Month: March 2008

Beyond belief

Salon has a provocative article by neurologist Robert Burton who discusses what the neuroscience of belief means for how we understand the world, drawn from his new book, On Being Certain.

We’re going to be posting an interview with Burton on Mind Hacks in the near future, but the Salon article should give you a flavour of some of his thoughts the brain and belief.

What’s most curious about work on the neuropsychology of belief is that it barely touches upon the memory research where they’ve had many of these things under the microscope for years.

I’m a huge fan of the work of Israeli psychologist Asher Koriat who has done some absolutely stunning work on the control of memory.

This may seem a relatively dry topic, but think for a minute about how you use your memory.

For example, you’ve almost certainly had the experience where you know that you know something but can’t remember the details, or that you know you recognise something, but can’t remember the occasion when you encountered it before.

Also, we seem able to judge when we’ve remembered something to our satisfaction, but this is quite a remarkable feat in itself. Think about how we could possibly do this.

You could say we know because the memory matches other memories we have in mind, but then these are subject to the same problem – how do we know that we’ve remembered them correctly?

In other words, there must be another system at work, and one of the primary components of this is what psychologists call the ‘feeling of knowing’ that communicates between our unconscious pool of stored information and our conscious sense of how successfully our memory is operating.

Koriat discussed these processes in a 2000 paper [pdf] that was a revelation for me when I read it. It convinced me of the importance of these wormhole-like processes that connect the conscious and unconscious mind.

In his article, Burton suggests what social implications arise from the science of belief, suggesting we should be a little more humble when we state what we ‘know’.

Link to Salon article ‘The certainty epidemic’.
pdf of Koriat’s 2001 paper on the ‘feeling of knowing’.

A stroke of insight

We’ve discussed the remarkable neuroanatomist Jill Bolte Taylor before but I’ve finally got round to watching her engaging TED talk on her experience of having a stroke, which is now available to watch online.

It’s a bit poetic in places. You can almost hear the sound of a thousand cognitive scientists gritting their teeth as she describes the supposed functions of each cerebral hemisphere and probably the sound of some of them fainting when she describes the “deep inner peace circuitry” of the right hemisphere.

Neuroanatomists may notice that this is almost exactly the same sound that occurs when psychologists describe something as a ‘frontal’ function.

The talk is gripping, however, and the highlight is her description of the day she had her stroke which is both insightful and very funny.

Link to video of Jill Bolte Taylor TED talk (thanks Sandra!)
Link to previous post on Jill Bolte Taylor with links to interview.

Pica: put your money where your mouth is

An upcoming article in the medical journal Clinical Toxicology reports on a man who suffered lead poisoning owing to his habit of eating roofing plates.

The tendency to eat the inedible is known as ‘pica‘. It is an established psychiatric diagnosis, is well-reported in the medical literature and has given us some of the more unusual case reports of recent years.

Although there is a specific diagnosis, the term is also used more widely as a general label for any eating behaviour that focuses on inedible objects.

Two of the most striking cases have involved coins. The x-ray on the right is from a case report from the New England Journal of Medicine where doctors discovered five and a half kilograms of coins, necklaces, and needles in a patient’s stomach.

In another case report from 1998, a British patient had swallowed £175.32 pounds worth of loose change and had a history of eating a wide range of curious objects:

At different times she has eaten tablets, coins, nuts, wire, plastic, ‘purple hearts’, Bob Martin’s dog conditioning powder and dried flowers. There is much comment made throughout her medical notes detailing vigorous negotiations about the colour, size, number, timing and supply of medication, including a large batch of hand-written letters to her doctor.

The behaviour in the more extreme cases in adults is usually associated with psychosis, as was the case with these two individuals.

It was also the case with one other gentleman, who had suffered lead poisoning after swallowing over 200 live bullets. The case report was rather wittily titled ‘Bite the Bullet’.

Normally, however, pica is most commonly seen in children with learning difficulties or autism spectrum diagnoses.

Perhaps giving partial support for the stereotype that pregnancy leads to unusual food cravings, it is known to occur more commonly in pregnant women, particularly from lower income families.

