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I wonder why people use leverage in the financial world. Why do they borrow to make investments they couldn’t normally make? While other ethical, legal and business systems in the world may disagree, it’s not abnormal to borrow money for business here. So why do I say it’s the root of a loss of integrity?

I’m not saying borrowing is bad all together. There’s good borrowing too. In any economy that’s big enough to create things that  person couldn’t create by himself in a brief period of time, someone will need to borrow someone else’s excess capital in order to complete the project. We can tell the difference between good borrowing and bad borrowing by looking at the goal of the borrowing. Are we borrowing to consume or to create. Borrowing to consume may be an emergency necessity, but as a way of life it’s unsustainable.

Handled correctly, borrowing and leverage are tools to create something. They are powerful tools as they let people have the time and resources to create what they could not otherwise have done. As with any tool, handled well, leverage can be a force for creation; handled poorly, it can be a force of destruction. A backhoe is an amazing tool for clearing land and used skillfully by a trained operator, can greatly aid in construction. Can you imagine the havoc if everyone drove a backhoe, even the people who weren’t trained to? That’s what’s happened with leverage. Our society has taken a tool that is supposed to be handled by a few expert tool handlers in order to construct bigger things, and, instead, has given everyone the ability to borrow other people’s money to consume more without constructing anything.

With a few people using leverage to construct projects in their area of expertise (building factories, starting companies, etc) the risk was manageable. A few of these experts would make mistakes and fail. They would go bankrupt and the lenders would not get all their money back. That’s the nature of risk. Some people lose and end up stressed, but others don’t. But with everyone using leverage the risk has become systemic. It’s all over and there’s nowhere safe.

I want to be clear that I’m not blaming people who borrowed money to buy a house. When I’m talking about excess leverage I’m talking about Wall Street brokers creating 40 to one or 100 to one leverage. And since they all did it, they all borrowed money to lend to each other. Instead of the normal person’s 5 to one leverage when they buy a house, these firms have leverage that’s so high that they have to get out at the first sign of something being wrong.

So what’s this got to do with addiction and the brain? Our brain is designed handles acute stress differently than chronic stress. Acute stress is not problem. Chronic stress, on the other hand, is a big problem. Our brain interprets all chronic stress as famine. That makes sense because it’s the only source of chronic stress that our ancient ancestors faced. So when bankers are living on a knife’s edge, and they know that if the brokers they lent money to lose even a little they’ll go bankrupt and if they do the bank won’t be able to pay the people it borrowed the money from in the first place, everyone in the system is living in chronic stress. I know several people who work in and around Wall Street and it’s been this way for a long time.

What happens in chronic stress is that the stress response blunts the brain’s ability to feel the dopamine release of reward. To feel good it needs more and more dopamine signal. The midbrain reward system doesn’t work right and the pre-frontal judgement area doesn’t get enough signal to work right. We become more motivated by hunger and less by rational thought. We become selfish and unthoughtful. It’s how we’re designed to act in a famine to protect our own lives.

So to bring these two posts to a conclusion, over use of leverage creates situations of chronic stress. In chronic stress, the very thing we need to act rationally becomes less powerful and baser needs gain in strength. We feel hungry and become greedy. We worry that what we’ll have will never be enough and we need to get more and more. Integrity goes into the background to some degree and people will increase leverage more and more, to get more and more in an unsustainable cycle. I’m not just making this up, the cycle has repeated itself again and again in history. Hopefully, if we understand that this is not a problem of “bad” people, but of humans under stress, we’ll make the systemic changes we need to prevent it from happening again.

© Howard C Wetsman MD FASAM

It’s pretty obvious to everyone that the country is going through some tough times, and not just economically. A pretty close second is the tough time we’re having ethically. Whether it’s a large Ponzi scheme, banks borrowing billions to pay bonuses to the executives that ran them into trouble in the first place, or someone trying to sell a Senate seat, it seems that there’s a lot of public behavior that you wouldn’t want to admit to your grandmother.

You may wonder how this interests an addiction doctor. This may seem like a round about explanation but it’s the only one I’ve got. Integrity is the basis of a good healthy life as well as a good healthy recovery whether you have addiction or not. In addition, the survival drive of an ill reward system is so powerful that the necessity for integrity seems to be the first victim.

People are very found of saying a lot about how much addicts lie. The old saw, “How do you know when an addict’s lying? His lips are moving,” pretty much sums it up. I don’t know how many, if any, of the people behind the behaviors above have the chronic illness of addiction, but it’s not that important to know. Addicts, that is people with this incurable disease, aren’t the only ones who have a reward system that can go haywire.

