Not So Scientific Results

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I am ashamed at the unscientific process that has been labeled as medicine and assigned as diagnostic care for me. I am aware that some amount of interpretation is necessary from a doctor when receiving tests results, but I was hopeful that it would be mostly numbers and a small bit interpretation instead of this skewed nearly useless information I have received. Sigh.

I completed 4 hours of a neuropsychological battery of tests, all norm referenced for my age and education. The results should be straightforward. I was expecting a readout similar to an SAT or these state tests my children are required to take each year. Nope. Instead I have a 4 page verbal letter from a doctor that met with me for 10 minutes before the test. She regurgitated exactly what I told her in that brief interview, incorporated notes from the psychometrist that proctored the testing, included some multiple choice questions from a survey they gave my husband that really did not describe me well at all, and then gave little attention to any actual test scores or what they might mean for different areas of my brain as I was hoping.

I was more than disgusted that during the pretesting interview, the doctor asked if I was disability payments. I said no – I want to get better. She said, oh, good to know, that will help me when I write up your results. What?? Like your results will change depending on what I ask you for, not on what the results actually are…ugh, no, not good.

I kept saying things like, “ugh, this hurts my head” and I meant that in a figurative or slang way that normal humans will say when presented with mental puzzles. It came back in my report that I had a severe headache during the exam. I had no actual head pain at the time. I guess I should not have said that but I thought the tech was also human, so oops for me skewing my results that way.

I asked a question about one portion of the test that I struggled with. It was the Benton Judgment of Line Orientation, where it is black and white lines in various angles and you have to match them to the correct angle. Here is an example.

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I got more wrong than right here and it was extremely difficult to focus on it. I asked her if she knew what it was testing or why it might be so difficult, or maybe it had anything to do with my migraine aura that often gets triggered with high contrast items, and she didn’t say much to me, but apparently she noted that I had aura that interfered with this test. I’m much more concerned there is something going on in this area of the brain. I did my own research and it seems that this is centered in the parietal lobe. I’m wondering why I have lost this ability and why they were so quick to not be concerned about it or blame it on a migraine that I did not have at that time.

My memory was intact, low average, but nothing that indicates dementia or neurodegenerative disease. I agree with this. I am not getting worse. My memory gaps are from the past, I seem to be able to slowly retain new info, just not at the rate I used to. Apparently I can do so in the low average rate for people of my age and education, which is frankly alarming to me, because I know I am impaired. But they don’t know where I starting. I struggled with digit span beyond 5 digits and the reversal of digits took me repeating it out loud first. Most alarming to me was the basic math set. I can no longer do arithmetic. For someone that used to do mental math like nothing, for someone that used to teach advanced algebra and calculus, it is alarming to me that I can no longer give an answer to a two step second grade level word problem. I know how to solve it, but the numbers swirl and disappear when I try to calculate anything. I still recall one problem. Johnny reads for 22 minutes each day Monday through Friday and reads an additional 15 minutes on Saturday. How many minutes does he read in total. I knew I had to multiply 22 by 5 and add 15 but I could not get there. I’ve been practicing my math facts again, I knew 25 x 4, so I was thinking it was over a 100 but that was as close as I could get. How sad. Apparently this was also not alarming to them. Hmmm.

So A few years ago I would have sped through and maxxed out this test, scoring high above average in each area. I always have.

They did indicate I have extremely slow processing, delays in thought, pauses in speech, possible cognitive dysfunction, possible depression, possible migraine statinous.

Recommendations are to take frequent breaks to prevent mental fatigue. Get plenty of rest and exercise. They also recommended I contact my state board for disabled persons to work with a counselor to help negotiate me an appropriate job.

This is a whole lot to process. The doctor went on vacation, but I do have some questions for her I think regarding the whole – I did not have a migraine during this exam thing. But I do appreciate the resource. Even though it will take me swallowing my pride, accepting my situation, maybe it is exactly what I need to get back out on there and start doing what I can do again. I can’t do what I used to do. I can’t get hired for the jobs I am applying for, I am overqualified, no one calls me. I think I will see what they can do for me.

