US Army PTSD treatment: heaven and hell

BBC News and The New York Times have just each published articles on the US Army’s treatment of psychologically traumatised soldiers so different that you’d think they were talking about entirely distinct programmes.

Two articles have just appeared on the BBC website giving a very positive view of the US military’s treatment of Army veterans diagnosed with post-traumatic stress disorder (PTSD) and other mental health problems.

The articles largely focus on the programme at Fort Hood and despite some peculiarities (it mentions treatment includes acupuncture, reiki, sound therapy and seemingly chakra-based meditation) the picture is of a small but promising approach to treating psychologically disabled soldiers.

In contrast, The New York Times presents a damning picture of the treatment programme in which the service is poorly organised, where prescription and illicit drug abuse is rife and where clinicians rely largely on large doses of medication to manage soldiers’ symptoms.

It’s hard to know what to make of the articles, as the BBC seem to have made no effort to ask any difficult questions, while the NYT article seems to be largely based on interviews of soldiers who felt they were poorly dealt with, while the Army’s own surveys discussed in the piece suggest most are happy with the services.

The stuff about New Age treatments is just a bit odd. Is this where the First Earth Battalion have got to these days?

UPDATE: Thanks to PsychFun for pointing out they are, in fact, two distinct programmes! (Grabbed from the comments)

The WTU talked about in the NYT article is a military unit for wounded soldiers, many of whom have PTSD. The BBC article is talking about a 3 week intensive PTSD treatment program, as your own link shows. Darn those confusing US Army acronyms!

Link 1 and Link 2 to BBC News articles.
Link to New York Times article.

Can I get an amen?

Photo by Flickr user dhammza. Click for sourceThis is an fMRI study on how Christian faith healers influence the brains of believers and non-believers. It is an absolutely remarkable experiment when you think about it but I still don’t know quite what to make of it.

The power of charisma–perceived charisma inhibits the frontal executive network of believers in intercessory prayer.

Soc Cogn Affect Neurosci. 2010 Mar 12. [Epub ahead of print]

Schjoedt U, St√∏dkilde-J√∏rgensen H, Geertz AW, Lund TE, Roepstorff A.

This study used functional magnetic resonance imaging to investigate how assumptions about speakers’ abilities changed the evoked BOLD response [changes in blood oxygenation indicating neural activity] in secular and Christian participants who received intercessory prayer. We find that recipients’ assumptions about senders’ charismatic abilities have important effects on their executive network. Most notably, the Christian participants deactivated the frontal network consisting of the medial and the dorsolateral prefrontal cortex bilaterally in response to speakers who they believed had healing abilities. An independent analysis across subjects revealed that this deactivation predicted the Christian participants’ subsequent ratings of the speakers’ charisma and experience of God’s presence during prayer. These observations point to an important mechanism of authority that may facilitate charismatic influence, a mechanism which is likely to be present in other interpersonal interactions as well.

There’s a write-up over at the excellent Inkling Magazine if you want more.

Link to PubMed entry for study (via @anibalmastobiza)
Link to write-up on Inkling.

Questioning ‘one in four’

The Guardian has an excellent article questioning the widely cited statistic that ‘1 in 4’ people will have a mental illness at some point in their lives. The issue of how many people have or will have a mental illness raises two complex issues: how we define an illness and how we count them.

Defining an illness is a particularly tricky conceptual point and this is usually discussed as if it is an issue particular to psychiatry and psychology that doesn’t effect ‘physical medicine’ but it is actually a concern that is equally pressing in all types of poor health.

The most clear-cut definition of an illness is usually given as an infectious disease that can be diagnosed with a laboratory test. For example, you either have the bacteria or you don’t.

However, you will acquire lots of new bacteria that will continue to live in your body, some of which ’cause problems’ and others that don’t. So the decision rests not on the presence or absence of new bacteria, but on how we define what it means for one type to be ‘causing a problem’. This is the central point of all definitions of illness.

For example, when are changes in heart function enough for them to be considered ‘heart disease’? Perhaps we judge them on the basis of their knock-on effects, but this raises the issue of what consequences we think are serious, and when we should consider them serious enough to count. Death within weeks, clearly, death within two years, maybe, but is still this the case if it occurs in a 90 year-old?

The idea of a personal change ‘causing a problem’ is also influenced by culture as it relies on what we value as part of a fulfilling life.

In times gone past, physical differences that caused sexual problems might only have been considered an illness if they prevented someone from having children. A man who had children, wanted no more, but was unable to have recreational sex with his wife due to physical changes might be considered unlucky but not ill.

The idea of normal sexual function was different, and so the concept of abnormality and illness were also different.

The same applies to mental illness. What we consider an illness depends on what we take for being normal and what someone has the ‘right’ to expect from life.

The fact that the concept of depression as an illness has changed from only something that caused extreme disability (‘melancholy madness’) to something that prevents you from being content is likely due to the fact that, as a society, we have agreed that we have a right to expect that we enjoy our lives. There was no such expectation in the past.

