Monthly Archives: March 2010

Review: Attitudes to Mental Illness 2010

The document reviewed here is a Department of Health document  ‘Attitudes to Mental Illness 2010′ and which is available here. I found the document slightly easier to read by starting at the back where the methodology is explained in detail. Random sampling took place and results were weighted according to the characteristics of the population in England in terms of age, sex and social grade (ethnicity data was included in the questionnaire). In the methodology section, the authors note that significant results imply that results are significant at the 5% level on the two-tailed t-test which presumably means that all of the sample data is normally distributed. I wasn’t clear on whether a correction for multiple comparisons was used. As there are a large number of comparisons being conducted between age groups, between genders and social grades as well as across surveys (i.e the previously conducted surveys) it would be expected that there would be false positives. So for instance with a Bonferroni correction, 10 comparisons would mean multiplying the resulting p values by 10 so that a p-value of 0.05 no longer remains significant at the 5% level. I wasn’t clear on this point. 1745 adults were selected using a random sampling method from areas across England (roughly 0.0035% of the English population). Results are displayed in graphs and also described in accompanying paragraphs. There is no interpretation of the data as far as I could see (e.g a discussion with reference to the literature).

Page 13 shows the sections of the survey. Scanning through the document there are 31 figures which I thought summarised the data effectively. There were a few points that I thought were interesting

In Figure 1 I didn’t notice any consistent trend in the data other than to say that the relationship between the lines remained fairly stable over time. The results here pertained to questions about social inclusion ranging from the nextdoor neighbour having a mental illness to a mental health institution being located within the neighbourhood. There was in fact a slight cross-over between the responses to the nextdoor neighbour and marriage questions over time seeming to indicate a possible trend to marriage becoming more acceptable to someone with a recognised mental illness.

Figure 2 was interesting because it showed significant age-group differences. Those over the age of 55 were more likely to judge those with a mental illness adversely i.e they shouldn’t hold public office. That is an interesting finding that would benefit from further follow-up with a qualitative study.

Figure 3 shows a significant difference between men and women in tolerance to people with a mental illness. Women were more likely to be tolerant in terms of their responses.

Figure 9 includes a graph of responses to inclusion in the community over time. Although there is an upward trend towards increasing acceptance in recent years the graph shows a lot of variability over time indicating many possibilites ranging from the question through to short-term factors that could influence responses.

Figure 16 was interesting as it most likely displays common perceptions of mental illness with schizophrenia being the most commonly identified mental illness with depression second. Perhaps here there could be clarification of what consitutes a mental illness. DSM-IV and ICD-10 contain a large number of diagnoses many of which may not feature prominently in the cultural ‘psyche’. It would be interesting to see the results of a survey in which familiarity with ICD-10/DSM-IV diagnoses is assessed in the general population as the public perception of mental illness may be biased towards a relatively small (although important) mental illnesses.

Figure 21 was encouraging in that 60% of the respondents samples believed that full recovery was possible for someone with a ‘mental health problems’ and there was confidence in the efficacy of medication and psychotherapy.

Figure 25 was  interesting as it showed that only 4% of the sample reported having a mental illness themselves although many of the respondents recognised the figure of 1 in 4 people having a mental illness. This implies either under-reporting or a biased sample.

Figure 30 shows that 50% of the sample would be uncomfortable talking to their employers about a mental illness. This means that there is some way to go in this area.

Figure 31 suggests that there has been a decrease in stigma.

This is a broad survey which can be usefully compared to previous surveys in this series. There are a number of encouraging findings in particular those relating to public perception of the possibility of recovery, integration into the community and efficacy of medication and psychotherapy. Areas which I thought were interesting were the self-reporting of mental illness as well as age-related perceptions of mental illness. These could be investigated further using a qualitative design.

