Year: 2007

Someone’s uploaded a video which serves both as an important teaching aid for MRI brain scanner safety and a wonderfully entertaining guide to the destructive power of a magnet the size of a small car.

The video itself is a a little bit old, and so has a sort of B-movie quality to it, but which makes it all the more fun.

However, it contains the classic sequence, part of virtually every MRI safety video, where technicians release a steel wrench near the magnet, which then flies through the air and obliterates a number of destructible objects in its path.

The magnetic field is designed to focus on a very specific area, and that’s where your head is placed when you’re scanned.

Any ferrous metals in the room will be drawn towards the centre of the field, probably at speed, which can be quite unfortunate if your head is occupying the same position.

We collected some nice examples of objects stuck in scanners earlier in the year, including chairs, oxygen bottles, and other assorted medical equipment.

If you want to see the sort of force generated by a steel oxygen bottle heading towards the centre of an MR magnet, there’s a short (and somewhat frightening) video on YouTube of some brave MRI technicians demonstrating the effect.

Unfortunately, this is exactly what happened in one tragic case where a six-year-old boy was killed. The incident is now also a standard part of MRI safety training.

However, the danger isn’t only from the ‘missile effect’. Additionally, elongated ferrous objects will try to align with the magnetic field. This is a problem if you have metal implants in your body.

For example, brain surgery to prevent aneurysms (strokes) often involves putting a small metal clip over the blood vessel to clamp it shut, to prevent blood flowing to the burst or weakened area. Nowadays, these clips are not ferrous, so aren’t a problem, but older ones might be affected by magnets.

Having a ferrous metal clip suddenly move inside your head can be disastrous, as it has the potential to shear the blood vessel, causing internal bleeding.

The video also talks about other sorts of possible MR hazards, largely involving the liquid helium and nitrogen boiling off and freezing, poisoning or pressurising the surroundings.

An explosion of an MRI magnetic when the gasses boiled off too quickly was caught on video by a TV news crew which creates quite a spectacular effect.

However, do bear in mind that these incidents are few and far between. Having an MRI is significantly safer than crossing the road.

If you go for an MRI scan, you’ll likely be interviewed and / or examined to make sure you have no metal in your body, and you’ll have all metal removed from you.

If you want to try, you can volunteer for brain scanning experiments where you’ll usually get a small payment and a picture of your brain – contact your local university or teaching hospital.

Link to B-movie style MRI safety video.
Link to video clip of oxygen bottle flying towards MRI scanner.
Link to MRI explosion video.
Link to previous Mind Hacks post on things stuck in scanners.

The New York Times has an article on the changing fortunes of the New York Psychoanalytic Institute and why psychoanalysis is being increasingly marginalised in mental health.

Psychoanalysis, the name for both the theory practice of psychological treatment developed by Freud, was once the driving force behind American psychiatry and the only game in town as far as psychological treatment was concerned.

It is now becoming increasingly marginalised, thought of as a bit eccentric, and overtaken by newer cognitive therapies. Some of the reasons for this are undoubtedly to do with the culture of psychoanalysis itself.

A major historical factor has been the long and contentious history of the movement, which has been subject to constant splits, disagreements and factional in-fighting.

Part of the reason for this, perhaps more than for other therapies, is that psychoanalysis involves a much closer relationship between theory and practice.

In this framework, mental illnesses arise from unresolved emotional conflicts that the mind tries to handle by various psychological defences. These defences may fail, or they may be counter-productive in the long-term, supposedly leading to the symptoms of mental disorder.

The goal of psychoanalysis is not necessarily to reduce the symptoms but to resolve the inner conflicts (Freud famously said he wanted to transform “neurotic misery into ordinary unhappiness”).

So, what tells you when the patient is improved? Why psychoanalytic theory of course.

And if you come up with a new theory of a disorder, you are, by definition, suggesting a new form of treatment, and often, new criteria for therapeutic success.

You also might be suggesting that your colleagues’ practice is wrong – hence the infighting and divisions.

In contrast, most other forms of treatment (including drugs and other psychological therapies) rely on descriptive measures of symptom improvement that form of the benchmark of psychiatric outcome studies, so theory and practice are much less intertwined.

