Being Human

One of the most influential and controversial papers in psychiatry was from a 1976 study published in The Lancet that found that people with schizophrenia had larger fluid filled ventricles in the brain.

Yesterday, I looked up the original paper in London's Institute of Psychiatry library and was amazed to see that the controversy seems ingrained into the paper copy, which has been ripped, repaired, damaged and defaced.

In the early days of scientific psychiatry, during the 1800s, many famous German psychiatrists expended a great deal of effort examining the post-mortem brains of patients with schizophrenia (also known at that time as dementia praecox) attempting to demonstrate Wilhelm Griesinger's theory that "all mental illness is disease of the brain."

Despite numerous studies, they were unable to replicate the success of studies on dementia, which they linked to specific changes in the brain. So for generations, schizophrenia came to be defined as a condition in which the brain was structurally normal.

This fact was often highlighted by the antipsychiatry movement to suggest that 'mental illness' was nothing more than a difference in human experience and there was no medical evidence supporting the work of psychiatrists.

But the fact was also cited by many psychiatrists resistant to the relatively new wave of medications that had appeared on the scene. The drugs were claimed to 'fix' the brain with the assumption that the discovery of clear evidence for brain differences would just be a matter of time.

Enter Eve Johnstone and her colleagues at Northwick Park Hospital in London, who, in the midst of this politically charged environment, completed a study that compared CAT brain scans of 18 patients with schizophrenia to a group of healthy control participants. Alongside the scans, the researchers also tested the participants' mental abilities with psychological tests.

The results were striking. They found the size of the ventricles, the fluid filled spaces in the brain, was, on average, larger in patients with schizophrenia and that it was correlated with the degree of difficulty with tests of memory, concentration and problem solving.

This caused enormous interest and controversy at the time. The paper copy from London's Institute of Psychiatry library clearly reflects this, as it has been read so many times (and possibly ripped out) that it is virtually in tatters and has been reattached with sticky tape in an otherwise pristine copy of the journal.

There are a few annotations on the page, including the word "Rubbish" written in the margin!

Although seminal, the study has been rightly criticised and one of the major difficulties with these sorts of studies is that because patients are normally taking antipsychotic medication, it's hard to distinguish where the effect is linked to schizophrenia or the treatment.

While some medication is thought to also thought to affect brain structure, a study on patients that have never taken medication seem to suggest some differences in ventricle size, on average, are still apparent.

The 'on average' bit is important though, as these differences are not present in everyone with the diagnosis. They're just an average difference when you compare a group of people with and without schizophrenia. Furthermore, we're still not quite sure of its significance.

So the topic is still as controversial as when Johnstone's study first appeared in 1976, although the argument has shifted from whether differences in the structure of the brain are associated with schizophrenia, to whether they are telling us anything useful.

Link to scan of article from Institute of Psychiatry library.
Link to PubMed entry for same.

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When phrases are coordinated, readers infer that the the juxtaposed elements are in some way parallel. Careless coordination produces unwanted inferences. Today's Daily Beast serves up an object lesson:

Stunned colleagues Friday described veteran CBS News producer Joe Halderman—who was arrested outside the network’s West 57th Street offices Thursday in the alleged scheme to blackmail David Letterman—as a rogue and a womanizer, a lover of literature, a “smart frat boy,” a swashbuckling journalist, and an occasional barroom brawler who distinguished himself in dangerous war zones and occasionally displayed a certain reckless streak.

Fucking literature lovers.

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I just found a curious case study of a man who developed 'robotic speech' after being hit by lightning. Rather than the "I am a Dalek!" style mechanical sound it seems to be more like the very. deliberate. and. exact. speech synthesis style, somewhat like Data from Star Trek the Next Generation

Lightning-induced robotic speech

Neurology. 1994 May;44(5):991-2.

To the Editor

Because of a recently observed case, I was intrigued by the communication of Cherington et al[1] concerning lightning encephalopathy. The authors referred to evidence by Critchley[2] that the cerebellum can be selectively injured in lightning-struck patients, Two of their there patients had signs of cerebellar dysfunction. MRI in one of their patients evidenced superior cerebellar atrophy.

