Psychologist to the dead

In Havana, even spirits of the dead can have troubled minds.

Although the concept of ‘troubled spirits’ is quite common throughout the world, the Cuban group Sociedad de Estudios Psicológicos Amor y Caridad Universal goes one step further and provides psychologists to treat the conflicted emotions of both the apparition and its possessed human host.

The latest edition of Anthropology and Medicine has a wonderful article that discusses the spiritualist group and their unique take on psychology.

In Havana, the idea that all beings – living and dead – can have psychic and emotional conflicts is common among followers of spiritism (espiritismo), a practice of spirit mediation whose origins are associated with the nineteenth-century mystical teachings of Frenchman Allan Kardec. Spirits too, have lived lives and acquired memories, and often, it seems, accumulated unproductive patterns of thought and behaviour that they are keen to vent on their living counterparts. In the worst of circumstances, believers are expected to seek potent ritual experts to dispatch such beings from the earthly planes of existence they disrupt.

It’s an absolutely fascinating read, as it looks inside the organisation which is at once church, spirit channelling group and clinic. This an amazing part that recounts a session of therapy with a ‘spirit’:

D began suddenly sobbing like a little girl and curling up in his seat like a child. Antonio asked a developed medium next to him to attend to the spirit: ‘investigator, ask her why she is crying, investigate!’ The woman began to talk to the spirit, and attempted to comfort her, but the spirit wouldn’t open up – she only cried incessantly. Antonio asked her directly: ‘what did they do to you? Take this opportunity to get it out of your chest’. ‘They abused me’, the spirit replied immediately.

Antonio turned to the group and explained, in teaching-mode, that this spirit was traumatised, and was reflecting her trauma on the girl (Y). The spirit shook, all shriveled up in her seat. ‘A man abused me’ she managed to say. Antonio kept up his questions, asking increasingly specific ones, and punctuating his investigation with forthright commands of ‘talk, speak!’ He also told the spirit: ‘but all that is over now’, urging it to move on. ‘This is why you took your own life, isn’t it?’ Again out loud to all of us, he remarked: ‘those were the days when virginity was sacred …’

According to the article, the group was founded in the 1950s by Claudio Agramonte who had a complex psychological theory of spirit psychology dictated to him by the spirit of a dead doctor called José de Luz.

Rather appropriately, the article is by a Portuguese academic called, Diana Espirito Santo, which literally translate to Holy Spirit Diana. An interesting case of nominative determinism of which I’m sure the spirits would approve.

The article goes on to discuss how the concepts of the group operate with the social world of Cuba, but is unfortunately locked behind a pay wall, because you’re not old enough to be trusted with anthropology and, anyway, it would probably spoil your dinner.
 

Link to summary on PubMed.
Link to DOI entry.

Fear of one’s own glance

The Australian and New Zealand Journal of Psychiatry has an intriguing article on a Japanese psychiatric diagnosis that doesn’t seem to have a Western equivalent: ‘fear of one’s own glance’ or jiko-shisen-kyofu.

On the basis of the Japanese diagnostic system, phobia of one’s own glance is characterized by a fear of one’s own glance, which they believe assumes an offensive nature and is uncontrollably directed at persons near them. Individuals with phobia of one’s own glance believe that their glance brings others discomfort, and people with this diagnosis convince themselves of the accuracy of their belief by interpreting the trivial behaviour of others (e.g. coughing, laughing, sniffing, sneezing, head turning, etc.) as evidence for this belief. Such patients feel deeply ashamed, demeaned, and unaccepted, and many eventually avoid social situations. A diagnosis of phobia of one’s own glance is not contingent upon whether or not a patient considers his or her thoughts to be excessive; therefore, neither the presence nor a lack of insight is essential for the diagnosis.

The paper gives several case studies that include people who are concerned that their glance made other people feel uncomfortable, was a nuisance or was socially harmful to others, or made the patient themselves feel uncomfortable.
 

