Category: Togetherness

American Scientist reviews a new book that suggests an intriguing hypothesis – that the reason that the distrust of people with a different skin color, different values or a different ideology is so prevalent is because the early development of crucial brain pathways makes it hard for people to accept new and unfamiliar experiences.

Wexler argues that when people are faced with information that does not agree with their internal structures, they deny, discredit, reinterpret or forget that information. When changes in the environment are great, corresponding internal changes are accompanied by distress and dysfunction. The inability to reconcile differences between strange others and ingrained notions of “humanness” can culminate in violence. The neurobiological imperative to maintain a balance between internal structures and external reality fuels this struggle for control, which contributes to making the contact zone a place of intractable conflict.

The book is Brain and Culture: Neurobiology, Ideology, and Social Change (ISBN 0262232480) by psychiatrist Bruce Wexler.

Link to review from American Scientist.

Edgar Jones and Simon Wessely give one of several examples of people diagnosed with psychiatric disorder giving exemplary service during the Second World War.

From p108 of their book Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War (ISBN 1841695807):

“As regards to the related question of how those diagnosed with psychiatric disorder actually performed in [World War II] combat, Plesset (1946) followed up 138 soldiers who in training had shown ‘sufficient adjustment difficulty to necessitate psychiatric attention’. After 30 days of combat, 137 remained on active duty, and one had received a gallantary medal. By the end of the war, 120 remained on active duty and eight had been awarded Bronze stars.”

Screening for those likely to suffer combat-related psychiatric disorder is one of the ‘holy grails’ of military psychiatry.

So far, this has proved impossible, as the single most important factor in predicting whether a soldier is likely to suffer combat stress reaction is the intensity of the fighting, rather than whether they have a history of mental illness.

Link to review of Jones and Wessely’s Shell Shock to PTSD.

I’ve just uploaded some archive film footage to YouTube of shell shock patients from World War One, taken from a recent Channel 4 documentary on soldiers executed for cowardice.

I was surprised to find that there is almost no video of this historically and clinically important condition on the internet.

The clip has footage of patients who displayed some extreme ‘shell shock’ reactions, including paralysis, shaking and convulsions.

These physical reactions are now considered a form of conversion disorder, where extreme emotional stress or turmoil is expressed as physical symptoms.

The clip also discusses the case of Private Harry Farr (covered previously on Mind Hacks) who was executed for cowardice, despite having been affected by the condition.

If you didn’t catch it the first we mentioned it, the recent article about his case that was recently published in the Journal of the Royal Society of Medicine [pdf] is a gripping and thought-inspiring read.

Link to YouTube video of shell shock patients.
pdf of article ‘The life and death of Private Harry Farr’.

There’s a fascinating opinion piece by psychologist Michael Tomasello in The New York Times arguing that humans, unlike other apes, have evolved to have the whites of our eyes showing to make social cooperation easier.

The idea is that this allows us to easily work out where other humans are looking, and this can help us to work out focus of attention and intention.

It has been repeatedly demonstrated that all great apes, including humans, follow the gaze direction of others. But in previous studies the head and eyes were always pointed in the same direction. Only when we made the head and eyes point in different directions did we find a species difference: humans are sensitive to the direction of the eyes specifically in a way that our nearest primate relatives are not. This is the first demonstration of an actual behavioral function for humans’ uniquely visible eyes.

Link to NYT article ‘For Human Eyes Only’.

The following quote is from p29 of Veronika Decides to Die (ISBN 0722540442) by Brazilian author Paulo Coelho.

It tells the story of a young woman who, after a failed suicide attempt, is admitted to a psychiatric hospital where she meets some curious and life-changing patients and medical staff.

Paulo Coelho was admitted to a psychiatric hospital himself when a student, and he drew on his own experiences to write the novel.

Veronika returned to her bed, and waited for the nurse to resume her reading. What did it mean to be mad? She hadn’t the slightest idea, because the word was used in a completely anarchic way: people would say, for example, that certain sportsmen were mad because they wanted to break records, or artists were mad, because they led such strange insecure lives, different from the lives of normal people. On the other hand, Veronika had seen thinly clad people walking the streets of Ljubljana in winter, pushing supermarket trolleys full of plastic bags and rags, and proclaiming the end of the world… What did it mean to be mad? Perhaps she should ask one of the mad.

Link to more info on the book.

I’ve just found an interesting letter to the British Journal of Psychiatry by A. J. McBride who noted the high level of mental illness in professional comedians.

