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

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    Did you know there are at least 85 blogs on neuro/psych topics written by individuals (or small groups) outside of the blog network model? And that you can follow a feed of these blogs in several ways?

    Independent Neuroblogs, a combined aggregate feed for non-network Neuroscience Blogs, started on FriendFeed in response to the proliferation (and increasing clout) of blog networks after the implosion of ScienceBlogs in 2010. The infamous PepsiGate scandal caused an exodus of bloggers from the once-mighty network (which still exists, by the way). Many bloggers went to other networks, including those hosted by Discover, Wired, Guardian, PLOS, and eventually Scientific American, or else started their own network, most prominently at Scientopia.

    At around the same time, a new aggregator at scienceblogging.org wanted to become "Your one-stop shop for the most recent posts from science blog networks." This left those of us who were not part of blog networks, whether by choice or obscurity or quirkiness, out in the cold (or rather in the neuroghetto). Hence, the Indie Neuroblogs list was formed, which you can also follow on Twitter @neuroghetto or through its RSS feed. This group was then included on scienceblogging.org under the banner of Aggregators and Combined Feeds of Independent Bloggers.

    The comprehensive ScienceSeeker site has since superseded scienceblogging.org. There you can select posts on Psychology and Neuroscience, or follow their respectivefeeds.

    Of course, there are many other blog networks out there that include bloggers on psych/neuro topics, such as Big Think, Field of Science, Forbes, Lab Spaces,1Nature Blogs, PsychCentral, Psychology Today, Occam’s Typewriter, Science 2.0, and others. And many authors write multiple blogs, some on networks and some independently.

    What initially started as a group of 38 blogs in September 2010 has grown to a list of 8596. There might be some that I've inadvertently excluded or overlooked. If I've missed your blog, or the blog of someone you know, please mention it in the comments and I will add it to the group.


    http://addiction-dirkh.blogspot.com/
    http://autismcrisis.blogspot.com/
    http://bgoodscience.wordpress.com/
    http://bjoern.brembs.net/
    http://blog.ketyov.com/
    http://blog.uberbrain.net/
    http://bodyinmind.com.au/
    http://bps-research-digest.blogspot.com/
    http://brainethics.org/
    http://brainimplant.blogspot.com/
    http://brainposts.blogspot.com/
    http://brainslab.wordpress.com
    http://brainstudy.wordpress.com/
    http://cellularscale.blogspot.com/
    http://changizi.wordpress.com/
    http://charbonniers.org/
    http://corticalcolumns.wordpress.com/
    http://corticalhemandhaw.blogspot.com/
    http://crackingtheenigma.blogspot.com/
    http://deevybee.blogspot.com/
    http://drvitelli.typepad.com/providentia/
    http://generallythinking.com/rethink/
    http://hardsci.wordpress.com/
    http://j0ns1m0ns.blogspot.co.uk/
    http://juniorprof.wordpress.com/
    http://kolber.typepad.com/ethics_law_blog/
    http://mindblog.dericbownds.net/
    http://mindhacks.com/
    http://mindingthebrain.blogspot.com/
    http://motorchauvinist.blogspot.com/
    http://neuralconnections.blogspot.com/
    http://neurealist.blogspot.com/
    http://neurobites.wordpress.com/
    http://Neurobonkers.com/
    http://neurochambers.blogspot.co.uk/
    http://neuroconscience.com/
    http://neurocritic.blogspot.com/
    http://neurocritic.posterous.com/
    http://neurodojo.blogspot.com/
    http://neurodudes.com/
    http://neuroecology.wordpress.com/
    http://neuroethicscanada.wordpress.com/
    http://neurokuz.blogspot.com/
    http://neurologicalcorrelates.com/wordpress/
    http://neuronarrative.wordpress.com/
    http://neuropsychological.blogspot.com/
    http://neuroshrink.com/
    http://neuroskeptic.blogspot.com/
    http://neurosphere.wordpress.com/
    http://neurowhoa.blogspot.com/
    http://noustuff.wordpress.com/
    http://practicalfmri.blogspot.com/
    http://prefrontal.org/blog
    http://psychiatrist-blog.blogspot.com/
    http://psychneuro.wordpress.com/
    http://psychothalamus.blogspot.com/
    http://psychsciencenotes.blogspot.com/
    http://psydoctor8.tumblr.com/
    http://scottsworlds.blogspot.com/
    http://sites.google.com/site/speechskscott/SpeakingOut
    http://theamazingworldofpsychiatry.wordpress.com/
    http://thebeautifulbrain.com/
    http://the-brain-box.blogspot.co.uk/
    http://the-connectome.com
    http://themagnetisalwayson.com/
    http://the-mouse-trap.com/
    http://thequantumlobechronicles.blogspot.com/
    http://thermaltoy.wordpress.com/
    http://whywereason.wordpress.com/
    http://wiringthebrain.blogspot.com/
    http://www.dictionaryofneurology.com/
    http://www.dormivigilia.com
    http://www.functionalneurogenesis.com/blog/
    http://www.gainesonbrains.com/
    http://www.ionpsych.com/
    http://www.neuralconnections.net/
    http://www.neurevolution.net/
    http://www.neuroscientificallychallenged.blogspot.com/
    http://www.sayginlab.org/blog/
    http://www.scienceofeds.org/
    http://www.shockmd.com/
    http://www.spring.org.uk/
    http://www.talkingbrains.org/
    http://www.talyarkoni.org/blog/
    http://www.thecuriousneuron.com/

    ADDENDUM: 
    The Thoughtful Vegetable
    Manchester Psychiatry Society
    WhatWeHaveUnleared
    Right Mind Matters
    Cedar's Digest

    LawsNeuroBlog
    Neuroscience postdoc blog
    Knowing Neurons
    Computing for Psychologists
    Daniel Bor
    Science and Education Blog


    Footnote

    1 Which has the dubious distinction of being the only blog network that has ever wanted me as a member...



    The Seductive Allure of Neuroscience Blogs


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  • 11/25/12--00:37: Meet The Neuro Doubters


  • Meet the “neuro doubters.” The neuro doubter may like neuroscience but does not like what he or she considers its bastardization by glib, sometimes ill-informed, popularizers.

    A gaggle of energetic and amusing, mostly anonymous, neuroscience bloggers — including Neurocritic, Neuroskeptic, Neurobonkers and Mind Hacks — now regularly point out the lapses and folly contained in mainstream neuroscientific discourse. This group, for example, slammed a recent Newsweek article in which a neurosurgeon claimed to have discovered that “heaven is real” after his cortex “shut down.” Such journalism, these critics contend, is “shoddy,” nothing more than “simplified pop.” Additionally, publications from The Guardian to the New Statesman have published pieces blasting popular neuroscience-dependent writers like Jonah Lehrer and Malcolm Gladwell. The Oxford neuropsychologist Dorothy Bishop’s scolding lecture on the science of bad neuroscience was an online sensation last summer.

    from Neuroscience: Under Attack
    By ALISSA QUART
    Published: November 23, 2012

    Thanks to author Alissa Quart for mentioning The Neurocritic in her New York Times Opinion piece, along Neuroskeptic, Neurobonkers, Mind Hacks, and Dorothy Bishop.1 Ms. Quart opens her salvo against bad neuroscience, and its misrepresentation in the popular press, with an easy target: Naomi Wolf and her Vagina: A New Biography. Several of the Neuro Doubters wrote popular, well-received posts that were critical of Ms. Wolf's grasp of neuroscience.2

    Another specific target is Chris Mooney's book, The Republican Brain. I have not read this book (or any excerpts) and therefore cannot offer an opinion on it. However, the "Political Brain" has been the topic of flawed studies, bad press releases, and even an ill-conceived op-ed in a famous newspaper, so I'll use this as an example of the varieties of Neuro Doubt.

    Flawed studies - One study concluded that Liberals Are Neurotic and Conservatives Are Antisocial, another that Conservatives Are Neurotic and Liberals Are Antisocial. OR perhaps Atheists Are Neurotic and Religious Zealots Are Antisocial.

    Bad press releases - The title of this spoof press release says it all: New research provides fresh evidence that bogus press releases may depend largely on our biological make-up. This well-deserved parody covered an unpublished study on the purported differences between the brains of Democrats vs. Republicans. The timing? Right before Election Day. It was a university press office's attempt at positive publicity that backfired, in my view.

    Ill-conceived op-eds (in the New York Times) - This is Your Brain on Politics presented the results of a neuroimaging study on swing voters in the Opinion Pages of the NYT (rather than in a professional journal).  A peer-review drubbing of sorts took place in a Letter to the Editor: Politics and the Brain.


    The Seductive Allure of Neuroscience Explanations



    One problem with the ubiquity of pop neuroscience is that pretty colorful pictures of brains can sway people to believe that some outlandish statement is true. This was shown by McCabe and Castel (2008) in "Seeing is believing: the effect of brain images on judgments of scientific reasoning." Another aptly-titled article, "The seductive allure of neuroscience explanations," provided verbal descriptions of brain scans to convince people that a bogus scientific argument was valid (Weisberg et al., 2008).


    The Rise of Neurobollocks and Neuromania

    It's actually very trendy these days to bash neuroscience. In fact it's so fashionable that I've considered starting a backlash against the backlash - The Neurocomplimenter (e.g., "That was a fantastic study! Good show!"). I am, after all, a working neuroscientist so I don't want to see my field go down in flames. But are we at risk for that? Is neuroscience really under attack? The most potent form of attack would be financial. I haven't noticed a specific decrease in federal funding for neuroscience; the downturn in the U.S. has affected research in general. What I have noticed is an increase in anti-neuroscientism punditry:
    An intellectual pestilence is upon us. Shop shelves groan with books purporting to explain, through snazzy brain-imaging studies, not only how thoughts and emotions function, but how politics and religion work, and what the correct answers are to age-old philosophical controversies. The dazzling real achievements of brain research are routinely pressed into service for questions they were never designed to answer. This is the plague of neuroscientism – aka neurobabble, neurobollocks, or neurotrash – and it’s everywhere.

    My response to such alarmist hype was to call it the Journomarketing of Neurobollocks. Yes, it's true that the neurorelationship self-help cottage industry (for instance) tries to sell books by claiming to be scientific. And that any knowledge of the brain is completely unnecessary for take-home messages that include the benefits of mindfulness meditation and tips for attaining goals.

    According to Quart:
    Neuroscience has joined company with other totalizing worldviews — Marxism, Freudianism, critical theory — that have been victim to overuse and misapplication. 
    [NOTE: I never suspected my discipline was self-aware enough to have a totalizing worldview...]

    But interestingly, I would guess that critical theorists are among those leading the charge against neuroscientism in academia, in a repudiation of overly biological and reductionist explanations for human behavior. 3


    Footnotes

    1 Thanks also to Time writer Maia Szalavitz, who recommended my blog to Ms. Quart.

    2 And her odd declarations, such as "dopamine is the ultimate feminist chemical in the female brain." See Feminist Dopamine, Conscious Vaginas, and the Goddess Array, Naomi Wolf's "Vagina" is full of bad science about the brain, and Mind Hacks author Dr. Vaughan Bell's pre-Vagina post on Naomi Wolf, porn and the misuse of dopamine. And don't miss the posts by our kindredscience writers.

    3 See Neuroetiquette and Neuroculture and Post-Antipsychiatry.


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    That's my interpretation of a new paper in Psychological Science (Briñol et al., 2012), which differs from the more exciting description given in a press release from APS:

    Bothered by Negative, Unwanted Thoughts? Just Throw Them Away

    If you want to get rid of unwanted, negative thoughts, try just ripping them up and tossing them in the trash.

    In a new study, researchers found that when people wrote down their thoughts on a piece of paper and then threw the paper away, they mentally discarded the thoughts as well...
    . . .
    Some types of psychological therapy use variations of this concept by trying to get patients to discard their negative thoughts. But [co-author Richard] Petty said this is the first study he is aware of that has validated that approach.

    So which interpretation is correct? Let's take a look, then judge for yourself.

    In Experiment 1, 83 high school students participated in a course designed to prevent eating disorders. They were randomly assigned to one of four conditions in a 2 × 2 factorial design: thought direction (positive vs. negative) × treatment ('thought disposal' vs. control). The students were told they were participating in a study on body image, and asked to write down either positive or negative thoughts about their bodies for 3 min. Then the students read what they had written, followed by instructions to contemplate their thoughts and then to either throw them in the trash ('thought disposal') or check for spelling errors (control). Finally, the participants were asked to rate their attitudes toward their bodies using three different 9-point scales.1

    If throwing your negative thoughts away was beneficial, you'd predict a reduction in negative attitudes relative to the control condition (which would result in a higher score, reflecting more favorable attitudes). That is not what was observed, however. A comparison of the two white bars below reveals there was no treatment effect in the negative-thoughts condition.2 In other words, body image scores did not improve in the group that discarded their lists. In contrast, there was a decline in body image for the positive-thoughts group that threw their lists away, relative to those who spell-checked.


    Fig. 1 (Briñol et al., 2012).Results from Experiment 1: participants’ mean rating of their attitudes toward their own bodies as a function of the type of treatment they received and the direction of their thoughts. 


    Not surprisingly, the authors had an alternate interpretation that hinged on the difference produced by thought-direction in the non-discarding control groups:
    Consistent with our hypothesis that a thought-disposal treatment can influence judgments by invalidating people’s thoughts, results showed that the attitudes of participants who physically threw their thoughts away showed less impact of the thought-direction induction than did the attitudes of participants who physically retained their thoughts. ... It is important to note that because the treatment was induced after thoughts were already generated, it could not affect the valence or the number of participants’ thoughts. Rather, the treatment decreased the strength of the influence that participants’ thoughts had on their attitudes.

    ...and this was because of lower scores in the positive condition, rather than higher scores in the negative condition (or both effects, for that matter). So unless you want to say there were baseline differences in body attitudes between the treatment groups (which is problematic), I'm not buying it.3


    Footnotes

    1Scores were averaged across the three scales.

    2 However, these two conditions were not statistically compared; I'm assuming that the difference between 5.6 and 5.4 was not significant. The Thought Direction × Treatment interaction was followed up only by pairwise comparisons between Thought Direction in the different Treatment groups.