Link to PubMed entry for study.

Going up in smoke

Some amazing graffiti art which has recently appeared in the Colombian city of Medellín near the Hospital metro station.

Medellín has the most amazing street art of any city I’ve ever been too, much of it genuinely beautiful, and often quite socially conscious, in contrast to the gangsta style that pervades many urban landscapes.
 


 

The text translates as ‘Tears, pain and desperation are the consequences of dirty money reflected in the harsh mirror of the city. Medellín is decaying through drugs while our lives go up in smoke’.

In Spanish: ‘Lagrimas, dolor y desesperado son las consecuencias del sucio dinero reflejado en el crudo espejo de la urbe. Medellín se nos pudre en drogas mientras nuestras vidas se van con el humo.’

The loneliness of the suicide bomber

The Boston Globe has an excellent article on whether suicide bombers are largely motivated by religious fanaticism or whether some might have symptoms of low mood and hopelessness that encourage them to end their lives.

The traditional thinking is that suicide bombing is enabled by concepts of martyrdom and retaliation and has little to do with a wish to escape a painful existence – as happens in ‘psychiatric’ suicides linked to sadness and mental illness.

But more recently, some researchers have begun to question whether some bombers might have been suicidal before being recruited, perhaps making them vulnerable to extremists seeming to offer an ‘honourable’ way out.

The issue is by no means settled but the Globe article does a great job of capturing the state of the research, although somewhat ironically, the debate seems to have become quite polarised.

But despite the accounts from their own published papers, scholar after scholar had dismissed the idea of suicidality among bombers. [Criminologist] Lankford remains incredulous. “This close-mindedness has become a major barrier to scholarly progress,” Lankford said.

 

Link to Boston Globe on the motivations of suicide bombers.

Feeling cliquey clean

Edge has a fascinating discussion on the social psychology of cleanliness and how our behaviour toward others is influenced by the environment in sometimes quite metaphorical ways.

The interview is with psychologist Simone Schnall and it does tend to be a little meandering although this turns out to be a huge bonus.

Schnall covers a whole raft of eye-opening findings on how our social behaviour is influenced by changes in the environment that seem only symbolically related to our behaviour.

For example, we feel warmer toward strangers when holding a hot drink, we allow our morals to become more flexible when we feel physically cleaner, and we evaluate the whole of our lives less positively during spells of bad weather.

The interview is packed full of these curious meaning-based influences on our lives and is available as a video or a transcript.
 

Link to Edge talk ‘A Sense of Cleanliness’.

Interview with Wade Davis: Part II – culture clashes

This is Part II of our interview with ethnobotanist and explorer Wade Davis where we discuss technology, culture and the slippery concept of human nature.

Davis kindly spoke to myself and science journalist Ana María Jaramillo while visiting Medellín’s excellent science museum Parque Explorer and in Part I we discussed altered states of consciousness and the use of psychedelic plants.

If you’re in Medellín, the science museum is shortly to host an exhibition curated by Davis, of photographs by the founding father of ethnobotany, Richard Evans Shultes.

Schultes travelled through then unexplored parts of the Amazon and studied the native peoples, their rituals and knowledge of the forest and was Davis’ professor and mentor.


Ana María: You wrote “Anthropology has long taught that whether a people’s mental potential goes into technical wizardry or unravelling the complex threads of memory inherent in a myth is merely a matter of cultural choice and orientation.” Do you think Western cultures have lost anything important with a greater focus on technical wizardry?

I’m no scholar of middle Europe but if you think of the moment that we elected to liberate ourselves from the tyranny of absolute faith, and that case, the tyranny of the church, the whole thrust of the Enlightenment was the power of the mind over the body of man. When Descartes said that ‘mind and matter is all that matters’ he thrust out all instincts for myth, mysticism and metaphor and basically, in a single gesture, devitalised Europe.

