When the Rug Gets Yanked Out from Beneath You: An Interview with Joel Metzger

I have known Joel Metzger for perhaps 20 years and was told I needed to meet this resilient thriver and hear his story of rebirth following a traumatic event that forever changed his life.

When we wake up each morning, we generally don’t imagine that this day could be our last on the planet. We go about our business, interacting with family, friends and co-workers, “clocking in and clocking out” on the job, assuming that another 24 hours will be granted to us or that they will be predictable.

Joel was one of those who likely didn’t question that belief. He is a consistent presence in our community and I had heard over and over throughout the years that he was the ‘Unofficial Mayor of Doylestown,’ since as he walked through town, he seemed to know nearly everyone and greeted them warmly. His sense of humor, intelligence, creativity and love for those in his life are among his gifts that didn’t leave him on that day.

He was “the foreman of a cabinet shop that manufactured components for private aircraft. On the side, I was a semi-professional puppeteer, directing my own troupe.” On that auspicious day, he had submitted his resume to puppeteer Jim Henson because he wanted to make a shift in his career. Little did he know that he would need to shift gears at an intersection that would also bring about a multitude of decisions he needed to make about navigating the roads that lay before him.

Please share about the pivotal event that turned your world upside down and inside out. How long ago did it happen?

Many years ago (over 30), my life almost ended with a car crash. Actually, in many ways it did end. I suffered a head trauma and spent two months in a coma and nine in hospitals. I must point out that this is all because of a drunk driver.

A head injury has indescribable impact and mine was a very severe one. The brain is a pretty important organ that’s right smack in the center of our personal universe. I lost every physical ability, was like a new-born baby for months, my wife left me, had to relearn how to speak, walk, and work a new career. My personality changed. I was moved to a new city. My ability to think is still challenged. I have major memory and balance problems.

What was the biggest lesson that emerged?

Everything changes. The rug can be yanked out from beneath you. And yet, we can know a constant foundation.

Who was the man you were before the accident and who are you now?  

Before the accident I was already on a path of learning what part of me is strong and central. I had been experientially examining this for ten years at that time. So, the injury was a practical demonstration of what I thought about and glimpsed. It was an acid test. Theories quickly flew out the window. Only what was solid and absolute could help.

If you could speak to him in a “what I wish I knew when I was you” manner, what would you say to him?

The very best can come out of what seems like the very worst.

How has inner awareness helped you to heal?

I could say a lot about that. Feeling stability inside is extremely important when your world shakes. This is needed when I walk (physical balance), as I my health improves (healing and imagery), as I go through the ups and down of living (always staying afloat), on my journey towards where I want to be (keeping my eyes on what is true), and more (including this lifestyle of being single and seeking a partner!).

How would you describe your life now?

Blessed! I am very focused on my project of expressing some of what I’ve learned. 

Please talk about The Piece We Need.

The Piece We Need is my expression about Inner Strength, “the piece we need to face serious challenges”.  This is a series of videos with animation and commentary.

I’ve been creating a series of videos about the inner resources we all have. There are now two compilations on Vimeo On Demand called Inner Strength and Inner Beauty. I encourage people to watch these videos if they are interested in my message.

What is the takeaway message in it?

We have access to a source of inner strength, and we need to learn to held on to it solidly, quickly, anytime. I say “we”, but I really mean me. It is very personal, and I only want to talk about myself. I say “inner strength” but really mean a whole carpetbag of inner resources. My life is a process of basing myself more and more on myself. 

Some who have experienced trauma live in fear of it occurring again. What keeps you living day by day in the midst of the unpredictability of life?

My breath. It’s my role model!!

I have enjoyed viewing Joel’s videos which highlight cartoon versions of himself and the other characters in them,  over the past few years and find inspiration in the ways he consistently turns inward when it would seem natural to seek external validation to make sense of the world. From this observer’s perspective in many conversations with him, it came to me that when he experienced the Traumatic Brain Injury, his sense of spiritual connection seemed to deepen and appreciation for life has grown incrementally.

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Scientists Explore Ties Between Alzheimer's And Brain's Ancient Immune System

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The Happiest People Earn This Much Money

The amount of income that makes people happiest.

