Cynicism and Alzheimer’s

Most of the time I see a single piece of research related to psychiatry reported by multiple news services, I figure the institution that produced it has a prizewinning public relations person.  I figure it is popular for some kind of unspoken agenda.

Maybe it is consistent with some level of political correctness.

Do you think that’s a cynical thought?  Perhaps I should be a little more cautious.

Even though I could not get to the original research paper, this article tells it right up front: “People with high levels of cynical distrust may be more likely to develop dementia.”

Yikes! It seems to be statistically valid, as well as making a statement that is pretty thought-provoking.

The study says that people who have that personality trait identified as “cynicism” — or more precisely, cynical distrust — are about five times more likely to get a diagnosis of Alzheimer’s disease than those who do not.

“Cynical distrust” which is defined as the belief that others are mainly motivated by selfish concerns.

Belief systems are probably the hardest thing in the world to change.

This belief seems to be a “character trait.”  It is a belief that people use again and again to deal with life situations, believing that continued experience validates the belief.

If anyone actually felt this way and wanted to change it, they would have to see one of my colleague psychologists and work long and hard.

This is assuming that they could remember their work from one session to the next, which is sometimes a difficult or impossible thing for an Alzheimer’s patient to do.

There is no anti-cynicism pill.  It is simply NOT something we have a biological correlate for.  I cannot say what chemical causes it, what neurotransmitter.  It is the stuff of psychology.  It is the stuff of research made of questionnaires and statistics that is fairly ubiquitous in psychology, and which (almost) never seems to involve bodily fluids — except as sampled by the rare mouth swab.

The investigators (at a university in Finland) picked a way of measuring cynicism that is a scale that can stay stable for years.  All we really know about these Alzheimer patients is that they had the diagnosis at the time of the study.

Even young folks can be cynical, so it is a pretty sure bet that these people were cynical for a while before they showed up with Alzheimer’s symptoms, which include a descent of the “cognitive;” that is, intellectual function, including troubles with memory and troubles with problem-solving.

The authors say the “cynicism” trait has been previously studied, and seems to have an increased incidence of heart disease.  This makes some kind of cosmic sense.  I think that is at least partly because we know about and generally acknowledge as “real” the “Type A” personality and acknowledge its association with heart disease.

I mean, if the guy who is driven to achieve is a buddy, we might even say “take it easy or else you will have a heart attack.”

Truth be told, there is a humongous body of evidence here, but it is not as “homogeneous” or as “robust” as one would like, so those who are interested in precisions and classifications have been studying the precisions of delineating the personality traits most likely to be associated with heart disease. I mean academicians have been studying this (and building careers) for over 50 years.

Switch focus.  Alzheimer’s is no less “real” an illness than heart disease.  Weakness of the heart wall, death of heart cells from lack of oxygen; well, these are things that you can see on autopsy and verify with a microscope.

Same thing with Alzheimer’s.  We define the illness by a series of lesions (abnormal tissues) in the brain that can ultimately lead to brain cell (neuronal) death.

So the take home message for me from the Finnish cynicism-and-Alzheimer’s study is that a character trait — the way people see the world and think about situations — can and does affect their physical health.

I started being aware of this possibility at some point fairly early in my psychiatric training, when I first became aware of something called “psychoneuroimmunology.”

Not that the concept of it was new to me.  Curiously enough, my Father-Of-Blessed-Memory, who within my memory of him never recommended to me any other reading even vaguely related to medicine, thought it was a good idea for me to read Norman Cousins  “Anatomy of an Illness” — which remains the only book I ever remember him paying retail to buy in hardcover.

I was actually happy to learn that he was the (proper) namesake of the UCLA center for psychoneuroimmunology.

The man was editor of the “Saturday Review” for 30 years, something my father loved to read.

He had heart disease and some kind of auto-immune arthritic disease, generally believed to be ankylosing spondylitis.

