Monthly Archives: January 2016

Passion And Desire – The Wild Horses Demand Freedom But Cause Chaos When Their Halter Is Let Slip

‘Travellers at least have a choice. Those who set sail know that things will not be the same as at home. Explorers are prepared. But of us, who travel along the blood vessels, who come to the cities of the interior by chance, there is no preparation. We who were fluent find life is a foreign language. Somewhere between fear and sex. Somewhere between the swamp and the mountains. Somewhere between God and the Devil passion is and the way there is sudden and the way back worse.’ So did Jeanette Winterson, in her written masterpiece, The Passion, describe and define passion and desire. In my youth as a twenty-something, this book was given to me by a good friend, Wendy Sanderson Smith, after she thought it would synchronize with my own temperament and approach to life back then (as I guess most folk in their twenties ‘lived’ and ‘loved’ in their own halcyon early adult days), and indeed it did. I have noticed that a lot of folk post pictures on Facebook (including myself) of their late teenage / early adulthood days, and often these include friends or activities from University or College times. My brother, John, sent me a video clip of some young folk doing extreme sports such as skydiving, bungee jumping and aerial cycling tricks, which led to a fun discussion of whether we still had the passion and desire to do such activities (or are physically capable of doing them) as our fifties fast approach, or as quaintly suggested in the film the Big Lebowski, ‘our revolution is over’. All these got me thinking of passion and desire, and what the teleological reason for their existence is, and whether losing our passions and desires as we get older, or at least refining, sublimating or managing them is a good or bad thing, or at least a necessary ‘evil’ allowing us to maintain the order and structure which is required to us to be successful in most facets of adult life.

Passion is defined as a very strong feeling about a person or a ‘thing’, and desire as a sense of longing for a person, object or outcome. Some research folk classify both passion and desire as emotions, which itself is defined as ‘relatively brief’ conscious experiences characterized by intense mental activity that results in a high degree of either pleasure or displeasure. But, others perceive extreme passion and desire to be part of the spectrum of obsessive disorders, and to have a degree of psychopathology underlying them. Passion and desire have through history been contrasted with reason, which together engage in a constant ‘battle’ to control one. Mostly passion has been given a ‘bad rap’, with Plato suggesting that individual desires must be ‘postponed’ in the name of ‘higher’ rational ideals, Baruch Spinoza suggesting that ‘the natural desires are a form of bondage’, and Dave Hume suggesting that passions and desires are ‘non-cognitive, automatic, bodily responses. To most religious doctrines, passion and desires are very much feelings and sensations to be resisted, unless that desire leads one towards ‘God’, when it can then become a mechanism for good and positive advancement of a ‘higher’ moral functioning and way of life, without the sinful desires of ‘the flesh’.

However, passion and desire have also been suggested to be (unless extreme) an important component of human bonding and the establishment of a sexual relationship with a mate, without which there would be potentially no propagation of the human species. Sexual attraction is based on the capacity of someone to arouse the sexual interest of another, and the requirement of someone else to respond to that capacity. Folk can be sexually attracted to physical qualities in another, or how they move, their voice, smell or what they wear and how they interact (flirting is a mechanism of triggering arousal in another), or their social status, but it is generally always a two way ‘thing’, with both individuals needing to find the prospective partner sexually attractive to each other. There is a strong brain-body ‘loop’ and physical sensations associated with desire and the feeling of ‘passion’ generated by another, including trembling, pallor, flushing, heart palpitations, pupil dilatation and general feelings of ‘weakness’. Folk in the throes of passion also describe ‘feelings’ and symptoms such as awkwardness, stuttering, shyness, confusion, and even insomnia and loss of appetite. Current research is working on trying to understand the mechanisms related to the development of these ‘symptoms’, and it is thought that perhaps acute hormonal (cortisol and pheromones for example) changes or components of the hypothalamic-pituitary-adrenal gland axis are involved in linking psychological ‘desire’ to physical body structures and physiological systems which generate these symptoms. Interestingly, a relationship between sexual attraction / desire and anxiety has been suggested, and when folk are more anxious, or are put in situations where they have heightened anxiety (for example generated by physical danger) they appear to experience increased sensations of desire and passion.

While as described above there are teleological (purposively beneficial) reasons why desire and passion exist, passions and desires can become pathological, particularly when they are uni-directional or unrequited. Limerence (also known as infatuated love) is the state of mind which results from an attraction to someone else in which there are obsessive thoughts and fantasies about that person and strong / overpowering desire to have one’s passion / love reciprocated. Obsessive love is defined as an obsessive desire to ‘possess’ another person towards whom a strong desire is felt, together with an inability to accept rejection of their desire by the person towards whom it is felt. Limerence involves intrusive and often intolerable / painful ‘thoughts’ of the person who is the ‘limerent’ (person towards whom the ‘crush’ is directed), an acute longing for reciprocation and fear of rejection, and periods of fantasizing about ideal circumstances where there is cohabitation with the limerent in an intimate way (sexual fantasy is a usual but not an absolute requirement of the limerence state). Interestingly, in this obsessive state there is always a ‘balance’ between hope and uncertainty, or indeed a requirement for both, and the uncertainty component results in constant analysis by the individual suffering from limerence levels of desire or passion, with every utterance or perceived body language of the limerent being pondered about endlessly, and analysed for meaning. Folk can remain in this limerence state for a prolonged period of time if their desires and passion are not requited, but if the limerent returns their affections, a ‘normal’ relationship can develop. If there is absolute rejection by the limerent, after a period of time the desires eventually become attenuated and the individual ‘moves on’ to another potential limerent and ‘transfers’ their extreme passions and obsessive desires to this next unfortunate soul. It is thought that early childhood trauma or a failure of childhood attachment bonding to their primary carer may be associated with this extreme level of passion or desire in folk with obsessive levels of passion and desire, though this theory is still controversial and not completely accepted by research folk in the field.

