Author Archives: author

Existential Communication – Old Wine in New Skins?

1 Reply

DOI: 10.31038/PSYJ.2024644

Abstract

Background: The term existential communication did not emerge but recently in medical terminology. It refers to doctor-patient-communication comprising issues of mortality, fragility of human being, and associated rational and emotional coping.

Objective and methods: A literature search the term existential communication was carried out in PubMed. Moreover, from the results and the author`s long background of facilitating “breaking-bad-news” workshops for oncologists, features of an existential communication are demonstrated.

Results: A PubMed search resulted in only 8 papers from the last decade explicitly using the term existential communication. Hundreds of papers used existential in various other attributions – from existential aspects to existential yearnings. The term existential was rooted in various directions of predominantly German existential philosophy, which after National-Socialism resonated in the USA and catalyzed pioneering strategies of psycho- oncological support. Some training programs for existential communication have been established and share the principles of breaking-bad-news communication.

Conclusion: Existential communication describes more precisely than end-of-life (EOL) discussion a long-standing and teachable medical task which must not be neglected without compromising high quality patient care, in particular in oncology and palliative medicine. Existential communication is prerequisite to avoid burdening patients with very advanced cancers with futile tumor-specific treatments and detrimental adverse-effects. Existential communication is important for patients but may foster a deeper professional satisfaction of health care professionals (HCP).

Keywords

Medical communication, Cancer, Psycho-oncology palliative care, Spirituality end-of-life discussion

Im existentiellen Bereich sind Wahrheit und Kommunikation dasselbe.

In the existential realm truth and communication are identical (translation HK) Hannah Arendt, 1957 [1]

Introduction

Originally the term existential communication has been a central concept of the existential philosophy of Karl Jaspers (1883-1969) [2], a renowned German philosopher and psychiatrist. Nearly a century ago, he coined existential communication for a uniquely dyadic and non-hierarchical communication which enables both interlocutors to evolve their distinctive personhood, their existence. The term opposed the Daseins-communication (communication of being) of daily life inclusive clinical practice. Thus, Jaspers` philosophical construct of existential communication was not established for clinical practice and consequently did not enter medical terminology. Hence, in 1969 Swiss- American psychiatrist Elisabeth Kübler-Ross could finish her landmark book On death And Dying [3] without using the term existential, even if her end-of-life conversations with patients doubtlessly meet today´s understanding of existential communication. Neither can be found the term existential in Cicely Saunders paramount book of palliative medicine of 1978 [4]. However, this book outlined her concept of total pain, which soon should shape the understanding of palliative care of the World Health Organization (WHO) [5] and of international and national palliative care societies [6]. Since then, state-of-the-art care of patients with life-threatening disease embraces a spiritual dimension. Almost simultaneously with the term spiritual the term existential emerged in the Anglo-American medical literature, though. Unlike existential communication the single term existential had entered psychiatric literature of German language already in the first half of the 20th century. The German philosopher Martin Heidegger (1889- 1976) had influenced the psychiatric and respective psychotherapeutic Daseins-Analysis of Ludwig Binswanger [7] and Medard Boss [8], both Swiss psychiatrists and psycho-analysts. Moreover, Viktor Frankl, an Austrian psychiatrist of Vienna, who had established his scientific reputation with innovative concepts of care for suicidal individuals and patients with depression, i.e. patients facing an existential crisis, had outlined his Existence-analysis and Logotherapy since the mid- thirties [9]. But during the Nazi-Era humanistic psychiatric patient care influenced by psychoanalysis and existential philosophy was eradicated in Nazi-dominated Europe and many of the most eminent representatives of German oncology and psychiatry – for being Jews – were forced to emigrate or into murderous concentration camps. In regard to their Nazi-collaboration German medical organizations put under taboo and discouraged any deeper reflection of existential philosophical issues like responsibility, guilt, and shame after the defeat of the Nazi-regime for more than one generation. However, US-American psychiatrists explicitly referring to the above mentioned European philosophers and clinicians soon should introduce the term existential into a now Anglo-American medical literature. Viktor Frankl, who had survived four concentration camps, took an important role for this transatlantic loop of the term existential. He refined his meaning-centered Logotherapy and Existence-analysis reflecting his years of existential threat and the murdering of his family in concentration camps. Initially his concept did not resonate much in the scientific community of post war Austria and Germany, but he gained recognition as a visiting professor at Harvard and other US- universities and with the English translation [10] of his post war book, which has been sold in millions of copies. In a 1991 survey Man’s Search for Meaning was rated one of the ten most influential books in the US. Independently, Stanford psychiatrist Irvin Yalom developed his very influential Existential Psychotherapy [11] leaning on Viennese psycho- analytic concepts and European pre-war existential philosophy. Yalom´s resources-centered therapeutic approach has been modified for psycho- oncological support for patients with cancer: at Stanford psychiatrist David Spiegel established his Supportive-Expressive Psychotherapy [12,13], while William Breitbart – a child of Holocaust survivors, and explicitly referring to Viktor Frankl – developed his Meaning-Centered Psychotherapy [14] at New York´s Sloan-Kettering Cancer Center. Spiritual, existential and finally existential communication had entered literature of oncology and palliative medicine, even if the conceptual understanding of different authors diverge [15].

Methods and Materials

A literature search was conducted in Pubmed (accessed June 21,2024) using the search term existential communication which resulted in 834 references. These comprised both papers using the combined term or just the single term existential or communication. Thus, many references dealt with the vast fund of medical communication which was considered helpful for outlining principles of existential communication. Moreover, the author returned to his extensive experience from facilitating workshops for clinicians on “breaking-bad-news” [16] where modules of communication on death and dying and associated emotions regularly were appreciated most by the participants.

Results

The term existential communication emerged in medical literature only a decade ago and of the 834 references only 6 papers had existential communication in their titles, with 5 of them affiliated with the Denish University of Odense [17-22]. In addition, 2 papers used the term (or modified as existential conversation [23]) in their abstracts or texts [24]. Hundreds of papers employed existential attributively to describe illness experiences, suffering, crisis, loss, shock, aspects of relationships and core values, feelings of guilt, isolation, and yearning (Table 1).

Table 1: Attributive use of existential in medical literature.

existential anxiety

e. conflicts

e. guilt

e. outcome

e. struggle

e. aspects

e. constructs

e. impact

e. pain

e. suffering

e. beliefs

e. crisis

e. uncertainty

e. perspective

e. support

e. burden

e. decision making

e. insight

e. intervention

e. problems

e. survivorship

e. terror

e. care

e. determinator

e. isolation

e. quality

e. thoughts

e. challenges

e. dimension

e. issues

e. questions

e. threat

e. circumstances

e. distress

e. loneliness

e. reactions

e. values

e. communication

e. encounter

e. loss

e. relation

e. vulnerability

e. concern

e. experience

e. meaning

e. rupture

e. well-being

e. condition

e. fear

e. needs

e. shock

e. yearnings

The term existential is embedded into two concurrent concepts. The European Association of Palliative Care (EAPC) und papers adopting its definition use spiritual as a meta-concept which includes existential [6]. Irvin Yalom`s Existential Psychotherapy considers existential as overarching concept, though, which comprises spiritual and religious issues [11]. In the same manner Scandinavian study groups understand existential as a meta-concept, which includes spiritual issues [20]. They are backed by a sample survey of the Denish population, which showed that “the existential” serves well as an overarching construct potentially including secular, spiritual and religious domains of meaning [25]. Moreover, general practitioners of the secular Denish society felt more at ease with the term existential in comparison to spiritual. However, the structural differences of both meta-concepts do not interfere much in actual communication with severely ill patients, and both meta- concepts sometimes may be found in parallel use by the same authors, or existential, spiritual and religious aspects are pragmatically put side by side on a same level [20,26].

Elise Tarbi`s study group at Boston`s Dana-Farber Cancer Institute defines existential communication “as any discussion concerned with confronting mortality and the fragility of existence; in particular, relating to major themes of (1) time as a pressing boundary; (2) maintaining a coherent self; and (3) connecting with others” [24]. This definition is compatible with the one used by the Denish study group at Odense University: “a metaconcept that includes communication about broad existential aspects and potentially, but not mandatorily, communication about spiritual and religious aspects [20].

Why Existential Communication?

In oncological and palliative care existential communication means communication in and about an existential crisis. Coping with a crisis situation depends on communication. Thus, existential communication features both a diagnostic and a therapeutical dimension [27]. The concept of total pain [4] already underscores the importance of giving attention to existential suffering for adequate symptom control [24,28] and quality of life. Otherwise patients might run the risk of being labeled as “difficult” by medical care providers. Breitbart pointed out that he teaches his trainees that “whenever they encounter an angry patient with advanced cancer think existential guilt […]Anger and anxiety have the same etymological roots, and in fact angry typically comes from fear. The fear of loss; loss of love, hope, life. [..]. Clinically I see Existential Guilt manifest as either depression, shame, anger, or intense death anxiety” [29].

Patients with advanced cancer usually want to talk about existential issues with their doctors. But doctors often fail to recognize these wishes or feel time pressured or incompetent for a sensitive wording or consider these issues too private to address. Moreover, physicians with their training in the biomedical approach often focus on obtaining objective measures and fixing a problem. Confronted with problems that cannot be measured objectively and with no direct solutions at hand this approach is bound to reach deadlock [26]. On the other hand, HCPs who engage in communication about existential issues report higher professional meaning and satisfaction and personal depth. Early communication on death and dying with patients with advanced oncological diseases entails less futile and costly oncological treatments and detrimental adverse effects in the weeks before death. These patients have a better quality of life, spend fewer days in a hospital, are less frequently admitted to intensive care units and have a higher chance to die outside a hospital [30]. As the percentage of patients receiving futile oncological treatment in the last weeks of their life did not diminish in the last decade eminent US- American cancer centers pleaded for a better training of oncologists to communicate with patients on existential issues [31].

Principles and Practice of Existential Communication

Existential issues like finitude, mortality and meaning of life cannot be solved but require an individual positioning, acceptance and maybe a possible reevaluation. Patients with life-threatening illness may have a lot of physical and psychosocial problems, but in contrast, they share their existential condition with their HCPs – even if the latter sense less urgency for grappling with their existential issues. Thus, doctors and nurses, wo feel confident in providing medical expertise or advice, generally feel far more challenged when a patient addresses existential suffering. It is beneficial for HCP-teams to reflect personal values and existential beliefs. As a matter of fact, doctors who have been confronted with existential threats in their biography tend to be more attentive to their patients` existential concerns [2]. Spiegel`s concept of “detoxifying dying” in group therapy constructively confronts one´s own mortality when faced with death or imminent loss and can be helpful for HCP-teams [12]. Communication is not an end in itself. Medical communication should be beneficial in coping with severe illness: patients should experience: (1) a sense of resonance – having been seen, heard and understood; (2) a “solidarity of mortals” – an empathetic relationship respecting the remaining autonomy and dignity; (3) hope – an expectation that in severe illness and even with facing death positive experiences may be possible [27]. For Suchman “the feeling of being understood by another person is intrinsically therapeutic: it bridges the isolation of illness and restores the sense of connectedness that patients need to feel whole.” [32] Quite often physicians neglect the crucial elements of establishing a therapeutic relationship: respectful greeting, eye contact, attention and showing interest and empathy. Connection will fail, if doctors just have eye contact with the display of their digital tools for timesaving and simultaneous documentation of patient information. Empathy is not identical with professional friendliness.

As soon as a patient gets informed about a life-threatening disease existential issues intermingle with questions about therapeutic options and treatment schedules: “How much time will I have left? “Why me?” “I am trapped in a black pit”, “I can´t be a burden for my family”, or “oh gosh, that´s the end!” During the last three decades very useful protocols for “breaking bad news” communication have been evaluated, even if lack of adherence to them still is a problem in clinical reality [33,34]. Existential topics are rarely expressed explicitly in palliative care conversations [21]. They often sprinkle patient-caregiver contacts for physical or psycho-social symptom assessment, medical or nursing procedures, or are woven within practical conversations during medical rounds. Statements like “It´s enough!”, “please give me something to die” deal with death, others with issues of justice and guilt: “Why do I have to suffer like this?” Issues of existential loss – loss of self-esteem and identity – emerge in sighs like “I am just a burden”, “This isn´t me anymore!” Again, as in “breaking-bad-news” communications, it is of paramount importance for HCPs not only to grasp the literal content of those statements but also to identify and to primarily address their implicit and dominant emotional contents: uncertainty, fear, despair, anger, shame, feelings of worthlessness. That is how emotional resonance is achieved [16,32,35]. A clinical snippet may demonstrate this approach:

Patient: “This is no life any more.”

Physician responding to the literal message:

“Oh no, we do everything to help you, you can rely on our palliative care expertise.” Physician responding to the emotional message:

“You are really despaired.” Pause, and when the patient confirms non-verbally (nod, eye contact):

“Please tell me what is haunting you most?”

The response to the literal message implicitly devaluates the present illness experience while dodging the emotional issue as a “empathetic terminator” [32]. To minimize a risk of rebuff patients weave existential cues within conversations during medical care or nursing procedures. They sound the openness of HPCs for existential communications [22]. This may be underlined by another clinical snippet:

A 67-year-old woman presenting with ascites was diagnosed with advanced ovarian cancer. She is scheduled for a diagnostic laparotomy. When the experienced anesthesiologist sees her the day before surgery to explain his procedure he is puzzled by the welcome statement of that friendly lady: “I wonder about my future?” The senior doctor hesitates, then answers: “In my opinion, people don´t reflect enough about death.” The patient is startled. She just answers to the technical questions relevant for adequate anesthesia. She is too upset to sleep during the night before surgery.

The patient´s statement “I wonder about my future” doubtlessly is a distinct existential cue. The doctor perceives the emotional message of fear of death. He could address this emotion by labeling it: “Are you afraid to die soon?” However, the doctor flinched from dealing with the emotional issue und took refuge to a rational comment, schoolmasterly dodging the patient´s existential distress. Every existential crisis is charged with unpleasant emotions. Therefore, physicians may be tempted to side-step these emotions by moving quickly to the field of professional action competence with comments, giving advice, or hurriedly suggesting solutions. But it is crucial to take up the patients´ emotional cues first in order to advance to an existential communication. Moreover, HCPs should keep in mind that strong emotions hamper cognitive information processing. Nevertheless, before engaging in an existential communication HCPs should clarify, whether there are any interfering uncontrolled physical symptoms such as pain, thirst, or an urge to urinate. The above snippet demonstrates: Existential clues often hit the HCPs by surprise. They have to decide whether momentarily engaging in an existential communication is a feasible or wise option. Anyway the HCP should signify having registered the cue, maybe – concerning the above snippet by commenting: “That´s an important issue for you, but it makes sense to wait for the results of tomorrow`s operation.” Or the consultant may request the patient´s consent to inform his responsible physician about a desire for a deeper communication, or may ask permission to pass a more specific religious topic to a chaplain.

Tarbi found that conversations with more discussion of prognosis also contained more discussion of existential topics [24]. But without showing a lack of courteous manners doctors often focused on strictly medical facts, failing to notice or ignoring the patient´s existential illness experience and strife for meaning and validation. “Courteous but not curious” is Agledahl`s [36] summary of analysis of doctor- patient encounters in a Norwegian teaching hospital. Whether patients open up to share their existential thoughts heavily depends on non-verbal and sensory elements of an encounter: whether a HCP is perceived both physically and relationally present. “The bodily sensation of presence and sensing seems to precede the verbal dimension of spiritual care and communication […] The patients use a sort of decoding in which they try to sense and decipher whether they will be accommodated, if they initiate a conversation about spiritual matters” [37]. Reciprocally HCPs have to decode the patients` non- verbal cues and keep in mind the most important principles of medical communication: (1) active listening – learning the illness experience; (2) asking questions – showing interest, and encouraging a narrative and its clarification; (3) perception – what and how does the patient communicate verbally and non-verbally. It is important to recognize that a patient is the single expert of his illness experience which he might share by answering to questions like:

“What burdens you most?”

“If you ponder on your illness, how much time do you think you have got to live?”

“When thoughts of death and dying come to your mind, do they cause fear or anxiety?”

“When you think about the rest of your life, what matters most for you?”

“Do you have a specific event or goal you would like to live?”

“When you think back, what did help you most in coping with your disease?”

“When you reflect on your life, what makes you really proud?”

I encourage this kind of “empathetic curiosity” which had been lacking in Agledahl`s study of patient-doctor encounters [36]. Addressing tabooed or anxiety-ridden issues reduces anxiety. Moreover, a simultaneous validation of coping efforts will diminish a patient´s sense of helplessness, hopelessness, and isolation and restore a sense of agency in spite of an advanced disease. Meanwhile, useful concepts of existential communication have been established [18,20,22]. In addition, established guidelines for “breaking bad news” in medicine and reviewed programs of communication skills training in oncology [34] comprise the principles of existential communication.

Conclusion

The recent term existential communication with its secular roots and associations excellently describes a long standing medical task which is crucial for state-of-the art patient care, especially in oncology and palliative medicine. In contrast to the common term end-of-life discussion existential communication semantically does not focus on the end of life but also on the life before. Existential communication also deals with maybe lifelong individual values and resources which impact treatment decisions. But on disease progression of advanced cancer oncologists often “skip over discussions of prognosis and jump to offering a new line of therapy” [31]. They struggle with “taking away hope” [38]. feel uncomfortable with existential issues, and biasedly believe that additional treatment will benefit the patient. That is why existential communications are to be actively scheduled in patient care and are particularly crucial when disease-modifying treatment is stopped. Existential issues of remaining life time and anxiety or confusion surrounding dying regularly emerge at this phase of an illness trajectory. At the same time therapeutic responsibility often changes which may structurally augment the patient´s suffering of having to leave behind loved ones. A patient`s complicit encouragement of his oncologist to offer additional treatment sometimes is motivated by the patient´s fear that otherwise his medical life-line will be cut. Therefore, an early integration of palliative care specialists into the oncological care team is important. Moreover, patients may feel very relieved when oncologists empathetically explain, that with stopping a futile treatment survival will not be shorter but quality of life will be better because adverse effects will cease.

Acknowledgment

The author thanks Matthias Demandt, MD,. for constructive comments on early versions of the manuscript

Competing Interest

The author declares that he has no competing interests.

Funding Information

The author did not receive external funding.

The author did not receive external assistance with data collection, analysis, and manuscript preparation

Ethical Declaration

This study did not involve human participants or animal subjects.

References

  1. Arendt H. in Ludz U. (ed.) (1989) Hannah Arendt, Menschen in finsteren Zeiten. Piper, Munich Zürich.99-112.
  2. Jaspers K. (1932) Karl Jaspers/Oliver Immel (ed.) Philosophie. Schwabe Verlag 2022, Basel
  3. Kübler-Ross E.(1969) On death and dying. The Macmillan Company New York.
  4. Saunders CM (ed.) (1978) The Management of Terminal Disease. Edward Arnold, London.
  5. https://www.who.int/news-room/fact-sheets/detail/palliative-care accessed July 10th,
  6. https://eapcnet.eu/eapc-groups/reference/spiritual-care/ accessed July 10th,
  7. Binswanger (1942) Grundformen und Erkenntnis menschlichen Daseins. Zürich.
  8. Boss (1979) Von der Psychoanalyse zur Daseinsanalyse. Europa Verlag, Zürich.
  9. Frankl V (1949) Ärztliche Seelsorge. Grundlagen der Logotherapie und Deuticke.Wien
  10. Frankl, V.E. (1963) Man’s search for meaning: an introduction to logotherapy. Washington Square Press.
  11. Yalom ID (1980) Existential Basic Books.New York.
  12. Spiegel D, Spira J.(1991) Supportive-Expressive Group Therapy. Psychosocial Treatment Labaratory, Stanford Univ.
  13. Spiegel D, Butler LD, Giese-Davis J, Koopman C, et (2007) Effects of supportive- expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial. Cancer 110: 1130-1138. [crossref]
  14. Breitbart W.(2002) Spirituality and meaning in supportive care: spirituality-and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10: 272-080. [crossref]
  15. Boston P, Bruce A, Schreiber R.(2011) Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage.41: 604-618.
  16. Kappauf (2004) Kommunikation in der Onkologie. Der Onkologe 11: 1251-1260.
  17. Andersen AH, Illes Z, Roessler KK.(2023) Regaining Autonomy in a Holding Environment: Patients’ Perspectives on the Existential Communication with Physicians When Suffering from a Severe, Chronic Illness: A Qualitative Nordic Study. J Relig Health. 62: 2375-2390.
  18. Assing Hvidt E, Hansen DG, Ammentorp J, Bjerrum L, al. (2017) Development of the EMAP tool facilitating existential communication between general practitioners and cancer patients. Eur J Gen Pract 23: 261-268. [crossref]
  19. Balle CK, Hvidtjørn D, Brintow MLB, Wu C, et (2024) Existential communication in maternity care – Mixed method evaluation of a postgraduate short course. Sex Reprod Healthc.41: 100983. [crossref]
  20. Hvidt EA, Ammentorp J, Søndergaard J, Timmermann C, Hansen DG, et al.(2018) Developing and evaluating a course program to enhance existential communication with cancer patients in general practice. Scand J Prim Health Care.36: 142-151. [crossref]
  21. Tarbi EC, Gramling R, Bradway C, Meghani (2021) “If it’s the time, it’s the time”: Existential communication in naturally-occurring palliative care conversations with individuals with advanced cancer, their families, and clinicians. Patient Educ Couns. 104: 2963-2968. [crossref]
  22. Timmermann C, Prinds C, Hvidt EA, Hvidt NC. (2023) Stimulating existential communication – first steps towards enhancing health professionals’ reflective skills through blended learning. PEC Innov. 2 1-3. [crossref]
  23. Strang S, Henoch I, Danielson E, Browall M, et al.(2014) Communication about existential issues with patients close to death–nurses’ reflections on content, process and meaning. Psychooncology.23: 562-568. [crossref]
  24. Tarbi EC, Gramling R, Bradway C, Broden EG, et al. (2021) “I Had a Lot More Planned”: The Existential Dimensions of Prognosis Communication with Adults with Advanced J Palliat Med. 24: 1443-1454. [crossref]
  25. Hvidt NC, Assing Hvidt E, La Cour (2022) Meanings of “the existential” in a secular country: a survey study. J Relig Health. 61: 3276-3301. [crossref]
  26. Andersen AH, Assing Hvidt E, Hvidt NC, Roessler (2020) ‘Maybe we are losing sight of the human dimension’ – physicians’ approaches to existential, spiritual, and religious needs among patients with chronic pain or multiple sclerosis. A qualitative interview-study. Health Psychol Behav Med. 8: 248-269. [crossref]
  27. Karlsson M, Friberg F, Wallengren C, Ohlén J.(2014) Meanings of existential uncertainty and certainty for people diagnosed with cancer and receiving palliative treatment: a life-world phenomenological study. BMC Palliat Care 13:28 [crossref]
  28. Dezutter J, Offenbaecher M, Vallejo MA, Vanhooren S, et al. (2016) Chronic pain care. Int J Psychiatry Med.51: 563-575.
  29. Breitbart W.(2017) Existential guilt and the fear of death. Palliat Support Care.15: 509-512. [crossref]
  30. Starr LT, Ulrich CM, Corey KL, Meghani (2019) Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review. Am J Hosp Palliat Med.36: 913-926. [crossref]
  31. Canavan ME, Wang X, Ascha MS, Miksad RA, et al.(2024) Systemic Anticancer Therapy and Overall Survival in Patients With Very Advanced Solid JAMA Oncol. e241129. [crossref]
  32. Suchman AL, Markakis K, Beckman HB, Frankel R.(1997) A model of empathetic communication in the medical interview. JAMA.277: 678-682. [crossref]
  33. Koch M, Seifart (2024) Rethinking parameters of “success” in breaking bad news conversations from patient’s perspective: the successful delivery process model. Support Care Cancer.32: 181. [crossref]
  34. Bloom JR, Marshall DC, Rodriguez-Russo C, Martin E, Jones JA, et (2022) Prognostic disclosure in oncology – Current communication models: A scoping review. BMJ Support Palliat Care. 12: 167-177.
  35. Matthews DA, Suchman AL, Branch WT (1993) Making “connexions”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med. 118: 973- 977.
  36. Agledahl KM, Gulbrandsen P, Førde R, Wifstad Å. (2011) Courteous but not curious: how doctors’ politeness masks their existential A qualitative study of video- recorded patient consultations. J Med Ethics.37: 650-654.
  37. Voetmann SS, Hvidt NC, Viftrup (2022) Verbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices. BMC Palliat Care. 21: 3.
  38. Kappauf HW.(2001) Aufhlärung und Hoffnung – Ein Widerspruch? Z Palliativmed. 2: 47-51.