Perhaps most well-known is the British comedian Spike Milligan who suffered from bipolar disorder and was frequently admitted to hospital.

In fact, a ward at the Maudsley Hospital in London, where he was admitted at least once, was opened by Spike. A plaque still commemorates the occasion.

The letter in the BJP was a comment on an earlier paper that noted the exceptionally high level of mental illness among jazz musicians.

Link to BJP letter on mental illness in comedians.
Link to BJP paper on mental illness in jazz musicians.

“In a culture where work can be a religion, burnout is its crisis of faith”. The New York Magazine has an in-depth article on the psychology of burn-out.

Burnout is not its own category in the Diagnostic and Statistical Manual of Mental Disorders. It’s not something that can be treated pharmacologically; it is not considered the same thing as depression or a midlife crisis, though sometimes they coincide. The term was first coined by a psychotherapist named Herbert Freudenberger, who himself probably took it from Graham Greene’s novel A Burnt-Out Case. (“I haven’t enough feeling left for human beings,” the book’s numb protagonist, Querry, wrote in his journal, “to do anything for them out of pity.”) While working at a free clinic for drug addicts in Haight-Ashbury, Freudenberger noticed that the volunteers, when discouraged, would often push harder and harder at their jobs, only to feel as if they were achieving less and less. The result, in 1974, was the book Burnout: The High Cost of High Achievement. Others soon followed. A subspecialty of psychology was born.

Isn’t Freudenberger just the best name for a psychotherapist?

Link to article ‘Can‚Äôt Get No Satisfaction’.

I’ve just discovered that The Times published a wonderfully insightful and moving account of psychosis from a young woman diagnosed with schizoaffective disorder.

Schizoaffective disorder is a diagnosis that indicates that the person experiences symptoms of both schizophrenia-like psychosis, and a serious mood disorder such as depression or bipolar.

The author of the article is Philippa King, who has been affected by mental illness since her childhood and experienced and continues to experiences intense hallucinations and delusions.

Her account is a striking commentary on both the mental health system and the experience of otherworldly states.

“You’re such a fool, a loser, idiot! They know your every move.” The voices I hear are abusive and critical. They can also be bizarre: “We are stoplights”, “You’re just cheap chocolate”, “Crazy lazy point-blank bicycle‚Äù. They produce a running commentary on my day-to-day actions or talk about me to each other. “Slash your wrist!” Worn down by the commands, I do as they say. I wrote in my diary: “It will be important to break the language barrier so all will underwater the manage the message.” I once sewed nine buttons on to my sleeve because someone said “nine or so” in conversation. It seemed terribly important to do so. It is not uncommon for people with schizophrenia like me to make up new words.

It distresses me that my thoughts are broadcast on the radio.

My DNA contains the whole of the Milky Way. I am constantly being pursued by enemies and lovers. I have scissored a mark from my skin, knowing it to be a tracking device planted by the Government. There are no locks, no devices to prevent intruders of the mind. There can be the frightening sensation of insects crawling beneath my skin. My food can suddenly turn into maggots. The round of my skull is the dome of the heavens with the world moving both inside and outside my head.

This is a remarkably lucid account of psychosis and a must-read for those interested in how the mind drifts into altered-realities during severe mental illness.

Link to Times article ‘A mind taut with pain’.
Link to more information about schizoaffective disorder.

Artificial intelligence pioneer and cognitive scientist Marvin Minsky whispers sweet nothings to The Boston Globe in an interview about emotion:

What, in your view, is love?

There’s short-term infatuation, where someone gets strongly attracted to someone else, and that’s probably very often a turning-off of certain things rather than something extra: It’s a mental state where you remove your criticism. So to say someone is beautiful is not necessarily positive, it may be something happening so you can’t see anything wrong with this person. And then there are long-term attachments, where you adopt the goals of the other person and somehow make serious changes in what you’re going to do.

Try putting that in your next Valentine’s card. Shakespeare be damned.

I tried to think up a joke based on artificial intelligence, Minksy and a love machine, but I haven’t managed it so far, so please consider it a kit and assemble one in your own time.

Link to ‘Minsky talks about life, love in the age of artificial intelligence’.

BBC News is carrying a curious story about a study on the use of psilocybin (the main active ingredient in ‘magic mushrooms’) as a possible treatment for obsessive-compulsive disorder, otherwise known as OCD.

Despite how these stories usually appear in the media, this research isn’t particularly unique. A steady trickle of studies on the potential therapeutic effects of psychedelic drugs has been apparent for the last two decades.