    3Psychological Science...meet me at camera 3.


    Reference 

    Brinol, P., Gasco, M., Petty, R., & Horcajo, J. (2012). Treating Thoughts as Material Objects Can Increase or Decrease Their Impact on Evaluation. Psychological Science DOI: 10.1177/0956797612449176

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    Will it strengthen the field of neuroscience? Or is it hurting its image in the eyes of the public? Or both? 




















    Another article on the limits of neuroscience has appeared in a high-profile media outlet aimed at a general audience. In The New Yorker, NYU Psychology Professor Gary Marcus writes about What Neuroscience Really Teaches Us, and What It Doesn't. As usual, the focus is on the seductive allure of colorized brain images:

    Neuroscience Fiction

    Posted by
    December 2, 2012

    ...Brain imaging, which was scarcely on the public’s radar in 1990, became the most prestigious way of understanding human mental life. The prefix “neuro” showed up everywhere: neurolaw, neuroeconomics, neuropolitics. Neuroethicists wondered about whether you could alter someone’s prison sentence based on the size of their neocortex.

    And then, boom! After two decades of almost complete dominance, a few bright souls started speaking up, asking: Are all these brain studies really telling us much as we think they are? A terrific but unheralded book published last year, “Neuromania,” worried about our growing obsession with brain imaging. A second book, by Raymond Tallis, published this year, invoked the same term and made similar arguments. In the book “Out of our Heads,” the philosopher Alva Noë wrote, ”It is easy to overlook the fact that images… made by fMRI and PET are not actually pictures of the brain in action.” Instead, brain images are elaborate reconstructions that depend on complex mathematical assumptions that can, as one study earlier this year showed, sometimes yield slightly different results when analyzed on different types of computers.

    Last week, worries like these, and those of thoughtful blogs like Neuroskeptic and The Neurocritic, finally hit the mainstream, in the form of a blunt New York Times op-ed, in which the journalist Alissa Quart declared, “I applaud the backlash against what is sometimes called brain porn, which raises important questions about this reductionist, sloppy thinking and our willingness to accept seemingly neuroscientific explanations for, well, nearly everything.”

    I wrote about Quart's op-ed piece in Meet The Neuro Doubters, where I tried to strike a balance between justified criticism of flawed studies and bad press releases versus trendy overhyped trashing of 'neurobollocks' and neuroscience research in general.Professor Marcus tries to maintain this distinction as well:
    Quart and the growing chorus of neuro-critics are half right: our early-twenty-first-century world truly is filled with brain porn, with sloppy reductionist thinking and an unseemly lust for neuroscientific explanations. But the right solution is not to abandon neuroscience altogether, it’s to better understand what neuroscience can and cannot tell us, and why.

    The first and foremost reason why we shouldn’t simply disown neuroscience altogether is an obvious one: if we want to understand our minds, from which all of human nature springs, we must come to grips with the brain’s biology. The second is that neuroscience has already told us lot, just not the sort of things we may think it has.

    Judging from reaction on social media, the position of abandoning neuroscience can be seen as a straw man, but Raymond Tallis takes his neurotrash rather seriously; so do many liberal intellectual media outlets. The danger of professional neurocriticism is that it will be used by the anti-science crowd to discredit a reductionist enterprise.


    What have we learned?

    In the wake of the 2009 voodoo correlations brouhaha (Vul et al., 2009), which caused some to dismiss all neuroimaging as garbage, I stated that...
    ...I am not a complete neuroimaging nihilist. For examples of this view, see Coltheart, 2006 and especially van Orden and Paap, 1997 (as quoted by Coltheart):
    What has functional neuroimaging told us about the mind so far? Nothing, and it never will: the nature of cognition is such that this technique in principle cannot provide evidence about the nature of cognition.
    So no, I am not a Jerry Fodor Functionalist. I do believe that learning about human brain function is essential to learing about "the mind," that the latter can be reduced to the former, that fMRI can have something useful to say, and (more broadly, in case any anti-psychiatry types are listening) that psychiatric disorders are indeed caused by faulty brain function. But there's still a lot about fMRI as a technique that we don't really know. The best-practice statistical procedures for analyzing functional images is obviously a contentious issue; there is no consensus at this point. Our knowledge of what the BOLD signal is measuring, exactly, is not very clear either [see the recent announcement in J. Neurosci. that "BOLD Signals Do Not Always Reflect Neural Activity."] The critics among us are not trying to trash the entire field of social neuroscience (or neuroimaging in general). Some of us are taking concrete steps to open a dialogue and improve its methodology, while others are trying to rein in runaway interpretations.

    And really, cognitive neuroscience is not the only guilty party here. All sorts of scientific findings are overhyped by the media, university press releases, even scientists themselves. Why do scientists do this? Because it's very difficult to get funding these days, and positioning one's basic research in mice as leading to an imminent cure for schizophrenia or autism is de rigueur. Then when it doesn't happen the public becomes disillusioned with science and politicians lobby for cuts in research funding.

    I'll leave you with this cordial Twitter debate that concisely summarizes the problem.



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    We all know that the mere presence of a brain scan image or a neuro-prefix adds instant credibility to any news story, right? And that the public (i.e., undergraduates) is easily swayed into believing in bogus psychological findings if accompanied by pretty colorful brains? Well countme in! But wait...


    Neuroscience Fiction Fiction?

    The day after the high-profile Neuroscience Fiction article by Dr. Gary Marcus appeared in The New Yorker, a stealthy blog post in Brain Myths summarized an unpublished paper (Farah & Hook, in press, PDF) that  refutes this notion.1

    Are Brain Scans Really So Persuasive?
    New evidence suggests the allure of brain scans is a myth

    Published on December 3, 2012 by Christian Jarrett, Ph.D

    A pair of psychologists at The University of Pennsylvania have highlighted a delicious irony. Sceptical neuroscientists and journalists frequently warn about the seductive allure of brain
    scan images. Yet the idea that these images are so alluring and persuasive may in fact be a myth. Martha Farah and Cayce Hook refer to this as the “seductive allure of ‘seductive allure’” (PDF via author website).

    Most of their evidence against the "seductive allure" is from unpublished data described in their in press article (which we can't evaluate yet):
    Two series of as yet unpublished experiments have failed to find evidence for the seductive allure of brain images. Michael, Newman, Vuorre, Cumming, and Garry (2012, under review) reported a series of replication attempts using McCabe & Castel’s Experiment 3 materials. Across nearly 2000 subjects, a meta‐analysis of these studies and McCabe & Castel’s original data produced a miniscule estimated effect size whose plausible range includes a value of zero. Our own work (Hook & Farah, in preparation) has also failed to find evidence that brain images enhance readers’ evaluation of research in three experiments comprising a total of 988 subjects.
    However, one published paper did fail to find an effect of fMRI images on how participants judged the scientific reasoning and credibility of a fake news story titled, “Scientists Can Reconstruct Our Dreams” (Gruber & Dickerson, 2012).2  The study was designed to replicate the previous study of McCabe and Castell (2008) with some notable exceptions. Rather than using a bar graph or an ugly and cluttered EEG topographic map as the comparison images in separate groups, Gruber and Dickerson used:
    ...a fantastical, artistic image of a human head and a cyberspace-esque background with swirly lines. The final group was given an image from the popular science fiction film Minority Report in which three children’s dreams of the future are projected on a screen and used to prevent crime.

    Very io9... But both studies did have a no-image condition.

    The Gruber and Dickerson study also added additional questions to explicitly assess credibility and authoritativeness, in addition to whether the scientific reasoning made sense. Results showed that in all cases, ratings did not differ statistically across the conditions, including the fMRI vs. no-image comparison.

    Hmm... Farah and Hook also debunked the study of Weisberg et al., (2008), which didn't use images at all but added neuroscience-y explanations to 18 actual psychological phenomenon. The problem was that the neuroscience-y paragraphs were longer than the no-neuroscience paragraphs. The author of the excellent but now-defunct Brain In A Vat blog had a similar objection, as explained in I Was a Subject in Deena Weisberg's Study:
    So how does it feel being held up to the scientific community as an exemplar idiot? Well, it’s a bit embarrassing. One of my coping mechanisms has been to criticize the experimental design. For instance, I think its problematic that the with neuroscience explanations were longer than the without neuroscience explantions. If subjects merely skimmed some of the questions (not that I would ever do such a thing), they might be more likely to endorse lengthier explanations.

    Neuroskeptic also raised this point in his otherwise [mostly] positive evaluation of the study, Critiquing a Classic: "The Seductive Allure of Neuroscience Explanations":
    Perhaps the authors should have used three conditions - psychology, "double psychology" (with additional psychological explanations or technical terminology), and neuroscience (with additional neuroscience). As it stands, the authors have strictly shown is that longer, more jargon-filled explanations are rated as better - which is an interesting finding, but is not necessarily specific to neuroscience.

    He noted that the authors acknowledged this objection, but also that the conclusions we can draw from the study are fairly modest.

    What does this mean for Neuro Doubt and Neuroscience Fiction and Neurobollocks? The takedowns of overreaching interpretations, misleading press releases, and boutique neuro-fields are still valid, of course, but the critics themselves shouldn't succumb to the seductive allure of seductive allure. But we must also remember that the most thorough critiques of seductive allure still await peer review.3


    Footnotes

    1 And makes me feel a little silly.

    2 The experiment must have been designed before these actual 2012 headlines: Scientists read dreams (Nature) and Scientists decode contents of dreams (Telegraph).

    3 I wrote to two of the authors of the original studies (Weisberg and Castel) to get their reactions, but haven't heard back. Very, very tragically, we cannot hear from Dr. McCabe (tribute in APS Observer, PDF). In retrospect, my latter inquiry may have been gauche, so I apologize for that.


    References

    Farah MJ, Hook CJ (in press). The seductive allure of "seductive allure". Perspectives in Psychological Science. PDF

    Gruber, D. & Dickerson, J. (2012). Persuasive images in popular science: Testing judgments of scientific reasoning and credibility. Public Understanding of Science, 21 (8), 938-948 DOI: 10.1177/0963662512454072

    McCabe DP, Castel AD. (2008). Seeing is believing: the effect of brain images on judgments of scientific reasoning. Cognition 107:343-52.

    Weisberg DS, Keil FC, Goodstein J, Rawson E, Gray JR. (2008). The seductive allure of neuroscience explanations. J Cogn Neurosci. 20:470-7.


    Scientists read dreams 
    Brain scans during sleep can decode visual content of dreams.



    Mo Costandi
    19 October 2012

    Scientists have learned how to discover what you are dreaming about while you sleep. A team of researchers led by Yukiyasu Kamitani of the ATR Computational Neuroscience Laboratories in Kyoto, Japan, used functional neuroimaging to scan the brains of three people as they slept, simultaneously recording their brain waves using electroencephalography (EEG).

    NOTE: The image from Minority Report was not used in the actual Nature News article...

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    Are happy people responsible for fewer accidents? Should positive psychology be a mandatory module in high school Driver's Ed classes? Taken together, a new paper in the 2012 Christmas issue of BMJ and a recent TEDx talk tell a potentially interesting story about happiness, car crashes, and mind wandering. Let's see how this dangerous idea holds up to scrutiny.




    Driving and Daydreaming

    It seems rather obvious that distraction is not good for driving, regardless of whether the offending diversion is from external or internal sources. Daydreaming (now known as "mind wandering", its more formal and scientific-sounding name) is a very common state of mind while driving. We'll often travel 10 miles down the road without being aware of our surroundings at all. But does this make us more prone to accidents? Galera et al. (2012) asked this question in a study designed to determine who was responsible for a motor vehicle accident (a "responsibility case-control study"). In other words, was the driver in question responsible for the auto accident? And what were they doing at the time?

    The authors interviewed 955 patients in the emergency room at Bordeaux University Hospital within 72 hours of a motor vehicle accident. They used a standardized instrument to determine if the patient was at fault (8-12 = responsible; 13-15 = contributory; >15 = not responsible). Notably, eyewitness reports were not considered. The interview protocol is described below (Galera et al., 2012):
    During the interview, patients were asked to describe their thought content just before the crash. ... Each thought was classified in one of the following categories: thought unrelated to the driving task or to the immediate sensory input, thought related to the driving task, no thought or no memory of any thought. To capture the intensity of the thought when the mind was wandering, the participant filled in a Likert-type scale (0-10) for each thought, answering the question: “How much did the thought disrupt/distract you?” 

    Scores were then categorized into three levels of mind wandering:
    • mind wandering with highly disrupting/distracting content (unrelated to the driving task or to the immediate sensory input)
    • mind wandering with little disrupting/distracting content (unrelated to the driving task or to the immediate sensory input)
    • none reported (no thought or no memory of any thought or thoughts related to the driving task)

    Also considered were possible confounding variables such as age, sex, season, time of day, vehicle model, amount of sleep (less than 6 hrs was considered sleep deprived), and use of any psychotropic drug in the previous week (sleeping pills, anti-seizure medications, and drugs for various psychiatric disorders).  Blood alcohol level was obtained from the medical record. Sources of external distraction were assessed (e.g., use of a mobile phone, texting, grooming, eating, watching TV, etc.), as was mood or emotional valence at the time of the crash (pleasure-displeasure on a 9-point Likert scale).

    The major finding was that mind wandering with highly distracting content was associated with a significantly higher likelihood of crash responsibility than if the driver reported no mind wandering. Also significantly related to responsibility were the expected factors of alcohol use and sleep deprivation, as well as the "emerging risk factors" of external distraction [which seemed expected to me], negative affect, and psychotropic medication use (see figure below - click for a larger view).

    Fig. 1 (Galera et al., 2012). Odds ratios for responsibility for road traffic crashes, adjusted for age, sex, season, time of the day, and location.


    Thus, internally distracting thoughts were clearly associated with a greater risk of causing an auto accident, with a higher odds ratio than for external distraction and even alcohol use. But what are we to make of the association with negative affect (a "displeased" mood)? Do happy drivers make better drivers??




