It is scientists who seek to get heaven in their heads

The wonderful image is an original drawing by the artist Masonic Boom, aka Kate St.Claire, as part of her series of psychological self portraits.

The quote in the image is from the author and philosopher G.K. Chesterton.

He was once asked by The Times to write an article on ‘What is wrong with the world?’ and send the following piece:

Dear Sirs,

I am.

Sincerely yours,
G. K. Chesterton

Thanks to Katie for allowing us to feature the image and it’s really worth seeing full size at the link below.

Link to full size image on Flickr.
Link to Masonic Boom collection.

The theatre of hysteria

I’m currently reading Elaine Showalter’s book Hystories, a cultural history of the concept of ‘hysteria‘, a term which has variously described the supposed effects of a ‘wandering womb’, unexplained neurological symptoms, panic, nervousness or just ‘making a fuss’.

She describes where medicine and media have collided, and highlights how popular interest in the condition has driven a long-standing tradition of fictional interpretations that have developed alongside medical understanding.

Showalter has a feminist angle although is generally even handed with the evidence and is not shy in highlighting the excesses of some past feminist writing on the subject.

One particularly interesting part is where she discusses how theatre interpreted the work of 19th century French neurologist Jean-Martin Charcot as it was happening.

Charcot is perhaps most famous for his work on hysteria and held regular Tuesday lectures at the Salp√™tri√®re hospital in Paris where he would theatrically demonstrate the symptoms of hysteria in favourite female patients who apparently ‘performed’ with an equal flourish.

As we mentioned previously, one of the reasons Charcot’s work was so widely known is because he used the newly developed technology of photography to create striking and sometimes pseudo-erotic portraits documenting the bodily contortions of his (largely) female patients. The picture on the right is of Augustine, one of his ‘star patients’.

These have been the inspiration for numerous contemporary plays, ballets, exhibitions and novels.

What I didn’t know was that these are not a modern phenomena, shows based on Charcot’s work work were popular since Charcot first began publishing his work and giving lectures (from p100):

As Charcot’s clinic achieved celebrity in the 1890s, images of hysteria cross over to theatre and cabaret. At the Chat Noir and Folies Berg√®re, performers, singers, and mimes who called themselves the “Harengs Saurs √âpileptiques” (The Epileptic Sour Herrings) or “Hydropathes” mimicked the jerky, zigzag movements of the hysterical seizure…

The poses of grande hyst√©rie enacted at the Friday spectacles of the Salp√™tri√®re closely resembled the stylized movements of French classical acting. Indeed, hysterical women at the clinic and fallen women in melodrama were virtually indistinguishable; the theatre critic Elin Diamond comments that both displayed “eye rolling, facial grimaces, gnashing teeth, heavy sighs, fainting, shrieking and choking; ‘hysterical laughter’ was a frequent stage direction as well as a common occurrence in medical asylums”…

Arthur Symons regarded the Moulin Rouge dancer Jane Avril as the embodiment of the age’s “pathological choreography.” These resemblances were not coincidental: writers, actresses cabaret performers and dancers like Avril attended Charcot’s matinees and then worked the Salp√™tri√®re style into their own performances.

An interesting twist is that Avril was actually treated by Charcot as a young girl after she ran away from an abusive mother and was admitted to the Salp√™tri√®re for ‘insanity’.

Link to details of Showalter’s book Hystories.
Link to first chapter.

The Maudsley cat

The not very good photo is of Coco, the Maudsley Hospital cat and one in a long line of felines who reside in psychiatric hospitals. Not all psychiatric hospitals have cats, but they’re not uncommon and exist as a sort of informal tradition of live-in feline therapy.

They’re very popular with both staff and patients, but their presence tends to drive managers up the wall, which just makes them all the more endearing. I’ve worked in three hospitals that have cats and almost invariably they live in the older adults ward, keeping the older folks company (and vice versa, of course).

The older adults ward at the Maudsley is called the Felix Post unit, after the distinguished psychiatrist of the same name. Coco’s predecessor was naturally called Felix, leading to occasional confusion where people assumed the ward was named after the cat.

