Mind Hacks

BBC’s Newsnight programme just had an interesting video report on the renewed debate about whether mental health services are institutionally racist.

While these accusations have been made for some time, what is new is that some black and ethnic minority mental health workers who work in these communities are starting to argue that this label actually makes it more difficult to provide fair treatment to their patients.

The subject was recently tackled in one of regular debates held at the Maudsley Hospital in South East London, which is available online as a podcast.

It is widely known that in the UK, black and ethnic ethnic minority people are much more likely to be diagnosed with a psychotic mental illness, such as schizophrenia, than other members of society.

While this was originally thought to be a sign of racism in itself, studies have suggested that this pattern is true of almost all immigrant communities (e.g. Finnish immigrants to Sweden), rather than simply a black and white issue, and that the rates still hold when psychiatrists are asked to diagnose cases based only on their symptoms with the ethic origin hidden.

The debate has now largely moved on and the focus is now on outcomes and experiences in the mental health system.

For example, regardless of the higher rates of psychosis, it seems that when in contact with mental health services, outcomes for Afro-Carribean people are much worse than white people.

This is where the subtlety in the debate lies. Higher rates of diagnosis in one racial group are not necessarilly a sign of discrimination, but poorer outcomes after treatment has started are more likely to suggest this group is not being fairly treated.

An influential report called ‘Breaking the Circles of Fear’ found that people from ethnic minorties tend to have a more negative experience of the mental health system and fear the consequences of becoming involved with it.

Furthermore, it found that mental health professionals were often afraid of talking about race issues for fear of appearing racist.

Psychiatrists Prof Swaran Singh (pictured) and Dr Shubulade Smith argue in the video report that accusations of racism actually make it more difficult for people from ethnic minority communities to get fair treatment, as it interferes with sensible clinical decision making.

In contrast, campaigners like Lee Jasper and psychiatrist Dr Kwame McKenzie argue that unless we admit that the system is racist, problems won’t be adequately addressed.

One important factor might be that immigrant communities tend to be poor, live in urban environments, have weaker family support and have higher rates of drug and alcohol abuse, all of which have been found to increase rates of schizophrenia.

This makes it difficult to disentangle the effects of mental health treatment, and a society where black and ethnic minority groups are more likely to live stressful and depressed communities.

The fact that ethnic minority psychiatrists are now starting to challenge the idea that the mental health system is racist must be a positive sign, however, as twenty years ago, most would be in agreement that it was not set up to deal with the needs of minority communities.

Link to BBC News on the debate with video report.
Link to podcast of Maudsley Debate ‘The Race Blame Game’.

Online science magazine Litmus Zine has a interesting report of one person’s experience of last year’s LSD conference that was convened to discuss the science of this curious molecule and celebrate discover Dr Albert Hoffman’s 100th birthday.

The conference took place in Basel, Switzerland and the attendees were reportedly a strange mixture of neuroscientists, hippys, psychologists, artists, sociologists and visionaries.

The article weaves the history of LSD with the topics of the conference, giving an account of the drug’s past and present.

I’ve not come across Litmus Zine before, but it looks like it’s got some great content already online and aims to take a fresh approach to science writing.

Link to article ‘Turn On, Tune In, Drop Out ‚Ķ Get Well?’ (thanks Mat!)

New Scientist has an open-access article on the increasing tendency for atypical American children to be diagnosed with ‘juvenile bipolar disorder’.

Children are being increasingly diagnosed with bipolar disorder in the US, despite the fact that there is limited evidence for its validity and disagreement about its symptoms.

As we reported in a previous Mind Hacks article, mental disorder presents differently in children (for reasons that are not well understood) and diagnosis is fraught with difficulties.

Not least because children often are not able to report their thoughts and emotions adequately, and many different forms of distress get expressed as ‘misbehaviour’, making it hard to distinguish between different causes.

One of the other effects of the increasing number of children diagnosed with bipolar, is that an increasing number are being medicated with drugs that have barely been tested in anyone other than adults.

This is despite the fact that parenting programmes, such as the Webster-Stratton ‘Incredible Years‘ programme, are known to be effective ways of improving behaviour.

Advocates for the disorder argue that it has been previously unrecognised and only now is it being properly diagnosed, and that it causes serious distress and impairment in affected children and their families.

The NewSci article looks at some of the trends in diagnosis and treatment, and speaks to child mental health researchers on both sides of the fence.

Link to NewSci article ‘Bipolar children – is the US overdiagnosing?’.

