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.