Doctor, I’m hearing voices (discussing psychiatry)

Both the British and American Journals of Psychiatry are now broadcasting their own monthly podcasts that discuss some of the feature articles in each month’s issue.

Unlike many of the articles themselves, the podcasts are freely available to download from the moment they’re released.

The British podcasts are hosted by Dr Raj Persaud and involve interviews with researchers and discussions about the issues raised by their findings.

In contrast, the American podcasts sound like an excessively thorough lecture given by a voice synthesiser.

I suspect the American version is an attempt to produce an audio version of the academic paper, while the British podcasts could probably picked up by non-specialists who could still get an understanding of the area, and by specialists who would enjoy them even if they’d already read the paper itself.

It’s interesting to see how many scientific journals are now creating podcasts to accompany their publication, and hopefully this will make research more widely accessible to the public at large.

Link to British Journal of Psychiatry podcasts.
Link to American Journal of Psychiatry podcasts.

Getting a head in childhood

The Times covers research published in the journal Paediatrics indicating that head size at one year old predicts intelligence in later childhood.

A research team led by Dr Catherine Gale measured the head circumference of 633 children at birth, and regularly afterwards.

The kept in contact with the families and assessed the children at 4 and 8 years for mental performance.

The team found that intelligence was positively related both to head size at birth, and to head growth during childhood.

Interestingly, the same team did a study looking back at older people’s medical records and compared their head size at birth and in adulthood, to their IQ measured in their 60s and 70s.

They found no relationship between birth head size and current IQ, but did find a relationship between adult head size and IQ.

This may suggest that their are complex life-long factors affecting brain development that affect intelligence differently as we age.

Link to article in The Times.

Electrical brain stimulation for coma reversal

This is one I missed a couple of months ago: Wired had an article on a novel technique that might help rouse people from coma – applying electrical currents to spinal nerves to stimulate the brain.

The surgeon mentioned in the story, Edwin Cooper, has published a number of studies on the technique, which involves applying an electrical current to the right median nerve which connects directly to the spine.

A Japanese team is attempting to do something similar, but uses electrodes implanted directly in the spine itself to stimulate the dorsal column.

The idea behind the treatment is that the electrical current travels up the spinal nerves and boosts the reticular activating system, a part of the brain stem known to be involved in arousal and motivation.

This in turn should boost the activity of higher brain centres, including the thalamus and then the cortex.

More recently, Japanese researchers have attempted to use electrodes implanted directly in the brain to increase arousal, with some success in early trials.

As an aside, Edwin Cooper is a member of the Lifeboat Foundation, a futurist organisation that aims to develop technology to save the planet from cataclysmic events such as global pandemics or holocaust.

This includes “self-sustaining space colonies in case the other defensive strategies fail”.

Needless to say, Ray Kurzweil is involved.

Link to Wired article ‘Back From the Dead’.

God moves in mysterious waves

Discover magazine has an excellent article on the neuroscience of religious or spiritual experience, an area sometimes known as neurotheology.

Although researchers vary in their own spiritual beliefs, it is possible to be an atheist and still study spiritual experience.

Just as a complete understanding of the visual system wouldn’t disprove the existence of any particular object you see (after all, it could be a true perception, or it could be an illusion), studying the experience of God, doesn’t really tell us anything about whether God exists or not.

One of the most established researchers in this area is Dr Michael Persinger who has stimulated the temporal lobes with weak but shifting magnetic fields (using a modified helmet, pictured) and claims to have induced the experience of a ‘sensed presence’ in na√Øve volunteers.

Persinger notes that minor temporal lobe disturbances are common throughout the population, and are more common in people with high numbers of paranormal beliefs.

Supposedly, a form is the helmet is available for sale over the internet, although as the tag-line of the website is “Neurotheology, Magnetic Brain Stimulation, Deja Vu, Death, God, Sex, Love, and more” it sounds more like a track-listing from a Hawkwind album than a serious piece of research equipment.