The maximum income for optimal happiness is between $60,000 and $75,000 per year, new research finds.

Any more than that is associated with falling levels of happiness — perhaps because, above this level, the sacrifices are not worth it.

The researchers also asked people about their satisfaction with life.

Life satisfaction involves evaluating our lives in comparison to goals and to other people; whereas happiness refers to daily levels of positive feelings.

The ideal income for the optimum level of life satisfaction is higher at $95,000 per person.

However, life satisfaction also began to drop once a person earned more than $95,000 a year.

Andrew T. Jebb, the study’s first author, said:

“That might be surprising as what we see on TV and what advertisers tell us we need would indicate that there is no ceiling when it comes to how much money is needed for happiness, but we now see there are some thresholds.

It’s been debated at what point does money no longer change your level of well-being.

We found that the ideal income point is $95,000 for life evaluation and $60,000 to $75,000 for emotional well-being.

Again, this amount is for individuals and would likely be higher for families.”

The results come from a Gallup World Poll of 1.7 million people in 164 countries.

Incomes in different countries were adjusted to take into account the purchasing power of the local currency — but the results are expressed in US dollars.

Mr Jebb said:

“…there was substantial variation across world regions, with satiation occurring later in wealthier regions for life satisfaction.

This could be because evaluations tend to be more influenced by the standards by which individuals compare themselves to other people.”

The drive to earn more money could also be hurting their happiness and life satisfaction, Mr Jebb said:

“At this point they are asking themselves, ‘Overall, how am I doing?’ and ‘How do I compare to other people?’

The small decline puts one’s level of well-being closer to individuals who make slightly lower incomes, perhaps due to the costs that come with the highest incomes. These findings speak to a broader issue of money and happiness across cultures.

Money is only a part of what really makes us happy, and we’re learning more about the limits of money.”

→ Explore PsyBlog’s ebooks, all written by Dr Jeremy Dean:

The study was published in the journal Nature Human Behaviour (Jebb et al., 2018).

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FDA Okays First Concussion Blood Test--but Some Experts Are Wary

The U.S. Food and Drug Administration last week gave its first green light to a company that wants to start selling a blood test to evaluate for mild traumatic brain injury, or concussion. The agency lauded the blood test as an innovative tool for speeding diagnosis and avoiding radiation exposure from brain scans. But some head trauma experts worry the authorization was pushed through too hastily.

“The data aren't as conclusive as we would have hoped, so I was surprised by the rapid FDA approval,” says Henrik Zetterberg, a professor of neurochemistry at the University of Gothenburg in Sweden, who was not involved with the project. The Brain Trauma Indicator, developed by San Diego–based biotechnology company Banyan Biomarkers, was reviewed and authorized for commercialization in fewer than six months. It was cleared under the FDA's Breakthrough Devices Program—an approvals process that aims to fast-track the development of promising and relatively low-risk medical technologies, after reviewing available data. Banyan says the new test will soon be available in hospitals.

The Brain Trauma Indicator measures blood plasma levels of the UCH-L1, a protein scientists believe helps dispose of cellular waste in the brain, and GFAP, a structural protein found in non-neuronal cells called astrocytes. Both are released at elevated levels following a concussion or other injury that damages nerve fibers, and both can be detected within 20 minutes of a head injury (although it may take longer for doctors and patients to get the results from a lab).

Concussions are notoriously difficult to diagnose, and patients suspected of having them are typically assessed by a doctor using the Glasgow Coma Scale—a series of physical tests for determining the level of consciousness—followed by a computed tomography (CT) head scan for brain abnormalities. CT scans are expensive, however, and many patients suspected of having traumatic brain injuries do not exhibit signs of visible damage when scanned. The blood test would provide hospitals and clinicians with a relatively quick screening tool to help them decide whether a CT scan would be likely to pick up any brain injury.

The FDA authorized marketing the Brain Trauma Indicator after examining data from a clinical study of nearly 2,000 blood samples from patients with suspected concussions. From that data, the agency concluded the test can predict the absence of lesions on a CT scan with an accuracy of 99.5 percent, making it reliable enough to rule out the need for a scan in at least one third of the patients.