    Matt Killingsworth gave a talk at TEDxCambridge (MA) about mind wandering and happiness, based on results obtained from an experience sampling study in thousands of people. An iPhone app and a web-based reporting system (trackyourhappiness.org) were used to record the data, and the findings were published as a short report in Science (Killingsworth & Gilbert, 2010).1

    Participants were randomly cued by the app to answer questions about their current state of happiness (“How are you feeling right now?” rate from 0-100), their current activities (“What are you doing right now?” report one or more of 22 activities), and whether they were mind wandering (“Are you thinking about something other than what you’re currently doing?” one of four options: no; yes, something pleasant; yes, something neutral; or yes, something unpleasant).




    Want to be happier? Stay in the moment(Filmed at TEDxCambridge.)


    Results suggested that the participants were less happy when they were mind wandering, and this difference was significant for neutral topics and (not surprisingly) for unpleasant topics.2


    Crucially, the authors postulated that mind wandering caused unhappiness, even though the data were correlational in nature.3 In fact, other studies have shown the opposite: that negative affect can lead to mind wandering (Smallwood et al., 2009, 2011). This would make sense, for example, in cases of depression (rumination) and anxiety (excessive worry).




    Mindfulness Training for Happy, Safer Drivers?

    Or should it be the Driver's Ed module on positive psychology? OK, I'm being a little ridiculous here, although this might make a good topic for an Onion talk. Correlation does not equal causation, and we don't know whether the emotional valence of "displeasure" in the Galera et al., 2012 driving study was anger or unhappiness (or disappointment, embarrassment, fear, etc. for that matter). What we do know is that self-reported internal distraction, rated retrospectively after an accident, was higher when the driver was responsible for the accident than when they were not at fault. Now all we need is a trackyourhappiness study for drivers to get accurate, moment-by-moment experience sampling. Oh, wait...


    Footnotes

    1 Although this was not mentioned in the talk... Perhaps it had something to do with the large discrepancies between some of the variables that were stated in the talk vs. published in the journal article (e.g., the frequency of sampling was "over the course of a day, minute to minute in some cases" in TEDx vs. a minimum of once a day and default of 3 times a day in Science, Supporting Online Material):
    Next, participants were asked to indicate the times at which they typically woke up and went to sleep, and how many times during the day they wished to receive a sample request (default = 3, minimum = 1).
    2 Participants were mind wandering 46.9% of the time: pleasant topics in 42.5% of samples, unpleasant topics in 26.5% of samples, and neutral topics in 31% of samples.

    3 In the Science paper, they explained it thusly: "time-lag analyses strongly suggested that mind wandering in our sample was generally the cause, and not merely the consequence, of unhappiness."


    References

    Galera, C., Orriols, L., M'Bailara, K., Laborey, M., Contrand, B., Ribereau-Gayon, R., Masson, F., Bakiri, S., Gabaude, C., Fort, A., Maury, B., Lemercier, C., Cours, M., Bouvard, M., & Lagarde, E. (2012). Mind wandering and driving: responsibility case-control study. BMJ, 345 (dec13 8) DOI: 10.1136/bmj.e8105

    Killingsworth, M., Gilbert, D. (2010). A Wandering Mind Is an Unhappy Mind. Science, 330 (6006), 932-932. DOI: 10.1126/science.1192439

    Smallwood J, Fitzgerald A, Miles LK, Phillips LH. (2009). Shifting moods, wandering minds: negative moods lead the mind to wander. Emotion 9:271-6.

    Smallwood J, O'Connor RC. (2011). Imprisoned by the past: unhappy moods lead to a retrospective bias to mind wandering. Cogn Emot. 25:1481-90.

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    Manteno State Hospital was a behemoth psychiatric hospital located in the Manteno Township of Illinois. By 1936, the total acreage was 1,200, and in 1954 the population reached its maximum of 8,195 patients. According to The Manteno Project:
    In 1930 the Manteno State Hospital received its first 100 patients and by the end of 1985, the hospital was closed and remaining patients were sent elsewhere. For over 50 years Manteno State Hospital was an institution that cared for the mentally and physically ill, the developmentally disabled and veterans of various wars. With a peak population of over 8,000 patients, Manteno State Hospital was a self contained city with little reliability on other municipal resources.

    The Manteno Project maintains a detailed timeline of events, including the 1939 Typhoid Fever Epidemic (which killed up to 60 patients), the 1957 initiation of "Art-O-Rama", the severe bed shortage of 1960, charges of immorality in 1966 [despite those charges the hospital went coed the very next year], and finally the MSH Scandals [and revelations] of 1970's:
    • Experimental surgeries on patients without consent in 1950s
    • Chinese-speaking patient kept in custodial care at MSH because no one could speak his language
    • High percentage of deaths among patients and charges of sexual assaults
    • Nearly 50% of all admissions are "voluntary" alcoholic patients

    Elsewhere, myths and ghost stories about its former inhabitants abound. Most noteworthy is the story of Genevieve "Gennie" Pilarski, "who lived and died as a ward of the State of Illinois." Gennie: Setting the Record Straight provides the greatest detail of her tragic life:

    “Gennie” was committed to MSH, by her parents in 1944 at the age of 25 when she had a “disagreement about where she would live“.  She had previously completed 3 years of college at the University of Illinois, majoring in chemistry and suffered from episodes of manic-depressive disorder.

    By 1950, “Gennie” was placed in a research ward at MSH where she was “experimented on” involuntarily.  This was not uncommon at MSH even though I find nothing stating that it was ever officially proclaimed a “research hospital”.  (At Elgin State Hospital, they conducted “human radiation experiments“.)

    According to the *Tribune article, in 1955 she was lobotomized:
    On February 18, 1955, the chart noted: “Has had extensive neurosurgery with bilateral extirpation of most of frontal and temporal lobes. . . . Now mute, totally dependent on commands for functioning of everything from toilet urges on up. To be given an experimental course of (electric convulsive therapy) to see if any affective change can be brought about.

    For the rest of Ms. Pilarski’s life, she was schlepped about from ward to ward and nursing home to nursing home.  It was at one of these nursing homes, at the age of 80, that she died, a ward of the state.  For the last 20 years of her life she was “incapable of any kind of human interaction” and spent her last days “buried under her bedclothes or roaming the halls of her nursing home, drooling and babbling“.
    . . .

    * DRIVING HER CRAZY IT’S TOO LATE TO HELP GENNIE PILARSKI. BUT WE CAN MAKE SURE THAT NO ONE NOW UNDER OUR CARE WILL SUFFER HER FATE, by Patrick T. Murphy, Cook County public guardian.. Chicago Tribune. Chicago, Ill.: Nov 15, 1998. pg. 1



    A desire to tell the truth about Genevieve Pilarski, and to commemorate her life, led to the gennie messages, an art project by Kristyn Vinikour. The story was told in a dramatic fashion using a friend who posed as Gennie, with words painted on her naked body. Although not explicitly stated, it seems the artist had access to Gennie's medical records or to previously written accounts (perhaps that Chicago Tribune article?) that used the psychiatrist's notes as source material.

    Upon her admission, a physician noted that Gennie was neat, clean, tidy. Extremely quiet, but friendly and agreeable, cooperative in ward and routine. Later, he charted "No active signs of pathology."


    This contrasted with progress notes from a later point in time, after 40 insulin coma treatments and 14 bouts of electroconvulsive therapy.

    "She is not especially neat or clean"


    I recommend viewing the gennie messagesin their entirety (with larger images available here).

    The writings have remained on the walls and bathtubs of the abandoned asylum, and others have photographed the site (with prints for sale on etsy, where you can find most anything).


    Abandoned Asylum - Manteno, Illinois - Rural Decay Photography


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  • 12/22/12--14:23: Your Brain on Coupons?
  • Are you incredibly stressed out by last minute Christmas shopping? Can you feel your heart race and your blood pressure rise as your evil competitor swipes the last MONSTER HIGH® SWEET 1600™ CLAWDEEN WOLF® Doll out of your hands? Well try shopping with coupons!




    That's right, Paul Zak and coupons.com have scientifically proven that coupons make you happier and more relaxed:

    CGU researchers discover that coupons can make shoppers happier and more relaxed

    Monday, November 26, 2012

    Researchers from Claremont Graduate University (CGU's) Center for Neuroeconomic Studies have discovered evidence to suggest that coupons can help make shoppers happy and relaxed.

    Their new study, “Your Brain on Coupons: Neurophysiology of Couponing” is the first known scientific research performed in a laboratory setting measuring the physiological and psychological effects of coupons on the human body. The study, expected to be formally published in the coming months, is based on research conducted by Professor Paul Zak and his team, who are widely credited for popularizing neuroeconomics and studying the effects of hormone oxytocin.

    And the study has found a solution for the challenge of creative gift giving: no more racking your brain for a personalized selection for your spouse. Coupons are even better than Christmas presents!!
    Zak’s team looked at the neurologic effects of couponing to find out what really happens when people receive a savings offer, such as a coupon or coupon code. They found that oxytocin, a hormone that is directly related to love and happiness, spikes when people receive a coupon, and, in fact, increases more than when people receive a gift. The data shows that coupons make consumers happier and more relaxed, underscoring that the holidays don’t have to be as stressful as people think.

    “The study proves that not only are people who get a coupon happier, less stressed and experience less anxiety, but also that getting a coupon—as hard as it is to believe—is physically shown to be more enjoyable than getting a gift,” Zak said.“These results, combined with the findings of other research, suggest that coupons can directly impact happiness of people, promote positive health and increase the ability to handle stressful situations, all of which is particularly valuable as we head into the holiday season when stress levels tend to be at an all-time high.”

    Be sure to quote this surprising finding when your father expresses disappointment upon opening his present and discovering coupons to save $1.50 on Hershey's Simple Pleasures, $3.00 on (1) AXE holiday pack, and 50¢ off Pampers. He's out of touch with his own body, which clearly exhibits greater joy with these beauties than if he had received that highly coveted Titleist 910D2 driver.


    Oxytocin is the Love Hormone

    And we all know that oxytocin is directly related to only love and happiness, right Ed Yong? 1

    Coupons.com has conveniently provided a sneak preview of these exciting results, well in advance of their publication in a peer-reviewed scientific journal. Isn't that what Open Science is all about?? 2

    Don’t Worry, Be Happy: Oxytocin on the Rise

    During the study, some participants received a $10 coupon while grocery shopping online while others did not. The findings resoundingly show that women3 who received coupons during the study had significantly higher levels of oxytocin and dramatically reduced stress. Key findings include:
    • Higher Oxytocin Levels. Up 38 percent, this marked response is higher than levels associated with kissing, cuddling and other social interactions related to this hormone that is known to be associated with happiness.
    • Decreased Stress. Coupons were associated with reductions in several different measures of stress in the heart, skin, and breathing in those who received a coupon over those who did not. Specifically:
      • Respiration rates fell 32 percent compared to those who did not get a coupon.
      • Heart rates dropped 5 percent from 73 beats per minute to 70 beats per minute.
      • Sweat levels on the palms of the hands were 20 times lower for those who received a coupon.
    • Find Your Happy Place. Those who received coupons were 11 percent happier than those participants who did not get coupons.
      • This was measured by participants rating how happy they were on a scale from 1 to 10 at the end of the experiment. This research, coupled with existing data, shows that happiness is dependent on a person’s physiological state and that social activities that relax us, like coupons, make us happier.

    Previously in The Neurocritic, I've written about how Professor Zak used to have a more circumspect view of oxytocin, calling out the Liquid Trust folks for their hyperbole (see Paul Zak, Oxytocin Skeptic?). Not any more...
    What happened in the last few years? Was it the TEDification of academic media success and book deals? Repeated use of the first person singular when referring to work done by a multitude of people?

    "...The Moral Molecule: The Source of Love and Prosperity details how I discovered a brain chemical, oxytocin, that makes us moral."

    But really, with only a few more shopping days left before Christmas, who can resist the seductive allure of Your Brain... on Coupons? 4


    BONUS! Special offer for readers of The Neurocritic! Use coupon code OXYTOCIN at checkout for 10% off everything in the AllTheFrills shop. Have a happy, relaxed day!


    Footnotes

    1#Schmoxytocin

    2 I'm sure they'd provide all their raw data if you asked them for it...

    3 Hmm, the Claremont press release didn't specify that the findings applied only to women. No wonder Dad was so unhappy...

    4 The HuffPo piece misidentifies Dr. Paul Zak as a neurologist. He has a Ph.D. in Economics from the University of Pennsylvania {PDF}.




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  • 12/26/12--20:34: Music and Empathy

  • I've been reading the book Rat Girl, a memoir by musician Kristin Hersh, who started the band Throwing Muses in 1980, at the age of 14 (along with Tanya Donelly, Leslie Langston, and David Narcizo). The book recounts an eventful year in her life (1985-86) when, among other things, she is diagnosed with bipolar disorder and her band is signed to record label 4AD.

    Below she describes the intense empathic connection between the band and their music and their audience, which stuck me as a profound (and idealistic) way to live:
    Our band was started on these two bullshit principles -- well, they're more like bullshit wishes, but here they are:

        1. That people should be able to touch one another and feel each other's pain. Physically, like you should be able to touch someone's cheek and feel their toothache; and emotionally, if you move someone, touch them deeply, you have to take responsibility for that depth of feeling and care about them.
        So it isn't just pain we should feel in each other -- happiness should seep out of pores, and clouds of jealousy and all the different kinds of love and disappointment should float around us. We could walk in and out of people's clouds and know what they're feeling. That'd be the kindest way to live on planet earth.

        2. That maybe our essential selves are drunk -- not wasted, just kinda buzzed enough to let go. If we were always a little tipsy, we'd be light, nonjudgmental, truthful. Our hang-up'd be shaken off, there'd be no second-skin barriers to honesty. Oh, and also no hangovers.

        We figure if those two things are true, then it'd be OK for a band to sound like we do: sorta painful and a little out of control. We'd play what the audience felt and feel it at the same time and they'd feel it reflected back to them in sound and we'd all care about each other's stories and clouds of feeling and ... good luck with that I think miserably through my stage fright, trudging past the knitters, hippies, junkies, drunks, painters and psychos.

    -from Rat Girl, p. 42-43.

    It's hard to maintain that level of emotional empathy without collapsing from the weight of pain and joy and exhaustion. One would need superpowers to hold up under such unguarded transparency and depth of feeling.

