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Deconstructing the most sensationalistic recent findings in Human Brain Imaging, Cognitive Neuroscience, and Psychopharmacology

older | 1 | .... | 12 | 13 | (Page 14)

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    TAKE HOME MESSAGE: All suicide attempts and parasuicidal gestures should be taken very seriously in patients with dementia.
    “Previous parasuicide is a predictor of suicide. The increased risk of subsequent suicide persists without decline for at least two decades.”

    A new case report on a 53 year old man1 with semantic dementia (SD) presented his prior parasuicidal gestures as “stereotypic behaviour” [ed. NOTE: repeated attempts to hang himself with a cord is “stereotyped behavior”], with tragic consequences:
    The patient showed abnormal behaviours such as following around his wife and frequently visiting a drug store to purchase sleeping pills, which necessitated hospitalization. Despite having no depressive symptoms including suicidal ideation, he repeatedly attempted to hang himself with a cord during a temporary stay at home. At the time of the interview, he stated, ‘I found a cord suspended from the ceiling, and so just played with it by hanging myself. It was just a play’, indicating an absence of suicidal ideation and lack of seriousness for the event. In March 2012, he died by hanging himself with a towel inside his hospital room.

    ...Despite the fact that the man had been severely depressed for two years before his SD diagnosis, had a well-documented history of suicidal ideation, and had made several suicide attempts (Kobayashi et al., 2018):
    In April 2009, the patient started to express suicidal ideation such as ‘I would like to hang myself’. From May to June, he was admitted to a psychiatric hospital because of a deliberate overdose. After being discharged, the patient started to show lack of ability to understand what others were saying, kept insisting on his own way, and became excessively fixated on certain things. In July 2010, he was dismissed from his job because of poor performance. In September 2010, the patient was hospitalized after multiple attempts to hang himself with a cord. During this hospitalization, he was found to have difficulty in naming familiar objects.

    His difficulty in naming familiar objects could be an early sign of neurodegeneration (especially in a 53 year old man), but by itself is not diagnostic. But he also had difficulty understanding what other people were saying, i.e. a problem in language comprehension. These symptoms are characteristic of semantic dementia, a type of frontotemporal lobar degeneration associated with a profound loss of meaning words and objects don't make sense any more. He did very poorly on subsequent neuropsychological testing. Neuroimaging results revealed atrophy in bilateral (but L > R) anterior and inferior temporal cortices that is characteristic of SD.



    Now, it's easy for me to sit back and be all critical. BUT:I am not a clinician, I was not involved in this case, and hindsight is often 20/20. But it always pays to err on the side of caution when suicidal actions are expressed, even in a person who denies being suicidal, but especially in one who may no longer understand exactly what he's doing.


    If you are contemplating suicide or know someone who is, please consult:

    Online Suicide Help directory


    Footnote

    1They say he's 50 in the Abstract, but the Case Presentation starts out by saying he's 53.


    Reference

    Kobayashi R, Hayashi H, Tokairin T, Kawakatsu S, Otani K. (2018). Suicide as a result of stereotypic behaviour in a case with semantic dementia. Psychogeriatrics Jul 30. [Epub ahead of print]


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    “Learn while you sleep” has been the claim of snake oil salesmen since the 1950s. The old pseudoscience methods involved listening to tapes and records. From a 1958 article by Lester David:
    Max Sherover, president of the Linguaphone Institute of New York ... coined the word “dormiphonics,” defining it as a “new scientific method that makes quick relaxed learning possible, awake or asleep.” Dormiphonics, declares Mr. Sherover, works by “repeated concentrated impact of selected material on the conscious and subconscious mind.”

    An “experiment” was conducted at the Tulare County Prison, where 100 convicts “volunteered to act as guinea pigs” (considered completely unethical by today's standards). During sleep, they were subjected to low-volume recordings that exhorted them to be better human beings: “Love shall rule your life. You shall love God, your family and others. You shall do unto others as you want others to do unto you. . .” The low voice also warned them away from the evils of alcohol.


