The insanity epidemic, 1907

I’ve happened upon an interesting snippet from the regular Nature “100 years ago” feature concerning a 1907 debate on whether insanity was really increasing or whether it just seemed that way due to changes in diagnosis and treatment methods.

It made me smile because it is almost exactly the same argument that is being had now about whether cases of autism are genuinely increasing or whether this just reflects changes in diagnosis and treatment methods:

Notwithstanding the much improved statistics recently issued by the Lunacy Commissioners, thoroughly satisfactory materials are still wanting for solving the question whether the prevalence of insanity is or is not increasing. The importance of the problem… imparts special interest to a paper by Mr. Noel A. Humphreys on the alleged increase of insanity… This paper shows in a striking manner the value of scientific statistics in checking crude figures.

The author expresses a decided opinion that there is no absolute proof of actual increase of occurring insanity in England and Wales, and that the continued increase in the number and proportion of the registered and certified insane is due to changes in the degree and nature of mental unsoundness for which asylum treatment is considered necessary, and to the marked decline in the rate of discharge (including deaths) from asylums.

From Nature 18 July 1907.

Link to Nature “100 years ago” snippet.
Link to Wikipedia page on epidemiology of autism.

Creative in love

The Scientific American Mind blog Mind Matters has a fantastic article on the links between love and creativity and how just thinking of a romantic relationship can have an immediate effect on creative thinking.

The piece covers several studies which have shown that love or the concept of love promotes a ‘big picture’ thinking style while thinking of a quick shag seems to do the reverse:

The clever experiments demonstrated that love makes us think differently in that it triggers global processing, which in turn promotes creative thinking and interferes with analytic thinking. Thinking about sex, however, has the opposite effect: it triggers local processing, which in turn promotes analytic thinking and interferes with creativity.

Why does love make us think more globally? The researchers suggest that romantic love induces a long-term perspective, whereas sexual desire induces a short-term perspective. This is because love typically entails wishes and goals of prolonged attachment with a person, whereas sexual desire is typically focused on engaging in sexual activities in the “here and now”. Consistent with this idea, when the researchers asked people to imagine a romantic date or a casual sex encounter, they found that those who imagined dates imagined them as occurring farther into the future than those who imagined casual sex…

A global processing style promotes creative thinking because it helps raise remote and uncommon associations.

Clearly there is a happy medium to be found here, and I have to say, “would you like me to balance your processing styles?” has the makings of a great chat-up line.

Link to Does Falling in Love Make Us More Creative? (via Frontal Cortex)

Side-effects from placebos can be drug specific

Photo by Flick user Cayusa. Click for sourceA fascinating study just published in the medical journal Pain examined the side-effects reported by patients taking placebos in clinical trials to test migraine drugs. It found that side-effects from placebo were almost as common as from the actual drug, but most interestingly, were specific to side-effects you would expected from the comparison medication.

In other words, the side-effects you get from a sugar pill in a study on anticonvulsant drugs closely resemble side-effects you get from anticonvulsants and are different from the side-effects you get from a sugar pill in a study on pain killers, which more closely resemble pain killer side-effects.

The researchers, led by neuroscientist Martina Amanzio, looked at trials for three type of migraine drugs: NSAIDs (like aspirin), triptans that work on the serotonin system, and anticonvulsant drugs more often used to treat epilepsy.

Side-effects from placebo are known as the nocebo effect and just the combined list of side-effects from the placebo groups in this study is surprising enough:

abdominal pain, anorexia or/and weight loss, attention difficulties, burning or/and flushing, chest discomfort, chills, diarrhea, dizziness, dry mouth, dyspepsia, fatigue, heaviness, injection side reaction, insomnia, language difficulties, memory difficulties, nasal signs and symptoms, nausea, numbness, paresthesia or/and tingling, pharyngitis, somnolence or/and drowsiness, stinging or/and pressure sensation, taste disturbance, tinnitus, upper respiratory tract infection, vomiting, weakness

It turns out that when placebo was being compared to an anticonvulsant, side-effects more common in these drugs – like fatigue, reduced appetite, sleepiness and tingling sensations – were more common in the placebo. In contrast, stomach upsets and dry mouth were more common in the placebo group when the comparison was with NSAID painkillers, which more often cause these symptoms themselves.