The article covers most of the major neurotheology research groups, and gives an overview of their main aims.

Link to article ‘The God Experiments’.

Liquid psychiatry

Due to the public’s confusion over the difference between psychiatry and psychology, I have developed a minor hobby out of spotting the word ‘psychiatry’ in places it shouldn’t be.

This was inspired by hearing someone on the bus accuse her friend of using ‘reverse psychiatry’ on her.

Another one that seems to pop up is ‘abnormal psychiatry‘, which is presumably where doctors treat mental illness while acting a bit oddly.

One of my favourites though, is on a drinks can sold by sandwich shop Pret. The ‘Yoga Bunny Detox’ drink is advertised as being ‘liquid psychiatry’.

I’ve checked the ingredients, and there seems to be no trace of psychotropic drugs, so I presume it just takes my blood and interviews me for signs of psychopathology.

Any other sightings of out-of-place psychiatry would be gratefully received.

Serotonin Christmas decorations

Purveyor of molecular gifts and jewellery Made With Molecules has just launched a new line for Christmas: serotonin Christmas decorations for your tree.

They’ve also added to their existing range with jewellery made from the caffeine molecule, and the theobromine molecule – one of the psychoactive ingredients in chocolate.

So if you want to decorate either yourself or your house with drugs and neurotransmitters, you know where to go.

Link to Made With Molecules

Are you normal? Are you mad?

BBC Radio 4 is running a series at the moment called Am I Normal? that looks at differences in the body and mind. The most recent edition was on madness and psychosis, and the audio is available online.

Psychosis is the mental state in which delusions and hallucinations are prominent, and is usually linked to diagnoses such as schizophrenia or bipolar disorder.

The programme tackles the experience of psychosis and how frequently these experiences occur in the general population.

Recent research has indicated that the experiences previously thought to be diagnostic of madness, actually occur in many people who never become distressed or impaired.

It may be the extent and impact of these experiences, rather than just their presence, that is important.

Weight is something which is distributed throughout the population, with some people being heavier than others, and some being considered so overweight as to need medical treatment.

In the same way, psychosis-like experience is thought to operate on a continuum, and those with the more frequent or intense experiences being more likely to end up being treated by mental health professionals because they are distressed or impaired.

One of the factors known to impact on how distressed and impaired people become is how they evaluate and make sense of strange experiences.

Knowing that odd ideas or hallucinations are common (studies estimate about 10-20% of the population report them at some point) can significantly reduce distress in some people, and makes others less likely to stigmatise or react badly.

Weird is the new normal. Spread the word.

Link to ‘Am I Normal?’ programme webpage.
realaudio of programme on madness.

The Myth of Thomas Szasz

Controversial psychiatrist Thomas Szasz is the subject of an in-depth article in The New Atlantis magazine that re-examines his legacy and impact on psychiatry.

Szasz has made some of the most important and cutting criticisms of modern psychiatry but is now largely ignored by both academia and patients’ rights groups.

This is partly because the classical liberal philosophy that motivates many of his arguments has become less popular and partly because he’s been associated with Scientology – known for its wild-eyed anti-psychiatry.

It is also true to say that while making some pertinent and uncomfortable observations, he’s also made some rather less impressive and sometimes, downright insulting, accusations.

One of his most well-known arguments is that mental illness is a ‘myth’. This is widely misunderstood to mean that Szasz is arguing that there is no such thing as mental suffering or bizarre behaviour, or that it shouldn’t be treated, which is not the case.

Szasz would argue that these things are labelled as mental illnesses because of society’s willingness to medicalise, and often control, people who behave abnormally.

He argues that while these things occur, they are not diseases in the same sense that, say, AIDS, is an disease, because there is no clear biological marker for mental distress.

In a sense, modern psychiatry is cursed only to deal with disorders that do not have a discrete biological cause.

As soon as a clear biological cause is found, the disorder is often taken out of the hands of mainstream psychiatry and becomes the domain of neurology or neuropsychiatry, as has happened with neurosyphilis, epilepsy, Huntingdon’s disease and many others.

