Mind Hacks

Smart drugs, 1948

There’s a copy of a wonderful 1948 article magazine available online entitled ‘Pills That Increase Your Intelligence’ from Modern Mechanix .

It discusses the possibilities of ‘smart drugs’ and is full of archaic language that makes it equally shocking and endearing.

Can you feed your brain some special food to make it smarter? Scientists have always laughed at the idea. Now they aren’t quite so cocksure. Maybe your brain does have faster speed and quicker getaway when it runs on certain fuels. New scientific discoveries indicate that brain power can be stepped up by swallowing tablets. These pills are not stimulating drugs but concentrates of a food element you eat every day.

Let’s look into the strange story of one particular brain. It wasn’t a very good brain. In fact, it belonged to a fourteen-year-old imbecile boy who had an intelligence quotient of 42 (the average I. Q. is 100). Every year the boy grew twelve months older, but his mental age increased only four and a half months. He kept running an intelligence deficit. Then he was fed little white pills, a dozen and a half daily. Within two months his mental age leaped ahead one year and five months. Sixty days on brain pills and his mental age increased as much as it had in the last five years!

It sounds much like the ‘miracle cure’ claims that conditions like autism attract to the present day.

Link to 1948 Modern Mechanix article (via Bad Science).

Salon have just announced the start of a regular series of neuroscience articles with the first tackling whether brain scans might enable us to communicate with people who are conscious but trapped in their paralysed bodies.

The article considers a recent scientific paper [pdf] on the use of brain imaging to detect awareness in people who might otherwise be thought to be in a coma-like state, but actually are largely unable to communicate with the outside world because they’re paralysed.

We’ve covered two studies during the last few years that have reported consciousness in what were thought to be unconscious patients owing to the fact that their brain activity seemed to reflect complex mental processes or could be altered at will, following verbal requests from the researchers.

There are two main implications of this work, the first is that we could better diagnose patients as being paralysed rather than in comas, and the second is the hope that we could design systems to read the brain activity in a reliable enough way to allow affected people to communicate with the ‘outside world’.

With all of the brain scan hype we get subjected to, the article considers an important but rarely discussed point – although revolutionary, fMRI isn’t a very accurate measure of brain activity and we can’t directly infer subjective mental states from brain scan data.

This means its utility as a tool for detecting consciousness, let alone ‘mind reading’, is severely limited.

Interestingly, the article is written by a neurologist called Robert Burton, who shares a name with the author of the 17th century book The Anatomy of Melancholy which remains one of the best books ever written on the troubled mind.

It seems this article is the first in a new series called Mind Reader – “a new Salon feature exploring the galaxy of the brain.”

Link to Salon article ‘The light’s on, but is anybody home?’.
pdf of review article on fMRI detectection of awareness in coma-like states.

PR for the self: managing identity on social networks

The New Atlantis magazine has an intriguing article that considers the social effects of sites like MySpace and Facebook and discusses how we are increasingly using these tools to carefully manage our public image – something that was previously only a concern for celebrities and media figures.

The article describes by describing the social networking sites and how they work and discusses a little of their history, but shortly after, it tackles the psychology of how we use them to manage our online identities.

The world of online social networking is practically homogenous in one other sense, however diverse it might at first appear: its users are committed to self-exposure. The creation and conspicuous consumption of intimate details and images of one‚Äôs own and others‚Äô lives is the main activity in the online social networking world. There is no room for reticence; there is only revelation. Quickly peruse a profile and you know more about a potential acquaintance in a moment than you might have learned about a flesh-and-blood friend in a month. As one college student recently described to the New York Times Magazine: “You might run into someone at a party, and then you Facebook them: what are their interests? Are they crazy-religious, is their favorite quote from the Bible? Everyone takes great pains over presenting themselves. It’s like an embodiment of your personality.”

The article also covers some key studies in social network analysis, the science of understanding how relationships between people facilitate large scale social interaction.

