Author: vaughanbell

Is medical school an empathotoxin?

Medical school seems to have a profound negative effect on empathy according to a research review just published in Academic Medicine.

The review of 18 studies found that self-reported emotional understanding declines markedly during medical training. Counter-intuitively, the crucial downturn happens when medical students start seeing patients.

Although the studies are almost completely based on self-report, at the very least they show a decline in being interested in others’ emotional states, even if we can’t be sure that emotional competency is being affected.

Apart from the start of clinical practice phase of training the other major influence in empathy decline was personal distress, which concurs with studies that suggest that people in general report less empathy as they feel worse.

Of course, there may be a number of other factors at work, including the stress of training, an attempt to cope with suffering patients and what the article describes as ‘poor role models’.

What this refers to is the traditional ‘learning through humiliation’ style of medical teaching that seems to be oddly prized by the medical establishment as a form of clinical hazing.

The occasional reply to concerns about physician empathy is usually something along the lines of “what would you prefer, someone who is a good clinician or someone who is a nice person?”.

Despite the false dichotomy, the study make it abundantly clear why empathy is important in medicine, as it is associated with:

• patients’ reporting more about their symptoms and concerns
• physicians’ increased diagnostic accuracy
• patients’ receiving more illness-specific information
• patients’ increased participation and education
• patients’ increased compliance and satisfaction
• patients’ greater enablement
• patients’ reduced emotional distress and increased quality of life
 

Link to PubMed entry for study.
Link to DOI entry for study.

For Whom the Bell Tolls: A psychological autopsy

The Independent has an excellent article on the life and death of writer Ernest Hemingway based on an academic article that attempted a ‘psychological autopsy’ to understand the reasons for his suicide.

Hemingway’s suicide has remained a sticking point for many of his biographers as it seemed incongruous with his adventurous, hard drinking and robustly out-going character.

In 2006, psychiatrist Christopher Martin published an examination of Hemingway’s death in the form of a ‘psychological autopsy‘ to better understand his final decision.

The method aims to get a picture of the dead person’s mental state, health, personality, and social situation to understand what motivated them to take their own life.

The Independent is a careful examination, based on Martin’s academic analysis, that looks at Hemingway’s personality and how the myth of the man had overshadowed many of his personal difficulties for many years.

It’s an in-depth and compelling read that gives a stark look at the darker side of the great writer’s mental life.
 

Link to Independent article on Hemingway (via @brainpicker)
Link to DOI entry and locked academic article.

Traumatic brain injuries in the Asterix comics

A team of neurosurgeons has completed an exhaustive study of the causes of traumatic brain injury in the Asterix comics.

Needless to say, it is a work of pure genius.

And if the conclusions at the end of the summary don’t make you beam with delight, you are dead inside.
 

Traumatic brain injuries in illustrated literature: experience from a series of over 700 head injuries in the Asterix comic books

Acta Neurochir (Wien). 2011 Jun;153(6):1351-5.

Kamp MA, Slotty P, Sarikaya-Seiwert S, Steiger HJ, Hänggi D.

Department for Neurosurgery
Heinrich-Heine-University Düsseldorf

Background: The goal of the present study was to analyze the epidemiology and specific risk factors of traumatic brain injury (TBI) in the Asterix illustrated comic books. Among the illustrated literature, TBI is a predominating injury pattern.

Methods: A retrospective analysis of TBI in all 34 Asterix comic books was performed by examining the initial neurological status and signs of TBI. Clinical data were correlated to information regarding the trauma mechanism, the sociocultural background of victims and offenders, and the circumstances of the traumata, to identify specific risk factors.

Results: Seven hundred and four TBIs were identified. The majority of persons involved were adult and male. The major cause of trauma was assault (98.8%). Traumata were classified to be severe in over 50% (GCS 3-8). Different neurological deficits and signs of basal skull fractures were identified. Although over half of head-injury victims had a severe initial impairment of consciousness, no case of death or permanent neurological deficit was found. The largest group of head-injured characters was constituted by Romans (63.9%), while Gauls caused nearly 90% of the TBIs. A helmet had been worn by 70.5% of victims but had been lost in the vast majority of cases (87.7%). In 83% of cases, TBIs were caused under the influence of a doping agent called “the magic potion”.

