A visual record of madness in 50s France

Luminous Lint has published a collection of evocative images by photographer Jean-Philippe Charbonnier who documented French psychiatric hospitals and psychiatric patients in the 1950s.

Some of the most important developments in psychiatry have happened in France.

Physician Phillipe Pinel was one of the first people to advocate humane treatment for patients with mental illness and epilepsy.

A famous painting shows him overseeing the removal of chains from patients at the Salpêtrière Hospital in 1795 Paris.

The photo collection shows French psychiatry in the 1950s and contain both hopeful and desperate scenes.

This sort of historical record is important both to realise how far psychiatry has developed since these bygone days, and to pick up where change still needs to occur.

Link to Jean-Philippe Charbonnier photo collection (via BB).

Working in the future imperfect

The aesthetically and intellectually compelling PsyBlog has a great article arguing that long-term career planning is often a waste of time as research has shown that we are unlikely to be able to predict what will make us happy in the future.

The research was a paper from Daniel Gilbert’s lab, that specifically studies happiness, how we understand it, and how it is affected by life events and our choices.

Gilbert has written a book about his research called Stumbling on Happiness that discusses the fact that although we think we know what will make us happy, it rarely does.

PsyBlog notes one particular experiment that highlights this effect:

My favourite is a simple experiment in which two groups of participants get free sandwiches if they participate in the experiment – a doozie for any undergraduate.

One group has to choose which sandwiches they want for an entire week in advance. The other group gets to choose which they want each day. A fascinating thing happens. People who choose their favourite sandwich each day at lunchtime also often choose the same sandwich. This group turns out to be reasonably happy with its choice.

Amazingly, though, people choosing in advance assume that what they’ll want for lunch next week is a variety. And so they choose a turkey sandwich Monday, tuna on Tuesday, egg on Wednesday and so on. It turn out that when next week rolls around they generally don’t like the variety they thought they would. In fact they are significantly less happy with their choices than the group who chose their sandwiches on the day.

The PsyBlog post draws these findings out and applies them to making career choices.

How will we know what make us happy in even 5 years away if we can’t even predict what sandwiches we’d be most happy with during the following week?

Link to PsyBlog post ‘Why Career Planning Is Time Wasted’.

Autism, In My Language

Amanda Baggs is a young woman with autism and she’s created a powerful and articulate video that ‘translates’ from her world of environmental interaction to the neurotypical form of speech and perception.

As well as a stunning view into how she experiences and makes sense of the world, it’s also a forceful philosophical argument concerning how the mainstream understands people who don’t think or communicate in a conventional way.

Presumably speech-less (either through choice or development), Baggs communicates to the viewer using a voice synthesiser and on-screen text.

She has also put many of her medical notes online, sharpening the contrast between our assumptions about autism, and the message she deftly communicates.

Well worth watching to the end. A profound and exciting insight into an alternative humanity.

Link to YouTube video ‘In My Language’ (via Joy of Autism).

What we still don’t know

The February edition of Wired magazine has a special feature on 42 of the biggest unanswered questions in science. Several of them concern the mind, brain and behaviour.

How the brain creates consciousness is, perhaps, one of the most obvious ones.

If you’re not familiar with sleep research, you might find the question about why we sleep a surprising inclusion. However, the difficulty with conducting neuropsychology experiments on sleeping people makes this a very difficult question to answer, despite some fascinating ongoing research.

The evolution of language is, perhaps, an example of the problem in reverse. Doing experiments on language is much easier, because we understand the system so we can manipulate meaning and syntax independently. However, the sheer complexity of language makes it a mammoth task.

Placebos are also a curious and mysterious phenomenon, and inspire wider questions about how expectation and suggestion affects the function of the body.

The final question concerns how the brain calculates movement. There are an infinite number of possible muscle movements that allow you to perform the same action – for example, picking up a cup.

Think about it for a second. You could just grab the cup, or walk to India first. Even if you chose the near option, each tiny adjustment to the muscles can be modified ad infinitum.

To pick up the cup, the brain has to choose the most efficient action out of an infinite number of possibilities. Working through an infinite number of possibilities should take infinite time, yet we move fluidly and often without conscious thought.

Interestingly, you can help clarify the issues and answer the question to the best of current knowledge, as each entry has a link to a wiki where you can make your suggestions for each mini-article.

Link to Wired on “What We Don’t Know”.

