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ESSAY: Dyspraxia, Personality, Pathology Toward a Neuro-functional Clinical Theory

Posted By Robert DePaolo On January 10, 2010 @ 4:45 pm In Disorders and Pathologies | No Comments

ABSTRACT

This article discusses aspects of personality function and psychopathology in terms of neural coordination, specifically with regard to the orchestration of excitation and inhibition networks in the brain. The idea is proposed that human experience, including reason, emotion and attribution is a function of a neural coordination/summation process. As a corollary, it is suggested that the field of clinical psychology might be streamlined with respect to personality typologies, diagnosis and treatment and that ultimately disorders can be considered under the rubric of psychological dyspraxia.

At present, connections between the study of the brain and the practice of clinical psychology seem at best remote. Hopefully, since the brain is in effect the organ of experience, the roots of both personality development and psychopathology will sooner or later be tied to its basic functions. At that point diagnosis, treatment and general thinking about the personality will not only become more neurologically topographic but perhaps streamlined as well – perhaps eventually leading to a unified theory of mind, brain and personality.
Such an achievement is probably a long way off, but the process must begin somewhere.  Actually, the quest for a Unified Theory has already begun, as per ideas propounded by Millon (1990) and Buss (1995) (albeit in broad bio-evolutionary rather than neuro-functional terms). Their work is of enormous importance. The notion that human behavior and personality bear some relationship to our evolutionary history is indisputable. However even changes brought about by natural selection must be manifest in organic terms. In other words, the course of human brain evolution is less clinically relevant than the question of how it functions at the present time. Just as important is the question of how brain function translates into personality.
Problems of Taxonomy

There are at present hundreds of syndromes currently listed in the DSM Manual. Since many of these overlap with respect to symptoms and etiologies, it seems reasonable to ask whether each syndrome is represented by a distinct brain function correlate, or whether a fairly narrow set of neuro-functional patterns are involved in most if not all mental disorders.  A partial answer is that despite that its vast number of neurons (estimated at 100 billion) the human brain can only process information and become activated in a limited number of ways. With respect to its cellular vastness, that is less ironic than it might seem. In order for any complex information system to function smoothly requires a simple operating system so as to avoid noise and entropy (Ratzan 2004). Thus our brain must have its funnel so that its numerous elements can be encoded into a functional simplicity.
The brain’s simplicity is perhaps best exemplified by its adherence to a binary activation process consisting of excitatory and inhibitory neuro-chemical activity (Chih, Engelman et al 2005). In the final analysis the human brain operates, and can only operate effectively when there is a precise orchestration of the stop and go neuronal mechanisms governing sensory, emotional, motor and cognitive activities. As Fries, Wornelsdorf et al (2009) have shown, when there is an imbalance between excitation and inhibition and the neuro-chemical facilitators modulating conductivity, psychosis can result.
A great deal is known about excitation and inhibition. For example Krautz, Molinoff et al (1965) demonstrated that the neurotransmitter gamma-aminobutyric acid serves as an inhibitor by activating a stop procedure preventing responses from occurring. The evolutionary benefit of such a mechanism is obvious. For example, consider the following vignette about an ancestral hominid hunter whose skills and performance will determine the survival or demise of the group.

With weapon in hand the hunter spots a deer. He pauses, zeros in on his prey and aims. He knows his throw must be both precise and forceful. Otherwise the deer will live on, whereas the tribe might not. In order to reduce noise in brain and body he must excite the muscles in one limb and inhibit those of the other. In so doing, not only is he better able to focus on the target but can also throw with greater force because he can anchor his body in time and space (ie brace himself) with the opposite limb.
If both limbs were activated at once, the hunter couldn’t possibly complete the task. If the timing was off, so that the opposite limb began to intrude on the action of the throwing (dominant) limb he would be similarly unsuccessful. In effect, survival depends most essentially on fluid orchestration of excitatory and inhibitory networks – but not just for throwing – let’s return to the hunter vignette.
Given the recent trend toward deforestation resulting from climatic cooling, protein has become a necessary component of the tribal diet. That means the hunt has taken on special significance, which in turn means the hunter’s emotions are tweaked. Yet if he gets too aroused his aim will suffer. Conversely, if he is under-aroused, the neuro-muscular boost from norepinephrine needed to create a forceful throw will not be forthcoming. Thus his emotional circuits also require proper orchestration. It is nature’s mandatory symphony, perhaps purveyed in the form of an equation: for the hunter, rhythm and coordination = survival.