Conclusions: Although over half of patients had an initially severe impairment of consciousness after TBI, no permanent deficit could be found. Roman nationality, hypoglossal paresis, lost helmet, and ingestion of the magic potion were significantly correlated with severe initial impairment of consciousness (p ≤ 0.05).

 

Link to PubMed entry for study (via @velascop).
Link to DOI entry for study.

But what does it teach you?

The New Yorker has a fantastic article on theories of education and how the reasons for why people go to college have changed over the years. The description sounds a bit dull but the article is really very good.

It tracks how the perception of what a college education should do, at least in the States, has changed and evolved over the years.

For example, selection by academic ability is a relatively new concept. Ivy League universities were largely considered as finishing schools for young men, and presumably, the occasional daring young woman who had the support of their family and felt there was more to life than getting up the duff (Americans: blessed with child).

In the mid 20th Century, the concept changed so college was considered a place to identify and shape the brightest members of society, while more recently it has become seen as a place to deliver needs-specific training.

The articles weaves in this story with modern ideas and preoccupations about whether students actually learn anything useful and whether education is being dumbed down, prettied up or sold out.
 

Link to New Yorker article.

Psychometric schooling snark

A sarcastic comment on the horrors of school, unexpectedly hidden away in the 1986 book A handbook of test construction: introduction to psychometric design by Paul Kline.

A test is said to be face valid if it appears to measure what it purports to measure, especially to subjects. Face validity bears no relation to true validity and is important only in so far as adults will generally not co-operate on tests that lack face validity, regarding them as silly and insulting. Children, used to school, are not quite so fussy.

 
Link to psychometric snark.

The psychiatrist delusion

My attention was caught by a recently published case study in which a patient with psychosis had the delusion that he was a psychiatrist:

“This 44-year-old single man was first admitted at the age of 27, with a two-week history of hyperactivity and decreased need for sleep. He described a feeling of well-being and believed he was a famous psychiatrist.”

I’ve met several such patients in my time working in mental health and from talking to other professionals I suspect its not uncommon. Hence, I’d be interested in tracking down other published cases of the delusion.

However, it’s very difficult to search for these cases using online databases because lots of articles have the terms ‘delusion’ and ‘psychiatrist’ in them even when they’re not describing this particular form of psychosis.

I’m keen to see if this delusion is widely documented in the scientific literature or whether it has been brushed under the carpet perhaps due to its obvious irony.

So, I need your help.

If you know of any published cases of people who have the delusion that they are a psychiatrist please add a link or reference in the comments below, drop me an email through this form, or contact me on Twitter here.
 

Link to locked case study mentioned above.
Link to DOI entry for same.

Biblioamnesia and the gentle fading of books

The Washington Post has a curious short article on what the author light-heartedly refers to as ‘biblio-amnesia’ where once-read books slowly fade from memory.

After I posted the story on internet service The Twitter, user @bfwriter pointed me toward a fantastic piece by poet Billy Collins, on exactly this experience.
 

Forgetfulness
by Billy Collins

The name of the author is the first to go
followed obediently by the title, the plot,
the heartbreaking conclusion, the entire novel
which suddenly becomes one you have never read,
never even heard of,

as if, one by one, the memories you used to harbor
decided to retire to the southern hemisphere of the brain,
to a little fishing village where there are no phones.

Long ago you kissed the names of the nine Muses goodbye
and watched the quadratic equation pack its bag,
and even now as you memorize the order of the planets,

something else is slipping away, a state flower perhaps,
the address of an uncle, the capital of Paraguay.

Whatever it is you are struggling to remember
it is not poised on the tip of your tongue,
not even lurking in some obscure corner of your spleen.

