Life lessons learned from Rake

I was a newcomer to the television show Rake, and have only watched it a few times. I was thinking last night during a particularly poignant episode (it's the last one for the series), that there are many life lessons that can be learned from Rake, and shows like it, which I think is a big part of their appeal.

As I am a newcomer, I'm not completely across the full plotline, characters, subtleties etc., so please forgive any errors. It's not really about the show so much anyway, as about what it can teach us. There's also one correction that 'needs' to be made (we are neuropsychologists after all), to the storyline involving the witness who had sustained a brain injury after a fight with Cleaver Greene.

1. The only certainty in life is change

When I started watching the show, Cleaver Greene was recently out of gaol, had no job, no clients, and no relationship; his apartment had been taken over by his secretary, and his ex-wife was about to remarry. By the end of the series, he had rebuilt his career, retained numerous high profile clients, his ex-wife was single again, and was building what appeared to be quite a healthy relationship with a new woman. Rake takes it to extremes of course, few people's life circumstances are that dire, or change that quickly, but no matter how bad things are, take comfort in the fact that they will change.

2. The brain is an amazing organ

The storyline about Rake's ex-wife Wendy being only able to speak Bahasa following a siege where she is held hostage by her fiancé seems a bit far-fetched, but there have been other cases of individuals losing their first language (temporarily) and only being able to speak a second language following trauma. (As far as I'm aware the other known cases have been following brain trauma rather than psychological trauma, so a bit of poetic licence has been taken by the show here. Or maybe she did sustain a brain injury, I'm not sure.). It is thought that this can happen following damage sustained in the area of the brain where language knowledge is stored. The ability to speak a first language tends to be localised to an area in the left hemisphere of the brain, whereas the ability to speak a second language predominantly comes from the right hemisphere. So when trauma results in better recall of the second language, it may be that they had an injury to the left side of the brain and are better able to access the knowledge of the second language localised to the right hemisphere.

The correction...

The other reference to the human brain in this episode warrants further discussion. Cleaver manages to discredit a witness who had recently sustained a mild traumatic brain injury (mTBI) by claiming that since he had developed amnesia, they couldn't rely on his testimony about events that had occurred (as far as I'm aware) some time prior to the injury. The type of amnesia that follows a mTBI tends to be difficulty recalling events that occurred around the time of the incident. People may experience retrograde amnesia (loss of memories formed shortly before the injury, typically minutes before for a mTBI) and/or anterograde amnesia (difficulties creating new memories after the injury, e.g., remembering new appointments, learning new tasks) following a mTBI. So while it is possible that the witness would not recall that it was Cleaver who attacked him, he is however very unlikely to have difficulties recalling details of the fraudulent deal which was the subject of the court case.

3. Being genuine is endearing

Cleaver Greene is a bit of a 'Warnie' (Shane Warne) type character. No matter how badly he behaves, he always has his fair share of loyal friends and lovers, and the appeal of his character is a big part of the show's success. This is because he is genuine. While he may tell the odd lie to get out of trouble, overall with Cleaver Greene what you see is what you get: he doesn't pretend to be anyone other than who he is. Pretending to be somewhat you're not may impress people in the short-term, but real friendships and relationships are built on a foundation of being genuine.

If you'd like to know more about traumatic brain injury, mental health issues, assessment of brain injury or illness or rehabilitation following brain injury, please contact the team at ANTS.

Removing the stigma of epilepsy

Emma Renwick, an epileptic, bravely shared her experience of dealing with epilepsy on the ABC Drum program website earlier this year. She did so in an effort to reduce the social stigma associated with epilepsy, in the hopes that her daughter, who also had epilepsy, would inherit a more accepting society.

She provided the full story of her own diagnosis and the lead up to it, as well as her personal and professional struggles coping with the impact of epilepsy.

When driving one Sunday morning she had a momentary 'outage', or loss of time, which almost resulted in a car accident. Weeks later the same thing happened, and again she blacked out while in the shower and almost hit her head on the ground.

