Category: Theory

The Journal of the Royal Society of Medicine just published a recent, and, presumably, slightly tongue in cheek article, drawing parallels between psychiatry, clinical psychology and traditional religious practices.

In reality, it’s not really attempting to address the question of whether psychiatry is a form of religion. Instead, it’s really asking whether psychiatry is now fulfilling some of the social roles that, for many people, were previously occupied by religion.

These include parallels between confession and therapy, proselytization and mental health campaigns, religious hierarchy and medical authority, sacraments and medication, and holy texts and diagnostic manuals.

The ‘psychiatry is a religion’ argument is weak, however, as despite similarities in some functions, none of these are core features of religion. As identified by cognitive anthropologist Pascal Boyer, the single common feature of all religious is a preoccupation with unseen sentient beings, of which psychiatry says nothing.

In fact, mainstream psychiatry remains firmly materialist – usually re-explaining experiences that many people attribute to spirits, forces or unseen influences as biological dysfunction. So, in the most fundamental sense, the practice of psychiatry is typically contra-religious.

You could argue that this is ‘replacing’ religion through colonising the spiritual sphere of explanation, but this makes it no more a religion than physics or evolutionary biology.

However, the article is interesting as it reflects an almost extinct genre in mainstream medical debate – a Thomas Szasz style view of psychiatry as a medical intrusion into an essentially social phenomenon. Namely, the classification and regulation of deviance, and the easing of distress caused by social maladjustment and existential crises.

The piece is probably better read as a concern about how medical theories have become the standard explanation for problems of human living, to the point where we assume that psychiatry can be an organising force in society.

Link to article ‘Is psychiatry a religion?’
Link to PubMed entry for same.

Neurophilosophy has a great post about how amnesia is represented in cinema, concluding that there’s only three movies that accurately represent memory loss.

The post is based on an article from the British Medical Journal by clinical neuropsychologist Sallie Baxendale who has written a number of excellent articles on topics such as epilepsy in music, at movies, and in the saints.

The three films mentioned as accurate depictions of amnesia are the masterpiece Memento, Spanish language film Sé Quién Eres, and, surprisingly, the Disney animated feature Finding Nemo.

The Neurophilosophy article is also illustrated with video clips so you can see some of the films under discussion.

Link to Neurophilosophy on ‘Amnesia at the movies’.

March’s Prospect magazine has an excellent article on ‘experimental philosophy’ that gives a good overview of an exciting new branch of philosophy as well as picking up on some of the growing criticisms and detractors.

The first half of the article covers the current methods and strands of thought in the field, discussing brain scans, trolley problems and intentionality. If you’re familiar with the ‘x-phi’ movement this is really just a well-written recap.

However, the second half tackles criticisms of the field by more established philosophers and is a useful counter-point to much of the unfettered enthusiasm which has gripped the recent media reports.

Points of disagreement include relying on the fuzzy data of brain scans, the fact that the field aims to find out about what people think in general rather than building the soundest conceptual solutions, and the accusation that it’s “a cynical step by researchers to appear cutting edge and to tap into scientists‚Äô funding”.

Ouch. If you’re not wincing already, it’s probably worth noting that this is the philosophical equivalent of saying your girlfriend looks fat in her new dress.

The piece finishes on the interesting idea that perhaps one of the field’s main contributions is to develop a context dependent philosophy that isn’t so swayed by the world view of academic thinkers.

Link to Prospect article ‘Philosophy‚Äôs great experiment’.

Philosopher Jerry Fodor has written a sceptical and entertaining review of a new book on the extended mind hypothesis – the idea that that we use technology to offload our mental processes and that such tools can be thought of as extensions of the mind itself.

The book in question is by fellow philosopher Andy Clark and is entitled Supersizing the Mind: Embodiment, Action and Cognitive Extension.

It’s a development of the original idea, described in Clark and Chalmer’s 1998 article called ‘The Extended Mind’, and it’s clear that Jerry Fodor is not a fan.

