The neurology of the undead

Wired has an excellent neurological guide to surviving the zombie holocaust that will keep you one shamble ahead when the undead attack.

The article and the wonderful accompanying infographics were inspired by the work of neuroscientist Bradley Voyek who, when he is not poking around in the decaying brains of zombies, looks at communication networks in the human brain.

Link to Wired piece on the neuroscience of the zombie apocalypse.

Internet dating and the science of fire starting

The New Yorker has a fantastic article about the psychology of online dating.

The piece explores how the big names of internet matchmaking attempt to strike up sparks between you and millions of other people and how they play off what attracts people in face-to-face encounters.

Psychology, maths and the economics of truth are used to bring people together, with each dating site having a different theory about how attraction works

It is tempting to think of online dating as a sophisticated way to address the ancient and fundamental problem of sorting humans into pairs, except that the problem isn’t very old. Civilization, in its various guises, had it pretty much worked out. Society—family, tribe, caste, church, village, probate court—established and enforced its connubial protocols for the presumed good of everyone, except maybe for the couples themselves. The criteria for compatibility had little to do with mutual affection or a shared enthusiasm for spicy food and Fleetwood Mac. Happiness, self-fulfillment, “me time,” a woman’s needs: these didn’t rate. As for romantic love, it was an almost mutually exclusive category of human experience. As much as it may have evolved, in the human animal, as a motivation system for mate-finding, it was rarely given great consideration in the final reckoning of conjugal choice.

The twentieth century reduced it all to smithereens. The Pill, women in the workforce, widespread deferment of marriage, rising divorce rates, gay rights—these set off a prolonged but erratic improvisation on a replacement. In a fractured and bewildered landscape of fern bars, ladies’ nights, Plato’s Retreat, “The Bachelor,” sexting, and the concept of the “cougar,” the Internet promised reconnection, profusion, and processing power.

Unsurprisingly, many dating sites now employ psychologists to optimise their hook up algorithms and the article explores the thinking and the practice behind the process.

A great read.

Link to excellent New Yorker article on internet dating.

The Ginger Jake poisonings

A mysterious epidemic of paralysis was sweeping through 1920s America that had the medical community baffled. The cause was first identified not by physicians, but by blues singers.

During the prohibition, alcohol was banned but people got buzzed the best way they could. One way was through a highly alcoholic liquid called Jamaica Ginger or ‘Jake’ that got round the ban by being sold as a medicine.

Eventually the feds caught on and even such poorly disguised medicines were blacklisted but Jamaica Ginger stayed popular, and alcoholic, due to the producers including an organophosphate additive called tricresyl phosphate that helped fool the government’s tests.

What they didn’t know was that tricresyl phosphate is a slow-acting neurotoxin that affected the neurons that control movement.

The toxin starts by causing lower leg muscular pain and tingling, followed by muscle weakness in the arms and legs. The effect on the legs caused a distinctive form of muscle paralysis that required affected people to lift the leg high during walking to allow the foot to clear the ground.

This epidemic of paralysis first made the pages of the New England Journal of Medicine in June 1930, but the cause remained a mystery.

What the puzzled doctors didn’t know was that the cause had been identified by two blues musicians earlier that year, in songs released on 78rpm records.

Ishman Bracey’s song Jake Liquor Blues and Tommy Johnson’s track Alcohol and Jake Blues had hit on the key epidemiological factor, the consumption of Jamaica Ginger, likely due to their being part of the poor southern communities where jake was most commonly drunk.

Slowly, the medical community caught on, noting that the additive damaged the spinal cord and peripheral nerves, and the adulterated jake was slowly tracked down and outlawed.

The story, however, has an interesting neurological twist. In 1978, two neurologists decided to track down some of the survivors of jake poisoning 47 years after the booze fuelled epidemic hit.

They found that the original neurological explanation for the ‘jake walk’ effect was wrong. The paralysis was actually due to damage to the movement control neurons in the brain (upper motor neurons) and not the peripheral nervous system.

Jake was much more dangerous than thought and the false lead was probably due to inadequate assessments when the epidemic hit, possibly because the stigma associated with the condition prevented a thorough investigation.

