The Origins of Anxiety: Studies in Behaviour and Brain Chemistry

It’s normal to experience feelings of worry and fear as a response to stressful situations, as well as physical symptoms such as increased heart rate and difficulty sleeping. For people living with anxiety disorders, however, such feelings can start to take over their lives and don’t necessarily have a rational trigger. Despite around one in five adults suffering from such disorders, little is known about how they actually work on a neurological level. Hence, medication used to treat anxiety disorders control symptoms (for example by increasing levels of serotonin) rather than eliminating any underlying neurological cause.

A recent study, however, has contributed to our understanding of the brain chemistry behind anxiety. Scientists at the University of Wisconsin School of Medicine and Public Health studied rhesus monkeys using MRI scanners to analyse early indicators of a susceptibility to anxiety disorders later in life. Led by Dr Ned Kalin, the researchers identified areas of the brain that may contribute to anxious behaviour patterns early in life; for example, the central extended amygdala, part of the brain’s reward system. Activity in this region has been shown to correlate with anxious behaviour; by analysing these tightly-woven networks, it is possible to estimate an individual’s overall chance of developing anxiety disorders.  

To test this, the team analysed each monkey’s anxiety level by introducing a human and observing their stress response. They also measured levels of cortisol as another indicator of stress. They then compared this assessment to the results found using MRI technology. As they predicted, monkeys who displayed more anxious behaviour were also found to have increased activity in the relevant elements of the central extended amygdala network. Because the monkeys used in the study were all related to each other to a greater or lesser extent, researchers knew exactly the family connections between all individuals and could calculate to what extent anxiety is hereditary. They found that interplay between Ce and BST, two different nuclei involved in the amygdala network, is highly hereditable. Understanding the hereditary element of anxiety disorders and how early indicators can predict later mental health could eventually point towards new methods of treatment and prevention.

Applicants for Psychology, Medicine, or related fields may wish to think about how such studies could contribute to our understanding of how to treat anxiety and other psychological disorders. Students could also consider the balance between neurological and environmental factors in the development, prevention, and treatment of such disorders

Studies in the field of cultural psychology have suggested that Chinese people tend to express psychological distress in much more psychical ways than people from other cultures. In particular, psychologists now believe that certain clusters of physical symptoms often reported by Chinese people should be diagnosed as clinical depression and treated as such, even though these symptoms vary considerably from those reported by depressed individuals elsewhere in the world. An interesting historical example of this comes from the 1980s, when the Chinese Minister of Health told American Psychiatrist and Medical Anthropologist Arthur Kleinman that mental illness did not exist in China. Indeed, figures indicated that the depression rate in China was only 2.3%, compared to America’s 10.3%. However, a different illness known as neurasthenia was very common, with symptoms such as dizziness and chronic pain. After careful examination of 100 patients with neurasthenia, Kleinman concluded that the majority of them were actually suffering from depression.

This phenomenon whereby psychological disorders manifest physically is known as somatisation. In the past, these differences were attributed to the Chinese being a less sophisticated and emotionally immature people, incapable of “properly” expressing their feelings. Other researchers suggested that the Chinese language was incapable of conveying emotions, but this research was heavily biased in favour of the English language. Nevertheless, contemporary studies continue to find a greater degree of somatisation among Chinese people. For example, a 2001 study conducted at The University of New South Wales found that depressed Malaysian Chinese individuals were more likely to report physical symptoms than depressed Euro-Australian individuals. Likewise, a 2004 study at the Massachusetts General Hospital found that 76% of Chinese Americans diagnosed with depression reported physical complaints. The authors suggested that Chinese Americans on the whole do not see a low mood as something worthy of being reported to a doctor. However, other researchers are arguing that the actual lived experience of depression is culturally shaped, and that if depressed Chinese people report more headaches, for example, it’s because they do in fact experience more headaches.

Applicants for Psychology or Medicine might want to use this example to consider to what extent medical science and psychology can produce objective results. What are the implications of the idea that symptoms can vary significantly across cultures? Applicants for Anthropology may want to think more broadly about cultural differences, and students wishing to apply for Linguistics should consider the extent to which differences in language may play a role.

For many years, the immune system has been thought of as a stand-alone, independent mechanism. However, more recently, numerous links have been found between neuroscience and the immune system. This relatively new field is known as psychoneuroimmunology (PNI). Although ordinary people have long believed that stress can make you ill or slow down recovery, until a few decades ago this was considered little more than an old wives’ tale in the medical community— despite many first-hand accounts linking, for example, stress to skin conditions, or cancer survival to the patient’s attitude and support network.