One explanation may be that before taking part in a clinical trial, patients are informed of the possible side-effects that the active drug may cause, regardless of whether they are going to be given placebo or the actual medication.

Information on the possible side-effects will be specific to the real medication, and, as we know that expectation plays a big part in the placebo effect, it is probably also shaping the nocebo effect and leading to the production of symptoms through expectancy.

Link to PubMed entry for study.

Ultra marathon for the mind

An extraordinary 2006 article from The New York Times profiles ultra-endurance cyclist Jure Robič who apparently regularly loses his sanity during his races Рliterally becoming psychotic as he pushes himself to the limit.

The craziness is methodical, however, and Robic and his crew know its pattern by heart. Around Day 2 of a typical weeklong race, his speech goes staccato. By Day 3, he is belligerent and sometimes paranoid. His short-term memory vanishes, and he weeps uncontrollably. The last days are marked by hallucinations: bears, wolves and aliens prowl the roadside; asphalt cracks rearrange themselves into coded messages. Occasionally, Robic leaps from his bike to square off with shadowy figures that turn out to be mailboxes. In a 2004 race, he turned to see himself pursued by a howling band of black-bearded men on horseback…

In a consideration of Robic, three facts are clear: he is nearly indefatigable, he is occasionally nuts, and the first two facts are somehow connected. The question is, How? Does he lose sanity because he pushes himself too far, or does he push himself too far because he loses sanity? Robic is the latest and perhaps most intriguing embodiment of the old questions: What happens when the human body is pushed to the limits of its endurance? Where does the breaking point lie? And what happens when you cross the line?

It’s a wonderfully written article that touches on the man himself, the physiology of fatigue and the psychological strain of intense athletic feats.

Link to NYT article on Jure Robič.

Classic Sacks

I’ve just found this remarkable TV interview with Oliver Sacks from 1986, only a year after the publication of his famous book A Man Who Mistook His Wife for a Hat.

It’s a fascinating discussion, not least because it’s something you don’t see much these days – an extended interview that focuses solely on a neuroscientist and his work.

There are no gimmicks or attempts to jazz it up with fancy editing and graphics. We see everything during the discussion, including Sacks’ many ‘ums’ and ‘ahs’ and even hear a telephone going off half way through!

Still, it’s a really wide ranging discussion which covers everything from the effects of brain injury to the role of doctors in exploring their patients’ lives.

From what I can make out, the interviewer is Harold Channer who did the piece for a Manhattan-based public access TV network probably before Sacks became well-known.

The video quality is a bit ropey but Sacks has a spectacular beard and is as chaotically engaging as ever. Classic stuff.

Link to Oliver Sacks interview from 1986.

No research, no problem

Time magazine has a remarkably one-sided article on America’s first ‘internet addiction’ clinic. The clinic turns out to be a few rooms in someone’s house, but the article gives away an interesting if not depressing gem about the likely status of the ‘internet addiction’ diagnosis in the DSM-V, the next version of the psychiatrists’ diagnostic manual:

“The central issue is the absence of research literature on this,” says Dr. Charles O’Brien, director of the University of Pennsylvania’s Center for Studies in Addiction and the current chair of the DSM-V committee to revise the manual, adding that with the backdrop of the health-care debate, now is a precarious time to introduce new disorders that will require more money to treat.

“At this point I think it’s appropriate that it’s not considered an official disease,” says O’Brien. “We are probably going to mention it in the appendix.”