Tobacco Pandemic: Challenges and Responses

6 Replies

DOI: 10.31038/CST.2024943

Abstract

Smoking is the leading cause of preventable death worldwide. Its toxicity affects every organ. It is a risk factor or aggravating cause of many diseases: cancer, chronic obstructive pulmonary disease, cardiovascular disease, diabetes, HIV infection and tuberculosis, and is a major source of environmental pollution. The socio-economic costs of smoking, already exorbitant, are likely to become unsustainable by 2050 for all countries, particularly low- and middle-income countries. Twenty years after the adoption and implementation of the WHO Framework Convention on Tobacco Control (FCTC), this article aims to take stock of the situation regarding tobacco use and tobacco control. All countries and international health agencies must be involved in the fight against the tobacco pandemic. It is more important than ever to strengthen tobacco control policies, particularly by helping people to stop smoking, to curb the pandemic and its devastating consequences.

Keywords

Smoking, Smoking-related diseases, Tobacco control, Smoking cessation, Public-health

Introduction

Currently more than 20% of the world’s population were smokers. Smoking remains a global health issue despite the gradual reduction in its prevalence. It is responsible for more than 8 million deaths a year worldwide [1]. The toxicity of tobacco products affects every organ in the body, and it is a direct cause, adjuvant and aggravating factor in many diseases: cancer, cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, HIV infection, tuberculosis, environmental health risks, all of which affect all countries, particularly low- and middle-income countries [2]. The prevalence and mortality of these diseases are set to rise sharply by 2050, entailing very high socio- economic costs. Twenty years after the adoption and implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), this article takes stock of the impact of this pandemic and the state of tobacco control, highlighting the necessity to intensify efforts to combat smoking.

Smoking: A Preventable Killer

Smoking is a chronic disease causing many illnesses. It is the leading preventable cause of death. Smoking cessation is associated with an improvement in life expectancy and quality of life, the greater the earlier the cessation, but even after the age of 60 it is associated with an increase in life expectancy [3].

Cancer

In 2022, there will be 20 million new cases and 9.7 million deaths from cancer. It is estimated that there will be more than 35 million new cases of cancer in 2050, an increase of 77% compared with 2022, particularly in low- and middle-income countries, where cancer mortality will double [4].

Smoking is associated with an increased risk of most cancers.The harmful effects of smoking are exacerbated by other factors (alcohol abuse, malnutrition, viral infections, air pollution) [3,4]. Smoking is the main cause of lung cancer (12.4% of all new cancer cases and 18.7% of all cancer deaths). The prevalence of this cancer is increasing in all countries and its incidence could rise by 47% between 2020 and 2040 [4].

The risk of cancer decreases with the length of time smokers have quit [3]. In Korea, a retrospective cohort study of 3 million smokers aged 30 years and older showed that the risk of cancer decreased after 10 years of smoking cessation (HR=0.83 ; 95% CI: 0.80-0.86) compared with continued smoking. The reduction in the risk of lung cancer is more pronounced for quitting before the age of 50 (HR=0.43; 95% CI: 0.35-0.53) compared with quitting at the age of 50 or older (HR=0.61 ; 95% CI: 0.56-0.66). Smoking cessation also reduces the risk of perioperative complications from excisional surgery and the risk of recurrence after cure, it increases life expectancy and quality of life in patients treated for cancer [5].

Cardiovascular Disease

Nearly two million deaths per year are attributable to smoking- related cardiovascular diseases, and the socioeconomic costs of these diseases will rise sharply by 2050 [6].

In high-income countries, tobacco-related cardiovascular mortality is tending to decrease among men, but is increasing among women. In France, for example, the incidence of myocardial infarction before the age of 65 increased by 50% in women (16% in men) between 2005 and 2014. For the same level of smoking, women have a 25% higher risk of coronary heart disease than men [7]. Almost 75% of deaths from cardiovascular disease occur in developing countries, where people have less access to primary health care, screening and early treatment of these diseases.

Mortality from coronary heart disease is reduced by 35% after 2 to 4 years of smoking cessation and by 50% after 10 years. Smoking cessation helps prevent coronary heart disease in young people, where smoking is the main cause. Quitting also reduces the risk of death or reintervention after coronary artery bypass graft surgery or angioplasty, stroke, abdominal aortic aneurysm and obliterative arteritis of the lower limbs [3,7].

Chronic Obstructive Pulmonary Disease

COPD is the fourth leading cause of death worldwide (4.7% of annual mortality), affecting 10.3% of the world’s population, and its prevalence is expected to increase by more than 20% by 2050 [6]. The socioeconomic costs of smoking are increasing, particularly in low- and middle-income countries [8].

Tobacco smoke is the main risk factor for COPD, and women are more susceptible than men [9]. Smoking accelerates the decline in lung function, which is a source of disability. It increases the frequency of exacerbations, leading to death and hospitalisation, and the development of cardiovascular, metabolic and cancer-related comorbidities [9].

Stopping smoking is associated with a reduction in patient-reported symptoms of chronic bronchitis within one to two months. It slows the decline in lung function (FEV1) in COPD patients and reduces the risk of respiratory infections, exacerbations, hospitalisations, death and smoking-related co-morbidities [3,9].

Diabetes

In 2021, 10.5% of adults aged 19-75 worldwide had diabetes mellitus; 90% of them lived in an emerging country. Diabetes will cause 6.7 million deaths. By 2045, 12.2% of adults will have diabetes, and the explosion in the number of cases, in which smoking is a key factor, will place a socioeconomic burden on all countries [10]. The prevalence of smoking is 20.8% in patients with type 2 diabetes and 10-30% in those with type 1 diabetes [11].

Smoking increases insulin resistance, the risk of prediabetes and diabetes in the general population, and gestational diabetes. Diabetic smokers have a 48% excess risk of premature death from all causes and a 36% excess risk of cardiovascular mortality. Smoking increases the risk of macroangiopathy and microangiopathy, hospitalisation for infections, cancer and depression [10,11].

In people with diabetes, smoking cessation reduces the risk of premature mortality, cardiovascular disease and progression of microangiopathy lesions. It also reduces the risk of cancer, hospitalisation for infections and maternal-foetal complications in gestational diabetes. Finally, it facilitates glycaemic control and reduces symptoms of anxiety and depression [11].

HIV Infection

Worldwide, 39 million people are living with HIV ; 630,000 die and 1.3 million are newly infected each year [12]. Antiretroviral therapy (ART) has significantly reduced AIDS-related mortality, but the proportion of deaths from non-AIDS-related causes has increased, mainly due to smoking, which is twice as common as in the general population [13].

HIV-infected smokers have lower CD4 cell counts, higher HIV viral loads and lower self-reported quality of life than HIV-positive non-smokers. Their risk of dying from cardiovascular disease, cancer or bacterial pneumonia is twice as high and with equivalent ART, smokers have a life expectancy 12 years less than non-smokers. [14].

Smoking cessation among people living with HIV is associated with a reduction in all-cause and smoking-related mortality compared with compared with continuous smokers. Stopping smoking reduces the risk of cardiovascular disease, bacterial pneumonia, COPD and cancer, especially lung cancer [13]. WHO recommends that smoking cessation interventions be integrated into HIV care [12].

Tuberculosis

In 2023, tuberculosis (TB) was no longer among the top ten causes of death worldwide, but it still caused 1.3 million deaths. Nearly 8 million new cases of TB were diagnosed: 410,000 people developed a multidrug resistant or resistant to rifampicin TB [15].

More than 80% of TB case and 90% of TB deaths occur in developing countries. The main drivers of the TB epidemic are the spread of HIV and drug-resistant TB, but smoking is responsible for 17.6% of TB case and 15.2% of deaths in high-burden countries [16]. Smoking, whether active or passive, triples the risk of tuberculosis infection and disease, particularly severe and infectious lung disease, forms resistant to anti-tuberculosis drugs, mortality and disease recurrence, and treatment failure [16].

Smoking cessation among smokers with TB is associated with better treatment adherence, higher cure rates, lower mortality and fewer relapses [16]. WHO recommends that TB and tobacco control should be tackled simultaneously to end the TB epidemic, which is one of the United Nations Sustainable Development Goals [17].

Environmental Health Risks

The WHO estimates that 12.6 million deaths worldwide (23% of all deaths) are attributable to the environment; 75% of pollution-related deaths occur in developing countries. Every year, tobacco production, processing and transport emit 84 million tonnes of CO2, contributing to global warming [18].

Air pollution and passive smoking are responsible for 35% of all cases of bronchopulmonary disease worldwide [18] Cigarette smoking produces toxic substances in mainstream smoke (inhaled by the smoker), second-hand smoke (burning of the glowing end of the cigarette), third-hand smoke (deposition of tobacco residue on surfaces) and cigarette butts [19].

The toxic gases and particles produced (polycyclic aromatic hydrocarbons (PAHs), nitrosamines, aldehydes, ketones, alcohols, phenols, PM2.5 and PM10 microparticles) cause lung cancer, COPD, respiratory infections and allergies, as well as cardiovascular, metabolic (type 2 diabetes, thyroid dysfunction), intestinal and mental diseases [20]. These facts are a justification for tobacco control and smoking cessation.

Tobacco Control and Smoking Cessation

Financial Implications of Smoking

A report from the World Health Organization (WHO) estimates that the annual economic cost of smoking worldwide, including health expenditure, lost productivity, is approximately $1.4 trillion (1.8% of the annual global gross domestic product) and in the USA, the economic cost of smoking is nearly $300 billion a year. [20]. Of this amount, 40% affects developing countries. In France, despite a decline in smoking prevalence, the social cost of smoking is estimated at €156 billion annually, representing an annual cost of €2,300 per inhabitant, regardless of smoking status [21]. In Belgium, this cost reaches €20 billion per year and €2,000 per inhabitant per year [22].

Globally, at least 70% of tobacco consumption occurs in low- and middle-income countries. In addition to the morbidity and mortality associated with tobacco use, the cultivation, processing, and disposal of tobacco products pose environmental risks, including atmospheric pollution, global warming, and changes to ecosystems. These challenges impede the economic development of these countries.

Modalities of Tobacco Control

All forms of tobacco use are detrimental to health and well- being. Only a comprehensive, global approach to tobacco control, encompassing regulation of production, marketing and smoking cessation, can effectively safeguard individuals and the environment from the adverse effects of tobacco use.

The WHO Framework Convention on Tobacco Control (FCTC) – A Legal Framework for Tobacco Control

Adopted in 2003 and implemented in 2005, it has been ratified by 183 countries, representing 90% of the world’s population [21]. Its objectives are “to protect present and future generations from the health, social, environmental and economic consequences of tobacco use and exposure to tobacco smoke by providing a framework for the implementation of tobacco control measures by Parties at the national, regional and international levels, with a view to achieving sustained and substantial reductions in the prevalence of tobacco use and exposure to tobacco smoke”.

It has led to the implementation of tobacco control measures: (1) demand reduction (increasing tobacco price and restricting its availability, banning all forms of tobacco advertising, informing and warning the public, providing cessation services); (2) supply reduction (combating illicit trade, banning sales to minors, unit sales, vending machines); (3) evaluation, scientific and technical cooperation on tobacco control.

These measures have already led to a reduction in the prevalence of smoking worldwide, but the devastating effects will only be felt in the long term.

Strengthening Tobacco Control

Tobacco control needs to be continuously strengthened to meet new challenges [1]. For example, banning the sale of all new tobacco products (nicotine pearls and pouchs, disposable vaping products and non-tobacco flavors, the use of menthol) and restricting the places where tobacco is consumed (health units, urban and outdoor areas) will make it possible to reduce the trade and consumption of tobacco. Plain packaging must become the rule, the sale of tobacco products must be strictly regulated and fighting illicit trafficking must be stepped up. Finally, the policy of increasing tobacco prices must be pursued relentlessly. Taken together, these measures will denormalize the image of smokers and smoking [18,21].

The Protection of Young People is a Priority

Smoking often starts in adolescence, and young people are a prime target for the tobacco industry. Their brains are more vulnerable to the effects of psychoactive substances such as nicotine. The prevalence of smoking peaks between the ages of 25 and 35, and tobacco addiction makes it difficult to quit [1].

The promotion of a tobacco-free lifestyle from an early age is based on: (1) the strict application of tobacco control measures (regular and consistent increases in tobacco prices, bans on the sale of tobacco to minors and on new tobacco products: nicotine pearls and pouchs, disposable vaping devices, smoke-free schools, universities and transport); (2) parental information and smoke-free homes; (3) educational initiatives in schools aimed at strengthening young people’s psychosocial skills and critical thinking are effective [24]. All these measures contribute denormalizing tobacco use, preventing smoking and, more generally, addictive behaviour [24,25].

Various actors are involved in preventing smoking (tobacco, cancer, respiratory associations, etc.). In 2024, the theme of World No Tobacco Day was ‘Protecting children from tobacco industry interference’, which raised awareness of the tobacco industry’s harmful influence on young people [26]. Many countries are working towards a ‘tobacco-free adult generation’ in the next decade [22].

Helping People to Stop Smoking

Strategies to Help People Quit

The provision of smoking cessation services is explicitly included in the FCTC (Art. 14) [23]. Smoking cessation is the only way to reduce the morbidity and mortality associated with tobacco use.

Smoking cessation is part of the treatment of diseases related to tobacco use. Health professionals must be involved in this intervention, using evidence-based non-medication strategies (counselling to quit, cognitive behavioral therapy) [26] and medication strategies (nicotine replacement therapy, bupropion, varenicline) [28].

Medications to help people stop smoking are not widely available in low- and middle-income countries because of their high cost and the lack of trained prescribers. Only a public health framework that takes into account the specific characteristics of these countries and based on the denormalization of smoking, the training of health professionals in smoking cessation and the provision of smoking cessation medications by international health authorities, will enable them to implement effective tobacco control [29].

Strategies for Harm Reduction?

There is no threshold of consumption below which smoking is safe [30]. However, can strategies be proposed to reduce risks and harms associated with smoking?

Tobacco companies offer products that deliver nicotine without burning tobacco (heated tobacco, snus, nicotine pearls and pouchs), promising an alternative to traditional cigarettes. These products may reduce the harmful effects associated with smoke inhalation (lung cancer, COPD), but they maintain nicotine dependence, they are not free of toxicity and therefore not credible proposals [31].

The electronic cigarette (e-cig.) vaporizes a nicotine-containing liquid that is much less toxic than tobacco smoke, making it a potential tool for reducing the risks of smoking when used exclusively, although there are uncertainties about the safety of long-term use. Recent studies [28,32] show that e-cig. can help people to quit smoking; further studies are needed to determine whether this benefit applies to smokers in developing countries [33]. The increasing use of e-cigarettes by young people, especially disposable (puff) and high-nicotine devices (JUUL), could lead to nicotine addiction and subsequent cigarette smoking [34], which has led many countries [35] and the WHO to propose measures to prevent e-cig. use by young people [36].

Conclusion

Twenty years after the implementation of the FCTC, every country in the world is affected by the tobacco pandemic, the leading cause of preventable death. Tobacco control in all its forms remains a major public health challenge because of its health, socioeconomic and environmental consequences. More than ever, health professionals need to be involved in smoking prevention initiatives and in helping people to quit.

Contribution to the Article

All authors contributed to the writing and correction of this article.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. Global report on trends in prevalence of tobacco use 2000–2030. Geneva: World Health Organization; 2024.
  2. The top 10 causes of death. World Health Organization, 2020.
  3. Leon ME, Dresler Reversal of risk after quitting smoking. Bulletin Epidémiologique Hebdomadaire. 2008.
  4. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 [crossref]
  5. Park E, Kang HY, Lim MK, Kim B, Oh JK. Cancer Risk Following Smoking Cessation in Korea. JAMA Netw Open. 2024 [crossref]
  6. Cardiovascular diseases (CVDs), World Health Organization, 2021.
  7. Thomas D. Tabagisme et prise en charge des Angéiologie 2021
  8. Chen S, Kuhn M, Prettner K, Yu F, Yang T, Bärnighausen T, et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: A health-augmented macroeconomic modelling study. Lancet Glob Health. 2023 [crossref]
  9. Global strategy for prevention, diagnosis and management of COPD (GOLD Report, 2024 update).
  10. International Diabetes Federation. IDF Diabetes Atlas 10th edition, 2021.
  11. Durlach V, Vergès B, Al-Salameh A, Bahougne T, Benzerouk F, Berlin I, et al. Smoking and diabetes interplay: A comprehensive review and joint statement. Diabetes Metab. 2022 [crossref]
  12. The path that ends AIDS: UNAIDS Global AIDS Update Geneva: Joint United Nations Programme on HIV/AIDS ; 2023.
  13. Giles ML, Gartner C, Boyd Smoking and HIV: what are the risks and what harm reduction strategies do we have at our disposal? AIDS Res Ther. 2018 [crossref]
  14. Helleberg M, Afzal S, Kronborg G, Larsen CS, Pedersen G, Pedersen C, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis. 2013 [crossref]
  15. Global tuberculosis report 2023. Geneva: World Health Organization; 2023.
  16. Perriot J, Underner M, Peiffer G, Flaudias V. Strategy and stopping smoking interventions in smokers with tuberculosis]. Rev Med Liege. 2020 [crossref]
  17. A WHO / the Union monograph on TB and tobacco control: joining efforts to control two related global epidemics. Geneva, 2007.
  18. Rojas-Rueda D, Morales-Zamora E, Alsufyani WA, Herbst CH, AlBalawi SM, Alsukait R, et .Alomran M. Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses. Int J Environ Res Public Health. 2021 [crossref]
  19. Zafeiridou M, Hopkinson NS, Voulvoulis Cigarette Smoking: An Assessment of Tobacco’s Global Environmental Footprint Across Its Entire Supply Chain. Environ Sci Technol. 2018 [crossref]
  20. WHO. Technical manual on tobacco tax policy and administration, Geneva: World Health Organization, 2021.
  21. Kopp P. Le coût social des drogues: estimation en France en 2019. Observatoire français des drogues et toxicomanie, 2023.
  22. Stratégie interfédérale 2022-2028 pour une génération sans tabac. Cellule générale de politique drogue, 2022.
  23. Convention cadre de l’OMS pour la lutte antitabac Organisation mondiale de la Santé 2003. Réimpression révisée, 2004, 2005.
  24. Peiffer G, Perriot J, Underner M. How can we prevent teenage smoking ? Rev Med Liege. 2024 [crossref]
  25. Ponsford R, Melendez-Torres GJ, Miners A, Falconer J, Bonell C. Whole-school interventions promoting student commitment to school to prevent substance use and violence, and improve educational attainment: a systematic review. Public Health Res (Southampt). 2024 [crossref]
  26. Hooking the next generation: how the tobacco industry captures young customers. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. C.
  27. Nian T, Guo K, Liu W, Deng X, Hu X, Xu M, et Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses. BMC Med. 2023 [crossref]
  28. Lindson N, Theodoulou A, Ordóñez-Mena JM, Fanshawe TR, Sutton AJ, Livingstone- Banks J, et al. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses. Cochrane Database Syst Rev. 2023 Sep 12 ;9(9): CD015226. [crossref]
  29. Kumar N, Janmohamed K, Jiang J, Ainooson J, Billings A, Chen GQ, et Tobacco cessation in low- to middle-income countries: A scoping review of randomized controlled trials. Addict Behav. 2021 [crossref]
  30. Lee The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV (1) — a review. Regul Toxicol Pharmacol. 2013 [crossref]
  31. Liakoni E,Christen SE, Benowitz NL. E-cigarettes, Synthetic nicotiner, Heated- tobacco and smokeless nicotine delivery products: the nicotine landscape beyond combustible cigarettes. Swiss Med Wkly 2024
  32. Auer R, Schoeni A, Humair JP, Jacot-Sadowski I, Berlin I, Stuber MJ, et Electronic Nicotine-Delivery Systems for Smoking Cessation. N Engl J Med. 2024 [crossref]
  33. Kalan ME, Mejia R, Egbe CO, Chopra M, Bteddini D, Jebai R, et Global Tobacco Research Network at Society for Research on Nicotine and Tobacco. E-cigarette use in low-income and middle-income countries: opportunity or challenge for global tobacco control. Lancet Glob Health. 2023
  34. Vallone DM, Cuccia AF, Briggs J, Xiao H, Schillo BA, Hair Electronic Cigarette and JUUL Use Among Adolescents and Young Adults. JAMA Pediatr. 2020. [crossref]
  35. Snell LM, Nicksic N, Panteli D, Burke S, Eissenberg T, Fattore G, et al. Emerging electronic cigarette policies in European member states, Canada, and the United States. Health Policy. 2021 [crossref]
  36. FCTC. Inhalateurs électroniques de nicotine et inhalateurs électroniques ne contenant pas de nicotine. Dehli, 2016

13C-rich Diamond in a Pegmatite from Rønne, Bornholm Island: Proofs for the Interaction Between Mantle and Crust

4 Replies

DOI: 10.31038/GEMS.2024671

Abstract

In this contribution, we show for the first time 13C-rich diamonds in a pegmatite of the 1,400 Ma old Rønne granite. The position of the first-order diamond line depends on the laser excitation energy in the case of deep (55µm) diamond crystals. The best values can be obtained at energies lower than 1mW. The value of 1309 cm-1 corresponds to 55% 13C-diamond, a pressure of ~7 GPa, and a depth of ~210 km. Diamond crystals about 20 µm under the sample surface show no such dependence. Diamonds in a pegmatite sample are unusual and are an essential hint for the involvement of supercritical fluids in the pegmatite formation.