It has floated away down a dark mythological river
whose name begins with an L as far as you can recall,
well on your own way to oblivion where you will join those
who have even forgotten how to swim and how to ride a bicycle.

No wonder you rise in the middle of the night
to look up the date of a famous battle in a book on war.
No wonder the moon in the window seems to have drifted
out of a love poem that you used to know by heart.

 

Link to WashPost piece on ‘biblio-amnesia’.
Link to Billy Collins poem text and audio (via @bfwriter)

Searching for the Alzheimer’s key

BBC Radio 4’s Crossing Continents has an excellent programme on how an extended family in Colombia with an inherited form of dementia are providing clues that may help us understand Alzheimer’s disease.

The research is being led by a group from the University of Antioquia in Colombia’s second city, Medellín, and has caused waves of excitement among those hoping for a new treatment for the condition.

The project was featured in The New York Times last year and we also covered some of the background to the research at the time.

It’s generally a great programme but my attention was caught by the programme’s description which makes out that the ethical problems are related to possible exploitation of a poor family in the developing world – when economics is really not the issue at hand.

The families do not have a significant financial benefit from their involvement and the debate is more over whether cognitively impaired people can fully consent to their participation.

It also concerns whether families, affected by incurable conditions that appear in young and middle aged people, are motivated by desperation for a cure when they might not understand that this is years away.

This is exactly the same issue that would face any family, anywhere in the world, so I’m not sure why the issue of the family being in the ‘developing world’ is particularly relevant.

The programme also discusses the risk that American could exploit scientists in the developing world.

I’ve been to the neuroscience centre discussed in the programme and it would put many Western research institutes to shame – it’s a modern, multi-disciplinary, high-powered research institute doing cutting edge science.

Not everything outside of Europe and the USA needs to be seen through the lens of poverty and exploitation. Usually, the science speaks for itself.
 

Link to Crossing Continents on leading dementia research.
Link to earlier NYT piece on the same research.

Where next for chronic fatigue after XMRV a bust

Nature News has an excellent piece reviewing the state of play after the first reports of the XMRV virus in people with chronic fatigue syndrome (CFS) have been put in doubt both by a string of failed replications and evidence of contamination in the original research samples.

Chronic fatigue syndrome or CFS is associated with diffuse body pain, persistent tiredness and loss of concentration and is controversial owing to the fact that some patient groups are determined to identify a ‘physical cause’ while many professionals understand and successfully treat it as having a significant ‘psychological’ component.

We covered the details of the intense debate last year, but the argument was heated further recently when first reports of a virus in some CFS patients have been shown to be extremely unlikely.

The hypothesis that the retrovirus has a role in chronic fatigue syndrome (CFS) has been dealt a serious blow by the publication of two damning papers in Science and an “expression of concern” from the journal’s editor over the original report that identified signs of XMRV infection in two-thirds of people with the condition but fewer than 4% of healthy people. The authors of that paper, led by Judy Mikovits at the Whittemore-Peterson Institute for Neuro-Immune Disease in Reno, Nevada, declined a request from Science to retract it, calling it “premature” in a statement.

“It’s a bust,” says Jonathan Stoye, a retrovirologist at the National Institute for Medical Research in London, part of the UK Medical Research Council (MRC), who was one of the fiercest critics of the association between XMRV and CFS. “People who are interested in this condition will have to move on.”

Yet scientists are not yet sure what the fallout will be for the future of research into CFS, also known as myalgic encephalomyelitis (ME)

The Nature News piece discusses where CFS research can go next now “XMRV’s 15 minutes of fame seem to be up” and whether this will reduce scientific interest in what is genuinely a debilitating condition.

Definitely worth a read.
 

Link to Nature news on ‘CFS: life after XMRV’ (via @edyong209).
Link to previous Mind Hacks post on roots of CFS controversy.

