Dent Neurologic


Coping With Stress and the Unknown | Livestream Recap

In light of current events, Dr. Horatio Capote opened discussion on how to deal with anxiety and stress, and how working together, as a community, can benefit all of us.


Anxiety is a “perfectly normal emotion…it’s how we’re built, it’s probably a signal to our brains that something is up, something may need to be adjusted, or we may need to be careful about something.” Anxiety is an important and, given the circumstances, appropriate emotion to be having. Everyone experiences anxiety at some point in their lives. However, anxiety is not only an emotional response but a disorder. According to Dr. Capote, one may be suffering from an anxiety disorder if the anxiety persists for “about two weeks…not just a blip, but an ongoing issue…that it affects our function in some kind of way.” These may include interpersonal, occupational, and/or physiological functions. If you believe you have an anxiety disorder, it is essential to contact your doctor so they can help you.

The unknown is “extremely stressful…when we don’t know, we can’t predict, we’re figuring it out…that is tough on us.” A study conducted at Sloan Kettering Cancer Center in New York City and “what they discovered is that it was much more stressful to await the results of, say, a biopsy…await the results of some testing than to hear “Yes, you have cancer.” …because once you know, now you have a game plan…now you’re not up in the air trying to figure it out.” In this current situation, medical professionals are learning about the behavior of the virus and, and the unknown adds to the communal stress.

Community & Credible Sources

Dr. Capote builds off of his statement about communal stress, stating that community and connectedness are incredibly important during this pandemic. It is more than just physical connectedness; it is emotional and spiritual connectedness, a feeling that we are all in this together. “Our brains, our neocortex, our limbic systems, are built that way..different parts of our brain are built to respond to each other. So, we’re all connected…even if we’re not physically as connected lately as we would often like to be.” We must remember that we are all part of the human race, and we are all learning as much as possible to help each other.

To help ourselves and one another, we, as a community, must rely on credible sources for our information. Dr. Capote strongly recommends, for example, gathering information from the Centers for Disease Control. It is a trustworthy, scientific source that is more reliable than the “unusual information out there on the internet.”

How to Help Ourselves

Pandemics have existed throughout humanity, but now “we have technology that we all find out about things instantly. In the past, a pandemic could wipe out a country and then go on to the next country, and maybe take ten years to circle the globe. Everything is accelerated as a result of our new technologies.” So what do we do in the face of the unknown and compounding stress? First, we remember that we are all human beings connected. We must be kind, understanding, polite to each other. Secondly, we must take care of our bodies by getting adequate sleep and fueling our bodies with proper nutrition and exercise. “These things that keep our bodies intact and keep us going are important. We should not…skimp on this,” says Dr. Capote. Lastly, he also mentions that we should treat ourselves “within reason, within the bounds of normalcy…whatever it is for you.” All of these points are basic ideas of things that we can do to keep ourselves level-headed in the face of the current environment.

Q&A with Doctor Capote

Q: There’s a lot of parents who are homeschooling for the first time, and this can be very stressful for them. Are there any tips that you would give those parents on how to deal with this new routine they’re going through?

A: It is a challenge. I think it always pays to be honest and not make-believe you know stuff when you don’t. You can teach a lot to your kids by modeling…like “Hey, that’s a good question. I don’t know. Let’s learn together; let’s figure this out together. Let me show you how I’ve learned to seek out information,” and do some joint problem-solving. Make it a bit of an adventure. It is an opportunity to strengthen those ties with your kids. You know, you see them more frequently. Mind you, you know, everybody in close proximity for prolonged periods of time can get on each other’s nerves. So, you know, that’s understandable. But I think, you know, being honest, remembering that you are the parent, do not give the impression that you’re the buddy. You are the parent, and you have some leadership to exert and some delineation of what is right and wrong and things like that. But turn it into an adventure where both of you are sort of co-learners, and you’re still the guider and the leader because you have more experience on how to get questions answered, and of course, you do have a higher body of knowledge than the student. Then on top of it, it’s likely that after some amount of time, you’ll start kicking up memories of the information that you do know, and you start being able to retrieve that more easily. Like anything, it’s a, you know, it’s like a muscle; the more you use it, the better you get at it. So it’s a challenge, but I would invite you to reframe it as an adventure cognitively. By the way, it should give us great empathy for our teachers in the community. Teachers are out there. Some say probably not being rewarded as well as they ought or at least appreciated as much as they should be. So, you know, the next time you see a teacher just like we do with our veterans and thank them for their service. I think this will give us a much greater appreciation for that as well. I know I have a lot to owe to my teachers back from elementary school, but yes, my high school teachers. Shoutout to Christopher Columbus High School at Miami, Florida! They were terrific and have taught me great things that I remember to this day.

