The Doctor Weighs In

By Dov Michaeli MD, Ph.D

The April 14 online edition of the Proceedings of the National Academy of Sciences carried an intriguing article titled “ Endogenous steroids and financial risk taking on a London trading floor”. Both authors, J.M. Coates and J. Herbert are from the Dept. of Physiology, Development and Neuroscience at Cambridge University . But J.M.C. is also from the School of business at Cambridge , and his main research interests are summarized by him thusly: “ I have been sampling endogenous steroids from traders on a trading floor in the City to determine the role of both testosterone and cortisol in their decision making and in their performance. I compliment this field work with behavioral experiments set in the lab and in artificial asset markets”

Raging hormones and bubbles

The rationale for this field of research is both compelling and fascinating. As stated by J.M.C  “ the waves of irrational exuberance and pessimism that destabilize the financial markets ,may be driven by naturally produced steroid hormones. With receptors in almost every nucleated cell in the body, steroids such as testosterone and cortisol affect the moods we experience, the memories we store and recall, and the behavior we display in competitive and risk-taking situations”.

This is absolutely fascinating because for the first time we find a serious attempt to explain economic phenomena on the basis of human physiology.

What they found

The investigators took saliva samples from 17 male traders on a London stock trading floor twice daily over the course of eight days. They monitored the traders' levels of testosterone, the hormone most often associated with aggression and sexual behavior, and cortisol, the so-called stress hormone.

They tracked those levels against the amount of money that a trader made or lost, and against the variation in the market. What they found was that when the traders made more money, they had elevated levels of testosterone. When the markets were particularly variable, they had elevated levels of cortisol.

Aha, you might aver; how do you know what is cause and what is effect? Isn’t it just as possible that traders had their testosterone levels go up as a consequence of making money?

Good thought, but…

A further analysis showed that traders who started their days with elevated testosterone made more money than those who didn't. One trader went on a six-day winning streak, making twice as much money each day as the previous one. Over that period, his testosterone levels rose steadily, some 74 per cent! This guy must have been a raging bull by the end of the week. Just think of the rollicking weekend he must have had.

So should stock traders join the ranks of sports figures and take testosterone as a performance enhancer?

Not quite. There is a point of diminishing returns; too much testosterone leads to too much aggression and reckless decision making. In some it may even lead to criminal behavior.

Cortisol, anxiety and risk management

Cortisol is one of the stress hormones. It rises when stress levels are up, which is stating the obvious. But what is less apparent is its role in limiting risk. Let’s go back to the savannah for a minute. You spot a lion striding toward you. Being the testosterone macho that you are you’d be perfectly willing to take the beast on. One guy, Samson, actually did it and lived to tell the tale, so why can’t you? Fortunately, your eyes send the brain another message: don’t kid yourself, this is dangerous! The order goes out to the adrenal glands and a flood of cortisol is released into the circulation, raising your anxiety level and making you have some second thoughts: after all, this is a tale from the bible, and you know how believable those are; besides, this guy Samson- did anybody see him kill the lion? Maybe he was just using it as a line to get Delilah to do what Philistine girls do better than the Israelite ones do? So you hedge your bets and climb up the closest tree. In other words, cortisol made you manage your risks more rationally.

Indeed, when the markets stopped going in one direction and started fluctuating, as markets always do, cortisol levels went up and trading became more restrained.

Of course there is a downside to cortisol as well, especially when exposure to it is chronic.

The downside of cortisol

A few days ago we reported on a Kaiser Permanente study that showed increased risk of dementia in males over 40 who had an increased central obesity, or abdominal girth that is 35 inches in women and 40 inches in men. Even men with a normal BMI had a 2 fold increase in risk if their abdominal fat was excessive. Now, if you think that you are in great shape because your BMI is within the normal limits, and you proudly display your six-pack abs to anybody who would care to look, think again . Experts now think that subcutaneous fat -- the flabby variety under the skin in areas like the buttocks, legs and arms -- while unfashionable, is fairly benign. Researchers at the Washington University School of Medicine in St. Louis demonstrated that when they removed an average of 22 pounds of subcutaneous fat via liposuction from 15 overweight women, they found no change in the women's cholesterol levels, triglycerides, insulin sensitivity or other health risks. We are talking here about visceral fat, or fat that underlines your awsome abs, lining your intestines and other internal organs. This fat in excess can be deadly. It is associated with the diseases of metabolic syndrome, but also with gall bladder disease, sleep apnea, numerous cancers, and dementia. So even if you are not flabby (you cannot pinch your skin and subcutaneous fat), but your belly is sticking out – you probably have excess visceral fat.

