Culture and the brain

A new book explores the links between neural networks, feelings and culture.

By Cathy Shufro

Bruce E. Wexler, M.D., professor of psychiatry, believes that understanding how our brains work can illuminate human experiences small and large—from why our favorite letters in the alphabet are those in our own names to why we must struggle to adjust when a loved one dies. In his new book, Brain and Culture: Neurobiology, Ideology, and Social Change, he summarizes contemporary research into the brain and how it explains why we resist the unfamiliar and the alien—whether it’s a colorful tattoo on our teenager’s biceps or the rhetoric of those who insist theirs is the only true religion.

“The aim of this book is to look at what we know about neural processes to see if that can increase our understanding of the psychological and social processes that rest upon this neurobiological platform,” said Wexler, a clinician and researcher at the Connecticut Mental Health Center. “Our appreciation of the neurobiology can help us to understand—and eventually deal with—both psychological and social issues.”

The connections between neurons that create networks derive not only from our genes but also from sensory input when we’re young. And human neural networks remain plastic into the third decade of life, much longer than those of any other animal.

The less flexible adult human brain strives to see the world in a way that “agrees with internal structures.” That’s why physicians evaluating a sick patient may choose a common diagnosis even when the patient’s problems don’t quite fit. “We complete perceptions in keeping with our expectations, and those expectations are based on past experience, but not necessarily on the facts at hand,” Wexler observed.

It is the comfort of the familiar that motivates some immigrants to settle in ethnic enclaves, Chinatowns and Little Pakistans that recreate their former homes. The generation gap is especially poignant for immigrants, whose children are shaped by a very different world from the one in which they grew up. And for all parents, the world changes from generation to generation. “Most children in the world today are raised almost entirely in human-made environments,” Wexler said. Because each new generation has different brains from those of their parents, they in turn raise their children differently—leading to what Wexler calls “transgenerational shaping of brain function.” But the generation gap discomfits all parents, because children loom large in parental neural networks.

“We don’t like our children to turn into foreigners, because our children are so richly represented within us,” said Wexler. Similarly, we have trouble adapting when a loved one dies, because that person occupied a central place in our neural networks. “It’s a very arduous task to restructure, and it takes adults about a year.”

What he calls “the neurobiological antagonism to difference” can help explain violent cultural clashes: genocide in Armenia, Germany and Bosnia; massacre in Rwanda; Christians warring against Muslim “infidels;” and Muslims attacking Western “infidels.”

Understanding our resistance to differences can point the way to reconciliation. Wexler now spends most of his spare time working for a nonprofit group he started called A Different Future. Its aim is to “amplify the voices” of Arabs and Israelis advocating peace—delivering a message of mutual respect that will embed itself into the neural networks of young Israelis and Palestinians.

Wexler admits that even his own neural networks may balk at the unfamiliar. On a trip though Ohio he saw a building that looked out of place. He remembers thinking, “What is a mosque doing here?”

Bookshelf focuses on books and authors at the School of Medicine. Send suggestions to Cathy Shufro at cathy.shufro@yale.edu.

Book notes

Play Ball with Me!
by Lynn Reiser, M.D. ’70, clinical professor of psychiatry (Alfred A. Knopf) This interactive picture book of guessing games introduces young readers to various ballgames through the recognition of simple objects.

Social Structures, Aging, and Self-Regulation in the Elderly
with contributions by Becca R. Levy, Ph.D., associate professor of epidemiology and psychology; edited by K. Warner Schaie, Ph.D., and Laura L. Carstensen (Springer Publishing Company) Contributors to this book explore how societal contexts influence aging and how self-regulation at the most basic levels of functioning influences the physical health and economic circumstances of people as they age.

Principles of Molecular Medicine, 2nd ed.
with contributions by Jean Bolognia, M.D. ’66, professor and vice chair of clinical affairs (dermatology), Daniel Goldstein, Ph.D., assistant professor of medicine (cardiology), and Stephen M. Strittmatter, M.D., the Vincent Coates Professor of Neurology and professor of neurobiology (Humana Press) This volume contains new sections on genetics, oncology and metabolic and infectious diseases. The authors discuss the latest findings about links between genetic mutations and diseases; genomic approaches to a variety of diseases; the potential of stem cells to regenerate muscle, heart and neural cell populations; and advances in the understanding of the biology of such previously untreatable neurodegenerative diseases as Huntington’s.

