Month: August 2007

ABC Radio National’s All in the Mind has just had a special edition on the increasingly contentious debate over whether addiction is a brain disease, and does a fine job of highlighting the politics behind the interpretation of the science.

This much is agreed upon: some people inherit a greater propensity for becoming addicted to certain drugs, and taken in enough quantities, some drugs can cause long-term alterations the brain’s reward system to make non-drug pleasures less rewarding, thereby increasing future chances of drug-taking.

The controversial issue, which All the Mind tackles, is over how much this should be described as a ‘brain disease’ or a ‘psychological problem’, and this is usually where the politics kicks in.

Whenever you hear this sort of rhetoric in mental health, it’s often a reflection of a deeper argument beneath the surface – an argument over how much someone is personally responsible, or more worryingly, ‘to blame’, for their state of distress or impairment. The same often goes for the ‘genes vs environment’, ‘nature vs nurture’ debate.

There is a condition which is a great example of how thinking only in terms of ‘mind or brain’, ‘genes or environment’ is flawed for anything which involves an external trigger.

Phenylketonuria (PKU) is a single-gene disorder that results in a missing enzyme which is needed to break down phenylalanine into the building blocks of certain neurotransmitters. Without the enzyme, phenylalanine accumulates in the body, leading to problems with brain development, cognitive impairments, seizures and psychosis.

However, if people with PKU avoid phenylalanine in their diet, they have no problems at all (this is why certain foods are marked with “contains a source of phenylalanine”).

So, is PKU a genetic disorder or an environmental one? A brain disease or a psychological problem? There is no single answer. It depends how you look at it.

In a sense it’s 100% genetic, because a single gene determines whether you have the missing enzyme or not. But in another sense, it’s 100% environmental, because it’s not a problem unless you encounter phenylalanine in the environment.

Similarly, you could say it’s a brain disease, because people with PKU inherit a problem with the neurotransmitter pathway, but in another sense, it’s a psychological problem, because poor diet decision-making and vigilance can determine the likelihood of becoming sick.

What is striking is that this division into ‘brain’ and ‘mind’ is completely artificial and counter-productive. You need to understand both to see how PKU affects someone’s life.

Buy you’ll also notice how political views could favour one view or another.

If you believe in the primacy of personal responsibility, push the psychological model, because this emphasises the affected person’s actions in staying well. At one extreme, it allows us to blame people who get sick through PKU for not being vigilant enough, or wanting other people to pick up the pieces when they fail to control their diets.

If you believe in the primacy of social responsibility, push the disease model, because this emphasises the effects of factors outside an individual’s control. At the other extreme, it allows us to absolve the person of individual responsibility for the effects of their illness.

Addiction is far more complex than PKU, not least because addiction to different substances, or indeed to behaviours such as gambling, can be quite different psychologically, neurologically and socially.

However, you can see how the models used to explain each disorder are selective or can go beyond the evidence in certain instances, so preference for an explanation can be politically biased.

My advice is to be suspicious of anyone who tries to tell you a complex disorder is purely mind or purely brain, and think about what is motivating someone to explain it largely in one way.

Similarly, think of the psychological and neurobiological evidence as complementary, rather than in competition, and be prepared to accept more than one model of how something works. Each might be accurate, but just useful for different things.

This edition of AITM is an example of all of these forces at work.

Link to AITM ‘Addiction: Dis-ease over diseased brains’.

Time magazine has an article on attempts to train law enforcement to prevent people with mental illness from needlessly ending up in behind bars. It includes some startling information, like the fact that more Americans receive mental health care in prisons than in hospitals.

“If you think health care in America is bad, you should look at mental health care,” says Steve Leifman, who works as a special advisor on criminal justice and mental health for the Florida Supreme Court. More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers.

In fact, the country’s largest psychiatric facility isn’t even a hospital, it’s a prison ‚Äî New York City’s Rikers Island, which holds an estimated 3,000 mentally ill inmates at any given time. Fifty years ago, the U.S. had nearly 600,000 state hospital beds for people suffering from mental illness. Today, because of federal and state funding cuts, that number has dwindled to 40,000. When the government began closing state-run hospitals in the 1980s, people suffering from mental illness had nowhere to go. Without proper treatment and care, many ended up in the last place anyone wants to be.

The article starts with a telling correction of a journalistic slip, apologising for stating that one reform was inspired when a man with schizophrenia shot a policeman, when in fact, it was the policeman who shot the patient.

A 1999 US survey found that over 60% of people thought that someone with schizophrenia is ‘somewhat’ or ‘very likely’ to commit an act of interpersonal violence, when we know that people diagnosed with the condition are much more likely to be the victim of violence than the perpetrator.

It seems there are some positive developments, however, and the article describes the Miami Police’s innovative and successful methods of including people with experience of mental disorder in their training, and when dealing with distressed people they encounter.

Link to Time article ‘De-Criminalizing Mental Illness’ (via Spikol).

Salon is reporting that the American Psychological Association is likely to issue a formal condemnation of many CIA interrogation tactics at its annual convention this weekend, although there may be loopholes meaning it falls short of an outright ban.

It has become clear that psychologists are playing a central role in developing and deploying CIA interrogations that a leaked report from International Committee of the Red Cross described as “tantamount to torture”.

Psychologists are important to the CIA partly because the American medical and psychiatric associations have banned their members from participation in such interrogations, citing the practices as abusive.

Views on a possible APA statement are mixed, however, with some concerned that a simple rebuke does not condemn the entire process of indefinite detention without due process and others worried that a ban will be counter-productive, as psychologists may be best placed to prevent abuse and develop humane procedures.

The APA conference has no less than eight sessions on the topic which will include military psychologists, human rights activists, psychologists who study conflict and multicultural issues, and a US Department of Defense interrogator.