The vignette is self-explanatory. It is clear that dyspraxia ie. a disruption of excitatory/inhibitory rhythms, effects motor proficiency, and in terms of the Yerkes-Dodson law (1908) with task-consonant arousal as well. The question is whether it plays a role in psychological functioning.
Rhythm and Location
While it is customary to think of emotional, cognitive, perceptual and motor faculties as emanating from specific sites in the brain, location might be less important than orchestration, particularly with respect to the excitatory/inhibitory apportionment in producing functions such as speech, movement, thought, emotion and perception. One reason for this has to do with the typically multi-sensory nature of most human skills. For example, despite the designation of Wernicke’s and Broca’s areas as language centers, language expression  and comprehension involve a number of integrative functions. For example, oral motor faculties in the parietal cortex must be activated for pronunciation, tone and emphasis.  Auditory faculties from the temporal lobe must be available to obtain feedback from the spoken word. Associative and conceptual skills from the associative cortex are needed so one can talk about “something.” Meanwhile, planning skills (ie. intent) originating in the frontal lobe are required for language to be presented in a pre-organized grammatical format. Beyond that, visual and spatial perceptual faculties emanating from the occipital lobe must be activated to reference concrete, objective ideas and to process non-verbal signals from listeners. Even social-emotional faculties are needed to filter out potentially offensive or incongruous remarks.
Since skills that are typically encompassed in the term ‘higher mental functions” involve multiple faculties it might be said that orchestration – which will subsequently be referred to here as psycho-synchrony is just as important as localized circuits in facilitating our unique cognitive, social, creative and communicative capabilities.

Definitions
The word synchrony can mean different things to different people. Here it is intended to mean a harmonious pattern of neural firing; not simultaneous, but in an orchestrated sequence in which one flurry complements another without intruding upon it and in which the overall firing pattern adheres to a systemic format. Psycho-synchrony refers to the various effects of those patterns on mood, cognition and behavior. Meanwhile dyspraxia refers to interruptions, or impediments to that process and psycho-dyspraxia refers to the psychological manifestations of that.
It is clear that motor experience is governed by excitation/inhibition synchrony  and that in the advent of dyspraxia the effectiveness of movement would be impaired In a way that would adversely affect perceptual motor proficiency. Here is it proposed that psycho-synchrony underlies all human experience and that our frame of reference, our interpretation of events, our likes, dislikes, fears, habits, memories, attitudes, temperament, pathologies and entire personality gestalt derive from rhythmic interactions within the central nervous system.
Psycho-synchrony is actually more complex than the bi-modular term “excitation/inhibition” might imply. While some neuronal clusters are predominantly excitatory, others inhibitory, this relationship can flip-flop, depending on the particular chemical receptors involved. For example inhibitory neurons can result in excitation if they innervate vesicles with acetylcholine, a neurotransmitter involved in memory, motor, respiratory and cardiac activation patterns. Thus psycho-synchrony ultimately pertains to neuro-chemical orchestration.
This model can be applied within the clinical domain. For instance, depression can be viewed as a form of dyspraxia with several dimensions. In some cases of depression there might be an inherited tendency among neuro-chemical structures toward excessive inhibition as a correlate of dopamine depletion (McCabe, Cowen et al (2009). In not being able to extend excitation patterns, the depressed person’s brain incurs a non-extentuation problem. Firing is too readily  inhibited or terminated. Consequently so are its experiential correlates; perspective, futuristic concerns, and hope. Thus a dysphoric mood prevails.

A second factor might be hyper-activation, whereby a depressed mood and mindset are hyper-excited such that the person cannot terminate them and move on to other experiences.  A third factor might involve a simpler form of dyspraxia that interferes with the interpretation of social-emotional experiences. This can occur in various ways. For example:
An event such as a hurtful social interaction or the loss of a loved could entail several possible cognitive-emotional interpretations. Psycho-synchrony – a balanced interpretation reflected in excitation, inhibition and related ideation and behavior would prevent any one (skewed) interpretation from becoming a pathological fixation. As a side note; the collective work of Ellis (2007), Smith & Lazarus (1990) and Scherer, Shorr et al (2001) has shown that beyond the actual occurrence of events, the person’s interpretations of those events can be surprisingly malleable.
Interpretations and appraisals are conveyed through neural impulse interactions. With a dyspraxic flow of neuro-chemical activity synchrony would not ensue, the end result being a skewed emphasis on one or another aspect of the experience. In the above example, well distributed, orchestrated neuropsychological distribution and rhythm result in a positive adaptation. Conversely, in a state of psycho-dyspraxia the person’s interpretation (or appraisal) might become skewed, leading to a pathogenic fixation that is unchecked by other possibilities.
Psycho-dyspraxia can be chronic, featuring a long standing habitual tendency toward skewed schemata and appraisal habits resulting from an imbalanced flow between excitatory/inhibitory networks. In that case the person could be said to have a dyspraxic personality structure.
In that context a parallel can be drawn between psychopathology and a phenomenon known as “spiking.” This is a process in which firing in one neural location breaks free of the reciprocal restraints of other systems – bearing in mind that the brain operates essentially as a neuro-experiential checks and balances system. Under such conditions the firing in singular neuro-experiential domains becomes excessive, ie of high amplitude. This most often occurs with brain damage or developmental disabilities but it can also result from hyper stimulation, in a process Pavlov (1927) referred to as protective inhibition. It can also occur in various forms of psychopathology.

