“Beam Me Home, Scotty!” 05, The Functions of the Parts of the Brain, The Brainstem

(Podcast)

In this next section, let’s temporarily transport ourselves off the USS Enterprise/Battleship Brain, back over to the brain itself so that we can learn the main functions of the four parts of the brain that we’ve already discussed. Once again, we’re in no-frills country here, so we’re going for the big ideas. Even the big ideas, though, take some time to explain, so I will address each of the four parts separately.

First, I would have you consider that the brainstem has two major functions:

  1. Reflex Center: The brainstem truly is the brain’s engine room. When messages come up from the body such as “Oxygen is getting low down here,” the brainstem will initiate the “Breathe!” protocol. No thought, just reflex. Or when the message is “Getting too hot down here,” it will implement the “Sweat!” protocol. You can rest assured that both you and the gecko on the GEICO commercials have functioning engine rooms with similarly functioning equipment. (For if they are not functioning, in fact, neither you nor the gecko are going to have much need for auto insurance.)

 

  1. Data-Gathering Center:  The brainstem is essentially the first stop for any sensory input from either the world inside the body or the world outside it. What you see, hear, smell, taste, feel: all of it is in some way first “detected” and “gathered” within the brainstem. Understand: this is just raw data, like 0’s and 1’s within a computer. Other parts of the brain determine whether this information is good news or not-so-good news (the limbic system) and then what this information is (the cortex) and what to do about it (the prefrontal cortex). But if you don’t know it’s coming, you won’t know what to do about it!

 

Think of it this way, in a brief preview of the USS Enterprise/Battleship Brain equivalent for the brainstem: The brainstem detects the incoming “atoms” of the new crew members/experiences as they are heading toward the transporter room.  This is a capacity that the “real” USS Enterprise didn’t have—and, as we shall see, it’s an extremely important capacity for understanding what happens to the brain during any trauma, and especially combat trauma.

Now that the ship is running and keeping an eye on the world, both inner and outer, let’s go on to the limbic system. On our way there, though, keep remembering our ultimate goal for all this: Decontaminating the Radioactive Emotions of War to Create a Radiating, Emotion-Filled Deployment Back into Life.

See you then!

05, The Functions of the Brain, The Brainstem

“Beam Me Home, Scotty!” 04, USS Enterprise/Battleship Brain, The Layout

(Podcast text)

Welcome back to our 4-part brain. Let’s now see how each part corresponds to a vital part of the ship. To do this, put your right hand up again, palm facing you.

First, look down at your palm and upper wrist, at what we already know is the brainstem. For purposes of this series, when we look down at this part of the brain, we are looking in the Enterprise’s Engine Room. Like the engine rooms of all ships, it keeps all systems in the ship running so that the ship may accomplish its mission. (More on how it does that next time.)

Now put your thumb back into your palm, forming what we already know is the limbic system. We are now looking at the Enterprise’s Transporter Room. For any of you not familiar with the series, the transporter room is the boarding station for the ship while it’s on a mission.

Basically, it is a platform that has a series of circles on the floor (like floor lights on a stage). To get on the ship, the crew in the Transporter Room pushes buttons and levers to allow the dematerialized atoms of the boarding person to appear above one of those circles and then to come together to form the solid person. To get off the ship, one simply does the reverse: one stands on one of the same circles; similar buttons and levers move; and the solid person dematerializes, his/her atoms being sent to some predetermined coordinates on the nearest planet or vessel.

I will define the Engine Room and the Transporter Room as comprising Engineering, and thus Engineering is the Enterprise’s version of the subcortex.

So now wiggle your fingers, and remember the cortex. In our Enterprise, the cortex represents the remainder of the ship, which I will refer to as the Crew itself. It represents all the functions that our brains do to make us human, and thus it represents all the “jobs” that our brain accomplishes on a day-to-day basis, usually unconsciously, to make life worthwhile.

Yet there is a final portion of the cortex that has a very specialized crew. Drop your four fingers over your thumb, and you form the prefrontal cortex, as we said earlier. When you do so, you then form the Enterprise’s Bridge. Yes, this is where we find Captain Kirk, who plays such a pivotal role in our experience of ourselves.

