Editorial Comment  2/4/2020:  Toward a Blueprint of the Brain

This week’s submissions reflect a strong bias to basic science, unapologetically.  There are times when the brain is a three-pound grey pudding with obscure eponyms assigned to slightly darker streaks and patches, waiting to lose a contest between its inebriated owner and a delivery van. 

Other times, we are provided with the work of those most-patient in the world of addictions, the investigators who seek to determine the architecture of and the actions within that brain.  The January 20, 2020 online Lancet provides an article supporting a view of combined antenatal alcohol and tobacco exposure as enhancing the risk for SIDS; a syndrome that remains etiologically controversial.  At one time felt to be the result of suffocation when sleeping with intoxicated parents, or when over-laid with blankets, for more than a century SIDS has as commonly been suspected to be neurologically-mediated (Duncan JR, Byard RW, Eds., Sudden Infant Death Syndrome: An Overview, book chapter:  https://www.ncbi.nlm.nih.gov/books/NBK513399/ ).

The possibility of structural changes in the brain must be a consideration in accounting for enhanced susceptibility to a type of opioid addiction (sic) in rats who have undergone trauma or adversity in early life.  In the provided article (Lewis SC et al., Molecular Psychiatry) on addiction susceptibility, the authors suggest a traumatic or deprivational source for an alteration in neuro-plasticity, as a contributor to addiction.  Separately, a Proceedings of the National Academy of Sciences study gives further consideration to architectural remodeling of the brain by alcohol itself.

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At one point, I leave this task- writing -  to sit briefly with my spouse, an emergency medicine physician, who watches the Superbowl.  I am reassured by her:  yes, this is the game with the pointy-ended ball.  But we soon find ourselves focused on one element of the game, the slap, clack and crunch of body-on-body contact that may signal another head injury.  I am fascinated and shamefully, I cannot look away; it is like watching the Indy 500 on our black-and-white Sears Silvertone, as a kid.  I am waiting for the inevitable car wreck to happen.  I suppose that I can rationalize, that there is a computation of risk by the footballers, by the race drivers, or by the drinkers; and that they could choose to do otherwise.  Yet I know that, for the drinkers at least, unimpaired good judgment does not figure in the choice.

- Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM