Category: Remembering

Despite the news reports, researchers probably haven’t discovered a mention of ‘PTSD’ from 1300BC Mesopotamia. The claim is likely due to a rather rough interpretation of Ancient Babylonian texts but it also reflects a curious interest in trying to find modern psychiatric diagnoses in the past, which tells us more about our own clinical insecurities than the psychology of the ancient world.

The claim comes from a new article published in Early Science and Medicine and it turns out there’s a pdf of the article available online if you want to read it in full.

The authors cite some passages from Babylonian medical texts in support of the fact that ‘symptoms of posttraumatic stress disorder’ were recorded in soldiers. Here are the key translated passages from the article:

14.34 “If his words are unintelligible for three days […] his mouth [F…] and he experiences wandering about for three days in a row F…1.”

14.35 “He experiences wandering about (for three) consecutive (days)”; this means: “he experiences alteration of mentation (for three) consecutive (days).”

14.36 “If his words are unintelligible and depression keeps falling on him at regular intervals (and he has been sick) for three days F…]”

19.32 “If in the evening, he sees either a living person or a dead person or someone known to him or someone not known to him or anybody or anything and becomes afraid; he turns around but, like one who has [been hexed with?] rancid oil, his mouth is seized so that he is unable to cry out to one who sleeps next to him, ‘hand’ of ghost (var. hand of […]).”

19.33 “[If] his mentation is altered so that he is not in full possession of his faculties, ‘hand’ of a roving ghost; he will die.”

19.34 “If his mentation is altered, […] (and) forgetfulness(?) (and) his words hinder each other in his mouth, a roaming ghost afflicts him. (If) […], he will get well.”

Firstly, it’s clearly a huge stretch to suggest these are symptoms of PTSD which is defined as groupings of intrusive memories of the traumatising event, heightened arousal or emotional numbing, avoidance of reminders and, since the DSM-5, depression-like symptoms.

The authors suggest that the strongest evidence for the fact that the ancient descriptions are PTSD is that the ‘ghost’ mentioned in the text is often considered to be the ghosts of enemies whom the patient killed during military operations, and these could be PTSD-like flashbacks.

The trouble is that ‘ghosts’ are given as causes of many disorders in Babylonian medicine. Furthermore, all of the symptoms the authors describe could clearly also describe epilepsy and, in fact, are described in Babylonian texts on epilepsy.

For example, these are all symptoms described in BM 47753 a Babylonian tablet on epilepsy, discussed a 1990 article, that also describes wandering, confusion and unintelligible speech.

If he keeps going into and out of (his house) or getting into and out of his clothes .. or talks unintelligibly a great deal, does not any more eat his bread and beer rations and does not go to bed…

If, in a state of fear, he keeps getting up and sitting down, (or) if he mutters unintelligibly a great deal and becomes more and more restless…

Most symptoms are diagnosed as a form of being touched by the hand of a supernatural being. Below are some ‘ghost’ afflictions that are clearly epilepsy related, including ‘ghosts’ who have died violently in various ways, including a ‘mass killing’.

If at the end of his fit his limbs become paralysed, he is dazed (or, dizzy), his abdomen is “wasted” (sc., as of one in need of food) and he returns everything which is put into his mouth …….-hand of a ghost who has died in a mass killing.

If when his limbs become at rest again like those of a healthy person his mouth is seized so that he cannot speak,-hand of the ghost of a murderer. R: hand of the ghost of a person burned to death in a fire.

If when his limbs become at rest again like those of a healthy person he remains silent and does not eat anything,-hand of the ghost of a murderer; alternatively, hand of the ghost of a person burned to death in a fire

Oddly, the authors of the ‘ancient PTSD’ article suggest that references to slurring of speech and cognitive difficulties might reflect co-morbid drug abuse. They also admit that all their cited symptoms could be caused by head injury but as prognosis is given as non-fatal, they were probably PTSD-related. But again, epilepsy seems a much better fit here both from a contemporary and Babylonian perspective.

In fact, historians Kinnier Wilson and Reynolds, who wrote the 1990 article on Babylonian epilepsy texts, were quite convinced that references to ‘ghosts’ were ancient terms for nocturnal epilepsy, not ‘flashbacks’.

But it’s also worth mentioning that the ‘ancient PTSD’ argument is in a long-line of studies that attempt to match contemporary psychiatric diagnoses to vague historical references as a way of legitimising the modern concepts.

However, the ways in which psychological distress, particularly trauma, is expressed are massively affected by culture. PTSD is unlikely to be a concept that transcends time, place and social structure.