    I'm wiped
    I'm so tired

    Carry me for a little while
    Carry me for a little while
    Carry me for a little while
    Carry me for a little while

    -Kristin Hersh, "Your Dirty Answer"




    Music and Mirror Neurons
    The mirror neurons, it would seem, dissolve the barrier between self and others. I call them "empathy neurons" or "Dalai Llama neurons".

    -- MIRROR NEURONS AND THE BRAIN IN THE VAT
    by V.S. Ramachandran

    Even the most ardent reductionists might be at a loss when contemplating how to reduce profound human experiences to a map of hemodynamic or electrical changes in the brain. But don't despair! Of course we should all know by now that music's ability to transmit emotion and elicit empathy is mediated by mirror neurons (Molnar-Szakacs & Overy, 2006):
    It has recently been proposed that music is best understood as a form of communication in which acoustic patterns and their auditory representations elicit a variety of conscious experiences (Bharucha et al., 2006). Here we review some recent evidence on the neural basis of musical processing in relation to two other modes of communication, language and action, both of which have been described as supported by the human mirror neuron system. We hypothesize that the powerful affective responses that can be provoked by apparently abstract musical sounds are supported by this human mirror neuron system, which may subserve similar computations during the processing of music, action and linguistic information.

    So the magical mirror neuron system is responsible for understanding very diverse types of stimuli (music, action, and language) and for evoking concomitant emotional responses to them. Such accounts always extrapolate from single unit recordings of mirror neurons in ventral premotor area F5 and inferior parietal lobule of monkeys to fMRI results in humans. In monkeys, a mirror neuron increases its firing rate when the animal performs an action, and when the animal watches someone else perform the action (Rizzolatti & Sinigaglia, 2010). As far as I know, no one has recorded mirror neuron activity directly from inferior prefrontal or parietal regions in humans.1

    This is not to say that mirror neurons do not exist in humans, just that the scope of the human "mirror neuron system" has expanded beyond recognition into an unfalsifiable theory: 2
    "Now wait a minute," said Professor Patricia Churchland[as paraphrased by Prof. Greg Hickok in Talking Brains]. "If mirror neurons are all over the brain then don't they lose their explanatory power? Aren't we now just back to our old friend, the How Does the Brain Work Problem?"

    A recent post at Brain Myths even suggests that mirror neurons might be The Most Hyped Concept in Neuroscience. Despite the hyperbole from Ramachandran, the reality is more mundane. For instance, we can understand actions we cannot perform:
    The ubiquitous idea that mirror neurons “cause” us to feel other people’s emotions can be traced back to the original context in which they were discovered – the motor cells in the monkey brain that responded to the sight of another person performing an action. This led to the suggestion that mirror neurons play a causal role in allowing us to understand the goals behind other people’s actions. By representing other people’s actions in the movement-pathways of our own brain, so the reasoning goes, these cells provide us with an instant simulation of their intentions – a highly effective foundation for empathy.

    ...The biggest and most obvious problem for anyone advocating the idea that mirror neurons play a central role in our ability to understand other people’s actions, is that we are quite clearly capable of understanding actions that we are unable to perform.3

    In the case of music, Molnar-Szakacs and Overy (2006) suggest its traditional relationship to motion (drumming, singing, etc.) engages the mirror neuron system.  Indeed, a recent study has claimed that music and movement share a dynamic structure that supports universal expressions of emotion. Nonetheless, we can appreciate an energetic drum solo without being able to play the drums.

    But this general line of reasoning raises the following questions: (1) Are musicians more empathetic? and (2) Do they engage the mirror neuron system to a greater extent than those without musical training?

    We'll examine these questions in a subsequent post...


    Footnotes

    1"Mirror neuron-like" activity has been recorded from the human hippocampus (Mukamel et al., 2010), but that's another story...  Archives of mirror neuron criticism can be found at Talking Brains and The Neurocritic.

    2Or in the words of Dr. Greg Hickok:
    I think the mirror neuron folks have a serious problem on their hands: there is apparently no empirical result that can falsify the theory. If a mirror neuron shows up in an unexpected place, it is a new part of the mirror system. If a mirror neuron's activity dissociates from action understanding, it was not coding understanding at that moment. If damage to the motor system doesn't disrupt understanding, it is because that part of the motor system isn't mirroring.

    3 Some have even claimed that mirror neurons can account for "certain listeners' misattribution of anger in the music of avant garde jazz saxophonists" (Gridley & Hoff, 2006). Is this because these listeners cannot play avant garde jazz saxophone?


    References

    Molnar-Szakacs, I., & Overy, K. (2006). Music and mirror neurons: from motion to 'e'motion. Social Cognitive and Affective Neuroscience, 1 (3), 235-241. DOI: 10.1093/scan/nsl029

    Rizzolatti G, Sinigaglia C. (2010). The functional role of the parieto-frontal mirror circuit: interpretations and misinterpretations. Nat Rev Neurosci. 11:264-74.




    I don't judge people
    I just watch them 'til it's time to look away
    I want to look away now
    Somebody's coming
    I don't want to live backwards
    I don't want even to look backwards
    It's not my fault...

    -Kristin Hersh, "Your Dirty Answer"

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  • 12/30/12--13:59: More Music, More Empathy
  • Fig. 1 (Molnar-Szakacs & Overy, 2006). Model of the possible involvement of the human mirror neuron system in representing meaning and affective responses to music. ... The shared recruitment of this neural mechanism in both the sender and the perceiver of the musical message allows for co-representation and sharing of the musical experience. Music notes from ‘The Lady Sings the Blues’ by Billie Holiday and Herbie Nichols.


    The previous post examined the relationship between music and empathy, including the emotional connection that can occur between musician and audience. My thoughts on the issue were originally inspired by a quote in the book Rat Girl, a memoir by musician Kristin Hersh:
    ...We'd play what the audience felt and feel it at the same time and they'd feel it reflected back to them in sound and we'd all care about each other's stories and clouds of feeling and ... good luck with that I think miserably through my stage fright, trudging past the knitters, hippies, junkies, drunks, painters and psychos.

    -Kristin Hersh, Rat Girl, p. 43

    Molnar-Szakacs and Overy (2006) suggested that these profound human experiences are mediated by activity in the supercharged mirror neuronsystem (Fig. 1).2 Although the box and arrow model is lacking in explanatory value, the hypothesis raised two questions: (1) Are musicians more empathetic? and (2) Do they engage the mirror neuron system to a greater extent than those without musical training?


    Are Musicians More Empathetic?

    Self-absorbed rock star stereotype aside, it would be difficult to determine causality if this were the case. Do more empathetic people choose to take up music (à la the tortured artist), or does musical training make one more empathetic?

    The best way to address question #1 is to look at those undergoing musical training. One such study reported that a 9 month-long program of musical group interaction (MGI) increased emotional empathy in 8-11 year old children (Rabinowitch et al., 2012). The MGI program consisted of musical "games" that seemed [to me, at least] designed to increase empathy, rather than musical prowess: entrainment games to be as rhythmically coordinated as possible, imitation games to repeat the musical phrases or gestures of the previous participant, and other games that called on the constructs of shared intentionality and intersubjectivity.

    Along with a passive control group that received no training, an active control group engaged in a verbal storytelling and drama version of group interaction that didn't involve music, singing, or gesture. It's notable that 33% of all children did not play a musical instrument (which included singing), so the study didn't really ask whether musical training per se can make you more empathetic. Nonetheless, there was a p=.054 level interaction of time (pre- vs. post-training) and group (MGI vs. both controls, who did not differ) on the self-report measure of empathy [which might have resulted from a higher pre-training empathy in controls, along with less improvement].

    Fig. 3 (Rabinowitch et al., 2012). Indexof Empathy scores.


    However, the MGI and control groups improved to an equivalent extent on an emotional face matching task, also designed to measure emotional empathy. While it's probably beneficial for children to engage in these group activities, we do not yet have a positive answer to question #1.


    Do Musicians Show More Mirror Neuron Activity?

    This question has a trivial element to it: of course a trained violinist will have a greater understanding of the movements and sounds involved in Beethoven's Violin Concerto in D major, so you'd expect differences in brain activity somewhere to reflect this.

    There are at least two studies potentially relevant to question #2 (Chapin et al., 2010; Babiloni et al., 2012). In neither case, however, do we need to invoke the existence of the mirror neuron system.

    In the first, BOLD signal changes in response to two different versions of the same musical piece (Chopin's Etude in E major) were compared in an fMRI study (Chapin et al., 2010). One version was an expressive piano performance with dynamic stimulus fluctuations, and the other was a synthesized "mechanical" version. In addition, the participants had varying levels of musical training: 7 were experienced (mean 9.2 yrs training) and 7 inexperienced (0.7 yrs training), with 7 more thrown out for various reasons. These are very small groups by modern fMRI standards.3

    Participants rated their emotional arousal and emotional valence while listening to the pieces before and after scanning, but not during the fMRI experiment. The combined arousal and valence ratings were not consistently correlated across the two time points, so making inferences about what the participants were feeling during the experiment is dicey.

    The fMRI results showed different activation patterns according to the main effects of performance type and musical experience (shown below). Mirror neuron-ish areas (inferior parietal lobule, inferior frontal gyrus but too anterior) showed greater activation for the expressive piece in both groups (A), but these regions didn't differ as a function of musical experience (B).

    Fig. 4 (Chapin et al., 2010). fMRI ANOVA results. Brain activations (F-maps) showing a significant main effect of a) performance type (F (1,24) > 7.19, corrected p < .02), SCG = subcallosal gyrus, PHG = parahippocampal gyrus, vACC = ventral anterior cingulate, FPC = frontopolor cortex, DMPFC = dorsal medial prefrontal cortex; and b) main effect of musical experience, BG = basal ganglia, vStri = ventral striatum.


    But there was an interaction between performance type and musical training, with experienced participants showing greater activation for the expressive piece in the too-anterior-for-mirror neurons IFG and the inferior parietal lobe. Importantly, activation in the mirror neuron-ish areas related to tempo changes in the expressive piece did not differ according to musical training:
    An unexpected finding of this study was that, for all participants, the tempo fluctuations of the expressive performance correlated with dynamic activation changes in brain regions that are consistent with the human mirror neuron system, including bilateral BA 44/45, superior temporal sulcus, ventral PMC, and inferior parietal cortex, along with other motor-related areas and with insula.

    Thus, the ability to perform a piece of music did not make a difference in the mirror neuron system BOLD response, so we do not have a positive answer to question #2. 4


    Do Emotionally Empathetic Musicians Show More Mirror Neuron Activity?

    Finally, the study of Babiloni et al. (2012) actually asked a third question: do trained musicians with more emotional empathy show greater mirror neuron system activity while watching their own performance, compared to musicians with a lower emotional empathy score?

    The participants were the members of three internationally renowned saxophone quartets (n=12) who played a classical music piece by Domenico Scarlatti while their EEG activity was recorded. They also watched a video of their own ensemble performance while EEG was recorded.


    Fig. 1A (Babiloni et al., 2012): Overview of the four musicians playing in ensemble during simultaneous EEG recordings.


    The participants completed Baron-Cohen's Empathy Quotient Test (EQT) to assess emotional empathy ("emotional contagion" - the ability to mirror an emotional response observed in another person and to experience it vicariously) and cognitive empathy (perspective-taking or theory of mind). Skipping over all the technical details to the bottom line, emotional empathy scores correlated with the degree of alpha wave desynchronization over a "mirror neuron" area in the right inferior frontal cortex during observation of their own performance:
    Results showed that the higher the empathy quotient test score, the higher the alpha desynchronization in right BA 44/45 during the OBSERVATION referenced to RESTING condition. Empathy trait score and alpha desynchronization were not correlated in other control areas or in EXECUTION/CONTROL conditions. These results suggest that alpha rhythms in BA 44/45 reflect “emotional” empathy in musicians observing own performance.

    Finally, we have a winner! The answer to question #3 is yes. Granting all the authors' assumptions and disregarding the relatively low n (for now), a higher emotional empathy score was associated with greater cortical activity in a mirror neuron area when a musician observed his own saxophone performance (as indexed by the percentage reduction, or desynchronization, of EEG alpha power).

    Did this have anything to do with their proficiency in playing with a musical ensemble? Probably not, but it might have made their music more powerful. Many punk musicians, for instance, were not very proficient, but their music was very emotionally intense and resonated with listeners.


    ADDENDUM (Dec 30, 2012): An important condition that was not included in this study is the observation of OTHER sax ensembles. Although watching one's own performance includes self and close colleagues, a true test of empathy would be to watch the performance of OTHERS. Watching a video of yourself involves a distinct memory of playing the piece, as well as emotions related to self-consciousness (e.g., pride, modesty, embarrassment at a minor slip, etc.).5

    ADDENDUM #2 (Dec 31, 2012): An anonymous commenter said that the EEG paper is totally bogus due to major unavoidable artifacts and to the uncertainty of EEG source localization. I address these technical problems and limitations in a subsequent comment.


    Footnotes

    1 I was also struck by this passage, which sounds a lot like synesthesia for pain:
    ...people should be able to touch one another and feel each other's pain. Physically, like you should be able to touch someone's cheek and feel their toothache; and emotionally, if you move someone, touch them deeply, you have to take responsibility for that depth of feeling and care about them.

    -Kristin Hersh, Rat Girl, p. 42
    Some have suggested that synesthesia for pain is mediated by (wait for it...) mirror neurons! But Hersh actually does have color-music synesthesia. E major is red, for instance. And this: "New song is done. It's burgundy and ochre with a sort of Day-Glo turquoise bridge—another tattoo on this pathetic little body." (ibid, p. 90).

    2 The human mirror neuron system extends well beyond the traditional ventral premotor and inferior parietal areas of monkey neurophysiology fame.

    3 The scanner is a very noisy environment, and in case you're wondering the authors used a sparse temporal sampling technique to increase the signal and to avoid interaction of the scanner noise with the music.

    4 Five of the seven experienced participants were trained pianists. They were unfamiliar with this specific piece, but I'm assuming they have the ability to perform it themselves.