Keywords

13C-rich diamond, Raman spectroscopy, Pegmatite, Supercritical fluid, Bornholm island

Introduction

During the work on deuterium and 13CO2-rich fluid inclusion in pegmatite quartz from the Rønne pegmatite from Bornholm Island, Denmark [1], we found as a surprise 13C-rich diamond inclusion. The G-band of graphite is completely missing. Diamonds in a more crustal rock are entirely out of place. In a couple of papers, the author and the co-authors [1-5] and references in there) have shown that supercritical fluid comes fast from the Earth’s mantle into the crustal region together with its load (diamond and other high-pressure minerals). In the crust region, the supercritical fluid changes into critical and under-critical fluid. In this state, chemical and physical processes that are nearly unknown happen.

Sample Material and Early Results

The about 1,400 Ma old granite from the Klippelokke quarry, 3 km ENE of Rønne (Bornholm Island, Denmark), contains an uncomplicated quartz-feldspar pegmatite veins (subhorizontal or vertical) with a conspicuous graphic texture and only minor amounts of mica. The potassium felspar is flesh-red (called “red admirals”), and the quartz glyphs are smoky-colored [3]. The quartz contains mainly fluid inclusions of secondary origin. However, a small number of quartz grains contain a very high number of carbonate-CO2 inclusions. Some inclusions also contain significant amounts of zabuyelite [Li2CO3] [3]. In such quartz grains, secondary fluid inclusions are rare. Figure 1 shows a typical 13C-rich diamond-calcite aggregate, which is 55 µm deep under the surface, demonstrating that such diamonds are not contaminations from the preparation [6]. The up to now found largest area with some graphite and 13C-rich diamond is 660 x 600 µm2 (like Figure 2). That means that in the Rønne pegmatite sample, diamond is not a rare phase. In quartz grains often related to graphite, there are also smooth spherical inclusions of different minerals (for example, coesite remnants and 13C-rich graphite). Generally, we used for our studies cleaned and, on both sides polished thick sections with a thickness of 500 µm.

Figure 1: Detail of the pegmatite quartz from Bornholm Island. The dashed line shows the inclusion of a 13C-rich diamond in quartz. The inclusion is not easy to see in the quartz material (only in polarized light). D – diamond, Cal – calcite. The diamonds are about 55 µm deep. Note the semicircular patterns of tiny diamonds right above.

Figure 2: Large area with many 13C-rich graphite (Gr) and 13C-rich diamond (D) crystals. The quartz in-between is characterized by very strong Raman bands (as high as the main quartz band at 464 cm-1 in the region (80 – 300 cm-1). The diamond-bearing area is about 20 µm deep.

Methodology

For our studies here, we used only microscopic and Raman spectroscopic technics.

Raman Spectroscopy

We have performed all microscopic and Raman spectroscopic studies with a petrographic polarization microscope with a rotating stage coupled with the EnSpectr Raman spectrometer R532. The Raman spectra were recorded in the spectral range of 0–4000 cm-1 using an up to 50 mW single-mode 532 nm laser, an entrance aperture of 20 µm, a holographic grating of 1800 g/mm, and a spectral resolution ranging from 4–6 cm-1. Generally, we used an objective lens with a magnification of 100x – the Olympus long-distance LMPLFLN100x objective. The laser power on the sample is adjustable down to 0.02 mW. The Raman band positions were calibrated before and after each series of measurements using the Si band of a semiconductor- grade silicon single-crystal. The run-to-run repeatability of the line position (based on 20 measurements each) is ± 0.3 cm-1 for Si (520.4 ± 0.3 cm-1) and 0.5 cm-1 for diamond (1332.7 ± 0.4 cm-1 over the range of 80–2000 cm-1). The FWHM = 4.26 ± 0.42 cm-1. FWHM is the Full- Width at Half Maximum. We used a water-clear natural gem-type diamond crystal (Mining Academy Freiberg: 2453/37 from Brasil) as a diamond reference (for more information, see Thomas et al. 2022 [4]. Other references are small diamond grains in pegmatite quartz left by the preparation [6]: Mean from 10 grains (Lorentz-fitting): 1332.7 ± 0.39 cm-1 and FWHM = 4.26 ± 0.42 cm-1.

Results

Raman measurements on four different diamond crystals in pegmatite quartz from Bornholm Island (Table 1) gave for the first- order Raman line a mean of 1313.52 ± 3.06 cm-1 (53 measurements; crystals: I-IV) and FWHM = 64.47 ± 3.61 cm-1. Opposite to gem diamond crystals, the FWHM value is enormous. This results from the long way from the mantle region at high temperatures and an extended stay at about 700°C in the intrusion level. The group with the lowest value for the first-order diamond line is 1309 ± 0.93 cm-1. They result in long-time measurements at low laser energy (≤1 mW), however, at long time (2000 s).

Table 1: Results of the measured data on the 13C-rich diamond from the Bornholm pegmatite. Crystals I-IV: 55 µm deep under the surface; crystal V: 20 µm deep.

Crystal

 Laser energy (mW) Mean (cm-1) ±1s FWHM (cm-1) ±1s

n

I

 50.0 mW 1318.24 – 62.16 – 2
I 29.1 mW 1315.33 1.78 65.82 10.59

20

I

 22.1 mW 1311.64 – 69.40 – 1
I 4.33 mW 1309.30 – 61.45 –

1

I

 0.92 mW 1308.60 – 60.28 – 2
I 0.15 mW 1309.00 0.93 56.65 4.00

6

II

 0.92 mW 1311.11 0.40 69.09 – 4
III* 29.1 mW 1315.80 0.89 63.32 2.40

10

IV

 9.1 mW 1313.16 0.18 68.70 3.20 6
IV 0.92 mW 1309.00 – 63.00 –

1

V**

 9.1 mW 1304.40 2.78 85.78 5.98

10

*Crystal III is a small, maybe different 13C-rich diamond -see Figure 1. **Crystal V is from the large area near the surface (20 µm deep) – see Figure 2.

Refrain from crystal III in Table 1; there is a passable correlation between the used laser energy (mW) for the 532 nm excitation) and the position of the first-order Raman line (P) of the studied 13C-rich diamond:

P = 1308.56 cm-1 + 0.1976 * (mW). (r2 = 0.928)              (1)

The scatter is the result of minor variations of the laser focus on the diamond sample, about 55 µm deep, from the sample surface. Such variations with the laser energy are not observed for diamonds in Figure 2.

Figures 3 and 4 show exemplarily typical Raman spectra of 13C-rich diamonds taken at different laser powers on the sample (taken with 29.1 and 0,91 mW on the sample, respectively).

The lowest value for the first-order diamond line is 1303.4 cm-1, obtained from the largest diamond-graphite area (660 x 600 µm2; see above). The large FWHM values for all measured diamond grains are the result of stress in an extraneous surrounding (upper crust), by a large dislocation density and 13C/12C disorder [6].

Figure 3: Raman spectrum of the first-order Raman line (29.1 mW on the sample) of 13C-rich diamond from pegmatite quartz from Bornholm Island (exposition 50 s). The line at 1158.9 is from the quartz of the matrix.

Figure 4: Raman spectrum of the first-order Raman line (0.91 mW on the sample) of 13C-rich diamond from pegmatite quartz from Bornholm Island (exposition 2000 s).

Interpretation

We have found in pegmatite quartz from Bornholm Island (Rønne granite) diamonds rich in 13C. Because there is a relatively good correlation between the used excitation energy and the 13C content in the diamond, we can accept that the data for the low energy represents the best Raman values for the 13C-rich diamond (1308.9 ± 0.16 cm-1, n = 9) because at high excitation and the dark color heating and Raman shift to higher values is inevitable. According to Schiferl (1997) [7] and Akaishi et al. (2000) [8], the results correspond to a hydrostatic pressure of about 7 GPa (~210 km depth), and according to Anthony and Banholzer (1992) [9] to 55% 13C in the studied diamond (see also Thomas et al. 2021) [10]. 13C-rich graphite has a D band at 1338 cm-1 and a G band at 1555 cm-1 [11]. The D band for the 12C implanted graphite is 1358 cm-1, and the G band is at 1581 cm-1. From the graphite with the typical very weak D and very strong G bands, the values are given in Table 2.

Table 2: Data for the Raman G band of graphite (Gr) – laser wavelength 532 nm.

Gr-Crystal

 Laser energy (mW) Mean (cm-1) ± 1s FWHM (cm-1) ± 1s

n
13C-rich Gr

29.1 mW

 1562.56 10.82 76.02 6.02

10
12C-rich Gr*

29.1 mW

 1581.5 – 13.50 –

1
Gutierrez et al. (2014)
12C Gr

–

 1581 – – –

–
13C Gr

–

 1555 – – –

–

*See Thomas et al. (2021) – [10].

Opposite the Variscan diamonds and lonsdaleite in the Lusatian Mts, the Erzgebirge, and Thuringia, which consistently show a graphite G band, the Rønne diamond shows in the case of 13C-rich diamond with no graphite band [12,13]. However, the pegmatite samples from Rønne contain very graphite-rich parties, too. The graphite is also 13C-rich and is sometimes coupled with the rare 1332.3 ± 2.7 cm-1 nano diamond. An important conclusion follows that the presence of 13C-rich diamond is a further important hint that supercritical fluids often cause the formation of pegmatites by supercritical water with their load, which takes part in their formation.

Acknowledgment

The short paper is dedicated to my parents, Gerhard (1915-1994) and Anni (1920-1993) Thomas, who have prematurely promoted my strong interest in chemistry and Earth sciences.

References

  1. Thomas R (2024) NaHCO3-NaDCO3 and 13CO2-rich fluid inclusion in pegmatite quartz from Bornholm Island/Denmark. Geol Earth Mar Sci In preparation.
  2. Thomas R, Rericha A (2024) Meaning of supercritical fluids in pegmatite Formation and critical-element redistribution. Geol Earth Mar Sci 6: 1-5.
  3. Thomas R, Davidson P, Schmidt C (2011) Extreme alkali bicarbonate- and carbonate- rich fluid inclusions in granite pegmatite from the Precambrian Rønne granite, Bornholm Island, Denmark. Contrib Mineral Petrol 161: 315-329.
  4. Thomas R, Davidson P, Rericha A, Recknagel U (2022) Water-rich coesite in prismatine-granulite from Waldheim/Saxony. Veröffentlichungen Naturkunde Museum Chemnitz 45: 67-80.
  5. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Ultra-high pressure mineral inclusions in the crustal rocks: Evidence for a novel trans-crustal transport Geoscience 12: 1-12.
  6. Keller DS, Ague JJ (2022) Possibilities for misidentification of natural diamond and coesite in metamorphic Neues Jb – Mineral Abh 197: 1276-1293.
  7. Schiferl D, Malcolm N, Zaug JM, Sharma SK, Cooney TF, et (1997) The diamond 13C/12C isotope Raman pressure sensor system for high-temperature/pressure diamond-anvil cells with reactive samples. J. Appl Phys 82: 3256-3265.
  8. Akaishi M, Kumar MDS, Kanda H, Yamaoka (2000) Formation process of diamond from supercritical H2O-CO2 fluid under high pressure and high temperature Diamond and Related Materials 9: 1945-1950.
  9. Anthony TR, Banholzer WF (1992) Properties of diamond with varying isotope Diamond and Related Materials 1: 717-726.
  10. Thomas R, Rericha A, Davidson P, Beurlen H (2021) An unusual paragenesis of diamond, graphite, and calcite: A Raman spectroscopic Estudos Geologicos 31: 3-15.
  11. Gutierrez G, Le Normand F, Aweke F, Muller D, Speisser C, et (2014) Mechanism of thin layers graphite formation by 13C implantation and annealing. Appl Sci 4: 180- 194.
  12. Thomas R, Trinkler M (2024) Monocrystalline lonsdaleite in REE-rich fluorite from Sadisdorf and Zinnwald/E-Erzgebirge, Geol Earth Mar Sci 6: 1-5.
  13. Thomas R, Recknagel U (2024) Lonsdaleite, diamond, and graphite in a lamprophyre: Minette from East-Thuringia/Germany. Geol Earph Mar Sci 6: 1-4.

NaHCO3-NaDCO3 and 13CO2-Rich Fluid Inclusion in Pegmatite Quartz from Bornholm Island/Denmark

4 Replies

DOI: 10.31038/GEMS.2024663

Abstract

In this short contribution, we present Raman data for the main lines of the synthetic system NaHCO3-NaDCO3. Furthermore, we show that some CO2– rich fluid inclusions in pegmatite quartz in the 1,400 Ma old Rønne granite from Bornholm Island contain D-rich nahcolite. Moreover, we also found 13C-rich CO2 in some fluid inclusions, as well as coronene [C24H12], a highly condensed six-ring polycyclic aromatic hydrocarbon. The occurrence of 13C-rich diamonds in a granite-pegmatite system forces the acceptance of supercritical fluids coming fast from the old mantle region. Maybe supercritical fluids are generally responsible for pegmatite formation.

Keywords

Raman spectroscopy, NaHCO3-NaDCO3-rich CO2 inclusions, 13CO2-rich inclusions, 13C-rich diamond, Pegmatites, Bornholm Island

During the study of nahcolite-rich [NaHCO3] inclusions in pegmatite quartz from Bornholm [1], we found carbonates that could not identified with Raman spectroscopy because of missing reference spectra. Other with Raman determined carbonates and bicarbonates are calcite, zabuyelite [Li2CO3], rare amounts of natrite [Na2CO3], gregoryite [K2CO3], kalicinite [KHCO3], and dawsonite [NaAl(CO3) (OH)2]. Also, graphite is present. A list of carbonate species is in Table 1, given in Thomas et al. 2011 [1]. Because most inclusions are composed of solid carbonates in CO2 only and there are a small couple of silicate melt inclusions, we can assume that the trapping temperature must be about 700°C or higher. After our studies [2,3] about supercritical fluids coming from mantle deeps, unusual mineral phases are possible. We think here on deuterium-bearing carbonates. No Raman spectra are available for deuterium-bearing nahcolite; therefore, we have synthesized such phases in the NaHCO3 – NaDCO3 system. Furthermore, we observed exceptional 13CO2-rich fluid inclusions, which can traced back to the reaction of the supercritical fluid with 13C-rich diamond present in the pegmatite quartz from Bornholm Island.

Sample Material

The about 1,400 Ma old granite from the Klippelokke quarry, 3 km ENE of Rønne (Bornholm Island, Denmark), contain uncomplicated quartz-feldspar pegmatite veins (subhorizontal or vertical) with a conspicuous graphic texture and only minor amounts of mica. The potassium felspar is flesh-red (called “red admirals”), and the quartz glyphs are smoky-colored (see Thomas et al. 2011) [1]. The quartz contains mainly fluid inclusions of secondary origin. However, a small number of quartz grains contain a very high number of carbonate- CO2 inclusions. Some inclusions also contain significant amounts of zabuyelite [Li2CO3] (see Thomas et al. 2011) [1]. In such grains, secondary fluid inclusions are rare. Figure 1 show typical nahcolite- bearing CO2 inclusions.

Figure 1: Typical nahcolite+D and CO2-bearing inclusion in pegmatite quartz from Bornholm Island.

Because there are no Raman spectra of deuterium-bearing nahcolite present as a reference in the literature, we have prepared such crystals by reaction of analytical poor NaHCO3 and D2O (heavy water).

The simple reaction is NaHCO3 + D2O → NaDCO3 +HDO (D2O in excess).                (1)

By the further reaction of NaDCO3 with the produced HDO, we obtain, according to the following equation, the stable compound Na2HD(CO3)2:

2 NaDCO3 + HDO → Na2HD(CO3)2 + D2O ­                  (2)

The pure NaDCO3 compound is rare after the reactions (1) because the DHO concentration increases steadily. The pure NaDCO3 phase forms during fractionated crystallization under the microscope as tiny crystals (Figures 2 and 3). X-ray studies about the last compound must follow.

Figure 2: NaDCO3 crystals grown from a concentrated NaDCO3 solution under the microscope (in transmitted light).

Figure 3: NaDCO3 crystals on silicon grown from a concentrated NaDCO3 solution under the microscope (in reflected light). The arrows show the pure NaDCO3 crystals.

Methodology

For our preliminary studies, we used only microscopic and Raman spectroscopic technics.

Raman Spectroscopy

We have performed all microscopic and Raman spectroscopic studies with a petrographic polarization microscope with a rotating stage coupled with the EnSpectr Raman spectrometer R532. The Raman spectra were recorded in the spectral range of 0–4000 cm-1 using an up to 50 mW single-mode 532 nm laser, an entrance aperture of 20 µm, a holographic grating of 1800 g/mm, and a spectral resolution ranging from 4–6 cm-1. Generally, we used an objective lens with a magnification of 100x – the Olympus long-distance LMPLFLN100x objective. The laser power on the sample is adjustable down to 0.02 mW. The Raman band positions were calibrated before and after each series of measurements using the Si band of a semiconductor-grade silicon single-crystal. The run-to-run repeatability of the line position (based on 20 measurements each) is ± 0.3 cm-1 for Si (520.4 ± 0.3 cm-1) and 0.5 cm-1 for diamond (1332.7 ± 0.4 cm-1 over the range of 80–2000 cm-1). The FWHM = 4.26 ± 0.42 cm-1. FWHM is the Full- Width at Half Maximum. We used a water-clear natural diamond crystal (Mining Academy Freiberg: 2453/37 from Brasil) as a diamond reference (for more information, see Thomas et al. 2022 [3].

class=”pdfsubheading”>Calibration Curve for the Determination of NaDCO3

For the construction of a provisional calibration curve between NaHCO3 and NaDCO3, we solved a small amount of analytical pure NaHCO3 in D2O 99.9% from PelementSamples, Belchertown, MA/ USA. We converted it into a significant excess of pure heavy water [D2O] into NaDCO3 according to reaction (1). We gave a droplet of this solution on a microscope glass slide with a hollow or semiconductor- grade silicon wafer (Figure 3 and Figure 4).

Figure 4: Raman spectrum of NaDCO3 on a Si wafer (520 cm-1 reference).

As described above, we produced NaDCO3-rich phases by reaction of NaHCO3 and heavy water (D2O) according to the equation (1) and (2). Richardson and Hood (1937) [4] wrote that the concentration of NaDCO3 is directly proportional to the amount of D2O. That means pure NaDCO3 crystals are rare (Figure 5).

Figure 5: Raman spectra of NaHCO3 (a) and very NaDCO3-rich nahcolite (b) with D = 0.99.

The obtained Raman data are presented in Figure 6. For the first experiment, we used glass test tubes. The solution is strongly alkaline (pH ~ 11) and reacts readily with glass, forming K2CO3, KHCO3, and other compounds. The formation of K2CO3 could proved by Raman spectroscopy (see also Conrad 2020) [5]. Therefore, for most experiments, we used later plastic vessels. In Table 1 are the results of the Raman determination listed.

Figure 6: Calibration curve for the determination of the deuterium in mol fractions determined from the Raman shift.

Table 1: Results of the Raman measurements on pure NaHCO3 and NaDCO3 and mixed Na(HD)CO3.

Compound

 Origin Mean (cm-1) FWHM (cm-1)

n
NaHCO3

RRUFF R070237

 1045.3 4.82

1
NaHCO3

This work

 1045.1 ± 0.9 5.41 ± 0.13

12
On Si
NaHCO3 This work

1044.1 ± 0.3

 7.14 ± 0.23

6
Na(H0.18D0.82)CO3 This work

1064.4 ± 1.8

 13.71 ± 4.39

12
NaDCO3 This work

1069.1 ± 0.2

 5.91 ± 0.33

13
On glass
Na(H0.02D0.98CO3 This work

1068.3 ± 0.4

 6.10 ± 1.17

10
NaDCO3 This work

1069.3 ± 0.6

 5.45 ± 1.18

11

Table 2: Results of the Raman measurements on pure NaHCO3 and mixed Na(H, D)CO3 in CO2 inclusion in pegmatite quartz from Bornholm Island.

Compound

 Origin Mean (cm-1) FWHM (cm-1)

n
NaHCO3 RRUFF R070237

1045.3

 4.82

1
NaHCO3 This work

1045.2 ± 0.4

 5.58 ± 0.89

15
Na(H0.32D0.68CO3 This work

1061.3 ± 2.5

 19.87 ± 6.58

21

Table 3: lists the main Raman lines of synthetic NaHCO3, NaDCO3, and mixed phases in inclusions in pegmatite quartz from Bornholm Island.

NaHCO3
(synthetic)

 Rel. Intensity NaDCO3
(synthetic)		 Rel. Intensity NaDCO3-rich Bornholm

Rel. Intensity

88.7

 s 75.1 s 70.0 m
110.5 vs 110.2 s 99.0

vs

141.4

 s 150.3 m 153.8 s
164.6

m

203.8

 w
224.5 w 225.6

w

684.7

 w 672.4 vw 695.2 vw
701.3

vw

1045.1

 vs 1069.2 vs 1065.1 s
1266.7 m

1434.5

 vw 1428.3

vw

Relative intensities: vs: Very Strong, s: Strong, m: Medium, w: Weak, vw: Very Weak. The mean for Bornholm is 1061.3 ± 2.5 cm-1 (21 different inclusions) and corresponds to D = 0.68 ± 0.11 and for 1065.1 cm-1 D = 0.84, the highest value.

From our observation under the microscope, we see for the reaction NaHCO3 + D2O an order of:

NaHCO3 → NaHnD1-nCO3 → NaDCO3 according to the equations (1) and (2).

Results

NaDCO3-rich CO2 Inclusion

In a small number of quartz grains in the Bornholm pegmatite, we found a high concentration of NaHCO3-rich CO2 inclusions. The amount of nahcolite [NaHCO3] in these inclusions is a high variable. Figures 7 and 8 show that variability, from about 0 to more than 40% (in rare cases up to 100%).

Figure 7: Complex NaHCO3-Na(H, D)CO3 inclusion in pegmatite quartz from Bornholm Island. V – CO2-rich vapor phase.

Figure 8: NaHCO3-rich CO2 inclusion in pegmatite quartz. a) The NaHCO3 inclusion is composed of pure nahcolite. b) a deuterium-rich nahcolite inclusion in quartz. The volume of this solid phase is about 40%.

13CO2-rich Vapor Phase in the NaHCO3-NaDCO3-Rich Fluid Inclusions

Some NaHCO3-NaDCO3-rich CO2 inclusions contain also 13CO2– rich phases. According to Vitkin et al. 2021 [6], there is a significant difference between the Raman position of pure 12CO2 and 13CO2, with 1388 cm-1 and 1370 cm-1 (Raman mode ν1), respectively. From measurements at nine different inclusions, we obtained a mean of 1381.6 ± 1.44 cm-1 and a FWHM = 14.8 ± 4.7 cm-1 corresponding to 35.56 ± 8% 13CO2. A natural reference with secondary CO2 inclusion in quartz, taken at the same conditions, gave almost pure 12CO2: 1387.94 ± 0.28 cm-1 (n = 11 different inclusions). Using a mean value comparison at a 0.999 statistical certainty results in a significant difference. A different method is used by Remingi et al. 2023 [7]. The 13CO2-rich fluid phase is the result of the interaction between supercritical fluid and 13C-rich diamond. Figure 9 shows an example of 13C rich diamond beside calcite in pegmatite quartz from Bornholm Island.