Index

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Responses

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Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review: Impairment of Instrumental ADL in Mild Cognitive Impairment

The paper reviewed here is ‘Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment’ by Ahn and colleagues and freely available here. In the conclusion, the authors write that

The patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLS’s related to memory and frontal/executive functioning were particularly affected in MCI

The study was carried out in South Korea. The researchers have selected

  • 66 subjects with MCI (mean age 70.76 years)
  • 61 health controls (mean age 64 years)

Controls were recruited by advertisement whilst the recruitment method for the MCI group was unclear. The criterion used for MCI are clearly stipulated and include

  • Cognitive performance of 1.5 SD below the age and education norm in one or more of the following domains: memory, language, visuoconstruction, and frontal/executive function
  • Cognitive decline by self and/or informant reporting

The subjects were also administered a battery of neuropsychological tests including

  • Digit span forwards and backwards
  • Korean-Boston Naming Test
  • Rey-Kim Complex Figure TEST
  • Clock Drawing TEST
  • Contrasting Program, Go-no-go Test

amongst others. The study focused on the performance of MCI subjects on two measures of functioning – The Seoul Instrumental Activities of Daily Living (SIADL) and the Seoul Activities of Daily Living. About the SIADL, the researchers write that it assesses a number of functions and that

These include the ability to prepare a balanced meal, remember appointments, keep financial records, remember to take medication and so on

and is composed of 15 items. The primary research questions seems to be fairly straightforward – is there a difference between the MCI and control groups on the ADL’s? The researchers used a multivariate logistical regression analysis to investigate this relationship. They also wanted to find the optimal cut-off point for MCI and used a ROC curve for this purpose.

The MCI group scored significantly higher on the S-IADL than the control group (4.47 v 1.44) and this difference remained after controlling for variables including age. The S-IADL discriminated well between the control and MCI groups with a sensitivity and specificity of 82%. The researchers write that the

MCI patients showed significantly more impairment in the areas of ‘using the telephone’, ‘preparing meals’, ‘taking medication’, ‘managing belongings’, ‘keeping appointment’, ‘talking about recent events’, and ‘leisure/hobbies’ than normal elderly controls

Conclusions

Although these results are extremely encouraging I’m not sure if they generalise to the english version of the IADL and maybe another study with the English version needs to be undertaken. However the MCI group have a mean age of just over 70 years of age and again it would be unclear if this would generalise to a group in their early 60’s or late 50’s although the correction for age indicated that a significant difference between the groups remained.

There is an interesting question here which is about the precise nature of the relationship between the memory and executive components of the neuropsychological test battery and the performance on the IADL. Making a telephone call presumably involves a number of cognitive functions – motor cognition, working memory, episodic memory, auditory processing, attention and executive functions at the very least. Therefore if we could see which areas of the brain light up, during a telephone conversation (i.e fMRI) on the basis of the above we might expect to see the corresponding areas in the relevant order although it is never that simple. It might be expected that if some tasks require more cognitive functions they would be more susceptible to the effects of MCI – thus there might be a  hierarchy (although the individual tasks will vary in complexity).

More importantly from this study, this has implications for the workplace. If people have MCI and are working then this study suggests that it may interfere with a number of tasks around the workplace. If that is the case, then it would mean that assistive technologies may be useful. Furthermore the need for assistive technologies could be estimated from performance on a paper and pen test given the effective discrimination between the MCI and control groups (as MCI was assessed using the neuropsychological tests discussed above). It will be interesting to see if this study is replicated using an English version of the IADL.

 

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

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Podcast

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Responses

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Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review: Predicting Conversion to Dementia

The paper reviewed here is ‘Automated Detection of Brain Atrophy Patterns Based on MRI for the Prediction of Alzheimer’s Disease‘ by Plant and colleagues and freely available here. There are two things about this paper i’d like to mention. The first is that I didn’t completely understand it. I could probably get to grips with it in full but with a few weeks of extra reading around the topic and discussion (maybe). I understood enough of it to get the gist of it though. The paper has relevance to the practice of older adults psychiatry if such applications as described here become widely available which isn’t the case at the moment. It shouldn’t be suprising that this is a complicated paper to understand. After all, it’s by an international collaborative of multidisciplinary specialists in psychiatry, neuroimaging science, neuroradiology and computer science. Potentially therefore the audience lies in those disciplines. At the same time however, the audience would need to have knowledge traversing a number of disciplines and I suspect that there would be an extremely limited number of people who would be able to fully understand the paper with no prior preparation. Rather than meaning that this is a fairly esoteric subject which will end up with a number of other papers collecting dust however, it has potentially important clinical implications. Read