Aglow in the Dark: The Revolutionary Science of Biofluorescence
by Vincent A. Pieribone, Ph.D., associate professor of cellular and molecular physiology and neurobiology, and David F. Gruber (Belknap Press) This book describes the human fascination with bioluminescence, or “living light.” It follows the path to one of the groundbreaking discoveries of the 20th century—green fluorescent protein, the glowing compound that has revolutionized molecular biology.

DNA Vaccines: Methods and Protocols, 2nd ed.
by W. Mark Saltzman, Ph.D., the Goizueta Foundation Professor of Chemical and Biomedical Engineering and professor of cellular and molecular physiology, Janet L. Brandsma, Ph.D., associate professor of comparative medicine and pathology, and Hong Shen, Ph.D. (Humana Press) This five-part volume contains state-of-the-art information about DNA vaccine technology. Part I contains DNA vaccine design protocols, focusing on methods that achieve optimal expression in host cells. Part II presents methods for DNA delivery. Part III discusses methods for enhancing the potency of DNA vaccines. Part IV describes several key areas of application in the field, including allergy, avoidance of autoimmunity, and neonate and infant vaccine response. The book concludes with a review of protocols for vaccine production and purification, and quality control methods.

College Life 102: The No-Bull Guide to a Great Freshman Year
by Andrew G. Kadar, M.D. ’73 (iUniverse) The author offers advice to newly arrived college students on how to succeed both inside and outside the classroom. Tips include how to dodge the stress of deadlines, enroll in classes after they’re officially filled, avoid the “freshman 15” and get better grades by studying smarter rather than harder. The book also provides information about nutrition, illegal drugs, contraception and tattoos and piercings.

Immunology of Pregnancy
by Gil Mor, M.D., associate professor of obstetrics, gynecology and reproductive sciences (Springer) This text reviews current knowledge about the role of the immune system during pregnancy and the interactions between the maternal immune system and the placenta. Mor analyzes studies related to the immunology of implantation and provides a practical approach for the application of basic reproductive immunology research to such pregnancy complications as pre-eclampsia and preterm labor.

“Shrink”: On Becoming a Psychotherapist
by Louis B. Fierman, M.D., associate clinical professor of psychiatry (Blue Dolphin Publishing) Fierman, now retired, recounts his “only-in-America” journey as the son of uneducated immigrant parents and how, with their support, he pursued a career as a maverick psychiatrist and psychotherapist at Yale and elsewhere.

Hematology: Basic Principles and Practice, 4th ed.
by Edward J. Benz Jr., M.D., FW ’79, Ronald Hoffman, M.D., Sanford J. Shattil, M.D., Bruce Furie, M.D., Harvey J. Cohen, M.D., Ph.D., Leslie E. Silberstein, M.D., and Philip McGlave, M.D. (Churchill Livingstone) This book covers the basic scientific foundations and clinical aspects of hematology. It provides practitioners with comprehensive and up-to-date information on hematology that reflects the rapid change in the molecular and cellular areas of the specialty.

The Profession of Ophthalmology: Practice Management, Ethics and Advocacy
edited by David W. Parke II, M.D., associate clinical professor of ophthalmology and visual science (American Academy of Ophthalmology) This three-part volume contains blueprints for business skills to develop and manage successful practices; a review of ophthalmology’s Code of Ethics and real-life case studies illustrating ethical behavior in ophthalmic-related situations; and a discussion of the importance of advocating on behalf of patients and the profession, and principles and methods for doing so.

