Tag Archives: psychiatry

tD

Bedlam and the Mysterious Air Loom

Air Loom machine

During my college years I was fortunate enough to spend time as a volunteer in a Victorian era psychiatric hospital in the United Kingdom. Fortunate in two ways: that I was able to make some small, yet positive difference to the lives of some of the patients; and, fortunate enough to live on the outside.

Despite the good and professional intentions of the many caring staff the hospital itself — to remain nameless — was a dreary embodiment of many a nightmarish horror flick. The building had dark, endless corridors; small, leaky windows; creaky doors, many with locks exclusively on the outside, and even creakier plumbing; spare cell-like rooms for patients; treatment rooms with passive restraints on chairs and beds. Most locals still called it “____ lunatic asylum”.

All of this leads me to the fascinating and tragic story of James Tilly Matthews, a rebellious (and somewhat paranoid) peace activist who was confined to London’s infamous Bedlam asylum in 1797. He was incarcerated for believing he was being coerced and brainwashed by a mysterious governmental mind control machine known as the “Air Loom”.

Subsequent inquiries pronounced Matthews thoroughly sane, but the British government kept him institutionalized anyway because of his verbal threats against officials and then king, George III. In effect, this made Matthews a political prisoner — precisely that which he had always steadfastly maintained.

Ironically, George III’s well-documented, recurrent and serious mental illness had no adverse effect on his own reign as monarch from 1760-1820. Interestingly enough, Bedlam was the popular name for the Bethlem Royal Hospital, sometimes known as St Mary Bethlehem Hospital.

The word “Bedlam”, of course, later came to be a synonym for confusion and chaos.

Read the entire story of James Tilly Matthews and his nemesis, apothecary and discredited lay-psychiatrist, John Haslam, at Public Domain Review.

Image: Detail from the lower portion of James Tilly Matthews’ illustration of the Air Loom featured in John Haslam’s Illustrations of Madness (1810). Courtesy: Public Domain Review / Wellcome Library, London. Public Domain.

Biosciences

Deconstructing Schizophrenia

Genetic and biomedical researchers have made yet another tremendous breakthrough from analyzing the human genome. This time a group of scientists, from Harvard Medical School, Boston Children’s Hospital and the Broad Institute, have identified key genetic markers and biological pathways that underlie schizophrenia.

In the US alone the psychiatric disorder affects around 2 million people. Symptoms of schizophrenia usually include hallucinations, delusional thinking and paranoia. While there are a number of drugs used to treat its symptoms, and psychotherapy to address milder forms, nothing as yet has been able to address its underlying cause(s). Hence the excitement.

From NYT:

Scientists reported on Wednesday that they had taken a significant step toward understanding the cause of schizophrenia, in a landmark study that provides the first rigorously tested insight into the biology behind any common psychiatric disorder.

More than two million Americans have a diagnosis of schizophrenia, which is characterized by delusional thinking and hallucinations. The drugs available to treat it blunt some of its symptoms but do not touch the underlying cause.

The finding, published in the journal Nature, will not lead to new treatments soon, experts said, nor to widely available testing for individual risk. But the results provide researchers with their first biological handle on an ancient disorder whose cause has confounded modern science for generations. The finding also helps explain some other mysteries, including why the disorder often begins in adolescence or young adulthood.

“They did a phenomenal job,” said David B. Goldstein, a professor of genetics at Columbia University who has been critical of previous large-scale projects focused on the genetics of psychiatric disorders. “This paper gives us a foothold, something we can work on, and that’s what we’ve been looking for now, for a long, long time.”

The researchers pieced together the steps by which genes can increase a person’s risk of developing schizophrenia. That risk, they found, is tied to a natural process called synaptic pruning, in which the brain sheds weak or redundant connections between neurons as it matures. During adolescence and early adulthood, this activity takes place primarily in the section of the brain where thinking and planning skills are centered, known as the prefrontal cortex. People who carry genes that accelerate or intensify that pruning are at higher risk of developing schizophrenia than those who do not, the new study suggests.

Some researchers had suspected that the pruning must somehow go awry in people with schizophrenia, because previous studies showed that their prefrontal areas tended to have a diminished number of neural connections, compared with those of unaffected people. The new paper not only strongly supports that this is the case, but also describes how the pruning probably goes wrong and why, and identifies the genes responsible: People with schizophrenia have a gene variant that apparently facilitates aggressive “tagging” of connections for pruning, in effect accelerating the process.