The force of a lightning strike threw a 20-year-old roofer to the ground from the truck in which he was standing. Panicked, he immediately began to run. A numbness and weakness of his arms and back cleared after several days, but the more striking abnormality was a profound alteration of his speech, which he described as having become robotic. Each syllable was clearly enunciated with a slight pause between syllables, so that while the flow of his speech was slowed, he was able to communicate well. His speech was actually easier to comprehend than that of some normal persons. His brother had indeed complained that the patient's premorbid speech had been too rapid and word-jumbled; that speech was transformed to robotic speech, with fine diction and super-clear enunciation. Each morning, his speech was "normal" until shortly after he began to talk, when it reverted to the robotic pattern for the remainder of the day. The neurologic examination was normal except for right upper extremity hypalgesia. Brain MRI was normal.

I considered his robotic-speech problem to be most like the "scanning speech" of cerebellar disease. I have found no references to similar cases, but the reports of selective cerebellar injury by lightning strike[1-3] lead-me to suspect that robotic speech maybe a more common sequel than has been recognized.

Gordan J. Gilbeft, MD
St. Petersbutg, FL

1. Cherington M, Yarnell P, Hallmark D. MRI in lightning encephalopathy. Neurology 1993; 43(7):1437-8
2. Critchley M. Neurological effects of lightning and electricity. Lancet 1934;1:68–72
3. Morocutti C, Spadaro M, Amabile G. TRH treatment in cerebellar ataxia following a lighting stroke. Ital J Neurol Sci 1989;10:531.

The original authors reply and seemed somewhat baffled, saying that it could equally arise from the shock of the experience rather than damage to the brain.

Link to PubMed entry for case study.

Prospect magazine has an interesting article covering psychologist Irving Kirsch's widely publicised meta-analyses that have questioned whether Prozac-style SSRI antidepressants are any better than placebo.

Kirsch has become well known for requesting unpublished trial data via the US Freedom of Information Act and pooling it with the published evidence. The conclusion of his latest re-analysis was that there was little difference between sugar pills and SSRIs in the treatment of depression.

This has kicked up all sorts of merry hell, not least because the media reported (and the Prospect article implies) that 'antidepressants don't work' which is clearly false. They do work, but the debate is over how much of the effect is due to placebo.

It's not quite as simple as it seems of course, as not everyone agrees with Kirsch's methods and, as noted in an insightful 2008 paper, his argument is based on the assumption that people who respond to antidepressants also respond to placebo in a similar way, when we know there are individual variations in both.

Kirsch apparently has a book coming out shortly which is likely to restart the debate and it's likely to be heated.

There are some hints of this in the article where several prominent psychiatric scientists give variations on the "don't criticise the evidence, you're harming children!" argument. In fact, head of the NHS trust where my research institution is based apparently blames 'the media, and psychologists' "who have a vested interest in constantly attacking antidepressants". Yes, we've reached that level already.

We went through a very similar process when concerns over whether SSRIs increased suicidal thinking in adolescents were raised. Lots of similar mud-flinging ensued.

Interestingly, a meta-analysis of suicide attempts and suicidal thoughts in 372 trials just published in the British Medical Journal found that overall SSRIs had no effect on risk of self-harm, and that when the data was divided by age, there was a slight increase in thoughts and attempt in people younger than 25 and a slight decrease in adults aged over 65 (the comments on the article are also worth reading).

It's probably worth saying that even in young people self-harm when taking antidepressants is very rare, but the fact that the drugs had no overall protective effect except in older people should give us pause for thought.

But getting people to focus on the evidence when they're wound up is like getting people to focus on the fire exits during a strip show. We all accept the importance of doing so but few can quite manage it when the time comes.

Link to Prospect article on antidepressants (via @researchdigest)

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The New York Times has an absolutely fantastic article on the psychology and neuroscience of anxiety and how an anxious temperament at birth can ebb and flow during our lifetime.

It's an in-depth article that really does justice to the topic, looking at extensive research into our anxious states, but also carefully questioning some of the sloppy assumptions of many article where brain activity is described as directly representing mental states.