The man believed we were essentially a nation of pill-taking hyochondriacs.

Instead of the limited, onerous, and potentially serious (potentially) complication-causing treatments of the time, he developed his own regimen which consisted primarily of humongous doses of vitamin C and being shown Marx Brothers videos.

He did pretty well and made it to age 75 and convinced us all that “Laughter is the best medicine” indeed!

I believe that a lot of Americans responded as my father did.  Anyone who has seen and known other humans seems to notice that the attitude toward the illness determines the effectiveness of treatment.  Most people are not as radical about their approaches as Norman Cousins was, and may not have to be.

One thing I have heard on occasion from other doctors is a sense of prescience of how patients are going to do as a function of their attitude, as well as a sense of frustration at their inability to change that attitude.

“Not so!” I protest, for here is a proven function of psychiatry.  There is a whole field devoted to this sort of thing.  We can help people change their attitudes, with medical interventions to attack medical causes of “poor attitude” such as depression, to the ever popular but sometimes hard-to-pay-for psychological treatment.

Robert Ader of the University of Rochester, was the founder of this movement of academic thought, looking at how psychology affects our ability to fight disease.

Research continues.

There was a time I did an informal review of issues related to patient attitudes and fighting disease.  I simply wanted all my patients to get as well as possible.

I have always been interested in consultation-liaison psychiatry — consulting with medical patients, often right in their room when they are hospitalized. I’ve worked this sub-specialty in VA hospitals, in a major Southwest organ transplant hospital and in several University hospitals.

I remember being told early on in my (French, general medical) education that a physician should be cheery when approaching a patient, and that Hippocrates had said something to that effect.

Once when I was in the military, I read like crazy about how a psychiatrist should present, especially the psychoanalytic classics (from the “pre-medication” monopoly era) as recommended by supervisors.

I have a vivid memory of having read something by Harry Stack Sullivan that said the psychiatrist should act neutral to facilitate “transference;” that is the projection of feelings, presumably coming from previous relationships, onto the psychiatrist for discussion and understanding.

By the time I got to something about women psychiatrists wearing saddle shoes and tweed skirts, I was ready to throw the book against the wall, but I didn’t.

I have always felt that all patients, especially psychiatric ones, needed, from me, more cheerleading than passivity.

What literature I have reviewed on psychoneuroimmonology has either seemed non-specific or involving measures of chemicals (like interleukins) that I cannot directly measure in the humans sitting across the desk from me.

I have to proceed by instinct.  I am hoping this area is going to prove to be one of the places where instinct will be proven correct — although sometimes, admittedly, the findings of applied psychology can look a bit counterintuitive.

I have done all I can here.  I try to at least minimize “bad” feelings that other people may throw at me from their past experiences.

I smile for my patients.

I avoid wearing white coats, the doctor’s uniform, so that I have at least a fighting chance that with people who had a bad experience with a doctor in a white coat — and many have — won’t hate me.

I do everything short of a formal standup comedy bit to get a laugh or at least a smile.

I try at least to point out to folks if they are stuck on a descending road of negative thinking, that life does not have to be that way.

I have cared for often for people with life-threatening illnesses, and they have seemed to do better if they treated their illness (cancer or AIDS) like a pain-in-the-neck they had to live past to take care of more important things.

As for Alzheimer’s, my money would be on prevention more than treatment.  Yes this is possible, although marketers seem to agree that prevention is a lot harder to sell than treatment.

There is much to be said for everything from the Mediterranean Diet to nutritional supplementation.  There is a lot to be said for constant brain use in learning new things, different things than ever learned before.

I remember when I was trying to finish up my degree in France, people were telling older folks to start building their memories by memorizing their shopping lists, which seems like a good and gentle idea.

Maybe the best way to start combating cynicism is to foster optimism.

I am still a believer in the basic goodness of humans.

Believing people rally are “good at heart” just might help fight Alzheimer’s.