From the Editor

Neuropolitics in the age of extremism: Brain regions involved in hatred

We psychiatrists encounter a wide and its citizens. But what we are cur- variety of intense negative emo- rently witnessing is a distressing degen- eration of into personal hatred Henry A. Nasrallah, MD tions in our patients on a daily and ad hominem attacks, with partisans Editor-in-Chief basis, whether in the clinic or on an frothing at the mouth as they describe inpatient unit. These include rage, the utter stupidity and dangerousness of irritability, hostility, paranoia, loath- their despised political opponents-cum- bitter enemies. They even declare each ing, and unadulterated hatred. other “mentally ill,” which is an absurd This disastrous political We evaluate, diagnose, and treat the explanation of why other people do not ‘climate change’ underlying psychiatric brain disorders agree with their belief system. Neither that generate such maladaptive emo- side can find an iota of redeeming value may have ominous tions, and have our patients regain in the political views of the “other side” repercussions for the their baseline functioning by resolving and hurl insults and epithets verbally the psychopathology that ignited their and in writing via dueling books that brains of the political amygdala and their limbic circuitry. become instant best sellers among the combatants themselves, But while we can manage the micro- partisan aficionados on both sides. and even for those on cosm of one patient’s mental state, we This disastrous political “climate are unable to intervene in the macro- change” may have ominous repercus- the sidelines cosm of an entire society ravaged by sions for the brains of the political com- extreme hyper-partisanship and naked batants themselves, and even for those bidirectional hatred. It is literally impos- on the sidelines who are subjected to the sible for even the most skillful psychia- relentless stress of witnessing a social trists to repair a nation caught up in train wreck in the making. As a neuro- poisonous emotional turmoil, irrecon- psychiatrist, I wonder if the collective cilable political differences, and a veri- national amygdala of the country is on table war of belief systems that mimic fire, and the national prefrontal cortex is religious fanaticism, which history tells being corroded by the pervasive and ugly us led to so many tragic wars over the negativity that engulfs us all, with social centuries and millennia. media that incites its users night and day, To comment on this Ideally, politics is supposed to be an adding gasoline to the fire. Chronic stress editorial or other topics elegant cerebral process, a debate of and its associated hypercortisolemia are of interest: henry.nasrallah ideas across disparate , the known to be neurotoxic to the hippo- @currentpsychiatry.com product of which is expected to be the campus and eventuate in clinical depres- advancement of the welfare of the nation sion and its grave consequences.