Robert Ader, the father of this field of study, made his breakthrough discovery quite by chance. He was working on variations of the Pavlov’s dogs experiment, feeding rats sweetened water and simultaneously injecting them with a harmful drug that suppresses the immune system. As predicted, the rats were conditioned to avoid the sweet water. Ader then stopped injecting the rats but continued to offer them the sugary solution. The rats continued avoided it—but intriguingly, some of them died. It seemed to him that not only had an avoidance response been conditioned, but the drop in immunity brought on by the drug was also somehow being conditioned such that the rats still died without receiving the drug. His subsequent studies showed that his hypothesis, although mocked in the scientific community, was indeed correct, and the door was opened for studies into the relationship between the central nervous system and the immune system.

As the field of PNI grows, many different connections are being uncovered. For example: during stress the body, which believes itself to be in imminent danger, uses cortisol to activate changes in the body to ensure that energy is available for a fight-or-flight situation, including suppressing the immune system, which uses a lot of energy. In a stressed person, cortisol levels are elevated for prolonged periods of time, leading to a weakened immune system. Of course, this mechanism evolved long ago, when you were more likely to run into a hungry predator than delays on the Central line. There is also evidence emerging that Oxytocin, produced during positive interpersonal interaction including hugging and mother-infant bonding, promotes significant health benefits such as the increased speed of wound healing.

Applicants for Medicine and Psychology should consider the links between these two fields, with reference to examples. They may wish to think about the role of serendipity and accidental discovery in research, as well as how developments in medical and scientific knowledge often depend on questioning preconceived ideas.

The recent case of Alfie Evans, a 23-month old who sadly passed away, has drawn huge attention in the media and has highlighted numerous ethical and legal issues at play within medical decisions.

Alife Evans was diagnosed with an unidentifiable degenerative neurological condition, and spent more than a year in a semi-vegetative state. His parents wanted Alfie to be flown to Italy to receive treatment in a hospital, however the hospital he was being treated at in the UK blocked this move, arguing it was not in his best interests. They argued due to the degradation of his brain tissue, further treatment would be “futile” and “unkind and inhumane”.

The key legal issue at play in the case was whether doctors have the ultimate right to decide whether withdrawing life-support treatment is in the best interests of a terminally ill child. However, the law in the UK does not offer a definitive answer to this question. The 1989 Children’s Act states that the state can intervene when a child is at risk of harm. This leads to a legal grey area, whereby the state can challenge the rights of the parents, where they believe they are not acting in the best interests of the child.

The case also highlights the complex interplay of the different medical ethical principles to be considered when deciding how best to treat a patient. The ethical principle of beneficence states that doctors should always act in the best interests of the patient and need to balance the benefits of treatment against the costs. However, patients also have autonomy and have the right to make decisions regarding their own treatment. In the case of a child, this decision falls to the parent, and this leads back to the crux of the case as to whether it is the doctors or parents who can decide this.

Law students could look at the complex legal issues involved in this case, and consider how these laws may differ between different countries. Both Philosophy and Medicine students should consider the ethical implications in the case and how these impact upon the decisions that were taken.

A recent study conducted at the University of Zurich has demonstrated that Lysergic acid diethylamide, commonly known as LSD or acid, can have a significant effect on a person’s sense of self. Participants were given 100 micrograms of the drug and were observed in simulated interactions with computer avatars. It was found that LSD compromises the brain’s concept of “integrated self”, blurring the boundary between ourselves and others. This phenomenon is thought to lie behind some LSD users’ accounts of feeling completely at one with the universe.

Through this discovery, scientists hope to unearth new treatments for conditions that affect a person’s sense of self, such as depression, borderline personality disorder, and schizophrenia. According to Katrin Preller, a psychologist who worked on the study, such treatments would constitute a breakthrough in psychiatric Medicine, since “we don’t currently have any medications that work to improve the social deficits in psychiatric disorders”; in fact, scientists actually have very little understanding of how social interactions work in the brain.

Applicants for Medicine and Psychology should think about what these discoveries might mean for the future treatment of psychiatric disorders, how a reduced sense of self could positively or negatively affect the lives of those struggling with mental health issues, and how clinical trials could be conducted to test the efficacy of LSD as a treatment for these disorders.

Those wishing to study Philosophy might want to consider the effect of mind-altering drugs on the human consciousness from a more abstract and speculative perspective, thinking about the implications of these discoveries for the idea of the ‘ego’ and human nature. For Theology applicants, William James’ The Varieties of Religious Experience is a seminal text on the theory of religious experiences, conversion, and mysticism, and includes sections on the role of drugs in experiences of detachment from the self and communion with the divine.