As in the program, we usually think that “the action happens” up on the Bridge, where we time and again meet our favorite crew members who interpret and lead us boldly where no one has gone before. Big Warning #1, though: the brain don’t quite work that way.  I won’t say that we don’t think that our Captain Kirks are in control of our lives. In a way, Kirk sort of is in control, even sort of meaningfully. But…

Suffice to say for now: don’t forget the other three parts.

If you don’t remember them, you see, you’ll be doomed never to understand what happens to a brain after war.

(BTW: Big Warning #2? There ain’t no Mr. Spock. But more on that later, too.)

Before we leave the layout and head over to the functional plan, however, one final “place” note. Look back at your hand, now folded with the Bridge looking right at you. Lift those four fingers and see the Crew again. Now notice the little pads at the bottom of your middle and ring fingers, at the very tip of the palm. With your left hand, feel that padded area, for it is a very important one in our series. You are now touching the Enterprise’s Processing Center/Sick Bay.

We’ll end up spending quite a bit of time there.

So, enough for now. As always, remember our motto:  Decontaminating the Radioactive Emotions of War to Create a Radiating, Emotion-Filled Deployment Back into Life. That’s our mission.

So on to a functional analysis of the brain. See you then.

04, USS Enterprise, Battleship Brain, The Layout

“Beam Me Home, Scotty!”: 03, The No-Frills, Four-Part Brain

(Podcast)

So this segment is our introduction to the brain. But before we start: why is it no-frills?

For this series, time and again I am going to refer to complex brain structures and events via simplified models. For example, we all know the brain is complicated, and I suspect that most of us would guess that it really has more than four parts, even if we wouldn’t know what those might be.

Yet I’d have you consider that, nonetheless, we can talk meaningfully about the brain by only talking about four general parts of it. To do this, raise your right hand before your face, palm toward you. (My thanks to Dr. Daniel Siegel in his book Mindsight for the example.)

Notice the palm of your hand, and then let your gaze go downwards, over your wrist, down your forearm. Imagine now that your palm and the upper part of your wrist are the deepest, most basic regions of your brain, sitting right atop your spinal cord (or, here, your forearm). This part of the brain, represented by palm and upper wrist, we are going to call the Brainstem. Again, this is no-frills: a lot of very distinct, complicated brain structures are in this area, with cool names such as the midbrain, the pons, and the medulla, with lots of other Greek-Latin names besides. We’re going to keep it simple, though—and for now we’re not going to worry what the brainstem does, but rather focus only on that it is.

Now, with your palm facing you, move your thumb inward (toward the left) until it is sitting in the middle of the palm. The thumb has now become our model of the Limbic System. As much as possible, try to keep your thumb’s first knuckle/thumbnail at a right angle to the rest of the thumb, forming almost a perch in the middle of your palm.

Now, spread the four remaining fingers apart as if to form the number 4. Wiggle them a bit. These four fingers represent the Cortex (or you might see neocortex). Think about a picture of the brain, with all the squiggly, worm-like stuff on top. That’s your fingers. That’s the cortex.

(And BTW: the brainstem and the limbic system make up what’s below the cortex, and thus they are often called the Subcortex. We’ll see that one pop up from time to time.)

Finally, take those four fingers and fold them down over the thumb, onto the palm of your hand. Your four fingers are now pressing into the base of the palm of your hand, the four fingernails looking right back at you. In our model, this is still cortex, but it is a special part of the cortex called the Prefrontal Cortex. This is a special part of the cortex that is going to play a major role in our U.S.S Enterprise/Battleship Brain. Don’t forget it.

Now take your semi-fist of a hand and rotate it clockwise by ninety degrees. You should now be looking at the thumb-side of your hand, the thumb tucked in away from you, your index finger curled over the top of it. This actually isn’t a bad representation of your brain sliced down the middle and seen from the side.

There you have it: your first brain briefing. Keep that in mind, and always remember our ultimate goal:  Decontaminating the Radioactive Emotions of War to Create a Radiating, Emotion-Filled Deployment Back into Life. So time to board the ship. See you next time.

03, The No Frills, Four Part Brain

“Beam Me Home, Scotty!” 02: Introduction to “Radioactive Emotion”

(Podcast text)

In the last segment, I introduced the idea of “The Brain as the Starship Enterprise” (or, alternatively, “Battleship Brain”). Let’s use this segment to flesh that out better.