It’s not clear why it occurs, but interestingly, it has been linked to iron and zinc deficiencies.

Link to NEJM case report with x-ray.

The English Surgeon

I had the pleasure of watching a screening of a stunning new documentary called The English Surgeon yesterday. It’s a film about the work of London-based neurosurgeon Henry Marsh and his colleague Igor Kurilets in the Ukraine.

However, to say the film was just about brain surgery would be vastly under value its significance, and to describe it as a meditation on the humanity of medicine would be to confine it to a cliché.

Although Marsh normally works at St George’s, one of London’s most established hospitals, he has regularly travelled to the Ukraine for 15 years to assist the development of neurosurgery in this still struggling country.

The contrast itself is striking. One scene sees Marsh and Kurilets looking through street market hardware stalls for screws, rivets and power tools to use in their operations.

One of the most gripping scenes is where the two surgeons open a patient’s skull using a Bosch power drill only to find the battery is going flat as they proceed.

The man has been only given local anaesthetic as the Ukrainian hospital doesn’t have the facilities to safely put someone under and wake them up after initial part of the procedure.

Some of the most moving moments concern the tension between the shortcoming of medicine and the hope of the patients. There are many profound moments that aren’t well captured by brief summaries, and I’m sure each viewer takes something different away from them, so you’ll need to experience them for yourselves.

It’s probably worth saying that the film is also incredibly funny in places, partly owing to Marsh’s phlegmatic personality, but partly owing to the dark humour and comic irony posed by the situations that arise.

Marsh was the subject of another documentary by the same filmmaker created for the BBC as part of their medical series Your Life in Their Hands. Sadly, it’s not available online (or anywhere by the looks of it), but let me know if it appears as a torrent and I’ll link to it.

If you want to see it on the big screen there are screenings in Norwich, Brighton, London, York, Glasgow and Edinburgh before the end of March, and apparently it will be shown on BBC Two on March 30th.

International readers will have to hope for a torrent as things currently stand.

As an aside, the soundtrack was composed by Nick Cave and Warren Ellis, and is fittingly beautiful.

Link to film website (thanks Kat!).

Medical model behaviour

Journalist and campaigner Liz Spikol has written an excellent piece for the Philadelphia Weekly on the influence of the ‘medical model’ on how we understand and treat mental illness.

To simplify a little, the ‘medical model’ approach involves classifying mental distress or impaired behaviour as cut-and-dry diagnoses and assumes that these disorders are best understood at the level of neurobiological changes in individual patients.

Alternative approaches might consider that mental disorders are not always adequately described as by making a clear dividing line between mental illness and mental health and probably exist as a spectrum of differences (the continuum model), and that you need to understand more than just the brain to understand why people become distressed or disabled (such as social influences).

Needless to say, drug companies have a vested interest in promoting medical model because it implies drugs are the best treatment.

At the other end of the spectrum, some groups completely reject the medical model and any attempt to classify distressing mental states or research the neuroscience of mental disorders, often because they feel it upholds existing social orders or power structures with which they disagree.

What each of these extremes miss, however, is that the ‘medical model’ is a tool, a conceptual approach. In some situations it will be useful, in others misleading, and most importantly, it can be questioned and revised where necessary and can exist alongside other approaches.

Beware of any group that pushes a conceptual tool as an ideology. They are usually trying to sell you something.

This applies equally for drug companies and pressure groups.

Liz Spikol’s article is so good because it evaluates the medical model in context. In this case, in terms of attitudes, advertising and the law concerning mental illness.

Link to Liz Spikol’s Philadelphia Weekly article.

2008-03-14 Spike activity

Slightly late quick links from the past week in mind and brain news:

Neurophilosophy posts a ‘best of‘ collection of its many excellent articles online.

The Kinsey Institute for sex research have started their own blog and regular podcast on all matters sexual.

Social networks are like the eye. Edge has a video lecture on an evolutionary take on the development of society.

The New York Times reviews the recent discussion on whether it’s wrong for scientists to take cognitive enhancers. Not like it hasn’t been happening for four millennia already.

When can children make the distinction between jokes and lies? The BPS Research Digest has a piece on some fascinating new research and the APA Monitor has a past article on research on child humour from the same team.