With overworked NHS ambulance crews enduring 15-hour shifts and ambulances in Wales now restricted to attending three types of emergency (choking, cardiac arrest and pregnancy), we have explored the role of the ambulance throughout history.

It might seem impossible for us to believe with our modern day reliance on ambulance services, but it wasn’t so long ago that doctors still came and visited their patients at home.

Medical transportation methods have been around since ancient times, however they haven’t always been that that fast. The concept of the ambulance first came about on the battlefield, as a means of removing injured soldiers from the line of fire. Chariots were used by the early Greeks and the Romans to move wounded away from more danger, however, in the 9th Century the less effective method of hammocks suspended between two wagons was introduced. The safe transport of an invalid passenger relied on both hammocks keeping the same slow, steady pace, especially down hills and around corners. The horse litter, devised in the 11th Century, used a similarly ineffective method.

The word ‘ambulance’ was first coined in the 14th Century from the Latin word ‘ambulare’ – ‘to move about’. These early ambulances were first used in Spain and were not transport methods, but medical tents that could be erected a safe distance away from the fighting. Solders would not have be transported to these ‘pop-up’ field hospitals until after a battle, which could last several days.

It was not until Dominique Jean Larrey, the famous French Napoleonic military surgeon, that the ambulance (in cart form) was used as fast and effective way of saving army lives. Larrey realised that men stood a better chance of survival if they received medical attention immediately. Another great advancement in the development of the ambulance came with the work of Jonathan Letterman, who came up with the notion of the army doctor or field medic during the American Civil War, and created the U.S. Ambulance Corps act.

It was former military servicemen that fought for an extension of the military ambulance service to serve a public need. This service ultimately replaced the doctor who made house calls with his little black bag. In 1895, Cincinati, Ohio was the first city to a hospital-based ambulance service.

Future Oxbridge Historians might gain from exploring the history of Medicine and medical practices. ‘Wannabe’ Medics could benefit from exploring if our health service is now regressing and how the NHS will be impacted by a severely reduced ambulance service.

Matthew Walker writes in his fantastic new book ‘Why We Sleep’ that two-thirds of adults in developed nations fail to obtain eight hours of sleep a night. This short article is to give a flavour of the effects of a lack of sleep, and what medical treatments are being developed as a result.

Lack of sleep has an adverse affect on literally every biological system in the human body.

A study quoted by Walker (2017) shows that men who sleep 5 hours a night have much smaller testicles than those who sleep 8 hours or more. Those men who routinely sleep 5-6 hours a night has a level of testosterone of someone 10 years older. This gives an insight in to the impact of sleep on hormonal regulation.

The amygdala is a brain structure responsible for strong emotional reaction. In sleep deprived people, you see around a 60% increase in responsiveness, leading to a lack of regulatory control of emotional response and increased extreme response. You only need to speak to an Oxford or Cambridge University student after pulling an ‘all-nighter’ to find this out for yourself.

The hippocampus – the ‘memory inbox’ of the brain – is particularly affected by lack of sleep. Without sleep, the memory circuits of the brain become ‘waterlogged’ preventing you to absorb new information. For this reason, sleep is incredibly important in education. Schools in the town of Edina, Minnesota, decided to try an experiment to test this. They shifted their school start times from 7.25am to 8.30am, and measured the difference for SAT scores. The result was a positive increase of over 200 points – enough to open up a different tier of university.

As we age, our cognitive ability declines. Another physiological signature of ageing is that sleep also gets worse, especially the deep quality of sleep. It has been discovered that these two aspects of ageing – cognitive decline and worsening sleep – are actually interrelated rather than simply correlated. Most recently discovered, a lack of sleep is a contributive factor to Dementia and Alzheimer’s disease (see the bibliography below for some of this evidence).

These discoveries are startling and frightening, but they are also exciting because they allow researchers to develop ways to do something about it.

What is now in the pipeline of being approved for public use is a technology called ‘direct current brain stimulation’, in which electro-pads are applied to the head and a small amount of voltage is inserted to the brain. Current tests of this technology are very promising, showing a measurable impact to physiology. If you apply this to healthy adults, for example, deep sleep brain waves can be amplified, and you can nearly double the amount of memory benefit.

Sleep is a non-negotiable biological necessity. The decimation of sleep is having a catastrophic impact on our health. Sleep is also a fascinating realm of study, in which new discoveries are occurring all the time. These discoveries are, in turn, leading to the development of new treatments, such as ‘direct current brain stimulation’.

