Dr Smile

The Philip K. Dick novel The Three Stigmata of Palmer Eldritch features a portable device which allows patients to consult with the virtual psychiatrist Dr Smile. If I’m not mistaken, the system seems to have re-invented by this research team:

Virtual patient: a photo-real virtual human for VR-based therapy

Stud Health Technol Inform. 2004;98:154-6.

Kiss B, Benedek B, Szijártó G, Csukly G, Simon L, Takács B.

A high fidelity Virtual Human Interface (VHI) system was developed using low-cost and portable computers. The system features real-time photo-realistic digital replicas of multiple individuals capable of talking, acting and showing emotions and over 60 different facial expressions. These virtual patients appear in a high-performance virtual reality environment featuring full panoramic backgrounds, animated 3D objects, behavior and AI models, a complete vision system for supporting interaction and advanced animation interfaces. The VHI takes advantage of the latest advances in computer graphics. As such, it allows medical researchers and practitioners to create real-time responsive virtual humans for their experiments using computer systems priced under $2000.

Link to PubMed entry for Dr Smile re-invention.

I only read it for the articles

The Economist has a delightful article on how we self-justify our dubious behaviour after the event using spurious reasons. It turns out we often deceive ourselves into believing that our hastily constructed justifications are genuinely what motivated us.

The article riffs on a recent study by marketing researchers Zoë Chance and Michael Norton, who asked male students to choose between two specially created sports magazines.

One had more articles, but the other featured more sports. When a participant was asked to rate a magazine, one of two magazines happened to be a special swimsuit issue, featuring beautiful women in bikinis.

When the swimsuit issue was the magazine with more articles, the guys said they valued having more articles to read and chose that one. When the bikini babes appeared in the publication with more sports, they said wider coverage was more important and chose that issue.

This, as it turns out, is a common pattern in studies of this kind, and crucially, participants are usually completely unaware that they are post-justifying their choices.

This may not seem surprising: the joke about reading Playboy for the articles is so old Ms Chance and Mr Norton borrowed it for the title of their working paper. But it is the latest in a series of experiments exploring how people behave in ways they think might be frowned upon, and then explain how their motives are actually squeaky clean. Managers, for example, have been found to favour male applicants at hypothetical job interviews by claiming that they were searching for a candidate with either greater education or greater experience, depending on the attribute with which the man could trump the woman. In another experiment, people chose to watch a movie in a room already occupied by a person in a wheelchair when an adjoining room was showing the same film, but decamped when the movie in the next room was different (thus being able to claim that they were not avoiding the disabled person but just choosing a different film to watch). As Ms Chance puts it: “People will do what they want to do, and then find reasons to support it.”

Further compounding the problem, Ms Chance and Mr Norton’s subjects, like the subjects of the similar experiments, showed little sign of being aware that they were merely using a socially acceptable justification to look at women in swimsuits. Mr Norton reports that when he informs participants that they were acting for different reasons than they claimed, they often react with disbelief.

I recommend reading the original study. It’s very accessibly written, and if you read nothing else, skip to page 9 (page 10 of the pdf file) and read the section entitled ‘Are People Aware That They are Justifying?’.

One of the key insights from psychology and one of the most practically applicable findings (particularly in clinical work) is that people’s explanations for why they do something are not necessarily a reliable guide to what influences their behaviour.

This also goes for ourselves and there are probably many areas in our life where we justify our actions, good or bad, with comfortable, plausible, fantasies.

Link to Economist piece ‘The conceit of deceit’.
Link to study text.

Brain wave furniture

The Neurocritic has found this wonderful designer sofa made around EEG or ‘brain wave’ data captured from artist Lucas Maassen, who also created the wonderful piece of furniture.

There’s more about the construction of the piece on a page on Maassen’s website, but it’s running a bit slow at the moment, so you may need to be a bit patient for it to load.

