Author: vaughanbell

Will the PTSD diagnosis disappear?

Psychiatrist Gerald Rosen argues that the diagnosis of post-traumatic stress disorder (PTSD) should be abandoned because it just re-describes emotional reactions that would otherwise be diagnosed as depression or anxiety, and is increasingly used where there was never any clear trauma in the first place.

He’s made his case in an editorial for the British Journal of Psychiatry and debates his ideas in an engaging discussion in a BJP podcast.

PTSD is the only psychiatric diagnosis where a clear cause forms part of the diagnosis. The person must have experienced a life-threatening event to themself or others, and must have experienced intense fear, helplessness, or horror at the time.

If this is followed by intrusive memories of the event, increased arousal (feeling ‘on edge’), avoidance of any reminders and these are long-lasting and they interfere with everyday life, the disorder can be diagnosed.

The trouble is, all of these can be found in people who have not experienced classical ‘trauma’. Some people, including Rosen, are arguing that many of the normal reactions to negative events are now being described in terms of mental illness and the concept of PTSD is becoming meaningless:

Peer-reviewed articles have even discussed the possibility of developing PTSD from watching traumatic events on television. It has been suggested that rude comments heard in the workplace can lead to PTSD because a victim might worry about future boundary transgressions: the conceptual equivalent of pre-traumatic stress disorder. New diagnostic categories modeled on PTSD have been proposed, including prolonged duress stress disorder, post-traumatic grief disorder, post-traumatic relationship syndrome, post-traumatic dental care anxiety, and post-traumatic abortion syndrome. Most recently, a new disorder appeared in the professional literature to diagnose individuals impaired by insulting or humiliating events ‚Äì post-traumatic embitterment disorder. Even expected and understandable reactions after extreme events, such as anxiety and anger, are now referred to as ‘symptoms’.

This does not mean that anyone who becomes disturbed after a negative experience shouldn’t be helped, just that PTSD is not a useful way of guiding the treatment. Critics argue that the existing categories of depression and anxiety are more than adequate.

In the podcast, Rosen discusses the possibility that PTSD may be ‘popular’ as a diagnosis because it’s perfectly suited to the legal system.

It defines a cause and an effect, a compensation lawyer’s dream. This is more important for the American health care system where mental health treatment is often only reimbursed by the insurance companies if a doctor can make a diagnosis.

PTSD might be the only way for a doctor to get insurance companies to pay for treating someone who is having difficulty adjusting to a bad experience.

Interestingly, the diagnosis of PTSD was largely accepted into the diagnostic manuals due to pressure from campaigners wanting the US government to treat Vietnam veterans’ mental health needs on their return from the conflict.

A recent study checked the service records of Vietnam veterans who were being treated for PTSD and found only 41% had been exposed to combat, despite their being no difference in the symptoms between ‘combat’ and ‘no combat’ troops.

This isn’t to suggest that some veterans were ‘faking’, just that there isn’t always a clear connection between a traumatic event and the symptoms of PTSD.

With these points in mind, Rosen makes for an interesting guest on a diagnosis that we now tend to take for granted.

Link to BJP podcast ‘Problems with the PTSD diagnosis’.
Link to PubMed entry for editorial.

Better living through caffeine

Developing Intelligence has a fantastic post on what pharmacology and neuropsychology has told us about getting optimally wired on caffeine.

In small amounts, caffeine boosts mental function, and the article looks at scientific studies that have told us which are the optimal doses, which psychological abilities are most affected and what you can take with caffeine to modulate its effect.

Obviously, caffeine has its health risks. Psychologically speaking, even everyday doses run the risk of withdrawal symptoms and have the tendency to increase anxiety, so as with any drug, it’s important to educate yourself so you can judge the risks for yourself.

The Wikipedia page on caffeine is wonderful, so it’s a great complement to the fantastic round-up of stimulation-related tips from Developing Intelligence.

Link to article ‘A User’s Guide to Getting Optimally Wired’ (via BadScience).
Link to Wikipedia page on caffeine.

Hats off to you sir

It’s not often you find yourself thinking ‘you know, I really need a brain hat, but I just can’t decide which one to buy’.

