Arch of Hysteria

I’ve just bought an excellent book called Invention of Hysteria which is about how the use of photography by the 19th century French neurologist Jean-Martin Charcot helped shape the our concepts of ‘hysteria‘ – a disorder where psychological disturbances manifest themselves as what seem like neurological symptoms.

Such patients would today be diagnosed with ‘conversion disorder’, usually after presenting to a neurology clinic with paralysis, blindness or epilepsy, only for it to be found that there is no damage to any of the areas you might expect or no seizure activity in the brain during a ‘fit’.

Importantly, the patients aren’t ‘faking’, they genuinely experience themselves as paralysed, blind, or otherwise impaired.

What recent research suggests is that there may be a disturbance in higher level brain function which may be suppressing normal actions or sensation.

To use a business analogy, none of the workers are on strike but the management is causing problems so the work can’t be carried out.

Charcot revived interest in this disorder through his weekly, somewhat theatrical, case demonstrations, and, as the book discusses, through some striking and equally theatrical photos and illustrations.

This wonderfully illustrated book examines the history of Charcot’s work at the Salp√™tri√®re, the famous Paris hospital, and how the newly developed technology of photography played a key role in popularising the disorder and shaping our ideas about hysteria.

In the last few decades of the nineteenth century, the Salpêtrière was what it had always been: a kind of feminine inferno, a citta dolorosa confining four thousand incurable or mad women. It was a nightmare in the midst of Paris’s Belle Epoque.

This is where Charcot rediscovered hysteria. I attempt to retrace how he did so, amidst all the various clinical and experimental procedures, through hypnosis and the spectacular presentations of patients having hysterical attacks in the amphitheater where he held his famous Tuesday Lectures. With Charcot we discover the capacity of the hysterical body, which is, in fact, prodigious. It is prodigious; it surpasses the imagination, surpasses “all hopes,” as they say.

Whose imagination? Whose hopes? There’s the rub. What the hysterics of the Salpêtrière could exhibit with their bodies betokens an extraordinary complicity between patients and doctors, a relationship of desires, gazes, and knowledge. This relationship is interrogated here.

What still remains with us is the series of images of the Iconographie photographique de la Salpêtrière. It contains everything: poses, attacks, cries, “attitudes passionnelles,” “crucifixions,” “ecstasy,” and all the postures of delirium. If everything seems to be in these images, it is because photography was in the ideal position to crystallize the link between the fantasy of hysteria and the fantasy of knowledge.

A reciprocity of charm was instituted between physicians, with their insatiable desire for images of Hysteria, and hysterics, who willingly participated and actually raised the stakes through their increasingly theatricalized bodies. In this way, hysteria in the clinic became the spectacle, the invention of hysteria. Indeed, hysteria was covertly identified with something like an art, close to theater or painting.

The book’s website has the first chapter freely available, but sadly none of the photos.

Most of Charcot’s books, containing many of the wonderful illustrations and photos, are listed on Google Books but for some reason I can’t work out, you can’t view the pages.

As they were published in the late 1800s, they should be well out of copyright, so its a bit frustrating we can’t read them.

To give you an idea, however, the illustration on the left is the ‘Grande Hysterie Full Arch’, one of Charcot’s classifications of hysterical epilepsy.

This is one of Charcot’s many illustrations of amazing bodily contortions that was used as inspiration by the famed and somewhat eccentric French sculptor Louise Bourgeois, as you can see in a (possibly NSFW?) article on her work from the Tate magazine.

Link to details of book with sample chapter.

Out of body experiences and grasping the ungraspable

This week’s ABC Radio National’s All in the Mind discusses what happens in the brain during out of body experiences, and why actions can be accurate even when our perceptions are not.

The first interview is with neurologist Olaf Blanke who discusses some of his recent compelling research, including a virtual reality experiment to induce out-of-body touch sensations in healthy participants and one with implanted brain electrodes to trigger full-blown out-of-body experiences in patients undergoing neurosurgery.

