Out of Mind online

Paul Broks is a British neuropsychologist who wrote a brilliant and insightful column on the brain and its disorders for Prospect magazine in the early 2000s, all of which are now freely available online.

The ‘Out of Mind’ column ran for the best part of five years. Alternately whimsical, profound and poetic, it recounted ephemeral scenes from meetings with brain altered individuals and spun them into reflections on the science and philosophy of human nature.

From July, 2004:

The bespectacled skeleton speaks. “Yes, I’m fine,” she says. Her jaw drops and rises squarely like a ventriloquist’s dummy. But where are the words coming from? All I can see are bones and electrodes. The view shifts and there’s the smoky shape of the heart. The tip of the catheter now appears at the bottom of the screen. This was inserted at the groin and is nudging upward, through an invisible artery, into the rib cage. The radiologist is deft and reaches the carotid in no time: base camp for the brain. He is ready now to squirt the drug into the cerebral blood vessels. Next scene: the inside of Julie’s head. There is nothing much to see.

You may recognise Broks from Into the Silent Land: Travels in Neuropsychology, quite possibly one of the most beautiful books ever written on the brain. His Prospect columns swim in the same deep blue waters.

Link to ‘Out of Mind’ column archive from Prospect Magazine.

Human pheromones: wishful thinking

Slate has a fantastic article about the science of scents and why ‘attraction-boosting’ human pheromone products are selling nothing but myths.

The article takes a curious look at the history of misapplied pheromone research and how it’s been used to sell everything from aftershave to soap.

“The whole pheromone thing got picked up by the mass media,” says Richard Doty, director of the University of Pennsylvania’s Smell and Taste Research Center and author of The Great Pheromone Myth. It feeds into our need to believe, he said, that there “is all this subliminal stuff going on that is affecting us—who we mate with, who we want to be with. It’s this mythical perspective.” And marketers, like women’s magazines, are only too happy to exploit that myth. That’s how a whole junk-science industry of pheromone-perfumes, pheromone-soaps, and pheromone-cosmetics managed to spring up from a strange menagerie of misconstrued mammal studies.

Personally, I’ve always believed in the power of the scent of raw man, which, I have discovered, is surprisingly under-appreciated.

Link to Slate article on the pheromone hype.

A response to the Baroness

The Independent have just published a letter I wrote to them in response to their recent opinion piece by Susan Greenfield.

She claims that computers are at risk of causing ‘mind change’ while scientists are ignoring the issue. Needless to say, I was not impressed.

I was interested to read Professor Susan Greenfield’s opinion piece “Computers may be altering or brains – we must ask how” (12 August), where she laments that other scientists are refusing to debate the issue of how the internet and computer technology are affecting the mind and brain. She also claims that other scientists are dismissing her concerns by saying “there’s no evidence”.

This is clearly nonsense. There are over 3,000 scientific studies on the effect of technology on the mind and brain and a scientific community actively engaged in this debate, all of which Greenfield chooses to ignore in favour of her own alarmist conclusions. I am sure this is not simple unawareness, because Professor Greenfield specifically invited me to present the evidence to her at a debate on this topic at the House of Lords. The transcript is available on her own website. [You can download it as a pdf]

If Professor Greenfield wishes to engage in the debate about the impact of technology she is more than welcome to join the research community and discuss the evidence behind her concerns. So far, this evidence does not suggest that children’s or anyone else’s brains are being damaged by mobile phones, email, or Facebook. We know each has its own balance of effects, positive and negative, like all other media (newspapers included).

But instead of engaging with the evidence, Greenfield uses her media profile to communicate her ill-informed concerns to the public at large. This is neither helpful to science nor to concerned parents attempting to understand how they can best help their children use technology to their benefit.

The professor clearly has good intentions, but to become genuinely helpful she needs to be aware about what we actually know about the impact of technology. I would welcome her informed contribution to the debate.

Although I won’t be holding my breath.

Link to Independent letters page for 18th August.

Ecstasy for war trauma: a flashback to earlier treatments

Mother Board has a completely fascinating article on the current ongoing trial testing whether MDMA or ‘ecstasy’ could be useful in treatment combat trauma.

The piece is interesting as much for what it doesn’t say, as for what it does, and for how it ties into the history of psychological treatments for posttraumatic stress disorder or PTSD.

The trial is testing whether MDMA can assist in psychological treatment for the condition, in which a traumatic event leads to a sense of current threat and intrusive sensory impressions that are maintained by a pattern of avoiding reminders.

The most effective tried-and-tested treatments for the condition are types of therapy that are ‘trauma-focused’ that involve, among other things, a mental revisiting of the traumatic memories to ‘take the sting out of their tail’.

But this is exactly what most people who arrive in psychologists’ offices don’t want to do. This makes sense from the perspective of someone who is troubled by these memories and wants to stop thinking about them, but the avoidance actually helps maintain the problem.

This is, in part, because the person never learns to adjust to the anxiety (they don’t habituate in technical terms) and the memories remain as fragmented impressions that don’t fit into a coherent narrative, making them more likely to intrude into the conscious mind.