As one gets older, several changes occur which attenuate the extreme passions which are associated with youth, and in most folk they are either assuaged by involvement in a healthy / mature relationship with the person one is attracted to (had a crush on), or one’s passions are sublimated into other ‘pursuits’. These can be work related, or a hobby, or sporting endeavours. This ‘sublimation’ can be healthy and lead to a sense of satisfaction and success in a chosen career or hobby or sport if there is genuine enjoyment of whatever is being done that one is passionate about, and in a circular way if one is successful in the field one choses to focus the attenuated drive in, it can potentially bring about an attenuation of the sublimated drive itself. However, if one does not enjoy work, or a hobby, but continue to do it obsessively and as a compulsion, as what happens in the case of attraction limerence, this can lead to workload related stress, burnout and a sense of dissatisfaction / psychological ‘pressure’ that is not assuaged no matter how hard one works. Perhaps therefore, many folk who work extremely hard, or are involved in hobbies or sports in an extreme manner in their middle or old age, may have sublimated drives related to unrequited passions and desires in their young adulthood (though the causation of this is very complex and a number of factors may be involved). Equally, some folk may never adequately sublimate their limerance related desires, passions and obsessions, and engage for most or all of their lives in unrequited, or requited but unfulfilling obsessional relationships in a serial manner. It must be noted that while most folk at some stage of their youth develop a ‘crush’ on someone or at least feel a sense of passion or desire for someone they meet or interact with, not all folk feel extreme desires, passions or limerences for other folk at any stage of their lives, and rather choose a mate and settle into life routines using cognitive / rational decision based processes, without feeling any substantial passion. Whether these folk perhaps have an abstract notion of romantic ‘love’ they ‘feel’ for their chosen partner, or genuinely feel no passion or emotional bond with their partner, and merely co-exist without any overt or covert show or feelings of passion and desire, is still not clear / well determined – though they clearly would need to choose a partner who is satisfied by such a ‘passionless’ but functional arrangement if it has a chance to be a success and a long-lasting relationship.

A ‘crush’ on someone, which occurs usually in early adulthood, has intense feelings, desires and passions associated with it. If the crush is requited it often creates long lasting memories that are usually positive and can be very intense. In one’s young adulthood there are fewer responsibilities and therefore more ‘freedom’ to explore and entertain such crushes, though of course if you are unfortunate enough to be on the receiving end of an unwelcome and unwanted crush or limerence it is surely not a pleasant experience, whether in early adulthood or at a later life stage. Passions and desires when they are not obsessive serve an important purpose from a mating and reproduction perspective. But passions and desires when they are unrequited, or when they are obsessive and / or cyclical, can be problematical, both at the time of their occurrence and long after in middle and late adulthood, and can cause future negative memories which are both intense and can potentially affect future dating strategy and relationship interactions. As most folk get older, and establish a successful relationship and have children, and become creators of life’s boundaries and infrastructure in which the next generation of young folk can ‘play’ and consummate their ‘passions’ as they please, the passions and ardour of youth seem to wane, or at least are more controlled – perhaps with the development of successful adult relationships any ‘rough edges’ remaining from one’s bonding and attachment period of childhood are removed and smoothed. However, it’s not clear if passion is still ‘felt’, in a wistful way, by most folk as they age. The success of films and books (such as Jeannette Winterson’s beautifully written books) dealing with unrequited love and lust, or of obsessive desire turned pathological (most folk of my generation will surely still get a ‘queasy’ feeling when remembering the ‘bunny boiler’ film Fatal Attraction, where the character portrayed by Glenn Close developed an almost fatal limerence / obsessive compulsion for that of Michael Douglas) would indicate that issues related to desires, passions and ‘crushes’, whether they are unrequited or have a ‘happy ending’ as happens in most films and books, are still at play / being processed in the psyche of most folk as they go about their daily routines and business.

My wise cousin, Andy Shave, often reflected in our youth on whether love or lust was more important in and for a successful relationship. The answer probably lies in the taming of the wild horses of passion, and the keeping of lust on a tight rein. But in the deep of the night, most folk still probably ‘dream’ of or at least remember wistfully the passions and high emotions and crushes of their youth, when late at night they sighed and gasped at the thought of their still unrequited love / lust object, and sang along to the Chris Isaak song, ‘what a wicked game to play, to make me feel this way, what a wicked thing to do, to let me dream of you’. But at some point in life, these passions need to become and remain as dreams and memories, and one has to forego the passion and lusts of youth in order for those horses of passion to become one’s servants, rather than one’s chaotic master, even if this is supremely challenging for those who have lived a lot of their lives travelling along the blood vessels of the city of the interior, somewhere between the swamp and the mountains, between fear and sex, between God and the Devil.

The Sensation Of Fatigue – A Complex Emotion Which Is Vital For Human Survival

After a couple of weeks back at work after a great Christmas season break, I have noticed this week a greater than normal level of fatigue than I normally ‘feel’ at the end of a routine working week. After one of the hottest December months on record in my current home town, where temperatures for a while were consistently hovering around forty degrees Celsius, we have had a wonderful rainy, cool period, and I have noticed that I feel less fatigued in the cooler environment, and routine daily activities seem ‘easier’ to perform than when it was excessively hot. As part of a New Year’s resolution ‘action plan’ to improve my level of fitness, I have increased my level of endurance exercise, and as always have enjoyed the sensation of fatigue I feel towards the end of each long (though I know that ‘long’ is relative when compared to younger, more fitter folk) bike ride I do as part of this ‘fitness’ goal. All of these got me thinking of the sensation of fatigue, an emotional construct which I spent a great many years of my research career trying to understand, and which still is very difficult to define, let alone work out its origins and mechanisms of elicitation in our physical body structures and mental brain functions.