Q: Are there any tips that you have on how to discuss what’s going on with children?

A: Sure, sure. Again, you know, some honesty, some information. Try not to editorialize too much, you know, “Oh, this is because this that.” It’s just like, “Well, there’s this virus that has arisen and viruses, you know, they tend to change and mutate over time.” You see, it as an opportunity, right? And what’s a virus? Is it a bacteria? Is it more of a biochemical structure? Does it have life? What is it? So all those exciting opportunities to learn science are there depending on the age of the child, of course. But it’s something that’s out there. It can make people sick, and we’re dealing with it. We’re learning about it as we’re dealing with it at the same time, and we’re trying our best. Honestly, we are probably better equipped than we ever have been in the history of humanity. We have a lot of very bright people thinking about this thing. We have a lot of excellent technology, and so we’re putting all of these things to bear to answer these essential questions.

Q: Can CBD help with your anxiety?

A: Yes. And this is from someone…I was initially a little bit skeptical, but it does turn out that CBD, which by the way, is extractable from both hemp as well as from cannabis, right, so it turns out that it has a beneficial effect on anxiety and probably sleep as well. We are proposing some studies on that soon. It’s just waiting for some FDA issues with the federal government to be able to do that. But, as you know, you can pretty much pick up CBD nowadays, I guess, at the corner store or the gas station or whatever. Mind you; there are products out there that our uber medical director, Director Laszlo Mutchler, actually went about purchasing CBDs from all these different places and had them laboratory analyzed. I found out that some of them only had 1% CBD in it, but they’re still calling it CBD and selling it out there. So that Latin phrase “caveat emptor” right “buyer beware,” that there’s different products thereof different qualities and, consequently, you would like to have something that is laboratory tested and certified actual CBD. I think over time we’ll see a lot more studies showing the efficacy of it. So double-blind placebo-controlled studies that will begin to show us its benefits on the, say, the sleep architecture and on the overall issue of curbing anxiety.

Q: Do you have any tips on how to talk to the elderly, whether it’s your parents, your grandparents, to make sure that they’re taking everything seriously without them feeling like you’re talking down to them or like they’re a child?

A: Sure. You know, as always, you speak genuinely to people. You start probably by saying, “Hey, the reason I’m having this conversation with you is because, you know, I love you, and I want you to do well. So whatever information I’m about to share with you is not it’s not coming from a bad place. It’s coming from a good place.” It’s my guess without knowing the particular situations. It’s hard to give specific advice. It may be hard to put things into context for some people. Some people have never experienced anything like this, and they’ve been around for a while. It may also be that older people, you know, they hear this information that they’re at a much higher risk and they’re anxious. They’re exceedingly concerned. I spoke to someone yesterday in a long-term care facility, and one of her neighbors had just passed away about four days ago. I don’t suspect anything, not from the virus. I think it was just her time. But yes, what happens, you know, another of your cohorts is gone, and you’re faced with your mortality. That’s scary, you know? When is it going to be my turn? And then on top of it, there’s this other new danger which threatens your life expectancy for sure, which is the coronavirus. So I can see it being very hard for people, you know, beyond their 60’s and 70’s to deal with things. But as always, we give honest information. We express our caring and our love, which is why we’re sharing knowledge, and we take it from them. So I think if you’re coming from the right place, if you’re not looking to be manipulative that, you know, shines through.

Q: Would you give that same advice to someone who is not following the guidelines that are in place? Is that kind of the same way you would talk to them? How would you reach out to someone who is not social distancing, not following the recommendations that are out there? How would you bring up that topic?

A: Well, I tend to try to use humor, so I would probably say something like, “Hey, I know you’re Superman and invincible, but listen. I’m worried about you. I mean, people are dying, and it’s best to take this thing seriously. I am! I am for myself and my family, and guess what? You’re part of my family, either immediate or the greater family of humanity. And for whatever reason, it just doesn’t look to me like you’re taking this as seriously as you should.”

There could be so many reasons for people who could be having some cognitive problems. People could be engaging in a lot of denial. I mean, we call these things “denial rationalization” we call these “defense mechanisms.”There’s a reason for that. We defend ourselves by utilizing these techniques. Now, there turns out to be a hierarchy of defense mechanisms. So, the most primitive defense mechanisms are denial. Even more primitive than that is the loss of contact with reality as hallucinations and things like. But the most sophisticated defense mechanisms are altruism and humor. So, people that are altruistic, they look out for others, they engage in philanthropy and caring for others and people that are funny. Those are the more sophisticated ego-coping mechanisms that we have.