Skeptic magazine has a great review of some of the key concepts in consciousness research in an article entitled ‘consciousness is nothing but a word’.

Psych Central discusses the recent news stories about a possible biological test for mood disorders.

To the bunkers! Simple nanotech experiment will one day lead to swarm of microscopic brain creatures, suggests BBC News article.

BBC News reports on a study that found that breathing engine exhaust fumes alters brain function. Full text available from PubMed entry.

Nominative determinism strikes again. The New York Times looks at the limits of the effects of our name on how we’re perceived.

Neuroanthropology has a piece on the anthropology of prisons and prisoners.

The New York Times again on differences in the DNA of identical twins, with the newly discovered copy number variations playing a key role.

The joy of boredom. The Boston Globe looks at the most undirectional of mental states.

The increasingly excellent Treatment Online discusses a recent study on genetic interactions in people with depression.

Jealousy in romantic relationships is associated with the height of partner, according to a study covered by New Scientist.

The excellent Simply Psychology has relaunched with a huge amount of psychology resources online.

The brain of Dionysus. Neuroscientist Susan Greenfield discusses what the Ancient Greek tragedies can tell us about the brain in The Telegraph.

Following deep brain stimulation

Wired Science have got a great short film that follows a two people who have deep brain stimulation devices implanted in their brains to treat tremors.

Tremor is a symptom of Parkinson’s disease and this was one of the earliest targets for early DBS trials.

The film follows someone who has exactly this difficulty, plus someone who has a different form a tremor disorder, known as essential tremor, through the process of the operation.

While most people assume brain surgery is all pre-planned beforehand, for many treatments for cognitive or behavioural functions, the surgeons need to wake up the patient after they’ve open their skull to make sure they’re targeting the right place (and avoiding damaging essential functions).

In this case, they wake the patients up during neurosurgery so they can test out their movements while stimulating different areas of the brain, in a trial and error style.

Wired Science also has a shorter film online about the post-mortem dissection of a brain of a patient who had Alzheimer’s disease that’s also well worth having a look at.

Link to video of deep brain stimulation neurosurgery.
Link to video on ‘The Brain of an Alzheimer’s Patient’.

A personal note / una nota personal

I qualify as a clinical psychologist in September and would like to work in Latin America for 6 months to a year afterwards.

If you know anyone in Spanish speaking Latin America who might be interested employing a newly qualified clinical psychologist who speaks passable Spanish (with room for improvement) and has a PhD in cognitive neuropsychiatry, please get in touch.

I can send my CV in Spanish or English and am happy to consider all types of psychology job.

For those not familiar with the world of psychology, Latin American has a long tradition of valuing psychology as an important scientific and clinical pursuit.

The first university course teaching psychology in Latin America started in 1897 and was taught by Prof Ezequiel Chavez in the Preparatory School of Mexico, five years later to become the National University of Mexico.

The first experimental psychology lab opened in 1891 in San Juan in Argentina, with the first university lab opening in 1898 in the Colegio Nacional of Buenos Aires.

In 1907 Latin America’s first professional psychology association was launched – the Sociedad de Estudios Psicologicos that gathered psychologists from across the region.

Owing to periods of social and political turmoil, Latin American psychology has traditionally been focused on applied research and practice – aiming to use psychology to improve the health and well-being of the population.

Latin America maintains a leading role in world psychology. As a testament to this, the Internation Neuropsychological Society will be holding their July conference jointly with the Neuropsychology Society of Argentina in Buenos Aires.

So, you can see why I’m keen to work in the region.

pdf of article on the history of Latin American psychology.

Inner speech signals, but isn’t a psychic telephone

New Scientist reports on a neck-band technology that allows the wearer’s silent thoughts to trigger messages over a phone line.

It sounds impressive, but the video that accompanies the story makes it look like the technology reads your inner thoughts and transmits them as sounds, when it fact it does something far more basic.

Whenever we think to ourselves, rather curiously, the vocal chords get activated very slightly – faintly mirroring what would happen if we were to say the words out loud.