That idea that only human beings can be animate or the idea that a bird could have animus was ridiculed and dismissed as ridiculous. It was pretty clear that the way that we treat the Earth as simply a raw resource to be consumed at our pleasure comes directly out of that process of devitalising the Earth.

That really goes back to the revelations of genetics where geneticists have shown that we’re all cut from the same genetic cloth, that race is a complete fiction, that the human genetic endowment is a continuum. And the corollary of that is that if we all share the same raw intellectual capacity we all share the same human genes and so how the genes are expressed is a matter of cultural choice.

That’s really my whole work with National Geographic to go around the world looking at cultures that manifest the human genus in different ways. Whether that be a shaman learning to manipulate plants with such dexterity to create a preparation like ayuhuasca or the Polynesian navigator who, through a process of dead reckoning, was able to chart the open oceans centuries before the Europeans dared leave the protection of the coastline, or the Buddhist science of the mind with 2500 years of empirical observation on the nature of mind.

To me these are all just options that human beings have taken. In terms of the relationship to the natural world the classic opposition to our world view is the Aborigines of Australia. What’s fascinating when you look at their entire intellectual devotion is that it is not to improve upon anything. We embrace this cult of improvement which technological wizardry expressed and made this really remarkable world we live in, which I’m not denigrating.

My friend Andy Weil, even though he’ll speak of the value of alternative medicine, says that if you get your arm ripped off in a car accident you don’t want to be taken to a shaman. But the physical impact of our world view on the planet has been demonstrable and what I find interesting is that in these cultures that define the world as being alive – like in Andean Peru where people really do believe that they have a reciprocal obligation to the Earth and the Earth in turn has reciprocal obligations to people. That doesn’t mean that the people of the Andes didn’t cut down the forests – they did – but in general that world has a much more gentle impact on the landscape than modernity has had.

And with the Aborigines it’s fascinating because they didn’t only not embrace the cult of progress but they embraced a world view that denied progress. Their who purpose in life was to not improve on anything – to do the ritual gestures necessary to maintain the world exactly as it was at the time of its origins and that’s a profoundly conservative way of thinking but it had real consequences. As a result – yes they didn’t develop a sophisticated material culture – but they didn’t create climate change either.

I don’t think any of this is about saying who’s right and who’s wrong but it’s just fascinating to recognise that there are different options and these other cultures aren’t failed attempts at being us but they’re unique answers to a fundamental question – what does it mean to be human and alive?

When people answer that question, they do so in 7,000 languages. The problem comes along through cultural myopia, which all cultures tend to have but with our unique power we are causing so many of these world views to be lost.

Vaughan: One of the things that anthropology is constantly doing is defying our expectation of what it is to be human. I’m wondering how much you believe in a common humanity?

Genetics shows that we’re all cut from the same genetic cloth, and, as I said, social anthropology shows that we all have the same adaptive imperatives. That’s what I find so cool about culture. Every culture has to deal with death, every culture deals with procreation, coupling or whatever, but within that communality there’s this amazing set of possibilities and so many unique outcomes.

Wading through the killing fields of the mind

BBC Radio 4’s From Our Own Correspondent has a gripping report on a meeting with a Cambodian psychologist who works in a country still trying to come to terms with the collective brutality initiated by the Khmer Rouge regime in the 1970s.

The text of the report is online and makes for powerful reading but I really recommend listening to it, either streamed from page linked above or by downloading the podcast available as an mp3.

The Khmer Rouge are considered to be perhaps the bloodiest regime in history, with over 7 million estimated killed. They began a form of genocide where average citizens were recruited into killing people considered to be subversive from their own community.

Needless to say, many are still living with those who committed the atrocities, or, with the memories of having atrocities committed against them.

The piece is reported an understated but powerfully insightful manner, the psychologist himself reflecting the ambivalence the society still feels towards its past.
 

Link to text of report and streaming audio link.
mp3 of podcast.