The pictured head piece is undoubtedly for the discerning customer, revealing a large section of the upper cortex with added plastic blood. Nice.

However, there’s also an alien brain hat for babies, a brain cap for keeping the sun out of your eyes, or even a high fashion wooly brain hat by a top designer.

Importantly though, friends don’t let friends wear brain golf visors.

Implicit associations

You might have prejudices you won’t admit to, or, don’t even know about. The Implicit Attribution Test claims to measure these hidden associations and it’s been one of the most important psychological developments during the last decade.

Edge has a video interview with two of its creators, psychologists Mahzarin Banaji and Anthony Greenwald, and an online version of the IAT which allows you to test your unconscious associations in relation to the US presidential candidates.

The IAT is a computer task that measures the strength of automatic, implicit or unconscious associations between concepts.

Let’s say we’re interested in whether black or white faces are more linked to positive or negative associations.

Faces of black or white people, and either pleasant or unpleasant words are flashed up on screen, one at a time. Participants are asked to press one key if the face is black or the word is pleasant, and other if the face is white or the word is unpleasant.

In other words, you’re asked to classify both black faces and pleasant words using the same response, and white faces and unpleasant words using the same response.

Next, you’re asked to do the same thing, but with the reverse associations: so you’re asked to classify black faces and unpleasant words together, and white faces and pleasant words together.

The idea is that you’re going to be quicker doing whichever classification best matches associations you already have.

So, if you already have unconscious associations between white and pleasant, and black and unpleasant, you’re going to be quicker when these two responses are grouped.

Importantly, the idea is that these associations are different from our conscious attitudes. Someone who is definitely not racist might still have negative associations with black people, perhaps because of exposure to social stereotypes.

Most studies have more than just the two conditions, to control for order, practice and other effects and if you’re interested, you can take part in this exact experiment online.

It was originally thought that the test could uncover people’s implicit or hidden attitudes (indeed, it was originally called the Implicit Attitude Test) but it’s now generally thought of just in terms of associations, because, in effect, it measures how closely two things are linked, and implicit attitude sounds more like a sort of evaluation or stance on something.

The value in this sort of test is not only in that it can pick out associations we might have but don’t admit to or aren’t aware of, but it can also map out how various things influence the unconscious structure of meanings in the mind and brain.

Needless to say, it’s been researched intensively since it was first uncovered, with research suggesting it can even pick up on hidden violent associations in psychopathic murderers.

Link to video interview and presidential IAT at Edge.
Link to previous WashPost article on the IAT.

Orgasm and the brain: body, soul and sensory nerves

How does the brain generate orgasm? It’s one of the most under-investigated human experiences but two articles, one in the LA Times and another in The Psychologist, discuss some of the key developments of recent years.

The LA Times article is a good description of some of the most interesting neuroscience studies in this developing field, but is a little uncritical in places.

Apparently “About 43% of women and 31% of men in the U.S. between ages 18 and 60 meet criteria for sexual dysfunctions, according to a 1999 report on the sexual behavior of more than 3,000 U.S. adults”.

This report was a research study published in the Journal of the American Medical Association that classified sexual dysfunction as reporting any one of the following during the last 12 months:

(1) lacking desire for sex; (2) arousal difficulties (ie, erection problems in men, lubrication difficulties in women); (3) inability achieving climax or ejaculation; (4) anxiety about sexual performance; (5) climaxing or ejaculating too rapidly; (6) physical pain during intercourse; and (7) not finding sex pleasurable

Almost all of which fall within the normal range of a year’s worth of regular sexual experiences, which probably explains why a third to almost half of people surveyed experienced at least one – but hardly a marker of a serious medical problem in itself.

There’s a much better article on orgasm in this month’s The Psychologist by Barry Komisaruk, Carlos Beyer and Beverly Whipple, authors of a recent book on ‘The Science of Orgasm’.

It looks at the research on the roles of neurotransmitters in orgasm, as well as what the brain scanning literature tells us about brain activity during sexual arousal and release.

