Placebo is not what you think

The New York Times covers an interesting development in the world of consumer medicine – a company selling placebos to consumers that they can use to ease their children’s ills.

For doctors, the use of placebos to treat medical conditions is explicitly banned by most medical associations but their use is widely debated.

Thousands of clinical trials have shown us that placebo is one of the most effective and safest of medicines (although it is not entirely without side-effects).

However, it is also one of the most misunderstood of treatments.

An article in this month’s Journal of the Royal Society of Medicine (which has been debating placebo over the past year or two) dispels some of the myths.

The placebo effect is usually equated with the average response of patients receiving placebo controls in randomized trials. However, it’s not quite that simple.

For example, not every improvement that happens after someone is given a placebo treatment is the ‘placebo effect’ (some symptoms will just get better by themselves) and not every improvement after medication is the active effect of the drug, some of that will be ‘placebo effect’ too.

Placebos are not ‘ineffective’. In fact, when three condition trials are run (no treatment vs placebo vs medical treatment), placebo consistently out performs ‘no treatment’ and of course, not uncommonly, the medical treatment condition as well.

Placebos are not a ‘non-specific’ treatment. A study on people who take the dopamine-boosting drug L-DOPA for Parkinson’s disease but who took a placebo L-DOPA pill, showed almost identical brain changes, as if they’d taken the real thing.

Furthermore, studies done in the 1970s showed that when heroin users inject water (sometimes done deliberately to alleviate cravings when drugs are in short supply), they can experience drug-like euphoria and have been observed to show opiate-like physiological signs such as pupil constriction.

This last point also demonstrates that placebo is not solely about expectancy, belief or ‘being fooled’, as the heroin users knew they were injecting themselves with water. Conditioned responses play a role.

This can also be seen from the fact that these specific effects of placebo tend to fade after a while, as the conditioning becomes extinguished.

The fact that placebo can be a relatively safe, effective, and sometimes selective treatment has led some to argue that doctors should be able to use it officially (although, of course, many use it unofficially).

Law professor Adam Kolber (who you may know from the excellent Neuroethics and Law blog) wrote a fascinating paper last year that reviewed the research and argued that in limited circumstances, placebos could be ethically used.

The article is available online and I really recommend reading the ‘Avoiding Deception’ section if nothing else – for series of recommendations on how placebo could be used without straight up deception.

Link to NYT on buy-your-own placebos for kids.
Link to JRSM article on placebo. Full text here (thanks Ines!).
Link to Adam Kolber’s article (scroll down for free full text download).

Spellbound by the box

A quote from the sardonic Alfred Hitcock where he notes the curious interaction between mind doctors and the moving image:

“Television has done much for psychiatry by spreading information about it, as well as contributing to the need for it.”

I suspect he was commenting on concerns about negative effects of television, although I wonder whether he still might say the same, in light of the enduring influence of pharmaceutical adverts and claims of disease mongering.

Hitchcock himself was famously fascinated by the psychiatry of the day, and his films are well known for containing Freudian themes.

The most obvious was Spellbound, which featured psychiatrists, a psychoanalytic plot, and a symbolic dream sequence designed by Salvador Dalí.

Free choice and the female science divide

The Boston Globe has a provocative article that sheds some new light on the old debate over why there are so few women in maths and physical science subjects. One important factor seems to be that they simply choose other professions, but if you think this answer is too simplistic, there may be more to it than meets the eye.

It no longer seems to be the case that women are being explicitly blocked from maths, physics and engineering jobs, although the number of women in these professions is still very small.

One strong argument for why women are in the minority is that they suffer from the effects of implicit sexism, a system designed to take advantage of male attributes and life choices.

Some argue that the lack of support and consideration for women’s lives puts them off, and so they decide against what seems like a bad option.

However, the article presents an interesting piece of evidence against this as being the major influence.

In her controversial new book, “The Sexual Paradox: Men, Women, and the Real Gender Gap,” [Susan] Pinker gathers data from the journal Science and a variety of sources that show that in countries where women have the most freedom to choose their careers, the gender divide is the most pronounced.