However, it’s probably true to say that Fodor starts from a definition of the mind which already excludes any form of information recording technology, be it a computer or a notepad, whereas the extended mind argument argues that we should rethink exactly these sorts of definitions.

The review gets a bit muddy in the middle as Fodor tries unsuccessfully to explain the difference between the confusingly similar but subtly different philosophical concepts of intentionality and intensionality in a paragraph but the article remains enormously good fun throughout.

Link to London Review of Books article ‘Where is my mind?’ (thanks Paul!)

The February edition of the British Journal of Psychiatry has a thought-provoking editorial by psychiatrist Jim van Os, arguing that we should reject the diagnosis of schizophrenia owing to its lack of validity and replace it with a concept of a ‘salience dysregulation syndrome’.

If you’re not familiar with the use of the term salience, it is used widely in cognitive science to describe the attention grabbing quality of things and psychosis is widely thought to involve, at least in part, a problem with the regulation of salience so normally unremarkable things seem important or alarming.

Although this idea has been kicked around for many years, it was popularised in recent years by an influential article by psychiatrist Shitij Kapur called ‘Psychosis as a state of aberrant salience’, as differences in dopamine function are regularly found in studies on delusions and hallucinations.

Importantly, disturbance in dopamine-regulated salience does not seem specific to schizophrenia, but is common across all psychotic disorders.

Consequently, van Os reviews the scientific literature that has repeatedly found that the diagnosis of schizophrenia does not seem to be a cut-and-dry category and that psychosis appears in various forms to differing degrees throughout the population.

He particularly argues for the importance of explicitly naming the problem as a ‘syndrome’, as despite that fact that most people accept that it is not a single disorder, it can get treated as such simply out of habit:

First, although criticisms about the diagnostic construct of schizophrenia may be deflected with the argument that it is merely a syndrome (the association of several clinically recognisable features that often occur together for which a specific disorder may or may not be identified as the underlying cause), the problem is that its very name and the way mental health professionals use and communicate about the term results in medical reification and validation through professional behaviour rather than scientific data, exposing psychiatry to ridicule and hampering scientific progress. It may be argued, therefore, that if it is a syndrome, calling it as such may serve to remind professionals (and downstream of these, the rest of the world) of the relatively agnostic state of science in this regard.

Second, given the fact that maximum utility in terms of conveying clinical information may be obtained by combining categorical with dimensional representations of psychopathology, DSM–V and ICD–11 may be best served by creating separate categorical and dimensional axes of the psychopathology of psychotic disorders.

Link to article ‘A salience dysregulation syndrome’.
Link to PubMed entry for same.

Dr Shock covers a new study examining the validity of one of the most popular methods for diagnosing ‘internet addiction’, Young‚Äôs Diagnostic Questionnaire, finding it lacks even the most basic ability to distinguish between frequent and infrequent net users.

Validity is one of the essential components of a psychological measure. It refers to whether it is actually measuring what it says it’s measuring.

One of the most common ways of testing validity is to see whether the scale predicts other aspects of behaviour or psychological functioning that we would expect would go along with the target behaviour.

In this case, we would expect ‘internet addicts’, as identified by a cut-off score on the Young’s Diagnostic Questionnaire, to spend more time on line than ‘non-addicts’, have greater levels of mental distress or behavioural impairment and would be more focused on specific internet activities.

Two psychologists, Nicki Dowling and Kelly Quirk, set out to test this on over 400 students – a group who have been previously highlighted as likely to be vulnerable to excessive internet use.

They found that those students who were clearly identified by the questionnaire as ‘internet addicts’ were no different in time spent online or psychological dysfunction from those students who were just below the cut-off.

What they did find, however, is those students who ticked zero to two items, the lowest ‘risk’ category, on the 8-item questionnaire typically used the internet for fewer hours and were likely to be depressed or anxious than the people who scored above the ‘addiction’ cut-off.

However, as three of the diagnostic items specifically refer to spending longer time online, and three specifically refer to low mood, anxiety or preoccupation, this is hardly surprising.

