Tell me lies, tell me sweet little lies

Photo by Flickr user adamknits. Click for sourceFlattery can work it’s magic, even when we know it’s insincere. The Boston Globe covers a new study that found that even when we realise the compliments we’re hearing are an attempt to butter us up, they can still have a persuasive effect.

Insincere flattery gets a bad rap. Sure, it sounds cheesy or even awkward. But new research suggests that one’s initial conscious reaction Рdiscounting the flattery as a self-serving ploy Рmay mask a more durable implicit positive emotional association with the flatterer. People who were given a printed advertisement from a department store that paid compliments to their sense of fashion had higher opinions of the store, but only when they weren’t given much time to think about it, or when they were asked several days later. This effect was boosted after people engaged in self-criticism but was nullified after people engaged in self-affirmation, suggesting that flattery Рeven the patently insincere type Рwill be especially effective on folks who are down on their luck.

Sadly, the study itself is locked behind a paywall, but there’s a longer summary of the experiment at the journal website which has a few more details.

By the way, could I just say what a lovely gas mask you’re wearing? Mind Hacks, getting the readers we deserve since 2004.

Link to brief Boston Globe write-up.
Link to study abstract.
Link to longer summary of study (via Neuromarketing).

A crime, criminality and forensic psychology blog

Forensic psychology and psychiatry attempt to understand criminality and legal reasoning and are among the most interesting areas of cognitive science, but, sadly, there are few good blogs on the internet which tackle the area. The In The News blog is an exception, however, and regularly has in-depth coverage of the psychological issues behind big legal news stories.

Like forensic psychology itself, it’s not the most instantly appealing of destinations, but the writing is fantastic. The author is California-based forensic psychologist Karen Franklin and some of the recent articles give a flavour of what to expect.

For example, coverage of the death of the oldest death row inmate at 94, and the legal battles that centred around his mental competency to appeal and be executed, discussion of whether ad-hoc diagnoses are being created to detain people whose crimes don’t amount to long-term imprisonment but are predicted to be a future menace to society, or whether the ‘war on drugs’ is being quietly abandoned by the Obama administration.

It’s probably worth noting that US forensic psychology and psychiatry can be quite different from other places, in that it is more much focused on working with courts, rather than offender treatment focused approaches which are more widespread in Europe.

However, In The News has long been a favourite read of mine and long may it stay so.

Link to In The News blog.

State of the art in cave painting

France has some of the world’s most spectacular cave paintings that depict wild animals in vivid outline surrounded by what were thought to be purely decorative markings.

These markings have been all but ignored until recent research, covered in a fascinating New Scientist article, gathered examples from 146 cave sites and found they shared core symbols and were arranged in meaningful patterns.

While some scholars like Clottes had recorded the presence of cave signs at individual sites, Genevieve von Petzinger, then a student at the University of Victoria in British Columbia, Canada, was surprised to find that no one had brought all these records together to compare signs from different caves. And so, under the supervision of April Nowell, also at the University of Victoria, she devised an ambitious masters project. She compiled a comprehensive database of all recorded cave signs from 146 sites in France, covering 25,000 years of prehistory from 35,000 to 10,000 years ago.

What emerged was startling: 26 signs, all drawn in the same style, appeared again and again at numerous sites (see illustration). Admittedly, some of the symbols are pretty basic, like straight lines, circles and triangles, but the fact that many of the more complex designs also appeared in several places hinted to von Petzinger and Nowell that they were meaningful – perhaps even the seeds of written communication.

According to the article, these seemingly meaningful groupings, potentially representing a sort of proto-writing, raise the question of whether symbolic communication developed far earlier than was previously thought.

It’s a wonderfully thought-provoking article and don’t miss the fantastic illustrations that accompany the piece.

Link to NewSci article ‘The writing on the cave wall’.

Human brain electrodes capture the twilight zone

Photo by Flickr user Alyssa L. Miller. Click for sourceSleep is a nightmare for neuroscientists but a new study using electrodes implanted deep within the brains of people going about their daily lives has revealed that the brain falls asleep from the inside out, contrary to what was expected.