    Knight Education Recordings (1960s)
    a commercially available product of the era


    Even earlier, the Psycho-Phone (Salinger, 1927) played wax cylinders with different self-help messages, e.g., “Prosperity” and “Life Extension” on a phonograph while the unwitting customer slept. The Cummings Center Blog has a great post on this odd contraption. Salinger sold the machines for the whopping price of $235 (the equivalent of $3,250 in 2017). He didn't need Kickstarter or Indiegogo.




    In the modern era, DIY brain stimulation enthusiasts promote self-experimentation with battery-driven devices. These transcranial direct current stimulation (tDCS) kits are available online, with a primary goal of enhancing cognitive performance. Using state-of-the-art professionally manufactured devices, scientists have published thousands of peer-reviewed papers, with mixed results as to the efficacy of different tDCS protocols.

    A newer method is transcranial alternating current stimulation (tACS), which delivers stimulation within precise frequency bands with the aim of synchronizing oscillations within that band (e.g., ~10 Hz for alpha, ~1-4 Hz for delta, etc.). The goal is to modulate ongoing oscillatory brain rhythms to affect behavior.1

    Today, the importance of sleep for the consolidation of previously learned material has been well-documented. Conceptually, this is quite different from the discredited “subliminal sleep learning” from days of yore. New research aims to improve retention of information learned during the day by delivering precisely timed and calibrated tACS during slow wave sleep (Ketz et al., 2018).



    Fig. 1 (modified from Ketz et al., 2018).(A) Target detection task. (B) Memory was tested on two image types: Repeated (identical to Original) and Generalized (same as Original but from different viewpoint). (C) tDCS montage used during training (left), and tACS montage used to augment slow waves during sleep (right).


    During the day, participants were trained on a difficult military task that required them to detect hidden targets (explosive devices, snipers, suicide bombers) that were concealed or disguised (Clark et al, 2012). As in their earlier study, tDCS or sham stimulation was delivered during the training phase (over right frontal or right parietal cortices). Previous findings indicated that significant improvements in learning and performance were observed after 30 min tDCS (anodal 2.0 mA) vs. “sham” (0.1 mA). However, this tDCS finding did not replicate in the current study (see Fig, 3A, left below). Why? The authors speculated that possible differences in current generation between their previous iontophoresis system (2.0 mA) and the present use of StarStim (1.0 mA) could explain the failure to replicate.

    After training, tACS was delivered during sleep. The authors' cool closed-loop approach recorded the dominant slow wave (SW) frequency, and then delivered stimulation to match the phase and frequency of this dominant oscillation (range of 0.5 to 1.2 Hz). Fig. 3A (right) doesn't look terribly impressive, however. tACS did not improve performance for Repeated images, and had highly variable effects for Generalized images. Nonetheless, the two- and three-way interactions were significant, as was the pairwise comparison between active tACS vs. sham for Generalized images (all p's ≈ .015 for n=16).



    Fig. 3 (modified from Ketz et al., 2018). (A) Waking tDCS effects (left) and SW tACS effects during sleep (right). (B) SW events broken down per sleep stage (left) and total SW events for each stimulation condition (right). Note that active stimulation had fewer total SW events compared with sham.


    Why was there no change in performance for Repeated images but a small improvement for Generalized images? The authors recognize this conundrum and say:
    ...it is unclear why there was no improvement in Repeated images induced by SW tACS, as might be expected based on previous studies.

    Then they speculate that consolidation of essential ‘gist’ — rather than recognition of specific items — was impacted by tACS.

    Media coverage of this modest finding was predictably overblown, and originated with the Society for Neuroscience press release, Overnight Brain Stimulation Improves Memory: Non-invasive technique enhances memory storage without disturbing sleep. If it enhances memory storage, then why were Repeated images unaffected? Anyway, most commenters at Hacker News were pretty skeptical, which was a pleasant surprise.


    Footnote

    1However, there is some question whether tACS delivered at typical stimulation intensities can really entrain endogenous rhythms (Lafon et al., 2017).