The United States, Norway, Switzerland, Canada, and the United Kingdom, which offer women the most financial stability and legal protections in job choice, have the greatest gender split in careers. In countries with less economic opportunity, like the Philippines, Thailand, and Russia, she writes, the number of women in physics is as high as 30 to 35 percent, versus 5 percent in Canada, Japan, and Germany.

“It’s the opposite of what we’d expect,” says Pinker. “You’d think the more family-friendly policies, and richer the economy, the more women should behave like men, but it’s the opposite. I think with economic opportunity comes choices, comes freedom.”

If the gender gap in many fields has its roots in women’s own preferences, that raises a new line of questions, including the most obvious: Why do women make these choices? Why do they prefer different kinds of work? And what does “freedom of choice” really mean in a world that is still structured very differently for men and women?

Of course, this doesn’t deny that there are still other reasons why women might be put off these careers (lack of female role models, perception / effect of a ‘boys club’ etc) but it’s interesting that support for female physical scientists seems not to correlate with their numbers.

The article also mentions an interesting point that women with high maths ability tend to have good verbal ability (meaning they have a much wider potential choice of careers) whereas this is less often the case with men. In essence, the article argues that women would rather select jobs with more human contact.

It’s probably worth saying that in the life sciences, females predominate. In fact, in psychology, men are typically outnumbered 10-1. Clinical psychology tends to be even more extreme.

Despite the vanishingly small number of male psychology undergraduates, I’ve never heard of any effort to recruit or attract more males to the subject.

I’m always curious as to why having few males in life sciences doesn’t seem to bother people but having few females in maths or physics does.

Can’t we have some equality in our equality?

Link to Boston Globe article on women in science and engineering.

Like a bullet in the head

Neurophilosophy has collected some of the most unusual cases of penetrating brain injury from the medical literature, with x-rays that illustrate how some of the most curious objects can end up on the wrong side of the bony brain protector.

You may recognise a couple that we’ve noted before on Mind Hacks, but this is a far more complete and frankly quite surprising collection.

The most amazing is the case of a “32-year-old Caucasian male with a history of repeated self-injury drilled a hole in his skull using a power tool and subsequently introduced intracerebrally a binding wire from a sketchpad”.

A striking, and, in some places, stomach churning collection of case studies.

Link to Neurophilosophy on unusual penetrating brain injuries.

Mental illness following The Exorcist

Horror movie The Exorcist remains one of cinema’s darkest and most frightening classics. So great was its power that rumours circulated about viewers running in fear, feinting, or even going mad after seeing the film. In fact, it caused such concern that it was discussed in the medical literature for its possible role in triggering mental illness.

In 1975 psychiatrist James Bozzuto wrote an article for the Journal of Nervous and Mental Disease entitled ‘Cinematic Neurosis Following The Exorcist’ that reported four cases of previously untroubled people who seemed to develop psychiatric difficulties after watching the film.

I’ll return to the case reports in a moment, but it’s probably worth mentioning that Bozzuto was not alone in discussing the possible ‘destabilising’ effect of the film. In fact, his commentary was remarkably reserved in comparison to some of his contemporaries.

A 1974 Time magazine article quoted some of his less inhibited colleagues:

After seeing the film, two young Chicagoans required hospitalization. “They’re way out in leftfield,” said Dr. Louis Schlan, psychiatrist and medical director of Riveredge Hospital in Forest Park, Ill. “They see themselves possessed by Satan.”

Many others who have seen the film experience nightmares, hysteria and an undefined, but nevertheless profound apprehension. “It is dangerous for people with weak ego control,” explains Dr. Vladimir Piskacek, a Manhattan sociologist and psychiatrist, “but it would not cause psychosis.” Small children may suffer from hallucinations after seeing The Exorcist, but Dr. Piskacek doubts that the film would permanently impair even an immature mind.

Predictably, there are widespread objections to the film’s R rating, which permits youths under 17 to see it if accompanied by a parent. Manhattan Child Psychiatrist Hilde Mosse warns that the film provides a “deadly mixture of sex, violence and evil. The idea that we can solve our problems by magic instead of by rational solutions is destructive. I lived through this before Hitler came to power. He said, ‘Listen to the language of your pure Germanic blood, your unconscious.’ The Jews in Germany then became the devil to be exorcised. The only thing The Exorcist can do,” Dr. Mosse concludes emphatically, “is to pull young people down to a primitive level.”