The appendix refers to Appendix B, which is a list of diagnoses worthy of future study, and yes, that’s the head of the DSM addiction committee saying that an “absence of research literature” makes something worthy of future study.

In which case, I might write to him and ask to have my own diagnosis of “impulsive diagnosis inclusion syndrome” listed on the same basis.

But not only is his reasoning rather odd, he’s also wrong. There’s quite a sizeable literature on the ‘internet addiction’ diagnosis and, as noted by a meta-analysis published last year, it turns out to be rubbish.

If you’re interested in reading something a little more balanced, I get to spar with Kimberley Young, one of the long-standing ‘internet addiction’ promoters, in an article in this month’s Canadian Medical Association Journal.

Link to Time on America’s first ‘internet addiction’ clinic.
Link to ‘internet addiction’ scrap in CMAJ.

Encephalon 76 slides home

The 76th edition of the Encephalon psychology and neuroscience carnival has just appeared on the Neuroskeptic blog and is packed full of mind and brain goodness.

A couple of my favourites include an excellent piece from Providentia about the violin prodigy Josef Hassid whose career was cut short by a brain tumour, and another is a great post on AK’s Ramblings about counter-intuitive labels in neuroscience.

A whole lot more mind and brain writing awaits, all bang up-to-date and hot off the press.

Link to Encephalon 76.

Where the wild things are

The Psychologist has an excellent article on the psychology behind the classic children’s book Where The Wild Things Are. It turns out that the author, Maurice Sendak, was heavily interested in psychoanalysis and intended the book to explore the inner life of children.

The article is by psychoanalyst Richard Gottlieb who examines some of the influences on the book and Sendak’s other works, noting that the author was in analysis himself and had an analyst as his life partner.

There is a remarkable thematic coherence to much of Sendak’s work, and this coherence links creative efforts that are decades apart and, additionally, links these works to what is known about his early life and formative years. Sendak himself has commented on his single-minded focus, saying, ‘I only have one subject. The question I am obsessed with is How do children survive?’ But it is more than mere survival that Sendak aspires to, for his children and for himself. He asks the question of resilience: How do children surmount and transform in order to prosper and create? It is tempting to imagine that Sendak conceives of the trajectory of his own life and art as a model for the way he has handled these questions in his works.

By the way, the whole issue of The Psychologist is freely available online, albeit as a slightly unwieldy Flash application.

It’s one of the best issues I can remember for a long time. You may want to check out an excellent article on the default network, an interview with Chris Frith, a piece on the psychology of storytelling or a review of recent discussions on the next big questions in psychology.

Link to The Psychologist on Where The Wild Things Are.

Full disclosure: I’m an unpaid associate editor and occasional columnist for The Psychologist. I read Where The Wild Things Are as a child and loved it.

Human, All Too Human

I’ve just discovered that probably one of the best series ever produced on philosophy is available on Google Video. The BBC series Human All Too Human includes three fantastic programmes on Friedrich Nietzsche, Jean Paul Sartre and Martin Heidegger – a trio of controversial thinkers who massively influenced 20th century philosophy.

It’s an interesting choice as all had fascinating and turbulent lives – Nietzsche ending his life in insanity, Heidegger a unrepentant Nazi defended by a Jewish ex-lover, and Sartre who walked the line between free love and womanising.

All had a huge influence on psychology at various stages, and you can clearly see how many struggled with concepts of mind and society.

The programmes tackle both the characters and their theories and are some of the most engaging and gripping programmes I’ve ever seen on philosophy, an essential subject that usually gets little more than satire or lip service from mainstream media.

They’re an hour each and worth every minute. Put some time aside, find a comfy chair and enjoy.

Link to programme on Jean Paul Sartre.
Link to programme on Martin Heidegger.
Link to programme on Friedrich Nietzsche.