Most interestingly, it has a good discussion of non-genital orgasm:

As reviewed in Komisaruk et al. (2006), there are published reports of orgasms elicited by stimulation also of lips, hand, knee and anus occurring during dreaming sleep, of phantom limbs, from electrical or chemical stimulation of the septum, amygdala or thalamus of the brain and of the spinal cord.

Orgasms have also been described by men and women when they suffer epileptic seizures that are triggered by specific activity (e.g. brushing the teeth: Chuang et al., 2004), or that occur spontaneously. While these epileptic orgasms are in some cases described as ‘unwelcome’ (Reading & Will, 1997), others describe them as pleasurable, one woman refusing anti-epileptic medication for that reason (Janszky et al., 2004)

We have measured autonomic and brain activity during orgasms that women have produced by thought alone. During the thought orgasms, the magnitude of the increases in heart rate, blood pressure, pain threshold, pupil diameter, and brain regions are similar to those that we observe during vaginal or cervical self-stimulation-induced orgasms (Whipple et al., 1992). It is not surprising that in those cases of thought-induced orgasms, the specific genital sensory thalamic and cortical, and specific limb-motoric regions, are not activated.

The article notes that a number of different nerve pathways may serve to communicate sensual stimulation to the brain, which may account for why different sites of stimulation can produce orgasm.

Link to LA Times article ‘Science of the orgasm’
Link the The Psychologist article on orgasm.

Full discloser: I’m an unpaid associate editor of The Psychologist.

Tieing knots with booze

An excerpt from Knots, a book of poetry by the radical psychiatrist R.D. Laing, that attempted to capture some of the traps, maladaptive thinking patterns and emotional bonds that we find ourselves in, usually in relationships with others.

Some of the poems describe simple but powerful vicious circles, others are complex and almost algorithmic labyrinths of self-justification and denial.

She has started to drink
  As a way to cope
  that makes her less able to cope

the more she drinks
the more frightened she is of becoming a drunkard

the more drunk
the less frightened of being drunk

Apparently, the book was made into a film, although I know very little else about the screen version. Luckily though, most of the poems are now available online.

Perhaps some of Laing’s insight was due to the fact that he was not without his own troubles. He suffered from depression and drinking problems during his life – infamously appearing on Ireland’s Late Late Show drunk and incoherent.

Link to poems from Knots by R.D. Laing.

Psychological torture: a CIA history

Advances in the History of Psychology has alerted me to a gripping video lecture on the development of CIA psychological torture techniques from the Cold War to War on Terror.

It was an invited lecture at the University of California by historian Prof Alfred McCoy who has long specialised in the history of the US secret services.

He argues that the results of CIA research into psychological torture can be clearly seen in both the treatment of prisoners in Guantanamo bay and images of the Abu Ghraib scandal.

By contrast when I looked at those photos, I did not see snapshots of simple brutality or a breakdown in military discipline. For example, that most iconic photo of a hooded Iraqi with fake electrical wires hanging from his extended arms shows not the sadism of a few ‘creeps’, but instead, the two key trademarks of the CIA’s psychological torture: the hood was for sensory disorientation and the arms extended for self-inflicted pain.

McCoy discusses how these techniques were researched and developed by some of the most distinguished cognitive scientists of the time and were reflected in now uncovered CIA documents, including the 1961 ‘Manipulation of Human Behavior’ research summary, the 1963 KUBARK interrogation manual, and the 1983 ‘Human Resource Exploitation Training Manual‘.

He notes that these techniques have been developed and legitimised by a legal framework that was deliberately designed not to outlaw existing techniques, despite the fact there is no strong basis for their effectiveness and evidence suggests that psychological torture has a similar long-term impact to physical torture.

Interestingly, he suggests that Guantanamo is both being used as a centre for gathering intelligence, as well as a sort of ‘lab’ for testing and developing new methods.

McCoy is the author of the recent book ‘A Question of Torture: CIA Interrogation from the Cold War to the War on Terror’ on which this talk is based, in which he also argues that the work on Donald Hebb and Stanley Milgram were partly funded by the CIA to help understand how to break through people’s psychological defences.

The lecture has a long introduction by one of the University’s dignitaries, so you can skip to 11:30 when it really starts in earnest.

