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Review of "The Healthy Aging Brain"

By Louis Cozolino
W.W. Norton, 2008
Review by Roy Sugarman, Ph.D. on Jul 28th 2009
The Healthy Aging Brain

Baby boomers now have grandchildren.  Lois Wyse remarked that grandchildren are so good, one should have them first, children later. Cozolino looks in the mirror and wonders who that old man looking at him might be. As we age, we do not feel as old as the person in the mirror, and like Cozolino's grandmother, we look closely for the young person hidden somewhere in the wrinkles. Jeanne Calment, who rightly catches Cozolino's imagination with her longevity, remarked that the only wrinkle she possessed was the one she sat upon.  This from a woman who lived past 127 and ate two pounds of chocolate a week. She also drank lots of red wine.  Only a French person could get away with that and still live to her old age.  By the time she died, blind, and with a promise to operate on her so she could see again, she declined, saying she had seen enough.

David Snowden has a raft of famous figures in his research, one most notoble, the notorious nun, Sister Beatrice, notorious for her survival without clinical deficit, despite the well established lesions of Alzheimer's in her brain.

We now know that the Okinawans who stayed in Okinawa continue to have the most post-centagenarians per 100 000 in the world, whilst the 150 000 of their relatives who moved to Brazil and eat like Brazilians enjoy almost 20 years less of lifespan.

The question is?.why?

Cozolino has given us clues to what path he would take, namely in his previous books  The Neuroscience of Human Relationships and The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain where he discussed the neuroscience of relationships and of psychotherapeutic relationships. This tells us where he is 'at'. It's in the bonds we make.

(I have discussed this briefly before, in 2007, in a session talking about boosting your brain.)

One of the main ways to boost your brain is to acknowledge the necessary role human socialization played in shaping the way our brain interacted with the evolutionary forces which prevailed during the last few hundred thousand years.  It was, as Elizabeth Gould has shown at Stanford, a vital shaping factor that continues constantly throughout life, as the environment shapes our neuronal interactions.  We evolved as social animals, and continue to do this, hence the ascendency of speech in our brains versus all the other primates. We also can hide our public speech, make it private, as thoughts, allowing us to both interact and not interact with others, our choice.

It was previously thought that we begin to socially withdraw as we prepare to die in old age, to prepare us, but Cozolino opines differently.

He points out that Bowlby's children, isolated in orphanages and hospitals, had an appalling death rate, way beyond that expected of infection and illness.  They were in fact isolated from each other to prevent cross-infection, but this very deprivation of them from social contact was the cause, not the effect , of their deaths, as we now know. Cozolino believes that this is true at the reverse end of the spectrum, as we enter our old age, where the increasing social isolation may in fact lead to, rather than prepare for, the departure unto death. So much so that Dr Kevorkian is now advocating that lonely and isolated elderly should be allowed to self-euthanize.

This vital connectedness is the vision of Cozolino: a form of attachment theory that has been re-jigged, Cozolino believes that the relatedness of human contact is a vital part of living, and enriches the brain.  Hence, he sets out to show that close socializing in young and old age is essential, and best done by grandparents with grandchildren.  He discusses the role that menopause plays, and of having children when over 40, as contributing to longevity in various ways.

Hence, in both animal and human studies, intense and rewarding relationships which engage the elderly and render benefits to both side of the attachment, prolong both the length and certainly the quality of life as we age.

So was it the close interpersonal relationships between the sisterhood of nuns that kept Sister Beatrice, and possibly even Dr Snowden alive longer? Or was it her diet, her movement, the college degrees, or other much proven and touted elements? Other nuns all ate the same as her, and certainly her resilience was fostered by this, but Jeanne Calment did not eat her chocolate alone: she seldom put mascara on her eyes, as it was her habit to laugh a lot, and she cried when she laughed.

Cozolino will hold out that it was this propensity to engage and attach to others that defined their resilience against the ravages of ageing.  As he notes, so many of us will feel disengaged, unloved, unattractive, and certainly unneeded.  What is life without close relationships? Adler is believed to have said that Freud remarked that we all need three things to live: somewhere, someone, and something valid to do.  It's the someone, the someone to love who will return the love, that Cozolino focuses on in his hypothesis.

So he sets out to establish the case for the brain as a social organ that survives and thrives thought simulating interpersonal interactions.  So as much as young brains are built and shaped by interactions with their carers, so the carers in turn are served neuronal-circuit building benefits by the interaction and the meanings of these.

His journey across the lifespan begins with the current theories of why the brain ages, looking at memory, the frontal lobes, stress and the hippocampus, and of course, cognitive reserve, the thing that enabled Sister B to stay cogent despite her lesions. The curiosity for others may be very well the substance of a neuronal stimulus that fires the cortical tone of reserve.  He looks at how the brain adapts and change, and how it specializes across a lifetime.  He therefore looks at the connections that  a lifetime of social embeddedness brings, and how wisdom emerges. With wisdom, hand in hand, is the maturity of emotions.