Applicants for Psychology, Human Sciences, Medicine, or Natural Sciences are encouraged to explore this topic further and pick up a copy of Matthew Walker’s book, ‘Why We Sleep’ (2017).

Not all superheroes wear capes, and in the 1960s some certainly didn’t wear white coats.

The news this week has centred on a scandal surrounding key UK charities, which was brought to the attention of the world by a whistle-blower. The work of medical ethicist Maurice Pappworth, however, began before the term ‘whistle-blower’ was used in this context.

Pappworth’s controversial book ‘Human Guinea Pigs: Experimentation on Man’ published in 1967, uncovered the terrible treatment faced by patients at the hands of doctors who saw them as little more than lab rats.

Pappworth reported that this shocking behaviour was demonstrated, not only by researchers in hospitals, but also by doctors in other facilities, including: jails, orphanages and psychiatric units. Bravely, Pappworth even named those individuals and institutions involved, leading to the issue being raised in Parliament. ‘Human Guinea Pigs’ raised the point that needless deaths were often caused by the unnecessary treatments patients were subjected too. The headlines at the time were filled with Pappworth’s astonishing comparison of the medical profession to that of Nazi death camps. By speaking out and writing a sensational book, Pappworth was ostracised by the rest of the medical establishment and was labelled as a ‘pestilential nuisance’ in his obituary.

A recent biographical novel written by Pappworth’s daughter on her death bed and published last month, aimed to restore Pappworth to his rightful place in the medical community and the history of Medicine.

Students wishing to study Medicine should examine the ethics of early medical research with human patients. Future Historians should investigate how our perception of certain historical figures can change over time. Philosophy and Theology students may wish to study the moral values involved to producing pioneering medicine.

The BBC has reported that the NHS is at a crisis, with hospitals running out of beds and patients being left on trolleys for hours.

Chris Hopson, of NHS Providers, said hospitals were unsafe and over-crowded.

This raises questions of funding and longer term plans to help the NHS in a time of crisis.

Politicians have rebuked these concerns by claiming that there are concrete plans in place to ensure that the health service will rectify any issues that are currently present and can cope in the future. 

However, mounting evidence highlighting severe problems has put pressure on both politicians and NHS officials to provide more clarity on the current status of the NHS and initiatives to combat such problems. Last year, the NHS missed several targets for A&E, cancer and planned operations across the UK. There is evidence to suggest that illnesses like the flu are rising, meaning that the lack of hospital beds will become more of a growing issue in the upcoming future.

Since 2010 the budget has been rising at about 1% a year on average, whereas traditionally the NHS got over 4%. Students wanting to study Economics should look into the causes and consequences of this percentage decrease.

Students that want to study Medicine should think about how important public opinion is to the effective running of the NHS. Furthermore, students may want to think about the growing obstacles facing doctors in a professional capacity and how this could affect the incentive to study to become a doctor.

Students that want to study HSPS should look into how the media’s representation of public bodies can infiltrate public opinion, and in extension affect voter choice. They should also start to assess how effectively these concerns are being dealt with by politicians.

Facial recognition and memory is innately human; being able to recognise faces is something fundamental to our ability to communicate and survive. Familiar faces are easy to recognise and humans can learn to identify unfamiliar faces from repeatedly presented images: for example, have you ever met President Trump? Probably not, but you can certainly recognise his face.

A recent study from the University of Cambridge found that this ability to recognise faces is more than just a human phenomenon. Researchers from the Department of Physiology, Development and Neuroscience trained eight sheep to recognise the faces of celebrities like Barack Obama, Emma Watson and Fiona Bruce. Initial recognition training involved sheep receiving a reward of food by breaking an infrared beam near the screen showing a celebrity photograph. The initial tests then presented two images: one showing the celebrity and one showing a stranger. The results showed that the celebrity was picked eight out of ten times. When the faces were shown at an angle, the sheep’s performance dropped by about 15%, comparable to that seen when humans perform the same task. Sheep were also seen to recognise photos of their human handlers without any pre-training, and were observed to do a ‘double-take’ before choosing the correct image.

The implications of these results are that, at least in the scientific domain, sheep can be useful models to help us understand disorders of the brain such as Huntington’s disease. Beyond research, Professor Jenny Morton who led the study said that “anyone who has spent time working with sheep will know that they are intelligent, individual animals.” Perhaps then there are wider implications on the way in which sheep will be both understood and perceived in years to come.

Philosophy, Psychology and PPE applicants may want to look into the implications of how our perception of animal intelligence may influence the social and economic landscape. Natural Sciences (B) and Medicine applicants may want to explore how studies like this enhance our ability to understand human diseases.