Delphine Oudiette, James W. Antony, and Ken A. Paller, ‘Fear Not: Manipulating Sleep Might Help You Forget’, Trends in Cognitive Sciences, 18 (2014), 3-4.

The very day that I published my previous post, which talked about sleeplessness and its psychological consequences, I checked Trends in Cognitive Sciences and found this article in the January issue. It made me think about Macbeth again.

*

Oudiette et al. are interested in whether traumatic memories (such as in the debilitating condition Post-Traumatic Stress Disorder) can be ‘attenuated’ by manipulations of sleep. Research suggests that during sleep memories are consolidated (made ‘stronger and more enduring’) when ‘patterns of brain activity are spontaneously reactivated’. It appears to be possible to tinker with these processes. In an experiment on mice that had been trained to associate electric shock with a particular smell, fear responses were heightened after a period of sleep in which the odorant in question had been reapplied. In a slightly different experiment on humans, later fear response was actually lessened when the associated smell was introduced during sleep.
      The authors acknowledge that they are a long way from a therapeutic treatment for traumatic memory like that in the film . However, as they say, interventions during sleep might well be less painful than reliving or facing traumatic experiences, which other therapies often involve. It’s an intriguing idea, however sketchy.

*

This made me think of two fictional comparisons. One (a bit of a stretch) was an episode of , which featured Vietnam war special forces troops who had undergone brain surgery that removed their need to sleep. Rather than making them more effective, it caused their brains to gain strange powers (e.g. telekinesis). Without sleep to regulate it, the X-Files writers seem to be saying, the potential of this organ might get out of control.
      The other instance is, as I said above, Macbeth. I quoted these lines in my previous post:

I have almost forgot the taste of fears;
The time has been, my senses would have cool’d
To hear a night-shriek; and my fell of hair
Would at a dismal treatise rouse and stir
As life were in’t: I have supp’d full with horrors;
Direness, familiar to my slaughterous thoughts
Cannot once start me.

I discussed there how the hero’s lack of sleep is part of his psychological and moral degeneration. The new article in Trends in Cognitive Sciences made me think further about what Shakespeare might be exploring about sleeplessness. Macbeth is deprived of sleep by conscience (although since he claims to hear a voice proclaim that he has ‘murdered’ sleep, there may be supernatural agents involved). Without sleep, he lacks one key way in which to process all the fears and memories of his insecure, murderous reign. The link isn’t all that close or exclusive – there are other reasons, including just simple habituation, why Macbeth has become inured to horror – but they are two prominent parts of his psychological decline.
      This is debilitating. The hero is anxious, restless. Lady Macbeth is not very different: she sleepwalks, restlessly trying to wash out bloodstains. But perhaps, like the X-Files soldiers, Macbeth is released and transformed. He can do terrible thing after terrible thing partly because he never consolidates the effects they are having on him. It’s interesting that he is so specific about his lack of response in . In one of the experiments discussed by Oudiette et al., this is the measure of fear that they use. Shakespeare is interested in the relationship of sleep and fear, and Macbeth is a compelling portrait of one extreme set of causes and effects.

*

The more I think about it, the more it seems probable that memory therapy during sleep might happen. The road towards the Lethe pill (standard kit for those in combat zones) or the night-time phobia clinic will surely be littered with terrified mice, and traumatized monkeys, and unanticipated consequences in humans. Ingenuity may yet prevail. As is often the case, the differences between literature and cognitive science, in what they can offer to an understanding of sleep, involve ethics. The scientific experiments arrange clear and controlled versions – you might say, simplified travesties – of what fear is really like. Fictions can set up scenarios that would never be allowed in the laboratory and yet which compose (counter-intuitively, even with the witches and all) more realistic versions of these powerful emotions. But the fictional knowledge (that vexing aspiration again) does not refine into categories, physiological theories, or hopes of therapy. People do keep going back to Macbeth, though, learning from it each time, partly through the implicit, exploratory question it is asking of our understanding of the mind – ‘so, could this be what it would really be like?’.

Todd F. Heatherton and Dylan D. Wagner, ‘Cognitive Neuroscience of Self-Regulation Failure’, Trends in Cognitive Sciences, 15 (2011), 132-9.
Ilia N. Karatsoreos and Bruce S. McEwen, ‘Psychobiological Allostasis: Resistance, Resilience and Vulnerability’, Trends in Cognitive Sciences, 15 (2011), 576-84.

