Mind Hacks

Frontal Cortex has just alerted me to a compelling four-part series on the quest to find the molecular basis of memory in Prof Gary Lynch’s neuroscience lab.

It’s not only an account of the science behind the research, but also of the characters and human drives of the people involved.

Old school Russian neuropsychologist A.R. Luria wrote case studies of brain injured patients that not only described the neuroscience of their disorders, but also described the people in such sensitive detail that you really felt you got to know them.

He called this ‘romantic science’ – something which Oliver Sacks cites as a major inspiration for his own work.

These LA Times pieces are not about brain injury, but they have the same quality of human passion intertwined with the story of scientific discovery.

The first time I spoke with the neuroscientist Gary Lynch, the conversation went something like this:

Me: I’m interested in spending time in a laboratory like yours, where the principal focus is the study of memory. I’d like to explain how memory functions and fails, and why, and use the work in the lab as a means to illustrate how we know what we know.

Lynch: You’d be welcome to come here. This would actually be a propitious time to be in the lab.

Me: Why’s that?

Lynch: Because we’re about to nail this mother to the door.

Link to four-part LA Times special ‘Chasing Memory’.

After much debate at the American Psychological Association conference a resolution was passed that condemns torture, bans psychologists from taking part in certain abusive activities, but still leaves significant grey areas for participation in contested CIA interrogation techniques.

The key section of the APA resolution is the following:

This unequivocal condemnation includes, but is by no means limited to, an absolute prohibition for psychologists against direct or indirect participation in interrogations or in any other detainee-related operations in mock executions, water-boarding or any other form of simulated drowning or suffocation, sexual humiliation, rape, cultural or religious humiliation, exploitation of phobias or psychopathology, induced hypothermia, the use of psychotropic drugs or mind-altering substances used for the purpose of eliciting information; as well as the following used for the purposes of eliciting information in an interrogation process: hooding, forced nakedness, stress positions, the use of dogs to threaten or intimidate, physical assault including slapping or shaking, exposure to extreme heat or cold, threats of harm or death; and isolation, sensory deprivation and over-stimulation and/or sleep deprivation used in a manner that represents significant pain or suffering or in a manner that a reasonable person would judge to cause lasting harm; or the threatened use of any of the above techniques to the individual or to members of the individual’s family;

The resolution is widely being interpreted as a snub to the CIA, but notably, participation in detainee “isolation, sensory deprivation and over-stimulation and/or sleep deprivation” are not specifically banned unless they are judged to cause “lasting harm” – without any clear definition of what this amounts to.

Salon points to a publicly available CIA interrogation manual from the 1960s that notes that these techniques quickly provoke hallucinations and stress that become “unbearable for most subjects” although the manual also notes a “profound moral objection to applying duress past the point of irreversible psychological damage.”

Some members were pressing for an outright ban in participation in all CIA interrogations, citing the whole process of internment without due process unethical, but this was not adopted by the APA, meaning the guidelines fall short of those already adopted by psychiatrists and physicians.

One notable aspect of this story is just how important it’s become. At the time of writing, Google News lists over 300 news items on the decision.

Much of the credit for this has to go to Salon who have followed the story since the beginning, at times catching APA with their pants down.

Their dogged investigations have obviously touched a nerve as they report that the APA president refused to answer questions from the publication when approached after a panel session.

Link to APA resolution.
Link to Salon article ‘Will psychologists still abet torture?’.
Link to APA press release on resolution.

‘Internet addiction’ doesn’t exist. It can’t, because it’s a logical impossibility, a category error, and there’s no good evidence that heavy internet use, in itself, is a risk to mental health.

A paper of mine, just published in the Journal of Mental Health [pdf], describes why, but I’m going to summarise the arguments here because of an infuriating and self-contradictory press release about “Internet addiction disorder” that seems to be all over the internet.

Perhaps the most important point is the concept of ‘internet addiction’ relies on a fundamental misunderstanding of what the internet is.

‘Internet addiction’ researchers conceive of the internet as if it were a set of activities when, in fact, it’s a medium for communication.

