Category: Theory

A new series of ABC Radio National’s All in the Mind has just kicked off with a thoughtful programme about treating traumatised people just after a tragic event.

If you’re not familiar with the contentious area of disaster response, you may be surprised to hear that there is no firm evidence that psychological treatment of just-traumatised people is any more helpful in the long-term than doing absolutely nothing.

This is in contrast to the widely held belief that all disaster victims ‘need’ to see mental health professionals. In fact, studies on psychological treatment in disaster victims have suggested the worrying result that some treatments may actually make matters worse in the long-term for some people.

This was famously found in studies on single session ‘debriefing’ but also less well known is that there is a similar conclusion with regard to multi-session psychological treatment that is aimed to prevent trauma in disaster victims.

To complicate matters, in the studies where the effects are shown to be harmful in the long-term, patients reported feeling better immediately after the sessions.

If you are a psychologist responding to a disaster, grateful and apparently relieved patients are extremely strong personal evidence that you are being helpful, even if in the long-term you might be causing problems.

This makes it very hard for some to accept that they need to question what they are doing.

But there is one over-arching and important point that trauma psychologist Richard Bryant makes in the programme – that, despite some good hints, the evidence is still not firm enough to say for sure whether we are helping, harming or being irrelevant when working with just-traumatised victims.

It must be stressed that this is in contrast to treating people who are still traumatised a long while after an incident and haven’t recovered on their own, where we know psychological treatment is helpful and important.

This issue of All in the Mind is a fantastic discussion of the potential benefits and drawbacks of ‘trauma debriefing’ and immediate psychological treatment and don’t miss some great additional material on the blog.
 

Link to AITM on ‘The mind in crisis’.
Link to additional material and audio on the AITM Blog.

Time magazine has a fantastic article that tackles common myths about the psychology of grief and the experience of losing a loved one.

We’ve discussed previously how many of the grief clichés (there are specific stages, you have to ‘let it out’ etc) have already been shown to be false but this Time piece goes in greater detail and traces the origin of these myths in the work of Elisabeth Kübler-Ross.

Kübler-Ross was an important pioneer in understanding grief, but she was basing her theories on very little evidence and we now know from more rigorous studies that many of her conclusions were wrong.

Although Kübler-Ross modified her position with regard to the famous ‘stage model’ of grief, where we supposedly pass through distinct stages – saying that they were never intended to be one after the other, later empirical studies have found little evidence for any consistent stages.

One of the reasons that the five stages became so popular is that they make intuitive sense. “Any natural, normal human being, when faced with any kind of loss, will go from shock all the way through acceptance,” Kübler-Ross said in an interview published in 1981.

Two decades later, a group of researchers at Yale decided to test whether the stages do, in fact, reflect the experience of grief. The researchers used newspaper ads and referrals to recruit 233 recently bereaved people, who were assessed for “grief indicators” in an initial interview and then in a follow-up some months later. In the Kübler-Ross model, acceptance, which she defined as recognizing that your loved one is permanently gone, is the final stage.

But the resulting study, published in the Journal of the American Medical Association in 2007, found that most respondents accepted the death of a loved one from the very beginning. On top of that, participants reported feeling more yearning for their loved one than either anger or depression, perhaps the two cornerstone stages in the Kübler-Ross model.

The article tackles many more common beliefs about suffering loss and is a highly recommended look into what is often thought to be ‘common knowledge’.
 

Link to Time on ‘New Ways to Think About Grief’.
Link to previous Mind Hacks post on grief myths.

Dana has an eye-opening article on the challenges of doing brain research in cultures that don’t share the same assumptions about science and human nature.

There are several sections of the article which turn our research assumptions on their head, owing to the fact that some common principles of ethical research turn out to be based on quite a narrow view of human values.

The idea that donating tissue is simply a matter of individual choice is not a belief held by many communities who believe that all people are interconnected – making individual donations a group decision.

The article touches on an example from the Havasupai people and a similar situation was discussed in an All in the Mind interview with a Maori neuroscientist.

However, I was particularly struck by this part on confidentiality which is often assumed to be the bedrock of human research.

Confidentiality poses another ethical challenge to researchers working with indigenous peoples. Participants in academic studies are invariably anonymous, but in many Native cultures, not identifying oneself, one’s family, and one’s homeland is unacceptable. Anonymity, they believe, undermines the cultural fabric of the community, and is akin to stripping its members of their traditions and beliefs.

 

Link to ‘Cross-Cultural Neuroethics: Look Both Ways’.

I’ve just found an enjoyable BBC World Service radio documentary on the relationship between tango and psychoanalysis in the Argentinian city of Buenos Aires.

Buenos Aires is the birthplace of tango and, as we’ve discussed before, has the highest ratio of psychologists to population of any place on earth.

The city has traditionally been one of the world centres for psychoanalysis and it remains a hub for theory and treatment drawn from the work of Sigmund Freud.

The BBC documentary looks at the relationship between the city’s love of therapy and one of the most psychological of dances, talking to both enthusiasts and conscientious objectors.
 

Link to documentary with mp3 and streaming.

Scientific American has an excellent article on the sociology of communicating new discoveries and how the relationship between science and journalism has changed over the years.