Heatherton and Wagner are interested in why sometimes we lose self-control. After being subjected to a , dieters eat more than non-dieters, one lapse disabling all their restraint. Neuroimaging suggests that brain regions pertaining to rewards, on the one hand, and self-control on the other, are involved in a sometimes precarious balance. Self-regulation exercises help; drinking alcohol does not. Further research could get further into the way that external stimuli and internal control mechanisms interact.
      Karatsoreos and McEwen develop the idea of ‘allostasis’, an adaptive resilience to changes and challenges, as an alternative to the more negative-seeming ‘stress response’. In addition to exploring how allostasis work at a molecular level, they discuss the effect of sleep-deprivation on the ability to adapt. When their circadian rhythms are compromised, mice do badly in changed mazes; jet lag shrinks the medial temporal lobes of air crews. Karatsoreos and McEwen end up wondering about modern life, where sleep-deprived humans face an unprecedentedly hectic environment.

*

Tragic dramas are often thought of as intensely psychological, in a loose sense at least. And in tragedies, adaptive resilience (or indeed, stress), and self-control, might both come into play. The point of this post is to ask what a literary work – Macbeth, in this case – might offer to anyone trying to understand such things. I want to start with two quirky, detailed connections, before suggesting something more substantial.

*

‘That Which Hath Made Them Drunk Hath Made Me Bold’
This is what Lady Macbeth says about wine: it has given her courage, and removed her inhibitions. She turns to the same idea when berating her husband: ‘Was the hope drunk / Wherein you dress’d yourself?’ Later in the play, a drunken porter takes his time opening the door; at a (surely not teetotal) banquet, Macbeth sees a ghost. Alcohol loosens minds at several key points in the play. This feature of the play, part of an atmosphere in which self-regulation fails and disaster breeds, looks a little different after reading Heatherton and Wagner.
      The play turns to self-regulation in the long scene set in England (4.3). Malcolm tests Macduff by claiming to have boundless appetites: ‘my more-having would be as a sauce / To make me hunger more’. This is just a ruse, the point being to make sure Macduff is on the side of right, not just against Macbeth. However, it brings the psychology of restraint back into focus, in a play where Macbeth, having fallen once, is capable of further, escalating violence.

‘Sleep No More’
We cannot blame the wine for the murders in Macbeth. It would be even harder to blame disrupted circadian rhythms for its atrocities. Nonetheless, the play makes an issue of sleeplessness:

      Methought I heard a voice cry ‘Sleep no more!
      Macbeth does murder sleep’, the innocent sleep,
      Sleep that knits up the ravell’d sleeve of care,
      The death of each day’s life, sore labour’s bath,
      Balm of hurt minds, chief nourisher in life’s feast, —

‘What do you mean?’ asks Lady Macbeth of her husband, when he speaks these lines. . By the end of the play she and her husband both suffer from bad sleep:

      I have almost forgot the taste of fears;
      The time has been, my senses would have cool’d
      To hear a night-shriek; and my fell of hair
      Would at a dismal treatise rouse and stir
      As life were in’t: I have supp’d full with horrors;
      Direness, familiar to my slaughterous thoughts
      Cannot once start me.

Macbeth is remarking on his indifference to horror, which might be thought of as a distortion of adaptive resilience, if not a failure. Having murdered sleep, he has wrecked allostasis. In the light of Karatsoreos and McEwen, this aspect of the play resonates a little more specifically and acutely. The wine and the sleeplessness together look like fragments of psychological insight. They don’t come together to form coherent conclusions (or even knowledge) about the mind, but they suggest ways in which discoveries in details, as well as in the thematic mainstreams, could be thought-provoking.

*

I would like to suggest a way in which Macbeth offers something more structured. Heatherton and Wagner end up by recognising that failures in self-regulation involve external factors (such as the nature of the tempting stimuli) and internal factors (such as the neurological make-up of an individual). They wonder how the contributions of external and internal are to be figured in each individual case. In Macbeth, there are equivalents to these external factors (opportunities and circumstances; the workings of the witches) and internal ones (what we are told, and what we have to infer, of his character).
      Some readers would privilege external or internal in their interpretation of the play. I would suggest that Shakespeare does not resolve the question, that in Macbeth’s unique and extreme case, the interaction between causes of different origins is something like alchemy, a mixing of ingredients that produces an extreme result. The play proposes that disentangling the contributions of internal and external may not be possible; that many things about human beings happen in the feedback loops between internal and external; and that seems like a believable (and appropriately tragic and horrifying) answer to the emerging scientific question.

