A review of The Future of the Mind: The Scientific Quest to Understand Enhance, and Empower the Mind

The Future of the Mind, authored by physicist Dr. Michio Kaku, explores how neuroscience might inform questions that philosophers have been debating for centuries: Do we have a soul? What happens after we die? Do we even have to die? And what would it take to produce a robot with human consciousness or emotions? To explore these questions, Dr. Kaku interviewed hundreds of scientists who are actively conducting ground breaking work in labs around the world, and from these conversations he made predictions on how these scientific findings would shape our future. The work that Dr. Kaku discusses, such as the latest advances in brain-computer-interfaces (BCI) for the disabled,¹ recording dream images with MRI machines,² or implanting memories in mice,^3,4 makes for a fascinating and engrossing read from start to finish. The Future of the Mind is at its best when taking readers through these areas of research and explaining the long-term significance, however many of the neurophilosophical questions posed are largely left to the readers’ imaginations for resolution.



The Future of the Mind is divided into three parts or books, and each book delves more and more into the technology of the future and the type of society that will exist decades and centuries from now. Book I sets the stage for how important physics is for neuroscience; the revolutionary technologies such as MRI, PET, and DBS have used basic physics knowledge, as Dr. Kaku notes, to promote the explosion of advances in the field of neuroscience. The state of these technologies in current research is introduced, along with how to conceptualize consciousness, and in Book II, he discusses how these technologies will enable us to conduct acts similar to telepathy and telekinesis, manipulate thoughts and memories, and enhance intelligence. Book III revisits the idea of consciousness and explores the possibilities related to mind-altering technologies, and suggests we reframe our understanding of consciousness beyond a single type of consciousness (i.e., dreaming, drug-induced states, and mental illnesses). He also suggests that the future understandings of consciousness may move beyond humans to include robots and aliens. Book III also explores ideas straight out of science fiction such as that one day our physical bodies will be too cumbersome for travel to other galaxies through deep space, so we’ll simply leave them behind.

Dr. Kaku excels at taking complex, difficult scientific research and explaining the work in such a way that is easily accessible to the public. His predictions are based on the most recent advances in science, and the criteria for his predictions are that 1) they must obey the laws of physics and 2) a working prototype must exist. For these reasons, even the most far-fetched ideas seem reasonable when presented in his easy to read, pop-culture referenced style. He describes proof-of-concept experiments that take place in mice or primates today and then tries to relate this to what could happen by the end of the century in humans. The Future of the Mind mostly takes place in the science of today and the science of decades and centuries from now, however it does not critically describe the science of tomorrow or even the immediate future.  For example, although we are probably quite far away from directly transferring complex memories to other people, recent work has shown that devices like transcranial magnetic stimulation (TMS) can enhance memory. This could potentially be used to change how the law operates by enhancing eyewitness memories,⁵ although the current implications of TMS are hardly mentioned. Despite focusing more heavily on the technologies that seem almost like science fiction in nature, Dr. Kaku makes current research clear, accessible, and informative to general audiences. The conversations within the book and Dr. Kaku’s effective communication style are perhaps particularly relevant now. With the announcement of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative by President Obama and the Human Brain Project by the European Union, the general public will increasingly need to find resources to enhance their awareness of what neuroscientific advances could potentially be forthcoming



