Today's lecture deals with a much neglected topic, at least online.
What's a connection between brain tumors and mental illness, cancer in the brain and mental health? How do these fit together? What causes what? And how does each one interact with and influence the other? How brain tumors change your personality?
My name is Sam Vaknin. I'm the author of Malignant Self-Love: Narcissism Revisited, a former visiting professor of psychology in Southern Federal University, and currently a professor of clinical psychology and business management in CIAPS, SIAS, Cambridge, United Kingdom.
And this is the fourth video number four in a series about the brain.
This magnificent, unprecedented, unfathomable, non-deciphered and little-known, mysterious organ device inside our skulls.
The previous three videos, see the links in the description.
Number one, narcissism, brain injury and trauma and personality.
Number two, brain neuroplasticity, the neuroscience of cell states.
And number three, COVID-19. How does it impact the brain and the central nervous system?
These are stand-alone lectures. You can watch them one by one or all together. They are not interrelated.
Brain tumors.
Before I discuss this specific type of family of cancers, I would like to share with you the way I see cancer.
Cancer is of course a family of diseases, some of them caused by viruses, some of them caused by chemicals, and so on so forth.
So it's very misleading to discuss cancer as if it were a monolithic entity.
But still, there's one thing in common to all cancers, the uncontrolled proliferation of cells.
I propose to view cancer as an organism, not a disease, an organism, a small animal with a life of its own, subject to evolution, evolutionary pressures, the rules of evolution, the path and dynamics of evolution.
So this organism resides inside our body and grows and evolves and transforms and changes and dies and starts to live again, exactly like every other organism.
It is in this sense reminiscent of mitochondria.
Mitochondria are remnants of much older organisms which got incorporated into our bodies.
Our bodies are huge zoos with zillions of bacteria and viruses and virus traces and bacterial traces incorporated into our DNA. About one third of our DNA is probably alien, not ours at all.
So, cancer is very detrimental to our health and our longevity. There's no debate about this, but it behaves more like an organism than a disease.
In this sense, cancer is parasitic.
There are various types of cancer, some of them are primitive. Others are hyper-complex.
It's exactly like the variety and diversity that we find in specific ecosystems and niches and habitats.
Our bodies, the habitat, cancer, various cancers, the organisms.
And we co-evolve.
Our bodies evolve together with the cancer.
We are symbionts. There is a symbiosis between the cancer and our body.
The cancer is a laboratory for weeding out life-threatening mutations.
It's like there's a giant experiment taking place using human bodies.
And the human bodies who picked up the wrong lottery ticket, the bad mutation, die out. They die out via the vector, the evolutionary vector of cancer.
Cancer therefore may be an experiment involving billions of people and weeding out or filtering out beneficial mutations from bad ones.
This is how I see cancer, as our partner in evolution, as a vector of our mutations, as something which is conducive and inducive to human evolution as well.
We co-evolve and we are in a symbiosis with a cancer as a kind of parasite.
Okay.
We know that disregulated cellular signaling networks drive the genesis of tumors, tumori genesis, so the genesis of tumors.
Signaling pathways control cellular behavior. Disregulated pathways, for example, due to mutations that cause genes and proteins to be expressed abnormally, can lead to diseases, most notably to cancer.
So cancer has something to do with disrupted communication, with communication gone awry, gone bad.
And you're beginning to see the similarities between the intricate molecular and signaling mechanisms underlying cancer and the intricate mechanisms and pathways underlying mental illness.
Because most mental illnesses can be reduced to communication disorders.
The communication disrupted could be biochemical in the case of psychotic disorders such as schizophrenia and the communication disrupted could be verbal for example in narcissism and borderline.
But we can very safely reduce the vast majority of mental illnesses into problems in communication, pathways gone wrong, signals gone missing, the whole structure of communication somehow quaking and shaking and breaking.