In other words, most people with PTSD initially arrive for treatment wanting a better form of avoidance because their current methods simply aren’t working. The mental health professional has the unenviable task of explaining that treatment involves exactly the opposite and reliving the event and experiencing the anxiety will be key.

It is so key, in fact, that anti-anxiety drugs like benzodiazapines (e.g. vallium) may reduce the effectiveness of treatment because they dull the experience of stress that the person needs to adjust to.

The MDMA trial is interesting in this regard, because ecstasy is, for many, a remarkably effective anti-anxiety drug.

So how does the drug facilitate the psychotherapy? Here’s the description from the article:

MDMA’s effects typically manifest themselves 30-45 minutes after ingestion, so it doesn’t take long for rhythms to develop in Charleston. Sessions at the clinic oscillate between stretches of silent, inward focus, where the patient is left alone to process his trauma, and unfiltered dialogue with the co-therapists. “It’s a very non-directed approach,” Michael Mithoefer told me. This allows subjects to help steer the flow of their trip. They are as much the pilots of this therapy as their overseers. “Once they get the hang of it,” Mithoefer explained, “sometimes people will talk to us for a while and then say, ‘OK, time to go back inside. I’ll come report when I’m ready.’”

That said, patients understand that if no traumas emerge, the Mithoefer’s must coax them out. But they’ve never had to. The traumas always emerge, and by now there have been over 60 sessions between an initial, smaller Phase 2 study and the present trials. Horrors are bubbling up naturally, patient after patient.

This harks back to a more psychoanalytic or Freudian-inspired idea of trauma and treatment. The goal of the therapy is to understand the inner self while the drug is intended to help us overcome psychological defences that prevent us from seeing things as they really are. In fact, this is a central assumption of the therapy.

This approach is not new. ‘Narcoanalysis’ was used widely in mid-20th Century where a range of drugs, from ether to sodium pentathal, were applied to patients with ‘war neurosis’ for exactly this purpose. Unfortunately, it was unsuccessful and abandoned.

So this is why the MDMA treatment is a gamble. All known effective psychological treatments for PTSD involve not only confronting the memories of what happened to make sense of them, but also re-experiencing the associated anxiety. A treatment with a drug that removes anxiety will, by current predictions, have limited effectiveness.

But this is also why the approach is interesting, because if it is shown to be genuinely effective, we might have to rethink our ideas about PTSD and its treatment.

Link to Mother Board article on the MDMA PTSD trial.

A dark chapter in the history of combat trauma

Neurology has an article that looks back at the dark history of ‘treating’ war trauma with torture during World War I.

During the conflict, ‘war neurosis‘ became a serious problem as thousands of troops where disabled by psychological trauma that often expressed itself as extreme anxiety and seemingly neurological symptoms – something called ‘shell shock’ early on in the conflict

Contrary to appearances, symptoms such as paralysis, blindness and tremors were not due to physical damage to the nervous system but to psychological stress.

These were classic presentations of ‘hysteria’, now diagnosed as conversion disorder, although many in the forces just assumed the affected soldiers were faking and felt they were motivated by cowardice.

Most famously, psychiatrist W.H.R. Rivers pioneered a psychotherapeutic treatment for ‘shell shock’ for British troops, although as there was no standard treatment so different countries and even different hospitals used different methods.

One of the most desperate ‘treatments’ was popularised by neurologists Clovis Vincent and Gustave Roussy, who widely applied it to traumatised French troops during the Great War.

The method involved ordering the traumatised soldier to go back to the front and electrocuting them until they agreed.

Although officially called faradization “torpillage was the term chosen by soldiers receiving the treatment because they likened the electric part of the therapy to being hit by a shell (une torpille).”

At first, faradization was carried out using virtually pain-free currents so that the soldiers would relate the painless nature of the treatment to their comrades. However, Roussy recommended the use of more intense faradization in difficult cases. To begin with, electrodes were placed on the targeted areas and then, if necessary, on more sensitive areas such as the soles of the feet or the scrotum. It was sometimes necessary to incorporate certain complementary measures like disciplinary isolation or a milk diet. Soldiers in the recovery phase performed military exercises under the supervision of officers who had been cured using the same method.

Growing awareness of the cruelty of the ‘treatment’ and an outraged story in a French national newspaper stopped the torpillage technique by the end of the war but it remains a dark chapter in the history of combat trauma management.

Link to Neurology article ‘The “torpillage” neurologists of World War I’

Auditory brain trip

If you’ve got 15 minutes to spare, you could do far worse than spending it listening to an excellent edition of the Guardian Science Podcast on the neuropsychology of hearing and language.

Perceptual and linguistic neuroscience has a tendency to bit a little technical and difficult to engage with but the programme is both wonderfully produced and totally brought to life by neuropsychologist Sophie Scott’s insightful enthusiasm.

From the brain structure of professional accent connoisseurs to human echolocation, the programme is full of surprising insights into the auditory brain. Great stuff.

Link to Guardian Science Podcast on language and hearing.