Trapped: Mental Illness in America’s Prisons

Photographer Jenn Ackerman has created a stunning and extensive video essay on Kentucky’s correctional facility for prisoners with mental illness, interviewing the inmates, staff and clinicians who form part of America’s biggest provider of residential psychiatry – the prison system.

Of course, the prisons were never designed to be providers of mental health care, but as a recent Time article noted, they have become the default treatment facility for the many people who fall through the cracks.

Ackerman has created a introductory film and also has put several prisoner interviews online, where we meet people in various states of distress and recovery. There’s also a fantastic film on ‘inmate watchers’ who have the responsibility to checking on vulnerable, volatile or suicidal inmates.

The films are sometimes disturbing, bleak in places and occasionally sublime, but are immensely revealing and show remarkable sensitivity in their construction.

From Ackerman’s written essay that accompanies the piece, I suspect that we only get to see the least affected people as those who are most ill are unlikely to be able to consent to being interviewed, meaning that even this bleak portrayal is likely to be a relatively positive depiction.

A man has been singing songs at the top of his lungs for the last two days, while another, hunched on his bed, wails from under a blanket. In a cell across the hall, a man shakes as he yells to his wife he has not seen in five years and to the thug down the street. In reaction to the noise, another man bangs endlessly on his cell door until an officer comes by and asks him to stop. He smiles and says he just wanted someone to talk to.

“We are the surrogate mental hospitals now,” says Larry Chandler, warden at the Kentucky State Reformatory in La Grange, Ky. With the rising number of mentally ill, the reformatory was forced to rebuild a system that was designed for security. Never intended as mental health facility, treatment has quickly become one of their primary goals.

Unfortunately, this situation is not unique to Kentucky. The continuous withdrawal of mental health funding has turned jails and prisons across the US into the default mental health facilities.

A 2006 report by the U.S. Department of Justice shows that the number of Americans with mental illnesses incarcerated in the nation’s prisons and jails is disproportionately high. Almost 555,000 people with mental illness are incarcerated while fewer than 55,000 are being treated in designated mental health hospitals.

Ackerman also has a gallery of still photographs and says she intends to make a feature length film which, if it has the impact of her online work, is likely to be profoundly moving.

Link to Trapped: Mental Illness in America’s Prisons.

Imagining missing limbs helps pain, reorganises brain

Neurology journal Brain has just published an elegant open-access study on how just six weeks of mental imagery training can help reduce phantom limb pain as well as reorganising the sensory and motor maps in the brain.

Phantom limbs are when amputees feel sensations that seem to be coming from the missing limb. Sometimes this can include pain which can either be constant or transitory.

Sensations from the nonexistent limb are thought to be due to the brain reorganising the areas which represent the body.

In the case of a phantom arm, for example, the area is no longer receiving sensations from the limb and so stops being so carefully defined. Areas serving other body areas (like the face) start to creep in and facial stimulation can be felt in the missing arm due to the fuzzy neurological boundaries.

This new study, led by neuroscientist Kate McIver, decided to test whether mental imagery can help keep these areas active and prevent the fuzziness creeping in, potentially reducing the phantom pain.

This is based on extensive research to show that imagining something activates similar brain areas to actually perceiving the sensation or executing the action. For example, imagining the sensation of a cool breeze across your arm actually increases activity in the brain areas responsible for arm sensations, while imaging picking something up activates arm-related motor areas.

The research team asked participants to rate their phantom limb pain and used fMRI to look at which brain areas were most active during some movement-related tasks. While in the scanner, the participants were asked to imagine actions with either the existing or phantom hand, to move the existing hand or were asked to purse (push together) their lips.

This last action tends to activate what was previously the hand area in the brain in people with phantom limbs, but doesn’t in people with intact limbs. Indeed, this is exactly what the initial brain scans reported, indicating that their brains had reorganised sensory boundaries.

The researchers then invited each participant for six weekly sessions that involved a mental ‘body scan’ technique that involved imagining free and comfortable movement in their phantom limb such as they could “stretch away the pain” and “allow the fingers, hand and arm to rest in a comfortable position”. Participants also practised in their own time.

After six weeks, pain ratings were taken again and the brain scanning was re-run. The painful sensations had significantly reduced and lip pursing no longer activated the hand area.

