Mind Hacks

Quito bound

Due to the complexities of the Colombian visa system, I am off to the beautiful city of Quito, Ecuador, for a week to organise the paperwork. I’m not sure how internet access will work out, so apologies if updates are a little less frequent than usual.

If anyone knows any good mind and brain things to see while I’m there, do let me know.

Already on the list is Hospital San Lazaro, one of the oldest psychiatric hospitals in Latin America. It’s considered part of Ecuador’s national heritage but I can’t see to find anything written about it in English.

However, YouTube has a very good short film about its history if you’re a Spanish-speaker or just want to see some of the historical photos and architecture.

Shimmering madness

There is an amazing blog, called either ru_medart or something I don’t understand in Russian, that collects artistic depictions of the mad from the history of art.

It’s a wonderful collection of images, and, as you might expect, many of the pictures depict the sort of ‘raving madness’ that was the stereotype of centuries past.

However, it also has portraits of famous people throughout history who have been mad or have been claimed as mad, as well as some more contemporary paintings and some wonderful illustrations of ‘hysterics’ from Charcot’s clinic at the Salp√™tri√®re in Paris.

The only obvious omissions are the paintings of Th√©odore G√©ricault who painted a series of 10 portraits of asylum patients in an attempt to capture the essence of madness, partly based on the belief that it was reflected in the physical features of the body.

The image on the right is of an absolutely stunning piece called ‘Shimmering Madness’ by the American artist Sandy Skoglund, made with jelly beans, wood, plastic, metal and motors. It looks stunning as an image but to see it in all it’s glory you really need to watch the short movie, and believe me, it is amazing.

Link to madness in art blog (via BoingBoing).

2010-02-19 Spike activity

Quick links from the past week in mind and brain news:

Neuro-linguistic programming: Cargo cult psychology? An excellent piece debunking NLP from the Journal of Applied Research in Higher Education appears online as a pdf. It always struck me as Scientology without the aliens.

PsyBlog has an excellent round-up of 10 influencers of conformity. Fuck me I will do what you tell me.

The US crime rate has been consistently falling, so why do the US public tend to think it’s on the rise? The Boston Globe investigates.

The BPS Research Digest has yet another nail in the coffin for the Freudian idea of repressed memories.

The chairman of the DSM-IV committee writes a stinging attack on the DSM-V for Psychiatric Times.

The Onion gathers the public’s view on the draft of the new psychiatric bible. “If they change which planets men and women are from, I’ll be pissed.”

Some lovely research on how pupil dilation reflects cognitive functions, in this case decision-making, is discussed by the mighty Neurophilosophy.

The LA Times has a story of how a new business model for dealing high purity heroin is targeting the middle-class. A Slate article from ’96 notes that this is an often repeated media story.

There’s an engaging interview with Iain McGilchrist, who’s just written a book about the brain’s hemispheres, over at Frontier Psychiatrist.

The Guardian has a short piece on why slot machine gamblers are so hard to study.

Peter Hughes is a psychiatrist blogging about his work on a Haiti mental health programme, over at the Royal College of Psychiatrists.

Newsweek has an excellent piece on how we assume neuroscience studies done on Westerners reflect universal human traits and recent efforts to develop local neuroscience resources.

What distinguishes women with unusually high numbers of sex partners? Barking Up the Wrong Tree reports the surprising answer of one study on the topic.

BBC News reports on continuing and mysterious deaths of (mostly) Scottish heroin users from anthrax. Interestingly, almost exactly the same thing happened a decade ago.

There’s a good report from the recent Cultural and Biological Contexts of Psychiatric Disorder conference over at Somatosphere.

The Brandon Sun reports that a man is found not responsible for killing a nun during an epileptic fit. The news is now officially complete. Move along.

Film from the original Pavlovian conditioning experiments is dug up by the wonderful Advances in the History of Psychology blog.

Reuters reports on a study finding that beds less visible from the nurses’ station in intensive care units have higher death rates.

“do women want to be humped for 13 minutes straight?” asks Neurotopia who is calling for an empirical investigation into the matter.

The Onion reports that the CIA are forced to complete all scheduled torture in one hectic weekend. “We were already way behind on false executions as it was”.

Pissed up on booze? Or a hard night on the alcohol breakdown product acetaldehyde? Neuroskeptic, a spectacularly good blog, covers an interesting new study.