I did end up with a migraine after the testing was done, from the stress and so many hours of overload and challenge and sitting in harsh lighting and whatever else. It wasn’t terrible though, and I was able to prevent it from exploding by taking gabapentin at onset like I usually do. So was aura actually starting earlier affecting my vision? Now I’m confused. I think I need to see my migraine specialist soon if I’m still being triggered this easily.

My neurons are too tired and freak out over the slightest provocation. Poor little neurons. It will be okay.

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Neuropsychological Assessments, Part 1

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Another test? But I’m so tired. What’s the point?

I took a mini neuropsychological test and it has earned me the diagnosis of memory loss and a recommendation to take more tests. I’m not exactly stunned by this. It does hurt my pride though. I mean to know something, or suspect something, is very different from seeing it written on your diagnosis rap sheet with a diagnosis code and a bunch of recommended tests, followup appointments, referrals to other specialists, and of course, nothing is complete without that pathetic look in their eyes, because I’m only 40 and most of their patients are dealing with age related dementia. And then I get that look of horror mixed with pity when I share a bit of my history, my traumatic past that no one wants to know about. Yeah. Sigh. See why I try to avoid people in general, its just easier on everyone.  But here was interesting actually, in a humiliating way, I could tell they kept checking if I was lucid. They repeated everything and kept asking the day and time and gave this look like I might grow horns or spit on them or something. I can only imagine what they deal with day to day. Well likely not people spontaneously growing horns. But it must take enormous loads of patience to treat people that aren’t sure where or when they are.

(Interesting backstory, I actually had a job once in a VA hospital giving these type of assessments for a longevity brain health study. I hope I controlled my expressions better than this nurse did when people gave incorrect answers. I hope I didn’t make them feel stupid. It is hard enough coming in there, to be poked prodded and assessed, we don’t need to be judged.)

So a gratitude moment. I know who and when I am.

But I have lost lots of who I am.

We need more info on what has happened, what areas of my brain have been affected. So here comes neuropsych evaluations, which includes a lengthy, like many hours of targeted cognitive ability testing and discussions with neuropsychologists. The mini test completely drained me and I needed a nap afterwards. I failed on skip counting, producing words in categories, and recalling events from certain dates in history. I’m more than a little worried to take the longer assessment, both for the stress and fatigue, and for its findings. Although I want to find out and start rehab if possible, I’m also terrified they will tell me there is nothing they can do, or that I can completely effed up and shouldn’t even be walking around unsupervised.

I almost canceled the upcoming exam. But I worked through my fears how I always do. I did some research. Science is so soothing and wonderful. I’m not excited about it, but I’m determined now to get some answers. This void of not knowing is somewhat comfortable and if I’ve learned anything by now, the right thing to do, is not the comfortable thing.

http://www.gatewayneuro.com/adult-neuropsychology/ ”

WHAT WILL THE RESULTS TELL ME?

Test results can be used to understand your situation in a number of ways:

  1. Testing can identify weaknesses in specific areas. It is very sensitive to mild memory and thinking problems that might not be obvious in other ways. When problems are very mild, testing may be the only way to detect them. For example, testing can help determine whether memory changes are normal, age related changes or if they reflect a neurological disorder. Testing might also be used to identify problems related to medical conditions that can affect memory and thinking, such as diabetes, metabolic or infectious diseases, or alcoholism.
  2. Test results can also be used to help differentiate among illnesses, which is important because appropriate treatment depends on accurate diagnosis. Different illnesses result in different patterns of strengths and weaknesses in testing. Therefore, the results can be helpful in determining which areas of the brain might be involved and what illness might be operating. For instance, testing can help to differentiate among Alzheimer’s disease, stroke, and depression. Your physician will use this information along with the results of other tests, such as brain imaging and blood tests, to come to the most informed diagnosis possible.
  3. Sometimes testing is used to establish a “baseline,” or document a person’s skills before there is any problem. In this way, later changes can be measured very objectively.
  4. Test results can be used to plan treatments that use strengths to compensate for weaknesses. The results help to identify what target problems to work on and which strategies to use. For example, the results can help to plan and monitor rehabilitation or to follow the recovery of skills after a stroke or traumatic brain injury.”

