Mind Hacks

The UK’s Science Museum has a special online exhibit about the history of mental health and illness that is packed full of fascinating photos and stories.

This rather unpleasant photo from the ‘mental institutions’ section particularly caught my eye. It is labelled “Elderly man in restraint chair, from a series of photographs taken of patients at West Riding Lunatic Asylum, Yorkshire, c. 1869.”

It’s interesting because it bears an interesting resemblance to a famous picture of James Norris, an ‘insane’ US marine who was found by the press to be permanently restrained in Bethlem Royal Hospital (the ‘Bedlam’ asylum) in 1814.

His condition so outraged the public that it was instrumental in a number of reforms to ‘madhouses’ including the 1828 Madhouses Act and the 1845 Lunacy Act.

However, the photo of the elderly gentleman is dated 1869, after both reforms, suggesting that this was either a temporary measure to restrain ‘unruly’ patients, or that the London-centric reforms just didn’t have much effect in the distant provinces of the United Kingdom.

On an unrelated point, the man is described as being a patient at ‘West Riding Lunatic Asylum’ the short name of the ‘West Riding Pauper Lunatic Asylum’.

British rock band Kasabian recently named their award winning album after the hospital but managed to mangle the name, entitling it ‘West Ryder Pauper Lunatic Asylum’.

Link to Science Museum mental health exhibit (via BPSRD).

As well being one of the most influential neurologists in the history of medicine, Georges Gilles de la Tourette, led a very colourful life.

The journal Clinical Neurology and Neurosurgery has an engaging article about his work on hypnotism and how he became involved in a debate over the possible criminal uses of hypnotism.

At one point, he took part in a celebrated trial where a murderer claimed she had been hypnotised to commit the crime, but most strikingly Gilles de la Tourette was shot in the head by a likely-psychotic patient who claimed he was ‘hypnotising her from a distance’.

The event was so striking it made the front page Le Pays Illustré.

On 6 December, 1893, at 18:45, at Gilles de la Tourette’s domicile, 39 rue de l‚ÄôUniversit√©, a young woman asked for him, and since he was not back from the hospital, she said she would wait for him. When he arrived fifteen minutes later, she immediately followed him and told that she had been hypnotized many times, being now without resources and asking for 50 francs. He vaguely remembered to have seen her (and indeed she had participated to several hypnotism sessions), and told her to give her name and address. Since she asked for money again, he went to the door, when he heard a shot and felt a violent shock in the back of the head.

Two new shots followed, but he could leave the room, feeling blood pouring down to his neck. This story was shortly reported in Le Progr√®s M√©dical by Georges Guinon, who arrived a few minutes later, and saw the woman quietly sitting in the waiting room, apparently satisfied. Guinon’s article was published with the purpose to stop the already spreading rumors of an assault perpetrated under hypnosis, since this would have been a major challenge to the La Salp√™tri√®re school theories that no crime could ever be accomplished during a hypnotic state.

The wound was not severe, and the same evening, Gilles de la Tourette was able to write to his friend the journalist Georges Montorgueil: “What a strange story”. Previous mentions of the event inaccurately reported that it led to a famous trial, while there was no trial at all. The woman, named Rose Kamper (born Lecoq, on 23 June, 1864, in Poissy) indeed was recognized to be insane. She had already spent time at the Sainte-Anne asylum, and was known to have written threatening letters to the administrator of the École Polytechnique Mr. Rochas. She later told that she suspected Gilles de la Tourette to be in love with her, but also that she had been hypnotized without her consent, with the consequence that her will had been annihilated.

She reported that she had been hypnotized “at distance”, and that there was another person in her, who had pushed her to shoot. She was examined by Brouardel, Ballet and Jules Falret, who concluded to what nowadays corresponds to paranoid schizophrenia, so that she was sent back to Sainte-Anne and other hospitals, from which she was intermittently released. Interestingly enough, a couple of days before the assassination attempt, Gilles de la Tourette and Montorgueil had published an article in L’Éclair on hypnotism contesting the Nancy school.

Gilles de la Tourette lived on for more than a decade after being shot although towards the end of the century his behaviour started to become a little bizarre.

In 1899 he published a famous article on recognising and treating the neurological effects of syphilis but when writing the paper he noticed the symptoms in himself, realised he had neurosyphilis and became profoundly depressed.

