Mind Hacks

A recent 60 country World Health Organisation study found that depression is the most serious chronic illness, worse than angina, arthritis, asthma, and diabetes. Unfortunately, the majority of people who experience depression live in low income countries where help is least likely to be available.

The New York Times has a fascinating article on an ongoing project in Goa, India, that screens every attendee at a local health centre and then uses psychological therapy to help with low mood or anxiety.

It’s not a simple case of just using Western techniques in a new environment.

As the NYT article mentions, mental illness carries a significant stigma in many cultures. For example, a diagnosis may not only be stigmatising for the affected person, but it may also mean the person’s children are less likely to be thought of as suitable marriage partners, potentially affecting the whole family’s future.

Futhermore, depression is known to present quite differently in some non-Western cultures. Studies have found that people are more likely to report ‘somatic symptoms’ such as diffuse pains or tiredness, rather than low mood or emotional problems.

This is partly due to stigma, but sometimes because certain languages don’t have the same, or even such a varied vocabulary for emotions and mental states.

I’m currently working with a Pakistani psychiatrist who often surprises me by pointing out that even what I assume are relatively straightforward words, such as depression or anxiety, might not have a direct translation in some Asian languages.

All of these issues mean that the treatment centre in Goa tackles the issue in a slightly different way:

Most are also apparently wary of visiting a mental hospital. In India, the stigma of mental illness remains strong. To minimize the problem, health workers avoid using the words “mental illness,” “depression” or “anxiety” with patients, relying on more commonly used words like “strain” and “tension.”

The patients “are happy to talk,” Dr. Sudipto Chatterjee, a psychiatrist at Sangath, said, “as long as you stay away from the idea of mental illness.”

I find the issue of having different vocabularies for our mental states fascinating.

The philosopher Wittgenstein noted how difficult it is to agree on common words for internal states because errors are so hard to correct.

If a mother and child see a rabbit and the child says “elephant!”, the mother can point to the rabbit and correct the misnomer. But what can a mother, or anyone do, if someone ‘misnames’ an emotion?

Or to put it another way, as we don’t have external things to refer to for internal states, how do we ever agree on a vocabulary that is at all meaningful?

I’m always curious when I come across differences concerning emotion words in other languages. For example, Spanish has the same word (verg√ºenza) for shame and embarrassment.

From my native language perspective it strikes me as amazing that another language doesn’t individually label these two states which seem to have such different personal and social implications.

I’m sure there are many reverse examples and many other emotional vocabulary mismatches across the world’s languages.

Link to NYT article ‘Psychotherapy for All: An Experiment’.

Discover Magazine has an exposé of a recent surge of news stories on insomnia and sleep disorders that stretch from the dull to the frankly unbelievable.

It turns out a fair number seem to be based on press releases from PR firms, some trying to promote hotels, but others coming from the National Sleep Foundation.

The author of the piece looked at the 2005 financial figures from this organisation and discovered that over 80% of its funding came from drug companies and almost three quarters was spent on ‘public education’ – i.e. advertising the existence of sleep disorders.

Of course, sleep disorders can be distressing, disabling and potentially dangerous but research suggests that particularly for insomnia, the judicious use of drugs should be a last resort (most have the potential for addiction), as behavioural and psychological treatments are safer and more effective for most people.

Unfortunately, these approaches are often not available, meaning ‘public awareness’ increases diagnosis but leads to drug prescription, partly because people go to doctors and list what symptoms they think they have from the advertising rather than describing their experiences.

The National Sleep Foundation do a lot of excellent work but the article suggests that there seems to be an element of disease mongering and astroturfing to their promotions.

Link to article ‘Deflating the Bogus Insomnia ‚ÄúEpidemic‚Äù’

Film-maker Martin Hampton has created a revealing documentary on four people with different degrees of compulsive hoarding, where individuals incessantly collect household objects, even to the point of not being able to throw out rubbish.

Compulsive hoarding is often linked to obsessive-compulsive disorder, where affected people experience intrusive thoughts or urges to complete certain actions (most commonly ‘washing’ or ‘checking’) even though they know how seriously these intrusions are affecting their lives.

Hampton’s documentary is a remarkably well made account of people with similar urges, in this case to collect and retain, and just lets the individuals and the images speak for themselves (it is also freely available online as wide screen HD, so looks wonderful).

Apparently the documentary was created as part of a Master’s course in visual anthropology, a field I’d not come across before, but which seems to be concerned with documenting the diversity of human experience through film.