Advances in the History of psychology has also been keeping track of recent discussion about the book and recent findings about the role of the CIA in funding American psychology research in the 50s and 60s.

Link to YouTube video of McCoy lecture.

Sealed with a reminisce

The Neuroscience for Kids website has created an online exhibition of neuroscience-themed stamps that depict everything from drugs to brain scans.

They also include the wonderful Swedish set displayed on the left that include a series of impossible shapes.

Unfortunately, the stamps aren’t dated. Rather surprisingly, Portugal put Egas Moniz, inventor of the frontal lobotomy, on their stamps, and it would be interesting to know when they were in circulation.

To be fair, he did win the Nobel Prize, although these days the mention of his award tends to make people shuffle their feet and mutter things like “well, of course, it wouldn’t happen in this day and age…”

Link to neuroscience stamp exhibition.

Researching the sublime

Jonah Lehrer, author of Proust was a Neuroscientist, is a guest on this week’s All in the Mind, where he discusses why he thinks the arts are an essential complement to the sciences in the attempt to understand human experience.

Lehrer argues that some artists aim to explore, capture or communicate aspects of our subjective experience that are otherwise indefinable.

Perhaps most controversially, he suggests that through these explorations some artists have glimpsed the functional organisation of the brain – even though we’ve only come to realise this in more recent lab work.

Nevertheless, Lehrer argues that art is more than just a reconnaissance mission for science.

Although some of its ‘discoveries’ can stimulate research or be validated by experiments, it also communicates what science cannot, and so is essential as part of the wider attempt to understand ourselves.

It struck me while listening to the programme that Lehrer talks about art in the same way many clinical scientists talk about working with patients.

In neuropsychology and neuropsychiatry particularly, clinicians will constantly be trying to integrate the empirical research and objective medical tests with the patient’s subjective account of their experience.

The patient’s narrative (soliloquy perhaps?) also helps direct a scientific approach to their individual problems, and raises broader scientific questions about the course of the disorder or the function of the normal system, now gone awry.

While clinicians are trained to draw these reflections from their patients with careful questioning, artists are like evangelists for the subjective – making their first-person experience available to all.

Moreover, these experiences often come in such fine and exquisite detail that not even the most skilled clinician could provoke such insights.

Link to AITM with Jonah Lehrer.

2008-02-08 Spike activity

Quick links from the past week in mind and brain news:

Is V1agra spam getting you down? Fear not, get more sex with V1tamin C!

OmniBrain discovers a long lost film on ‘Frightening Diseases of the Mind’.

How good is Neurofeedback for treating attention deficits? Sharp Brains has a great review of the evidence.

The fantastic Furious Seasons hosts a pdf of a recent academic article on the increasing overdiagnosis of child bipolar disorder.

The New York Times has the shocking news that brilliant discoveries typically need years of hard word.

Subliminal images of drug paraphernalia can trigger cravings in addicts, according to a new study reported by Treatment Online.

Pregnancy ‘does cause memory loss’ according to a new study covered by The Guardian.

Discover Magazine asks if Osama’s only 6 degrees away, why can’t we find him? I’ve asked a similar question about Shakira myself.

10 reasons people lie to their psychotherapists. World of Psychology rounds up an informal survey.

The ‘Google generation’ a myth according to a new study. Susan Greenfield and chums take note.

A Blog Around the Clock interviews psychologist Vanessa Woods, who goes into the jungle to observe the behaviour of bonobos.

“Colin Blakemore: An organ so complex we may never fully understand it”. A poorly worded headline unintentionally describes the head of the Medical Research Council as an organ.

More headline innuendo pleasure from The New York Times: “Drop Down and Give Me More Than She‚Äôs Doing”. Sadly, about the psychology of exercise.

Metapsychology reviews a book that documents medical complicity in torture during the war on terror. So truly awful that words fail to describe it adequately.

More from The New York Times with an article and audio reading from an upcoming book on obsessive-compulsive disorder.

PsyBlog looks at the limits of cognitive dissonance, one of the most important theories in social psychology.

Don’t breath the pig brains. Sound advice from Neurophilosophy.