In fact, historians have not been able to convincingly find any PTSD-like descriptions in history and there seems a virtually complete absence of any records of flashbacks in the medical records of First and Second World War veterans, let alone in Ancient Babylon.

War, violence and tragedy has left its psychological mark on individuals from the beginning of time.

PTSD is a useful diagnosis we’ve created to help us deal with some of the consequences of these awful events in the limited but important contexts in which it occurs – but it’s not a universal feature of human nature.

Who knows whether anything like PTSD existed for the Babylonians but the fact that we can use it to help people is all we need to legitimise it.

I’ve just found a curious article in the scientific journal Clinical Anatomy which reprints a Victorian story called ‘Celebrating new year in Bart’s dissecting room’ where the corpses come to life. It finishes with some interesting observations about the psychological impact of dissecting a dead body as a rite of passage for medical students.

The story is of “a somewhat desultory student” who has been treating the body on which he has been working disrespectfully and is reminded of its humanity as it comes to life. “As a result, he resolves to behave differently in the future”.

The authors of the article, which reprints the story, discuss its modern day relevance for young medical students faced with a dead body they have to cut up.

In some dissecting rooms, even into the twentieth century, the dead were still being treated with irreverence and levity (Smith, 1984).

Today, it is understood that some of these behaviors may result from unresolved tensions. Recent studies by Hafferty (1991), Horne et al. (1990), and Gustavson (1988), have shown that first reactions to the dissecting room and to dissection itself may include faintness, physical symptoms of unease, even flight. Anxiety may be expressed as embarrassment, levity, or bravado.

Coping mechanisms include the bestowal by students of fictitious names or speculative personalities or life stories upon the dead. A curious sort of bond can develop between the student and the “person” of the dead body. The emotional experience contrasts with and supplements students’ efforts to internalize anatomical knowledge. There may evolve a sense of familiarity, contact and intimacy, mixed perhaps with a sense of transgression or guilt, and of obligation.

For those not from the UK, ‘Barts’ refers to St Bartholomew’s Hospital which is the oldest working hospital in Europe and probably best known for being associated with Sherlock Holmes.

The article is open, so you can read it online in full.
 

Link to ‘Celebrating new year in Bart’s dissecting room’.

London’s innovative biomedical centre, the Wellcome Collection, have created a fascinating interactive story on how ‘mesmerism’ and hypnosis played an important role in the history of mind and madness.

It’s written by the fantastic Mike Jay, who has penned many excellent books on the high-strangeness of the early science of the mind in the 1800s, and has been wonderfully realised as an interactive web site.

It’s called ‘Mindcraft: a story of madness, murder and mental healing’ and rather curiously, but also rather usefully, it has its own trailer.

After you’ve gone to the website, you just need to keep scrolling down to work through the story and you’ll be diverted into video, narrative and text along the way.
 

Link to Mindcraft.

For such an obscure corner of the medical literature, Cotard’s delusion is remarkably well known as the delusion that you’re dead. This was supposedly first described by Jules Cotard in 1880 but I seem to have found a description from 1576.

It’s worth noting that although Cotard’s delusion has come to represent ‘the delusion that you’re dead’, Jules Cotard’s original description was not actually that – it was a delusion of negation where the patient believed, as noted by Berrios and Luque, that she had “no brain, nerves, chest, or entrails, and was just skin and bone”, that “neither God or the devil existed”, and that she did not need food for “she was eternal and would live forever”.

In its modern use, Cotard’s delusion typically refer to the belief that you’re dead, you don’t exist, or that your body is rotting or absent. It is rare but can occur in severe psychosis.

While spending my weekend reading Basil Clarke’s book Mental Disorder in Earlier Britain (yes kids, I’m like Snoop Dogg but for out of print history of psychiatry books), I found a mention of not one but possibly two cases of Cotard delusion.

They were apparently described Levinus Lemnius’s 1576 book The Touchstone of Complexions, as Clarke recounts:

A ‘Hypochondriake person’ was unshakeably convinced that frogs and toads were eating his entrails. This was accepted, and he was given purges and enemas, the doctor slipping ‘crawlynge vermyne’ into the pot to satisfy him. A case of a man who thought his buttocks were made of glass was incomplete. Another patient had fallen into ‘such an agonie, & fooles paradise’ that he thought he was dead and gave up eating. After a week, friends came into the dark parlour in shrouds and settled down for a meal. The ‘Passioned Party’, on asking, was told that they were dead and that dead men ate and drank. ‘Straightwayes skipped this Pacient out of his Bedde and joined them.’ After supper he was given a sleeping draught.

The mention of the man who believed he had glass buttocks is also interesting as this is the glass delusion, the belief that you are made of glass and might shatter.

