Racism, mental illness and the limits of diagnosis

hate_knuckles.jpgThe Washington Post reports that a group led by psychologist Edward Dunbar are pushing to get extreme prejudice, such as intense racism or homophobia, diagnosable as a mental illness.

It may seem a little ridiculous to medicalise what are essentially extreme opinions, but the move is interesting for what it says about psychiatric diagnosis in general. In particular, it cuts to the very idea of what defines a mental disorder.

For example, the diagnostic criteria for schizophrenia are based around two ideas:

The first is that there are behaviours and experiences present that are atypical or culturally anomalous (e.g. ‘hearing voices’ or delusions), the second is that the disorder involves some form of disability – in the case of schizophrenia, the criteria specify social or occupational dysfunction.

It could be argued that extreme racism could involve both. Extreme racism is indeed uncommon, and in today’s multicultural society, might involve a significant social deficit if contact with other races or cultures is consistently avoided or becomes distressing.

In fact, considering that about 11% of healthy adults score above the average of delusional inpatients on measures of delusional thinking, it could be argued that extreme racism (at least in some countries) might be more atypical than the sort of beliefs that are typically diagnosed as signs of mental disorder.

In other words, it’s quite hard to refute the idea that extreme racism isn’t a mental disorder within the general philosophy of the current diagnostic system.

This highlights the social relativity of the diagnostic system, which you might either use to argue for the inclusion of a new diagnosis of ‘racist disorder’, or, perhaps, more realistically, to draw attention to the fact that the current system does not adequately define mental pathology in all cases.

Link to article ‘Psychiatry Ponders Whether Extreme Bias Can Be an Illness’.

How to read a paper

Via Ben ‘Bad Science‘ Goldacre (here) comes this hot tip: Trisha Greenhalgh’s How to read a paper. Although it focusses on medical research, many of the principles apply to all scientific papers. Although it’s great when science can be expressed in everyday language, the ability to go direct to the original research, as reported by the researcher themselves, is an invaluable skill (and one hopefully this link, and the Mind Hacks book, can give you some handles on).

Walking zombie syndrome

wide_bw_eye.jpgAntonio Melechi explores one of the bizarre corners of the medical literature in his book Fugitive Minds (p211, ISBN 0099436272):

In 1979, the Journal of the Tennessee Medical Association announced that the ‘Walking zombie syndrome’ – a condition in which depression and withdrawal led individuals to unconsciously believe that they were dead – was on the increase. Illness, coma, high fever, operations performed under partial anaesthesia, and bereavement were, it claimed, just some of the situations through which a ‘death suggestion’ could be unwittingly assimilated.

Fortunately, there was, according to the hypnotherapists who ‘discovered’ the condition, one simple and effective cure: age regression. By returning patients to the event which triggered the ‘death suggestion’, the ‘symptoms of death’ could, it was claimed, be at once relived and remedied.

Although most physicians remained unaware of the diagnosis or treatment, the pseudo-illness continued to claim factitious casualties. By the late 1980s, the United States had apparently overtaken Haiti as the zombie capital of the world. According to one estimate, there were ‘thousands of walking zombies on the streets of every city’.

Link to PubMed entry for ‘The Walking Zombie syndrome in depressive disorders’.
Link to review of ‘Fugitive Minds’.

Voting causes happiness? Really?

I love the New Economics Foundation and I think they do great work, but at first glance this report on Britain’s democractic deficit looks like it makes the classic correlation-is-not-causation blunder:

‘There is significant evidence that the democratic deficit at the heart of the British electoral system is making us unhappy. The 2001 post election survey shows that there is a strong link between levels of personal well-being, the health of communities and voting behaviour. People who voted in the election tended to be more trusting, have higher levels of civic duty, were more engaged in their local communities and were happier than people who didn‚Äôt vote.’

More here

Stingy Materialism

Geoffrey Miller, in an essay on the future of neuroscience, has this to say about the relationship of mind to brain:

Too many of us have become Stingy Materialists. A Stingy Materialist takes the view that subjective experiences may not be real if they have not yet been associated with particular brain areas, neurotransmitters, or genes. They suppose that if we have found the brain area for pain, then pain is a real emotion; but if we haven’t yet found the brain area for sexual jealousy or existential dread, they are probably not real emotions. Likewise, if we have found neurotransmitter deficits in schizophrenia, then it is a real disorder; but if we have not found such deficits in irritability, then perhaps it is not a real disorder.

Stingy Materialists lack confidence in their doctrine and in their consciousness, with the result that they fetishize neuroscience, and seek its approval for all things subjective. Since neuroscience is still in its infancy, this results in an infantile view of human nature, in which people are portrayed with crude outlines and primary colors, like stereotypes from a Jerry Bruckheimer action film.

Read the rest:
Miller, G. F. (2002). The science of subtlety. In J. Brockman (Ed.), The next fifty years, pp. 85-92. New York: Vintage. Link (MS Word doc, sorry)

Bad science on autism vaccine link

The Guardian’s Bad Science column, written by doctor Ben Goldacre, is an excellent resource for anyone who wants scientific straight talk on fashionable nonsense, and often references core ideas of the philosophy of science (which is a neat trick to pull off in a few hundred words in a newspaper column). This week Ben fires off both barrels at the Daily Mail columnist Melanie Philips for utterly misunderstanding the implications of a systematic review of studies investigating a link between the MMR vaccine and autism (there most probably isn’t one). Philips takes criticsms of existing research showing no connection between MMR and autism to jump to the opposite conclusion, supported by flimsy evidence for there being a link(Creationist watchers, does this bad science syllogism feel familiar?). Ben’s recommendation is strong, but justified:

Either learn how to interpret data yourself, or trust those who can do it for you

Details in the full article

An Intelligently Designed Brain

A letter in the Economist (27th of August) on Intelligent Design:

SIR ‚Äì The human brain has 100 billion extremely complex neurons connected by 1,000 trillion synapses. It is mathematically impossible for anything this unimaginably complex to have been the product of an unguided evolution, even over limitless aeons. One doesn’t have to know the rules of mathematical probability to recognise this. The brain could only have been created by a limitless intelligence, call it what you may.

Aside from the fact that the letter writer is out by a factor of ten on the number of neurons in the brain (there are 1,000 billion neurons, with an average of 1,000 synapses) he is also advancing a fallacious argument. The human brain may be tremendously complex, but it isn’t a complexity designed by God. You start your life with exactly one cell, and it’s not even a brain cell. In the womb this cell turns into the 1,000 billion cells of the brain and all the other body cells besides, all without the intervention of God at any stage. The complexity of the brain, a staggering complexity which develops under the guidence of natural laws, is actually an argument against ‘Intelligent Design’, not for it.

Death to common sense

deepthought.jpgOnline science think-tank Edge has a discussion about the role of common sense theories in explaining physics and cognitive science.

Science writer John Horgan bemoanes the fact that scientific theories have become so complex and fantastical that common sense has gone out of the window.

He cites various examples in the physical and ‘mind sciences’ which, he claims, demonstrates that theories are becoming useless and untestable.

In reply, Horgan’s comments are met with a robust response, with psychologist Daniel Gilbert going as far as saying “such a silly trifle that it doesn’t dignify serious response”!

Link to ‘In Defense of Common Sense’.

Evolutionary psychology: The fightback

red_cave.jpgA piece by Amanda Schaffer on Slate charts the growing opposition to evolutionary psychology. Although this opposition has always been present, it is being increasingly based on scientific rather than political arguments.

Previous criticisms of evolutionary psychology (EP), such as Rose and Rose’s ‘Alas Poor Darwin’, have not always been received well, with some reviews suggesting they were attacking a straw-man version of EP and using politically motivated arguments.

Defenders of EP have sometimes relied on the angle that critics are not well-versed in biology (notably, not a criticism that could be used against ‘Alas Poor Darwin’) and misunderstand the scientific evidence.

A recent book by David Buller (mentioned previously on Mind Hacks) has gained most publicity for dissecting the evidence used to back up EP, and showing that it is not as strongly supported as some of its champions claim.

One recent review, by philosopher Jerry Fodor, applaudes Buller’s careful analysis of the data, but disagrees with some of Buller’s conclusions.

In particular, Fodor feels his acceptance of a form of evolutionary adaptation for mental states is misguided, a finished with some advice for would-be gamblers on successful theories:

Over the years, people keep proposing theories that go: “what everybody really wants is just . . .” (fill in the blank). Versions fashionable in their times have included: money, power, sex, death, freedom, happiness, Mother, The Good, pleasure, success, status, salvation, immortality, self-realization, reinforcement, penises (in the case of women), larger penises (in the case of men), and so on. The track record of such theories has not been good; in retrospect they often look foolish or vulgar or both. Maybe it will turn out differently for “what everybody really wants is to maximize his relative contribution to the gene pool”. But I don‚Äôt know any reason to think that it will, and I sure wouldn‚Äôt advise you to bet the farm.

Link to article ‘Cave Thinkers: How evolutionary psychology gets evolution wrong’.
Link to review of ‘Adapting Minds’ by Jerry Fodor.

How culture shapes illness


Media analysis magazine Stay Free! has an interview with medical historian Edward Shorter on how psychiatric symptoms have changed over the years, showing, he claims, how we subconsciously express culturally acceptable distress.

The interview was conducted in June 2003, which I missed it at the time, but Shorter’s work is usually too good to pass up when you get the chance.

Author of the acclaimed A History of Psychiatry, he is not easily pigeon-holed into the simple labels usually given to those who pitch into the psychiatry debate.

Although a strong believer in the reality of mental illness, he presents evidence for the influence of culture on how symptoms express themselves, and how doctors’ expectations affect what they diagnose and treat.

In contrast to the usual tempered and cautious claims made by academics, he is not afraid to state his point of view in clear terms, making provocative points, even if you don’t agree with him.

STAY FREE!: You wrote about how some of the most fashionable people have the most cutting edge symptoms, the ones that are most medically up to date. Can you give me an example?

SHORTER: If we’re talking about today, new illnesses appear first among educated people simply because they are more plugged into medical media. These middle- and upper-class people are the first to begin monitoring themselves or their children for evidence of peanut-butter allergies or excessive tiredness. It is from these relatively small social groups that the symptoms radiate out.

Shorter reflects a growing trend in understanding the social dimensions of psychopathology.

Anthropologist Roland Littlewood’s Pathologies of the West, and sociologist Robert Bartholomew’s Exotic Deviance both examine the issue from different angles with refreshing insight.

Link to interview with Edward Shorter from Stay Free! magazine.
Link to article ‘Protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears’ from the British Journal of Psychiatry.

Psychology’s top 10 misguided ideas

Here’s one we can all join in on. Psychology Today magazine has a column from earlier this year on The Loose Screw Awards which gives out (notional) prizes for ‘psychology’s top 10 misguided ideas’. This includes “The P.T. Barnum Medal for Mass-Market Potential” (which goes to the Mozart effect), “The Idea That Launched a Thousand Suits” (recovered memories) and “Most Bureaucratic” which goes to the idea that terminally ill people go through five distinct stages of dying (denial, anger, bargaining, depression and acceptance) and that any deviation from this strict pattern is detrimental to the patient. It has been claimed that the theory was based on interviews with patients who hadn’t been told that they were terminally ill. Which would explain their anger and denial – they were being lied to by the very people who were supposed to be looking after them!

Fun as the list in the article is, I can’t help feeling that there are a few ideas that missed out on prizes, or at least on honourable mentions. What about a “Scientific Gold-Rush Prize” (Neuroimaging?). Or a “Delusions of Grandeur Trophy” (Evolutionary Psychology? Psychoanalysis? Could be a close race…). Maybe the “Restating the Obvious in Esoteric Jargon Medal” (we’d probably need a gold, silver and bronze for this one).

A few years ago a poll of 200 psychiatrists produced a similar list of bad ideas in mental health. The Independent ran an article on it (‘Ten Things That Drive Psychiatrists To Distraction’) and there’s quite a few items (psychosurgery, electroshock therapy) that I’d put in my top ten. All in all, a sharp reminder of the sad history of ideas in psychology. Anyone got any other nominations?