The new work is also part of a field called grounded or embodied cognition. Basically, this ever-growing understanding of human mental function notes that all ideas and concepts—including hard-to-grasp ones like personality and trustworthiness—are ultimately anchored in concrete situations that happen to flesh-bound bodies.

By Kai MacDonald
scientificamerican

What do a chilly reception, a cold-blooded murder, and an icy stare have in common? Each plumbs the bulb of what could be called your social thermometer, exposing our reflexive tendency to conflate social judgments—estimations of another’s trust and intent — with the perception of temperature. Decades of fascinating cross-disciplinary studies have illuminated the surprising speed, pervasiveness and neurobiology of this unconscious mingling of the personal and the thermal.

The blurring of ‘heat’ and ‘greet’ is highlighted in a recent experiment by Ohio University’s Matthew Vess, who asked whether this tendency is influenced by an individual’s sensitivity to relational distress. They found that people high in the psychological attribute called attachment anxiety (a tendency to worry about the proximity and availability of a romantic partner) responded to memories of a relationship breakup with an increased preference for warm-temperature foods over cooler ones: soup over crackers. Subjects low in attachment anxiety — those more temperamentally secure — did not show this “comfort food” effect.

In a related part of the same experiment, subjects were asked to reconstruct jumbled words into sentences that had either cold or warm evocations. (Sentence reconstruction tasks involving specific themes are known to unconsciously influence subsequent behavior.) After being temperature-primed, Vess’s subjects rated their perceptions of their current romantic relationship. As in the first condition, subjects higher in attachment anxiety rated their relationship satisfaction higher when prompted with balmier phrases than with frosty ones.

The fact that individual differences in a relationship-oriented trait (attachment anxiety) are related to a person’s sensitivity to unconscious temperature-related cues speaks to the “under the hood” unconscious mingling that occurs between our social perceptual system and our temperature perception system. Though people predisposed to worry about their relationships seem to be more sensitive to these cues, we are all predisposed to the blurring of different types of experience. Similar recent experiments have demonstrated, for example, that briefly holding a warm beverage buoys subsequent ratings of another’s personality, that social isolationsensitizes a person to all things chilly, that inappropriate social mimicry creates a sense of cold, and that differences in the setting of the experimental lab’s thermostat leads test subjects to construe social relationships differently.

Vess’s experiments follow a much longer line of psychological research exploring the reasons people avoid a cold shoulder, lament a frigid partner and have to “cool off” after a spat. In point of fact, the mercury in our social minds has been of interest since at least the 1940’s, when landmark work on impression-formation by the pioneering social psychologist Solomon Asch demonstrated the “striking and consistent differences of impression” created by substituting the words “warm” and “cold” into a hypothetical person’s personality profile. Since then, a panoply of studies of social perception in a host of cultures have validated the centrality of these temperate anchors in forming rapid unconscious impressions of a person.

It will come as no surprise that the ultimate confluence of the thermal and the personal happens between our ears. The neuroscientist Jaak Panksepp, for example, has noted that the neural machinery for attachment and bonding is actually cobbled together out of more primitive brain areas used for temperature regulation. Adding to this theme, the psychiatrist Myron Hofer’s seminal research in the 1970’s demonstrated that certain parameters of rodent maternal attachment behavior (e.g. variations in touch or warmth) act as “hidden regulators” of various physiological responses (e.g.digestion) in their pups. Around the same time, another psychiatrist, John Bowlby, penned his now-canon observations about the central importance of attachment for the social and psychological development of young humans, reminding us that we are just another part of a chain of mammals that depend on the care of others for survival.

The new work is also part of a field called grounded or embodied cognition. Basically, this ever-growing understanding of human mental function notes that all ideas and concepts—including hard-to-grasp ones like personality and trustworthiness—are ultimately anchored in concrete situations that happen to flesh-bound bodies. For example, our faces respond to disconcerting behavior (incest) in a similar way to disgusting ingestive behavior (crunching a cockroach). Moral from oral.

In the realm of relationships, this mingling of the less and more-concrete means that attachment experiences with specific others, their unconscious emotional tone, and the temperatures they actually feel activate and are stored in overlapping networks of brain areas. These are the so-called multimodal brain regions (a key one is called the insula) that blend different channels of sensory experience into a singular whole. In individual brains, then, the multichannel experience of being safe with another (initially, a mother) is forever fused with the experienced physical warmth that comes with being safe, fed and held. At the level of both brain and experience, this multi-sensory co-experiencing forms a wordless bedrock that implicitly grounds relational language, interpersonal evaluation, social cognition, and even imagined ingestion. “Warm” triggers “trust,” as well as the reverse.