Travel and Tropical Medicine: Infectious Disease Clinics of North America
by Frank J. Bia, M.D., professor of medicine and laboratory medicine, and David R. Hill, M.D. (Saunders) Topics covered in this guide include new vaccines against yellow fever and Japanese encephalitis, the current prevention of malaria and treatment of such common syndromes as traveler’s diarrhea and cutaneous leishmaniasis. Other chapters address pretravel screening of high-risk travelers, problems associated with airline travel, sexual tourism and the interactions between HIV infection and tropical diseases.

Kelley’s Textbook on Rheumatology, 7th ed.
by Clement B. Sledge, M.D. ’55, Edward D. Harris Jr., M.D., Ralph C. Budd, M.D., Gary S. Firestein, M.D., Mark C. Genovese, M.D., John S. Sergent, M.D., and Shaun Ruddy, M.D. (Saunders) This book provides encyclopedic coverage not only of the etiology and pathogenesis of rheumatic diseases, but also of the biology of the normal joint, immune and inflammatory responses, evaluation of the patient and diagnostic tests and procedures. The book includes a bound-in DVD with chapter-by-chapter multiple-choice questions for board review.

Understanding Cancer: A Patient’s Guide to Diagnosis, Prognosis, and Treatment, 2nd ed.
by C. Norman Coleman, M.D. ’70 (Johns Hopkins University Press) This book describes new treatments that target specific types of cancer and explains how to gather and interpret information when making decisions about treatments. It also provides guidance for preparing for visits to doctors and the hospital. Topics include biomarkers, novel imaging techniques, molecular signatures and profiling and molecular-targeted therapy. Some of these therapies are currently available only through clinical trials, and the author includes a detailed discussion of what is involved in participating in such trials.

The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, 300 George Street, Suite 773, New Haven, CT 06511, or via e-mail to cheryl.violante@yale.edu.

In circulation

Blogging saves doctors time

With all the information on the Web already, why would anyone want to add to the volume by reading blogs? To save time, according to librarians at Yale’s Cushing/Whitney Medical Library.

Yale reference librarian Charles J. Greenberg, M.L.S., M.Ed., for example, maintains a blog for surgeons at http://surgery-update.blogspot.com. “Surgeons don’t have time to look at all the journals,” said Greenberg, the library’s coordinator of curriculum and research support. He describes his blog as “the equivalent of a newsstand for information on certain emerging surgical topics.” Greenberg assembles his “newsstand” by combing 30 leading medical and surgical journals each month and posting entries on surgical news two or three times a week.

Greenberg’s blog can be reached from the home page of the medical library, which maintains its own blog (http://elibrary.med.yale.edu/blog/) to inform visitors of library news. Postings include descriptions of two newly acquired electronic databases offered by the library, one containing 1,800 online journals (The Science Direct Freedom Collection), and the other listing drug eruptions and interactions. The library website lists links to two other blogs by Yale medical librarians. Education services librarian Jan Glover, M.L.S., uses hers to dispense advice about doing online (http://janstips.blogspot.com/). Glover posts research tips and entries that highlight databases. “Someone might not know a database existed, and it might be perfect for their topic,” she said.

Janene Batten, M.L.S., reference librarian for the School of Nursing, started a blog about 18 months ago that focuses on items of interest to nurses (http://ysnlibrary.blogspot.com/), and she posts something new several times a week. Blogging took off during the run-up to the 2004 general election, said Web Services Librarian Hongbin Liu, M.L.S., who coordinates the library ’s blogs. With blogs, said Liu, “everybody can be a freelance journalist.” Liu uses Technorati, a blog search engine, to monitor the growth of blogs. As of October there were 56.4 million blogs worldwide, not counting some of those that are written in languages other than English. Blogging, says Liu, is here to stay.

—Cathy Shufro

In Circulation focuses on activities at the Cushing/Whitney Medical Library. Send suggestions to Cathy Shufro at cathy.shufro@yale.edu.



Caplan		Johansson



Ludmerer		Sapolsky

On campus

Changing the ethical culture of pharma

The last five years, said Arthur Caplan, Ph.D., have seen the demonization of the pharmaceutical industry. Conflicts of interest, censored scientists, flawed drugs and devices placed on the market, and the failure to protect subjects of clinical trials, have been “flat-out ethical disasters,” said Caplan, chair of the Department of Medical Ethics at the University of Pennsylvania School of Medicine.

