Writing on cocaine, literally

The New York Times reviews a new book about the early enthusiasm for cocaine among the medical community and particularly how it affected two of the world’s most influential doctors.

The book is called ‘An Anatomy of Addiction’ and looks at how psychoanalyst Sigmund Freud and pioneering surgeon William Halsted became heavily dependent on the drug.

A long-term cocaine and morphine addict, Halsted is of particular interest because he wrote a scientific article about cocaine, while clearly off his face on cocaine.

Despite being almost complete nonsense it got published in the New York Medical Journal in 1885.

Rather ironically, it was entitled “Practical comments on the use and abuse of cocaine”. This is the first paragraph:

Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, if not declared, by most so very sure to prove, especially to them, attractive, still I do not think that this circumstance, or some sense of obligation to rescue fragmentary reputation for surgeons rather than belief that an opportunity existed for assisting others to an appreciable extent, induced me, several months ago, to write on the subject in hand the greater part of a somewhat comprehensible paper, which poor health disinclined me to complete.

This was a different era in the the history of cocaine, however. So different in fact, that His Holiness the Pope endorsed a cocaine infused wine.

Link to NYT article on Freud and Halsted on cocaine.

Subtle word change affects election participation

A subtle word change to refer to the self on a pre-election survey seems to significantly boost the number of voters in national elections.

A new study led by psychologist Christopher Bryan and published in the Proceedings of the National Academy of Sciences investigated how the sense of self motivates the public act of voting.

The authors point out that in terms of individual self-interest, voting is irrational. Just the probability of being killed in a car accident on the way to the polls far outweighs the likelihood that the average American’s vote will influence the outcome of most elections.

But from a public point of view, voting is essential for a functioning democracy, so the study tested the hypothesis that doing something positive for the community might motivate people by giving a potential boost to our self-image.

To do this, the researchers ran three experiments where they asked potential voters to complete an internet survey asking about the upcoming elections.

Importantly, half the people got a survey that referred to the act of voting while the other half got an identical survey but where the questions were worded to refer to them as a voter, directly implicating their self-identity.

For example, one version of a question would use a verb to refer to voting as an act (“How important is it to you to vote in the upcoming election?”) while another would use a noun to directly implicate the respondent (“How important is it to you to be a voter in the upcoming election?”)

Directly after the survey, respondents in the self-implicating condition said they were much interested in voting in the upcoming election than those who completed the ‘voting as act’ survey, suggesting that the self-focused wording boosted enthusiasm.

Crucially, the effect also transferred into actions as another study looked at public voting records and found that those who had completed the self-focused survey were actually more likely to vote than those who had completed the action-focused survey.

Finally, the researchers ran the same study using a survey company to randomly select a nationally representative sample of people. These respondents were also more likely to vote if they completed the self-focused ‘election survey’.

Studies that attempt to influence behaviour often find effects that are ‘small but reliable’.

In contrast, the authors note that the effects of the simple word change “are among the largest experimental effects ever observed on objectively measured voter turnout” – increasing actual turnout by more than 10%.

The researchers suggest that the effect is not solely about make the questions more self-relevant, but more strongly linking the self to a concept generally regarded as positive – voting.

This means the perception of the concept itself is also key and the effect might be reversed if the wording change referred to something generally regarded as negative – for example, a criminal act.

Link to open-access study in PNAS.

Google, memory and the damp drawers Olympics

If pant-wetting were a sport, the recent study on how memory adjusts to the constant availability of online information would have launched the damp drawers Olympics.

‘Poor memory? Blame Google’ claimed The Guardian. ‘Internet search engines cause poor memory, scientists claim’ said The Telegraph. ‘Google turning us into forgetful morons’ wibbled The Register.

If you want a good write-up of the study you couldn’t do better than checking out the post on Not Exactly Rocket Science which captures the dry undies fact that although the online availability of the information reduced memory for content, it improved memory for its location.

Conversely, when participants knew that the information was not available online, memory for content improved. In other words, the brain is adjusting memory to make information retrieval more efficient depending on the context.

Memory management in general is known as metamemory and the storage of pointers to other information sources (usually people) rather than the content itself, is known as transactive memory.

Think of working in a team where the knowledge is shared across members. Effectively, transactive memory is a form of social memory where each individual is adjusting how much they need to personally remember based on knowledge of other people’s expertise.

This new study, by a group of researchers led by the wonderfully named Betsy Sparrow, found that we treat online information in a similar way.

What this does not show is that information technology is somehow ‘damaging’ our memory, as the participants remembered the location of the information much better when they thought it would be digitally available.