From these insights, other questions abound. Regarding the biology of attachment and warmth, for example, one wonders whether certain molecules—the attachment hormone oxytocin, for example — bias cognition and behavior in a balmier direction. After all, given its vital role in birth, nursing, and early attachment bonds, oxytocin has a strong unconscious association with warm milk, a tendency to inspire trust and generosity, and the capacity to make more benign the valuation of others. Oxytocin even boosts a persons’ perception of the warmth of their own personality, and a ‘warm touch’ intervention in married couples enhances oxytocin levels. On the opposite hormonal pole, might testosterone—which decreases trust — also make things seem colder?

My late, beloved father—a psychologist — had a puckish propensity to char the toast that was a mandatory component of his hand-made hot breakfast ritual. Thanks to social neuroscience, I can now better appreciate (and perpetuate) the wisdom of this ritual linking hot food with heart-felt.

That is the thing that you begin to terrifyingly appreciate: Dementia is not absence; it is not a nonstate; it actually could be a condition of more rather than less feeling, one that, with its lack of clarity and logic, must be a kind of constant nightmare.

By Michael Wolff
theweek

ON THE WAY to visit my mother one recent rainy afternoon, I stopped in, after quite some constant prodding, to see my insurance salesman. He was pressing his efforts to sell me a long-term-care policy with a pitch about how much I’d save if I bought it now, before the rates were set to precipitously rise.

I am, as my insurance man pointed out, a “sweet spot” candidate. Not only do I have the cash (though not enough to self-finance my decline) but I also have a realistic view: Like so many people in our 50s — in my experience almost everybody — I have a parent in an advanced stage of terminal breakdown.

It’s what my peers talk about: our parents’ horror show. From the outside — at the office, restaurants, cocktail parties — we all seem perfectly secure and substantial. But in a room somewhere, hidden from view, we occupy this other, unimaginable life.

I didn’t need to be schooled in the realities of long-term care: The costs for my mother — who is 86 and who for the past 18 months has not been able to walk, talk, or address her most minimal needs and, to boot, is absent a short-term memory — come in at about $17,000 a month. And while her LTC insurance hardly covers all of that, I’m certainly grateful she had the foresight to carry such a policy.

And yet, on the verge of writing the first LTC check, I backed up.

We make certain assumptions about the necessity of care. It’s an individual and, depending on where you stand in the great health-care debate, a national responsibility. And yet, I will tell you, what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering — who can so conscientiously facilitate it?

In 1990, there were slightly more than 3 million Americans over the age of 85. Now there are almost 6 million. By 2050 there will be 19 million — approaching 5 percent of the population.

By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude, really, and resources.

This is not anomalous; this is the norm. Contrary to the comedian’s maxim, comedy is easy, dying hard.

Seventy percent of those older than 80 have a chronic disability, according to one study; 53 percent in this group have at least one severe disability, and 36 percent have moderate to severe cognitive impairments.

Alzheimer’s is just one form — not, as it happens, my mother’s — of the -ever-more-encompassing conditions of cognitive collapse that are the partners and the price of longevity. There are now more than 5 million demented Americans. By 2050, upward of 15 million of us will have lost our minds.

This year, the costs of dementia care will be $200 billion. By 2050, $1 trillion.

Make no mistake, the purpose of long-term-care insurance is to help finance some of the greatest misery and suffering human beings have yet devised.

I HESITATE TO give my mother a personality here. It is the argument I have with myself every day — she is not who she was; do not force her to endure because of what she once was. Do not sentimentalize. And yet…that’s the bind: She remains my mother.

She graduated from high school in 1942 and went to work for the PatersonEvening News, a daily newspaper in New Jersey. In a newsroom with many of its men off to war, Marguerite Vander Werf — nicknamed “Van” in the newsroom and forevermore — shortly became the paper’s military reporter. Her job was to keep track of the local casualties. At 18, a lanky 95 pounds in bobby socks, my mother would often show up at a soldier’s parents’ front door before the War Department’s telegraph and have to tell these souls their son was dead.

She married my father, Lew Wolff, an adman, and left the paper after 11 years to have me — then my sister, Nancy, and brother, David. She did freelance journalism and part-time PR work (publicity, it was called then). She was a restless and compelling personality who became a civic power in our town, got elected to the board of education, and took charge of the public library, organizing and raising the money for its new building and expansion. She was the Pied Piper, the charismatic mom, a talker of great wit and passion — holding the attention of children and dinner-party drunks alike.

My father, whose ad agency had wide swings of fortune, died, suddenly, in that old-fashioned way, of a heart attack at 63, during one of the downswings. My mother was 58 — the age I am now — and left with small resources. She applied her charm and guile to a breathtaking reinvention and personal economic revival, becoming a marketing executive at first one and then another pharmaceutical company. At 72, headed to retirement but still restless, she capped off her career as the marketing head of an online-game company.

