Grief, mental illness and psychiatry’s sad refrain

Scientific American covers a coming shake-up in how grief is defined in relation to mental illness as the forthcoming DSM-5 diagnostic manual aims to radically redefine how mourning is treated by mental health professionals.

It’s worth saying that the DSM-5 has yet to be finalised and will not appear until 2013 but the changes to how grief is classified seem quite drastic.

Two proposed changes in the “bible” of psychiatric disorders—­the Diagnostic and Statistical Manual of Mental Disorders (DSM)—­aim to answer that question when the book’s fifth edition comes out in 2013. One change expected to appear in the DSM-5 reflects a growing consensus in the mental health field; the other has provoked great controversy.

In the less controversial change, the manual would add a new category: Complicated Grief Disorder, also known as traumatic or prolonged grief. The new diagnosis refers to a situation in which many of grief’s common symptoms—such as powerful pining for the deceased, great difficulty moving on, a sense that life is meaningless, and bitterness or anger about the loss—­last longer than six months. The controversial change focuses on the other end of the time spectrum: it allows medical treatment for depression in the first few weeks after a death. Currently the DSM specifically bars a bereaved person from being diagnosed with full-blown depression until at least two months have elapsed from the start of mourning.

It is particularly striking that normal grief could be classified as a mental illness under the new proposals as this brings into question how we define mental illness itself.

Contrary to popular belief, there is not one ‘standard way’ of grieving and people’s response vary widely in response to losing a loved one. However, it’s true to say that being sad and withdrawn is certainly common enough for it to count as a normal reaction to loss.

This brings to mind psychologist Richard Bentall’s tongue-in-cheek proposal to classify happiness as a mental disorder due to the fact that it is “statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system”.

Perhaps we can also look forward to simmering anger, dashed hopes and unrequited love disorders for the DSM-6?

Link to SciAm article ‘Shades of Grief’.

The testing of Alan Turing

The Providentia blog has a brilliant three part series on Alan Turing, focusing on how his homosexuality was treated at the time both as a mental illness and a criminal act.

As with all of the posts of Providentia it’s wonderfully written and captures the sad circumstances leading to the death of one of the world’s artificial intelligence pioneers and breaker of key German codes in the Second World War.

The piece places Turing’s ‘treatment’ in the context of how homosexuality was conceived and dealt with by the medical establishment of the time

In a 1949 paper, F.L. Golla and his colleagues presented the results obtained from a sample of thirteen convicted homosexuals and concluded that “libido could be abolished within a month” with sufficiently high dosages of female sex hormones. The authors concluded that “in view of the non-mutilating nature of this treatment and the ease with which it can be administered to a consenting patient we believe that it should be adopted whenever possible in male cases of abnormal and uncontrollable sexual urge”. Politicians and newspaper editorials alike praised the potential value of hormonal therapy. While critics warned that there was still too many unknowns involving the treatment, the potential gain was felt to be worth the risks involved. Controlling “unnatural” sexual urges with hormone treatments fit in well with the radical advances being made in other areas of psychiatry. Considering other types of experimental treatment being tried (including aversive conditioning, lobotomies, and electroconvulsive therapy), such treatment seemed relatively benign.

A highly recommended read about an exceptional man who was sadly let down by the country for whom who worked to protect.
Link to ‘The Turing Problem’ Part 1.
Link to ‘The Turing Problem’ Part 2.
Link to ‘The Turing Problem’ Part 3.

X-rated neuroanatomy

Slate has a curious article on how many of the anatomical names for parts of the brain are based on the nether-regions of the human body or bawdy allusions to sex.

Régis Olry, of the University of Quebec, and Duane Haines, of the University of Mississippi, brought the whole sordid tale to light in an intriguing pair of articles for the Journal of the History of the Neurosciences. These “historians of neuroanatomy” (yes, there is such a profession, and we should be grateful for it) reviewed a very old, circuitous medical literature and found that the human brain was once described as comprising its very own vulva, penis, testicles, buttocks, and even an anus. In fact, part of the cerebrum is still named in honor of long-forgotten whores.

A past professor of neuroanatomy told me that one of the old arguments for why women couldn’t be doctors is because the their delicate nature would be affected by all the rude Latin jokes in the anatomical names.