As described in these three very different examples from my own life, fatigue is experienced by all folk on a regular basis in a variety of different conditions and activities. Perhaps because of this, there are many different definitions of fatigue. In clinical medicine practice, fatigue is defined as a debilitating consequence of a number of different systemic diseases (or paradoxically the treatment by a variety of different drugs) or nutritional deficits. In exercise physiology, fatigue is defined as an acute impairment of exercise performance, which leads to an eventual inability to produce maximal force output as a consequence of metabolite accumulate or substrate depletion. In neurophysiology, fatigue is defined as a reduction of motor command from the brain to the active muscles resulting in a decrease in force or tension as part of a planned homeostatic process to prevent the body from damage which could result from too high a level of activity or too prolonged activity. In psychology, fatigue is defined as an emotional construct – a conscious ‘sensation’ generated by the cognitive appraisal of changing body or brain physiological activity which is influenced by the social environment in which the activity changes occur, and the mood status, temperament and background of the person ‘feeling’ these physiological changes. It will be evident from all of these different definitions how complex fatigue is an ‘entity’ / functional process, and how hard it is for even experts in the field to describe to someone asking about it what fatigue is, let alone understand it from a research perspective.

A number of different physical factors have been related to the development of the sensation of fatigue we all ‘feel’ during our daily life. During physical activity, it has been proposed that changes in the body related to the increased requirements of the physical exertion being performed cause the sensation of fatigue to ‘arise’. These include increased heart rate, increased respiratory rate, increased acid ‘build up’ in the muscles, reduced blood glucose or muscle or liver glycogen, or temperature changes in the body, particularly increased heat build-up – though for each study that shows one of these factors is ‘causal’ of the sensation of fatigue, one can find a study that shows that each of these specific factors is not related to the development of the sensation of fatigue. It has also been proposed that changes in the concentration of substrates in the brain structures associated with physical or mental activity are related to the sensation of fatigue – such as changes in neurotransmitter levels (for example serotonin, acetylcholine, glutamate), or changes in the nutrients supplied to the brain such as glucose, lactate or branched chain amino acids. But, again, for each study whose findings support these hypotheses, there are studies that refute such suggestions. It has also been suggested that a composite ‘aggregation’ of changes in all these body and brain factors may result in the development of the sensation of fatigue, via some brain process or function that ‘valences’ each in a fatigue ‘algorithm’, or via intermediate sensations such as the sensation of breathlessness associated with increased ventilation, the sensation of a ‘pounding’ heart from cardiac output increases, the sensation of being hot and sticky and sweating which result from temperature increases in the body, and / or the sensation of pain in muscles working hard, all of which are themselves ‘aggregated’ by brain structures or mental functions to create the complex sensation we know and describe as fatigue.

Which physical brain structures are involved in the creation of the sensation of fatigue is still not known, and given the complexity of the factors involved in its generation, as described above, large areas of the brain and a number of different brain systems are likely to be involved – the motor cortex as muscle activity is often involved, the sensory cortex as signals from changes in activity in numerous body ‘parts’ and functions are ‘picked up’ and assimilated by the brain, the frontal cortex as cognitive decision making on the validity of these changes and the need for potential changes in activity as a result of this ‘awareness’ of a changed state is required, the hippocampus / amygdala region as the current changes in physiological or mental activity must be ‘valenced’ against prior memories of similar changes in the past in order to make valid ‘sense’ of them as they currently occur, and the brainstem as this is the area where ventilation, heart function and a variety of other ‘basic’ life maintaining functions are primarily controlled, for example, amongst many other potential brain areas. We don’t know how the function of different brain areas is ‘integrated’ to give us the conscious ‘whole’ sensation we ‘feel’, and until we do so, it is difficult to understand how the physical brain structures ‘create’ the sensation of fatigue, let alone the ‘feeling’ of it.

How the mental ‘feeling’ of fatigue is related to these physical body and brain change ‘states’ is also challenging for us research folk to understand. Clearly some ‘change’ in structures, baseline physical values or mental states by whatever induces the fatigue process, be it physical or mental exertion or illness, is required for us to ‘sense’ these and for our brain and mental functions to ‘ascribe’ the sensation of fatigue to these changed states. It has previously been shown that the sensation of fatigue which arises during exercise is related to the distance to be covered, and increases as one gets closer to the finish line. While this sounds obvious, as one would expect the body to become more ‘changed’ as one exercises for a longer period, it has been shown that when folk run at the same pace for either five or ten kilometres, despite their pace being identical in both, at the 4km mark in the 5 km race the rating these folk give for the sensation of fatigue is higher than it is at 4km of the 10 km race, which is ‘impossible’ to explain physiologically, and suggests that folk ‘set’ their perceptual apparatus differently for the 5 and 10 km race, based on how far they have to go (what H-V Ulmer described as teleoanticipation), by changing the ‘gain’ of the relationship between the signals they get from their body depending on how far they plan to go. Two great South African scientists, Professor Ross Tucker of the University of Free State, and Dr Jeroen Swart of the University of Cape Town, have expanded on this by suggesting that there is a perceptual ‘template’ for the sensation of fatigue in the brain, and the sensation of fatigue is ‘created’ in an organized, pre-emptive ‘way’ by mental / cognitive processes in the brain, and the sensation of fatigue is ‘controlled’ by this template depending on the distance and / or duration of a sporting event. If something unexpected happens during an event, like a sudden drop in temperature, or a competitor that goes faster than expected, this will create an unexpected ‘change’ in signals from the body and requirements of the race, and the sensation of fatigue will become more pronounced and greater than what is expected at that point in the race, and one will slow down, or change plans accordingly. Ross and Jeroen’s fascinating work show how complex the mental component of the sensation of fatigue and its ‘creation’ by brain structures is.