I’ve been enjoying Helen Mort’s blog ‘Poetry on the Brain’ recently. She also seems to be working on a two-way conversation between literature and cognitive science. As well as reflections on poems, she tackles scholarship on the subject. I was pleased to be reminded of Jonah Lehrer’s Proust Was a Neuroscientist (Boston: Houghton Mifflin, 2007). I feel like I want to distance myself from the more partisan and territorial qualities in this book’s treatment of cases where artists have reached insights (into memory, for example, or perception) before scientists. But maybe only a little.
      Helen Mort’s blog will give you plenty to read while ‘What Literature Knows About Your Brain’ takes a break until the new year.

Thalia R. Goldstein and Paul Bloom, ‘The Mind on Stage: Why Cognitive Scientists Should Study Acting’, Trends in Cognitive Sciences, 15 (2011), 141-2.

Goldstein and Bloom think ‘it is now time for cognitive science to take the stage’. They see that have turned to science to understand their discipline better, and they want to return the compliment. This isn’t interdisciplinary reciprocation, though. They think the phenomenon of ‘realistic acting’ is worth investigation, and that it might help them aim for a better understanding of pretence, deception, and/or ‘social cognitive capacities, such as theory of mind or empathy’. What they don’t explicitly allow for is the possibility that writers, actors, directors and audiences might already have valuable insights into these very things.
      I am addressing a very brief essay, which is optimistic and open-minded about the project it proposes. I recognise that it would be a big step to expect a scientific psychological study to look to the world of the theatre for its knowledge about a topic, rather than for a chance to offer insights. However, it seems to me a small step to realise that writers, actors, and directors could all offer considerable expertise in how, for example, empathy works. Their success depends on a shrewd practical understanding of how we see things through others’ eyes.

*

Furthermore, even in a constructive spirit I need to note some problems in the things that Goldstein and Bloom take for granted. ‘Realistic acting’ is seen as a new phenomenon; before the 20th century, ‘performance was highly stylized’. They also say that ‘it was not until Elizabethan England that characters had inner states portrayed onstage (via monologues directed to the audience)’. Of course, acting styles change, and I see what they are getting at here; I may need to rely on a similar degree of indulgence whenever I paraphrase developments in cognitive science.
      Nevertheless, I do think that they are relying on a narrow idea of ‘inner states’. In much earlier drama there are representations of anger, confusion, love, and so on, all of which are inner states within some definitions. What there aren’t necessarily are representations of mental processes as we have been taught to recognise them by modern novels, modern acting styles, and other rather specific contexts. I also don’t know what to do with intriguing that suggests most humans routinely attribute intentions (another kind of inner state) to moving shapes. Our social cognition appears to be very resourceful in finding ways to get below the surface.
      In addition, it does seem to me to matter that the notion of what is ‘realistic’ isn’t absolute. One of the priorities of Aristotle’s Poetics, describing the very beginnings of western drama, is consistency in representation (so, for example, a soldier character should not be scared of blood, and should speak like a soldier). What we see as stylized gestures in earlier British acting styles might have struck their audience as very effective ways of communicating convincing impressions and effects. The history of performance and the changing theory of drama over time could add a lot of sophistication to the use of the term ‘realistic’.
      As it stands, though, it’s a problem, as in an arresting claim from the very beginning of the article: ‘One of the main pleasures of contemporary life is the observation of realistic acting in dramatic theatre, television comedies, award-winning movies, and pornography.’ I don’t know what to make of this. The styles of acting that typify theatre, television, and cinema are all different, and within each medium there are further variations. The last item on the list seems a real stretch. As far as I know, pornography has no reputation for realistic acting, only for the unflinching representation of something other media would not. It seems to be better known for bad acting and for extremely unrealistic scenarios.

*

It is better to end by welcoming willingness from cognitive scientists to engage with the theatre as an environment in which to learn about cognition. It will obviously take some work to make the case that the intricacies of literary and theatrical terminology and practice should be part of this exploration. Likewise, it will not be simple to make the case that pertinent knowledge is already to be found in plays and performances. That’s something in which this blog hopes to participate.