However, there’s more about the piece at The Neurocritic who also picks up on an update to the neuroscience of EEG alpha wave activity, stereotypically thought to reflect nothing more than a ‘state of relaxation’ in times past, but now known to be involved in a much wider rage of active brain processes.

Link to The Neurocritic on The Electroencephalographer’s Couch.
Link to Maassen’s Brain Wave Sofa page.

Johnson and the Nutt Sack

As regular readers will know, we often note the passing of the regular British ritual where the UK government asks a group of scientific advisers to give evidence on the harmfulness of drugs and then ignores them.

The unwritten rule is that everyone feigns mild exasperation and then goes about their business as if nothing had happened, but the Home Secretary Alan Johnson has gone and spoiled the party by firing neuroscientist David Nutt, the head of the drugs advisory committee, for, well, waving that damned evidence about.

The home secretary’s officially sacked the chief adviser for breaking what turns out to be a non-existent rule about discussing government policy in a recent lecture – using the carefully mischosen words “I cannot have public confusion between scientific advice and policy”.

Subsequently, two other scientists from the advisory committee have resigned and both the government’s Chief Scientific Advisor and the Science Minister expressed their dismay.

An evidence free drugs policy isn’t a British speciality, unfortunately, as shown by a recent World Health Organisation study that showed that severity of drug laws around the world have virtually no relation to the drug use of the population.

So why did the home secretary break the unwritten rule about quietly ignoring the evidence in the service of some pointless sabre rattling? Surely nothing to do with the fact that a general election is coming up.

Rare ‘shell shock’ footage online

One of the most important films in the history of psychiatry, depicting treatment of ‘shell shocked’ British soldiers during World War One, has just been made freely available online by UK medical charity the Wellcome Trust who are currently releasing lots of their archive footage.

The film was made by Sir Arthur Hurst in 1917 when large numbers of soldiers with ‘shell shock’, later to be called ‘war neurosis’, were returning from the front – in this case to a make-shift military hospital in South Devon, England, which was previously an agricultural college.

Time and time again you’ll read in news articles that post-traumatic stress disorder (PTSD) is the new name for what used to be called ‘shell shock’ but this is false and you can easily see why in the film.

The most prominent symptoms of the World War One patients are ‘hysterical’ symptoms. These are symptoms that appear to be due to nervous system damage (such as paralysis, tremor or blindness, to name but a few) despite the fact that it is possible to demonstrate that the parts of the nervous system involved in the seemingly impaired ability are working perfectly fine.

A long-standing idea is that these impairment are caused by the subconscious mind ‘converting’ emotional distress into physical symptoms, but there is little good evidence to say whether this is likely or not.

These conditions are now diagnosed as ‘conversion disorder‘ or ‘dissociative disorder‘ and, while it is accepted that trauma may play a role in triggering them it is not a requirement.

This makes it quite different from PTSD, which requires the patient to have experienced a traumatic event and that includes symptoms of hyperarousal (feeling ‘on edge’), having intrusive memories of the event, and avoiding reminders of the trauma.

As we’ve discussed before on Mind Hacks, PTSD was a direct result of the Vietnam war (indeed, it was originally called ‘post-Vietnam’ syndrome) and was partly introduced as a way of allowing veterans to get treatment for their war-trauma-related psychiatric difficulties.

The 1917 film was hugely important because it unequivocally showed to a wide audience that mental stress could lead to dramatic physical difficulties, highlighting the importance of psychiatry which was often considered to be a ‘second rate’ medical speciality.

It is also an important historical document because it shows some dramatic symptoms that rarely appear in such a stark form and also outlines the treatments of the day.

The first patient seen is Pte. Meek, age 23. He has complete retrograde amnesia, hysterical paralysis, contractures, mutism and universal anaesthesia. There is a shot of him in a wheelchair with a nurse, and the intertitles explain that he is completely unaware of the efforts to overcome the rigidity of his ankles, and a man is seen trying to bend his feet. He had a sudden recovery of memory nine months later, with gradual recovery of body functions. Seven months after this we see him teaching basket-making, which was his peacetime job. Two and a half years after onset he makes a complete recovery, and there is a shot of him running up and down stairs waving his arms.