There are multiple other factors which are involved in the generation of the sensation of fatigue, or of its modulation. I did my medical PhD (an MD) on chronic fatigue syndrome which developed in athletes who pushed themselves too hard until they eventually physically ‘broke down’ and developed the classical fatigue symptoms associated with chronic fatigue, where they felt fatigue even when not exercising, which was not relieved by prolonged periods of rest. These athletes clearly pushed themselves ‘through’ their fatigue symptoms on a regular basis until they damaged themselves. As one of the pioneer and world-leading experts in the fatigue field, Professor Sam Marcora, has pointed out, one’s ambitions and drives and ‘desire for success’ are a strong indicator both of the level of the symptom of fatigue folk will ‘feel’, and how they resist these symptoms. In these chronically fatigued folk we studied, something in their psychological makeup induced them either to constantly continue exercising despite the symptoms of fatigue, or made them ‘feel’ less sensations of fatigue for the same work-rate (assuming their fitness levels and physical capacity was similar) to most folk who do not experience this syndrome (the vast majority of folk). To make the matter even more complex, these folk with chronic fatigue described severe sensations of fatigue at rest, but when we put them on a treadmill, some of them paradoxically felt less, rather than more, sensations of fatigue when running as compared to resting, and their extreme sensations of fatigue returned (to an even greater degree) in the rest period after they completed the running bout. Furthermore, if one gives stimulants to folk when they exercise, such as caffeine, it appears to reduce the ‘awareness’ of the sensations of fatigue. Sam is doing some interesting work currently looking at the effect of caffeine on attenuating the sensation of fatigue – as did Dr Angus Hunter several years ago – and thereby using it as a ‘tool’ to get folk to exercise more ‘easily’ as they appear to ‘feel’ fatigue less after ingesting caffeine. All this shows again that the sensation of fatigue is both a very complex emotion, and a very ‘labile’ one at that, and can change, and be changed, by both external factors such as these stimulants, and internal factors such as one’s drive or ‘desire’ to resist the sensation of fatigue as they arise, or even ‘block them out’ before they are consciously generated. More research, and very advanced research techniques, will be required for us to clearly understand how and such potential ‘blockages’ of the sensation of fatigue happen, if they indeed occur.

The sensation of fatigue is therefore an immensely complex ‘derivative’ of a number of functions, behaviours, and psychological ‘filters’, and what we finally ‘feel’ as fatigue is ‘more’ than a simple one-to-one description of some underlying change in our physical body and brain that requires adjustment or attenuation. The sensation of fatigue is clearly a protective phenomenon designed to slow us down when we are exercising too hard or too long in a manner that may damage our body, or when we are working too hard or too long and need a ‘time out’, or when the environment one is performing activities of daily living in may be harming one. But there are usually more complex relationships and reasons for the occurrence of the sensation of fatigue than what on the surface may appear to be the case. For example, the increase in work related fatigue I feel is surely related not just to the fact that it is the end of a busy week – it is perhaps likely to be related to a ‘deep’ yearning to be back on holiday, or to the fact that my mind is not ‘hardened’ yet to my routine daily work requirements, or has been ‘softened’ by the holiday period so that now I feel fatigue ‘more’ than is usual. In a few weeks time this will surely be attenuated as the year progresses and my weekly routines, which have been ‘honed’ over many years of work, are re-established, and I will feel the ‘usual’ rather than excessive symptoms of fatigue as always on Thursdays and Fridays. The extreme feeling of fatigue I felt during the very hot December month may also be related to some subconscious ‘perception’ that my current living environment is perhaps not optimal for me lifestyle wise for a long term living basis, and this ‘valenced’ how I perceived the environment as one of extreme heat and therefore extreme (and greater than expected) fatigue last month. And that I am ‘enjoying’ the sensations of fatigue I feel when exercising may mean that I am perhaps not pushing my exercise bouts as hard as I could, and need to go harder, or that my mind and body is setting a pace that feels enjoyable both so I continue doing it, or to protect me from a potential heart attack if I go harder. All of these may be the case, or equally, all of these could be mere speculation – the science folk in the area of fatigue have a big mountain to climb, and many more hours in the lab, before we more fully understand the complex emotion which the sensation of fatigue is, and how and from where it arises and is controlled.

A time may come when Sam Marcora and other excellent research colleagues like him find the ‘magic bullet’ that will ‘banish’ the sensation of fatigue, and we will be able to work harder and exercise longer because of it. But then would the cold drink after exercise taste so good, or the feeling of accomplishment one gets at the end of a long exercise bout as a result of resisting the sensation of fatigue long enough to achieve one’s goals for the particular exercise bout one has just completed still occur? This is something to ponder on, when fatigued, as I am now after two hours of writing, as I sip my cup of coffee, and wait for my ‘energy’ to return so I can begin the next task of a routine Sunday, whether it be cycling with the kids, walking the dog, or any other fatigue-removing activity as I prepare for the next fatiguing cycle which is the work and sport week ahead!

Death and Our Own Dying – Death Related Anxiety And The Understanding Of Its Certainty Patterns Our Daily Life

In the last few weeks our family has had to come to terms with the fact that the health of our wonderful dog, Grauzer the Schnauzer, who whose been our faithful companion of eleven years, and has travelled with us from Cape Town in South Africa to Newcastle upon Tyne in the UK, and then back to Bloemfontein in South Africa, is failing, and as much as we don’t want it to happen and hope he lives on for a few years more, it is very likely in the next few weeks he will be taking the journey to the next world of unlimited lamp-posts and cats and ferrets that do not move as quickly as they do in this one. My old friend and world leading Sport and Exercise Scientist, Professor Andy Jones, last week retweeted some fascinating data of what folk die from during their lifetimes at different ages, and it was fascinating to see this and understand that one had got ‘safely past’ some of the childhood and early adult related cause of death, but that equally, now being well into middle-age, a whole host of nasty causes of death could potentially be one’s fate at any time from now into the future. My great brother, John, heard the unfortunate news that one of his school classmates had passed away of natural causes at the age of forty seven, and we soberly reflected over the Christmas period that ‘there by the grace of god went we’, and we resolved to pay more attention to our health and fitness, in the chance that this would make a difference and prolong for as long as possible into the future the inevitable fate which awaits all of us. All these got me thinking about death and dying, the biggest mystery of life, and perhaps the biggest factor at play in our lives and consideration of our future.