The study has a poignant description of the social effect of the condition:

The shame experienced by those with jake leg possibly led some with a minimal functional disorder to deny that they ever had the disease, and patient 4 stated that he knew some such people. We heard of other men with obvious impairment who claimed to have had a stroke.

If you want to read more on this curious piece of neurological there’s a great article on Providentia you can check out for free and a renowned 2003 article from The New Yorker which is locked behind a paywall due to digital prohibition.

Link to Providentia post on Ginger Jake.

Epilepsy, inside and out

The New York Times has an inspiring piece about neurologist and epilepsy specialist Brien Smith who has just become chairman of the Epilepsy Foundation. Unusually, his interest is more than just professional as he has epilepsy himself.

I was really struck by this part, as it shows how even trained medical professionals can unnecessarily freak out when they see someone having a seizure:

One day during medical school, my classmates and I learned that one of the most well-liked doctors-in-training in the hospital had had a seizure while leading morning work rounds.

The sight of him writhing had caused the other doctors and nurses on the ward to panic. Some stood mute, frozen with fear. An intern, believing that the seizure arose from low blood sugar levels, took his half-eaten jelly doughnut and held it against the mouth of his seizing colleague. Others yelled to the ward secretary to “call a code,” and continued to do so even after another dozen doctors and nurses had already arrived on the floor.

The young doctor eventually recovered. But for many of the medical students and doctors who heard about the episode or were on the wards that day, the dread of that morning would linger long beyond our years of training. Epilepsy was, and remains, a frightening and mysterious malady.

Time and again, I have seen this happen. People call ambulances unnecessarily. People risk the life of the person having a seizure by trying to put something in their mouth (to stop them ‘biting their tongue’). People risk injury to the person by trying to hold them down.

If you want to be one of the few people who don’t freak out when someone has a seizure and if you want to be genuinely helpful, read this brief page on first aid for epilepsy.

And if you have a couple more minutes, check out The New York Times piece on neurologist Brien Smith and his unique insight into the condition. Highly recommended.

Link to NYT piece on Brien Smith (via @mocost).

The malware of medical science

Just when you thought the pharmaceutical industry had used up every dirty trick in the book, it has been revealed that a ‘study’ of the epilepsy drug gabapentin (aka Neurontin) was never really intended to investigate the medication, but was primarily intended to get doctors to prescribe it more often.

A report published in the Archives of Internal Medicine examined documents uncovered in legal cases that show that a drug trial called ‘Study of Neurontin: Titrate to Effect, Profile of Safety’ (STEPS) was largely designed to involve doctors in a marketing programme that would appear like a scientific trial.

Actually, it was a scientific trial of a sort, but rather than studying the effect of the drug on patients, they were studying the effect of marketing on the doctors.

Parke-Davis sales representatives collected and recorded individual subject data. In a clear example of data tampering, they not only attended epilepsy patients’ office visits (under the guise of “shadowing” the clinician), but also actively promoted the use of Neurontin and blocked the use of competing medications, particularly lamotrigine (Lamictal), at those visits. They also rewarded participating investigators with free lunches and dinners.

Without informing either patients or physicians, the drug company’s marketing department monitored each investigator’s prescribing practices. It documented a 38% increase in prescriptions of Neurontin after investigators attended an introductory briefing, as well as a 10% increase in the average prescribed dose. It also compared prescribing patterns between study investigators and a control group of nonparticipating neurologists, and documented increased prescribing of Neurontin only among the study participants.

Big Pharma: the malware of medical science.

Link to good write-up in Internal Medicine News.
Link to locked study in the Archives of Internal Medicine.
Link to locked related editorial in the Archives of Internal Medicine.

From character analysis to orgasm batteries

Slate has a brilliant article on one of the most troubled and yet fascinating people in the history of psychology – William Reich – inventor of the orgasmotron.

Reich was one of Freud’s inner circle but decided to propose his own ideas rather than follow the Freudian orthodoxy, something which got him promptly kicked out of the chosen few.

The point of contention was that Reich favoured analysing the personality as a whole, rather than individual symptoms, using a system he developed call ‘character analysis’.

His system had a massive impact on psychoanalysis but as time went on he became more and more radical to the point of seeming to have lost his marbles.

