Ojai 2002 Summary

June 13-16, 2002

ABSTRACT

The FPR’s second workshop met in June 2002 focused on planning for the upcoming conference on PTSD in December of 2002, discussion of questions that were formulated in last year’s workshop, and identifying future goals of the foundation, especially regarding the education of integrative researchers. The workshop participants included several of the invited speakers for the Dec. conference. Breakout group discussions covered the following topics (some of which are summarized in this memo; see Appendix for list of participants):

Culture and Development (Moderator: Steve Lopez)
Methodological Issues (Moderator: Beate Ritz)
Culture, Trauma and Neurobiology (Moderator: Marvin Karno)
Cultural Perspectives on Psychiatric Theory and Practice (Moderator: Marjorie Kagawa-Singer)
Cognition, Emotion, Culture and the Brain (Moderator: Douglas Hollan)
Philosophical Issues (Moderator: Carole Browner)

See Appendix (below) for list of participants.

PTSD Conference

One question that was considered was whether these conference sessions and presentations should be more integrated, and if so, how should this be done? If we attempt to integrate the fields more in the conference, then this needs to be balanced by taking a more singular topical focus.

Discussants also thought it important to identify what are significant PTSD-related topics that are not being addressed in the present plans for the conference. Some of the neglected topics include: dissociation, forgetting and remembering trauma, defining normality versus abnormality, the fallacy that everything universal is biological (and a neglect of neuroplasticity), and what to make of different symptom profiles (even within the same culture). Additional critiques of, and suggestions for, the organization and topics being covered in the conference included:

We may be focusing too much on the individual. . . What about social processes? What about social/political violence, and the reality of post-coloniality as a primary context for PTSD sufferers? There needs to be more bridging of the social and the individual.
Is there too much focus on the biological approach in the present organization? Some discussants argued that the social dimensions and contexts of PTSD are even more basic than the brain and the biology of PTSD and that we need to take culture more seriously. In opposition, since the biological focus is new it may not be so bad to put it first.
We need to give more attention to contextualizing neuroscience and clinical approaches to PTSD. For example, what social aspects get in the way of therapy?
We should also think about the omissions in distinct fields — culturally why are there these omissions?
How to synthesize the complex interactions between traumatic experience, neurobiology, development and culture?

Emotion, biology and culture (Moderator: Marvin Karno)

Orienting questions:

How can we understand the intersection between physiology and culture in shaping the expression of emotions?
What is the connection between emotion and social context?
What can fear conditioning studies tell us about real-world responses to trauma?
As we develop more elaborate biological explanations for responses to trauma, what is the role of cultural explanations? (Do cultural explanations become irrelevant?)

Discussion Summary:

The group focused on the broad questions relevant to PTSD and planning for the December conference. As a result several new questions were put forth:

Basic Science and PTSD

What do we and don’t we know about the basic science of PTSD? Although there are strong animal models of basic fear, including intriguing research in extinction of fear, some preliminary evidence for structural changes related to fear, and some understanding of modularity in relation to fear (the amygdala in particular appears to be central in every fear response), very little is understood in basic science about extreme fear, symbolic fear, and the more complex trauma of PTSD. In addition, although basic science can provide some understanding of inhibitory memory, more conscious memory processes of dissociation and repression are not readily studied (or operationalizable) in work with rats/the basic sciences.

“Recovery” of Traumatic Memories

The phenomena of the decades long absence of traumatic memory and recovery of these memories is a critical issue — is this something that we need to address at the conference in December? “Accuracy” and “loss” or “recovery” of memories is a huge issue with many conflicting approaches that we could not fully address in this conference, but nonetheless we may need to address it to some degree in December. Towards this end, two suggestions were put forth: we could invite Dan Brown to give an overview of the history of loss and recovery of traumatic memory and/or we could invite Daniel Schacter, who focuses on the contextual cues associated with memory could give a more middle-of-the-road view of memory.