He was forced to leave his job in 1901 owing to his increasingly delusional behaviour and was admitted to the Lausanne Psychiatric Hospital in Switzerland when he eventually died in 1904.

Link to PubMed entry for article on Gilles de la Tourette.

RadioLab discusses how the final novels of Agatha Christie subtly reflected the early stages of dementia as her written vocabulary and her ability to use the nuances of language slowly began to diminish.

The discussion is based on a linguistic analysis of her books by English professor Ian Lancashire who found in his study [pdf] that the range of vocabulary in her final works markedly declined and her use of indefinite words (like ‘something’ or ‘anything’) greatly increased, indicating that her striking ability to manipulate the English language was fading as she began to develop dementia.

This is not the first analysis that has looked at the literary output of a great author as she declined. A 2005 study analysed the text of three Iris Murdoch books, who famously lost her literary abilities as Alzheimer’s disease began to take hold, and found a similar pattern in her later writing.

In the case of Murdoch, and probably in the case of Christie, both of these analyses were on books completed before the authors were diagnosed with the condition (although we don’t know if Christie was ever formally diagnosed owing to the secrecy of her family).

In fact, we know that this is a common pattern, in that years before people get diagnosed with Alzheimer’s disease there is a slow but steady decline of mental function that is a little beyond what we would expect from normal ageing but not so severe that it is clear the person has the condition.

The RadioLab programme also discusses the well-known ‘Nun Study‘ project which has studied the relationship between biological and life-style factors and the risk of getting Alzheimer’s disease in a group of nuns.

In one of the studies from the project, the researchers found a link between getting Alzheimer’s and the linguistic skills of the nuns that they demonstrated in an essay they wrote when they first entered the convent as young women – those who wrote the more complex essays were less likely to develop the dementia later in life.

This reflects an idea in dementia research known as the ‘cognitive reserve‘ which suggests that your mental ability is a bit like a fuel tank and when wear-and-tear on the brain drags your ability below a critical point in later life, you start going into the rapid decline of dementia.

Those with more mental ability are therefore more resistant (although not immune) to dementia. While level of education has been consistently linked to protection against dementia, it could just be that those who have more natural mental capacity study more, but there is some recent research that suggests education may help ‘top up’ the cognitive reserve fuel tank to help protect against the disease.

Link to RadioLab piece ‘Vanishing Words’.

The journal Memory has a remarkable case study of a man who began memorising the whole of John Milton’s epic poem Paradise Lost at the age of 58. The researchers tested him at age 74 and found they could pick any part of the 10,565 line poem and he could successfully remember the next 10 lines.

JB is an active, articulate septuagenarian who began memorising Paradise Lost at the age of 58 in 1993 as a form of mental activity to accompany his physical exercise at the gym. Although he had memorised various poems in earlier years, he never attempted anything of this magnitude. JB stated that he wanted to do something special to commemorate the then-upcoming millennium. ‚ÄúWhy not something really challenging like, oh, ‘Paradise Lost’?‚Äù he said. He began by walking on a treadmill one day while trying to memorise the opening lines of the poem. After those lines were committed to memory, he extended the task over successive sessions to see how far he could go. JB, who regards himself as a theatre person, reflected on this process this way:

“The real challenge was just not to memorise it, but to know it deeply enough to really tell Milton’s story. As I finished each book, I began to perform it and keep it alive in repertory while committing the next one to memory. ‚Ķ The goal eventually became not just a series of performances, but to do all twelve books on the same occasion.”

Nine years later, JB achieved his goal. He recited Paradise Lost in its entirety over a 3-day weekend. Since that 2001 performance JB has given numerous public recitations, although for many of these performances, due to the time it takes to recite the poem (approximately 3 hours for Books I and II), he limits his performance to several books, rather than all of the books in their entirety. Typically, he moves and expresses emotion during a performance to help signify changes in characters, and he gives copies of the poem to the audience so that they can follow his memorised recitation.

Psychologist John Seamon discovered JB after attending one of his performances where he recited the whole of Books I and II from memory.

Seamon and his team asked JB to take part in tests regarding the epic work where they cued him with two lines selected from anywhere in the poem and asked him to recall the following 10 lines. In one part they picked out lines as they went through the books in order, in another they just chose books at random.

