Author: vaughanbell

After several sleep-defying flights from the UK, I’m pleased to say I’ve arrived in Medell√≠n and look forward to working with some of the many talented cognitive scientists and clinicians they have here in Colombia.

I’ve been kindly looked after by Jorge and his wife Claudia who are both local psychiatrists and in addition to looking out for sleep-deprived psychologists, teach and treat patients in the city.

I’m particularly indebted to Jorge who is largely responsible for my being here in Colombia and has been enthusiastic and helpful in equal measure.

I should have a permanent internet connection in the near future (I’m currently working off a dialup) so hopefully normal Mind Hacks service should resume shortly.

The latest edition of Scientific American Mind has just arrived on the shelves and the online articles are one of the best selections I’ve seen in a very long time – with pieces on brain-computer interfaces, five ways in which brain scans mislead us, toddlers and their temper tantrums, the science of gossip, why we can’t imagine death and why metaphors are shaping the ‘war on terror’.

The article on the psychology of death is from the always interesting Jesse Bering and has been inspired by an evolutionary view of death concepts:

The common view of death as a great mystery usually is brushed aside as an emotionally fueled desire to believe that death isn‚Äôt the end of the road. And indeed, a prominent school of research in social psychology called terror management theory contends that afterlife beliefs, as well as less obvious beliefs, behaviors and attitudes, exist to assuage what would otherwise be crippling anxiety about the ego‚Äôs inexistence…

Yet a small number of researchers, including me, are increasingly arguing that the evolution of self-consciousness has posed a different kind of problem altogether. This position holds that our ancestors suffered the unshakable illusion that their minds were immortal, and it’s this hiccup of gross irrationality that we have unmistakably inherited from them. Individual human beings, by virtue of their evolved cognitive architecture, had trouble conceptualizing their own psychological inexistence from the start.

This is reflected in the many studies which have show that we reason what might be thought as rather oddly about death – we have a tendency to attribute mental states to dead people.

Even if you believe in an immortal soul, it is unlikely that the mind continues in any way which we could conceive, and yet we tend to implicitly assume that certain abilities and attributes continue after death.

The other freely available articles are also fantastic. It’s one of the best issues in ages, so well worth having a look at.

Link to October SciAmMind.

The September edition of the Nature Neuroscience podcast Neuropod recently appeared online and covers the treatment of depression, how deaf people retain their ability to speak, a psychoanalytic contribution to the understanding of stock market instability, and a feature on the London play Reminiscence (in which I make a brief appearance).

The discussion on depression is particularly interesting as it’s based on a recent review article by Robert DeRubeis that looked at the neural effects of antidepressants and cognitive therapy as they help treat depression.

The piece on the psychoanalytic study of financial markets struck me as completely left-field but is also very interesting, as psychologist David Tucket argues that fund managers have too much information and so internalise models or rules of thumb that are as equally affected by emotion and concerns about their job as hard evidence, meaning that as a population, the whims of the human psyche can cause large economic effects.

The rest is very interesting too, and the interview with myself and Michael and Effy from the Reminiscence team is a lovely conclusion to a hugely enjoyable project.

Link to Neuropod homepage with streamed audio archive.
mp3 of September edition.

An article in The Guardian by psychoanalyst Darian Leader argues that new psychological therapies are driven by a capitalist approach to mental well-being and that they commoditise the soul.

This article is the latest salvo aimed at bashing cognitive-behavioural therapy (CBT), an evidence-based psychological treatment which has inspired the ire of psychoanalysts for recently being heavily funded by the UK government.

CBT is a psychological therapy that typically looks at the link between thoughts, feelings and behaviour and is usually time-limited to 12 or 16 sessions. It is evidence-based with meta-analyses and randomized controlled trials showing it to be effective for various conditions and it is subject to improvement and testing by cognitive science.

Not only that, but the research has been almost entirely funded independent of industry or special interest groups, meaning some of the major conflicts of that pervade mental health are absent (although some remain relevant).

Leader’s article repeats several common accusations which, when not plain wrong, are just a bit bizarre.

Chief among these are the fact that CBT does not go ‘deep enough’ and doesn’t address the root problem, and this is apparently related to a ‘quick fix’ capitalist view of human nature (a criticism often made by UK psychologist Oliver James).

There are two parts to the ‘doesn’t go deep enough’ criticism. The first is that psychoanalysis says that symptoms are not the problem, they’re just the expression of an underlying conflict, so if you treat the symptom another will appear in its place unless you’ve dealt with the unconscious turmoil. Virtually the only verifiable aspect of this is the idea of ‘symptom substitution’ which is both testable and entirely without evidence, as we discussed previously.

Leader refers to the fact that something could be empirically testable as the ‘new rhetoric of “science”‘ (yes, those are really scare quotes around the word science), but that aside, psychoanalysis certainly does go ‘deeper’ than CBT. This is because it continues for years on end.

Owing to the fact that public health organisations are reluctant to fund poorly validated treatments, there are few psychoanalysts who work in the health public system, so a typical session from the many hundreds of you will need can set you back about £60-100 pounds a hour in the UK.

I only mention this because it strikes me that a psychoanalyst is the last person who should be accusing anyone of mental capitalism, let alone focusing his criticism on a therapy that’s widely available on the public health system.

The rest of the article is full of curious straw men, saying that CBT aims to ‘correct’ people’s thinking (it doesn’t, it trains people to test themselves for how useful their assumptions and beliefs are), that it is unconcerned with early experiences (it isn’t and considers that many of our assumptions come from earlier life and childhood), and that symptoms are just seen as meaningless aberrations of the mind (if this was the case, why would CBT even try to tackle them?).