Psychedelic anaesthetic ketamine has been used with some success to treat alcoholism, and MDMA (‘Ecstasy’) is being researched as an agent to assist psychotherapy, particularly to treat post-traumatic stress disorder or PTSD.

A long-running research project, headed by (the appropriately named) Prof Deborah Mash from the University of Miami, has looked at the potential of the hallucinogen ibogaine in treating addictions. There’s more at this pdf.

In fact, there was some promising work done in the 1960s on the use of LSD in treating alcoholism before it was stopped due to government worries about the rising drug culture, and we reported previously on contemporary trials of LSD and psilocybin in the treatment of cluster headaches.

So, the fact that someone is researching the potential of psilocybin for treating OCD is not as surprising as it might at first seem.

What did catch my eye, however, was this quote from psychiatrist Dr Paul Blenkiron:

“About 12% of people can suffer flashbacks after less than 10 exposures [to psychedelics] many years later, beyond the six months of this study, so long term effects should be carefully assessed.”

Despite looking, I can’t find any concrete figures on a) the frequency of ‘flashback’ experiences, and b) whether they are a genuine drug-related phenomenon or not (one study suggested they could be induced by suggestion after placebo).

If anyone knows of any good research done on this area, please let me know, as I haven’t found anything so far with some good data on this still-seemingly anecdotal experience.

Also, although the BBC mentions the study, it doesn’t say where it’s going to be published. There’s a link to the Journal of Clinical Psychiatry on the page, but there’s nothing on the JCP website or on PubMed yet.

Curiouser and curiouser.

UPDATE: The comments have some fantastic additional information on ‘flashback’ research, including the source of the figures quoted by Dr Blenkiron. Thanks very much everyone!

Link to BBC News article “Psychedelic drug ‘hope for OCD'”.
Link to great Canadian Journal of Psychiatry article on LSD.
Link to recent LA Times article on psilocybin treatments.

Yesterday, ‘mass hysteria’ closed a school in Barnsley. According to an article in The Times, 30 or so pupils began feeling ill after watching a widely used biology video, and as other pupils heard about the malady, the effect spread.

The school officials eventually gathered everyone together in the school hall suspecting a gas leak, and paramedics advised the school should be closed.

The original class were taken to hospital, but no signs of physical illness have been reported and no gas leak has been found. The episode has been put down to ‘mass hysteria’.

Mass hysteria is typically called ‘mass sociogenic illness’ in the research literature and was the subject of a fascinating 2002 article by sociologist Robert Bartholomew and psychiatrist Simon Wessley.

This article was published in the British Journal of Psychiatry and charts the history of mass sociogenic illness from the middle ages to the present day.

The authors also note some of the tell-tale signs that distinguish sociogenic illness from genuine mass poisoning, and suggest there are two main types:

“Wessely (1987) identifies two types of mass sociogenic illness ‚Äî ‘mass anxiety hysteria’ and ‘mass motor hysteria’. The former is of shorter duration, typically one day, and involves sudden, extreme anxiety following the perception of a false threat. The second category is typified by the slow accumulation of pent-up stress, is confined to an intolerable social setting and is characterised by dissociation, histrionics and alterations in psychomotor activity (e.g. shaking, twitching, contractures), usually persisting for weeks or months.”

Batholomew has written a completely enthralling book on this subject called Little Green Men, Meowing Nuns and Head-Hunting Panics: A Study of Mass Psychogenic Illnesses and Social Delusion (ISBN 0786409975) which comes highly recommended both as a guide to this medical curiosity, and as a tour through the more unusual aspects of our social psychology.

Link to Times article ‘Mass hysteria forces evacuation of school’.
Link to BJP article ‘Protean nature of mass sociogenic illness’.

A study on homeless people admitted to a psychiatric emergency clinic has reported that a third have active psychosis.

The study, published in the medical journal Social Psychiatry and Psychiatric Epidemiology, was conducted in Bordeaux state hospital in France.

That study also found that most of the homeless people admitted to the clinic had already been identified by mental health services as suffering from a severe mental illness, suggesting that homelessness was a consequence of losing contact with mental health support.

Among those homeless people with psychosis, there was an over-representation of men, and people with drug addictions.

The actual number of homeless people with psychosis may actually be higher, as clinic samples tend to under-estimate the extent of mental health problems in the population, owing to the fact that people who go to clinics tend to be there for immediate help for current difficulties.

Link to abstract of scientific paper.

BBC Radio 4 is running a series at the moment called Am I Normal? that looks at differences in the body and mind. The most recent edition was on madness and psychosis, and the audio is available online.