And it also discusses some recent ideas on how these tools might be changing the nature of our relationships as a consequence of simply becoming part of the equation.

Link to article ‘Virtual Friendship and the New Narcissism’.

Encephalon 32 arrives

Edition 32 of the Encephalon psychology and neuroscience writing carnival has just been published on Living the Scientific Life.

A couple of my favourites include an article on foreign accent syndrome and another on the cerebellum as the cause of dyslexia.

Head on over for plenty more scientific curiosities from the internet’s best mind and brain writers.

Link to Encephalon 32.

The greatest may never come

Over the next two weeks the BPS Research Digest will be publishing articles by leading psychologists on the greatest psychology experiment that’s never been done.

Each contributor was asked to think of a psychology study they would love to see completed, even if it would be so impractical, it would never be possible.

Two will be published each day over over the coming week, and the first ones have just appeared online.

Susan Blackmore suggests we could brain scan people as they die to understand near-death experiences, while Pam Maras thinks we should do a social psychology experiment that looks at every possible interaction in everyday life.

During the week, the authors will suggest studies on the mind of the unborn child, resisting oppression, kindness-centred care for psychosis, the effect of switching parents, and radically reshaping the mind to improve its performance, to name but a few.

Other authors include Richard Gregory, Will Meek, Richard Bentall, Chris Chatham, Martin Seligman, Jeremy Dean, Alex Haslam, Judith Harris, Scott Lilienfeld and Annette Karmiloff-Smith.

So keep tabs on the BPS Research Digest over the coming week to catch the latest releases.

I’ve also been asked to contribute, and an article on using detectives to find the line between reality and psychosis will be appearing in the next few days.

I realise that means I included myself as a ‘leading psychologist’ in the opening line, but the more accurate description of “articles by leading psychologists and one over-caffeinated keyboard monkey” made the intro a bit clumsy. Either way, it should be a great series.

Link to ‘The most important psychology experiment that’s Never been done…?’

Trauma from events that never occurred

A study just published in the medical journal Psychosomatics reports four case studies of people who developed PTSD after experiencing a traumatic event that never occurred – while their emotional reaction was real, the events were hallucinated.

Post-traumatic stress disorder can occur when someone has experienced a traumatic event over which they had no control. PTSD is diagnosed when memories of the event intrude into everyday life, the person feels the need to avoid anything which could remind them of the situation, and they feel excessively anxious and on edge.

The patients described in the article had all been admitted to intensive care for serious medical conditions, but this was not the direct cause of their trauma.

While in intensive care the patients became delirious, a state where consciousness is clouded, thinking is impaired, and delusions and hallucinations are common.

In these cases, the delusions and hallucinations led the patients to believe they were about to die horrible deaths, were being threatened or were experiencing horrific events.

Later, when they recovered from their primary condition, they had all the symptoms of PTSD – but specifically for the incident that had only occurred in their disturbed thinking.

Here’s one of the case studies:

“Mr. A” was a 56-year-old white man who developed end-stage liver disease from a combination of alcohol and viral hepatitis. Aside from remitted alcohol dependence, he had no other psychiatric history. After liver transplantation, he experienced a difficult medical course, with sepsis, renal failure, biliary reconstruction, respiratory failure, and immunosuppressive medication neurotoxicity from tacrolimus. Several electroencephalograms showed diffuse generalized slowing of the background rhythms and documented seizures. He had persistent delirium for several months postoperatively.

While having delirium, he was extremely agitated, requiring restraints to prevent him from hurting himself and/or dislodging lines and catheters. He appeared awake, but was frequently incoherent and disorganized. However, he was able to articulate paranoid delusions that the staff were trying to kill him and his son. He was also observed to be responding to auditory and visual hallucinations.

Four months after the transplant, when he was discharged from the hospital, his delirium had resolved. He was no longer confused or disoriented, was not actively hallucinating or delusional, and his mood was good, with only occasional, transient symptoms of anxiety.