A major factor in determining this deadly distribution of fat is cortisol. This is probably why people under chronic stress are more prone to all the diseases we just mentioned.

But wait, there is more. Cortisol also causes increased risk of arthritis. It also leads to shrinkage of the prefrontal cortex and hippocampus, brain regions associated with decision making and factual memory, meanwhile it contributes to growth in the amygdala, a region associated with emotional memory and anxiety. Not good stuff.

The good news

Cortisol levels can be controlled by reducing stress levels. And visceral fat is the first to go when someone loses weight in general. Aerobic exercise, like walking or running, is particularly effective. Doing sit-ups, abdominal crunches and pilates can strengthen your abdominal muscles, and help hold your stomach in, but they won't target visceral fat specifically.

Some final thoughts on stock trading

Here are some questions that beg for a study.

· Are women better traders because they are less prone to wild speculation?

· Are stock traders more prone to heart disease and diabetes? Or more critically for their clients, are they likelier to become demented?

· Should clients insist on a broker’s full disclosure of his health record?

Or may be the answer is a lot simpler: get a woman broker.

By Dov Michaeli MD, Ph.D

Neurobiological research has discovered that our brain is an arena for fierce competition: primitive reactions such as fear and aggression competing with cooperation and altruism, risk-seeking competing with risk aversion, male testosterone competing with your inner female—all competing for attention. Whose attention? – your brain’s prefrontal cortex, the executive that gets all the inputs, weighs them one against the other and then makes a decision which one should prevail—and the outcome of this process is your behavior.

Adolescent behavior

Research on the neurobiology of children’s and adolescents’ behavior revealed that the prefrontal cortex is still immature and performs its executive functions in an incomplete, and sometimes in an haphazard way. Sometimes the loud volume of a risk-seeking voice would drown out the more cautious whisper, and the poorly functioning prefrontal cortex, still lacking Solomonic wisdom, does not exert its judgment; the result is ‘adolescent behavior’.

Is it solely a function of the prefrontal cortex?

If all judgment resided in this cortex, one would expect that once all the neurons are programmed, correctly connected, and fully functioning all adults would behave in a, well, adult way. But consider these statistical finding about the behavior of adults age 35-54, published in a New York Times op-ed by Mike Males:

• 18,249 deaths from overdoses of illicit drugs in 2004, up 550 percent per capita since 1975, according to data from the National Center for Health Statistics.
• 46,925 fatal accidents and suicides in 2004, leaving today’s middle-agers 30 percent more at risk for such deaths than people aged 15 to 19, according to the national center.
• More than four million arrests in 2005, including one million for violent crimes, 500,000 for drugs and 650,000 for drinking-related offenses, according to the F.B.I. All told, this represented a 200 percent leap per capita in major index felonies since 1975.
• 630,000 middle-agers in prison in 2005, up 600 percent since 1977, according to the Bureau of Justice Statistics.
• 21 million binge drinkers (those downing five or more drinks on one occasion in the previous month), double the number among teenagers and college students combined, according to the government’s National Household Survey on Drug Use and Health.
• 370,000 people treated in hospital emergency rooms for abusing illegal drugs in 2005, with overdose rates for heroin, cocaine, pharmaceuticals and drugs mixed with alcohol far higher than among teenagers.
• More than half of all new H.I.V./AIDS diagnoses in 2005 were given to middle-aged Americans, up from less than one-third a decade ago, according to the Centers for Disease Control

In Conclusion

To ascribe all behavior, good or bad, to the structure and function of the brain is not only simplistic and incorrect biologically, it is socially dangerous; “The devil made me do it” as an excuse for sociopathic behavior is simply not compatible with a functioning civil society. Unfortunately, defense attorneys are already recruiting expert witnesses who make this deterministic argument in court.

 Males concludes his article thus: “ In reality, human brains are highly adaptive. Both teenagers and adults display a wide variety of attitudes and behaviors derived from individual conditions and choices, not harsh biological determinism. There’s no “typical teenager” any more than there’s a “typical” 45-year-old.

Commentators slandering teenagers, scientists misrepresenting shaky claims about the brain as hard facts, 47-year-olds displaying far riskier behaviors than 17-year-olds, politicians refusing to face growing middle-aged crises ... if grown-ups really have superior brains, why don’t we act as if we do?”

To which I can only add: amen!

Dov Michaeli MD Ph.D is in the biotech industry, and frquently has his doubts about his own prefrontal cortex.