Whether or not you are familiar with the characters and story line of Star Trek, most of us have some notion of a “battleship” made up of a group of people who fall under a Chain of Command, all of whom are working together to accomplish some mission. To do that, everyone from the ship’s captain to the lowest sailor must know her or his job, as well as do it reliably and, when necessary, flexibly and creatively.

Think of your brain as a battleship that, in spite of its limited size, can absorb thousands upon thousands of new crew members throughout many years. Each new experience—whether of a TV commercial, your favorite meal, or your worst fear—is like a new crew member who has boarded the ship and needs to be readied to become part of the life of the ship (or not), like it or not.

The ship’s Command and crew need to have some way of recognizing when new crew members are on their way. Even more importantly, though, they must have a reliable way to process those crew members: to make sure that they are “healthy” (and thus will not endanger the crew already on board) and to figure out how they can be added (or not) to the crew that is already on board.

To understand how new experiences become new “crew members,” we have to become very acquainted with one word, a word without which we, literally, as human beings could not be conscious, let alone be fully human: emotion (sorry).

Now, let’s understand what I mean when I use the word emotion. In this series, don’t confuse emotion with feeling. Feelings can be quite complex: love, envy, hate, curiosity. In some way, feelings have to bring in a variety of “processed crew members” (mental processes) to do what they have to do. You need to use a lot of words to describe accurately a feeling.

In contrast, emotions are more like shout-outs, specifically ones of only two basic types: “Yeah!” and “No Way!”  Emotions are essentially wordless, which makes them hard to talk about. You’ve got to feel them, either in your gut or in whatever part of your body does the “yeah, that!” or the “no, not that!” job.

That’s why when I use the word experience, I am referring to what we’ll call from now on emotional experience. When an experience comes our way, our bodies (believe it or not), start classifying it as “Yeah!” or “No way!” long before we know what’s happening. (More on that later in the series. Bear with me.)

So on Battleship Brain, our own personal U.S.S. Enterprises, each new emotional experience boards our ship as a new crew member. The “Yeah!” crew members are warmly welcomed. The “No Way!” ones? Sometimes more so, sometimes less so.

Some emotional experiences in life. though—IED (improvised explosive devices) blasts, violent deaths, for example—are so “No Way!”, I am going to call them radioactive emotional experiences or radioactive emotions. These new crew members that are boarding our Battleship Brains, I’m going to call radioactive crew members. If you get near them? You get sick. Really sick.

Unfortunately, the crews of all our Battleship Brains (combat veteran or not) have no choicein the types of emotional experiences they must endure once those experiences are on their way to us. The ship gets the boarding crew members it gets.  As many a soldier has told me, “It is what it is.”

So that is “what happens” in war: radioactive crew members board the ship, sometimes in small numbers, sometimes as entire brigades of horror. The uglier the individual crew members, the larger their numbers?  You get the picture.

So the rest of this series will be about one simple question: “What do I (or does my loved one) do about these radioactive crew members?”

And while the answer will be long and complicated, I am very glad to tell you that you/he/she can do something about them. Remember our series motto: Decontaminating the Radioactive Emotions of War to Create a Radiating, Emotion-Filled Deployment Back into Life.

Decontaminate so that you can redeploy. Simple (ha, ha) as that.

So let’s get going. Next stop? Why, intelligence gathering, of course. Let’s get the “lay of the land” before us. Let’s talk about the brain.

See you then.

02, Introduction to Radioactive Emotion

“Beam Me Home, Scotty!”: 01, Combat Veterans, PTSD, & How the Brain Is Like the Starship Enterprise

(Podcast text)

Hello! My name is Rod Deaton, but the soldiers and combat veterans whom I’ve had the honor to serve usually just call me “Doc.”  I am a psychiatrist, meaning that I have a medical degree and that I have training and experience in working with persons with a variety of emotional challenges using psychotherapy, medications—and explanations.

Currently I am the Medical Director of the Warrior Wellness Unit at TriStar Skyline Madison Campus Hospital, located just outside Nashville, Tennessee, in the U.S. Previously I worked at the VA Hospital in Indianapolis, Indiana. In both places I have worked with combat veterans who have served in the United States military during the country’s most recent conflicts in Iraq and Afghanistan. My job has been—and continues to be—to help them begin to find ways to heal their emotional wounds of war so that they can go on to live richer, more meaningful lives.

That’s why I’m here: to talk to you about those emotional wounds.

People disagree about what to call those wounds, believe it or not—and quite passionately. To be honest, I often find myself agreeing with many criticisms.

Still, let’s face facts: almost everybody who has ever heard a newscast or read a newspaper since 9/11 has heard of Post-Traumatic Stress Disorder, or PTSD. Almost everybody knows, therefore, that combat experiences can lead some veterans to struggle with the symptoms of PTSD. So, let’s not reinvent the wheel: I’m going to call these emotional wounds combat PTSD and leave it at that.

But I’m not here just to talk about combat PTSD.

You see, usually when combat veterans or their loved ones ask me about combat PTSD, they want to talk about, “What’s wrong with me or with my loved one after the war?”

We’re not going there, for talk like that doesn’t help. Why? Because it explains absolutely nothing.

Instead, let’s you and I talk about, “What happened to me or to my loved one during the war, and what keeps on happening now?” That is the kind of talk that can lead to explanation and by which we can not only begin better to understand combat PTSD, but also by which we can even do something to start healing those emotional wounds of war.

Life happens to all of us, every day. Our brains do the best they can to make sense of what happens, not only to survive, but also, thankfully, to thrive as much as possible, no matter what happens.

That is all combat PTSD is, then: the brains of combat veterans, doing the best they can to make sense of what happened over there.

So let’s you and I talk about what happened back then to you or your loved one, about what is happening now and, thankfully, about what can happen in the future so that all those emotional wounds can stop hurting so much.

I want to help you understand better what happened so that you can make life happen again.

That is why I am making these series of PDF files and audio recordings: I cannot treat you or your loved one with therapy or medication, but I can try to explain to you about combat PTSD. The PDF files are transcripts of the audio recordings.

Even if I cannot be your treating psychiatrist, I hope I can be someone you can sit down and have coffee with or ride in the car with, some four or so minutes at a time, as often as you’d like, as we try to understand what happens during and after war by taking an extended, metaphorical trip, believe it or not, on a ship that’s been flying through space for some fifty years now, Star Trek’s Starship U.S.S. Enterprise.

Trust me:  “Battleship Brain,” as I’ll also call it, is a lot more like the USS Enterprise than you might ever have imagined. In the course of the series, for example, we’ll cover topics such as:

  1. The Ship Itself (i.e., the brain itself)
  2. Starfleet Academy, the Crew, and Standard Operating Procedures, or SOPs (i.e., our caretakers and their longstanding effects on us)
  3. The Ship on a Routine Mission (the brain and “normal” experiences)
  4. The Ship on a Combat Mission (the brain and what I’ll call “radioactive” experiences)
  5. The Decontamination Team: The Chemical Warfare Team and the Special Forces (the crucial role of nurturance in our lives)
  6. The Decontamination Process (how therapy and medications work)
  7. The Withdrawal of Starfleet Command (the effect of leaving military service)
  8. Deactivation vs. Deployment (how to make life work again).

My motto for the series is going to be: Decontaminating the Radioactive Emotions of War to Create a Radiating, Emotion-Filled Deployment Back into Life.  So next time, let’s start with what it means for an emotion to be “radioactive,” and let’s start to think what it might be like to see how the brain is like a Chain of Command on a mission.

Talk to you next time.

01, Introduction

 

As Times Goes By

As I walked through the outpatient waiting area, I passed one of the young guys in the civilian program, I thought, communing with his smart phone. Upon reaching the nurses’ station, though, I realized my error, walked back, and for a few moments stared at the soldier unobserved, at his stocking cap with the chic, mirrored sunglasses perched thereon, sunset orange, at his technicolor tennis shoes facing no visual competition from the all-gray track suit that most likely cost a fraction of the shoes’ price, from Target, likely.

Texting completed, he looked up and smiled. “Hey!”

“Good holidays?” I asked.

Shifting to a frown that spoke volumes, “We need to talk,” he said.

Marital tensions, again. Similar ones had brought him to me only weeks ago with a near-suicide story worthy of the name. Today, though, he was only angry, willing to keep trying, but only for so much longer.

In the ensuing weeks, you see, he’d begun to forgive himself for imagined errors and real deaths. No longer was he feeling unworthy of happiness because he’d happened to have decent-enough numbers in War’s lottery.