She went to the doctor, who ordered a CT scan and referred her to a neurologist. She was diagnosed with epilepsy - Absence epilepsy. While the term epilepsy conjures up images of lying on the ground having fits, there are actually several different forms of epilepsy. They can be divided into two major groups of seizures: focal (partial) or generalised seizures. Most people with epilepsy experience focal seizures. In this type of seizure the activity starts in one area of the brain (often the temporal lobe), and may spread to other brain regions. These can be further divided into:

Focal seizure - awareness retained (formerly known as simple partial seizures): the person experiencing the seizure is conscious and aware of what is happening
Focal dyscognitive seizure (formerly known as complex partial seizures) - awareness altered: the person is unaware of what is happening
Focal seizures evolving to a bilateral convulsive seizure (formerly known as generalised Tonic-Clonic seizures): the seizure activity starts on one side of the brain and them moves to the other hemispere

During generalised seizures the abnormal activity occurs in both brain hemispheres simultaneously. There are numerous types of generalised seizures, one of which is an absence seizure. Absence seizures are of short duration, and can often appear as if the person is 'zoning out'.

There are also 'other' types of seizures, which don't fit within the above categories.

More information can be found here, as well as this useful flowchart:

Epilepsy is the most common chronic brain condition in Australia and affects more than 220,000 people. Yet despite this, Emma reports, there is a high degree of discrimination against people with epilepsy. This includes exclusion, bullying, harassment and even assault at school and in the workplace. This is despite the fact that epilepsy is not contagious, does not develop as a result of any wrongdoing on the part of sufferers, and in many cases, is well controlled with medication.

Emma writes her story in an effort to help end such discrimination, and to further educate people about this very common condition. Read her story here.

ANTS can undertake thorough assessment to help you better understand and manage your epilepsy. Please contact us for more information.

Protecting your brain's 'borders'

With all the current discussion in Federal politics about 'protecting our borders' it's an opportune time to talk about a less controversial border - the one in our brain. It's called the blood-brain barrier (BBB). Our brain houses up to 650 kilometres of blood vessels! These vessels are lined by a structure, the BBB, which regulates the passage of nutrients, proteins, chemical substances and microscopic organisms between the bloodstream and the brain tissue. Basically, it controls what is, and what isn't, allowed to leave the blood supply and enter the brain.

Blood vessels supply our organs with the nutrients that they need, and help to remove waste products. It has long been known that the blood vessels in the brain and spinal cord are particularly good at protecting the brain from harmful substances, through the BBB, but until recently it hasn't been completely understood how this occurs.

Emerging research using imaging techniques has revealed that the blood vessels in the brain

and spinal cord are lined with specialised cells. These cells have molecular passageways embedded in the cell membrane. These passageways will actively block some chemicals, which are likely to be dangerous to the brain, and play a role in pushing other chemicals across into the brain. The entry and exit of these chemicals are controlled by cells called astrocytes and pericytes.

In mouse models, a deficiency in pericytes has been shown to increase the permeability of the BBB to chemicals. And a deficiency in astrocytes has been shown to result in small haemorrhages at the BBB/brain junction.

Using a 'two photon' microscope to probe inside the living brain, researchers have seen these astrocytes and pericytes doing their job, as well as witnessed white blood cells move across from blood vessels into the brain, and back again.

In addition immune system cells, 'microglia', search the brain for harmful substances that have found their way into the brain, and look for damaged or cancerous cells, and remove them.

The practical application of this knowledge is that neuroscientists are now discovering that many neurodegenerative conditions such as Alzhemier's dementia and Parkinson's disease involve defective BBB and related cells.

For example, it is thought that Alzheimer's dementia involves having too much of a chemical called beta-amyloid in the brain. The BBB has a protein that brings the beta-amyloid out of the bloodstream into the brain, and another protein does the opposite. Perhaps keeping the beta amyloid out of the brain might be a prevention, or even a cure, for Alzheimer's dementia.

We look forward to more research in this area, helping us to better understand, and hopefully formulate better treatments for these neurodegenerative diseases.

See-through brain?

