A visual history of madness

The Paris Review has an extended and richly illustrated piece by historian Andrew Scull who tracks how madness has been visually depicted through the ages.

Scull is probably the most thorough and readable historian of madness since the death of the late, great Roy Porter, and this article is no exception.

Modern psychiatry seems determined to rob madness of its meanings, insisting that its depredations can be reduced to biology and nothing but biology. One must doubt it. The social and cultural dimensions of mental disorders, so indispensable a part of the story of madness and civilization over the centuries, are unlikely to melt away, or to prove no more than an epiphenomenal feature of so universal a feature of human existence. Madness indeed has its meanings, elusive and evanescent as our attempts to capture them have been.

By the way, most of the illustrations in the web article seem to be clickable for high resolution full screen versions, so you can see them in full detail.

Link to Madness and Meaning in Paris Review.

Half a century of neuroscience

The Lancet has a good retrospective looking back on the last 50 years of neuroscience, which in some ways, was when the field was born.

Of course, the brain and nervous system has been the subject of study for hundreds, if not thousands, of years but the concept of a dedicated ‘neuroscience’ is relatively new.

The term ‘neuroscience’ was first used in 1962 by biologist Francis Schmitt who previously referred to the integrated study of mind, brain and behaviour by the somewhat less catchy title “biophysics of the mind”. The first undergraduate degree in neuroscience was offered by Amherst College only in 1973.

The Lancet article, by one of the first generation ‘neuroscientists’ Steven Rose, looks back at how the discipline began in the UK (in a pub, as most things do) and then widens his scope to review how neuroscience has transformed over the last 50 years.

But many of the problems that had beset the early days remain unresolved. Neuroscience may be a singular label, but it embraces a plurality of disciplines. Molecular and cognitive neuroscientists still scarcely speak a common language, and for all the outpouring of data from the huge industry that neuroscience has become, Schmitt’s hoped for bridging theories are still in short supply. At what biological level are mental functions to be understood? For many of the former, reductionism rules and the collapse of mind into brain is rarely challenged—there is even a society for “molecular and cellular cognition”—an elision hardly likely to appeal to the cognitivists who regard higher order mental functions as emergent properties of the brain as a system.

It’s an interesting reflection on how neuroscience has changed over its brief lifespan from one of the people who were there at the start.

Link to ’50 years of neuroscience’ in The Lancet.

A misdiagnosis of trauma in Ancient Babylon

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.

A new year with an old friend

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’.

The celebrity analysis that killed celebrity analysis

Most ‘psy’ professionals are banned by their codes of conduct from conducting ‘celebrity analysis’ and commenting on the mental state of specific individuals in the media. This is a sensible guideline but I didn’t realise it was triggered by a specific event.

Publicly commenting on a celebrity’s psychological state is bad form. If you’ve worked with them professionally, you’re likely bound by confidentiality, if you’ve not, you probably don’t know what you’re talking about and doing so in the media is likely to do them harm.

Despite this, it happens surprisingly often, usually by ‘celebrity psychologists’ in gossip columns and third-rate TV. Sadly, I don’t know of a single case where a professional organisation has tried to discipline the professional for doing so – although it must be said that mostly it’s done by self-appointed ‘experts’ rather than actual psychologists.

A new article in Journal of the American Academy of Psychiatry and the Law traced the history of how this form of ‘celebrity analysis’ first got banned in the US under the ‘Goldwater Rule’.

The Goldwater Rule stemmed from a scandal surrounding a 1964 publication in Fact magazine that included anonymous psychiatric opinions commenting on Senator Barry Goldwater‘s psychological fitness to be President of the United States. Fact, a short-lived magazine published in the 1960s, carried opinionated articles that covered a broad range of controversial topics. In the 1964 September/October issue entitled, “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater,” the opinions of over 1,800 psychiatrists commenting on Goldwater’s psychological fitness were published…

Of the 2,417 respondents, 571 deferred from providing comments, 657 responded that Goldwater was fit to be president, and 1,189 responded that he was not fit. None of the psychiatrists whose comments were published had examined Goldwater, however, and none had permission from him to issue their comments publicly. In the article, Goldwater was described with comments including “lack of maturity”, “impulsive”, “unstable”, “megalomaniac”, “very dangerous man”, “obsessive-compulsive neurosis”, and “suffering a chronic psychosis”… Much was made of two nervous breakdowns allegedly suffered by Goldwater, and there was commentary warning that he might launch a nuclear attack if placed under a critical amount of stress as president.

Goldwater responded by bringing libel action against Ralph Ginzburg, Warren Boroson, and Fact… The United States District Court for the Southern District of New York returned a verdict in favor of the senator… The AMA and APA immediately condemned the remarks made in the Fact article after its publication. Individual psychiatrists also spoke out against the ethics of the published comments.

Most people who are subject to ‘celebrity analysis’ don’t have the luxury of bringing libel suits to defend themselves but it’s probably worth remembering that if someone is seeming to give a professional opinion on someone’s psychological state whom they’ve never met, they’re probably talking rubbish.

Link to article on ‘Psychiatrists Who Interact With the Media’

Madness, murder and mental healing

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.

Cushing’s abandoned brains

I’ve just found a great short documentary about the abandoned brain collection of pioneering neurosurgeon Harvey Cushing.

The video describes how Cushing’s archives, which genuinely involved hundreds of brains in jars, as well as rare slides and photos of the early days of brain surgery, were rediscovered in the basement of Yale University and restored to public view.

Cushing is often called the ‘father of modern neurosurgery’ and spent a lot of time studying brain pathology by archiving and classifying tumours, bleeds and post-mortem brains in jars for others to learn from, as well as creating amazing medical illustrations – including the one below.

This archive became less necessary as technology moved on and the brain collection was moved into the basement below the medical school dormitories at Yale University and forgotten about.

The archives were eventually found again and restored as the Cushing Center which is now open to the public.

While the video focuses on the brains, Morbid Anatomy put some of the photos of patients from the archive online which are quite striking in themselves.

Link to Cushing’s Brains documentary on YouTube.
Link to Morbid Anatomy gallery of Cushing’s photos.