…

The research team began by focusing on a location on the human genome, the MHC, which was most strongly associated with schizophrenia in previous genetic studies. On a bar graph — called a Manhattan plot because it looks like a cluster of skyscrapers — the MHC looms highest.

…

Using advanced statistical methods, the team found that the MHC locus contained four common variants of a gene called C4, and that those variants produced two kinds of proteins, C4-A and C4-B.

The team analyzed the genomes of more than 64,000 people and found that people with schizophrenia were more likely to have the overactive forms of C4-A than control subjects. “C4-A seemed to be the gene driving risk for schizophrenia,” Dr. McCarroll said, “but we had to be sure.”

Read the entire article here.

Idea Soup

Doctor Lobotomy

walter-freeman

Read the following article once and you could be forgiven for assuming that it’s a fictional screenplay for Hollywood’s next R-rated Halloween flick or perhaps the depraved tale of an associate of Nazi SS officer and physician Josef Mengele.

Read the following article twice and you’ll see that the story of neurologist Dr. Walter Freeman is true: the victims — patients — were military veterans numbering in the thousands, and it took place in the United States following WWII.

This awful story is all the more incomprehensible by virtue of the cadre of assistants, surgeons, psychiatrists, do-gooders and government bureaucrats who actively aided Freeman or did nothing to stop his foolish, amateurish experiments. Unbelievable!

From WSJ:

As World War II raged, two Veterans Administration doctors reported witnessing something extraordinary: An eminent neurologist, Walter J. Freeman, and his partner treating a mentally ill patient by cutting open the skull and slicing through neural fibers in the brain.

It was an operation Dr. Freeman called a lobotomy.

Their report landed on the desk of VA chief Frank Hines on July 26, 1943, in the form of a memo recommending lobotomies for veterans with intractable mental illnesses. The operation “may be done, in suitable cases, under local anesthesia,” the memo said. It “does not demand a high degree of surgical skill.”

The next day Mr. Hines stamped the memo in purple ink: APPROVED.

Over the next dozen or so years, the U.S. government would lobotomize roughly 2,000 American veterans, according to a cache of forgotten VA documents unearthed by The Wall Street Journal, including the memo approved by Mr. Hines. It was a decision made “in accord with our desire to keep abreast of all advances in treatment,” the memo said.

The 1943 decision gave birth to an alliance between the VA and lobotomy’s most dogged salesman, Dr. Freeman, a man famous in his day and notorious in retrospect. His prolific—some critics say reckless—use of brain surgery to treat mental illness places him today among the most controversial figures in American medical history.

At the VA, Dr. Freeman pushed the frontiers of ethically acceptable medicine. He said VA psychiatrists, untrained in surgery, should be allowed to perform lobotomies by hammering ice-pick-like tools through patients’ eye sockets. And he argued that, while their patients’ skulls were open anyway, VA surgeons should be permitted to remove samples of living brain for research purposes.

The documents reveal the degree to which the VA was swayed by his pitch. The Journal this week is reporting the first detailed account of the VA’s psychosurgery program based on records in the National Archives, Dr. Freeman’s own papers at George Washington University, military documents and medical records, as well as interviews with doctors from the era, families of lobotomized vets and one surviving patient, 90-year-old Roman Tritz.

The agency’s use of lobotomy tailed off when the first major antipsychotic drug, Thorazine, came on the market in the mid-1950s, and public opinion of Dr. Freeman and his signature surgery pivoted from admiration to horror.

During and immediately after World War II, lobotomies weren’t greeted with the dismay they prompt today. Still, Dr. Freeman’s views sparked a heated debate inside the agency about the wisdom and ethics of an operation Dr. Freeman himself described as “a surgically induced childhood.”

In 1948, one senior VA psychiatrist wrote a memo mocking Dr. Freeman for using lobotomies to treat “practically everything from delinquency to a pain in the neck.” Other doctors urged more research before forging ahead with such a dramatic medical intervention. A number objected in particular to the Freeman ice-pick technique.

Yet Dr. Freeman’s influence proved decisive. The agency brought Dr. Freeman and his junior partner, neurosurgeon James Watts, aboard as consultants, speakers and inspirations, and its doctors performed lobotomies on veterans at some 50 hospitals from Massachusetts to Oregon.