Interview with Wade Davis: Part I – altered states

Anthropologist and explorer Wade Davis recently gave a talk at Medellín’s fantastic science museum Parque Explorer and myself and science journalist Ana María Jaramillo managed to grab some of his time to discuss altered states of consciousness and cultural diversity.

If you’re not familiar with Davis’ work, his TED talk on ‘Cultures at the far edge of the world’ is a great place to start.

It was a particular pleasure to talk to Davis in Medellín, because he has had a long connection with the city, previously holding a post at the Botanic Garden, and has extensive experience of Colombia.

His book, One River, discusses his time in Colombia as a student of the legendary botanist and explorer Richard Evans Schultes who was the first to scientifically describe numerous psychoactive plants and substances – including the famous psychedelic of the Amazon peoples – yagé or ayuhuasca.

Our interview is in two parts, and this first part will cover how mind-altering substances integrate with culture and Davis’ own experience with psychedelics. Tomorrow, we’ll discuss diversity of human cultures across the world.


Ana María: I’d like to know how cultural context transforms the effect of a mind-altering substance. For example, is there a difference in experience between someone who takes yagé in a traditional context and someone who takes it outside the ritual, for recreation.

I think it makes a profound difference. Just speaking of psychotropic plants and preparations, everybody who has seriously studied them has always looked at what’s called ‘set and setting’. The ‘set’ is the mental set that you bring to the experience and the setting is the physical ambience in which you experience the explosion of consciousness. Part of the ‘set’ is your own cultural predispositions to the experience

I remember noticing this very much so in Haiti when I studied voodoo. It was just astonishing to witness voodoo acolytes in a state of trance, possessed by the spirit as they saw themselves, handling burning embers with impunity. And when I say that I’m not indulging in some kind of New Age mysticism, I just saw people walking around with burning coals in their mouths, and I can assure you that I would have burnt my tongue terribly whatever the circumstance.

People often ask me, when you were studying voodoo did you become possessed? But the idea was ridiculous to me. If you listened to what I was saying about it, or anyone else was saying about the really unique richness of the cultural experience, it’s just not something you can just try on like a cloak. You can’t just go down to Haiti, put down your money, or put down your soul, and suddenly become a voodooist.

It just has to be something in the very fibre of your being when growing up. Similarly, I think that the set and the setting in which indigenous people in the Amazon experience these substances is probably very unique and it’s also not uniform in any one culture. I remember once when I was with the Cofán and we had taken yagé in a very traditional context and afterwards I turned to the people I had been up all night with and said “I don’t know about you guys but that stuff scares the hell out of me” and they said “scares us too!”

So I think the experiences are idiosyncratic but also culturally specific, that’s my sense of it. But I don’t pretend to be any kind of authority. It’s mainly just based on my own experience, other people might disagree.

It’s interesting how these things change though. I find it fascinating that there is this ayahuasca phenomenon, it’s literally sweeping Europe and sweeping the United States. I meet young people who take ayahuasca and they speak so positively about the experience whereas I remember the whole point of ayahuasca was facing down the jaguar, being ripped away from the tit of jaguar woman. That was sort of what its point was.

I think our reaction to these substances can change over time too, almost as age cohorts move though. I’m someone who’s very happy to say that not only did I used psychedelics and enjoyed them but that they changed my life. I don’t think I would speak the way I speak, write the way I write, synthesise information the way I do, understand those notions of cultural relativism as reflexively as I do, if I hadn’t taken psychedelics.

I often think it’s interesting that if we look at the social changes of the last 30 years – everything from new attitudes towards the environment, new sense of the holistic integration of the Earth, women going from the kitchen to the board room, people of colour from the woodshed to the Whitehouse, gay people from the closet to the alter, that we always leave out of the recipe of social change that millions of people all around the world lay prostrate before the gates of awe after having taken some psychedelic.

We came out of a place with profound alienation of our cultures, experimenting with psychedelics in a very fresh way – there was not a lot of expectation. We rediscovered lots of new drugs and just tried them on ourselves so there were a number of things we could say we were the first to take. Not that I want to dwell on that, but the idea that were trying to find some idea of what it means to be human.

