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Journal

A reflective journal of my practice, process, and thoughts.

Conversation with Naiara Demnitz (University of Oxford), Skype 10-06-19

I’m very thankful to have shared a conversation last Monday with Naiara Demnitz, Post-Doc Researcher, Department of Psychiatry at University of Oxford. Naiara coordinated workshops held at Oxford as a component of the Shared Language project, a collaboration between Camberwell and Oxford in 2017, and in a tutorial earlier this year Jonathan suggested I might make contact regarding areas of my research concerning memory and neuroscience. We discussed some of the concerns of my project, and Naiara graciously helped answer some of my questions on neurobiological processes, with an objectivity and subject-specialist knowledge which will undoubtedly be valuable for my research, and in particular an effect on shaping the language of my project, in both written and visual form. Language is where we started.

N: Tell me a little bit about what you’ve got in mind?

M: I was talking to Jonathan about the Shared Language project in relation to my research; neuroscience, cognition, memory, and he recommended that maybe I get in touch with you regarding my project because a conversation might reveal some cross-overs and shared ground. So my project is very broad and roaming and I’m trying to tighten up my research now, but at the root of my work is loss, at its most basic, and looking at potential poetic relationships between neurological and geological processes. There are lots of shared terms and examples of vocabulary between the two subject areas on a very basic level for example ‘trace decay’ in memory and recall processes and ‘trace fossil’ in geology describing things that hold some similarity – a snapshot of something in action. Or this idea of the churning of the earth and fragmentation – the archaeology of that as the pursuit of stitching the missing pieces together as an analogy for struggling with memory.

N: This is interesting – I was thinking about what those relationships you described could possibly be - when I think of association I think of a correlation and – of course, this is a language connection – that seems so obvious now. There are definitely some overlaps between those uses but I’ve never heard of anyone make that comparison before. So are you working towards representing that in a spoken form or a language comparison, or visually?

M: Initially I was thinking of it being purely visual but the more research I’ve done the more I have begun to consider the project to be interdisciplinary with the scope for development into experiments with language in spoken or written form as well. The course itself is Fine Art Digital, and I’ve begun to explore CG and 3D rendering and animation – trying to learn how to use those processes to recreate scenes of memories – or fragments of those memories. It is still very broad at this point. The personal basis for the entire research project is that three of my grandparents had neurological issues – Parkinson’s, Alzheimer’s and Brain Cancer, so as a young person I witnessed these transformations and was fascinated by them and remain so – I’m also very interested in what’s happening to the earth at the moment, and so there is an element of microcosm-macro/’as above-so below’ kind of thing going on… I was talking to Jonathan about reframing those negative experiences of witnessing neurological change as being more transformative rather than just negative/traumatic. One of the pieces I’ve been working on is a 3D extrusion from a scan of something I made when I was about 6 years old maybe – cuttings from seed packets stuck down on a sheet of paper and a description of how ‘these are some of the vegetables my Grandad and I have planted in our allotment’. It kind of looks like a landmass because of the way the highlights of the image have been extruded outwards, though obviously it is just a piece of paper. It makes something really ephemeral look much more ‘active’ and living. Representation of the absence of memory – the gaps in-between, etc… I was imagining that access to information, or trying to piece information together, in neurological process, is a facet of neuroplasticity?

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N: Neuroplasticity is usually reserved as a term that describes a neural adaptation; this could be from learn something new or a new skill, so it’s both change but you’re talking perhaps about negative change in exploring loss of matter – these have different underlying processes. What would bring you to neuroplasticity - what would be the interest there?

M: Again I think for me at this level it still is rooted in language and getting to grips with what these terms mean – and could mean. It’s this idea I think of adaptation and how we respond to change - I know that some of your research concerns lifestyle factors and in relation to that I also wonder how environmental factors might affect our neurological health?