It’s a remarkably comprehensive analysis that looks not only at science publication but how it relates to our regular patterns of social communication.

This informal style of communication has been deliberately excluded from science in recent decades through the adoption of peer-review and a uniform impersonal writing style, as a way of imbuing the process with a form of institutional trust.

According to the author, online science pioneer Bora Zivkovic, this model is now being challenged by internet science writing where trust is gained through transparency – showing your working and background through links to original source – rather than having an institutional stamp of approval.

I think he’s a little hard on traditional science journalists, but as an analysis of how trust works in science communication, and how that is being affected by the online science community, it’s an incredibly thought-provoking piece.
 

Link to ‘The line between science and journalism is getting blurry…again’

Cannibalism is a lot more common in human history than you’d guess and an intriguing article in Slate looks at the how a change in living situation might have made the temptations of the flesh all the more appealing.

The piece is by psychologist Jesse Berring who gets his teeth into the scientific debate about whether chowing down on another human may be a genuine biological adaptation, owing to the frequency with with famine-like conditions have appeared in human history.

The bottom line, says Petrinovich, is that when you’re hungry enough, ravenous really, and when all other food sources—including “inedible” things you’d rather not stomach such as shoes, shoelaces, pets, steering wheels, rawhide saddlebags, or frozen donkey brains—have been exhausted and expectations are sufficiently low, even the most recalcitrant moralist among us would shrug off the cannibalism taboo and savor the sweet meat of man … or woman, boy or girl, for that matter. It’s either that or die, and among the two choices, only one is biologically adaptive.

A behavior can be adaptive without being an inherited biological adaptation, of course. But because starvation occurred with such regularity in our ancestral past, and because the starving mind predictably relaxes its cannibalistic proscriptions, and because eating other people restores energy and sustains lives, and because the behavior is universal and proceeds algorithmically (we eat dead strangers first, then dead relatives, then live slaves, then foreigners, and so on down the ladder to kith and kin), there is reason to believe—for Petrinovich, at least—that anthropophagy is an evolved behavior.

The piece isn’t for the feint-hearted, but is certainly a fascinating take on one of the strongest of human taboos.

There is also a link at the bottom to a video discussion between “Robert Wright of BloggingHeads.tv and psychologist Paul Bloom of Yale on what motivates cannibals.”

From the appearance of the screen shot, I think they’ve been practising the look if nothing else.
 

Link to Slate piece ‘Bite Me: An evolutionary case for cannibalism’.

Seed Magazine has an excellent piece on ‘redefining mental illness’ that discusses the limits of labelling mental disorders and whether we can understand disability purely in terms of the mind.

The piece captures the highlights from a recent online blog discussion on the topic and is inspired in part by the ongoing update to the American Psychiatric Association’s diagnostic manual, the DSM-5, due to be released in May 2013.

One of the big changes to the manual is likely to be the introduction of dimensions, so instead of just having to decide whether “you have it or you don’t” psychiatrists will be able to rate symptoms on a sliding scale.

This has been inspired evidence that hallucination-like experiences or unlikely magical beliefs are not restricted to people with schizophrenia or other psychotic disorders, but are also present, albeit to varying degrees, in everyone.

This has led some to argue that we should abandon diagnoses for mental disorders as they’re just arbitrary cut-off points that have no scientific basis.

But if everyone has their own ‘unique dose’ of unusual experiences, like everyone has their ‘unique dose’ of typical daily anxiety, we should see a nice smooth curve when we measure it in the population. Some people have a little, some people have lots, and we should find everyone else in between.

It turns out, that this is not the case with hallucinations, delusions, reality distortions and unusual magical beliefs.

A recent over-arching meta-analysis of all the data from past research suggests that some people show a qualitative difference in the type of psychosis-like experiences they have – in other words, there is a natural break – but this doesn’t match up with who is likely to be diagnosed with schizophrenia.

Here are the authors in their own words:

The weight of evidence suggests there is a nonarbitrary boundary between those with and without schizophrenia. Certainly, the prevalence estimates of the psychometric risk categories indicate that this nonarbitrary boundary is well below the threshold for schizophrenia, capturing approximately 11% of the population.

In other words, there is not a smooth continuum between normality and schizophrenia. In fact, there seems to be clear difference in 11% of the population, but this happens in most cases in people who never become mentally ill.

Less than 1% of the population will qualify for a diagnosis of schizophrenia and only 3% for any type of psychotic disorder involving hallucinations and delusions.

That leaves 8% who have, perhaps what we could call ‘schizophrenia-like’ unusual experiences (as opposed to ‘regular’ unusual experiences), but who don’t ever seem to become disabled.

What this may mean is that defining mental disorders like schizophrenia largely on the basis of certain experiences may be missing the point, because they don’t in themselves cause a problem for most people.

But what this also means, is that the diagnostic manuals will remain very rough guesses until the publishers decided to draw their diagnoses from science, rather than doing science to try and justify their diagnoses.
 

Link to Seed on ‘Redefining Mental Illness’.
Link to ‘What is Mental Illness’ blog carnival.
Link to PubMed entry for meta-analysis of psychosis-like experiences.