    References

    Clark VP, Coffman BA, Mayer AR, Weisend MP, Lane TD, Calhoun VD, Raybourn EM, Garcia CM, Wassermann EM. (2012). TDCS guided using fMRI significantly accelerates learning to identify concealed objects. Neuroimage 59(1):117-28.

    Ketz N, Jones AP, Bryant NB, Clark VP, Pilly PK (2018). Closed-Loop Slow-Wave tACS Improves Sleep-Dependent Long-Term Memory Generalization by Modulating Endogenous Oscillations. J Neurosci. 38(33):7314-7326.

    Lafon B, Henin S, Huang Y, Friedman D, Melloni L, Thesen T, Doyle W, Buzsáki G, Devinsky O, Parra LC, A Liu A. (2017). Low frequency transcranial electrical stimulation does not entrain sleep rhythms measured by human intracranial recordings. Nat Commun. 8(1):1199.





    Hugo Gernsback
    December 1921


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    Dr. Bernard Carroll (Nov 21, 1940 – Sep 10, 2018)




    I was friends with Dr. Carroll (“Barney”) on Twitter, and always enjoyed his wit.



    Before that he was an early commenter and supporter of my blog, The Neurocritic. Which pleased me to no end, given this brief biography from his blogger site.


    My blogs Health Care Renewal
    Occupation Psychopharmacology
    Introduction Past chairman FDA Psychopharmacologic Drugs Advisory Committee.
    Past chairman, department of psychiatry Duke University Medical Center.
    Interests Professional ethics, medicine


    He didn't know who I was and didn't care. He assessed me by the quality of my writing, and allowed me entrée into a world I would have no access to otherwise.1

    As I'm facing the most catastrophic loss of my life, I will miss him too. He was a brilliant, principled, and compassionate man.


    Remembrance from Health Care RenewalRemembering Dr Bernard Carroll


    Obituary in BMJ by Dr. Allen Frances (and Dr. Barney Carroll):

    Barney Carroll: the conscience of psychiatry
    A pioneer in biological psychiatry, more recently Bernard Carroll (‘‘Barney’’) became a withering critic of its compromised ethics and corruption by industry. Shortly before his death, he helped prepare this obituary—his last chance to help correct the perverse incentives that too often influence the conduct and reporting of scientific research.
    . . .

    Barney rejected grand biological theories that offered neat, simple-but-wrong explanations of psychopathology. Ever aware of the complexity of the human brain, he was an early rejecter of blind optimism that any simple imbalance of monoamine transmitters could account for the wide variety of mental disorders. More recently, he deplored the ubiquitous hype that suggested that genetics or neuroimaging or big data mining could provide simple answers to deeply complex questions. He predicted—presciently—that these powerful new tools would have great difficulty in producing solid, replicable findings that could be translated to clinical practice.





    Footnote

    1 i.e., Very senior male psychiatrists. When I wrote my blog post about being female, and my wife's diagnosis of stage 4 cancer...

    So yeah, think of this as my “coming out”. Sorry if I've offended anyone with my ability to blend into male-dominated settings.

    Thank you for reading, and for your continued support during this difficult time.

    ...Barney was the first to comment, with his usual wit and grace: “I am pretty sure we can handle that. Bless you both.”

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    With profound grief, I announce that Sandra’s journey has come to an end.



    Gardens at Government House, Victoria BC (June 2017)


    Sandra Dawson was taken from this earth by the indiscriminate brutality of metastatic cancer. She died on October 2, 2018 at the age of 51. This horrific experience was not a “fight.” She did NOT lose a battle against the unchecked proliferation of malignant cells. Instead, Sandra saw the final phase of her life a journey. She was incredibly brave while facing the ravages of this terrible disease, and she was ultimately accepting of her fate. She was gracious and generous in sharing the final stages of her journey with friends and family, and also with nearly 25,000 followers of her @unsuicide Twitter account.1There was an outpouring of love and support and visitors and flowers, which buoyed her spirits and made her feel loved.

    She really loved flowers.