By Dov Michaeli , MD, Ph.D

One of the plays we saw last Sunday in Ashland was “Distracted”, describing a mother whose nine year old child was diagnosed with Attention Deficit Hyperactivity disorder, or ADHD. The kid was a lively, curious, imaginative, highly intelligent child who was bored with his school, couldn’t keep his mind concentrated on the dumb and further dumbed down assignments-and was labeled by his teacher as “challenged”. It was all downhill from there. The child was seen by all kinds of healers (school nurse, psychologist, neuropsychologist, homeopathic psychiatrist), loaded up with drugs designed to “control” his behavior which in turn led to a new diagnosis: bipolar disorder. I had been vaguely aware of the problems of over- diagnosis and misdiagnosis in child psychiatry, but no idea of its alarming extent.

The problem quantified

In a study published in the September 2007 issue of the "Archives of General Psychiatry" the researchers examined 10 years of data from the National Ambulatory Medical Care Survey (NAMCS), an annual, nationwide survey of visits to doctors' offices over a one-week period, conducted by the National Center for Health Statistics. Their finding was astounding.

· The researchers estimated that in the United States from 1994-1995, the number of office visits resulting in a diagnosis of bipolar disorder for youths ages 19 and younger was 25 out of every 100,000 people. By 2002-2003, the number had jumped to 1,003 office visits resulting in bipolar diagnoses per 100,000 people. This is a 40 fold increase in 8 years! In contrast, for adults ages 20 and older, 905 office visits per 100,000 people resulted in a bipolar disorder diagnosis in 1994-1995; a decade later the number had risen to 1,679 per 100,000 people, a “mere” two fold increase.

· About half of all children and adolescents who received a diagnosis of bipolar disorder also received a diagnosis of ADHD.

What could account for this increase?

There could be several factors accounting for this “epidemic”.

· Increased awareness of the disorder. This may be true to a limited extent, but a sudden awareness by child psychiatrists (90% of the diagnoses were made by them, only 10% by pediatricians)is simply not credible. What were they teaching in medical schools and psychiatry training programs in the decades up to 1995?

· Was there a sea change in our knowledge of childhood bipolar disorder since 1995? There has been great progress made in understanding the neurobiology and genetics of the disease. Great progress has been made in drug treatments of psychiatric disorders. But such advances do not affect the diagnosis. The latter is based on observation of behavior, not on objective criteria such as fMRI scans of the brain, or biochemical markers of the disease.

· The classical manifestation of bipolar disorder is a period of euphoria alternating with deep depression. Yet in children and adolescents euphoria is almost never present. The children are depressed, angry and given to tantrums. But isn’t it reasonable to expect a child who is more or less ignored by his harried parents, or is chauffeured from one activity to another, or is subjected to the constant anxiety of Little League and pressure to get the top grades in school, will be angry and depressed? Animal experiments have demonstrated that chronic anxiety, or lack of parental attention, lead to profound depression and aggressive behavior. What makes us think that we are somehow different?

· I think that the most credible, and most cynical reason for the huge increase in the diagnoses of bipolar disorder and ADHD is money. The diagnosis is made on subjective criteria, and this is an invitation to abuse. I suspect that when this issue will get investigated in depth, it will turn out that psychiatric overdiagnoses are first cousins of excessive cardiac caths, excessive imaging studies, excessive bypass surgeries, excessive prescription of medications, and so on and so on.

I am not a policy wonk, but I sense that this corruption of medicine cannot continue without dire consequences for our society.

Dov Michaeli MD, Ph.D is in the biotech industry, researching the development of new drugs.

I was really amused by Dr. Pat Salber’s latest posting on hapless guys gone shopping.  Was this a subtle literary allusion to Damon Runion’s “On guys and dolls”? His ‘guys’ are pretty much the same: a bunch of pathetic, testosterone-exuding losers. Even more amusing was the storm of plaintive protests from our guy readers, who claimed that this was a stereotype that was divorced from modern reality.

Seriously, how did stereotypes come to be accepted? If they did not have some roots in reality, Darwinian theory predicts that they would not survive the selective force of public acceptance. If you think that the “dumb blonde” or the “stupid jock” stereotypes have no basis in reality—think again.

Evolutionary Psychology.