Most neuropsychology studies require people to complete tasks while the brain is being monitored and the technologies that allow passive recording either only measure activity on the brain surface (EEG, MEG) or are too uncomfortable to measure realistic sleep (fMRI, PET). This is one of the reasons human sleep has been difficult to study and why we still understand little about it.

A new study just published online in the Proceedings of the National Academy of Sciences used the innovative technique of recording from semi-permanent electrodes implanted in the brains of 13 people undergoing assessment for difficult-to-treat epilepsy. These electrodes stay in for several weeks, meaning the researchers had access to brain activity as people continued their lives and, of course, as they drifted off to sleep.

Certain types of epilepsy don’t respond to normal treatment and neurosurgery to remove a small part of the brain that triggers the seizures is known to be an effective treatment in many cases. However, this is only feasible when it’s possible to locate where the seizures originate.

In rarer cases still, a standard EEG or brief surgical test doesn’t give a good idea of where this might be, so surgeons can insert depth electrodes into the most likely areas. These remain in place and record any unusual activity directly from locations across the brain.

The researchers, led by neuroscientist Michel Magnin from the University of Lyon, asked the patients if they could also use this data to help understand what happened during sleep onset.

They found that as people drifted off to sleep, the deep brain area the thalamus wound down several minutes before the cortex.

This is surprising because the thalamus has traditionally been considered a structure that regulates alertness and ‘relays’ information to the rest of the brain from the body and the spinal cord.

It was often assumed that it would ‘shut down’ the cortex first, because this is often considered to be where our ‘higher’ conscious functions like abstract thought and complex perception lie, while continuing with its minimal vigilance functions. A bit like a neural ‘standby’ setting.

Instead, what seems to happen is that the thalamus ‘disconnects’ itself and leaves the cortex freewheeling before it finally settles down into inactivity.

Indeed, freewheeling is, perhaps, a good description here. The researchers found lots of uneven activity in the upper brain areas as they were left to drift off.

Interestingly, sleep onset is one of the times when we are most likely to experience hallucinations. In fact, they are so common as to have been given their own name – hypnagogic hallucinations – while this drifting off period is known as hypnagogia.

Although they didn’t specifically ask about the whimsical thoughts and unusual perceptions that typically occur in this state, the researchers speculate that this pattern of freewheeling close-down might explain why hallucinations are so common at this time.

Link to PubMed entry for study.

On the brain train

Tom kindly sent me a copy of his new book The Rough Guide to Brain Training which I’ve been thoroughly enjoying reading. I don’t think you’re ever going to get the most objective review from someone who’s already an admirer of Tom’s work, but I shall do my best.

I have to say, I’m not a big fan of puzzles, largely, it must be said, because I’m useless at them. The book is full of puzzles, but thankfully for me, they are interspersed by essays and snippets that give you a remarkably honest and science-based view of ‘brain training’ and the evidence for it.

In fact, right on the first page, in the introduction, the book is clear:

For now, it is safe to say that we don’t know of any magic bullets for brain training – there is no single kind of task or set of tasks which will improve brain fitness. And anyone who claims otherwise is probably trying to sell you something.

This is such as refreshing change from brain training books and games that make wild claims and go on about ‘neuroplasticity’ without understanding what it means and not knowing when it’s relevant.

There is none of that here. Everything is drawn from the science (Tom’s put all the references online, if you want to read up) and the book has many short essays that introduce you to how the brain works, how to keep it in good condition and how to optimise learning.

Also, virtually every page has a short paragraph giving a neuroscience fact taken from the research literature. For example:

American physician Robert Bartholow was the first to directly show that electrical activity on the surface of the brain controlled the body. In 1874, Bartholow was able to provoke movements of the body and limbs of patient Mary Rafferty by inserting electrodes through a hole in her skull.

There’s lots more where that came from. To be honest, if you’re not into puzzles there’s going to be a fair chunk of the book that’ll serve as no more than eye candy, but if you do, you’ll find them accompanied by some great short essays and snippets.

Link to more information on the book.
Link to essay written for the book but only available online.

Full disclosure: we both write for Mind Hacks, but I suspect if you’re reading this, you already know.

The World War Two rumour labs

During World War Two, the US Government considered setting up ‘rumour clinics’ to collect and analyse hearsay that might undermine the war effort. The government plan never got off the ground but the idea was taken up by independent psychologist who create numerous clinics that aimed to debunk popular rumours and educate the American public about the psychology of tittle-tattle.