The problem of correctly diagnosing an illness is a related problem. After we have decided on the definition of an illness, there is the issue of how reliably we can detect it – how we fit observations of the patient to the definition.

This is a significant issue for psychiatry, which largely relies on changes in behaviour and subjective mental states, but it also affects other medical specialities.

Contrary to popular belief, most ‘physical’ illness are not diagnosed with lab tests. As in psychiatry, while lab tests can help the process (by excluding other causes or confirming particular symptoms) the majority of diagnoses of all types are made by what is known as a ‘clinical diagnosis’.

This is no more than a subjective judgement by a doctor that the signs and symptoms of a patient amount to a particular illness.

For example, the diagnosis of rheumatoid arthritis depends on the doctor making a judgement that the mixture of subjectively reported symptoms by the patient and objective observations on the body amount to the condition.

The key test of whether an illness can be counted is how reliably this process can be completed – or, in other words, whether doctors consistently agree on whether patients have or don’t have the condition.

This is more of an issue for psychiatry because diagnosis relies more heavily on the patient’s subjective experience, but it is wrong to think that bodily observations are necessarily more reliable.

For example, the Babinski response is where the toes curl upward after the plantar reflex is tested by stroking the bottom of the foot. It is commonly used by neurologists to test for damage to the upper motor neurons but it is remarkably unreliable. In fact, neurologists agree on whether it is present at a far lower rate than would be acceptable for the diagnosis of a mental illness or psychiatric symptom.

The problem of reliably diagnosing a condition is relatively easy to overcome, however, as agreement is easy to test and refine. The problem of what we consider an illness is a deeper conceptual issue and this is the essence of the debates over how many people have a mental illness.

The ‘1 in 4’ figures seems to have been mostly plucked out of the air. If this seems too high an estimate, you may be surprised to learn that studies on how many people qualify for a psychiatry diagnosis suggest it is too low.

There is actually no hard evidence for one in four ‚Äì or any other number ‚Äì because there’s never been any research looking at the overall lifetime rates of mental illness in Britain. The closest thing we’ve had is the Psychiatric Morbidity Survey, run by the Office of National Statistics. The latest survey, done in 2007, found a rate of about one in four, 23%, but this asked people whether they’d suffered symptoms in the past week (for most disorders).

We don’t know what the corresponding rate for lifetime illness is, although it must be higher. Several such studies have been done in other English speaking countries, however. The most recent major survey of the US population found an estimated lifetime rate of no less than 50.8%. Another study in Dunedin, New Zealand, found that more than 50% of the people there had suffered from mental illness at least once by the age of 32.

Psychiatry has a tendency for ‘diagnosis creep’ where unpleasant life problems are increasingly defined as medical disorders, partly due to pressure from drug companies who develop compounds that could genuinely help non-medical problems. The biggest market is the USA where most drugs are dispensed via insurance claims and insurance companies demand an official diagnosis to fund the drugs, hence, pressure to create new diagnoses from companies and distressed people.

Whenever someone criticises a diagnosis as being unhelpful a common response is to suggest the critic has no compassion for the people with the problem or that they are wanting to deny them help.

The most important issue is not whether people are suffering or whether there is help available to them, but whether medicine is the best way of understanding and assisting people.

Medicine has the potential to do great harm as well as great good and it is not an approach which should be used without seriously considering the risks and benefits, both in terms of the individual and in terms of how it shifts our society’s view of ourselves and the share of responsibility for dealing with personal problems.

So when you hear figures that suggest that ‘1 in 4’ or ‘50%’ of people will have a mental illness in their lifetime, question what this means. The figure is often used to try and destigmatise mental illness but the most powerful bit of The Guardian article shows that this is not necessary:

People who experience mental illness often face stigma and discrimination, and it’s right to oppose this. But stigma is wrong whether the rate of mental illness is one in four, or one in 400. We shouldn’t need statistics to remind us that mental illness happens to real people. By saying that mental health problems are nothing to be ashamed of because they’re common, one in four only serves to reinforce the assumption that there’s something basically shameful about being “abnormal”.

If you want more background on the ‘1 in 4’ figure or discussion about how we understand what is mental illness and who has it, an excellent three part series on Neuroskeptic tackled exactly this point.

Link to ‘How true is the one-in-four mental health statistic?’
Parts one two and three of excellent Neuroskeptic series

Charlie Rose Brain Series online and complete

The Charlie Rose discussion show has an ongoing series on the brain and all of the episodes are available online where some of world’s leading neuroscientists extensively tackle the big questions of the field.

I’m just watching the programmes at the moment and while they can seem a little stiff at times, it lovely to see neuroscience being discussed without being dumbed down but while key concepts are explained and explored.

The discussions are co-hosted by Charlie Rose and Nobel prize winning neuroscientist Eric Kandel and the seven shows so far have tackled The Great Mysteries of the Human Brain, The Perceiving Brain, The Acting Brain, The Social Brain, The Developing Brain, The Ageing Brain and The Emotional Brain.