Carl Jung: a character of complexes

Carl Jung, the brilliant kaleidoscopic mind of psychoanalysis, died 50 years ago next week and The Guardian have the first part of a new series exploring his life and work.

In the history of psychology, Jung lives as a intense sunburst of experiences and ideas.

Sometimes the rays are so bright it’s hard to distinguish which are inspiration, which are psychosis, and which are a shining fusion of the two.

His life was equally as intriguing as his ideas and no less subject to both his brilliance and baffling self-indulgence.

He remains one of the most compelling figures in psychology this new series aims to capture some of his colourful life.
 

Link to ‘Carl Jung, part 1: Taking inner life seriously’.

Alice through the crooked glass

Not Exactly Rocket Science covers a fascinating study where participants felt they were the size of a doll or had expanded to giant proportions simply by using a headset, a camera and a bit of foot stroking.

In a typical experiment, a volunteer is being stroked while wearing a virtual reality headset. She’s lyng down and looking at her feet, but she doesn’t see them. Instead, the headset shows her the legs of a mannequin lying next to her.

As she watches, Bjorn van der Hoort, one of Ehrsson’s former interns, uses two rods to stroke her leg, and the leg of the mannequin, at the same time. This simple trick creates an overwhelming feeling that the mannequin’s legs are her own. If the legs belong to a Barbie, she feels like she’s the size of a doll. If the legs are huge, she feels like a 13-foot giant.

Van der Hoort performed this illusion on almost 200 people. Questionnaires revealed that they did indeed think of the mannequins as their own body parts. Familiar objects didn’t break the spell. When van der Hoort threatened the mannequins’ legs with a knife, the volunteers’ skin broke into a worried sweat, as if their real bodies were in danger. If he touched the doll’s legs with a pencil or his finger, the recruits thought they were being prodded by giant objects. Rather than feeling like dolls in a normal world, they felt like normal people in a giant world.

The researchers Not Exactly Rocket Science dub this the ‘Alice illusion’ after the changes in size experienced by the heroine in Alice in Wonderland.

These experiences can also be experienced as part of ‘Alice in Wonderland Syndrome’ which is usually associated with migraines or epilepsy (although they can occur without any brain disorder) likely due to them affecting the brain’s system for understanding the body’s relation to the surrounding space.

Temporary body-warping experiences are being created in the lab, however, in healthy normal folks and with surprisingly simple tricks.

The Not Exactly Rocket Science piece covers the latest delightful example.
 

Link to NERS on the ‘Alice illusion’.
Link to full text of scientific study.

From the bottom of my hard disk

The latest edition of RadioLab is a wonderful exploration of how we interact with machines and whether it is possible to simulate the humanity at the core of who we are.

While most discussions on this topic tend to focus on theoretical artificial intelligence of the future, the programme instead looks at technologies that attempt to connect with us emotionally and might already be allowing us to form intense emotional bonds to machines.

Both delightfully playful and profound, it covers everything from emulated romance to sentient toys.

We begin with a love story–from a man who unwittingly fell in love with a chatbot on an online dating site. Then, we encounter a robot therapist whose inventor became so unnerved by its success that he pulled the plug. And we talk to the man who coded Cleverbot, a software program that learns from every new line of conversation it receives…and that’s chatting with more than 3 million humans each month. Then, five intrepid kids help us test a hypothesis about a toy designed to push our buttons, and play on our human empathy. And we meet a robot built to be so sentient that its creators hope it will one day have a consciousness, and a life, all its own.

A beautiful hour of radio.
 

Link to RadioLab on ‘Talking to Machines’.

Animated psychiatry

Beards and Bowties is a wonderful animated short film about the outdated stereotypes of psychiatrists that still persist.

It’s been created by psychiatrist Kamran Ahmed and is a light-hearted exploration of how psychiatry is perceived by people he meets and others in the medical profession.

The film notes that the important speciality is stigmatised, not just by the general public but by other doctors, and it aims to show a more accurate picture of what psychiatry can be.