The reward system is a survival mechanism. It’s what gets us to find food in a famine. When I lecture about the reward system to people without the disease I often refer to hunger. When I ask how many people in the audience steal on a regular basis, no one raises their hand. When I ask how many people would steal to eat if they hadn’t eaten in four days, everyone raises their hands. Can you imagine how many of us would still be here if our ancestors had been able to say something like, “Well, I know I’m starving, but to go steal food is an antisocial act that might cause the death of others, so it would be better if I died of starvation?” That may be a fine sentiment that we’d like to think we were capable of but the human race wouldn’t be around for long if we were.

When people are under stress, the reward system is supposed to not work the way it does when we’re not under stress. That’s one of it’s values; it senses what’s critically important to survival, and under stress, what’s critically important to survival is different.

I can just hear someone out there saying, “Hey wait a minute. Scientists have show that cooperation rather than competition actually increases survival. You’re full of poop.” Actually I don’t think they said, “Poop.” But the point’s the same. Why do we ask, “What’s in it for me,” when it would be more effective to ask, “How can I help others so they can help me?” I can’t say I know the absolute answer, but I have a an idea.

The reward system is the essentially the same in all mammals. Ours, the rat’s, it doesn’t matter. This thing is in us for the survival of the organism itself and it’s been serving that role evolutionarily a lot longer than whatever got us to produce civilization. It’s just older and stronger than the new parts of the brain. In fact, the newer parts seem to be wired in such a way as to turn off when the reward system isn’t acting normal. So that would mean that all these people out there acting selfishly were under some stress that got their  reward system to act in a non-normal way.

I think that is probably the case, and it begs the question of what kind of stress and how’d they all end up under stress. I think the answer lies in one word, leverage. Leverage is when you use a tool to enable something of small power to move something that takes a larger power. In financial terms it means borrowing somebody else’s money so you can act as if you had that much money. It may or may not be normal in evolutionary terms for humans to use leverage, I can’t argue that point. But it seems that leverage is necessary precursor to going off the rails of integrity, and I right more about that later.

© Howard C Wetsman MD FASAM

Why “Why” is important

Correlational studies are the first step in examining the relationship between disease and genetics. These studies tell us “what” but cannot tell us “why” these things are correlated. The correlations found can only be applied in the context of the understanding of the disease process. An example is the relationship between Major Depressive Disorder, Serotonin (5HT), and a Serotonin Transporter (5HTT) polymorphism (HTTLPR).

The HTTLPR polymorphism of the serotonin transporter was discovered to have short (s) and long (l) variants. It was noticed early on that transporters from individuals bearing the s allele had less activity at the transporter, that is, took less serotonin up from the synapse. Selective Serotonin Reuptake Inhibitors (SSRIs) were used in treating depression and it had been hypothesized that “low 5HT” was the cause of depression. To account for how a low activity reuptake pump could cause low levels of neurotransmission a hypothesis was developed that the s allele caused dysfunction by increasing synaptic serotonin, thereby causing a reactive loss of responsiveness at the serotonin receptor, and leading to decreased serotonin tone. It didn’t seem to occur to anyone to ask why increasing serotonin by blocking reuptake further with an SSRI would help in such a situation. The medications were useful in depression and someone had found the polymorphism and its function so the two had to be reconciled. Unfortunately, a lot of money and literature has been expended to expand on and enlarge the hypothesis.

What no one seemed to consider was evidence that such “low serotonin tone” causes of depression didn’t make much sense. SSRI anti-depressants work much better in people with the l allele as they have too much function at the 5HTT. But people with the s allele seemed to have more depression, more violence, more reactivity to angry faces, and more neuroticism on personality testing.

There is an explanation for this seeming contradictory information. The higher serotonin is, the lower is dopamine release. So for those with the s allele who have less expression of the serotonin transporter, and therefore higher synaptic serotonin levels, there will be a lower dopamine tone. Low dopamine tone has been associated with aggression, inability to feel reward or pleasure, irritability, poor sleep and several other things seen in “depression.” Here’s why this difference is very important.

SSRIs have been implicated in causing suicidal ideation and suicides. Actually the warning extended to all the new non-tricyclic antidepressants, all but one of which is an SSRI. If depression was caused by low 5HT tone, this wouldn’t make sense, and, in fact, psychiatry has responded with derision towards the idea. However, if SSRIs increase 5HT and thereby decrease DA tone, it would be expected that we would see some of the things we see with the s allele at the HTTLPR site. Interestingly, of all the anti-depressants that were lumped in the suicide warning, the one not actually associated with any suicides was buproprion, the lone dopamine raising agent.

So correlation is not enough, we have to understand such relationships in the clinical context of modern medicine. Unfortunately, such context can get stuck in a rut with no one doing much thinking, even when things don’t go right.

© Howard C Wetsman MD FASAM