“I’m not a bad man,” he said to me. “I deserve better.”

Music to my ears, my young friend, to my ears.

Dark Shadows

‘Twas The New York Post, (ah, venerable news source), that published the review of Demon Camp, the story of a combat veteran who sought to rid himself of War’s demons—the “Destroyer,” shadow of Death—via a husband-wife exorcism team in eastern Georgia. The book’s author postulates that whatever good the soldier experienced must have resulted from a mental “virtual exposure therapy” that still allows him to fight his demons and “always win.”

Perhaps.

I write with no interest in exorcisms. In an age of statistics, pills, and cognitive techniques, though, I sometimes wonder how many of my colleagues believe that their words, printed or spoken, adequately contain the horror of even the metaphorically demonic, confident that by exclaiming “Prefrontal Cortex!” in lieu of “Be Healed!” they have given superior succor to a war-tortured soul.

How many, I can only wonder, have abandoned words long enough to allow their own prefrontal cortices to absorb the limbic horrors of the veterans before them, enough so that the dark shadows of soldiers’ nights invade them just enough to feel in their depths, even momentarily, one whispered word: “Die!”

Talk about cognitive restructuring.

The Vet Whisperers

Hippotherapy, it’s called: horses that calmly offer the wounded a chance to re-find connection, a mutual gaze, to venture a stroke of a hand across a neck, proposing the possibility of trust once again. In Pennsylvania’s Lehigh Valley, Straw, a mare once gravely injured herself, offers herself up as equa semper fidelis et parata, always faithful and prepared to engage combat veterans in a silent conversation about what it means to heal, to move forward again.

In War, the soldier at another soldier’s side is not merely a back-up, but rather an extension of one’s very being, a part of one’s self who just happens to be a few steps ahead, behind, a chunk of one’s soul who might, moments from now, be propelled into oblivion, leaving in the wake a crater in land and heart that dares anyone to try to fill it.

When one has a gaping hole in one’s essence, one often does not find comfort in language spoken by any human, no matter how loved she or he may be. Yet a gentle nudge along the edges of the wound by a horse, a dog, can possibly begin its closure, one tail wag, one snort at a time, an unspoken whisper to remind man now, not beast, that peace, even if it never seemed possible again, still perhaps can be.

Brainspotting

After thirty years as a psychiatrist, I have come to a certain detente with my field. Experts smarter-than-I gladly inform me, in press or in person, of what constitutes adequate “evidence” for the identification of maladies, the efficacy of treatments, the title of “best practices.”

Oh, so lucky am I.

I always look forward to the day when a combat veteran first encounters “Brainspotting,” a trauma recovery technique so unworthy of notice by the scientifically rigorous. How can a patient’s gaze at a pointer, stalled at a particular point in the visual field, lead to anything but a feel-good parlor trick, after all?

“What was that Houdini s*** she just did with me?” my patient asks, a mere hour after his session with my colleague. “How can just looking at a particular spot cause my mind, finally, to stop racing down godforsaken alleys?”

Just yesterday he sobbed before me, despairing that Life could get better. Now he flashes a smile that seems both to fear and to dare Fate’s vengeance for his hopeful hubris.

“So many meds, so much therapy, all these years—and after two hours, I feel a calm I’ve not felt in years. Seriously?”

Nothing up my sleeve, I only reply, also smiling, “Seriously.”

Grand Opening

I still recall Dr. Hook’s The Cover of the “Rolling Stone,” my generation’s lament over what it takes to get noticed around these parts. What lyrics might have been spawned had BuzzFeed, The Daily Kos, and YouTube then been available?

Sean Azzariti, cannabis activist, twice-deployed Marine with PTSD, got his notice as he made his purchase of Colorado’s finest Bubba Kush yesterday, before God and all news outlets, as the cries of hurrah and humbug began wafting their way around the globe.

If only I could decide which way to waft.

Intoxicants are dangerous. There are successful PTSD treatments.

Yet the existence of treatments does not entail their availability. Sadly, even the available is sometimes the incompetent.

“Bird’s ready to land, green light’s on,” the soldier tells me. “You see it in each other’s eyes, no need to talk, the fear, Death. I still see them, those eyes.”

No hymn to weed here. But I see those eyes, too, of the so-called living.

So many eyes. So much to be done.

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