Figure 9: 13C-rich diamond in a near spherical calcite inclusion in pegmatite quartz from Bornholm Island. The figure shows the diamond grain (D) in calcite. In the calcite is a CO2-rich fluid inclusion (Fl).

From 10 different measuring points on the diamond (see Figure 10), a mean of 1316.11 ± 2.5 cm-1 and an FWHM = 60.54 ± 7.16 cm-1, and according to Thomas et al. (2021) [6], this value corresponds to about 40% 13C, which is relatively high. In the 13CO2-rich inclusions, we have often observed coronene [C24H12] (~1351 cm-1, FWHM = 9.9). Coronene is a highly condensed six-ring polycyclic aromatic hydrocarbon. For the formation, high temperatures are necessary.

Figure 10: Raman spectrum of 13C-rich diamond in pegmatite quartz from Bornholm Island.

Discussion

The enrichment of D2O can be explained by enrichment of D2O by diffusion because the light water (H2O) diffuses faster than the heavy water D2O (Thomas and Davidson 2019) [8-11] in the supercritical fluid. The presence of 13C-rich diamond (Figure 10) shows clearly that a supercritical fluid has transported diamonds via supercritical fluid from mantle depths to the intrusion level of pegmatites. These findings force the idea that supercritical fluids are responsible for the formation of some pegmatites, as the author and coauthors have shown in many papers.

Acknowledgment

We dedicate this paper to Adolf Rericha from Falkensee/Germany for his insistent interest in supercritical fluids.

References

  1. Thomas R, Davidson P, Schmidt C (2011) Extreme alkali bicarbonate- and carbonate- rich fluid inclusions in granite pegmatite from the Precambrian Rønne granite, Bornholm Island, Denmark. Contrib Mineral Petrol 161: 315-329.
  2. Thomas R, Rericha A (2024) Meaning of supercritical fluids in pegmatite Formation and critical-element redistribution. Geol Earth Mar Sci 6: 1-5.
  3. Thomas R, Davidson P, Rericha A, Recknagel U (2022) Water-rich coesite in prismatine-granulite from Waldheim/Saxony. Veröffentlichungen Naturkund Museum Chemnitz 45: 67-80.
  4. Richardson JS, Hood GR (1933) An experiment with heavy water. The Journal of Physical Chemistry 37: 82-84.
  5. Conrad J (2020) Deuterium isotope effects on acid ionization and metal oxide – hydrolysis under hydrothermal conditions. Thesis, Guelph, Ontario, Canada. Pg: 505.
  6. Thomas R, Rericha A, Davidson P, Beurlen H (2021) An unusual paragenesis of diamond, graphite, and calcite: A Raman spectroscopic study. Estudos Geologicos 31: 3-15
  7. Remigi S, Frezzotti ML, Rizzo AL, Esposito R, Bodnar RJ, et al. (2023) Spatially resolved CO2 carbon stable isotope analyses at the microscale using Raman Scientific Reports 13: 1-11.
  8. Thomas R, Davidson P (2019) Shaw meteorite: water-poor and water-rich melt inclusions in olivine and Mineralogy and Petrology 113: 1-5.
  9. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Ultra-high pressure mineral inclusions in the crustal rocks: Evidence for a novel trans-crustal transport Geoscience 12: 1-12.
  10. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Supercritical fluids conserved as fluid and melt inclusions in quartz from the Sherba-Gold Mine, Barberton, South Aspects in Mining & Mineral Sciences 10: 1193-1196.
  11. Vitkin V, Polishchuk A, Chubchenko I, Popov E, Grigorenko K, et al. (2020) Raman laser spectrometer: Application to 12C/13C isotope identification in CH4 and CO2 greenhouse gases. Applied Sciences 10: 1-11.

China Moves against Taiwan: Using AI Simulation and Mind Genomics Thinking to Explore an International Conflict

3 Replies

DOI: 10.31038/ALE.2024122

Abstract

This paper is part of a series of papers using generative AI to simulate issues of current importance in the world of nations and their interactions. Through AI and the Mind Genomics platform, BimiLeap.com, one can explore different facets of a situation. The study here on the potential move of China on Taiwan explores the topic from five viewpoints, each simulated by AI, and the entire processing taking less than 24 hours, and at low cost. Phase 1 deals with reconstructing the recent past through simulated interviews with government officials. Phase 2 deals with the mind-sets of the Chinese people regarding Taiwan. Phase 3 projects the future history of the conflict by positioning the simulation in 2030 and simulating one’s recall of events six years before when the conflict between China and Taiwan took place. Phase 4 simulates a congressional hearing to explore the conflict. Phase 5 presents five simulations of what one must do to avoid the problem. The five phases provide an easy-to-understand briefing document, designed to capture the “human face” of the conflict, and involve the reader in critical thinking about issues and solutions.

Keywords

China-Taiwan conflict, Generative AI, Geopolitical issues, International conflict, Mind Genomics

Introduction

The relationship between China and Taiwan has been a contentious issue for decades, with China viewing Taiwan as a rogue province and Taiwan viewing itself as a sovereign state. The conflict has roots in the Chinese Civil War, where the defeated Nationalist Party retreated to Taiwan, establishing a separate government. Despite growing trade and cultural exchanges, political tensions have not fully dissolved. In 2024, tensions are at extreme levels, with China’s President Xi Jinping making increasingly threatening statements about Taiwan’s autonomy. The Chinese people view this as a rightful step to ensure China’s global standing. On the other hand, Taiwan’s President Tsai Ing-wen faces immense pressure from both citizens and international allies. The U.S. and other international allies have played a central role in maintaining peace in the region, but the stakes have never been higher. Intensifying espionage and propaganda efforts have driven public sentiment further to extremes, with Chinese media portraying Taiwan as dangerously rebellious and Taiwanese media portraying China as an oppressive neighbor. The future hinges on how long Taiwan can hold out and what the international community is willing to do in its defense [1-3].

Phase 1 — Reconstructing the Past Through Simulated Interviews

Simulating history through imaginary interviews offers profound insights beyond mere facts, allowing for a deeper understanding of the intentions, motivations, tensions, and decisions that might have been obscured in official records or documents. This mode of exploration fosters empathy, deeper understanding of complexities, and a recognition that history is more than a collection of dates and events; it is a narrative shaped by the thoughts, emotions, and actions of individuals and institutions. By placing oneself in the shoes of both the interviewer and the interviewee, one can ask pointed questions that reflect contemporary concerns and imagine the answers through the lens of the individuals involved, reconstructing not just their public- facing personas but their personal doubts, ambitions, and limitations. This exercise in empathy allows for a deeper understanding of the uncertainty and messiness of decisions that might seem inevitable or preventable with the benefit of hindsight [4-6].

Simulated interviews also help to test assumptions, uncovering underlying ideologies, competing narratives, and significant ideological blind spots that governed behavior and choices. They also model a different type of dialogue, allowing for a better understanding of the role of personality and individual agency in history. This approach instills analytical rigor and creative empathy, skills crucial for any student of history. Table 1 shows the instructions to the AI to synthesize the interviews with ten government officials.

Table 1: Simulated interviews about the China-Taiwan situation with 10 government officials.

Phase 2 — Mind-Sets of China Regarding Taiwan

Mind Genomics is an emerging science which identifies different “mind-sets” based on cognitive patterns, preferences, and biases. It suggests that people respond to the same issue in different but predictable ways, not because they are irrational or misinformed. This concept can be applied to geopolitical issues like the China-Taiwan conflict, helping to deconstruct varying viewpoints in China regarding Taiwan’s status and potential actions. Within China, multiple mind- sets exist regarding Taiwan, including nationalistic, historical, economic, and strategic perspectives. Understanding these different mind-sets can help decision-makers craft targeted policies to appeal to specific segments of the population, preventing oversimplification of the complex issue of the China-Taiwan conflict.

Table 2 shows the three mind-sets synthesized by AI. China’s mind- sets regarding Taiwan are influenced by its historical conception of sovereignty and territorial integrity, as well as its long-standing belief in a unified China dating back to imperial dynasties. The Chinese government views Taiwan as an integral yet temporarily estranged part of the modern Chinese nation-state, with the Taiwan question seen as a symptom of a larger historical trajectory. The Chinese leadership is aware of the political repercussions of losing Taiwan, and any deviation could weaken the Chinese Communist Party’s (CCP) grip on the narrative. Taiwan’s strategic role in global geopolitical dynamics, particularly its dominance in advanced semiconductor production, further influences Beijing’s approach. China’s approach to Taiwan is long-term, with strategic patience informed by the Confucian principle that “time will solve all problems.” However, the international context is not overlooked, with Taiwan’s close ties to the United States, alliances with Japan, and its pivotal role in the Indo- Pacific strategy. The prevailing mind-set of the Taiwanese people, who overwhelmingly prefer maintaining the current status quo, conflicts with Beijing’s strategy of eventual reunification. Understanding China’s mind-set can help navigate its decision-making processes and understand its complex emotions and motivations [7-9].

Table 2: Mind-sets of China Regarding Taiwan.

Phase 3 — Looking Forward by Looking Backwards: The Experts Recall What Happened Six Years Ago

Edward Bellamy’s novel “Looking Backward” offers a unique approach to understanding the future by imagining it as if it has already occurred. By placing the reader in the year 2000, looking back at the societal transformations that fixed the problems of 1887, Bellamy provides a structured way of imagining possible trajectories and assessing the decisions that lead to certain outcomes. This technique can be applied to the fraught situation between China and Taiwan, as it allows for better analysis and prevention of repeating mistakes.

Bellamy’s method enhances our ability to learn by structuring our critical analysis, allowing us to mentally walk backward and identify key events or errors that determined the future. The immediacy of the China-Taiwan conflict is complicated by militaristic, economic, and geopolitical uncertainties, but by mentally projecting Taiwan as having already been annexed or successfully defended its sovereignty, the outcome can only be understood and studied.

Storytelling is another aspect of “looking backward,” making complex international relations more graspable for everyone involved in the process. By offering a blueprint in the form of an already- imagined outcome, Bellamy effectively shifts the reader toward structured speculation.

Looking backward frames today’s decisions with the weight of historical responsibility while maintaining the speculative flexibility the future demands. By using Bellamy’s method creatively, we may better navigate the tense and dangerous waters of contemporary geopolitics [10-13].

Table 3 presents us the results of ten interviews with individuals who were simulated to be conversant with the issues, and who had opinions about what could have been done better. The approach follows Edward Bellamy’s approach of telling the story of a moderately recent past to foretell the future in a way which is palatable and interesting.

Table 3: Ten interviews about the Chinese move on Taiwan which occurred five years before.

Phase 4 — Questions and Answers at the Congressional Hearing

Simulating a congressional hearing with unnamed professionals recounting their memories of an event like a Chinese move on Taiwan can be an educational and thought-provoking exercise. It allows readers to explore complex foreign-policy issues within a structured context, encouraging critical thinking, engagement with hypothetical expertise, and scenario analysis. This method focuses on roles and expertise rather than individuals, allowing readers to consider the processes and systems that underpin decisions. Table 4 presents the simulated congressional hearing.

Table 4: Simulated questions and answers at a congressional hearing about the Chinese move on Taiwan.

Simulating a congressional hearing can also deepen understanding of contemporary geopolitics and history by placing students in hypothetical situations where they need to apply historical knowledge, critical analysis, and strategic thinking. It also trains students and participants to ask better questions, identifying gaps in knowledge and anticipating the need for further information.

The interdisciplinary nature of the simulation allows readers to understand how disciplines interact in policy decisions, highlighting the union of various domains of expertise in resolving international conflicts. While some may enjoy the freedom of working within fictive or simulated environments, others may find the exercise challenging due to the added responsibility of dealing with a complex situation that has not “actually” happened but could happen in the future.

Ultimately, employing simulations in history and policy classes can nurture analytical skills, leadership potential, and decision-making acumen. A hearing simulation on an event like a Chinese move on Taiwan helps attendees and readers practice working with complex, nuanced issues, serving as an effective preparatory exercise for those who may enter fields in government, law, international relations, or academia where nuanced and critical decisions will be valued [14-16].

Phase 5 — Five “Faces of Prevention”

In times of uncertainty, questions play a crucial role in national security, foreign policy, and crisis management. The unpredictability of information and insights can create tension when different answers create more ambiguity. Consultations from experts from the cabinet and Pentagon bring varied experiences, fields of study, and specializations to the table. Receiving different answers does not necessarily signify the system is failing or confused, but it highlights the reality of complexity and the necessity of pulling from diverse perspectives [17-19].

Repetition of questions can signal attention to the critical nature of the issue, revealing nuances in arguments, gaps in logic, or overlooked information. Inconsistency in responses may give a broader, more comprehensive understanding of the nuances faced, prompting deeper thinking. Table 5 shows four different answers to the same question: What steps should be taken to prevent similar acts of aggression in the future?

Table 5: Five answers to the same question: What steps should be taken to prevent similar acts of aggression in the future?

Discussion and Conclusion

China’s intentions and potential military actions towards Taiwan are a major concern for national security and policymakers worldwide. AI-enabled simulations have been used to study and predict China’s strategies, including triggers, diplomatic channels, military postures, and deterrence scenarios. These simulations provide quicker, more adaptable analyses of complex geopolitical scenarios, allowing policymakers to run multiple “what-if” scenarios that take into account economic pressures, diplomatic relationships, and military movements. However, concerns about overemphasis on AI-based simulations exist, as they may not fully grasp cultural, historical, and deeply embedded political factors. To ensure AI does not dominate the decision-making process, traditional simulation techniques, field experience, and diplomatic insight should be used alongside AI- based simulations. Simulation exercises can help decision-makers better prepare for potential real-world conflicts without endangering national security or international stability.

Acknowledgments

The authors delightedly acknowledge the ongoing help of Vanessa Marie B. Arcenas and Isabelle Porat in the preparation of this manuscript and its companions.

References

  1. Amonson K, Egli D (2023) The Ambitious Dragon: Beijing’s Calculus for Invading Taiwan by Journal of Indo-Pacific Affairs 6: 37-53.
  2. Roy D (2000) Tensions in the Taiwan Survival 42: 76-96.
  3. Wang TY (2023) Taiwan in 2022: An Eventful Asian Survey 63: 247-257.
  4. Albores P, Shaw D (2008) Government preparedness: Using simulation to prepare for a terrorist Computers & Operations Research 35: 1924-1943.
  5. Borning A, Friedman B, Davis J, Lin P (2005) Informing Public Deliberation: Value Sensitive Design of Indicators for a Large-Scale Urban In: Proceedings of the Ninth European Conference on Computer-Supported Cooperative Work 449-468.
  6. DiCicco JM (2014) National Security Council: Simulating Decision-making Dilemmas in Real International Studies Perspectives 15: 438-458.
  7. Dweck CS, Yeager DS (2019) Mindsets: A View From Two Eras. Perspectives on Psychological Science 14: 481-496.
  8. Moskowitz H, Kover A, Papajorgji P (2022) Applying Mind Genomics to Social IGI Global.
  9. Wu AX (2014) Ideological polarization over a China-as-superpower mind-set: An exploratory charting of belief systems among Chinese internet users, 2008-2011. International Journal of Communication 8: 2650-2679.
  10. Berridge V (2016) History and the future: Looking back to look forward? International Journal of Drug Policy 37: 117-121.
  11. Franklin JH (1938) Edward Bellamy and the Nationalist The New England Quarterly 11: 739-772.
  12. Levi AW (1945) Edward Bellamy: Ethics 55: 131-144.
  13. Zhang P (2015) The IS History Initiative: Looking Forward by Looking Communications of the Association for Information Systems 36: 477-514.
  14. Kahn MA, Perez KM (2009) The Game of Politics Simulation: An Exploratory Journal of Political Science Education 5: 332-349.
  15. Mariani M, Glenn BJ (2014). Simulations Build Efficacy: Empirical Results from a Four-Week Congressional Journal of Political Science Education 10: 284- 301.
  16. Rinfret SR, Pautz MC (2015) Understanding Public Policy Making through the Work of Committees: Utilizing a Student-Led Congressional Hearing Simulation. Journal of Political Science Education 11: 442-454.
  17. Hart P (2002) Preparing Policy Makers for Crisis Management: The Role of Journal of Contingencies and Crisis Management 5: 207-215.
  18. Hetu SN, Gupta S, Vu VA, Tan G (2018) A simulation framework for crisis management: Design and Simulation Modelling Practice and Theory 85: 15-32.
  19. Rosenthal U, Pijnenburg B (eds) (1991) Crisis Management and Decision Making: Simulation Oriented Scenarios. Springer Science & Business Media.

Anticipating and Countering Foreign Malign Influence Such as Disinformation and Propaganda: The Contribution of AI Coupled with Mind Genomics Thinking

2 Replies

DOI: 10.31038/ALE.2024121

Abstract

This paper presents a new approach to understand FMI (foreign malign influences) such as disinformation and propaganda. The paper shows how to combine AI with the emerging science of Mind Genomics to put a “human face” on FMI, and through simulation suggest how to counter FMI efforts. The simulations comprise five phases. Phase 1 simulates a series of interviews from people about FMI and their suggestions about how to counter the effects of FMI. Phase 2 simulates questions and answers about FMI, as well as what to expect six months out, and FMI counterattacks. Phase 3 uses Mind Genomics thinking to suggest three mind-sets of people exposed to FMI. Phase 4 simulates being privy to a strategy meeting of the enemy. Phase 5 presents a simulation of a briefing document about FMI, based upon the synthesis of dozens of AI-generated questions and answers. The entire approach presented in the paper can be done in less than 24 hours, using the Mind Genomics platform, BimiLeap.com, with the embedded AI (ChatGPT 3.5) doing several levels of analysis, and with the output rewritten and summarized by AI (QuillBot). The result is a scalable, affordable system, which creates a database which can become part of the standard defense effort.

Keywords

AI simulations, Disinformation, Mind genomics, Foreign malign influences

Introduction: The Age of Information Meets the Agents of Malfeasance

Information warfare is a powerful tool for adversarial governments and non-state actors—with propaganda, fake news, and social media manipulation being key strategies to undermine democracies, particularly the United States. Foreign actors like Russia and China exploit socio-political divides to spread fake news, amplifying racial tensions and cultural clashes. The U.S. government is increasingly concerned about disinformation and propaganda efforts from foreign adversaries, with agencies like the Department of Homeland Security (DHS) and Federal Bureau of Investigation (FBI) warning about evolving tactics. The private sector, particularly social media companies, has a key role in countering propaganda but has been criticized for being insufficient. To combat these threats, the U.S. government, social media companies, and civil society organizations need to collaborate effectively, using innovative techniques to detect and counter malign influences without infringing on civil liberties [1-4].

The war on disinformation continues apace. Sustained efforts are evermore vital to preserve the integrity of democratic systems. Malign influences do their evil work through their deliberate use of deceptive or manipulative tactics. The actors may be state or non-state actors, who spread false information, distort public perception, or undermine trust in democratic institutions. Traditional media plays one of two roles, or sometimes both roles. Traditional media either amplifies misinformation by reporting unverified stories or counteracts it by adhering to journalistic standards of fact-checking and verification. The outcome is a tightrope, balancing act, one part being freedom of expression, the other being the structural harm from the willy-nilly acceptance of potentially injurious information. Balancing freedom of expression with the need to protect citizens from harmful deceit can be difficult [5-7].

Strategies currently in use include increased investment in fact- checking initiatives, creating algorithms to detect fake accounts and bots, public awareness campaigns about media literacy, and stricter regulations about political ad funding, respectively. Nonetheless, it is inevitable that challenges remain in detecting and removing disinformation, clearly in part due to the avalanche effect, the sheer volume of content and evolving tactics. Fact-checking can help reduce the spread of false stories, but it is often limited by reach, speed, and the willingness of individuals to believe corrections. Artificial intelligence may identify patterns in disinformation campaigns, flagging suspicious accounts or content, but may struggle to distinguish among opinion, satire, and deliberately harmful misinformation [2,8].

Misinformation can erode trust in traditional media by making it difficult for the public to discern what is true and what is propaganda. Broad laws targeting online speech often raise concerns about censorship and the infringement of free speech. Media literacy programs give people the tools to critically evaluate sources and identify fake news, but they require widespread implementation and can be hindered by existing biases [9-11].

This paper moves the investigation of malign influences such as fake news into the direction of the analysis of the everyday. The paper attempts to put a human face on malign influences by using AI to simulate interactions with people, with questions that people might ask, and with ways that people deal with information sent out by “actors” inimical to the United States. The paper presents AI “exercises” using the Mind Genomics platform, BimiLeap.com.

Phase 1: Putting a Human Face on the Topic Through Snippets of Stories with Recommendations

The psychological principle of presenting a “human face” to issues like foreign malign influences (FMI) resonates with people as they are naturally driven by stories. Simulating interviews with individuals recounting personal struggles with misinformation injects warmth, vulnerability, and relatability, making it easier to feel empathy [12-14]. Building trust and emotional connection is essential in addressing the erosion of trust in media, government, and social institutions. To this end, Table 1 presents 22 short, simulated interviews with ordinary people, as well as the recommendation that they make.

Table 1: AI simulated snippets of interviews and recommendations about FMI (foreign malign influences).

Phase 2: Simulating Advice

AI can be used to generate specific questions and detailed, actionable answers to counter foreign malign influences (FMI). This approach allows for quick identification of common points of intrusion or manipulation by foreign actors, providing an organized strategy to address key vulnerabilities. AI-driven directives prioritize immediate actions, enabling individuals or institutions to respond swiftly to rapid information warfare. AI’s ability to flesh out complex situations while accounting for multiple variables allows it to present tangible alternatives and outcomes with ease through simulation, providing a “what if ” perspective. This actionable level of detail bridges the gap between theory and practice, making recommendations feel natural and embedded in the broader scenario being played out in real-time simulation. The iterative nature of AI allows for constant feedback and improvement, making it better suited to the evolving circumstances of FMIs. AI’s role also provides clarity and simplicity, making it suitable to create directives for targeted messaging campaigns, media outlets, and the general public [15-17].

Table 2 shows questions and answers based on a simple AI “understanding” of the topic, along with additional analyses such as predictions of what might happen six months out, and FMI’s counterstrategy. Information presented in this manner may produce more compelling reading, and a greater likelihood that the issues of FMI end up recognized and then thwarted.

Table 2: Questions, answers, strategies and counterstrategies for FMI efforts.

Phase 3: Mind-sets of People in the United States Exposed to FMI

Mind-sets are stable ways individuals react to stimuli or situations which are shaped by cognitive processes, personal experiences, emotional predispositions, and sociocultural factors [18-21]. AI- generated mind-sets can be crucial for understanding how different people process misleading material, such as the topic of this paper, Foreign Malign Influence (FMI). Machine learning algorithms use clustering methods, unsupervised learning, and statistical analysis to generate or simulate these mind-sets. By feeding AI real-world data, AI can identify distinct groups of people who respond to information in specific ways. This enables predictions on how these groups will behave when confronted with different types of foreign malign influence, making interventions more effective. Table 3 shows the simulation of three mind-sets of individuals responding to FMI information.

Table 3: AI simulation of three mind-sets, created on the basis of how they respond to misinformation presented by the FMI.

