Response-Based Neurology in Psychiatric Practice Robin Routledge, MD

1. 5 • Response-Based Neurology in Psychiatric Practice • Robin Routledge, MD

2. Summary • The brain is a response to the world. • The brain is in a systemic balance with the world it perceives. It has many adaptations to context. • These ideas show responses to extreme adversity are not illness. 2

3. Neuron shapes TOO COMPLICATED

4. schematic of a neuron In Middle Out

5. schematic of a neuronal system One neuron Another neuron

6. schematic of a hundred billion neurons

7. schematic of a hundred billion neurons

8. schematic of a neuronal and environmental system Nervous system Environment

9. Mind is social Mind emerges from interaction between brain and environment Bateson: Mind and Nature

10. Human sensation • Hearing • * Volume • * pitch • * location • Vision • * Light • * Colour • * 3D

11. Human sensation • Touch • * Size • * Shape • * texture • Temperature • * Pain • * Fast • * slow 11

12. Human sensation • Taste • Smell • Stretch • Joint position • vibration 12

13. Human sensation • hormone levels • Satiety (grehlin, leptin, PYY, GLP) • Carbon dioxide • Arterial Pressure 13

14. Maintaining the machine Autonomic control Hormones immune response inflammation

15. Purposeful awareness of perceived sensation is • Mindfulness 15

16. Making meaning local sensation suppresses sensation around it

17. Making meaning • Competing maps of three dimensional space are assembled from combined sensations and given a sense of time. 15

18. Making meaning More than one organization or meaning is generated. These are like competing virtual realities. 16

19. Making meaning One “representation” (Plato)suppresses other versions around it. 17

20. Making meaning

21. Making meaning

22. Networks of neurons located in different parts of the brain hum together like guitar strings. They assemble chords. 20 20

23. Certain parts make special contributions but remain interdependent 21 21

24. Making meaning • The brain is split in two halves with very little communication between them. • Each half organizes perception very differently and the difference allows a subtlety of perception. 22 22

25. Memory • The brain does not recall exactly. • Memories are stored better if they are emotional. • Memories are recalled differently depending on the circumstances at the time of recall.

26. Brain Action Parts of our brain cooperate to number and to name things. These actions (calculations and language) are like actions we take on our external world.

27. “Mirrorcells” fire when we see another person do something we understand. Mirror cells act as though we are doing what we perceive the other to be doing. • This sense of the other may be the foundation of compassion. 25

28. The social smoothnessof physical movements is coordinated by the most foreword part of the frontal cortical lobes. • This part of the brain can modify amygdala’s warning of danger. 26

29. neuroplasticity Neurons constantly replace or prune connections. They do this in response to how they are used. So if you do something different, they will slowly make new connections. 27

30. neuroplasticity The brain is like a hedge 28

31. neuroplasticity An opening in a hedge 29

32. Summary • The brain is a response to the world. • The brain assembles representations of the world. • The brain adapts to the circumstances it selects. 30 30

33. Psychiatryis itself a response • a response to current culture • it started with the beginning of industrialism • Psychiatric classification began in the asylums 31

34. the Psychiatric History of “Trauma” 1. da Costa American Civil War 2. Shell Shock World War One 3. Combat Fatigue World War Two 4. Brain WashingKorean War 5. Post Traumatic Stress DisorderVietnam War 6. Trauma Informed Carecurrent theory 7. Response Based Care future theory 32

35. Some Brain responses to adversity • Physical Readiness • Option One: • increased muscle tone • increased heart rate • increase breathing • lubricated armpits • increased pupil size (more light in) • Harder to poop or pee . 33

36. Some Brain responses to adversity • Physical Readiness • Option Two: • loss of skeletal muscle tone • decreased heart rate • decrease breathing • decreased pupil size (less light in) • poop and pee 36

37. Some Brain responses to adversity • Cognitive Readiness • numbed/calm emotional response • heightened alertness & vigilance • altered perception of time • rapid review of meaning of context • evaluation of social “representations” • weighing alternative strategies/tactics 37

38. Social*responses to adversity Expressed Emotion (EE) studies show social response to terrible things has a powerful influence on outcome. * ”social” as the brain sees it 34

39. schematic of a neuronal and environmental system Nervous system Environment

40. Conclusion • The brain is responsive. • It grows in the direction it is used. • The brain is in a systemic balance with the world it perceives. It has many adaptations to context. 36 36

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