Broadly speaking, this field is attempting to explain human behavior in evolutionary terms, or more specifically, in terms of survival advantage. The field is fraught with problems, the major one being that its analysis is by and large retrospective. What I mean by that is that the investigator describes a certain human behavior, and then in effect says “but of course, it makes a lot of evolutionary sense”, many times without a shred of empirical evidence, all the fruit of armchair “thought experiments”. An example: in 2001 a book was published by MIT Press (can it get more prestigious than that?) titled “A Natural History of Rape: Biological bases of Sexual Coercion”. In it the authors, Craig Palmer and Randy Thornhill, argue that rape should be expected because it increases the number of the rapist’s offspring; voilá, survival advantage—Q.E.D. Both authors are respected university researchers, but I submit that such a conclusion ignores overwhelming neurobiological evidence suggesting that far from doing what comes naturally, our rapist guy is actually deficient in his decision making power and his “executive functioning”—traits that reside in the prefrontal cortex of the brain.

Well, maybe not a very scientific “science”, but you’ve got to admit that it’s a lot of fun.

Seriously now.

One of my favorite evolutionary psychologists is Dr. Satoshi Kanawaza of the London School of economics, a truly creative researcher and thinker. To give you an idea why I like to read his papers, here is a selection of a few of them:

1. Kanazawa, Satoshi. 2007. "Beautiful Parents Have More Daughters: A Further Implication of the Generalized Trivers-Willard Hypothesis (gTWH)", Journal of Theoretical Biology. 244: 133-140

2. Takahashi, Chisato, Toshio Yamagishi, Shigehito Tanida, Toko Kiyonari, and Satoshi Kanazawa. 2006. "Attractiveness and Cooperation in Social Exchange", Evolutionary Psychology. 4: 315-329.

3. Kanazawa, Satoshi. 2006. "Why the Less Intelligent May Enjoy Television More than the More Intelligent", Journal of Cultural and Evolutionary Psychology. 4: 27-36.

4. Kanazawa, Satoshi. 2006."Violent Men Have More Sons: Further Evidence for the Generalized Trivers-Willard Hypothesis(gTWH)" Journal of Theoretical Biology. 239: 450-459

5.Kanazawa, Satoshi and Deanna L. Novak. 2005. "Human Sexual Dimorphism in Size May Be Triggered by Environmental Cues." Journal of Biosocial Science. 37: 657-665. What ‘size’ is he referring to?

6. Kanazawa, Satoshi. 2005. "Big and Tall Parents Have More Sons: Further Generalizations of the Trivers-Willard Hypothesis." Journal of Theoretical Biology. 235: 583-590

7. Kanazawa, Satoshi and Griet Vandermassen. 2005. "Engineers Have More Sons, Nurses Have More Daughters: An Evolutionary Psychological Extension of Baron-Cohen's Extreme Male Brain Theory of Autism and Its Empirical Implications

8. Yamagishi, Toshio, Shigehito Tanida, Rie Mashima, Eri Shimoma, and Satoshi Kanazawa. 2003. "You Can Judge a Book by Its Cover: Evidence that Cheaters May Look Different from Cooperators." Evolution and Human Behavior. 24: 290-301

9. Kanazawa, Satoshi and Rebecca L. Frerichs. 2001. "Why Single Men Might Abhor Foreign Cultures." Social Biology. 48: 321-328.

And so on, and so on.

If we apply some rudimentary logic to the titles, we would have to conclude that  big and tall men (paper 6) are violent  (paper 4) and they are also ugly, because if they were attractive they would have had more daughters (paper 1).

Since I had the fortune of having one son and one daughter I am in limbo (recently abolished by the Catholic Church, after several centuries of existence): I should be short, non-violent, and ugly. My wife wholeheartedly concurs. Saving grace, I don’t like to watch TV, which at least makes me intelligent (paper 3).

Back to the dumb blonde

A recent paper by Kanazawa and Jody L. Kovar of Indiana University of Pennsylvania ( "Why Beautiful People Are More Intelligent." Intelligence. 32: 227-243,2004.) illustrates the “thought experiments” used in many such publications. The authors suggest that:

1. Blondes are perceived in most cultures as more attractive,

2. Men prefer great looks over awesome intelligence (to wit, the irrefutable “evidence” that “gentlemen prefer blondes”).

It would then make perfect evolutionary and economic sense for blondes to invest their energy and talents in snagging an attractive, high earning man, rather than invest in their own education. All their daughters (paper 1) will be intelligent, attractive and… blonde.

Hence the stereotype. These gals are not dumb, they just didn’t go to school; they actually made a smart economic decision. Who would argue with such logic? Certainly not a dumb blonde.

In terms of my own situation, I am a total evolutionary failure. And you, Pat, are just too smart for your own evolutionary good.

Dov Michaeli MD, Ph.D

A few weeks ago (May 9, 2007) we posted a comment on Gina Kolata’s article in the New York Times (May 8, 2007) The article basically laid the blame for the obesity epidemic afflicting us at our genes. Kolata reviewed work suggesting that genes are involved in obesity, with the implication that a fight to lose and maintain a lower weight is not only excruciating, it is practically futile.