    Sandra was many things – a writer, a blogger, a jewelry designer, a crochet artist, a mental health advocate, a board member of the Mental Health Commission of Canada, and the 2016 winner of a Sovereign's Medal for Volunteers from The Governor General of Canada, for over a decade of work in suicide prevention.



    Government House, Victoria BC (June 2017)



    September 10 was World Suicide Prevention Day, and Dr. Erin Michalak of CREST.BD wrote a touching tribute to Sandra’s work.

    Sandra Dawson’s Legacy

    . . .

    “Most significantly, Sandra created the Unsuicide directory of online and mobile crisis supports, as well as a popular corresponding Twitter feed (@Unsuicide) with close to 25,000 followers. Her Unsuicide online supports are authentically grounded in her lived experience of bipolar disorder, but also unfailingly focused on helping people, regardless of their geography, to access credible and safe online and mobile support tools. In 2016, she was awarded the Sovereign’s Medal for Volunteers from the Governor General of Canada in acknowledgement of the impact of her work as an advocate for people facing mental health challenges and in suicide prevention.”

    But mostly I think of her as a writer.



    Radar Queer Reading Series, SF Public Library (October 2016)


    She was also my partner and wife of nearly 12 years.


    December 2017


    We met in 2006 through our respective blogs, The Neurocritic and Neurofuture. The neuroblogging community was quite small then. Neurofuture started in January 2006 a blog about Brain Science and Neurofuturism that was ahead of its time (so to speak):
    The future is now, in many ways. Neuroscience and psychiatry are fields that have experienced tremendous growth, especially in the last few decades, and these advances already have practical applications. … At the same time, much is still unknown…
    . . .

    Neuroscience, psychiatry, neuroethics and transhumanism are the four areas of focus for this blog. They have applications in a broad range of fields, and I'll be aggregating diverse information. Expect a lot of interesting links. I invite your comments.

    In June 2006, she started a video blog, Channel N, that shared interesting content related to neuroscience, psychology, and mental health. Channel N eventually moved to Psych Central, a trusted mega-site for mental health, depression, bipolar, ADHD & psychology information. Sandra also wrote posts for World of Psychology, the main PsychCentral blog, including many Top 10 lists, which were always popular.

    Along with Steve Higgins, she blogged for Omni Brain (from December 2006 – January 2008), which was “an exploration of the serious, fun, ridiculous / past, present, future of the brain and the science that loves it” – as part of the long-defunct Science Blogs network.


    But Sandra’s real love was writing fiction (mostly under the pseudonym S. Kay). She wrote an unpublished novel (or two), flash fiction, and a novella that was published by Maudlin House (ironically titled Joy).





    The advent of Twitter really changed her writing. She started writing microfiction, ultra-short stories in the form of Tweets (140 characters or less). Sometime they were standalone zaps that told an entire tiny tale.





    Other times, she crafted a number of tweets together to tell a longer story. These were published in various venues and included pieces such as Neurotech Light and DarkCloud Glitches, Facebook Algorithm of Death,2 and her final piece, Goth Robots (robots were always a favorite theme; see the interview Weird words with S. Kay). Her blueberrio tumblr has a comprehensive list of her published work.




    Her masterwork was Reliant, “an apocalypse in tweets” published in 2015 by the late tNY Press (but still available for purchase at Amazon):
    “Selfies, sexbots, and drones collide in these interwoven nanofictions about a society before, during, and after its collapse. With dazzling humor and insight, debut author S. Kay reveals a future that looks disconcertingly like the present. Beautifully illustrated by Thoka Maer, Reliant is a bold examination of society's unrequited love for technology.”
    There was a nice review in Entropy by Christopher Iacono.




    But my proudest literary-moment-by-proxy was when Sandra read at Writers With Drinks, a long-standing, monthly series of readings by spectacular writers, held in a bar and hosted by the talented and amusing Charlie Jane Anders. It was a fun evening and the ideal crowd for reading Reliant.



    Writers With Drinks (Nov. 14, 2015)


    Sandra's next book, Lost in the Land of Bears (designed and published by Reality Hands), had a truly unique limited edition faux fur cover, but it's still available as an e-book.