Several months later, in the transplant clinic, he reported reexperiencing events he had hallucinated while having delirium in the intensive care unit (ICU), and, thus, he met DSM‚ÄìIV criteria for PTSD. He recalled detailed paranoid delusions that the hospital staff had chained his son to his bed and were beating him to death. He recalled struggling against the restraints, hoping to free himself to save his son. He described hearing his son’s screams for help and sounds as if his son was being pummelled.

He reported recurrent nightmares of these events and even daytime flashbacks of these experiences, typically when spending time alone. He attempted to avoid thinking about these events and the hospitalization, but described difficulty doing so because the thoughts were intrusive and difficult to dismiss. Not only did he avoid discussing the events, but he also had difficulty returning to the hospital because it caused him to recall these images. He was observed to be restless and hypervigilant in the transplant clinic.

Both the medical illness and the psychoactive painkillers can contribute to the disturbed thinking that lead to delirium. This in turn can significantly affect how people remember their recovery.

In fact, one study found that some patients had no factual recall of intensive care at all, their only memory of the time was of their delusions. This group were particularly likely to be traumatised.

People are sometimes embarrassed to talk about these experiences, but they are surprisingly common. Studies have estimated that between between 12.5% and 38% of ICU patients experience delusions and hallucinations.

Link to study abstract.

ATDT

I’m not really one for blog memes, but I was pleased to see Psych Central has given us a nod. Actually, we’ve had a few of these now and they always give us a boost, but getting one from John Grohol is especially welcome because he’s the granddaddy of online psychology info.

It’s a bit like having Freud announce that you’ve got good taste in cigars.

For those of you who don’t know, Grohol is a psychologist who’s been putting mental health information on the net since the early nineties, and was putting information on BBS’s before that. He’s officially old school (if you thought ZMODEM was the best thing since sliced bread, you’re old school too).

At this point it’s probably worth mentioning that Mind Hacks is a substantial team effort of which my hypergraphia is just one part. Just Tom and Matt’s behind the scenes emails would fill a blog of their own. Plus we get a load of material sent by friends and readers (you know who you are! at least, Christian certainly does). Thanks!

Distant echoes of Shatner’s Bassoon

Language Log is doing a sterling job of keeping up with the increasing pace of Dr Alfred Crockus’ research, and seem to have found an important neuroanatomical link between the Crockus and another surprisingly neglected brain area, Shatner’s Bassoon.

The Crockus is the shameless and unintentionally hilarious invention of educational consultant Dan Hodgins, which he claims is four times larger in girls and so supports his own ideas about teaching (incidentally, he’s currently ‘on tour‘ if you want to hear his crockus first hand).

Shatner’s Bassoon was the invention of satirist Chris Morris, who persuaded various media figures that it was an area of the brain targeted by the fictional street drug ‘cake‘.

Several TV personalities and David Amess, a Tory MP, took part in Morris’ spoof TV programme with absolutely no insight into the completely ridiculous premise of the whole affair.

The best bit is when they do an earnest public education announcement, warning of the drug’s dangers and informing the viewers that it may be sold under the names of looney toad twat, russell dust, chronic basildon donut, Joss Ackland’s spunky backpack, bromicide, ponce on the heath, cool thwacks, and Hattie Jacques’ portentious cheese wog.

The video is available online, and it is a testament both to the fact that people are easily blinded by scientific sounding nonsense, and to the fact that celebrity endorsement of good causes can be as much about their public profile as it is about the cause itself.

David Amess went as far as asking a question about “cake” in parliament which you can read in Hansard, the official parliamentary record.

Interestingly, the Home Office assumed his question about ‘cake’ referred to 3,4-methylenedioxy-N-benzylamphetamine (MDBZ), one of the drugs synthesised by legendary psychedelics researcher Alexander Shulgin. The description of the drug appears in his book PiHKAL – a sort of Principia Psychedelica of mind-bending phenethylamines, of which ecstasy (MDMA) is probably the best known.