With Hitler, hallucinating children and Satanic possession being invoked in relation to the film, it’s no wonder that people had anxieties about its influence.

Bozzuto’s explanation for his four case studies is perhaps a little mundane in comparison, but the influence of the media hysteria is plain to see.

One case is particularly striking, owing to gentleman’s florid magical thinking about the Devil and his possible malign influence.

Case 4. Mr. Lyle H. was a 24-year-old black male who initially came to the emergency room for three visits approximately 1 month after seeing “The Exorcist”. At that time, he complained of flashbacks and of getting “nervous”, especially with his two children and his wife; he was frightened that his 5-year-old daughter was possessed, had insomnia, and felt that certain people “looked strange”. He was given Vallium and referred to the Psychiatric Clinic. After being contacted for his first interview, he was fearful of coming for he felt that the therapist may have been involved with the Devil.

The patient stated that he knew little about the movie but had seen it discussed on a TV talk show before. He went with his wife and another couple. He was so upset during the movie that he had to walk out, and afterward he was frightened, feeling that the Devil “would come”. He had immediate insomnia, 15-pound weight loss over the past month, and numerous nightmares of vampires chasing women with himself interfering. He could not look people directly in the eye for fear he might imagine them to be devils…

Also, since seeing the movie, he complained of a stiff neck which he related to an identification with the girl in the movie. He was afraid to use a razor that his brother-in-law had given him because it might be stolen and it would imply he had done something wrong and would therefore be like the Devil.

Bozzuto suggests that each of his patients was already under significant pressure and the film was the last stressful straw that broke the camel’s back.

He also suggests, invoking the spirit of Freud, that the movie’s theme of losing control to the love-hate figure of the Devil may have had special significance for the four, each of which was apparently struggling with an ambivalent relationship.

According to Bozzuto, the similarity triggered repressed feelings, leading to an emotional crisis and a subsequent breakdown.

While the cases remain entirely anecdotal, it’s interesting that they made it into print at all, considering that almost all films have the potential to trigger emotional crises in some.

The fact that the issue of ‘Exorcist madness’ was considered serious enough to appear in a medical journal is more likely testament to the fact that the film touched a raw nerve in the America of the 1970s, than the fact that it raised the hackles of some of its audience members.

Link to PubMed entry for ‘Cinematic neurosis following The Exorcist’.
Link to Time article ‘Exorcist fever’.

‘Miracle cure’ for dyslexia fails to make the grade

Today’s edition of Bad Science covers a so-called ‘miracle cure’ for dyslexia which has been persistently promoted in the UK media, despite numerous complaints upheld by media regulators, veiled threats of legal action against people who say it doesn’t work and five editors of a scientific journal resigning over the publication of a flawed study on the treatment.

Personally, I would have thought anyone promoting their ‘treatment’ under the name “miracle cure” is asking for trouble but apparently with enough celebrity endorsement you can get away with promoting your product without the need for irony (quite hard work in modern Britain, I can tell you).

The system was developed by paint millionaire Wynford Dore and involves various balancing and co-ordination exercises supposedly to strengthen the cerebellum, which Dore argues is functionally impaired in dyslexia.

There’s actually a fair amount of independent research on the role of the cerebellem in dyslexia but, sadly, the idea that exercises might help treat this has the sole drawback of not being supported by the scientific evidence.

Interestingly, it seems that the company went bankrupt yesterday and have just closed up shop. That might have been a result of charging £2,000 for the course.

Ben Goldacre has more on the whole sordid tale over at Bad Science.

Link to Bad Science on the Dore ‘miracle’ ‘cure’ for dyslexia.

Terry Pratchett, on the ropes

On the Ropes, BBC Radio 4’s programme about people in difficult situations, interviews author Terry Pratchett about his recent diagnosis of Alzheimer’s disease.