This was apparently common in cases of madness during the Late Middle Ages but is now virtually non-existent. Famously, it affected Charles VI of France.

An article in the American Journal of Forensic Medicine & Pathology discusses the history of ‘modern toxic antipersonnel projectiles’ and it has a short history of ammunition designed to introduce incapacitating hallucinogenic substances into the body.

As you might expect for such an unpleasant idea (chemical weapon hand guns!) they were wielded by some fairly unpleasant people

The Nazi Institute of Criminology then ordered a batch of more powerful 9-mm Parabellum cartridges that could be used with the Walther P38. This time the bullets contained Ditran, a mixture of 2 structural isomers comprising approximately 70% 1-ethyl-2-pyrrolidinylmethyl-alpha-phenylcyclopentylglycolate and 30% 1-ethyl-3-piperidyl-alpha-phenylcyclopentylglycolate (also known as Ditran B). Ditran B is the more active of the 2 isomers, both of which are strong anticholinergic drugs with hallucinogenic properties similar to those of scopolamine. Victims are thrown into such a state of mental confusion that they are incapable of reacting appropriately to the situations they find themselves in…

3-Quinuclidinyl benzilate, also known as QNB and coded BZ by NATO, is a military incapacitating agent. Like Ditran, it is an anticholinergic causing such intense mental confusion as to prevent any effective reaction against an enemy. These bullets were featured in the arsenal of the Serbian forces invading Bosnia-Herzegovina, particularly in Srebrenica in the 1990s.

 

Link to locked article ‘Modern Toxic Antipersonnel Projectiles’

You may think you know your own mind, but when it comes to memory, research suggests that you don’t. If we’re trying to learn something, many of us study in ways that prevent the memories sticking. Fortunately, the same research also reveals how we can supercharge our learning.

We’ve all had to face a tough exam at least once in our lives. Whether it’s a school paper, university final or even a test at work, there’s one piece of advice we’re almost always given: make a study plan. With a plan, we can space out our preparation for the test rather than relying on one or two intense study sessions the night before to see us through.

It’s good advice. Summed up in three words: cramming doesn’t work. Unfortunately, many of us ignore this rule. At least one survey has found that 99% of students admit to cramming.

You might think that’s down to nothing more than simple disorganisation: I’ll admit it is far easier to leave things to the last minute than start preparing for a test weeks or months ahead. But studies of memory suggest there’s something else going on. In 2009, for example, Nate Kornell at the University of California, Los Angeles, found that spacing out learning was more effective than cramming for 90% of the participants who took part in one of his experiments – and yet 72% of the participants thought that cramming had been more beneficial. What is happening in the brain that we trick ourselves this way?

Studies of memory suggest that we have a worrying tendency to rely on our familiarity with study items to guide our judgements of whether we know them. The problem is that familiarity is bad at predicting whether we can recall something.

Familiar, not remembered

After six hours of looking at study material (and three cups of coffee and five chocolate bars) it’s easy to think we have it committed to memory. Every page, every important fact, evokes a comforting feeling of familiarity. The cramming has left a lingering glow of activity in our sensory and memory systems, a glow that allows our brain to swiftly tag our study notes as “something that I’ve seen before”. But being able to recognise something isn’t the same as being able to recall it.

Different parts of the brain support different kinds of memory. Recognition is strongly affected by the ease with which information passes through the sensory areas of our brain, such as the visual cortex if you are looking at notes. Recall is supported by a network of different areas of the brain, including the frontal cortex and the temporal lobe, which coordinate to recreate a memory from the clues you give it. Just because your visual cortex is fluently processing your notes after five consecutive hours of you looking at them, doesn’t mean the rest of your brain is going to be able to reconstruct the memory of them when you really need it to.

This ability to make judgements about our own minds is called metacognition. Studying it has identified other misconceptions too. For instance, many of us think that actively thinking about trying to learn something will help us remember it. Studies suggest this is not the case. Far more important is reorganising the information so that it has a structure more likely to be retained in your memory. In other words, rewrite the content of what you want to learn in a way that makes most sense to you.

Knowing about common metacognitive errors means you can help yourself by assuming that you will make them. You can then try and counteract them. So, the advice to space out our study only makes sense if we assume that people aren’t already spacing out their study sessions enough (a safe assumption, given the research findings). We need to be reminded of the benefits of spaced learning because it runs counter to our instinct to relying on a comforting feeling of familiarity when deciding how to study

Put simply, we can sometimes have a surprising amount to gain from going against our normally reliable metacognitive instinct. How much should you space out your practice? Answer: a little bit more than you really want to.