Morris’ spoof news series, The Day Today and Brass Eye, function equally well as hilarious entertainment and a careful analysis of the language of news media we’ve come to uncritically accept.

As a result, Chris Morris taught me more about deconstructing the media than Derrida ever did.

Language Log has been just as funny lately, and is doing an equally important job in pointing out how the language of neuroscience is now so all-pervasive, that people are willing to make up areas of the brain to support their point of view.

As an aside, if anyone knows of any other fictional brain areas, do get in touch. I feel these need collecting in one place.

Link to Language Log on ‘The Crockus and the Bassoon’.
Link to Brass Eye on ‘cake’.

Seeking free will: a debate

The Dana magazine Cerebrum has just published a debate between a psychiatrist and neurologist on how we can make sense of free will in the age of neuroscience.

The choice of professionals is an interesting one because each typically deals with what are assumed to be quite different disruptions in free will.

Neurologists often treat patients who have problems controlling their movements, cognition or consciousness – owing to clear, identifiable brain damage to the systems involved in these processes.

Someone with Parkinson’s disease, for example, seems to have little conscious control over their tremor or rigid movements.

Psychiatrists on the other hand, typically deal with people who don’t have clear brain damage, but whose brain’s are nonetheless functioning in such as way that they experience unstable moods, odd perceptions, or come to hold seemingly impossible beliefs.

Here the idea of free will is a bit more conceptually tricky. We can clearly say that someone who has Parkinsonian tremor is not ‘willing’ their movements, but what about someone whose brain disturbance means they hear voices?

Some people who hear voices can have conversations with them. In this situation, the person would seem to be exercising some influence over their hallucinations, because the voices respond to what’s being said, but many people can’t ‘will’ the voices away.

One particularly interesting phenomenon in this regard is ‘command hallucinations’ – usually hallucinated voices that command the person to do something.

Often, the commands are pointless – touch the table, cross the street, take off your hat – but sometimes they can be terrifying instructions – for example, that the person must harm themselves.

In some cases, these commands seem irresistible, the person feels completely compelled to follow their hallucinated instructions.

We don’t really have a good understanding (or, to be fair, even a bad understanding) of why some command hallucinations are distressing but impotent, while others seem to compel the person to comply.

There are many more examples of how free will is affected in both psychiatry and neurology. In both specialities, there are conditions where the boundaries of free will cover a big grey area, and all of them raise really quite profound questions about our freedom to act as we want.

The Cerebrum debate tackles exactly these sorts of issues by two people who undoubtedly have to deal with them on a daily basis.

Link to Cerebrum article ‘Seeking Free Will in Our Brains: A Debate’.

Advancing the history of psychology

I’ve been enjoying the Advances in the History of Psychology blog lately, which is full of interesting snippets about the past and often digs into the historical background of contemporary hot topics.

For example, here’s an interesting bibliography about psychoactive drug use in psychology, and here’s another about Benjamin Franklin’s interest in ‘electrotherapy’.

It’s run by the same people who produce the completely invaluable Classics in the History of Psychology archive, that has a huge website with some of the most important texts from psychology’s colourful past.

Both are excellent, and I look forward to reading more.

Link to Advances in the History of Psychology blog.
Link to Classics in the History of Psychology archive.

Want fries with that?

Neurophilosophy discusses a recent study that suggests that the inclusion of large amounts of starchy foods into our diet helped fuel the evolution of the brain.

It’s interesting because it’s not the first study to suggest that specific changes in diet improved nutrition and brain development:

According to one theory, increased consumption of meat by our ancestors provided the additional energy needed for brain expansion. (Cooking would have further increased the amount of calories obtained from meat.) Another holds that a switch to a seafood-rich diet would have provided polyunsaturated fatty acids which, when incorporated into nerve cell membranes, would have made the brain function more efficiently.

And now, a study published in Nature Genetics adds starchy tubers to the smorgasbord of foodstuffs that may have contributed to the expansion of the human brain.