The brain is, understandably, a popular topic for research. Traditionally researchers wishing to study the brain have had to use invasive and time-consuming methods of cutting it up. However, recently a team lead by Dr Karl Deisseroth at Stanford University has developed a method to make brains transparent, allowing them to be studied without having to be sliced up. The process can also be used with other organs, "revolutionising the three-dimensional study of important organs within the body".

The brain is surrounded by lipids that help form the membranes around the cells and bind the tissues together. This membrane blocks the view into the brain. The revolutionary new process referred to as CLARITY replaces the lipids with a clear gel, which preserves the tissues while revealing the internal structure of the brain. The gel is injected into the organ and is absorbed into the tissue. The lipids are then removed, while the rest of the brain remains intact, leaving the neurons, axons, dendrites, proteins and synapses in place and able to be viewed.

Previously these structures could only be seen following the brain being sliced up, and only across tiny slivers of tissue. Researchers then needed to reconstruct three-dimensional data from images of these thin slices to form a three dimensional view of the brain.

Using CLARITY scientists can then use fluorescent proteins and neuro-imaging to see neuronal connections, subcellular structures, proteins, nucleic acids and how cells interact and relate to each other. This opens up the possibility of viewing large networks of neurons with unprecedented ease and accuracy.

The procedure has already been used to investigate the nerves in the post-mortem brain of an autistic boy. They noticed unusual patterns in the neurons, which is likely to help advance the understanding of autism.

We at ANTS look forward to hearing more about how this procedure can be used for advancing our understanding of various neurological and neuropsychological conditions.

Living by values

Values are broad preferences concerning appropriate courses of action or outcomes, which guide ethical action. Commonly held values are honesty, equality, justice and commitment. Value identification, value creation and values-based living are the basis for many religions, philosophies and psychological therapies. A good (though maybe somewhat morbid!) way to identify your personal values is to think about what you would like people to say at your funeral. Or alternatively what you'd like your family to say about you on your 80th birthday, or your partner to say on your golden wedding anniversary.

Values play an important role in good psychological health. In his blog Anger in the Age of Entitlement, Steven Stosny, Ph.D and psychotherapist states that "If you devalue more than you value, your life will be bad, no matter how many good things happen to you. If you value more than you value, your life will be good, regardless of how many bad things happen to you".
That is a very interesting concept, and it explains why:

• Often the things we think will make us happy don't
• Why some people who appear outwardly to have everything are not happy, and
• Why some people who appear to have very little do seem to be happy.

Nelson Mandela is one good example of this. He experienced the death of his father as a child, was expelled from one university and dropped out of another for being a poor student, was imprisoned, experienced the death of two of his children, was not allowed to attend the funeral of his mother and one of his children, and was twice divorced. Despite these setbacks he continued to devote himself to his values of democracy and equality, achieved his goal of democracy in South Africa, and created an important legacy. It is likely that he was able to keep pursuing his goals despite his bad experiences because he was living by his values.

On the other hand, daily we hear about various celebrities, who despite their wealth, status and popularity have drug addictions, convictions for various offences and even on occasion attempt or complete suicide. While we do not know what happens in their personal lives, it is likely that they pursued fame and money thinking that it would make them happy, while ignoring or violating their deepest values. Certainly it is highly unlikely that anyone's deepest values include destroying their bodies and harming other people.

Anything involving the brain that is done repeatedly becomes habituated. Repeatedly pursuing a certain mindset creates neural pathways in the brain that become strengthened until that way of thinking is essentially automatic. If we continue to think about the ways we have been wronged for example, complain about other people and pursue revenge, then resentment will become our automatic way of thinking. If we actively choose to see setbacks as opportunities for growth and pursue compassionate understanding, then we are creating values based thinking, which is likely to lead to more happiness.

The upshot is that values-based living will lead to more happiness and better emotional health. In a practical sense, when something happens in our lives that makes us feel devalued, we are likely to recover more quickly and to have a better overall outcome if we strive to value rather than devalue. For instance, when going through a break up it is better to find ways to feel loved and to love others rather than to blame and demonise the other person.

Certainly easier said than done!