Death is defined as the final cessation of vital functions in an individual or organism which results in the ending of life. One’s death can be a result of a number of different phenomena, from senescence (biological ageing, or in more common terms, old age), disease, violence and murder, predation by wild animals, accidents, suicide, and any number of other mechanisms that potentially can cause one to die. While how exactly to define and diagnose the occurrence of death is still debated in medical circles, generally most folk would accept that someone has died when their heart and respiratory organs stop working and cannot be sustained without external artificial assistance, along with evidence of brain death as evidenced by a ‘flat-line’ EEG (which monitors the presence of rhythmical brain waves) and a lack of cortical function or primitive brain reflexes. When this happens, the body of any person or organism starts decaying and decomposing shortly after the onset of death. Interestingly, not all ‘living’ organisms die (the definition of what constitutes a ‘living’ organism is still hotly debated), with exceptions being the hydra and jellyfish species, which appear to be immortal and never die, and can maintain their existence ‘forever’ unless they are physically torn asunder. Similarly, organisms which reproduce asexually, and unicellular organisms, also appear to ‘live’ eternally. So one can postulate that death is a ‘by-product’ of a complex cellular structure, where somatic (body) cells are created in a complex arrangement by a combination of some ‘plan’ and some energy form, which allows the occurrence of ‘life’ as we know it, but decays with time and eventually deteriorates functionally to a degree that ‘death’ occurs.

What happens to us around the time and ‘after’ death is of course still a matter of conjecture. A fair bit of research has been done on folk who have had a near-death experience where they have been clinically ‘brought back from the dead’ after either a heart attack, or a near drowning, or accident related trauma, all which lead to hypoxia (shortage of oxygen supply) to and of the brain. Most describe a feeling that they are ‘blacking out’ for what to them is an unknown and unpredictable period of time, and an awareness that one is dying, until by chance / good medical practice they are ‘brought back to life’ by resuscitation and other clinical interventions. A lot of these folk also describe a sense of ‘being dead’, a sense of peace and wellbeing and painlessness, an out-of-body experience as if they were ‘floating’ above and ‘watching’ their physical self, a ‘tunnel experience’ of entering darkness via a tunnel of light, reviewing their life in a manner often described as ‘seeing their life history flashing before their eyes’, or seeing ‘beings of light’, all before the absolute darkness / nothingness of unconsciousness (‘death’) occurs, or they ‘return’ to their body as they are resuscitated. Of course all this is first person / qualitative descriptive information, and is impossible scientifically to replicate, but it is interesting that so many folk describe similar experiences as they ‘die’. We also do not know at all what then occurs after this phase, as all these folk are ‘brought back to life’, so we are not aware what happens ‘next’ as part of the death process. Into this knowledge void folk put their own interpretation of what happens, or will happen to them, when they do die – religious folk would describe and I guess hope for some type of ‘heaven’ as the ‘next phase’, or some transcendence or continuation of one’s ‘spirit’ or ‘soul’ into another body or as an entity which exists and ‘drifts’ through the ether eternally – while secular folk would either say they are not sure of what happens, or believe that there is nothing ‘after’ death, and everything just switches off and a blankness / nothingness occurs similar to when one is in a deep sleep. Of course all of these are pure conjecture, and it is for each of us to experience and understand what is ‘ahead’ for us after own deaths only when it happens, when all shall be made clear, or we will disappear into the eternity of nothingness, and know nothing about it or anything further of our life, past, current or future.

What is for sure is that for most folk, the thought of one’s own imminent or potential mortality causes anxiety (and I have never heard anyone say with any sincerity that they really are totally not scared of death and dying, and in those that do, it is almost always manifestly evident bravado), often to a morbid degree, where it is known as thanatophobia. Thanatophobia, or death anxiety, is defined as a feeling of dread, apprehension or anxiety when one thinks of the process of dying, or the totality of death, and its impact on one’s own ‘life’ which is all that we know and ‘have’. Death anxiety can be related to the fear of being harmed and the way one will die, or to existential fear that nothing may exist after we die, or to the fear of leaving behind loved ones and things and processes we believe are reliant on us for their continuation. It has been suggested that folk ‘defend’ themselves against the anxiety they feel about their own death and dying (or that of loved ones) by ‘denial’, which results in a lot of transference, acting out, or ‘covering up’ behaviour either consciously or subconsciously, such as attempting to acquire excessive wealth or power, or committing violence against others, or breaking rules and life boundaries, or celebrating / living life in a manic way, all of which have an emotional cost, and do not usually attenuate the underlying death anxiety. Interestingly, a century and more ago, most folk used to die in a more ‘open’ way than what currently occurs, usually in the comfort (or discomfort) of their homes, surrounded by their loved ones. In contrast, today a greater proportion of folk die in hospitals or hospices, ‘away’ from the ‘visible’ world, and it is usual for most folk never to see someone actually die in their lifetime until their own death is imminent. It has been postulated that this ‘hiding’ of death from us may have paradoxically created a greater fear of death because of us never ‘seeing’ or being involved with death, and therefore death is an ‘unknown’ entity or occurrence which causes an exacerbated fear due to the fear of the unknown nature of death, rather than just a fear of death itself. It has been suggested that folk with more physical problems, more psychological problems or a ‘lower ego integrity’ (lower self-confidence) suffer from greater death anxiety. Folk like Viktor Frankl have suggested that having some life ‘meaning’, or a sense of peace from achieving life goals, or paradoxically letting go of life goals, may attenuate the feelings of death anxiety. Supporting this, death anxiety is apparently greatest during the ages of 35-65 (and is felt by children as young as five years old), but after 65, again paradoxically, death anxiety appears to decrease, perhaps because after retirement one ‘lets go’ of earthly goals and desires, or reaches a sense of peace regarding one’s life and achievements. Of course there has to be a relationship between goals / desires and death anxiety for this to be true, and it is not clear if such a relationship clearly exists, even if it does seem to be logical ‘link’.