These theories tend to be quite controversial and tend to cause numerous back and forth arguments in the literature, partly because they’re quite hard to test, largely owing to the fact that the brain has the consistency of toothpaste and so doesn’t leave much of a fossil record.

The study picked up by Neurophilosophy is interesting because it tracks a gene that codes for a starch enzyme, needed to break down starch into glucose.

It’s a relatively new approach to an old problem, although as the article mentions, the link to brain evolution is still circumstantial.

However, it’s an interesting areas and the Neurophilosophy article is a great brief guide to some of the thinking behind these theories.

Link to Neurophilosophy on ‘Diet and brain evolution’.

2007-09-21 Spike activity

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

SharpBrains has an interview with cognitive behaviour therapy guru Judith Beck about using CBT for effective dieting.

Wired wonders whether EEG-based brain-to-game interfaces may mess with our heads.

Hard-up students: Aren’t there a lot of psychology textbooks on torrent servers these days? Just sayin’

Genes which raise risk for schizophrenia have likely been positively selected for during evolution, reports SciAm.

The BPS Research Digest reports that having a pen in your mouth impairs your ability to recognise emotions in others, as you’re not as good at mirroring their facial expression.

Sally Satel discusses the early rumblings over the new DSM (due out 2012) in The New York Times.

NPR has an interesting programme on the the application of mathematics to tracking social networks of terrorists.

A lovely snippet from Cognitive Daily: more evidence that everyone has a little synesthesia.

Pinker’s working the crowd: An NPR radio interview on the new book, and Discover Magazine interview on the same.

Can information be directed to different networks in the brain depending on the “transmission frequency“, like the channels on a TV? Developing Intelligence investigates.

Forget troubled teens. The New York Times reports on baby boomers behaving badly.

To the bunkers! Further evidence that Skynet is about to become sentient:
* AIs set loose in virtual worlds to ‘hone their skills’.
* Reason Magazine will be saying ‘I told you so’ when AIs keep us as pets!

OmniBrain notes that the 2008 Visual Illusion Contest is open and accepting entries.

Track the performance of the neurotech industry!

Dr Petra discusses a recent study that asked teens about their definition of virginity – which is remarkably variable.

US Government outsources their wacky mind-control fantasies to Russia.

Analyse the negative, bask in the positive. PsyBlog has some evidence-based advice for increasing life satisfaction.

PsychCentral notes that the APA have earmarked $7.6 million ($7.6 million!) to upgrade their website over the next two years. PsychologicalReviewTube to be launched in 2009.

Pure Pedantry has found some beautiful pictures of the pre-synapse.

Gone, and yet forgotten

An interesting section from neuropsychiatrist Michael Kopelman’s 2002 review article on the neuropsychology of memory disorders where he tackles transient global amnesia – a form of brief, severe, but mysterious amnesia that resolves in a few hours. No-one really knows what causes the majority of cases.

Transient global amnesia (TGA) most commonly occurs in the middle-aged or elderly, more frequently in men, and results in a period of amnesia lasting several hours. As is well known, it is characterized by repetitive questioning, and there may be some confusion, but patients do not report any loss of personal identity.

It is sometimes preceded by headache or nausea, a stressful life event, a medical procedure, intense emotion or vigorous exercise. Hodges and Ward (1989) found that the mean duration of amnesia was 4h and the maximum 12h. In 25% of their sample, there was a past history of migraine, which was considered to have a possible aetiological role.

In a further 7%, the patients subsequently developed unequivocal features of epilepsy in the absence of any previous history of seizures. There was no association with either a past history of or risk factors for vascular disease, nor with clinical signs indicating a vascular pathology. In particular, there was no association with transient ischaemic attacks.

In 60-70% of the sample, the underlying aetiology was unclear.

Link to full-text of paper ‘Disorders of memory’.

Won’t you help me doctor beat

Musicogenic epilepsy is a neurological disorder where epileptic seizures are uncontrollably triggered by music. Gloria Estefan’s Dr Beat is a catchy 80s pop song where she calls for medical assistance because music is irresistibly moving her body, moving her soul and affecting her brain.