This little known chapter in the history of the war is outlined in an article for the History of Psychology journal which describes how the famous Harvard psychologist Gordon Allport created one of the most successful wartime clinics which tackled some quite surprising rumours:

The set-up of the Boston Clinic became the prototype for the many clinics that would follow in the months to come. The focal point of the Clinic was a column published every Sunday in the newspaper. Prevalent rumors were chosen for analysis and refutation. These rumors would be labeled as such and printed in italics, followed by an answer or refutation labeled “Fact” and printed in bold type. Frequently, the column would include a psychological analysis of prevalent rumors, aimed at increasing public understanding of the psychological motives underlying the spread of different types of rumor. The column was also distributed to high schools and posted on community bulletin boards, with the expectation that such measures would promote public understanding of rumor in wartime. In addition to counteracting rumors, members of the clinic were often also responsible for classifying and analyzing rumor data, distributing flyers, gauging public opinion, and giving speeches on wartime rumor spreading.

In the first column of the Boston Herald Rumor Clinic, rumors were reported to the Clinic by “official agencies”; by the following Sunday, however, the Clinic had begun receiving and analyzing rumors sent in by readers. All readers were encouraged to provide rumors, with the only stipulation being that they must sign their names; anonymous rumors would not be considered. By the third week, the Clinic had received more rumors than they had time or space to analyze (“The rumor clinic,“ 1942b). Rumors ranged from the simplistic and common to the elaborate and eccentric.

The most common rumors analyzed in the Herald were those pertaining to waste of rationed materials, government dishonesty and corruption, mistreatment of American soldiers, the imminence of defeat or victory, and the future value of war bonds. Unusual or less feasible rumors were also considered, including a story circulating about glass or poison being found in crabmeat packed in Japan (The rumor clinic, 1942d) and a story about a woman employed at a shell filing factory whose head exploded after receiving a permanent at the local beauty parlor (The rumor clinic, 1942c). These latter types of anecdotes received less attention in the column, but appeared periodically amid a sea of more common rumors, such as those regarding rationing and corruption.

Unfortunately the full article is locked behind a paywall, so, ironically, you only have access to this second-hand information.

Link to PubMed entry for article.

Kay Redfield Jamison on love and loss

ABC Radio National’s All in the Mind has an engaging interview with psychologist and author Kay Redfield Jamison who discusses her new book which is both a memoir of losing her husband and a consideration of the psychology of grief.

Towards the end of the interview she tackles the distinction between grief and depression, which has recently returned as a contentious topic after lying fallow for many years.

Since Freud’s essay Mourning and Melancholia, the two have been linked in many psychological theories. Freud’s idea was that both were similar types of reaction to loss although in depression it might not be clear to the conscious mind what was lost because the prior attachment might have had unconscious components.

In other words, a small event might trigger a big grief reaction event though it might not be clear why – because some of the psychological value of what you have lost might exist only in the unconscious.

Although the essay is one of the foundational texts of psychoanalysis, nowadays only the most orthodox followers of Freud would agree fully with this theory of depression and the idea that grief and depression are fundamentally the same is no longer widely subscribed to.

Nevertheless, psychiatry is once more approaching grief as a potential form of mental illness, albeit from a different angle.

The concept of complicated grief, where grieving is considered to be more intense, disabling or extended than normal, has been much discussed as an area where psychiatric treatment may be warranted. It’s an interesting concept because it essentially sets limits on what should be considered a normal response to personal loss.

It’s not an official diagnosis as yet, but various proposals set the limits for ‘normal’ grieving at 6 months or one year.

More recently, the draft version of the new American diagnostic bible, the DSM-V, has gone even further and removed bereavement as an exclusion for a diagnosis of major depressive disorder. This means that two weeks of low mood, loss of pleasure and interest in activities, poor sleep, appetite or concentration after a loved one had died could get you a diagnosis of mental illness.

It’s a difficult area, because while it is important not to medicalise normal and healthy reactions to the loss of a significant person in your life, we also wouldn’t want to miss treating mental illness simply because the person has experienced a loss. Clearly there is a balance, although it’s difficult to say where it is.

