Down the barrel of a nail gun

The ANZ Journal of Surgery just published the summary of a conference paper describing 12 patients with head injuries caused by nail guns. It makes for some surprising reading.

You might think brain injuries from nail guns would be rare, but there are a startling number of case studies in the medical literature.

A recent review of suicide attempts by nail gun noted it was unusual, but this new case series suggests that many of this type of brain injury are caused in this way.

In fact, out of the 12 cases, three quarters were attempting to kill themselves.

Mostly, the cases concern a single nail, but one case was particularly extreme:

The other case involved a staggering 24 nails of 5cm length and represents the largest number of intra-cranial nails in a surviving patient.

This beats the previous record of 12 nails, held by a man reported in a case study from a neurosurgery team in Portland, Oregon.

The picture is the X-ray of Isidro Mejia, who survived a nail gun accident in 2004, where he was unfortunate enough to have four nails embedded in his skull and two in his neck.

Removal of a nail often involves a craniotomy, where the surgeons have to cut around the bit of skull where the nail is embedded, and remove it in one piece.

There are some images of this operation in an article from the Spanish language neurosurgery journal Neurocirugía which is available online as a pdf.

Link to abstract of nail gun head injury case series.
pdf of Spanish language case report of neurosurgical nail removal.

Skywalker: personality disordered or misunderstood?

Wired has picked up on the annual ‘psychiatrists diagnose fictional character’ story by noting that researchers have diagnosed Anakin Skywalker, aka Darth Vader, with borderline personality disorder. But is he genuinely disordered or just misunderstood?

The diagnosis of personality disorder describes someone who is consistently emotionally unstable, impulsive and has difficulty forming stable relationships, often seeming aggressive and lacking in self-control.

Borderline personality disorder or BPD is a subtype, particularly characterised by feelings of emptiness and unstable identity, suicide and self-harm, extreme and fluctuating views of others, and occasional paranoid thinking.

In 1988 two psychiatrists published an influential study that questioned the diagnosis of personality disorder, suggesting it was just a label for patients that psychiatrists didn’t like.

Lewis and Appleby gave a group of psychiatrists a number of clinical case studies, and asked them to rate their attitudes towards the patients, and say how they would treat them.

All the psychiatrists were given the same descriptions, except that some included an additional piece of information: that the patient had been given an earlier diagnosis of personality disorder.

This simple piece of information led the patients to be rated as less deserving of care, more difficult, manipulative, attention-seeking, annoying, and more in control of their suicidal urges and debts.

The authors of the study concluded that personality disorder “appears to be an enduring pejorative judgement rather than a clinical diagnosis. It is proposed that the concept be abandoned”.

Although widely used, the diagnosis is still controversial, with some researchers arguing it is a useful and important classification, although admitting there’s still plenty of work to be done.

So does Anakin Skywalker have borderline personality disorder? He probably fulfils the diagnostic criteria.

But the questions should really be ‘does the diagnosis do anything except express our dislike for him?’ and ‘will medicalising his problems help him to improve his life?’.

Link to Wired article on diagnosing Anakin Skywalker (via OmniBrain).

2007-05-25 Spike activity

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

The BPS Research Digest reports on yet another study on the cognitive benefits of meditation.

CrimePsychBlog picks up on an interesting study on the etiology of the psychopathic serial killer.

Core cognitive ability is mostly developed before adolescence, reports SciAm.

Accidental Mind has some illustrated brain notecards to download.

ABC Radio National’s Health Report has a special on Alzheimer’s disease, testosterone and the ageing brain.

Developing Intelligence investigates the neural basis of planning abilities.

The use of oxygen just after a stroke may actually harm the brain rather than help it, suggests a new study reported in SciAm.

Companies tune in to the potential of sound for marketing, reports The Economist.

A couple of interesting news stories on the treatment of mental illness in the US military are picked up by Corpus Callosum.

Wired report on new commercial prototypes for ‘home use’ magnetic brain stimulators.

A perceptual deficiency may make us better foragers, suggests research expertly covered by Cognitive Daily.

SciAm investigates the effects of having half the brain surgically removed.

Narrative self, split brain

If you liked our recent post on what the stories of our lives say about us, Philosophy Now has an article on how the self might be based on our ability to create narratives.

