Category: Togetherness

This month’s Prospect magazine features a touching story about Nia – “..too beautiful to be in a psychiatric ward“. The true tale conveys elegantly the dilemma that often faces psychiatrists as they weigh up the benefits of antipsychotic medication against the side effects that can sometimes be worse than a patient’s original symptoms. In this story Nia’s beauty is ruined by the only drug that alleviates her psychosis – Olanzapine. What unnerves the psychiatrists is that she doesn’t seem to care, whereas they do. “The treatment had reversed a Faustian pact in which Nia had been beautiful and mad, and replaced it with another‚Äîin which she was fat and sane. But was it really a blessing that Nia seemed to have no conception of what she had lost?“

Link to story by deputy editor of Prospect Alexander Linklater and psychiatrist Robert Drummond (access to this item is free).

From Nancy Etcoff’s book Survival of the Prettiest: The Science of Beauty (ISBN 0385478542):

“People judge appearances as though somewhere in their minds an ideal beauty of the human form exists, a form they would recognise if they saw it, though they do not expect they ever will. It exists in the imagination.” (p11)

“Attitudes surrounding beauty are entwined with our deepest conflicts surrounding flesh and spirit. We view the body as a temple, a prison, a dwelling for the immortal soul, a tormentor, a garden of earthly delights, a biological envelope, a machine, a home. We cannot talk about our response to our body’s beauty without understanding all that we project onto our flesh.” (p20)

A few days after our post on ‘hikikomori’ – the extreme social withdrawal increasingly seen in Japanese adolescents – the New York Times published an in-depth article on the controversy surrounding the phenomenon.

Coincidence? Well… yes. But an interesting and well-timed one nonetheless.

For all the attention, though, hikikomori remains confounding. The Japanese public has blamed everything from smothering mothers to absent, overworked fathers, from school bullying to the lackluster economy, from academic pressure to video games. “I sometimes wonder whether or not I understand this issue,” confessed Shinako Tsuchiya, a member of Parliament, one afternoon in her Tokyo office.

Link to article ‘Shutting Themselves In’.

The term “involuntary” used to describe Tourette syndrome tics is a source of confusion since it is known that most people with TS do have some control over the symptoms. Before tic onset, individuals with TS experience what is called a “premonitory urge,” similar to the feeling that precedes yawning.

What is recognized is that the control which can be exerted from seconds to hours at a time may merely postpone and exacerbate outbursts of symptoms. Tics are experienced as irresistible as a yawn and must eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work.

Typically, tics increase as a result of tension or stress (but are not solely caused by stress) and decrease with relaxation or concentration on an absorbing task. In fact, neurologist and writer Oliver Sacks has described a man with severe TS who is both a pilot and a surgeon.

Fascinating section from the Wikipedia article on Tourette syndrome.

Link to Tourette Syndrome Association (UK).

A psychoanalyst once proposed that ‘madness is when you can’t find anyone who can stand you’. This is not such a flippant definition as it might first appear. In practice, the mad are created when those around them can no longer cope with them, and turn them over to specialists and professionals. They are people who have broken the ties that bind the rest of us in our social contract, who have reached a point where they can no longer connect.

But by this definition James Tilly Matthews, paranoid schizophrenic or not, was not mad. It is striking that throughout his story, even at the prodigious heights of his delusions, there are always those around who trust him, and he consistently inspires sympathy, affection and love.

From Mike Jay’s The Air Loom Gang: The Strange and True Story of James Tilly Matthews and his Visionary Madness (ISBN 0593049977, p58).

Matthews had previously been involved in peace negotions between France and England and returned believing himself controlled by a mysterious ‘air loom’. Also believing the government to be under its influence he shouted “treason!” in the House of Commons.

After his arrest and confinement at ‘Bedlam’ Hospital, he became the subject of the first ever book-length psychiatric case study in 1810. John Haslam, the hospital apothecary, wrote-up his case as part of an effort to embarass the medical establishment who he believed, contrary to their claims, did not understand either madness or Matthews’ case.

Link to article on James Tilly Matthews and the ‘air loom’ by Mike Jay.
Link to John Haslam’s 1810 ‘Illustrations of Madness’.

Wikipedia has a fascinating article on the phenomenon of hikikomori – where large numbers of Japanese adolescents are socially withdrawing, often to the extent of seeking extreme isolation and self-confinement, presumably due to various personal and social difficulties.

Although the article hints that hikikomori is considered a phenomenon of medical concern, there’s very little written about it in the medical literature catalogued on PubMed.

This may suggest that the (largely Western) medical literature has not touched on the subject, or that the phenomenon is not usually considered of psychiatric importance, even in Japan.

There’s plenty of links to news sources discussing the phenomena on the Wikipedia page, but I’ve not been able to find many substantial english language articles written for scientific or academic publications.

Any pointers greatfully received…

Link to Wikipedia article on ‘Hikikomori’.

A stranger has come
To share my room in the house not right in the head,
A girl mad as birds

Bolting the night of the door with her arm her plume.
Strait in the mazed bed
She deludes the heaven-proof house with entering clouds

Yet she deludes with walking the nightmarish room,
At large as the dead,
Or rides the imagined oceans of the male wards.

