An alternative beauty in parenthood

Vela has an amazing essay by a mother of a child with a rare chromosomal deletion. Put aside all your expectations about what this article will be like: it is about the hopes and reality of having a child, but it’s also about so much more.

It’s an insightful commentary on the social expectations foisted upon pregnant women.

It’s about the clash of folk understanding of wellness and the reality of genetic disorders.

It’s about being with your child as they develop in ways that are surprising and sometimes troubling and finding an alternative beauty in parenthood.
 

Link to Vela article SuperBabies Don’t Cry.

A neuroscientist podcaster explains…

There’s a great ongoing podcast series called A Neuroscientist Explains that looks at some of the most important points of contact between neuroscience and the wider world.

It’s a project of The Guardian Science Weekly podcast and is hosted by brain scientist Daniel Glaser who has an interesting profile – having been a cognitive neuroscientist for many years before moving into the world of art and public engagement.

Glaser takes inspiration from culture and current affairs – which often throws up discussion about the mind or brain – and then looks at these ideas in depth, typically with one of the leading researchers in the field.

Recent episodes on empathy and music have been particularly good (although skip the first episode in the series – unusually, there’s a few clangers in it) and they manage to strike a great balance between outlining the fundamentals while debating the latest ideas and findings.

It seems you can’t link solely to the podcast but you can pick them on the page linked below.
 

Link to ‘A Neuroscientist Explains’

Annette Karmiloff-Smith has left the building

The brilliant developmental neuropsychologist Annette Karmiloff-Smith has passed away and one of the brightest lights into the psychology of children’s development has been dimmed.

She actually started her professional life as a simultaneous interpreter for the UN and then went on to study psychology and trained with Jean Piaget.

Karmiloff-Smith went into neuropsychology and starting rethinking some of the assumptions of how cognition was organised in the brain which, until then, had almost entirely been based on studies of adults with brain injury.

These studies showed that some mental abilities could be independently impaired after brain damage suggesting that there was a degree of ‘modularity’ in the organisation of cognitive functions.

But Karmiloff-Smith investigated children with developmental disorders, like autism or William’s syndrome, and showed that what seemed to be the ‘natural’ organisation of the brain in adults was actually a result of development itself – an approach she called neuroconstructivism.

In other words, developmental disorders were not ‘knocking out’ specific abilities but affecting the dynamics of neurodevelopment as the child interacted with the world.

If you want to hear more of Karmiloff-Smith’s life and work, her interview on BBC Radio 4’s The Life Scientific is well worth a listen.
 

Link to page of remembrance for Annette Karmiloff-Smith.

Is psychosis an ‘immune disorder’?

A fascinating new study has just been published which found evidence for the immune system attacking a neuroreceptor in the brain in a small proportion of people with psychosis. It’s an interesting study that probably reflects what’s going to be a cultural tipping point for the idea of ‘immune system mental health problems’ or ‘madness as inflammation disorder’ but it’s worth being a little wary of the coming hype.

This new study, published in The Lancet Psychiatry, did blood tests on people who presented with their first episode of psychosis and looked for antibodies that attack specific receptors in the brain. Receptors are what receive neurotransmitters – the brain’s chemical signals – and allow information to be transferred around the nervous system, so disruption to these can cause brain disturbances.

The most scientifically interesting finding is that the research team found a type of antibody that attacks NMDA receptors in 7 patients (3%) out of 228, but zero controls.

The study found markers for other neuroreceptors that the immune system was attacking, but the reason the NMDA finding is so crucial is because it shows evidence of a condition called anti-NMDA receptor encephalitis which is known to cause episodes of psychosis that can be indistinguishable from ‘regular’ psychosis but for which the best treatment is dealing with the autoimmune problem.

It was only discovered in 2007 but there has been a long-running suspicion that it may be the best explanation for a small minority of cases of psychosis which can be easily misdiagnosed as schizophrenia.

Importantly, the findings from this research have been supported by another independent study that has just been published online. The two studies used different ranges for the concentration of NMDA antibodies they measured, but they came up with roughly the same figures.

It also chimes with a growing debate about the role of the immune system in mental health. A lot of this evidence is circumstantial but suggestive. For example, many of the genes associated (albeit weakly) with the diagnosis of schizophrenia are involved in the immune system – particularly in coding proteins for the major histocompatibility complex.

