Dr. Philip Grossi
Thursday, 30 April 2015

The connection between humans and their dogs is fascinating and intriguing. I have many patients who are extraordinarily attached to their dogs, spend large sums of money on sick dogs, rejoice at their unconditional love and affection, and mourn when they die. How did dogs come to occupy this trusted friendship and powerful social attachment.

Dogs respond to pointing cues to find hidden food or other rewards. There are other social cues that dogs respond to such as gaze direction to which children also respond. Both children and dogs interpret eye contact as communication suggesting a similar or shared cognitive style.

What explains these human-like attributes in dogs? Genetic studies have established that dogs evolved from wolves; but, wolves do not seek human assistance in solving problems nor so they attend to social cues as dogs do. Since the dog's human-like tendencies do not appear to be genetic in origin, possibly they were shaped by domestication, i.e., selection based on temperament which allowed dogs to interact with humans like partners. If this is the case, then there should be underlying biological processes which support this social and cognitive evolutionary convergence.

In a prior blog I talked about the important  role of oxytocin, a nonapeptide neuropeptide, in social interactions and formation of bonds between members of the same species. Can it also produce these effects in members of separate species? T. Romero and J. Oliva have studied the effect of administered oxytocin on dogs relative to other dogs and on the effect on dogs attending to human social cues. The results showed an increase in social contact between dogs, more social contact with humans, and more attendance to human social cues.  Could this suggest that increased oxytocin in dogs leads to an increased oxytocin response in humans?  Such a finding would suggest a dynamic similar to that found in a mother-infant bond.

Now comes Miho Nagasawa et. al. whose recent article in Science described an experiment in which the researchers watched 30 dog owners interacting with their dogs (varying breeds and ages) and measured the changes in urinary oxytocin before and after they interacted. The dogs that looked at their owners longest had the largest changes in urinary oxytocin. Their owners experienced a similar response. They could not replicate this with wolves. This supports the feedback loop described above and suggests that is transmitted partly by sustained eye contact between dog and human. 

Is the relationship one of cause and effect?  Nagasawa then administered oxytocin to another group of dogs before they interacted with their owners. They found an increase in mutual gaze between dog and owner. Strikingly they also observed an increase in oxytocin in the dog owners mediated by increase mutual gaze. This occurred in female dogs only.

These findings mirror findings in humans described by O. Weisman Nagasawa's results suggest that dogs have piggybacked on our parental behavior  such as staring into our eyes to produce rewarding caretaking behavior. This phenomena is bidirectional and so dogs experience reward as well. These behaviors convey selective advantage with regard to human preferences. It appears that we are tuned into dogs in a similar way we are tuned into children. Our relationship to dogs thus appears to be based on human bonding pathways.

A Few Bars

Dr. Philip Grossi
Monday, 05 January 2015

I have recently been thinking of the evolution of psychiatry from the later part of the nineteenth century and my own exposure, as a psychiatrist, to this evolution over the last half century.  During the later part of the nineteenth century psychiatric illnesses were conceptualized as either organic or functional based on the findings at postmortem examination. At that time the tools for examination of the brain were too crude to reveal subtle organic changes to nerve cells and brain tissue.  Thus alcoholism, Huntington's disease and Alzheimer's were classified as organic diseases but schizophrenia, bipolar disorder, mood disorders, and anxiety disorders were classified as functional mental illnesses because no brain pathology could be identified. These illnesses were often thought of as being in a person's head and were often considered a result of pathological rearing, e.g., the schizophrenogenic mother.

This distinction is no longer consistent with our modern concept of mental states. Psychiatrists no longer believe that only certain mental states are mediated by biological processes; but, now we believe that all mental processes are biological and are the result of cellular processes which are in turn dependent on biochemical processes and their genetic underpinnings. The process of coming to these conclusions has been convoluted and tortuous. Starting in the 1880s Freud began his investigation of hysteria. He developed a new method of investigating manifest and latent verbal content produced by patients. Freud's prolific and elegant writing (he was nominated for a Nobel prize in literature) propelled psychoanalysis into the dominant theoretical formulation of mental states for the first half of the twentieth century.  During the 1950s the investigative power of psychoanalysis was exhausted and its reliance on the subjective interpretation of the psychoanalyst came under heightened scrutiny because it did not allow for empirical testing of its conclusions. It lost any claim to scientific inquiry and became more a therapeutic art which was exactly the opposite direction of the rest of medicine.

