InnerQuest NC Psychiatry and Counseling

Cancer Drug Shows Promise For Alzheimer Disease

Science online recently reported that an FDA approved cancer drug shows tremendous promise in treating Alzheimer Disease (AD). An association between the presence of beta-amyloid and the development of AD was discovered nearly two decades ago. It is unclear if the beta-amyloid deposition causes dementia or is simply associated with the condition. Researchers at Case Western Reserve University in Cleveland found that bexarotene, a cancer drug used to treat T-cell lymphoma, cleared beta-amyloid deposits from the brains of mice that are a model of AD. Background Apolipoprotein E (APoE) is a class of molecules that binds to a specific receptor on liver (& other) cells and is essential for transport and metabolism of triglyceride rich lipoprotein, fat-soluble vitamins, and cholesterol. In addition to its role in lipid metabolism that is involved in cardiovascular disease, APoE also seems to play important roles in AD and immune system regulation. In the nervous system, astroglial and microglial cells are the primary producers of APoE while neurons primarily make receptors for APoE. The "glial" cells can be thought of like scaffolding that provides structure and support for neurons the cells that are thought to be the messengers within our nervous system. APoE is a protein and there are three different but related genes that have been found in human beings that are responsible for making this protein. One of these genes, APoE-4, is implicated in AD and a few other conditions. Among Caucasians and Japanese carriers of this APoE-4 gene, there is between a 10 and 30 times increased risk of developing AD by age 75 when compared to those not carrying the gene. AD is characterized by deposits of a peptide beta-amyloid. APoE enhances the breakdown of this peptide. Clearly there are often other contributing factors to the development of AD since one third of those with AD do not have the APoE-4 gene and even some people who carry two APoE-4 genes (homozygous) do not develop AD. Another variant of the APoE gene, APoE-2 may offer some degree of protection against developing AD. Bexarotene is approved for the treatment of a T-cell lymphoma that comprise about 1 in 10 lymphomas. It boosts the production of APoE and this leads to more efficient clearance of beta-amyloid. The brains of AD sufferers contain plaques comprised of beta-amyloid. Theoretically, a substance that increases production of APoE may be expected to improve the clearance of beta-amyloid and thereby improve the functioning of AD sufferers. Facts About AD An estimated 5.4 million Americans of all ages have Alzheimer’s disease in 2012. This figure includes 5.2 million people age 65 and older(47), A1 and 200,000 individuals under age 65 who have younger-onset Alzheimer’s.(48) • One in eight people age 65 and older (13 percent) has Alzheimer’s disease.A2 • Nearly half of people age 85 and older (45 percent) have Alzheimer’s disease.A3 • Of those with Alzheimer’s disease, an estimated 4 percent are under age 65, 6 percent are 65 to 74, 44 percent are 75 to 84, and 46 percent are 85 or older. New Finding The study, conducted by Dr. Gary Landreth and published online in Science on February 9, 2012, found that in AD mice with significant accumulation of plaques administration of bexarotene removed 30% of plaques after 72 hours of treatment and 50% were removed after seven days. The microglial cells were activated and increased their rate of removal of beta-amyloid. Furthermore, the behavioral deficits that are seen in the AD mice with plaque accumulation was reversed within 72 hours of administration. These benefits persisted even after the bexarotene was stopped. Dr. Landreth hopes to secure FDA approval for Phase 1 human trials in healthy volunteers and the dosage will be much lower than the doses used in chemotherapy. Since the goal of eventual therapies developed from this discovery would be to maintain elevated levels of APoE and not necessarily to produce ever increasing amounts of APoE, a therapeutic dose might only be given several times each month. It remains to be seen if the startling results obtained in the mouse model will be reproduced in humans. One very interesting possibility that these findings point to is that the bexarotene appears to have cleared per-existing plaques. To date, most AD treatments have been directed at slowing or preventing the deposition of new plaques. For the estimated 5.4 million Americans with AD and millions more around the world, these findings are great news!   Links: http://www.sciencemag.org/content/335/6075/1503.abstract?sid=b6d9bfb5-0840-4b77-8d3f-0056f58ca21f http://abcnews.go.com/Health/Alzheimers/alzheimers-disease-doctors-prescribe-skin-cancer-drug/story?id=16962357 http://www.scientificamerican.com/article.cfm?id=alzheimers-disease-sympto Leonard Cruz, M.D. innerQuest Psychiatry & Counseling

High Anxiety and the Risks of Democracy: The Psychology of the American Voter