Folk that ‘give their life away’, whether in combat as part of a perception of national duty, or to save a family member, or in a life-threatening emergency where they react to such a situation and are prepared to die to save others, are challenging to understand in relation to the death anxiety and fear of death issues described above which most folk would admit to having. Clearly having a ‘higher cause’ must be valenced by these folk to be more important than their own life, or their lives must be perceived to be meaningless enough to ‘give it away’ in such instances. It is difficult to tell which of these (a perception of a higher cause or a meaningless life) is most germane in these different examples, and indeed whether these folk have a fear of death or anxiety about it, but continue with their course of action despite feeling such, or whether some cognitive process or learned way of thinking removes this fear / anxiety before they perform their last act of sacrifice or wilful death. Sigmund Freud suggested that there is a death drive in all folk, which opposes the ‘Eros’ drive (lust for life / breeding / survival), and that when folk want to die, or risk their life doing for example extreme sports like parachuting or mountain climbing where there is a high chance of death occurring, it is part of some primordial desire to ‘go back’ to some pre-life state, though of course a theory like this is difficult to prove or disprove as we cannot yet measure ‘drives’ in a direct way.

So how does knowledge of this anxiety related to the awareness of death as the final life process we will go through, and indeed of death itself, both affect and assist us with how we live our life? We do seem to either consciously or unconsciously create a ‘scaffold’ or pattern of our life plans and life stages related to the relative perceived imminence of death. For example in our twenties we explore ‘life’ with mostly a freedom from the fear of death (though paradoxically this exploratory behaviour often can end in accidental death), perhaps because one believes that one has many years of life ahead of one, and death will occur at a time far in the distance ahead. As one enters one’s thirties, one is for some reason to a greater degree confronted by an understanding of one’s mortality, perhaps due to early signs of physical deterioration such as not being able to compete as well as one used to at sport, or hair loss / developing baldness, or experiencing the death of one’s parents which ‘brings’ awareness of both the reality and finality of death to oneself, amongst many other potential reasons. Because of this one therefore starts ‘planning’ the life left ahead of one based on average mortality figures (most folk believe and hope they will live to between 70-80 years if things go well for them) – for example buying a house that will be paid off before one ‘retires’, having children at a young enough age to see them grow up to adulthood, or writing a will for the first time. The concept of retirement is interesting related to death and dying, and is surely based on a ‘calculation’ of a death age beyond the retirement age, thereby allowing one to have a little ‘down time’ / a time of peace before shuffling off this mortal coil, even though paradoxically health reasons often do not allow folk as much enjoyment of this time as they would if they rather planned a work ‘gap period’ in their forties or early fifties where they took time out from work to relax or travel, and subsequently worked on until death occurred, rather than waiting until being ‘old’ to enjoy retirement with the time left before their death. So a lot of our life appears to be patterned and planned out based on an understanding that a finite amount of years are available to us. This is perhaps why when one has a health scare, or a cancer diagnosis, or when a young person goes to war where the chance of death is manifestly increased at this ‘incorrect’ time of the person’s life, fear of death, death anxiety and denial mechanisms come into play, that can be very difficult to attenuate or ‘put out’ of one’s mind.

As much as one would like to, as the main character in the film ‘Lawless’ concluded after his much revered brother, who he thought was immortal, died at the end of the film, no-one leaves this world alive. Understanding this creates a sense of anxiety in us (unless we perhaps have strong religious beliefs), both for what we will lose, and for what we will leave behind. But, paradoxically, the thought of death perhaps also creates a sense of wonder each day we wake up that we are indeed alive for another day, and makes the grass seem greener, the sun shine brighter, and the water seem wetter, given we know that one day we will no longer ‘have’ all these things around us. Once in my youth I capsized when paddling down a river in my kayak and was pinned under a rock for a period of time, and had that ‘out of body’ feeling described above, and my whole life to that point played out in a fast sequential ‘movie’ in front of my eyes, and then I felt everything go black and remembered nothing more. Fortunately I was ‘let go’ / washed out from under the rock, and when I regained my senses everything did indeed seem much sweeter, lusher, brighter, and more brilliant, and does still to this day. I am of the age when according to the statistics I should most fear death, and indeed, with a young family, each day I do fear that I will not see my son and daughter grow up if I die suddenly. I held my wonderful dog Grauzer in my arms as I brought him home from the vet this morning with the news that I might not be able to hold him such for much longer, and a feeling of immense sadness and impending loss almost overwhelmed me. But then I thought about the good times we have had together, and understood that the circle of life, which for him is nearly complete, was and is a full and happy one, and I understood also that part of my sadness for him is my fear for my own mortality and the sense of permanence that accompanies his impending death. I took note of the fact that, as described above, at the end of one’s life the fear of death is usually paradoxically attenuated and lessens, and hoped that dogs get to that similar point of peace at the end of their time too. And yes, his fur does feel softer, his wagging tail and uplifted ‘happy’ face each time he sees me seems even ‘sweeter’, given I know that soon he will go forever into the great unknown, and will be with us no more. Death and dying is still the greatest mystery life has for us, and a challenge we all have to go through on our own, and we will only gain the knowledge of what death is ‘about’ when we go through the dying process ourselves. When eventually facing one’s own imminent death, perhaps the best one can do is try and find the courage to meet it ‘head on’, as suggested in the wonderful words of the Nick Glennie-Smith song, ‘Sgt. Mackenzie’, written in homage to his grandfather who died in the first Great war – ‘Lay me down in the cold, cold ground, where before many men have gone. When they come, I will stand my ground, and not be afraid’ – though of course we all hope that the need to do this will occur many years from now, with all our loved ones around us, and with the contentment of a life well lived in our final moments. But we can be sure of one thing, and that is we will never get out of this world alive, unless we are an amoeba or jellyfish. And maybe, just maybe, the world is a better place because of this, or at least it feels such in those moments when we ponder on the glory of life, with the aching awareness that at some future point in time we no longer will be ‘in it’, and will go off on our own journey, alone, into the great big, wide, unknown.