Communication in mental illness, disrupted communication in mental illness, resembles very much disrupted communication or disregulated communication and signaling in the genesis, the creation, the formation of tumors.
This is one similarity between cancer and mental illness.
And if we consider the fact that cancer is based on mutation, arises out of mutations in many cases, and that mental illness has a neurobiological foundation, we may even conceive of cancer as some sort of precursor or catalyst to mental illness, something that creates mental illness in the body via neurobiological pathways, disregulated cellular signaling, and other pathways in the brain and outside the brain.
In neurooncology, we know that cancer impacts and modulates mental health, not only in the brain, but also in the guts, in the intestines. The guts or the intestines should be probably reconceived as part of the neurological system.
But there's a video that I dedicated to this as well.
Right now, let's focus on the brain.
And let's start with an article by Madhusoodanan, Farah and others, Psychiatric aspects of brain tumors: a review published in the World Journal of Psychiatry in September 2015.
Literature, of course, in the description. You can find all the articles and so and so.
The authors say, infrequently psychiatric symptoms may be the only manifestation of brain tumors.
They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety or anorexia. Symptoms may be misleading, complicating the clinical picture. Early diagnosis is critical for improved quality of life.
Symptoms that suggest workup with neuroimaging include new onset, psychosis, mood and memory symptoms, occurrence of new, atypical symptoms, personality changes, and anorexia without body dysmorphic symptoms.
The majority of large studies, say the authors, discussing brain neoplasms and psychiatric symptoms, date back to the 1930s.
Since psychiatric nomenclature and disease parameters change constantly, it is difficult to analyze this topic in a consistent manner.
The authors enlighten us. Most brain tumors present with specific neurologic signs due to mass effect.
However, in rare cases, brain tumors may present primarily with psychiatric symptoms.
A study by Kishner reported that 78% of 530 patients with brain tumors had psychiatric symptoms. However, 18% presented only with these symptoms as the first clinical manifestation of a brain tumor.
One in five people with brain tumors present with psychiatric symptoms, not with neurologic symptoms. It's very important.
Back to the article.
Due to the neuronal connections of the brain, a lesion in one region may manifest a multitude of symptoms depending on the function of the underlying neuronal fokey.
Symptoms of brain lesions depend on the functions of the networks underlying the affected areas.
For instance, a significant association has been found between anorexia symptoms and hypothalamic tumors, a probable association between psychotic symptoms and pituitary tumors, memory symptoms and thalamic tumors, and mood symptoms and frontal tumors.
The authors found 172 cases with psychiatric symptoms, and they divided the psychiatric symptoms to seven main categories.
Depressive symptoms, apathy, manic symptoms, psychosis, personality changes, eating disorders, and miscellaneous for other less frequently encountered symptoms.
Frontal lobe lesions and ventricular cysts may present with personality changes. This may include disinhibition, hypersexuality, and aggressive behaviors.
I'm going to focus only of the personality changes part.
If you want to read about the other manifestations, other psychiatric expressions of brain tumors, go to the article. There are tables there, and the tables are very detailed, and they link to studies.
Okay, table number five deals with brain tumors and personality changes.
And among the personality symptoms, there were hypersexual behavior, and this was attributed to a tumor in the ventricular area, a ventricular cyst.
There were personality changes which involved also memory impairment and poor concentration. There was in the extramedullary tumors with infiltration of the cerebral dura. And it's what is known as plasmacytoma, plasmacytoma and similar tumors.
Then there were frontal lobe symptoms in the absence of neurological signs, in angioma.
Personality changes, which involved aggression, usually focused, the tumor was focused in the ventricular. It was a cyst.
So it seems that ventricular cysts induce personality changes, which resemble very much narcissism in psychopathy, or even more so psychopathy.
So aggressive behavior, emotional lability, these were induced by ventriculus.
There were personality changes coupled with walking difficulties, incontin continents and other neurologic signs. These usually emanate from tumors in the frontal load. And the case of stage four, multiple metastases.
