On the challenges of studying suicide

Nature has an important article on why virtually no-one is trying to develop treatments to prevent suicide because research with such high-risk patients is almost impossible to get approved.

Most psychiatric drug trials today—the majority of which are industry sponsored—exclude anyone expressing thoughts of suicide. This is for ethical as well as practical reasons: physicians consider it taboo to give people on the brink of suicide an experimental drug, let alone a placebo, if other options are available, and many additional safety precautions are required to run trials in this vulnerable population. To complicate matters, few mental health experts are trained in how to conduct suicide research, and those who do are often afraid of lawsuits.

As a result, institutional review boards aren’t always so amenable to this kind of high-risk research. “It takes forever to get anything approved to do suicide prevention research, and it’s incredibly frustrating,” says Marjan Holloway, a clinical psychologist who is running clinical trials with suicidal military personnel at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Kate Comtois, a psychologist at the University of Washington in Seattle who has run psychotherapy trials in people with borderline personality disorder (BPD), expresses a similar concern. “I hear many stories from other institutions where people have basically given up recruiting high-risk patients because their institutional review boards are so cautious that they throw up roadblocks,” she says.

Suicide research also suffers from a practical problem related to the development of risk-assessments.

Normally, if I want to develop a way of predicting who will develop depression or not, I can assess a group of people and I can return later and see whether my predictions were right or not.

If I do the same with a suicide assessment and it suggests that several people are at high-risk of suicide, I have a moral duty to intervene and help them.

What complicates the issue is that this often applies regardless of the quality of my assessment. In other words, imagine that my suicide assessment is useless but I don’t know it – I will still intervene.

This means it’s often hard to get the assessment ‘off the ground’ in terms of its testing and development and this is why most scales are based on research looking at less serious outcomes, like having suicidal thoughts, that aren’t a very good predictor of whether someone will actually try to kill themselves or not.

This is also one reason why ethical review boards, and indeed researchers, are reluctant to get involved in this research.

Who wants to be known as someone who had several patients kill themselves during a trial to test an experimental form of suicide prediction? Despite the fact that, actually, virtually all the established scales are equally as ‘experimental’ due to lack of data.

The Nature article does a fantastic job of tackling these delicate issues and highlighting the need for better research on a crucial issue.

Link to Nature article ‘The Ultimate Endpoint’ (via @Neuro_Skeptic)

Inside The Ailing Brain

The Ailing Brain is a fantastic documentary series on the brain and its disorders that’s freely available online. It has been produced in Spanish but the first part is now on YouTube with English subtitles.

The series is among the best neuroscience documentary series I have even seen (along with Susan Greenfield’s Brain Story – made before she lost the plot) with the first part tackling the science and effects of neural implants.

If you see nothing else, go to 6:10 to watch what happens when a patient with an implanted deep brain stimulation device to treat Parkinson’s Disease switches off the machine. It’s an amazing sight.

But if you’ve got 20 minutes, you’d be very well advised to take some time to watch the whole episode as it’s both wonderfully produced and utterly compelling.

There are three programmes so far although the second and third haven’t been subtitled yet. But if you understandeas español, you can check out the whole series here. The second part is on memory disorders and the third is on mental illness.

I’ll post more on Mind Hacks when the other parts with English subtitles appear. Wonderful stuff.

Link to ‘Refurbished Brains’ episode with English subtitles.
Link to whole series in Spanish.

A bipolar expedition

In 2008, The Lancet published an amazing article on the ‘psychological effects of polar expeditions’ that contains a potted history of artic madness.

Unfortunately, the paper is locked, or shall we say, frozen, behind a paywall, although this snippet on the history of mental health problems on artic expeditions makes for quite surprising reading.