Philip Dawdy is an investigative journalist who runs the Furious Seasons blog and he’s been on Eli Lilly’s case for some time.

He’s been following the ongoing legal proceedings over whether the drug company obscured information about the side effects of antipsychotic drug Zyprexa, and has been posting some seemingly incriminating documents online that have probably made the company quite uncomfortable.

His work has just got him a mental health award that was voted for by mental health professionals and service users.

It was created by a corporate sponsor who fund the award but get no say in who receives the honour. The name of the sponsor? Eli Lilly.

I love the smell of irony in the morning.

Link to Furious Seasons on forthcoming award.

Reporter Quinn Norton, who had a magnet implanted into her finger to allow her to ‘feel’ magnetic fields has finally had it removed – returning her to the normal world of the ‘five senses’.

We reported on the operation last year, and Norton wrote up her experiences in an extended Wired article that also looked at the role of body modification in extending the human sense range.

Norton notes that even though she glad she’s had the magnet removed (it wasn’t without problems – it broke up in her body and got infected) she still misses the extra sense:

In the background of all this are the questions the magnet led me to, the ones that make the magnet look pedestrian. Human augmentation and even advanced treatment really begin to erode at what we think humans are, in society, in the justice system, in medicine itself. What are we going to become inevitably is also the question of who we are now, and beginning to ask the former brings home how little we know about the later.

I’m excited and scared to be trying to find out. I miss my magnet, but I knew it wasn’t well understood when I started. I’m glad I know what a spinning drive and a ringing telephone wire feel like. I’m sad I can’t feel them anymore.

Link to Quinn Norton on losing her sixth sense.
Link to Wired article on magnet implant.

Security guru Bruce Schneier has written an insightful article for Wired about rational precautions for rare risks, and why the typical response after a rare catastrophe is usually psychologically satisfying but practically irrelevant.

He writes the article in the wake of the Virginia Tech shootings, which have caused a number of bizarre responses by people worried about whether it might happen again (banning fake guns in theatrical productions, for example).

Trying to reduce the risk from the rare people who are both violent and mentally disturbed is often the responsibility of forensic psychologists and psychiatrists.

Interestingly, they don’t spend their whole time thinking ‘how can we stop this person murdering someone’, as although this is the sort of thing that hits the headlines, it’s actually incredibly rare.

People who have already murdered someone are generally locked away and don’t pose much of a risk, but for someone who has never murdered anyone or never attempted to, predicting whether they will can be very difficult.

In fact, it’s difficult to gather data to determine whether your predictions are accurate or not.

Imagine you have a risk assessment that predicts that a person is highly likely to murder someone.

To best evaluate your prediction, you’d want to wait and see if it turns out to be true, but in these circumstances, you can’t. You have to intervene.

Once you’ve intervened, you don’t know whether your prediction was true or not.

Forensic mental health professions spend a lot of time thinking, as Schneier recommends, ‘have we done everything that is feasible to reduce the risk to the public based on what we know about the most common risks’.

In other words, they focus on the principle of maximising safety, rather spending all their time and energy on highly unlikely events that may be impossible to predict.

As they tend to be so frequently in touch with the legal system, their second line of thinking tends to be ‘if the extremely unlikely does occur, will we be seen to have done everything that was required by the courts’, because at the end of the day, the law is the final say on what is acceptable when predicting the unpredictable.

Link to ‘Virginia Tech Lesson: Rare Risks Breed Irrational Responses’.
Link to information on forensic psychology.
Link to online book on forensic psychiatry from the Royal College of Psychiatrists.

OmniBrain has alerted me to the fact that the winners of the 2007 Visual Illusion contest have been announced, with all of the top ten entries viewable online.

Most of the entries are animated and range from the striking to the subtle.

My favourite is the one pictured, simple but effective, which you really need to see in action to get the full effect.

There’s many more at the link below, most with psychological explanations of how they work.

Link to top 10 winners.

As an update to an earlier story, psychologist Daniel Gilbert’s book Stumbling on Happiness has been announced as the winner of The Royal Society Prize for Science Books.

The book is a hugely entertaining look at the science of happiness, covering everything from brain science to decision making experiments using sandwiches.

It’s perhaps most interesting for presenting research on how bad we are at predicting how happy our choices will make us, and how future events will impact our sense of well-being.

One useful recent additon to the book’s website is a brief study guide for lecturers wanting to use the book, as Gilbert does, for teaching students.

Link to announcement from The Royal Society.
Link to coverage from BBC News.
Link to book website.
Link to Daniel Gilbert’s lab homepage.