However, it’s worth being a little circumspect about this new enthusiasm for thinking of psychosis as an ‘immune disorder’.

Importantly, these new studies did blood tests, rather than checking cerebrospinal fluid – the fluid that your brain floats around in which lies on the other side of the blood-brain barrier, so we can’t be sure that these antibodies were actually affecting the brain in everyone found to have them. It’s likely, but not certain.

Also, we’re not sure to what extent anti-NMDA antibodies contribute to the chance of developing psychosis in everyone. Certainly there are some cases where it seems to be the main cause, but we’re not sure how that holds for all.

It’s also worth bearing in mind that the science over the role of the genes associated with the schizophrenia diagnosis in the immune system is certainly not settled. A recent large study compared the role of these genes in schizophrenia to known autoimmune disorders and concluded that the genes just don’t look like they’re actually impacting on the immune system.

There’s also a constant background of cultural enthusiasm in psychiatry to identify ‘biomarkers’ and anything that looks like a clear common biological pathway even for a small number of cases of ‘psychiatric’ problem gets a lot of airtime.

Curiously, in this case, Hollywood may also play a part.

A film called Brain On Fire has just been shown to film festivals and is being tested for a possible big release. It’s based on the (excellent) book of the same name by journalist Susannah Cahalan and describes her experience of developing psychosis only for it later to be discovered that she had anti-NMDA receptor encephalitis.

Hollywood has historically had a big effect on discussions about mental health and you can be sure that if the movie becomes a hit, popular media will be alive with discussions on ‘whether your mental health problems are really an immune problem’.

But taking a less glitzy view, in terms of these new studies, they probably reflect that a small percentage of people with psychosis, maybe 1-2%, have NMDA receptor-related immune problems that play an important role in the generation of their mental health difficulties.

It’s important not to underestimate the importance of these findings. It could potentially translate into more effective treatment for millions of people a year globally.

But in terms of psychosis as a whole, for which we know social adversity in its many forms plays a massive role, it’s just a small piece of the puzzle.
 

Link to locked Lancet Psychiatry study.

The hidden history of war on terror torture

The Hidden Persuaders project has interviewed neuropsychologist Tim Shallice about his opposition to the British government’s use of ‘enhanced interrogation’ in the Northern Ireland conflict of the 1970s – a practice eventually abandoned as torture.

Shallice is little known to the wider public but is one of the most important and influential neuropsychologists of his generation, having pioneered the systematic study of neurological problems as a window on typical cognitive function.

One of his first papers was not on brain injury, however, it was an article titled ‘Ulster depth interrogation techniques and their relation to sensory deprivation research’ where he set out a cognitive basis for why the ‘five techniques’ – wall-standing, hooding, white noise, sleep deprivation, and deprivation of food and drink – amounted to torture.

Shallice traces a link between the use of these techniques and research on sensory deprivation – which was investigated both by regular scientists for reasons of scientific curiosity, and as we learned later, by intelligence services while trying to understand ‘brain washing’.

The use of these techniques in Northern Ireland was subject to an official investigation and Shallice and other researchers testified to the Parker Committee which led Prime Minister Edward Heath to ban the practice.

If those techniques sound eerily familiar, it is because they formed the basis of interrogation practices at Guantanamo Bay and other notorious sites in the ‘war on terror’.

The Hidden Persuaders is a research project at Birkbeck, University of London, which is investigating the history of ‘brainwashing’. It traces the practice to its use by the British during the colonisation of Yemen, who seemed to have borrowed it off the KGB.

And if you want to read about the modern day effects of the abusive techniques, The New York Times has just published a disturbing feature article about the long-term consequences of being tortured in Guantanamo and other ‘black sites’ by following up many of the people subject to the brutal techniques.
 

Link to Hidden Persuaders interview with Tim Shallice.
Link to NYT on long-term legacy of war on terror torture.

Hallucinating sleep researchers

I just stumbled across a fascinating 2002 paper where pioneering sleep researcher Allan Hobson describes the effect of a precisely located stroke he suffered. It affected the medulla in his brain stem, important for regulating sleep, and caused total insomnia and a suppression of dreaming.