Jamison has an interesting perspective on the issue, as she’s a clinical psychologist interested in mood disorders, but also has experienced profound depression and loss herself.

Link to AITM interview with Kay Redfield Jamison.
Link to AITM blog on some of the diagnostic issues.

Information scares and the media: a history

Slate has just published an article I wrote on how media scare stories that warn us that technology will damage the mind have been with us from the time of the printing press and continue to the present day.

A respected Swiss scientist, Conrad Gessner, might have been the first to raise the alarm about the effects of information overload. In a landmark book, he described how the modern world overwhelmed people with data and that this overabundance was both “confusing and harmful” to the mind. The media now echo his concerns with reports on the unprecedented risks of living in an “always on” digital environment. It’s worth noting that Gessner, for his part, never once used e-mail and was completely ignorant about computers. That’s not because he was a technophobe but because he died in 1565. His warnings referred to the seemingly unmanageable flood of information unleashed by the printing press.

My favourite chapter in the long history of how information dissemination has been assumed to damage the mind is the protracted debate that occurred when schools became compulsory.

They were thought to take children away from their ‘natural’ development and study was widely considered to be a danger, with many medical texts of the time citing excessive study as the cause of madness (e.g. this one)

Interestingly, the relatively recent diagnosis of ADHD is almost the reverse, and not being able to concentrate on school work is now considered a mental illness.

That’s not to say that all technology and all uses of technology are harmless. For example, there is growing evidence that television viewing by young children is associated with slowed cognitive development but the media is typically obsessed with the newest technology rather than the actual risks identified by health studies.

Link to Slate article on tech scares and the media.

Seeing red, feeling hot, realising nothing

Photo by Flickr user Thomas Hawk. Click for sourceSeeing red leads men to view women as more attractive and more desirable despite them not being aware of any change in their perceptions. A delightful study from last year that, as the authors note, has ‘clear practical implications’!

Romantic red: red enhances men’s attraction to women.

J Pers Soc Psychol. 2008 Nov;95(5):1150-64.

Elliot AJ, Niesta D.

In many nonhuman primates, the color red enhances males’ attraction to females. In 5 experiments, the authors demonstrate a parallel effect in humans: Red, relative to other achromatic and chromatic colors, leads men to view women as more attractive and more sexually desirable. Men seem unaware of this red effect, and red does not influence women’s perceptions of the attractiveness of other women, nor men’s perceptions of women’s overall likeability, kindness, or intelligence. The findings have clear practical implications for men and women in the mating game and, perhaps, for fashion consultants, product designers, and marketers. Furthermore, the findings document the value of extending research on signal coloration to humans and of considering color as something of a common language, both within and across species.

pdf of full text of study.
Link to PubMed entry for study.

Discussing the False Prophets

In light of the retraction of the infamous Lancet paper that first started the MMR panic, the Point of Inquiry podcast has a fantastic interview with doctor and vaccine developer Paul Offit who has received death threats for publicly refuting the spurious connection between childhood jabs and autism.

He’s also the author of the book Autism’s False Prophets that traces the emergence of the vaccine protestors, the origin of their fears and the faulty thinking which has driven their campaign.

Offit reflects on the reaction to the book during to the interview and gives a coherent account of what conclusions we can and can’t draw from the science on how autism develops.

It’s a lively and important interview that is well worth 30 minutes of your time.

Link to Point of Inquiry interview with Paul Offit.

France strikes transexualism from list of mental illnesses

France has become the first country in the world to remove gender identity disorder, also known as transexualism, from its list of officially recognised mental illnesses. This is huge news but seems yet to have been picked up by English language news sources.

The news was reported yesterday in the French national daily Le Figaro and by the AFP newswire in French and English, so my details are from the Spanish language report (e.g. this report in Colombian national El Tiempo).

My translation of an excerpt from the Spanish-language AFP newswire report:

The Minister of Health, Roselyne Bachelot, had announced on 16th May 2009, before the International Day Against Homophobia and Transphobia, that transexualism would not be not considered a psychiatric disorder in France.

On that occasion, numerous personalities from the world of politics and science had signed an article that appeared in the press to petition the World Health Organisation to stop “considering transexuals as affected by mental illness”.