In a way then, Szasz is right, because psychiatry necessarily applies medical concepts only to fuzzy human phenomena.

As science advances, the concepts become less fuzzy, and so Szasz’s arguments might apply to a smaller and smaller number of disorders.

This would be the case, perhaps, if it weren’t for the fact that other unpleasant experiences and behaviours are increasingly included in psychiatry’s remit. Extreme shyness can now be diagnosed as social phobia, for example.

The New Atlantis article examines some of the motivations behind Szasz’s 40 year crusade, the hubris of 60s psychiatry, and why he is now less relevant in modern psychiatric practice when he was once centre stage.

Link to article ‘The Myth of Thomas Szasz’.

If you’ve got it, flaunt it (P.S. You’ve got it)

The Economist has a short but uplifting article on research that suggests that we underestimate how good looking we are when compared to other members of the same sex, possibly to keep us on our toes and work hard to attract a partner.

If you have ever sat alone in a bar, depressed by how good-looking everybody else seems to be, take comfort—it may be evolution playing a trick on you. A study just published in Evolution and Human Behavior by Sarah Hill, a psychologist at the University of Texas, Austin, shows that people of both sexes reckon the sexual competition they face is stronger than it really is. She thinks that is useful: it makes people try harder to attract or keep a mate.

Dr Hill showed heterosexual men and women photographs of people. She asked them to rate both how attractive those of their own sex would be to the opposite sex, and how attractive the members of the opposite sex were. She then compared the scores for the former with the scores for the latter, seen from the other side. Men thought that the men they were shown were more attractive to women than they really were, and women thought the same of the women.

This is quite an interesting finding in itself, but also seems to go in the opposite direction to most other normal cognitive biases we have, which lead us to judge ourselves in a better light than others.

The effect nicknamed the Lake Wobegon Effect is where we consistently judge ourselves to be above average compared to others.

Also, we are more likely to think that positive events happen because of our own actions, and negative events are due to other people or external factors.

Interestingly, there’s quite a bit of evidence that mental illness is associated with the loss of these positive biases, giving us a statistically more realistic but emotionally painful view of reality.

Link to Economist article.

On testing the dead

The Financial Times has an article on recent research into Cotard delusion – a firm unshakeable belief that you’re dead – which can occur during mental illness or neurological disturbance.

The article focuses on a study by Drs Ryan McKay and Lisa Cipolotti on a patient named ‘LU’ who presented with the delusion when being assessed for the impact of severe epilepsy caused by a viral brain infection.

They describe the case in their paper:

At neuropsychological assessment LU presented with the Cotard delusion. She repeatedly stated that she was dead and was adamant that she had died two weeks prior to the assessment (i.e. around the time of her admission on 19/11/2004). She was extremely distressed and tearful as she related these beliefs, and was very anxious to learn whether or not the hospital she was in, was “heaven”. When asked how she thought she had died, LU replied “I don‚Äôt know how. Now I know that I had a flu and came here on 19th November. Maybe I died of the flu.” Interestingly, LU also reported that she felt “a bit strange towards my boyfriend. I cannot kiss him, it feels strange ‚Äî although I know that he loves me.” Other presenting symptoms included reported sensations of dizziness, as well as musical hallucinosis (hallucinations of disco music), tactile hallucinations (a feeling of running water on her left forearm) and visual hallucinations (moving walls).

The study tested theories which suggest it is caused by trying to make sense of losing automatic emotional responses to familiar people – a consequence of the brain damage.

Some researchers have argued that this is the basis of a similarly curious syndrome, known as Capgras delusion, where someone believes that their friend, spouse or relative has been replaced by a near-identical looking impostor.

In Capgras delusion, it is thought that the same problem with automatic emotional response is present, but that the person attributes the problem to external changes in the world (“it’s something to do with my wife…”) and reasoning problems lead to the delusion itself (“…and she’s been replaced by an impostor”).

