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.

Hope Versus Depression

In Hesiod’s telling of the Greek myth of Pandora—the first woman on earth—Pandora is said to have opened a large jar from which all evils escaped into the world, leaving behind hope. Hope was the only thing that remained for us humans. Hope is not tangible, but a state of positive expectation. Hope is an illusion—a trick of the mind—that motivates us to anticipate rewards, rewards that are themselves purely cerebral encouragement. Hope is a house of cards built on the anticipation and yearning for illusory and ephemeral rewards. When Pandora left us with hope she left us with a whole bunch of tricks of psychology. Perhaps for those with depression, even hope escaped out of “Pandora’s box.”  In reality we struggle and suffer and gain momentary pleasure and transient satisfaction until we are released from this ongoing strife by death. This is how we view the life of animals, but not how we view our own lives.  This trick of psychology—Pandora’s Box—releases us from acknowledging our natural daily grind of survival. We have something that we do not ascribe to animals. Humans have feelings, emotions and hope.

In order to understand why we have emotions, we must grasp that humans have a very large brain. Our brain is the most complex entity in the universe and it is this complexity that provides us with a clue of what it does. It represents the world—as we know it—as a model. A virtual reality machine designed to understand our environment and predict the world. It is our passport for survival as individuals and as a species. Emotions are our transient indicators of how well we are approaching this virtual ideal.  Emotions nudge us to change towards specific expectations. Our brain is a perfectly balanced tool to help us improve. However, having such a complex thinking organ comes with one huge disadvantage: It also has the capacity for self-reflection. And self-reflection might be the Achilles Heel in our survival strategy.

In order for the brain to deal with this seemingly inconvenient critical contemplation, it has developed ways of dealing with self-reflection and the obvious daily struggle to survive and our eventual death. Our brain has generated hope as an illusion of a utopia, a heaven—whether on earth or in the afterlife. For the long term we have hope that everything has a meaning, a purpose.  We have a narrative, a story that we make our own. For this hope to be realistic we need to think of ourselves as unique and at the center of our reality. A selfish existence—solipsism—necessary in order for us to have hope. Without a selfish investment in the outcome we would have no interest in hope. Hope is selfish and central to being human.

In 2017 Claudia Bloese wrote that, “…almost all major philosophers acknowledge that hope plays an important role in regard to human motivation, religious belief or politics.” Hope can either be seen as a way to motivate humans to do better, or an excuse to be lazy and hope for the best. In psychology, starting with Charles Snyder’s hope theory, there are two components to hope: the belief that there is a possibility of happiness in achieving goals, and a path to achieving these goals. A kind of behavioristic stepladder, with each successive step-up being promoted by positive reinforcement. But this interpretation changed with Ernst Bloch‘s three-volume work The Principle of Hope (1954-1959). Bloch transforms the aim not of happiness but of an ideal state. Bloch argued that we aim to achieve our goals not because we become happier but because we will achieve our utopia. This is an important admission. For Bloch, a German Marxist, hope is not about being optimistic—some kind of behaviorist ploy of gaining pleasure for every rewarding behavior—hope is an ambition to attain an ideal state. In this interpretation of hope, there is only one other alternative, if not heaven then hell.

The psychology of hope has converged with the utopian and dystopian view of mankind. And Bloch’s proposition fits in with traditional religious beliefs about utopia. Bloch argues that the utopian package entails no death, no disease, no injustices and where everyone is equal. Richard Rorty, the American pragmatist philosopher shares such an interpretation as well. Rorty further acknowledges that hopelessness is always based on the absence of a narrative of (political) progress. This lack of (positive) narrative defines depression.

This is the triad of depression: lack of self worth, negative evaluation of situations and lacking optimism for the future. The opposite of hope, depression is defined by the feeling that “there is nothing to live for.” Depression is having a narrative arc that does not anticipate positive changes. Both hope and depression project into the future. The difference comes in that in order for hope to be real our psychology needs to get rid of the looming prospect of death that has a long shadow in our future. Hope cannot exist with the acknowledgment that we will stop existing. Death is the antithesis of hope. How do we “cure” this final nothingness in our narrative arc?

One of the wrinkles in this concept of hope however is the fact that we all die. What’s the point of everything if at the end of this journey we find that it was just a transient passage. Hosting a party at an airport lounge. There is something rotten in the center of hope, this forbidden fruit for the depressed. In the 1900s William James, the early psychologist called this fear of death the  “worm at the core” of our being. This tension between the belief that we behave as though we are at the center of a consistent universe, with the knowledge of the certainty of our death. To psychologists that now follow Terror Management Theory, this tension constitutes a fundamental quandary for humankind, affecting us radically as nothing else does.