That simply didn’t sound right. At least 10 genes have been discovered thus far that are involved in obesity and diabetes; more are bound to be discovered. We also know that the US population is fast approaching the 50% mark of overweight (BMI 25-29.99) or obese (BMI > 30). These genes presumably are not recent mutations. Why is it then, that only relatively recently did these genes express themselves to cause the outbreak of obesity? I think the answer is quite obvious: we have here a classic case of genetic/ environmental interaction. The genes have been there all along; they haven’t changed. The new elements that caused such a massive upward shift in BMI are the invention of the car, television, computers, all leading to a sedentary life style. Couple this with profound changes in our dietary and eating habits, resulting in a significant increase in caloric intake, and you’ve got an inescapable outcome: weight gain.

Don’t go shopping for food when you are hungry

I don’t know who first pronounced this maxim, but I am sure many of us rediscovered it many times, independently. What we actually discovered is that hunger is such a powerful physiological drive that no rational, moderating influence can keep it in check.

The hunger drive

Our gut reaction, so to speak, to hunger is primarily hormonal. Fat cells secrete a hormone, leptin (leptos means thin, in Greek), that travels to the brain, and signals a message of satiety; the more leptin, the less hunger. Another hormone, called ghrelin is secreted from the stomach when it is empty, and its signal to the brain is hunger; the more ghrelin, the more hunger. This description is obviously a vast oversimplification, but the basic mechanism is clear: our sense of hunger or satiety is a balance between hormones with opposing influences on the center in the brain that controls feeding. This area, called the hypothalamus has neuronal connections to two other important areas: the amygdala, and the nucleus accumbens. Activation of the amygdala, when the hypothalamus senses hunger, causes a sense of alarm, sometimes accompanied by aggressiveness, easy irritability and other hard-edged feelings. On the other hand, a sense of satiety and fullness activates the nucleus accumbens, which is the seat of all the warm and fuzzy feelings, like reward and pleasure. The neurotransmitter that mediates this sense of pleasure is dopamine.

The cocaine connection

It turns out that dopamine is also secreted in the nucleus accumbens in response to cocaine, amphetamines and other recreational drugs. In fact, the response of the cells that carry the dopamine receptors to the sudden rise in dopamine concentration is to reduce the number of receptors, so as to keep the stimulus within manageable bounds, so to speak. This phenomenon is called receptor downregulation. To keep the pleasurable sensation at its previous level one needs to take even more cocaine, which in turn causes even more downregulation. You can readily see the neurobiological downward spiral that we call addiction.

Lo and behold, the same pattern is seen in brain scans during binge eating: Surfeit of dopamine, activation of the nucleus accumbens, and downregulation of dopamine receptors.

The brain’s “adult supervision”

Of course, being civilized creatures we could not let ourselves be governed by such “primitive” drives as pleasure and reward on the one hand, or anxiety, aggression and rage on the other. Indeed, evolution endowed us with a highly developed area in the brain called the prefrontal cortex. This is the seat of judgment and rational decision-making. It weighs the messages arriving from the reward and anxiety centers and renders judgments that find their expression in what we call behavior.

However, this Solomonic wisdom does not always prevail. When exceptionally strong messages arrive from one center, they overwhelm the messages from the other, and the judgment of the prefrontal cortex becomes skewed, or completely overwhelmed by the flood of the incoming powerful signals. Each one of us, after along period of fasting, must have felt an overwhelming desire to binge-eat. Only when we are finally disgustingly stuffed, do we ask ourselves: what am I doing? In neurobiological terms, the storm of signals from the amygdala (hunger to the point of anxiety) and the nucleus accumbens (“how sweet it is”, and the hell with the diet!) subsided, and the ever stern, judgmental prefrontal cortex reasserts itself (“have you no shame?”).

So, is it genes or addiction?

I believe that the addiction model is a more plausible explanation of the overeating epidemic that is afflicting us now. It also explains the extreme difficulty in “kicking the habit”, losing weight and maintaining it over a long period of time. As any recovered drug addict will tell you: one never really kicks the habit; it is a constant battle, and one is always on the brink.

The encouraging aspect of this grim picture is that addiction is susceptible to therapeutic intervention. There are drugs that can blunt the addictive urge. For instance, the drug naloxone reverses the effects of morphine. Interestingly, naloxone also blunts the hunger drive and reverses binge-eating.