‘The extracted AD clusters were used as a search region to extract those brain areas that are predictive of conversion to AD within MCI subjects. The most predictive brain areas included the anterior cingulate gyrus and orbitofrontal cortex. The best prediction accuracy, which was cross-validated via train-and-test, was 75% for the prediction of the conversion from MCI to AD‘ (my underlining)

The essence of what the researchers were doing was identifying a group of subjects who were likely to develop Alzheimer’s Disease and then image their brains using an MRI scanner. They needed to compare these with two other groups – those that already had Alzheimer’s Disease and healthy controls. Then they used a number of sophisticated analysis techniques to discriminate between those with Mild Cognitive Impairment who went on to develop AD and those that did not. They identified individual brain regions that discriminated between the subjects and even give a predictive accuracy of 75%.

However the above is contingent on a number of assumptions which can be individually questioned.

Firstly what can be said about the subjects in the study. Well although some of the demographic details are given such as the average age, there are a number of other factors which aren’t clear from the article (there is an associated data article which I wasn’t able to access at the time of writing – perhaps the data might have been included there). So for instance, were there any concurrent medical illnesses, what were the numbers of years of education, blood pressure, concurrent medication and so on. I assume that the subject group was german given the approval by a Munich based ethics committee although this is implicit rather than explicit in the paper.

The next point is the bottom line. There are 9 people who convert from MCI to AD and 15 who don’t. Essentially that’s the basis for the comparisons. It’s a rather obvious and often repeated point but a larger sample size for comparison with a well characterised sample would be expected to lead to greater reliability as well as a better knowledge of generalisability.

The MRI scanner is 1.5T. The larger the field strength, the larger is the possible image resolution. The subjects’ images were normalised to an anatomical template. There were some additional steps which involved ‘masking’ the images to remove the CSF leaving just white and grey matter. I didn’t understand the process used to achieve this end. I’ve made this point elsewhere but where papers are highly technical it would be good for the research group to create a video and upload it to YouTube (for free) and link to it in the article so the interested reader can try and get up to speed quickly.

The authors then explain the data analysis. The section on feature selection was unclear to me and although people in the field might read it rather easily, I struggled to understand the entropy equation. Entropy as I understood it was a tendency for a gradient of energy to equilibriate after time or to substitute information for energy with similar results. So I wasn’t clear on why this term was being used here and it would benefit from an explanation as above. There are references to other papers but this phenomenon of linking in with other papers behind pay-walls is either costly in terms of resources or unhelpful (indeed it would mean there was a hidden cost in those papers were a fee is required) although is probably not an issue in university departments with appropriate subscriptions (even here however this is not the case as some of the referenced papers can be in obscure journals that are not included in a university’s subscriptions). So after reading a bit further on, i’m not sure I understand by what the authors refer to as feature detection although the term is usually used in neural network terminology to indicate patterns in information that are identified by a neural network architecture. If this were the case, then the authors might be referring to the algorithm for learning in the network when they talk about entropy although it is still unclear to me.

Moving onto clustering, the researchers write that they are using an approach to identify ‘highly discriminatory’ voxels and ‘remove noise’. Presumably they determine this by choosing conversion to AD as the outcome measure. However on scanning through this section I was unable to find the terms AD or MCI and instead it was an abstract generic mathematical discussion using language that is probably relevant to a highly specialised field of neuroimaging science but it doesn’t gel with the language used in the introduction.

I found that the explanation of classification was slightly easier to understand relating both to the AD/MCI categories with a little reading between the lines and also the explanation of analysis is consistent with neural network architectures.

With a limited amount of time to read the paper (a few hours), i’ve moved quickly through the training and visualisation sections. These sections quickly move into symbols. Now the problem with these symbols is that they make sense to someone in the very specialised field but are next to meaningless for people outside the field. Again here an animation or talk through video would be helpful. Symbols tend to be an abstract representation acquired once a shared understanding has been agreed – a useful shorthand for communication within the field. The authors might question why this should be communicated to someone outside of the field – after all one of the purposes of the method section is to communicate information to other groups for replication. I would argue that it’s necessary for clinician’s to understand the reasoning behind the ‘knowledge’ which they will be using to make clinical decisions when such approaches become more widespread.