Coincidence? I think not.

Doctor, I’ve got this feelin’ deep inside of me, deep inside of me
I just cant control my feet, when I hear the beat
when I hear the beat
Hey doctor, could you give me somethin’ to ease the pain
cause if you dont help me soon gonna lose my brain
gonna go insane

Despite Ms Estefan’s requests, painkillers are unlikely to help with the acute effects of seizure.

First-line treatment is usually a rapid acting benzodiazepine and long-term stabilisation with a common anticonvulsant such as sodium valproate.

While her concerns about her mental health are understandable (people with epilepsy are at a slightly higher risk of developing mental illness), the majority of people with the condition lead full and active lives, so her fear of insanity is largely unfounded.

There are many cases of musicogenic epilepsy in the medical literature but, unfortunately, only a few few are freely available online. One is particularly interesting though and is available as a pdf file.

It’s a 1957 article published in Psychosomatic Medicine that reports three fascinating cases, including a girl who had her seizures triggered by swing music that induced, among other things, hallucinations of a smartly dressed couple.

For those of you wanting something a bit more up-to-date though, YouTube has the a Dr Beat Mylo remix Dr Who video mashup. Same symptoms, new medical staff.

pdf of ‘Musicogenic Epilepsy: Report of Three Cases’.
Link to Dr Beat lyrics.
Link to original Dr. Beat video.
Link to Dr Beat remix Dr Who tribute mashup.

The Financial Times has a slightly bizarre article on the application of neuroscience to architecture that suggests that we’re genetically predisposed to feel relaxed around flowers, the hearth and food, and that homes need to be designed to release certain neurotransmitters.

The piece is about the Academy of Neuroscience for Architecture (ANFA) which aims to use neuroscience in building design and encourage brain research into the effects of buildings.

I’m all for the wider application of neuroscience, and I’m sure there are some relevant findings that could be applied, but the article is full of so many erroneous brain clich√©s that I just despair.

Zeisel is also a director of the Academy of Neuroscience for Architecture (ANFA), an organisation launched in 2003 to encourage scientists to get out of the lab and partner with architects and designers. “It’s the future of the field,” he says. “People might ask what neuroscience has to do with designing an ’emotional’ house but our emotions are managed by our brain,” Zeisel says. “When our brains are happy a certain endorphin gets released, so we need to design homes in order to release that neuro-transmitter.”

Endorphins are the brain’s natural opioids and are released in a wide variety of situations. They are indeed released when we feel pleasure, but are also released when we feel stress or pain.

So designing homes to maximise the release of endorphins will just as likely lead to uncomfortable, stressful hell-holes.

Take our desire for eye contact with others as an example. “A couple of million kitchens are planned each year and probably only about 5 per cent obey the most basic principles for human communication,” [kitchen designer!] Grey says. In most, the person preparing the food at the sink, stove or counter has to face away from his or her family or guests, decreasing sociability in what should be a social zone. “As a result the brain continues to produce adrenalin and cortisol, the hormones associated with fear and anxiety,” he says. “Whereas if they are facing [into the room] then oxytocin, the bonding hormone, and serotonin, associated with relaxation and enjoyment, are released.”

So, it not only makes the common but false link between specific mental states and general neurotransmitters, makes unproven claims between specific activies and the release of these neurotransmitters, but also makes the unsupported claim that facing away from people in the kitchen causes fear and anxiety, while facing towards them causes relaxation and enjoyment.

Zeisel suggests that responses to some features of the home might even be innate. “We are born with genetically developed instincts that make us feel relaxed around flowers, the hearth, food and water,” he says. “It’s simply an emotional need and using those things in the environment will make us feel more comfortable.” On the flip side, places that seem too sterile or too confusing are perceived as dangerous, which can trigger the hypothalamus to release stress hormones.