    James Knight wrote a great review at Sabotage Reviews.


    Sandra was an early adopter of all forms of online communication. She was an avid blogger, social media user, and before that an online diarist. She was prescient about the future of social media:
    I have no optimism that social media will bring the world together with mutual empathy improving society. Sheep are still sheep and their bleatings still need shepherds to make them a coherent flock. An important lesson for the next decade. The media is still the media and if anything, is more segregated than ever.

    Sandra Dawson, January 4, 2007


    I could go on and on about her other wildly creative projects, like her Spambot Psychosis origami text cube, her beachpunk jewelry, her minibook necklaces (sample here), her upcycled cashmere brooches, her Postcards from the Post-Apocalypse, and her exhibit of crocheted art hats (and bonus EEG cap) at Femina Potens (the Cultivating Cozy exhibition).



    January 18th, 2008



    But what I can't express in words right now is how much I'll miss her.






    Footnotes

    1 Like me, she had many Twitter accounts and blogs and pseudonyms; the latter included Sandra K, Sandra Kiume, and S. Kay.

    2Sadly, this was based on a true story that had an even more tragic ending.




    I love you.
    RIP.

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  • 10/31/18--01:59: Survey Skeleton


  • Karger Medical and Scientific Publishers has a lovely Survey Skeleton peeking out enticingly on some of their journal websites now.




    It's to lure you to take their survey, where you can win attractive prizes....




    ...such as the unique Vesalius: The Fabric of the Human Body (value CHF 1,500).





    Just thought you should know.



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    Frontispiece from: Blicke in die Traum- und Geisterwelt (A look into the dream and spirit world), by Friedrich Voigt (1854).


    What are you most afraid of? Not finding a permanent job? Getting a divorce and losing your family? Losing your funding? Not making this month's rent? Not having a roof over your head? Natural disasters? Nuclear war? Cancer? Having a loved one die of cancer?

    FAILURE?

    There are many types of specific phobias (snakes, spiders, heights, enclosed spaces, clowns, mirrors, etc.), but that's not what I'm talking about here.

    What are you really afraid of? Death? Pain? A painful death?

    Devils, demons, ghosts, witches, and other supernatural apparitions? This latter category (haunting, demon possession) is common among many cultures with religious or spiritual practices, and can evoke primal fear. As a former Catholic, I am still frightened by movies or TV shows that involve demonic possession, like American Horror Story: Asylum.




    I used this show as an exemplar in a post about Possession Trance Disorder in DSM-5.

    A fantastic long-form article by Nike Mariani has just appeared in The Atlantic. The author intermixes the individual case study of Louisa Muskovits with the history of exorcism and facts about its modern-day resurgence.

    American Exorcism
    Priests are fielding more requests than ever for help with demonic possession, and a centuries-old practice is finding new footing in the modern world.
     . . .
    • The official exorcist for Indianapolis has received 1,700 requests so far in 2018.
    • Father Thomas said that as many as 80 percent of the people who come to him seeking an exorcism are sexual-abuse survivors.
    • Some abused children are subjected to such agonizing experiences that they adopt a coping mechanism in which they force themselves into a kind of out-of-body experience. As they mature, this extreme psychological measure develops into a disorder that may manifest unpredictably. “There is a high prevalence of childhood abuse of different kinds with dissociative disorders,” Roberto Lewis-Fernández, a Columbia University psychiatry professor who studies dissociation, told me.

    This brings me to another topic I've been meaning to write about for weeks. Sleep paralysis is the terrifying condition of being half awake but unable to move (or speak or scream). It can feel like you're frozen in bed, aware of your surroundings yet completely paralyzed. This is because the complete muscle atonia typically experienced during REM sleep has oozed into lighter stages of non-REM sleep. Scary dream imagery can intrude while in this state, making it even worse.

    A fascinating new paper covers interpretations of this frightening phenomenon across different cultures (Olunu et al., 2018). A common theme is being attacked, visited, or sat upon by supernatural beings, such as demons, witches, ghosts, and spirits.