I note, however, that the film portrays other doctors and psychologists almost entirely as stereotypes, to the point where the psychiatrist shoves the bearded, pipe-smoking psychologist out of the way to show his medical certificate! Thanks colleague.

Psychodynamic types would probably mutter something about projective identification but I’d probably just mark it down as a little ironic.

However, the film is still hugely entertaining and captures the diversity of modern psychiatry.
 

Link to ‘Beards and Bowties’ on YouTube (via @rcpsych)

It came from the Amazon

The Guardian has a curious report about “the latest drug to emerge from South America” which is supposedly “twice as powerful as crack cocaine at just a fraction of the price”. What the journalist doesn’t know, I suspect, is that this is a common form of cocaine paste that is widely known around the region.

The article and video report tackle what is described as “a highly addictive mix of cocaine paste, gasoline, kerosene and quicklime called Oxi” that is supposedly highly hallucinogenic.

However, everything in the description of the drug and its appearance in the video seems to suggest it is just a new name for a widely used form of cheap cocaine paste known by the Spanish names basuco or paco.

For those not aware of how cocaine is produced from the coca leaf, a 1993 Forensic Science Review article (full-text mirrored here) outlined the usual stages of illegal manufacture.

Although ‘Oxi’ is described as including “gasoline, kerosene and quicklime” all of these are standard ingredients in the creation of cocaine paste itself, which itself is an intermediate stage in the production of powder or crack cocaine.

In fact, in the most common production process the subsequent stages just remove the unpleasant solvents, like gasoline and kerosene, from the cocaine paste to produce the purified product.

However, unrefined cocaine paste that still contains these chemicals is widely sold in South America as a cheap but nasty high. Refined cocaine is largely created for export but the paste mainly appears on the local market and is most prevalent in economically deprived areas.

It usually comes as a powder or as crack cocaine-like rocks that can be smoked for a short intense euphoria – which encourages frequent use – and a mid-brain dopamine boosting neurochemical profile that often induces paranoia and paranoid psychosis of exactly the sort described by users in the video.

My guess would be that ‘Oxi’ is just a new name being used to locally market this form of cocaine paste in the Brazilian area of the Amazon region whereas it is sold as basuco in the rest of the Spanish speaking areas.
 

Link to Guardian report about ‘Oxi’.
Link to mirror for paper on illegal cocaine production.
Link to search of scientific article on basuco (mainly in Spanish).

A reflection of the greatest

A surprising study has just appeared in The Journal of Personality and Social Psychology about whether narcissists realise what others think about their egotistical self-image.

Narcissism is a trait where people are more concerned about themselves than others and tend to think they are better and more important than their peers.

This has often been considered to be a form of self-delusion or self-serving cognitive bias, while this new study deliberately tested whether highly narcissistic realised what others thought about them.

The study came to the surprising conclusion that narcissism is usually accompanied by a crystal clear insight into how others don’t share the shining view that narcissists have of themselves.

You probably think this paper’s about you: Narcissists’ perceptions of their personality and reputation

J Pers Soc Psychol. 2011 May 23. [Epub ahead of print]

Carlson EN, Vazire S, Oltmanns TF.

Do narcissists have insight into the negative aspects of their personality and reputation? Using both clinical and subclinical measures of narcissism, the authors examined others’ perceptions, self-perceptions, and meta-perceptions of narcissists across a wide range of traits for a new acquaintance and close other (Study 1), longitudinally with a group of new acquaintances (Study 2), and among coworkers (Study 3).

Results bring 3 surprising conclusions about narcissists: (a) they understand that others see them less positively than they see themselves (i.e., their meta-perceptions are less biased than are their self-perceptions), (b) they have some insight into the fact that they make positive first impressions that deteriorate over time, and (c) they have insight into their narcissistic personality (e.g., they describe themselves as arrogant). These findings shed light on some of the psychological mechanisms underlying narcissism.

 

Link to PubMed entry for study.