Analysts will argue that these other treatments only deal with the surface symptoms and don’t deal with the ‘deeper concerns’, but the same issue arises – what constitutes ‘deep’ in this context is psychoanalytic theory.

In contrast, the development of cognitive behaviour therapy (CBT) has seen an opposite pattern. If new innovations work, they are typically re-included under the same CBT banner – giving the impression of a single unified therapy, when in fact, the boundaries are quite loose and determined by what has been shown to be effective in studies.

One of the other quirks of psychoanalysis, is that it’s selective for people who are quite wealthy.

Training as a psychoanalyst takes up to seven years, and requires you are in therapy yourself, usually for five times a week, at a cost of up to £100 ($200) a session. This comes on top of the cost of the training course itself.

For patients, therapy can also take years, and while most analysts will have discounts for the less well off, the costs can be significant. So despite some notable exceptions, it’s mostly the wealthy treating the wealthy – a curious enclave of the upper middle classes.

These factors also mean it’s very difficult to subject psychoanalysis to randomised controlled trials, because it’s so unlike anything else. This has made a new generation of clinicians, brought up with the mantra of ‘evidence based medicine’, suspicious of it.

With great reluctance in some quarters, the principles of psychoanalysis have been shoehorned into a number of briefer versions: psychoanalytic psychotherapy, transference-focused psychotherapy and so on.

Interestingly, symptom outcome studies have found that these can be quite effective, particularly it seems for ‘personality disorders‘ – a group of fairly ill defined diagnoses, but which typically involves destructive mood and relationship problems.

Despite the eccentricities and circular reasoning involved in some aspects of psychoanalysis, 100 years of practice has led to some important insights.

However, only recently has research started to pull out the wheat from the chaff in terms of how it can be applied to the demands of 21st century mental health care.

Link to NYT article ‘Patching Up the Frayed Couch’.
Link to AJP editorial on treatment of borderline personality disorder.

Renowned psychologist Dr Mary Pipher has handed back her American Psychological Association presidential award in protest at the organisation’s refusal to ban participation in US military interrogations which some deem to be torture under the Geneva Convention.

However, the whole issue of psychologists participation in government interrogations shadows a significant, but little mentioned, change in the status of psychologists in the medical establishment.

Fifty years ago, clinical psychologists were little more than test technicians who provided information for psychiatrists to interpret.

During the last decade, clinical psychology training has become equally, if not more, arduous than medical training, and psychological interventions have been shown to be highly effective.

Consequently, psychologists are now being considered on a par with physicians in many organisations. For example, psychologist-led mental health and brain-injury teams are increasingly common.

This change in status is being increasingly reflected in the law. In the UK’s 2005 Capacity Act, psychologists are now able to sign assessments concerning someone’s mental competence to make a contested decision, something that was previously reserved for medical doctors.

The recently approved UK Mental Health Bill is likely to allow psychologists, rather than just psychiatrists, to take a lead in ‘sectioning’ people – i.e. detaining them if they’re deemed a risk to themselves or others owing to mental illness.

In the the US military, and in some US states, psychologists are now able to prescribe medication, previously the sole domain of physicians, and the APA is pushing for the extension of these rights.

Not all psychologists are of a same mind on these issues, and many see these changes as much as a ‘poison chalice’ as as benefit.

In many ways, psychologists and psychiatrists are a ‘good cop, bad cop’ double act in mental health. Psychiatrists can forcibly drug and detain people, while psychologists can tut and scowl with the patient and continue to work collaboratively to improve their mental state.

Of course, patients may be a lot less willing to work with psychologists if they’ve played a role in their detention or forcible medication.

Internal debates aside, the fact that the US Government is quite happy to rely on psychologists, rather than physicians, for their interrogation practices is testament to a general change in status.

Contentious issues concerning a potent mix of economics, ethics and power balance shifts are common for physicians, who are used to governments wanting to give or take responsibilities away from them to suit their political agenda or latest reform plan.

In contrast, these sorts of ethical dilemmas are relatively new for psychologists.

What makes this an interesting time, is that psychology is in a transition period where lots of legal changes are being made to solidify their responsibilities.

This makes the profession much more susceptible to influence by government, and it will be interesting to see how these issues play out, of which the debate over military interrogations is perhaps only an early skirmish.

Link to interview with Dr Mary Pipher.