In the first half of the interview, Pratchett talks about his early years as a writer and how he came to write the Discworld series and other novels.

In the latter half, he talks through the realisation that he had Alzheimer’s, from being tested for his initial relatively minor stroke, to being more comprehensively assessed for his ongoing cognitive difficulties.

He gives a fascinating first-person account of how he experiences the difficulties and the effects of the medication on his mind.

After his diagnosis, Pratchett was surprised at how little Alzheimer’s disease research was going on and donated half a million points pounds to scientific research.

Pratchett fans have set up Match It For Pratchett, a drive to match the Discworld author’s donation and boost degenerative brain research.

Link to On the Ropes interview with Terry Pratchett.
Link to Match It For Pratchett.

The brains of dead Russian geniuses

What makes a man a genius? Russian neuroscientists were pondering this exactly this question in the early 1900s and did exactly what seemed sensible at the time – they collected and dissected the brains of some of the greatest cultural figures in a huge collection called ‘The Pantheon of Brains’.

It’s a fascinating story told in a recent article published in the medical journal Brain. Amazingly, the last brain was only added in 1989.

Rather fittingly, the collection contains the brains of some of the Russia’s greatest psychologists and neuroscientists and has many curious aspects to it, such as the mysterious death of its founder. After death, his brain was immediately added to the collection.

In 1927, Bekhterev came up with a plan to organize ‘The Pantheon of Brains’ in Leningrad in order to collect elite brains. It was a severe irony of fate that precisely when the question about creating the Pantheon had been positively solved, the very initiator of this creation, Bekhterev, suddenly passed away. The circumstances are still questionable.

On December 17, 1927, the First All-Union Congress of Neuropathologists and Psychiatrists was held in Moscow. Bekhterev, along with L. S. Minor and G. I. Rossolimo, was elected as honourable chairmen of the congress. On December 23rd, the last day of the congress, Bekhterev gave a presentation during the afternoon session. In the evening, symptoms of a gastrointestinal disorder started and 24 hs later, Bekhterev died of (as officially stated) acute heart failure. Without any further post-mortem pathoanatomical investigation, his brain was removed, in accordance with his will, and his body was cremated the next day. However, the idea did not fade away.

In 1928, the neuroanatomical laboratory of Vogt and his Russian colleagues were reorganized into the Moscow Brain Research Institute, where the structured collecting and mapping of the brains of famous Russians started. Bekhterev did not see his plan come to fruition, but his own brain enriched the collection of the Moscow Institute (the weight of his brain was 1720g). The collection acquired the brains of Soviet politicians, famous writers, poets, musicians, etc.

It is not surprising that these included the brains of prominent Russian neuroscientists, such as neurologist, G.I. Rossolimo (1860–1928) Р1543g; physiologist, I.P. Pavlov (1849–1936) Р1517g; neurologist, M. B. Kroll (1879–1939) Р1520g; psychiatrist, P. B. Gannushkin (1875–1933) Р1495g; psychologist, L.S. Vygotsky (1896–1934). During the Soviet period, the work of the Moscow Brain Research Institute continued behind closed doors.

The collection was still expanding as recently as 1989, when it acquired the brain of A.D. Sakharov [A. D. Sakharov (1921–89) was an eminent Soviet nuclear physicist, dissident and human rights activist. He was an advocate of civil liberties and reforms in the Soviet Union. He was awarded the Nobel Peace Prize in 1975] — 1440g.

You gotta love the fact that the authors have added exactly how much each person’s brain weighed.

Sadly, the full text isn’t available online, although Brain does fully release articles after a set amount of time (a year I think) so it should eventually see the light.

Link to PubMed entry for article.

2008-05-23 Spike activity

PLoS Medicine has an eye-opening study on how the local price of alcohol is related to the level of violence in the area.

To the bunkers! Robot removes brain tumour.

BBC News Magazine has an interesting piece on ‘celebrities we love to hate’ with comments on the phenomenon of celebrity from a number of sociologists.

ABC Radio National’s excellent All in the Mind had a great edition on the science of happiness.

Petra Boyton looks at a recent study on how alcohol and drug use among European young people is deliberately and strategically linked to sexual behaviour.