This is known as subvocal speech and can be picked up by EMG sensors on the neck that pick up the tiny electrical signals generated by the weakly activated muscles.

While the technology doesn’t exist to turn these signals back into speech, it is possible to train the system to distinguish between a number of different general patterns which can trigger specific computer commands.

Lancet Neurology reported in 2004 that the same team had a basic system running that recognised six words (stop, go, left, right, alpha, omega) and 10 digits, to allow ‘silent’ control of a machine or a software application.

The team seem to have developed the technology and it can apparently now recognise many more commands, however, it doesn’t ‘translate’ thoughts into their corresponding words.

In the video, the wearer is triggering sound recordings of specific sentences, pre-arranged to provide answers to the rehearsed telephone ‘conversation’. Still impressive, but not a genuine conversation in the way we would normally think of it.

As an aside, for more than 20 years now, we’ve know that subvocal speech accompanies hallucinated voices in people who have been diagnosed with psychosis.

This means people who hear constant hallucinated voices will probably not be able to use the system effectively.

However, we now know that healthy individuals have much higher levels of hallucinations than previously thought, although most people are not bothered or distressed by them.

For example, in a 2004 study Louise Johns and colleagues found that 0.7% of the British population had experienced an auditory hallucination in the last year.

It’s interesting to speculate that a significant minority of the population might experience problems with this technology as their hallucinations accidentally trigger commands or send messages on their behalf!

Link to NewSci story ‘Nerve-tapping neckband allows ‘telepathic’ chat’.
Link to video of product presentation.

Undercover psychiatry

An interesting historical snippet from p48 of psychiatrist Giovanni Stanghellini’s book on the phenomenology of psychosis, Disembodied Spirits and Deanimated Bodies:

The German psychiatrist Karl Willmanns, who would later be director of the Heidelberg Clinic until the rise of the Nazis, published a book [in 1906] on the disenfranchised. He had been following them around at night in the outskirts of town, dressed as one of them, often inviting them into his own home, and ‘lending’ them money.

In his book, Zur Psychopathologie de Landstreichers, Willmanns sought to show how many of the homeless were schizophrenic. His university post, then the most important in German psychiatry, was taken from him, apparently because he diagnosed a form of hysterical blindness in Adolf Hitler.

The book itself is concerned with exploring psychosis using the philosophical tradition of phenomenology, which attempts to carefully describe and understand the structure of subjective consciousness.

Needless to say, this is particularly important so scientific studies can aim to understand what it is important to try and measure in conscious experience, not just attempt to study what is easily measurable.

However, not everyone believes that our own subjective experience is necessarilly a reliable guide to even the conscious mind.

Philosopher Eric Schwitzgebel is a particularly strong critic, suggesting that ‘naive introspection’ is inherently flawed. His debate with psychologist Russell Hurlburt, who disagrees, was recently published as a book.

Link to review of Disembodied Spirits and Deanimated Bodies.
Link to details from publisher.

Exporting psychological treatments, importing wisdom

A recent 60 country World Health Organisation study found that depression is the most serious chronic illness, worse than angina, arthritis, asthma, and diabetes. Unfortunately, the majority of people who experience depression live in low income countries where help is least likely to be available.

The New York Times has a fascinating article on an ongoing project in Goa, India, that screens every attendee at a local health centre and then uses psychological therapy to help with low mood or anxiety.

It’s not a simple case of just using Western techniques in a new environment.

As the NYT article mentions, mental illness carries a significant stigma in many cultures. For example, a diagnosis may not only be stigmatising for the affected person, but it may also mean the person’s children are less likely to be thought of as suitable marriage partners, potentially affecting the whole family’s future.

Futhermore, depression is known to present quite differently in some non-Western cultures. Studies have found that people are more likely to report ‘somatic symptoms’ such as diffuse pains or tiredness, rather than low mood or emotional problems.

This is partly due to stigma, but sometimes because certain languages don’t have the same, or even such a varied vocabulary for emotions and mental states.

I’m currently working with a Pakistani psychiatrist who often surprises me by pointing out that even what I assume are relatively straightforward words, such as depression or anxiety, might not have a direct translation in some Asian languages.