“France is the first country in the world that does not consider transexualism as a mental illness” said Jo√´l Bedos, French representative of IDAHO (International Day Against Homophobia and Transphobia), to AFP on Friday. “It’s historic”, added Philippe Caste, spokesperson for the ‘Interasociativa lesbiana, gay, bi y trans’. “It was something very important and was greatly anticipated since the promise was made” added Roselyne Bachelot.

This move will likely be widely supported by the transgender community. However, the prospect of the diagnoses being removed in all countries might be a double-edge sword for some. Although the fact that being diagnosed as mentally ill is a requirement to obtain sex-reassignment in some places has been resented, the removal of the diagnosis could raise fears that the procedure may become less accessible.

Simply being transgendered or having trangender desires itself does not currently qualify for the diagnoses, as it requires significant psychological distress to also be present. However, campaigners argue that this distress is largely caused by discrimination and stigma, to which the diagnosis contributes.

The move by France, however, does not de-list the diagnoses from the World Health Organisation’s ICD-10 classification or the American Psychiatric Association’s DSM and, in fact, the draft DSM-V only slightly modifies the criteria for the diagnoses in children and adults although does rename it ‘gender incongruence’.

Nevertheless, this will put pressure on both the World Health Organisation and the American Psychiatric Association to remove the diagnoses which have a long-standing target of criticism from the LGBT community.

Link to French-language report in Le Figaro.
Link to Spanish-language AFP newswire report.

Hallucinating reality’s wallpaper

Photo by Flickr user mike138. Click for sourceHallucinations usually appear as illusory objects on the normal background of reality, but an interesting case report in the medical journal Movement Disorders reports a case of someone who hallucinated background scenery on which real people were superimposed.

We describe a patient with PD [Parkinson’s disease], who had unusual background scenery VHs [visual hallucinations] on which a true person was superimposed…

In December 2008, when her husband died, she experienced background scenery VHs appearing in the left upper part of her visual fields. The abnormal scenery often became larger to encompass the full visual fields and always comprised the countryside where she was born and grew up….

In July 2009, she spoke to her deceased husband in the medical examination room, and she experienced a background scenery VHs during the examination. A physician requested her to draw the VH, and she drew a countryside scene, appearing sad. When asked how a physician in front of her was reflected in her visual field, she replied that the physician appeared normal but beside a river in the midst of the VH.

Link to PubMed entry for brief case report.

2010-02-12 Spike activity

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

Literary critic Marco Roth discusses the ‘rise of the neuronovel‘ on ABC Radio National’s Bookshow. Good discussion except he seems to think all reference to the brain is necessarily reductionist.

PsyBlog looks at research on why the media seems biased when you care about the issue – examining a study finding Pro-Israelis and Pro-Palestinians both report an identical news report is biased against them.

Why won‚Äôt the University of Washington release the data showing that ‘Baby Einstein’ DVDs slowed language development in children? BrainSpin investigates.

New Scientist reports that damage to the back part of the posterior lobe is more likely to lead to feelings of transcendence and spiritual experiences.

More draft DSM-V coverage: an excellent summary of the proposed changes at PsychCentral. Some more comments from New Scientist. It’s for psychiatrists only! says a debate in Psychiatric Times. Good coverage on the legal aspects from In the News.

The Washington Post discusses whether ‘learning styles‘ are scientifically supported or a convenient myth.

To the bunkers! Can battlefield robots take the place of soldiers? asks BBC News.

Neurotopia has some excellent coverage of a recent study on the ‘cocaine vaccine‘.

Can the power of thought stop you ageing? asks BBC News who cover Ellen Langer’s famous experiments in an old folks’ home. Also tackled briefly in a recent Horizon documentary on ageing *cough*torrent*cough*

The Frontal Cortex has a wonderfully lucid piece on a new study finding that the amygdala may be involved in loss aversion – the effect where we put more energy into avoiding losses than acquiring gains.

The older the age of parents at conception, the greater the risk of autism, according to a new study discussed in The New York Times. Although it’s worth saying that even in older patients the chances of your baby developing autism are still very small.

New Scientist reports on a new campaign to get neuroscientists to sign a peace pledge against the militarisation of brain science.