Merging abandoned versions of Freudianism and Marxism, Reich saw repression and neurosis as causes and results of bourgeois property ownership and patriarchy. He established free sex clinics and roved the city in a van from which he proselytized for Communism and orgasm. The open expression of libido, beginning with free love between adolescents, would raise the proletarian political consciousness. Soon, Reich was drummed out of the analytic movement and the Communist Party.

This, you may be surprised to hear, was not Reich at his most left-field.

He also began to believe that the power of orgasm, called orgone, could be stored in batteries and could be absorbed from the sky by the use of a special machine called a cloudbuster.

If the name of the machine seems familiar, it’s probably because it ‘Cloudbusting’ was the title of a song and video by Kate Bush which told the story of Reich’s machine and his downfall.

He eventually died in prison after being arrested by the FBI for illegally distributing his ‘orgone energy accumulator’ leaving a chaotic legacy that stretches from the profound to the ridiculous.

Link to Slate article on Willhelm Reich.

A 30 second piece of our minds

A new book has been published called 30 Second Psychology. It’s been written by some familiar folks and aims to capture fifty of the most important theories of psychology in one punchy package.

It’s been edited by Christian Jarret of the BPS Research Digest and includes contributions from me, Mo Costandi, Dave Munger and Tom Stafford.

The book covers everything from psychotherapy to cognitive neuroscience and, as normal, the others have done a much better job than me. Thankfully, though, I have been edited into sense.

Here’s part of my entry on Abraham Maslow’s humanistic psychology and how it inspired client-centred counselling, nude psychotherapy and love-ins.

Abraham Maslow trained as a hard-nosed experimental psychologist who became disillusioned with defining human nature through lab experiments and was dissatisfied with the Freudian alternative. Instead of seeing humans as the passive recipients of experience or slaves to unconscious drives, Maslow saw us as motivated by an ultimate need to become fulfilled and ‘self-actualized’ where we are at peace with ourselves and others and have the psychological freedom “to become everything that one is capable of becoming.” Humanistic psychology grew from this inspiration and placed subjective lived experience, rather than the unconscious mind, at the centre of human nature.

These ideas were taken up by psychotherapists, most notably by Carl Rogers, who based ‘client-centred therapy’ on the principles of genuineness and acceptance of a person’s basic worth. Although Maslow was sometimes uncomfortable with how his approach was adopted by the 1960s counter-culture, leading to everything from love-ins to nude psychotherapy, his central themes of respect for individual autonomy and the encouragement of personal development are now at the core of all most modern psychological treatments and his ‘hierarchy of needs’ is still considered a important theory of human motivation.


Link to more details from the publishers.
Link to book on Amazon.

An unusual form of the Babinski reflex

A curious anecdote about legendary neurologist Joseph Babinski accidentally hitting on the butler of famous physician Henry Head:

Babinski [1857–1932] stayed with Henry Head in London. He spoke no English but on retiring wanted to use a bidet and summoned the butler who spoke no French; he therefore used sign language to indicate what he wanted and the butler construed the gestures as Babinski propositioning him and resigned from the household.

I’m sure we’ve all made that mistake at some point.

As re-told in an article in this month’s neuroscience journal Brain on the late William McDonald.

A dose of female intelligence

Harvard Business Review interviews a research team who have found that increasing the number of women in a team raises group intelligence.

Of course, the findings could also be as accurately described as showing that men make groups more stupid, although the researchers are far too tactful to mention this particular interpretation.

Woolley: We’ve replicated the findings twice now. Many of the factors you might think would be predictive of group performance were not. Things like group satisfaction, group cohesion, group motivation—none were correlated with collective intelligence. And, of course, individual intelligence wasn’t highly correlated, either.

Malone: Before we did the research, we were afraid that collective intelligence would be just the average of all the individual IQs in a group. So we were surprised but intrigued to find that group intelligence had relatively little to do with individual intelligence.

HBR: But gender does play a role?

Malone: It’s a preliminary finding—and not a conventional one. The standard argument is that diversity is good and you should have both men and women in a group. But so far, the data show, the more women, the better.

As a male clinical psychologist, I am now completely accustomed to being intellectually out-gunned by my female colleagues, but it’s important to realise that there’s more to group work than intelligence.