She has come possessed
Who admits the delusive light through the bouncing wall,
Possessed by the skies

She sleeps in the narrow trough yet she walks the dust
Yet raves at her will
On the madhouse boards worn thin by my walking tears.

And taken by light in her arms at long and dear last
I may without fail
Suffer the first vision that set fire to the stars.

‘Love in the asylum’ by poet Dylan Thomas (1914 – 1953).

Last Saturday’s Guardian featured an essay by Andrew Brown on science’s attempt to explain why so many people the world over are religious.

Brown says that many religions have existed without a belief in eternal life, thus undermining the argument that by promising an afterlife, religion evolved as a way for humans to cope with their mortality.

A more plausible explanation, he says, is that religion is a by-product of an aspect of our minds and behaviour that evolved for some other purpose. According to biologist David Sloan Wilson, one such purpose could be coherent and successful group behaviour. Consider how lust inspires us to mate, which has the evolutionarily advantageous knock-on effect of producing babies. Similarly, the pursuit of the sacred inspires us to religion, which has the evolutionary advantageous knock-on effects of causing us to form coherent groups and to follow rules.

Link to Guardian essay.

The New York Times reports on the interaction between isolated communities and the researchers which visit them. Remote peoples are often involved in psychology, anthropology and medical science research, although the NYT article focuses on how the researchers are regarded by their participants.

Another member of the tiny and reclusive Ariaal tribe, Leketon Lenarendile, scanned a handful of pictures laid before him by a researcher whose unstated goal was to gauge whether his body image had been influenced by outside media. “The girls like the ones like this,” he said, repeating the exercise later and pointing to a rather slender man much like himself. “I don’t know why they were asking me that,” he said.

Link to article ‘Remote and Poked, Anthropology’s Dream Tribe’.

An untitled poem on transformation, science and insanity by the 13th century Persian poet Jalal al-Din Muhammad Rumi:

I have lived on the lip
of insanity, wanting to know reasons,
knocking on a door. It opens.
I’ve been knocking on the inside!

Real value comes with madness
matzub below, scientist above.

Whoever finds love
beneath hurt and grief

disappears into emptiness
with a thousand new disguises.

Apparently, matzub is the name for people who become ecstatic with holy enlightenment. From Rumi: Selected Poems (p281, ISBN 0140449531).

Link to wikipedia article on Rumi.

The American Psychological Association’s flagship publication Monitor on Psychology summarises the research on gay parents and finds their children are generally healthy, happy and well adjusted, despite occasional homophobic teasing.

Patterson‘s and others’ findings that good parenting, not a parent’s sexual orientation, leads to mentally healthy children may not surprise many psychologists. What may be more surprising is the finding that children of same-sex couples seem to be thriving, though they live in a world that is often unaccepting of their parents.

In fact, an as-yet-unpublished study by Nanette Gartrell, MD, found that by age 10, about half of children with lesbian mothers have been targeted for homophobic teasing by their peers. Those children tended to report more psychological distress than those untouched by homophobia.

But as a group, the children of lesbian moms are just as well-adjusted as children from more traditional families, according to the data from Gartrell’s National Longitudinal Lesbian Family Study.

Link to article in APA monitor.
Link to Patterson’s full report “Lesbian and Gay Parenting” from the APA.

Carl Zimmer considers the tension between biological and psychological explanations of the mind (and, perhaps, the soul) in the conclusion to his history of early brain science Soul Made Flesh (ISBN 0099441659, p296):

Our souls are material and yet immaterial: a product of chemistry but also a pulsating network of information – a network that reaches beyond the individual brain to other brains, linked by words, glances, gestures, and other equally immaterial signals, which can leave a mark as indelible on a scan as a stroke or a swig of barium, and yet never become merely physical themselves.

Link to excerpt from Soul Made Flesh.

The cover story in December 5th’s Newsweek is available online and tackles the science and treatment of anorexia, focusing particularly on why it seems to be increasingly prevalent in children as young as eight.

At a National Institute of Mental Health conference last spring, anorexia’s youngest victims were a small part of the official agenda‚Äîbut they were the only thing anyone talked about in the hallways, says David S. Rosen, a clinical faculty member at the University of Michigan and an eating-disorder specialist. Seven years ago “the idea of seeing a 9- or 10-year-old anorexic would have been shocking and prompted frantic calls to my colleagues. Now we’re seeing kids this age all the time,” Rosen says. There’s no single explanation for the declining age of onset, although greater awareness on the part of parents certainly plays a role. Whatever the reason, these littlest patients, combined with new scientific research on the causes of anorexia, are pushing the clinical community‚Äîand families, and victims‚Äîto come up with new ways of thinking about and treating this devastating disease.

Unfortunately, the article has a somewhat oversimplified account of psychiatrist Walter Kaye’s recent research review and hypothesis about anorexia: that starvation might be a response to a disturbed serotonin system, particularly to high levels at areas in the brain with the serotonin 5HT_1A receptor – a system particularly linked to anxiety and obsessiveness.