It does, however, raise the interesting question of our relationship to technology and particularly its impact on performance in different contexts.

For example, people making life or death decisions may train using computers but may have to work without them. This transition usually takes place during the student years.

So how can we promote content memory for important information? Probably something old-fashioned like exams.

Link to excellent write-up of study on Not Exactly Rocket Science.

The buried story of Los 33

The Guardian has an insightful and moving article on how the thirty three Chilean miners and their families have coped with their post-disaster world, many under the beguiling spotlight of the global media.

The article looks at the largely unknown story of the how the men’s families dealt with the days leading up to their rescue, who were not even known to be alive until their famous note appeared attached to the drillhead after 17 days underground.

It also examines the difficult process of adjustment that both the men and the families have faced since the rescue.

Back home, the men have received weekly therapy as part of a government insurance scheme that covers their incomes until they are able to go back to work. But their global travels have meant patchy attendance – and pretty quickly, the authorities were threatening to withdraw the therapy if they continued to go abroad and miss sessions. Meeting the miners, you sense that there has been no coherent strategy to help them find their way back to any sort of normality, no serious attempt to help them through their extraordinary experience.

Ariel says he does not need any therapy; others complain that the meetings are pointless and lead nowhere. You sense they have not been told in any coherent way the long-term nature of the trauma they may have suffered and the type of treatment that may require. They were, after all, trapped underground for longer than any other recorded group of men. Certainly in many cases the therapy has combined with much shorter-term solutions: astonishing levels of medication – pills to let them sleep, pills to keep them calm when awake.

Some of the men find solace with one another. The bonds of friendship and solidarity they forged down the mine are now stronger than those with their own families. Others refuse to see one another at all – jealousy over who is appearing where, appearance money and fame have driven them apart. That is the men.

Their wives and partners have to live with them, desperately trying to work out how to cope with quiet lives blown apart. For them, of course, there has been no help on offer.

Apparently the author of the piece has made a documentary about the men and their families on exactly this topic called ’17 Days Buried Alive’ which is due to be broadcast on UK TV on the 12th of August.

Link to article on ‘Los 33’ (via @JadAbumrad)

Antipsychotics and the profit panacea

Aljazeera has an interesting if not worrying article about the fact that antipsychotic drugs have become “the single top-selling therapeutic class of prescription drugs in the United States, surpassing drugs used to treat high cholesterol and acid reflux.”

The huge rise in prescriptions has been sparked by the availability of a relatively new class of drugs called ‘atypical antipsychotics’.

All antipsychotics block the D2 type of dopamine receptor and their effect on the mesolimbic dopamine pathway is what largely causes the reduction in psychotic symptoms.

The older drugs block D2 receptors fairly indiscriminately in the brain, including in the nigrostriatal pathway.

This pathway is involved in movement regulation and blocking dopamine here leads to similar problems to Parkinson’s disease (tremors, rigid and uncontrollable movements) – a type of dementia where this brain area starts to break down due to disease.

The newer ‘atypical antipsychotics’ usually also block serotonin 2A (5HT-2A) receptors in the key movement pathway.

Serotonin normally reduces dopamine release but because serotonin is being blocked, more dopamine is released in the movement pathway with the newer atypical antipsychotic drugs than with the older typical antipsychotic medications.

This means less Parkinson’s-like movement side-effects with the atypicals – a genuine advance – but unfortunately, the serotonin effect causes additional problems with weight gain and often obesity, diabetes and heart problems.

However, these problems are perhaps easier to control and more ‘socially acceptable’ (compare with someone who make strange contorted movements during conversation).

On the commercial side, many newer atypicals are still under patent, meaning one company has sole control over their manufacture and sale, while other companies are not able to make cheaper copies.

Over time, these newer drugs have been promoted, legally and illegally, by drug companies for a wider and wider range of problems – everything from depression to dementia.

Despite limited evidence for their effectiveness in these areas, the sales campaign has been a huge success and the drugs are now being widely prescribed.

Once upon a time, antipsychotics were reserved for a relatively small number of patients with hard-core psychiatric diagnoses – primarily schizophrenia and bipolar disorder – to treat such symptoms as delusions, hallucinations, or formal thought disorder. Today, it seems, everyone is taking antipsychotics. Parents are told that their unruly kids are in fact bipolar, and in need of anti-psychotics, while old people with dementia are dosed, in large numbers, with drugs once reserved largely for schizophrenics. Americans with symptoms ranging from chronic depression to anxiety to insomnia are now being prescribed anti-psychotics at rates that seem to indicate a national mass psychosis…

What’s especially troubling about the over-prescription of the new antipsychotics is its prevalence among the very young and the very old – vulnerable groups who often do not make their own choices when it comes to what medications they take. Investigations into antipsychotic use suggests that their purpose, in these cases, may be to subdue and tranquilize rather than to treat any genuine psychosis.