What Are You Talking About? Communication Processing Issues

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I care about you, truly I do, but could you get to the point please?

One of the most difficult tasks I face daily is engaging in spontaneous conversation. The amount of energy and focus required to follow your words, not get distracted, process your words, understand your meaning and any subtext like sarcasm or body language, then hold onto facts and details from beginning to end of what seems like a never ending onslaught of words…well, it’s nearly torture. I will ask you stupid questions. I will ask you to repeat yourself. I will ask about something you already explained. I will miss key points. I will mix up names or dates. I will get confused on sequencing. I will try to guess your emotional state and lose track of your words again. You will be waiting for a response and I have no idea what you asked me, I’m about a paragraph behind, still processing all of those words, attaching meaning.

I’ve never been an extrovert, but I used to speak fairly eloquently at times, or at least would sound educated and not rude. I used to get tired after attending parties, now I avoid them completely. Attempting to follow multiple conversations is far too taxing on my system. If phone calls need to be made, I either rehearse my lines and write down my facts and questions, or ask my husband to make the call for me rather than find myself in a position of confusion, unable to answer someone’s simple query. I’m not used to feeling slow and stupid. I know this isn’t my fault, but I can’t help wanting to hide it, and feeling ashamed.

Texting is much easier for me, as it allows me to respond with a delay, to process at my own pace. I have been accused of stalling, and some people have read into my delays. They don’t understand. I need time to think. I have to figure out your words, then find my own.

Often while speaking, I can “see” the word I want, but I can’t get to it. I can describe it, but can’t name it. I do this often with my kids, as they understand my deficits and don’t ind playing word games. I used to live in a world of words – roll in them, run and jump and play in them easily. Now they hide from me. I am aware there is a better word for what I am saying or writing, but I can no longer access it. It’s like they all fell down a deep dark well and I can only hear their echoes now.

So I apologize upfront, but if you call me, I am likely not going to answer the phone. I am likely not going to attend the family gathering. I am likely not going to the team picnic. I am likely not going to the kids’ awards ceremonies. I am likely not going to sit in the bleachers at the kids’ baseball games. If I do attend, it will not be for very long. I seem to have about 15 minutes that I can tolerate in a conversation rich environment before my brain overloads and shuts down. It can take me several days to recover from that level of fatigue.

So I am careful. I manage by doing what is absolutely required of me. If I need to take my kids to a doctors appointment on Tuesday, I will not attend something stressful and not mandatory on Monday. Or if I attend, I keep myself at a safe distance so I do not get overwhelmed, engulfed by a crowd, lost in a sea of noise.

http://www.tbicommunity.org/resources/publications/professional_education_social_comm.pdf –

“These cognitive problems can contribute to social communication difficulties:

Attention/Concentration problems can lead to:
Difficulty resisting distraction during conversation
Problems keeping track of what other people are saying
Problems in staying on-topic

Memory problems can lead to:
Repeating oneself when talking
Losing track of the conversation topic
Mixing up instructions or messages

Executive Functioning problems can lead to:
Having trouble starting conversations
Interrupting others
Poorly organized speech
Excessive talking

Impaired Social Cognition can lead to :
Difficulty understanding sarcasm or “getting the joke”
Poor use of feedback from others
Difficulty taking someone else’s perspective “

Brain Games are More than Fun

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You injure your knee and you know you are in for months, possibly years of rehab involving stretching, massaging, and exercising the weak area. It is obvious to others also because you are limping, walking slowly, wearing a brace, using a cane, or have some other visible sign.

What about a brain injury? What does rehab look like? What does an injured brain look like? This of course depends on the extent of damage. I’m talking about a closed brain injury. No apparent bruising, swelling, or twitches. The damage is internal. It causes delays and slow processing. The injured person may appear to be sleepy or grumpy or not interested when in fact trying their hardest to pay attention. I’m guessing though your first thought is not, oh, I wonder if their neurons were damaged. No, more likely you get frustrated, feel rejected, and leave the annoying person.