It’s like finding out people who say they are sad are more likely to be depressed.

What the study did clearly show, however, is that the criteria for distinguishing ‘addicts’ from ‘non-addicts’, which has been the basis of the majority of ‘internet addiction’ research, doesn’t even reliably distinguish between amount of use and psychological distress.

This is important, because the criteria have been offered by proponents as the basis of a possible ‘internet addiction’ diagnosis in the forthcoming updated psychiatric diagnostic manual, the DSM-IV.

This comes only a few weeks after a recent study reported the damning conclusion that previous studies used “inconsistent criteria”, where subject to “serious sampling bias” and usually reported associations rather than doing any sort of work on causal influences.

Link to Dr Shock internet addiction post ‘Garbage In, Garbage Out’.
Link to study.
Link to DOI entry for same.

Advances in the History of Psychology has just alerted me to a new programme on NPR Radio about the debates over the ‘in revision’ version of the American Psychiatric Association’s diagnostic manual that defines mental illness for significant parts of the world.

It covers some of the most contentious potential diagnoses in the to-be-released DSM V and doesn’t have the most balanced discussion in some cases (e.g. the guy claiming that people against the diagnoses of gender identity disorder – transexualism – just ‘see the stigma’ of the condition).

Most interestingly though, it quotes part of the non-disclosure agreement that members of the DSM committee have had to sign, making a legally binding restriction against discussing:

All work product unpublished manuscripts and draft and other prepublication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information, in any form, that emanates from, or relates to, my work with the APA task force or work group.

Yes, there is a legal restriction banning members from discussing the development of one of the most important documents in medicine.

The DSM committee vice-chair Darrel Regier says this is a good thing because otherwise “it would just be cacophony and mass confusion” – presumably referring to the annoying tendency of public debate to raise points that you hadn’t thought of before.

Diagnoses decided by an unelected committee in secret sessions that are legally prevented from discussing their work. Science marches on.

Link to NPR Radio on DSM-V development (via AHP).

Edge has an interesting essay by V.S. Ramachandran arguing that while we may not be any closer to understanding consciousness, an understanding of the neuroscience of ‘the self’ may be within our grasp as demonstrated by studies showing how our perception of self-awareness breaks down in curious ways after brain injury.

There are lots of wonderful examples of how the self can become warped, but I’m not sure that it is entirely held together with Ramachandran’s long held enthusiasm for the explanatory power of mirror neurons.

However, it’s an entertaining and provocative read and well worth your time despite, and probably because of, the somewhat expansive tone in places.

There is one odd section though, the second section of bullet-pointed text, where he refers to the “anterior cumulate” which almost certain should refer to the frontal brain area the ‘anterior cingulate‘, as the anterior cumulate doesn’t exist (an example of Bell’s Frontal Nomenclature Hypertrophy syndrome I wonder?).

Following that paragraph is another where he suggests akinetic mutism is the lack of visual consciousness, which is exactly what it isn’t. In fact, it’s the inability to independently initiate action without external prompting, linked to anterior cingulate damage, and one of the defining features is that the problems are not caused by visual impairments.

Link to Edge on ‘Self Awareness: The Last Frontier’.

The Philosopher’s Magazine has an interesting interview with David Chalmers on the extended mind hypothesis – the idea that the mind exists not only in ourselves but is extended out to the technology we use.

However, the technology does not have to be computers and digital technology, something as simply as a notebook is enough:

‚ÄúThe central example in our original paper was an Alzheimer‚Äôs patient. We called him Otto. Like a lot of Alzheimer‚Äôs patients, to get around, he uses external tools to manage his life. In particular, he carries a notebook around everywhere with relevant information and consults it whenever he needs it. So, when a normal person thinks, ‘I want to go to the museum,’ they recall, ‘OK, the museum‚Äôs on 53rd Street’ and off they go. When Otto wants to go to the museum, he looks it up in his notebook, reads the museum is on 53rd Street and off he goes.