He seemed to stumble on a couple of books when they were tackled sequentially, but generally his verbatim recall was generally above 90% and seemed more consistent when the books were picked out randomly. The team also video-taped one of his live performances and found his average accuracy was between 97% and 98%.

Although not formally tested, JB’s everyday memory is apparently normal for his age, with his exceptional memory for Milton’s poem apparently arising from his relentless practice and dedication.

This is a common pattern in mental practice or ‘brain training’ style scenarios where we get better at the tasks we repeat but that improvement doesn’t seem to carry over very effectively into other areas of mental life.

If you’re interested in seeing JB in action he has his own webpage, mentioned in the scientific article, where he advertises his performances and where you can watch video of him reciting the poem.

Link to PubMed entry for case study.
Link to JB’s website.

The latest All in the Mind from ABC Radio National has a fascinating discussion about how the definition of schizophrenia shifted throughout the 20th century in the USA as it morphed from being a disease of the withdrawn middle class female to being the affliction of the aggressive black man.

The program is an interview with psychiatrist Jonathan Metzl who discusses his new book The Protest Psychosis: How Schizophrenia Became a Black Disease.

Unfortunately, discussions about mental illness and race can quickly starting going round in circles. As we’ve discussed previously, the fact that an ethnic minority has higher rates of mental illness, does not, in itself, provide strong evidence that the mental health system is racist – as this could easily be a reflection of poverty or immigration, both of which have been shown to have been linked to mental illness independently of the skin colour of the peoples concerned.

However, Metzl’s critique is somewhat more subtle and he suggests that in mid-20th century America there were attempts, implicit or otherwise, to pathologise the civil rights movement by shifting the diagnosis for certain conditions – most notably, schizophrenia.

In fact, in 1968, an article in the Archives of General Psychiatry even proposed what was called ‘protest psychosis’, “a special type of reactive psychosis” that affected “American Negroes” which was caused by “the stress of asserting civil rights in the United States”.

At the time, the excessive and ad hoc use of the diagnosis of schizophrenia in the USA led to the famous ‘US-UK Diagnostic Study‘ where the States was brought in line with the standards and definitions used in Europe.

By the way, if you’re a regular All in the Mind listener don’t miss the extra audio that turns up on the blog. Sadly, you can’t download the extra audio directly because it is embedded in a playing widget, but if you mouseover or ‘View source’ you can see the whole URL for the extra mp3s and download by pasting this into your browser.

Link to AITM on ‘protest psychosis’.

I’ve just discovered the powerful story of the German psychiatrist Alice Ricciardi-von Platen. She refused to take part in the growing eugenics movement in the 1930s Germany that targeted people with mental illness for sterilisation and euthanasia, resisted the Nazi party and wrote a book documenting Nazi medical abuses of psychiatric patients after being asked to observe the Doctors Trial at Nuremberg.

As a result, she was ostracised from the German medical community and her book was repressed. It wasn’t rediscovered by German historians until thirty years after it was published in 1948.

Afterwards she became highly respected for her work developing group therapy and worked in Britain and Italy right into her late nineties.

There is surprisingly little about her online or in the academic literature although she received two glowing obituaries in the British press when she died in 2008.

We like to think that each of us would stand up to human rights abuses even if everyone else around us was involved but we know from countless social psychology experiments that it is an incredibly difficult thing to do. Consequently, I always have immense admiration for people like Ricciardi-von Platen who did so in the most difficult of circumstances.

We also like to think that the Nuremberg trials put an end to the political abuse of psychiatry but a recent article in Schizophrenia Bulletin tracked the history of these abusive practices noting that they have been regularly used throughout the 20th century and into the 21st.

From the Soviet use of sluggishly progressing schizophrenia to silence dissidents, to the Nazi’s incorporation of psychiatry into eugenics, to psychiatrists’ collaboration with torture during dictatorial regimes in Latin America, to China’s use of psychiatric hospitals to persecute Falun Gong members and to the collaboration with ‘war on terror’ torture in the US (albeit in the light of outright condemnation from the American Psychiatric Association).

Sadly, psychiatry has been co-opted many times over as a tool of oppression. Complacency is the enabler of these abuses and people like Alice Ricciardi-von Platen are a reminder that even the most powerful forces can be resisted.

Link to obituary from The Times.
Link to obituary from The Guardian.