The Future of the Mind is the most engaging when it presents a well-organized breakdown of future technologies; however, a large portion of the books is dedicated to theory of consciousness and altered states of consciousness. Even though Dr. Kaku is well-versed in these subjects and acknowledges the help of over 200 individuals in researching material, he overly simplifies what it means for humans to be conscious and then applies his overly simplistic definition to complex areas of study such as altered consciousness, the consciousness of the future, and alternative beings that may be conscious. Dr. Kaku refers to his theory of consciousness as the “space-time theory of consciousness” and is defined as “the process of creating a model of the world using multiple feedback loops in various parameters in order to accomplish a goal.” In physics, space-time is any formula or model where space and time are placed onto one continuum, and Dr. Kaku, a theoretical physicist who also studies string theory, defines consciousness within these two parameters. In this theory, there are four levels of consciousness, 0 – III, and every organism is assigned a second numerical value associated with how many feedback loops, or parameters of space, he is able to interact with. For example, plants are placed in the lowest level, level 0, but if a plant is able to regulate itself based on 3 parameters (temperature, sunlight, and moisture) it would have a value of 0:3, where 0 represents the level of consciousness on his space-time theory continuum and 3 is the number of feedback loops that the plant is able to use for regulation. Humans are distinct from other organisms in that humans are able to model a situation not only in respect to space, but also time; we can plan ahead not only for tomorrow, but also for times beyond our lifetime. We are capable of “mediating and evaluating many feedback loops in order to accomplish a goal.” A numerical value can also be assigned to humans based on how many realistic outcomes, or parameters of time, a person can model for a specific outcome (e.g., III:100). Human consciousness is understandably a huge task and an enormous area of evolving research, but Dr. Kaku aims to dissolve the difficulties with his theory in explaining this concept and providing a definition in terms that are well applied in the physics field. However, it is unconvincing that consciousness can be reduced to a two value numeric though, especially when discussing disorders of consciousness. Dr. Kaku applies his theory to a few mental disorders including schizophrenia and OCD, stating that problems arise when feedback loops are in conflict. For example, paranoia is an imbalance between the amygdala that recognizes fear and the prefrontal cortex that evaluates this fear. Dr. Kaku does state that this is only a “preliminary sketch,” and future research will unveil the complexities of mental illness that are not discussed in The Future of the Mind.

Photo from: psychpulse.com

While the description of human consciousness is shaky at best throughout the entire book, one of the most engrossing chapters describes the ideas behind silicon consciousness, or how machine intelligence could evolve so that robots are able to feel emotionally and conduct sophisticated thought processes, including those that involve ethical choices. The space-time theory of consciousness is applied to robots that have been developed today and the future state of robotics. While this model is overly simplified in terms of the complexity that is human consciousness, this model actually works quite well when describing robots because robots are still mostly confined to laboratory settings. Today, robots are really simple machines that belong in level I in Dr. Kaku’s space-time theory (one step above plants) because they do have the ability to use physical space as a parameter and they may have a few different sensors that act as feedback loops.  In his model of consciousness, robots would have to be able to interact with others and use this interaction as a feedback loop to enter level II to have any sense of emotional value. To be on par with humans on level III where the threat of take-over is near, robots must be able to use time as a parameter in which they make decisions. Placing robots on the same level as a worm puts the idea of the singularity, the point when artificial intelligence surpasses human intelligence, into perspective. Although the space-time theory works to describe the state of robotics today, this theory will eventually fall short as technology become more sophisticated.



In speaking of the future that is decades and centuries away Dr. Kaku heavily references the transhumanist Dr. Ray Kurzweil’s ideas that we will have the potential to upload our consciousness onto computers, clone humans, or have nanobots that will keep us healthy, although Dr. Kaku is a bit more conservative in acknowledging many of the obstacles for each of these causes. Similarly to Dr. Kurzweil though, Dr. Kaku does believe that silicon consciousness and advances from the BRAIN project will carry us into the future and trusts that “the real impact of this technology…will be to liberate the mind, not enslave it.” This is a powerful statement and idea that is continually conveyed, and ultimately what makes a reader want to live to experience a day in the not so near future if it is anything like what The Future of the Mind predicts. In making these bold predictions Dr. Kaku delivers a book that laudably describes the science taking place today and potentially in the future. These scenarios raise numerous ethical questions such as how using such consciousness scales will impact our healthcare practices or the legal status of nonhuman animals and silicon “minds,” or even how cognitive privacy will be protected in a society where mind-reading is possible.  If the society that The Future of the Mind poses is realized, the socioethical implications of such technological advances will need to be addressed beyond just the readers’ imagination, but by scientists and policy makers alike.