Starvation might be a response to these effects, as it is known to lower trytophan and steroid hormone metabolism, which, in turn, might reduce serotonin levels at these critical sites and, hence, ward off anxiety.

Importantly, the effects on serotonin levels are often restricted to certain brain areas. Furthermore, studies on a different type of serotonin receptor, the 5HT_2A, actually suggest a decrease in serotonin activity at this type of receptor.

Kaye also suggests that disturbance to the serotonin system may arise owing to a combination of genetics, puberty-related hormone changes, stress and cultural pressures – not just a “brain disease”, as one psychiatrist is quoted as saying.

The article does, however, report moving accounts of individuals and families affected by the condition, and contains links to a podcast, including interviews with clinicians and researchers.

Link to article ‘Fighting Anorexia: No One to Blame’ (via PCSD&A).
Link to abstract of Kaye and colleagues article on serotonin and anorexia.

Mohammed, founder of Islam, is often described as having epilepsy. He’s even described as such on epilepsy information site epilepsy.com. The historical basis for such claims are almost certainly false, however, and first stem from a historian writing almost 200 years after the Prophet’s death.

The myth has been most comprehensively debunked by the respected American historian of medicine Owsei Temkin in his book The Falling Sickness: This History of Epilepsy from the Greeks to the Beginnings of Modern Neurology (ISBN 0801848490). To quote from p153…

As is to be expected, the positive bias of Islam was countered by an opposite bias in the Christian world. As to the origin of the diagnosis “epilepsy”, everything points to Christian Byzantium, an empire that was no only hostile to Islam but at frequent war with the Arabs. Less than 200 years after Mohammed’s death, the Byzantium historian Theophanes (died about 817) told a story which was bound to make Mohammed appear and fraud and to discredit the belief in his divine mission.

According to Theophanes, Mohammed had the disease of epilepsy. And when his wife noticed it, she was very much grieved that she, being of noble descent, was tied to such a man, who was not only poor but epileptic as well. Now he attempts to soothe her with the following words: “I see a vision of an angel called Gabriel and not being able to bear the sight of him, I feel weak and fall down.” But she had a certain monk for a friend who had been exiled because of his false faith and who was living there, so she reported everything to him, including the name of the angel. And this man, wanting to reassure her, said to her: “He has spoken true, for this angel is sent forth to all prophets”. And she, having received the word of the pseudo-prophet, believed him and announced to the other women of her tribe that he was a prophet. (Theophanes, 1007, Chronographia, vol. 1, p334)

The is the story which was accepted by Western historians, theologians and physicians. The story has all the earmarks of religious and political propoganda. Hence it was repudiated by Gibbon as “an absurd calumny of the Greeks”.

PDF of Owesei Temkin’s obituary.

The Observer has an article on the growing ‘autistic pride’ movement that aims to reframe autism as a variation of human experience with its own set of advantages and disadvantages, rather than as a neurological disorder that needs to be ‘cured’.

Many people with autism or Asperger’s syndrome describe people without such traits as ‘neurologically typical’ or NTs, based on the idea that autism might involve different brain ‘wiring’.

The autistic pride movement has found a natural home on the internet and several sites take a witty approach to making their point.

The Institute for the Study of the Neurologically Typical turns autism science on its head, by spoofing a research centre that examines non-autistic people as unusual or pathological.

The movement often places itself within a wider ‘neurodiversity‘ movement, demanding that society respects differences in brain structure and function, rather than always focusing on trying to ‘correct’ them.

The article also mentions the autism software project Reactive Colours, whose director, Wendy Keay-Bright, we interviewed back in July.

Link to Observer article ‘Say it loud, autistic and proud’.
Link to wikipedia article on autism rights movement.
Link to Institute for the Study of the Neurologically Typical.

The New York Times has an article about the increasing willingness of young people to ‘prescribe’ themselves, and their friends, psychiatric drugs:

For a sizable group of people in their 20’s and 30’s, deciding on their own what drugs to take – in particular, stimulants, antidepressants and other psychiatric medications – is becoming the norm. Confident of their abilities and often skeptical of psychiatrists’ expertise, they choose to rely on their own research and each other’s experience in treating problems…

Perhaps, this is a curious result of consumer cynicism about the links between the pharmaceutical industry and the medical profession.

Drug marketing, in the USA at least, can be legally targeted at consumers, rather than at doctors only. Much of the marketing gives the impression that medications are low-risk and widely beneficial, when the reality can be far more complex.

Despite the fact that many psychiatric drugs can be of great value in treating mental distress or impairment, most will cause some form of side-effect and many are still without evidence of their long-term safety.

Rather than distrusting the pharmaceutical industry, which is usually cited as having an untoward influence on medical practice, young self-confident consumers may have, ironically, fallen for the ‘pill for every ill’ marketing hype and focused their cynicism largely on the medical profession.

Link to reg free NYT article ‘Young, Assured and Playing Pharmacist to Friends’ (via BrainBlog).