Year: 2007

Slate has an article by a psychologist and a psychiatrist who argue that addiction is not a ‘brain disease’, contrary to much of the recent rhetoric about drug abuse. This is one side of the debate that is driving our attempts to understand addiction.

The ‘brain disease’ concept (also known as the ‘disease model’) is one that is often thrown around in debates about mental distress or behavioural problems, but it is far from the neutral, scientific term that many of its supporters might believe.

In a sense, every problem of mind and behaviour is a ‘brain disease’, because we’ve identified it as a problem and it involves the brain, as does everything else related to thought or action.

However, a comprehensive explanation requires not only neuroscience, but also psychology and social factors to make it complete and meaningful.

Calling a mental problem a ‘brain disease’ often implies that these other factors aren’t important, and, most tellingly, suggests that the person isn’t responsible for the effects of the disorder, and, consequently, their actions.

The level of personal influence varies by condition, but, importantly, psychologists now know that the effects of all illnesses, from Alzheimer’s disease to the common cold, can be influenced by how we understand them and what we believe about our own ability to influence the effects.

There is no doubt that genetics and the development of nervous system significantly influence the risk of becoming an addict, but addiction, perhaps more than many other disorders, is amenable to personal choice, albeit to varying degrees at various stages of its course.

Theodore Dalrymple (the pen name of psychiatrist Anthony Daniels) noted in The Wall Street Journal that many people are quite able to choose to give up their addiction when sufficiently motivated and argues, in his usual provocative style, against the excess medicalisation of substance abuse:

It is not true either that addicts cannot give up without the help of an apparatus of medical and paramedical care. Thousands of American servicemen returning from Vietnam, where they had addicted themselves to heroin, gave up on their return home without any assistance whatsoever. And in China, millions of Chinese addicts gave up with only minimal help: Mao Tse-Tung’s credible offer to shoot them if they did not. There is thus no question that Mao was the greatest drug-addiction therapist in history.

However, we shouldn’t forget that there is now a large body of evidence highlighting the importance of inheriting a vulnerability to become addicted, and the most addictive drugs tend to modify exactly the bits of the brain that are involved in desire and wanting, making them less amenable to ‘will power’.

This research was recently highlighted by a Time magazine article on the neurobiology of addiction and Dr Nora Volkow’s recent radio interview on the drugs and the brain.

Both spin the ‘brain disease’ angle, and many argue that this reduces stigma. The trouble is, research has found that purely biological explanations of mental problems tend encourage stigma in the public, patients and mental health professionals.

One of the key findings of these studies is that purely biological explanations of mental disorders imply that people are less in control of their actions.

Psychological therapies are known to be effective treatments for drug addiction and one of the key components is to boost the patients ‘self-efficacy’ – that is, their belief that they can take control of their life.

We know that self-efficacy, essentially a scientific term for a sense of personal responsibility and control, is one of the most important predictors of recovery from addiction.

Genetic research has shown us that some people, through no fault of their own, have inherited an increased risk for addiction. Neurobiology has shown us that drug use modifies the brain to make resisting temptation harder.

Nevertheless, describing addiction as purely a ‘brain disease’ is neither useful nor meaningful, and may actually reduce the likelihood that someone will overcome their difficulties.

We need to understand addiction as a problem of mind, brain and society, and make sure everyone knows they play an important role in overcoming problem drug use, whether it occurs in each of us individually, or in the neighbourhood that we live in.

Anti ‘disease model’:
Link to Slate article on addiction.
Link to Theodore Dalrymple article in WSJ.

Pro ‘disease model’:
Link to Time article ‘The neurobiology of addiction’.
Link to Dr Nora Volkow radio interview

PsyBlog has picked up on a neat study from way back in ’87 that found that couples faces look more alike the longer they stay together, and the researchers suggest that empathy might play a part.

The study asked a group of participants to judge how similar pairs of photographs were. Some of the photos were taken after 25 years of marriage, some on the wedding day.

Couples were more likely to be judged as looking similar at the 25 year mark than when first married.

Couples were then asked to complete a questionnaire about how satisfied they were with their partnership. The study found that the couples who grew more alike were more likely to report being happy, share worries or concerns with each other, and perceive themselves to have similar attitudes.

The researchers suggest that empathy might play a part in the increased facial similarity.

Interestingly, now we know that more empathetic people tend to mimic other people’s facial emotional expressions more readily.

So after 25 years, the effect of more frequently copying another person’s face, might mean it would it would take on similar features.

There’s other explanations and some caveats, of course, and PsyBlog considers some of them as it looks at the study in more detail.

Link to PsyBlog on ‘Empathy Causes Facial Similarity Between Couples to Increase Over Time’.