The Library of Congress Music and the Brain podcast is excellent.

Oh Christ, Louann Brizendine has written a follow-up to her stereotype-waving book ‘The Female Brain’ called (can you guess?) ‘The Male Brain’. Elle, yes that Elle, has an ass-kicking review and interview.

New Scientist covers a study that used mobile phone signals to track daily movements and finds we’re actually very predictable.

The now widely reported genetic overlap between mental disorders should be undermining the diagnostic boundaries of psychiatric diagnoses but don’t shake the tree man, because, like, who knows what’ll fall out? Wiring the Brain discusses the evidence.

BBC News reports on a dating study that found women prefer ‘men who are kind’. No word on whether they prefer men who have more enthusiasm than talent and drink too many energy drinks.

“Placebo treatments stronger than doctors thought”. Not sure whether that’s a headline or a philosophy puzzle. Either way, it’s a story in the Seattle PI.

The Splintered Mind introduces the concept of cognitive shielding. Permits you to shout “They canne hold captain!” when losing an argument.

Sleep is a feminist issue, claim prominent feminists. Noami Wolf disagrees in The Times.

Teenagers: hyper-mortals

A common belief about teenagers is that they implicitly assume that they are invincible or immortal and think little about their own deaths. A new study just published in the Journal of Adolescent Health shows this to be a myth, however, as they vastly over-estimate their chances of dying within the next year.

By the mid-teens, our ability to judge the likelihood of uncertain events is usually equal to that of adults, so we might expect that adolescents can judge the chance of death as accurately as grown-ups.

This study, led by psychologist Baruch Fischhoff, surveyed 3,436 14-to-18 year-old adolescents and a local group of 124 seventh graders and 132 ninth graders asking them to estimate their chance of dying in the next year, enquiring about what sort of neighbourhood they lived in, whether they’d experienced or witnessed any violent events and whether they’d had any serious health problems.

Although the statistical death rate is 0.08%, the most common estimates where that they had a 5% of 10% chance of dying within the next year. Interesting, there was a larger than expected number of teens who judge their chance of dying within the next year as 50%, although this likely suggests that they were indicating a sort of 50/50 answer as a way of expressing “I don’t know”.

Adolescents assumptions about how likely they were to die were strongly related to their reports of how much crime they expected to experience and not or only very weakly related to if they’d experienced violent events or had health problems.

In other words, teenagers seem to be personally pessimistic and live in a world where they perceive themselves to have a high chance of dying despite the relatively small actual risk.

Link to PubMed entry for study.

Tell me lies, tell me sweet little lies

Flattery can work it’s magic, even when we know it’s insincere. The Boston Globe covers a new study that found that even when we realise the compliments we’re hearing are an attempt to butter us up, they can still have a persuasive effect.

Insincere flattery gets a bad rap. Sure, it sounds cheesy or even awkward. But new research suggests that one‚Äôs initial conscious reaction – discounting the flattery as a self-serving ploy – may mask a more durable implicit positive emotional association with the flatterer. People who were given a printed advertisement from a department store that paid compliments to their sense of fashion had higher opinions of the store, but only when they weren‚Äôt given much time to think about it, or when they were asked several days later. This effect was boosted after people engaged in self-criticism but was nullified after people engaged in self-affirmation, suggesting that flattery – even the patently insincere type – will be especially effective on folks who are down on their luck.

Sadly, the study itself is locked behind a paywall, but there’s a longer summary of the experiment at the journal website which has a few more details.

By the way, could I just say what a lovely gas mask you’re wearing? Mind Hacks, getting the readers we deserve since 2004.

Link to brief Boston Globe write-up.
Link to study abstract.
Link to longer summary of study (via Neuromarketing).

A crime, criminality and forensic psychology blog

Forensic psychology and psychiatry attempt to understand criminality and legal reasoning and are among the most interesting areas of cognitive science, but, sadly, there are few good blogs on the internet which tackle the area. The In The News blog is an exception, however, and regularly has in-depth coverage of the psychological issues behind big legal news stories.

Like forensic psychology itself, it’s not the most instantly appealing of destinations, but the writing is fantastic. The author is California-based forensic psychologist Karen Franklin and some of the recent articles give a flavour of what to expect.