Reprinted from the Huffington Post http://www.huffingtonpost.com/pythia-peay/election-anxiety_b_1981971.html Written by Pythia Peay The presidential election is upon us and the body politic, buffeted by anxiety, is under stress. In part two of my interview with Jungian psychoanalyst Murray Stein, president of the International School of Analytical Psychology, he addresses the psychology around being a voter in America's large and ever-changing democracy. The following is an edited version of our conversation. Pythia: Every four years, American voters endure a period of anxiety as they wait and see who their next president will be. No one ever talks about this, but is this part of the territory that comes with participating in a democracy? Stein: Absolutely. A person living in ancient Egypt wouldn't have had to endure these seasons of anxiety around election time, since the pharaoh decided everything for them. So it does call for emotionally mature people to tolerate the uncertainties of an election. With all the money that's behind the creation of images and ads, the dilemma that voters face is whether they can believe what they see. But on a personal level, voters have to be aware of other psychological factors influencing their decision -- family dynamics, for example, such as "my father is voting for that candidate, so I'm choosing the other candidate." So the demand on voters to educate themselves in order to make a conscious choice when they pull that lever is very high. Pythia: I can imagine that for some citizens, the feelings of discomfort could become so pronounced they might even shy away from voting. Could you say more about how to tolerate these feelings of anxiety? Stein: Nobody likes anxiety. Pharmaceutical companies make a lot of money from this type of psychic pain by marketing anti-anxiety drugs. But the desire to be rid of anxiety is really a desire for regression to a childlike state where you don't have to worry about anything, because everything will be taken care of. Freud said that the ego is the seat of anxiety, because anxiety is linked to becoming a separate individual with choice and responsibilities. So those who are psychologically mature carry around anxiety all the time. If they're living their life fully, they're always taking risks, they know that the people they love are at risk, and politically they know that there are no guarantees that their candidate will win the election. Pythia: If the recent debates are any indication, it seems that one of the criteria by which Americans judge their presidents is their ability to be strong and aggressive. To an extent, I think it's important for a leader to possess these traits. But is our over-emphasis on strength part of our discomfort with freedom -- we want a powerful leader to compensate our anxiety? Stein: The desire to have a strong leader comes out of profound anxiety and the wish to get rid of it. People look for somebody to lead them, and to tell them what to do. But as history has shown, the so-called strong leader can sometimes be a dangerous figure. For a democracy like ours, it's better to have someone with common sense and the ability to find a sane balance among competing forces. What we look for in citizens in a democracy is that they are able to be strong individuals who can carry anxiety and accept the responsibility to vote according to the best interests of the country. They also accept the results if an election goes against their wishes. That's a part of maturity -- you can't win every game. An election is a contest, and someone will lose while the other wins. Pythia: On the issue of competition, I wonder if some of the anxiety voters experience around the election stems from the combative nature of American politics. For instance, one of my sons said he was excited to watch the debates because they were going to be like good boxing matches. I, on the other hand, experience a lot of anxiety around watching the two candidates go up against each other. In handling my anxiety in a mature way, do I have a duty to watch the debates despite my discomfort? Stein: These political contests are like a blood sport. The two candidates are highly trained political athletes; they know how to accept a victory or a loss. Some people who are watching the debates and the race get a thrill out of seeing whether their guy is winning or not, while others find it agonizing to watch. That said, there are some anxieties that aren't necessary to take on board. If watching the debates makes you too anxious, I would suggest you stay away from it, and study it afterwards. The most important duty of a citizen is to cast a ballot that is informed. Elections can go awry, people can elect the wrong person and then regret it. But these are the risks of democracy, and I don't see any other system given the stage in the evolution of consciousness that we're in today. Pythia: What does democracy have to do with the evolution of our human consciousness? Stein: As I alluded [to] earlier, people were once satisfied to live under rulers they believed it was their duty to obey. But that isn't the case today. Americans especially don't think like that. Increasingly, we're living in the age of the individual, and individuals demand a voice. If you take that freedom away, a huge pressure builds up; you can see this happening in the Middle East. So despite the inevitable setbacks, I believe that the growing awareness that the individual has rights, dignity and even a quasi-divine status as a soul is a part of the evolution of human consciousness. And basically democracy is the only system that respects this kind of awareness -- so we have to have democracy and bear the anxiety of these elections. Click Here to Read the Original Article in the Huffington Post