Future shows include The Anxious Brain, The Mentally Ill Brain, The Disordered Brain, The Deciding Brain, The Artistic Brain and The New Science of the Mind, all of which will appear online just after they are broadcast on US TV.

A great introductory guide to contemporary cognitive neuroscience.

Link to Charlie Rose Brain Series.

Cultures of foreplay

Photo by Flickr user LLima. Click for sourceI’ve just read a fantastic article in the Journal of Sex Research on culture and how we decide what is a sexual disorder or ‘paraphilia’. It has a fascinating section where it talks about cultural variation in common or acceptable sexual practices and it touches on how foreplay differs between societies.

Kissing during foreplay, it seems, is not universal and seems to be a particular fetish of Western lovers.

Finally, in most cultures, sexual intercourse is preceded by some degree of foreplay—that is, sensory and sexual stimulation intended to induce arousal. This stimulation may be visual, tactile, or otherwise. When visual, it may be the sight of the partner or parts of his or her body or clothing, but these may vary across cultures (Bhugra, 2000). Kissing as part of sexual foreplay is common in the West but virtually unknown in other parts of the world (Ford & Beach, 1965). There are some cultures where penetration was the key element to intercourse, and neither foreplay nor afterplay was recorded. Ford and Beach pointed out that physical pain and biting are sometimes permitted as part of sexual foreplay and, therefore, such behaviors are likely to be readily incorporated into the sexual repertoire. Thus, individuals learn about methods of sexual arousal and sexual activity from their cultural habits and, in order to avoid being labelled and treated as deviant, they conform to prevalent and expected mores.

Unfortunately, the article is locked behind a paywall. Undoubtedly for your own good though. Imagine what would happen if you started to deviate from culturally accepted foreplay practices. Anarchy. And then where would we be?

Link to PubMed entry for article.

2010-04-23 Spike activity

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

The New York Times discusses how a belladonna hallucination could have been the start of alcoholics anonymous.

Dream rehearsal helps remembering, according to a study covered by Not Exactly Rocket Science.

The Times covers breezy people who go around saying yaka-wow. Some yaka-wow socks are also in progress.

An interesting in-scanner set-up for live face-to-face interaction during brain imaging experiments is covered by the BPS Research Digest.

The Smithsonian Magazine has an in-depth article on the neuroscience of how our brains make memories.

There’s an excellent discussion how to delay instant gratification and offset delay discounting with future thinking over at The Frontal Cortex.

Nature News covers genetic evidence suggesting that neanderthals may have interbred with humans.

To the bunkers! New Scientist covers the development of robots with sensing skin.

Neurophilosophy covers an interesting embodied cognition experiment where body movement influenced memory and emotions.

How should we explain the origins of novel behaviors? asks American Scientist.

Neurotopia discusses the neuroscience of ‘photic sneezing‘ or why we sometimes sneeze when we look at the sun.

Evidence on the link between obesity and dementia is discussed in The New York Times.

PsyBlog has an absolutely fascinating post on our tendency to be over-cynical about trusting other people and how it can be overcome through accurate feedback of others’ trustworthiness.

Is there search for extra-terrestrial life missing the most likely signs of <a href="Alien intelligence″>alien intelligence? asks The Economist.

Minds of the Edge is a powerful documentary and online resource about mental health in the states. You can view all online.

I keep forgetting how good BrainBlogger is. Note to self: remind me more often please.

New Scientist has an article on Bruce Bueno de Mesquita, the ‘predictioneer‘, whose game theory based model of political prediction has been remarkably accurate.

Visions of the brain. The Beautiful Brain blog has a fantastic podcast that talks to three artists about their approach to visualising inner landscapes.

Popular Science have video of the autonomous garbage collecting ‘dustbot‘ designed to wander your neighbourhood. To the bunkers!

Is memory for music special? Asks Dr Shock. Apparently it is not.

Wired has excellent piece on the history of the Multidisciplinary Association for Psychedelic Studies and how the scientific research organisation stands in relation to the drugs counter-culture.

The busy night

Two things I love are sleeping and data collection. Now, thanks to a new iPhone app, I can do both at once.

Sleep Cycle uses the accelerometer in the iPhone to record vibrations in your mattress caused by you moving in the night. In this way it acts as an actigraph, keeping a record of your body movement, which in this context reflects how deeply you are asleep.

sleepgraph.jpgHere is the data from my last night’s kip. As you can see I show a fairly typical pattern: sleeping deeper in the first half of the night, compared to the second half, and having alternating patterns of deep and light sleep (although I seem to cycle through the stages of sleep every hour, rather than the typically quoted every one and a half hours).

The app also has an alarm which promises to wake you up during a lighter stage of sleep, so saving you the unpleasant sensation of being woken by your alarm from deep sleep. I’ve yet to try this out but it sounds like a good thing, as long as avoiding the jarring sensation is worth forgoing the extra minutes shut-eye!

Link: to the Sleepcycle app