    -- click on image for a larger view --


    The eerie presences are called Jinn in Egypt, Kabus in Iran, Phi Um in Thailand, Old Hag in lots of places, and the especially horrifying Kokma in Saint Lucia, which are “attacks by dead spirits or unbaptized babies that jump into a body and squeeze the throat”. In Nigeria, believers in supernatural explanations exist alongside others who hold rational explanations:
    Nigerians describe it as “visitation of an evil spirit, witches, or some form of spiritual attack.” Others have beliefs that it may be due to anxiety or emotions associated with family problems.
    The Wikipedia page on the folklore of the night hag also has a pretty good listing.


    Interestingly, sleep paralysis was considered as a partial explanation for “demonic possession” in the case of Louisa Muskovits (Atlantic):
    Louisa seemed to vacillate between this unhinged state and her normal self. One minute she would snarl and bare her teeth, and the next she would beg for help. “It definitely had this appearance where she was fighting within herself,” Harp [her former therapist] told me.

    . . .
    [Another time] Louisa ... woke up abruptly, only to find her body locked in place—but with the added shock of what seemed to be visual hallucinations, including one of a giant spider crawling into her bedroom. Louisa was so jolted that she barely ate or slept for three days. “I didn’t feel safe,” she said. “I felt violated.”

    . . .
    Sleep paralysis seemed like a promising explanation. A phenomenon in which sufferers move too quickly in and out of rem sleep for the body to keep up, sleep paralysis causes a person’s mind to wake up before the body can shake off the effects of sleep. Hovering near full consciousness, the person can experience paralysis and hallucinations.

    But Louisa didn’t think this could account for the hand on her collarbone, which she swore she’d felt while she was completely awake [oh of course it can account for this phenomenology!].


    What are your experiences of sleep paralysis?


    Further Reading

    When Waking Up Becomes the Nightmare: Hypnopompic Hallucinatory Pain

    The Phenomenology of Pain During REM Sleep

    The Neurophysiology of Pain During REM Sleep

    Possession Trance Disorder in DSM-5

    Spirit Possession as a Trauma-Related Disorder in Uganda

    "The spirit came for me when I went to fetch firewood" - Personal Narrative of Spirit Possession in Uganda

    Possession Trance Disorder Caused by Door-to-Door Sales

    Fatal Hypernatraemia from Excessive Salt Ingestion During Exorcism

    Diagnostic Criteria for Demonic Possession

    The Devilish Side of Psychiatry


    Reference

    Olunu E, Kimo R, Onigbinde EO, Akpanobong MU, Enang IE, Osanakpo M, Monday IT, Otohinoyi DA, John Fakoya AO. (2018). Sleep Paralysis, a Medical Condition with a Diverse Cultural Interpretation. Int J Appl Basic Med Res. 8(3):137-142.



    Scene from The Wailing. Although it's certainly not for everybody, it is an amazing film.



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    Nothing says home for the holidays like a series of murders committed by family members with a shared delusion. So sit back, sip your hot apple cider or spiked egg nog, and revel in family dysfunction worse than your own.

    {Well! There is an actual TV show called Homicide for the Holidays, which I did not know. Kind of makes my title seem derivative... but it was coincidental.}


    “Folie à deux”, or Shared Psychotic Disorder, was a diagnosis in DSM-IV-TR:

    (A) A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion. 

    (B) The delusion is similar in content to that of the person who already has the established delusion. 

    (C) The disturbance is not better accounted for by another Psychotic Disorder (e.g., Schizophrenia) or a Mood Disorder With Psychotic Features and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

    Folie à deux occurs in the secondary partner, who shares a delusion with the primary partner (diagnosed with schizophrenia, delusional disorder, or psychotic depression). In in DSM-5, folie à deux no longer exists as a specific disorder. Instead, the secondary partner is given a diagnosis of “other specified schizophrenia spectrum and other psychotic disorder” with a specifier: “delusional symptoms in the partner of individual with delusional disorder” (APA, 2013).