Please note - the following is an in depth film analysis and reveals film plot... I could anticipate the reactions of fellow moviegoers to The Black Swan as I walked out of the theater. Those who were vocal about it thought it preposterous and laughable. I found it to be a wonderful depiction of a young woman integrating her shadow and ultimately being destroyed by it within a psychologically intense battle ground of the theatre of the ballet. The external manifestations of Nina's delusions, hallucinations were violent and disturbing but I believe to be a perfect mirror into the inner violence, drama, that this type of person might experience in real life. So one has to step back from the imagery and not take it too literally to appreciate the psychology of the film. Is this woman in need of therapy? Of course, but pathologizing her problem will only distance her struggle from our own. And is not some of the world’s greatest art drawn from this very beautiful and brutal mosaic. The Black Swan is directed by Darren Aronofsky who also directed Requiem for a Dream and Pi, both of which explored the darker aspects of human nature. He continues that journey with The Black Swan but in this film the beauty of the ballet is contrasted with the stark brutal realities of the day to day rituals of the ballerina. We are confronted immediately with a world of bodily destruction from the daily exercise routines to the purging required to maintain a cachectic frame. In an interview by George Stephanopolous Natalie Portman chides a reviewer who called a ballerina “fat” in a production of the Nutcracker (retrieved from http://www.blogher.com/fat-ballerinas-black-swan-diet-dont-let-tiimes-set-tone) reheating the controversy behind the shadow realm of this beautiful art form. We have the tension of the opposites in the form of the extreme discipline of one’s body and the need for control and its opposite the need to abandon the ego and lose one self. The character of Nina embodies this tension and the risk of going to far in abandoning the ego. But before we discuss the end we must go to the beginning. The story of swan lake must be appreciated as this is the psychological backdrop of the film. Odette is a beautiful woman by night and by day a white swan, the result of a spell placed on her by the evil sorcerer Von Rothbart. The only way to lift the spell is by her falling in love with a prince. Prince Seigfried out hunting one evening witnesses the beautiful swan queen who is a swan wearing a crown and her transformation from swan to woman and falls in love with her and they spend the night together. The next day she becomes a swan again and he plans to marry her but the sorcerer anticipates this and brings his daughter Odile to meet him making her look like Odette. The prince marries her thinking it is Odette and Odette discovers the betrayal and returns to the lake. The prince discovers what he has done and goes to Odette and asks for forgiveness which she gives him but it is too late. The spell can now never be broken and she decides death is her only escape. In some versions the prince follows Odette to her death by drowning in the lake and in other versions she acts alone. The ballet Swan Lake becomes for Nina the perfect vas hermeticum within which she will be transformed. Being a swan half the time and a beautiful woman the other half, Nina (Odette) is under a spell cast by the evil sorcerer (Von Rothbart) who originally turned her into a swan. In order for Odette to be freed from the spell (become a whole person) she must fall in love with a prince (Seigfried). Nina's mother is the sorcerer who keeps Nina in the mother realm (swan realm). One is reminded of Rapunzel and the sorceress who keeps Rapunzel in the tower until the prince comes to rescue her. Nina's desire for ballet is the mechanism to work through this enchantment and disengage from this realm and from her mother in the process. Seigfried is the Director who, in his desire for a perfect ballet, tries to push Nina into herself to explore her shadow which is her sexuality, her ambitiousness, her jealousy, anger, rage, all of which is represented by Lilly (Odile) (sounds similar). The name Nina means "little girl" in Spanish and the meaning beind the name Lilly as the Black Swan, I suspect, it is taken from Odile the name for the Black Swan in the fairy tale and Lilly rhymes with