Yet Zetterberg, who has been identifying biomarkers associated with brain injury and other neurological disorders in his lab, questions the usefulness of UCH-L1 as a concussion biomarker, and says his own testing has found it unreliable. “It's very important to look at the timing of the sample,” he says. “UCH-L1 might work at early time points, but if a sample is collected two to three days after an injury, perhaps other markers would be better.”

Joseph Fins, a professor of medicine and medical ethics at Weill Cornell Medical Center, applauds the approval and says, “This test is an advance for triaging CT scans.” But he cautions it may not capture all minor concussions—like those that do not produce structural changes in the brain.“A negative blood test means that proteins were not released—not necessarily that there was not a mild concussion,” he says. “If it’s assumed that a patient did not have a concussion because the test is negative, and then the patient resumes the sporting activity, the effects of the next head injury can be augmented.”

“It's promising that the FDA has approved something,” Zetterberg says. “But much more research is needed,” he adds—especially comparisons of different biomarkers at different time points after injury—to develop a more reliable blood test for concussion. CT scan abnormalities, he says, are just one aspect of this type of injury.

 

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Many Struggling Readers Have Binocular Vision Problems

A new Canadian study finds that many elementary school children who read below grade level have challenges with their eyesight — even if standard tests say their vision is 20/20.

Researchers from the University of Waterloo found that one-third of a group of children with reading difficulties tested below-normal in binocular vision. Healthy binocular vision is defined as both eyes being able to aim simultaneously at the same visual target. Problems with binocular vision may lead to eye strain, fatigue or double vision.

“A complete binocular vision assessment is not always part of the standard vision test,” said Dr. Lisa Christian, lead researcher on the project and an associate clinical professor at the School of Optometry and Vision Science, University of Waterloo. “However, binocular vision problems could be compounding a child’s academic difficulties, and should be investigated.”

The research involved a retrospective review of 121 children between the ages of six and 14 who had all been assigned an Individual Education Plan (IEP) specifically for reading. The findings show that more than three-quarters of these children had good eyesight, but when they were tested for binocular vision, more than a third of them scored below what was considered normal.

Optometrists classify binocular vision anomalies under three main categories: accommodation, vergence and oculomotor. The symptoms may sometimes appear benign or may be masked as other problems.

Children with accommodative issues have trouble focusing or have difficulty changing their focus from one distance to another. For example, our eyes have a natural focusing system, similar to a camera. When the eyes cannot switch focus correctly, the images appear blurry.

Children with vergence problems have trouble turning their eye in or out — eye movements required for reading. When reading a book up close, for example, our eyes need to be able to move inward to see the words. Children with oculomotor issues have trouble with eye tracking and may lose their place while reading.

“Kids can see words on the page, but if (for example) they have difficulty turning their eyes in to read or focusing words on a page, they may experience symptoms of eye strain, double vision or fatigue after five or 10 minutes,” Christian said. “It’s not just about visual acuity, but about how well the eyes work together when performing an activity such as reading.”

“Full eye examinations, particularly in children with vision issues, may be a tool for parents and educators to assist children who are found to have difficulty reading.”

Source: University of Waterloo

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High Dopamine May Cause Psychosis Patients to Focus More on Expectations

A new study finds that schizophrenia patients with auditory hallucinations often hear what they expect to hear. In fact, the hallucinations may be an extreme version of a perceptual distortion quite common among healthy people.

Research has long established that people who experience hallucinations and other psychotic symptoms tend to have elevated dopamine, but the exact link between dopamine and hallucinations has remained unclear.

In the new study, researchers at Columbia University Irving Medical Center (CUIMC) and New York State Psychiatric Institute (NYSPI) found that elevated dopamine could be causing some patients to rely more on expectations, which could then result in hallucinations.

The findings help explain why treatments targeting the production of dopamine could help alleviate this condition.

“Our brain uses prior experiences to generate sensory expectations that help fill in the gaps when sounds or images are distorted or unclear,” said Guillermo Horga, M.D., Ph.D., assistant professor of clinical psychiatry at CUIMC and a research psychiatrist at NYSPI.

“In individuals with schizophrenia, this process appears to be altered, leading to extreme perceptual distortions, such as hearing voices that are not there. Furthermore, while such hallucinations are often successfully treated by antipsychotic drugs that block the neurotransmitter dopamine in a brain structure known as the striatum, the reason for this has been a mystery since this neurotransmitter and brain region are not typically associated with sensory processing.”