“We argue this is part of his memory all along. We would say that even before the ordinary person recalled the information, they believed the museum was on 53rd Street. Why? Because that stuff was there in their memory, available, so to speak, for them. Exactly the same is true of Otto: that information was there in his memory, in the notebook, available for him there when he wants it. So we argue even before he read the information from the notebook, he believed that the museum was on 53rd Street.”

It’s interesting to note that language, is, of course, a technology, despite the fact we tend to think of it as something largely internal.

Chalmers also goes on to discuss the limitations of the theory and discusses what the idea implies for our concepts of the mind as they relate to the brain and the material world.

Link to Philosopher’s Magazine interview ‘A Piece of iMe’.
Link to original Clark and Chalmers extended mind paper.

Edge has a fascinating video interview with philosopher Alva Noë who discusses his work on the philosophy of consciousness, arguing that we will be led astray if we think of consciousness solely as a brain process that happens within us without reference to how we act in the world.

Noë is primarily arguing for a form of embodied cognition which argues that the mind and brain can only be understood as situated in the world in which we interact. The function of the mind is inherently connected to the sorts of tasks we need to do to survive on a day-to-day basis.

This view has been bolstered by experimental work which has shown that we perceive the world differently depending on the task we are doing or how we intend to act.

For example, in one of my favourite studies, psychologist Dennis Proffitt and his colleagues found that we perceive distances as shorter when we have a tool in our hand, but only when we intend to use it.

Noë uses the fantastic analogy of dance to highlight how we can only understand this practice by considering the dancers, the world and the mind together. Dance does not exist solely between our ears.

Consciousness is not something that happens in us. It is something we do.

A much better image is that of the dancer. A dancer is locked into an environment, responsive to music, responsive to a partner. The idea that the dance is a state of us, inside of us, or something that happens in us is crazy. Our ability to dance depends on all sorts of things going on inside of us, but that we are dancing is fundamentally an attunement to the world around us.

And this idea that human consciousness is something we enact or achieve, in motion, as a way of being part of a larger process, is the focus of my work.

Experience is something that is temporarily extended and active. Perceptual consciousness is a style of access to the world around us. I can touch something, and when I touch something I make use of an understanding of the way in which my own movements help me secure access to that which is before me. The point is not that merely that I learn about or achieve access to the world by touching. The point is that the thing shows up for me as something in a space of movement-oriented possibilities.

Noë goes on to talk about how perception represents meaning, how we can be led astray in neuroscience if we artificially separate action and perception, and how our definition of ‘life’ can help us understand consciousness.

Link to video interview and transcript of Alva Noë interview.
Link to previous Mind Hacks post on embodied cognition.

The July issue of Neurosurgery had a fantastic article that discusses where the brain, nervous system and neurological illness are mentioned in the Bible and Talmud.

In some places the nervous system is specifically mentioned, such as where the Bible and Talmud specifically prohibit eating the sciatic nerve from slaughtered animals apparently in deference to the fact that Jacob is described as having a sciatic nerve injury in Genesis.

The article also discusses various forms of neurological illness that appear. Not all the cases are clear cut, and the article carefully examines where historians have suggested specific incidences may have been describing neurological disorders.

However, there are clear references to early forms of neurosurgery, and the piece makes this interesting aside on the Roman emperor Titus:

Interestingly, it is said that Titus (AD 39–81), who crushed Jewish rebellion with brutality and burned the Temple of Jerusalem in AD 70 (Fig. 6), underwent trephination of his cranium for chronic headache (possibly tinnitus) and, during this procedure, in which he lost his life, a tumor was found that resembled a sparrow or swallow and was two selas in weight. The sela coin was approximately one-third the width of a hand and was, interestingly, the size of the hole made with the aforementioned trephination tool. Some have posited that, based on the weight and size of such a mass, the differential diagnosis would include a hemangioma, meningioma, andacoustic neuroma. Multiple cranial trephinations aredescribed as a treatment for seizure disorders in the Talmud (Hullin 57a).