This my BBC Future article from last week. The original is here

There’s an amusing passage in Andrew Solomon’s book Far From the Tree where he recounts his own experience of a curious attempt at surrogate partner therapy – a type of sex therapy where a ‘stand in’ partner engages with sexual activity with the client to help overcome sexual difficulties.

In Solomon’s case, he was a young gay man still confused about his sexuality who signed himself up to a cut-price clinic to try and awaken any possibility of ‘hidden heterosexual urges’.

It’s a curious historical snapshot, presumably from the early 1980s, but also quite funny as Solomon dryly recounts the futile experience.

When I was nineteen, I read an ad in the back of New York magazine that offered surrogate therapy for people who had issues with sex. I still believed the problem of whom I wanted was subsidiary to the problem of whom I didn’t want. I knew the back of a magazine was not a good place to find treatment, but my condition was too embarrassing to reveal to anyone who knew me.

Taking my savings to a walk-up office in Hell’s Kitchen, I subjected myself to long conversations about my sexual anxieties, unable to admit to myself or the so-called therapist that I was actually just not interested in women. I didn’t mention the busy sexual life I had by this time with men. I began “counselling” with people I was encouraged to call “doctors,” who would prescribe “exercises” with my “surrogates” – women who were not exactly prostitutes but who were also not exactly anything else.

In one protocol, I had to crawl around naked on all fours pretending to be a dog while the surrogate pretended to be a cat; the metaphor of enacting intimacy between mutually averse species is more loaded than I noticed at the time. I became curiously fond of these women, one of whom, an attractive blonde from the Deep South, eventually told me she was a necrophiliac and had taken this job after she got into trouble down the morgue.

You were supposed to keep switching girls so your ease was not limited to one sexual partner; I remember the first time a Puerto Rican woman climbed on top of me and began to bounce up and down, crying ecstatically, “You’re in me! You’re in me!” and how I lay there wondering with anxious boredom whether I had finally achieved the prize and become a qualified heterosexual.

Surrogate partner therapy is still used for a variety of sexual difficulties, although only fringe clinics now use it for pointless ‘gay conversion therapy’.

Although it is clearly in line with good psychological principles of experiential therapy, it has been quite controversial because of fears about being, as Solomon says, “not exactly prostitutes” along with some well-founded ethical concerns.

In the UK, the first bona fide clinic that used surrogate partner therapy was started in the 1970s and run by the sexologist Martin Cole – who was best known to the British public by his actually rather wonderful tabloid nickname Sex King Cole.

He spent several decades scandalising the establishment with his campaign for open and direct sex education and unstigmatised treatment of sexual dysfunction.

You can see the extent to which he rattled the self-appointed defenders of English morality by his mentions in parliamentary speeches made by concerned MPs who retold second-hand tales of scandal supposedly from Cole’s clinics.

This 1972 speech by MP Jill Knight veers from the melodramatic to the farcical as she describes how a sex surrogate “was with a client when a thunderous knocking occurred on the door and the glass panels in the door revealed a blue-clad figure topped by a policeman’s helmet. She knew at once that it was her fiance, who happened to be a policeman.”

If you want an up-to-date and level-headed discussion of surrogate partner therapy, an article by sex researcher Petra Boyton is a good place to start, and its something we’ve covered previously on Mind Hacks.

As for Cole, The Independent tracked him down, still working, in 1993, and wrote a somewhat wry profile of him.

The past is not just a foreign country, but also one we are all exiled from. Like all exiles, we sometimes long to return. That longing is called nostalgia.

Whether it is triggered by a photograph, a first kiss or a treasured possession, nostalgia evokes a particular sense of time or place. We all know the feeling: a sweet sadness for what is gone, in colours that are invariably sepia-toned, rose-tinted, or stained with evening sunlight.

The term “nostalgia” was coined by Swiss physicians in the late 1600s to signify a certain kind of homesickness among soldiers. Nowadays we know it encompasses more than just homesickness (or indeed Swiss soldiers), and if we take nostalgia too far it becomes mawkish or indulgent.

But, perhaps, it has some function beyond mere sentimentality. A series of investigations by psychologist Constantine Sedikides suggest nostalgia may act as a resource that we can draw on to connect to other people and events, so that we can move forward with less fear and greater purpose.

Sedikides was inspired by something called Terror Management Theory (TMT), which is approximately 8,000 times sexier than most theories in psychology, and posits that a primary psychological need for humans is to deal with the inevitability of our own deaths. The roots of this theory are in the psychoanalytic tradition of Sigmund Freud, making the theory a bit different from many modern psychological theories, which draw on more mundane inspirations, such as considering the mind as a computer.