References



(1) Homer, M. L.; Nurmikko, A. V.; Donoghue, J. P.; Hochberg, L. R. Sensors and Decoding for Intracortical Brain Computer Interfaces. Annu. Rev. Biomed. Eng. 2013, 15, 383–405.



(2) Horikawa, T.; Tamaki, M.; Miyawaki, Y.; Kamitani, Y. Neural Decoding of Visual Imagery During Sleep. Science 2013, 340, 639–642.



(3) Liu, X.; Ramirez, S.; Pang, P. T.; Puryear, C. B.; Govindarajan, A.; Deisseroth, K.; Tonegawa, S. Optogenetic Stimulation of a Hippocampal Engram Activates Fear Memory Recall. Nature 2012, 484, 381–385.



(4) Ramirez, S.; Liu, X.; Lin, P.-A.; Suh, J.; Pignatelli, M.; Redondo, R. L.; Ryan, T. J.; Tonegawa, S. Creating a False Memory in the Hippocampus. Science 2013, 341, 387–391.



(5) Vedder, A.; Klaming, L. Human Enhancement for the Common Good—Using Neurotechnologies to Improve Eyewitness Memory. AJOB Neurosci. 2010, 1, 22–33.







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Strong, K. (2014). A review of The Future of the Mind: The Scientific Quest to Understand Enhance, and Empower the Mind. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/a-review-of-future-of-mind-scientific.html

Translating Preclinical Test Results into “Real World” Consequences

By Jalayne J. Arias, JD, MA



Jalayne J. Arias is the Associate Director of the NeuroEthics Program and Assistant Professional Staff in the Department of Bioethics at the Cleveland Clinic. Ms. Arias’ work incorporates empirical and conceptual projects addressing critical legal and ethical issues inherent in diagnosing, treating, and researching Alzheimer’s disease and other neurodegenerative conditions. Most recently, she served as the principal investigator for the study Stakeholders’ Perspectives on Preclinical Alzheimer’s Diagnosis: Patients, Families and Care Givers. Her recent publication, Confidentiality in preclinical Alzheimer disease studies (Neurology), addresses confidentiality concerns relevant to biomarker testing in Alzheimer’s.



In 2007, Dr. Dubois and co-authors introduced the concept of prodromal Alzheimer’s disease in their Lancet article revising diagnostic criteria. In 2011, the National Institutes of Aging and the Alzheimer’s Association supported a series of papers introducing a new paradigm for diagnostic criteria, including Mild Cognitive Impairment and preclinical Alzheimer’s disease. Both papers and new definitions of Alzheimer’s disease incorporate the discovery of Amyloid beta, a biomarker that purports to indicate disease pathology. The concept of using biomarkers, which are detectible years before a patient begins experiencing symptoms, offers the potential for offering preclinical testing in the clinical context. Yet, as researchers continue to validate biomarkers, little is known about how preclinical test results may affect patients and their families.



The Reveal Studies have examined the potential consequences of disclosing genetic disposition to Alzheimer’s to patients. Results indicated that individuals who learned they were APOE positive were more likely to purchase long-term care insurance. Additionally, an assessment of psychological outcomes resulted in data supporting that there were no long-term psychological consequences for individuals who learned they were APOE positive. Important differences between genetic markers for Alzheimer’s and biomarkers, including amyloid beta, should be acknowledged. First, a genetic disposition indicates a risk factor. Comparatively, a biomarker is purported to indicate active disease process. Whether this distinction will have psychological impacts is not yet know. However, another key difference must be highlighted. Unlike genetic information, biomarkers are not protected under the Genetic Information Non-Discrimination Act. This raises questions about individuals who have or will have biomarker status documented in their medical records. Are there legal mechanisms that protect again discrimination based on biomarker status? Could, or even should, insurers or employers use biomarker status to make decisions regarding employment and insurance eligibility?