Call of the weird

Film-maker Louis Theroux has written an insightful article for the BBC website about society’s view of weirdness and his experience of meeting out-of-the-ordinary people.

He suggests that ‘weirdness’ is in the eye of the beholder as the idea of what makes someone ‘weird’ is just the result of our transient views of what is considered normal, regardless of how common the actual opinion or behaviour is.

Furthermore, he notes that ‘weird’ behaviour is often understandable if you put yourself in the person’s shoes.

Though it’s been helpful as a kind of short-hand for the sort of stories I do, the term “weirdness” actually does a disservice to the people I cover. Looking closer at what seemed – at first hand – the oddest of behaviour and I’ve always found a kind of logic.

I was recently reading a book of neurological essays called Phantoms in the Brain, which had an introduction by neurologist Oliver Sacks. He discussed brain disorders with symptoms that to me seemed very weird indeed – patients who don’t recognise their own limbs as belonging to them, for example, or who sometimes think one side of their body belongs to someone else.

But these are, he says, “quite normal defence mechanisms” which the unconscious uses to make sense of the world. “Such an understanding removes such patients from the realm of the mad or the freakish,” he continues, “and restores them to the realm of discourse and reason – albeit the discourse and reason of the unconscious.”

It’s interesting that Theroux makes a connection between people considered ‘socially weird’ and those considered ‘clinically disordered’.

There’s a been an ongoing debate in psychiatry about the extent to which particular psychiatric diagnoses are influenced by social perceptions of certain behaviour and the wish to classify them as different.

For example, people will regularly talk about “the mentally ill” as if they were a coherent group (e.g ‘these health reforms will affect the mentally ill’) but almost never talk about “the physically ill” in the same way.

We know that mental illness is not a cut-and-dry affair. Psychosis, for example, is found on a continuum with everybody having psychosis-like experiences to some degree.

People diagnosed with psychotic disorders just have very frequent or intense experiences that cause them distress or impairment. The rest of us hardly notice them or aren’t bothered by them if they do occur.

In other words, the odd beliefs and behaviours of the ‘weird’ are just part of life’s rich tapestry.

Theroux ends by saying that “weird beliefs” never stood in the way of him making a human connection, which is another way of saying that we classify people are weird to put unnecessary distance between ‘them’ and ‘us’, when in reality, there is only us.

Link to article ‘Weird, or just in search of meaning?’.

Kicking the habit the hard way

A study published in today’s edition of Science reports that nicotine addicted patients who acquired damage to the insula – an area just behind the temporal lobes – reported that the urge to smoke reduced after their brain damage occurred.

The insula is coloured red in the diagram on the right and has been heavily linked to emotional responses, particularly the perception and experience of disgust.

However, this new study, led by Nasir Naqvi, suggests that the insula is also heavily involved in addiction-related cravings.

Studying patients with brain damage is one of the most powerful methods in cognitive neuroscience.

While brain scans can tell you which areas of the brain might be associated with a particular experience or behaviour, they can’t tell you whether that area is necessary or not.

If you think a brain area might be crucial for a certain process, finding someone who has damage to that area should confirm whether your idea is correct or not by seeing whether they still have the ability or experience you think is linked to the area.

In Bechara and colleagues’ study, they included a series of patients who had insula damage, either after suffering a stroke, or after having it deliberately removed as part of brain surgery to treat epilepsy or brain cancer.

Because this sort of damage is rarely precise and causes damage to a number of areas in addition to the insula, a series of patients was studied.

While other damage was present, the patients only had insula damage in common.

This means when group results are analysed, the strongest overall effect should be related to insula damage, whereas effects from damage to other areas wouldn’t be as apparent, because it’s not common to all patients.

The researchers compared the group with insula damage to other smokers who had suffered non-insula brain damage by measuring who quit smoking, how strong the cravings were and how easy it was to give up.

Insula-damaged patients were much more likely to have quit smoking than the other patients, to experience less cravings, and to have found it easier to give up.

The researchers start their paper by noting that “cigarette smoking [is] the most common preventable cause of morbidity and mortality in the developed world”.

You can bet this study will cause massive interest in the pharmaceutical industry who will be attempting to work out the neurochemistry of the insula to try and create drugs which will make treating addiction easier.

Undoubtedly, education and prevention will be much cheaper, but it’s hard to make money out of people who don’t become addicted.

That’s progress for you.

Link to ScienceNow write-up of study.
Link to study abstract.