Experiments published in 2008 used a standard way to test Terror Management Theory: asking participants to think about their own deaths, answering questions such as: “Briefly describe the emotions that the thought of your own death arouses in you.” (A control group was asked to think about dental pain, something unpleasant, but not existentially threatening.)

TMT suggests that one response to thinking about death is to cling more strongly to the view that life has some wider meaning, so after their intervention they asked participants to indicate their agreement with statements such as: “Life has no meaning or purpose”, or “All strivings in life are futile and absurd”. From the answers they positioned participants on a scale of how strongly they felt life had meaning.

The responses were influenced by how prone people were to nostalgia. The researchers found that reminding participants of their own deaths was likely to increase feelings of meaninglessness, but only in those who reported that they were less likely to indulge in nostalgia. Participants who rated themselves as more likely than average to have nostalgic thoughts weren’t affected by negative thoughts about their mortality (they rated life as highly meaningful, just like the control group).

Follow-up experiments suggest that people prone to nostalgia were less likely to have lingering thoughts about death, as well as less likely to be vulnerable to feelings of loneliness. Nostalgia, according to this view, is very different from a weakness or indulgence. The researchers call it a “meaning providing resource”, a vital part of mental health. Nostalgia acts a store of positive emotions in memory, something we can access consciously, and perhaps also draw on continuously during our daily lives to bolster our feelings. It’s these strong feelings for our past that helps us cope better with our future.

Thanks to Jules Hall for suggesting the topic of nostalgia. If you have an everyday psychological phenomenon you’d like to see written about in these columns please get in touch @tomstafford or ideas@idiolect.org.uk

This was my BBC Future column from last week. The original is here.

A slide from what looks like a fascinating talk by memory researcher Robert Bjork is doing the rounds on Twitter.

The talk has just happened at the Association for Psychological Science 2014 conference and it describes some ‘Important peculiarities of memory’.

You can click the link above if you want to see if the image, but as it’s a little fuzzy, I’ve reproduced Robert Bjork’s text below:
 

Important peculiarities of the human memory system

• A remarkable capacity for storing information is coupled with a highly fallible retrieval process.
• What is accessible in memory is highly dependent on the current environmental, interpersonal, emotional and body-state cues.
• Retrieving information from memory is a dynamic process that alters the subsequent state of the system.
• Access to competing memory representations regresses towards the earlier representation over time

 

A lovely summary of memory’s quirks.
 

Link to Robert Bjork’s staff page.
Link to APS 2014 page with videos of the keynote talks.

The BBC News site has a special multimedia feature on a case of false confession to murder that has been been troubling Iceland from the 1970s and has recently erupted again.

The Beeb have clearly gone a bit ‘Scandinavian detective drama’ on the whole thing but it is a gripping story, not least because it involves forensic psychology legend Gisli Gudjonsson who worked on the case when he was a young police officer and later when he became a leading expert in false confessions.

In many ways, it’s a classic case of memory distrust syndrome where accused people begin to distrust what they remember and begin to believe what’s been suggested to them. In this case, through pressure of interrogation, use of memory affecting drugs and already being motivated to comply.

It’s a fascinating case and not fully resolved – a final investigation into the miscarriage of justice is about to be published by the Icelandic government.
 

Link to ‘The Reykjavik Confessions’

British Pathé, the vintage news organisation, have released all of their archive online including some fascinating newsreels on psychiatric institutions of times past.

A particularly interesting film is Inside Rampton! a 1957 newsreel which focuses on Rampton Secure Hospital – which was, and still is, one of England’s three highest security psychiatric hospitals.

The others are Ashworth and the more widely known Broadmoor Hospital – all three of which are designed to treat mental illness in people who pose a serious risk to the public.

On of the points of the film is to report on the hospital following accusations, common at the time, that people were admitted to the institution despite having ‘nothing wrong with them’ and that patients were subject to harsh treatment.

You can read about the controversy in this 1957 Spectator article that talks about the classic and still relevant tension in forensic mental health services between treatment and legal sanction.

Both the film and the article mention the case of Marie Mayo, who was sent to the hospital due to an ‘administrative error’ causing a significant scandal. One of the other Pathé films is a brief report on her release and return home.

There was widespread public concern at the time that psychiatric institutions were randomly locking people up and that residents were subject to abuse.

The Inside Rampton! film is the first wave of serious concern that subsequently led to Enoch Powell’s ‘water tower’ speech and the political moves to bring down the asylum system, as well as the anti-psychiatry movement and its push for a radical approach to mental distress.
 

Link to Inside Rampton! on YouTube.
Link to Spectator article ‘Heartbreak among the roses’.