Swimming in the tides of war

My recent Beyond Boundaries column for The Psychologist explores how the micro-culture of Colombian paramilitary organisations may have shaped the expression of post-traumatic stress disorder in demobilised fighters.

Dr Ricardo de la Espriella’s office is surprisingly quiet. Buried deep within San Ignacio University Hospital, the growl of the chaotic Bogotá traffic is perceptibly absent. Despite the street-level pandemonium, the capital city of Colombia remains an oasis of relative calm in a troubled country. The five-decade-old conflict has been pushed back from the urban fringes and persists, unabated, in the rural areas where it continues to devastate the country’s diverse cultural landscape. Dr de la Espriella has long promoted an understanding of how psychological distress is filtered through cultural norms. ‘There are difficulties in recognising post-traumatic stress in certain populations, which is why cultural psychiatry is so important’ he stresses, highlighting the surprising variation in response to suffering. In this case, however, he is not talking about the culture of ethnic or racial groups, but the micro-culture of illegal paramilitary organisations.

While working on a project to rehabilitate ex-members of illegal armed groups, he noticed a striking absence of post-traumatic stress disorder in his patients, despite them having experienced extreme violence both as combatants and civilians. Many had taken part in massacres and selective assassinations, and many had lost companions to equally brutal treatment. There were high levels of substance abuse, aggression and social problems, but virtually none showed signs of anxiety. Intrigued, de la Espriella decided to investigate more closely and carefully interviewed the ex-paramilitary patients again, using the Clinician Administered PTSD Scale, which asks specific and detailed questions about post-trauma symptoms. After this more detailed examination, more than half could be diagnosed with the disorder.

The reason for why none of these symptoms presented in day-to-day life seemed to lie in paramilitary subculture. While aggression and drug abuse are tolerated, anxiety is taboo to the point where members showing signs of anxiety can be killed by their compatriots for being ‘weak’. This brutal emotional environment shapes the men to neither show nor spontaneously report any form of fear or nervousness. De la Espriella reported his findings in the Colombian Journal of Psychiatry where he discusses the difficulties in treating people who have been involved in violence and killing. His work also raises the uncomfortable question of who we consider to be a victim of conflict. Can we extend compassion to those who commit the atrocities or do we allow those who swim in the tides of war to drown in its powerful currents?

Thanks to Jon Sutton, editor of The Psychologist who has kindly agreed for me to publish my column on Mind Hacks as long as I include the following text:

“The Psychologist is sent free to all members of the British Psychological Society (you can join here), or you can subscribe as a non-member by going here.

Link to column from The Psychologist (bottom of page).

The chaos behind a legendary portrait

I just found this fascinating account of how Vincent Van Gogh cut off his own ear while seemingly severely mentally ill, the event that led him to paint one of his most famous pictures.

The account is apparently reconstructed from known events at the time but also has van Gogh’s own description of the event, taken from letters to his sister.

On Christmas Eve 1888, after Gauguin already had announced he would leave, van Gogh suddenly threw a glass of absinthe in Gauguin’s face, then was brought home and put to bed by his companion. A bizarre sequence of events ensued. When Gauguin left their house, van Gogh followed and approached him with an open razor, was repelled, went home, and cut off part of his left earlobe, which he then presented to Rachel, his favorite prostitute.

The police were alerted; he was found unconscious at his home and was hospitalized. There he lapsed into an acute psychotic state with agitation, hallucinations, and delusions that required 3 days of solitary confinement. He retained no memory of his attacks on Gauguin, the self-mutilation, or the early part of his stay at the hospital…

At the hospital, Felix Rey, the young physician attending van Gogh, diagnosed epilepsy and prescribed potassium bromide. Within days, van Gogh recovered from the psychotic state. About 3 weeks after admission, he was able to paint Self-Portrait With Bandaged Ear and Pipe, which shows him in serene composure. At the time of recovery and during the following weeks, he described his own mental state in letters to Theo and his sister Wilhelmina: “The intolerable hallucinations have ceased, in fact have diminished to a simple nightmare, as a result of taking potassium bromide, I believe.”

“I am rather well just now, except for a certain undercurrent of vague sadness difficult to explain.” “While I am absolutely calm at the present moment, I may easily relapse into a state of overexcitement on account of fresh mental emotion.” He also noted “three fainting fits without any plausible reason, and without retaining the slightest remembrance of what I felt”

Although absinthe is commonly associated with hallucinations and madness, and the author of the article wonders whether it might have helped cause his epilepsy, this is unlikely due to the fact that the effect of absinthe’s ‘special ingredient’ is largely a myth.

The distinctive aspect of the drink, the chemical thujone from the wordwood plant, is actually present in such small quantities that absinthe has virtually no psychoactive effects beyond the alcohol.

However, epilepsy does raise the risk of psychosis and it is suspected that he had temporal lobe epilepsy which is particularly associated with this reality-bending mental state.