Exploring mind-sets in the context of FMI provides insights into social resilience and helps design better defense mechanisms against misinformation. Educational platforms can teach people how to recognize manipulation techniques based on their underlying mind-set. Furthermore, governments, social media companies, and other stakeholders can measure the effectiveness of counter- disinformation campaigns by targeting specific mind-sets and adjusting their message based on real-time feedback or simulation predictions from AI.

Phase 4: Predicting the Future by Looking Backwards

The “Looking Backwards” strategy is an innovative method for predicting trends and outcomes, inspired by Edward Bellamy’s “Looking Backwards” process. By mentally placing ourselves in 2030 and reviewing the events of 2024, we can distance ourselves from innate biases, misinformation, anxieties, and uncertainties of the present moment. This mental distance allows for clearer, more holistic insights into the trajectory of ongoing issues, such as foreign malign influences attempting to flood the U.S. with disinformation. Table 4 shows the AI simulation of looking backward from 2030.

Table 4: Predicting the future by looking backward at 2024 from 2030 to see what was done.

By looking back at 2024 from 2030, we can better assess the societal, political, and psychological ramifications of foreign influence operations, especially disinformation campaigns. By identifying the steps taken today that resulted in negative or positive outcomes by 2030, we might adjust our efforts now, fortifying our democratic resilience against foreign ideologies seeking to undermine our stability. This approach also holds potential when shared with the public, as it can help improve resilience and empower the democratic system to remain agile [22-26].

Phase 5: Creating a Briefing Document — Instructing the AI Both to Ask 60 Questions and Then to Summarize Them

In this step AI was instructed to create 60 questions, and provide substantive, detailed answers to each. The questions focused on various aspects regarding the impact of foreign disinformation on public opinion, civic engagement, and stability. These responses were then condensed into a more digestible briefing using summarizing tools like QuillBot [27-29]. This process allows for the inclusion of ideas and hypotheses that might not be immediately apparent to human analysts due to cognitive biases or blind spots [30,31] (Table 5).

Table 5: A simulated “set of five questions briefing document” about FMI, based upon the AI-generated set of 60 questions and answers, followed by an AI summarization of the results.

In the short term, AI-generated answers are objective and free from emotional bias, allowing analysts to base their next moves on data-driven insights. In the long term, AI technologies can be used for long-term planning and resilience strategies, allowing for rapid adjustment to evolving situations and trend recognition. This AI- driven approach also contributes to international cooperation against FMI, fostering a united front against foreign disinformation.

Discussion and Conclusions

The paper shows how the team developed a system using artificial intelligence, Mind Genomics, and real-time simulation capabilities to identify, counteract, and neutralize foreign malign influences (FMI). The system aims to understand the psychological and tactical mechanisms driving disinformation campaigns, and in turn generate strategic responses to reduce their efficacy.

AI simulations mimic real-world strategic meetings, interpersonal interviews, and situational dynamics, revealing the “human face” of the enemy and transforming large volumes of data into actionable intelligence. Mind Genomics thinking creates mind-sets, allowing for the identification of different tactics employed by adversaries. This allows mapping of a psychological landscape, understanding which messages take root and which defensive strategies resonate best with different audience segments. Real-time insights are crucial for adjusting countermeasures in sync with the adversary’s shifting methods.

The system has potential to influence public perception and bolster civic resilience by simulating the actions of enemy actors and the reactions of different segments of society. It could enable preemptive action, enabling policymakers and national security analysts to deploy specific public information campaigns or strategic maneuvers based on projections. The system’s broader geopolitical implications extend beyond national borders, creating a cooperative defense mechanism against foreign powers which exploit misinformation to sow international discord.

Acknowledgments

The authors gratefully acknowledge the ongoing help of Vanessa Marie B. Arcenas and Isabelle Porat in the creation of this and companion papers.

References

  1. O’Connell E (2022) Navigating the Internet’s Information Cesspool, Fake News and What to Do About University of the Pacific Law Review 53(2): 252-269.
  2. Schafer JH (2020) International Information Power and Foreign Malign Influence in In: International Conference on Cyber Warfare and Security; Academic Conferences International Limited.
  3. Weintraub EL, Valdivia CA (2020) Strike and Share: Combatting Foreign Influence Campaigns on Social The Ohio State Technology Law Journal 702-721.
  4. Wood AK (2020) Facilitating Accountability for Online Political The Ohio State Technology Law Journal 521-557.
  5. Rasler K, Thompson WR (2007) Malign autocracies and major power warfare: Evil, tragedy, and international relations theory. Security Studies 10(3): 46-79.
  6. Thompson W (2020) Malign Versus Benign In: Thompson WR (ed.), Power Concentration in World Politics: The Political Economy of Systemic Leadership, Growth, and Conflict. Springer pp. 117-142.
  7. Tromblay DE (2018) Congress and Counterintelligence: Legislative Vulnerability to Foreign Influences. International Journal of Intelligence and Counterintelligence 31(3): 433-450.
  8. Lehmkuhl JS (2024) Countering China’s Malign Influence in Southeast Asia: A Revised Strategy for the United Journal of Indo-Pacific Affairs 7(3): 139.
  9. Bennett WL, Livingston S (2018) The disinformation order: Disruptive communication and the decline of democratic institutions. European Journal of Communication 33(2): 122-139.
  10. Bennett WL, Lawrence RG, Livingston S (2008) When the Press Fails: Political Power and the News Media from Iraq to University of Chicago Press.
  11. Wagnsson C, Hellman M, Hoyle A (2024) Securitising information in European borders: how can democracies balance openness with curtailing Russian malign information influence? European Security 1-21.
  12. Feuston JL, Brubaker JR (2021) Putting Tools in Their Place: The Role of Time and Perspective in Human-AI Collaboration for Qualitative Proceedings of the ACM on Human-Computer Interaction 5(CSCW2): 1-25.
  13. Jiang JA, Wade K, Fiesler C, Brubaker JR (2021) Supporting Serendipity: Opportunities and Challenges for Human-AI Collaboration in Qualitative In: Proceedings of the ACM on Human-Computer Interaction 5(CSCW1): 1-23.
  14. Rafner J, Gajdacz M, Kragh G, Hjorth A, et al. (2022) Mapping Citizen Science through the Lens of Human-Centered AI. Human Computation 9(1): 66-95.
  15. Aswad EM (2020) In a World of “Fake News,” What’s a Social Media Platform to Do? Utah Law Review 2020(4): 1009.
  16. Garon JM (2022) When AI Goes to War: Corporate Accountability for Virtual Mass Disinformation, Algorithmic Atrocities, and Synthetic Propaganda. Northern Kentucky Law Review 49(2): 181-234.
  17. Hartmann K, Giles K (2020) The Next Generation of Cyber-Enabled Information 2020 12th International Conference on Cyber Conflict 233-250.
  18. Brownsword R (2018) Law and Technology: Two Modes of Disruption, Three Legal MindSets, and the Big Picture of Regulatory Indian Journal of Law and Technology. 14(1): 30-68.
  19. Dang J, Liu L (2022) Implicit theories of the human mind predict competitive and cooperative responses to AI Computers in Human Behavior 134: 107300.
  20. Moskowitz HR, Gofman A, Beckley J, Ashman H (2006) Founding a New Science: Mind Journal of Sensory Studies 21(3): 266-307.
  21. Papajorgji P, Moskowitz H (2023) The ‘Average Person’ Thinking About Radicalization: A Mind Genomics Cartography. Journal of Police and Criminal Psychology; 38(2): 369-380.
  22. Levinson MH (2005) Mapping the Causes of World War I to Avoid Armageddon ETC: A Review of General Semantics 2(2): 157-164.
  23. Rapoport A (1980), Verbal Maps and Global Politics. ETC: A Review of General Semantics 37(4): 297-313.
  24. Rapoport A (1986) General Semantics and Prospects for Peace. ETC: A Review of General Semantics 43(1): 4-14.
  25. Sadler E (1944) One Book’s Influence Edward Bellamy’s “Looking ” The New England Quarterly 17(4): 530-555.
  26. Vincent JE (2011) Dangerous Subjects: US War Narrative, Modern Citizenship, and the Making of National Security 1890-1964 (Doctoral dissertation, University of Illinois at Urbana-Champaign)
  27. Bayatmakou F, Mohebi A, Ahmadi A (2022) An interactive query-based approach for summarizing scientific documents. Information Discovery and Delivery 50(2): 176-191.
  28. Fan A, Piktus A, Petroni F, Wenzek G, et al. (2020) Generating Fact Checking Briefs. In: Proceedings of the 2020 Conference on Empirical Methods in Natural Language Processing 7147-7161.
  29. Fitria TN (2021) QuillBot as an online tool: Students’ alternative in paraphrasing and rewriting of English writing. Englisia: Journal of Language, Education, and Humanities 9(1): 183-196.
  30. Radev DR, Hovy E, McKeown K (2002) Introduction to the Special Issue on Computational Linguistics 28(4): 399-408.
  31. Safaei M, Longo J (2024) The End of the Policy Analyst? Testing the Capability of Artificial Intelligence to Generate Plausible, Persuasive, and Useful Policy Analysis. Digital Government: Research and Practice 5(1): 1-35.

The Psychology of Deterrence: Using AI with Mind Genomics to Broadcast the Seriousness of the Response to Nations Promising to Use Nuclear Weapons

2 Replies

DOI: 10.31038/ALE.2024114

Abstract

The paper introduces the use of AI coupled with Mind Genomics technology (BimiLeap.com) to understand the topic of how countries think about the U.S.’ position on nuclear deterrence. The entire exercise is done using AI (ChatGPT 3.5), with the BimiLeap.com platform. The five sections cover a broad range of aspects for the topic, and are set up to be rapid, cost effective, easy to do, and in some respects, virtually automatic. The results presented in this paper required approximately six hours to generate, including the initial and secondary AI analyses. The range of aspects goes from simulated “listening to enemy strategy meetings” to key emerging ideas, and onto AI-suggested innovations, expected responses by different audiences, and finally suggested questions and both optimistic and pessimistic answers. The paper is presented as an approach, with the topics easy to change, and the scalability straightforward to demonstrate.

Keywords

AI-generated simulations, Mind Genomics, Nuclear deterrence, Strategic signaling

Introduction

The U.S.’ nuclear arsenal is a crucial part of its strategic defense, but its lack of open threat to nations has led to aggressive postures. To revise defense signals without compromising global stability or reputation, U.S. policymakers must evolve strategic signaling, including bolstering military presence, conducting high-profile exercises, and issuing diplomatic statements. Monitoring hostile nations’ rhetoric and consistent communication of “red lines” is crucial for effective nuclear deterrence. AI simulation and Mind Genomics thinking offer a powerful tool to understand high-level strategic discussions in the minds of nation-states. AI simulation platforms can analyze geopolitical data and simulate decision- making processes based on historical patterns, key events, and diplomatic or military postures. Mind Genomics, the study of how individuals or groups structure their thinking and interpret the world, can codify the thought processes of leaders and policymakers. By merging these technologies, the U.S. can simulate different nations’ responses to various U.S. actions, such as bolstering military presence, conducting strategic exercises, or issuing diplomatic statements [1,2]. This approach can break down a nation’s strategic rationale into cognitive and cultural predispositions, enabling more accurate forecasts of a nation’s response to U.S. policy changes [3,4]. It can also function as a form of strategic empathy, enabling the U.S. to craft tailored policies.

Phase 1: Simulating Private Strategy Discussions Among Opponents of the USA

AI-driven simulations of enemy conversations can provide valuable insights into American policy and strategy development (Table 1). By role-playing the enemy’s perspective, AI can anticipate potential threats and understand weaknesses in American policies [2]. This predictive insight can mitigate risks and enhance national defense mechanisms [5]. AI simulations can also expose blind spots within current strategic thinking, revealing perspectives that American strategists may not see naturally. This effort can fuel defensive preparedness and negotiation tactics [6]. AI simulations can compress time and offer predictive outcomes based on potential decisions, allowing agencies to respond in real-time to threats while staying ahead of competitors [7,8]. However, there are risks and limitations to AI-assisted simulations. One issue is over-reliance on technology and algorithms instead of human judgment and intuition. AI algorithms may not have human motivations, emotions, or spontaneity, leading to irrational or emotional decisions. Additionally, AI simulations may not reflect real discussions due to human factors. Despite these limitations, AI-assisted simulations can enhance understanding, decision-making speed, and avoid blind spots.

Table 1: AI simulation of an overheard “enemy” discussion about American nuclear policy.

Phase 2: Key Ideas Emerging

The key ideas in the topic questions revolve around the concept of U.S. nuclear deterrence and strategic signaling — focusing on how the United States can communicate its readiness to use military force, including nuclear weapons, to deter adversaries without explicitly threatening them [9-12]. These key ideas emphasize the delicate balance the United States must maintain in its nuclear deterrence strategy, combining visible military strength with subtle diplomatic moves to ensure that its adversaries perceive its willingness to defend its interests while avoiding global instability. Table 2 shows 12 key ideas emerging from the simulation present in Table 1 and a subsequent AI- based analysis by the Mind Genomics platform, BimiLeap.com.

Table 2: Key ideas emerging from the AI simulation of an enemy strategy meeting, and then a second and further AI analysis. The analyses were done by the Mind Genomics platform, BimiLeap.com.

Phase 3: Innovations in Products and Services

The themes associated with U.S. nuclear deterrence and strategic signaling offer several conceptual frameworks for developing new products, services, or experiences [13-15]. Table 3 presents products and services suggested by AI, based upon the material presented in Tables 1 and 2. The AI further evaluated the information in both Tables, and generated the suggestions in Table 3.

Table 3: Innovation in products and services, suggested by AI, and based upon the information shown in Tables 1 and 2.

Phase 4: The Different Players (Positive Versus Negative Audiences)

Several distinct audiences would have a strong interest in the topic questions, each bringing a unique perspective based on their professional, academic, or geopolitical involvements [16-18]. These audiences are shown in Table 4 and comprise both those who are “interested” and those who are not interested, viz., possibly “hostile.” Once again, the analysis was done after the fact, in a second pass through the data to provide more insight by AI.

Table 4: Positive and negative audiences.

Phase 5: AI-Generated Questions and Answers for Further Thought

The AI was presented with the situation presented in Table 2. The AI was instructed to create questions, and then give both an optimistic answer and a pessimistic answer to the same question. Table 5 shows the results. The benefit here is that the AI can generate a great number of questions in a short time and provide answers [4,19-21].

Table 5: AI generated questions and two answers for each question; optimistic versus pessimistic, respectively.

Discussion and Conclusions

AI combined with Mind Genomics works as a safe testing ground where various communication scenarios — words, actions, or threats— can be “played forward” to understand precisely how they may backfire, escalate tensions, or bring about desired mediations. Such tools would also enable the U.S. to make faster, informed decisions in unprecedented crises, whether arising from smaller rogue nations or larger superpowers. By anticipating hostile rhetoric, understanding a nation’s internal political conditions, and knowing exactly where the “red lines” fall, AI simulations can precisely calculate the tipping point at which a country might enter an irreversible aggressive stance. Thus, this system works like a blueprint for creating not only stronger deterrence policies but also more effective diplomatic resolutions. Finally, the long-term potential of these simulations lies in their ability to integrate into international consensus-building. For deterrence to be effective, it must not only be unilateral but shared among allies. This enhanced AI and Mind Genomics model could be a framework that multiple democratic governments employ to analyze the decisions of shared adversaries. In doing so, the U.S. would gain not only tactical advantages but help contribute to a shared platform of predictive thinking, ensuring stability and global peace.

Based upon the AI exercise reported here, the key ideas related to U.S. nuclear deterrence and strategic signaling can be grouped into six distinct themes:

Perception and Willingness

Perceptions of U.S. Willingness to Use Nuclear Weapons. Some adversaries doubt the U.S.’ willingness to use nuclear weapons, leading to questions about the effectiveness of its deterrent posture.

Actions and Military Readiness

Actions to Signal Deterrence. The U.S. can engage in military actions such as exercises, missile testing, and tough diplomatic messaging to show its readiness and resolve. These actions not only test U.S. readiness, but they are also key components in strategic signaling to deter adversaries.

Diplomatic Efforts and Communication

Importance of Diplomatic Language. Strategic use of diplomatic language can underscore U.S. seriousness without escalating tensions. Diplomatic support of public signaling is pivotal, both with adversaries and allies, ensuring that messages are clearly communicated through multiple channels. Establishing and clearly communicating red lines helps avoid ambiguity and ensures adversaries are clear about the consequences of crossing thresholds.

Adversary Reactions and Feedback

Adversaries’ denouncements, such as accusing the U.S. of “escalation,” might paradoxically indicate that U.S. signaling is effective and being acknowledged. Visible shifts in rhetoric or behavior toward calls for diplomacy from adversaries can be viewed as signs of effective deterrence.

Geopolitical Assessment and Strategy Adjustment

Strategic signaling must be informed by constant assessments of adversarial military activities and propaganda to ensure proper messaging and deterrent force are applied. Signs of successful deterrence include adversaries scaling down aggressive maneuvers and showing a willingness to negotiate.

Failures, Escalation, and Risk Management

If adversaries respond to U.S. signaling with increased military presence or aggression, it points to a failure in deterrence, necessitating strategic recalibration. The U.S. must strike a balance between projecting sufficient strength to deter adversaries without causing unintended escalation or regional destabilization.

Acknowledgments

The authors gratefully acknowledge the ongoing help of Vanessa Marie B. Arcenas and Isabelle Porat in the preparation of this and companion manuscripts.

References

  1. Cox J, Williams H (2021) The Unavoidable Technology: How Artificial Intelligence Can Strengthen Nuclear The Washington Quarterly 44(1): 69-85.
  2. Davis PK, Bracken P (2022) Artificial intelligence for wargaming and The Journal of Defense Modeling and Simulation: Applications, Methodology, Technology.
  3. Horowitz M, Kania EB, Allen GC, Scharre P (2018) Strategic Competition in an Era of Artificial Center for a New American Security.
  4. Johnson J (2021) Deterrence in the age of artificial intelligence & autonomy: a paradigm shift in nuclear deterrence theory and practice? Defense & Security Analysis 36: 422-448.
  5. Goldfarb A, Lindsay JR (2022) Prediction and Judgment: Why Artificial Intelligence Increases the Importance of Humans in War. International Security 46: 7-50.
  6. Johnson J (2019) Artificial intelligence & future warfare: implications for international Defense & Security Analysis 35: 147-169.
  7. Layton P (2021) Fighting Artificial Intelligence Battles: Operational Concepts for Future AI-Enabled Joint Studies Paper Series, 4.
  8. Turnitsa C, Blais C, Tolk A (2022) Simulation and John Wiley & Sons, Inc.
  9. Borges AF, Laurindo FJ, Spínola MM, Gonçalves RF, et (2021) The strategic use of artificial intelligence in the digital era: Systematic literature review and future research directions. International Journal of Information Management 57: 102225.
  10. Flournoy MA, Lyons RP (2016) Sustaining and Enhancing the US Military’s Technology Strategic Studies Quarterly 10: 3-14.
  11. Morgan FE, Boudreaux B, Lohn AJ, Ashby M, et (2020) Military Applications of Artificial Intelligence: Ethical Concerns in an Uncertain World. RAND Corporation.
  12. Stone M, Aravopoulou E, Ekinci Y, Evans G, et (2020) Artificial intelligence (AI) in strategic marketing decision-making: a research agenda. The Bottom Line 33: 183- 200.
  13. Mühlroth C, Grottke M (2020) Artificial Intelligence in Innovation: How to Spot Emerging Trends and Technologies. IEEE Transactions on Engineering Management 99: 1-18.
  14. Sayler, KM (2020) Artificial Intelligence and National Security. Congressional Research Service, R45178.
  15. Scharre P (2023) Four Battlegrounds: Power in the Age of Artificial W.W. Norton & Company.
  16. Ali MB, Wood-Harper T (2022) Artificial Intelligence (AI) as a Decision-Making Tool to Control Crisis Situations. In: Ali M (ed.), Future Role of Sustainable Innovative Technologies in Crisis Management, IGI Global,. 71-83.
  17. Johnson J (2021) Artificial Intelligence and the Future of Warfare: The USA, China, and Strategic Manchester University Press.
  18. Tsotniashvili Z (2024) Silicon Tactics: Unravelling the Role of Artificial Intelligence in the Information Battlefield of the Ukraine Asian Journal of Research 9: 54-64.
  19. Aydin Ö, Karaarslan E (2023) Is ChatGPT Leading Generative AI? What is Beyond Expectations? Academic Platform Journal of Engineering and Smart Systems 11: 118-134.
  20. Ehsan U, Wintersberger P, Liao QV, Mara M, et (2021) Operationalizing Human- Centered Perspectives in Explainable AI. In: Extended Abstracts of the 2021 CHI Conference on Human Factors in Computing Systems, 1-6.
  21. Rospigliosi P (2023) Artificial intelligence in teaching and learning: what questions should we ask of ChatGPT? Interactive Learning Environments 31: 1-3.

The Formation of Some Quard Veins in the Lusatian Massif, E-Germany by Supercritical Fluids/Melts Bearing Lonsdaleite and Diamond and Comparison with Other Similar Formations in Middle-Saxonian and Thuringian/E-Germany

4 Replies

DOI: 10.31038/GEMS.2024662

Abstract

In this paper, we show that quard veins in the Lusatian Massif were primarily generated by supercritical fluids coming from mantle deeps, rising very fast into the crust region. For the substantiation of our conclusions, we use the occurrence of lonsdaleite and microdiamonds in the root zones of quard crystals from these quard veins. Hydrothermal fluids afterward reworked the so primarily formed veins in more than one step. This hydrothermal activity hides the primary origin of the veins. For corroboration of the proofs, we used other examples from the Saxon Granulite Massiv, the Central Erzgebirge, and E-Thuringia.

Keywords

Lusatian Massif, Quartz veins, Lonsdaleite, Diamond, Raman spectroscopy

Introduction

In a row of publications, the author and co-authors [1-8] have used melt inclusions to the characterization of the pegmatite-forming melt and the high-temperature quartz veins in the Lusatian massif. Primarily, these studies focused on single aspects of new minerals in this region and the formation of respective geological objects. That also includes the determination of pseudo-binary solvus curves and some element enrichment related to such curves, which often show a Lorentzian distribution [2,3,7,8]. In this contribution, we will show that all studied objects clearly indicate that supercritical fluids or melts trigger the cause of the formation of those apparent and different objects (granites, pegmatites, and quartz veins). The first indications came from the high- speed intrusion velocity of the Königshainer granite melt [5], with about 700 to 1000 m/year. Later, this value increased significantly because larger magmatic epidote crystals could be found. Up to this point, there was a relationship between granite-forming melt and the formation of quartz veins and supercritical fluids or melts already not given. However, the similarities of the solvus curves of all studied objects were a solid hint of a uniform process. In addition, the Lorentzian distribution of some main and trace elements around the solvus crest demands a process of overriding importance. The finding of diamond and water- rich stishovite in a different geological unit, the Saxonian Granulite Massif, opened the eyes to processes that were not important up to now [8,9]. An earlier paper showed Thomas et al. (2020) [10] on the example of emeralds from the Habachtal that the new results of melt inclusions in this mineral generated a conflict with the accepted geological model. With the acceptance of supercritical fluids, this conflict is soluble. Here, we will show that the formation of the granite stock from Königshainer and a large part of quartz veins in the Lusatian region are influenced or generated by supercritical fluids or melts coming from mantle depths.