This Saturday marks the 40th anniversary of the first major decriminalisation of male-male sexual acts in the UK. Dr Petra Boynton looks back at how the change came about and has dug up some fascinating articles on the experience of <a href="http://www.bmj.com/cgi/content/full/328/7437/427
“>patients and professionals who took part in ‘gay conversion therapy’ in the 60s and 70s.

At one time, homosexuality was considered both a criminal act and a mental disorder.

It was decriminalised in both the US and the UK before it was removed from the diagnostic manuals, and treatments to change homosexuals into heterosexuals peaked in the 1960s and early 1970s.

Two articles were published in the British Medical Journal in 2004 that highlighted the experiences of patients and professionals who were involved in ‘conversion therapy’ either voluntarily or because of a court order.

One paper describes some of the methods:

In electric shock aversion therapy, electrodes were attached to the wrist or lower leg and shocks were administered while the patient watched photographs of men and women in various stages of undress. The aim was to encourage avoidance of the shock by moving to photographs of the opposite sex. It was hoped that arousal to same sex photographs would reduce, while relief arising from shock avoidance would increase, interest in opposite sex images. Some patients reported undergoing detailed examination before treatment, while others were assessed more perfunctorily.

Patients would recline on a bed or sit in a chair in a darkened room, either alone or with the professional behind a screen. Each treatment lasted about 30 minutes, with some participants given portable electric shock boxes to use at home while they induced sexual fantasies. Patients receiving apomorphine were often admitted to hospital due to side effects of nausea and dehydration and the need for repeated doses, while those receiving electric shock aversion therapy attended as outpatients for weeks or in some cases up to two years.

Oestrogen treatment to reduce libido (two participants in the 1950s), psychoanalysis (three private participants and one NHS participant in the 1970s), and religious counselling (two participants in the 1990s) were also reported. Other forms of treatment were electroconvulsive therapy [ECT], discussion of the evils of homosexuality, desensitisation of an assumed phobia of the opposite sex, hypnosis, psychodrama, and abreaction. Dating skills were sometimes taught, and occasionally men were encouraged to find a prostitute or female friend with whom to try sexual intercourse.

The professionals interviewed in the study present mixed views, but “most doubted the treatment’s efficacy, however, and came to question whether they were acting in patients’ best interests. They began to think that treatment was underpinning questionable social values and that patients might say anything to convince them that it had worked to avoid yet more treatment or further legal repercussions.”

As we reported earlier this month, this is currently a hot topic for the American Psychological Association, who are currently re-assessing their guidelines on whether they should explicitly denounce ‘conversion therapy’.

If you want to know more about how homosexuality was de-listed as a mental illness, there’s a fantastic radio programme online which looks at how the campaign was intricately tied up with one woman’s remarkable family history.

Link to Dr Petra on 40 years of decriminalisation.
Link to BMJ article on patients’ experience of ‘conversion therapy’.
Link to BMJ article on professionals’ experience of ‘conversion therapy’.
Link to radio programme ’81 words’.

BBC News reports on a recently published study that found that myths about epilepsy and its treatment are still widely believed, possibly putting people at risk. This post will tell you how to help someone having a seizure.

The research project, led by Dr Sallie Baxendale, used the internet to survey over 4,500 people concerning their knowledge of the effects of epilepsy, and what to do if someone has a seizure.

The study found that myths about the effects are widespread, many people still believe that epilepsy commonly causes ‘foaming at the mouth’ and is strongly linked to violence, neither of which are the case.

More worringly, a third of people thought they should put something in the mouth of a person having a seizure to stop them ‘swallowing their tongue’ and two-thirds would always call an ambulance.

Never put anything in the mouth of someone having a seizure (they could choke) and you only need to call an ambulance if it’s the person’s first seizure, if the seizure has been going on for more than five minutes, if they don’t regain consciousness between seizures, or if they’re physically injured.

This is the advice from Epilepsy Action about how to help someone who is having a tonic-clonic seizure.

These are what are sometimes called ‘fits’ and used to be called ‘grand-mal’ seizures. ‘Grand mal’ literally means ‘great evil’, and so understandably, isn’t used by the medical profession, although it still is used in day-to-day language by some people not familiar with the proper name.

Tonic-Clonic seizures

The person loses consciousness, the body stiffens, then falls to the ground. This is followed by jerking movements. A blue tinge around the mouth is likely. This is due to irregular breathing. Loss of bladder and/or bowel control may occur. After a minute or two the jerking movements should stop and consciousness may slowly return.