SPM settings were given and then the authors report the method used for assessing white matter lesions.

In the results section, by the time I reached table 2 I had two thoughts

1. The results here seem impressive – high accuracy in the 90%’s, good sensitiviy and specificity

2. How did they get to this stage (which relates to the above discussion)

Again in Table 4 (AD v MCI)

1. These results are impressive and I recognise the brain regions involved

2. How did they get to this stage?

Unfortunately it’s easy to understand the significance of the results. Without fully understanding how the researchers got to this stage however I am left with three options

1. Make no decisions. Seems like a waste of 2 hours.

2. Reject the results. Seems a shame as a lot of work has gone into this and the researchers will undoubtedly be competent in their respective fields.

3. Accept the results. Pragmatism. Unfortunately if I didn’t understand the process by which the results were arrived at then I have to rely on ….. blind faith.

The same applies to Table 5.

Moving onto the discussion (I skipped the other bits that weren’t as interesting), the researchers write that

Using AD and HC as training data and MCI as test data, we achieved an accuracy of 50%–75% to predict conversion into AD

The authors also acknowledge the small sample size. In the above, the AD and control groups have been used to train the software thus making use of all subjects in the study and not just the 24 with MCI.

Conclusions

So there are some potentially useful results notably a complex multidisciplinary approach to discriminating people who convert from MCI to AD based on MRI and computer learning algorithms. Obviously if these results are valid then it would be nice to have this set-up available in a research setting with a focus on trialling interventions in the high-risk group. Papers like this are going to become increasingly commonplace. If a research group has an effective means for predicting who will convert from MCI to AD then it’s going to be very important and will most likely be repeatedly used and refined. Then there will come a point at which the clinicians will have to get up to speed with this approach. Only this runs into the problems described above. There has to come a point at which each step in the process is translated into an understandable format accessible to clinicians. If not then the clinician in the future will end up receiving a few numbers, without being able to argue about the underlying reasoning or being able to point out errors and exceptions. In that case, the clinician becomes deskilled in the decision-making process. This is the risk of using ever more sophisticated technology and research paradigms. The clinician still needs to be ‘connected’ to the increasingly complex underlying process.

There are a number of questions I still have

1. What are some of the other characteristics of the sample e.g comorbid illness?

2. When are papers going to be rated according to complexity?

3. When are complex papers going to link to videos explaining the methodology/results?

4. Will papers get more complex as even more disciplines become involved in large projects with multistage methods?

5. Who is the ideal audience for this paper and which people shouldn’t be reading this paper? (I think the results here are relevant to clinicians working in the field of dementia although perhaps it would be more relevant as the described approach becomes more accessible).

6. Would these results be more interesting if we had baseline MRI scans decades before the subjects developed MCI for comparison purposes?

7. If the reader has to take a leap of faith in accepting the results of a complex study then on what basis is this made. Is it a simple reduction to the ‘calibre’ of the researchers involved including the university that they work at, their title, previous publications and so on and if so is this a reliable approach?

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link

Podcast

You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast).

TAWOP Channel

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Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

News Round-up: March 2010 4th Edition

The Royal College of Psychiatrists has launched a four-step general election manifesto for mental health available here. The manifesto has four points

‘1. Stop harmful cuts to mental health services

2. Treble mental health research funding

3. Invest in early intervention

4. Put mental health at the heart of public health’

and relevant groups including psychiatrists, patients and carers are being encouraged to discuss this with their local parliamentary candidates as the election approaches. Further details on how to engage are given at the College general election page.

The Alzheimer’s forum (AF) has an interesting post on the relationship between metabolic disease and Alzheimer’s Disease (AD). There is a recent meta-analysis looking at the use of augmentation with acetylcholinesterase inhibitors in schizophrenia and schizoaffective disorder involving six open-label and 24 double-blind RCT’s with the authors showing benefits for memory and performance on the Trail Making Test Part A (Ribeiz et al, 2010) .