And in the middle, there’s different ones, and interestingly enough, if you look at the development of the human being, you actually see that we tend to go through these different defense mechanisms as we mature. So little kids could probably spend a whole lot of time in denial and anger, and all kinds of stuff and then that comes that magical time in adolescence when everything seems funny and people just laughing up a storm no matter what. I know for me as a kid, I discovered Monty Python, and I thought that was hilarious. So you know you just see people going through all these stages. Unfortunately, some people seem to get stuck in a stage, or you have to help them move a little across those borders. Well, again, that’s the whole idea of connectedness in one way or another. So certainly, there are a lot of online communities that occur. There our faith communities that are meeting online.

I heard yesterday about a church that is basically operating almost like a drive-in theater. People are pulling up in their cars and listening to the sermon on a screen, and sometimes they honk the horn instead of “Amen,” but they’re connected. They’re connected even though they’re not that physically connected. There turns out to be online AA meetings and NA meetings, so people are engaging in the fellowship of sobriety that way. So I think we’ll see a lot more of that happening and, honestly, there can be great benefit to that as well. You can get a different sort of experience, but a connection on another level as well. We adopted telemedicine very quickly and, interestingly enough, I’ve noticed that and, you know, not to brag on myself, but I consider myself observant, and I think I listen to people and hear them out. But now, with telemedicine, I listen more attentively. I also have noticed that the people I’m connecting with, they’re better at describing things. They’re paying more attention to these details and telling me about it. So it may make us better communicators in the long run. It’s very interesting.

They say there are silver linings to everything. I see families get more connected, spending more time together, and I think it may enhance our communication skills because we’ve been so accustomed to texting a few words here and there or throwing out a…some message on Twitter and stuff like that. So this is an opportunity to engage in some of these uniquely human capabilities that we have. By the way, this is a little bit of an aside, but what the heck I’m the one talking so I could say whatever I want! One of my favorite things to remark on is a statement, you know, it’s not an exact quote, but basically, Sigmund Freud, the of the fathers of psychiatry was trained as a neurologist, so it’s always been part of the neurosciences. So, Dr. Freud just ran across this group of patients that were difficult to understand with the neurology he had been taught. So he developed this sort of, what he called the sort of artificial language of psychoanalysis to help describe what he was seeing. But he predicted one day we’ll know enough neuroanatomy, neurophysiology, and neuroscience in general, and my language will disappear. We won’t need these words that I’ve created. We will understand how it’s happening in the brain. So sure enough, the ventral tegmental area and the nucleus accumbens is kind of the reward center of the brain. That’s actually where, so to speak, sex, drugs, and rock and roll happen. So that would probably be the seat of the id of all of these impulses, of all of these urges. That would be where the id flows from. We know the anatomical location of that in the brain. And then the super-ego, that part that sort of holds down the id, the inhibitory part that he talked about turns out to be the prefrontal cortex. So in the prefrontal cortex, where the executive functions of the brain reside, we actually see these fibers that reach down into the ventral tegmental area and inhibit.

They hold that thing down, and that would be the seat of the super-ego. Now interestingly enough, what I’ve just described is a little bit of a yin and yang. These opposing forces so in that counterbalance between the id and the super-ego arises, the ego, the self. One person might be a little bit heavier on the super-ego and that the personality arises a lot more on the regimented sort of obsessive side, and some person might be on the other side of that spectrum. So it’s that balance and friction and, I guess, yin and yang between those two things out of which can arise the personality. Another interesting thing, people’s sense of empathy, the seat of empathy turns out to be the amygdala. People, by the way, that get infectious yawning, turn out to be exceedingly empathic. But you can actually take pictures of people grimacing in pain and show them to someone under PET scanner, and you see the amygdala light right up. So we’re showing this deep that empathic connection, “Oh my God, that person is experiencing pain. It must be awful for them.” By the way, if you go to some maximum-security prison somewhere in America where people with antisocial personality disorder reside, you will see that that amygdala does not light up. That is how you could be a cold-blooded killer. You don’t have that. You don’t experience it, and nothing lights up in your brain, alright, I could kill you. So that’s another interesting phenomenon as well as we gain our knowledge of the brain and how it functions and how it makes us who we are. We’re figuring out a lot. I think that there are things beyond the physicality of the brain as well, you know, the whole spiritual perspective as well. So we’re not, at least in my estimation… we’re much more than just an interesting machine with lots of interesting parts that work together. We have sort of this ability to transcend all of that as well.