Do…
* Protect the person from injury – (remove harmful objects from nearby)
* Cushion their head
* Look for an epilepsy identity card or identity jewellery
* Aid breathing by gently placing them in the recovery position [pictured] once the seizure has finished
* Be calmly reassuring
* Stay with the person until recovery is complete

Don’t…
* Restrain the person
* Put anything in the person’s mouth
* Try to move the person unless they are in danger
* Give the person anything to eat or drink until they are fully recovered
* Attempt to bring them round

Call for an ambulance if…
* You know it is the person’s first seizure
* The seizure continues for more than five minutes
* One tonic-clonic seizure follows another without the person regaining consciousness between seizures
* The person is injured during the seizure
* You believe the person needs urgent medical attention

Obviously, if no-one knows whether it’s the person’s first seizure and they are unable to tell you, or no-one knows when the seizure started, call an ambulance.

Also, some people who have seizures will have strong emotional reactions when they come round owing to the brain disturbance.

The person might regain consciousness and seem terrified, traumatised, confused or very anxious (not always the case, some people feel elated).

This may cause onlookers to get equally anxious and panicky. Stay calm and just reassure the person (and everyone else if necessary!), gently letting them know what’s happened.

The Epilepsy Action first aid page also has information on dealing with other types of seizure.

Take the opportunity to read through the information – the next five minutes of your life could save someone else’s.

Link to Epilepsy Action first aid information.
Link to BBC News story ‘Many ‘believe myths’ on epilepsy’.
Link to abstract of research report.

SharpBrains has a great interview with neuropsychologist Prof Yaakov Stern who discusses his research on maintaining a healthy brain and gives plenty of great advice for keeping your edge throughout life.

Stern talks about the cognitive and neural ‘reserve theories’ which argue that the mind and brain have a certain tolerance to decline and damage before they go into the freefall of dementia.

It’s sort of a threshold theory, suggesting that if the strain on the brain reaches past a certain point, the system starts to break down rapidly.

The amount of ‘reserve’ or the threshold varies between individuals, so some people are more likely to get dementia than others.

We know that genetics is one component, but what Stern’s research has also shown is that we can play an active part in boosting our reserve and raising our dementia threshold.

In other words, by changing our lifestyle we can maintain our mental sharpness for longer and reduce the chances of getting a degenerative brain disease.

Healthy diet, exercise and nutrition are key, but education, keeping mentally active and having a varied social life might also be important.

AF: Can you give us some examples of those leisure activities that seem to have the most positive effects?

YS: For our 2001 study we evaluated the effect of 13 activities, combining intellectual, physical, and social elements. Some of the activities with the most effect were reading, visiting friends or relatives, going to movies or restaurants, and walking for pleasure or going on an excursion. As you can see, a variety. We saw that the group with high level of leisure activities presented 38% less risk (controlling for other factors) of developing Alzheimer’s symptoms. And that, for each additional type of activity, the risk got reduced by 8%.

There is an additional element that we are starting to see more clearly. Physical exercise, by itself, also has a very beneficial impact on cognition. Only a few months ago researchers were able to show for the first time how physical activity promotes neurogenesis in the human brain. So, we need both mental and physical exercise. The not-so-good news is that, as of today, there no clear recipe for success. More research is needed before we prepare a systematic set of interventions that can help maximize our protection.

The interview also has plenty more practical advice, links to the original scientific papers, and a video, which I can’t watch because it’s blocked at work. Grrrr!

Link to SharpBrains interview with Prof Yaakov Stern.

Online magazine InCharacter has an article on what autism can tell us about honesty and deception, by autism researcher Prof Simon Baron-Cohen.

People with autism or related conditions are often poor at both deception and recognising deception in others. It’s not always the case, but it’s quite a common attribute.

Baron-Cohen’s article explores what we know about some of the differences in autistic thinking, and what might be so different that an effective understanding of deception becomes almost impossible.

He argues that a key skill is ‘meta-representation’, the ability to think about other thoughts, imaginary scenarios or abstract principles in yourself or others.

The key is that it’s not just thinking or imagining, it’s being able to think about thinking or imagining.

When this specifically involves thinking about what other people are thinking, understanding their perspective, it is often called ‘theory of mind‘.

You can see why this is a key skill in deception. You need to have a theory or understanding of what the other person is thinking or is likely to think, to work out how to hide the real state of the world from them.

As people with autism often perform poorly on tasks that test ‘theory of mind’ (despite some debate about whether the experiments are suitable) it has been suggested that a poor understanding of deception is a result of this difficulty.

Baron-Cohen’s article examines some of the research behind these ideas, but also looks at why the human race might have generally evolved to be good deceivers, with some notable exceptions in people who are nowadays likely to be diagnosed with autism.

In other autism news, Bad Science has been doing a fantastic job of tackling dodgy news stories that regularly hit the press, particularly a recent front-page Observer article that seemed to have little trouble deceiving people about autism research.

Link to InCharacter autism and deception article.
Link to Bad Science on another type of autism and deception story.