But having all the earmarks of anxiety in the brain does not always translate into a subjective experience of anxiety. “The brain state does not make it a disorder,” Kagan told me. “The brain state exists, and the statement ‘I’m anxious,’ exists, and the correlation is imperfect.” Two people can experience the same level of anxiety, he said, but one who has interesting work to distract her from the jittery feelings might do fine, while another who has just lost his job spends all day at home fretting and might be quicker to reach a point where the thrum becomes overwhelming. It’s all in the context, the interpretation, the ability to divert your attention from the knot in your gut.

The article is incredibly well written and it tackles a huge range of topics in the understanding of fear and anxiety. Highly recommended.

Link to NYT article 'Understanding the Anxious Mind' (via @mocost)

Rick Rubenstein wrote:

Is the usage "I can't speak to the Iranian situation" as opposed to "I can't speak [about/regarding] the Iranian situation" relatively recent (or at least recently accelerating), as I perceive it to be? I feel as though I first noticed it about a decade ago, and found it very strange. I'm now almost accustomed to it.

There's no question that "speak to (a topic)" is quite a bit more recent than "speak of (a topic)", and somewhat more recent than "speak about (a topic)". But Rick is probably not old enough to have noticed the difference.

In the OED's entry for speak, the sub-entry II.11.a. Speak of, which is glossed "To mention, or discourse upon, in speech or writing", is cited from about 825:

c825 Vesp. Psalter cxviii. 46 [Ic] sprec of cyðnissum ðinum in ᵹesihðe cyninga. c950 Lindisf. Gosp. Luke ix. 11 [He] spræcc him of ric godes. c1175 Lamb. Hom. 73 Of þe halie fulht spec ure drihten on oðer stude. c1200 ORMIN 6784 Goddspellboc ne spekeþ þ nohht Off all þatt oþerr genge. c1340 HAMPOLE Pr. Consc. 2683 Here es þe thred parte of þis buke spedde Þat spekes of þe dede. 1422 Secreta Secret., Priv. Priv. 203 Of this Spekyth the boke of Iudyth. 1530 PALSGR. 727/2, I go nowe beyondsee, but if God send me lyfe you shall here speke of me. 1603 PARSONS Three Convers. Eng. II. viii. 481, I shall haue occasion to speake againe of these heretiks in the next chapter. 1730 A. GORDON Maffei's Amphith. 58 The Theatre..is spoke of by Martial. 1818 SCOTT Br. Lamm. xviii, ‘And speaking of red-game,’ said the young scape-grace, interrupting his father. 1884 tr. Lotze's Metaph. 43 A common-place with every philosophy which spoke of Things at all.

In contrast, the sub-entry II.14.e. Speak to, glossed "To treat of or deal with, to discuss or comment on, (a subject) in speech or writing", is only cited from 1610, almost eight centuries later:

1610 J. DOVE Advt. Seminaries 42, I desire them therefore..to speake to these foure points. 1637 HEYLIN Answ. Burton 78, For your charges,..I meane to take them..in order, and speake as briefely to them, as you would desire. 1662 STILLINGFL. Orig. Sacræ II. vi. §4 Though it be a subject little spoken to either by Jewish or Christian Writers. 1706 STANHOPE Paraphr. III. 555 Part of this Scripture hath already been spoken to. 1724 SWIFT Drapier's Lett. Wks. 1755 V. II. 110 A lawyer, who speaks to a cause, when the matter hath been almost exhausted by those who spoke before. 1778 EARL MALMESBURY Diaries & Corr. I. 166 Unprepared as he was for such a proposition, he could not, he said, off-hand, speak to it accurately. 1869 Daily News 28 Apr., The report..was spoken to by the Most Rev. Chairman..and the Bishop of Derry. 1880 Ibid. 19 Mar. 2/3, I wish to call your attention..to..that allegation, and I shall endeavour to speak to it.