While these questions seem premature, given the fact that biomarkers are not currently being used in clinical settings to detect Alzheimer’s at the preclinical state, they are being used in other contexts. A recent task force of the Society of Nuclear Medicine and Molecular Imaging and the Alzheimer’s Association evaluated the appropriate use for Amyloid PET. Their conclusions indicate that Amyloid PET imaging may be appropriate in a sub-population of patients. Additionally, biomarker testing is done in the research context. In some studies, researchers are using biomarker status as an inclusion criterion. Given this, by definition, those enrolled in such studies are biomarker positive, which effectively discloses biomarker status. An initial evaluation of the potential legal protections showed that there are minimal and potentially no federal protections for individuals who are enrolled in these studies. As a result, if biomarker status becomes a part of a research participant’s medical record, which is then disclosed to employers or insurers, there may be adverse consequences for participants without viable recourse.

Arias JJ and Karlawish J (2014)

Additional research is needed in this area, including gaining a better understanding of the legal consequences and protections for individuals who are amyloid positive or positive for other biomarkers that indicate disease pathology. This research should also examine if and how insurers and employers would use this information. Another research question is whether biomarker status should be a factor in determining whether an individual may pose a public safety risk in the future should they continue to remain employed and develop cognitive impairment. For example, should an employer be able to use biomarker status when considering employment decisions for a bus driver or an accountant? While researchers continue to work towards validating biomarkers that purport to indicate active disease pathology, parallel research on the consequences for individuals with positive biomarker status will be imperative.





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Arias, J. (2014). Translating Preclinical Test Results into “Real World” Consequences. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/translating-preclinical-test-results.html

When is diminishment a form of enhancement? Another twist to the “enhancement” debate in biomedical ethics

By Brian Earp, MSc

Photo by Rob Judges

Brian Earp is a Research Fellow at the Uehiro Centre for Practical Ethics at the University of Oxford. He is an interdisciplinary researcher with training in cognitive science, experimental (social) psychology, philosophy, and ethics. With Professor Julian Savulescu, Brian is writing a book on the neuroenhancement of love and marriage, to be completed this year.

There is a big debate going on about “enhancement.” For many years now, people have realized that new technologies, along with discoveries in neuroscience and pharmacology, could be used in ways that seem to go beyond mere “medicine” – the treating of deformity or disease. Instead, to use a phrase popularized by Carl Elliot, they could make us “better than well.” Faster, stronger, smarter, happier. Quicker to learn, slower to forget. It has even been suggested that we could use these new technologies to “enhance” our love and relationships, or make ourselves more moral. 



These kinds of prospects are exciting to some. To others, they are frightening, or at least a cause for concern. As a result, there has been a stream of academic papers—alongside more popular discussions—trying to get a handle on some of the ethics. Is it permissible to take “medicine” even if we aren't “sick”? Should we be worried about “Playing God”? Do some people have an obligation to enhance themselves? And so on.



At least one major problem has been lurking in the background. And that is that, quite simply, “enhancement” could mean almost anything. Definitions are often vague, if they’re attempted at all. Some authors resort to simply listing out various interventions, with the hope that the reader will somehow “intuit” how they all hang together. But there are some common themes. In a recent paper with my colleagues Anders Sandberg, Guy Kahane, and Julian Savulescu, I called attention to at least two major “approaches” to understanding the term enhancement that seem to crop up in the academic literature.