Do we really want a world of better decisions but with fewer dick jokes? Just the thought of it keeps me up at night.


Link to article in Harvard Business Review (and don’t miss the podcast).

In search of invisible violence

NPR Radio covers an amazing inattentional blindness experiment that investigated how easy it is to miss a vicious beating in the street – after a policemen was convicted of ignoring an attack during a pursuit.

Inattentional blindness is the phenomenon where we don’t notice something seemingly obvious because we are paying attention to some other details.

It was most famously demonstrated by the ‘gorillas in our midst’ experiment where observers asked to count the number of passes between basketball players fail to notice a man in a monkey suit walking though the action.

Following a policeman’s conviction for supposedly ‘keeping quiet’ about a beating that he ran past while in pursuit of someone else, the same researchers wanted to know whether people asked to follow a jogger and monitor their behaviour would miss a simulated attack in the street.

Then about a minute in the run, slightly off to the side, [researchers] Chabris and Simons had three students stage a fight.

“We had two students beating up a third, punching him and kicking him and throwing him to the ground,” Chabris says.

The question was whether the students would see the fight, and under the conditions — nighttime — that most closely resembled [policemen] Conley’s experience. The numbers were shockingly low.

“Only about a third of the subjects reported seeing the fight that we had staged,” says Chabris.

It’s a brilliant piece of applied research, a great report with an amazing backstory, and the full text of the study is available online if you want more details.

Link to NPR report.
Link to full text of study.

The trouble with psychiatry

If you want an incisive critique of modern psychiatry, look no further than an excellent article in The New York Review of Books.

It brilliantly captures the fights over diagnosis and the DSM, the problem of drug companies buying influence by paying physicians, and why the promises of drug treatments are often propped up with marketing hype.

The article is well-informed, doesn’t mince words, and the author is no anti-psychiatry flak. She’s Marcia Angell, ex-editor of the New England Journal of Medicine, one of the world’s leading medical journals.

One of the leaders of modern psychiatry, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, who was among the first to study the effects of stimulants on attention deficit disorder in children, wrote that American psychiatry in the late twentieth century moved from a state of “brainlessness” to one of “mindlessness.” By that he meant that before psychoactive drugs (drugs that affect the mental state) were introduced, the profession had little interest in neurotransmitters or any other aspect of the physical brain. Instead, it subscribed to the Freudian view that mental illness had its roots in unconscious conflicts, usually originating in childhood, that affected the mind as though it were separate from the brain.

But with the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus shifted to the brain. Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological model of mental illness, Eisenberg in his later years became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry.

If you want a great insight into the difficulties of psychiatry and how they’ve emerged, this article is one of the best introductions you could hope for.

Link to article in the NYRB (via 3QD).

A curious hysterical blindness

The New York Times has an extended book review that explores female hysteria in 19th Century Paris while demonstrating a curious hysterical blindness of its own.

The piece reviews a new and supposedly excellent book by Asti Hustvedt called ‘Medical Muses: Hysteria in Nineteenth-Century Paris’.

Hysteria is the presentation of seemingly neurological symptoms without any damage to the nervous system that could explain it. Although we can’t explain why many neurological disorders appear, neurological symptoms – almost by definition – are linked to clear and detectable damage.

Those that appear without the presence of such damage were traditionally labelled ‘hysteria’ although are now subsumed under various diagnoses such as conversion disorder or somatoform disorder.

Charcot was a highly influential 19th Century neurologist who essentially defined the shape of modern neurology and he was fascinated by hysteria. This is the subject of Asti Hustvedt’s new book.

I’ve not read the book but the review, and many pieces like it, focus on neurologist Jean-Martin Charcot’s interest in female hysteria as a demonstration of how the female body and sexuality were uniquely pathologised in 19th century medicine.

This would be interesting were it not for the fact that solely focusing on ‘female hysteria’ misrepresents what happened.

Not least because after more than two thousand years of hysteria being portrayed as being a uniquely feminine disorder, Charcot identified and campaigned for the existence of male hysteria.

This is from medical historian Mark Micale:

During the 1880s, Charcot published the case histories of more than 60 male “hysterics” and treated countless others in his daily hospital practice. Between a third and a quarter of the overall number of hysterical patients he presented in his printed works were men or children. In these writings, Charcot formulated an elaborate set of medical ideas about the disease in males, including a theory of aetiology, a model of symptomatology, and a programme of therapeutics.

