Tag Archives: psychiatry

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The cognitive benefits of sadness

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Jonah Lehrer at Wired has been looking into recent research into depression, and wondering whether it isn’t in fact a sort of evolutionary advantage.

The study itself was simple: A large group of subjects ranging from healthy to clinically depressed played a decision-making task on a computer. Their goal of the task was to hire the best applicant in a simulated job search. Each applicant was assigned a monetary value – some were much better than others – and presented in random order to the subjects.

While this task might seem somewhat arbitrary, the scientists note that it closely resembles a common everyday dilemma. It doesn’t matter if we’re shopping for clothes or going on dates — it’s often unclear when we’ve explored enough options, when we should stop searching and just make a damn decision. Furthermore, this task was designed so that it has a known optimal strategy, with the best decision-makers sifting through a certain number of alternatives.

Here’s where things get interesting: depressed patients approximated the optimal strategy much more closely than non-depressed participants did. The main problem with healthy subjects is that they proved lazy, unwilling to search through enough applicants. Those with depression, on the other hand, were much more willing to keep on considering alternatives, which is why they performed far better on the task. While this study comes with many caveats, it remains an interesting demonstration that depression, at least in specific situations, seems to enhance our analytical skills, making us better at focusing on social dilemmas.

It’s a very seductive idea for anyone who has ever experienced clinical depression (which I have and still do), but a decade of hanging around on the internet has made me leery of what I think of as “wish-fulfilment science” – these are bits of science journalism, usually psychological diagnoses, that make you feel that your particular affliction actually makes you a superior snowflake rather than simply a special one.

(For an extreme version of such, see Gary Westfahl’s earnest but extraordinarily ill-advised Aspergers confessional at Locus Online; “fans are Slans”, indeed. It’s one thing to “own” your afflictions, but very much another to claim they put you in the evolutionary vanguard.)

But as Lehrer points out, the prevalence of depression suggests there must be some evolutionary benefit to it, and my own experiences of rumination match up strongly with what he’s discussing, with respect to obsessing over social dilemmas and so forth. Does that make depressed people somehow “better” than everyone else? I don’t think so; the price is pretty high, and the insights gained into oneself and the world aren’t necessarily the sort of insights that make it any easier to sleep at night. (Quite the opposite, in fact.)

That said, I’ve always refused pharmacological treatments for it… partly because I’ve seen what antidepressants have done to people I’ve known for years (I don’t see chronic anxiety, character change and mood swings as a “cure”, I’m afraid), but mostly because, as Tennessee Williams put it, I worry that killing my demons might kill my angels as well.

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Morgellons: mystery illness or memetic hysteria?

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Fascinating article over at The Guardian about morgellons, which – depending on who you ask – are either an as-yet unrecognised parasitic disease that causes unidentifiable fibers to grow through human skin, or a delusional condition whose symptoms are passed around from sufferer to sufferer in much the same way as the latest lulzy meme on the intertubes.

Morgellons was named in 2001 by an American called Mary Leitao, whose son complained of sores around his mouth and the sensation of “bugs”. Examining him with a toy microscope, Leitao found him to be covered in unexplained red, blue, black and white fibres. Since then, workers at her Morgellons Research Foundation say they have been contacted by more than 12,000 affected families. Campaign group the Charles E Holman Foundation states there are sufferers in “every continent except Antarctica”. Thousands have written to Congress demanding action. In response, more than 40 senators, including Hillary Clinton, John McCain and a pre-presidential Barack Obama, pressured the Centres For Disease Control And Prevention (CDC) to investigate; in 2006, it formed a special taskforce, setting aside $1m to study the condition. Sufferers include folk singer Joni Mitchell, who has complained of “this weird incurable disease that seems like it’s from outer space… Fibres in a variety of colours protrude out of my skin: they cannot be forensically identified as animal, vegetable or mineral. Morgellons is a slow, unpredictable killer – a terrorist disease. It will blow up one of your organs, leaving you in bed for a year.”

So it’s new, frightening and profoundly odd. But if you were to seek the view of the medical establishment, you’d find the strangest fact about this disease: morgellons doesn’t exist.

Based on the article and my (admittedly limited and mostly second- and third-hand) experience with delusional and paranoid conditions, I’m putting my money on morgellons being a Western technologised equivalent to the witchdoctor penis-theft scares that you hear about sometimes. The caveat here, of course, is that I Am Not A Doctor, Nor Do I Play One On Television, and that the writer of the piece might have cherrypicked the quotes that made the cut, but even so, the casual similarities in language between morgellons sufferers and, say, alien abductees or conspiracy theorists is hard to escape:

Threads of conversation rise from the hubbub: “I mix Vaseline with sulphur and cover my entire body”; “The more you try to prove you’re not crazy, the more crazy they think you are”; “The whole medical community is part of this. I wouldn’t say it’s a conspiracy but…”

Many of the attendees have been diagnosed with DOP [Delusions of Parasitosis], a subject that enrages one of the first speakers – Dr Greg Smith, a paediatrician of 28 years’ experience. “Excuse me, people!” he says. “This is morally and ethically wrong! So let me make a political statement, boys and girls.” He pulls off his jumper, to reveal a T-shirt reading, “DOP” with a red line through it. “No more!” he shouts above wild applause. “No more!”