Rates of dementia higher in Indigenous Australians

Indigenous Australians have much poorer health outcomes and higher rates of some illnesses than non-Indigenous Australians. Estimates from the Australian Bureau of Statistics (ABS) show than an Indigenous male born in 2005-2007 was likely to live to 67.2 years, about 11.5 years less than a non-Indigenous male (who could expect to live to 78.7 years). An Indigenous female born in 2005-2007 was likely to live to 72.9 years, which is almost 10 years less than a non-Indigenous woman (82.6 years). They also have higher infant mortality rates, at between 5-13 for every 1,000 births (depending on the state), compared to 4 in every 1,000 for the total population.

ABS research also shows that Indigenous Australians on average also have higher rates of cardiovascular disease, cancer, diabetes, kidney disease and asthma.

A ground-breaking recent study has also found that they are more likely to suffer from dementia.

A three-year study titled Koori Growing Old Well Well was conducted between 2009 and 2012 across five urban and regional Indigenous communities in New South Wales. It involved 336 participants aged over 60 years. Preliminary results revealed that at 21 percent the prevalence of dementia is three times the rate of non-Indigenous Australians. It also found that there is an earlier age of onset amongst Aboriginal Australians, with almost three quarters of participants with dementia being aged between 60 and 70 years, compared to other Australians where the majority of people with dementia are aged over 70 years.

The poorer overall health of Aboriginal Australians plays a role in their higher rates of dementia. Risk factors for some forms of dementia include high blood pressure, obesity, smoking and diabetes.

The lead researcher, Professor Tony Broe reported "Aboriginal people in urban areas have a high incidence of many of the risk factors that have been linked to dementia in studies around the world".

Some issues with research in this field are that some Indigenous people are reluctant to share their health issues and do not want to accept that their loved ones have dementia.

These results have prompted doctors to call for appropriate services tailored specifically for the Indigenous community. Professor Broe says the findings will be used to develop education and services for older Indigenous people with dementia and for their families.

Could previous researchers have been wrong about the role of amyloid in Alzheimer's disease?

Amyloid proteins in the brain have long been implicated as the culprit behind Alzheimer's disease. Amyloid are insoluble protein aggregates that arise from inappropriately folded proteins and polypeptides. These form tangles or plaques. They have been associated in the pathology of more than 20 serious neurodegenerative disorders, including Alzheimer's disease. They’re thought to disrupt the seamless workings of the neurons responsible for memory and movement.
Recent studies in the US and in Australia, have however found that amyloid may not be as destructive as previously thought.

Two recent US studies have found that amyloid proteins may in fact play a protective rather than a destructive role in the brain. The studies run by Professor Lawrence Steinman of Stanford University found that treating mice with multiple sclerosis (MS) with amyloid proteins reduced brain inflammation and reversed MS-related paralysis.

A second study extended the finding to show that small portions of several notorious amyloid-forming proteins (including tau and prion proteins) can also alleviate symptoms in mice with the condition — despite the fact that the fragments can and do form the long tendrils, or fibrils, previously thought harmful to nerve health. This supported previous research showing that Alzeimer's disease is much worse in animals born without the genes that produce amyloid.

He reported, "we were so fixated on the idea that amyloid is bad for the brain that if one goes back and looks at the old literature and the new literature, one finds there's a lot of publications where people have ignored these kinds of experiments in humans where, for instance, lower levels of amyloid are associated with earlier dementia".

In another recent Australian study run by Dr Bryce Vissel of the Garvan Institute of Medical Research, researchers have found that the amyloid plaques that are characteristic of Alzheimer's disease appear much later in the disease than previously thought, and after the development of cognitive symptoms. This indicates that neurodegenerative processes such as memory loss and executive dysfunction occur independently of amyloid plaques.

Instead it is proposed that inflammation in the brain is the leading cause of brain damage and neurodegeneration in Alzheimer's disease. Lawrence suggested that amyloid proteins may soak up harmful molecules that are responsible for inflammation.

The studies suggest that anti-amyloid therapies may not be the best way to manage the disease, and that therapies focusing on reducing inflammation may be more beneficial.