Our psychology came up with a more subtle solution than simply to completely ignore our mortality. We have learned to trick ourselves that perhaps even if we die, we don’t really die. A small part of us remains (soul), or this is only temporary (reincarnation), or we remain living in other dimensions (legacy), or everyone else is already dead (zombies) or this is all a dream anyway (intellectualization.) All together these sophisticated tricks embrace hope and are a formidable barrier to accepting death.

This tension is alleviated by some sophisticated thinking strategies. And these tricks are exactly what are needed to dispel that loss of hope, that depression. But does the science support this view?

In a review of the effectiveness of therapies for depression Andrew Butler and his colleagues reported that Cognitive Behavior Therapies (CBT) was better than antidepressants for depression and was found to be effective for many other mental disorders.  Which is good news since a recent study by the Canadian Marta Maslej and her colleagues reported that medication for depression increases the risk of dying early from all causes, by some 33%. So if we look at the mechanisms of CBT we find some surprising insights. In a classic book on cognitive therapy in 1979, Aaron Beck and his colleagues go on to say that the difference is due to the “…gross changes in his cognitive organization…” (p.21) These cognitive deficits involve:

1.  Arbitrary inference: making preconceived conclusion

2.  Selective abstraction: focusing on select negative aspects

3.  Overgeneralization: applying the lessons from an isolated incident to broader contexts

4.  Magnification and minimization: highlighting the negative and diminishing the positive

5.   Personalization: relating external event to self

6.   Absolutistic dichotomous thinking: categorizing events into two extreme classes (perfect vs. broken)

But if the function of our mind is to develop a view of the world, a world that might be dangerous, then these aspects of cognition are what we do best for our survival. In a world that can and does ultimately kill you, you have to make everything personal.  We select quickly what is good or bad and enhance the ability to protect ourselves and ensure that future events are anticipated, especially if they are likely to be dangerous. The fact that this makes us feel miserable is a separate issue. This cognitive organization is designed for survival, focused exclusively on what could harm you and that ultimately there is no hope as we are all mortal. This acceptance of mortality is perhaps the reason for the salience of death and suicide ideation, attempts and engagement.

Aaron Beck and his colleagues go on to report that: “A way of understanding the thinking disorder in depression is to conceptualize it in terms of “primitive” vs. “mature” modes of organizing reality.”(p.14).  Within our line of thought, if we see depression as a natural state without the tricks of hope, then we can interpret this excellent description of “primitive…gross changes in [his] cognitive organization.” Rather than a mature embrace of this bag of tricks, those with depression are stuck without their own bag of tricks. This is where CBT comes in. Resulting in a narrative arc that our life holds great benefits and pleasure and success and accomplishment, CBT is a way of accepting this bag of tricks that accompany hope. To paraphrase Dan Gilbert, we manufacture happiness. The conclusion is that we accept and promote certain beliefs that round the edges off our ultimate fate—we delude our impending death by having these celebratory moments like bread crumbs on the path to nirvana.

Understanding how we maintain this delusion—of hope—for so long is the linchpin of human psychology. As we get older we lose this shine of hope. We face our mortality up close and personal. As a result, depression increases with older age. From the very first step we take, we strive for independence. Our brain gains mastery in predicting the environment we live in and gaining a sense of self-mastery, even hubris. We control others when we have a positive disposition, when we have a positive story line. Out brain understands this advantage. Our positive narrative arc attracts others and our brain gains better mastery of the environment.   The mastery of our brain is perhaps the only understood at older age, when some of the social façade starts to disintegrate. The question is whether it is better to be happy and live in a delusion of hope or to be depressed and be right. Hesiod’s story of Pandora might have revealed a deeper truth.

© USA Copyrighted 2017 Mario D. Garrett 

References

Bloeser, Claudia and Stahl, Titus, "Hope", The Stanford Encyclopedia of Philosophy (Spring 2017 Edition), Edward N. Zalta (ed.). Accessed online: https://plato.stanford.edu/archives/spr2017/entries/hope/

Beck, A. T. (Ed.). (1979). Cognitive therapy of depression. Guilford press.

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review, 26(1), 17-31.

Crona, L., Mossberg, A., & Brådvik, L. (2013). Suicidal Career in Severe Depression among Long-Term Survivors: In a Followup after 37–53 Years Suicide Attempts Appeared to End Long before Depression. Depression research and treatment, 2013.

Gilbert, D. (2009). Stumbling on happiness. Vintage Canada.

O'donnell, I., Farmer, R., & Catal, J. (1996). Explaining suicide: the views of survivors of serious suicide attempts. The British Journal of Psychiatry, 168(6), 780-786.

Maslej, M. M., Bolker, B. M., Russell, M. J., Eaton, K., Durisko, Z., Hollon, S. D., ... & Andrews, P. W. (2017). The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis. Psychotherapy and Psychosomatics, 86(5), 268-282.

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Why Does God Want to Kill Me?

We know that we will die.