However, this is only likely to be the tip-of-the-iceberg and the crucial decision will be on what gets put into the final resolution for members to vote on, with one group, led by Neil Altman, pushing for a complete moratorium on participation.

What remains unclear is whether the APA leadership, headed by APA president Sharon Stephens Brehm, will even allow a vote on Altman’s moratorium. That leadership is seen by some psychologists as too chummy with government interests and with the military in particular. Backers of the moratorium are set to meet with APA leadership before next weekend just to negotiate for the opportunity to bring their resolution up for a vote before the council.

Psychologists interviewed by Salon noted a series of potential loopholes embedded in the resolution condemning CIA tactics. A simple example is the ban on isolation and sleep deprivation, favorite tactics of the CIA. But the resolution from Brehm and the APA leadership only forbids the methods when “used in a manner that adversely affects an individual’s physical or mental health.” There will be efforts in San Francisco to plug those loopholes, and to force a vote on a moratorium.

Link to Salon article ‘Psychologists to CIA: We condemn torture’.
Link to APA Monitor on 2007 Convention Highlights.

This week’s New Scientist has a number of interesting mind and brain articles. The most striking is on locked-in syndrome, where people are completely paralysed despite having intact minds.

The article is by author Laura Spinney who wrote a novel based on locked-in syndrome called The Quick (ISBN 0007240503).

One of the challenges is to find a route for affected patients to communicate with the ‘outside world’. Sometimes eye movements are spared, which famously allowed Jean-Dominique Bauby to write the profoundly beautiful book The Diving Bell and the Butterfly (ISBN 0007139845).

She notes one case where all other routes had failed, so a rather unorthodox approach was tried with initial success, only to slip frustratingly away.

Despite the technology, communication is still a considerable challenge for these people. To operate the TTD [Thought Translation Device – converts movements into words] requires months of arduous training, and the failure rate is high. Last year, in the journal Neurology, Birbaumer and colleagues described a particularly tragic case of failure (vol 67, p 534). A 46-year-old German woman who had been diagnosed with the degenerative disease amyotrophic lateral sclerosis [ALS], also known as motor neuron disease, had made it clear that she desperately wanted to live. By the time she came to Birbaumer’s attention, she had already been locked in for a year. After trying in vain to train her to use the TTD, they decided her chances might improve if they implanted the electrodes in her brain rather than sticking them to her scalp. For this, they needed her consent, which she clearly couldn’t give. Impasse.

Then, walking past an electronics store one day, Birbaumer’s colleague Barbara Wilhelm spotted a medical device for measuring the pH of saliva, and had an idea. They trained the woman to change the acidity of her spit by imagining either the taste of lemon, or the taste of milk. She learned to push the pH one way to say “yes”, the other to say “no”. When they asked her if she agreed to them implanting the electrodes, she replied yes, repeatedly; three hours later, however, she lost control of her salivary pH. The electrodes were implanted, but she hasn’t achieved any control over her brain activity. Birbaumer is still trying to tap into other potential channels of communication, but he fears that after a certain time locked-in patients may lose the capacity to control anything voluntarily.

The issue also has a cover story on whether conscious beings could spontaneously arise from the universe, and another on the effect of breakfast on mental performance.

As New Scientist is still a little bit backward none of the articles have been made freely available (ever wondered why Scientific American gets more coverage on the net?), so you’ll need to find a copy at your local newsagent or library to have a look.

Link to table of contents.

Neuromatrix is a soon to be released action-adventure video game for kids that aims to effortlessly teach them about the function of the brain.

It’s aimed at 10-15 year olds and, from the impressive video trailer, it seems to have a bit of a Half-Life vibe about it – a sort of 3D science-based adventure – probably without all the killing though.

Apparently, the brains of scientists from a neuroscience research centre have been attacked by nanobots, and your job is to save them from certain destruction.

The video game takes you through some of the major brain areas and as you tackle each part, you learn about the scientific method, neurons, the motor cortex, the hippocampus and amygdala.

There’s even extensive teacher’s notes online, so adults can try and keep with the kids.

As for me, I’m still waiting for the sequel to Granny’s Garden.

Link to Neuromatrix website (via Brain Waves).
Link to video trailer.

I’m just reading a fantastic book called Muses, Madmen and Prophets: Rethinking the History, Science, and Meaning of Auditory Hallucination (ISBN 9781594201103) – a wonderfully written book on the complex science and history of ‘hearing voices’.

Annoyingly, the book is published under the name ‘Hearing Voices’ (ISBN 041377645X) in the UK. Annoying, because its the same title as many other books, many of which are on completely different topics.

The book looks at the history of the experience, from some of the most influential ‘voice hearers’ in history, such as Socrates and Joan of Arc, to its classification by psychiatry as a key diagnostic sign of schizophrenia, to its reconsideration as part of the normal diversity of mental phenomena.

We now know that there are many more people who hear voices and never become mentally ill compared to those who become acutely impaired or distressed by the experience.

The book looks at the recent research on the neuropsychology of hallucinated voices but also takes wonderful detours into the significance of the experience for understanding notions of free will and intentionality, creativity and inspiration, and madness and the divine.

The author, ex-editor of Atlantic Monthly, brings an interesting personal angle into the work, as both his father and grandfather heard voices to differing degrees.

So far, I’ve found it poetic, wide-ranging and difficult to put down.

If you’re interested in hearing more, Smith discusses his book and investigations on Boston WBUR Radio which you can listen online.

I also just discovered that Neurophilosophy has a great post on a recent case study of a person with brain injury that affected their speech areas who heard hallucinated voices that had a speech impediment.

Link to book info.
Link to discussion on Boston WBUR radio.
Link to Neurophilosophy on ‘Hearing speech impaired voices’.