    The first cases were reported in the 19th century by the French psychiatrists Baillarger (1860) and Lasègue & Falret (1877). The latter authors note that insanity isn't contagious, but under special circumstances...
    a) In the “folie à deux” one individual is the active element; being more intelligent than the other he creates the delusion and gradually imposes it upon the second one who is the passive element. At the beginning the latter resists but later, little by little, he suffers the pressure of his associate, although at the some degree he also reacts and influences the former to correct, modify, and coordinate the delusion that then becomes their common delusion, to be repeated to all in an almost identical fashion and with the same words.
    The two individuals are in a close relationship and typically live in an isolated environment.

    A recent paper by Guivarch et al. (2018) covered the history of the disorder, and performed a literature review on folie à deux and homicide. They found 17 articles:
    In the cases examined, homicides were committed with great violence, usually against a victim in the family circle, and were sometimes followed by suicide. The main risk factor for homicide was the combination of mystical and persecutory delusions. The homicides occurred in response to destabilization of the delusional dyads.

    Body mutilation is not uncommon: “These features appear in the reported case of a mother who was delusional and killed her young son by hitting him on the head 3 times with a hatchet.”

    The authors presented a detailed history of induced psychosis involving Mr. A (the secondary) and Mrs. A (the primary, who had a family history of delusion). Shortly after getting married, they had a child who was removed by social services due to inadequate parenting.
    Subsequently, the couple engaged in several years of delusional wandering in France and Italy, traveling from village to village to accomplish “a divine mission”, during which time they were hosted in monasteries or abbeys. They expressed delusional feelings but never visited a psychiatrist and were never confronted by the police. The couple's relationship transformed; the partners stopped having sexual relations and quickly established a delusional hierarchical relation, with Mrs. A being called “Your Majesty” and Mr. A considering himself “King of Australia, Secretary of Her Majesty”.

    After about 20 years of this, in a fit of overkill, Mr. A murdered a random 11 year old child by inflicting 44 stab wounds. Earlier, he had felt humiliated and persecuted at a police check point, which provoked an “incident.” The murder of the child was part of their delusional divine mission, to make a necessary sacrifice that would restore balance.


    Paranoia of the exalted type in a setting of folie à deux

    The famous case of Pauline P (“a dark, rather sulky looking but not unattractive girl of stocky build”) and Juliet H (“a tall, willowy, frail, attractive blonde with large blue eyes”) was also mentioned (Medlicott, 1955). The two girls established a very close bond, constructed an elaborate make-believe world of fictional characters, withdrew from all others, became sexually involved, and developed a superiority complex. They killed Pauline's mother “because one of the girls was going to move with her parents, which would have led to the separation of the delusional dyad (Medlicott, 1955).” This formed the basis of the fantastic 1994 film, Heavenly Creatures, featuring Melanie Lynskey and Kate Winslet.




    Granted, their indissoluble bond was pathological, but laughable 1955 views of same-sex relationships were on display in this analysis:
    There is of course no doubt that the relationship between these two girls was basically homosexual in nature. Pauline made attempts in 1953 of establishing heterosexual relationships, but in spite of intercourse on one occasion there was no evidence of real erotic involvement. All her escapades were fully discussed with Juliet which is a common feature amongst people basically homosexual in orientation.

    Yes, we can generalize and say that all teenage girls in the 1950s commonly bragged about their heterosexual exploits with their lesbian lovers.

    From Pauline's 1953 diary:
    “To-day Juliet and I found the key to the 4th World.  ... We have an extra part of our brain which can appreciate the 4th World. Only about 10 people have it. When we die we will go to the 4th World, but meanwhile on two days every year we may use the key and look in to that beautiful world which we have been lucky enough to be allowed to know of, on this Day of Finding the Key to the Way through the Clouds.”

    Your family gatherings may not always be harmonious, but presumably your delusional children are not plotting to kill you. Happy Holidays.





    References

    Baillarger J. (1860). Quelques exemples de folie communiquée. Gazette Des Hôpitaux Civils et Militaires 38: 149-151.