Later, Smith tells me he’s been a sufferer since 2004. “I put a sweatshirt I’d been wearing in the garden over my arm and there was this intense burning, sticking sensation. I thought it was cactus spines. I began picking to get them out, but it wasn’t long before it was all over my body.” He describes “almost an obsession. You just can’t stop picking. You feel the sensation of something that’s trying to come out of your skin. You’ve just got to get in there. And there’s this sense of incredible release when you get something out.”

[…]

The next day, nursing practitioner Dr Ginger Savely, who claims to have treated more than 500 morgellons patients, leads an informal discussion in the conference room. Around large circular tables sit the dismissed and the angry. “I’ve seen a fibre go into my glasses,” says one. “I’ve seen one burrow into a pad,” adds another. “One of my doctors thinks it’s nanotechnology”; “I was attacked by a swarm of some type of tiny wasps that seemed to inject parts of their bodies under my skin”; “They have bugs on public transport. Never put your suitcase on the floor of a train.”

OCD, paranoia, compulsive cleanliness… morgellons clearly exists, but whether it exists anywhere other than the minds of its victims is a question for folk more qualified than myself. (Also, the quote about a doctor “thinking it’s nanotechnology” suggests either quackery or, at best, pandering. The cynic in me suspects a lot of these poor people have been strung along by consultants of dubious ethical integrity; that particular social disease is as old as medicine itself, if not older..)

Even assuming that morgellons is a delusional condition whose symptoms are passed on in a memetic fashion, though, an interesting question arises: could this phenomenon be weaponised somehow? Why use a real biological weapon, with its potential to harm your own people as easily and indiscriminately as your enemies, when simply deluding an entire city or nation-state into thinking they have some debilitating syndrome would do the same job? If you did so, would the more paranoid of your own troops – believing it possible that the disease isn’t fake at all and that they’re being duped as well – acquire the symptoms sympathetically? And if a condition can be passed from person to person in such a way, even if there’s no demonstrable medical cause or trigger for it, is it any different to a “real” disease after all? Perhaps the software of the human platform has finally got sufficiently sophisticated and networked to evolve its own code-only viruses…

… unless they were coded up by whatever the human-hardware equivalent of a bot-net operator is. Which sounds pretty far fetched, of course. But maybe that’s just what They want you to think? 😉

Footnote: I wonder if the above article will provoke a sudden spike in new sufferers coming forward?

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Schizophrenia: caused by retroviruses?

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I remember blogging the toxoplasma-causes-schizophrenia speculation right here back in 2006, and it’s been a hardy perennial on the weird’n’wonderful blog circuit ever since… but as science-fictional as it sounds – pure Invasion-of-the-Bodysnatchers stuff, albeit without the Communist subtext – an increasing number of psychiatrists are starting to conclude that schizophrenia isn’t caused by distant parenting or dodgy genes, but by a virus that we all carry within ourselves [via TechnOcculT]. Just one of many, in fact:

Viruses like influenza or measles kill cells when they infect them. But when retroviruses like HIV infect a cell, they often let the cell live and splice their genes into its DNA. When the cell divides, both of its progeny carry the retrovirus’s genetic code in their DNA.

In the past few years, geneticists have pieced together an account of how Perron’s retrovirus entered our DNA. Sixty million years ago, a lemurlike animal—an early ancestor of humans and monkeys—contracted an infection. It may not have made the lemur ill, but the retrovirus spread into the animal’s testes (or perhaps its ovaries), and once there, it struck the jackpot: It slipped inside one of the rare germ line cells that produce sperm and eggs. When the lemur reproduced, that retrovirus rode into the next generation aboard the lucky sperm and then moved on from generation to generation, nestled in the DNA. “It’s a rare, random event,” says Robert Belshaw, an evolutionary biologist at the University of Oxford in England. “Over the last 100 million years, there have been only maybe 50 times when a retrovirus has gotten into our genome and proliferated.”

But such genetic intrusions stick around a very long time, so humans are chockablock full of these embedded, or endogenous, retroviruses. Our DNA carries dozens of copies of Perron’s virus, now called human endogenous retrovirus W, or HERV-W, at specific addresses on chromosomes 6 and 7.

If our DNA were an airplane carry-on bag (and essentially it is), it would be bursting at the seams. We lug around 100,000 retro­virus sequences inside us; all told, genetic parasites related to viruses account for more than 40 percent of all human DNA. Our body works hard to silence its viral stowaways by tying up those stretches of DNA in tight stacks of proteins, but sometimes they slip out. Now and then endogenous retroviruses switch on and start manufacturing proteins. They assemble themselves like Lego blocks into bulbous retroviral particles, which ooze from the cells producing them.