A further irony is that when actually tested with “science” – sorry, science – psychoanalytically-inspired therapies of the briefer kind actually do quite well for the limited evidence that exists. This seems to be particularly the case for people diagnosed with ‘personality disorder’ – a vague and controversial category but one which suggests the person has pervasive problems with sustaining relationships.

Interestingly, transference is one of the genuinely important, testable and innovative ideas to come out psychoanalysis, and it specifically describes how experiences of past relationships affect how we interpret social interactions.

Unfortunately, psychoanalysis has always had something a little homeopathic about it, suggesting that it treats people ‘holistically’ and so empirical studies and “science” are irrelevant. Oddly, Freud was quite convinced of the opposite – that he was doing science, despite virtually avoiding anything scientific during the development of his now famous therapy.

It comes down to the fact that if you want any particular therapy funded by the government or your health insurance company you need to do studies to show it’s effective.

Now let me give my statement of ‘full disclosure’ – I’m trained in CBT and have used it regularly. I don’t think it’s perfect or a cure all, but it is a very useful and effective way of working with distressed people, despite its drawbacks.

I think a lot of psychoanalysis is bunk but I also think other parts, like transference, are wonderful and innovative. Psychoanalytically-inspired therapies seem also to be powerful and effective on the basis of the little rigorous evidence that exists.

What’s odd is that rather than being pleased that a psychological therapy is being widely promoted and throwing their ideas into the mix, some psychoanalysts seem to have gone on the attack and retreated into the the “we’re above science” position, while this actually seems a perfect opportunity to take the chance to test the evidence for psychoanalytic treatments while the funders are listening.

I’m constantly struck by the irony that for a practice that focuses on resolving conflicts, psychoanalysis has a long tradition of infighting. This latest episode seems to be the most recent manifestation of this recurrent pattern. Troubled infancy perhaps?

UPDATE: With uncanny timing, today’s New England Journal of Medicine has published a meta-analysis on the effectiveness of long-term (1 year+) psychodynamic psychotherapy in complex mental disorders, finding it a useful and effective treatment. It’s not a huge sample of studies (11 RCTs and 12 observational studies) but clearly suggests the benefit of this type of psychological treatment (thanks Ben!).

Link to oddly acerbic ‘A quick fix for the soul’ article.

The latest edition of The New Yorker has the tragic story of a US Marine who became famous after writing about his struggle with PTSD for the Marine Corps Gazette, met the President as a result, but who later killed himself owing to the intensity of his experiences.

The New Yorker Article weaves the story of decorated Staff Sergeant Travis Twiggs with commentary on the effects of PTSD and the current support for US veterans who have been traumatised by their experiences.

Compared with other American wars, the conflicts in Iraq and Afghanistan seem to be producing victims at a high rate. A recent RAND Corporation study estimated that three hundred thousand veterans of America’s post-9/11 wars—nearly twenty per cent of those who have served—are suffering from P.T.S.D. or major depression, and many more cases are expected to surface in the years ahead. This elevated rate is generally attributed to the rigors of a long war being fought without conscription: multiple deployments and heavy use of National Guard and reserve units. And on the ground, at unit level, the discouragement of anyone with stress symptoms from asking for help is intense. The same RAND study found that, mainly because of the stigma still attached to P.T.S.D., only half of those afflicted have sought treatment.

Twiggs was apparently a highly experienced, highly decorated and trusted marine and the article demonstrates one of the key findings of military psychiatry: every man has his limit.

The holy grail of military psychiatry has been to develop a way of predicting who will suffer psychiatric illness before deployment but this has never been realised because the biggest predictor is not the character or attributes of the soldier, but the intensity of the fighting to which they’re exposed.

Saying that, there are other factors which do contribute, and unfortunately the US military seem to have a policy of extended and lengthy tours which may explain why rates of PTSD are higher in the deployed US military than in the soldiers of other forces in the same conflict.

The New Yorker article is vivid and tragic in equal measure, but helps to illustrate the personal experiences behind the statistics.

Link to New Yorker article ‘The Last Tour’ (via Furious Seasons).
Link to Travis Twiggs’ article for the Marine Corps Gazette.

ABC Radio National’s All in the Mind had a two part series on the implications of neuroplasticity – particularly the discovery that the brain can physically ‘rewire’ itself through adulthood, albeit in a more limited way in comparison to the process that occurs during childhood.

I found the second part a little more satisfying than the first as it’s a bit more focused, but it’s also interesting as it mostly discusses the relationship between neuroplasticity and psychotherapy.

The interviewee is psychiatrist Norman Doidge who is obviously quite a committed Freudian and argues than many of Freud’s ideas can be now understood in terms of neuroplasticity.

Some of his comments are provocative, some innovative and others a little too much like dogma re-interpreting modern neuroscience, but it’s a fascinating conversation none-the-less.

One of the difficulties with the term ‘neuroplasticity’ is that it’s actually fairly vague. It is often applied to normal neuronal changes (during memory formation, for example) to the growth of new neurons (neurogenesis) to the changes in activation after brain injury seen on neuroimaging studies and to improvements in abilities after brain injury even when no direct measurement of the brain has taken place.

This means it can be all things to everyone and easily fits into any other explanation of change without necessarily adding anything.

We know that neuroplasticity happens. Saying how it happens is key, and a measure of a good explanation is where this knowledge helps us understand the cognitive and behavioural changes better.

Indeed, Doidge does a good job of discussing how various forms of neuroplasticity might reflect different types of behavioural changes, which makes the programme time well spent.

Link to part one of ‘The power of plasticity’
Link to part two.