The first is the Functional-Augmentative Approach to Enhancement. According to this type of approach, “interventions are considered enhancements insofar as they improve some capacity or function (such as cognition, vision, hearing, alertness) by increasing the ability of the function to do what it normally does.” The debate then usually turns on whether it’s OK to “enhance” someone (in this sense) who doesn’t have a “medical” problem, at least not on that particular dimension. This then leads to a second way of understanding enhancement, which we called:



The Not-Medicine Approach to Enhancement. According to this type of approach, to quote the bioethicist Eric Juengst, “the term ‘enhancement’ [characterizes] interventions designed to improve human form or functioning beyond what is necessary to sustain or restore good health.” This is the sense of “better than well” that many people (seem to) have in mind when they are engaging in these kinds of debates.



Both of these definitions have flaws. For one thing, they focus almost exclusively on the “augmentation” of capacities or functions—on “going beyond” the ordinary limits of medicine, or even human nature. But what about interventions that work in the opposite direction? One common example of “enhancement”—found throughout the neuroethics literature—is the use of drugs or other technologies to “blunt” painful memories (for example, after a breakup). Although such an intervention is clearly relevant to these discussions, it seems a little bit more like a “diminishment” than an “enhancement.” How should we consider cases like this?



Here are some other examples. What about the use of “anti-love biotechnology” to help a victim of domestic abuse break ties with her abuser? Or voluntary “chemical castration” for pedophiles seeking to change? To pick something less disturbing, how about appetite suppressants to help someone with her dieting goals? Enhancements? Diminishments? Both?



There’s a simple solution to this puzzle. All of these interventions are “enhancements” in the sense that they are geared toward improving well-being. “That is, once we shift our focus from the particular capacity or function being modified, to the overall normative goal of the modification itself” we stumble upon a third approach to understanding enhancement, which we call:



The Welfarist Approach to Enhancement. On this approach, “enhancement” is defined as “any change in the biology of psychology of a person which increases the chances of leading a good life in a given set of circumstances.” As we explore in our paper—see below for the reference and a link—we think that this approach resolves a number of conceptual ambiguities in the bioethics literature, and offers a useful framework for thinking through the use of new technologies in terms of how they can promote human flourishing. We look forward to hearing what you think!







This post can also be viewed on the Psychiatric Ethics Blog. 



Highlighted paper [open access]



Earp, B. D., Sandberg, A., Kahane, G., and Savulescu, J. (2014). When is diminishment a form of enhancement? Rethinking the enhancement debate in biomedical ethics. Frontiers in Systems Neuroscience, Vol. 8, Article 12, 1-8.



Related reading [open access]



Earp, B. D., Sandberg, A., & Savulescu, J. (2014). Brave new love: The threat of high-tech “conversion” therapy and the bio-oppression of sexual minorities. American Journal of Bioethics: Neuroscience, Vol. 5, No. 1, 4-12.



Earp, B. D., Wudarczyk, O. A., Sandberg, A., & Savulescu. J. (2013). If I could just stop loving you: Anti-love biotechnology and the ethics of a chemical breakup. American Journal of Bioethics, Vol. 13, No. 11, 3–17.



Earp, B. D., Sandberg, A., & Savulescu, J. (2012). Natural selection, childrearing, and the ethics of marriage (and divorce): Building a case for the neuroenhancement of human relationships. Philosophy & Technology, Vol. 25, No. 4, 561-587.



Wudarczyk, O. A., Earp, B. D. , Guastella, A., & Savulescu, J. (2013): Could intranasal oxytocin be used to enhance relationships? Research imperatives, clinical policy, and ethical considerations. Current Opinion in Psychiatry, Vol. 26, No. 5, 474-484.





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Earp, B. (2014). When is diminishment a form of enhancement? Another twist to the “enhancement” debate in biomedical ethics? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/when-is-diminishment-form-of.html

(en)Gendering psychiatric disease: what does sex/gender have to do with posttraumatic stress disorder (PTSD)?