Link to AJP article on ‘The Illness of Vincent van Gogh’.

Book review: Willpower by Baumeister & Tierney

“Willpower: Rediscovering the greatest human strength”, Roy Baumeister & John Tierney, 2011

I’ve just finished this book, and yet I still couldn’t tell you what it was trying to claim. It’s a grab-bag of research on willpower, nearly all of it done by social psychologist Baumeister and colleagues, and including his celebrated experiments on ego-depletion. The ego-depletion experiments appear to show that willpower is a limited resource dependent on blood sugar. Using it to control your impulses diminishes it in the short-term, but can build it up – like a muscle – in the long term. Ultimately, however, this book presents this set of findings with little to offer in terms of coherent insight. The advice given for our daily lives is glib and unhelpful. The reader is told, for example, that to avoid smirking at an idiotic boss in a meeting, we should avoid strenuous mental work beforehand (p27). As if we all have the liberty of avoiding strenuous mental work whenever we want! Being told not to be tired sort of begs the question, in my opinion, and in self-help terms is about as useful as being told to “be clever” or “have great ideas”.

The case studies which pepper the book are brief and unsatisfying, obviously intended to give the ideas the appearances of flavour, rather than add any real depth whatever argument is being made. In general, the writing is adequate to poor, with an over reliance on a set of cheap journalistic tricks to sustain momentum. Journalistic tricks such as the one I use in the next paragraph…

…Annoying isn’t it? The references to events and celebrities who have temporarily floated to the surface of the toilet bowl of American popular culture will make this book date very badly in the next few years (and already meant that this, admittedly sheltered, British reader had to use wikipedia to work out who was being talked about in some chapters). I’m guessing that science journalist Tierney wrote this book, with advice from Baumeister (an impression fostered by the authors’ insistence on talking about themselves in the third person, which is disorienting). Even so, some of the psychological clangers are inexcusable and would shame an undergraduate (for example, squirrels burying nuts for later are dismissed as following “programmed behaviours, not conscious saving plans” (p15). To make this assertion gives the impression that we know both what a squirrel is thinking and what the nature of a conscious saving plan is (we don’t). To arbitrarily dismiss the highly flexible and foresightful behaviour of the squirrel as merely “programmed” prevents you, at one stroke, from understanding properly the role of automatic mental processes in our own future-orientated behaviour). The examples of sexism, on the other hand, are at least so blatant that they can be enjoyed for the full force of their anachronistic misogyny. (p56 tells us “most women cope quite well with PMS at work”, which has a lovely quality of being superficially positive, whilst implying that actually we should expect many women not to be able to cope, especially at work, and even those who do only manage to do it “quite well”.). The references to the literature are patchy, making it frustrating if you want to check the source for some of the authors’ most interesting claims.

Overall this book is a great disappointment. Roy Baumeister is one of the most exciting social psychologists, managing to do experimental work which addresses fundamental issues of what it means to be human. This book, on the other hand, is an example of how sterile experimental psychology can be when faced with the complexities of a core human dilemma, such as that of self-control. Although it is written in a breezy style, it never really grips the attention like the books of Malcolm Gladwell (which it obviously aspires to emulate). Because the treatment of the psychological evidence is superficial, and it never gives a full account of exactly what theoretical position they are trying to argue for or against, the book is scientifically unsatisfying. The other flaws I’ve discussed above make it, overall, an annoying book to read.

If you want a self-help book with an appreciation of the psychology of willpower, read Dave Allen’s Getting Things Done. If you want an entertaining and accessible account of the science of volition read Dan Wegner’s The Illusion of Conscious Will. If you want an account of self-control with a genuine appreciation of the nuances of the human condition try George Ainslie’s Breakdown of Will. This book will satisfy none of these needs.

Full disclosure: I’m reviewing this book because I was asked to by the publisher, who sent me a free copy. I’m glad I didn’t pay for it

UPDATE: So apparently quite means “very” in American English, while it means “fairly” in British English. This changes the sense of the PMS line I quote slightly, perhaps making it less insulting, but I would argue that the whole is still patronising and sexist (as are other lines in the book). Thanks Chris for the tip-off

Game not over

The Guardian covers a new study on how video games can persist in our perception as fleeting hallucinations in an effect labelled ‘game transfer phenomena’.

Unfortunately, the study has been published in an obscure journal which means I’ve not been able to read it in full, although the write-up quotes the lead researcher, Mark Griffiths:

“The academic literature goes back to 1993,” says Griffiths. “There was a case of a woman who had auditory hallucinations; she just couldn’t get the tune of the game she was playing out of her head – it was very intrusive. But what came out of our pilot research were lots of different experiences, some that were auditory, some visual and some were tactile. We had the example of a teacher who dropped his pen and immediately reached for a joypad button to retrieve it, as though he were in a game.