Throughout this period, Charcot campaigned energetically for his theory of masculine hysteria, and by the time of his death, in 1893, the idea was widely accepted within mainstream European medical communities. Many of Charcot’s medical contemporaries judged his work on the topic to be among the most scientifically significant parts of his oeuvre, and the School of the Salpetriere, as it was called, was associated internationally with the theme of male hysteria.

It’s true to say that the female ‘hysterical patients’ gained much more attention (due to a combination of public fascination, Charcot’s love of showmanship and the recent invention of photography) but it’s interesting to note that this pattern has continued into the modern day.

This is despite the fact that’s the famous neurologist’s own interests were far more balanced. A curious historical parallel.

Link to review in the NYT.
Link details of ‘Medical Muses: Hysteria in Nineteenth-Century Paris’.

The psychology of expert predictions

This week’s edition of BBC Radio 4 All in the Mind has a fantastic section on the psychology of knowledgeable predictions that bursts lots of bubbles about the power of experts but also discusses how to make more accurate predictions.

You can listen to the whole programme online but it seems the crucial section has accidentally found it’s way onto YouTube which you can catch here.

The discussion is with author Dan Gardner and by psychologist Dylan Evans who tackle the links between risk, prediction and knowledge.

It has lots of fascinating insights, including the fact that the fame of experts is inversely related to their accuracy, that US weather forecasters are better than UK forecasters (and not because UK weather is more difficult), and that more confident predictions are more likely to be wrong.

If you want to catch the whole of All in the Mind the section of grief myths is also wonderful.

Link to All in the Mind.
Link to section on expert predictions.

Is medical school an empathotoxin?

Medical school seems to have a profound negative effect on empathy according to a research review just published in Academic Medicine.

The review of 18 studies found that self-reported emotional understanding declines markedly during medical training. Counter-intuitively, the crucial downturn happens when medical students start seeing patients.

Although the studies are almost completely based on self-report, at the very least they show a decline in being interested in others’ emotional states, even if we can’t be sure that emotional competency is being affected.

Apart from the start of clinical practice phase of training the other major influence in empathy decline was personal distress, which concurs with studies that suggest that people in general report less empathy as they feel worse.

Of course, there may be a number of other factors at work, including the stress of training, an attempt to cope with suffering patients and what the article describes as ‘poor role models’.

What this refers to is the traditional ‘learning through humiliation’ style of medical teaching that seems to be oddly prized by the medical establishment as a form of clinical hazing.

The occasional reply to concerns about physician empathy is usually something along the lines of “what would you prefer, someone who is a good clinician or someone who is a nice person?”.

Despite the false dichotomy, the study make it abundantly clear why empathy is important in medicine, as it is associated with:

• patients’ reporting more about their symptoms and concerns
• physicians’ increased diagnostic accuracy
• patients’ receiving more illness-specific information
• patients’ increased participation and education
• patients’ increased compliance and satisfaction
• patients’ greater enablement
• patients’ reduced emotional distress and increased quality of life

Link to PubMed entry for study.
Link to DOI entry for study.

For Whom the Bell Tolls: A psychological autopsy

The Independent has an excellent article on the life and death of writer Ernest Hemingway based on an academic article that attempted a ‘psychological autopsy’ to understand the reasons for his suicide.

Hemingway’s suicide has remained a sticking point for many of his biographers as it seemed incongruous with his adventurous, hard drinking and robustly out-going character.

In 2006, psychiatrist Christopher Martin published an examination of Hemingway’s death in the form of a ‘psychological autopsy‘ to better understand his final decision.

The method aims to get a picture of the dead person’s mental state, health, personality, and social situation to understand what motivated them to take their own life.

The Independent is a careful examination, based on Martin’s academic analysis, that looks at Hemingway’s personality and how the myth of the man had overshadowed many of his personal difficulties for many years.

It’s an in-depth and compelling read that gives a stark look at the darker side of the great writer’s mental life.

Link to Independent article on Hemingway (via @brainpicker)
Link to DOI entry and locked academic article.