Q: Another question we have is for people who might be having, like you were saying, they obsess over something, or they’re empaths, they might be having panic attacks during this time. Whether it’s someone they know was going through something or if they find themselves obsessing over the news or if they have a cold and are obsessing over it themselves. So what are any tips you can give for someone who might be mid-panic attack?

A: Well, it’s important to understand that no one has ever died of a panic attack, although it feels that way. By the way, if you have frequent panic attacks, I would say more than two or three a week, it sort of, it may certainly be worthwhile to seek out some help with that. Now the panic attack and the whole sort of anxiety response is an important evolutionary phenomenon. We tend to focus sometimes on the emotional perspective of these things, but in fact, it’s very physical. There’s a part of the brain called the locus coeruleus, the little place that looks like a prune… ciruela coeruleus means prune. Anyway, the little place that looks like a prune secretes adrenaline, so in the face of a threat in the environment…boom! Adrenaline comes out. And what does adrenaline do? Well, it can make us hyperventilate, so we get lots of oxygen on board in case we need to fight or flee, in case we need to put them up or run away.

Because of this hyperventilation, that tends to make your ph in your blood change, you blow off CO2, and so your blood becomes more basic, and you can get tingly sensations in your fingertips and throughout. It cuts down circulation in the limbs, so if you get slashed, you won’t bleed out, and it shunts the blood to the major organs in the torso. It opens up your peripheral vision so you can spot danger coming at you from the sides more easily. It really prepares you for an emergency. If there were a bus coming at you down the street, you would want to have that system intact because it would prepare you to save yourself. The unfortunate thing is if this thing is happening all the time and for no reason at all, then it can become taxing. It can begin to have negative consequences on your body and your brain, and that’s when you would want to seek out some professional help with that. There are many ways to help, not only just medications, but certainly cognitive behavioral therapy is quite good, and oftentimes the simultaneous use of these different things can be synergistic. So one plus one equals three when you do things together like that. You may get much greater effects as well.

Q: So those are all the questions that we have. Is there anything else you want to add in? Maybe mention how people can call and make an appointment?

A: Absolutely. You are certainly welcome to seek us out. We are glad to help and to be of service. We have a great many different technologies that we utilize to help people, not just medications. We also have techniques like transcranial magnetic stimulation that turns out to be very good for treatment-resistant depression. We have electro-convulsive therapy. We have other medication treatments that are not exactly like taking a pill. We have a very, very good intravenous ketamine program. That one is actually quite impressive in that if you are a responder, you can see impressive and very rapid results from it. I’ve been impressed by it. I know I’ve said the same word like ten times. I’d be an awful author, but it’s been really exciting to see that happen. There are other treatments as well on the horizon. We are involved in a lot of research at the DENT. I believe I’m the principal investigator, I think in 27 different trials right now.

The DENT, in general, probably has close to 100 trials going on. We are America’s largest Neuroscience group. People come to us for help with researching new things, so we often have our ear to the ground for what’s up and coming. We may be able to get you into a trial for something new if you’ve tried all these different things, and nothing’s worked so far. We may be able to get you onboard for a new trial. So, a lot of aspects to the kind of work that we do at the DENT. We’re always glad to help in any way that we possibly can. If there’s something we don’t do quite often, our different providers, the doctors, and staff can reach out to other thought leaders throughout the country and find out more details. We’re proud to be from Buffalo. We love our community. We’re glad to help any way that we can. We’ve been here since 1963—some of the very first work that we did actually involved Parkinson’s disease.

We welcome the opportunity to help people in our community, and now with the espousal of telemedicine, we have actually been able to reach out. We do have people that come in from other regions and travel and come here to be seen, but now I think we will have the opportunity to expand our reach to different parts of the state and perhaps other states and help people without them having to be physically present all the time. So that’s maybe one of the silver linings of this whole thing. We’re really espousing the different new technologies and figuring out more ways that we can help people. So give us a call. We will try to help any way that we can, and hopefully we’ll all get through things together as part of the overall community, the sisterhood, and brotherhood of humanity


Q: And if someone’s provider is closed right now, they can always come to us, right? If someone’s doctor’s office is closed, but they really need to see, they can always come DENT?

A: Oh yeah. Sure, sure

Q: Do you have anything else you want to add in?

A: No. Listen, I wish you all well. Stay safe, take care of yourselves, and thanks for taking some of your valuable time and listening to me. I think together we’ll get through all of this and come out the better for it.

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

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