status is dependent on whether an individual has mental capacity. This status determines what rights a person has.  Although these laws are justified because they protect others in society, there remain other discriminations inherent in a society. Discriminations based on our power to make decisions on behalf of someone. We have inherited “cognitive citizenship.”  In her 2004 PhD thesis Petula Mary Brannelly reported that it is not policy or legislation but clinicians personal values that resulted in one in ten people with dementia being detained against their will and result in having the most restrictive of care outcomes.

Again, Ruth Bartlett who has devoted much of her research on defining citizenship in dementia care, followed sixteen dementia activities campaigning for social change. She revealed that although campaigning can be energizing and reaffirming there were also drawbacks. Other than fatigue due to their disease, the activists reported oppression related to how they were expected to behave.  Although the struggle for citizenship has only just begun for people living with dementia, there is still a missing piece. Bartlett recently examined ‘dementia friendly communities’ where citizenship is perhaps most clearly enacted. But again in disability, the concept of equal but separate remains an issue. Citizenship needs to occur in public social spaces. It is about a redistribution of power.

Susan Behuniak discusses the many different definitions of power and how the person with dementia has been treated in the past, and more importantly, how they need to be treated in the future. The problem is that  legal status remains dependent upon cognition. The question whether an individual has mental capacity or not, determines whether a legal person exists or not, and this status then determines the rights the person can have. The move is to reimagine the person with dementia. Initially through the medical interpretation the person with dementia was simply a “patient” than through Kitwood we came to see a “person” together with an “embodied self” and now, with legal rights we see people with dementia as a “citizen.” The problem with citizenship is that the people interpret the law as requiring competency and capacity. But this is not true. We have laws that protect fetuses,, children, animals even trees. Eventually the aim is to see a person with dementia as a “vulnerable person” who has both rights and protections. We are at a time when organizations and caregivers/family are supporting the individual to ensure that laws to protect these rights are not being ignored through discrimination. Organizations will have to transform themselves from promoting a cure to promoting care. This is already happening. In the United States, Alzheimer's Association has experienced this move from cure to care. Local agencies concerned about care divorced themselves from the national organization that remain concerned with cure. Citizenship of vulnerable persons is the next frontier in care for people with dementia.

© USA Copyrighted 2017 Mario D. Garrett 

The Psychology and Mathematics of Time in Aging

Aging is defined by time. Even though our bodies are in a constant process of change, some cells in our bodies remain with us from conception. Our bodies have 37 trillion cells that are constantly duplicating, updating, maintaining and replacing themselves. Each cell contributes to a specific organ in the body. Jonas Frisen, a stem cell biologist at the Karolinska Institute in Stockholm developed a method for determining the age of each organ. Although some cells remain with us the duration of our life—neurons of the cerebral cortex, cells of your inner lens in our eyes, muscle and valve cells of your heart—the rest of our body is in a constant frenzy of change and rejuvenation so that with time we get to replace whole organs:

1.         Intestines replaced every 2-3 days old,

2.         Taste buds replenish themselves every ten days.

3.         Skin and lungs (2-4 weeks)

4.         Liver is replaced (5 months)

5.         Nails (6-10 months).

6.         Red Blood cells, every four months after travelling over 300 miles and going through the heart 170,000 times, 60 times per hour our red blood cells are given respite and are renewed

7.         Hair if the follicles have not fallen off every 3-6 years)

8.         Bones (every 10 years) and lastly

9.         Heart--most of it (every 20 years)

Despite this newness, we measure our age by our chronology—how much measured time has elapsed. On average our body is only eleven years old. However with each replication a slight imperfection results. We see these imperfections and assign it to the “aging” of our bodies. We resign ourselves to accepting our aging as an indication of our chronological time but it isn’t. Physical aging are mistakes that happen. But we mesh the two together. Aging and time are glued together and only when we look closer do we see that each is unique and separate.

We have a story, a narrative arc playing in the background of our life. Time is a special dimension, an unrelenting linear and absolute progression. Although time seems intuitive, we have a great difficulty even conceptualizing what time is, let alone explaining what it is. We have ways of measuring sequences and flow of events that we call time, but time remains elusive to explain.