Accounts of expeditions throughout the 19th and early 20th centuries rarely mentioned episodes of psychiatric disturbance or interpersonal conflict, as such was not in keeping with the image of polar explorers, who were expected to have specific qualities and characteristics, such as strength and resilience. Nevertheless, equally rare was the polar expedition that did not have at least one member who was debilitated by depression, anxiety, paranoia, alcoholism, or sleep disorders. During Sir Douglas Mawson’s second Antarctic expedition (1910–14), that person was Sydney Jeffryes, the radio operator, whom Mawson believed “surely must be going off his base. During the day he sleeps badly, gets up for dinner looking bad, husky; mutters sitting on his bunk in the dark afterward.”

Frequently, the entire crew of a polar expedition would experience melancholy and depression, as was the case of the Belgica expedition to Antarctica in 1898–99. As described by the great polar explorer and expedition physician, Frederick A Cook, “The curtain of blackness which has fallen over the outer world of icy desolation has descended upon the inner world of our souls. Around the tables, in the laboratory, and in the forecastle, men are sitting about sad and dejected, lost in dreams of melancholy from which, now and then, one arouses with an empty attempt at enthusiasm.”

Cook tried to treat these symptoms by having crew members sit in front of large blazing fires. This baking treatment, as he called it, could be the first recorded attempt to use light therapy to treat symptoms of winter depression or seasonal affective disorder. Other expeditions, such as the Greely expedition of 1881–84, met a far worse fate than the Belgica exploration. In their attempt to establish a scientific base on Ellsmere Island in the Arctic, the crew of the Greely expedition was driven to mutiny, madness, suicide, and cannibalism, leaving six survivors of a crew of 25 men.


Link to frozen Lancet article.

Bring the love

The world of art, neuroscience and, er… competitive affection, collide in a delightful film about a love competition held in an fMRI scanner.

The piece is by film-maker Brent Hoff who seems to be making a series of films based on the idea of emotion competitions.

In this film, competitors are asked to ‘love someone as hard as they can’ while being brain scanned with the prize going to the person with the greatest amount of brain activity.

I was a bit thrown by the piece as I couldn’t work out whether it was a mis-representation of an actual study – the scanning is run by genuine Stanford researchers Melina Uncapher and Bob Dougherty – or an offbeat competition that brought some neuroscientists on board.

So I contacted Melina and got the back story to the unusual piece:

I should say at the outset that it was not intended to be a study, nor was it intended to discover anything new about the brain. It was intended to be a public outreach piece, to help raise awareness that science can be beautiful (in the hopes of advancing interest in science). The finding was simply this: when a group of participants were instructed to ruminate on the person or concept they associate with love, BOLD signal in the nucleus accumbens showed individual differences.

The filmmaker Brent has a thing for emotional competitions, beginning with a previous film entitled The Crying Competition. In that case, as in the Love Competition case, people were explicitly instructed that it was a competition among the other participants in the room, and the person with the highest/fastest respective metric wins.

Here, the person with the highest signal in nucleus accumbens was considered the winner. Contestants were instructed to this prior to entering in the scanner. They all met each other during the interviewing stage, so there was a bit of competitiveness in the air, but it was tempered by the fact that they were considering those they love.

Melina also explained that scans in the film not only show nucleus accumbens activity. They also included a functional connnectivity analysis – essentially seeing which other brain areas change their activity in unison with the nucleus accumbens, which is why you can also see activity across the brain.

Link to film The Love Competition (thanks Sally!)

The seers and oracles

An evocative passage from the 1976 book Hallucinogens and Shamanism about the use of the hallucinogenic Psilocybe mexicana mushroom by the Mazatec people of Mexico.

The Mazatecs say that the mushrooms speak. If you ask a shaman where his imagery comes from, he is likely to reply: I didn’t say it, the mushrooms did. The shamans who eat them; their function is to speak, they are the speakers who chant and sing the truth, they are the oral poets of their people, the doctors of the word, they who tell what is wrong and how to remedy it, the seers and oracles, the ones possessed by the voice.


Link to details of book.

The hidden history of lobotomy’s non-inventor

A fascinating snippet on the notorious supposed inventor of the frontal lobotomy, Egas Moniz, from an article in the Polish Journal of Neurology and Neurosurgery:

Egas Moniz: a genius, unlucky looser or a Nobel Committee error?