The article looks at how the self has been related to our ability to make narratives out of the disconnected events in our lives, and particularly focuses on the theories of philosophers Alasdair MacIntyre and Paul Ricoeur.

MacIntyre emphasises that the concept of personal identity is not only logically dependent upon the concept of a narrative, but it’s also the other way round. In other words it is meaningless to talk about a character biography unless one presupposes that its subject has a personal identity. The biography must be about a continually-existing thing. Conversely, it is pointless, meaningless, to state that some being has a personal identity through time, and at the same time deny that this being has a possible biography.

[In Ricoeur’s theory] narratives, or more precisely plots, synthesise reality. A plot fuses together intentions, causal relations, and chance occurrences in a unified sequence of actions and events. Ricoeur seems to think that the plot creates a unified pattern in a chaotic series of events, ties them together, making them meaningful wholes.

This idea has also been taken up by more cognitive science-oriented philosophers, most notably, Daniel Dennett.

In his paper ‘The Self as a Center of Narrative Gravity’, Dennett argues that the main function of consciousness is to generate a sense of narrative for our experiences.

He references experiments on ‘split-brain‘ patients, whose cortical hemisphere’s cannot directly communicate because their main link, the corpus callosum, has been severed.

In some situations, these patients seem to show a self which isn’t a unified whole, where some knowledge and experience is accessible to some parts (like perception) but not others (like speech).

Despite these obvious divisions, the patients report that they still feel like an apparently unified “sole inhabitant” of the body, as if their narrative is maintained.

Link to Philosophy Now article ‘Don Quixote and The Narrative Self’.
Link to Dennett’s article ‘The Self as a Center of Narrative Gravity’.

Confronting suicide on campus and online

Two articles published yesterday examine youth suicide by focusing on the increasing number of suicides among US college students and how Korean authorities are trying to crack down on suicide websites and online pacts.

An article in the The LA Times examined how student suicides are leading people to question the adequacy of campus mental health services.

The student years often put a particular strain on mental health.

Because of existing support, many people are now able to attend university that would have never gone before because their mental disorder couldn’t be adequately managed.

However, the transition to university life can put additional strain on some people, and the late teens and early twenties are when most mental health problems emerge, even for people who don’t attend college.

The New York Times article investigates how suicidal young people in South Korea are using the web to trade tips and organise suicide pacts.

As part of a wider suicide prevention plan, The Korean authorites are now trying to crack down on these websites in a bid to stop young people encouraging each other’s suicidial tendencies.

Link to LA Times article ‘Suicides a symptom of larger UC crisis’.
Link to NYT article ‘Tracking an Online Trend, and a Route to Suicide’.

Headlong into brain injury and skullduggery

These completely passed me by last year but are well worth checking out: BBC Radio 4 broadcast a couple of excellent radio programmes – one on the effects and treatment of mild brain injury and other other on the doomed historical attempt to link intelligence to skull size.

Mild traumatic brain injury doesn’t necessarily mean that effects are minor.

For some people, fatigue, poor concentration, memory difficulties and irritability may continue when the immediate affects of the injury have subsided.

These symptoms can be quite dramatic, even after simple concussion, and there is now significant interest in this post-concussional syndrome as it is quite disabling for some people.

What is interesting, is that there is evidence that these symptoms can arise out of a combination of the original brain damage plus psychological distress and poor coping strategies.

In other words, it’s not just the brain injury that causes the problems but also how people make sense of and deal with their experience.

The programme on skull size and intelligence looks at how early 20th century researchers tried to link intelligence to skull size in the futile attempt to prove that various races where biologically inferior.

A dodgy aim but an important chapter in the history of science gone wrong.

Link to documentary on mild brain injury.
Link to documentary on intelligence and skull size.

The story of your life

The New York Times has an interesting piece on an often neglected area of psychology that looks at the significance of the stories we use to explain our lives to ourselves and others.

A small but active area of research called ‘narrative psychology‘ has been examining how we make and use stories about our experiences for some years now.