As I hadn’t seen Coco all summer I enquired and it turns out he’s “gone to Liverpool”, which I’m assured isn’t a euphemism to protect those of fragile mood, but a genuine change in his location as the ward manager moved with Coco in tow. So for the first time in decades, the Maudsley is without a hospital cat.

Promising Alzheimer’s drug announced

The results of a moderate sized trial on a new Alzheimer’s drug have just been announced and the results, if reliable, may suggest that the treatment is one of the most important medical breakthroughs of the century.

Alzheimer’s disease is a type of dementia, a degenerative disorder of where the brain starts to degrade more quickly than would be expected through normal ageing.

One of the common features of Alzheimer’s disease is the accumulation of neurofibrillary tangles in the brain. These are clumps of tau protein that accumulate inside dying neurons. There have been debates about whether these cause the problems or are just the result, but most researchers are now coming round to the idea that tau protein tangles are the main problem.

The drug has been given the tradename ‘remben’ and was initially thought to be useful as it dissolved tangles in the test tube. It has just been tested in a Phase II trial which have been announced at an Alzheimer’s research conference.

The results of the first announced trial has not been published but there are details on the conference press release which I’ve included below the fold.

What’s most impressive from the preliminary details, is that the drug seemed to both slow or even stop cognitive decline in some cases, as well as eliminating the decline in blood flow in the areas usually most affected by the disease suggesting that it is halting the spread of tangles.

Interestingly, the company behind the drug, TauRx, have just launched their website today to catch the wave of publicity.

However, I’m wondering whether there’s more to it than meets the eye because, if I’ve got it right, the drug isn’t actually new.

Its chemical name is methylthioninium chloride but it’s also known as methylene blue and was synthesised way back in 1876. It was shown to be active against malaria by Paul Ehrlich in 1891 and later as a useful antibacterial drug (have a look at this fascinating NYT article from 1910).

In the late 1980s it was tried as a treatment for manic-depressive disorder and found to be useful.

Is this seems surprising, you may be interested to know that methylene blue was the basic compound from which the first antipsychotic drug chlorpromazine or Thorazine was made (in case you’re wondering, this family of antipsychotics can also work as anti-bacterial drugs, but have not been used due to other drugs having less side-effects).

If this is really just methylene blue, what this means in financial terms is that the drug can’t be patented.

In other words, anyone can make the drug which means its much harder to make money on it as pricing becomes competitive. In contrast, a patent gives you a time-limited monopoly – albeit one that can earn billions.

A widely available cheap generic drug that treats a major disease is actually a fantastic thing for society, but developing them is not typical behaviour for pharmaceutical companies who tend to shun unpatentable drugs.

Also, it’s probably true to say that the history of drug development shows a typical three stage process:

1. We’ve found a miracle cure!
2. We’ve found a miracle cure, but it can kill people.
3. It’s not a miracle cure, it can kill people, but it’s worth the risk in many cases.

So, time will tell how useful it is in the real world, but pretty much everyone has their fingers crossed that it will work out as a useful treatment.

Link to write-up from The Telegraph.

Continue reading “Promising Alzheimer’s drug announced”

Is the cinematograph making us stupid?

I’ve just found an eye-opening 2003 article in the Journal of the American Medical Association on the work on 19th century neurologists George Beard and Silas Weir Mitchell, who thought the pace of life and the effect of new technology was harming the mind and brain of citizens in 1800s America – echoing similar concerns we still hear today.

The two physicians were influential in pushing the idea that these effects resulted in ‘neurasthenia‘, a kind of fuzzy catch-all diagnosis for mental or emotional malaise.

What’s interesting is we’re experiencing something almost identical over 100 years later.

As we’ve noted several times, leading scientists or commentators can make international headlines by simply suggesting that new technology is harming the mind, brain and relationships of the modern citizen, despite a general lack of evidence or flat out evidence to the contrary.