Nevertheless, he told an audience at the School of Management in September, this demonization is irresponsible. “The pharmaceutical industry is not the tobacco industry,” he said. “The pharmaceutical industry produces medicines that relieve pain, save lives and cure patients. The pharmaceutical industry does do a lot of good.”

How, he asked, can the industry change its ethical culture? He called for mandatory registries of all clinical trials that would make data—and reports of adverse events—public. Epidemiology, he said, must trump marketing. He also called for tougher Food and Drug Administration monitoring of Phase IV, when drugs are in the marketplace.

“I think pharmaceuticals need to commit to the scientific foundations of the industry,” he said.

—John Curtis

An ongoing disaster stemming from neglect

For Roberto Johansson, M.D., Ph.D., Hurricane Katrina was a disaster that didn’t have to happen. During a talk at the Department of Epidemiology and Public Health in October, he described what he saw in his hometown of New Orleans. “Roads were out. Telephone lines were out. The fire department broke down. EMS totally broke down. The hospitals were marginal at best,” he said.

But a long history of neglect—of the levees, of the city’s schools and of the city’s poor—compounded the problem, he said. And the order to evacuate came late. “Many of the people that stayed couldn’t get out because they were medically disabled or poor,” he said, noting that doctors, nurses and other healthcare workers stayed on their jobs.

Disasters, he said, follow five stages. First comes knowledge of a possible disaster, followed by a warning phase. Then comes impact. In the rescue phase first responders try to save lives, and those outside the strike zone mobilize to help. The recovery phase, in which New Orleans finds itself, tries to keep survivors at a functioning level.

“Katrina,” he said, “is a story that must not be forgotten.”

—J.C.

Tracing the history of medical education

In the mid-19th century, medical schools were faculty-owned, for-profit operations that churned out doctors after just a few months of lectures.

With the Flexner Report of 1910, medical educators realized that medical schools should be integral parts of universities, said Kenneth M. Ludmerer, M.D., professor of medicine and history at Washington University in St. Louis, in his address at the 30th Annual Yale Affiliated Hospitals Symposium in November.

By the 1920s, medical school had become academic centers that emphasized research and clinical care. The fee-for-service era of the 1960s to 1980s also afforded rich learning opportunities because hospital stays were longer. But that learning environment has been threatened by managed care, with its emphasis on seeing as many patients as possible.

Today, Ludmerer sees a need for a social contract that funds and values medical education and research, while medical schools teach and practice cost-effective medicine. Despite the faults of the current system, Ludmerer said he wouldn’t trade today’s problems for those of a century ago. “It’s better to have problems financing treatment for Alzheimer’s disease and cancer than to watch children die of diphtheria,” he said.

—Jill Max

Baboons, humans and stress: the cost of being an SOB

Baboons in Africa’s Serengeti Plain spend just three hours a day finding food, said Robert Sapolsky, Ph.D. “That leaves nine hours of daylight for them to be really crappy to the other baboons,” Sapolsky said, adding that such behavior carries a cost. “Physiologically, it’s very expensive to be a bastard all day long.”

In his keynote talk at a symposium in October sponsored by the Department of Psychiatry, Sapolsky, a professor of biological sciences and neurology and neurological sciences at Stanford University, described how chronic stress—in humans as well as baboons—can cause or contribute to physical and mental afflictions ranging from heart disease, ulcers and memory loss to infertility and even diminished growth. “If stress goes on too long, it becomes pathogenic,” he said.

But Sapolsky, who studies the relationship between personality and stress-related disease in wild baboons, found cause for optimism. Male baboons have “pungent individualistic personalities,” he said. Some handle stress well; others don’t. There is compelling evidence that the same is true for humans. “If some baboons see the watering hole as half full, so can we,” he said.

—Jennifer Kaylin


			Originally published in Yale Medicine, Winter 2007. Copyright © 2007 Yale University School of Medicine. All rights reserved.