Social Context and PTSD

Does culture affect vulnerability to effects of trauma? What are good and bad effects of clinical therapy? How does culturally associated repression of strong emotion (as occurs in Cambodia, Java, etc.) affect response to PTSD? Is numbing and repression or suppression of traumatic experience a necessary form of protection against the effects of PTSD, or is exposure therapy given by therapists or in the form of truth and reconciliation practices (as have been used in South Africa) a better solution? In the case of severe trauma is exposure therapy ethical? Is it better to tell or not to tell about traumatic experience? Does cognitive behavioral therapy work across ethnic groups–does it work better for more highly rationalizing people (Anglos)? Are individual, social, and political processes homologous, or separate but influence each other?

The group came to the agreement that long-term follow up studies of exposure therapy and disclosure of traumatic experience as opposed to repression of traumatic memories are necessary. In addition the political, social, and cultural influences upon, and implications of, disclosing or repressing traumatic memories and experiences must be more fully addressed. A reminder was also put forth to beware of over-generalizing our discussion of “culture” — there is extraordinary variation in how different individuals’ social networks support, encourage or discourage dealing with trauma.

“Post” as a misnomer in Posttraumatic Stress

What happens when the “post” in posttraumatic stress disorder isn’t applicable, when a culture is characterized by chronic exposure to trauma? Can people habituate to trauma? What is the role of randomness in traumatic experience and recovery from trauma? We need to also consider how individual and social trauma is connected. When traumatic events occur they have the potential to decimate not just individuals, but also cultures and normalizing social structures, which may in turn further hinder recovery from individual traumatic experiences.

PTSD and Addiction

Should we address addiction at the conference? Interesting points to consider are that drug abuse is extremely high among veterans. In the basic sciences there are intriguing parallels in extinction process research. For example, alcohol, having similar effects to the use of benzodiazepenes, gives acute relief yet blocks extinction.

Methodological Issues for Linking the Different Levels of Study

How would we structure a study that would link social context and effects to neurobiology? Some studies have been done comparing different exposures/provocation using functional MRI. What about imaging studies in different cultural groups with PTSD? Although not an imaging study, physiological measures, for example, pulse-rate following response to scenes of various traumatic stressors has been compared in a study of Cambodians, Vietnam veterans, and normal controls. In the study, for the Cambodians pulse-rate went up in response to all stressors, for the Vietnam vets pulse rate did not go up in response to any stressor, and for the “normal” controls pulse rate went up with exposure to scenes of domestic violence.

Child Development, Biology and Culture (Moderator: Marie-Francoise Chesselet)

Participants: Anderson-Fye, Chesselet, Fiske, Greenfield, Iverson, Lance, Pynoos, Ritz, Tobin

Orienting questions:

What is the effect of one’s past experiences on vulnerability to trauma (e.g. does subjection to persistent and pervasive trauma have an immunizing effect)?
How do child rearing and early childhood experiences affect the organization of the developing brain (e.g. what are the effects on the development on brain systems that mediate emotion and stress response)?
What is the relationship between brain development, input integration, and the experience and expression of emotions in children?

Discussion Highlights:

“Immunizing” may be the wrong word–the view of previous experience as immunizing could potentially prevent the use of support for trauma victims. Part of this question demands that we more clearly define what is “trauma”. Also, how can we delineate what is an adaptive or maladaptive response to trauma? Vulnerability is not necessarily a bad thing.

Defining “Trauma”

Does trauma exist when people are impaired by it, have symptoms, or seek help? Is it identifiable regardless of culture? Is it necessarily painful? Scheper-Hughes’ work (Death Without Weeping) may be one counter example to this “universal” view of trauma. Is predictability (or lack thereof) at the heart of trauma? We also need to be more specific about different types of memory.

Group 3: Political and Cultural Contexts (Moderator: Marjorie Kagawa-Singer)

Participants: Boehnlein, Brown, Garro, Del Vecchio Good, Kagawa-Singer, Martin, Mayer, Scheper Hughes, Schumann, Yngvesson

Orienting questions:

How do cultural meaning systems and political contexts effect the impact of traumatic experiences?
Do these explanations/contexts alter the onset, course and outcome of PTSD? If not, what does this say about the power of cultural models to shape experience? If yes, how should these models be framed, understood and utilized in clinical and policy concerns?