From Stroboscope to Dream Machine

Photo from‘From Stroboscope to Dream Machine: A History of Flicker-Induced Hallucinations’ is a wonderful article that has just appeared in medical journal European Neurology. It charts how an early finding in visual neuroscience was adopted by the Beat writer William Burroughs and became a fixture of the psychedelic sixties.

Flicker induced hallucinations have been noted throughout history and typically occur when a strong light flashes between 8 and 12hz, also known as the alpha rhythm. They most commonly trigger a type of hallucination called a form constant that comprises of geometric shapes and patterns.

Alpha rhythms have been heavily linked to the function of the occipital lobe and, as we suspect from recent research, ‘inputting’ alpha waves into the visual system via flickers seems to cause hallucinations by knocking a deep brain structure called the thalamus and the occipital lobe out of sync.

As both are part of the visual system, the effect is a bit like knocking a conversation out of sync – misperceptions occur.

Burroughs happened upon the phenomenon and set about creating a machine to produce these hallucinations:

The flicker phenomenon reminded Burroughs of a story he had recently been told by his soul mate Brion Gysin (1916-1986). At the time they both inhabited a cheap hotel in 9, rue Gît Le Coeur, a small alley in the middle of the Latin Quarter of Paris. The place has been known as the Beat Hotel ever since. Gysin was a man with many skills; he was a painter, a poet, a calligrapher, a musician and a cook, all in one lifetime.

On December 21, 1958, as his diary reports, he had been travelling on a bus in southern France. He had fallen asleep, leaning with his head against the window pane. On passing by a row of trees, sunlight came flickering through and Gysin started to hallucinate:

‘an overwhelming flood of intensely bright patterns in supernatural colours exploded behind my eyelids: a multi-dimensional kaleidoscope whirling out through space. The vision stopped abruptly when we left the trees. Was that a vision?’.

Gysin knew by experience what neurophysiologists like Walter were talking about. Burroughs was able to hand him the theoretical framework.

The next step was to manufacture a stroboscope for private use. Gysin persuaded one of his friends, Ian Sommerville (1940-1976), to make one. Sommerville, who was originally a mathematician, came up with a simple but effective design

This was later developed into the commercially produced dreammachine, essentially a light with a rotating slotted lampshade designed to produced flickers in the alpha range. It became popular as both a way of inducing hallucinations on its own and as an aide to hallucinogenic drug trips.

There are plans online from a company who still make the machines to order.

The hallucinations don’t occur in everyone (in fact, I’ve probably spent a few hours of my life in front of a frequency controlled strobe trying to trigger the effect with no luck) and in people with photosensitive epilepsy the flickers can trigger seizures.

The effect is almost unknown in the psychedelic circles circles in which it was once popular, but has now been adopted by neuroscientists wanting a lab-based method to research hallucinations.

If you’re interested in reading more about the whole fascinating story, I can’t recommend the short but fascinating book Chapel of Extreme Experience enough.

Link to full-text of article on flicker hallucinations.
Link to DOI entry for same.

2009-09-25 Spike activity

Quick links from the past week in mind and brain news:

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Is the Internet melting our brains? asks Slate of author Dennis Baron who says no, it’s just another cycle in the human history of technology distrust.

Neurophilosophy discusses recent research on how patients in the coma-like persistent vegetative state can show conditioned learning and that those that day are more likely to show recovery.

Psychoanalyst Susie Orbach discusses the psychology and politics of the body on ABC Radio National’s Saturday Extra.

TED Blog has an interesting interview with Oliver Sacks relating to his recent talk on hallucinations.

Thank you Developing Intelligence for being of the few places not to fall for the ‘fMRI of dead fish is an example of a voodoo correlation’ red herring. They’re different effects and the DevIntel post discusses the difference.

Neuroanthropology has an excellent and somewhat philosophical post on mind body duality in the treatment of combat-related PTSD.

Free will is not an illusion after all, much to the surprise of New Scientist who report on new research suggesting an alternative interpretation to Libet’s famous brain activation before conscious intention to move study.