So what to do? How to exercise sluggish neurons? You need to use those neurons, and to do that, you need to think. Everything you do is processed in different combinations of areas of the brain. If you damaged the area needed for spatial reasoning doing shape puzzles can help get those pathways working by making new connections around the injured areas. You may never recover completely, but with the brains capacity for plasticity it is possible to relearn, and do what you need using uninjured areas. Remarkable really.

All games are good in my opinion, (I may update this if I learn otherwise, but so far every game seems to be helping me) if they require mental stamina, attention, working memory. I use lumosity because I like to see my stats in each area, like memory, speed, attention, language and problem solving. There are many free options out there. I find that some days I can’t play them at all, and I’m never sure why, what is malfunctioning exactly those days, but I have the scores and stats staring at me as proof something is wonkier than usual. I always need a nap after a gaming session, the fatigue sets in and I have no choice, sleep will happen.

I also like welltris, and was so super excited to find it in a browser version. It was my favorite game in high school, so soothing. It’s like Tetris, but the shapes drop down 4 walls not just 1. You can play it for free here – https://classicreload.com/welltris.html

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Another great find was color sudoku. Since a lot of my injured area seems to have affected numbers and math, I was having trouble concentrating on standard sudoku. Apparently, by switching to colors, removing the numbers,  I could use a different area of my brain and focus on the logic instead. I can do them now! You can play a color sudoku game free here – http://www.primarygames.com/puzzles/sudoku/colorsudoku/

I lost all of my math facts recall. I use various games to help me relearn those, I don’t have  a favorite, I use a different one everyday by searching math facts game so I don’t get bored. They are designed for lower elementary students so can hurt my pride a little…but slowly it is working, my recall is gaining speed and accuracy.

I am grateful all of these tools exist for free and all I have to do is google for 30 seconds to find something new to try. I’m not sure if I am actually encouraging new neuron growth or not, but I feel better than doing nothing, less helpless and powerless while I wait for my appointment with the specialist. I figure it can’t hurt, and just might help.

https://www.scientificamerican.com/article/brain-games-do-they-really/ – “Yes, those computerized brain-training games seem like a cool idea. They are based in large part on clear evidence that living in an enriched environment with lots of mental stimulation produces positive brain changes. And we agree there’s huge potential for tapping into your own neuroplasticity (that is, the brain’s ability to change itself by remodeling nerve cell connections after experience) to enhance mental fitness and prevent age-related memory decline. The well-established benefits of early life education on reducing later risk for dementia has also given much credence to the theory that building a greater cognitive reserve capacity can help the brain compensate for injury—analagous to the concept that more cell phone towers equals fewer dropped calls. Furthermore, several brilliant neuroscientists have, in recent years, served as the designers of the best brain games on the market.

But there’s a crucial catch: most of these early studies were done on rodents. So lost in the brain game buzz is the obvious question: Are these claims true when it comes to human brain performance and aging? Can they really make your brain faster and stronger? Are there really better than the tried-and-true approach: remaining healthy, active, and engaged in the world around you? In other words, are they worth the money?

To date, more than 50 studies have examined the benefits of brain training in humans but only a handful have tested whether or not the benefits persist and transfer over to real life. Results from one of the best studies, published earlier this year in the Journal of the American Geriatrics Society, is certainly encouraging, however. As Glenn Smith of Mayo Clinic and her colleagues report, cognitively normal older adults who trained their brain were able to improve their auditory information processing speed by about 58 percent (versus 7 percent in controls). In their multi-center IMPACT trial, 487 adults ages 67 to 93 years worked for eight weeks at Posit Science’s Brain Fitness Program, which seeks to improve brain function by stimulating the auditory system. The Posit Science program is premised on the idea that as we get older our brains become less efficient at processing information from the senses (not because of specific hearing or vision loss but because of degenerative changes in the brain’s associative cortex), which then leads to a decline in memory. The control group did a more conventional cognitive learning program that entailed viewing educational videos on art and history. At the end of the study the brain training group also demonstrated more gains on measures of overall cognition and memory than the control group, but the differences were less impressive (4 percent versus 2 percent improvement). Forty-eight percent of people in the active training group (versus 40 percent of controls) also reported positive changes in their daily life such as greater self-confidence, better recall of shopping lists and attending to conversations in noisy settings. “

I personally think it matters more that you are actively thinking, and enjoying it. I happen to enjoy PC games. Someone else might do better with card games. Just like exercise, it won’t work if you don’t put in the hours. I like leveling up and seeing my trends across time.