Dov Michaeli, MD, Ph.D

If you enjoyed reading this, you may also want to read:

• Obesity:  The devil made me do it
• Genes and food -- good and genes

Last week we looked at the complex interactions of genes, brain circuits, hormones, psychology and culture in forming the mass killer’s persona. But keep in mind, most killers don’t have genetic or anatomical defects that we know about, although some new ones may be discovered in the future.

Obviously then, psychology and culture must be playing a major role in the seemingly unprecedented wave of violence we are experiencing.  Unprecedented? Not quite.

Scriptural violence

Here are a few choice nuggets from the Bible:

• Lot , a pious man living in Sodom, took into his home some traveling strangers who stopped for the night. No sooner than did the men retire for the night, a rumor spread around town that the men were homosexual.
  The destruction of Sodom and Gomorrah by John MartinThe enraged Sodomites assembled in front of Lot ’s house and demanded that he surrender his guests. When he refused, they forced their way in and, well, sodomized them. The first recorded anti-gay crime. But unlike today, the punishment was swift and terrible: God rained fire and brimstone on the town and obliterated it off the face of the earth. Don’t worry about Lot , God warned him to leave immediately.

• Moses, who spoke to God himself, transmitted His injunction to “wipe the Amalekites off the face of the earth”. Who are those terrible Amalekites that deserved what we call today ‘genocide’? They apparently were a nomad tribe in the desert who raided the Israelites as they made their way to the Promised Land. In fact, Moses was denied entry to Canaan, according to a later biblical exegesis, after leading his people in the desert for forty years, because he failed to completely annihilate them.

The story of the concubine in Gibeah: an academic study.

The Concubine of Gibeah 3 by Janet ShafnerThere once was a man and his concubine from the tribe of Ephraim who were traveling in the land Benjamin, another Israelite tribe. As the couple dined in the city of Gibeah , a mob assembled outside and pounded on the door. The mob captured the concubine, then raped and beat her to death. The man collected her corpse the next day and traveled home. The other tribes of Israel were outraged at the crime, assembled an army and razed several Benjaminite cities, killing every man, woman, child and animal they could.

Brad Bushman, a social psychologist at the University of Michigan in Ann Arbor, is the lead author of a study, "When god sanctions killing: effect of scriptural violence on aggression," published in the March issue of Psychological Science (vol. 18, pp. 204-207; 2007).  He had about 500 students read the tale about the tribe of Ephraim in order to study the role of “higher authority” in the propagation of religious violence. For half the students he added another passage:

When the man returned home, his tribe prayed to God and asked what they should do. God commanded the tribe to “take arms against their brothers and chasten them before the Lord”.

The students then took part in an exercise designed to measure aggression. About half of the study participants were from Brigham Young University , and almost all of them were religious Mormons. The other half were from the Free University in Amsterdam . Of the Dutch group, only 50% believed in God, and 27% in the Bible (astonishingly high percentages, for Europeans).

But for both groups, regardless whether they lived in the U.S. or the Netherlands , or whether they believed in God or not, the trends were the same:

Those who were told that God had sanctioned the violence against the Israelites were more likely to act aggressively in the subsequent exercise.

What does the study mean?

First, what it doesn’t mean: one cannot conclude that religious people are more aggressive than non-religious people. But it does suggest that people are more prone to aggression when they feel that it is sanctioned by some higher authority, be it God, or his clergy.

Jihadist terrorism and the silence of religious authorities.

One could quote passages from the Bible and the Koran that would make it sound like these were manifestos of some violent cults. In fact, modern religion tries to de-emphasize the violent aspects of the scriptures. The story of the Amalekites was edited out of many versions of modern Hagaddahs, and in others its violent message is softened with an injunction to be charitable to the stranger among us. But with the notable exception of a few courageous Moslem women, there is a deafening silence coming out of the religious community. The feeble voice of moderate Moslem clergy and intellectuals is almost invariably accompanied by their loud protestations of American aggression or Western social permissiveness. Western clergy and intellectuals, being "sensitive" and "politically correct", are not much better—they are experts at diffusing the responsibility: it is not the religion and its leaders that are at fault; it is the “root causes” whatever they are, it is poverty, or Western cultural imperialism, or insensitivity and intolerance toward other cultures. It fell to a Saudi security official to state, after reporting the foiling of a vast Al Qaida plot and the arrest of 172 young jihadists, to add: "unless we change the ideology (of religious extremism), more young people will fall pray to terrorism".

If we ever needed rigorous academic proof that religious authorities can, and sometimes do, propagate aggressive and violent behavior—now we have it in the study by Bushman and his coworkers.