The NYT article picks up on some research findings from Dr Dan McAdams’ research group that show some common themes in life stories and suggest they may be linked to particular psychological characteristics:

In analyzing the texts, the researchers found strong correlations between the content of people’s current lives and the stories they tell. Those with mood problems have many good memories, but these scenes are usually tainted by some dark detail. The pride of college graduation is spoiled when a friend makes a cutting remark. The wedding party was wonderful until the best man collapsed from drink. A note of disappointment seems to close each narrative phrase.

By contrast, so-called generative adults — those who score highly on tests measuring civic-mindedness, and who are likely to be energetic and involved — tend to see many of the events in their life in the reverse order, as linked by themes of redemption. They flunked sixth grade but met a wonderful counselor and made honor roll in seventh. They were laid low by divorce, only to meet a wonderful new partner. Often, too, they say they felt singled out from very early in life — protected, even as others nearby suffered.

The article also suggests that the narratives are heavily influenced by our social knowledge, so we apply cultural templates for stories of success, failure and redemption to best make sense of our experience.

Link to NYT article ‘This Is Your Life (and How You Tell It)’.

The irrational guide to gaming the system

The latest edition of Scientific American has a freely available feature article on how our decisions are often irrational in game theory terms, but can still be more beneficial than the supposed rational choice.

Game theory tries to understand choices when individuals are working independently and each choice affects the other person’s gains or losses.

In other words, it asks the question ‘considering I don’t know what choice the other person is going to make, what is the best option to maximise my own outcome?’.

This was famously the basis of the American Cold War policy of stockpiling huge amounts of nuclear missiles.

Obviously it would be better if there were fewer nuclear weapons in the world, but if the USA decided to reduce the number of missiles, how could it trust the Soviets to do the same?

Game theory suggested that the best option was to have so many weapons that they could destroy the other country. This way, if the other country reduced their stockpile, they were safe, and if they didn’t, both countries were equally armed.

If this were the case, the potential outcome for starting a nuclear war would be the destruction of both countries. As each wanted to avoid this fate, the idea was that it resulted in a stable but uneasy standoff.

Without a hint of irony, the policy was called MAD, short for Mutual Assured Destruction.

While this is perhaps an extreme example of game theory in action, it can be applied to many situations in which gains and losses are dependent on another person’s choices.

In essence, it’s a mathematical take on a psychological guessing game.

The SciAm article looks at how there are many situations where game theory predicts the most rational outcome, but which may actually lead to much less gains for everyone than if people make an irrational response.

One version of the most rational outcome is the Nash equilibrium, named after Nobel-prize winning mathematician John Nash, who was also the subject of the film A Beautiful Mind.

This is where everyone has settled on a choice where no one has anything to gain by choosing something else.

As the article discusses, this rarely happens in practice, however, and in many cases people just take the risk that they may get screwed over and maximise their benefits as a result.

This suggests that game theory can be a narrow view of human interaction (for example, it doesn’t account for the role of dialogue in the arms race).

This was also a criticism made by Adam Curtis, producer of documentary series The Trap, who argued that game theory had given a cynical and oversimplified view of human psychology that has been disastrously applied to politics.

Whether you buy Curtis’ political view or not, it’s a fascinating example of how trying to model psychological decision making can have a huge influence on world politics.

Curtis’ documentary is variously available online, but unfortunately, video streaming sites are blocked from work, but it seems to turn up quite frequently on a Google search.

And if you want more on economics and rationality, ABC Radio National’s The Philosopher’s Zone just had a programme on the ethics of economic rationalism.

UPDATE: The Trap episode 1, episode 2 and episode 3 are available on Google video. From some reason episode 3 is in three 20 minutes chunks, but the next chunk is linked from each page.

Link to SciAm article ‘The Traveler’s Dilemma’.
Link to The Philosopher’s Zone on economic rationalism.

Encephalon 23 arrives

The 23rd edition of psychology and neuroscience writing carnival Encephalon has just been published, this time ably hosted by Madam Fathom.

A couple of my favourites include a fantastic article on inducing slow wave sleep by stimulating the brain with magnets – from the wonderfully named Phineas Gage Fan Club, and some excellent coverage from The Neurocritic on an intriguing theory about how higher cognitive functions might be organised in the brain.

If you want more of the latest musings from the internet’s keenest mind and brain writers, you know where to go.

Link to Encephalon 23.