Psychiatry 2.0

Dr D has an article on attachment disorder and how this relates to her own experience with her baby. I think Dr D’s blog is one to watch. Dr D relates the theory to her own experience and in this way is able to engage with parents and is already beginning to build up a wider audience. Shrink Rap have a discussion of the recent passage of President Obama’s health bill with 11 comments at the time of writing. The AJNR blog has a discussion of a case study of a lady with a ‘six week(s) history of odd behavior, increasing apathy, expressive aphasia, and mild headache’ with images included here. There is an article on the Everyday Sociology blog about how researchers use census data to advance knowledge about sociology. The Mental Nurse has a thoughtful look at coverage of mental illness in the media. The Neurocritic reviews an interesting Cortex paper on ‘paranormal phenomenon’ related to seizure activity. A useful diagram showing the transentorhinal cortex where AD pathology first appears is presented at the Neuropathology blog. At PsychCentral there is a post featuring an interview on the topic of highly sensitive individuals. Singularity Hub has an interesting piece on science publishing and social media. MS Views and Related news has a link to an article by a blogger with Multiple Sclerosis who has recent undergone an experimental surgical procedure and writes about his experience. There is a mention (and photo) of the ‘father’ of the MMSE, Dr Folstein at the Tangled Neuron. Dr Shock reports on a web behaviour test at the BBC website. Buckeye psychiatry has a brief look at the antidepressant Vilazodone which is due to be reviewed by the FDA. Mind Hacks has another Spike Activity including a link to a NYTimes article on the mental health system in Haiti following the earthquake.

There is a fascinating look at a study investigating how ‘fast food’ may generate psychological responses that modify behaviour at ‘We’re Only Human’. The subjects in the study were asked to look at a computer screen and solve a task while very rapid images of fast-food related symbols were flashed up in the periphery. When these symbols were presented (priming) the subjects would respond more rapidly and this was interpreted as they were feeling ‘time pressure where there was none’. There were additional stages in the experiment. When subjects were primed with the fast food symbols they would select more efficient household item designs e.g a four-slice toaster rather than a two-slice toaster.

Finally the subjects primed with the fast food symbols were more likely to accept a small amount of money in the present rather than delay acceptance of a larger amount of money.

So the term ‘fast-food culture’ takes on a new meaning.

Evolutionary Psychiatry

A possible new hominin species has been discovered and the findings reported in the journal Nature. A finger bone was found in Siberia and an analysis of the mitochondrial DNA was undertaken. There is a suggestion that this species would have lived 30,000 years ago and could have coexisted with humans, neanderthals and Homo Floresiensi. There is detailed coverage in this article and a critical perspective is given here. If the above is confirmed by further analysis then it has been suggested that there were multiple waves of migration out of Africa rather than the two classically described. The relationship to mental illness is more tenuous as these findings are relevant to generic models of human evolution e.g adaptation to cohabitation with a competing hominin species which in turn can be used to interpret illness.

References

Ribeiz SR, Bassitt DP, Arrais JA, Avila R, Steffens DC, Bottino CM.CNS Drugs. 2010 Apr;24(4):303-17. Cholinesterase inhibitors as adjunctive therapy in patients with schizophrenia and schizoaffective disorder: a review and meta-analysis of the literature.

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

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Podcast

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TAWOP Channel

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Responses

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Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Blog Review: Psychiatry Fun Blog

The blog reviewed here is the ‘Psychiatry Fun Blog‘ by an anonymous psychiatry resident on the West Coast of the USA. I checked out the blog after receiving an e-mail from the author.

Appearance and Design

The blog uses the google blogging platform with a white background throughout. There are several articles per page featuring black font with blue hypertext links. Posts are dated with comments enabled and category tags. The colourful title pane features some artistically rendered emoticons and sets the tone for the blog which is slightly tongue-in-cheek in parts while retaining sensitivity where appropriate.

