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Response-Based Neurology in
Psychiatric Practice
Robin Routledge, MD
Summary
• The brain is a response to the
world.
• The brain is in a systemic
balance with the world it
perceives. It has many
adaptations to context.
• These ideas show responses to
extreme adversity are not illness.
2
Neuron shapes
TOO
COMPLICATED
schematic of a neuron
In
Middle
Out
schematic of a neuronal system
One neuron
Another neuron
schematic of a hundred billion
neurons
schematic
of a hundred billion neurons
schematic of a neuronal and
environmental system
Nervous system
Environment
Mind is social
Mind emerges from interaction
between brain and environment
Bateson:
Mind and Nature
Human sensation
•
*
*
*
Vision
Light
Colour
3D
•
*
*
*
Hearing
Volume
pitch
location
Human sensation
•
*
*
*
Touch
Size
Shape
texture
•
*
*
*
Temperature
Pain
Fast
slow
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Human sensation
• Taste
• Stretch
• Joint position
• Smell
• vibration
12
Human sensation
• hormone levels
• Satiety (grehlin,
leptin, PYY, GLP)
• Carbon dioxide
• Arterial Pressure
13
Maintaining the machine
Autonomic control
Hormones
immune response
inflammation
Purposeful awareness of
perceived sensation is
Mindfulness
15
Making meaning
local sensation suppresses
sensation around it
Making meaning
• Competing maps of three
dimensional space are assembled
from combined sensations and given
a sense of time.
15
Making meaning
More than one organization or
meaning is generated.
These are like competing virtual
realities.
16
Making meaning
One “representation” (Plato)
suppresses
other versions around it.
17
Making meaning
Making meaning
• Networks of neurons located in
different parts of the brain hum
together like guitar strings. They
assemble chords.
20
Certain parts
make special
contributions
but remain
interdependent
21
Making meaning
• The brain is split in two halves with
very little communication between
them.
• Each half organizes perception very
differently and the difference allows
a subtlety of perception.
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Memory
1. The brain does not recall exactly.
2. Memories are stored better if they
are emotional.
3. Memories are recalled differently
depending on the circumstances at
the time of recall.
Brain Action
Parts of our brain cooperate to number
and to name things. These actions
(calculations and language) are like
actions we take on our external world.
• “Mirror cells” fire when we see
another person do something we
understand. Mirror cells act as though
we are doing what we perceive the
other to be doing.
• This sense of the other may be the
foundation of compassion.
25
• The social smoothness of physical
movements is coordinated by the
most foreword part of the frontal
cortical lobes.
• This part of the brain can modify
amygdala’s warning of danger.
26
neuroplasticity
Neurons constantly replace or
prune connections. They do this
in response to how they are
used. So if you do something
different, they will slowly make
new connections.
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neuroplasticity
The brain is like a hedge
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neuroplasticity
An opening in a hedge
29
Summary
• The brain is a response to the
world.
• The brain assembles
representations of the world.
• The brain adapts to the
circumstances it selects.
30
Psychiatry
is itself a response
 a response to current culture
 it started with the beginning of
industrialism
 Psychiatric classification began in the
asylums
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the Psychiatric History of “Trauma”
1.
2.
3.
4.
5.
6.
7.
da Costa
American Civil War
Shell Shock
World War One
Combat Fatigue
World War Two
Brain Washing
Korean War
Post Traumatic Stress Disorder Vietnam War
Trauma Informed Care
current theory
Response Based Care
future theory
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Some Brain responses to adversity
Physical Readiness
Option One:
•increased muscle tone
•increased heart rate
•increase breathing
•lubricated
armpits
.
•increased pupil size (more light in)
•Harder to poop or pee
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Some Brain responses to adversity
Physical Readiness
Option Two:
•loss of skeletal muscle tone
•decreased heart rate
•decrease breathing
•decreased pupil size (less light in)
•poop and pee
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Some Brain responses to adversity
Cognitive Readiness
•numbed/calm emotional response
•heightened alertness & vigilance
•altered perception of time
•rapid review of meaning of context
•evaluation of social “representations”
•weighing alternative strategies/tactics
37
Social* responses to adversity
Expressed Emotion (EE) studies
show social response to terrible
things has a powerful influence on
outcome.
* ”social” as the brain sees it
34
schematic of a neuronal and
environmental system
Nervous system
Environment
Conclusion
• The brain is responsive.
• It grows in the direction it is used.
• The brain is in a systemic balance with
the world it perceives. It has many
adaptations to context.
36
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