An earlier illusory death

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.

Hallucinogenic bullets

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’

A Rush of Blood to the Brain

An article from Culture, Medicine, and Psychiatry that discusses the concept of ‘moral disability’ and brain trauma in Victorian times includes a fascinating section on what was presumably thought to be the science of ‘knocking some sense into the brain’.

The piece is by medical historian Brandy Shillace who researches Victorian scientific ideas and how they affected society.

Sadly, the article is locked (quite rightly, humanities can kill if not used correctly) but this is the key section:

While eighteenth-century French philosopher François Bichat had suggested that a blow suffered to one side of the head might restore the good senses of the disordered side, Wigan’s work suggested that “where such mental derangement depends on inflammation, fever, impoverished or diseased blood, or other manifestly bodily disease,” it could be cured by actively seeking and rooting out the source, by trephining the brain or otherwise subduing the offending hemisphere… The Lancet was replete with unusual cases of brain trauma and its curious results, many that seemed to support Wigan in his assumptions about physical trauma, variously applied.

I performed a survey from 1839 to 1858 and discovered a case of brain trauma in numerous issues, eight of which were particularly revelatory of the unusual nature of the brain and its hemispheres. The 1843 account of Dr. Peter S. Evans, “Derangement of the Brain by a Sudden Shock and Its Recovery,” claims that a boy was beaten into idiocy, and then beaten out of it again (regaining his full senses after being whipped by a cart driver). One of Wigan’s cases describes a young gentleman in a “paroxysm of maniacal delirium” who shot himself sane.

Not recommended.

Link to locked article in Culture, Medicine, and Psychiatry

Why our faith in cramming is mistaken

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

Seeing ourselves through the eyes of the machine

I’ve got an article in The Observer about how our inventions have profoundly shaped how we view ourselves because we’ve traditionally looked to technology for metaphors of human nature.

We tend to think that we understand ourselves and then create technologies to take advantage of that new knowledge but it usually happens the other way round – we invent something new and then use that as a metaphor to explain the mind and brain.

As history has moved on, the mind has been variously explained in terms of a wax tablets, a house with many rooms, pressures and fluids, phonograph recordings, telegraph signalling, and computing.

The idea that these are metaphors sometimes gets lost which, in some ways, is quite worrying.

It could be that we’ve reached “the end of history” as far as neuroscience goes and that everything we’ll ever say about the brain will be based on our current “brain as calculation” metaphors. But if this is not the case, there is a danger that we’ll sideline aspects of human nature that don’t easily fit the concept. Our subjective experience, emotions and the constantly varying awareness of our own minds have traditionally been much harder to understand as forms of “information processing”. Importantly, these aspects of mental life are exactly where things tend to go awry in mental illness, and it may be that our main approach for understanding the mind and brain is insufficient for tackling problems such as depression and psychosis. It could be we simply need more time with our current concepts, but history might show us that our destiny lies in another metaphor, perhaps from a future technology.

I mention Douwe Draaisma’s book Metaphors of Memory in the article but I also really recommend Alison Winter’s book Memory: Fragments of a Modern History which also covers the fascinating interaction between technological developments and how we understand ourselves.

You can read my full article at the link below.

Link to article in The Observer.

The concept of stress, sponsored by Big Tobacco

NPR has an excellent piece on how the scientific concept of stress was massively promoted by tobacco companies who wanted an angle to market ‘relaxing’ cigarettes and a way for them to argue that it was stress, not cigarettes, that was to blame for heart disease and cancer.

They did this by funding, guiding and editing the work of renowned physiologist Hans Selye who essentially founded the modern concept of stress and whose links with Big Tobacco have been largely unknown.

For the past decade or so, [Public Health Professor Mark] Petticrew and a group of colleagues in London have been searching through millions of documents from the tobacco industry that were archived online in the late ’90s as part of a legal settlement with tobacco companies.

What they’ve discovered is that both Selye’s work and much of the work around Type A personality were profoundly influenced by cigarette manufacturers. They were interested in promoting the concept of stress because it allowed them to argue that it was stress — not cigarettes — that was to blame for heart disease and cancer.

“In the case of Selye they vetted … the content of the paper, they agreed the wording of papers,” says Petticrew, “tobacco industry lawyers actually influenced the content of his writings, they suggested to him things that he should comment on.”

They also, Petticrew says, spent a huge amount of money funding his research. All of this is significant, Petticrew says, because Selye’s influence over our ideas about stress are hard to overstate. It wasn’t just that Selye came up with the concept, but in his time he was a tremendously respected figure.

Despite the success of the campaign to associate smoking with stress relief, the idea that smoking alleviates anxiety is almost certainly wrong. It tends to just relieve anxiety-provoking withdrawal and quitting smoking reduces overall anxiety levels.

Although the NPR article focuses on Selye and his work on stress, another big name was recruited by Big Tobacco to promote their theories.

It’s still little known that psychologist Hans Eysenck took significant sums of cash from tobacco companies.

They paid for a lot of Eysenck’s research that tried to show that the relationship between lung cancer and smoking was not direct but was mediated by personality differences. There was also lots of other research arguing that a range of smoking related health problems were only present in certain personality types.

Tobacco companies wanted to fund this research to cite it in court cases where they were defending themselves against lung cancer sufferers. It was their personalities, rather than their 20-a-day habit, that was a key cause behind their imminent demise, they wanted to argue in court, and they needed ‘hard science’ to back it up. So they bought some.

However, the link between ‘father of stress’ Hans Seyle and psychologist Hans Eysenck was not just that they were funded by the same people.

A study by Petticrew uncovered documents showing that both Seyle and Eysenck appeared in a 1977 tobacco industry promotional film together where “the film’s message is quite clear without being obvious about it — a controversy exists concerning the etiologic role of cigarette smoking in cancer.”

The ‘false controversy’ PR tactic has now became solidified as a science-denier standard.

Link to The Secret History Behind The Science Of Stress from NPR.
Link to paper ‘Hans Selye and the Tobacco Industry’.

Memories of ‘hands on’ sex therapy

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.