All of these issues mean that the treatment centre in Goa tackles the issue in a slightly different way:

Most are also apparently wary of visiting a mental hospital. In India, the stigma of mental illness remains strong. To minimize the problem, health workers avoid using the words “mental illness,” “depression” or “anxiety” with patients, relying on more commonly used words like “strain” and “tension.”

The patients “are happy to talk,” Dr. Sudipto Chatterjee, a psychiatrist at Sangath, said, “as long as you stay away from the idea of mental illness.”

I find the issue of having different vocabularies for our mental states fascinating.

The philosopher Wittgenstein noted how difficult it is to agree on common words for internal states because errors are so hard to correct.

If a mother and child see a rabbit and the child says “elephant!”, the mother can point to the rabbit and correct the misnomer. But what can a mother, or anyone do, if someone ‘misnames’ an emotion?

Or to put it another way, as we don’t have external things to refer to for internal states, how do we ever agree on a vocabulary that is at all meaningful?

I’m always curious when I come across differences concerning emotion words in other languages. For example, Spanish has the same word (verg√ºenza) for shame and embarrassment.

From my native language perspective it strikes me as amazing that another language doesn’t individually label these two states which seem to have such different personal and social implications.

I’m sure there are many reverse examples and many other emotional vocabulary mismatches across the world’s languages.

Link to NYT article ‘Psychotherapy for All: An Experiment’.

The way to a man’s hiccups…

A case of a man with unstoppable hiccups has just been published online in the medical literature. Rather unusually, it turned out they were caused by early stage Parkinson’s disease.

Parkinson’s disease is most commonly associated with movement difficulties and the public most associate it with tremor or shaking.

However, it can have a wide range of other effects (more recently, problems with cognitive functions and mental health have been recognised), although this seems to be the first time hiccups have been reported as an early symptom.

The case study is reported in the journal Parkinsonism and Related Disorders:

The patient was a 62-year-old male who had been suffering from intractable hiccups for more than 6 months. The initial intermittent nature of hiccups became continuous over time. When he was quiet, the hiccups were more prominent, although his symptoms tended to decrease when he was speaking.

The hiccups frequently interrupted his speech particularly towards the end of a sentence. The hiccups tended to disappear when he was asleep. Hiccup frequency increased with emotional stress such as anxiety and anger. The patient was depressed and socially isolated due to the embarrassment caused by his continuous hiccups.

It’s a curious case, but the paper also contains a fascinating paragraph on the causes of hiccups. One cause can be with (unsurprisingly) the organs in the chest, but another can be disruption to part of the brainstem called the medulla.

The causes of hiccup can be divided into ‘peripheral’ and ‘central’. A wide variety of peripheral conditions can cause hiccup including: gastroesophageal pathologies, renal failure, malignancies, medications, abdominal surgery and even myocardial infarction.

Central causes can result from structural or functional disorders of the medulla or various other supraspinal neural elements such as multiple sclerosis, medulla oblongata cavernoma, brainstem tumors, basilar artery aneurysm, cerebellar hemangioblastoma, dorsal and lateral medullary infarctions…

The antidopaminergic agent chlorpromazine is the only drug approved for the treatment of intractable hiccups.

I never knew there was an approved drug for difficult to control hiccups, let alone chlorpromazine, the first antipsychotic drug to be developed and widely used in the 1950s.

However, stranger treatments have been discussed in the medical literature.

Perhaps some of the finest moments in hiccup medicine have come from the small but determined literature on the use of digital rectal massage (translation: finger up the arse) as a treatment.

The abstract of 1990 article from the Journal of Internal Medicine is fantastic simply for its deadpan delivery. Needless to say, it was honoured with an IgNobel award.

Link to PubMed entry for case study.

dothetest.co.uk

bball.jpg
Transport for London have combined two of my favourite things: safety for cyclists and classic Psychology experiments. The website dothetest.co.uk provides a test of awareness that Mind Hacks fans will instantly recognise as an updated (urbanised!) version of Hack #41: “Make Things Invisible Simply by Concentrating (on Something Else)”. Fantastic!