Sample Material and Earlier Results

Details of the used sample material are in the references above. A short explanation is necessary for the quartz samples from Lauba. For the preparation (grinding and polishing) of quartz thick sections (500 µm thick), diamond was not used. For polishing this quartz, we used a suspension of silica in a ten percent KOH solution using the Speed Fam of the Danish company Haldor Topsøe. From both sides, 100 µm were removed. Generally, we tried to remove all diamond rests from all used samples, which may have been induced by grinding and polishing (see results and discussion in Thomas et al., 2023) [9] using an ultrasound bath. A large number of quartz veins in the Lusatian Massif were described by Bartnik (1969) [11]. By an extensive effort, we could only study a minimal number of samples. For the selection of usable samples, the root zone must contain melt inclusions because diamonds, etc., are present only in these zones. The water-clear parts of the quartz crystals do not include such minerals. These are formed by later activation and recrystallization.

The following samples are studied:

  1. Quartz from the Königshainer granite [4,5].
  2. Quartz crystals from Sproitz [12].
  3. Quart crystal from Caminau [13].
  4. Quartz crystals from Lauba [13].
  5. Quartz crystals from Oppach [2,3,6].
  6. Quartz crystals from Steinigwolmsdorf [7,16].
  7. Massif blue quartz with a brownish coat at fissures from Berthelsdorf near Neustadt W-Lusatian [14].

Unusual in sample 7 is the abundance of graphite (Raman band: 1579.4 ± 3.0, FWHM = 21,5 ± 6.4 (FWHM – Full-Width at

Half Maximum) and the occurrence of tiny crystals of thortveitite (R061065, 97% Match, see Lavuente et al., 2016) [15].

In the root zone, there are many melt inclusions. Rehomogenization at different temperatures and pressures of ~4.5 kbar and the following determination of the water concentration in the melt inclusions give a pseudo-binary solvus curve (Figure 2).

Figure 1: A typical quartz crystal from Steinigtwolmsdorf/Lusatia [16].

Figure 2: Pseudo-binary solvus curve (Temperatur vs. water concentration) derived from re-homogenized melt inclusions in quartz from Steinigtwolmsdorf/Lusatia. CP is the critical point (740°C, ~4.5 kbar, 27% H2O). It is very typical for such solvus curves that the distribution of some principal and trace elements obey a Lorentzian curve, like Figure 3, the distribution of NaCl and CaCl2 versus water concentration.

What we see from Figure 3 is that Na and Ca behave reciprocally. That means that at or near the critical point of a solvus curve, a strong separation of elements, maybe also isotopes, is probably. That would be a pleasant and new research theme for the future. Like the NaCl distribution in Figure 3, we found similar distributions in many examples (Thomas et al. 2019a and 2022a) [8]. For Oppach, extremely high sulfate concentrations are typical (for example, 21.3% SO4) – see Thomas 2024a) [17]. The opening of a solvus curve around the critical point starts with a singularity [18]. The solvus and the Lorentzian distribution of elements around the critical point is after that authors a strong proof of supercritical transition to critical and under-critical conditions. The evidence of lonsdaleite and diamond from the mantle deep in rocks and minerals in the upper crust underlines the existence of supercritical fluids that transport material from the mantle deep into the crust. Therefore, the finding of lonsdaleite and diamond as inclusions in rocks and quartz of widespread quartz veins in the Lusatian Massif generates a new approach.

Figure 3: Schematic Lorentzian distributions of NaCl and CaCl2 in melt inclusions from Steinigtwolmsdorf/Lusatia in dependence on the water content. The plot is highly schematic because the determination of NaCl and CaCl2 in highly complex fluid systems is not adequately known.

Phenotypes of Lonsdaleite and Diamond in More Crustal Rocks and Quartz Veins

Here, we will show exemplarily some lonsdaleite and diamond crystals that occur in minerals of untypical crust positions (Figures 4-6).

Figure 4: Diamond (D) in blue quartz from Berthelsdorf near Neustadt, W-Lusatian. The rounded light brown diamond grain is about 20 µm deep. The fluid inclusion right beside the diamond demonstrates that the hydrothermal recrystallization of the quartz did not affect the diamond. Fl: fluid inclusion

Figure 5: Raman spectrum of the rounded diamond inclusion in blue quartz from Berthelsdorf near Neustadt, W-Lusatian. The diamond inclusion is 20 µm deep under the surface.

Figure 6: Needles in the root zone of quartz from Caminau near Königswartha, Lusatian Massif. The upper photomicrograph shows a jumble of needles in quartz composed of lonsdaleite (Lon) and hydroxylbasnäsite-Ce [Ce(CO3)(OH)] and vapor. The lower photomicrograph shows details of such a needle. The needle is deep enough (45 µm) to form by contamination. V: vapor phase

The formula given in Figure 6 is the ideal chemistry. According to Antony et al. (2003) [19], it is the more real formula (Ce, La) (CO3)(OH, F) (see Lafuente et al. 2016 – [15]: RRUFF R060283). According to Kirillov (1964) [20], hydroxylbasnäsite-Ce is typically a late phase of the hydrothermal stage formed by the dissolution and reprecipitation of earlier carbonatite minerals. The main Raman band of lonsdaleite shown in Figure 6 is 1318.7 ± 4.6 cm-1. This example demonstrates a maybe late formation of lonsdaleite. Some needles are even bent. Often, lonsdaleite forms prismatic crystals or whiskers [2,3]. A reference spectrum for natural lonsdaleite (Kumdykol diamond deposit, North Kazakhstan) is given by Shumilova et al., 2011 [21]. According to Németh et al. (2014) [22], lonsdaleite does not exist as discrete crystals. In this contribution, we cannot resolve this question because we only use Raman spectroscopy. However, some observations speak for the existence of lonsdaleite as whisker- like crystals [3; Figure 7].

Figure 7: The microphotography a) shows an older, more gray quartz cluster (marked with “+”) from Sproitz with diamond, lonsdaleite, and graphite (black) in hydrothermal quartz (marked with “*”). The Raman spectra (b) show the differences between the two quartz generations: red, which is an older quartz, and blue, which is hydrothermal quartz.

Figure 7 shows an isolated quartz cluster with lonsdaleite, diamond, and graphite in the root zone of a quartz crystal from Sproitz (sample SP3) from the N-slope of the Gemeindberg in the rural district Görlitz/Lusatian Massif [12]. The quartz cluster shows a different Raman spectrum (red) in contrast to the matrix quartz (blue spectrum). Firstly, this quartz cluster was primarily a different SiO2-polymorph formed at high pressure (coesite?). For comparison, we have also included the results on different rocks from Middle- Saxonian and Thuringian/E-Germany (see Table 2 and Figure 8) as well as Thomas and Recknagel 20024, Thomas and Trinkler 2024 [2,3]. Figure 8 shows an example of diamond-bearing perovskite in the granulite rock from Waldheim/Saxony (see also 2022b) [23]. The prismatic form of the diamonds is unusual. Maybe lonsdaleite was the precursor of this diamond.

Figure 8: Diamond (D) in perovskite (Prv) [CaTiO3] embedded in rutile (Rt) as foreign mineral inclusion in the prismatine rock from Waldheim/Saxony, E-Germany.

The occurrence of perovskite inclusion in diamonds indicates, according to Nestola et al. (2018) [24], the recycling of oceanic crust into the lower mantle. Looking at Figure 8 raises the question of the reverse: come the diamond embedded in perovskite, saved by rutile, also from the lower mantle? The first finding of H2O-rich stishovite (7.5 GPa at 1000°C, corresponding to a depth of 230 km) in the same rock [8] speaks for it.

Methodology

The techniques used (microscopy, homogenization measurements on melt inclusions, Raman spectroscopy, and electron microprobe) are described in the references above. Because Raman spectroscopy is crucial in this study, we will give more details here.

Raman Spectroscopy

Primary for the first identification of the mineral inclusion in quartz, we used for all microscopic and Raman spectrometric studies a petrographic polarization microscope with a rotating stage coupled with the RamMics R532 Raman spectrometer working in the spectral range of 0-4000 cm-1 using a 50 mW single mode 532nm laser. Details are in Thomas et al., 2022 and 2023 [18]. For the Raman spectroscopic routine measurements, we used the Olympus long- distance LMPLN100x as a 100x objective. We carefully cleaned the samples to delete diamond contaminations due to the preparation. For the Raman determination, we used only 20 or more µm deep crystals from the sample surface [18]. The laser energy on the sample is adjustable down to 0.02 mW. The Raman band positions were calibrated before and after each series of measurements using the Si band of a semiconductor-grade silicon single-crystal. The run-to-run repeatability of the line position (based on 20 measurements each) was ±0.3 cm-1 for Si (520.4 ± 0.3 cm-1) and 0.5 cm-1 for diamond (1332.3 ± 0.5 cm-1 over the range of 50 – 4000 cm-1). We used a natural diamond crystal as a reference (for more information, see Thomas et al., 2022b) [23]. Only crystals under the surface should be measured to prevent diamond contaminations introduced by preparation (grinding, polishing). If the lonsdaleite and diamonds have needle- and whisker- like or other forms (disk-like, spherical crystals with very smooth surface, spherical sector), then the mistake is strongly reduced. We do not heat the quartz samples for homogenization of the present melt inclusions to prevent the lonsdaleite and diamonds from extensive transformation into graphite.

Results

Raman Data

First, we will show that diamonds are present in all studied quartz samples that contain a root zone. In the more or less water-clear part of the quartz crystals, we have never found lonsdaleite and diamond. We have found a general evolutionary development: lonsdaleite → lonsdaleite + diamond → diamond → nano-diamond + graphite → graphite (or, more generally, carboniferous material). Each lonsdaleite or diamond phase shows more or less a strong graphite band. A Raman spectrum of lonsdaleite is shown in Figure 9. Table 1 shows the results of our studies on lonsdaleite and diamond crystals, mostly in quartz from the Lusatian Massif. For comparison, results for the Middle-Saxonian and Thuringian regions are in Table 2.

Figure 9: Raman spectrum of lonsdaleite in quartz from Steinigtwolmsdorf/Lusatia (Raman band at 1317.8 cm-1, FWHM = 31.9 cm-1, Raman mode: A1g – see Wu 2007) – [25].

Table 1: Raman spectrometric determined the main lines of lonsdaleite and diamond in the Königshainer granite and some quartz veins in the Lusatian Massif.

Location

 Mineral Host Raman band (cm-1) ± 1σ FWHM (cm-1)

Number of grains
Königshain Lonsdaleite Feldspar

1317.6 ± 4.5

 98.0 ± 2.3

5
Diamond Feldspar

1331.7 ± 3.5

 97.3 ± 4.4

6
Diamond Zircon

1336.7 ± 4.9

 75.9 ± 17.7

9
Sproitz SP3 Lonsdaleite Quartz

1319.0 ± 2.7

 43.2 ± 7.2

3
Diamond Quartz

1333.7 ± 5.3

 60.6 ± 24.4

8
Caminau Lonsdaleite Quartz

1318.7 ± 4.6

 36.8 ± 1.5

6
Diamond Quartz

1332.2 ± 3.4

 53.9 ± 7.1

13
Lauba Lonsdaleite Quartz

1316.5 ± 1.1

 9.6

3
Diamond Quartz

1327.5 ± 5.2

 45.9 ± 29.3

6
Oppach Lonsdaleite Quartz

1316.5

 56.7

1
Diamond Quartz

1329.6 ± 4.7

 75.1 ± 9.0

10
Steinigtwolmsdorf Lonsdaleite Quartz

1317.2 ± 0.4

 31.3 ± 2.2

5
Diamond Quartz

1331.2 ± 5.0

 50.9 ± 11.0

6
Berthelsdorf bei Neustadt Diamond Blue-Quartz

1331.8 ± 3.8

 64.9 ± 14.3

14

Table 2: Comparision of lonsdaleite and diamond related to supercritical fluids or melts in Middle-Saxonian and Thuringian occurrences.

Location

 Mineral Host Raman band (cm-1) ± 1σ FWHM (cm-1)

Number of grains
Waldheim, Saxonia Lonsdaleite Zircon, Rutile

1320.4 ± 3.4

 74.8 ± 8.8

7
Diamond Zircon, Rutile

1331.5 ± 3.5

 78.3 ± 10.7

22
Diamond Zircon

1336.7 ± 4.9

 75.9 ± 17.7

9
Diamond Perovskite

1331.8 ± 1.2

 65.6 ± 8.1

10
Greifenstein granite Diamond Beryl

1328.6 ± 5.6

 ~60

14
Diamond Quartz

1333.7 ± 5.3

 60.6 ± 24.4

8
Ehrenfriedersdorf Lonsdaleite Quarz

1318.6

 100

1
Diamond Quartz

1331.5

 46.0

1
Annaberg granite Diamond Quartz

1339.4 ± 12.1

 41.8 ± 12.0

20
Zinnwald Lonsdaleite Fluorite

1318.0 ± 3.8

 9.6

3
Sadisdorf Diamond Fluorite

1331.8 ± 5.2

 83.1 ± 13.9

11
Lonsdaleite Fluorite

1316.5

5
Cunsdorf, Thuringia Lonsdaleite Quartz

1322.2 ± 1.31

 75.6 ±10.9

47
Diamond Quartz

1329.6 ± 4.7

 71.6 ± 28.8

10

Remark

Some needles in the quartz from Caminau contain long and small lonsdaleite crystal sections with Raman bands between 1311.8 and 1313.0 cm-1 (Raman mode A1g), corresponding, according to Wu (2007) [25] to the 2H polytype of diamond (data not in Table 1), similar to the Raman spectrum in Figure 9.

From both tables, we obtain for the lonsdaleite and diamond three groups (I: lonsdaleite, II: diamond, III: diamond under mechanical stress [26]:

  1. 1320.6 ± 2.3 cm-1 FWHM = 65.7 ± 22.8 cm-1          n = 85
  2. 1331.0 ± 1.9 cm-1 FWHM = 68.6 ± 13.4 cm-1          n = 121
  3. 1338.8 ± 1.2 cm-1 EWHM = 52.4 ± 15.8 cm-1          n = 38

n is the number of measured lonsdaleite and diamond crystals.

All studied lonsdaleite and diamond crystals show one or two graphite-like solid G- and D2 bands of carbonaceous material [26,27]. Figure 10 shows the frequency distribution of the G-band for lonsdaleite and diamond.

Figure 10: Frequency distribution of the G-band for lonsdaleite and diamond.

The Gaussian distribution data of the G-band position (Figure 10) for lonsdaleite and diamond are in Table 3, and the data for the corresponding FWHM are in Figure 11 and Table 4. According to Frezzotti (2019) [28], the Raman analyses show clear evidence that nano-sized diamonds and, obviously, also the lonsdaleite crystals show hybrid structures, consisting of nano-diamond and -lonsdaleite and carbon groups indicated by the mostly present G-bands assigned to C=C stretching vibrations E2g of graphite [29].

Table 3: Gaussian data of the G band for lonsdaleite and diamond (r2=0.91774).

Raman band

 Area Center (cm-1) Width (cm-1) Height
1 (green) 100.29 1556.4 14.65

5.46

2 (blue)

 380.86 1580.0 17.44 17.42
3 (magenta) 114.11 1604.1 12.73

9.03

Table 4: Gaussian distribution data for the FWHM of both components (green and red) for lonsdaleite and diamond found in crustal rocks (granite, granulite) and minerals (fluorite, quartz, perovskite, and zircon).

Raman band

 Area Center (cm-1) Width (cm-1) Height
1 (green) 334.81 59.23 26.04

10.26

2 (red)

 251.25 71.35 13.16

15.23

Figure 11: Frequency distribution of the FWHM for the G-bands for lonsdaleite and diamond (r2 = 0.95066).

Discussion

The proof of lonsdaleite and diamond in crustal surroundings, together with the excellent solvus curves constructed from melt inclusions and the Lorentzian distribution of some elements, are strong proofs of supercritical fluids coming very fast from mantle deeps, bringing microcrystals of lonsdaleite and diamond as load into the crust region. The finding of these minerals in the root zones of quartz veins in the Lusatian Massif demonstrates straightforwardly that the quartz veins primarily start with the intrusion of supercritical fluids, maybe of the Variscan age, carrying lonsdaleite and diamond. Later, these early primary quartz veins are multistage reworked at lower temperatures by intensive hydrothermal activity. Through this activity, a lot of proof of the primary origin is destroyed. Only by a very intense search can such remnants be found. Meinel (2022) [30] discusses intensively the genesis of diamonds by very high volatile internal pressure in closed systems in relatively low deeps. Thomas and co-authors [2,3,7,8,18] have shown that supercritical fluids/melts are detectable in the whole region between Lusatia, East- and Middle Erzgebirge, N-Bohemia [31] and E-Thuringia and someplace else (for example emerald deposit in the Habachtal, Austria [10]. Sometimes, however, lonsdaleite and diamond occur as needle and whisker- like crystals instead of smooth spherical microcrystals transported by supercritical fluids or melts. The same results were obtained for moissanite whiskers in beryl from Ehrenfriedersdorf (2023b) [32]. That must be an in situ formation at the upper crust. Therefore, the question result: Is the coincidence of supercritical fluids or melts with cooler upper crust granites an excellent localization for outstanding processes: solvus formation, extraordinary element enrichment in the form of the Lorentzian distribution, speedy changes of the viscosity and diffusivity of the supercritical fluids to near- and under critical conditions? This question opens new points of view for future research.

Acknowledgments

We dedicate this paper to Prof. Hans Jürgen Rösler (1920-2009), Prof. Otto Leeder (1933-2014), both from the Mining Academy Freiberg, and Dr. Günter Meinel (1933-2012) from Jena.

References

  1. Thomas R (2023a) The Königshainer granite: Diamond inclusions in zircon. Geol Earth Mar Sci 5: 1-4.
  2. Thomas R, Recknagel U (2024) Lonsdaleite, diamond, and graphite in a lamprophyre: Minette from East-Thuringia/Germany. Geol Earth Mar Sci 6: 1-4.
  3. Thomas R, Trinkler M (2024) Monocrystalline lonsdaleite in REE-rich fluorite from Sadisdorf and Zinnwald/E-Erzgebirge, Geol Earth Mar Sci 6: 1-5.
  4. Thomas R, Davidson P, Rhede D, Leh M (2009) The miarolitic pegmatites from the Königshain: a contribution to understanding the genesis of pegmatites. Contrib Mineral Petrol 157: 505-523.
  5. Thomas R, Davidson P (2016) Origin of miarolitic pegmatites in the Königshain granite/Lusatia. Lithos. 260: 225-241.
  6. Thomas R, Davidson P (2017) Hingganite-(Y) from a small aplite vein in granodiorite from Oppach, Lusatian Mineralogy and Petrology. 111: 821-826.
  7. Thomas R, Davidson P, Appel K (2019) The enhanced element enrichment in the supercritical states of granite–pegmatite systems. Acta Geochim 38: 335-349.
  8. Thomas R, Davidson P, Rericha A, Voznyak D (2022a) Water-Rich Melt Inclusion as “Frozen” Samples of the Supercritical State in Granites and Pegmatites Reveal Extreme Element Enrichment Resulting Under Non-Equilibrium Miner J 44: 3-15.
  9. Thomas R, Davidson P, Rericha A, Recknagel U (2023) Ultrahigh-pressure mineral inclusions in a crustal granite: Evidence for a novel transcrustal transport mechanism. Geosciences. 94: 1-13.
  10. Thomas R, Davidson P, Rericha A (2020) Emerald from the Habachtal: new Mineralogy and Petrology. 114: 161-173.
  11. Bartnik D (1969) Die Quarzgänge im Lausitzer Geologie 18: 21-40.
  12. Schwarz D, Tietz O, Rogalla O, Rosch F (2015). Ein Quarzgang am Gemeindeberg von Kollm in der Berichte der Naturwissenschaftlichen Gesellschaft der Oberlausitz. 23: 139-150.
  13. Lange W, Tischendorf G, Krause U (2004) Minerale der Verlag G. Oettel. Pg: 258.
  14. Witzke T, Giesler T (2011). Neufunde und Neubestimmungen aus der Lausitz (Sachsen), Part 3. Aufschluss 62.
  15. Lafuente Downs RT, Yang H, Stone N (2016) The power of databases: The RRUFF project. In Highlights in Mineralogical Crystallography; Armbruster T, Danisi RM, Eds.; De Gruyter: Berlin, Germany; München, Germany; Boston, MA, USA: 1–30. ISBN 9783110417104.
  16. Thomas R, Davidson P, Rericha A, Tietz O (2019b) Eine außergewöhnliche Einschlussparagenese im Quartz von Steinigtwolmsdorf/Oberlausitz. Berichte der Naturwissenschaftlichen Gesellschaft der Oberlausitz. 27: 161-172.
  17. Thomas R (2024a) Melt inclusions in an aplite vein in granodiorite of the Lusatian Massif: Extreme alkali sulfate Geol Earth Mar Sci. 6: 1-5.
  18. Thomas R, Rericha A (2023) The function of supercritical fluids for the solvus formation and enrichment of critical elements. Geol Earth Mar Sci 5: 1-4.
  19. Anthony JW, Bideaux RA, Bladh KW, Nichols MC (2003) Handbook of Mineralogy, 5. Mineral Data Publishing, Tucson, Arizona. Pg: 813.
  20. Kirillov AS (1964) Hydroxyl bastnäsite, a new variety og bastnäsite. Doklady Akademii Nauk SSSR. 159: 93-95 (translation).
  21. Shumilova TG, Mayer E, Isaenko SI (2011) Natural monocrystalline Lonsdaleite, Doklady Earth Sci. 441: 1552-1554.
  22. Neméth P, Garvie LAJ, Aoki T, Dubovinskaia N, Dubrovinsky L (2014) Lonsdaleite is faulted and twinned cubic diamond and does not exist as a discrete Nature Communications 5: 1-5.
  23. Thomas R, Davidson P, Rericha A, Recknagel U (2022b) Discovery of stishovite in the prismatine-bearing granulite from Waldheim, Germany: A possible role of supercritical fluids of ultrahigh-pressure origin. Geosciences. 12: 1-15.
  24. Nestola F, Korolev N, Kopylova M, Rotiroti N, Pearson DG, et al. (2018) CaSiO3 perovskite in diamond indicates the recycling of oceanic crust into the lower Nature, Letter. 555: 237-241.
  25. Wu BR (2007) Structural and vibrational properties of the 6H diamond: First- principles Diamond and Related Materials. 16: 21-28.
  26. Zaitsev AM (2001) Optical Properties of Diamond – A Data Springer.
  27. Beyssac O, Coffee B, Chopin C, Rouzaud JN (2002) Raman spectra of carbonaceous material in metasediments: a new geothermometer. J metamorphic Geol 20: 859-871.
  28. Frezzotti ML /2019) Diamond growth from organic compounds in hydrous fluids deep within the Earth. Nature Communications. 10: 1-8.
  29. Gogotsi YG, Kailer A, Nickel KG (1998) Pressure-induced phase transformations in Journal of Applied Physics. 84: 1299-1304.
  30. Meinel G (2022) Betrachtungen zum irreversiblen Verlauf der Erdgeschichte: Ein Versuch zur Beschränkung des aktualistischen Prinzips in der Geologie auf nicht von der geologischen Entwicklung abhängige Vorgänge. Berlin und Pg: 231.
  31. Thomas R (2024b) Rhomboedric cassiterite as inclusions in tetragonal cassiterite from Slavkovsky les -North Geol Earth Mar Sci 6: 1-6.
  32. Thomas R (2023b) Grow of SiC whisker in beryl by a natural supercritical VLS Aspects in Mining and Mineral Science. 11: 1292-1297.

