To Bedlam and Part Way Back

BBC Radio 4 has a fantastic documentary on one of then 20th century’s great poets, Anne Sexton, who struggled with mental illness throughout her adult life and eventually committed suicide at the age of 46.

Uniquely, tapes of Sexton’s psychotherapy sessions with psychiatrist Martin Orne were found after her death giving an alternative insight into her mental life.

The programme dramatises excerpts from the tapes and talks to members of her family about her life, writing and frequent hospitalisations.

Sexton is typically classified as one of the ‘confessional’ poets, although, regardless of the label, her work is certainly very personal and reveals an articulate if not fragile look at many key relationships in her life.

Because of the BBC’s archive of doom, you only have three days to listen to it before it disappears for good into the abyss, although it is well worth catching if you get the chance.

Link to BBC Radio 4 documentary ‘Consorting with Angels’.

Two drugs show best treatment possibility for MS

In massive news for neurology, The New England Journal of Medicine has published three important studies reporting that two new drugs for multiple sclerosis are more effective than existing treatments and can be taken in pill form.

Multiple sclerosis is a bitch. It’s a neurological disorder where the immune system starts attacking myelin – the protective covering of nerves in the brain and spinal cord – leading to unpredictable attacks that typically leave the person a little more disabled each time.

Problems can include movement difficulties, chronic pain, fatigue, cognitive problems, mood instability and impairments to the body’s automatic processes like digestion, bladder and bowel control.

One problem with the the current treatments that try and slow down the disease itself, rather than just manage the effects, is that they all require regular injections or infusions via a drip.

These new studies report on two drugs: one is cladribine which is already widely used in leukaemia, and the other is fingolimod, which is not yet available commercially. Crucially, both can be taken as pills without the need for injections.

The studies that investigated these drugs were very impressive. They had large numbers of patients in many countries; they were conducted with the co-operation of drug companies but were led by independent researchers; they continued for about two years; they were compared against placebo and, in the case of fingolimod, against the current best available treatment – beta interferon; and they looked at both chances of relapse and at changes in brain structure.

The studies did not include the most disabled people with MS are all were able to walk, although patients with mild and moderate disability were included.

The results suggest that the drugs are not only easier to take but are better than the current best available treatments and reduced the chances of the patient having a relapse of MS as well as the damage to the white matter in the brain.

The drugs work quite differently from current treatments – which largely reduce inflammation directly – by changing the balance of how the immune system releases T cells so more antiinflammatory ‘helper’ T cells are available.

Unfortunately, the drugs are not without side effects, and although these effects were rare, altering the immune system led to more herpes infections and an increase in the development of cancer.

Herpes infections can take the form of the annoying but relatively benign, like in local infections such as cold sores, shingles and genital herpes, but when it gets into the whole body or brain it can cause serious damage or even lead to death, which happen to two patients in the trial, although in this case it was out of more than 1,100 people in total. The people with cancer generally recovered well – there was one death but it isn’t entirely clear it was linked to the treatment.

Although these drugs are not cures, they only slow the disease down, this is still massive news and a major development in neurology.

One of the practical big issues will be how the drugs are priced by the pharmaceutical companies and you can be sure they’re not going to be cheap.

However, one small hope is that the two compounds are owned by rival companies and as they seem to have broadly equivalent effects it will be hoped that competition will drive the price down.

Link to good write-up from The Times.
Link to good technical summary in the NEJM, sadly paywalled.

A Brilliant Madness online

I’ve just discovered that the excellent PBS documentary A Brilliant Madness that looks at the life of Nobel-prize winning mathematician, John Nash, is available online either as streamed video or as a torrent.

Nash was famously the subject of the Oscar-winning film, A Beautiful Mind, although the while the main plot elements are true – he both won the Nobel prize and experienced decades of psychosis – his life was heavily fictionalised to the point of being schmaltzy.

The PBS documentary is a more honest, but no less inspirational, look at Nash, and is based on the Pulitzer Prize winning biography by Silvia Nasar.

Nash himself gives an articulate account of his own illness and how society deals with those who experience other realities, while the documentary traces Nash’s sometimes less-than-flattering earlier life story to his later years where he is widely considered to be an altogether more gentle and humane individual.

If you want to know the real story behind A Beautiful Mind or more about Nash it is essential viewing.