Born in 1895 to a family of Philadelphia doctors, Yale-educated Dr. Freeman was drawn to psychosurgery by his work in the wards of St. Elizabeth’s Hospital, where Washington’s mentally ill, including World War I veterans, were housed but rarely cured. The treatments of the day—psychotherapy, electroshock, high-pressure water sprays and insulin injections to induce temporary comas—wouldn’t successfully cure serious mental illnesses that resulted from physical defects in the brain, Dr. Freeman believed. His suggestion was to sever faulty neural pathways between the prefrontal area and the rest of the brain, channels believed by lobotomy practitioners to promote excessive emotions.

It was an approach pioneered by Egas Moniz, a Portuguese physician who in 1935 performed the first lobotomy (then called a leucotomy). Fourteen years later, he was rewarded with the Nobel Prize in medicine.

In 1936, Drs. Freeman and Watts performed their first lobotomy, on a 63-year-old woman suffering from depression, anxiety and insomnia. “I knew as soon as I operated on a mental patient and cut into a physically normal brain, I’d be considered radical by some people,” Dr. Watts said in a 1979 interview transcribed in the George Washington University archives.

By his own count, Dr. Freeman would eventually participate in 3,500 lobotomies, some, according to records in the university archives, on children as young as four years old.

“In my father’s hands, the operation worked,” says his son, Walter Freeman III, a retired professor of neurobiology. “This was an explanation for his zeal.”

Drs. Freeman and Watts considered about one-third of their operations successes in which the patient was able to lead a “productive life,” Dr. Freeman’s son says. Another third were able to return home but not support themselves. The final third were “failures,” according to Dr. Watts.

Later in life, Dr. Watts, who died in 1994, offered a blunt assessment of lobotomy’s heyday. “It’s a brain-damaging operation. It changes the personality,” he said in the 1979 interview. “We could predict relief, and we could fairly accurately predict relief of certain symptoms like suicidal ideas, attempts to kill oneself. We could predict there would be relief of anxiety and emotional tension. But we could not nearly as accurately predict what kind of person this was going to be.”

Other possible side-effects included seizures, incontinence, emotional outbursts and, on occasion, death.

Read the entire article here.

 

Idea Soup

Culturally Specific Mental Disorders: A Bad Case of the Brain Fags

Is this man buff enough? Image courtesy of Slate

If you happen to have just read The Psychopath Test by Jon Ronson, this article in Slate is appropriately timely, and presents new fodder for continuing research (and a sequel). It would therefore come as no surprise to find Mr.Ronson trekking through Newfoundland in search of “Old Hag Syndrome”, a type of sleep paralysis, visiting art museums in Italy for “Stendhal Syndrome,” a delusional disorder experienced by Italians after studying artistic masterpieces, and checking on Nigerian college students afflicted by “Brain Fag Syndrome”. Then there is: “Wild Man Syndrome,” from New Guinea (a syndrome combining hyperactivity, clumsiness and forgetfulness), “Koro Syndrome” (a delusion of disappearing protruding body parts) first described in China over 2,000 years ago, “Jiko-shisen-kyofu” from Japan (a fear of offending others by glancing at them), and here in the west, “Muscle Dysmorphia Syndrome” (a delusion common in weight-lifters that one’s body is insufficiently ripped).

All of these and more can be found in the latest version of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) manual.

[div class=attrib]From Slate:[end-div]

In 1951, Hong Kong psychiatrist Pow-Meng Yap authored an influential paper in the Journal of Mental Sciences on the subject of “peculiar psychiatric disorders”—those that did not fit neatly into the dominant disease-model classification scheme of the time and yet appeared to be prominent, even commonplace, in certain parts of the world. Curiously these same conditions—which include “amok” in Southeast Asia and bouffée délirante in French-speaking countries—were almost unheard of outside particular cultural contexts. The American Psychiatric Association has conceded that certain mysterious mental afflictions are so common, in some places, that they do in fact warrant inclusion as “culture-bound syndromes” in the official Diagnostic and Statistical Manual of Mental Disorders.