The second interview is with psychologist Melvyn Goodale, famous for his work on distinguishing the visual streams in the brain: the dorsal stream and the ventral stream.

Some of the most striking and important results from this work come from patients who have suffered damage to one or the other stream.

In the programme, Goodale talks about brain-injured patient DF, who can correctly and accurately grasp objects she cannot consciously ‘see’. The opposite has been found in other patients, who can accurately see and describe objects they cannot accurately grasp.

This suggests that these two visual pathways, although complimentary, are specialised for different things, one for identifying objects, and the other for working out where they are and how to manipulate them.

The different function of the two pathways can also be demonstrated in healthy people as well.

You may recognise the visual illusion on the left, sometimes called the Titchener or Ebbinghaus illusion. The two circles in the middle are actually the same size, but look different due to their context.

Researchers have created a graspable version of the illusion by putting hoops on a flat surface.

When they’ve measured how people adjust their fingers to pick up the middle circles, they find that we don’t over or underestimate the size. Our fingers are always perfectly adjusted to the actual size.

In other words, it seems that while our perception is fooled by the illusion, our actions aren’t, showing how the specialisation of each visual stream can be seen in everyone.

There’s now a minor cottage industry of research attempting to understand exactly what influences the effect.

UPDATE: “All in the Mind has been honoured with the Grand Award at 2008 New York Radio festivals for best entry across all categories, as well as a Gold World Medal in the Health / Medical category”. – I’m sure it won’t come as a surprise to most Mind Hacks readers but fantastic to have it recognised by the non-initiated!

Link to AITM on out-of-body experiences and other tricks of consciousness.

Trip At The Brain

It’s an age old story. Boy meets girl. Boys loses girl. Boy thinks it might be because he was hypnotised by a crazed scientist who was swinging a brain on a chain. Boy thinks this might explain why the girl was originally a nun but changed into hallucinatory sex vampire.

Yes, it’s the video for mostly nonsensical ‘Trip At The Brain’, produced in 1988 by the skate metal pioneers Suicidal Tendencies.

I suspect it’s what might happen if you were the lead singer of a metal band who hallucinated evil neuroscientists while on a bad trip, or if you were a neuroscientist who hallucinated a metal band while on a bad trip.

Nevertheless, it remains one the finest examples of 20th century neuroscience, heavy metal and hallucinatory sex vampire art.

Link to video of Suicidal Tendencies’ ‘Trip at the Brain’

Average guesses to hit the mark

The Economist has a short but sweet article on a new study that has found that asking the same person to make two guesses and averaging the answer is more accurate than any one guess alone, with more time between guesses improving accuracy.

The study is apparently by psychologists Hal Pashler and Ed Vul and has just been published in Psychological Science, but unfortunately the journal website is down at the moment, but I shall link to the original study when it reappears.

According to The Economist though, here’s the punchline:

The two researchers asked 428 people eight questions drawn from the “CIA World Factbook”: for example, “What percentage of the world’s airports are in the USA?” Half the participants were unexpectedly asked to make a second, different guess immediately after they completed the initial questionnaire. The other half were asked to make a second guess three weeks later.

Dr Vul and Dr Pashler found that in both circumstances the average of the two guesses was better than either guess on its own. They also noticed that the interval between the first and second guesses determined how accurate that average was. Second guesses made immediately improved accuracy by an average of 6.5%; those made after three weeks improved the accuracy by 16%.

Link to Economist article ‘The crowd within’.

Psychotic visitors to the White House

In 1965, The American Journal of Psychiatry published a curious article on delusional people who had visited the White House in Washington DC, wanting to see the President.

The article reviewed the cases of 40 people admitted to the Washington D.C. General Hospital from 1960-1.

It also outlined 10 cases in more detail, this is number 6:

Case 6. A 44-year-old Negro woman “was invited” to see the President many times and prior to her trip wrote that she was finally coming. She hoped the President would stop the “gum chewing” in her head and would stop the police persecution that had caused her ears to flop and her body to go out of shape. She complained of policemen in her ears and riding up and down her nose. The patient was acutely psychotic and her stream of thought disorganized, but she claimed that she had first visited the governor of her home state and the Pentagon before trying to see the President. She refused to discuss previous hospitalization. Diagnosis: schizophrenic reaction, paranoid type.