It is time to speak up and tell the unvarnished truth—a culture that justifies violence in the guise of religion is intolerable in the 21^st century. Religious leaders need to raise their voices against this perversity.

Genes

In 1993 scientists reported on a Dutch family, 14 members of whom were sociopaths, involved in aggressive crimes such as bullying, physical violence, rape, and arson. They all had in common a mutation in a gene that makes an enzyme called MAOA. The function of this enzyme is break down neurotransmitters such as serotonin and noradrenaline (or norepinephrine, a chemical first cousin of adrenaline). The ready conclusion was: defective enzyme caused elevated level of serotonin and noradrenaline, resulting in overactive brain circuits that serve aggressive behavior.

Case closed? Not so fast…

In a wonderful summary of the topic in Newsweek magazine ( April 30, 2007 ) one of my favorite writers on the subject, Sharon Begley) describes a 2002 study in New Zealand of 442 men who were followed since their birth. Indeed, men with low MAOA were more likely to engage in persistent fighting, bullying, cruelty and violent crime. But not all of them; only men who had been neglected or abused as children fit the bill. Men who grew up in a normal environment exhibited none of the violent traits.

Neuroanatomy

In previous postings we waxed scientific about the amygdala, two almond-shaped structures deep inside the brain, that are the seat of primitive emotions such as rage and fear; these constitute the emotional basis of the fight or flight reaction, which is mediated by noradrenaline. These waves of seemingly overwhelming emotions are checked and inhibited by another, more modern structure in the brain: the prefrontal cortex. This structure is the seat of judgment, planning, abstract thinking. It inhibits inappropriate or impulsive behavior, and is engaged in constant self-monitoring (could it be the anatomical seat of the Freudian super ego?). So in typical Ying/Yang fashion, the outcome of our behavior must then be the product of the amygdala and prefrontal interaction. Remember the then famous case of Kip Kinkel, a 15 year old who in 1998 killed his parents and two dozen schoolmates in Springfield , Oregon ? His brain scan showed a completely silent prefrontal lobe; he had nothing to check and balance his raging anger emanating from his amygdala.

Is this it? Not quite…

Hormones

Women love to point out, without much evidence I might add, that men’s aggressive behavior can be traced to their testosterone-addled brain. Only partly true. The level of testosterone is within normal limits between 20% and 200% of the mean; that’s a huge range of normal. However, if the level of testosterone exceeds 400% of the mean, then indeed women are right—men with these levels are more prone to violence. In fact, testosterone is an equal opportunity hormone; in a species of hyenas (I forget which) the first newborn in a litter, be it male or female, will eat the rest of the brood within days of birth. It turns out that this vicious sibling has inordinately high levels of testosterone in its brain, much higher then the other hapless siblings.

But to assume that we are simple automatons, following helplessly the script written by our genes, brain circuits and hormones, would deny a self evident fact—we don’t behave automatically, we do have a certain degree of free will.

Psychology

The interaction of biology and the life one leads turns out to be of paramount importance in shaping the criminal mind. The most important characteristic of the behavior of mass killers is paranoia. They have the sense that the whole world is against them, that everybody but themselves is responsible for their troubles, that the world is unfair. They are usually depressed and socially isolated.

This kind of personality, you might say, could be the product of brain circuitry gone awry. But here is a fascinating finding from animal and human studies: behavior can change brain circuitry and function-- an outstanding example of nature/nurture interaction. So what are the non-biological roots of violent behavior? We finally arrive at the inevitable:

Society and culture

It is the social environment that allows, indeed encourages, psychopathic criminal behavior. Many societies have members with genes gone awry, with malfunctioning brain circuits, with males suffering from raging hormones, with children raised in violent homes. But, sad to say, we have the dubious distinction of being the champions of gun violence in the civilized world. In 2004 there were 29,645 deaths due to gun violence in the US , or 10.08 per 100,000. For comparison, France had 4.93, Belgium 3.67,and Spain 0.75 per 100,000.

In 5 years of war in Iraq about 3200 of our soldiers got killed. Yet, we tend to see the situation in Iraq as intolerable but we dismiss  the carnage in our own streets with a helpless shrug: "It’s the culture… "

We mentioned the case of Kip Kinkel. Yes, his prefrontal lobe did not do its job. But here is rest of the story: a psychotherapist actually suggested that his dad buy him a gun so they could have something to do together.

As Pogo said: we have met the enemy, and it is us.

Dov Michaeli MD, Ph.D

I am a big fan of the Family Violence Prevention Fund.  They have been on the cutting edge of every issue related to family violence  for years now.  These issues range from helping the criminal justice system respond better to victims to improving the health care system response to family violence.  If there is a way to try to reduce the tragedy of family violence, the Fund is there trying to figure out the best way to do it.