The opposite of spiking is seen in a high-energy, fast frequency, low amplitude firing pattern in the brain in which all circuits balance each other out and contribute proportionately, such that no single site dominates. In such instances the attentive, cognitive and emotional processing skills of the person are maximized. The person has access to all brain sites and functions in proper proportion. That disposes him to reasonableness in his thinking and behavior.
Obviously the relationship between neural synchrony and experience is reciprocal. For example, a child who models a parents’ negative self appraisals and hopeless language might come to exhibit depressive symptoms. In that instance psycho-dyspraxia would arise from learned negative language habits. Still, that would have to be represented in the brain somehow; reflected not just in a specific chemical depletion but also in broad-based non fluidity in the brain‘s response to input.
Experience as a summation
One predicted outcome of psycho-synchrony is that all experience would be summary in nature; that is, a result of all the pluses (excitation) and minuses (inhibition) arising from  inputs in the brain. Whether processing social signals during a conversation, pondering the potential outcome of a job interview or dreading the loss of a loved one, the person would feel and think in terms of a net-excitation process. To the extent that excitation over-dominated, the person might feel agitated or angry. If inhibition dominated, he might, in accord with neural dynamics, feel anxious or depressed. If the proportion was close to equal, he might be able to dismiss the event and exhibit no emotional reaction at all. (As an aside; It might be too simplistic to suggest that psychopathology might one day be reduced to mathematical computation of electro-chemical differentials but in neurological terms it could be possible).
The ways in which neural summation could influence mood, behavior and cognition are myriad. With regard to cognition, a great many attitudes are derived from proportionate assessments of experience. More specifically, logic syllogisms which are a foundation of thought patterns pro-social and anti-social typically entail apportionment. For example a psychopath might assume the role of “avenging angel ” in which case an abusive childhood background might lead to a fixation on potential threats to himself, thus an excessive concern with self protection. In such instances his capacity to process social signals through empathy would not be missing – as goes the current thinking – but overridden by other neuro-experiential concerns. He might perceive signs of fear and vulnerability in his victim, but would tend to “spike” in the direction of self concerns, thereby insulating himself against the moral and social implications of his behavior.  His sensorium would be dyspraxic. In that sense, ego function and moral development could be said to depend on synchrony as well.