Link to information on the documentary from PBS.
Link to flash streamed version.
Link to torrent.

Cognitive Daily has left the bulding

Cognitive Daily, one of the most established and respected psychology blogs on the internet, has just announced it has come to an end on the five year anniversary of its first post.

We’ve been fans of CD since, well, since they started as they kicked off only a few months after we did.

However, all is not lost, as both Dave and Greta will continue with their many online projects and there is a mysterious ‘new project’ soon to be announced (greatest hits? musical? concept album?)

What will we do with all that time we’ve freed up? Greta plans to continue her work as Professor of Psychology at Davidson College, teaching and mentoring students, conducting research, and sharing her love of music, literature, and art. Dave will continue as editor of and weekly columnist for SEEDMAGAZINE.COM, and he’ll maintain his personal blog, Word Munger and his obsessively-updated Twitter account. In addition, Dave’s planning a new project, to be unveiled within the next few weeks. Look for more information about it on Twitter and Word Munger.

Many thanks to you both for five years of fantastic psychology coverage on Cognitive Daily and we wish you all the best for future projects.

Link to Cognitive Daily announcement.

Lost in frustration

Photo by Flickr user honikum. Click for sourceNew Scientist has a piece on culture and psychological distress by Ethan Watters, the same chap who wrote the recent and widely discussed New York Times article on the ‘globalisation of mental illness’. This new article looks at similar territory but also pulls out some examples of where concepts and symptoms don’t translate well between different societies.

The meaning matters as much as the event,” says Ken Miller, a psychologist at Pomona College, Claremont, California, who studied in Afghanistan and elsewhere the reactions to war trauma.

He found many psychological reactions that were not on any western PTSD symptom list, and a few with no ready translation into English. In Afghanistan, for example, there was asabi, a type of nervous anger, and fishar-e-bala, the sensation of agitation or pressure.

Giathra Fernando, a psychologist at California State University, Los Angeles, also found culturally distinct psychological reactions to trauma in post-tsunami Sri Lanka. By and large, Sri Lankans didn’t report pathological reactions in line with the internal states making up most of the west’s PTSD checklist (hyperarousal, emotional numbing and the like). Rather, they tended to see the negative consequences of tragic events in terms of damage to social relationships. Fernando’s research showed the people who continued to suffer were those who had become isolated from their social network or who were not fulfilling their role in kinship groups. Thus Sri Lankans conceived the tsunami damage as occurring not inside their minds but outside, in the social environment.

It’s probably worth mentioning that this goes both ways and there are many everyday psychological concepts in English and Western society that don’t translate well into other languages.

Some of these become obvious when you read studies that have attempted to translate questionnaires originally in English into other languages.

For example, here’s an excerpt from a study that translated a mental health questionnaire from the World Health Organisation into Urdu:

This item [“Do you have trouble thinking clearly?”] presented considerable problems in translation. It measures the disturbance in concentration and cognition associated with depressive disorders. We could not find an exact substitute for the term, “clear thinking” in colloquial Urdu, and the nearest semantic and technically equivalent term that was acceptable in back translation was “wazay soch bichar”

Unfortunately, it doesn’t say what ‘wazay soch bichar’ is in English, so if you’re an Urdu speaker do get in touch as I’d love to find out.

It’s also often the case that words such as ‘anxiety’ may have a related word in another language but the sensations associated with it are not the same.

The New Scientist piece, taken from a forthcoming book by Watters, argues that Western concepts are now being exported around the world and local people are increasingly describing mental and social distress in terms of Western, and particularly, American, diagnoses.

UPDATE: Many thanks to Mind Hacks reader Matt for getting in touch with the translation:

i have a translation of ‘wazay soch bichar’ for you. my colleague nasir says the literal translation of it is ‘obvious thinking’ and agrees there is no direct translation of ‘thinking clearly’ in urdu and that ‘wasay….’ is the best available.

Link to ‘How the US exports its mental illnesses’.

Leave my soul alone

I’m re-reading the excellent book Into the Silent Land by neuropsychologist Paul Broks and was reminded of a part where he recounts an eerie poem about a 1938 operation to remove a brain tumour.