N: So it’s an idea coming from a plasticity point of view. Although a lot of the variability in our brains is determined by genetics, so there is not a lot we can do about it, there is still some variability that is a reflection of everything you do and this includes lifestyle choices. So I think a very easy example here is alcohol consumption – even what we consider to be moderate amount of drinking actually has a really strong effect on – in your case, memory, which is interesting, on the hippocampus* – this is a really important area for memory. When looking at people from their 30’s onwards, even moderate amounts of drinking throughout middle age would affect the volume of the hippocampus later on in life. Personally, my research looks at exercise, and I get older adults to exercise for a long time and look at then look at their brains using MRI. In this case encouraging older adults to exercise – the result is that the brain is more wired up to create connections or to form new neurons, so we’re looking into that. Using lifestyle factors that might be able to hone in on those bits of change that help protect the brain and that is something appealing to us because it’s something we can change. So far there’s very little we know about how to change the genetics of someone to improve their brain but these are small things which we would hope might make a difference, and these examples are quite easy for example most of us know about the effects of alcohol but I still drink! It’s why I pick this example out because it’s interesting in terms of behaviour.

M: That’s interesting though because it hits on the engagement and activity aspect of research, and you’re right – I mean, as you were explaining that there I was immediately thinking ‘Wow, I’m about to turn 30 – how much alcohol am I drinking?!’. In terms of my research as well – the geological change – there are some fascinating behavioural aspects in responses to what is happening right now – and this is another tangent, but we generally all have this idea of climate change as ‘happening’ in the air and in the invisible atmosphere, but actually some of the more dramatic effects of global warming are trembling right beneath our feet, inside of the earth – but engaging people to act positively on things that we cannot ‘see’ or feel as if are out of our control, is difficult.

N: Yes, and on the practical side, a really positive thing that I think would come of your project that’s gearing up to be is a change in language. Dementia Friends is a movement by the Alzheimer’s Society and their idea is to spread awareness about what dementia is, and trying to make people a bit more conscious about how they can help others living with dementia. One key point is just to change the language around dementia, and they want to completely eradicate the term ‘dementia sufferer’ and change that to a person ‘living with’ dementia. It’s a really small change but the idea is that you put the person first and you don’t simply characterise them through the disease. I do see it happening. A friend was recently at a conference and a politician giving a talk used the term dementia sufferer, and there were dementia patients in the audience, and one of them challenged him saying ‘do not describe me like that’ – certainly a lot of people still use that. It’s not that we’re trying to make everything sound positive – of course not – but just to try and change the focus of that. It doesn’t all have to be about loss – it can be about what is still there. 

M: I was thinking about those experiences of not only witnessing but maybe living with dementia as being transformative and how this works, possibly those experiences open up different spaces I guess of cognition, and maybe there is so much there that can be affected or ‘drowned’ by our responses formed around those negative connotations of ‘this is a bad thing’. I suppose as a personal example, witnessing a loved one that has suffered as a result of disease at an ‘end point’, but in a very peaceful state, you might say ‘free’ or removed of a type of concern, the same kind of anxiety that the person’s family might have had around them is something powerful.

N: I see what you mean – It could be a fine line though and I think you would have to be careful as there are some other considerations such as is it actually that the person is at a point where they cannot express themselves in the same way, rather than a case of not wanting to – we might perceive something as peaceful but to them it might actually be something physically difficult, which is obviously very hard to see. There is something called the ‘compensation hypothesis’, by Cabeza**, and he looked at how, let’s say a function in your brain tends to be very lateralised, when you get older it tends to become bilateral – recruiting from areas that it would not recruit before – and this is an example of a way that we can see our brain is adapting to change.

M: It’s that objectivity that I really appreciate. There are so many fine lines and so much of what I’m doing isspeculation really – so to have that insight is really helpful in terms of working towards making arts engaging and accessible, especially when those projects concern areas such as health or environment. 

N: Maybe this is something that might be relevant to your research - in my area, often if you are working with a new group of patients but you don’t necessarily know so much about their experience you would do a Public Patient Involvement (PPI), and make arrangements for a focus group – bringing people in to ask questions, say ‘what do you think about these ideas and do they resonate with you’…

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M:I think that’s a great idea actually – thank you! Going back to the Shared Language project and thinking about the visual language of medical imaging, I was wondering about vulnerability in relation to memory… what does ‘vulnerability’ look like in the brain? I guess this is a question about indicators in neuroimaging – can you ‘see’ a vulnerability through an MRI scan? 