    5 This was pointed out to me by Sandra Kiume of Channel N.


    References

    Babiloni, C., Buffo, P., Vecchio, F., Marzano, N., Del Percio, C., Spada, D., Rossi, S., Bruni, I., Rossini, P., & Perani, D. (2012). Brains “in concert”: Frontal oscillatory alpha rhythms and empathy in professional musicians NeuroImage, 60 (1), 105-116 DOI: 10.1016/j.neuroimage.2011.12.008

    Chapin, H., Jantzen, K., Scott Kelso, J., Steinberg, F., & Large, E. (2010). Dynamic Emotional and Neural Responses to Music Depend on Performance Expression and Listener Experience PLoS ONE, 5 (12) DOI: 10.1371/journal.pone.0013812

    Molnar-Szakacs I, Overy K. (2006). Music and mirror neurons: from motion to 'e'motion. Social Cognitive and Affective Neuroscience 1(3): 235-241.

    Rabinowitch, T., Cross, I., & Burnard, P. (2012). Long-term musical group interaction has a positive influence on empathy in children. Psychology of Music DOI: 10.1177/0305735612440609

    Rizzolatti G, Sinigaglia C. (2010). The functional role of the parieto-frontal mirror circuit: interpretations and misinterpretations. Nat Rev Neurosci. 11:264-74.




    I have a gun in my head
    I'm invisible
    I can't find the ice

    -Throwing Muses, "Hate My Way"

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    While everyone else rings in the New Year by commemorating the best and brightest of 2012 in formulaic Top Ten lists, The Neurocritic decided to wallow in shame. To mark this Celebration of Failure I have compiled a Bottom Ten list, the year's least popular posts as measured by Google Analytics.

    Methods: The number of pageviews per post was copied and pasted into an Excel file, sorted by month with each month placed into a different tabs. Then the total pageviews for each post was prorated by month, to give an estimate of monthly views.

    Results: The posts are listed in inverse order, starting with #10 and ending with #1 (least popular).

    10 Most Unpopular Posts of 2012

    10. (Every Day Is) Halloween - A list of 15 posts from The Neurocritic's Halloween and Horror archive.

    9. Blow Your Mind with Hostile THINKIES (Brain Filled Hostile THINKIES!) - From the Wacky Packages 8th Series.

    8. All about the brain and its workings. - This one hurts, because it's a Very Short Review of this blog in the New York Times Magazine by Professor Tyler Cowen. I very rarely brag, and this just reinforces its pointlessness for someone poor at self-promotion.

    7. Last Chance to Vote in the Neuro Film Festival - This is the final post in a series of four that attempted to promote the Neuro Film Festival. Unsuccessfully, I might add.

    6. Sister Rose Pacatte Explains It All For You - The story of Sister Rose, a very entertaining nun living with MS.

    5. Scrumptious Skulls - Delicious chocolate skulls handcrafted by artist Marina Malvada. Chocolate? Skulls? What more could you want?


    4. 2012 Neuro Film Festival - Sponsored by the American Academy of Neurology.

    3. Morbid Curiosity in Chicago - An exhibit of the Richard Harris Collection, which included a lot of skulls.

    2. Speaking of Aphasia... - Aphasia Speaks, a short film about Kristen, a 34-year-old physical therapist, who suffered a stroke.

       ...and bringing up the rear:

    1. Nineteenth Annual Cognitive Neuroscience Society Meeting - Unless you're advertising a party, don't write blog posts to announce a conference, even if you include an abstract of Your Brain on Food.


    Discussion: We can see three major themes emerge: Halloween and Skulls, the Neuro Film Festival, and the Cognitive Neuroscience Society meeting.

    Conclusion: People do not like documentary films about neurological illnesses, skulls of any kind, and the CNS Meeting or morbid cultural events when held in Chicago.

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    The Lord's Resistance Army (LRA) has waged a long and brutal campaign to overthrow the government of Uganda. Rape and torture are commonly used tactics. Children are kidnapped and forced to serve as soldiers children and youth comprise almost 90% of the LRA, according to the UN. These child soldiers experience incredibly high rates of trauma exposure, post-traumatic stress, and depression.

    A recent study examined the culturally-specific psychological syndrome of spirit possession in this population (Neuner et al., 2012). Although spirit possession is common in many cultures, the phenomenon investigated here is a local variant called cen, where "the ghost of a deceased person visits the affected and replaces his or her identity." It is particularly prevalent in former child soldiers who have killed others. Although some forms of spirit possession are considered relatively benign in Northern Uganda, cenis seen as harmful.

    It is important here to consider the complex role of religion and magical belief in motivating and sustaining the LRA (Jackson, 2010), along with socioeconomic and political grievances. The Acholi ethnic group has been depicted as marginalized victims of the Ugandan government by the LRA leader, Joseph Kony. Religion is used as a further means of control (Jackson, 2010):
    The quasi-religious aspects of Kony’s internal cosmology take this sense of victimhood and expand it, through a magpie-like propensity to adopt elements from other belief systems into which he has come into contact. The result is a hotch-potch of beliefs that are used to reinforce the idea that the Acholi are victims and Kony the mystic who can stop protect them. Violence, in this world-view, is conveniently seen as a means of ‘cleansing’ – an evil that is necessary to purify the Acholi so that they can be saved...

    Furthermore, the Neuner et al., (2012) paper notes that Kony...
    ...justified his claim to power by spirit possession and said to have supernatural abilities.1 It is reasonable to assume that this propaganda, which drew on widespread local beliefs, has been a fertile ground for the development of harmful forms of spirit possession in the local population, in particular former child soldiers.

    With this background in mind, the authors conducted a survey of 1,113 individuals between the ages of 12 and 25 yrs to determine the rates of spirit possession, trauma exposure, and psychological distress. The actual interviewers were members of vivo, an organization that provides psychosocial support to children in Northern Uganda. During a pilot study, the five-item Cen Spirit Possession Scale was developed (shown below).


    -- click on image for a larger view --

    Notably, a high level of spirit possession (four or more characteristics) was observed in 14.3% of those who were abducted, but only 3.7% of the participants who were not abducted. Girls were more likely to experience cen than boys. In addition, spirit possession was associated with extreme poverty, greater trauma exposure, sexual trauma, and being forced to kill. Most of the youths were treated via traditional means:
    Among those who had ever sought help for spirit possession, 15.2% had carried out the nyono tonggweno ritual (stepping on the egg in a cleansing ceremony), 7.9% mato oput (reconciliation ritual after killing), 7.9% lwoko pik wang (washing away the tears), 31.5% other traditional interventions, mainly taking traditional herbs, and 70.2% sought help at a church or from a priest.

    Cen led to worse outcomes compared to those without spirit possession, including higher suicide risk, lower functioning, greater perceived discrimination, and higher incidence of PTSD (44.5% vs. 9.8%).2 The authors conclude:
    Although cen was not limited to former child soldiers, they reported higher rates of spirit possession, which may be related to the fact that they were more intensely exposed to the LRA belief system.

    At the same time it has to be emphasized that spirit possession is usually not perceived as psychopathology within the local culture. Although our data is consistent with the association of cen with impaired mental health, a reduction of this phenomenon to mere psychopathology is inappropriate. The clinical perspective taken in this survey must be complemented by sociological, historical and anthropological studies investigating the cultural and social interpretation of this phenomenon.

    Given the cultural specificity of cen, it might be interesting to consider how Western psychiatry views cases of spirit possession.3 In DSM-IV, this syndrome would be classified as Dissociative Disorder Not Otherwise Specified, with more specific research criteria (but not official diagnosis) fitting Dissociative Trance Disorder (possession trance). Has this changed in DSM-5? We'll take a look in the next post.


    Footnotes

    1 The New York Times has a fascinating document that details Kony's religious beliefs. He was "possessed" by quite a large number of spirits...

    2 See also Remembering and Forgetting in Traumatized Ugandan Refugees.

    3 The film industry presents its own flamboyantly supernatural depiction of demon possession for entertainment, as we all know.


    References

    Jackson P (2010). Politics, Religion and the Lord’s Resistance Army in Northern Uganda. Religions and Development, Working Paper 43. University of Birmingham.

    Neuner, F., Pfeiffer, A., Schauer-Kaiser, E., Odenwald, M., Elbert, T., & Ertl, V. (2012). Haunted by ghosts: Prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda. Social Science & Medicine, 75 (3), 548-554 DOI: 10.1016/j.socscimed.2012.03.028


    Grace, Milly, Lucy… Child Soldiers (trailer)


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    "I was lost in the wilderness, and I could smell something strange. I was near a main road and someone asked me what I was waiting for. I said I was lost. I saw smoke around me, and I was told my eyes were swollen. All of a sudden, something started moving all over my body."

    -Christine, a former child soldier in Uganda





    DWOG PACO

    This video was made as part of an extraordinary multimedia project that chronicles the lives of 40 women in northern Uganda. It recounts the harrowing experiences of these former child soldiers and portrays the current difficulties of reintegrating into society. The piece focuses on five women who had been abducted by the Lord’s Resistance Army (LRA) as children. Each of these five were given a digital camera, so each woman became a more active participant in the telling of her story - a participatory anthropographia of sorts.

    My previous post discussed Spirit Possession as a Trauma-Related Disorder in Uganda. In the process of doing a follow-up on how cen phenomena might be classified in the forthcoming DSM-5, I came upon the video above and the larger DWOG PACO project of Marc Ellison, a photojournalist from Vancouver, Canada. This work deserved to be highlighted separately, so the evolution of Dissociative Disorder Not Otherwise Specified and Dissociative Trance Disorder (possession trance) will be discussed in the next post.

    The Acholi phrase dwog paco (“come back home”) is used as a derogatory and stigmatizing label, which hinders recovery and reintegration into the community. Post-traumatic stress disorder, spirit possession, and other mental health issues faced by the Ugandan women are discussed at length as part of the multimedia project:

    The Acholi tribe, which inhabits much of the worst affected regions of northern Uganda, believe in the existence of jogi – spirits or forces that can be either good or evil (Mpyangu, 2010). Usually in conflict and post-conflict zones inhabitants complain of hunger, mortality, disease, poverty, homelessness. However, the Acholi are more concerned about the vengeful spirits of those killed during the conflict. They are believed to have a pernicious influence if not appeased. The cen, or polluting spiritual force, possesses those who have killed, done wrong, witnessed a killing, or touched the body of a corpse, by entering that person’s mind or body resulting in dissociative states, nightmares, flashbacks or psychosis that remain until the wrongdoing is put right (Mpyangu, 2010). The Acholi also believe that cen is contagious and can infect an entire family or community (SWAY, 2008). Consequently anyone thought to be haunted by cen is shunned and avoided by the community.

    The project is moving and unforgettable. Learn more about Alice, Christine, Janet, Jennifer and Mary. You can also view the galleries of Janet's, Christine's, Jennifer's and Alice's photography.

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  • 01/12/13--13:37: Fisher-Price Synesthesia


  • Synesthesia is a rare perceptual phenomenon in which the stimulation of one sensory modality, or exposure to one type of stimulus, leads to a sensory (or cognitive) experience in a different, non-stimulated modality. For instance, some synesthetes have colored hearing while others might taste shapes.

    GRAPHEME-COLOSYNESTHESIA is the condition in which individual printed letters are perceived in a specific, constant color. This occurs involuntarily and in the absence of colored font. It is the most common and widely-studied of all types of synesthesia (Mattingley, 2009). Many studies have suggested that the phenomenon is not due to associative learning, i.e. exposure to colored letters or blocks as a child (Rich et al., 2005). One neurological explanation is that it's due to greater white matter connectivity between the inferior temporal lobe regions that process letters and colors (Rouw & Scholte, 2007). 1


    Learned Synesthesia

    However, a new study has identified 11 synesthetes whose grapheme-color mappings appear to be based on the Fisher Price plastic letter set made between 1972-1990 (Witthoft & Winawer, 2013). 2 Letter-color mapping data were obtained from the participants using either The Synesthesia Battery Web site (synesthete.org) or in-house software. This required that the subjects use a color picker to identify the hue of 26 upper case letters and 10 numerals three times each (presented in random order). They did this in two separate sessions, and then the consistency within and across sessions was evaluated. The participants also completed a speeded Stroop-like task, where they had to identify whether the color font was congruent (A) or incongruent (A) relative to their synesthetic mapping.

    Lo and behold, the resultant mappings were "startlingly similar" to the colors used in the Fisher Price toys from their childhoods! And 10 of the 11 participants reported owning the colorful plastic magnetic letters. In the figure below, the subjects are arranged left to right according to the number of matches with the Fisher Price set. S11 showed the fewest matches (n=14), yet the probability of obtaining 14 or more matches in 26 chances was estimated to be less than 1 in 1 billion...



    Fig. 2 (modified from Witthoft & Winawer, 2013). Letter-color matching data from the 11 subjects. The diagram shows the color selected for each letter, averaged across three trials for each subject. The left-most column indicates the colors of the Fisher-Price refrigerator magnets used by all but 1 of the subjects as children.


    Thus, the results provided clear evidence of a learned contribution to color-grapheme synesthesia, at least in this group of participants. But they don't negate a more purely perceptual version of the phenomenon in other synesthetes. The two synesthesiae can peacefully coexist:
    Whereas some researchers have focused on genetic and perceptual aspects of synesthesia, our results indicate that a complete explanation of synesthesia must also incorporate a central role for learning and memory. We argue that these two positions can be reconciled by thinking of synesthesia as the automatic retrieval of highly specific mnemonic associations, in which perceptual contents are brought to mind in a manner akin to mental imagery or the perceptual-reinstatement effects found in memory studies.

    Nonetheless, for some color-grapheme synesthetes, it's always a Red Letter A...


    Footnotes

    1 However, a newer study says it's more complicated than that (Hupé et al., 2012). These authors found that synesthetic letter experience did not activate color area V4, and that grapheme-color synesthetes did not show greater connectivity in the inferior temporal cortex:
    At the end, careful reading of the relevant literature casts some doubt on the textbook story that synesthetes activate “color area V4” when viewing achromatic graphemes (but experiencing color) and on structural brain differences reported between synesthetes versus nonsynesthetes.
    2  Interestingly, Witthoft and Winawer cited a 19th century study that proposed the same thing (Calkins, 1893).