he working version of this manual, the DSM-IV, specifies 25 such syndromes. Take “Old Hag Syndrome,” a type of sleep paralysis in Newfoundland in which one is visited by what appears to be a rather unpleasant old hag sitting on one’s chest at night. (If I were a bitter, divorced straight man, I’d probably say something diabolical about my ex-wife here.) Then there’s gururumba, or “Wild Man Syndrome,” in which New Guinean males become hyperactive, clumsy, kleptomaniacal, and conveniently amnesic, “Brain Fag Syndrome” (more on that in a moment), and “Stendhal Syndrome,” a delusional disorder experienced mostly by Italians after gazing upon artistic masterpieces. The DSM-IV defines culture-bound syndromes as “recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular diagnostic category.”
And therein lies the nosological pickle: The symptoms of culture-bound syndromes often overlap with more general, known psychiatric conditions that are universal in nature, such as schizophrenia, body dysmorphia, and social anxiety. What varies across cultures, and is presumably moulded by them, is the unique constellation of symptoms, or “idioms of distress.”

Some scholars believe that many additional distinct culture-bound syndromes exist. One that’s not in the manual but could be, argue psychiatrists Gen Kanayama and Harrison Pope in a short paper published earlier this year in the Harvard Review of Psychiatry, is “muscle dysmorphia.” The condition is limited to Western males, who suffer the delusion that they are insufficiently ripped. “As a result,” write the authors, “they may lift weights compulsively in the gym, often gain large amounts of muscle mass, yet still perceive themselves as too small.” Within body-building circles, in fact, muscle dysmorphia has long been recognized as a sort of reverse anorexia nervosa. But it’s almost entirely unheard of among Asian men. Unlike hypermasculine Western heroes such as Hercules, Thor, and the chiseled Arnold of yesteryear, the Japanese and Chinese have tended to prefer their heroes fully clothed, mentally acute, and lithe, argue Kanayama and Pope. In fact, they say anabolic steroid use is virtually nonexistent in Asian countries, even though the drugs are considerably easier to obtain, being available without a prescription at most neighborhood drugstores.

[div class=attrib]More from theSource here.[end-div]

Book Reviews

Book Review: The Psychopath Test. Jon Ronson

Hilarious and disturbing. I suspect Jon Ronson would strike a couple of checkmarks in the Hare PCL-R Checklist against my name for finding his latest work both hilarious and disturbing. Would this, perhaps, make me a psychopath?

Jon Ronson is author of The Psychopath Test and the Hare PCL-R, named for its inventor,  Canadian psychologist Bob Hare, is the gold standard in personality trait measurement for psychopathic disorder (officially known as Antisocial Personality Disorder).

Ronson’s book is a fascinating journey through the “madness industry” covering psychiatrists, clinical psychologists, criminal scientists, criminal profilers, and of course their clients: patients, criminals and the “insane” at large. Fascinated by the psychopathic traits that the industry applied to the criminally insane, Ronson goes on to explore these behavior and personality traits in the general population. And, perhaps to no surprise he finds that a not insignificant proportion of business leaders and others in positions on authority could be classified as “psychopaths” based on the standard PCL-R checklist.

Ronson’s stories are poignant. He tells us the tale of Tony, who feigned madness to avoid what he believed would be have been a harsher prison sentence for a violent crime. Instead, Tony found himself in Broadmoor, a notorious maximum security institution for the criminally insane. Twelve years on, Tony still incarcerated, finds it impossible to convince anyone of his sanity, despite behaving quite normally. His doctors now admit that he was sane at the time of admission, but agree that he must have been nuts to feign insanity in the first place, and furthermore only someone who is insane could behave so “sanely” while surrounded by the insane!

Tony’s story and the other characters that Ronson illuminates in this work are thoroughly memorable, especially Al Dunlap, empathy poor, former CEO of Sunbeam — perhaps one of the high-functioning psychopaths who lives in our midst. Peppered throughout Ronson’s interviews with madmen and madwomen, are his perpetual anxiety and self-reflection; he now has considerable diagnostic power and insight versed on such tools as the PCL-R checklist. As a result, Ronson begins seeing “psychopaths” everywhere.

My only criticism of the book is that Jon Ronson should have made it 200 pages longer and focused much more on the “psychopathic” personalities that roam amongst us, not just those who live behind bars, and on the madness industry itself, now seemingly lead by the major  pharmaceutical companies.