For example, coverage of the death of the oldest death row inmate at 94, and the legal battles that centred around his mental competency to appeal and be executed, discussion of whether ad-hoc diagnoses are being created to detain people whose crimes don’t amount to long-term imprisonment but are predicted to be a future menace to society, or whether the ‘war on drugs’ is being quietly abandoned by the Obama administration.

It’s probably worth noting that US forensic psychology and psychiatry can be quite different from other places, in that it is more much focused on working with courts, rather than offender treatment focused approaches which are more widespread in Europe.

However, In The News has long been a favourite read of mine and long may it stay so.

Link to In The News blog.

State of the art in cave painting

France has some of the world’s most spectacular cave paintings that depict wild animals in vivid outline surrounded by what were thought to be purely decorative markings.

These markings have been all but ignored until recent research, covered in a fascinating New Scientist article, gathered examples from 146 cave sites and found they shared core symbols and were arranged in meaningful patterns.

While some scholars like Clottes had recorded the presence of cave signs at individual sites, Genevieve von Petzinger, then a student at the University of Victoria in British Columbia, Canada, was surprised to find that no one had brought all these records together to compare signs from different caves. And so, under the supervision of April Nowell, also at the University of Victoria, she devised an ambitious masters project. She compiled a comprehensive database of all recorded cave signs from 146 sites in France, covering 25,000 years of prehistory from 35,000 to 10,000 years ago.

What emerged was startling: 26 signs, all drawn in the same style, appeared again and again at numerous sites (see illustration). Admittedly, some of the symbols are pretty basic, like straight lines, circles and triangles, but the fact that many of the more complex designs also appeared in several places hinted to von Petzinger and Nowell that they were meaningful – perhaps even the seeds of written communication.

According to the article, these seemingly meaningful groupings, potentially representing a sort of proto-writing, raise the question of whether symbolic communication developed far earlier than was previously thought.

It’s a wonderfully thought-provoking article and don’t miss the fantastic illustrations that accompany the piece.

Link to NewSci article ‘The writing on the cave wall’.

Human brain electrodes capture the twilight zone

Sleep is a nightmare for neuroscientists but a new study using electrodes implanted deep within the brains of people going about their daily lives has revealed that the brain falls asleep from the inside out, contrary to what was expected.

Most neuropsychology studies require people to complete tasks while the brain is being monitored and the technologies that allow passive recording either only measure activity on the brain surface (EEG, MEG) or are too uncomfortable to measure realistic sleep (fMRI, PET). This is one of the reasons human sleep has been difficult to study and why we still understand little about it.

A new study just published online in the Proceedings of the National Academy of Sciences used the innovative technique of recording from semi-permanent electrodes implanted in the brains of 13 people undergoing assessment for difficult-to-treat epilepsy. These electrodes stay in for several weeks, meaning the researchers had access to brain activity as people continued their lives and, of course, as they drifted off to sleep.

Certain types of epilepsy don’t respond to normal treatment and neurosurgery to remove a small part of the brain that triggers the seizures is known to be an effective treatment in many cases. However, this is only feasible when it’s possible to locate where the seizures originate.

In rarer cases still, a standard EEG or brief surgical test doesn’t give a good idea of where this might be, so surgeons can insert depth electrodes into the most likely areas. These remain in place and record any unusual activity directly from locations across the brain.

The researchers, led by neuroscientist Michel Magnin from the University of Lyon, asked the patients if they could also use this data to help understand what happened during sleep onset.

They found that as people drifted off to sleep, the deep brain area the thalamus wound down several minutes before the cortex.

This is surprising because the thalamus has traditionally been considered a structure that regulates alertness and ‘relays’ information to the rest of the brain from the body and the spinal cord.

It was often assumed that it would ‘shut down’ the cortex first, because this is often considered to be where our ‘higher’ conscious functions like abstract thought and complex perception lie, while continuing with its minimal vigilance functions. A bit like a neural ‘standby’ setting.

Instead, what seems to happen is that the thalamus ‘disconnects’ itself and leaves the cortex freewheeling before it finally settles down into inactivity.

Indeed, freewheeling is, perhaps, a good description here. The researchers found lots of uneven activity in the upper brain areas as they were left to drift off.

Interestingly, sleep onset is one of the times when we are most likely to experience hallucinations. In fact, they are so common as to have been given their own name – hypnagogic hallucinations – while this drifting off period is known as hypnagogia.