Psychosis is the mental state in which delusions and hallucinations are prominent, and is usually linked to diagnoses such as schizophrenia or bipolar disorder.

The programme tackles the experience of psychosis and how frequently these experiences occur in the general population.

Recent research has indicated that the experiences previously thought to be diagnostic of madness, actually occur in many people who never become distressed or impaired.

It may be the extent and impact of these experiences, rather than just their presence, that is important.

Weight is something which is distributed throughout the population, with some people being heavier than others, and some being considered so overweight as to need medical treatment.

In the same way, psychosis-like experience is thought to operate on a continuum, and those with the more frequent or intense experiences being more likely to end up being treated by mental health professionals because they are distressed or impaired.

One of the factors known to impact on how distressed and impaired people become is how they evaluate and make sense of strange experiences.

Knowing that odd ideas or hallucinations are common (studies estimate about 10-20% of the population report them at some point) can significantly reduce distress in some people, and makes others less likely to stigmatise or react badly.

Weird is the new normal. Spread the word.

Link to ‘Am I Normal?’ programme webpage.
realaudio of programme on madness.

The Economist has a short but uplifting article on research that suggests that we underestimate how good looking we are when compared to other members of the same sex, possibly to keep us on our toes and work hard to attract a partner.

If you have ever sat alone in a bar, depressed by how good-looking everybody else seems to be, take comfort—it may be evolution playing a trick on you. A study just published in Evolution and Human Behavior by Sarah Hill, a psychologist at the University of Texas, Austin, shows that people of both sexes reckon the sexual competition they face is stronger than it really is. She thinks that is useful: it makes people try harder to attract or keep a mate.

Dr Hill showed heterosexual men and women photographs of people. She asked them to rate both how attractive those of their own sex would be to the opposite sex, and how attractive the members of the opposite sex were. She then compared the scores for the former with the scores for the latter, seen from the other side. Men thought that the men they were shown were more attractive to women than they really were, and women thought the same of the women.

This is quite an interesting finding in itself, but also seems to go in the opposite direction to most other normal cognitive biases we have, which lead us to judge ourselves in a better light than others.

The effect nicknamed the Lake Wobegon Effect is where we consistently judge ourselves to be above average compared to others.

Also, we are more likely to think that positive events happen because of our own actions, and negative events are due to other people or external factors.

Interestingly, there’s quite a bit of evidence that mental illness is associated with the loss of these positive biases, giving us a statistically more realistic but emotionally painful view of reality.

Link to Economist article.

The Financial Times has an article on recent research into Cotard delusion – a firm unshakeable belief that you’re dead – which can occur during mental illness or neurological disturbance.

The article focuses on a study by Drs Ryan McKay and Lisa Cipolotti on a patient named ‘LU’ who presented with the delusion when being assessed for the impact of severe epilepsy caused by a viral brain infection.

They describe the case in their paper:

At neuropsychological assessment LU presented with the Cotard delusion. She repeatedly stated that she was dead and was adamant that she had died two weeks prior to the assessment (i.e. around the time of her admission on 19/11/2004). She was extremely distressed and tearful as she related these beliefs, and was very anxious to learn whether or not the hospital she was in, was “heaven”. When asked how she thought she had died, LU replied “I don‚Äôt know how. Now I know that I had a flu and came here on 19th November. Maybe I died of the flu.” Interestingly, LU also reported that she felt “a bit strange towards my boyfriend. I cannot kiss him, it feels strange ‚Äî although I know that he loves me.” Other presenting symptoms included reported sensations of dizziness, as well as musical hallucinosis (hallucinations of disco music), tactile hallucinations (a feeling of running water on her left forearm) and visual hallucinations (moving walls).

The study tested theories which suggest it is caused by trying to make sense of losing automatic emotional responses to familiar people – a consequence of the brain damage.

Some researchers have argued that this is the basis of a similarly curious syndrome, known as Capgras delusion, where someone believes that their friend, spouse or relative has been replaced by a near-identical looking impostor.

In Capgras delusion, it is thought that the same problem with automatic emotional response is present, but that the person attributes the problem to external changes in the world (“it’s something to do with my wife…”) and reasoning problems lead to the delusion itself (“…and she’s been replaced by an impostor”).

In contrast, one theory of Cotard delusion is that it might be partly caused by the same emotional response impairment, but where the person attributes it to an internal change (“it’s a problem with me…”) with reasoning problems leading to the delusional belief (“…and the problem is, I’m dead”).