The mental imagery seemed to have ‘simulated’ arm actions and sensations well enough so that the neurological boundaries remained sharp and cross-area fuzziness didn’t encourage phantom pain.

Link to full text article in Brain.
Link to PubMed entry.

Don’t get high on your own supply

An article from Forensic Sciences International investigated evidence for addiction in anaesthetists by analysing hair samples.

The paper reports on four court cases where anaesthetists were suspended for suspected addiction to the drugs they use to put people to sleep or kill pain during operations.

Each case involved hair analysis to gather evidence, owing to the fact that many drugs will leave traces in the hair as it grows, leaving a timeline of drug use.

Chemical dependency is a disease that can affect all professions. Among the health care professionals, anesthesiologists represent a specific group. Numerous factors have been proposed to explain the high incidence of drug abuse among anesthesiologists. These include: easy access to potent drugs, particularly narcotics, highly addictive potential of agents with which they are in contact, and easy diversion of these agents since only small doses will initially provide an effect desired by the abuser.

Opioids are the drugs of choice for anesthesiologists, and among them fentanyl and sufentanil are the most commonly used. Alcohol is mostly abused by older anesthesiologists. Propofol, ketamine, thiopental and midazolam are also abused. In fact, all but quaternary ammonium drugs can be observed. Signs and symptoms of addiction in the hospital workplace include: unusual changes in behavior, desire to work alone, refusal of lunch relief or breaks, volunteer for extra cases, call, come in early and leave late, frequent restroom breaks, weight loss and pale skin, malpractice, behind on charts ….

Toxicological investigations are difficult, as the drugs of interest are difficult to test for. In most cases, half-lives of the compounds are short, and the circulating concentrations weak. It is, therefore, necessary to develop tandem mass spectrometry procedures to satisfy the criteria of identification and quantitation. In most cases, blood and/or urine analyses are not useful to document impairment, as these specimens are collected at inadequate moments. Hair analysis appears, therefore, as the unique choice to evidence chronic exposure.

Depending the length of the hair shaft, it is possible to establish an historical record, associated to the pattern of drug use, considering a growth rate of about 1cm/month. An original procedure was developed to test for fentanyl derivatives. After decontamination with methylene chloride, drugs are extracted from the hair by liquid/liquid extraction after incubation in pH 8.4 phosphate buffer. Fentanyl derivatives are analyzed by GC-MS/MS. The following cases are included in this paper:

Case 1: 50-year-old anesthetist, positive for fentanyl (644 pg/mg); Case 2: 42-year-old anesthetist, positive for fentanyl (101 pg/mg) and sufentanil (2 pg/mg); Case 3: 40-year-old anesthetist, positive for codeine (210 pg/mg), alfentanil (30 pg/mg) and midazolam (160 pg/mg); Case 4: 46-year-old nurse, found dead, positive for alfentanil (2 pg/mg) and fentanyl (8 pg/mg). In these cases, the combination of an alternative specimen (hair) and hyphenated analytical techniques (tandem mass spectrometry) appears to be a pre-requisite.

A recent review article noted that while doctors were generally healthier than the general popular, addiction remains a particular risk for physicians, stating “addiction impairs more physicians than any other disorder or disease. Though alcohol use, abuse, and dependence are no more prevalent among physicians than other professionals, physicians display higher rates of prescription drug abuse and dependence than the general population.”

Link to abstract of study on hair analysis.
Link to abstract of study on prescription drug abuse among physicians.

Magic in mind

Interest in the cognitive science of magic is really hotting up with Nature Neuroscience having just published a review article jointly authored by some leading cognitive scientists and stage illusionists. They argue that by studying magic, neuroscientists can learn powerful methods to manipulate attention and awareness in the laboratory which could give insights into the neural basis of consciousness itself.

The neuroscientists involved are Stephen Macknik and Susana Martinez-Conde, while the magicians are Mac King, James Randi, Apollo Robbins, Teller from Penn and Teller, and John Thompson.

If this collection of names sounds familiar, it’s because this time last year the same group presented a symposium at the Association for the Scientific Study of Consciousness on ‘The Magic of Consciousness’.

The new article rounds up the conference discussion and The Boston Globe has a piece looking at some of the highlights.

This is not the only cognitive science article that explores what neuroscience can learn from the mystic arts. In a forthcoming article [pdf] for Trends in Cognitive Sciences psychologist Gustav Kuhn.