Control of Movement And Action – Technically Challenging Conceptual Requirements And Exquisite Control Mechanisms Underpin Even Lifting Up Your Coffee Cup

During the Christmas break we stayed in Durban with my great old friend James Adrain, and each morning I would as usual wake around 5.00 am and make a cup of coffee and sit outside in his beautiful garden and reflect on life and its meaning before the rest of the team awoke and we set off on our daily morning bike-ride. One morning I accidentally bumped my empty coffee mug, and as it headed to the floor, my hand involuntarily reached out and grabbed it, saving it just before it hit the ground. During the holiday I also enjoyed watching a bit of sport on the TV in the afternoons to relax after the day’s festivities, and once briefly saw highlights of the World Darts Championship, which was on the go, and was struck by how the folk competing seemed with such ease, and with apparent similar arm movements when throwing each dart, to be able to hit almost exactly what they were aiming for, usually the triple twenty. When I got back home, I picked up from Twitter a fascinating article on movement control posted by one of Sport Sciences most pre-eminent biomechanics researchers, Dr Paul Glazier, written by a group of movement control scientists including Professor Mark Latash, who I regard as one of the foremost innovative thinkers in the field of the last few decades. All of these got me thinking about movement control, and what must be exquisite control mechanisms in the brain and body which allowed me to in an instant plan and enact a movement strategy which allowed me to grab the falling mug before it hit the ground, and allowed the Darts Championship competitors to guide their darts, using their arm muscles, with such accuracy to such a small target a fair distance away from them.

Due to the work over the last few centuries of a number of great movement control researchers, neurophysiologists, neuroscientists, biomechanists and anatomists, we know a fair bit about the anatomical structures which regulate movement in the different muscles of the body. In the brain, the motor cortex is the area where command outflow to the different muscles is directly activated, and one of the highlights of my research career was when I first used transcranial magnetic stimulation, working with my great friend and colleague Dr Bernhard Voller, where we able to make muscles in the arms and leg twitch by ‘firing’ magnetic impulses into the motor cortex region of the brain by holding an electromagnetic device over the scalp above this brain region. The ‘commands for action’ from the motor cortex travel to the individual muscles via motor nerves, using electrical impulses in which the command ‘code’ is supplied to the muscle by trains of impulses of varying frequency and duration. At the level of the individual muscles, the electrical impulses induce a series of biochemical events in and around the individual muscle fibres which cause them to contract in an ‘all or none’ way, and with the correct requested amount of force output from the muscle fibre which has been ‘ordered’ by the motor cortex in response to behavioural requirements initiated in brain areas ‘upstream’ from the motor cortex, such as one’s eyes picking up a falling cup and ‘ordering’ reactive motor commands to catch the cup. So while even though the pathway structures from the brain to the muscle fibres are more complex than I have described here – there are a whole host of ‘ancient’ motor pathways from ‘lower’ brainstem areas of the brain which also travel to the muscle or synapse with the outgoing motor pathways, whose functions appear to be redundant to the main motor pathways and may still exist as a relic from the days before our cortical ‘higher’ brain structures developed – we do know a fair bit about the individual motor control pathways, and how they structurally operate and how nerve impulses pass from the brain to the muscles of the body.

However, like everything in life, things are more complex than what is described above, as even a simple action like reaching for a cup, or throwing a dart, requires numerous different muscles to fire either synchronously and / or synergistically, and indeed just about every muscle in the body has to alter its firing pattern to allow the body to move, the arm to stretch out, the legs to stabilize the moving body, and the trunk to sway towards the falling cup in order to catch it. Furthermore, each muscle itself has thousands of different muscle fibres, all of which need to be controlled by an organized ‘pattern’ of firing to even the single whole muscle. This means that there needs to be a coordinated pattern of movement of a number of different muscles and the muscle fibres in each of them, and we still have no idea how the ‘plan’ or ‘map’ for each of these complex pattern of movement occurs, where it is stored in the brain (as what must be a complex algorithm of both spatial and temporal characteristics to recruit not only the correct muscles, but also the correct sequence of their firing from a timing perspective to allow co-ordinated movement), and how a specific plan is ‘chosen’ by the brain as the correct one from what must be thousands of other complex movement plans. To make things even more challenging, it has been shown that each time one performs a repetitive movement, such as throwing a dart, different synergies of muscles and arm movement actions are used each time one throws the dart, even if to the ‘naked’ eye it appears that the movement of the arm and fingers of the individual throwing the dart seems identical each time it is thrown.