So far, this has only been an educated guess by researchers and has never been tested.

McKay and Cipolotti assessed whether LU typically made internal or external attributions for negative events, and found, consistent with the existing hypothesis, that she made consistent internal attributions.

One unexplained part, both in this study, and in delusions in general, is why these unusual experiences and odd attributions lead to delusions, and not simply to confusion (e.g. “people feel strange, I think it’s a problem with me, but and I don’t know what to make of it”).

It is thought that reasoning problems or cognitive biases are involved, most likely caused by damage or disturbance to the right hemisphere of the brain.

However, there is still little conclusive evidence for the very striking reasoning errors you might expect with such strikingly unusual delusions.

Link to FT article ‘Deadly serious’.
Link to abstract of scientific study.

ABC News report that Oakland police tasered a man having an epileptic seizure because he became agitated when restrained. They subsequently prosecuted him for assault and disorderly conduct. You couldn’t make it up if you tried.

From a press release from the Epilepsy Foundation:

The case in Michigan involved Daniel Beloungea, who was taking a daily walk in his neighborhood when he experienced a complex partial seizure, which left him in a state of semi-consciousness. Complex partial seizures are associated with repetitive involuntary movements, sometimes for up to 30 minutes, with post-seizure disorientation. Beloungea needs to walk daily as a form of rehabilitation to help restore functioning in his legs; this functioning was impaired following brain surgery to treat his seizures. A person passing by noticed Mr. Beloungea acting erratically and called police to report his behavior. When officers arrived on the scene, they apparently assumed that his failure to respond to their questions and his erratic involuntary movements amounted to resistance, and failed to recognize the obvious signs of a seizure. Furthermore, they failed to inspect the medical alert bracelet he was wearing, which indicates clearly that he has epilepsy.

According to police reports, when Mr. Beloungea was unresponsive to police direction, the bag he was carrying was kicked by police from his hand, and when he flailed his arms involuntarily, he was tasered, sending 50,000 volts of electricity through his body (risking serious injury or death); hit with a police baton; threatened at gunpoint; and handcuffed behind his back. (The handcuffing itself is dangerous for persons experiencing a seizure, as it can lead to further seizure-related agitation and struggling, possibly causing asphyxiation or even cardiac arrest.) He was then prosecuted for assaulting police officers and disorderly conduct, notwithstanding considerable evidence, including the state’s own mental health evaluation, confirming that his actions were involuntary and solely the product of a seizure.

There’s more in an article from The Oakland Press and there’s an article and two video clips from ABC News.

The video clips are interesting, as they show Beloungea being recorded as part of a clinical EEG investigation for epilepsy.

The videos have recordings of his behaviour and recordings from his brain synchronised together.

The second clip shows what most people might think of as an epileptic seizure – someone who’s obviously not with it, making repetitive movements.

The first clip, also shows a seizure (look for the intense EEG activity), but his movements seem more coordinated and purposeful.

Complex partial seizures are where the person has impaired consciousness (complex), where only a part of the brain is involved (partial) and where neurons are taken over by synchronous waves of activity and can’t continue their normal operation (seizure).

Because of the selective nature of these seizures, they tend only to affect certain brain functions, often leading to actions that are carried out without conscious control.

We know that the more we practice actions the less conscious effort is needed to carry them out, and that we only need to intervene consciously when special care or attention is needed. Driving a car or riding a bike are classic examples.

It is possible that in some people with complex partial seizures, consciousness becomes so disconnected from action that ‘best guess’ automatic actions are carried out but without awareness of the details which might otherwise inhibit the person’s inappropriate responses.

For example, in the first video clip, Beloungea has to be prevented from removing the EEG recording equipment. It may be annoying, but people with awareness will put up with annoyance for the sake of the medical assessment. During a seizure, this ability to inhibit automatic responses can be lost.

There are many reports in the medical literature of people carrying out actions during a seizure that they would normally prevent themselves from doing – such as a vegetarian eating a sausage.

It seems the police weren’t trained to recognise someone having this type of epileptic seizure, which seems a preventable but tragic oversight.

How Beloungea came to be prosecuted for actions which the court accepted were beyond his control seems much more bizarre and worrying.

If you want to learn how to recognise and help someone who is experiencing an epileptic seizure, there’s more information here.

Link to ABC News story and video clips.
Link to Oakland Press story.
Link to Epilepsy foundation press release.
Link to excellent discussion from Afarensis.
Link to ‘First-aid for seizures’.