    References

    Mattingley JB. (2009). Attention, automaticity, and awareness in synesthesia. Ann NY Acad Sci. 1156:141-67.

    Rich AN, Bradshaw JL, Mattingley JB. (2005). A systematic, large-scale study of synaesthesia: Implications for the role of early experience in lexical-colour associations. Cognition 98:53-84.

    Rouw R, Scholte HS (2007). Increased structural connectivity in grapheme-color synesthesia. Nature Neuroscience 10:792-797.

    Witthoft, N., & Winawer, J. (2013). Learning, Memory, and Synesthesia Psychological Science DOI: 10.1177/0956797612452573



    It's a Red Letter A...

    Letters A-Z, plus extra letters E, I, L, N, O, P, R, S, and T:
    • FPT971 - Red letter "A".
    • FPT972 - Orange letter "B".
    • FPT973 - Yellow letter "C".
    • FPT974 - Green letter "D".
    • FPT975 - 2 each - Blue letter "E".
    • FPT976 - Purple letter "F".
    • etc. ... 

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    American Horror Story: Asylum takes place in 1964 at Briarcliff Manor, a terrifying mental institution for the criminally insane. The show uses every over-the-top stereotype in the book straightjackets, isolation cells, shock treatment, the chronic masturbator, the nymphomaniac, the sadistic nun, the evil mad doctor, unethical experimentation, wrongful commitment, alien abduction, demonic possession, you name it yet it still manages to be scary and stylish and suspenseful.



    The episode about a poor soul possessed by the devil naturally includes an exorcism by Catholic priests. The afflicted boy becomes ugly and deformed by the demon, who spews out lewd words and exerts its supernatural telekinetic powers by throwing objects (and priests) across the room.




    Regarding exorcism, the Catholic Encyclopedia says:
    Exorcism is (1) the act of driving out, or warding off, demons, or evil spirits, from persons, places, or things, which are believed to be possessed or infested by them, or are liable to become victims or instruments of their malice; (2) the means employed for this purpose, especially the solemn and authoritative adjuration of the demon, in the name of God, or any of the higher power in which he is subject.

    Religious belief in the existence of demons is a sincere part of the Catholic faith, so demonic possession can be a particularly frightening Hollywood trope for devout Catholics (and former Catholics). Walking out of the theater into the dark parking lot and entering your empty apartment after a midnight showing of The Exorcist can be creepy for the believer and the agnostic alike. Even if Satan isn't lurking in your shower, a serial killer like "Bloody Face" could be under your bed. Indoctrination into a belief system where devils are real can haunt a young child into adulthood.

    In contrast, the rationalist perspective presents historical and medically-based views of possession phenomena in terms of epilepsy, schizophrenia, and possession trance disorder (PTD), a possible variant of dissociative identity disorder. Nothing evil or supernatural takes over the identity of the person with PTD. Nonetheless, exorcisms performed on mentally ill people continue to this day.

    For example, Tajima-Pozo and colleagues (2011) reported on the case of a 28 yr old woman in Spain who had been diagnosed with paranoid schizophrenia. Over the course of 5 yrs she had been treated with the antipsychotic drugs clozapine, risperidone, ziprasidone and onlanzapine, without complete remission. She was an inpatient on a psychosis ward, and yet some diabolical priests managed to get in and convince her that she was possessed by demons. Some of the priests had knowledge of the patient's psychiatric history and should have known better. But they performed multiple exorcisms anyway, which disrupted her clinical treatment.1

    In DSM-IV, spirit possession falls under the category of Dissociative Disorder Not Otherwise Specified, with more specific research criteria (but not an official diagnosis) fitting Dissociative Trance Disorder (possession trance):
    This category [DDNOS] is included for disorders in which the predominant feature is a dissociative symptom (i.e., a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment) that does not meet the criteria for any specific dissociative disorder.
    . . .

    Dissociative trance disorder: single or episodic disturbances in the state of consciousness, identity, or memory that are indigenous to particular locations and cultures. Dissociative trance involves narrowing of awareness of immediate surroundings or stereotyped behaviors or movements that are experienced as being beyond one's control. Possession trance involves replacement of the customary sense of personal identity by a new identity, attributed to the influence of a spirit, power, deity, or other person and associated with stereotyped involuntary movements or amnesia, and is perhaps the most common dissociative disorder in Asia. Examples include amok (Indonesia), bebainan (Indonesia), latah (Malaysia), pibloktoq (Arctic), ataque de nervios (Latin America), and possession (India). The dissociative or trance disorder is not a normal part of a broadly accepted collective cultural or religious practice. 


    Note the culture-specific aspect of the disorder, which shows substantial heterogeneity in its expression. Dr. Romeo Vitelli at the blog Providentia has written about some of these phenomena. For instance, Amok is an aggressive trance-like state in Malay culture, whereas Pibloktoq is an acute dissociative reaction in the Inuit tradition, caused by evil spirits possessing the living. In two previousposts here at The Neurocritic, we also learned about cen in Uganda, ghosts that replace the identity of the afflicted individual. 


    Dissociative Disorders in DSM-5

    Will there be changes for Dissociative Trance Disorder (DTD) in DSM-5? The new (and already reviled) psychiatric manualmakes its debut in May 2013.2  A 2011 paper by Spiegel et al. described some of the proposed changes to the dissociative disorders. The Pathological Possession Trance (PPT) component of DTD is claimed to be be similar to dissociative identity disorder (DID, or the diagnosis formerly known as "multiple personality disorder"):
    It is a disorder of identity alteration that occurs during an altered state of consciousness. Of course, unlike DID, the alternate identity or identities in PPT are attributed to possession (by an external spirit, power, deity, or other person) rather than to internal personality states. Associated symptoms of PPT include stereotyped or culturally determined behaviors or movements that are experienced as being controlled by the possessing agent and/or full or partial amnesia for the event.
    So pathological possession trance would be included under DID, while dissociative trance without possession would remain under dissociative disorders NOS.Or...
    Alternatively, DSM-5 could (a) retain all of DTD in DDNOS (and an appendix), or (b) incorporate DTD (or only PPT) as a new disorder.

    “Possession” is a broader construct than PPT because it may be used as a nonspecific attribution for explaining events (e.g. illness, misfortune) that go beyond pathological identity alteration. By contrast, in PPT we focus only on the subset of possession experiences–(1) an alteration of consciousness wherein the person experiences his/her the identity as being replaced by an ancestor, spirit, or other entity (i.e. possession trance), and (2) these alterations are involuntary, distressing, uncontrollable, often chronic, and involve conflict between the individual and his/her surrounding social or work milieu (i.e. the possession trance is a pathological one).

    Ultimately, the recommendation was to include PPT under the DID umbrella. The phrase “an experience of possession” would be added to Criterion A of DID.



    Kibuuka Kigaanira (R) with a priestly assistant.
    Photo Courtesy of Euginia Bonabana, from The Sunday Monitor [Uganda]
     
    Alternate activism: From Kibuuka Kigaanira in the mid-19th century to Kalondoozi in the present, possession practices provide important political space for citizens to negotiate power and authority, while appointed leaders are held to account.

    -from Spirit possession and power play since pre-colonial times


    Pathological Possession Trance: Perspectives from Uganda

    Previously, I wrote about Spirit Possession as a Trauma-Related Disorder in Uganda and quoted from a personal narrative of spirit possession from Christine, a former child soldier. How well will the new DSM-5 criteria fit cen phenomena in Northern Uganda? The diagnosis for possession trance would now be DID. However, a recent paper by van Duijl et al. (2012) suggests this might be a nosological disaster for the classification of spirit possession in Uganda.

    In their study, the authors collected narratives from 119 spirit possessed individuals. They also developed a checklist for locally relevant dissociative and possession symptoms.
    The CDS-Ug is a locally designed checklist based on information obtained in focus group discussions with traditional healers, religious leaders, health professionals, and people of the community. It covers common and typical symptoms of dissociation and spirit possession, including:

    1. Okukangarana: described as being shocked by a situation in such a way that later on one cannot remember the situation (amnesia)
    2. Okurogwa: described as talking in a different voice, which others recognize as the voice of an (ancestral) spirit (possession trance)
    3. Eibugane: feeling influenced by unidentified forces causing behavior different from one’s usual behavior
    4. Okukyekyera: traveling outside one’s home without remembering (fugues or ‘night dances’)
    5. Okusharara: feeling as if something from outside holds one’s body or mind so that one cannot move, think, or speak, which is attributed to an outer force (feeling paralyzed)
    6. Okugwa: shaking of the head or body, seen as an expression of spirits (involuntary repetitive movements)
    7. Okugamba endimi: speaking in tongues (glossolalia)
    8. Okwehindura: making sounds and movements as if one has become an animal, for example, a cock, monkey, or goat, without remembering this behavior afterward (possession by animal)
    Spirit possessed patients were asked whether and how these eight features applied to themselves.

    The data were analyzed to examine possible clusters of symptoms, merged with a checklist developed from the personal narratives, and then compared to the old DSM-IV DTD criteria and the new DSM-5 DID criteria.

    Two distinctive clusters emerged.3 One cluster included shaking, stereotyped movements, and speaking in voices of spirits ("active symptoms"). The second cluster included amnesia, fugues, and feeling paralyzed ("passive symptoms"). The passive symptoms were a better fit with DID, but the active symptoms were more like DTD. Furthermore, many symptoms fell outside either diagnosis:
    ...experiences such as hearing voices (e.g., of spirits or deceased), strange dreams, feeling influenced or held by powers from outside, feeling paralyzed, or moving around in fugue-like states are not explicitly covered by the experimental DSM-IV research criteria nor by proposed criteria for DID in DSM-5.
    Overall, the authors felt the DSM-IV experimental criteria for dissociative trance and possession trance disorders encompassed the experience of spirit possession to a greater extent than the DSM-5 DID criteria. They do not think possession trance disorder should be subsumed under dissociative identity disorder, nor do they think dissociative trance and possession trance should be separate categories, as they occurred on a continuum in this Ugandan population. Instead, a more culturally-inclusive mindset might have prevented some of the DSM-5 changes from moving forward.
    Although the presentation of DID and PTD considerably overlaps and both are covered by the criteria outlined in Table 3, we are not in full support of this approach. Ranking PTD (described in over 360 societies) under DID (described in considerably fewer societies) expresses a Western ethnocentric approach. Ranking characteristic symptoms of PTD such as stereotyped uncontrolled movements as ‘non-epileptic seizures or other sensory-motor (functional neurological) symptoms’ in DSM-5 also heavily imposes a medical descriptive framework and disregards emic attributions. In addition to this, DID is strongly associated with early childhood sexual abuse and neglect, whereas stressors associated with PTD are more broadly framed and require a culturally sensitive approach.

    In DSM-5, Possession Trance Disorder no longer exists.


    ADDENDUM (Jan 20, 2013): I should have posed this question directly: Does it make any sense to use DSM-5 (or DSM-IV) criteria to diagnose spirit possession across cultures?


    Footnotes

    1Besides being backwards and barbaric, exorcisms can be deadly, as this case of Fatal Hypernatraemia from Excessive Salt Ingestion During Exorcism shows. Ingestion of salt or salt water is part of the ritual.

    2If you want to know why it's already reviled, start here and follow links. Or Google DSM-5 controversy. I don't feel a need to offer my opinion at the present time.

    3These two clusters could account for ~46 % of the variance.


    References

    Duijl, M., Kleijn, W., &amp; Jong, J. (2012). Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda. Social Psychiatry and Psychiatric Epidemiology DOI: 10.1007/s00127-012-0635-1

    Spiegel, D., Loewenstein, R., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., &amp; Dell, P. (2011). Dissociative disorders in DSM-5. Depression and Anxiety, 28 (9), 824-852 DOI: 10.1002/da.20874

    Tajima-Pozo, K., Zambrano-Enriquez, D., de Anta, L., Moron, M., Carrasco, J., Lopez-Ibor, J., & Diaz-Marsa, M. (2011). Practicing exorcism in schizophrenia Case Reports, 2011 (feb15 1) DOI: 10.1136/bcr.10.2009.2350




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    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease seen most often in athletes with repeated concussions.1 The condition has drawn extensive media attention due to the number of cases reported among retired NFL players. The disease can only be diagnosed at autopsy, because the brain tissue has to be stained for characteristic protein abnormalities which cannot be visualized in a living human.

    Until now, that is, according to a new study by Gary Small and colleagues at UCLA (Small et al., 2013). Positron emission tomography (PET) and the molecular imaging probe FDDNP 2 were use to visualize levels of the protein tau, which forms neurofibrillary tangles in Alzheimer's disease and other tauopathies. Or what is presumed to be tau.

    Elevated levels of FDDNP were observed in in the brains of 5 former NFL players relative to those of 5 control participants. The players were referred for testing because of symptoms of mild cognitive impairment. These five participants in the study (out of 19 potential volunteers) had a mean age of 59 yrs; MMSE scores of 28 vs. 30 in controls; and higher depression scores than controls, but no clinically significant depression in most.

    The authors admit this is a very preliminary study that needs to be replicated and validated in larger samples. Yet they are optimistic they have a discovered a means of imaging CTE pathology in the brains of living patients.

    But I would like to cast some doubt on this notion for two reasons:

    (1) FDDNP is supposedly a tracer for both tau and amyloid beta (which forms plaques in Alzheimer's and other dementia), but some experts think it's neither. Studies have shown that it binds to a variety of misfolded proteins. For example, it selectively labels prion plaques in Creutzfeldt–Jakob disease (Bresjanac et al., 2003).

    At any rate, FDDNP does not appear to be specific for CTE pathology.


    (2) The distribution of FDDNP binding in the brains of the retired players does not appear to be the same as CTE tau pathology that has been observed at autopsy (McKee et al., 2012). Last month the Boston University group found evidence of CTE in the brains of in 68 male subjects, most of whom played contact sports. McKee et al. identified a series of four stages of CTE, with progressive worsening of clinical symptoms and neuropathology.

    My guess is that the participants in the Small et al. study, if they do indeed have CTE, might be at stage I or perhaps stage II, but this is hard to tell given the very limited clinical and cognitive data on these patients (they had "a history of cognitive or mood symptoms").