A Secret not worth keeping

If you roll your eyes every time you hear more media hype surrounding the pseudoscientific ‘think your way to victory’ film The Secret, Scientific American has a short, sharp, shock of a reply to its dodgy claims about the mind and brain.

A pantheon of shiny, happy people assures viewers that The Secret is grounded in science: “It has been proven scientifically that a positive thought is hundreds of times more powerful than a negative thought.” No, it hasn’t. “Our physiology creates disease to give us feedback, to let us know we have an imbalanced perspective, and we’re not loving and we’re not grateful.” Those ungrateful cancer patients. “You’ve got enough power in your body to illuminate a whole city for nearly a week.” Sure, if you convert your body’s hydrogen into energy through nuclear fission. “Thoughts are sending out that magnetic signal that is drawing the parallel back to you.” But in magnets, opposites attract–positive is attracted to negative. “Every thought has a frequency…. If you are thinking that thought over and over again you are emitting that frequency.”

The brain does produce electrical activity from the ion currents flowing among neurons during synaptic transmission, and in accordance with Maxwell’s equations any electric current produces a magnetic field. But as neuroscientist Russell A. Poldrack of the University of California, Los Angeles, explained to me, these fields are minuscule and can be measured only by using an extremely sensitive superconducting quantum interference device (SQUID) in a room heavily shielded against outside magnetic sources.

Actually, I’m all for anything that helps people to think more positively, but basing your advice on misinformation and empty promises is a recipe for disaster.

Link to SciAm article ‘The (Other) Secret’.

Is the mental health system racist?

BBC’s Newsnight programme just had an interesting video report on the renewed debate about whether mental health services are institutionally racist.

While these accusations have been made for some time, what is new is that some black and ethnic minority mental health workers who work in these communities are starting to argue that this label actually makes it more difficult to provide fair treatment to their patients.

The subject was recently tackled in one of regular debates held at the Maudsley Hospital in South East London, which is available online as a podcast.

It is widely known that in the UK, black and ethnic ethnic minority people are much more likely to be diagnosed with a psychotic mental illness, such as schizophrenia, than other members of society.

While this was originally thought to be a sign of racism in itself, studies have suggested that this pattern is true of almost all immigrant communities (e.g. Finnish immigrants to Sweden), rather than simply a black and white issue, and that the rates still hold when psychiatrists are asked to diagnose cases based only on their symptoms with the ethic origin hidden.

The debate has now largely moved on and the focus is now on outcomes and experiences in the mental health system.

For example, regardless of the higher rates of psychosis, it seems that when in contact with mental health services, outcomes for Afro-Carribean people are much worse than white people.

This is where the subtlety in the debate lies. Higher rates of diagnosis in one racial group are not necessarilly a sign of discrimination, but poorer outcomes after treatment has started are more likely to suggest this group is not being fairly treated.

An influential report called ‘Breaking the Circles of Fear’ found that people from ethnic minorties tend to have a more negative experience of the mental health system and fear the consequences of becoming involved with it.

Furthermore, it found that mental health professionals were often afraid of talking about race issues for fear of appearing racist.

Psychiatrists Prof Swaran Singh (pictured) and Dr Shubulade Smith argue in the video report that accusations of racism actually make it more difficult for people from ethnic minority communities to get fair treatment, as it interferes with sensible clinical decision making.

In contrast, campaigners like Lee Jasper and psychiatrist Dr Kwame McKenzie argue that unless we admit that the system is racist, problems won’t be adequately addressed.

One important factor might be that immigrant communities tend to be poor, live in urban environments, have weaker family support and have higher rates of drug and alcohol abuse, all of which have been found to increase rates of schizophrenia.

This makes it difficult to disentangle the effects of mental health treatment, and a society where black and ethnic minority groups are more likely to live stressful and depressed communities.

The fact that ethnic minority psychiatrists are now starting to challenge the idea that the mental health system is racist must be a positive sign, however, as twenty years ago, most would be in agreement that it was not set up to deal with the needs of minority communities.

Link to BBC News on the debate with video report.
Link to podcast of Maudsley Debate ‘The Race Blame Game’.

Faster, Pussycat! Kill! Kill!

I’ve just found an entry on PubMed for a curious sounding case study:

An unusual perversion: the desire to be injured by an automobile operated by a woman.

American Journal of Psychiatry. 1960 May;116:1032.