Certainly, and especially in non-literate societies, the elderly were the bearers and repositories of the wisdom of the collective groups.  This may have begun to wane with writing and libraries, even worse, the internet, but possibly this has declined with simply the speed at which things change, rendering in some people's minds, the wisdom of our elders useless. Most adults look to their children for advances, not to their parents, as Cozolino points out.  A native American puts it to Cozolino that without a repository for their memories, older people forget, decline.  Their wisdom dies with them as well as the emotional maturity, making us more afraid of the group known as the aged.  Our bias against this out-group is interesting.  As bigoted as I may be against others, by and large, I could never become one of THEM: ageism is different.  Early death aside, we all become THEM in this instance.  There are many challenges to wisdom.

One of these is the decline of the body, and so Cozolino's next section moves to health.   No surprises here, food, sleep, exercise. In terms of mindset, low neuroticism and high conscientiousness attend 100+ aged citizens, as well as extraversion and high levels of morale, resulting in and from, engagement with others, support from others, and the maintenance of relationships. My wife is the curator of a museum, and her favorite volunteer is a man in his '90's, a survivor of WWII, a doctor, a PhD, an archaeologist, the conductor of an orchestra, and so on, all in one man, and now, a curatorial assistant in a museum whose work is meaningful to him.

As much as we need to nurture ourselves, so we need to nurture others who engage with us, sustaining relationships.  The importance of touch and laughter is not the province of the young alone, but of the ageing ones amongst us. Obviously, the presence of close relationships confers a feeling of security to the blind autonomic nervous system, so we are aware that when trouble comes, we are protected to a certain extent, and at worst, we will not die alone, something that scares even younger people.  And of course there is a whole chapter on grandparenting, and its value to all.

Speaking later of challenges and inclusion, he gives his predictors of cognitive health: education, intellectual stimulation, engaged lifestyle, strenuous activity, sleep quality, low cortisol levels, a sense of self efficacy, and of course, recovery (leisure). Oh, I get it, you have to have money!! Well, it would help I guess, the quality of a lot of these is not good in most countries, and most people outside of the west will have a hard time of it. So my Okinawans are most unlikely to get that stuff, but they certainly eat only fresh produce, fish, and of course, they are a tight Japanese community, so back to Cozolino's relatedness.

Humanistic views of self determinism are all on top of this stuff, with self efficacy and relatedness always prominent in the search for authenticity.  In this vein, he advances 52 things (that's one a week in a year) that we can do, including playing with children, puppies, public displays of affection, buy an incomprehensible gadget and get someone young to help, and so on.  The last 100 or so pages are just readings.

Cozolino takes a whole, and very nice, book, to get us to share our lives.  My problem with this is that is pretty much something we all try to do, but often, there is little success.  Which is why Dr Kevorkian is talking to older people who are healthy in other respects, but want to die, as they are lonely, and the pain is really unbearable.  Cozolino has a wealth of audiences who will pay to see him, but most of the older guys I know in the homes for the elderly find their own kin unwilling to listen to them.  The world is full of Abraham Simpsons, languishing and telling stories of the old days. It's not that their memories fail them, and that's all they remember, it's just that most haven't had any fun since the old days. And most just don't have the money to do a lot, or the mobility to get where that stuff might be.

I am glad he wrote this book, happy with his formulation, his ideas of getting retirement homes built on the same territory as day care units.

So what he is saying, is that for a lot of people, it's too late.  For the rest of us, the time to contemplate that is NOW, not later, as the rot begins early.  Snowden noted that the less colorful the writing of the nun's in their early years, the worse they looked when their diaries ended, the worse their brains, their lives. Despite the sisterhood.

Silo's are dangerous, but this silo, if one joins it to the other things necessary to avoid ageing badly, is a good one, but I imagine for many people, the hardest.  Some of us have few friends, are not liked.

I am reminded of a nice Japanese story.  A lonely man approaches a psychologist who recommends he purchase a dog to walk with in the park each night.  Soon enough, he meets another dog owner, and spends time each night with her and her friends, getting home later each night, the dog pawing at the door, dying to get out, becoming increasingly lonely and frustrated. This goes on more and more, and one night, he comes home late, and finds that he has left the kitchen door open. No, no.  The dog is still there, but the cat has gone. Cats just won't put up with that kind of neglect.

So the time to build resilience is now, with food, sleep, movement exercise, and the stuff above, enriching the brain, but of course, no one will deny, the real reason for what we are as humans, is others, and our connections to them.

Which is why competitive work with good recovery is better than volunteer work in healing disability.  If age is not to be a disabling condition, we have to be with, around, and connected to others.

A great start, Dr Cozolino; now take it further.


© 2009 Roy Sugarman


Roy Sugarman, Ph.D., Consultant  in Applied Neuroscience, Human Performance Institute, Sydney, Australia

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