Discussion Highlights:

Trauma and cultural or political contexts

What is more malleable–The biology or the social/political aspects of PTSD? What is the power of cultural reinterpretation (both pre and post) in regard to the valence (positive and negative) of trauma? Culture may be viewed as an extended cortex, interacting with sex, genes and locally specific effects on the brain. Culture is both inside and outside–the brain is plastic and takes on aspects of its environment. Therefore in regard to PTSD there is a need for more intervention at a social level.

What is the historical context of PTSD? Why are we hypersensitive to PTSD at this point in time? (Or are we?) What are the cultural differences regarding expression and symptoms of PTSD? Is the dose of exposure still a consistent variable in response to stress/trauma? Overall we need to strive for empirical groundedness in taking this interdisciplinary approach. One potentially important question to consider — Is stress innoculating or sensitizing? One problem with the immunological model is that resistance might not be the healthiest response. There is interesting research in pediatric pain which shows pain sensitization in infants and children (Liebeskin???). Being able to label fear appears to quiet down the amygdala, can this have the same effect upon traumatic memory or experience?

Further philosophical/theoretical/methdological issues involved in integrating cultural and neuroscientific levels of analysis (Moderator: Beate Ritz)

Participants: Barad, D’Andrade, Good, Greenfield, Hollan, Lance, Mitchell, Ritz, Schumann, Weisler, Yngvesson

Orienting questions:

Ethical and Philosophical Issues:

What are the ways in which cultural context shapes and is shaped by neuroscientific and psychiatric practices?
How do cultural theories of the mind relate to neurobiological studies on brain organization (e.g. hemispherization, neurochemical processes)?

Methodological Issues:

How do researchers working in different domains and with different models agree on objects of analysis and measurement?
How can we arrange questions along a neurobiological/anthropological continuum to facilitate communication between the fields?

Discussion Highlights

Criticism of Culture as Mere “Context”

A few of the members made the point that it is incorrect to think only of how cultural context shapes and is shaped by neuroscientific and psychiatric practices. The danger of this approach is that it tends to externalize culture, increasing the dichotomy between an “external” culture and an “internal” brain. Instead we should recognize that culture is both internal and external, despite the fact that research often demands that we choose to look at it from a particular perspective. This criticism of focusing on culture as predominantly “context” was highlighted by the question–“is there culture if there is only one person in the room?” — Yes! Because the individual is enculturated, and because even a single person in a room is driven by evolved built-in social-cultural needs.

Neurobiology and Cultural Theories of Mind

This topic brought up additional questions of what is culture and how do we identify it — is it behavioral? Is it social interaction? Is it social transmission and learning? (If so then are rats and mice who socially transmit food preferences, or termites who transmit architectural strategies, engaging in cultural activities?)

In regard to human behavior, the correlation to neural circuits is not solidly understood or localizable to specific synapses. In regard to human social interactions, some work (by Fiske et al. for example) is being done to search for localized regions of the brain associated with particular types of social relational interactions (Authority Ranking, Communal Sharing, etc.) Similarly Patricia Greenfield is investigating the developmental aspects of this. We are reminded that localization in the brain may be addressed at at least two levels–we can talk about local synaptic networks within a single topographic map or we can talk about the larger connectionist models that address how different areas of the brain are connected. At this point the connectionist models are less well understood and much looser, however this does not change the validity of synaptic models of learning.

Some participants are skeptical about the centrality of a focus on localization and argue that non-localized approaches to understanding connections between culture and the brain should be exploited. Rather than asking “where” culture is in the brain, perhaps we should first ask “when”?

Concerns for Bridging Neurobiology and Anthropology

Two main overlapping issues emerged in this discussion–first, should there be work done at both the neurobiological and anthropological levels? and second, should these be integrated? While it is largely agreed that there is a need to work from both the bottom up and top down, there are some concerns as to whether these two fields can ever really meet in the middle. One aspect of incompatibility involves methodological assumptions. Neuroscientists, for the most part, use the same epistemology, the same methods, whereas not all anthropologists follow the same rules — hence, is anthropology a science? A critique of this position noted that anthropological research (such as Ochs’ study of physics labs) has shown that indeed even in “hard science” the rules of science are not all the same. A second apparent epistemological incompatibility that neuroscientists identify is that anthropologists tend not to ask questions that can be answered fully, they tend not to present falsifiable hypotheses for testing. Some anthropologists agree, but claim that although anthropologists mostly don’t test theory, they use theory to interpret–good theory allows you to understand the complexity of something. Ultimately it is important to accept different ways of knowing, different epistemologies, however should we retain these as separate levels, or can we and should we aim to link these these up?