In contrast, one theory of Cotard delusion is that it might be partly caused by the same emotional response impairment, but where the person attributes it to an internal change (“it’s a problem with me…”) with reasoning problems leading to the delusional belief (“…and the problem is, I’m dead”).

So far, this has only been an educated guess by researchers and has never been tested.

McKay and Cipolotti assessed whether LU typically made internal or external attributions for negative events, and found, consistent with the existing hypothesis, that she made consistent internal attributions.

One unexplained part, both in this study, and in delusions in general, is why these unusual experiences and odd attributions lead to delusions, and not simply to confusion (e.g. “people feel strange, I think it’s a problem with me, but and I don’t know what to make of it”).

It is thought that reasoning problems or cognitive biases are involved, most likely caused by damage or disturbance to the right hemisphere of the brain.

However, there is still little conclusive evidence for the very striking reasoning errors you might expect with such strikingly unusual delusions.

Link to FT article ‘Deadly serious’.
Link to abstract of scientific study.

Police taser a man having an epileptic seizure

ABC News report that Oakland police tasered a man having an epileptic seizure because he became agitated when restrained. They subsequently prosecuted him for assault and disorderly conduct. You couldn’t make it up if you tried.

From a press release from the Epilepsy Foundation:

The case in Michigan involved Daniel Beloungea, who was taking a daily walk in his neighborhood when he experienced a complex partial seizure, which left him in a state of semi-consciousness. Complex partial seizures are associated with repetitive involuntary movements, sometimes for up to 30 minutes, with post-seizure disorientation. Beloungea needs to walk daily as a form of rehabilitation to help restore functioning in his legs; this functioning was impaired following brain surgery to treat his seizures. A person passing by noticed Mr. Beloungea acting erratically and called police to report his behavior. When officers arrived on the scene, they apparently assumed that his failure to respond to their questions and his erratic involuntary movements amounted to resistance, and failed to recognize the obvious signs of a seizure. Furthermore, they failed to inspect the medical alert bracelet he was wearing, which indicates clearly that he has epilepsy.

According to police reports, when Mr. Beloungea was unresponsive to police direction, the bag he was carrying was kicked by police from his hand, and when he flailed his arms involuntarily, he was tasered, sending 50,000 volts of electricity through his body (risking serious injury or death); hit with a police baton; threatened at gunpoint; and handcuffed behind his back. (The handcuffing itself is dangerous for persons experiencing a seizure, as it can lead to further seizure-related agitation and struggling, possibly causing asphyxiation or even cardiac arrest.) He was then prosecuted for assaulting police officers and disorderly conduct, notwithstanding considerable evidence, including the state’s own mental health evaluation, confirming that his actions were involuntary and solely the product of a seizure.

There’s more in an article from The Oakland Press and there’s an article and two video clips from ABC News.

The video clips are interesting, as they show Beloungea being recorded as part of a clinical EEG investigation for epilepsy.

The videos have recordings of his behaviour and recordings from his brain synchronised together.

The second clip shows what most people might think of as an epileptic seizure – someone who’s obviously not with it, making repetitive movements.

The first clip, also shows a seizure (look for the intense EEG activity), but his movements seem more coordinated and purposeful.

Complex partial seizures are where the person has impaired consciousness (complex), where only a part of the brain is involved (partial) and where neurons are taken over by synchronous waves of activity and can’t continue their normal operation (seizure).

Because of the selective nature of these seizures, they tend only to affect certain brain functions, often leading to actions that are carried out without conscious control.

We know that the more we practice actions the less conscious effort is needed to carry them out, and that we only need to intervene consciously when special care or attention is needed. Driving a car or riding a bike are classic examples.

It is possible that in some people with complex partial seizures, consciousness becomes so disconnected from action that ‘best guess’ automatic actions are carried out but without awareness of the details which might otherwise inhibit the person’s inappropriate responses.