And finally, there are bizarre, there are tumors that induce bizarre, disinhibited behavior, and these usually are tumors in the multiple left orbital frontal and right thalamus, astrocytoma.
If the personality change is withdrawal, avoidance, inappropriate behavior, usually the tumor is in the bifrontal.
And if the personality changes mostly involve emotional lability, again, we are talking about a ventricular cyst.
Rage attacks, bulimia, uninhibited and brutal sexual behavior, periods of depression, suicidal attempts, or suicidal ideation. The tumor is in the frontal temporal part, lobe, and then it's an astrocytoma.
So you see that a variety of types of brain tumors can induce the entire spectrum of cluster B personality disorders as well as mood disorders and eating disorders.
And so there is a study, trends in brain cancer research, published by Nova Science Publishers 2006, which also contains additional information about all this.
Now I advise you to watch the video about brain injury and brain trauma and how brain injury and trauma very frequently induces a state which is indistinguishable from narcissistic personality disorder.
Have fun.
Before we discuss brain trauma and brain injury and how they replicate personality disorders such as narcissisticpersonality disorders, psychopathy, and so on so forth, I would like to read to you a segment from a publication by the American Brain Tumor Association.
The publication is titled Neuropsychiatric Symptoms of Brain Tumors, and you can find a link in the description.
I would like to read to you only a segment from this publication, Neuropsychiatric symptoms or brain tumors.
Introduction. Brain tumors and their treatments can cause a number of mood, behavioral, or cognitive symptoms that present or overlap, like mental health disorders. These are called neuropsychiatric symptoms, also known as neurobehavioral symptoms.
If untreated, these symptoms can cause significant change in the patient's personality, mood, and behavior. In extreme cases, these changes can lead to situations in which the patient, their caregiver, loved ones or others, are placed at risk.
The following is a list of common psychiatric symptoms that can be experienced by those diagnosed with a brain tumor.
Abusive behavior, verbal, emotional, physical.
Aggression, hostile or violent attitude or behavior.
Anger, a strong feeling of displeasure and hostility.
Anxiety, excess fear or worry.
Apathy, a lack of concern, interest, motivation.
Confusion, a lack of orientation, or not knowing what to do next.
Coping, adjustment, difficulty, difficult emotions, example, sadness or worry, or behaviors that arise in response to stressors.
Delirium, a sudden change in mental status, including confusion.
Delusion, a belief that contradicts reality.
Depression, a group of symptoms that includes sadness and loss of interest in pleasurable activities.
Flight risk, a tendency to leave one's environment suddenly without notifying others. Grandiosity, a sense of superiority, sometimes associated with mania, hippomania. Hallucinations, hearing, seeing or smelling something that isn't there. Impulsivity, disinhibition, example given, spending, sexual behavior, acting with little or not for thought or consideration of consequences, lack of restraint. Insomnia and sleep-wake cycle disorder can include staying awake at night or sleeping in the day. Mania, hippomania, a state of inflated self-esteem, decreased need for sleep, increasing goal-oriented activity, difficulty maintaining attention, racing faults, and excessive involvement in pleasurable activities. Hypo mania is a milderful of mania.
Memory loss, from transient to profound, like dementia. Profound personality change, exaggeration of underlying personality traits or the development of new ones. Rage, violent, uncontrollable anger. Paranoia. An unwarranted belief that others intend to cause harm, sometimes accompanied by unreasonable self-importance.
Psychosis, a general term for loss of contact with reality, may include delusion or hallucination.
Social withdrawal, less involvement in social activities suicidal behavior can include a number of behaviors including talking about wanting to die and gestures toward harming oneself violent behavior physical sexual or emotional attacks
my name is Sam Wagner. I'm the author of Malignant Self-Love, Narcissism Revisitor. Phineas Gage was 25 years old, construction forming. He lived in Vermont in the 1860s.