In attempting to integrate neuroscience and anthropology there are at least two basic communication concerns to consider. First, is everything reducible? And, second, do both types of researchers recognize the idea of hypothesis testing? (The question of can we apply testable hypotheses to cultural anthropology is critical from the perspective of neuroscientists.) Other participants argued that anthropology is not primarily about hypothesis testing, but is still valuable to neuroscience because it is about how to best gather data, especially to gather behavioral data through observations at a deeper level than any other field. As a descriptive science, anthropologists produce knowledge however it is not in the language of hypothesis testing. We may not test theories, but rather we use theories to give a deeper explanation to the data.

Issues of mid-level analysis in interdisciplinary research on brain, mind and culture (Moderator: Rob Lemelson)

Participants: Anderson-Fye, Boehnlein, Chesselet, Fiske, Iverson, Lemelson, Martin, Mayer, Pybnoos

Orienting questions:

Are there meaningful correlations between biological markers and cultural phenomena and, if so, what are the implications?
Why does our ability to find simple correlations between brain mechanisms and neuropsychology vary?

Discussion Summary:

Meaningful Correlations Between Biological Markers and Cultural Phenomena?

In an ideal world there is a two-way exchange between neuroscience and anthropology. One area of research might look at implications of trauma and children’s social functioning in school. The focus of our research and questions should not necessarily be on how biomarkers predict illness, but rather, social functioning. Since schools are not necessarily concerned with PTSD directly but are concerned with behavior and since startle affects performance, then research on PTSD may be motivated in such a direction.

In regard to domestic violence, it is important to consider how biological changes affect familial social adjustments. . . and how might we come to intervene effectively and appropriately?

Stress can induce altered pain perception. What is psycho-somatic? Early life stress can cause hypersensitivity (CRF modulates this response). Observations of PTSD in quadrapelegics provide an interesting example for extending our understanding — is there inhibition of PTSD because of the lack of visceral feedback?

Challenges to Making Meaningful Connections

There are many difficulties with making links that are culturally sound. There is a mixed literature regarding child-raising and outcomes cross-culturally including regarding variations in verbal and physical contact, and sleeping norms, and maternal deprivation, among others. In addition, we need to consider the roles of other (non-mother) primary care providers. Finally, there is little study of transition points and cultural norms.

An important question to consider is are there empirical studies to facilitate dialogue between neuroscience and cultural studies (or clinical research)? Perhaps we also need to consider what stands in between “culture” and “neuroscience”. Is the field of neuroscience ready for integration with fields such as anthropology? Some participants argued that although in 10 to 15 years, neuroscience may be ready to integrate more with the social sciences, at this point it is at the crossroads of studying so many mechanisms that neuroscientists may be much less interested in studying more “hazy” connections with anthropology or other social sciences.

Other participants argued that neuroscientists are always interested in what is the next thing to reduce, therefore anthropology for example is valuable for guiding what the next problem will be. Neuroscience needs anthropology to describe behavior and hence to provide neuroscience with something to investigate at another level.

Pedagogy and future program

Promoting True Interdisciplinarity

One of the main goals of this foundation is to promote education and research that is truly interdisciplinary, something that although it has been paid lip service among different departments, was very limited at UCLA. Unfortunately the claim of interdisciplinarity is often used too loosely among programs and in seminars — people with different expertise involved on a single teaching or research project is not enough. However, the UCLA Center for Culture, Brain and Development, which has drawn together graduate students, post-docs, and faculty from various departments has been one initial significant step towards interdisciplinarity as supported by the FPR.