Although they didn’t specifically ask about the whimsical thoughts and unusual perceptions that typically occur in this state, the researchers speculate that this pattern of freewheeling close-down might explain why hallucinations are so common at this time.

Link to PubMed entry for study.

On the brain train

Tom kindly sent me a copy of his new book The Rough Guide to Brain Training which I’ve been thoroughly enjoying reading. I don’t think you’re ever going to get the most objective review from someone who’s already an admirer of Tom’s work, but I shall do my best.

I have to say, I’m not a big fan of puzzles, largely, it must be said, because I’m useless at them. The book is full of puzzles, but thankfully for me, they are interspersed by essays and snippets that give you a remarkably honest and science-based view of ‘brain training’ and the evidence for it.

In fact, right on the first page, in the introduction, the book is clear:

For now, it is safe to say that we don’t know of any magic bullets for brain training – there is no single kind of task or set of tasks which will improve brain fitness. And anyone who claims otherwise is probably trying to sell you something.

This is such as refreshing change from brain training books and games that make wild claims and go on about ‘neuroplasticity’ without understanding what it means and not knowing when it’s relevant.

There is none of that here. Everything is drawn from the science (Tom’s put all the references online, if you want to read up) and the book has many short essays that introduce you to how the brain works, how to keep it in good condition and how to optimise learning.

Also, virtually every page has a short paragraph giving a neuroscience fact taken from the research literature. For example:

American physician Robert Bartholow was the first to directly show that electrical activity on the surface of the brain controlled the body. In 1874, Bartholow was able to provoke movements of the body and limbs of patient Mary Rafferty by inserting electrodes through a hole in her skull.

There’s lots more where that came from. To be honest, if you’re not into puzzles there’s going to be a fair chunk of the book that’ll serve as no more than eye candy, but if you do, you’ll find them accompanied by some great short essays and snippets.

Link to more information on the book.
Link to essay written for the book but only available online.

Full disclosure: we both write for Mind Hacks, but I suspect if you’re reading this, you already know.

The World War Two rumour labs

During World War Two, the US Government considered setting up ‘rumour clinics’ to collect and analyse hearsay that might undermine the war effort. The government plan never got off the ground but the idea was taken up by independent psychologist who create numerous clinics that aimed to debunk popular rumours and educate the American public about the psychology of tittle-tattle.

This little known chapter in the history of the war is outlined in an article for the History of Psychology journal which describes how the famous Harvard psychologist Gordon Allport created one of the most successful wartime clinics which tackled some quite surprising rumours:

The set-up of the Boston Clinic became the prototype for the many clinics that would follow in the months to come. The focal point of the Clinic was a column published every Sunday in the newspaper. Prevalent rumors were chosen for analysis and refutation. These rumors would be labeled as such and printed in italics, followed by an answer or refutation labeled ‚ÄúFact‚Äù and printed in bold type. Frequently, the column would include a psychological analysis of prevalent rumors, aimed at increasing public understanding of the psychological motives underlying the spread of different types of rumor. The column was also distributed to high schools and posted on community bulletin boards, with the expectation that such measures would promote public understanding of rumor in wartime. In addition to counteracting rumors, members of the clinic were often also responsible for classifying and analyzing rumor data, distributing flyers, gauging public opinion, and giving speeches on wartime rumor spreading.

In the first column of the Boston Herald Rumor Clinic, rumors were reported to the Clinic by ‚Äúofficial agencies‚Äù; by the following Sunday, however, the Clinic had begun receiving and analyzing rumors sent in by readers. All readers were encouraged to provide rumors, with the only stipulation being that they must sign their names; anonymous rumors would not be considered. By the third week, the Clinic had received more rumors than they had time or space to analyze (‚ÄúThe rumor clinic,‚Äú 1942b). Rumors ranged from the simplistic and common to the elaborate and eccentric.

The most common rumors analyzed in the Herald were those pertaining to waste of rationed materials, government dishonesty and corruption, mistreatment of American soldiers, the imminence of defeat or victory, and the future value of war bonds. Unusual or less feasible rumors were also considered, including a story circulating about glass or poison being found in crabmeat packed in Japan (The rumor clinic, 1942d) and a story about a woman employed at a shell filing factory whose head exploded after receiving a permanent at the local beauty parlor (The rumor clinic, 1942c). These latter types of anecdotes received less attention in the column, but appeared periodically amid a sea of more common rumors, such as those regarding rationing and corruption.