A Trans-Diagnostic Approach to Trauma-Related Mental Health Problems

3 Replies

DOI: 10.31038/JNNC.2024713

Abstract

In this paper, a trans-diagnostic approach to the treatment of trauma-related mental disorders is presented. The clinical rationale for the approach is described along with several core principles of the treatment model. These include: the problem of attachment to the perpetrator; the locus of control shift; and the problem is not the problem. Rather than focusing on diagnoses, in this approach the focus is on the underlying conflicts, cognitive errors and maladaptive coping strategies. Psychiatric diagnoses are usually made within what the author calls the single disease model: in that approach there is a primary diagnosis with additional comorbid diagnoses. The assumption of that approach is that a diagnosis determines the treatment plan, and the potential treatment plans are differentiated, distinct and specific to the primary diagnosis. According to the author, however, that is not how much mental health treatment actually operates, in either psychopharmacology or psychotherapy: instead, polypharmacy is the norm, the same medications are used for a variety of different diagnoses, and psychotherapy is often multimodal and not based on any one model. For trauma-related disorders, the author advocates that the ICD-11 concept of complex PTSD should apply to the majority of cases. Rather than a diagnosis of DSM-5 PTSD with comorbid diagnoses, treatment is designed to address a poly-symptomatic trauma response that spans many DSM-5 categories. Rather than focusing on separate diagnoses, trauma-informed psychotherapy should address a set of commonly occurring underlying conflicts, cognitive errors and defenses.

Keywords

Trans-diagnostic approaches, Mental health diagnoses, Treatment planning

Introduction

The purpose of this paper is to describe a trans-diagnostic approach to the treatment of mental disorders and the rationale for it. The clinical rationale for the approach is described along with several core principles of the treatment model. These include: the problem of attachment to the perpetrator; the locus of control shift; and the problem is not the problem. Rather than focusing on diagnoses, in this approach the focus is on the underlying conflicts, cognitive errors and maladaptive coping strategies. No effort will be made to provide a literature review or to support the approach with evidence.

The Single Disease Model: Diagnosis Determines Treatment

What I call the single disease model dominates medicine and psychiatry. For example, a bacterial ear infection, a sprained ankle and pregnancy are biologically distinct, separate problems with different etiologies and treatments. It is possible for a pregnant woman to have a sprained ankle and an ear infection as well, but these are co-occurring diagnoses not variations on a single disorder or condition. For any presenting problem, the task of the physician is to set up a differential diagnosis and then, through history taking, physical examination and laboratory testing (bloodwork, X-rays, sputum or urine samples, etc.) to arrive at a single diagnosis. There are complex cases such as those seen regularly in ICUs in which a person has extensive comorbidity, but these are the exception rather than the rule.

By and large, distinct biological disorders, diseases or conditions have distinct treatments. That is why a single disease diagnosis has to be made by the doctor, either as a confirmed diagnosis or as a working hypothesis. When I finished medical school and started my psychiatry residency, it was evident that psychiatry identified itself as a branch of medicine: psychiatrists made a differential diagnosis then a single diagnosis, and the diagnosis determined the treatment plan. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), from DSM-III (1980) [1] to DSM-IV (1984) [2] to DSM-5 (2013) [3], is divided into different sections such as psychotic disorders, eating disorders, substance use, mood disorders and so on. The terminology for the different sections has varied across editions, but the single disease model has dominated the organization of the manual throughout its history.

On the one hand, that makes sense: it is obvious that someone with bulimia is very different from someone with severe schizophrenia and they do not require the same treatment. When there is no extensive trauma history or comorbidity, the treatments of bulimia and schizophrenia are highly differentiated. In outpatient and private practice settings one encounters individuals for whom the single disease model fits fairly well.

During my residency years in Canada (1981-1985), individuals with substance abuse disorders were referred to specialty programs and were not treated within general psychiatry, in part because they did not require psychiatric medications unless they were in acute withdrawal. Then, within a few years, a new term appeared in the psychiatric literature on substance abuse: now we had to grapple with the dual diagnosis patient, which was regarded as a complex, challenging subset of substance abuse patients. In fact, individuals with extensive comorbidity are the norm in substance abuse populations, as I found in research I published in 1992 [4]: among 100 participants in treatment for substance use at an outpatient specialty clinic, 62 met criteria for major depressive disorder, 39 for a dissociative disorder and 36 for borderline personality disorder on a structured interview; 43 reported childhood physical and/or sexual abuse. The structured interview did not diagnose anxiety disorders, eating disorders or a wide range of other DSM-III disorders, so the research identified only a small portion of the comorbidity in the participants.

One of the main reasons for identifying a single or primary psychiatric diagnosis, I was taught in my residency, was to guide the selection of medications: for depression one prescribed antidepressants, for psychosis antipsychotics, for anxiety anxiolytics, for insomnia hypnotic-sedatives and for bipolar disorder mood stabilizers. The classes of medication matched the different sections in DSM-III. It all made sense in theory but not in practice. In practice, psychiatric inpatients were given a single primary diagnosis – even if additional comorbidity was acknowledged, it was viewed as secondary and not the primary focus of treatment.

A very short exposure to psychiatric inpatient units revealed that most patients were on multiple different classes of psychiatric medication for their supposed single, primary disorder. The single disease model did not in fact guide or determine treatment. Theory did not match reality. Polypharmacy was the norm, as it is today. It was, and still is, common for a psychiatric inpatient to be on an antidepressant, an antipsychotic, a mood stabilizer, and a benzodiazepine and to have been prescribed many different medications in each of those categories in the past.

The same thing is true for outpatient psychotherapy. There are distinct types of psychotherapy such as cognitive therapy, psychoanalytic psychotherapy, internal family systems therapy, EMDR and so on and some outpatients do get manualized, distinct forms of psychotherapy. However, none of those therapies are diagnostically specific – a cognitive therapist will do cognitive therapy for depression, anxiety, a personality disorder, PTSD, and numerous other disorders. Most psychotherapists and counselors practice a technically eclectic, multi-modal approach that varies a bit from client to client but is broadly the same. Treatment is not really determined by a single disease diagnosis, which is nevertheless required for insurance billing.

In the United States, the Food and Drug Administration (FDA) will not approve a new medication unless it has been shown to be better than placebo for a single DSM diagnosis such as major depressive disorder. In order to get published in a psychiatry journal, most research has to be about a single DSM disorder. Conferences, books and journals often identify a DSM category in their titles and most speakers identify themselves as experts on a DSM category. Experts on eating disorders, by and large, do not attend schizophrenia conferences, do not talk to schizophrenia experts, do not read schizophrenia journals and do not treat anyone with a primary diagnosis of schizophrenia. The mental health field is a collection of separate silos with minimal cross-talk.

The trans-diagnostic approach outlined in the present paper is based on my Trauma Model [5] and my Trauma Model Therapy [6] which rests on the foundation of the general trauma model.

Predictions of the Trauma Model

The Trauma Model [5] is designed to be scientifically testable and makes a series of testable predictions. For example, assume that the results of a large study in the general population were: women who met lifetime criteria for major depressive disorder were compared to women who did not; the female relatives of the depressed women had higher rates of major depressive disorder than the female relatives of non-depressed women; the male relatives of the depressed women had higher rates of alcohol abuse and antisocial personality disorder than the male relatives of the non-depressed women.

A common interpretation of these results within biological psychiatry would be that the primary cause of the depression in the women and the alcoholism and antisocial personality in the men was genetic: an inherited set of risk genes running in the affected families was expressed phenotypically as depression in the women and as alcoholism and antisocial personality disorder in the men. The Trauma Model makes a different interpretation: it is very depressing to be female and to grow up in an extended family of antisocial alcoholic men. These men will be perpetrators of neglect, family violence and physical and sexual abuse of their children. That’s what’s making the women depressed, not their genes.

These two interpretations of the data need not be mutually exclusive. The Trauma Model predicts that, for this example, and for mental disorders in general, there is a distribution of genetic risk from very low to very high. For the women in these families, the abuse, overall, is contributing much more to their risk for depression than are their genes. However, a few women will be at such high genetic risk that they will become clinically depressed even without severe trauma. It’s a question of the odds of depression; the degree of risk for it will increase with increasing trauma in large samples of women.

This prediction of the Trauma Model could be tested through adoption studies. The prediction is that children adopted at birth out of high-trauma families into low-trauma families will have a much-reduced risk for depression, PTSD, dissociative disorders, borderline personality disorder, anxiety disorders and a wide range of mental health problems. In the opposite direction, women adopted at birth out of non-trauma families into trauma families will have a greatly increased lifetime prevalence of all these disorders.

In a similar fashion, consider a large twin study of schizophrenia in which it was found that identical or monozygotic (MZ) twins had a much higher concordance for schizophrenia than non-identical dizygotic (DZ) twins. Let’s say that when the first MZ twin interviewed has schizophrenia, the other MZ twin has it 40% of the time; when the first DZ twin interviewed has schizophrenia, the other twin has it only 12% of the time. Within biological psychiatry this would be interpreted as evidence that schizophrenia has a strong genetic component.

The Trauma Model makes a different prediction: if severe childhood trauma was measured in a schizophrenia twin study, the results would be: twin concordance is highest in MZ twins concordant for trauma; second highest in DZ twins concordant for trauma; third highest in MZ twins discordant for trauma; and lowest in DZ twins discordant for trauma. Such results would support the hypothesis that the trauma is contributing more to the development of schizophrenia than the genes.

Overall, the model predicts, survivors of severe childhood trauma will resemble each other, and will have similar treatment needs irrespective of their primary diagnosis: the treatment of a woman with a primary diagnosis of bulimia and severe trauma will resemble that for a woman with a diagnosis of schizophrenia and severe trauma, and will be quite different from the treatment needs of a woman with bulimia and no severe trauma – the latter woman will fit the single disease model better than the trauma survivor with bulimia.

My name appears in the back of DSM-IV because I was a member of the DSM-IV dissociative disorders committee: I had an inside view of the process and spoke with a leader of the DSM process in between DSM-IV and DSM-5. The DSM leaders rejected the concept of Complex PTSD (C-PTSD) because it threatened the conceptual foundation of the DSM system, namely the single disease model. C-PTSD was incorporated into ICD-11 in 2019 [7] but does not appear in DSM-5 even though extensive research-supported submissions were made to the committees developing both DSM-IV and DSM-5 to include a category corresponding to C-PTSD, no matter what it was called.

The basic idea behind C-PTSD is that it is a trans-diagnostic disorder that includes features across many domains of symptoms, self-regulation difficulties and interpersonal conflicts. Within this framework, depression, anxiety, substance use, anger problems, personality disorders and PTSD symptoms are all elements of an inclusive trauma response, not of separate single disorders. C-PTSD dismantles the walls between the different DSM-5 silos and threatens the conceptual foundations of the DSM system.

Curiously, while resisting the inclusion of the concept of C-PTSD, no matter what its official title, the DSM criteria for PTSD have gradually drifted in the direction of C-PTSD without acknowledging it. Compared to DSM-III PTSD, DSM-5 PTSD includes a much greater emphasis on anger, negative cognition and mood, and interpersonal conflicts.

A Focus on Function, Conflicts, Coping Strategies and Symptoms

Within Trauma Model Therapy, the focus is not on DSM-5 disorders as such. Patients/clients do meet criteria for many comorbid DSM-5 disorders but the focus is on the person’s function, conflicts, coping strategies and symptoms. The DSM-5 disorders are not ignored, they just aren’t the focus. The goal is to reduce symptoms and conflicts while improving the person’s overall function and self-regulation skills. This does not mean that medications are irrelevant or disallowed: most people treated within my inpatient and outpatient programs for the last 35 years have been on multiple psychiatric medications at the time of admission and at discharge.

Trauma Model Therapy is evidence-based and supported by a series of prospective cohort studies [8-16]. There have been no randomized controlled trials because those would require millions of dollars in external funding, which has not been available.

Core Principles of Trauma Model Therapy

The core principles of Trauma Model Therapy include: the problem of attachment to the perpetrator; the locus of control shift; the problem is not the problem; just say ‘no’ to drugs; addiction is the opposite of desensitization; and the victim-rescuer-perpetrator triangle [6]. Here I will focus on the first three of these. The therapy is multi-modal and involves cognitive therapy, experiential groups, inner child work, self-regulation skill building, systems approaches and trauma education. Most recently, clients in an outpatient program I owned and ran for four years received a 91-page collection of lesson plans tagged to the group therapy sessions, which took place 20 hours per week. This program was discontinued due to low reimbursement rates by insurance companies combined with endless denials, appeals and administrative tasks.

The Problem of Attachment to the Perpetrator

The problem of attachment to the perpetrator is a core element of the treatment model. It is based on the fact that mammals are dependent for survival on adult caretakers for a period of time after birth that varies from species to species, and in humans lasts for years. Built into mammalian biology is a set of attachment mechanisms and processes: attachment to caretakers is built into mammalian biology and DNA and in humans is not due to race, culture, gender, IQ or personality. It is not optional and happens automatically. The human child loves and needs to be loved by his or her caretakers, who are usually the child’s biological parents but can be adoptive or foster parents. In a stable, healthy family this all works out – the child develops good self-esteem and secure attachment and is able to take risks in the outside world because there is a safe base to return to, home.

In a severe trauma family, there is a varying combination of emotional and physical neglect, physical, sexual and emotional abuse, absent caretakers, family violence and highly disturbed family dynamics. The child must and does attach to mom and dad, which I call mode A. However, another instinctual reaction is also operating – just like a withdrawal reflex when one touches a hot stove, the child fears, avoids and withdraws from the perpetrator(s), who are also the primary attachment figures – I call that mode B.

That is an impossible problem for the child to comprehend or solve: how to attach to people from whom you must run away. The survival imperative is to attach to an adult caretaker: the idea of the model is that there is an over-ride by the attachment systems. In order to survive, mom and dad must be OK and the child must be in mode A. For this to be true, a fundamental dissociation is required, not in order to protect the child’s feelings but to keep the attachment system up and operating. Bad mom and dad must be put out of sight and out of mind, at least enough to maintain attachment.

Sometimes mom and dad are present and not abusive. At other times they are absent, neglectful or abusive and the child activates mode B, but after a while there has to be an over-ride and a return to mode A. The child develops what is called a disorganized attachment style. From my perspective, this is actually a highly organized and tactical survival strategy: it solves the problem of attachment to the perpetrator, which is how to maintain an attachment to people who might literally kill you.

When the person comes into Trauma Model Therapy decades later they are taught about the problem of attachment to the perpetrator in group and individual therapy and in reading assignments. They then make a core realization: I loved the people who hurt me; and I was hurt by the people I loved. When this sinks in it leads to a lot of grief, mourning and loss – mourning the loss of the childhood I never actually had, which was a good, stable childhood. Addictions, acting out, rigid defenses and other survival strategies that worked in childhood but are maladaptive now must be unlearned and healthier coping strategies must be learned and practiced.

A related cognitive error is the belief that I must be weird, sick or mentally ill to love my perpetrators. The corrective cognition is telling yourself that loving your perpetrator proves only one thing: you are a mammal. It seems that no amount of abuse completely extinguishes the positive attachment, no matter how much it is disavowed, dissociated and buried.

The Locus of Control Shift

The locus of control shift is the second core principle of Trauma Model Therapy. Like attachment to the perpetrator, it is not based on race, culture, gender, IQ or personality – it is based on normal childhood cognition, which I call the mind of the magical child: I am at the center of the universe, everything revolves around me, and I cause everything that happens in my world. The child automatically shifts the locus of control – the control point – from inside the perpetrator to inside the self: I am bad, I am causing the abuse, it is my fault, and I deserve to be treated that way. These core negative self-beliefs get reinforced over and over by what the parents do (the abuse) and what they do not do (protecting the child and stopping the abuse), then by bullying at school, a sexually abusive coach, a rape at the frat house and an abusive partner or spouse.

This is the source of the self-blame, self-hatred and self-punishment that is virtually universal in survivors of severe, chronic childhood trauma. The paradox is that it is good to be bad: because the abuse is being caused by badness inside me, I can control it and stop it. All I have to do is decide to be a good little girl or boy, then mom and dad will forgive me and everything will be OK. The locus of control shift confers a developmentally protective illusion of power, control and mastery at the cost of the badness of the self. It also solves the problem of attachment to the perpetrator because it sanitizes mom and dad and creates an illusion that they are safe attachment figures. Thirty years later, the battered wife leaves the battered spouse shelter and returns home, vowing to be a better wife so that he won’t be so stressed and won’t have to hit me anymore. The domestically violent husband forgives her for leaving him temporarily and they enter a short-lived honeymoon phase until he beats her again.

When the client really gets it and it really sinks in that he or she is not bad and deserved to be loved and protected like every other child, that is good and relieves the self-blame and self-hatred. However, it also dismantles the illusion of power, control and mastery and throws the person into an underground reservoir of unresolved grief, loss, powerlessness and helplessness. I always say that no one in their right mind would want to go there, which de-stigmatizes and normalizes the avoidance so that we can look at the cost-benefit in the present of holding onto the locus of control shift.

The Problem Is Not the Problem

The problem is not the problem is adapted from general systems theory and family therapy. Rather than being psychologically meaningless symptoms of brain dysfunction, symptoms are viewed in the context of the person’s life story and are understood as maladaptive coping strategies that helped the person survive their childhood. Sometimes the model does not apply because the individual’s symptoms are endogenous, biologically driven and consistent with the disease model. However, in a substantial majority of cases, the author believes, the principles of Trauma Model Therapy can be applied and be helpful. It is important to avoid all-or-nothing thinking: for one person, psychotherapy is the primary intervention, and medications are adjunctive; for the next person, the opposite is true. Some clients want only medication, some want only psychotherapy, and some want a combination, irrespective of the clinician’s views. In all cases, the approach should be collaborative not dictatorial.

The assumption in Trauma Model Therapy is that the presenting problem – hearing voices, flashbacks, substance use – is a solution to an underlying problem. For example, a person drinks heavily to drown the sorrows arising from complex, chronic abuse and neglect and loss of loved ones. The problem is the grief, self-blame and lack of healthy self-regulation skills: alcohol solves the problem temporarily and is basically an avoidance strategy. The fact that alcohol works temporarily reinforces the addiction, as does the fact that the effect wears off and the person has to drink more.

Once the person makes a serious commitment to abstinence and to doing the work, the therapy can begin: that commitment is an ongoing process with fluctuating hard work and avoidance, often with temporary relapses. Once enough grief work, cognitive therapy and internal family systems tasks have been sufficiently completed, and healthy self-regulation strategies have been practiced and learned, it becomes much easier to say ‘no’ to alcohol. Simply removing the defense, addiction or maladaptive coping strategy does not solve the underlying problems: hence the concept of the ‘dry drunk’ who is still miserable and difficult to tolerate.

Rather than being symptoms of brain disease, voices are understood as arising from dissociated ego states, especially if they speak in sentences and paragraphs and converse with each other – they can be engaged in psychotherapy and participate in the work. They are holding thoughts, feelings and beliefs that have been disowned and disavowed by the person. They aren’t just symptoms to be gotten rid of, rather they are parts of the person and parts of an overall survival strategy that needs to be adjusted: it worked well in the emergency situation of childhood but isn’t working so well now.

Flashbacks are conceptualized in a similar fashion: rather than being symptoms of brain damage or dysfunction, flashbacks are an effort to review the tapes of the trauma. What happened leading up to the trauma? What red flags did I miss? If I can make a list of all the red flags, stay hyper-aroused and scan for danger, I can spot the red flags in the future and take evasive action. It is my own fault that I didn’t do so the first time (locus of control shift).

Conclusions

The author has reviewed some of the principles of Trauma Model Therapy, which is a trans-diagnostic approach to mental health problems and addictions. The assumption is that trauma in many forms is a major driver of symptoms and disorders across the mental health field, in a proportion that varies from case to case. The model provides a rationale for trauma therapy irrespective of diagnosis and provides an extensive set of strategies, techniques and interventions for the therapist [6]. Its effectiveness is supported by a set of prospective treatment outcome studies.

References

  1. Diagnostic and statistical manual of mental disorders, 3rd. ed (1980) Washington, DC, USA: American Psychiatric Association.
  2. Diagnostic and statistical manual of mental disorders, 4th. ed (1994) Washington, DC, USA: American Psychiatric Association.
  3. Diagnostic and statistical manual of mental disorders, 5th. ed (2013) Washington, DC, USA: American Psychiatric Association.
  4. Ross CA. Kronson J, Koensgen S, Barkman K, Clark P, Rockman G (1992) Dissociative comorbidity in 100 chemically dependent patients. Hospital and Community Psychiatry 43: 840-842. [crossref]
  5. Ross CA (2007) The trauma model: A solution to the problem of comorbidity in psychiatry. Richardson, TX: Manitou Communications.
  6. Ross CA, Halpern N (2009) Trauma model therapy: A treatment approach for trauma, dissociation and complex comorbidity. Richardson, TX: Manitou Communications.
  7. World Health Organization (2019). International Classification of Diseases and Related Health Problems. Geneva: World Health Organization.
  8. Ellason JW, Ross CA (1996) Millon Clinical Multiaxial Inventory – II follow-up of patients with dissociative identity disorder. Psychological Reports 78: 707-716. [crossref]
  9. Ellason JW, Ross CA (1997) Two-year follow-up of inpatients with dissociative identity disorder. American Journal of Psychiatry 154: 832-839. [crossref]
  10. Ross CA, Ellason JW (2001) Acute stabilization in a trauma program. Journal of Trauma and Dissociation 2: 83-87.
  11. Ellason JW, Ross CA (2004) SCL-90-R norms for dissociative identity disorder. Journal of Trauma and Dissociation, 5(3).
  12. Ross CA, Haley C (2004) Acute stabilization and three month follow-up in a trauma program. Journal of Trauma and Dissociation 5(1).
  13. Ross CA, Burns S (2007) Acute stabilization in a trauma program: A pilot study. Journal of Psychological Trauma 6(1).
  14. Ross CA, Goode C, Schroeder E (2018) Treatment outcomes across ten months of combined inpatient and outpatient treatment in a traumatized and dissociative inpatient group. Frontiers in the Psychotherapy of Trauma and Dissociation 1: 87-100.
  15. Ross CA, Engle M, Baker B (2018) Reductions in symptomatology at a residential treatment center for substance use disorders. Journal of Aggression, Maltreatment & Trauma 28(10).
  16. Ross CA, Engle M, Edmonson J, Garcia A (2020) Reductions in symptomatology from admission to discharge at a residential treatment center for substance abuse disorders: A replication study. Psychological Disorders and Research 28, Available from: https://shorturl.at/WGdDm

Clinical Validation and Study of Stem Cell Transplantation in Treatment of Vitiligo

4 Replies

DOI: 10.31038/CST.2024942

Abstract

Objective: Because the current treatment technology cannot really solve the problem of the loss of melanocytes in the area of vitiligo, resulting in poor curative effect and low cure rate of vitiligo, known as the cancer of immortal people; Based on this, Liu Jingwei’s team proposed “the theory of implanting melanocyte processing plant in vitiligo affected areas” to fundamentally solve the worldwide problem of melanocyte loss in vitiligo affected areas.