As for Speak about (sub-entry II.8), it's cited back to 1300 or so, validating Rick's sense of its antiquity:

a1300 Cursor M. 24795 For to spek abute sum pais. 1605 SHAKES. Macb. I. iii. 83 Were such things here, as we doe speake about? 1671 H. M. tr. Erasm. Colloq. 263 He falls on speaking about the success of their business. 1737- [see 14b]. 1843 J. H. NEWMAN Lett. (1891) II. 430 Sermons which speak more confidently about our position than I inwardly feel.

Rick also asks, "I'm also curious which side of the Atlantic this usage may have sprouted from." It seems clear from the OED entry that all the early action was on the British side of the Atlantic.

More seriously, it's quite possible that there's been a recent to-ward change in the balance of usage among the prepositions used with speak to express topic (which include at least of, about, regarding, on, upon, and to, of course with somewhat different shades of meaning and structural distributions).

Unfortunately, it's going to be a chore to test this quantitatively. One obvious problem is that there may be various things between the verb and a prepositional phrase expressing topic, e.g. "Mr. Pettijohn spoke at length regarding the Rocky Top Road issue". Another, more serious, problem is that in most instances of "speak to", the object of to is the audience, not the topic ("Palin Speaks to Investors in Hong Kong"). So (lacking an automatic classifier with adequate performance), you'd have to get a suitable random sample of instances of speak over time, and classify each one by hand. This is likely to take more work than will fit into one Breakfast Experiment™, at least with the resources now available to me.

[Note that the specific pattern "speak to the * situation" is apparently not common enough to support a trend analysis. For example, it has apparently only occurred once in the NYT news archive since 1981. So the net would have to cast more broadly in order to spot a trend, I think.]

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Quick links from the past week in mind and brain news:

USA Today has an interesting piece on how social networking sites are becoming research targets in health and psychology.

The oft-replicated finding in relationship research that, on average, women would be most hurt by romantic betrayal and men by sexual betrayal, is covered by Cognitive Daily.

New Scientist discusses a new imaging study that highlights the importance of the hippocampus in conceptual learning.

Love is a like a zoom lens, according to The Guardian. Sex is like a microscope, or an oscilloscope, depending on what you're in to.

The New York Times has a piece on increased rates of dementia seen in American football players and how the NFL are trying to downplay the data.

Do people really lie three times within 10 minutes of meeting someone new? asks PsyBlog questioning the common statistic.

Time reports on a study finding that social comparisons with thin people who are big eaters can lead people to choose larger food portions.

Gamers are more aggressive to strangers, says New Scientist who clearly haven't read the study which didn't measure aggression to anyone.

Time magazine has another good article on how frequency of email contact can be modelled with a remarkable simple mathematical formula.

Religion protects against drug use in dance. Doping in ballroom dancing, who knew? (apart from Jesus)

Furious Seasons covers a new study finding that the majority of psychiatric drugs are prescribed by family doctors.

I wish I could be at the Encultured Brain conference, organised by the chaps from the excellent Neuroanthropology blog.

The Globe and Mail covers research on how women's attitudes to their genitals is linked to orgasm frequency and health behaviour.

The development of implantable electronic http://www.nytimes.com/2009/09/27/health/research/27eye.html?em=&pagewanted=all">retinas is covered by The New York Times.

Both the British and American psychology associations have just launched their respective history of psychology websites.

New Scientist covers an overly melodramatic promo video by charity Autism Speaks and the spoof videos by people with autism.

The limits of a universal view of mental illness are discussed by Frontier Psychiatrist.

Psychiatric Times has concluded a three part series on the science behind fMRI brain scanning experiments.

Can the right kinds of play teach self-control in children? asks The New York Times as it discusses a radically different approach to child behaviour.

BBC News reports on a new study of treatment for drug addicts in the UK and finds treatment programme successes are encouraging.

Anticipating an interaction with an obese person provokes feelings of social power, reports the BPS Research Digest.

The Neurocritic has a neurogasm which looks more like a shampoo bottle than a drink but Paris Hilton is having one so it must be science, right?

The interesting origins of the British Prime Minister on antidepressants so what poppycock is tackled by Neuroskeptic.

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