An US Iraq veteran who wrote about his PTSD, sadly, kills himself.

BPS Research Digest picks up on interesting new study that found that women’s memories are more speech-filled than men’s.

Am I part of the cure, or am I part of the disease? Scientific American looks at the psychological health benefits of blogging, and on the flip side, whether it’s driven by pathology.

Those concerned about their blogging habits may want to diagnose themselves with a couple of light-hearted lists of social media related psychopathologies.

PsyBlog reports on a new study that found that online daters site spend seven times longer looking at other people’s profiles and sending emails than they did going on real dates.

Frontal Cortex has found a interesting video of someone’s speech function being temporarily ‘switched off’ by TMS.

Getting doctors to routinely enquire about domestic violence may help detect and prevent this vastly under-recognised problem, according to The New York Times.

Psychological Science has an accurate (if not slightly formulaic) article on ‘mirror neurons‘.

Researcher mull possible use of oxytocin to treat social phobia, reports BBC News.

Computer World asks the somewhat ridiculous question “Asperger’s and IT: Dark secret or open secret?”. Secret? How about “Asperger’s and IT: blessing or gift?”

One of the original internet psychologists, John Suler, has a posse… sorry, blog.

The Wall Street Journal reports “Research shows that people often do get a high from shopping – the brain releases chemicals such as dopamine or serotonin”. Oh gag me, please. Release us from these tired, misleading clich√©s.

Sage Journals are giving away free access on registration to all their academic journals until the end of May (thanks Patricio!).

BBC News reports on unlikely suggestions to bring in testing for brain doping in school students.

Could an Acid Trip Cure Your OCD? The use of psychedelic drugs in the treatment of mental illness is considered by Discover Magazine.

The New York Times has some brief audio interviews of people talking about their experience with ADHD.

Older brains may be slower because they’ve just got more information to sift through. The advantages and disadvantages of wisdom are considered by The New York Times.

The ironies of peer pressure: smokers give up in groups, reports BBC News.

Drugs, anthropology and embodied cognition. A lost weekend, or a collection of interesting links from Neuroanthropology. You decide.

Ecstasy’s impact

I’ve just noticed this review article that concisely reviews what we know about how the street drug ecstasy (MDMA) affects the function of the brain.

In terms of life-threatening physical damage, MDMA is a great deal safer than most other recreational drugs including alcohol and tobacco, but there is increasing evidence that it impacts on memory, and the effect seems to be related to dose.

In other words, the more ecstasy you take, the more likely memory problems will be worse.

The neuropsychology of ecstasy (MDMA) use: a quantitative review.

Hum Psychopharmacol. 2007 Oct;22(7):427-35.

Zakzanis KK, Campbell Z, Jovanovski D.

A growing number of empirical studies have found varying neuropsychological impairments associated with use of 3,4-methylenedioxymethamphetamine (MDMA) use. We set out to determine to what extent neuropsychological abilities are impaired in MDMA users. To do so, meta-analytical methods were used to determine the magnitude of neuropsychological impairment in MDMA users across pre-specified cognitive domains. We found that cognitive impairment secondary to recreational drug use may result in what might be described as small-to-medium effects across all cognitive domains with learning and memory being most impaired. We also found that total lifetime ingestion of MDMA appears to be negatively associated with performance on tasks ranging from attention and concentration to learning and memory. Implications and limitations of these findings are discussed.

Sadly, the full-text of the paper isn’t freely available online, but the main punchlines are in the summary.

Link to PubMed entry for paper.

What do you need to do to be considered an expert?

Sociologist Harry Collins is interviewed in American Scientist on his fascinating mission to find out what we need to do to be considered an expert and what different types of expertise exist.

Collins has spent many years studying how science works. Not how it is supposed to work, through experiments and falsification and gradual knowledge building, but how it actually works, through social networks, economics and traditions.

He studied physicists who research gravitational waves and realised he was able to have in-depth conversation with gravitational wave theorists even though he couldn’t run the equipments or do the maths. As most expertise plays out in conversation, how much of an expert was he?