A quick dive into quantum physics dispel any such illusion that time is stable or linear. For example in quantum entanglement two electrons remain connected, no matter how far apart they are, in synchrony. The electrons remain attached in time but not space. In this quantum universe, time doesn't exist at all. In the split slit experiment—where electrons interfere with each other after going though two slits but only when they are not being recorded—seems to suggest that electrons can go back in time, or at best do not conform to our linear time. Whatever our linear time means. Einstein called time a “stubbornly persistent illusion”. He was wrong, time is our reality that fails to find evidence outside of our consciousness.

Time is something that we create for ourselves and we do this by measuring it. And we measure time with great relish. Other than external means of measuring time—an impressive and historical array of clocks and watches, celestial movement, temples and seasonal rituals—our mental representation of time is fundamentally linked to our body. Our internal time is determined by our own biological, neurological and emotional reality. Many theories attempt to explain how time emanates from our mind and our body. But the biggest contributor to our sense of time is our own sense of aging—time speeds up with age.

Internal Clock

Our bodies are sophisticated watches—chronographs—that seem to get faster with age. The psychologist William James at the turn of the 20th century observed that years seems to pass more rapidly as we grow older. Many have attempted to prove this observation, but with variable success.  Then the French biophysicist Lecomte du Nouy in 1937 associated this phenomenon of a racing time with the slowing in cellular activity in aging bodies. He connected time with our physiological processes. To this day, although there is much evidence supporting this theory, the relationship between our physiological processes and our estimate of time remains contested. Studies do not show clear-cut outcomes. We have not found all of the mechanisms that control our sense of time. But in our explorations, we are learning more about the variability of how we judge time.

For example in 1958 Sanford Goldstone, William Boardman and William Lhamon with Baylor University Houston, Texas asked institutional older adults to count 30 seconds at a rate of one count per second. Older adults (average age 69 years) tended to report a shorter time interval then younger adults (average age 24 years). But the evidence goes back and forth. In 2005 Marc Wittman and Sandra Lehnhoff with the Ludwig-Maximilian University Munich, agree that despite the widespread belief that the subjective speed of the passage of time increases with age, results are inconsistent. They support the widespread belief that the passage of time speeds up with age although they do point out that such incremental changes are subtle.  Despite stereotypes that even though older people see the passage of time increasing, younger participants anticipated that time will be slower when they get older. The authors also concede that there remain other factors that conflict with a purely age-based interpretation of the speeding of time.

Older adults switch from "time lived since birth" to "time left to death.” One lag (since birth) seems long while the other lag (left to death) seems short and is getting shorter. Perhaps it is this sense of urgency, and our attempt to catch up with our legacy when we see time as going too fast. In an experiment in 1961 Michael Wallach, and Leonard Green with MIT found that both the type and quality of activity and the perceived time remaining makes time speed up. This sense of urgency is what influences our impression of time accelerating. Our activity and our sense of urgency determine time. Those older adults who are dying and fearing death feel more pressured by the passage of time. Similarly those who are busy also see time passing by faster. In contrast, Steve Baum with Sunnybrook Medical Center, Toronto and his colleagues report that time also moved slower for many institutionalized elders.  People in institutions who engage in few daily activities see time as going by more slowly. Older adults report both extremes; time getting faster while others report time going slower.

Heteroscedasticity

This does not make sense. And we are missing the first principle of gerontology—heteroscedasticity. Older adults become more varied the older the group becomes.

We have older adults who are catatonic in nursing homes while others remain in the community, active, engaged and at the peak of their capacity.  Jacob Tuckman uncovered this fact in 1965 when he reported that although there is a slight increase in the cadence of time among older adults (60 and over) he reported that they were both the group that saw time pass quickly as well as the group that saw time most slowly.  Older adults were just more aware of time and reacted to the perception of time in “both directions.”