Yet four out of every five younger adults aged between 18 and 29 believe in the afterlife. At the same time fewer of them say they believe in a god. These Millennials born around 1980-1994—despite doubting the existence of God, believing the Bible is a book of fables, not attending religious services, never praying, and  reporting “being not religious at all”—still believe that they have aspects of immortality. They feel entitled enough to be saved after they die without the necessity of a god to save them. The more entitled they feel—white and middle class—the more likely that they do not believe in god but that there is an afterlife waiting for them. Minorities do not feel this entitlement to the same degree.
This resurgence in the belief of immortality without the shackles of believing in god is new. But they have to ask themselves why does god want to kill them in the first place. Such an entitled group needs to face this question head on. For the answer might hold a greater insight then religion, and to address this question we have to look at physical (biological) anthropology.
As a specie, survival is our only ambition.  The only way the successive generations prosper is if they are a good fit in their environment and survive long enough to create a new generation. Nature has two extreme methods to achieve this single aim. One is to produce an enormous number of offspring and hope that a few survive long enough to pass on their genes. Another approach—one followed by humans—involves having few children whom we nurture until adulthood. This is our survival strategy as a species. These strategies have mythological names: Semelparity refers to “r” strategists (large number of offspring and then die), and Iteroparity for “K” strategists (a few offspring whom we nurture).
Nurturing is an important—and integral—component of our survival strategy. Nurturing involves having things to teach and living long enough to be able to teach them. Which is why we live so long and have such a big brain, the two go together. Aging is not a dustbin of genetics, but an integral part of our strategy for endurance as a species. Aging and having a big brain go hand-in-hand as nature’s plan for our survival.
With aging also comes the opportunity to learn about the environment. We learn in terms of our skills and also through our biology. We develop immunity from the day we are born and some of these biological adaptations end up in our genes through the transfer of genetic material. Our genes are more permeable then we once thought. We get genes not just from our parents but also from the environment. We get gene transfer from bacteria (plasmids), fungi, viruses, sometimes siblings, mothers from their children. We are a magnet for adaptive genetic material from our environment. As we age we pick-up new genetic material and modify existing genes (epigenetics) before we pass these genes on to our children. Our lives are devoted to just this aim.
Because of our big brain we need more than that…we need a more substantial meaning in life because out brain has made us solipsists—at the center of the universe.
Our brains create virtual realities. We create a model of how the world works. For this world to have meaning to us—other than a simple mental toy that helps us predict our environment—we have to be at the center and “own” this world. We therefore believe that we are unique and have free will. Our impression of reality, dictated by having an image of the world that is just, fair and constant, also requires that we do not think about our own death or our model of the world becomes untenable. This is where our belief in immortality comes in. But god wants to kill us, because that is how our species improves. The faster the turnover, with new generations coming through, the better our species can adapt to the environment.  But this clashes with our model of the world.
We want our world to stay constant so that we can retain some level of control over this finely tuned balancing trick. Anticipating our death destroys this impression that the world is orderly and just. But there is one problem with this made-up reality, we see others eventually get old, frail and die. We point at aging as the culprit. That is when we see aging as the problem that we need to solve rather than a survival strategy.
But if we understand aging we will understand the tricks of our psychology. Our strategy for survival—Iteroparity “K” strategy—means that we nurture younger generation. With our increasing lifespan we have been extending this nurturing longer. Could it be that we have been nurturing them too long? That this younger generation have forgotten how to be adults themselves.  The younger generation increasing sense of entitlement is but a reaction to the knowledge that they are truly one mortal link in the immortal chain of life. The shackle of religion that buffers us from this realization is no longer strong enough.
For this new generation, we have nurtured them to the extent that they feel important enough that they do not have to consider death. The model created by their brain includes an afterlife to alleviate the possibility that they are not at the center of the universe. Emerging generations are rejecting death and they are also not having children. By liberating themselves from religion, norms and expectations they are rejecting the need to have children. Children will necessitate them to move away from being at the center of the universe.
 Our aging is an integral part of survival up to a point. Because we have extended our longevity we are nurturing our children too long. Our human psychology that relies on us being at the center of the universe feeds off this nurturing and becomes a prominent feature of our existence. Throughout all this nature wants too maintain a turnover. We are meant to die, as much as it is detrimental to the individual, aging and death form our strategy as a species. Our personal salvation is that we delude ourselves this reality and for emerging generations they are doing this by avoiding god and believing in an afterlife.

  © USA Copyrighted 2017 Mario D. Garrett 

References

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

Harley, B., & Firebaugh, G. (1993). Americans' belief in an afterlife: Trends over the past two decades. Journal for the Scientific Study of Religion, 269-278. 

Twenge, J. M., Sherman, R. A., Exline, J. J., & Grubbs, J. B. (2016). Declines in American adults’ religious participation and beliefs, 1972-2014. Sage Open, 6(1), 2158244016638133.   

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