And also cultural relativism and just the idea that other peoples of the world aren’t failed attempts at being you, that comes powerfully from the psychedelic experience. I one point I remember I took some big heroic dose of some drug, I can’t remember exactly, San Pedro I think, and I was stopped by my friend just before I could send a telegram to my professor at Harvard that was going to say ‘Eureka! We’re all ambulatory plants!’ I don’t think that would have really got me too far.

That said, I found that psychedelics were extremely useful to me when I was young, when I was trying to de-construct the world that I had been born into but didn’t necessarily want to live in. And then as I carefully constructed a world, became married, became a father, developed a career, created a world, I found psychedelics profoundly disorienting and not very helpful.

Vaughan: Do you think the kind of disorientation you mentioned also happens on a cultural level? I’m very struck by the fact that many Western cultures are officially hostile to a lot of psychedelic drugs and yet there are many traditional cultures which have used them for thousands of years. I’m interested in that process of integration.

I think that’s a key point. For whatever reason, people in the West define drugs by culturally routed moral and legalistic opinion and therefore the drugs we habitually use we dismiss with euphemisms. So we don’t use caffeine we have a ‘coffee break’, or we’ll have a ‘cocktail party’ or a ‘quick smoke’. The irony is, is that the drugs we do choose to use, by chance turn out to be pharmacologically some of the most powerful and arguably some of the dangerous. Obviously, tobacco being the first to come to mind.

What you see in indigenous cultures by contrast, and lots of people have written about this, is that they seem to recognise that the desire to periodically change consciousness is an acceptable desire and the ethnographic record says it’s so ubiquitous in the human record that you have to see it as a basic human appetite. But they also recognise that the pure effects of these substances can be profoundly disquieting and so they insulate that possibility in a protective cloak of ritual.

Of course, they use their drugs in natural forms – again, I’m not speaking with hippy ethnography – but it’s just a more benign way of taking any drug. And that doesn’t mean that they only use these drugs for ‘culturally useful purposes’ – that was a sort of wonderful puritanical rap laid on us by anthropologists in the 70s who wanted to say it was OK for Indians to take drugs but not us because they don’t really have fun when they use drugs. That’s just not true. The Yanomami love getting high – that’s what they do all day long.

But there obviously seems to be great lessons in that because we remain tormented by drug problems that don’t go away. Andy Wild wrote a long time ago that there’s no such thing as a good or bad drug just good and bad ways of using drugs.

The interesting thing about these substances is not the pharmacological effects but the question of whether they are helpful to you. Do they help you understand something about your life and destiny and your sense of being in the world? I think with psychedelics that they can be profoundly useful but there like a telephone call – once you get the call and get the message you can hang up as Ram Dass famously said.

Clapham Junction and the frustrations of dementia

I’ve just found an amazing Terry Pratchett article published in the Journal of Mental Health earlier this year entitled ‘Diagnosing Clapham Junction syndrome’ where he discusses his experience with dementia.

Pratchett was diagnosed with posterior cortical atrophy, usually considered to be an atypical form of Alzheimer’s disease that is focused on the back of the brain and tends to cause particular disruption to visual abilities.

You can’t battle it, you can’t be a plucky “survivor”. It just steals you from yourself. And I’m 60; that’s supposed to be the new 40. The baby boomers are getting older, and will stay older for longer. And they will run right into the dementia firing range. How will a society cope? Especially a society that can’t so readily rely on those stable family relationships that traditionally provided the backbone of care?

What is needed is will and determination. The first step is to talk openly about dementia because it’s a fact, well enshrined in folklore, that if we are to kill the demon then first we have to say its name. Once we have recognized the demon, without secrecy or shame, we can find its weaknesses. Regrettably one of the best swords for killing demons like this is made of gold – lots of gold. These days we call it funding. I believe the D-day battle on Alzheimer’s will be engaged shortly and a lot of things I’ve heard from experts, not always formally, strengthen that belief. It’s a physical disease, not some mystic curse; therefore it will fall to a physical cure. There’s time to kill the demon before it grows.