Insights from the Development of the Center for Culture, Brain and Development:

One way to approach interdisciplinarity is to address the multiple levels of potential interdisciplinarity. The first level involves identifying the basic assumptions that one field makes about other fields, and being able to recognize what are valid and invalid assumptions about other fields. At a deeper level, the second level involves being able to read across fields, to understand, evaluate, and keep up to date with the literature in other fields. A third level of interdsiciplinarity involves creating or joining a truly collaborative team in which people can understand and work with each other constructively on a problem. This form of collaboration can provide several challenges in different areas (as was highlighted in previous workshop discussions of conflicts in methodological assumptions regarding what constitutes a good question or good evidence is not always agreed upon between the fields of neuroscience, anthroplogy, and psychology). A fourth level, and a degree of interdisciplinarity that is sometimes less practical to aim for, is when an individual is able to do multidisciplinary work his- or herself.

One of the most important factors in supporting the success of interdisciplinary work is that there must be a theory that connects the processes of the different levels. This lack of connective theories (such as good theories about the way neuroprocesses affect culture, or the ways that social processes affect development, etc.) is a key challenge that our group faces. This search for connective theory is important in our consideration of how we train students — we must teach students that there is a theoretical story as to how cultural processes affect neuroprocesses, etc. In addition to supporting these theoretical connections, taking a problem based focus, rather than a methdological or disciplinary focus is critical.

In sum, there are different levels of depth of interdisciplinary training and research and we need to decide what level we want to get to. In addition, a problem oriented focus is a crucial impetus for stimulating true interdisciplinary work.

Biological vs. Social/Cultural Factors as Foundational

Throughout the weekend researchers in the social sciences and humanities mentioned an interest in learning more and integrating more neurobiology however, how much does an independent researcher need to know from this field? Some participants proposed that neurobiology is most basic and that the study of the brain is foundational to the proposed integrative work.

In contrast to this opinion, other participants argued that social factors are at least as foundational, if not more so, than biological factors. Therefore we need to focus attention on levels of integration in a different way. We need to understand the processes of interaction between the individual level, the small group level, and the level of larger social processes.

Understanding Neuroscience as Metaphor or Mechanism?

Recognizing that at least some knowledge of the brain is important for interdisciplinary work, what then are the tools then that are needed to assist people in achieving sufficient proficiency in neurobiology? What are the fundamentals that people need to know and can this be achieved in a one year seminar or training program?

So far many of the program aims described have been top-down approaches that seem to merely dip into neuroscience at a metaphorical level. The CBD has dipped into the top of neuroscience by integrating brain imaging, but these images are only a descriptive part of neuroscience they do not explain mechanism. It is critical to recognize that neuroscience is about mechanism primarily, not metaphor. Too often researchers from outside of neuroscience will over-generalize metaphorically about knowledge of the brain. They mix up mechanisms, and at that point they lose the power — it’s no longer neuroscience, it’s fantasy. So it is critical that if the FPR wants to integrate neuroscience in their educational program then we must have respect for the detail and specificity in mechanism. In regards to developing a curriculum for non-neuroscientists then, this respect for the details demands that we pay closer attention to biology–from molecules, to cells, to communication between cells, to synapses, etc. Therefore, perhaps one goal of the FPR should be to sponsor a work group to develop a curriculum in neuroscience that can offer basic training for non-neuroscientists while maintaining respect for the detailed mechanisms of the science.

In opposition, other participants argued that neuroscience is not just about mechanism. There are neuroscientists who are also metaphysicians and philosophers who can add in very productive ways to interdisciplinary discussions of particular problems (brain death, etc.) It may be beneficial to encourage multiple means of neuroscience training — for non-neuroscientists, again taking a problem based focus in even basic neuroscience education may be more productive than offering a more abstract approach to understanding neural mechanisms.

Interdisciplinary Training For Non-Anthropologists

We need to keep in mind that this integrative training should be developed both ways. Anthropologists and psychologists not only need to be taught neuroscience, but neuroscientists and clinicians need to be taught core theoretical concepts and literature in anthropology. As anthropologists are encouraged to spend time learning to work in a lab or clinic, so to should neuroscientists and psychiatrists spend extended periods of time “hanging-out” in some community setting and learning how to interview in an anthropological way.