Link to the awareness test here

Link to a previous post on mindhacks.com discussing inattentional blindness

Could you endure such pain, at any hand but hers?

I finally got round to having a look at the New York Times migraine blog and found it full of fantastic writing and some wonderful artwork that aims to capture the perceptual distortions associated with the mother of all headaches.

There’s a particularly good article by Oliver Sacks (his first book was on migraine) who discusses the common geometrical patterns that can occur in the hallucinatory images, known as a form constants.

Interesting, the mathematician Paul Bressloff has suggested [pdf] that these necessarily arise when the firing of neurons in the primary visual cortex is destabilised.

Although Bressloff was particularly addressing certain hallucinations caused by psychedelic drugs, the form constants are, well, constant across conditions, so are likely to arise from a similar process in migraines too.

There are many more articles describing the science, personal stories and art of the head pounding, vision distorting and stomach churning headache. The gallery is particularly good if you’re not familiar with the range of visual effects.

However, no one seems to have touched on a poem by Robert Graves where he uses migraine as a metaphor for love (or is it the other way round?) capturing the beauty and pain of both.

Symptoms of Love

Love is universal migraine,
A bright stain on the vision
Blotting out reason.

Symptoms of true love
Are leanness, jealousy,
Laggard dawns;

Are omens and nightmares –
Listening for a knock,
Waiting for a sign:

For a touch of her fingers
In a darkened room,
For a searching look.

Take courage, lover!
Could you endure such pain
At any hand but hers?

Link to NYT’s Migraine Blog (via Neurophilosophy).

Pimping insomnia

Discover Magazine has an exposé of a recent surge of news stories on insomnia and sleep disorders that stretch from the dull to the frankly unbelievable.

It turns out a fair number seem to be based on press releases from PR firms, some trying to promote hotels, but others coming from the National Sleep Foundation.

The author of the piece looked at the 2005 financial figures from this organisation and discovered that over 80% of its funding came from drug companies and almost three quarters was spent on ‘public education’ – i.e. advertising the existence of sleep disorders.

Of course, sleep disorders can be distressing, disabling and potentially dangerous but research suggests that particularly for insomnia, the judicious use of drugs should be a last resort (most have the potential for addiction), as behavioural and psychological treatments are safer and more effective for most people.

Unfortunately, these approaches are often not available, meaning ‘public awareness’ increases diagnosis but leads to drug prescription, partly because people go to doctors and list what symptoms they think they have from the advertising rather than describing their experiences.

The National Sleep Foundation do a lot of excellent work but the article suggests that there seems to be an element of disease mongering and astroturfing to their promotions.

Link to article ‘Deflating the Bogus Insomnia ‚ÄúEpidemic‚Äù’

Possessed

Film-maker Martin Hampton has created a revealing documentary on four people with different degrees of compulsive hoarding, where individuals incessantly collect household objects, even to the point of not being able to throw out rubbish.

Compulsive hoarding is often linked to obsessive-compulsive disorder, where affected people experience intrusive thoughts or urges to complete certain actions (most commonly ‘washing’ or ‘checking’) even though they know how seriously these intrusions are affecting their lives.

Hampton’s documentary is a remarkably well made account of people with similar urges, in this case to collect and retain, and just lets the individuals and the images speak for themselves (it is also freely available online as wide screen HD, so looks wonderful).

Apparently the documentary was created as part of a Master’s course in visual anthropology, a field I’d not come across before, but which seems to be concerned with documenting the diversity of human experience through film.

Possessed does this admirably and seems to have garnered numerous awards since it’s release.

UPDATE: Grabbed from the comments. An update and a request from the director!

I am the director of this film and am now researching the next stage of the project. I am trying to compile a collection of peoples experiences of OCD and other anxiety based disorders. I have found from experience that although symptoms might be similar, the actual particularities of the obsessions and compulsions are often very varied. For example, one might wash ones hands 30 times a day, but have a very unique self discovered reason for doing so. I would be very grateful to hear of your or any friend / acquaintances experiences / difficulties. Many thanks and I hope you find the film interesting. Please email me at martin@martinhampton.com

Link to Martin Hampton’s documentary Possessed (via MeFi).