I have to say, in one section, Pratchett is probably a little hard on clinicians in terms of how long it takes to diagnose dementia, which is not an easy task.

Dementia is usually defined as a decline in mental abilities that happens faster than would be expected from normal ageing and is associated with degeneration of the brain.

There are many types of dementia, and diagnosis is often broken down into ‘possible’, ‘probable’ and ‘confirmed’ versions.

Rather frustratingly, for those wanting a precise and confident diagnosis of, let’s say, Alzheimer’s disease, a ‘confirmed’ diagnosis can only be officially made on the basis of close examination of the brain tissue after the symptoms are known.

In practice this means that dementia can only be ‘confirmed’ after death. The result is that most people get a diagnosis of ‘possible’ or ‘probable’ dementia.

The former is made when the person has known cognitive problems and estimates that they were much better before, and the latter only when testing has shown that there has been a definite decline over at least six months.

For a diagnosis of Alzheimer’s, this needs to affect at least two areas of mental functioning, so a tried and tested decline in just memory over six months would still leave some doubt. This means a wait of a year can be pretty standard for a ‘probable’ diagnosis.

After finally getting his diagnosis after experiencing difficulties for some time, Pratchett says “you could have used my anger to weld steel”. It’s worth saying that the frustration is shared.

By the way, Pratchett’s article was published in a special open-access edition of the Journal of Mental Health focussing on classification where several people discuss their experience of hearing their diagnosis.

There’s a particularly good piece by Mark Vonnegut, son of science fiction author Kurt Vonnegut who was previously diagnosed with schizophrenia and is now a qualified doctor, working as a primary care pediatrician.
 

Link to Terry Pratchett on ‘Diagnosing Clapham Junction syndrome’.
Link to table of content for open-access edition.

Oxytocin is a complex character

Not Exactly Rocket Science elegantly covers a new study that counters the tired ‘love drug’ stereotype associated with the hormone oxytocin.

Although several studies have found that doses of the hormone, usually sprayed into the nose, increase feelings of trust, it is also becoming clear that this just one effect and it may be heavily dependent on situation or the characteristics of the person.

Contrary to the cliché, we reported on a study last year that found that the drug increased feelings of envy and gloating in a trading game.

This new research looked at how a dose of oxytocin altered men’s feeling about their social relationships – including with their mothers – and very different reactions were discovered.

[Psychologist Jennifer Bartz] found that when she averaged out the volunteers’ results, the sniffs of oxytocin hadn’t seemed to colour their memories of their mothers. But things changed when she looked at them individually. Those who felt more anxious about their relationships took a dimmer view of their mother’s parenting styles when they sniffed oxytocin, compared to the placebo. Those who were more secure in their relationships reacted in the opposite way – they remembered mum as being closer and more caring when they took the oxytocin.

These results show that oxytocin is far from being a simple “love hormone”. As Bartz says, it has a “more nuanced role… than previously thought,” and one that varies from person to person. It’s “not an all-purpose attachment panacea.”

 

Link to NERS on new oxytocin study.

An infection of mental fog

The Guardian has an excellent article on how tropical diseases are a major and largely unrecognised risk to the mental agility of young children as parasites directly or indirectly affect the brain.

Frustratingly, the diseases are widespread and, in many cases, easily treatable, if only the resources were available.

Unfortunately, the same problems that make treatment scarce also mean that the conditions are under-researched and it’s still not clear in many cases how the diseases end up causing mental deterioration.

We are still a long way from understanding the mechanisms by which a given disease may affect cognitive function. For instance, a parasitic worm infection may have its main effect on educational progress by causing diarrhoea and malaise, leading the child to miss school or to be listless and unmotivated in the classroom. But there may be more direct effects on brain development caused by malabsorption of nutrients or iron-deficiency anaemia. It has also been suggested that the toxins generated by some parasites may affect brain function.