Developing Intelligence looks at how gestures during speech affect what we communicate.

School of Everything! Want to learn something or have something to share. Fine out who can teach you in your local area.

How to Study. The BPS Research Digest has a guest feature looking at the psychology of optimum learning.

Deric Bownds discusses how blindsight has been created in people without brain damage, using TMS.

The he-haw boys and the eye-drillers

A 61 year-old lady was admitted to a Florida hospital with florid hallucinations after suffering a stroke to her thalamus. She saw curious strangers and visitors with odd clothes, but rather unusually, the ones on the right always seemed pleasant and happy, whereas the ones on the left always seemed fearful and unsettling.

The case was reported in the journal Cognitive Neuropsychiatry and is of interest because the emotional content of the hallucinations seem to match the dominant emotion of the corresponding hemisphere of the brain.

[The patient] described the right visual hallucinations as consisting of “college age boys in colourful Hawaiian shirts” that “are too happy, talk too much”, and that are somewhat “too energetic”. The patient called them the “he-haw boys,” and reported that she could hear them talking.

The left visual hallucinations were described as “men in black religious clothes that make no noises.” The patient called them “the eye drillers”, and stated that “they look a hole right through you”. The patient provided vivid drawings of the hallucinations that accentuated the positive and negative associations she had with each hallucination. The patient provided vivid drawings of the hallucinations that accentuated the positive and negative associations she had with each hallucination.

This is not the first time that hallucinations have been reported to be differing in emotional tone depending on which side of space they appear.

This is likely due to the way emotion is processed in the brain.

Perception of negative emotions often relies largely on the right hemisphere, where positive emotions are processed by both the right and the left hemispheres. In fact, this pattern of brain response has been found in children as young as 10 months old.

The woman in this case report didn’t suffer damage to the hemispheres directly, but to the thalamus. This area is often called the brain’s relay station as it is extensively connected to hemispheres, so damage in this area can often mimic damage to the cortex.

Link to PubMed abstract of case report.

Psychedelic Science online

In 1997, BBC science programme Horizon broadcast a legendary edition on the use of psychedelic drugs in medicine. Luckily, it’s been uploaded to Google Video and you can now watch the whole thing online.

It came at an interesting time in psychedelic drug research – when the authorities were still touchy (they’d only raided Shulgin’s licensed lab three years earlier) but were just starting to allow some stirrings of research since they’d shut it down almost completely in the 1960s.

The programme looks at the history of psychedelic drug research when it was still easily possible, focusing on Osmond and Hoffer’s early work on using LSD in treating addiction and facilitating psychotherapy.

It’s also got loads of great historical footage from the early research but also talks to the new generation of researchers looking at compounds such as ayahuasca and ibogaine, who are now the senior figures in this growing area.

Unfortunately, the video is a bit grainy in places but it’s quite watchable and it’s got a great soundtrack. The producers used Future Sound of London, Massive Attack and a number of tracks from the Ninja Tune label to give the programme a trippy feel.

Link to ‘Psychedelic Science’ edition of Horizon.

Impostors and the subtleties of self-presentation

‘Impostor Syndrome’ is where someone feels they aren’t as competent as everyone else thinks they are and fears they could be found out.

I’ve heard the term used by psychologists and in everyday language to describe this situation but never realised it’s been the subject of serious psychological research.

Several studies have looked at the issue and The New York Times has a brief article on the findings. They suggest that the ‘syndrome’ is actually more subtle than the simple description lets on – in fact, it may be a way of managing others’ expectations.

In a study published in September [pdf], Rory O’Brien McElwee and Tricia Yurak of Rowan University in Glassboro, N.J., had 253 students take an exhaustive battery of tests assessing how people present themselves in public. They found that psychologically speaking, impostorism looked a lot more like a self-presentation strategy than a personality trait.

In an interview, Dr. McElwee said that as a social strategy, projecting oneself as an impostor can lower expectations for a performance and take pressure off a person — as long as the self-deprecation doesn’t go too far. “It’s the difference between saying you got drunk before the SAT and actually doing it,” she said. “One provides a ready excuse, and the other is self-destructive.”