For the study, the research team designed an experiment that induced an auditory illusion in both healthy participants and participants with schizophrenia. They observed how building up or breaking down sensory expectations can modify the strength of this illusion. They also measured dopamine release before and after administering a drug that triggers the release of dopamine.

The findings show that the schizophrenia patients tended to perceive sounds in a way that was more similar to what they had been cued to expect, even when sensory expectations were less reliable and the illusions weakened in healthy participants.

This tendency to inflexibly hear what was expected became worse after they were given a dopamine-releasing drug, became more pronounced in participants with elevated dopamine release, and more apparent in participants with a smaller dorsal anterior cingulate (a brain region previously shown to track reliability of environmental cues).

“All people have some perceptual distortions, but these results suggest that excess dopamine can exacerbate our distorted perceptions,” said Horga. “Novel therapies should aim to improve the processing of contextual information by targeting the dopamine system or downstream pathways associated with modulation of perceptual processing, which likely include the dorsal anterior cingulate cortex.”

The study is published in the journal Current Biology.

Source: Columbia University Medical Center

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Screening All Adults for Hepatitis C is Most Cost-Effective Way to ID Those Infected

Screening all adults for hepatitis C (HCV) is the most cost-effective way to identify more people with the disease as well as improve patients’ health and quality of life, compared to the current recommendations of screening only certain populations.

Hepatitis C is a viral infection that causes liver inflammation and sometimes serious liver damage. Many people with HCV experience neuropsychiatric symptoms such as brain fog, confusion, irritability, difficulty concentrating, and fatigue. These symptoms make it difficult to carry on everyday tasks.

The Centers for Disease Control and Prevention (CDC) currently recommends HCV testing for people born between 1945 and 1965, the highest risk population in the U.S. However, recent statistics have shown a growing incidence rate of HCV among young people.

“Due in part to the opioid epidemic and the increase in injection drug use, the country has seen an increase in cases of HCV among young people,” says Benjamin Linas, M.D., co-senior author of the study and infectious disease physician at BMC and an associate professor of medicine at Boston University Medical Center. “The CDC could address this public health concern by recommending all adults receive a one-time HCV test.”

To address this gap in testing, researchers from Boston Medical Center, Massachusetts General Hospital (MGH), and Stanford University created a simulation model to estimate the effectiveness of HCV testing strategies among different age groups.

They compared the effects of testing four age brackets: current testing recommendations (those born between 1945 and 1965), testing people over 40 years old, testing people over 30 years old, and testing all adults over 18 years old. All strategies included the current recommendations for targeted testing of high-risk individuals, such as people who inject drugs.

The researchers discovered that, compared to current recommendations, screening all adults over 18 for HCV would identify more than 250,000 additional people with the disease, increase cure rates from 41 percent to 61 percent, and reduce death rates for HCV-attributable diseases by more than 20 percent. Overall, screening for all adults would increase life expectancy and quality of life while remaining cost-effective.

“When we expanded testing, the results were compelling,” says Joshua Barocas, M.D., lead author on the study, an infectious disease physician at MGH and an instructor in medicine at Harvard Medical School. “Changing the current recommendations could have a major public health impact, improving the quality of life for young people with HCV, and reducing death rates.”

The study pulled data from national databases, clinical trials, and observational cohorts to inform their simulation models, which took into account the same demographics and HCV epidemiology of the U.S. population.

Although all of the age-based strategies lowered costs associated with managing chronic HCV and advanced liver disease, the strategy of testing all adults was most effective. Even in a simulated scenario that required twice as much testing among uninfected people to identify the same number of HCV cases, the testing-all-adults strategy remained cost-effective.

“Testing all adults would lead to earlier diagnosis and treatment for many people, which would help to prevent cirrhosis and other long-term complications,” says Joshua Salomon, Ph.D., co-senior author of the study and professor of medicine at Stanford University. “Overall, when you consider both the better health outcomes and the reduced costs of managing long-term liver disease, expanded testing offers excellent value for money.”

Researchers say these findings should be considered by the CDC for future recommendations on HCV testing.

Source: Boston Medical Center

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