People become addicted to substances or activities, but it’s impossible to become addicted to a medium. You can be no more addicted to the internet than you can to language or radio waves.

This is important because the proposed criteria for internet addiction or pathological internet use (there is no accepted classification, contrary to what the press release says) typically make reference to ‘using the internet’ or ‘spending time online’ without reference to any specific activity.

It’s important to specify specific activities, because, as noted above, the concept of a behavioural addiction logically requires one.

It’s also important to make the distinction between something being compulsive, something that you want to do again (commonly, but confusingly, called ‘addictive’ in everyday language), and a fully-fledged behavioural addiction – a mental disorder where you keep doing the activity even when it has serious damaging effects.

The cinema, reading books, going for walks, chatting to friends and any other enjoyable activity can be compulsive, but it doesn’t make it an addiction, even if it’s a daily time consuming activity and you get pissed off if you can’t do it.

Some online activities are almost universally accepted as being genuinely addictive (e.g. gambling) whereas others are subject to significant debate (e.g. gaming, chat).

This is not to say that some of the people who have been described as having ‘internet addiction’ don’t have any problems or aren’t suffering.

There are definitely people who are dysfunctional in day-to-day life, have significant problems with mood and motivation, and who spend a huge amount of time online.

However, there’s little evidence that heavy internet use actually causes these problems:

Although initial work suggested that time spent online was correlated with a small but significant increase in loneliness and depression (Kraut et al., 1998), subsequent replications and extensions found the reverse (Howard et al., 2001; Moody, 2001; Wastlund et al., 2001) and a follow-up to the original Kraut et al. study found the negative effects were no longer present and that, in contrast, internet use was generally associated with positive effects on communication, social involvement, and well-being (Kraut et al., 2002). A key finding from this latter study was that extroverts generally showed a positive relationship between internet use and social well-being measures, whereas introverts showed the reverse – reporting an increase in isolation and loneliness. It is still not clear why this might be the case, although it has been suggested that the internet might provide tools to ‘amplify’ predispositions (Joinson, 2003), so that extraverts can meet more people and socialise, while introverts can keep them at a distance.

Furthermore, it’s difficult to see why addiction is the best way of understanding these problems.

Addiction researcher Prof Mark Griffiths has outlined some elements that an activity needs to have to be considered addictive, notably salience, mood modification, tolerance, withdrawal, conflict and relapse.

He also notes that the proposed description of ‘internet addiction’ does not fulfil these criteria.

The core problem is not using repetitive, extended internet use, or even intrusive thoughts about keeping track of online events (otherwise 90% of the office workforce would be diagnosed), but low mood and social withdrawal.

In Japan, almost exactly the same problems have been named ‘hikkikomori‘. One of the key characteristics of hikkikomori individuals is that they isolate themselves and occupy their time with the internet and video games.

But the Japanese, rather sensibly, identify the core problem as social withdrawal, and the excessive solitary activities as symptoms – just ways in which isolated people try to fill the void.

In fact, this is exactly what a recent study of internet game users found: the driving force behind internet games was less the ‘fun’, the kick of the game if you will, but instead a sense of achievement, freedom and social connectedness.

There’s always a temptation to try and fit fuzzy human problems into comfortable pre-existing categories because it makes us feel useful and qualified to use our existing tools.

Psychiatrists and psychologists have clear and defined treatments for addiction but very little for social withdrawal, because social withdrawal isn’t a diagnosis in itself.

The press release is apparently based on a published paper in the Journal of Clinical Psychopharmacology, although it has yet to appear.

It may contain a revolutionary new argument, but I doubt it, as there is not a single study showing that heavy internet use causes the features of an addiction.

And certainly not the supposedly “extreme and menacing” condition that is described as affecting 10% of all internet users.

Link to press-release on Science Daily.
pdf of paper ‘Online Information, Extreme Communities and Internet Therapy: Is the Internet Good for Our Mental Health?’.

Time magazine is reporting that ‘behaviour detection officers’ have been introduced to US airports who have been trained to pick out potential terrorists by analysing, at least in part, facial expressions. Despite the enthusiasm of the authorities for this new approach, there’s no clear evidence that it will be effective.