The poem is by Welsh poet and doctor Dannie Abse and, looking it up on the internet, I discovered that the poetry archive has a wonderful entry for the piece online that not only includes the text but also a recording of Abse introducing and reading the poem.

The uncanny incident, probably caused by stimulation of the cortical surface, was witnessed by Abse’s brother, also a doctor, when observing an operation by the famous neurosurgeon Lambert Rogers.

In the Theatre
by Dannie Abse

(A true incident)

Sister saying—‘Soon you’ll be back in the ward,’
sister thinking—‘Only two more on the list,’
the patient saying—‘Thank you, I feel fine’;
small voices, small lies, nothing untoward,
though, soon, he would blink again and again
because of the fingers of Lambert Rogers,
rash as a blind man’s, inside his soft brain.

If items of horror can make a man laugh
then laugh at this: one hour later, the growth
still undiscovered, ticking its own wild time;
more brain mashed because of the probe’s braille path;
Lambert Rogers desperate, fingering still;
his dresser thinking, ‘Christ! Two more on the list,
a cisternal puncture and a neural cyst.’

Then, suddenly, the cracked record in the brain,
a ventriloquist voice that cried, ‘You sod,
leave my soul alone, leave my soul alone,’—
the patient’s dummy lips moving to that refrain,
the patient’s eyes too wide. And, shocked,
Lambert Rogers drawing out the probe
with nurses, students, sister, petrified.

‘Leave my soul alone, leave my soul alone,’
that voice so arctic and that cry so odd
had nowhere else to go—till the antique
gramophone wound down and the words began
to blur and slow, ‘ … leave … my … soul … alone … ’
to cease at last when something other died.
And silence matched the silence under snow.

Link to poetry archive entry for ‘In the Theatre’.

The dream life of children

Photo by Flickr user Grace. Click for sourceWhile we may have an elaborate dream life as adults, it seems we develop the ability to have rich and vivid dreams as we grow – children start off having relatively simple dreams that become more complex throughout childhood.

Below is an excerpt from a scientific review article on ‘dreaming and the brain’, shortly to be published in Trends in Cognitive Sciences, that addresses how our dream life changes and develops during our early years.

One of the criticisms of these findings might be that dreams seem less complex in younger children because their language isn’t rich enough to describe them fully. However, there is good evidence against this idea – the complexity of dreams is not strongly related to verbal ability, although it is to the vividness of the child’s mental imagery.

When do children start dreaming, and what kind of dreams do they have? Given that children often show signs of emotion in sleep, many assume that they dream a great deal. However, a series of studies by David Foulkes showed that children under the age of 7 reported dreaming only 20% of the time when awakened from REM sleep, compared with 80–90% in adults.

Preschoolers’ dreams are often static and plain, such as seeing an animal or thinking about eating. There are no characters that move, no social interactions, little feeling, and they do not include the dreamer as an active character. There are also no autobiographic, episodic memories, perhaps because children have trouble with conscious episodic recollection in general, as suggested by the phenomenon of infantile amnesia.

Preschoolers do not report fear in dreams, and there are few aggressions, misfortunes and negative emotions. Children who have night terrors, in which they awaken early during the night from SWS [slow-wave sleep] and display intense fear and agitation, are probably terrorized by disorientation owing to incomplete awakening rather than by a dream. Thus, although children of age 2–5 years can see and speak of everyday people, objects and events, they apparently cannot dream of them.

Between the ages of 5‚Äì7 years, dream reports become longer, although they are still infrequent. Dreams might contain sequences of events in which characters move about and interact, but narratives are not well developed. At around 7 years of age, dream reports become longer and more frequent, contain thoughts and feelings, the child’s self becomes an actual participant in the dream, and dreams begin to acquire a narrative structure and to reflect autobiographic, episodic memories.

It could be argued that perhaps all children dream, but some do not yet realize that they are dreaming, do not remember their dreams, or cannot report them because of poor verbal skills. Contrary to these intuitive suggestions, dream recall was found to correlate best with abilities of mental imagery rather than with language proficiency… Put simply, it is children with the most developed mental imagery and visuo-spatial skills (rather than verbal or memory capabilities) that report the most dreams, suggesting a real difference in dream experience.

I’ve removed the numeric references for ease of reading, but you can find the full research sources in the original article.

Link to PubMed entry for article.
Link to DOI entry for same.