There’s no evidence that we are genetically predisposed to feel relaxed around “flowers, the hearth, food and water”. Perceiving things are dangerous does indeed lead to the release of stress-related hormones, but there’s no evidence that ‘confusing’ or ‘sterile’ buildings do this.

Of course, buildings that are ‘too sterile’ or ‘too confusing’ might do, but therein lies a circular argument, because you’ve already defined them as having a negative influence.

Professor Joan Meyers-Levy of the University of Minnesota’s Carlson School of Management is another academic interested in how our surroundings affect our physical and mental states. Her research shows that when people are in a room with high ceilings, it activates sections of the right brain associated with freedom and abstract thinking. In low-ceilinged rooms, more constrained thinking is brought to the fore. “There’s a preference in terms of real estate for high ceilings and it‚Äôs [not only] the sense of power and wealth that conveys but also [the fact that] vertical space could have a beneficial mental influence,” she says.

To be completely fair to Meyers-Levey, her study [pdf] was a perfectly reasonable investigation into the effect of ceiling height on priming – an effect where an initial stimulus quickens your ability to react to related things.

However, the brain is not even mentioned in the paper, let alone measured in any way. The bit about high-ceilings activating the ‘right brain’ has just been added, seemingly from nowhere, by the journalist.

Two papers were recently published in Cell about the application of neuroscience to architecture, but importantly, they speculate, but don’t actually reference any studies that have looked at the influence of building design on the brain. The article then goes on to repeat several of the speculations as fact.

I think the article may be a candidate for the Dr Alfred Crockus Award for the Misuse of Neuroscience.

As an aside, Crockus fans may be interested to hear that he’s been tracked down to the hitherto unknown but undoubtedly endorphin stimulating ‘Boston Medical University Hospital’.

UPDATE: Christian just reminded me that he wrote an article for The Psychologist late last year that looked at how psychology is being increasingly used in architecture. It also discusses specific scientific research on psychology and building design. It’s an excellent antidote to the Crockus from the FT.

Link to ropey FT article.
Link to Psychologist article ‘Is there a psychologist in the building?’.

Sexuality special in this week’s Psychiatric Times

The latest edition of the Psychiatric Times has a special section on sexuality that discusses everything from dealing with sex-related problems as a clinician, to the science of sexual orientation.

It’s actually quite a refreshing change from much of the recent hype we’ve seen about sexual dysfunction, which usually suggests that a patch, pill or prostheses is an essential treatment for unsatisfactory sex.

Psychiatrists who develop an interest in clinical sexuality tend to employ 2 different paradigms, depending on the clinical situation. One is quite familiar to modern psychiatric continuing education. The patient has a disorder, we possess a range of medication treatments, and the etiological theories support our treatment. Lifelong premature ejaculation is an ideal example.

Another paradigm is necessary for most sexual disorders, however. We approach these disorders from the viewpoint of general etiology rather than disorder-specific causation. Sexuality unfolds in adolescence and continues to evolve over decades of adult maturation. The sexual problem serves as a window into personal development and individual and relationship psychology. Sex is understood to be about the unfolding of the individual self, the capacity to give and receive pleasure, the capacity to love and to be loved, the ability to be psychologically intimate, and the ability to manage expected and unexpected changes throughout adulthood.

Since few sexual dysfunctions have a specific treatment, diagnosis per se usually is not the determinant of treatment. Rather, it is the invitation to study the context in which the problem arose. Treatment rests on the clinician’s understanding of how biological, psychological, interpersonal, and cultural factors combined in this case to create the symptom. This second paradigm reminds psychiatrists that the management of sexual disorders often requires interest and skills in psychotherapy.

The fact that most sexual problems are a manifestation of wider difficulties with relationships, mood, or adjustment is taken as read by most clinicians working in the area.

Unfortunately, most of the messages we encounter from TV, magazines and V!aGr4 spam suggest sexual difficulties are nothing more than a physical problem that needs a fix – as if you could help someone drive better by selling them tyres.

Link to August Psychiatric Times.