America’s Transport Security Administration describes the job as involving “voluntary encounters with the public under the SPOT Program, to determine whether elevated behaviors indicate that the individual may be involved in a terrorist or criminal act or activity”.

SPOT stands for “Screening Passengers by Observation Techniques” and, according to The New York Times, was created in consultation with psychologist Paul Ekman.

This means the SPOT system is likely to be based on one of Ekman’s two commercial systems for analysing facial expressions: the Facial Actions Coding System (FACS) or the Micro-Expression / Subtle Expression Training Tool (METT/SETT).

Ekman’s Facial Actions Coding System (FACS), a well-researched method for coding the individual muscle movements or component parts that make up a facial expression.

The idea is that its hard to fully hide emotions as they often quickly or partially emerge on the face before we suppress them, so by being able to detect ‘microexpressions’ we can get a better idea if someone might be trying to hide inner stress.

The FACS system is available commercially and the introductory chapters of the manual and investigator’s manual are available online.

It is designed by to be used by researchers, who have time to carefully examine video tape, but also by people who need to catch microexpressions as they happen – on the fly.

Research has shown that people who are better at detecting microexpressions are better as detecting lies [pdf], but so far, the (admittedly limited) evidence suggests that training people to detect microexpressions doesn’t make people better lie detectors.

There are only two small studies I know of that have tested this (I would be interested to hear of more), none of which inspire much hope. Both studies looked at whether FACS training improved clinicians ability to detect faked vs genuine pain.

A 1993 study found that it improved the ability to detect faked but not genuine pain. A 2004 study found it had no effect on accuracy.

The METT/SETT is even less well-researched. In fact, only one pilot study that I know of has used it at all.

Yet Ekman makes some grand claims for its effectiveness. In a recent article for the journal Behavioral Science and the Law he notes that:

This Micro Expression Training Tool (METT) (Ekman, 2002) includes feedback about the correct answers, morphed faces contrasting the most difficult to discriminate emotions, and a pre and post test. In two recent studies, Ekman & Frank (2005) provided training on detecting deception using METT. They obtained a very large
increase in accuracy with less than one hour of training with METT.

Rather than research published in a peer-reviewed journal the Ekman and Frank (2005) reference turns out to be to a document listed only as “Revealing concealed emotions. Retrieved from http://www.paulekman.com”, which, I’m damned if I can find. Anywhere.

However, it is likely these techniques are already being used in training law enforcement officers, security guards and the like. Ekman’s corporate website notes that he’s signed a three year contract with the UK Police’s Anti-Terrorist Unit at New Scotland Yard.

One possibility is that either Ekman’s company or the US authorities have done extensive unpublished research to show that training in these or similar methods are effective at helping staff detect potential terrorists or risky passengers.

One difficulty with all deception research is that participants told to lie in the lab are not necessarily good models for ‘real-life’ deception, with all its complex motivations and emotional force.

Lab-based lies are likely to be a poor substitute an actual covert terrorist situation.

Link to Time article ‘A New Tack for Airport Screening: Behave Yourself’.
Link to NYT article ‘Faces, Too, Are Searched at U.S. Airports’.

ABC Radio National’s All in the Mind has just had a special edition on the increasingly contentious debate over whether addiction is a brain disease, and does a fine job of highlighting the politics behind the interpretation of the science.

This much is agreed upon: some people inherit a greater propensity for becoming addicted to certain drugs, and taken in enough quantities, some drugs can cause long-term alterations the brain’s reward system to make non-drug pleasures less rewarding, thereby increasing future chances of drug-taking.

The controversial issue, which All the Mind tackles, is over how much this should be described as a ‘brain disease’ or a ‘psychological problem’, and this is usually where the politics kicks in.

Whenever you hear this sort of rhetoric in mental health, it’s often a reflection of a deeper argument beneath the surface – an argument over how much someone is personally responsible, or more worryingly, ‘to blame’, for their state of distress or impairment. The same often goes for the ‘genes vs environment’, ‘nature vs nurture’ debate.