Following this line of argument, we might expect atheists to be scared away from neuroscience as well owing to the number of structures that are named after gods.

If you remain unshocked by the vulgarity of the brain, the Slate article may be for you.

Link to Slate article on bawdy neuroanatomy.

Is free will spent by a knock-out drug?

I’ve got a brief article in Wired UK about whether the knock-out drug burundanga could help us understand the neuroscience of free will.

The drug is actually an extract of plants from the brugmansia family with the active ingredient being scopolamine.

The urban legend goes that when you’ve been spiked with the drug you do whatever you’re told and can’t remember anything afterwards. The truth is probably less spectacular but surprisingly, its effect on conformity has never been tested.

You may remember I made a radio programme on the same topic with the lovely people from ABC All in the Mind and although the article has just come out, it was actually the inspiration for the documentary.

Link to Wired UK article on knock-out drugs and free will.
Link to ABC All in the Mind documentary on burundanga.

An anatomy of The Anatomy of Melacholy

BBC Radio 4’s In Our Time tackled one of the most important books in the history of psychology, psychiatry and literature – Robert Burton’s classic 17th Century text The Anatomy of Melancholy.

Although the book is commonly referred to by its abbreviated title it actually has the far more wonderful name of ‘The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections, Members, and Subsections. Philosophically, Medicinally, Historically, Opened and Cut Up’.

In the book, Burton explores melancholy, depression and low spirits in all of its forms as well as curating views and opinions of the state from literature, history and medicine.

It is known as a huge labyrinth of a work that is as chaotic as it is beautiful. It has barely been out of print since it was first published in 1621.

In Our Time discusses the writing of the book, the somewhat mysterious life of its author and its historical significance.

I have to say, I’ve not read it all, as even the modern paperback clocks in at an impressive 1,382 pages.

However, one of my favourite parts is the description a description of the glass delusion – a false belief that one is made of glass and might shatter. Curiously, this was widely reported at the time of Burton’s book but has now almost entirely disappeared.

As, to be honest, I will probably never read the book in its entirety, I fully intend to use the latest edition of In Our Time to get a excellent grounding in Burton’s landmark tome to sound much cleverer than I really am.

As the discussion is so fascinating, you could probably do the same.

Link to streamed version and info for this edition of In Our Time.
Link to podcast page.

The return of BBC All in the Mind

I’ve just realised the latest series of BBC Radio 4’s excellent All in the Mind has started and has been running some fantastic shows.

So far, the programmes have covered everything from portable baby labs to psychopaths to mirror-touch synaesthesia where people feel the sensations that they see in other people.

If you want the podcasts you’ll have to go to a completely separate page called ‘Medical Matters’ (good ‘old BBC) which you can find here.


Link to AITM homepage with streaming audio and programme details.
Link to podcast downloads.

Diamond in the rough

We’ve covered a few cases of people swallowing unusual things before, although this is probably one of the strangest cases we’ve yet come across in the medical literature.

A diamond thief was caught by a security guard during a burglary and needed a free hand to fight him off, so he swallowed the precious stone.

He was detained and taken to hospital but the diamond failed to pass naturally, so the police obtained a court order allowing the doctors to remove the diamond through the, er… tradesman’s entrance.

Often, the presence of unusual foreign objects inside the body are the result of mental illness or accident but this is the first case I know that has occurred due to quick thinking.

A 36-year-old man involved in the burglary of a precious diamond was surprisingly found at the crime scene by a security agent while he was just holding in his hand the precious stone. To keep the stone in a safe place during the battle with the security agent, the thief put the stone in his mouth and swallowed it.

Once the thief was arrested by the police, he was kept under surveillance and the stools were screened to retrieve the stone. Unfortunately, the bowel movements of the suspect were rare and the stone was not evacuated in a timely fashion. The patient was then referred to our hospital for an abdominal X-rays recommended by current medical and forensic guidelines.

The abdominal X-ray showed the stone in the cecal area. Because of court order, we shortened the waiting time until natural expulsion. Therefore, the patient underwent a total colonoscopy in the presence of police officers that easily allowed uncommon stone retrieval using a basket catheter.

The picture above, by the way, is what a diamond looks like through an endoscope, after is has got stuck up the nether regions of a burglar.

Link to case study.
pdf of full text.