Migraine and Seizure Spectrum

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It seems that everything in the brain once properly researched is found to exist on a spectrum of connection rather than unrelated events or disorders. As someone with a disordered brain, this is not surprising to me whatsoever. I read through lists of overlapping symptoms. My neurologists, psychologists, psychiatrists, neuropsychologists, and a few others involved in studying and healing my brain are never 100% sure of my diagnosis, like to change my diagnosis and treatment plan often.

What is obvious – something is wrong with my neurons. It affects every part of my body and my life. I have migraines – do I also have seizures? I take anti-seizure meds to control for both. I have never had a complete grand mal drop to floor tonic clonic type of experience. I have had bouts of vision loss, confusion, garbled hearing and speech, limb weakness and shaking. They call this migraine aura because it lasts too long to be seizure activity.

It seems unclear now to researchers though, that perhaps a seizure could occur DURING a migraine. Triggered by the unbalanced electrical activity and intense pain and stress chemicals. Hmmm. I have had sudden waves of intensity of something, sparks of more misery during the hours of already intense migraine misery. I think it is possible. No one has an EEG on me while my head is packed in ice, while I’m lying on my bathroom floor in a 12 hour vomiting cycle, trying to pull what feels like an ice pick out of my brain, writhing around, barely conscious, unable to speak, my heart racing, going from ice cold to sweating buckets, my breathing fast and shallow. I’m afraid I will die while simultaneously somewhat wishing I will die to end this suffering.

http://news.psu.edu/story/332549/2014/10/30/research/link-seen-between-seizures-and-migraines-brain – “Seizures and migraines have always been considered separate physiological events in the brain, but now a team of engineers and neuroscientists looking at the brain from a physics viewpoint discovered a link between these and related phenomena.

Scientists believed these two brain events were separate phenomena because they outwardly affect people very differently. Seizures are marked by electrical hyperactivity, but migraine auras — based on an underlying process called spreading depression — are marked by a silencing of electrical activity in part of the brain. Also, seizures spread rapidly, while migraines propagate slowly.

… “We know that some people get both seizures and migraines,” said Schiff. “Certainly, the same brain cells produce these different events and we now have increasing numbers of examples of where single gene mutations can produce the presence of both seizure and migraines in the same patients and families. So, in retrospect, the link was obvious — but we did not understand it.”

… “What they found was completely unexpected. Adding basic conservation principles to the older models immediately demonstrated that spikes, seizures and spreading depression were all part of a spectrum of nerve cell behavior. It appeared that decades of observations of different phenomena in the brain could share a common underlying link.

“We have found within a single model of the biophysics of neuronal membranes that we can account for a broad range of experimental observations, from spikes to seizures and spreading depression,” the researchers report in a recent issue of the Journal of Neuroscience. “We are particularly struck by the apparent unification possible between the dynamics of seizures and spreading depression.””

Sometimes I want to buy my own EEG and try to capture events at home. But I also know that some partial seizures can be so brief and deep inside the brain that they may be nearly impossible to detect. All I have are my odd sensations and actions, memory loss, confusion, my family asking what is wrong.

I don’t know exactly what is wrong. What are my neurons doing today?