“Most of the experiences were neutral and often quite positive. We distinguished between what we call automatic GTP, which are almost like reflexes or classically conditioned responses, and those where players deliberately take elements out of the game and work them into their day-to-day routines.”

Needless to say, the tabloids got carried away and ran with ‘gamers losing touch with reality’-type stories although it sounds like the authors of the study were probably a little over-enthusiastic with their own descriptions.

Despite this, it sounds like an interesting study describing how conditioned responses and perceptual expectations learnt in video games might be get triggered in other situations.

I knew someone would get round to studying those weird thoughts about Tomb Raider at some point.

Link to Guardian article on ‘game transfer phenomena’

The birth of ‘synthetic marijuana’

Addiction Inbox has an interview with pharmacologist David Kroll where he discusses the origin of the countless synthetic cannabinoids that have recently flooded the market as ‘legal highs’ and ‘incense’.

You may know Kroll better as the author of the long-running top-notch pharmacology blog Terra Sigillata where he has been tracking the ‘synthetic marijuana’ story since its early days.

In this recent interview he gives a fantastic brief description of how these compounds were born and became big business as ‘legal highs’.

Every area of CNS pharmacology has chemists who try to figure out the smallest possible chemical structure that can have a biological effect. In fact, this is a longstanding practice of any area of pharmacology. Huffman was an excellent chemist who in the 1990s was trying to figure out the most important part of the active component of marijuana that might have psychotropic effects. These compounds made by him and his students, surprisingly simple ones, I prefer to call cannabimimetics since they mimic the effect of the more complex cannabinoids in marijuana. These basic chemistry and pharmacology studies are what ultimately lead to new drugs in every field – a facet of chemistry called “structure-activity relationships” or SAR.

But since they are simple, they are relatively easy to make – some of Huffman’s work at Clemson was actually done by undergraduate chemistry majors. So, it was no surprise that they would be picked up by clandestine drug marketers, even though cannabis (UK) and marijuana (US) are freely available. The attraction to users was, until recently, that Huffman compounds (prefixed with “JWH-” for his initials) could not be detected in urine by routine drug testing. Hence, incense products containing these compounds have been called “probationer’s weed.”

In the interview he also discusses drug legality, drug development and prescription. Well worth checking out.

Link to David Kroll interview at Addiction Inbox.

Twelfth century orgasmic brain heat

Hildegard of Bingen was a twelfth century nun, possibly with repressed lesbian desires, who had visions, was a proto-scientist, advised the Pope, composed music, and, er, wrote about the role of the brain in the female orgasm.

BBC Radio 4’s Great Lives just had a fantastic programme about her where they read out her description of the female orgasm and how it is driven by a ‘sense of heat’ in the brain.

Remember, if you could possibly forget, that this was written by a nun in the 12th century.

When a woman is making love with a man, a sense of heat in her brain, which brings forth with it sensual delight, communicates the taste of that delight during the act and summons forth the emission of the man’s seed. And when the seed has fallen into its place, that vehement heat descending from her brain draws the seed to itself and holds it.

I for one, certainly feel closer to God after reading that.

Hildegard is most well known among neuroscientists for the descriptions of her visions which Oliver Sacks has interpreted as likely stemming from migraines as these can can cause an array of visual distortions and hallucinations.

Although from now on, I shall give equal consideration to her interest in erotic brain heat.

Link to programme info and streaming.
mp3 of the same in different location because the BBC are a bit slow.

Teenage kicks

National Geographic has an excellent article on teenage risk-taking and adolescent brain development.

It goes some way to explaining both the dangerous mistakes that typically peak in the late teens and, I like to think, the bad fashion sense which seems to follow a similar pattern.

Importantly, the piece goes beyond the usually ‘well the frontal lobes are still developing, aren’t they?’ explanation that gets wheeled out whenever teen neuroscience is discussed and hits on some of the gritty details.

Are these kids just being stupid? That’s the conventional explanation: They’re not thinking, or by the work-in-progress model, their puny developing brains fail them.

Yet these explanations don’t hold up. As Laurence Steinberg, a developmental psychologist specializing in adolescence at Temple University, points out, even 14- to 17-year-olds—the biggest risk takers—use the same basic cognitive strategies that adults do, and they usually reason their way through problems just as well as adults. Contrary to popular belief, they also fully recognize they’re mortal. And, like adults, says Steinberg, “teens actually overestimate risk.”

So if teens think as well as adults do and recognize risk just as well, why do they take more chances? Here, as elsewhere, the problem lies less in what teens lack compared with adults than in what they have more of. Teens take more risks not because they don’t understand the dangers but because they weigh risk versus reward differently: In situations where risk can get them something they want, they value the reward more heavily than adults do.

Probably one of the most comprehensive introductions to teen risk you’ll read in a good while.

Link to National Gerographic on Teenage Brains.