The clean smelling Ed Yong reports on research finding that clean smells promote generosity and fair play while dark rooms and sunglasses promote deceit and selfishness over at Not Exactly Rocket Science.

The Times previews research suggesting that Autism and Asperger’s may be underdiagnosed or wrongly diagnosed in women.

Amnesic shellfish poisoning is memory loss that can be caused by a toxin found in shellfish. Neuroskeptic investigates the curious memory baffling poison.

Dr Petra has a great analysis of the changes to sexual disorders proposed in the draft DSM-V.

There’s an excellent report on NPR on the history of ‘child bipolar disorder’ and its slap down in the draft DSM-V by the brilliant Alix Spiegel.

Terra Sigillata has some excellent background on one of the legislation avoiding ‘synthetic marijuana’ products recently to hit the market.

Bolivia launches Coca Colla, a remake of the popular soft-drink that puts genuine coca-leaf extract back in the recipe, according to The Telegraph.

Slate has an article on how an irrational fear of baby-snatching on maternity wards is driving extreme security measures.

We know you got flow. The BPS Research Digest covers a study on ‘social flow’, when you’re in the zone with your social life.

NHS Choices has a fantastic video where Ben Goldacre explains the placebo effect.

The first prototype of light controlled brain implants for humans is sort-of-announced by a neurodevice company, according to the EE Times.

Neuroanthropology rounds-up a special issue of Psychiatric Times on cross-cultural psychiatry.

Jared Diamond discusses the ‘natural experiments’ of human history in the ABC Radio National Book Show.

The Chronicle of Higher Education has a striking article about the experience of being a university professor during psychosis.

A worry study on the influence on US ‘war on drugs’ aid in Colombia is discussed over at Slate.

“There is no such thing as sexual intercourse”. Pascal Boyer has a stinging critique of post-modern ‘de-constructions’ in the social sciences over at Culture and Cognition.

BBC News covers the research on time perception and enjoyment.

The burglar with the lemon juice disguise

I’ve just re-read the classic study “Unskilled and unaware of it” which established that when we’re incompetent at something we’re often so incompetent that we don’t realise that we’re incompetent. I had forgotten that it starts with a wonderful story about an inept bank robber.

In 1995, McArthur Wheeler walked into two Pittsburgh banks and robbed them in broad daylight, with no visible attempt at disguise. He was arrested later that night, less than an hour after videotapes of him taken from surveillance cameras were broadcast on the 11 o’clock news. When police later showed him the surveillance tapes, Mr. Wheeler stared in incredulity. “But I wore the juice” he mumbled. Apparently, Mr. Wheeler was under the impression that rubbing one’s face with lemon juice rendered it invisible to videotape cameras (Fuocco, 1996).

We bring up the unfortunate affairs of Mr. Wheeler to make three points. The first two are noncontroversial. First, in many domains in life, success and satisfaction depend on knowledge, wisdom, or savvy in knowing which rules to follow and which strategies to pursue. This is true not only for committing crimes, but also for many tasks in the social and intellectual domains, such as promoting effective leadership, raising children, constructing a solid logical argument, or designing a rigorous psychological study. Second, people differ widely in the knowledge and strategies they apply in these domains (Dunning, Meyerowitz, & Holzberg, 1989; Dunning, Perie, & Story, 1991; Story & Dunning, 1998), with varying levels of success. Some of the knowledge and theories that people apply to their actions are sound and meet with favorable results. Others, like the lemon juice hypothesis of McArthur Wheeler, are imperfect at best and wrong-headed, incompetent, or dysfunctional at worst.

Perhaps more controversial is the third point, the one that is the focus of this article. We argue that when people are incompetent in the strategies they adopt to achieve success and satisfaction, they suffer a dual burden: Not only do they reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the ability to realize it. Instead, like Mr. Wheeler, they are left with the mistaken impression that they are doing just fine. As Miller (1993) perceptively observed in the quote that opens this article, and as Charles Darwin (1871) sagely noted over a century ago, “ignorance more frequently begets confidence than does knowledge” (p. 3).

This effect has since been named the Dunning-Kruger effect after the authors of the study.

Link to PubMed entry for study.