    The FDDNP results showed elevated signals in the players in a number of subcortical regions (including caudate, putamen, thalamus, subthalamus, midbrain, and amygdala), but nowhere in the cerebral cortex. On the other hand, stage I CTE tau pathology in post mortem brains is found in limited discrete locations: mild pathology in the cerebral cortex and minimal pathology in the amygdala and hippocampus (McKee et al., 2012). In stage II, pathology within the cortex spreads, and pathology in the medial temporal lobe (amygdala and hippocampus) is still mild.

    Maybe there's a bias for subcortical labelling with FDDNP PET, versus cortical pTDP-43 immunoreactivity in post-mortem tissue. 3  That's possible, but Small and colleagues have previously reported extensive neocortical FDDND signal in mild cognitive impairment (Small et al., 2012).


    I'm not an expert, and I could certainly be wrong about all of this. Development of in vivo imaging probes for neurodegenerative diseases is a very active area of research. The new hyperphosphorylated-tau radioligand [F-18]-T807 could be more specific for imaging tauopathies (Chien et al., 2012). Scientific developments like these will be especially crucial once any type of treatment for CTE comes along.

    - Original link to study via Deadspin and Nature editor Noah Gray.


    Footnotes

    1 More background information, taken from my earlier post on Blast Wave Injury and Chronic Traumatic Encephalopathy: What's the Connection?
     A defining pathological feature is tauopathy - abnormal accumulations of the tau protein seen in other dementias (e.g., Alzheimer's disease). Aggregations of hyperphosphorylated tau into neurofibrillary tangles (NFTs) are a defining feature, as in frontotemporal lobar degeneration and amyotrophic lateral sclerosis -- yet CTE is distinct from both of these (McKee et al., 2009). CTE results in cognitive and behavioral changes including memory impairments, poor impulse control, alterations in mood, suicidal behavior, disorientation, and ultimately dementia.
    2 Co-authors Small and Barrio are among the inventors of the FDDNP approach. They have received royalties and may receive royalties on future sales.

    3Noah Gray raised this point.


    References

    Bresjanac M, Smid LM, Vovko TD, Petric A, Barrio JR, Popovic M. (2003). Molecular-imaging probe 2-(1-[6-[(2-fluoroethyl)(methyl)amino]-2-naphthyl]ethylidene) malononitrile labels prion plaques in vitro. J Neurosci. 23(22):8029-33.

    Chien DT, Bahri S, Szardenings AK, Walsh JC, Mu F, Su MY, Shankle WR, Elizarov A, Kolb HC. Early Clinical PET Imaging Results with the Novel PHF-Tau Radioligand[F-18]-T807. J Alzheimers Dis.2012 Dec 12. [Epub ahead of print]

    McKee, A., Stein, T., Nowinski, C., Stern, R., Daneshvar, D., Alvarez, V., Lee, H., Hall, G., Wojtowicz, S., Baugh, C., Riley, D., Kubilus, C., Cormier, K., Jacobs, M., Martin, B., Abraham, C., Ikezu, T., Reichard, R., Wolozin, B., Budson, A., Goldstein, L., Kowall, N., & Cantu, R. (2012). The spectrum of disease in chronic traumatic encephalopathy Brain DOI: 10.1093/brain/aws307

    Gary W. Small, Vladimir Kepe, Prabha Siddarth, Linda M. Ercoli, David A. Merrill, Natacha Donoghue, Susan Y. Bookheimer, Jacqueline Martinez, Bennet Omalu, Julian Bailes, Jorge R. Barrio (2013). PET Scanning of Brain Tau in Retired National Football League Players: Preliminary Findings. Am J Geriatr Psychiatry, 21


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    The last post covered a new study claiming to identify markers of chronic traumatic encephalopathy (CTE) in living patients using a method called FDDNP PET (Small et al., 2013). Previously, the disease could only be diagnosed at autopsy due to the requirement to process post mortem tissue for the presence of tau protein. The paper made a big splash in the media because the patients in the study were five former NFL football players.

    Combining the journal article with twodifferent news reports, I was able to identify the following information about the players and their brains (which are shown in the figure above):
    • NFL1: Fred McNeill, 59-year-old former Vikings linebacker - mild cognitive impairment, experienced momentary loss of consciousness after each of two concussions
    • NFL2: Wayne Clark, 64-year-old former backup quarterback - no symptoms except age-consistent memory impairment, experienced momentary loss of consciousness and 24-hour amnesia following one concussion
    • NFL3: 73-year-old former guard - dementia and depression, suffered brief loss of consciousness after 20 concussions and a 12-hour coma after one concussion
    • NFL4: 50-year-old former defensive lineman - mild cognitive impairment and depression, suffered two concussions w/ loss consciousness for 10 min after one of them
    • NFL5: 45-year-old former center - mild cognitive impairment, sustained 10 concussions and complained of light sensitivity, irritability, and decreased concentration after the last two
    ESPN identified two players by name and the others by position and age. The San Francisco Chronicle identified the players by position and symptoms. The actual journal article reported the symptoms along with histories of concussion.

    Mr. Clark, who has been doing quite well in his post-football life, was quoted in ESPN:
    Clark, now 65, said in an interview that he was exposed to limited contact and sustained only one major concussion during his career. During a 1972 game at Miami, he was holding on a field goal attempt that was blocked and was injured while trying to make the tackle.

    Film of the play failed to show how the injury occurred, and Clark didn't remember. "It was a total blackout," he said.

    Clark, who ran a Southern California video services business and officiated high school football games after his playing career ended, said he reacted with "interest, not alarm," after being told that he had signs of CTE.

    "I don't feel like I'm suffering from any real symptoms at this point, and didn't have any sense of anything going on except normal age-related issues," he said. He decided to participate in the hope that "it could help other people and maybe help me."

    What are the ethics of telling Mr. Clark that he has "signs of CTE" after a undergoing a scan that has not been validated to accurately diagnose CTE? It seems unethical to me. I imagine it would be quite surprising to be told you have this terrible disease that has devastated so many other former players, especially if your mood and cognitive function are essentially normal.

    One objection I raised previously was that FDDNP is not specfiic for tau; it also labels beta amyloid and prion proteins. If you take a look at the NFL3 brain above, it shows extensive signs of atrophy.1 He is the oldest participant, and his lifetime injuries were the most severe. But it's not clear whether this former player has Alzheimer's disease, CTE, or another neurodegenerative disorder.

    ESPN says the evidence in favor of CTE is definitive, however:
    CTE found in living ex-NFL players

    By Steve Fainaru and Mark Fainaru-Wada 

    Brain scans performed on five former NFL players revealed images of the protein that causes football-related brain damage -- the first time researchers have identified signs of the crippling disease in living players.

    Researchers who conducted the pilot study at UCLA described the findings as a significant step toward being able to diagnose the disease known as chronic traumatic encephalopathy, or CTE, in living patients.

    The SF Chronicle was a little more circumspect:
    A clue to brain disorder - before death

    By Drew Joseph 

    For the first time, scientists think they have detected in living patients a protein that accumulates in the brains of people suffering from chronic traumatic encephalopathy, a neurodegenerative disorder tied to repeated brain injuries that afflicts football players and military veterans.

    . . .

    The study was limited by the small number of participants, and the scientists could not definitively determine the protein was tau.

    That article also quoted an outside expert, UCSF neurosurgery professor Dr. Geoffrey Manley:
    More to be done
    Researchers cannot be sure if the protein was tau because the chemical marker binds to other proteins as well. Dr. Geoffrey Manley, a neurosurgery professor at UCSF and chief of neurosurgery at San Francisco General, said the study raises interesting ideas but cautioned that the findings need to be verified.

    "We need to make sure that all the basic science behind this is solid and we know beyond a shadow of a doubt that we're looking at tau," he said.

    Nonetheless, the bulk of the coverage has already diagnosed these men with CTE. It seems that Dr. Gary Small, study coauthor and FDDNP patent holder, has also diagnosed these patients, according to CNN:
    "We found (the tau) in their brains, it lit up," said Dr. Gary Small, professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA and lead author of the study, published Tuesday in the American Journal of Geriatric Psychiatry.

    What was startling, said Small, was the specific pattern of the tau they found: "It was identical to what's seen in a condition called chronic traumatic encephalopathy, CTE, that has only been diagnosed at autopsy." [NOTE: no, it's not.2]

    As I said before, I could be wrong about all of this and maybe FDDNP PET does provide a definitive diagnosis of CTE (the definition of which may need amending). But don't you want to be sure before breaking the news to one of your patients?


    Footnotes

    1 It's very easy to see enlargement of the ventricles and widening of the cortical sulci on this scan.

    2 In post mortem brain tissue, McKee et al. (2012) found neurofibrillary tangles (NFTs) in "focal epicentres in cerebral cortex, usually frontal lobe" in CTE stages I–II. It was not until CTE stages III-IV that they found "High densities of NFTs in thalamus, hypothalamus, mammillary bodies, brainstem." Presumably NFL1, NFL2, NFL4, and NFL5 are not showing advanced signs of pathology, given their mild (or non-existent) symptoms.


    References

    McKee, A., Stein, T., Nowinski, C., Stern, R., Daneshvar, D., Alvarez, V., Lee, H., Hall, G., Wojtowicz, S., Baugh, C., Riley, D., Kubilus, C., Cormier, K., Jacobs, M., Martin, B., Abraham, C., Ikezu, T., Reichard, R., Wolozin, B., Budson, A., Goldstein, L., Kowall, N., & Cantu, R. (2012). The spectrum of disease in chronic traumatic encephalopathy. Brain.

    Gary W. Small, Vladimir Kepe, Prabha Siddarth, Linda M. Ercoli, David A. Merrill, Natacha Donoghue, Susan Y. Bookheimer, Jacqueline Martinez, Bennet Omalu, Julian Bailes, Jorge R. Barrio (2013). PET Scanning of Brain Tau in Retired National Football League Players: Preliminary Findings. Am J Geriatr Psychiatry, 21.

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    Be a pioneer! Get in on the ground floor! Launch your career into orbit! Submit a paper to theIntergalactic Journal of Science special issue on “New Perspectives in Intergalactic Cognitive Science.”

    Here's the Call for Papers:
    Cognitive Science is expanding at an exponential rate. However, the field is in need of unification. A unification of the how and why of the great diversity of cognitive architectures. A unification of the experiental contents now believed to be so diverse. A unification of scientific method, now varying per stellar community.

    If you’ve been itching to write about “Phenomenology of guilt in a recently discovered synthetic-based species of robots” or “An experimental study on the effect of space-travel on short-term memory within carbon-based species,” then this is the journal for you.

    The Neurocritic has been a forward-looking blog since its inception seven years ago today, so it’s only appropriate to celebrate by embracing the cutting edge of cognitive science.

    See you in the future!

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    Should a professional society honor a highly accomplished investigator who conducted studies in the past that would now be considered unethical?

    Distinguished professor and clinical psychologist Dr. David H. Barlow was recognized for his achievements by the Association for Psychological Science (APS) last year as the recipient of the 2012 James McKeen Cattell Fellow Award:
    David H. Barlow has made enormous theoretical and empirical contributions in many areas of clinical psychology. He is best known for his efforts to develop psychological treatments for anxiety disorders. His early work on the treatment of agoraphobia laid the groundwork for exposure-based treatments that are today regarded as the gold standard. As we learned more about the relationship of agoraphobic avoidance to the occurrence of panic attacks, Barlow led the way in the development of treatments for the remediation of panic symptoms.

    Much of Barlow’s research is based on the notion that anxiety is a disorder of emotion. He holds this to be the case regardless of the specific emotional disorder, and this has led him in the later years of his career toward the development and testing of a unified protocol for the transdiagnostic treatment of such disorders....

    What you might not have known is that such disorders have included homosexuality and transsexualism. Barlow advocated and practiced aversion and conversion therapies to "cure" gay and transgendered people of their "deviant" sexuality.

    While I do not wish to detract from Dr. Barlow's many positive accomplishments, I feel it is important to expose the questionable practices of the past and to hold people accountable for their actions. I looked far and wide to find a mea culpa from Dr. Barlow, much like Dr. Robert Spitzer's public apology for his published work on reparative therapy as a "cure" for homosexuality (Spitzer, 2003).1 But I did not find such a statement anywhere.

    Should we question the judgment of APS in honoring Dr. Barlow with the Cattell Award? 2 Are they tacitly condoning exorcism in transsexuals (Barlow et al., 1977) and aversion therapy in gay men (Barlow et al., 1969; Hayes et al., 1983)? At the very least, APS did not publicly acknowledge or condemn these former practices, which remain secretly buried in the past.

    I contacted two divergent experts to ask their opinions. Psychologist Dr. John Grohol, who founded the mental health networking and education site Psych Central, turned the question around:
    "Should we honor professionals who may have made questionable judgments in their early career? I would ask a question in return -- Should we forever withhold such honors for the poor judgments one makes in one's early career?"
    On the other hand, Professor Lynn Conway, the pioneering computer scientist, electrical engineer, and transgender activist, was surprised about the award. She felt an appropriate course of action is...
    "... to expose these old miscreants and get their misdeeds on the record. That way they'll all have to run for cover in the years ahead..."

    Let's examine some of these practices below so you can decide for yourself.


    Exorcism for Transsexualism?

    As some of you might have gathered, I came across this paper during my exorcism researchBarlow and colleagues (1977) didn't actually perform the exorcism themselves, but observed the resulting change in behavior "fortuitously" and used it as an example of how atypical gender identity could be modified, if not prevented all together:
    Although the prevention of transsexualism is the ideal, work in this area has been fraught with ethical problems...
    The authors reported the detailed case history of "John", a 21 year old patient who had a clear identity as female and wished to transition. Before doing so, John was persuaded to visit a Fundamentalist Christian doctor, who performed an exorcism:
    The physician administered a total physical exam and said that he could live quite well as a woman, but the real problem was possession by evil spirits. After some discussion of this, John reported a session which lasted 2-3 hr and involved exhortations and prayers over John by the physician and laying on a hands on John's head and shoulders. During this period, John reported fainting several times and arising to the continuing of the prayers and exhortations, resulting in the exorcism of 22 evil spirits which the physician called by name as they left his body.  ... The physician noted ... that he showed John that his life was a fake and that Jesus could redeem him and that a standard prescription of Scripture readings caused the spirit of the woman in John to disappear.