While working on a railroad bed, he packed powdered explosives into a hole in the ground, using tamping iron. The powder heated and blew in his face. The tamping iron rebounded and pierced the top of his skull, ravaging his frontal lobes. In 1869, his doctor, a chap by the name of Harlow, reported the changes to Phineas Gage's personality following this horrible accident. The doctor wrote, Finias Gage became fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom, manifesting but little deference to his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating. He said that Phineas Gage was devising many plans for future operation, which are no sooner arranged that they are abandoned for other, more appealing, but equally feasible alternatives.
Finias Gage's mind was radically changed so that his friends and acquaintances said that he was no longer Phineas Gage, concluded the doctor. In other words, his brain injury turned Phineas Gage into a psychopathic narcissist. Is this possible? Can a head trauma or brain injury induce a full-fledged personality disorder? Well, not really. Similarly, startling transformations have been recorded among soldiers with penetrating head injuries suffered in World War I. Orbitumidial wounds made people pseudo-psychopathic. They suddenly became grandiose, euphoric, disinhibited, and puerile. When the dorsolateral convexities were damaged, those affected became lephagic, and apathetic, or in the lingo of their time, pseudo-depressed. A doctor by the name of Gishvin noted that in many cases both syndromes appeared. The wounded soldiers became both pseudo-psychopathic and pseudo-depressed. But the diagnostic and statistical manual is absolutely clear. People with brain injuries may acquire traits and behaviors which are typical of certain personality disorders. But head trauma never results in a full-fledged, long-term personality disorder. I'm quoting from page 689 of the DSM. The enduring pattern of personality disorder should not be due to the direct physiological effects of a substance, such as a drug or a medication or to a general medical condition such as head trauma. In my book, Malignant Self-Love, Narcissism Revisited, I wrote, It is considerable that the third unrelated problem causes chemical imbalances in the brain, metabolic diseases such as diabetes, pathological narcissism, and other mental health syndras. There may be a common cause, a hidden common denominator, or perhaps a group of genes. Certain medical conditions can activate the narcissistic defense mechanism. Chronic ailments are likely to lead to the emergence of narcissistic traits or a narcissistic personality style.
Traumas, such as brain injuries, have been known to induce states of mind akin to full-blown personality disorders.
Such narcissism, quote unquote, is reversible actually, and tends to be ameliorated or disappear altogether when the underlying medical problem goes away.
Other disorders like bipolar disorder, formerly known as manic depression, are characterized by mood swings that are not brought about by external events. These mood swings are endogenous, not exogenous. They have the outcome of biochemical processes in the brain.
But the narcissistic mood swings, by comparison, are strictly the results of external events, not internal ones. The narcissist perceives and interprets certain events, for instance, the obtaining of narcissistic supply or the lack of narcissistic supply. And these cause mood swings.
But phenomena which are often associated with narcissistic personality disorders such as depression or obsessive-compulsive behaviors can and are treated with medication.
Rumor has it that SSRIs, such as fluoxetine, known as Prozac, might have adverse effects if the primary disorder is narcissistic personality disorder.
They sometimes lead to a serotonin syndrome, which includes agitation and exacerbates the rage attacks, typical of a narcissism.
The use of SSRIs is associated in times with delirium and the emergence of a manic phase, even with psychotic microepisodes.
This is not the case, luckily, with heterocyclics, MAOIs, and other mood stabilizers, such as lithium. Blockers and inhibitors are regularly applied without discernible adverse effects, as far as narcissistic personality disorder is concerned.
Not enough is known about the biochemistry of narcissistic personality disorder.
There seems to be some vague link to serotonin, but no one knows for sure. There isn't a reliable, non-intrusive method to measure a brain and central nervous system serotonin levels.
So it's mostly guesswork at this stage.
Head injury induces temporary narcissistic behaviors and traits. Brain biochemistry and genetic makeup may encourage the formation of narcissistic personality disorder.
That's all we know at this stage.