And we know that time is flexible and malleable in our mind. The elaboration came when Richard Block replicated a study that found that time intervals with many events are experienced as longer than intervals filled with fewer events.  In uneventful situations, such as in a typical nursing home when a period of time is not filled with distracting events, time seems to pass slower.  For those adults that are engaged and active, there is not enough time to complete their activities, and therefore time goes by too fast. We might be measuring time on the basis of events that happen. Our physiology not only dictates time, but we look at the environment to tell us how fast or slow we need to move time.  The environment might provide a metronome. We are looking for events that happen in order to synchronize our internal time clocks. This is known as the Kappa Effect.

We intuitively measure time by the space in between events—in this case, blinking lights. The experiment is easy. Imagine you have a reference light that blinks once for a split second, then spaced a few inches to the right another light blinks and then twice as far to the right another light blinks. Even though the time lag between the second blink and the third blink is the same, we always assume that the third blink is delayed because it is further away from the first blink. Our internal clock is sensitive to how objects appear in space.  Events bunched together are seen as occupying a shorter period of time while events that are spread out are seen as taking longer time. But it is not just distance. There are numerous factors that influence our timing.

Some of these factors include the type of stimuli (visual, auditory, tactile), the intensity, size or strength of stimuli, complexity, uniqueness, including background and contrast, as well as speed and variance in speed all influence whether we perceive time as slowing or speeding. Most importantly, we attach emotional meaning to events. In 2007 Sylvie Droit-Volet  and Warren Meck reported how our sense of time is moderated by how we feel. So that time seems short when we are having fun and extends when we are bored.

It could be that time does not get faster with age but it seems that it does because we have an urgency to do things before we die. We speed up time in order for us to coherently make sense of our urgency. We tend to try and accomplish too many things despite perhaps not having the energy to accomplish them. And it is not our perception that slows down or speeds up but our memory of it.

Similar to the experience of fear, where time seems to slow down, what speeds up n is our memory not our attention. David Eagleman with Baylor College of Medicine, Houston, Texas designed a clever experiment that conclusively showed that fear for example does not actually increase how fast we are at noticing events, and therefore slowing time. He found that instead what happens is that we gain improved memory that packs that time unit with many details and events.  Knowing this however does not explain neurological conditions that results in both time speeding as in the “zeitraffer” phenomenon, or the obverse experiences called “akinetopsia”, when motion slows or stops altogether.

The fact that time perception can reflect neurological problems indicate that something “mechanical” is happening in the brain. It seems that motion and time are related neurologically. This is not only how we think or memorize, it is how we are built. The only other place this happens is in cinema: a movie that is controlled by the timing of projecting individual frames. Likewise, our brain records individual frames—many more than we are aware of, and perhaps with many different layers, emotional, visual, auditory—and then like a film reel plays them out for us on the basis of an internal time. The brain plays these memory frames at speeds that make the story coherent. So if more detail is needed then it slows the film down (fast time) and when the story is uneventful the brain speeds it up (slow time). All of this is done in the visual cortex.

We are learning that time is a complex psychological phenomenon. It is not an illusion, but a reality that exists at the center of our consciousness. With time there are variances in the context (busy vs bored), differences in individual experiences (older vs younger) and there are also complexity of time (neurological vs external measures.) Understanding that we have memories that are snapshots (some of which remain in our subconscious) rather than a movie, elevates time to the master conductor of our memories. Time orchestrates our memories. But this still does not explain why older adults are more prone to speed time up.

The Logarithmic Time

Aging is like a logarithm, the older we get the short the percentage of time that has elapsed. It’s just mathematics. This was first estimated by Paul Janet (1823-1899). He found that the apparent length of an interval at a given time is proportional to the age of the observer. For a ten-year-old a year adds 10% to her life, but only half that value (5%) for a twenty-year-old. For a 90 year old, 10 years is an ninth of their life, while for a twenty year old 10 years is half their life., hence the perceived shortness of time as we get older. James Kenney wrote an interesting blog on this function and he estimated that time is perceived logarithmic, meaning that it gets shorter as we age. He referred to this function as Logtime. In estimating the length of a year we compare it to our age. We see time proportionally so that the older we are chronologically the smaller the proportion of a time unit. We are predisposed to see time going faster, regardless of all other factors. This observation is further supported by an earlier understanding of time by a German physician Karl von Vierordt (1868). Vierordt‘s Law states that short event are perceived as longer than they are and longer events as shorter.  There is a convergence.  This also applies to historical events as well where we estimate long past events as more recent than they were which gives the impression that time is speeding. For older adults, events that happened thirty years seem more recent. And we do this to help our memory.