There were other developments which moved psychiatry away from psychoanalysis and toward biology and empirical testing. In 1952 chlorpromazine was discovered in France.  It was the first of a class of tranquilizers which were used to suppress hallucinations and other psychotic phenomena.  Derivatives of that class are still used today. Also in 1952 several new drugs were tested in the treatment of tuberculosis. The researchers found that patients treated with those agents became "energized, were inappropriately happy, and even discipline problems." Upon further investigation these drugs were discovered to function a monoamine oxidase inhibitors (MAOI). In the late fifties several drugs with this mode of action were introduced into the marketplace and promoted as antidepressants. Keep in mind that prior to 1952 there were no antidepressants and the word "antodepressant" was not even in the English language. People who were depressed prior to 1952 were given either opiates or stimulants.

In 1965 Joseph Schildkraut published an article in the American Journal of Psychiatry entitled "The Catecholamine Hypothesis of Affective Disorders". This article documented the neuropharmacological studies which suggested that the newly introduced antidepressants produced their clinical effects by altering catecholamine metabolism. This stimulated research which eventuated in the introduction of the SSRIs in the late 1980s and early 1990s. In the last fifteen years other attempts to elucidate higher order mental processes, emotions and thinking, using genetic tools have been gaining research prominence.  Determining the genetics of mental illnesses has been much more challenging than neurological illnesses because there is no single gene causing the illness such as in Huntington's disease. The mental illnesses appear to be caused by many genes of small effect which interact with one another and with the environment to cause a genetic predisposition. Once certain environmental factors are added to this predisposition, the illness is expressed.  A good example of this is the work done on identical twins where one twin meets criteria for the illness. Since the genes are identical in the twins, one would expect a concordance rate of 100%, that is, all of the twins would have the illness.  Turns out that only 69 twin pairs have the illness. 

I have tried to whistle a few bars of a very long and involved song and dance.  I hope I have conveyed an overall sense of the trends in psychiatry over the last fifty years.





Dr. Philip Grossi
Tuesday, 22 October 2013

Bullying is defined as aggressive behavior directed at another in order to achieve or maintain a dominant position with the intention of causing mental or physical pain or harm. It influences the victim, bystanders, and the bully. It is not the same as teasing because teasing involves students of similar size or status. Bullying also tends to be repetitive and can be physical, social, or verbal.  Contrary to common belief that it is found mostly in grammar school, it is found through the high school school years.  Indeed bullying is more common in middle school and high school where the physical aggression of grammar school children is replaced by taunts, laughing at others, or name-calling. Often social media is used.  Boys and girls report being bullied almost equally but girls tend to report and seek help more often. Victims of physical violence or having property damaged are more likely to report bullyinig than those subjected to name-calling, exclusion, or having rumors spread about them.

Patients seen in the office who have suffered bullying often present with depression, anxiety, and a variety of somatic complaints such as stomachaches, headaches, and insomnia.  Interestingly, bullies often are depressed and suicidal.  Bullying situations often involve people taking different roles, i.e., sometimes as bully and sometimes as victim. Those individuals that take either role tend to manifest impaired, unsafe, and untrustworthy interpersonal relationships. Bystanders to bullying are also affected adversely. These individuals often feel hopeless and report negative emotions during bullying. Bullying often heralds other problems in the child's history.  They often come from families where violence is seen or physical or sexual abuse is present.  The depression , anxiety, and defiance often persist into adulthood and manifest with those same symptoms or fighting or domestic violence. 

For a much more comprehensive presentation on bullying, go to