Methods: 50 cases of vitiligo patients who had failed various treatments were selected by homologous pairing principle, and the complete outer hair root sheath containing hair follicle melanocyte stem cells was extracted and isolated by patented technology, and the resting hair follicle melanocyte stem cells in the outer hair root sheath were activated, and the outer hair follicle root sheath was prepared into a processing plant of melanocyte and implanted in the affected area of vitiligo.

Results: The melanocyte stem cells in the outer hair root sheath could be continuously transformed into melanocytes and enter the epidermis along the outer hair root sheath, thus inducing white spots to recolor. After 1 year, the cure rate of 50 patients with vitiligo was as high as 92%. At present, this technology has obtained 1 Chinese invention patent and 11 utility model patents, and also obtained international PCT patents, and obtained patent acceptance in the EU, the United States, Japan, South Korea and Thailand through the PCT patent way.

Conclusion: “The theory of implanting melanocyte processing plant in vitiligo affected area” were successfully transplanted to the affected area of vitiligo, which breaks through the traditional vitiligo treatment thinking, creates a new theory of vitiligo treatment, completely solves the source of melanocytes in vitiligo affected area, so that it has increased its cure rate to more than 90%. This patented technology cannot only completely cure vitiligo but also is not easy.

Keywords

PCT, Vitiligo, Outer root sheath, Melanocyte stem cell, Melanocyte processing plant

As a clinical refractory disease, vitiligo has a significant impact on the physical and mental health of patients, threatening the state of their marriage, social interactions, and employment. As the pathogenesis of vitiligo remains unknown, the ineffective rate of various treatments for vitiligo patients has reached 50% [1]. Therefore, vitiligo has always been regarded as a chronic disease in dermatology. The new method for treating vitiligo invented by the team of Liu JW (Nanhai Renshu International Skin Hospital) has been granted patents by the China Patent (Invention Patent) [2] (Technical Method for Treating Leucoderma Based on Hair Follicle Melanocyte Stem Cell Transplantation, Patent No.: ZL201910769979.1) and by the Patent Cooperation Treaty (PCT) [3] (Patent No.: PCT/CN2021/072340). At present, there are many surgical methods for treating vitiligo that utilize melanocyte (MC) transplantation. However, only the hair follicle MC stem cell (McSC) transplantation technology has been used effectively, becoming a massive breakthrough in the treatment of vitiligo.

General Data

A total of 50 vitiligo patients who had been treated in Nanhai Renshu International Skin Hospital using other methods for more than 1 year between June 2020 and March 2022 with unsatisfactory outcomes were selected as the research subjects for the present study. Inclusion criteria were as follows: 1) patients meeting the diagnostic criteria for vitiligo, 2) individuals over 4 years old, 3) those with no contraindications for ultraviolet radiation and no photosensitivity, 4) patients and their guardians who were able to adhere to the medical treatment, 5) patients who had not received any other treatments within 1 week and those with more than two white patches, at least one of which had received only the 308-nm excimer laser therapy as the control group, and 6) those who signed the informed consent form. Exclusion criteria included the following: 1) patients with malignant skin tumors, 2) those with mental disorders, 3) individuals with infected lesions at the white patch site, and 4) pregnant or lactating women. The present study was a key research and development project of Hainan Province in 2021, named Clinical Research and Application of the Transplantation of the Complete Outer Root Sheath of the Hair Follicle in the Treatment of Vitiligo (Project No.: ZDYF2021SHFZ048), which was approved by the Ethics Committee of the hospital on June 1, 2020 [Approval No.: 2020 (Clinical Research) RS002].

The 50 study subjects included 24 males and 26 females 4–62 years old, with an average age of (34.23±4.14) years. Vitiligo can be classified into localized type (n=29), generalized type (n=3), acrofacial type (n=5), and vulgaris type (n=14). In addition, leukoderma can be categorized into progressive (n=8) and stable (n=42) stages. In the control group, a total of 89 white patches were not surgically treated, and each patient had at least one such white patch. These white patches took up an area of 680 cm2 in total, with the largest area per patch of 89 cm2 and the smallest area per patch of 2 cm2. A total of 126 white patches were surgically treated in the treatment group, taking up a total area of 2,517 cm2, with the largest area per patch of 135 cm2 and the smallest area per patch of 1 cm2.

Instrument

The equipment used in the present study included a Peninsula 308- nm excimer laser system [model: XECL-308C; Shenzhen Peninsula Medical Co., Ltd. (Shenzhen, Guangdong, China), working medium: xenon chloride (XeCl), wavelength: 308 nm].

Therapeutic Dose

Prior to the 308-nm excimer laser therapy, the minimal erythema dose was tested in the abdomen of all patients using the instrument in the operation mode for the minimal erythema dose. The minimal erythema dose response was observed in each patient within 24–48 h after the irradiation. This dose was considered as the initial dose of the first operation.

Surgical Procedures

For the treatment group, disinfection and local anesthesia were carried out in a 10,000-level laminar flow operating room. Vitiligo was surgically treated according to the method recorded in the PCT- protected Technical Method for Treating Leucoderma Based On Hair Follicle Melanocyte Stem Cell Transplantation (hereinafter referred to as the invention patent) as follows: 1) the outer root sheath (ORS) containing hair follicle McSCs was extracted, and complete hair follicles containing McSCs were obtained using follicular unit extraction technology; 2) the complete ORS containing McSCs was obtained via the hair follicle separation method specified in the invention patent; 3) the obtained hair follicle McSCs were cultured in vitro using a special culture medium that is described in the invention patent. The stem cell activity was further generated to achieve transformation into mature MCs; 4) the obtained hair follicles containing McSCs were inactivated using the utility model patent Novel Vitiligo Hair Follicle Inactivation Needle (Patent No.: ZL201921329885.4) [4] according to the inactivation method in the invention patent, thus achieving dark pigmentation in the skin of vitiligo patients without hair growth; and 5) hair follicles containing McSCs with a complete ORS were transplanted using two utility model patents, including Planting Needle for Vitiligo Treatment (Patent No. ZL201921450324.X) [5] and A Plant Pilot Pin for Hair Follicle Transplants (Patent No.: ZL201921277579.0) [6].

In both the treatment group after the operation and control group, irradiation was conducted using a Peninsula 308-nm ultraviolet light therapy device 1–2 times/week, and the interval between the two irradiation procedures was no more than 7 days. The initial irradiation time was set up based on the minimal patient erythema dose. If erythema persisted for 12–48 h after the treatment, the irradiation dose was appropriate. Each white patch was irradiated 30 times as a course of treatment, and clinical observation of all patients lasted for more than half a year. Local patients in Hainan Province received free phototherapy once a week in the hospital. Patients outside the province underwent phototherapy using a home-use Peninsula 308- nm excimer laser therapy device as required, and the therapy status was reported at least once a week.

Evaluation Criteria

  1. The efficacy for the vitiligo treatment was evaluated based on the efficacy evaluation criteria formulated by the Pigmentation Disorder Group of the Dermatology and Venereal Disease Committee of the Chinese Society of Integrated Traditional Chinese and Western The therapy was regarded as effective only when patients were cured. Vitiligo was deemed to be cured after patches at the treatment site completely disappeared and the skin color basically returned to normal. The cure rate was calculated according to the following formula: cure rate = number of cured cases/total number of cases × 100%. The efficacy was also compared.
  2. Adverse reactions in all patients during the 308-nm excimer laser therapy, such as folliculitis, blisters, skin itching, burning sensation, and pain, were counted and recorded.
  3. Efficacy satisfaction questionnaires were distributed to all patients with a total score of 100 points on the last day of the follow-up. A score lower than 90 points was considered to indicate unsatisfactory efficacy.

Results

Therapeutic Results

One patient in the whole cohort received surgery at two different sites and was recorded as two cases. In the treatment group, 46 cases (92%) were cured, while four cases (8%) were not, resulting in the total cure rate of 92%. None of the 50 cases were cured in the control group and had a cure rate of 0%. Among the uncured patients, two suffered from hypothyroidism and took Eutyrox for a long time. Two acrofacial type patients were over 50 years old.

Adverse Reactions

During the 6-month follow-up after the treatment, the incidence rate of adverse reactions was 10% in the treatment group, with one case of skin itching, four cases of folliculitis, and zero cases of other discomforts. No obvious adverse reactions were detected in the control group.

Satisfaction Degree

Efficacy satisfaction questionnaires were distributed to all patients on the last day of the follow-up. The score was 100 points in 22 patients, 95 points in 20 patients, 90 points in five patients, and below 90 points in three patients, demonstrating an efficacy satisfaction rate of 94%.

A Typical Case

A 35-year-old male patient had multiple depigmented patches on the right side of his face for the duration of 17 years. White patches the size of a small fingernail appeared on the right side of the patient’s face for no obvious reasons 17 years prior. Various drug therapies, fire acupuncture, and laser therapies were performed in this patient with unsatisfactory results. Over the course of the past year, white patches on the right side of the patient’s face expanded, gradually affecting the forehead, eyelids, eyebrows, part of the nose, lower lip, and right side of the neck, occupying large areas. Due to the patient’s lack of confidence in stem cell transplantation, white patches in some areas (marked in Figure 1) were surgically treated for the first time. Two months after stem cell transplantation combined with 308-nm excimer laser therapy, a large amount of melanin was produced in the white patch areas. White patch areas that were previously operated on were repigmented six months after the operation. In particular, the lips and eyelid mucosa where vitiligo could not be cured in the past were repigmented with no color difference. White patches on the unoperated area only received 308-nm excimer laser therapy and did not change as a result (Figure 1).

Figure 1: A case of vitiligo on the face: The first operation

The patient underwent a second operation combining stem cell transplantation with eyebrow implantation on the remaining white patch area on the face and neck six months later. Six months after the combined therapy, white patches in the operated area were completely cured, while those in the unoperated area receiving only the 308- nm excimer laser therapy remained unchanged (Figure 2). White patches on the ears and scalp of the patient have been recently treated surgically and are now recovering.

Figure 2: A case of facial vitiligo: The second operation

Discussion

Theoretical Basis and Research Progress for Hair Follicle McSCs in Vitiligo Treatment

Because mature MCs in the basal layer of the white patch area are partially or completely deficient, repigmentation of the white patch area is often achieved by the production of melanin granules by MCs migrating from outside this region. In 1959, Staricco et al. [7] have confirmed the existence of a large number of immature MCs containing no melanin in the ORS of hair follicles, which cannot synthesize melanin, are negative to dihydroxyphenylalanine (DOPA), and are thus regarded as amelanotic melanocytes (AMMCs). In 1979, Ortonne et al. [8] have found that after the psoralen plus long- wave ultraviolet therapy for vitiligo lesions, DOPA-negative and non-dendritic MCs in hair follicles migrate to the epidermis along the ORS of hair follicles and differentiate into mature MCs. On this basis, the hypothesis for the MC reservoir existence in hair follicles was put forward for the first time. In 1991, Cui et al. [9] have found that the inactivated MCs in the middle or lower part of the skin lesion hair follicle are activated and proliferate after the vitiligo treatment, changing from a non-functional to a functional state, and then migrate to the epidermis along the ORS of the hair follicle, forming pigmented spots at the hair follicular orifice. Dong et al. [10] have discovered that neural crest-derived McSCs located on the hair follicle bulge can effectively differentiate into mature MCs under the irradiation from narrow-band ultraviolet B (NB-UVB) rays and gradually migrate along the ORS to be repigmented at the hair follicular orifice of the vitiligo epidermis. Hair follicle AMMCs can serve as a reservoir for skin MCs in the treatment of vitiligo [11-13]. MCs are derived from the embryonic neural crest and begin to migrate to the epidermis and hair follicles 2–5 weeks after embryonic development. MCs migrating to hair follicles can be divided into two types: one type with melanin synthesis activity located in the hair matrix and infundibulum of the hair follicle in the anagen period, and the other type is inactivated AMMCs located in the ORS in the anagen period showing no melanin synthesis activity. In recent years, it has been shown that AMMCs can be activated by some specific factors, proliferate, migrate, and produce melanin, manifesting some characteristics of stem cells [14,15].

The McSCs and pre-MCs have been classified into AMMCs in numerous studies [16]. Hair follicle McSCs are located in the bulge area at the bottom of the hair follicle (upper 1/3), mostly in a resting state, with slow periodicity and ability to maintain self-renewal. They are typical representatives of regenerative stem cells [17]. However, as research progresses, it has been confirmed that stem cells in a transitional state, namely, pre-MCs, are present in the ORS of hair follicles. These cells do not synthesize melanin but are active in the pigment production cycle. As the direct source of MCs, pre-MCs are the earliest initiator of each pigmented hair cycle [18]. Pre-MCs are transitional cells between McSCs and MCs, which are formed by the proliferation and differentiation of McSCs in the previous hair growth cycle. They are essentially McSCs. As mature MCs in the basal layer of the white patch area are partially or completely deficient, the repigmentation of the white patch area is often achieved through the production of melanin granules by MCs migrating from outside this area. MCs migrating to the epidermis eventually settle on the basement membrane, forming mature MCs that continuously produce melanin [19]. McSCs serve as a melanocyte reservoir for the repigmentation of the affected skin in vitiligo patients. McSCs proliferate and migrate upwards to the nearby epidermis upon activation, forming pigment islands around hair follicles (Figure 3) [20].

Figure 3: A case of oral vitiligo

Clinical Research on McSC Transplantation for Vitiligo Treatment

In 2002, Nishimura et al. [21] investigated the proliferation of melanoblasts and found that stem cell factors expressed in the epidermis form a channel between the ORS and the epidermis, along which MCs migrate from the hair follicle to the epidermis. If the ORS containing McSCs is directly transplanted under the epidermis, the McSCs in the ORS can be activated by a 308-nm excimer laser, while those transported along the ORS can be processed into mature MCs.

Among all laser wavelengths, 308 nm is the laser wavelength where the absorption values of human DNA and proteins almost peak. This contributes to the production of pyrimidine dimers, purine dimers, and other substances, thus triggering the corresponding biological photoimmune response and repigmentation [22]. It has been pointed out that the 308-nm laser changed the microenvironment of hair follicles, facilitated the maturation and differentiation of McSCs, and stimulated the migration of MCs to the epidermis (Figure 4) [23].

Figure 4: A case of vitiligo at the end of the finger

The transplantation of McSCs for treating vitiligo is a technological invention in the implantation of an MC processing plant, which provides a basis for a new theory of vitiligo treatment. The PCT- protected technical method used in the present study employed the following processes: extraction of autologous hair follicles, inactivation of hair follicles, separation of complete ORS, culture and activation of McSCs in the ORS, and harvesting and transplantation of functional McSCs. The complete hair follicle ORS supplies melanoblasts for McSCs. After the ORS containing functional McSCs was transplanted to an area under the epidermis, the 308-nm excimer laser activated the McSCs in the ORS to produce MCs in vitro, thereby continuously producing mature MCs and successfully establishing an MC processing plant in the affected skin of vitiligo patients.

Clinical Research and Theoretical Innovation in McSC Transplantation for Vitiligo Treatment

Although there are presently many surgical methods for treating vitiligo, including epidermal transplantation, MC transplantation, skin tissue engineering, ORS suspension transplantation [24], and single hair follicle transplantation [25], the actual transplants are MCs, which will be inactivated or become apoptotic after completing a life cycle, leading to re-whitening of the skin in vitiligo patients. In particular, surgical methods other than single hair follicle transplantation require microdermabrasion for the transplantation of MCs, resulting in significant damage, uneven repigmentation, and proneness to scarring. Single hair follicle transplantation has been adopted to treat vitiligo more than 20 years ago, but the essence of this method is to implant hair follicles into the dermis and subcutaneous tissues, through which only MCs at the junction of the basement membrane zone and the ORS can enter the epidermis. As only a small segment of the ORS has been transplanted, it is necessary to transplant a large number of hair follicles to achieve repigmentation of whole white patches. This method requires a large number of hair follicles for the treatment of hairless white patches, after which the hair becomes unmanageable. In addition, this method utilizes punctiform repigmentation in most cases and is thus ineffective for white patches in the mucosa. Therefore, it is only suitable for the treatment of vitiligo on skin portions with hair. Hair follicle McSC transplantation method in the present study was adopted to transplant the complete ORS of hair follicles to an area between the epidermis and dermis. After the operation, new MCs were continuously generated via in vitro activation of McSCs in the ORS, thus achieving patchy repigmentation. Since hair follicles were inactivated before the operation, they fell out naturally post-operation after one hair cycle (Figure 5).

Figure 5: A case of vitiligo on the feet.

The PCT-protected Technical Method for Treating Leucoderma Based on Hair Follicle Melanocyte Stem Cell Transplantation is the first in the world to propose a technique for transplanting hair follicle McSCs to treat vitiligo based on the complete ORS. Using this method, McSCs can be directly transplanted to the epidermis of vitiligo patients, thereby treating large-area vitiligo via extraction of small quantities of hair follicles. In addition, the present invention also shows marked efficacy in hairless areas, which indicates that stem cell transplantation is also applicable for the treatment of white patches on the mucous skin membrane.

This is the first time that transplantation of the skin environment containing McSCs with complete hair follicle ORS has been proposed for treating vitiligo. Additionally, this invention patent method provides a basis for a new theory of vitiligo treatment by implanting an MC processing plant, which provides a source of MCs for the treatment of vitiligo and lays a foundation for repigmentation of white patches (Figure 6).

Figure 6: A case of vitiligo on the head

This invention patent introduces a new method of transplanting McSCs for vitiligo treatment without dermabrasion. Vitiligo patients were surgically treated without dermabrasion, and repigmentation with no color difference after the vitiligo operation was achieved via minimally invasion transplantation using the self-developed plant pilot pin for hair follicle transplants and planting a needle for vitiligo treatment.

Conclusion

Liu et al. have obtained McSCs in a functional state using a PCT- protected technical method and implanted them and melanoblasts to an area under the epidermis. Continuously activated by a 308- nm excimer laser in vitro, McSCs in the ORS were transformed into mature MCs and migrated along the ORS to multiple hair follicle orifices in the vitiligo area or sebaceous gland openings in the hairless area to achieve central-type repigmentation with no color difference. McSC transplantation addresses the issue of MC sources for patients with vitiligo and provides a new solution for its treatment. With a cure rate of 92%, this method brings new hope for recovery to 70 million patients with vitiligo worldwide.

References

  1. Patel NS, Paghdal KV Cohen GF (2012) Advanced treatment modalities for vitiligo [J]. Dermatol Surg [crossref]
  2. Liu J Technical method for treating leucoderma based on hair follicle melanocyte stem cell transplantation. China. ZL201910769979.1 2021.01.12, Publication Number: CN110339214A.
  3. LiuJing-wei. Technical method for treating vitiligo through hair follicle melanocyte stem cell transplantation. China. PCT/CN2021/072340, WO2022/151450.
  4. Liu J W. Novel vitiligo hair follicle inactivation needle. China. ZL201921329885.4, 2020.07.14. Publication Number: CN210990699U.
  5. Liu J W. Planting needle for vitiligo treatment. China. ZL201921450324.X, 2020.09.08. Publication Number: CN211434526U.
  6. Liu J W. A plant pilot pin for hair follicle transplants. China. ZL201921277579.0, 09.08. Publication Number: CN211433043U.
  7. Staricco RG. Amelanotic melanocytes in the outer sheath of the human hair follicle[J]. J Invest Dermatol 1959 [crossref]
  8. Tobin DJ, Bystryn JC (1996) Different populations of melanocytes are present in hair follicles and epidermis [J]. Pigment Cell Res [crossref]
  9. Cui J, Shen LY, Wang GC (1991) Role of hair follicles in the repigmentation of J Invest Dermatol 97(3): 410-416. [crossref]
  10. Dong D, Jiang M, Xu X, et al (2012) The effects of NB-UVB on the hair follicle derived neural crest stem cells differentiating into melanocyte lineage in vitro[J] J Dermatol Sci [crossref]
  11. Yu HS (2002) Melanocyte destruction and repigmentation in vitiligo: a model for nerve cell damage and regrowth[J]. J Biomed Sci [crossref]
  12. Slominski A, Wortsman J, Plonka P M, et Hair follicle pigmentation [J]. J Invest Dermatol 2005. [crossref]
  13. Bernard Hair cycle dynamics: the case of the human hair follicle [J]. J Soc Biol 2003 [crossref]
  14. Ma HJ, Zhu WY, Wang DG, et Endothelin-1 combined with extracellular matrix proteins promotes the adhesion and chemotaxis of amelanotic melanocytes from human hair follicles in vitro[J]. Cell Biol Int 2006 [crossref]
  15. Lei TC, Vieira WD, Hearing In vitro migration of melanoblasts requires matrix metalloproteinase-2: Implications to vitiligo therapy by photochemotherapy [J]. Pigment Cell Res 2002 [crossref]
  16. Takada, K, Sugiyama, K, Yamamoto, I, et al. Presence of amelanotic melanocytes within the outer root sheath in senile white hair[J]. J Invest Dermatol 1992 [crossref]
  17. Nishimura EK, Granter SR, Fisher DE. Mechanisms of hair graying: Incomplete melanocyte stem cell maintenance in the niche [J]. Science, 2005. [crossref]
  18. Hsu YC, Li L, Fuchs E. Transist amplifying cells orchestrate stem cell activity and tissue regeneration [J]. Cell. 2014 [crossref]
  19. Slominski A, Wortsman J, Plonka PM, et (2005) Hair follicle pigmentation [J]. J Invest Dermatol 124(1): 13-21. [crossref]
  20. Matz H, Tur Vitiligo[J] (2007) [title] Curr Probl Dermatol 35: 78-102.
  21. Nishimura EK, Jordan SA, Oshima H, et al. Dominant role of the niche in melanocyte stem-cell fate determination[J]. Nature 2002 [crossref]
  22. Jmb A, Shk B, Hjj A, et al. Suberythemic and erythemic doses of a 308-nm excimer laser treatment of stable vitiligo in combination with topical tacrolimus: A randomized controlled trial – Science Direct[J]. Journal of the American Academy of Dermatology 2020. [crossref]
  23. Noborio R, Nomura Y, Nakamura M, et al. Efficacy of 308-nm excimer laser treatment for refractory vitiligo: A case series of treatment based on the minimal blistering dose[J]. Journal of the European Academy of Dermatology and Venereology 2020. [crossref]
  24. Vinay K, DograS, ParsadD, et Clinical and treatment characteristics determining therapeutic outcome in patients undergoing autologous noncultured outer root sheath hair follicle ce11 suspension for treatment of stable vitiligo [J]. J Eur Acad Dermatol 2014. [crossref]
  25. Na GY, Seo SK, Choi SK. Single hair grafting for the treatment of vitiligo[J]. J Am Aead Dermatol 1998. [crossref]