Now, they have a marvelous extension of their efforts -- that is a focus on helping boys learn to respect the women in their lives and to actively disavow activities and attitudes that are at the core of violence against women.  Innovative, yes.  But listen to this.  They have a program that targets coaches, that's right, sports coaches, to engage them as role models to help boys grow into nurturing, supportive boyfriends, husbands, sons, nephews, and friends of girls and women.  What a great idea!

Violence against women is not and never has been simply a "women's' issue."  It is an issue that affects men, women, children, and indeed everyone directly and indirectly related to the victim and the abuser.  Thank heavens an organization like the Family Violence Prevention Fund has taken a broader view of the problem and has begun to address the family violence as an issue that impacts just about everyone.

To learn more about Coaching Boys into Men, check out this site:  CBIM

To help support the Fund as it engages men in their programs, do what I do every year, give the best Father's Day Gift possible, a donation on behalf of your guy to the Founding Fathers program of the Family Violence Prevention Fund.  It is much better than just giving a "thing".  Just ask the men in my life -- Dov, Jason, Kevin, Gili, wouldn't you rather be gifted a Founding Father membership than get one more tie or another pair of socks.  This gift is not just for you -- it is also for your daughters, your wives, your sisters, your mothers and grandmothers and your girlfriends.

Thank you, Family Violence Prevention Fund, you are doing life-changing work.  And for that I say:  Amen.

Pat Salber, MD, MBA

This is the title of an op-ed in the New York Times (Monday, February 12, 2007 ) by Lynn Chu, a New York lawyer, and John Yoo, a deputy assistant attorney general from 2001 to 2003, currently a law professor at UC Berkeley and a visiting scholar at the American Enterprise Institute.

For a moment I was excited by this title, because for quite a while I have been pondering the biological mechanisms underlying aggressive vs. non-aggressive (pacific?) behavior. Of course, you wouldn’t expect to find the answer in an article authored by two lawyers--and I didn’t. But it was not a total disappointment; the article was full of mischaracterizations (calling all Democrats Pacifists) and just plain verbal bullying.

Which again got me to think- what make aggressive people tick?

The answer, my friend, is written in the brain.

Our negative feelings of aggression, fear, hatred, revenge, all originate from deep inside the brain, in structures called the amygdala. This is not to say that these feelings are inherently bad—if they were, evolution would have selected them out of animals. The fight or flight reaction, so essential to an animal’s survival, originates in the amygdala. So does rage, important when your herd or tribe are under attack. These are ‘primitive’ reactions, in an evolutionary sense, since they are common to lower animals, and reside in the more ancient parts of our brain.

About 300,000 years ago, our ancestors became Homo sapiens (literally, thinking man). This new species was distinguished from other ape-men (Australopithecus) in the rapid development of a ‘new’ lobe in the brain- the prefrontal cortex. This area receives messages from all over the brain, processes them, suppresses some, allows others to be expressed; in other words—it makes judgments! How human, or, dare I say, civilized?

Was this prefrontal lobe just a device to make us high browed intellectuals? Probably not. It definitely had a survival advantage when our ancestors had to cooperate while hunting, or go hungry if they didn’t. Just as important, they had to make nice to the women of the tribe—or they’d end their lives without offspring.

So what makes people behave aggressively?

My own theory is that either their amygdala are overactive, or their prefrontal cortex is a bit lax in controlling the stream of negativity flowing in.

I first thought about this when I watched Bill O’Reilly (of “Culture Wars” fame) on TV debating Paul Krugman, a Princeton economist and a New York Times columnist. So there was O’Reilly, big, blustering, making totally unsubstantiated statements, and using the volume of his voice to ‘persuade’. Seated next to him was this diminutive man, affable, speaking in facts and figures, keeping his voice low, being polite to a fault. Perfect, I thought, amygdala vs. prefrontal brain match! Indeed, this ‘debate’ almost did not end up with words; the amygdala man was physically threatening the prefrontal man with physical harm, in plain view for the whole country to see.

You would think that evolution would have bred out people with unrestrained amygdala. Alas, evolution is just too slow a process to for us to enjoy it. But if we as a species survive another 1000 generations, our offspring will probably look back at us as semi-formed humans, a way station to a fully human species. Shouldn’t we leave a time capsule to tell them that we also had Einsteins, and Beethovens, and Martin Luther Kings, not just O’Reillys and Rush Limbaughs?

Dov Michaeli, MD, PhD