For 25 years, she lived in an apartment building in Ridgewood, N.J. Once a week, every week, she drove into Manhattan to cook dinner for my family and help my three children with their homework — I am not sure how I would have managed my life and raised children without her.

This is the woman, or what is left of the woman, who now resides in a studio apartment in one of those new boxy buildings that dot the Upper West Side — a kind of pre-coffin, if you will. It is even, thanks to my sister’s diligence, my mother’s LTC insurance and savings, and the contributions of my two siblings and me, what we might think of as an ideal place to be in her condition.

A painting from 1960 by March Avery, from the collection she and my father assembled — an Adirondack chair facing a blue sea — hangs in front of her. Below the painting is the flat-screen TV where she watches cooking shows with a strange intensity. She is attended 24/7 by two daily shifts of devoted caregivers.

It is peaceful and serene.

Except for my mother’s disquiet. She stares in mute reprimand. Her bewilderment and resignation somehow don’t mitigate her anger. She often tries to talk — desperate guttural pleas. She strains for cognition and, shockingly, sometimes bursts forward, reaching it — “Nice suit,” she said to me, out of the blue, a few months ago — before falling back.

That is the thing that you begin to terrifyingly appreciate: Dementia is not absence; it is not a nonstate; it actually could be a condition of more rather than less feeling, one that, with its lack of clarity and logic, must be a kind of constant nightmare.

“Old age,” says one of Philip Roth’s protagonists, “isn’t a battle, it’s a massacre.” I’d add, it’s a holocaust. Circumstances have conspired to rob the human person of all hope and dignity and comfort.

When my mother’s diaper is changed she makes noises of harrowing despair — for a time, before she lost all language, you could if you concentrated make out what she was saying, repeated over and over and over again: “It’s a violation. It’s a violation. It’s a violation.”

MY MOTHER’S CARDIOLOGIST had been for many years monitoring her for a condition called aortic stenosis — a narrowing of the aortic valve. The advice was do nothing until something had to be done. But now that she was showing symptoms that might suddenly kill her, why not operate and reach for another few good years? What’s to lose?

My siblings and I must take the blame here. It did not once occur to us to say, “You want to do major heart surgery on an 84-year-old woman showing progressive signs of dementia? What are you, nuts?”

Here’s what the surgeon said, defending himself, in perfect Catch-22-ese, against the recriminations that followed the stark and dramatic postoperative decline in my mother’s “quality-of-life baseline”: “I visited your mom before the procedure and fully informed her of the risks of such a surgery to someone showing signs of dementia.”

You fully informed my demented mom?

The operation absolutely repaired my mother’s heart — “She can live for years,” according to the surgeon. But where before she had been gently sinking, now we were in free fall.

Six weeks and something like $250,000 in hospital bills later (paid by Medicare — or, that is, by you), she was reduced to a terrified creature — losing language skills by the minute. “She certainly appears agitated,” the psychiatrist sent to administer anti-psychotic drugs told me, “and so do you.”

MY SISTER COMES over every morning. She brings the groceries, plans the menu, and has a daily routine for stretching my mother’s limbs. I’m here a few times a week (for exactly 30 minutes — no more, no less). Her grandchildren, with an unalloyed combination of devotion and horror, come on a diligent basis.

A few weeks ago, my sister and I called a meeting with my mother’s doctor. “It’s been a year,” I began, groping for what needed to be said. “We’ve seen a series of incremental but marked declines.” My sister chimed in with some vivid details.

We just wanted to help her go where she’s going. (Was that too much? Was that too specific?)

She does seem, the doctor allowed, to have entered another stage. “Perhaps more palliative care. This can ease her suffering, but the side effect can be to depress her functions. But maybe it is time to err on the side of ease.

“Your mom, like a lot of people, is what we call a dwindler,” said the doctor.

I do not know how death panels ever got such a bad name. Perhaps they should have been called deliverance panels. What I would not do for a fair-minded body to whom I might plead for my mother’s end.

The alternative is nuts: paying trillions and bankrupting the nation as well as our souls as we endure the suffering of our parents and our inability to help them get where they’re going. The single greatest pressure on health care is the disproportionate resources devoted to the elderly, to not just the old but the old old, and yet no one says what all old children of old parents know: This is not just wrongheaded but steals the life from everyone involved.

After due consideration, I decided that I plainly would never want what LTC insurance buys, and, too, that this would be a bad deal. My bet is that, even in America, we baby boomers watching our parents’ long and agonizing deaths won’t do this to ourselves. We will surely, we must surely, find a better, cheaper, quicker, kinder way out.

Meanwhile, since, like my mother, I can’t count on someone putting a pillow over my head, I’ll be trying to work out the timing and details of a do-it-yourself exit strategy. As should we all.