Between two to five seconds seem to be the time where we are present, and within this short period we have a fairly accurate time. While memory and anticipation form the majority of our awareness. It helps therefore to have a retrievable memory that assigns more importance to the more recent events (and therefore more likely to be pertinent) and to bunch experiences into more manageable time limits.

Conclusion

Again, Steve Baum and his colleagues report that among 296 institutionalized and community dwelling elderly (average age 75.4 years) faster time perceptions were associated with being healthier—less clinical depression, enhanced sense of purpose and control, and “younger” perceived age—while the opposite perception held true for older adults who were more frail and saw themselves as “older” where time was going slower.

If time orchestrates our memory, dictating the speed and therefore the length of our life’s story then it determines or at least indicates our expected life span. Logtime determines that this period of perceived remaining time is experienced to be shorter the older we get. That is the mathematics of the basis of our perceived shortening time. If our Logtime is determined by how much time we believe we have remaining, then the healthier we are the more accomplishments we want to achieve and the faster time seems to pass. The more things that we want to accomplish, the greater the urgency and therefore the shorter we feel our remaining time to be. Time is faster. 

We dictate time speed by our urgency and our age. In return, our time metronome selects memories to make the story, our narrative arc, coherent. The counter-intuitive prediction being that the faster you think that time is going, the longer you are likely to live. How we see time is an indication of our life story. We might be accessing cues from both our body and the environment that tells us when that final curtain is likely to be.

© USA Copyrighted 2017 Mario D. Garrett 

References

Baum, S. K., Boxley, R. L., & Sokolowski, M. (1984). Time perception and psychological well-being in the elderly. Psychiatric Quarterly, 56(1), 54-61.

Eagleman, D. M. (2008). Human time perception and its illusions. Current opinion in neurobiology, 18(2), 131-136.

Goldstone, S., Boardman, W. K., & Lhamon, W. T. (1958). Kinesthetic cues in the development of time concepts. The Journal of genetic psychology, 93(2), 185-190.

Spalding, K. L., Bhardwaj, R. D., Buchholz, B. A., Druid, H., & Frisén, J. (2005). Retrospective birth dating of cells in humans. Cell, 122(1), 133-143.

Wittmann, M., & Lehnhoff, S. (2005). Age effects in perception of time. Psychological Reports, 97(3), 921-935.

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Montclair Film Festival On Aging

Are Hormetins the new Fountain of Youth in Aging?

Although aging is inevitable—most likely due to the accumulation of damage at the cellular level, rather than from any one specific program—the actual rate of aging can be an adaptive feature in nature. So although we will all die, there is a certain amount of plasticity in how fast we age and therefore how early or late we die. This plasticity is likely to be controlled by relatively simple mechanisms. Aging research focusing on this plasticity has shown some encouraging results.

Hormetins—sometimes referred to as adaptogens—are a mild stress-induced action that has long-term and broad beneficial effects. Following the dictum that what does not kill you make you stronger, hormetins kick start the body to respond to the mild stress and this response has broader and longer-lasting benefits. Benefits that translate to living longer.

Mild Stress can be induced through four main methods. The easiest and most common is physical activity like exercise, heat, gravity and irradiation. There are emerging interest in psychological methods like meditation, brain exercises, juggling and balancing. However, out of all these methods, hormetins—a unit of a hormesis—are best defined by a supplement. Pop a pill and let your body do the work.

Nutritional stress includes caloric restriction, and anti-oxidants, polyphenols—found more commonly in as fruit and vegetables, tea, red wine, coffee, chocolate, olives, and extra virgin olive oil—flavonoids—plants especially parsley, onions, berries, tea, bananas, all citrus fruits, red wine, and dark chocolate—and lastly micronutrients—that include some vitamins and trace amounts of  iron, cobalt, chromium, copper, iodine, manganese, selenium, zinc and molybdenum..