GUEST CONTRIBUTOR
This post is by Roz Oates
(Roz is a Ph.D. candidate with Durham University’s ‘Hearing the Voice’ research team. She presented this project at the This Is My Body conference, featured in an earlier post.)

Exploring the Power of Reminiscence Poetry to Assist those with Cognitive Decline

Recent research shows that poetry provides a medium for those with dementia to speak out about their experiences of living with the disease. Those with medium-state dementia, such as my grandmother, who can no longer write poetry alone, can however be assisted to do so. After going to a talk given by , a poet who has made ‘poems out of the world of people with dementia for the past fifteen years’, I decided that I would try to co-facilitate poetry with my grandmother.

*

She was keen to write poems with me. The wider context of our being together and having a cup of tea was crucial to creating and sharing the poems. I therefore made a point of starting the session each time in this way. I then suggested to my grandmother a theme such as ‘going to the seaside when a child’, and we explored this memory together. After that, we started the poem. If my grandmother had difficulty thinking of a first line, I asked leading questions: Why did you like going to the seaside? Did you take a bucket to the seaside? What colour was it? After a short time, my grandmother usually got into a flow, and she did not need me to ask leading questions as often. I read the poem aloud back to her as it grew, so that she would be reminded of what she had said. Afterwards I gave my grandmother a printed copy of the poem. These poems offer helpful benefits by enabling my grandmother to convey the subjective reality of dementia and by restoring personhood and dignity.
      Below is a poem that I wrote with my grandmother about her bedroom in her present nursing home.

My Room is my Castle

My room is my castle.
It has three solid walls,
and a fourth, with a big window.
It’s very warm and comforting
and sometimes I’m alone in it
and sometimes I have friends with me.
It’s a very good way of living
when you’re old and getting tired,
because always the situation can fit
your present needs. It has moveable walls
and a very high ceiling
and if you wish you can reach for the stars.
With the stars come many, many memories
of a life that was young and not so young
and very old.

My grandmother’s description of her room as ‘my castle’ suggests a level of contentment, where she feels protected. Although it ‘can fit her present needs’ as she says, she also seeks a fantastical dimension. The room has ‘moveable walls’ and ‘a very high ceiling’ that allows her to reach for the stars. This seems to give her comfort, while enabling her to bridge together the different phases of her life from the young to the very old.

*

Poetry particularly lends itself to facilitating communication with someone with dementia. As poetry is often learnt in infancy, its rhythms and sounds make it the most memorable language. The free verse form which my grandmother uses allows her to use short phrases, without feeling the pressure to provide cohesive sentences that prose demands. Poetry also brings vivid images into my grandmother’s mind, such as the castle, which is associated with security, and then comfort. At the point where my grandmother struggled to think of a new line, using a cat puppet to act out the next sentence helped with creating a flow. This also added to the enjoyment that she found in creating the poem. Overall, the process seems to have helped my grandmother, who is unable to accept her present life with dementia, to reflect on positive memories of past lives, and this encourages her to communicate more.
      Creating these poems also provided a focus for the time I spent with my grandmother, and she felt encouraged that we were doing something productive together. In her own words, ‘writing poems is like playing bat and ball’, as we engage in this collaboration. Even though her memory is now very compromised, the poetry stays in her mind to some point, as she can remember that we write poetry together.

*

This process has triggered my interest in beginning a research project, where I will co-facilitate poetry with several patients who have early to medium stage dementia, using the same method that I did with my grandmother. By showing what qualities poetry has to convey the sense of loss for the dementia sufferer, I will investigate how metaphor is a primary agent in gaining the dementia sufferer some self-assurance and sense of identity. In the ‘now-orientated existence’ of dementia, argues that the metaphors the dementia patient uses to describe the past may provide insight into their current experience of the disease.
      However, I am also interested in whether it is the case that these poems, by bringing together true and false memories – for they may well not all be true – can lead to an overall gain in true memories. So to establish the reliability and accuracy of a person’s recollections, I will compare the content of the memory before writing a poem, with that presented during the process, then after. I also plan to revisit the same recollection on a separate occasion, when I will ask the dementia sufferer about the same theme, such as visiting the seaside, so as to produce a second poem, and see if similar images and connections are generated.