The paper also contains some interesting speculation: “In 1960, when Mr. Eisenhower was President, only nine patients were admitted, but 32 were hospitalized in 1961, Mr. Kennedy’s inaugural year. This would suggest that some personal characteristic of the President was important.”

The study was actually based on similar research conducted more than 20 years before, on psychotic visitors to government offices in Washington DC.

Link to full text of ‘Psychotic visitors to the White House’.
Link to ‘Psychotic visitors to government offices in the national capital’.

Back from the dead

A scene from a thousand horror movies, retold in the medical literature, with an additional lesson about the correct use of cerebral perfusion and angiography in diagnosing the brain dead patient.

Presumably, learnt shortly after the doctors had stopped screaming.

I love the use of the phrase “the situation became confusing”, just after the dead guy starts moving again.

Unusual movements, “spontaneous” breathing, and unclear cerebral vessels sonography in a brain-dead patient: a case report.

Bohatyrewicz R, Walecka A, Bohatyrewicz A, Zukowski M, Kepiński S, Marzec-Lewenstein E, Sawicki M, Kordowski J.

Transplant Proc. 2007 Nov;39(9):2707-8.

A patient with a brain injury fulfilled all clinical criteria for brainstem death diagnosis. Two standard sets of tests were performed; according to Polish regulations, the patient could be declared brain dead. However, shortly after the completion of the tests and before the final brain death declaration, 6 triggered “assisted” breaths/min were noticed. After careful analysis of the ventilator settings, it was concluded that low trigger sensitivity and airway pressure oscillations during heart contractions were the reasons.

Additionally, a few minutes later, spontaneous jerking movements of lower limbs and clonic movements of neck muscles secondary to painful stimuli were noticed. The situation became confusing; therefore, cerebral Doppler sonography was performed, showing circulatory arrest in both of the internal carotid, middle cerebral, and left vertebral arteries. The basilar artery was not visualized. Forward flow with increased pulsatility was recorded in extracranial and intracranial segments of the right vertebral artery. Cerebral circulatory arrest was still uncertain; therefore, the diagnostic procedures were completed with conventional cerebral angiography, which showed a lack of cerebral blood flow.

Finally, the patient was declared brain dead; kidneys and bones were harvested. Cardiogenic oscillations associated with incorrect low ventilator trigger settings may falsely suggest persistence of breathing efforts in a brain-dead patient. In the case of any unusual events during brain death diagnosis, cerebral perfusion tests should be performed with cerebral angiography as the “gold standard.”

Link to PubMed entry.

Psychobabble worst offenders

PsyBlog has collected the responses to its request for the most annoying psychobabble and you can now vote for your favourite worst offender.

The list reminds me of how many terms, particularly from psychoanalysis, have become part of the language, probably without people realising it.

Being ‘in denial’, being ‘anal’, being ‘defensive’, feeling ‘split’ over a decision, ‘projecting’ your fears, ‘repressing’ a thought, having a big ‘ego’, increasing ‘libido’ and feeling ‘castrated’ were all terms created or popularised by Freud and his followers.

Sadly for jargon haters, today’s psychobabble is tomorrow’s everyday language.

As the late psychologist Julian Jaynes pointed out, the Ancient Greek epic the Iliad makes no reference to a concept of the self or any mental states anywhere in the text.

Much of our everyday language of the mind is a relatively new cultural invention, suggesting that language is just another form of technology.

Hopefully though, some of the more annoying linguistic technologies will fall into disuse fairly soon, although I have to say, I have a fondness for some of the more arcane terms.

‘Enthusiastical’, meaning a form of religiously induced madness, is charmingly Dickensian, and ‘alienist’ – the old word for psychiatrist – has a completely different spin now we tend to think of little green men when we hear the word.

Link to PsyBlog psychobabble vote.