The trick is to ensure that the trauma is mild enough not to be counterproductive.  With nutrients this is easier to achieve since most of these nutritional supplements are water-soluble and therefore in cases of ineffectiveness you are at worst producing expensive urine.

The problem with nutrients is that everyone is trying to make a buck. Not just snake-oil salesman but also academicians and researchers getting into the “business” of selling immortality and anti-aging pills. In table 2 are a number of nutrients on the far right and far left, that are promoted as beneficial to living longer. On the far right, from Rhodioia  down to Glucosamine, these are said to contribute to the mechanism to their left (shaded smaller cirlces), from Stress Resilience to Tumor Suppression.

We can see that although there are many potential mechanisms, in this review there are nine mechanisms they all contribute to the two main and connected mechanisms through their anti-oxidant benefits and by mimicking caloric restriction (large shaded circles to the left).

Hormesis represents a gyroscope in maintaining a balance between an individual and the environment. Even if a slight elevation of a certain toxic chemical, event or condition in the environment occurs, the body chemistry changes to prepare for it. But this balancing act is not without limitation. The capacity for the body to make biological/chemical adjustments is limited, but there is plasticity in this system of person–environment interaction. Nadine Saul with the Humboldt-University of Berlin and his colleagues have argued that the process of hormesis is a balance that has both positive and negative outcomes. It emerged that for every longevity improvement, there is a reduction in the capacity of the organism for growth, mobility, stress resistance, or reproduction. Saul argues (correctly it seems) that longevity comes at a price, and although hormesis seems to promote longevity, other hormetic costs may ensue, some of which are unknown and unpredictable.

The mechanism of hormesis remains an enigma, although we continue to learn more about how the body develops resilience in response to changes in the environment. In 1962, Italian geneticist Ferruccio Ritossa discovered that heat shock proteins are produced when cells are exposed to a variety of stresses. Initially identified with fruit flies that were exposed to a burst of heat resulting in the production of new proteins that help cells survive. The epigenes responsible for this are called “vitagenes” and maintain balance within cells under stressful conditions. As with the heat shock proteins, these act as chaperones, as minders, in assisting the establishment of “proper protein behavior.” Despite these terms, we do not know how this function is carried out.

Similarly, we now acknowledge that caloric restriction itself might be effective because of its hermetic qualities—a shock to the body—rather than through diet. This might be the case since there are  multiple ways of producing the same effect without adhering to a diet of calorie reduction. The underlying mechanism—rather than the reduction of calories—becomes important. And the underlying mechanism is a shock. If we accept this mechanism, then we should ask “why?”   Why does a shock cause the body to build resilience?

The answer is both simple and radical. A shock causes the body to build resilience because the body is designed to do exactly that. Our body interacts with the environment in order to survive. And to accomplish this adaptation there must be plasticity, some wiggle room, in our capacity. And our biology is a constellation of different entities that depend on each other. How it does this adaptation is more enigmatic, but we now know that there are plasmids and bacteria that help address the needs of our body. These might even recombine with our own DNA to make these adaptations more permanent.

Just as Thales of Miletus (624-546 BCE) the ancient Greek philosopher created science by arguing that we should stop referring to natural phenomena as the “will of god,” in our world we should move away from looking at end of life diseases as “caused by aging” and become more appreciative of the balance we maintain with our natural world. By discarding the new mythology of aging—immortality gurus—we can then focus on plasticity in older age. The fountain of youth might be a fountain for living-well in older ages.

© USA Copyrighted 2017 Mario D. Garrett 

References

Garrett, M. (2017). Immortality: With a Lifetime Guarantee. Createspace. USA.

Lenart, P., & Bienertová-Vašků, J. (2017). Keeping up with the Red Queen: the pace of aging as an adaptation. Biogerontology, 18(4), 693-709.

Rattan, S. I. (2017). Hormetins as Drugs for Healthy Aging. In Anti-aging Drugs (pp. 170-180). Royal Society of Chemistry.