Perhaps the scientist that has made the most progress in solving these hugely complex and still not well understood control process has been Nikolai Bernstein, a Russian scientist working out of Moscow between the 1920’s and 1960’s, and whose work was not well known outside of Russia because of the ‘Iron Curtain’ (and perhaps Western scientific arrogance) until a few decades ago, when research folk like Mark Latash (who I regard as the modern day equivalent of Bernstein both intellectually and academically) translated his work into English and published it as books and monographs. Bernstein was instructed in the 1920’s to study movement during manual labour in order to enhance worker productivity under the instruction of the communist leaders of Russia during that notorious epoch of state control of all aspects of life. Using cyclographic techniques (a type of cinematography) he filmed workers performing manual tasks such as hitting nails with hammers or using chisels, and came to two astonishing conclusions / developed two movement control theories which are astonishingly brilliant (actually he developed quite a few more than the two described here), and if he was alive and living in a Western country these would or should have surely lead to him getting a Nobel prize for his work. The first thing he realized was that all motor activity is based on ‘modelling of the future’. In other words, each significant motor act is a solution (or attempt at one) of a specific problem which needs physical action, whether hitting a nail with a hammer, or throwing a dart at a specific area of a dartboard, or catching a falling coffee cup. The act which is required, which in effect is the mechanism through which an organism is trying to achieve some behavioural requirement, is something which is not yet, but is ‘due to be brought about’. Bernstein suggested that the problem of motor control and action therefore is that all movement is the reflection or model of future requirements (somehow coded in the brain), and a vitally useful or significant action cannot either be programmed or accomplished if the brain has not created pre-requisite directives in the forms of ‘maps’ of the future requirements which are ‘lodged’ somewhere in the brain. So all movement is in response to ‘intent’, and for each ‘intent’ a map of motor movements which would solve this ‘intent’ is required, a concept which is hard enough to get one’s mind around understanding, let alone working out how the brain achieves this or how these ‘maps’ are stored and chosen.

The second of Bernstein’s great observations was what is known as motor redundancy (Mark Latash has recently suggested that redundancy is the wrong word, and it should have been known as motor abundancy), or the ‘inverse dynamics problem’ of movement. When looking at the movement of the workers hitting a nail with a hammer, he noticed that despite them always hitting the nail successfully, the trajectory of the hammer through the air was always different, despite the final outcome always being similar. He realized that each time the hammer was used, a different combination of arm motion ‘patterns’ was used to get the hammer from its initial start place to when it hit the nail. Further work showed that each different muscle in the arm was activated differently each time the hammer was guided through the air to the nail, and each joint moved differently for each hammer movement too. This was quite a mind-boggling observation, as it meant that each time the brain ‘instructed’ the muscles to fire in order to control the movement of the hammer, it chose a different ‘pattern’ or ‘map’ of coordinative muscle activation of the different muscles and joints in the arm holding the hammer for each hammer strike of the nail, and that for each planned movement therefore, thousands of different ‘patterns’ or ‘maps’ of coordinated muscle movement must be stored, or at least available to the brain, and a different one appears to be chosen each time the same repetitive action is performed. Bernstein therefore realized that there is a redundancy, or abundancy, of ‘choice’ of movement strategies available to the brain for each movement, let alone complex movement involving multiple body parts or limbs. From an intelligent control systems concept, this is difficult to get one’s head around, and how the ‘choice’ of ‘maps’ is made each time a person performs a movement is still a complete mystery to movement control researchers.

Interestingly, one would think that with training, one would reach a situation where there would be less motor variability, and a more uniform pattern of movement when performing a specific task. But, in contrast, the opposite appears to occur, and the variability of individual muscle and joint actions in each repetitive movement appears to maintain or even increase this variability with training, perhaps as a fatigue regulating mechanism to prevent the possibility of injury occurring from potentially over-using a preferentially recruited single muscle or muscle group. Furthermore, the opposite appears to happen after injury or illness, and after for example one suffers a stroke or a limb ligament or muscle tear, the pattern of movements ‘chosen’ by the brain, or available to be chosen, appears to be reduced, and similar movement patterns occur during repetitive muscle movement after such an injury, which would also be counter-intuitive in many ways, and is perhaps related to some loss of ‘choice’ function associated with injury or brain damage, rather than damage to the muscles per se, though more work is needed to understand this conceptually, let alone functionally.

So, therefore, the simple actions which make up most of our daily life, appear to be underpinned by movement control mechanisms of the most astonishing complexity, which we do not understand well (and I have not even mentioned the also complex afferent sensory components of the movement control process which adjust / correct non-ballistic movement). My reaction to the cup falling and me catching it was firstly a sense of pleasure that despite my advancing age and associated physical deterioration I still ‘had’ the capacity to respond in an instant and that perhaps the old physical ‘vehicle’ – namely my body – through which all my drives and dreams are operationalized / effected (as Freud nicely put it) still works relatively okay, at least when a ‘crisis’ occurs such as the cup falling. Secondly I felt the awe I have felt at many different times in my career as a systems control researcher at what a brilliant ‘instrument’ our brains and bodies as a combination are, and whatever or whoever ‘created’ us in this way made something special. The level of exquisite control pathways, the capacity for and of redundancy available to us for each movement, the intellectual capacity from just a movement control perspective our brain possesses (before we start talking of even more complex phenomena such as memory storage, emotional qualia, and the mechanisms underpinning conscious perception) are staggering to behold and be aware of. Equally, when one sees each darts player, or any athlete performing their task so well for our enjoyment and their success (whether darts players can be called ‘athletes’ is for another discussion perhaps), it is astonishing that all their practice has made their movement patterns potentially more rather than less variable, and that this variability, rather than creating ‘malfunction’, creates movement success and optimizes task outcome capacity and performance.

It is in those moments as I had when sitting in a beautiful garden in Durban in the early morning of a holiday period, reflecting on one’s success in catching a coffee cup, that creates a sense of wonder of the life we have and live, and what a thing of wonder our body is, with its many still mystical, complex, mostly concealed control processes and pathways regulating even our simple movements and daily tasks. In each movement we perform are concealed a prior need or desire, potentially countless maps of prospective plans for it, and millions of ways it can be actualized, from which our brain chooses one specific mechanism and process. There is surely magic in life not just all around but in us too, that us scientist folk battle so hard to try and understand, but which are to date still impenetrable in all their brilliance and beauty. So with a sigh, I stood up from the table, said goodbye to the beautiful garden and great friends in Durban, and the relaxing holidays, and returned to the laboratory at the start of the year to try and work it all out again, yet knowing that probably I will be back in the same place next year, reflecting on the same mysteries, with the same awe of what has been created in us, and surely still will no further to understanding, and will still be pondering, how to work it all out – though next year I will be sure to be a bit more careful where I place my finished coffee cup!

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