I imagine it caused havoc during rush hour.

Unfortunately, the paper doesn’t have a summary, and I’m not able to access back issues of the AJP at the moment, so it will have to remain a mystery for the time being.

Link to PubMed entry.

A report from LSD creator’s 100th birthday conference

Online science magazine Litmus Zine has a interesting report of one person’s experience of last year’s LSD conference that was convened to discuss the science of this curious molecule and celebrate discover Dr Albert Hoffman’s 100th birthday.

The conference took place in Basel, Switzerland and the attendees were reportedly a strange mixture of neuroscientists, hippys, psychologists, artists, sociologists and visionaries.

The article weaves the history of LSD with the topics of the conference, giving an account of the drug’s past and present.

I’ve not come across Litmus Zine before, but it looks like it’s got some great content already online and aims to take a fresh approach to science writing.

Link to article ‘Turn On, Tune In, Drop Out ‚Ķ Get Well?’ (thanks Mat!)

Jerry Fodor’s aunt

Many thanks to Ulrich Mohrhoff for reminding me of the Jerry Fodor article I was trying to remember where he explains his theory of mental representation to his aunt.

The article is called “Fodor’s Guide to Mental Representation: The Intelligent Auntie’s Vade-Mecum”, published in Mind, (New Series, Vol. 94, No. 373, Jan., 1985, pp. 76-100) and reprinted in Readings in Philosophy and Cognitive Science (ISBN 0262071533).

The whole article doesn’t seem to be available online, but the first page does seem to appear on JSTOR.

The opening paragraph is wonderful:

It rained for week and we were all so tired of ontology, but there didn’t seem to be much else to do. Some of the children started to sulk and pull the cat’s tail. It was going to be an awful afternoon until Uncle Wilfred thought of Mental Representations (which was a game we hadn’t played for years) and everyone got very excited and we jumped up and down and waved our hands and all talked at once and had a perfectly lovely romp. But Auntie said she couldn’t stand the noise and there would be tears before bedtime if we didn’t please calm down.

Link to first page of ‘Fodor’s Guide to Mental Representation’.

You can’t make metaphysics out of fudge

Philosopher Jerry Fodor has written a wonderfully entertaining review of Galen Strawson’s new book ‘Consciousness and Its Place in Nature’ for the London Review of Books.

In his book, Strawson looks at the assumption that consciousness arises from the physical matter of the brain and comes to the startling but coherent conclusion that maybe everything has the capacity for consciousness.

Fodor explains it like so:

So, then, if everything is made of the same sort of stuff as tables and chairs (as per monism), and if at least some of the things made of that sort of stuff are conscious (there is no doubt that we are), and if there is no way of assembling stuff that isn’t conscious that produces stuff that is (there’s no emergence), it follows that the stuff that tables, chairs and the bodies of animals (and, indeed, everything else) is made of must itself be conscious. Strawson, having wrestled his angel to a draw, stands revealed as a panpsychist: basic things (protons, for example) are loci of conscious experience. You don’t find that plausible? Well, I warned you.

Fodor is always a great read (just have a look at the first paragraph of the review) and he often writes amusing and original articles.

One of his papers (and for the life of me I can’t remember which) takes the form of him explaining a philosophical argument to his aunt.

His ideas causes all sorts of controversy in cognitive science. For example, he argues that humans have a language of thought – a sort of common basic code that all thought is based on.

Artificial intelligence researchers love this approach, as you might expect, but it drives many people nuts as they object to the ideas that the mind is just an information processor and that concepts and beliefs can be independently represented in the brain.

My favourite retort is from a book by Still and Costall called ‘Against Cognitivism’ (ISBN 0745010253) who write that Fodor’s theories are

“where one tries to keep a reasonably straight face while presenting the absurd consequences of the scheme as exciting theoretical revelations”.

Have that sir!

There’s a funny tagline at the bottom of Fodor’s review relating to such criticisms which made me chuckle:

Jerry Fodor teaches philosophy and psychology at Rutgers University. Everyone wonders why he is writing still another book about the language of thought.

And if anyone knows the name of the Fodor article I can’t remember, do let me know!

Link to review of ‘Consciousness and Its Place in Nature’ (via 3Q).
Link to details of book.