Antipsychotic drugs have been one of the great advances of 20th century medicine. For the first time we have an effective treatment for psychosis, one of the most disabling of any of the disorders, that works for at least a fair proportion of patients.

The side-effects of both the older and newer drugs, however, are among the worst of any medication and they should genuinely be used with caution.

Unfortunately, the well-being of patients has become secondary to the profit margins of large pharmaceutical companies who continue to promote these drugs to as many patients as possible, regardless of their benefits or adverse effects.

The Aljazeera article tracks this campaign to the point where they have become top selling medications.

Link to ‘How Big Pharma got Americans hooked on anti-psychotic drugs.’

Book review: Crazy Like Us

‘Cultures become particularly vulnerable to new beliefs about the mind and madness particularly during times of social anxiety or discord’, notes Ethan Watters in this compelling book. Watters sees social discord as making cultures ‘vulnerable’ to new beliefs, rather than simply ‘receptive’, and this sentence captures both the depth of insight in Crazy Like Us and its main theme – that sees the spread of Western ideas about mental illness as a form of psychological imperialism.

‘Imperialism’ is perhaps too strong a word, as Watters is neither overtly political nor tiresomely polemic in his analysis, which results in one of the most engaging, accessible and well-researched non-academic books about culture and mental illness available. But in summing up he does tend towards suggesting that Western ideas about the disordered mind are imposed on other cultures, when occasionally there are more subtle stories in the details.

Not unlike the adoption of Western music and fashions by young people in traditional cultures, the shift toward new ideas is as often driven by local enthusiasm for concepts of wealth and sophistication as by deliberate outside forces. The book gives several examples of how changes occur by a combination of the two, as, for example, aggressive drug company campaigns to market the Western concept of depression to the public in Japan relied on the fact that these ideas had been already adopted by Japanese psychiatrists, many of whom trained in Europe and America.

Watters discusses culture as a powerful determinant of how we express psychological distress and mental illness. This influence is not always positive, and the book notes how Western models of mental illness may be detrimental over traditional ideas of coping, for example by silence or even spirit possession. The clearest example is how disasters and emergencies often draw in well-meaning ‘experts’ who clumsily apply Western concepts of psychological trauma and pathologise local reactions that may be psychological helpful but don’t fit the model.

I was left with a few minor quibbles, including the reliance on World Health Organisation data on how schizophrenia outcomes in developing countries are better than in developed countries, when more recent work has shown that there is so much variation between countries that this generalisation really means very little. These, however, remain minor concerns in the overall scheme of things. The book is not an academic tome and the approach is narrative, but Watters has clearly mastered the scientific research where it counts. As an introduction to (and perhaps even a revelation of) how culture and mental illness are intertwined, you are unlikely to find a more engaging and thought-provoking book.

This review was originally published in The Psychologist and you can read it online here.

It’s worth noting the book is available in both a US edition and a UK edition which seem to differ only in the subtitle.

Link to Crazy Like Us companion site.

Two weeks of hell, forty years ago

It’s been forty years since the Stanford prison experiment and the university’s alumni magazine has asked the participants and researchers for their reflections on their role in the notorious events of 1971.

It makes for a fascinating read as it not only gets Zimbardo to comment on the eventually out-of-control study but also talks to one of the abusive ‘guards’ (now a mortgage salesman) one of the ‘prisoners’ (now a teacher) and the whistleblower who eventually called for the study to end.

This is from Craig Haney, one of the researchers from the study:

I also realized how quickly we get used to things that are shocking one day and a week later become matter-of-fact. During the study, when we decided to move prisoners to different parts of the prison, we realized that they were going to see where they were and be reminded they’re not in a prison—they’re just in the psych building at Stanford. We didn’t want that to happen.

So we put paper bags over their heads. The first time I saw that, it was shocking. By the next day we’re putting bags on their heads and not thinking about it. That happens all the time in real correctional facilities. You get used to it. I do a lot of work in solitary-confinement units, on the psychological effects of supermax prisons. In places like that, when prisoners undergo the so-called therapy counseling, they are kept in actual cages. I constantly remind myself never to get used to seeing the cages.

The article sheds light both on the study and the lives of the the key players, now and then.

Link to article on Stanford Alumni Magazine (via @crimepsychblog)