Mallory Bowers is a 5th year Neuroscience doctoral candidate working with Dr. Kerry Ressler at Emory University. Prior to graduate school, Mallory received her Bachelor of Arts from the University of Pennsylvania. Mallory is interested in behavioral neuroscience, with a particular focus on how neural plasticity contributes to learning. With Dr. Ressler, Mallory is using a mouse model of exposure-based psychotherapy to better understand the neurobiology of learned fear. Specifically, her research focuses on a potential interaction between the cholecystokinin and endogenous cannabinoid systems that may underlie extinction of cued fear. Mallory was on the organizing committee for the 2013 “Bias in the Academy” Conference and is President of Emory Women in Neuroscience (E-WIN).



As I’ve become more entrenched in the PTSD field, I’ve been struck by the prominent sex/gender difference in the prevalence of PTSD (among many other psychiatric disorders) and the categorical use of male animal models. As researchers begin to explore sex differences in animal models of stress, anxiety, and fear, evidence suggests that male animals are more vulnerable to acute and chronic stress, while females appear to be more resilient (Cohen and Yehuda 2011). The results of these animal studies contradict the human epidemiological data, with lifetime prevalence of PTSD at 10-14% in women and 5-6% in men in the United States (Breslau, Davis, et al. 1991, Breslau, Davis, et al. 1997, Kessler, Sonnega, et al. 1995, Resnick, Kilpatrick, et al. 1993). In this post, I’d like to explore the ways in which socio-cultural conditioning genders an individual’s sense of self, influences definitions and language surrounding mental health, and supports frameworks of gender bias (a putative low-grade, chronic stressor) - potentially contributing to sex/gender differences observed in the prevalence of certain psychiatric disorders, specifically PTSD.



Sex and Gender Primer



Sex refers to the biological and physiological characteristics that define men and women, including sex chromosomes, gonads, and hormones. The definition of gender is more complicated, but generally refers to socially and culturally endorsed roles, behaviors, and activities for men and women. Gender can describe the relationship between one’s traits and one’s sense of self as male, female, or somewhere in between. Social and cultural influences promote gender scripts from infancy throughout adulthood. For the purposes of this post, I use the term sex/gender to acknowledge the importance of both physical and cultural features, particularly in describing the interpretations of data from human research.

Via BigStockPhoto.com

Importance of self-definition



Consistently, evidence from psychology research suggests that sense of self and self-definition (also referred to as self-construal) can function as a lens through which individuals can interpret information (Wyer and Srull 1984). Rigid gender roles in Western cultures, some have suggested, could differentially impact the development of self-construal (Cross and Madson 1997, Cross, Bacon, et al. 2000). In considering sex/gender differences in prevalence of PTSD, could a gendered self-construal precipitate risk for PTSD by influencing interpretation of trauma? In fact, trauma severity is thought to contribute to prevalence of PTSD, where trauma severity is defined by subjective emotional response that varies based on individual perception (Foa, Zinbarg, et al. 1992, Kessler, Sonnega, et al. 1995, Yehuda 2002, Yehuda 2004).



Interestingly, analysis of US epidemiological data reveals sex/gender differences in PTSD for certain types of trauma – specifically, trauma that involves interpersonal conflict. Kessler et al. find significant sex/gender differences in rates of PTSD when trauma involves molestation, physical attack, combat, shock, threat with a weapon, physical abuse, or witnessing injury or death (Breslau, Davis, et al. 1991, Kessler, Sonnega, et al. 1995). Men and women develop PTSD at comparable rates when trauma involves sudden injury, accident, natural disaster with fire, or witnessing injury or death (Breslau, Davis, et al. 1991, Kessler, Sonnega, et al. 1995). This suggests that it is not merely the presence of trauma, but the interpretation of a specific trauma that results in sex/gender differences in the prevalence of PTSD. If trauma severity - shaped by an individual’s subjective perception - influences risk for PTSD and perception (or self-construal) is gendered according to socio-cultural conditioning, then researchers need to address whether strict gender binaries influence self-construal and/or traits that differentially precipitate risk for PTSD.