Odile (short i and long e). Also it is the familiar form of Lillith the first woman who rejected Adam because she would not submit to a man. Lillith was considered evil because she was uninhibited and unrestrained so she was banished (to shadow). This is a perfect description of Lilly who is all that Nina is not. It is not surprising that Nina fantasizes making love with Lilly. Nina as a little girl can only grow up when she is able to confront her shadow. Her death is the price we pay when we give ourselves over to the archetypal completely without maintaining hold on the totality of our personality and its roots in the outer world. I love the fact that the movie begins with the emergence of this "other" that resembles Nina but is in the shadows. Nina sees her in glances at the train station, in the mirror, and it is Nina being pursued by her shadow from the very beginning. So the shadow is her and Lilly interposed and this is done visually throughout the movie. As this shadow self emerges it is sexual, confident, enraged at her mother, jealous, ruthless, and all what Nina is not. The stealing of Beth's (the old ballerina who Nina has replaced) possessions is very interesting. She wanted to be perfect and the stealing of these things, a nail file, and lipstick were a ritualization of acquiring the perfection that she saw in Beth. On a psychological level the scratching at her self was like cutting which is a way to ward of anxiety and more symbolically a way to get at the self lying beneath the surface only taking it to a literal extreme. It is also a way to feel as though one is regaining control over one's self, just as bolemia and anorexia are similar attempts to hold on to control. But the Director (therapist) is encouraging Nina to let go. This is not something she will accomplish by controlling herself but only by letting go of herself. So the Director, as the hero, must pull Nina out of the mother realm (the tower) and away from the literal mother. Nina (Odette) must die so the merging of the black swan and white swan can create the transcendent third. The integration of the shadow must result in the death of the ego, the old self, the staus quo. When Nina offers her final words that she is now perfect she has gone from one extreme to another. To be perfect she would need to be the Black Swan and she becomes so. The risk in integration of the shadow is one can be consumed by it and overidentify with it and become psychotic. So Nina goes from one Swan to another but remains a swan, inflated, disconnected from the outer world, relationships, and in the end dies. We may also see Nina as the puella capitvated by this archetype. As a swan she is in the realm of sublimatio flying high in the sky. The swan is connected to the sky and to water As a woman she is shackled to a brutal discipline The swan is connected to the sky and the water (unconscious) but in order for Nina to become a whole person she must come down to earth (coagulatio). The tension between these two realms will create a third called circulatio, the merging of these two realms. "It ascends to the heavens and descends to the earth and receives the power of above and below. Then you will have the glory of the whole world. Therefore all darkness will flee from you” (Edinger). But she is overtaken by the darkness; darkness did not flee her. She was unable to keep the two realms in tension, the swan realm and the human realm. When she fell to earth it was as a wounded swan as if she had been shot by Seigfried from the very beginning. It is a perfect image at the very end of the ballet and the movie in which Nina falls to the earth-her swan nature must become personalized, so she can become a person she is intended to be. Flying high above the earth she was ambitious and fantasy-bound so the fall on stage was both the death of the puella, the swan nature, the death of Nina and the integration of the black swan Lilly, who she killed psychologically. In the audience we see the mother who seems to need Nina to complete this transformation, as much as she resisted it in life and perhaps a transformation her mother was never able to complete. We do inherit our parents’ shadow content and Nina seems to sacrifice herself for this transformation. - Dan Ross, RN
I just finished viewing the film We Have to Talk About Kevin. I watched the film primarily out of obligation as we are about to host a seminar on it. I knew nothing about it, other than Dan Ross was moved by it and wanted to lead a seminar about “the Predator.” I was absolutely blown away by the film and sit here in a stunned state. I don’t write many blog’s for the Asheville Jung Center. In fact I haven’t written any prior to this; but I sit here so stunned that I feel I have no choice. I’m a psychiatrist and have been practicing some 20 years now. I’ve seen many wonderful patients over the years and been delighted by their dreams and stories. I’ve also, however, had a handful of patients that make my hair stand on end and keep me up at night. I’ve run into patients that seem to have no