Collins and his colleagues wanted to test the difference between tacit knowledge, what we can do without being able to explain, and explicit knowledge, so they devised some fascinating experiments to see if people could tell the difference.

One ingenious experiment involved testing whether people could tell the difference between a colour blind person and normally sighted version from just talking to them about colour. It turns out, they can’t.

Technical decision-making is often a matter of debating in committees and the like, so the way expertise works itself out in conversation was always going to be a central concern. We decided to use the forerunner of the “Turing test”‚Äîthe “imitation game”‚Äîto see whether one kind of expert could be distinguished from another in conversational tests. In the imitation game, a judge asks open-ended questions of, say, a full-blown expert and someone with interactional expertise only, without knowing who is who. The judge tries to tell the difference. In the best-known of the experiments we did in Cardiff, color-blind people were found to be indistinguishable from color perceivers, and we argued this was because the former had been immersed in the language of the latter all their lives.

As a result of this project, the research team have created a ‘periodic table’ of different types of expertise and how they manifest themselves.

Collins’ research is also discussed in an interview for this month’s Scientific American and many of his publications on expertise are available on his website.

Link to American Scientist interview.
Link to Scientific American interview.
Link to Collins’ expertise publications.

Don’t believe the neurohype

Wired magazine has just published a must-read article on the hyping of neuroimaging technology by companies wanting to sell brain scans on the deceptive premise that they can tell you something about your mood and personality, the effectiveness of adverts or whether you’re being truthful.

Here at Mind Hacks, we’ve covered several highlights in the ongoing parade of brain scan powered bullshit in the past (FKF Applied Research I’m looking at you) but this new article, by psychiatrist Daniel Carlat, is an engaging guide that tackles many of these issues in one go.

Neuroimaging studies that measure brain function are almost always done on large numbers of people and the results are usually only reliable when average differences between groups are compared. This makes it difficult to make sensible judgements about any one individual.

Brain scanning is also often reported as if it is revealing exactly which parts of the brain do what, but it typically only reports associations.

For example, an experiment might find that fear is associated with amygdala activation. But it’s impossible to say the reverse, that every time the amygdala is activated, the person is fearful.

Here’s an analogy. On average, people from New York may be more impatient than people from other cities.

If you predicted that all people from New York were impatient on the basis of this, you’d be grossly mistaken so many times that it would make your prediction invalid.

In fact, taking the average attributes of populations and applying them to individuals is stereotyping, and we avoid it because it is so often wrong as to cause us to misjudge people.

Alternatively, if you met an impatient person and therefore concluded that they must live in New York, you’d be equally inaccurate.

But this is essentially what these commercial brain scan companies are doing, but they are selling it as if it is reliably telling us about an individual person or an individual product because people tend to be blinded by the fact it just seems more scientific. After all, it’s neuroscience right?

Scientists and responsible clinicians will know about these shortcomings and make sure they don’t oversell their findings, but commercial companies are not selling you the data, they’re selling you a way of make you feel better about your insecurities, whether they be commercial concerns or health worries.

Interestingly, the Amen Clinic comes in for criticism which seems to specialise in pushing and overinterpreting SPECT scans to patients.

These guys were the subject of a similarly critical article in Salon the other week and were pulled up the the Neurocritic blog last year for suggesting political candidates should be brain scanned to see what sort of people they are.

If you want to be immune to this sort of nonsense, the Wired article looks at some of the current commercial offerings and how they’re trying to sell you short.

Link to article ‘Brain Scans as Mind Readers? Don’t Believe the Hype’.

Linguistic feathers ruffled by high tech new school

This week’s Nature has a feature article on how a new breed of computational linguists are attempting to understand the evolution of language by using high powered computer models. The traditionalists are not impressed, and accuse the new school of reducing language to numbers and oversimplifying to the point of meaninglessness.

It’s an old debate in the human sciences, and relates to whether aspects of human experience can be meaningfully quantified.

Some psychologists, for example, completely reject any scientific approach to thought and behaviour because they say it strips human experience of exactly what it means to be human – the lived subjective experience of life.