Gendered representations of PTSD



Although I propose that gendered self-construals could interact with particular types of trauma, manifesting in differential rates of PTSD among men and women, this is likely not the sole mechanism contributing to sex/gender differences in rates of PTSD. One possibility is that sex/gender specific presentations of PTSD in men leads to “misdiagnosis”. Young girls who are exposed to trauma are more likely to report “internalizing” symptoms - depression, anxiety, and hyperarousal, whereas boys more often report “externalizing” symptoms, such as aggression and conduct problems (Buckner, Beardslee, et al. 2004, Gustafsson, Larsson, et al. 2009). Men present with more denial, emotion control, behavioral problems, suicidality, violence, and substance abuse following sexual trauma (Darves-Bornoz, Choquet, et al. 1998, Kaufman, Divasto, et al. 1980). These externalizing versus internalizing symptoms, some have posited, contribute to sex/gender differences in the diagnosis of antisocial personality disorder (ASPD) and borderline personality disorder (BPD) – which some have suggested are the same disorder with gender specific presentations (Hudziak, Boffeli, et al. 1996, Lobbestael, Arntz, et al. 2005). With differential rates of PTSD among men and women, potentially derived from differences in symptomatology, one reasonable question to ask is - are there gender essential psychiatric disorders? This is particularly interesting, as most psychiatric disorders are not diagnosed by “objective” measures, such as biomarkers, but by suites of symptoms characterized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This question might be clarified by comparing the symptomatology of psychiatric disorders that present with sex/gender differences.



The stress of gender bias



Moreover, is gender inequality generally stressful – possibly contributing to higher rates of PTSD and other psychiatric disorders in women? Notably, several international studies (conducted in Canada, Australia, Germany, and Switzerland) have not found significant sex/gender differences in the prevalence of PTSD (Creamer, Burgess, et al. 2001, Lukaschek, Kruse, et al. 2013, Maercker, Forstmeier, et al. 2008, Stein, Walker, et al. 1997). According to the 2013 Global Gender Gap report, these countries rank equal to or higher than the United States on an index measuring the percentage of inequality between men and women that has been closed (meaning, these countries have lower rates of sex/gender inequality than the United States). The stress of microaggressions (Sue 2010) related to gender bias and discrimination is likely to exert long-term ramifications, potentially contributing to rates of psychiatric disease like PTSD, as research demonstrates that pre-trauma risk factors like life stress predict PTSD (Brewin, Andrews, et al. 2000).



Interestingly, researchers have begun to uncover links between chronic stress - which often precipitates psychiatric disease - and rates of cellular aging. Cellular environment, which can be regulated by perceived stress via oxidative stress, plays an important role in controlling telomere length (Epel, Blackburn, et al. 2004). Telomeres are regions of repetitive nucleotide sequences that protect the end of chromosomes. Telomeres protect gene truncation during DNA replication, as DNA polymerases are unable to continue DNA duplication through the end of chromosomes (Blackburn and Gall 1978). Studies suggest that oxidative stress shortens telomeres, and that antioxidants can decrease the rate of shortening (von Zglinicki 2002). African-Americans who are subject to significant racial discrimination, due to “weathering” or higher psychosocial stress, exhibit greater rates of telomere shortening compared to Caucasians (Rewak, Buka, et al. 2014). Further, African-Americans who report more interpersonal experiences of racial discrimination and have greater internalized negative racial bias have shorter telomere lengths compared to other African-Americans (Chae, Nuru-Jeter, et al. 2014). Some researchers report higher rates of PTSD among African-Americans compared to other races, although the literature is mixed, potentially due to problems of underreporting of psychiatric disease in African-Americans (Breslau and Anthony 2007, Kessler, Sonnega, et al. 1995). As in African-Americans, telomere length could provide a biological correlate of psychosocial stress due to gender bias, which could, in part, offer an explanation as to why women are more likely to develop PTSD. Addressing the question of whether the stress of gender inequality contributes to higher rates of PTSD and other psychiatric disorders is likely to be extremely complicated. However, the results of these studies could be transformative in how we think about psychiatric disease and how we might design and conduct future research to identify novel targets for treating and preventing PTSD.