 

Sensory Overload – Leave Me Alone

My neurons get overwhelmed and overloaded easily, much more quickly than most people. I have lost my ability to filter and tune out the world around me, so information is absorbed and attempted to be processed all at once. What does this mean? If I am in a crowded room – I hear every voice equally, every shuffle and squirm, every cough and sneeze and mumble. I smell everything, oh man do I smell it. Ease up on the cologne, hair spray, and perfumes, it makes me sick. Then add in every cough drop, mint, chewing gum, body odor, bad breath, yup people are smelly. Ok, that’s two only 2 senses and I’m already nauseous and overwhelmed. Crowds tend to bump into each other, I get touched, nudged, surrounded and my skin crawls and tries to shrink and disappear with each assault. My vision may start out clear, but most indoor settings use awful fluorescent lights with a tone and flicker that causes me physical pain. I start to squint. My vision blurs, gets noise and static like an old TV. If they flash or strobe any lights I’m a goner, even closing my eyes doesn’t work as I can still sense the changes through my closed lids.

Confusion sets in. I can no longer read, comprehend the words I see or hear. All the faces around me suddenly look ominous and distorted. My heart races, I start sweating, feel a choking feeling as I struggle to breathe. Yup – Panic is taking hold. I know to start breathing exercises, get myself to a quieter location, try some grounding to give my poor tired neurons a break. But at this point, all I can do is damage control, because the stress sequence has already started. My brain is overloaded and I need to rest. I have run out of processing capacity, like trying to run Photoshop on my old computer, just too much data coming through – a crash is inevitable.

http://www.braininjury-explanation.com/consequences/invisible-consequences/overstimulation-flooding – “In over stimulation feelings of panic can prevail upon the brain-injured. The person may be sweating, have tremors, can be vomiting, and thinking is difficult.
These are the basic reactions of the body to survive in a situation that is perceived as very dangerous. It is also called the fight or flight response. One person is going to flee from the overstimulation of the noise or stimulus of the moment. The other person faints. Most of them cannot think anymore or are very upset first.

The basic emotion of fear and the ensuing responses are generated and directed by the amygdala. The amygdala is part of the oldest part of the brains, the limbic system. This system is a kind of emotional sentry. All that matters is survival. If there is danger, immediately adrenaline, noradrenaline and cortisol are released into the body to flight, fight or freeze.”

I appear to be withdrawn, isolated and antisocial now. I avoid crowded places. Truth is I never enjoyed them but I could manage before. Now it is torture. I don’t think this is depression and anxiety, or fears causing me to stay home, not exactly. I do fear the overload response, it absolutely horrible. Imagine if lights, sounds and smells caused you pain, not just discomfort. Imagine if you could not make sense of what people were saying to you? You see them asking you something, but can’t hear their voice above everyone else’s, or if you do, the words seem foreign. Then you can’t remember who they are, or why you are there. Confusion sets in with totality. When processing stops – it stops. It is really super scary to be walking up to the counter to order a sandwich one moment, and the next find everyone staring at you, grabbing at you, saying things you don’t understand.

After some peace and rest, I always come back online, and with practice I am learning not to get myself to a state of total confusion. But there is always this nagging, underlying fear – what is I lose my mind forever? What if I stay like that one day?

I don’t feel like I am recovering or healing. I feel like I have been stuck here for years. Like I made some progress initially, but then it stopped. And that also terrifies me. Is this as good as it gets? This is not my brain.big-bang-422305_1920.jpg

How Social is Your Brain

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Do you join in or prefer to stay home alone? Does your brain have something to do with these preferences? Why do some people easily relate to others, have charm and charisma, tons of empathy, make and keep friends easily? Why do others remain alone? How much do we need to interact with other people to stay healthy? Is it really a preference or are these behaviors born out of fear and anxiety?

I don’t have these answers.

People are fascinating to me. And often annoying, predictable, overwhelming. Although I blog, I do not have a facebook or twitter or instagram or any other social media account. I found them boring, just like small talk and chit chat and parties and hanging out. I care about people. I have a high level of empathy and ability to feel for others. If you tell me your pet died, I will likely tear up. If I see a hundred people posting complaints on facebook, I get overwhelmed quickly. If  I see another meme or picture of your lunch or cat, I might scream out of frustration. I don’t get it. Whatever. You do what entertains you. I’ll stick to reading scientific journals to entertain me.