conscious at all; that have no remorse for any act. I’ve had rageful patients, incredibly abusive spouses and even one that shot his wife and his two children execution style. I’ve been haunted by these encounters and never truly known what to do with them. This film brought these feelings and memories into Technicolor and left me stranded on a desolate reef. What is a sociopath? How are they formed? Is it nature, nurture, or a cruel act of fate? How can anyone sink to the level of random murder? Anyone who has been horrified by Columbine or any mass killing or even the sociopathic car salesman talking you into the wrong vehicle must see this film. Be prepared to lose your grounding of what you thought was typical humanity and be left in a disturbing paralysis. Regardless of whether you can make our seminar next week or not, do see this movie. It hits the absolute bowels of our society, but you will not regret it. Steven Buser, MD Founder, Asheville Jung Center
It’s been 11 years since 9-11 and in that period of time it seems there has been little progress made toward bridging the enormous divides that existed and possibly contributed to the iconic images the world recorded on that fateful Tuesday. If some of those responsible for flying airplanes into the Twin Towers of the World Trade Center imagined they were redressing a wrong committed when infidels occupied holy lands to Muslims in the first Gulf War, their dramatic action led to an even larger presence of Westerners throughout the Middle East. Westerners watched the carnage of 9-11 and the United States briefly received the heartfelt empathy from people around the world but within months our military might was acting with a sort of collective bravado that made President Bush's premature declaration of victory not only wrong but absurd. Coming September 20, 2012 "Bridging West and East: C. G. Jung and richard Wilhelm, a Fateful Relationship" Within 7 years of 9-11 the world witnessed the United States of America elect its first Black President, surely a sign of hope that differences were being overcome. However, bridging the divide between Islam and the West, between the poor and the rich, or even between blacks and whites in America has proven difficult. Eleven years after the world witnessed nearly 3000 people consumed in a blaze fueled by hatred as much as unspent jet fuel, the lessons that might have been learned go unrecognized. Jung and analytical psychology have had answers to some of these most vexing problems. That the psyche may dichotomize the world of its impressions, that enantiodromia is as fundamental a feature of psychological function as the wave/particle duality is a fundamental feature of an electron, and that there are paths that allow a person to transcend such dichotomies are well established after nearly a century of Analytical Psychology. In fact, those avenues explored by Jung to contend with the divides of our psychological life have much earlier roots. When Richard Wilhelm set out as a Christian Missionary to China he left behind the conventional practice of Western Missionaries that begins and ends in the goal of conversion. Instead, he entered his mission field with deep respect and reverence for a culture and its people with thousands of years of collective history. While he served he also listened and opened himself to the wisdom that was before him. Because of that attitude, he was able to notice the jewel of the The Secret of the Golden Flower when he came upon it. He applied himself to translating it into German and thereby broadened that avenue by which Westerners might seek to reconcile apparent opposites.   Eleven years has been accompanied by dramatic changes. Here are some examples of things the world witnessed since the collapse of two towering and iconic images of Western capitalism.
  • Countless lives lost through war, terror, starvation, treatable diseases, senseless gun violence, and downstream health effects of environmental degradation.
  • Countless efforts by poor, disenfranchised people around the world to secure basic human rights including the Arab spring, Chinese dissidents, striking South African mine workers, self-immolation by Tibetan Buddhist monks, an indigenous leader delivers a petition with 600,000 signatures to the Brazilian government demanding that construction of a $10 billion dam be halted (Ireo Kayapo), Occupy WalL Street protesters seeking to diminish economic inequalities, women seeking inclusion and seeking basic safety and protection, and much more.
  • Repeated instances of threatened economic uncertainty related to a hyperfocus upon principles that are becoming enshrined despite conflicting evidence. When taken to extremes, these ideas contribute to uncertainty and dramatic reversals. They include: the invisible hand made famous by Adam Smith’s infrequent invocation, free trade, globalization, deregulation, high frequency trading (H.F.T.), procurement of natural resources (like rare earth elements), ECB and debtor nations like Greece, Spain, Ireland, Portugal), and more.