[…]

Through this research, a rough account is emerging of how HERV-W could trigger diseases like schizophrenia, bipolar disorder, and MS. Although the body works hard to keep its ERVs under tight control, infections around the time of birth destabilize this tense standoff. Scribbled onto the marker board in Yolken’s office is a list of infections that are now known to awaken HERV-W—including herpes, toxoplasma, cytomegalovirus, and a dozen others. The HERV-W viruses that pour into the newborn’s blood and brain fluid during these infections contain proteins that may enrage the infant immune system. White blood cells vomit forth inflammatory molecules called cytokines, attracting more immune cells like riot police to a prison break. The scene turns toxic.

In one experiment, Perron isolated HERV-W virus from people with MS and injected it into mice. The mice became clumsy, then paralyzed, then died of brain hemorrhages. But if Perron depleted the mice of immune cells known as T cells, the animals survived their encounter with HERV-W. It was an extreme experiment, but to Perron it made an important point. Whether people develop MS or schizophrenia may depend on how their immune system responds to HERV-W, he says. In MS the immune system directly attacks and kills brain cells, causing paralysis. In schizophrenia it may be that inflammation damages neurons indirectly by overstimulating them. “The neuron is discharging neurotransmitters, being excited by these inflammatory signals,” Perron says. “This is when you develop hallucinations, delusions, paranoia, and hyper-suicidal tendencies.”

If they’re right, then medicine may be close to discovering a way to head schizophrenia off at the metaphorical pass; having seen first-hand the sudden (and often terrifying) way in which those maladies can destroy the lives of their sufferers (and those close to them), I sincerely hope they are.

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Mental illness: America’s biggest export?

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A fascinating (if slightly grim and worrying) article at the New York Times by Ethan Watters suggests that Western psychiatry may be successfully homogenising the mental illnesses of the entire planet, thanks to aggressive programs designed to export “psychiatric literacy”. The intent was good, but the results may not be – as it seems that the expression and symptoms of mental illnesses around the world have changed to suit the blueprints brought by the white man..

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

[…]

Of course, we can become psychologically unhinged for many reasons that are common to all, like personal traumas, social upheavals or biochemical imbalances in our brains. Modern science has begun to reveal these causes. Whatever the trigger, however, the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession, semen loss or serotonin depletion, predict and shape the course of the illness in dramatic and often counterintuitive ways. In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. These disorders could also be treated with alternative medicine. For instance, if one would consider trying CBD moon rocks, it might help alleviate the symptoms. This does not mean that these illnesses and the pain associated with them are not real, or that sufferers deliberately shape their symptoms to fit a certain cultural niche. It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.

Well worth a read.

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New PlaceboTM! Now 50% more effective!

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pillsYou’ve heard of the placebo effect, right? Well, apparently it’s becoming stronger, much to the chagrin of the pharmaceuticals industry who are finding that less drugs are passing clinical trials as a result:

MK-869 wasn’t the only highly anticipated medical breakthrough to be undone in recent years by the placebo effect. From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.

The upshot is fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmaceutical industry. Last November, a new type of gene therapy for Parkinson’s disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn’s disease, an intestinal ailment, citing an “unusually high” response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.

It’s not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late ’90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

You’ll not find me shedding many tears for Big Pharma, frankly; as pointed out in the rest of the article, their profit margins of the last few decades has been based on turning psychiatric treatments into mental cosmetics, and the increase in the placebo response may well be tied to their incredibly effective marketing procedures – by associating drug consumption with positive images of well-being, they’ve stimulated our response to all pills, regardless of their chemical make-up. Research is increasingly suggesting that one of the biggest prerequisites for getting better is simply a reasonable expectation that one actually will. [via BoingBoing]

I’ve got something of a personal stake in this, having seen far too many friends diagnosed with one form or another of psychiatric condition and promptly put on a regime of drugs that have shattered their personalities – and lives – permanently. I’m not denying the existence of mental illness, but I’m quite convinced that overdiagnosis is rife, with many drug-treatable “syndromes” being little more than completely natural phases of mental development or reasonable responses to environmental conditions which would respond far better to counselling and emotional support. Hence I was intrigued to read an article by medical anthropologist Eugenia Tsao [via @somatosphere], who recommends that members of her profession and others should start pushing back against the relentless attempts to pathologize (and hence monetize) our reactions to our social environment:

What is revealed about a society, in which drugs are touted with increasing regularity as a treatment of choice for entirely natural responses to conditions of unnatural stress? How have we been persuaded to equate such things as recalcitrant despair (“Dysthymic Disorder,” DSM-IV-TR 300.4), adolescent rebellion (“Oppositional Defiant Disorder,” DSM-IV-TR 313.81) and social apathy (“Schizoid Personality Disorder,” DSM-IV-TR 301.20) with aberrant brain chemistry and innate genetic susceptibilities rather than with the societal circumstances in which they arise? What does it mean when increasing numbers of people feel as though they have no choice but to self-medicate with dubious chemical substances in order to stay in school, stay motivated, stay employed, and stay financially solvent?

Anyone here remember an obscure industrial band called Consolidated? They had a lyric on their Business of Punishment album that went something like “they must remain sick / so we can continue to treat them”. [image by neur0nz]