German intellectuals were struggling with similar issues in the 1890s but a related debate arises in consciousness studies in the form of the hard problem.

It wonders how we can explain the fact that our conscious experience – which we understand subjectively, can arise from the biological function of the brain – which we understand empirically and objectively.

While not all problems are quite so intractable, many issues in human science bump up against the maxim “not everything that can be measured is meaningful, and not everything that is meaningful can be measured”.

Whether a particular method gets the balance right is a constant source of arguments.

The Nature article notes that traditional linguists tend to use their interpretation of word meaning combined with historical records to track how language has developed over time, while newer methods code rough assumptions into numerical models and then compute likely patterns.

It is putting it mildly to say that many historical linguists find the evolutionary biologists working on language histories to be bungling interlopers who have no idea how to handle linguistic data. It is also an understatement to say that some of these interlopers feel that their critics are hidebound traditionalists working on a hopelessly unverifiable system of hunches, received wisdom and personal taste. And that’s just the mood between the historical linguists and the newcomers. Lots of the newcomers don’t like each other either. ‚ÄúWhy get excited about it when it is still so preliminary?‚Äù says Johanna Nichols, a historical linguist at the University of California, Berkeley. ‚ÄúWe are not impressed by a computational or mathematical paper per se. We have to see that it blends well with what is known by historical linguistics and really adds to our knowledge. Then we will be excited.‚Äù

Link to Nature article ‘The language barrier’.

Psychology’s greatest case studies

BBC Radio 4 have just broadcast a fantastic new radio series called Case Study that looks at some of the most influential, and most remarkable, case studies in the history of psychology.

The most recent edition was on the famous case of Phineas Gage, the 19th century American railway worker who had a 6 foot tamping iron shoot through his head during a railroad construction accident.

Gage’s job was to clear boulders by drilling holes in them, filling the hole with gunpowder, and tamping the charge down with a large iron bar.

If ever there was an accident waiting to happen, this was it, and lo and behold, the iron bar sparked on the rock, igniting the charge and firing the metal rod through his frontal lobes.

The rest, they say, is history. Or rather, is one of the histories, as there are many legends and stories surrounding his life which turn out to be less than reliable.

The programme looks at the known facts, the speculation, and the huge impact of the case on the development of neuroscience, which had never known a patient with such damage to the frontal lobes who had survived before.

The other programmes are equally as interesting, one edition covers the story of the ‘Wild Boy of Aveyron’ who largely grew up in the woods without any human contact, while another edition tackles the case of Kitty Genovese, a young woman who was murdered apparently in full sight of bystanders who failed to intervene.

Needless to say, influential cases attract influential myths and psychologists’ favourite ‘fireside stories’ of what occurred don’t always match the known facts.

The series is presented by Claudia Hammond, who also presented the excellent Mind Changes series about influential psychologists, and who will be presenting the upcoming series of BBC All in the Mind.

Thanks to Tenyen for letting me know about the series, although I notice I was pre-empted by Neurophilosophy.

Link to programme on Phineas Gage.
Link to programme on The Wild Boy of Aveyron.
Link to programme to Kitty Genovese.

Crowded thoughts: the 70s boom in multiple personalities

Below is an excerpt from psychologist John Kihlstrom’s ¬≠2005 review article on dissociative disorders where he talks about the sudden ‘epidemic’ of multiple personality disorder, now know as DID, in the 1960s and 70s.

Dissociative Identity Disorder or DID is a diagnosis that describes where someone manifests various personalities, often of a diverse range of people – from children to adults of either sex.

It is controversial partly because diagnoses seemed to massively increase when two famous films on the disorder were popular.

Kihlstrom makes the interesting point that the increase in the number of people diagnosed with the disorder was also matched by an increase in the number of personalities each person seemed to have.

An interesting feature of the DID “epidemic” is an increase not just in the number of cases but also in the number of alter egos reported per case. In the classic literature, the vast majority of cases were of dual personality (Sutcliffe & Jones 1962, Taylor & Martin 1944). By contrast, most of the new cases compiled by Greaves (1980) presented at least three personalities; in two other series, the average number of alter egos was more than 13 (Kluft 1984, Putnam et al. 1986).