Such effects may be temporary, the child catching up with his or her peers once the infection has been cured, or long-lasting, if brain development is disrupted during a critical phase. Research in this area is difficult, but is urgently needed if we are to develop effective preventive strategies.

 

Link to Guardian piece ‘Out of sight, out of mind’.

The boundaries of mental illness

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.

A misperceptive critic

It’s not often that hallucinations indulge in media criticism, but this case of Charles Bonnet syndrome recently published in the journal Optometry is a delightful exception.

Everyone, it seems, is a critic, including perceptual distortions generated by, in this case, macular degeneration.

A 79-year-old man presented to the clinic with intermittent hallucinations of 6 months’ duration before this visit. He reported it occurred mostly in the evening, when he saw visions of road maps, Christmas wreaths, and faces that blocked his television screen. The faces were not of people known to him and often had elaborate hats or headdresses. When he rode in a car, he often saw houses that he knew were not truly present, and when he watched his favorite celebrity television dancing show, he saw multiple dancers rather than the 2 actually dancing. He was not disturbed or frightened by these hallucinations; he knew that they were not real. On the contrary, he felt they were amusing and reported they were often more entertaining than what was actually on television.

 

Link to PubMed entry for case report.
Link to DOI entry for same.

Treating the most dangerous

If you only listen to one podcast this week, make it this one.

The BBC World Service Exchanges at the Frontier has a compelling discussion with Gwen Adshead, a forensic psychiatrist and psychotherapist at the high security Broadmoor Hospital, who discusses on working with some of the most dangerous psychiatric patients in the country.

I was left both moved and inspired by the programme as Adshead discusses the humanity in caring for those who may have committed some of the most dreadful crimes and how one works to rehabilitate those many people would consider ‘evil’.

The discussion doesn’t shy away from tackling the hard questions of forensic psychiatry, scientific and ethical, and you’ll find no better introduction to the sharp end of dealing with people may be both patient and prisoner.

There’s also an extended hour long version of the programme that you can stream online.

Humane. Challenging. Revealing. Enlightening. Genuinely unmissable.
 

mp3 of podcast.
Link to programme page.
Link to page with streamed hour-long extended version.

The forest of hope and despair

VBS.TV has a short poignant documentary on the Aokigahara forest in Japan, which has become one of the world’s most popular locations for people to commit suicide.

The film is from the perspective of the warden who discusses why people are drawn to the forest and how people spend some of their most difficult moments.

The popularity of the location has been attributed to a best-selling novel in which two people end their lives there and the fact it was featured in the controversial Japanese book The Complete Manual of Suicide.

The 20 minute documentary is by no means gratuitous although does have a few difficult scenes. Mainly though, it is one man’s philosophical reflections on the beautiful but troubled environment that ultimately ends on a note of hope and optimism.

An understated but quietly powerful film.
 

Link to streamed documentary on Aokigahara.

A psychological rift in the perception of war

BBC Radio 4’s Analysis programme has a fascinating edition on how the public’s psychological perception of war is changing and how this is having an effect on the armed forces.

It’s drawn from a UK perspective and its bookended by a bit of political stuff but the main part is full of interesting observations on how our understanding of acceptable soldiering is changing.

For example, medals for bravery are increasingly given for soldiers who rescue their wounded comrades under fire, rather than for killing the enemy as they used to be, despite the fact that killing the enemy remains a necessary part of a soldier’s job.

The core point of the programme is to explore the how the public and the military view of conflict is diverging and what effect this has on the operations of the armed forces.

Difficulties in adjusting back to civilian life are known to contribute to mental health problems in soldiers and I wondered how much the growing sense of ‘not being understood’ contributes to this but could find no research which directly tackled the issue.
 

Link to Analysis ‘Defence: no stomach for the fight?’
mp3 of podcast of the programme.
Link to text of script.