Current 6 October 2018 I think I sensed this odious scenario neural coin! It prompts me to wonder coming 2 years ago during the bizarre what happens to the capacity to love presidential , when I wrote an among political extremists when their Editorial Staff editorial describing the “fear and loath- putamen and insula are filled up with EDITOR Jeff Bauer SENIOR EDITOR Sathya Achia Abraham ing” that permeated the political pro- hate. It also makes me wonder if unbri- ASSISTANT EDITOR Jason Orszt cess and the unusual behavior of the dled hatred can be “enjoyable” and even WEB ASSISTANTS Tyler Mundhenk, Kathryn Wighton candidates.1 A year after the election, I addictive, as passionate romantic love is. Art & Production Staff commented about the toxic zeitgeist of The bottom line: Consider the brain CREATIVE DIRECTOR Mary Ellen Niatas political extremism from a psychiatric changes that are occurring on a large ART DIRECTOR Pat Fopma DIRECTOR, JOURNAL MANUFACTURING 2 perspective. The situation appears to be scale in at least a hundred million politi- Michael Wendt getting worse, and the folie en masse is cal partisans, and whether those neural PRODUCTION MANAGER Donna Pituras intensifying and its hateful cacophony is circuits get even more intensely acti- Publishing Staff PUBLISHER Sharon J. Spector deafening to our sensibilities. vated following the , regardless DIRECTOR eBUSINESS DEVELOPMENT Aaron Beck, MD, the father of cog- of the outcome. Alison Paton SENIOR DIRECTOR OF SALES nitive-behavioral therapy (CBT), wrote Finally, we must remain cognizant Tim LaPella 3 CONFERENCE MARKETING MANAGER a book about hate. It may be a fantasy, of the epigenetic consequences of emo- Kathleen Wenzler but I wish the leaders on both sides tions and stress.5 There is solid scientific Editor-in-Chief Emeritus would agree to a course of CBT to rec- evidence that extremes of human expe- James Randolph Hillard, MD ognize the destructive path of intran- riences can modify gene expression in Frontline Medical Communications sigent hyper-partisanship. They might sperm and fetuses, resulting in a trans- PRESIDENT/CEO Alan J. Imhoff then transcend their egocentric attitudes generational effect upon the children CFO Douglas E. Grose SVP, FINANCE Steven Resnick and inspire millions of their followers to of the extreme partisans, and also the VP, OPERATIONS Jim Chicca communicate rationally, instead of stok- children of nonpartisan observers, who VP, SALES Mike Guire VP, SOCIETY PARTNERS Mark Branca ing the fires of resentment and enmity experience unmitigated anxiety due to VP, EDITOR IN CHIEF Mary Jo Dales toward the “other side.” the inescapable cloud of negative affect VP, EDITORIAL DIRECTOR, CLINICAL CONTENT Karen Clemments 6 Let’s get back to science: Where are shrouding their daily lives. So politicians CHIEF DIGITAL OFFICER Lee Schweizer VP, DIGITAL CONTENT & STRATEGY the pathways of hate located in the brain? should be cognizant that perpetuating Amy Pfeiffer An interesting study was conducted to a bitter war against each other may be PRESIDENT, CUSTOM SOLUTIONS JoAnn Wahl detect the neural circuits that mediate detrimental to their progeny and future VP, CUSTOM SOLUTIONS Wendy Raupers VP, MARKETING & CUSTOMER ADVOCACY hate.4 The researchers obtained func- generations. I am frankly worried about Jim McDonough VP, HUMAN RESOURCES & FACILITY tional magnetic resonance imaging scans the epigenetically disrupted emotional OPERATIONS Carolyn Caccavelli of participants while they were viewing stability of voters circa 2035, born in these DATA MANAGEMENT DIRECTOR Mike Fritz Jared Sonners the face of a person they hate compared days of unprecedented and tumultuous CIRCULATION DIRECTOR CORPORATE DIRECTOR, RESEARCH with the face of an acquaintance toward hatred by their hyper-partisan parents. & COMMUNICATIONS Lori Raskin DIRECTOR, CUSTOM PROGRAMS whom they have neutral feelings. They Patrick Finnegan also calculated a “hate score” for each AllMedx participant for the analysis. They found PRESIDENT Douglas E. Grose VICE PRESIDENT, SALES that viewing a hated person increased the Henry A. Nasrallah, MD John Maillard activity in several brain regions, includ- Editor-in-Chief EDITORIAL DIRECTOR/COO Carol Nathan ing the medial frontal gyrus, right puta- In affiliation with Global Academy for men, premotor cortex, frontal pole, and References Medical Education, LLC 1. Nasrallah HA. Fear and loathing abound in the PRESIDENT David J. Small, MBA medial insula bilaterally. The activation ‘off-label’ presidential election of 2016. Current in 3 areas correlated with the intensity of Psychiatry. 2016;15(7):21,26. 2. Nasrallah HA. The toxic zeitgeist of hyper- the hatred: right insula, right premotor partisanship: a psychiatric perspective. Current cortex, and right frontal-medial gyrus. At Psychiatry. 2018;17(2):17-18. 7 Century Drive, Suite 302 3. Beck AT. Prisoners of hate: the cognitive basis of Parsippany, NJ 07054 the same time, the right superior frontal anger, hostility, and violence. New York, NY: Harper- Tel: (973) 206-3434 Fax: (973) 206-9378 Collins; 1999. gyrus showed deactivation. Interestingly, www.frontlinemedcom.com 4. Zeki S, Romaya JP. Neural correlates of hate. PloS One. hate and romantic love shared activa- 2008;3(10):e3556. doi: 10.1371/journal.pone.0003556. Subscription Inquiries: [email protected] tion in 2 areas: the putamen and insula. 5. Griffiths BB, Hunter RG. Neuroepigenetics of stress. . 2014;275:420-435. Published through an This suggests that passionate love and 6. Bartlett AA, Singh R, Hunter RG. Anxiety and educational partnership passionate hate are 2 sides of the same epigenetics. Adv Exp Med Biol.2017;978:145-166. with Saint Louis University

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