Link to NYT article on ‘impostor syndrome’.
pdf of McElwee and Yurak’s paper.

It Came From Inner Space

In light of the unusual behaviour displayed by some of NASA’s astronauts in recent times, the American space agency is aiming to use increased psychological screening for its potential space travellers.

They say there is nothing new orbiting the sun and, as testament to this, the exact same issue was discussed way back in 1959, in a special issue of the American Journal of Psychiatry on ‘space psychiatry’.

It’s a rather curious discussion to say the least, showing a mix of 1950s prejudice, naive awe, and some rather charming if not slightly potty Freudian analysis.

An article by A.J Silverman and colleagues discusses the possibilities of using psychological selection techniques for space crew and notes that it should exclude “the person with a history of constantly fighting and rebelling both against peers and authority figures, as well as those with pressing homosexual or other major neurotic conflicts.”

Silverman was writing at a time when homosexuality was still 15 years away from being de-listed as a mental illness but the issue of whether to send an openly gay person into space is still a hot topic. Apparently, Lance Bass, ex-‘N Sync singer and commercial astronaut, might be the first.

Despite a few throwaway comments, the authors of the ‘space psychiatry’ articles actually spend much more time discussing the terrors of outer space, and how they relate to the terrors of inner space, rather than how to screen crews.

Air Force Captain George Ruff notes two serious sources of space anxiety: one is “the possibility that equipment failure or operator error may cause death within a few seconds”. The other, is “the subject’s infantile fantasies” (Houston, we have an unresolved Oedipus complex).

In contrast, Eugene Brody sees ‘separation anxiety’ as the most likely source of psychological disturbance. This is what young children suffer when they are taken, even temporarily, from their mothers.

Brody thought this would be equally as stressful when astronauts were separated from ‘mother earth’ and suggested that the consequences could be dire:

These factors plus the sensory input patterns which may be encountered in space flight, and such apparently basic fears as that of impenetrable darkness might in theory at least be expected in time to produce-even in a well-selected and trained pilot-something akin to the panic of schizophrenia. The regressive defense may be revealed in symptom formations such as hallucinations or delusions…”

In other words, Brody is arguing that the existential loneliness of space may break down the usual defences of astronauts causing them to experience their innermost conflicts as delusions and hallucinations, imposed upon reality.

What’s remarkable, is this is strikingly similar to the main themes in Stanislaw Lem’s influential novel Solaris which was published in 1961, two years after the American Journal of Psychiatry special issue.

It’s interesting to speculate that Lem may have been inspired to explore these concepts after they were discussed by American psychiatrists and disseminated by starry-eyed futurists.

Link to AJP ‘Symposium of Space Psychiatry’ (sadly, closed access).
Link to USA Today article on astronaut selection.
Link to Wired article on hopes for gay astronauts.

Just because you’re paranoid

There is simply not enough conspiracy theory-driven paranoid funk rock in the world.

By the looks of his YouTube video Ralph Buckley is hoping to redress the balance with a song that rages against psychiatry, the media, George Bush, Prozac, corporations, socialised health care, mind control, the police state, and the government. Phew!

Not one to let his shaky grasp of neurobiology temper his attack on the New World Order, he notes that antidepressants are hallucinogenic like LSD and both were created to keep down the masses. Fact.

Prozac, zoloft, wellbutrin, paxil etc…are psychoactive drugs (in the hallucinogen family) not unlike LSD which is also another drug developed by the government for purposes of mind control. Curious coincidence? How many ‘coincidences’ does it take before a conspiracy stops becoming a conspiracy?

How many conspiracy theorists does it take to change a light bulb? The light bulb didn’t change man, that’s WHAT THEY WANT YOU TO THINK!

Despite the pharmacological mix-up, Buckley definitely has the funk and cuts some mean blues into the deal. The track is from an album called ‘9/11 Conspiracy Blues’ and he’s a big Ron Paul supporter if you want to get a feel for his suspicious outlook on life.

Best of all though, he rhymes ‘schizophrenia’ with ‘fuck the media’ and you gotta respect that.

Link to Buckley’s paranoid blues track ‘schizophrenia’.