Kuhn has done some fantastic experimental studies looking at eye movements and attention of people watching magic tricks.

It’s not only an academic interest as Kuhn is apparently an illusionist himself and he’s one of a number of psychologists who also happen to be stage magicians. Just off the top of my head psychologists Richard Wiseman and Robert Moverman are also ex-professional conjurers. I’ve come across several others and so its perhaps not so surprising that these new articles have been published, but more that they took so long.

Both articles look at some common and no so common magic tricks and explain the cognitive science behind how they work:

Persistence of vision is an effect in which an image seems to persist for longer than its presentation time12, 13, 14. Thus, an object that has been removed from the visual field will still seem to be visible for a short period of time. The Great Tomsoni’s (J.T.) Coloured Dress trick, in which the magician’s assistant’s white dress instantaneously changes to a red dress, illustrates an application of this illusion to magic. At first the colour change seems to be due (trivially) to the onset of red illumination of the woman. But after the red light is turned off and a white light is turned on, the woman is revealed to be actually wearing a red dress. Here is how it works: when the red light shuts off there is a short period of darkness in which the audience is left with a brief positive after-image of the red-dressed (actually white-dressed but red-lit) woman. This short after-image persists for enough time to allow the white dress to be rapidly removed while the room is still dark. When the white lights come back, the red dress that the assistant was always wearing below the white dress is now visible.

Link to Nature Neuroscience article (via BB).
pdf of Trends in Cognitive Science article.
Link to Boston Globe write-up.

Encephalon 51 arrives with a flourish

The rather poetic 51st edition of the Encephalon psychology and neuroscience writing carnival has just been published online and is graciously hosted by The Mouse Trap.

It has a distinctly poetic theme on this occasion, with a set of cognitive science haikus enlivening proceedings.

A couple of my favourite posts include one on the continuing mirror neuron hype and another on the cultural feedback loop between psychiatry and our expression of mental distress.

Link to Encephalon 51.

On the edge of truth

Discover Magazine has a brief but interesting interview with ex-NSA psychologist Eric Haseltine, who directed research into interrogation and lie detection.

He discusses the use of new technologies that measure body and brain function – i.e. the still not-yet-very-good ‘brain scan lie detectors’ – but also talks about the skills humans need to be able to pick up when someone is trying to deceive them.

Interestingly, he cites the development of human skills as where the biggest advances are likely to be made in the future:

What is the hottest area today in deception detection?

Human lie detectors. I think the low-tech training of humans to be better interpreters of information is where the most productive work is going to be. The reason being that you can either train a human to do it or train a computer to do it, and human brains are still much better computers than computers are.

Link to Discover Magazine interview with Haseltine.
Link to New Yorker article on the shortcomings of ‘brain scan lie detection’.
Link to past interview with Haseltine on US national security.

Interview with self-trepanner, Heather Perry

Neurophilosophy has a fantastic interview with Heather Perry, a 37-year old British woman who organised a modern-day trepanation to insert a hole in her skull in an attempt to alter her state of consciousness.

Perry gives a lucid insight into her motivations and describes the rather ad-hoc operation in rather gory detail:

How exactly did you perform the trepanation?

I used a hand trepan initially, but that wasn’t proving to be terribly successful. Then there was a problem with the people who owned the property we were staying in, so we decided we’d have to just leave it. I wrapped my head up in a towel and we got out of there. A couple of days later, we had another go. We abandoned the hand trepan and got an electric drill instead. I injected myself with a local anaesthetic and then slashed a big T-shaped incision in my scalp, right down to the bone. I was sat there in the bathroom feeling quite relaxed and they started with the drill. It didn’t take that long at all, probably about 20 minutes. Eventually I could feel a lot of fluid moving around. Apparently, there was a bit too much fluid shifting around, because they’d gone a little bit too far and I was leaking some through the hole, but this wasn’t especially dangerous as there are three layer of meninges before you get to the brain.

It’s an interesting read not least because Perry is rather circumspect when discussing the procedure.

You might expect that someone who had arranged for a hole to be drilled in her skull to be completely convinced about the rather far-out claims for trepanation.

While she does mention some claimed effects and findings, she seems quite measured in her assessment and largely seems to have tried the procedure as an exploration rather than a ‘cure’ in any specific sense.

Link to Neurophilosophy interview with Heather Perry.