    Immediately after the session John announced he was a man, discarded his female clothes (hiding his breasts as best he could), and went to the barber shop to have his long hair cut into his current short, masculine style...

    Rather than condemn the outlandish and unethical behavior of this physician, and counsel John (who had identified as Judy) on her previously excellent adjustment as female and readiness for surgery, they considered this a successful change in gender identity. An even more questionable event was a visit to a faith healer. After the laying on of hands, John reported that his breasts (size 36B) had disappeared immediately. Personally, I think a psychiatric assessment would have been in order.

    Very worth reading in regard to this paper is the text on Rogue Theories of Transsexualism written by Professor Conway. She says that "By seeing a collection of such theories side-by-side, we grasp the strangeness of them all."


    Aversion Therapy to Cure Sexual Deviance

    Even more outrageous were the papers on aversion therapy. As a prelude to the actual practices described by Barlow et al. (1969), I will use American Horror Story: Asylum as a near-exemplar.



    The year is 1964. Lana Winters is a reporter investigating the unethical practices at Briarcliff Manor, a mental institution for the criminally insane. She's caught snooping around and is committed against her will to keep her quiet, with the ostensible reason being that she is gay. She is forced to have shock treatment. Sympathetic psychiatrist Dr. Oliver Thredson tries to persuade her to undergo aversion therapy, which is presented as more "humane." She eventually agrees because she thinks it'll get released her from Briarcliff once Thredson pronounces her "cured."

    Under the direction of Dr. Thredson, Winters views a slide show of erotic pictures of women. She has an iv drip going into her left arm. She starts to get physically ill while viewing the slides and then throws up into a metal bucket.




    Winters: "What is this stuff?"

    Thredson: "Apomorphine. Standard drug for this kind of cutting edge aversion therapy. They use it at Harvard, Brigham Young, Cornell. The theory is that we're training your body to be physically repelled by certain.....triggers."

    Next slide: a picture of her girlfriend smoking a cigarette in bed. He cranks up the apomorphine until she vomits again.


    Experimental control of sexual deviation through manipulation of the noxious scene in covert sensitization

    Come on, you're saying, it couldn't have been that bad in real life. Plus the paper was published in 1969, that's ancient history by now. But if you were one of the men interviewed for this story on When gays were 'cured', you might think otherwise.

    Barlow et al. (1969) didn't actually administer apomorphine, but they did try to make same sex attraction as physically repulsive as possible. The study was a case report of two patients treated with aversion therapy. One especially offensive aspect of the paper is that a pedophile and a gay man were treated as equivalently deviant. The description of the gay subject was particularly condescending:
    The S2 was a 32-yr.-old married male who reported a 14-yr. history of homosexual experiences averaging about three contacts per week, usually in public toilets. He recently had fallen in love with a "boyfriend," which was threatening his marriage and which motivated him to seek treatment. Sexual relations with his wife, although prevalent early in the marriage, had been virtually nonexistent for the previous 3 yr.
    The protocol paired descriptions of sexually arousing scenes with nauseating scenes.  I'll quote the noxious script in its entirety to allow the full impact to wash over you:
    In each session Ss were given relaxation instructions and presented with eight scenes. In four scenes S was described approaching the small girl (male), feeling nauseous and vomiting. For example, in one of the homosexual scenes, S2 was described approaching his boyfriend's apartment.

    "As you get closer to the door you notice a queasy feeling in the pit of the stomach. You open the door and see Bill lying on the bed naked and you can sense that puke is filling up your stomach and forcing its way up to your throat. You walk over to Bill and you can see him clearly, as you reach out for him you can taste the puke, bitter and sticky and acidy on your tongue, you start gagging and retching and chunks of vomit are coming out of your mouth and nose, dropping onto your shirt and all over Bill's skin."

    The description of the nauseous scene was usually expanded and lasted from 30 to 60 sec. In the remaining four scenes S would be described approaching the small girl (male) and beginning to feel nauseous. At that point he would turn, start walking away from the scene, and immediately feel relieved and relaxed.

    They concluded that an intensely disgusting and obnoxious scenario could serve as a substitute for apomorphine and shocks in aversion therapy designed to straighten out gay men.

    A follow-up experiment with four gay male subjects manipulated the instructions given during phases of covert sensitization (pairing of sexually arousing scenes with vomiting scripts) and extinction (no pairing). To assess the effects of treatment on arousal patterns, penile circumference was measured while the subjects viewed slides of nude men (Barlow et al., 1972).


    1973 and Beyond

    The American Psychiatric Association removed homosexuality from its list of mental illnesses in 1973. (see DSM-II Homosexuality Revision). Should we forgive Barlow for work conducted before then? He was still a strong advocate of aversion therapy around this time (Barlow, 1973):
    "[other authors] speak of the necessity of increasing more appropriate and assertive heterosocial behaviors in the treatment of sexual deviation. Despite these views, aversion therapy aimed at eliminating sexual deviation is increasingly advocated as the treatment of choice (Barlow, 1972), due in part to the growing application of the experimental behavioral sciences to the clinic and in part to the relative success of this technique..."

    Dr. Grohol made the following observation:
    "At the time, [homosexuality] was a recognized mental disorder, so it may have been a reasonable area in which to conduct research. While it's both difficult and repugnant to utter those words today, it highlights one of the drawbacks of the DSM classification system -- it's a malleable, social-constructed manual as much as it is based in hard, scientific data."

    Barlow continued to publish accounts of homosexual conversion treatments after 1973 involving exposure to male and female nudes (and porn) while penile circumference was measured (Herman et al., 1974; Barlow et al., 1975).  The latest one I could find was from 1983, which treated one exhibitionist, two pedophiles, and one gay man with covert sensitization (Hayes et al., 1983). The technique paired arousing scenes with aversive scenes designed to disgust or humiliate the participant. The authors issued a caveat, yet accepted the gay man into this treatment program and continued to use the term "deviant" (just to be consistent with the criminals):
    Subject 2, an unemployed 39-yr-old single white male, sought treatment to decrease homosexual behavior and to increase heterosexual arousal (thus, he is not sexually deviant by current classification).* 
    . . .

    Despite the strong recommendations by some (e.g. Begelman, 1975) not to treat homosexuals for their homosexuality, this individual had clearly stated his preferences and was accepted into treatment.

    *The use of terms like ‘deviant arousal’ is problematic with this subject, but they are used for the sake of consistency. ‘Undesired arousal’ is more accurate and better reflects our attitudes towards this case.

    Did any of these behavior therapy techniques work? There's no evidence that they did. Studies were poorly controlled and overly reliant on self-report, follow-ups were brief, and participants were inadequately characterized (Serovich et al., 2008). Moreover, there is ample evidence that the treatments were harmful (King & Bartlett, 1999). Some patients became severely depressed and suicidal.

    Not all behavior therapists were in favor of pathologizing homosexuality in the early-mid 1970s. Dr. Gerald C. Davison, President of the Association for Advancement of Behavior Therapy (AABT) from 1973-1974, gave an impassioned speech at the annual meeting where he argued against the use of conversion therapies for gays and lesbians (Sept. 2003 AABT Newsletter, PDF).3


    In their review on British psychiatry and homosexuality, King and Bartlett (1999) suggested that mental health professionals should be aware of past mistakes, including ones they themselves may have committed:
    Although many professionals may have been well intentioned in helping a disadvantaged group of patients towards what they regarded as a better adjustment to life, very few seem to have later questioned the wisdom of their work. In the past 20 years, one psychiatrist has written of the excesses of the profession (Bancroft, 1975, 1995). Bancroft claimed that he would not now provide aversion therapy because of its limited effectiveness and because of different social attitudes towards homosexuality (Bancroft, 1991, 1995). Others who published in the British psychiatric press, such as Nathaniel McConaghy in Australia, continued to defend their methods into the 1980s.  ...  Professionals who published extensively on this topic, such as Bancroft, McCulloch, McConaghy, McDougall, Storr and Glasser, remain in prominent positions as commentators or as principals or chairs in institutions around the world.

    It is my view that many more of these distinguished professionals should publicly reconsider their earlier work, as did Spitzer and Bancroft. To be forgiven, they must acknowledge their wrongdoing.

    I e-mailed to Dr. Barlow to ask if he had any comments about his early work in light of contemporary views of homosexuality, or whether he had issued such a statement in the past. I haven't heard back, but I will post such remarks (with permission) if I receive them.

    Ironically, Barlow ended his 2012 acceptance speech with the following important yet vague words:
    "Time marches on. Ideas change — hopefully for the better."


    Footnotes

    1 From Spitzer reassesses his 2003 study of reparative therapy of homosexuality in the Archives of Sexual Behavior (the same journal that published his original study):
    I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some “highly motivated” individuals.
    2 However, APS is certainly not unique in honoring Dr. Barlow, who is the author of over 500 articles.

    3 Meanwhile, Barlow (who was AABT President from 1978-1979) published the "Heterosocial Skills Behavior Checklist for Males" in 1977 (Barlow et al., 1977). It was used to evaluate the behavior of sexual deviants (in this case, "five homosexuals, two transsexuals, one pedophiliac, one sadist, and one rapist"). One nugget of wisdom: when interacting with a member of the opposite sex, it is inappropriate to "giggle or laugh in a high-pitched manner, staccato and uncontrolled."


    References

    Barlow DH (1973). Increasing heterosexual responsiveness in the treatment of sexual deviation: A review of the clinical and experimental evidence. Behavior Therapy 4:655-671.

    Barlow DH, Abel GG, & Blanchard EB (1977). Gender identity change in a transsexual: an exorcism. Archives of sexual behavior, 6 (5), 387-95. PMID: 921523

    Barlow DH, Agras WS, & Leitenberg H (1972). The contribution of therapeutic instruction of covert sensitization. Behaviour research and therapy, 10 (4), 411-5. PMID: 4637499

    Barlow DH, Agras WS, Abel GG, Blanchard EB, Young LD. (1975). Biofeedback and reinforcement to increase heterosexual arousal in homosexuals. Behav Res Ther. 13:45-50.

    Barlow DH, Leitenberg H, & Agras WS (1969). Experimental control of sexual deviation through manipulation of the noxious scene in covert sensitization. Journal of abnormal psychology, 74 (5), 597-601. PMID: 5349402

    Hayes SC, Brownell KD, & Barlow DH (1983). Heterosocial-skills training and covert sensitization. Effects on social skills and sexual arousal in sexual deviants. Behaviour research and therapy, 21 (4), 383-92, PMID: 6138027

    Herman SH, Barlow DH, Agras WS. (1974). An experimental analysis of exposure to "explicit" heterosexual stimuli as an effective variable in changing arousal patterns of homosexuals. Behav Res Ther. 12:335-45.

    King M, Bartlett A. (1999). British psychiatry and homosexuality. Br J Psychiatry 175:106-13.

    Serovich JM, Craft SM, Toviessi P, Gangamma R, McDowell T, Grafsky EL. (2008). A systematic review of the research base on sexual reorientation therapies. J Marital Fam Ther. 34:227-38.

    Spitzer RL. (2003). Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Arch Sex Behav. 32:403-17.

    Spitzer RL. (2012). Spitzer reassesses his 2003 study of reparative therapy of homosexuality. Arch Sex Behav. 41:757.


     
    Dr. David H. Barlow - APS 24th Annual Convention (2012)

    "Time marches on. Ideas change — hopefully for the better."
    -David H. Barlow

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    In a stunning new finding, a German neurologist has discovered the locus of evil in the brain, indicated by red arrows in the figure above. It shows up as a dark mass on the MRI of every single evil person in the universe.

    Dr Gerhard Roth told The Daily Mail:
    'We showed these people short films and measured their brain waves,' he said.

    'Whenever there were brutal and squalid scenes the subjects showed no emotions. In the areas of the brain where we create compassion and sorrow, nothing happened.'

    The dark mass at the front of the brain, he says, appears in all scans of people with records for criminal violence.

    It's truly remarkable that brain waves (EEGactivity) show up in the shape of a Hitler moustache on an MRI scan. Let's take a closer look at the original story:

    Where evil lurks: Neurologist discovers 'dark patch' inside the brains of killers and rapists
    • Scans reveal a patch at the front of the brain can be seen in people with records for criminal violence 
    • German scientist who made the discovery classifies evil in three groups
    By Allan Hall In Berlin
    PUBLISHED: 10:32 EST, 5 February 2013 | UPDATED: 18:29 EST, 5 February 2013

    A German neurologist claims to have found the area of the brain where evil lurks in killers, rapists and robbers.

    Bremen scientist Dr Gerhard Roth says the 'evil patch' lies in the brain's central lobe and shows up as a dark mass on X-rays.

    . . .
    He added: 'When you look at the brain scans of hardened criminals, there are almost always severe shortcomings in the lower forehead part of the brain.

    . . .
    'Or there are physiological deficits, because certain substances such as serotonin in the forebrain are not working effectively.

    'But this is definitely the region of the brain where evil is formed and where it lurks.


    The Reality

    OK, I superimposed the Hitler moustache on the scan above. But in reality, this is one of the most ridiculous news stories about the brain to come along in quite a while. Clearly, The Daily Mail did not get the memo on the backlash against Brain Porn and Neurobollocks in the popular press.

    There is no such thing as the 'central lobe', and 'the lower forehead part of the brain' is not a descriptive anatomical term. The 'dark patch' is clearly some sort of artifact, along with the black diagonal bar coming out of the skull. This is truly a laughable attempt at science journalism, and rather damaging to Dr. Roth's reputation (although that's his own fault).

    As Vaughan Bell said in his post on The dark patch of death:

    "...it’s not satire if written while high on cleaning products."

    Link via @Keith_Laws


    ADDENDUM (Feb 8, 2013): An indignant anonymous German commenter alerted me to a press release from Universität Bremen saying that the "central lobe" does not exist at all, and the terminology was "due to a deep misunderstanding of statements in an interview." My reply to this comment suggested there were other problems with the ideas expressed in the tabloid articles and noted that Dr. Roth's ideas have been criticized previously.


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