Another bit that caught my eye was the possible description of the effects of stroke in Psalm 137: “If I forget thee, O Jerusalem, let my right hand forget her cunning. If I do not remember thee, let my tongue cleave to the roof of my mouth; if I prefer not Jerusalem above my chief joy”.

Along with Matthew Wilder’s 80s hit Break My Stride, Psalm 137 is the basis for the song Jerusalem by Hasidic reggae star Matisyahu.

Which, as far as I know, makes Matisyahu the only person to have written a track that makes a combined tribute to 80s synth-reggae, a Biblical verse about the holy city of Jerusalem and the cerebro vascular accident.

By the way, the image on the left is a medieval depiction of Cain smiting Abel through the grisly and fatal act of giving him a traumatic brain injury. And they say TV makes kids violent.

Link to Neurosurgery article.
Link to PubMed entry for same.

This month’s British Journal of Psychiatry has a fascinating essay by psychiatrist Sean Spence who argues that while most attention has been focused on ‘smart drugs’ and cognitive enhancement, medication is already been subtly used to improve ethical behaviour and we should prepare for a revolution in ‘moral pharmacology’.

Spence argues that the cognitive enhancement debate has an undertone of smarter = better, but that people with high IQs can still conduct atrocities, so perhaps we need to start thinking about focusing on ‘humane drugs’ rather than ‘smart drugs’.

Crucially, the argument does not concern medicating people against their will, an area of constant moral debate. Spence is talking about people taking medication willingly, knowing that it will improve their future behaviour towards others and improving their social responsibility.

Recent considerations of the ethics of cognitive enhancement have specifically excluded consideration of social cognitions (such as empathy, revenge or deception), on the grounds that they are less amenable to quantification. Nevertheless, it would be regrettable if this limitation entirely precluded consideration of what must be an important question for humanity: can pharmacology help us enhance human morality? Might drugs not only make us smarter but also assist us in becoming more ‘humane’?

When voiced in such a way, this proposal can sound absurd, not least since we may suspect that such mental manipulation would render us ‘artificially’ moral. Where would be the benefit of being kinder or more humane as a consequence of medication? This is an understandable (though reflexive) response. However, if we stop to consider what is actually happening in certain psychiatric settings, then we may begin to interrogate this proposal more systematically. I shall argue that within many clinical encounters there may already be a subtle form of moral assistance going on, albeit one that we do not choose to describe in these terms. I argue that we are already deploying certain medications in a way not totally dissimilar to the foregoing proposal: whenever humans knowingly use drugs as a means to improving their future conduct.

For example, someone who may be prone to impulsive actions may take a medication to make them less likely to take irresponsible decisions, or perhaps decides on a drug that reduces their level of aggression.

Indeed, this is part of what psychiatrists assist with at the moment, but Spence suggests that the moral aspect is often couched purely in medical terms when it is clear we need to consider morality to fully make sense of the ethical implications.

Link to essay ‘Can pharmacology help enhance human morality?’.
Link to PubMed entry for same.

The BPS Research Digest has alerted me to a fantastic debate in this month’s Prospect magazine about whether behavioural economics is the savour of the dismal science or just fad in the boom and bust of economic theories.

It’s presented as a sarcastic exchange of letters between Pete Lunn (author of Basic Instincts: Human Nature and the New Economics) and Tim Harford (author of The Logic of Life: Uncovering the New Economics of Everything) and makes some powerful points on both sides of the discussion.

The main thrust of the criticism is that behavioural economics has some interesting lab findings but hasn’t really changed any of the large scale theories of how the economy actually works, while the main line of defence is that this is not a sign of scientific bankruptcy, just the result of it being a young science.

It’s a great complement to the recent Economist article that took a critical look at neuroeconomics.

Link to Prospect debate on behavioural economics.
Link to BPSRD commentary.

I’m currently reading the wonderful but very long book The Discovery of the Unconscious which I shall post more about later.