By the same token, a person whose psycho-dyspraxia is skewed in the direction of inhibition would tend to be response-deficient, leading to a perceived lack of control. That could be manifest as anxiety, depression, or it might “swing back” in the form of a “neural correction,” leading to intermittent explosive behaviors.
Other forms of psychopathology could originate in similar fashion, including sexual perversions. For instance, the coupling of sex with violence in the mind of a rapist or sadist could be viewed in terms of neural skewing among limbic circuits. More specifically, sex involves input contributions, not just from the hypothalamus but also from limbic lobes devoted to oldfaction  (Joseph 2000) and aggression (Couppis 2008). It is not as if, during the act of sex, only altruistic neural structures are involved. Sex is part love, part muscular, part submissive, part dominant, part aggressive. It entails pan-arousal, which sets the stage (even in normal circumstances) for quasi-aggressive, even appetitive behaviors. The lion gently bites the lioness during mating. Sharks and whales collide with one another in a fairly chaotic form of foreplay. Humans are no exception. We engage in oral behaviors, occasionally even mildly aggressive behaviors during sex. Since both affection-inducing and harm-inducing limbic circuits are activated, neural synchrony is important. Skewing in the direction of aggression and away from altruism, affection and/or social communicative functions might result in relative suppression of the hypothalamus, septum and cerebral cortex and enhancement of amydaloid activity. Those dyspraxic conditions can spill over to the psychological domain, leading to a perception by the psychopath  that aggression is more yielding than love in the quest for pleasure. While the notion of a psychopath as being dyspraxic might seem unduly euphemistic, it is neuropsychologically plausible.
Temperament
While Bates & Wachs (1994) have provided recent evidence for a genetic influence on temperament Eysenck (1967) was among the first to introduce this concept into the clinical field via his contention that persons inherit either tough-minded or tender-minded characteristics.  Here is it suggested that temperament might also be related to psycho-synchrony. One reason for this assertion is that temperament – which one can define as a broad arousal-mood readiness for imminent experience – depends to an extent on both resting and reactive arousal levels. This does not necessarily mean that baseline autonomic activity is always higher for introverts than extroverts, or that the former react more strongly to blatant and sudden inputs. It does mean that factors inherent in varying traits, such as creativity, spontaneity, withdrawal, introversion, extroversion and lethargy can be discussed in terms of the orchestration of excitation/inhibition patterns. Indeed such traits can be put on a continuum as Eysenck suggested.
According to this hypothesis, psycho-dyspraxia is not always pathogenic. In fact it could occasionally lead to positive outcomes. For example it is very difficult to be creative in the absence of spike activity. Creativity typically involves sudden insights in which an idea or concept “breaks free from the neuro-experiential pack” and consumes the individual. It typically involves some sort of elation effect. In such moments fast frequency, low amplitude (balanced) neural activation might actually be counterproductive. On the other hand, despite their penchant for creative insights the propensity of “spikers” for making mountains out of molehills might make them more vulnerable. They might -as the old saying goes -suffer more for their art than those with greater psycho-synchrony.
Conversely, persons with a more even distribution of excitation and inhibition will not typically spike. They may seldom experience elation or depression. Thus they might be a bit more tolerant and ironically, socially adaptable than the creative type. Also, because their neural activation patterns are more synchronized they might reap the benefits of a maximally activated (fast frequency-low amplitude) habitual firing pattern that can “weigh all possibilities quickly.” That could provide the luxury of a superior attention span, as Fries, Wornelsdorf et al (2008) have suggested and perhaps a stronger intellect in general.
Meanwhile, the person who spikes in an inhibitory direction will tend to shut down more than react, and their temperamental trend might be toward isolation, internalization, somatization, fantasy and dereistic thought.
Personality theorists such as Cattell (1957) and Allport (1937) proposed similar ideas – though not necessarily in terms of a neural process. Since less was known about the brain back then they were unable to connect the dots between personality constructs and brain function. As a result many of their ideas were lost amidst the recent empirical drift in the field of psychology. That doesn’t mean they were wrong. It is conceivable the concept of psycho-synchrony can revive those ideas a bit, particularly as pertains to current clinical practice.

Pathology
The thesis presented here, is of course theoretical, though not without research support. Dyspraxia has been deemed a factor in varous neuro-muscular disorders (Nicolelis 2006), (Dimasio 1994) and in autism (Polleux & Lauder 2004).  The Fries study established that some forms of psychopathology result from what a neuro-chemical process similar to dyspraxia, particularly with regard to the psychoses. Meanwhile, Nigg (2000) has indicated that dyspraxic phenomena are involved in milder psychiatric disorders. Cleary the orchestration of central nervous system activity plays some role in human experience. Whether psycho-synchrony could provide a foundational concept in the study of personality and pathology is another question entirely.
One theoretical snag has to do with excitation/inhibition dynamics within the brain. For example the brain site most capable of inhibition is the cerebral cortex. Yet only 30 % of its neurons are inhibitory. Thus it would appear the relationship between excitation and inhibition in the brain is not one of parity. It appears activation is the prime medium of thought, emotion and behavior. It stands to reason, since the most fundamental evolutionary benefit of brains for any creature lies in its capacity to solve problems through movement.
That has clinical implications. For example, based on that premise, clients with excitatIon-skewed dyspraxia might have a better prognosis in therapy than clients who are inhibition-skewed. Also, since the life styles, moods and thought patterns of active, responsive people are more consonant with brain function, they might have greater emotional adaptive potential than those with psychologically and physically sedentary life styles.
With respect to treatment: since (by virtue of neuronal apportionment) it is more probable that in any given situation brain circuits will be skewed toward excitation, treatment methods with active components such as vivo practice sessions, a skill-learning orientation, and in general, a doing rather than merely contemplating interpretive methodology might be more effective. Unfortunately, few studies are available to support or disconfirm any of these assumptions.
Perhaps more within the realm of possibility is the use of rhythm as a therapeutic component.  Might activities in the areas of music, percussion, dance and other neuro-synchronizing exercises help alleviate the client’s psycho-dyspraxia, and as an augmentation of interactive counseling, create a greater propensity for perspective, hope and mental balance? Loewy (2004) and Jourdain  (1985) have suggested such a possibility but at present this too remains in the realm of speculation.

REFERENCES

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