The next patient is Pte. Preston, who has amnesia, word blindness and word deafness, except to the word ‘bombs’, and his response to this is shown. When a doctor says ‘bombs’, he dives under a bed. Pte Ross Smith is also seen, who has a facial spasm. The spasm ceases under hypnosis, but return on waking. He has a lateral tremor of the head, treatment being relaxation and passive movements. There is a shot of him lying in bed having his head moved around.

You can watch the film at the Wellcome website, or they’ve uploaded it as five parts to YouTube. The first part is here and you can click through the rest.

Link to film and info from the Wellcome Trust.
Link to first part on YouTube.

Final destination, Golden Gate Bridge

Photo by Flickr user yuzu. Click for sourceThere’s a remarkable article on the world’s most popular suicide spot, San Francisco’s Golden Gate Bridge, in the latest American Journal of Psychiatry.

The article has several case studies of people who have died from jumping from the bridge and some fascinating quotes from one of the few people who have survived their attempts.

It is full of curious snippets of information, and one of the clearest things to come through from the article is that the bridge has a sort of iconic attraction for those wanting to kill themselves (indeed, in hindsight, the name itself seems darkly ironic).

This is not just a morbidly romantic statement, it seems to be backed up by research:

Evidence that the Golden Gate Bridge serves as a suicide magnet is provided by Seiden and Spence’s study of individuals who jumped from either the Golden Gate Bridge or the Bay Bridge, both of which connect to San Francisco. The bridges were built within 1 year of each other, have similar heights, and are similarly lethal to jumpers. Seiden and Spence looked at individuals who drove onto either bridge to kill themselves. (They excluded suicides in which the person walked onto either bridge, as the Golden Gate Bridge has pedestrian access while the Bay Bridge does not.)

They found that between 1937 and 1979, 58 people drove across the Bay Bridge to commit suicide from the Golden Gate Bridge. However, no one drove across the Golden Gate Bridge to commit suicide from the Bay Bridge. This suggests that the Golden Gate Bridge has a powerful association with suicide in the minds of some individuals, to the extent that they would drive over one potentially lethal bridge to die at another.

The article also mentions some other facts: the idea that the death is painless is a myth – jumpers die from massive heart, chest or nervous system injuries or by drowning; jumping from the bridge has a 99% fatality rate; there are only 28 known survivors; the suicide rate is counted solely on recovered bodies, bodies washed out to sea, jumpers witnessed but not found, and unclaimed cars in the parking lot are not counted.

The article reminds me of the uncomfortable 2006 film The Bridge about people who jumped from the bridge.

It’s uncomfortable viewing because it is one of the few documentaries to address the life history, psychological state, motivations and final moments of people who committed suicide (akin to the ‘psychological autopsy‘ used by professionals), but also because it was made in quite an unethical way.

The filmmakers asked permission to place cameras near the bridge to capture the landscape, but instead filmed jumpers. They then contact the families of those who had died and interviewed them about the persons’ life but without informing them that they’d got film of them dying.

The result is a equally fascinating, insightful, tragic and disturbing and I’ve never settled how comfortable I am with the final product.

The American Journal of Psychiatry article finishes by recommending, on the basis of good evidence, that a suicide barrier would prevent deaths at the bridge.

One of the clearest findings in suicide research is that reducing access to lethal methods reduces suicide (going against the myth that ‘if someone wants to kill themselves, they’ll always find a way’).

Apparently, after much discussion a barrier for the Golden Gate Bridge has been agreed, but it is stalled while surveys are carried out and no final completion date has been agreed.

Link to PubMed entry for Golden Gate Bridge article.