If I see you at the grocery store, I am not likely to stop and chat. I am not likely to even recognize you out of context. If you are my kid’s teacher, I will only recognize you in the classroom where you belong. I am there to get my groceries and get back home. I am not trying to be rude. I just don’t enjoy the stressful, strained conversation, of “how are you”, “I am fine, you?” “nice weather today” “yes” “sooo” “welll” “ok have a good day”…We aren’t friends, we don’t have to pretend, and we both are here to pick up toilet paper and ground beef and get home before the ice cream melts.

I’ve never enjoyed small talk. Public speaking? Yes. I love getting up on stage and performing, giving a speech or lecture. I understand most people list this as one of their greatest fears, but for me, mingling at a party or running into an acquaintance causes much more anxiety. Why? Is my brain different?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588649/ – “Social behavior depends critically on context and intention, a sensitivity that arises from the rich interplay between controlled and automatic processing of social information, and a modulation long emphasized within social psychology (Todorov et al. 2006). One way of viewing such modulations is to think of an initial feed-forward sweep of social information processing that is rapid and automatic, followed by cycles of additional processing that are biased by the first, but modulated by top-down effects that may incorporate controlled processing and conscious intent (Cunningham & Zelazo 2007). There are numerous examples at all levels of processing showing how contextual information modulates, or even gates, social information processing. At the sensory perceptual level, information about faces is processed differently depending on context. Thus, a surprised face can be interpreted as looking afraid or looking happy, depending on a preceding sentence (Kim et al. 2004). Afraid and angry faces are interpreted differently depending on whether their gaze is direct or averted (Adams & Kleck 2003). Some context modulates what we counterfactually expect might happen. Thus, in the example of social norm compliance, brain structures associated with strong emotions are activated only when the subject knows that punishment is possible, not when it is known to be impossible (Spitzer et al. 2007). An important and common finding (often utilized as a control condition in imaging studies) is that knowing that a particular event or outcome was intentionally caused by another person leads to a different interpretation than knowing that the event was unintentional or was caused by a computer. Thus, in the case of the negative emotions and anterior cingulate activation induced by social exclusion, this obtains only when the subject is convinced that other people are volitionally excluding him or her, not when the “exclusion” is explained as a technical malfunction of some sort (Eisenberger et al. 2003). What we know about people from their past behavior provides an important context that modulates our responses to, and actions toward, others. In studies of empathy, it was found that our perception of other people’s fairness (from their behavior in an economic game) modulated how much empathy was felt when they were observed to be given painful electric shock, an effect that correlated with activation of the insula (Singer et al. 2006).

Emotional responses can be modulated not only by context, but also volitionally by reinterpreting a situation, or indeed solely by willful control. This is effortful, develops relatively late in childhood and adolescence, and depends on the prefrontal cortex (Ochsner & Gross 2005). Although it is somewhat simplistic, one useful heuristic is that more anterior regions within prefrontal cortex can exert cognitive control over successively posterior regions (Koechlin et al. 2003), an idea consistent with the role of frontal polar cortex (Brodmann’s area 10, the most-anterior part of the brain) in overriding ongoing processing to explore new options in nonstationary environments (Daw et al. 2006). Interestingly, as we reviewed above, frontal polar cortex also appears to be a region that has expanded the most in human evolution (Semendeferi et al. 2001), and it is a region activated when we need to explicitly represent another person’s mind as distinct from our own or the state of the world (Amodio & Frith 2006). Such a role may be critical to social communication, cooperation, and deception, and it may be unique to humans (Saxe 2006).”

Social and emotional responses are too complex to give any answers. My history shaped me, as well as my brain structure. I know I am socially different than most people I meet. I am not sure what drives these differences and if it is worth changing them. I used to try and force myself to be more social, thinking it was unhealthy for me to be alone so much. But these days I am thinking it was unhealthy to force myself to fit into some notion of a social norm that works for others. I’ll look more at this later from the introvert perspective and personality point of view rather than the ‘there’s something wrong with my brain’ point of view. Needs more discussion for sure to see what a healthy spectrum of human differences can cover.