The BPS Research Digest covers research on how your personality type affects the situations you place yourself in. One of many excellent post from the BPSRD this week.

ABC Radio National’s Ockham’s Razor discusses the many illness of dictionary creator Dr Samuel Johnson. You may be interested to know that another major contributor was William Chester Minor who wrote many definitions as a patient in Broadmoor Criminal Lunatic Asylum.

PsyBlog has an excellent post on how long it takes to form a habit.

A photograph of your loved one can reduced pain intensity according to a study covered by Neuronarrative.

New Scientist <a href="
“>covers research on how different alleles of the COMT gene are associated with exam performance. Ignore the ‘gene for x’ nonsense and it’s actually quite an interesting article.

Welcome to the rehab center from the future via a humorous photo gallery from Wired.

Neuroskeptic covers a fascinating case study of a man with a missing limbic system.

Another interesting advance in the still limited field of ‘brain scan mind reading‘ is covered by Wired.

Cognition and Culture has a short piece on how to think, say, or do precisely the worst thing for any occasion.

The Wall Street Journal has a piece on the shocking news that treating your employees well increases their productivity.

When does consciousness emerge? The Splintered Mind has a brilliantly thought-provoking post on the emergence of the conscious mind in individuals and species.

The Neurocritic has a piece on a recent but necessarily speculative paper on the neuroscience of torture and the negative effects on accurate memory recall.

It always seems worse than you think

There is a clich√© in media stories where figures for a disease or condition are quoted followed by a statement that “the true figures may be higher”. Sampling errors mean that initial figures are equally as likely to be under-estimates as over-estimates but we only ever seem to be told that the condition is under-detected.

For example, this is from a recent (actually pretty good) New Scientist article about gender identity disorder (GID) in children, a condition where children who are biologically male feel female and vice versa:

It is unclear how common GID is among children, but many transsexual adults say they felt they were “in the wrong body” from an early age. The incidence of adult transsexualism has been estimated at about 1 in 12,000 for male-to-females, and around in 1 in 30,000 for female-to-males, although transsexual lobby groups say the true figures may be far higher.

These estimates are usually drawn from prevalence studies where a maybe a few hundred or thousand people are tested. The researchers extrapolate from the number of cases to make an estimate of how many people in the population as a whole will have the condition.

These estimates are made with statistical tests which give a margin of error, meaning that within a certain range, typically described by confidence intervals, the real figure is likely to be between a range which equally includes both higher and lower values than the quoted amount.

For any individual study you can validly say that you think the estimate is too low, or indeed, too high, and give reasons for that. For instance, you might say that your sample was mainly young people who tend to be healthier than the general public, or maybe that the diagnostic tools are known to miss some true cases.

But when we look at reporting as a whole, it almost always says the condition is likely to be much more common than the estimate.

For example, have a look at the results of this Google search:

“the true number may be higher” 20,300 hits

“the true number may be lower” 3 hits

You can try variations on the phrasing and see the same sort of pattern emerges. I’m curious as to why this bias occurs, or whether there’s another explanation for it.

The English Surgeon online

Last year I posted about a wonderful film called The English Surgeon, a sublime documentary about the work of neurosurgeons Henry Marsh and Igor Kurilets in the Ukraine. It turns out you can now watch it for free online at the PBS website until 9th October.

As I mentioned last time “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 clich√©.”

As far as I can work out, it should be available wherever you are in the world.

By the way, it turns out that Henry Marsh is the husband of social anthropologist Kate Fox who wrote the book Watching the English that we discussed earlier, so interesting to see that Marsh embodies many typical English traits.

Link to The English Surgeon online (via @mocost @balajajian).