N: Vulnerability is such a sort of complex system, right? What you get in an FMRI scanner is a bold response - essentially the theory behind it is that the parts of the brain that are working the hardest are where the parts the blood gets pumped to, and it changes from oxygenated to deoxygenated blood and that difference you see highlighted in an FMRI scanner. It is a proxy of neuronal activity – we don’t see neurons firing – what we see is an indirect mark of what we think is a sign of a certain area of the brain working. So you have to think of clever experiments where you can isolate a certain function, for example I could get people who are very socially isolated and scan their brains when they are looking at things which remind them of social cues, and you can sort of subtract that to see the difference – but on the other side of that you have to think of the confounds of that – people who are socially isolated might have behavioural problems, they might be going through other mental health issues or diseases – so to get to a complex behaviour it is way too hard for us to say [in a scan] that this is the function of someone looking isolated or vulnerable.

M: Again this goes back to subjects of absence and the invisible or the unseen, and makes me think of those subjects that we don’t quite have a grasp on in relation to how we feel about our environment, and environmental change – if we can’t feel it or see it then is it there… the fact that you can’t pinpoint a ‘vulnerability’ or say that ‘I have seen this therefore it will result in this type of process’, is really interesting in itself. Back to neuroimaging, I imagine that the digital is really important in clinical research?

N: Definitely. To give you an idea of the department that I’m based at, it consists of a third neuroscientists, a third physicists and a third engineers – our engineers design all of the software we use in-house which is constantly being redesigned and updated for the latest experiments we are doing and we just could not work without them. I studied psychology in undergrad and I had never coded anything in my life, and I remember arriving and absolutely panicking because everything was in script – it is so crucial. The physicists are the ones who design all of the sequences that we use and make sure the scanners are serviced. It’s different maybe in a way that a generation and a half ago clinical researchers wouldn’t have needed this sort of involvement with engineering and computing but nowadays it’s just indispensable. I think a really good example is UK Biobank – I think it currently be the biggest studies in the world. Half a million people are being studied in the UK – full medical works: blood, saliva, some of them get a full body scan, and 10,000 of them are getting brain scans. The idea is that this is a massive cohort – the definition of big data, and the idea is that now you will be able to get the full biomass of people who might be susceptible to certain types of disease and things like this… Just the sheer number of that, we could not do that without the incredible software, I mean all of the software which is designed specifically for this. A big part of future medical science I think will be intertwined with that.

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M: Do you think that will translate into engagement as well, and also for example the use of digital technologies, applications and more interactive methods for testing patients?

N: That’s a really good question and one I’m not sure I have an answer for but I have seen more of a big move towards it in the last few years – a lot of people are developing those apps and technologies, and trying to validate them against the traditional methods. The traditional method of testing somebody would usually be to sit-down with a pen and paper memory test. Most neuropsychologists will agree that there are huge limitations with these methods but we still do them because they are the most validated ones, those are the ones that we have normative values for etc. So more and more people are trying to develop their own. The big barrier to that is then having to show that these are meaningful. This will be easier now we have these studies with such big numbers – perhaps if you have half a million people doing it it’s validated against what came before because you will have your own normative values. So we’re sort of able to slowly move forward. I can see how this would change things. There are lots of other concerns which I’m less familiar with such as some ethical concerns, the state having so much of this data. Another example is that my friend is working with something called Game Changer, which is an app, and they are looking at memory testing -  I think you can actually try it at home.

M: There is something more sensory about using an app as well rather than responding to a question. I know that a single question in itself can put a surprising amount of stress on the brain. It’s a completely different process, if you are physically engaging in something in order to negotiate a kind of self-assessment rather than sitting before somebody and responding to questioning. 

What does the future look like?

N: My perception of what I think will happen is that there will be a huge change in relation to the area I have worked in which has not always received an awful lot of attention, which is neurological diseases and mental health especially – I think there has already been a massive change with that, and particularly in a public-led way – the increased awareness around Alzheimer’s Disease in the UK is a good example. I’d like to think that in the future, or at least a really small part of the future, is that we’ll see a lot of progress in the treatment and research of mental health and psychiatric diseases.

* Topiwala et al., 2017, BMJ
** Cabeza et al., 2002, Neuroimage

Matt Fratson