Unfortunately the full article is locked behind a paywall, so, ironically, you only have access to this second-hand information.

Link to PubMed entry for article.

Kay Redfield Jamison on love and loss

ABC Radio National’s All in the Mind has an engaging interview with psychologist and author Kay Redfield Jamison who discusses her new book which is both a memoir of losing her husband and a consideration of the psychology of grief.

Towards the end of the interview she tackles the distinction between grief and depression, which has recently returned as a contentious topic after lying fallow for many years.

Since Freud’s essay Mourning and Melancholia, the two have been linked in many psychological theories. Freud’s idea was that both were similar types of reaction to loss although in depression it might not be clear to the conscious mind what was lost because the prior attachment might have had unconscious components.

In other words, a small event might trigger a big grief reaction event though it might not be clear why – because some of the psychological value of what you have lost might exist only in the unconscious.

Although the essay is one of the foundational texts of psychoanalysis, nowadays only the most orthodox followers of Freud would agree fully with this theory of depression and the idea that grief and depression are fundamentally the same is no longer widely subscribed to.

Nevertheless, psychiatry is once more approaching grief as a potential form of mental illness, albeit from a different angle.

The concept of complicated grief, where grieving is considered to be more intense, disabling or extended than normal, has been much discussed as an area where psychiatric treatment may be warranted. It’s an interesting concept because it essentially sets limits on what should be considered a normal response to personal loss.

It’s not an official diagnosis as yet, but various proposals set the limits for ‘normal’ grieving at 6 months or one year.

More recently, the draft version of the new American diagnostic bible, the DSM-V, has gone even further and removed bereavement as an exclusion for a diagnosis of major depressive disorder. This means that two weeks of low mood, loss of pleasure and interest in activities, poor sleep, appetite or concentration after a loved one had died could get you a diagnosis of mental illness.

It’s a difficult area, because while it is important not to medicalise normal and healthy reactions to the loss of a significant person in your life, we also wouldn’t want to miss treating mental illness simply because the person has experienced a loss. Clearly there is a balance, although it’s difficult to say where it is.

Jamison has an interesting perspective on the issue, as she’s a clinical psychologist interested in mood disorders, but also has experienced profound depression and loss herself.

Link to AITM interview with Kay Redfield Jamison.
Link to AITM blog on some of the diagnostic issues.

Information scares and the media: a history

Slate has just published an article I wrote on how media scare stories that warn us that technology will damage the mind have been with us from the time of the printing press and continue to the present day.

A respected Swiss scientist, Conrad Gessner, might have been the first to raise the alarm about the effects of information overload. In a landmark book, he described how the modern world overwhelmed people with data and that this overabundance was both “confusing and harmful” to the mind. The media now echo his concerns with reports on the unprecedented risks of living in an “always on” digital environment. It’s worth noting that Gessner, for his part, never once used e-mail and was completely ignorant about computers. That’s not because he was a technophobe but because he died in 1565. His warnings referred to the seemingly unmanageable flood of information unleashed by the printing press.

My favourite chapter in the long history of how information dissemination has been assumed to damage the mind is the protracted debate that occurred when schools became compulsory.

They were thought to take children away from their ‘natural’ development and study was widely considered to be a danger, with many medical texts of the time citing excessive study as the cause of madness (e.g. this one)

Interestingly, the relatively recent diagnosis of ADHD is almost the reverse, and not being able to concentrate on school work is now considered a mental illness.

That’s not to say that all technology and all uses of technology are harmless. For example, there is growing evidence that television viewing by young children is associated with slowed cognitive development but the media is typically obsessed with the newest technology rather than the actual risks identified by health studies.

Link to Slate article on tech scares and the media.

Seeing red, feeling hot, realising nothing

Seeing red leads men to view women as more attractive and more desirable despite them not being aware of any change in their perceptions. A delightful study from last year that, as the authors note, has ‘clear practical implications’!

Romantic red: red enhances men’s attraction to women.

J Pers Soc Psychol. 2008 Nov;95(5):1150-64.

Elliot AJ, Niesta D.