Broken hearted

Photo by Flickr user Gabriela Camerotti. Click for sourceThe Wall Street Journal has an article on a curious medical condition called ‘broken heart syndrome’ where grief or strong emotion seems mimic a heart attack.

The piece starts with a case description of a lady who had just experience the death of her husband from a heart attack and her reaction which seemed to also be a heart attack:

When doctors performed an X-ray angiogram expecting to find and treat a blood clot that had caused Mrs. Lee’s symptoms, they were surprised: There wasn’t any evidence of a heart attack. Her coronary arteries were completely clear.

Doctors eventually determined that Mrs. Lee had suffered from broken-heart syndrome, a name given by doctors who observed that it seemed to especially affect patients who had recently lost a spouse or other family member. The mysterious malady mimics heart attacks, but appears to have little connection with coronary artery disease. Instead, it is typically triggered by acute emotion or physical trauma that releases a surge of adrenaline that overwhelms the heart. The effect is to freeze much of the left ventricle, the heart’s main pumping chamber, disrupting its ability to contract and effectively pump blood.

The condition is also known as Takotsubo cardiomyopathy and it’s probably worth saying that the idea that the condition is caused by a spike of adrenaline is still under debate although the WSJ article does a good job of looking at alternatives further down the piece.

Link to WSJ on ‘broken heart syndrome’ (via @dreamingspires)

The draft of the new ‘psychiatric bible’ is published

The draft version of the American Psychiatric Association’s DSM 5, the psychiatric ‘bible’ that defines the revised criteria for diagnosing mental illness, has finally been published.

It’s a masterpiece of compromise – intended to be largely backwardly compatible, so most psychiatrists could just get on diagnosing the few major mental illnesses that all clinicians recognise in the same way they always did, with some extra features if you’re an advanced user.

One of the most striking extra features is the addition of dimensions. These are essentially mini questionnaire-like ratings that allow the extent of a condition to be numerically rated, rather than just relying on a ‘you have it or you do not’ categorical diagnosis.

For example, the proposed dimension of emotional distress in depression is available online as a pdf and you will recognise the format if you’ve ever filled out a mood questionnaire. Take this item for example: “I felt worthless…” Never / Rarely / Sometimes / Often / Always.

One of the most striking changes is to the diagnosis of schizophrenia, which, although the core features remain the same, has changed radically in some ways. This is interesting because many people thought it would be largely untouched with just the addition of dimensions, but actually it’s been fundamentally restructured.

For many years, schizophrenia has been divided into various subtypes: paranoid schizophrenia, disorganised schizophrenia, catatonic schizophrenia, and the like, that reflect different symptom profiles.

The subtypes are currently a mess. It’s possible for two people to be diagnosed with schizophrenia with not a single psychological symptom in common and the groupings were made on a rather ad-hoc basis.

In the draft version the subtypes have been completely eliminated and instead, the replaced by dimensions, reflecting the fact most of the symptoms occur in different patients at different severities and that symptom profiles can change over time.

There is also a long overdue fix. Catatonic schizophrenia is a subtype that describes a pattern where patients have movement problems: catatonia – like being ‘frozen’ in one place or having an unusual symptom called waxy flexibility where no movement is initiated but if a limb is moved, it just stays there – a bit like a bendy doll.

It’s an unusual condition that was first described by the psychiatrist Karl Kahlbaum in 1874, but which isn’t actually specific to schizophrenia. In fact, it is more likely to turn up alongside severe depression and bipolar disorder, or in some types of brain damage, and is treated in a completely different way to schizophrenia, responding best to anti-anxiety drugs and ECT.

For reasons of misguided convenience, and against the best knowledge that was around for a century, it got classified as a subtype of schizophrenia. In a move that will have older psychiatrists rolling their eyes in a ‘I told you so’ sort of way, it is now a specifier that can just be plonked onto pretty much any other diagnosis if it occurs.

One of the changes likely to have the widest and most controversial effects is the creation of the ‘Psychosis Risk Syndrome‘ – a sort of something’s-a-bit-strange-but-you’re-not-completely-mad state, where people might have hallucinations, delusion-like ideas and disorganised thoughts, but not to the extent that they are completely disabled by them.