Practical Directions for the Foundation — Create a Reader

It could be very helpful to determine what might be key readings in a multi-disciplinary training program. This might involve creating a reader, a series of readers, or at the very least a list of key literature in each field. Developing such a resource could be an important piece in assisting and encouraging the teaching of courses across disciplines. Sections of this “reader” would likely need to be updated every few years.

Consider Clinical Relevance

Something we might want to keep in mind is maintaining a focus on clinical relevance — What does this knowledge lead us to? And, how does it help people who are taking care of people who are traumatized and sick? Research should go both ways. Rather than just working from theory or the science lab out towards the clinic, successful clinical programs should also be scientifically dissected and analyzed, studied to inform our theory.

Learning to Ask the Right Question

In another opinion, perhaps learning what are the important questions to ask in different disciplines, rather than necessarily learning the details of those disciplines, is what is most important. Rather than learning mere content in a classroom, people need to be introduced to the methods of inquiry and process of different disciplines by spending time in labs or in clinical settings, working on projects, and having the opportunity to model the practice of different disciplines.

Therefore in addition to developing a curriculum, we might want to consider developing opportunities for appreticeship type training. More than just a seminar it might be helpful to have a core collaborative group of faculty from multiple fields. Teams of people that can help researchers figure out how to design the interdisciplinary research, to determine the most relevant and valuable questions to ask, and to identify the resources available to answer different parts of the question

Practical Consideration of the End-Poinst of this type of Training

Are we training people to never get a grant or a job? In the end, researchers still have to present to the AAA or the APA. How can we encourage this multi-disciplinarity, but still assure that our students will be marketable?

Models for Interdisciplinary Training

Would training in neuroscience be best achieved through semester long seminars or through intensive few week courses during the summer? . We need to look at previous pedagogical models — what has worked before? If we are discussing pedagogy, it would be good to have some idea of the models that are out there, the models that work, and at what level they work. (Connie has done a search on different models of integration and science, with a focus on biology and culture, perhaps this is material that could be presented at a future conference or workshop.)

Interdisciplinary Teams

An alternative to educating the individual in multiple areas is to do projects involving interdisciplinary teams. For example, offer fellowships to teams of researchers forcing them to interact and work together on a single project rather than individual interdisciplinary projects. In previous experience, a big part of the struggle following getting people together to work on grant proposals for multi-disciplinary research centers, is that of negotiating a common vocabulary between the various specialities and the foundational aspects of each speciality. The NSF (and NIH?) have offered very large grants for funding interdisciplinary graduate work, however takes a huge effort to pull together a proposal that is likely not to be funded.

Participants

Mahar Agusno, MD, Gadjahmada University
Eileen Anderson-Fye, Ed.D, UCLA/FPR
Mark Barad, MD, Ph.D, UCLA
James Boehnlein, MD, M.S.C., Oregon Health and Science University
Joel T. Braslow, MD, PhD, UCLA
William Brown, M.Sc., PhD Candidate, Dalhousie University
Marie-Francoise Chesselet, MD, PhD, UCLA
Roy D’Andrade, PhD, UCSD
Mary-Jo DelVecchio Good, PhD, Harvard University
Alan P. Fiske, PhD, UCLA
Linda Garro, PhD, UCLA
Byron Good, PhD, Harvard University
Patricia Greenfield, PhD, UCLA
Douglas Hollan, PhD, UCLA
Portia Iverson, President, Cure Autism Now
Marjorie Kagawa-Singer, PhD, M.N., R.N., UCLA
Marvin Karno, MD, UCLA
David J. Kinzie, MD, Oregon Health Sciences University
Robert Lemelson, PhD, UCLA
Debra Martin, PhD, Hampshire College
Emeran Mayer, MD, UCLA
ill Mitchell, PhM.ScD Candidate, UCLA/FPR
Robert Pynoos, MD, UCLA
Beate Ritz, MD, PhD, UCLA
Nancy Scheper Hughes, PhD, UC Berkeley
John H. Schumann, PhD, UCLA
Allan Tobin, PhD, UCLA
Steven Weisler, PhD, Hampshire College
Barbara Yngvesson, PhD, Hampshire College