As Kenny (1986) noted, it was almost as if there were some kind of contest to determine who could have (or be) the patient with the most alter egos. The famous Eve, of course, appeared to have three personalities (Osgood & Luria 1954, Thigpen & Cleckley 1954). But when popular and professional interest in MPD was stimulated by the case of Sibyl, who was reported to possess 16 different personalities (Schreiber 1973), Eve replied with her own account of her illness, eventually claiming 22 (Sizemore & Huber 1988).

Despite the almost-infinite number of possible synaptic connections in the brain, one might say that the mind simply is not big enough to hold so many personalities. The proliferation of alter egos within cases, as well as the proliferation of cases, has been one of the factors leading to skepticism about the disorder itself.

In general, dissociative disorders are where one part of consciousness seems to be ‘split off’ or inaccessible to another.

For example, psychogenic amnesia or conversion disorder (‘hysteria’) are more common examples and hypnosis seems to reliably induce the phenomena in some people.

These are still some of the most mysterious processes in psychology and are fraught with controversy, particularly as they’re often linked to repressed memories from abuse or trauma.

This is one of the more difficult areas to study scientifically because it largely relies on self-report, and Kihlstrom notes there is still no convincing evidence that trauma or abuse leads to amnesia for the event.

Link to PubMed abstract of Kihlstrom’s review.
Link to full-text of pre-print.

Virtual Iraq used to treat post-war trauma in US vets

Continuing yesterday’s virtual reality theme, The New Yorker has an in-depth article about how US Iraq veterans diagnosed with post-traumatic stress disorder are being treated in a VR simulation of battle situations.

The VR simulation is actually a modified version of Full Spectrum Warrior, a military tactics video game that was first developed to train US army soldiers before being released as a commercial product.

PTSD is an anxiety disorder that can be diagnosed if a person has experienced a potentially life threatening experience, and has intrusive traumatic memories, persistently increased arousal, and avoids reminders of the event.

Helping someone re-visit aspects of the original experience is an important part of the psychological therapy. This is relatively easy for someone who was traumatised in a traffic accident, but is considerably more difficult for a soldier who was traumatised in a distant and still-active war zone.

Virtual reality aims to safely simulate the environment and features of combat. The idea is that the intensity can be controlled by the therapist to manage exposure and to make sure the patient is never challenged with more anxiety than they can manage.

“This shows you why you need a trained therapist,” Rizzo said, turning off the machine and watching Aristone, who was bent over, with his hands on his knees, taking deep breaths. “Someone who knows exposure therapy, who knows how little things can set people off. You have to understand the patient. You have to know which stimuli to select. You’d never do what I just did—you’d never flood them. You have to know when to ramp up the challenges. Someone comes in and all they can do is sit in the Humvee, maybe with the sound of wind, and may have to spend a session or two just in that position. For P.T.S.D., it’s really intuitive. We provide a lot of options and put them into the hands of the clinician.”

One of these is Karen Perlman, a civilian psychologist who uses Virtual Iraq with patients at the Naval Medical Center San Diego. Perlman is an apple-cheeked, middle-aged native Californian with cascading brown hair, who, when I met her, was wearing an elegant short black dress with a pink-blue-and-purple tie-dyed silk scarf. At first glance, Perlman does not seem to be the sort of person a young marine would cotton to, but Rizzo says that she has a gift, and so far eight of the nine patients she has treated no longer meet the criteria for P.T.S.D. (This number does not account for those who dropped out.) “It’s a very collaborative relationship,” she told me in February, when Skip Rizzo and I drove down to San Diego. “I know which stimuli I’m going to add as the therapy progresses. I’m not going to overwhelm them. There are no surprises. I say, ‘I think you’re ready for the I.E.D. blast or for more airplanes.’ I’m not only adding more, but increasing the duration of each one. It’s intensive, but for P.T.S.D. you need a treatment that is intensive.”

The team have published some published some initial studies from the treatment which looks promising.

The project joins a growing number of studies that have found VR a promising method for treating trauma.

Link to New Yorker article ‘Virtual Iraq’.