Saturday, August 20, 2016

Brief thoughts on compassion fatigue

Brooks originally wanted to design the doll so that it cried more and more hysterically until it got what it wanted, but Hasbro said this was unworkable. The doll had to remain at the level of entertainment, rather than become an actual simulation of human life.
Gaby Wood, "Living Dolls"

When a small boy washed up on the coast of Turkey a couple of years ago, a cartoon in Charlie Hebdo provoked a small outcry when it depicted the youth, in a counterfactual universe, growing up to be a man who harasses women (“our” women!). I’m not sure what the original intent of the author was, although it seems like an ironic comment on the racist double standard whereby well-off white lads are given lenient sentences when they actually do commit an assault, but dead Arab boys who have yet to hit puberty are a sad case, but maybe let’s not get TOO upset, because who knows what they'll be like if they grow up

Although such prejudices may exaggerate a lack of compassion, many people saw the sadness at an individual level but then simply felt overwhelmed by the scale of the issue. Most people that I know want to have some kind of compassion towards the many unfortunate people out there. However, as individuals we can only do so much while trying to live our own lives successfully. When compassion fatigue sets in, burnout may follow.

Burnout is characterised by an increased cynicism and emotional fatigue, as well as doubts about the value of one's work. Within the helping professions (e.g. counsellors, mental health nurses) occupational burnout is quite prevalent. Furthermore, within these professions burnout should be of particular concern, as it has the potential to quickly affect others; a burnt out psychologist won't offer the same quality of care to a client. Indeed, this is also the case among informal caregivers (e.g. people caring for a relative with dementia); a burnt out family carer is more likely to see their relative go into long-term care outside their own home. To put the impact of burnout in context, the state of the art in this area is still unclear on the distinction between burnout and depression. Perhaps the lack of a consensus on how exactly burnout should be defined doesn't help.

I suspect that a major risk factor for compassion fatigue and burnout is overly high expectations in helping, and perhaps high expectations of the person receiving help. Help offered in a psychological context is rather more complex than the endangerment of a small child's life. No one who seeks help is perfect, and sadly many people engage in self-destructive and self-sabotaging behaviour. When does sympathy give way to frustration, which gives way to apathy? How long does one bang one’s head over the misattributions some people make before one stops trying to point them out? Self-care is important, so is self-awareness, and so too awareness of the other.  

Perhaps there’s something more fundamental underneath all this. Do we want to go beyond compassion and understanding to something deeper? It’s prosaic to say that a display of emotion (e.g. sadness) in another person can make us feel sad in our own way. But can true empathy (feeling what another person feels) truly exist? Or are feelings that appear to be shared simply a simulacrum of what we perceive to be the other person's emotion? The answer is the latter. Each consciousness is private. Will a difficulty in accepting this worsen compassion fatigue?

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Saturday, August 6, 2016

From the depths came the form: gut microbiota and brain cells

As I mentioned previously in a recent post, germ-free rodents have given us a greater understanding of the interaction between the brain and the gut, with animals deficient in microbiota displaying altered anxiety-like and social behaviour.

New research (open access research that is!) from the mighty APC Microbiome Institute has indicated alteration in the brains of these animals. Compared to normal control animals, germ-free animals had increased volume of both the amygdala and hippocampus, regions of the brain associated with processing of emotional and stressful stimuli. This was despite the fact that overall brain volume was not changed, suggesting a proportionate increase in regions of the brain associated with the kind of function that is demonstrably impaired in germ-free animals.

The researchers decided to look further, examining not only regions of the brain, but also brain cells. Using previously established methods they were able to categorise the neurons into different classes. They analysed the extent and complexity of dendrites (the branch-like structures at the end of neurons that receive neurochemical input from other neurons). They found more highly developed dendritic material in a number of different types of neurons in the brain regions of interest. It would thus seem that the lack of microbiota is impacting at a more microscopic level within the brain.

The authors point out the regions of the brain in which they found these alterations interact with (among other things) the hypothalamic-pituitary-adrenal axis, which is responsible for hormonal responses to stress. The impact of the microbiota on these specific brain regions are thus likely to impact upon other brain regions, notwithstanding a lack of change in overall brain volume.

The outstanding question is how the gut microbiota has such a striking effect upon the microstructure of the brain. There a number of different candidate explanations. For example, there is evidence that gut bacteria can use nutrients from the diet to produce neurochemicals. However, the process whereby these neurochemials within the gut lead to serious changes in the brain remains (to the best of my knowledge) somewhat of a mystery. Research that brings us closer to solving this problem will no doubt be generating a lot of buzz in the coming years.

Luczynski, P., Whelan, S. O., O'Sullivan, C., Clarke, G., Shanahan, F., Dinan, T. G., & Cryan, J. F. (2016). Adult microbiota‐deficient mice have distinct dendritic morphological changes: differential effects in the amygdala and hippocampus. European Journal of Neuroscience.

(Banner image for this blog post is a detail from Figure 3, Luczynski et al., 2016).

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Wrap you brain with germs