Possessed does this admirably and seems to have garnered numerous awards since it’s release.

UPDATE: Grabbed from the comments. An update and a request from the director!

I am the director of this film and am now researching the next stage of the project. I am trying to compile a collection of peoples experiences of OCD and other anxiety based disorders. I have found from experience that although symptoms might be similar, the actual particularities of the obsessions and compulsions are often very varied. For example, one might wash ones hands 30 times a day, but have a very unique self discovered reason for doing so. I would be very grateful to hear of your or any friend / acquaintances experiences / difficulties. Many thanks and I hope you find the film interesting. Please email me at martin@martinhampton.com

Link to Martin Hampton’s documentary Possessed (via MeFi).

The New York Times has a fun article on how psychotherapists decorate their office and what this might portray about the inner life of the shrink.

Psychoanalysts (Freudian psychotherapists) in particular are very careful about what sort of impression they project about themselves, preferring, at least initially, to be as insubstantial as possible so the patient can transfer feelings and impressions onto them, allowing relationship patterns and emotional reactions to be uncovered and worked on.

However, many psychotherapists work from home, using rooms in their house as offices. The NYT piece notes that a recent academic paper in the journal Psychoanalytic Psychology caused a storm by questioning the ethics of this practice, as impressions or even people from the therapists family life might interfere in the crucial relationship forming process.

Of course, the office is also a way of making the patient feel comfortable and at ease and so the tension between how the therapist attempts to express this, and how they express themselves, can be quite revealing.

Freud famously had a painting over his psychoanalytic couch of Jean-Martin Charcot (Freud’s mentor) presiding over the swooning and almost bare breasted young woman ‘Blanche’. No wishful thinking going on there of course.

In the UK, where most psychological treatment happens in the NHS, the rooms are often comfortable but plain outpatient appointment rooms that are shared and booked as necessary.

Occasionally, clinicians will have their own office in which to see patients. In these case, I’ve noticed that psychotherapists and counsellors have a much better sense of interior decoration (all rugs and soft lighting) than clinical psychologists, who tend to go for books and photocopied papers look.

Link to NYT article on therapists’ offices.

Thanks to Debbie from the My Mind on Books blog who managed to track down the original academic article from psychologist Benny Shanon who argues that Moses’ experiences on Mount Sinai may have been due to a hallucinogenic experience.

Shannon suggests that a mixture prepared from the acacia tree and the bush peganum harmala could have been responsible.

The article is freely available so you can read it in detail for yourself. As well as Shanon’s main idea, it also contains a wealth of information about the use of psychedelic plants in the ancient world.

Link to article ‘Biblical Entheogens: a Speculative Hypothesis’.

Placebo has its effect through our beliefs and expectations. Because we get many of our assumptions through culture, changing social attitudes could alter how effective it is.

Placebo is sometimes called the ‘expectancy effect’ and describes the fact that our expectations of what the dummy treatment will do can influence the outcome.

We noted before that the colour of the pill can significantly alter its effect, but it’s intriguing to think that we probably get most of these sorts of expectations from our culture.

Bad Science looks at how the strength of the placebo effect has changed over time for different drug trials, suggesting that as our cultural beliefs change, the effectiveness dummy treatments might also change depending on how they’re presented.

Similarly, The New York Times have just published a brief article on a new study that found placebos described as costing $2.50 a dose are more effective pain killers than those presented to participants as costing 10 cents a dose.

In other words, if placebo is a form of faith healing, changes in our collective faith will alter the healing potential of a placebo associated with those ideas.

These social effects on placebo are interesting, because we judge the effectiveness of medications by comparing them to placebo. Furthermore, we know the effectiveness of most medications will be partly explained by the placebo effect.

In other words, changes in our cultural attitudes influence the effectiveness of medication.

While we assume that much of medicine objectively definable, much is only comprehensible by making sense of social issues.

For example, drug side-effects are usually talked about as if they are objectively described properties of the chemical.

However, its easy to see that these actually depend on the person, not the drug.

For example, take the drug terazosin. It lowers blood pressure and shrinks the prostate.

If you have high blood pressure but a normal prostate, the side-effect is a reduced prostate. If you have prostate problems but normal blood pressure, the side-effect is reduced blood pressure. If you have both high blood pressure and prostate problems, it’s potentially side-effect free.

One man’s treatment is another man’s side-effect. This is why the sociology of medicine is as important as biology, chemistry or another other bench-based science in understanding illness and treatment.

Link to Bad Science on placebo.
Link to NYT on price of placebo study.