In many nonhuman primates, the color red enhances males’ attraction to females. In 5 experiments, the authors demonstrate a parallel effect in humans: Red, relative to other achromatic and chromatic colors, leads men to view women as more attractive and more sexually desirable. Men seem unaware of this red effect, and red does not influence women’s perceptions of the attractiveness of other women, nor men’s perceptions of women’s overall likeability, kindness, or intelligence. The findings have clear practical implications for men and women in the mating game and, perhaps, for fashion consultants, product designers, and marketers. Furthermore, the findings document the value of extending research on signal coloration to humans and of considering color as something of a common language, both within and across species.

pdf of full text of study.
Link to PubMed entry for study.

Discussing the False Prophets

In light of the retraction of the infamous Lancet paper that first started the MMR panic, the Point of Inquiry podcast has a fantastic interview with doctor and vaccine developer Paul Offit who has received death threats for publicly refuting the spurious connection between childhood jabs and autism.

He’s also the author of the book Autism’s False Prophets that traces the emergence of the vaccine protestors, the origin of their fears and the faulty thinking which has driven their campaign.

Offit reflects on the reaction to the book during to the interview and gives a coherent account of what conclusions we can and can’t draw from the science on how autism develops.

It’s a lively and important interview that is well worth 30 minutes of your time.

Link to Point of Inquiry interview with Paul Offit.

France strikes transexualism from list of mental illnesses

France has become the first country in the world to remove gender identity disorder, also known as transexualism, from its list of officially recognised mental illnesses. This is huge news but seems yet to have been picked up by English language news sources.

The news was reported yesterday in the French national daily Le Figaro and by the AFP newswire in French and English, so my details are from the Spanish language report (e.g. this report in Colombian national El Tiempo).

My translation of an excerpt from the Spanish-language AFP newswire report:

The Minister of Health, Roselyne Bachelot, had announced on 16th May 2009, before the International Day Against Homophobia and Transphobia, that transexualism would not be not considered a psychiatric disorder in France.

On that occasion, numerous personalities from the world of politics and science had signed an article that appeared in the press to petition the World Health Organisation to stop “considering transexuals as affected by mental illness”.

“France is the first country in the world that does not consider transexualism as a mental illness” said Jo√´l Bedos, French representative of IDAHO (International Day Against Homophobia and Transphobia), to AFP on Friday. “It’s historic”, added Philippe Caste, spokesperson for the ‘Interasociativa lesbiana, gay, bi y trans’. “It was something very important and was greatly anticipated since the promise was made” added Roselyne Bachelot.

This move will likely be widely supported by the transgender community. However, the prospect of the diagnoses being removed in all countries might be a double-edge sword for some. Although the fact that being diagnosed as mentally ill is a requirement to obtain sex-reassignment in some places has been resented, the removal of the diagnosis could raise fears that the procedure may become less accessible.

Simply being transgendered or having trangender desires itself does not currently qualify for the diagnoses, as it requires significant psychological distress to also be present. However, campaigners argue that this distress is largely caused by discrimination and stigma, to which the diagnosis contributes.

The move by France, however, does not de-list the diagnoses from the World Health Organisation’s ICD-10 classification or the American Psychiatric Association’s DSM and, in fact, the draft DSM-V only slightly modifies the criteria for the diagnoses in children and adults although does rename it ‘gender incongruence’.

Nevertheless, this will put pressure on both the World Health Organisation and the American Psychiatric Association to remove the diagnoses which have a long-standing target of criticism from the LGBT community.

Link to French-language report in Le Figaro.
Link to Spanish-language AFP newswire report.

Hallucinating reality’s wallpaper

Hallucinations usually appear as illusory objects on the normal background of reality, but an interesting case report in the medical journal Movement Disorders reports a case of someone who hallucinated background scenery on which real people were superimposed.

We describe a patient with PD [Parkinson’s disease], who had unusual background scenery VHs [visual hallucinations] on which a true person was superimposed…

In December 2008, when her husband died, she experienced background scenery VHs appearing in the left upper part of her visual fields. The abnormal scenery often became larger to encompass the full visual fields and always comprised the countryside where she was born and grew up….

In July 2009, she spoke to her deceased husband in the medical examination room, and she experienced a background scenery VHs during the examination. A physician requested her to draw the VH, and she drew a countryside scene, appearing sad. When asked how a physician in front of her was reflected in her visual field, she replied that the physician appeared normal but beside a river in the midst of the VH.

Link to PubMed entry for brief case report.