For example, in the first video clip, Beloungea has to be prevented from removing the EEG recording equipment. It may be annoying, but people with awareness will put up with annoyance for the sake of the medical assessment. During a seizure, this ability to inhibit automatic responses can be lost.

There are many reports in the medical literature of people carrying out actions during a seizure that they would normally prevent themselves from doing – such as a vegetarian eating a sausage.

It seems the police weren’t trained to recognise someone having this type of epileptic seizure, which seems a preventable but tragic oversight.

How Beloungea came to be prosecuted for actions which the court accepted were beyond his control seems much more bizarre and worrying.

If you want to learn how to recognise and help someone who is experiencing an epileptic seizure, there’s more information here.

Link to ABC News story and video clips.
Link to Oakland Press story.
Link to Epilepsy foundation press release.
Link to excellent discussion from Afarensis.
Link to ‘First-aid for seizures’.

Neuroanatomy drawn in blood

Neurofuture’s Sandra Kiume, who seems to have a knack for discovering striking neuroart projects, has picked up on some pieces by Laura Splan, who has produced detailed neuroanatomy images drawn with her own blood.

Thought Patterns is a series of images inspired by neuroanatomical structures. Each drawing was created using blood taken from my fingertips as the primary medium. The series explores the relationship between the images being depicted and the source of the medium with which they are drawn. I was drawn to these images as a formal exploration of the elements of our body that tell us we sense pain or pleasure.

Wow. There’s more at the links below.

Link to Neurofuture post.
Link to Laura Splan’s website.

2006-11-24 Spike activity

Quick links from the past week in mind and brain news:

Our obsession with physical appearance may not be so shallow, after all suggests an article in the Washington Post.

The New York Times discusses how personal space and physical presence in one-to-one communication differs between cultures.

More from PsyBlog’s series on emotion: Neural Correlates of Emotional Judgements.

Noonday Demon author Andrew Solomon discusses current progress in understanding and treating depression.

Is this the first self-aware robot? Good analysis and more detail (and video!) from the Neurophilosopher here.

V.S. Ramachandran considers some of the key issues in consciousness research in an article for Seed Magazine.

Study finds new generation antipsychotics are not much better than the old ones (again).

B Fred Skinner

In some circles behaviourism is associated with a kind of fascism, or at the very least an austere puritanism (to contrast it with its nemesis, the literary/humanistic psychoanalysis). B.F. Skinner particularly suffers from this association, because of his pivotal role in the development of the science and philosophy of behaviourism, and perhaps because of some of his political writings (e.g. ‘Beyond Freedom and Dignity‘, 1971). There’s even an entirely false story that he applied behaviourist control techniques to his family, with disastrous results.

Skinner As Self-Manager by Rober Epstein, a student and later colleague of Skinner, gives an account of Skinner, and his style of life, which is in stark contrast to the disempowering, mechanistically-clinical, image some might have of behaviourist psychology:

Each day of our collaboration brought new projects and new excitement, and, as I got to know Skinner better, my awe began to subside. He insisted, for one thing, that I call him ‚ÄòFred,‚Äô and it‚Äôs hard to be in awe of someone named Fred (his full name is Burrhus Frederic Skinner)… Fred‚Äôs manner was casual and far from intimidating. He often leaned back in his chair as he spoke, and his eyes sparkled with the energy of a man in his 20s, even though he was past 70. He told jokes and recited limericks, and he loved to hear new ones.

To my knowledge, and all of the rumors notwithstanding, Fred did not rely on ‘behavior modification’ techniques to ‘control’ people. Quite the contrary. He was relaxed, natural, and gentle in most of his dealings with other people. His interpersonal style was made milder, if anything, by the scientific principles he helped to develop, because his research convinced him that punishment was a poor tool for changing behavior, so he avoided using it in his everyday life.

Life, to Fred, was a series of joys to relish and challenges to overcome, and he did both extremely well…Fred was the most creative, most productive, and happiest person I have ever known.