Love outside the lines

The BBC Radio 4 programme Saturday Live recently had a segment on the UK Government’s belated apology to Alan Turing for his 1952 conviction for homosexuality. The programme’s resident poet, Matt Harvey, penned this short but poignant poem to mark the occasion:

here’s a toast to Alan Turing
born in harsher, darker times
who thought outside the container
and loved outside the lines
and so the code-breaker was broken
and we’re sorry
yes now the s-word has been spoken
the official conscience woken
– very carefully scripted but at least it’s not encrypted –
and the story does suggest
a part 2 to the Turing Test:
1. can machines behave like humans?
2. can we?

Link to programme details. Scroll down for poem.

Transhuman nature

ABC Radio National’s All in the Mind has just had an excellent programme on ‘the singularity‘, the idea that at some point in the future computer power will outstrip the ability of the human brain and then humanity will be better off in some sort of vague and unspecified way.

The idea, is of course, ludicrous and is based on a naive notion that intelligence can measured as a type of unitary ‘power’ which we can adequately compare between computer and humans. The discussion on All in the Mind is a solid critical exploration of this wildly left-field notion as well as the community from whence it comes.

It’s a popular theme among transhumanists who, despite seeming to have a mortal fear of human limitations, I quite like.

Transhumanists are like the eccentric uncle of the cognitive science community. Not the sort of eccentric uncle who gets drunk at family parties and makes inappropriate comments about your kid sister (that would be drug reps), but the sort that your disapproving parents thinks is a bit peculiar but is full of fascinating stories and interesting ideas.

They occasionally take themselves too seriously and it’s the sort of sci-fi philosophy that has few practical implications but it’s enormously good fun and is great for making you re-evaluate your assumptions.

By the way, there’s loads of extras on the AITM blog, so do check it out.

Link to All in the Mind on ‘the singularity’.
Link to extras on AITM blog.

Migraine as inspiration

Photo by Flickr user Auntie P. Click for sourceI’ve just found a brief but interesting study finding that migraines are much more common in neurologists than the general public which inspired an interesting reply by Oliver Sacks.

The prevalence of migraine in neurologists

Neurology. 2003 Nov 11;61(9):1271-2.

Evans RW, Lipton RB, Silberstein SD.

To assess the prevalence of migraine among neurologists and neurologist headache specialists, the authors performed a survey of neurologists who attended a headache review course. The 1-year and lifetime prevalences of migraine in the 220 respondents were as follows: male neurologists, 34.7%, 46.6%; male headache specialists, 59.3%, 71.9%; female neurologists, 58.1%, 62.8%; and female headache specialists, 74.1%, 81.5%. Migraine is much more prevalent among neurologists than in the general population.

Sacks later wrote to the journal to mention an earlier study finding much higher levels of migraine-related visual disturbances in doctors than other people. He also wonders:

Speculating on the possible reasons for the prevalence of migraine in neurologists, and particularly headache specialists, Evans et al. wonder, among other possibilities, whether “a personal history of migraines might stimulate an interest in neurology and headache as a subspecialty.” For myself, with a personal history of classical migraines (and, more often, isolated visual ones) going back to childhood, the extraordinary phenomena of the aura (which for me included transient or partial achromatopsia, akinetopsia, as well as visual agnosias, alexias, etc), excited an interest in the brain, and especially in visual processing, at an early age. These migraines were certainly one of the reasons I was attracted to neurology, why I chose migraine as the subject of my first book, and why I devoted a large part of this book to illustrating the varied presentations of visual auras in my patients

However, he gets short shrift from the researchers who curtly point out that their survey asked whether neurologists’ experience of migraine had influenced their career choice and they said no, so it can’t be true.

This is clearly not the finest psychological reasoning in the world and I remain fascinated by whether personal experience shapes the specialisation of clinicians.

It only happens in some cases of course. It’s probably rare that neurologists had their interest sparked after major brain damage or oncologists after experiencing cancer.

We do know, however, that psychiatrists are more likely to have experienced mental illness than other doctors and I wonder how many other links between clinical speciality and illness experience there might be.

Link to PubMed entry for study (via @anibalmastobiza)