  • Developing shifts in power from West to East, from North to south, from mature industrialized to emerging , industrializing nations.
  • Countless threats of tipping points being reached in terms of environmental degradation like: the accumulation of toxins in the Pacific garbage patch, global warming accelerating the melting of Arctic ice, Colony Collapse Disorder that is threatening bee populations, food and water supply shortages, debris from the Japanese tsunami washing ashore in the US introducing potentially invasive species, and loss of biodiversity.
  • Introduction of potentially disruptive technology like: introduction of genetically modified foods, genomic research (including gene therapy), adoption of WiFi, adoption of Bluetooth standards, the public offering of Google (2004), Facebook is launched (2004), adoption of LED lighting, the opening of GPS (approx. 2004), Twitter is launched (2006)the first release of the iPhone (2007), introduction of the Kindle e-ink reader (2007), the release of the first iPad (2010), wider use of hydraulic fracturing (fracking), expansion of deep water oil drilling,
Bridges to connect the vast differences between Islam and the West or the East and the West. There is a tinderbox full of volatile issues that can easily be ignited. On September 20, 2012 The Asheville Jung Center, in conjunction with ISAPZurich, will be presenting “Bridging West and East: C. G. Jung and Richard Wilhelm, a Fateful Relationship”. Dr. Murray Stein, along with Bettina Wilhelm (Richard Wilhelm’s granddaughter, and Shiuya Sara Liuh , a Training Candidate at ISAPZurich, will present the conference. Richard Wilhelm translated the I Ching and The Secret of the Golden Flower , two books that had profound effect upon C. G. Jung.   The polarization between nation states, between cultures, and even between factions with different cultures has become more exaggerated since the collapse of the Twin Towers 11 years ago. Richard Wilhelm devoted himself to bridging the chasm between the cultures of the East and West. Perhaps one way we can honor the 11th anniversary of 9-11 is to rededicate ourselves to building bridges that transcend the polarizations that continue to reassert themselves. Let us allow the streams from many different traditions to merge into a mighty river whose force can wash away any residue of fear and animosity arising from the illusions about our human condition. Many readers of the AJC are People of the Book. The following words are offered as a sort of meditation, you are invited to approach it as a sort of lectio divina. “You must be free from the pairs of opposites. Poise your mind in tranquility.” (Bhagavad Gita) “And thus have We willed you to be a community of the middle way, so that [with your lives] you might bear witness to the truth before all mankind,” (Qur'an al-Baqarah2:143) “The wolf also shall dwell with the lamb, and the leopard shall lie down with the kid; and the calf and the young lion and the fatling together; and a little child shall lead them.” (Isaiah 11:6) Jesus said to them: When you make the two one, and when you make the inside as the outside, and the outside as the inside, and the upper as the lower, and when you make the male and the female into a single one, so that the male is not male and the female not female, and when you make eyes in place of an eye, and a hand in place of a hand, and a foot in place of a foot, an image in place of an image, then shall you enter [the kingdom]. The Gospel of Thomas (Nag Hammadi Coptic Text) ““Nothing can exist without its opposite; the two were one in the beginning and will be one again in the end.” (C. G. Jung)   "When yang has reached its greatest strength, the dark power of yin is born within its depths. For night begins at midday when yang breaks up and begins to change to yin." (Commentary by C. G. Jung in the Secret of the Golden Flower)   “Thus one can no longer maintain the division between the observer and the observed. (in quantum theory) Rather, observer and observed are merging and interpenetrating aspects of one whole reality… (Wholeness and the Implicate Order 1981, p.9 )   “There were two brothers, the Black Knight and the White Knight, and they set off on a quest, each on his own, one going north and the other one south. After many years they met in a dark wood, and did not know each other. They immediately assumed that they were enemies until, when both were lying bleeding to death on the grass, they undid their helmets and recognized that they were brothers.” (Journey Inward, Journey Outward 1968, p.2)   Len Cruz