However, I noticed this little gem about hypnosis in the late 1800s which just smacks of the current hand-wringing over the non-existent (or rather can’t-existent) ‘internet addiction’.

The problems described are so obviously not addiction, and, in fact, like the internet, there’s no specific activity to be addicted to that is defined by the term ‘hypnosis’. After all hypnosis is just where you concentrate and someone makes suggestions – can you be addicted to concentration and listening? Obviously not.

Nevertheless, the concerns got framed in the language of addiction as a placemarker for a fear of the unknown and as a fig leaf for other social problems (from p118):

Deleuze and the early mesmerists also described the evils resulting from too frequent or too prolonged hypnotic sessions. Such subjects gradually became addicted to hypnosis: not only did their need for frequent hypnotization increase, but they became dependent on their particular magnetizer, and this dependency could often take on a sexual slant. This well-known fact was rediscovered by Charcot, who gave an account of a woman who had been hypnotized five times within three weeks and who could think of nothing but her hypnotist, until she ran away from her home to live with him. Her husband took her back, but she fell into severe hysterical disturbances that necessitated her admission to a hospital.

Link to Wikipedia page on The Discovery of the Unconscious.

Today’s featured article on Wikipedia is a rather splendid article on parapsychology – the scientific study of the supposed paranormal phenomena of the mind.

Academic parapsychology is notable for the exceptional quality of the experiments it conducts and the inconclusive nature of its findings – at least to mainstream science.

Large reviews of many studies (meta-analyses) tend to find that ‘psi’ effects are statistically significant but of small effect. The disagreement comes in over whether this small effect is a genuine reflection of paranormal ability or just an artefact of research – such as negative findings being published less often.

The history and process are fascinating though, with some of the great luminaries of psychology, such as William James, having been interested in experimental studies of psychic powers.

Link to Wikipedia page on ‘parapsychology’.

As part of Seed Magazine’s on innovative thinkers in science, they published a podcast interview with archaeologist Lambros Malafouris who is pioneering the study of ancient cultural artefacts as a way of constraining theories in evolutionary psychology.

One of the criticisms of some evolutionary psychology is that it too often involves over-interpretation and ‘just so’ stories – explanations of why we have certain psychological attributes that are stories rather than hypotheses that can be easily tested.

Malafouris has taken the novel approach of using the findings from archaeology to systematically generate and test theories of the evolution of the mind. He seems particularly interested in embodied cognition, the idea that the mind can only be understood in relation to how it interacts with the world through body and action.

The mainstream approach to cognition holds that it happens in the mind and that material culture is nothing more than an outgrowth of our mental capacities. Archaeologist Lambros Malafouris is challenging this deep-seated idea with a radical new notion: the hypothesis of extended mind, which posits that material culture is not a reflection of the human mind but an actual part of it. Take, for instance, a blind man’s stick. “Where does the blind man end and the rest of the world begin?” he says. “You might see the stick as something external, but it plays a very important role in the perceptual system of this person. It extends the boundaries of this human‚Äîthe stick becomes an integral part of the cognitive architecture.”

If material culture is an extension of human cognition, our engagement with it has actively shaped the evolution of human intelligence, Malafouris argues. For example, ancient clay tablets that allowed people to actually write down records were not mere objects, he says. Instead, they became integral adjuncts of the human memory system. The invention of such a technology “changes the structure of the human mind,” says Malafouris, a post-doctoral fellow at the University of Cambridge. Rather than happening wholly in the head, he argues, cognition develops and evolves through the interplay between intelligence and material culture.

In fact, there’s an increasing focus on related ideas. Some of my favourite studies have been done by psychologist Dennis Proffitt who has found numerous effects of tool use on thinking and perception.

One of my favourite studies is where he found that we perceive distances as shorter when we have a tool in our hand, but only when we intend to use it.

Malafouris is using these ideas and adds to the relatively new but exciting field of cognitive archaeology.

Link to Seed interview with Lambros Malafouris.