    Guivarch J, Piercecchi-Marti MD, Poinso F. (2018). Folie à deux and homicide: Literature review and study of a complex clinical case. International Journal of Law and Psychiatry 61:30-39.

    Lasègue C, Falret J. (1877). La folie à deux (ou folie communiquée). Annales Médico Psychologiques 18: 321-355. English translation (Dialogues in Philosophy, Mental and Neuro Sciences, December 2016).

    Medlicott R. (1955). Paranoia of the exalted type in a setting of folie à deux; a study of two adolescent homicides. The British journal of medical psychology 28:205-223.


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    Our memory for the details of real-life events is poor, according to a recent study.

    Seven MIT students took a one hour walk through Cambridge, MA. A day later, they were presented with one second video clips they may or may not have seen during their walk (the “foils” were taken from another person's recording). Mean recognition accuracy was 55.7%, barely better than guessing.1


    Minimal recognition memory for detailed events. Dashed line is chance performance. Adapted from Fig. 2 of
    Misra et al. (2018).


    How did the researchers capture the details of what was seen during each person's stroll about town (2.1 miles / 3.5 km)? They were fitted with eye tracking glasses to follow their eye movements (because you can't remember what you don't see), and a GoPro camera was mounted on a helmet.


    from Fig. 1 (Misra et al., 2018).


    One problem with this setup, however, was that the eye tracking data had to be excluded. The overwhelmingly bright summer sun prevented the eye tracker from obtaining accurate images of the pupil. Thus, Experiment 2 was performed inside the Boston Museum of Fine Arts with a separate group of 10 students.


    from Fig. 1 (Misra et al., 2018).


    Recognition performance was better in Experiment 2. Mean accuracy was 63.2% well above chance (p=.0005) but still not great. Participants correctly identified clips they had seen 59% of the time, and correctly rejected clips they hadn't seen 67% of the time. One participant (#4) was really good, and you'll notice the individual differences below.

    Dashed line is chance performance. Adapted from Fig. 2 of Misra et al. (2018).


    In Exp. 2, the investigators were able to look at the influence of eye fixations on memory performance. Not surprisingly, people were better at remembering what they looked at (fixated on), but this only held for certain categories of items: talking people, objects rated as “distinctive” (but not distinctive faces), and paintings (but not sculptures).




    How do the authors interpret this finding? We don't necessarily pay attention to everything we look at.
    “What subjects fixated on also correlated with performance (Fig. 4), but it is clear that subjects did not remember everything that they laid eyes on. There is extensive literature showing that subjects may not pay attention or be conscious of what they are fixating on. Therefore, it is quite likely that, in several instances, subjects may have fixated on an object without necessarily paying attention to that object. Additionally, attention is correlated with the encoding of events into memory. Thus, the current results are consistent with the notion that eye fixations correlate with episodic memory but they are neither necessary nor sufficient for successful episodic memory formation.”

    For me personally, 2018 was a year to forget.2 Yet, certain tragic images are etched into my mind, cropping up at inopportune times to traumatize me all over again. That's a very different topic for another time and place.


    May your 2019 brighten the sky.


    The number 2019 is written in the air with a sparkler near a tourist camp outside Krasnoyarsk, Russia, on January 1, 2019. (The Atlantic)


    Footnotes

    1 However:
    “Two subjects from Experiment I were excluded from the analyses. One of these subjects had a score of 96%, which was well above the performance of any of the other subjects (Figure 2). The weather conditions on the day of the walk for this subject were substantially different, and this subject could thus easily recognize his own video clips purely from assessing the weather conditions. Another subject was excluded 260 because he responded 'yes'>90% of the trials.”

    2 See:

    I should have done this by now...

    The Lie of Precision Medicine

    Derealization / Dying

    There Is a Giant Hole Where My Heart Used To Be

    How to Reconstruct Your Life After a Major Loss


    Reference

    Misra P, Marconi A, Peterson M, Kreiman G. (2018). Minimal memory for details in real life events. Sci Rep. 8(1):16701.





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