Telomere Shortening (via nia.nih.gov)

Future directions and recommendations



By exclusively focusing on animal studies, or worse – conflating sex and gender in human research, researchers may accidentally disregard an important source of influence on neurobiology – society and culture. To avoid this ambiguity, scientists are advised to be discerning when referring to “sex” and “gender” in the interpretation of data (e.g. gender may not be appropriate when discussing a mouse model). As most human research is correlative, researchers will be unable to tease apart whether differences are attributed to sex or gender (to state otherwise would be un-scientific). Additionally, sex and gender influences are not necessarily mutually exclusive. Therefore, data interpretations should acknowledge as much.



Future scientific endeavors, particularly in the investigation of sex/gender differences in the prevalence of PTSD, will benefit from an alliance with the humanities who can provide a rich knowledge on how sociocultural factors shape conceptions of not only gender, but also illness. In this way, researchers can more thoroughly parse through risk factors for PTSD, such as differences in self-construal and gender bias. Furthermore, cross disciplinary, collaborative dialogue between the sciences would create more inclusive definitions of mental illness, as outlined by the DSM-V.



In highlighting the ways that society and culture influence the etiology and definition of PTSD, I hope I’ve underlined the work that needs to be done in order to bridge the gap in our understanding of psychiatric disease.





References



Blackburn, E.H. and J.G. Gall (1978). A tandemly repeated sequence at the termini of the extrachromosomal ribosomal RNA genes in Tetrahymena. J Mol Biol 120 (1): p. 33-53.

Breslau, N., G.C. Davis, P. Andreski, and E. Peterson (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 48 (3): p. 216-22.

Breslau, N., G.C. Davis, P. Andreski, E.L. Peterson, and L.R. Schultz (1997). Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry 54 (11): p. 1044-8.

Breslau, N. and J.C. Anthony (2007). Gender differences in the sensitivity to posttraumatic stress disorder: An epidemiological study of urban young adults. J Abnorm Psychol 116 (3): p. 607-11.

Brewin, C.R., B. Andrews, and J.D. Valentine (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68 (5): p. 748-66.

Buckner, J.C., W.R. Beardslee, and E.L. Bassuk (2004). Exposure to violence and low-income children's mental health: direct, moderated, and mediated relations. Am J Orthopsychiatry 74 (4): p. 413-23.

Chae, D.H., A.M. Nuru-Jeter, N.E. Adler, G.H. Brody, J. Lin, E.H. Blackburn, et al. (2014). Discrimination, racial bias, and telomere length in African-American men. Am J Prev Med 46 (2): p. 103-11.

Cohen, H. and R. Yehuda (2011). Gender differences in animal models of posttraumatic stress disorder. Dis Markers 30 (2-3): p. 141-50.

Creamer, M., P. Burgess, and A.C. McFarlane (2001). Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychol Med 31 (7): p. 1237-47.

Cross, S.E. and L. Madson (1997). Models of the self: self-construals and gender. Psychol Bull 122 (1): p. 5-37.

Cross, S.E., P.L. Bacon, and M.L. Morris (2000). The relational-interdependent self-construal and relationships. J Pers Soc Psychol 78 (4): p. 791-808.

Darves-Bornoz, J.M., M. Choquet, S. Ledoux, I. Gasquet, and R. Manfredi (1998). Gender differences in symptoms of adolescents reporting sexual assault. Soc Psychiatry Psychiatr Epidemiol 33 (3): p. 111-7.

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Bowers, M. (2014). (en)Gendering psychiatric disease: what does sex/gender have to do with posttraumatic stress disorder (PTSD)? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/05/engendering-psychiatric-disease-what.html