In one fascinating section, Hobson describes the hallucinations he experienced, likely due to his inability to sleep or dream, which included disconnected body parts and a hallucinated Robert Stickgold – another well known sleep researcher.

Between Days 1 and 10 I could visually perceive a vault over my supine body immediately upon closing my eyes. The vault resembled the bottom of a swimming pool but the gunitelike surface of the vault could be not only aqua, but also white or beige and, more rarely, engraved obsidian or of a gauzelike nature mixed with ice or glass crystals.

There were three categories of formed imagery that appeared on these surfaces. In the first category of geologic forms the imagery tended to be protomorphic and crude but often gave way to the more elaborate structures of category two inanimate sculptural forms.

The most amusing of these (which occurred on the fourth night) were enormous lucite telephone/computers. But there were also tables and tableaux in which the geologic forms sometimes took unusual and bizarre shapes. One that I recall is a TV-set-like representation of a tropical landscape.

In category three, the most elaborate forms have human anatomical elements, including long swirling flesh, columns that metamorphosed into sphincters, nipples, and crotches, but these were never placed in real bodies.

In fact whole body forms almost never emerged. Instead I saw profiles of faces and profiles of bodies which were often inextricably mixed with penises, noses, lips, eyebrows; torsos arose out of the sculptural columns of flesh and sank back into them again.

The most fully realized human images include my wife, featuring her lower anatomy and (most amusingly) a Peter Pan-like Robert Stickgold and two fairies enjoying a bedtime story. While visual disturbances are quire common in Wallenberg’s syndrome, they have only been reported to occur in waking with eyes open.

Blurring of vision (which I had), and the tendency of objects to appear to move called oscillopsia (which I did not have), are attributed to the disturbed oculomotor and vestibular physiology.

 

Link to locked report of Hobson’s stroke.

Making the personal, geospatial

CC licensed photo by Flickr user Paul Townsend. Click for origin.There is an old story in London, and it goes like this. Following extensive rioting, there is an impassioned debate about the state of society with some saying it shows moral decay while others claim it demonstrates the desperation of poverty.

In 1886, London hosted one of its regular retellings when thousands of unemployed people trashed London’s West End during two days of violent disturbances.

In the weeks of consternation that followed, the press stumbled on the work of wealthy ship owner Charles Booth who had begun an unprecedented project – mapping poverty across the entire city.

He started the project because he thought Henry Hyndman was bullshitting.

Hyndman, a rather too earnest social campaigner, claimed that 1 in 4 Londoners lived in poverty, a figure Booth scoffed at as a gross exaggeration.

So Booth paid for an impressive team of researchers and sent to them out to interview officials who assessed families for compulsory schooling and he created a map, initially of the East End, and eventually as far west as Hammersmith, of every house and the social state of the families within it.

Each dwelling was classified into seven gradations – from “Wealthy; upper middle and upper classes” to “Lowest class; vicious, semi-criminal”. For the first time, deprivation could be seen etched into London’s social landscape.

I suspect that the term ‘vicious’ referred to its older meaning: ‘of given to vice’- rather than cruel. But what Booth created, for the first time and in exceptional detail, was a map of social environments.

The map is amazingly detailed. Literally, a house by house mapping of the whole of London.

The results showed that Hyndman was indeed wrong, but not in the direction Booth assumed. He found 1 in 3 Londoners lived below the poverty line.

If you know a bit about the capital today, you can see how many of the deprived areas from 1886 are still some of the most deprived in 2016.

So I was fascinated when I read about a new study that allows poverty to be mapped from the air, using machine learning to analyse satellite images Nigeria, Tanzania, Uganda, Malawi, and Rwanda.

But rather than pre-defining what counts as an image of a wealthy area (swimming pools perhaps?) compared to an impoverished one (unpaved roads maybe), they trained a neural network learn its own associations between image properties and income on an initial set of training data before trying it out on new data sets.

The neural network could explain up to 75% of the variation in the local economy.

Knowing both the extent and geography of poverty is massively important. It allows a macro view of something that manifests in very local ways, mapping it to street corners, housing blocks and small settlements.

It makes the vast forces of the economy, personal.
 

Link to Booth’s poverty map.
Link to Science reporting of satellite mapping study.