This is drawn from research on what has been called the ‘prodromal’ or ‘at risk’ mental state with the hope that it could identify and treat patients before they become properly psychotic.

One difficulty is that only about a third of people identified as being ‘at risk’ actually become psychotic at a later date. This wouldn’t be particularly worrying were it not for the fact that people in this ‘at risk’ state (perhaps better called 1-in-3 chance state) are often prescribed antipsychotic drugs.

As the first effective treatment for madness, antipsychotics are some of the most important drugs in medical history, but they are also some of the most toxic with long-lasting effects on the body and brain. The thought of giving them out to large numbers of people who might never become psychotic frightens many.

There is also the issue that this diagnosis might pathologise lots of eccentric but perfectly functional people. Research has shown that about %10 of Joe Public have higher levels of hallucinations and delusion-like ideas than the average psychotic inpatient but are rarely bothered by their experiences.

In other words, lots, and I mean lots, of people have unusual experiences – hearing voices, magical ideas, expansive moments – that never cause them any problems, but these people could now be diagnosed with a form of not-quite-mental-illness.

The other diagnoses that have received a radical rethink are the personality disorders which have been completely reconceptualised. Interestingly, the idea has been brought more in line with psychological definitions of personality and the consequent disorders are described as being disruptions to the self (identity integration, integrity of self-concept, and self-directedness) and interpersonal relations (empathy, intimacy and cooperativeness, and complexity and integration of representations of others).

A new child diagnosis of Temper Dysregulation Disorder with Dysphoria has been added. If this seems unremarkable it’s actually big slap in the face for a small but vocal group of US psychiatrists who have been pushing the idea of ‘child bipolar disorder’ – arguing that sad children who have tantrums are showing a juvenile form of ‘manic depression’.

This has become popular, almost entirely in the US, and has led to the alarming rise in children taking antipsychotics. The LA Times reports that this new diagnosis has been created in large part to stop kids being diagnosed with child bipolar. That’s the slap.

Many of the other changes are largely bug fixes. The much discussed change where Asperger’s syndrome and autism have been combined into autism spectrum disorder fixes the anomaly that the only difference between Asperger’s and high functioning autism was a technical point about what age the child started talking.

Post-traumatic stress disorder has been tightened up so it doesn’t rely solely on someone’s self-definition of trauma, preventing PTSD being diagnosed after seeing disasters on TV or after being troubled by upsetting but everyday events, such as insults at work.

The sexual disorders see quite a few additions including hypersexual disorder, that attempts to define being too interested in sex as a mental illness, and paraphilic coercive disorder, that is likely to cause legal controversy as it defines being turned on by forcing people into sex as a psychiatric problem, rather than a moral failing.

Binge-eating disorder has been added, addiction diagnoses for specific drugs have been created (included cannabis withdrawal), gambling addiction has been added, and the manual mentions ‘internet addiction’ in the non-committal, we need more information category.

Another interesting change is to conversion disorder, traditionally known as ‘hysteria’, where medical symptoms appear – such as paralysis – without the usual tissue or nerve damage. The Freudian theory is that the mind is ‘converting’ trauma into physical symptoms to protect consciousness from the mental pain, but the last remnants of Freud have been removed.

Previously, the clinician had to attribute motivations, unconscious or otherwise to the symptoms, but now they just have to appear without being explained by “a general medical condition, the direct effects of a substance, or a culturally sanctioned behavior or experience”.

The related cluster of dissociative and somatoform disorder have also been subtly de-Freuded, as American psychiatry presumably wishes to finally put the old Viennese ghost to rest.

As for the scientific basis of the disorders as distinct separate entities rather than somewhat cobbled together pragmatic descriptions, a quote in The New York Times article hits the nail on the head:

The good news, said Edward Shorter, a historian of psychiatry who has been critical of the manual, is that most patients will be spared the confusion of a changed diagnosis. But “the bad news,” he added, “is that the scientific status of the main diseases in previous editions of the D.S.M. — the keystones of the vault of psychiatry — is fragile.”

Link to draft version of the DSM-V.
Link to Washington Post coverage.
Link to New York Times coverage.
Link to LA Times coverage.
Link to Wall Street Journal blog coverage.
Link to NPR coverage via Integral Options Cafe.