Neurol Neurochir Pol. 2012;46(1):96-103.

Lass P, Sławek J, Sitek E.

Portuguese neurologist António Egas Moniz is one of the most intriguing figures in the history of medicine. While an invention of angiography in 1927 is his acknowledged merit, lobotomy, invented in 1935 became a black legend of psychiatry, although sporadically it is performed also today. There are even postulates to withdraw the Nobel Prize, which Moniz received in 1949 for inventing the lobotomy. Moniz in fact re-invented lobotomy, primarily introduced in 1888 by a Swiss psychiatrist Gottlieb Burckhardt and later forgotten. Its popularisation, including its abuses was chiefly done by American neurologists Walter Freeman and James Watts.

Aside the science, Moniz was an exceptionally colourful person, a merited politician, Portuguese minister of foreign affairs, the head of its delegation at Versailles in 1918, in 1951 he was even proposed a position of a Presidentof Portugal. He was a versatile humanist and a writer, even a gambling expert. His person is hard for black and white evaluation, definitely deserving a re-evaluation from today’s historical perspective.


Link to abstract of article on PubMed.

Wishful resilience

The New York Times has an extended article that uncritically dicusses a $125 million US Military programme currently designed to increase resilience against mental illness.

If you’re interested in the effects and treatment of psychological trauma, it’s always worth keeping tabs on what the military are doing. The concept of trauma has largely been driven by the military and they are usually pioneers in developing treatments and interventions.

The Comprehensive Soldier Fitness programme is a US Army programme based on positive psychology and was developed with the help of the field’s guru Martin Seligman.

Rather than aim to treat mental health problems, it aims to prevent them by improving the psychological strength of individual soldiers. Owing to the fact that the US Military has surprisingly high levels of PTSD, it is clearly designed with this in mind.

It involves completing a 110 item questionnaire called the ‘Global Assessment Tool’ that gives scores based on the four domains of programme: emotional fitness, social fitness, family fitness and spiritual fitness (it would be interesting to see how atheists score on this last part).

The idea is that the programme can then be tailored to the GAT profile of each soldier to strengthen vulnerabilities and build on existing strengths.

If you were going to base your programme on a psychometric assessment, most importantly, you would want to know that your assessment predicted problems or coping in particular soldiers.

For example, if a particular soldier had a low score on, let’s say, the emotional fitness part of the scale, it would be important to know that tells us about what sort of problems the soldier is likely to have in real life and during his or her service.

You would also want to know that the assessment told us about the likelihood of the solider getting mental illness. It makes sense, right? If you’ve designed a programme intended to prevent mental illness based on an assessment, the assessment should tell us which soldiers are at higher risk for psychiatric difficulties so we can help with skills and abilities that mitigate the risk.

In psychological jargon, this is known as predictive validity and it can be tested statistically.

It is not known whether the Global Assessment Tool does actually predicts anything useful about US soldiers’ problems because this was never tested.

We know this because the GAT and the other aspects of the Comprehensive Soldier Fitness Programme were the subject of the special issue of American Psychologist that had numerous articles on the development and evidence for the programme by the programme’s creators, including an article on the GAT.

As a whole, it seems the Army implemented the programme wholesale and has since been evaluating it in retrospect, which seems a little bit of an odd way of going about it.

By the way, the New York Times article is really focused on ‘posttraumatic growth’ – the psychological benefits that surviving trauma can bring. In places it seems to imply a sort of split view of the phenomenon where you either are traumatised or experience growth – when in reality, it’s possible to be both disabled in some aspects of life while growing in others.

One of the best things I read on this recently was Stephen Joseph’s book What Doesn’t Kill Us: The Psychology of Post-Traumatic Growth (note: I’m blurbed on the back but I don’t make any money from it) that, as a level-headed look at the concept, comes highly recommended.

Link to NYT article on post-traumatic growth.