There is a condition which is a great example of how thinking only in terms of ‘mind or brain’, ‘genes or environment’ is flawed for anything which involves an external trigger.

Phenylketonuria (PKU) is a single-gene disorder that results in a missing enzyme which is needed to break down phenylalanine into the building blocks of certain neurotransmitters. Without the enzyme, phenylalanine accumulates in the body, leading to problems with brain development, cognitive impairments, seizures and psychosis.

However, if people with PKU avoid phenylalanine in their diet, they have no problems at all (this is why certain foods are marked with “contains a source of phenylalanine”).

So, is PKU a genetic disorder or an environmental one? A brain disease or a psychological problem? There is no single answer. It depends how you look at it.

In a sense it’s 100% genetic, because a single gene determines whether you have the missing enzyme or not. But in another sense, it’s 100% environmental, because it’s not a problem unless you encounter phenylalanine in the environment.

Similarly, you could say it’s a brain disease, because people with PKU inherit a problem with the neurotransmitter pathway, but in another sense, it’s a psychological problem, because poor diet decision-making and vigilance can determine the likelihood of becoming sick.

What is striking is that this division into ‘brain’ and ‘mind’ is completely artificial and counter-productive. You need to understand both to see how PKU affects someone’s life.

Buy you’ll also notice how political views could favour one view or another.

If you believe in the primacy of personal responsibility, push the psychological model, because this emphasises the affected person’s actions in staying well. At one extreme, it allows us to blame people who get sick through PKU for not being vigilant enough, or wanting other people to pick up the pieces when they fail to control their diets.

If you believe in the primacy of social responsibility, push the disease model, because this emphasises the effects of factors outside an individual’s control. At the other extreme, it allows us to absolve the person of individual responsibility for the effects of their illness.

Addiction is far more complex than PKU, not least because addiction to different substances, or indeed to behaviours such as gambling, can be quite different psychologically, neurologically and socially.

However, you can see how the models used to explain each disorder are selective or can go beyond the evidence in certain instances, so preference for an explanation can be politically biased.

My advice is to be suspicious of anyone who tries to tell you a complex disorder is purely mind or purely brain, and think about what is motivating someone to explain it largely in one way.

Similarly, think of the psychological and neurobiological evidence as complementary, rather than in competition, and be prepared to accept more than one model of how something works. Each might be accurate, but just useful for different things.

This edition of AITM is an example of all of these forces at work.

Link to AITM ‘Addiction: Dis-ease over diseased brains’.

Time magazine has an article on attempts to train law enforcement to prevent people with mental illness from needlessly ending up in behind bars. It includes some startling information, like the fact that more Americans receive mental health care in prisons than in hospitals.

“If you think health care in America is bad, you should look at mental health care,” says Steve Leifman, who works as a special advisor on criminal justice and mental health for the Florida Supreme Court. More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers.

In fact, the country’s largest psychiatric facility isn’t even a hospital, it’s a prison ‚Äî New York City’s Rikers Island, which holds an estimated 3,000 mentally ill inmates at any given time. Fifty years ago, the U.S. had nearly 600,000 state hospital beds for people suffering from mental illness. Today, because of federal and state funding cuts, that number has dwindled to 40,000. When the government began closing state-run hospitals in the 1980s, people suffering from mental illness had nowhere to go. Without proper treatment and care, many ended up in the last place anyone wants to be.

The article starts with a telling correction of a journalistic slip, apologising for stating that one reform was inspired when a man with schizophrenia shot a policeman, when in fact, it was the policeman who shot the patient.

A 1999 US survey found that over 60% of people thought that someone with schizophrenia is ‘somewhat’ or ‘very likely’ to commit an act of interpersonal violence, when we know that people diagnosed with the condition are much more likely to be the victim of violence than the perpetrator.

It seems there are some positive developments, however, and the article describes the Miami Police’s innovative and successful methods of including people with experience of mental disorder in their training, and when dealing with distressed people they encounter.

Link to Time article ‘De-Criminalizing Mental Illness’ (via Spikol).