The JAMA article notes how neurasthenia was associated with the cultural concerns of the time:

Families migrated from the countryside to the city, men left traditional jobs as tradesmen and farmers to join the growing ranks of businessmen and office workers, women went from being mothers and daughters to also being university students and physicians, and technological developments such as telegraphs, telephones, and railroads became increasingly common parts of everyday life. As a diagnosis, neurasthenia commanded an intuitive legitimacy because it incorporated the anxieties that arose from these changes into the way people thought of their health. It could attribute a bank manager’s headaches to his hectic schedule and the obsession for detail his job demanded.

Similarly, a young woman’s depression could be understood as neurasthenia brought on by the mental drain of attending a newly founded coeducational university, where she competed for grades. In many cases, diagnoses of neurasthenia attached themselves to traditional ideals, such as the restorative virtues of farming vis-√†-vis the fast-paced stress of modern business or the Victorian belief in women’s disposition for motherhood rather than scholarship. For Beard and Mitchell, neurasthenic patients were casualties of modern society whose bodies and minds simply could not keep up with the seemingly accelerated lifestyles of men and women in the latter part of the 19th century.

It’s a lovely illustration of the fact that since the dawn of popular medicine, our cultural concerns about changes in society are likely to be expressed in the language of illness and disease.

The article also notes that then, like now, the concerns are accompanied by an encouragement to return to the traditional ways of doing things (in this day and age – encouraging kids to ‘play proper games’ or have ‘genuine relationships’) rather than highlighting ways of healthy adaptation to the new technology.

This is not to say that all fears about new technologies are unfounded, but its clear that they are quickly medicalised and get far more prominence than the evidence supports, both in the 19th century and in the 21st.

Link to JAMA article ‘Neurasthenia and a Modernizing America’.

A party game that goes down like a red balloon

I just found this clever advert for The Economist which has an immediate impact but kinda becomes a bit awkward if you think about it for too long.

Presumably, it’s meant to convey the idea that the magazine is ‘mind expanding’. But as we mentioned in an earlier post, we tend to ascribe different sorts of properties to the mind and brain.

One key difference is that we don’t ascribe physical properties to the mind, which is a bit of a pain when you’re trying to create a visual advert. So the designers went for a brain.

But ‘brain expanding’ is just kind of awkward. It makes me think of hydrocephalus – a condition where faulty fluid drainage causes internal pressure which literally balloons the brain.

In young children with soft skulls this causes skull deformation, in adults it just tends to squash the brain against the side of the skull. Either way, it usually needs surgical intervention to insert a shunt valve to treat the drainage problem, else brain damage and death follow in a high proportion of cases.

Nevertheless, if you can get your hands on any of these balloons you’ve instantly got yourself a neurosurgery party game for kids. The first kid to fashion a shunt out of a drinking straw gets a special John Holter prize.

Yes, I know I should get out more.

Link to Economist advert.

Juggling can change brain structure within 7 days

A new study just published in PLoS One reports that learning to juggle alters the structure of motion detection areas in the brain within as little as 7 days.

Led by neuroscientist Joenna Driemeyer, the study builds on a previous research that also found juggling could alter brain structure, although this previous study waited three months before the brain was checked for alterations using high resolution structural MRI scans.

This new study also took 20 non-jugglers and asked them to learn to juggle, but scanned them after 7, 14 and 35 days.

After only 7 days, a motion specialised part of the occipital lobe known as V5 had increased in density. In both studies, the changes were maintained over the subsequent weeks of practice, but these areas returned to their pre-learning state after several weeks without juggling.

This is an interesting example of rapid ‘neuroplasticity‘, the ability of the brain to adapt structurally to new situations.

However, the authors are careful to note that they can’t tell whether the brains of the participants had generated more neurons, or whether existing cells grew in size, or additional glial cells were developed, or maybe there were just changes in how much blood or other brain fluids packed the area.

Also, the fact that changes seemed to occur at the beginning of the learning cycle but that further practice maintained but didn’t cause additional changes led the researchers to speculate that learning a variety of new things, rather than simply practising old skills, may be most effective in terms of brain structure alterations.

Link to ‘Changes in Gray Matter Induced by Learning ‚Äî Revisited’.
Link to PubMed entry for paper.

Full disclosure: I’m an unpaid member of the PLoS One editorial board.