Content

This is a very young blog which begins in March 2010. The author is quite provocative and identifies important themes and then takes a deliberately polarised stance to foster debate. He does this through commentary on other articles and chooses articles which are rich sources for debate. In an article on the suggested DSM-V criteria for Schizoaffective Disorder, he comments experientially on some of the practical aspects of diagnosis. Essentially I would argue that polarisation can often lead to inaccuracy but at the same time can facilitate debate and narrative. In the comments sections on the blog, commentators  sometimes use pejorative terms or some rather blunt language but the dialogue in blogs can often change rapidly during the initial formative period as a stable audience is established. There is an interesting premise in this blog. How can psychiatry be fun? After all, the psychiatrist must deal with some very serious and distressing problems. This is why this blog has an interesting journey ahead. Obviously these very serious problems are just that – very serious. But psychiatrists are human beings and this is essential given the importance of the therapeutic alliance which as with any relationship is the most human of activities. Thus there should be a forum in which the participants are able to develop their skills in psychiatry, to learn about their subject while also recognising their human reality. This learning – in the theoretical arena and away from the clinical setting – can be playful which is what this blog sets out to be.

Other bloggers such as the Neurocritic often integrate song clips into their articles to both illustrate issues under discussion and to provide some entertainment at the same time. This is just one approach. While superficially this area might seem trivial I would argue that there is more to it than this. If learning about psychiatry can be made fun then maybe this will help with learning and also will help to sustain a pattern of lifelong learning. This is speculation but too me seems intuitively obvious. If the learning always takes place in a serious context then it seems likely that the act of learning would be compartmentalised and classical conditioning principles might then apply. However such an approach is not possible without the development of an appropriate infrastructure, a culture, a language that facilitates this particular approach to learning and perhaps that is where this blog and others like it will play an emerging role.

Conclusions

This is a young blog with a nice design layout and some provocative articles on current topics with the author giving some straight-talking views. The premise of the blog is an important one and I will follow this with interest.

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

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Podcast

You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast).

TAWOP Channel

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Responses

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Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Book Review: Natural Selections

The book reviewed here is ‘Natural Selections. Selfish Altruists, Honest Liars and other Realities of Evolution’ by David P Barash and narrated by L J Gansner. Gansner delivers a moderately paced expressive performance. Barash is a professor of psychology and has an impressive bibliography that can be seen here. Barash discusses a number of issues relating to evolution and how this influences the view we have of ourselves. Two themes that I found of particular interest were Barash’s discussion of evolutionary aspects of altruism and the implications of evolution for existentialism. Indeed a core part of Barash’s book as suggested in the title is the evolutionary interpretation of selfishness and altruism. Barash gives an abundance of examples from nature which support the argument for a ‘selfish gene’ as well as similar arguments at the level of the organisms. In essence, Barash presents reproduction as a means of projecting the organism’s genes into the future. I thought that the distinction between the gene and the organism was interesting. Can a genome be a collection of ‘selfish’ genes or is it a combination of ‘selfish’ and ‘altruistic’ genes with the genome forming the negotiated vehicle for this collection. There are numerous examples from the animal kingdom that illustrate gender differences in behaviour as well as specific aspects of behaviour. In the discussion of existentialism, Barash contrasts the freedom of choice with the dilemmas about free will posed by an understanding of natural selection and related areas but is able to reconcile these with an example. The example convincingly demonstrates how much freedom that we have independent of our genetic heritage. Thus Barash is able to both illustrate some of the biological aspects of behaviour and to retain the freedom of expression in his ‘painting’ of the human condition which in the end results in a brighter picture than the title suggests.

References

David P Barash. Natural Selections. Selfish Altruists, Honest Liars and other Realities of Evolution .2007 Bellevue Literary Press. (P)2009 Audible, Inc.

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link

Podcast

You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast).

TAWOP Channel

You can follow the TAWOP Channel on YouTube by clicking on this link

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Interview with Cole Bitting

It’s been a great privilege to have spent some time interviewing Cole Bitting, the author of the FABLE blog (see review here). Cole has written some really great posts and has an interest in the intersection between neuroscience and literature. Here’s a transcript of the interview.

JM Thank you for agreeing to take part in this interview.
CB I’m glad to contribute
JM Firstly whereabouts are you based?
CB I’m in St Louis .. we missed much of the snow that has buried a good part of the country .. still it’s cold
JM How did you get into writing the blog?
CB I work with people in crisis so I have a background with trauma. My blog Fable is the forum for translating my experience and the studying I have done into written material and material for speaking. Maybe I can offer an analogy to explain my focus. So the youngest kid knows when you push a rubber ball of a table it will fall and bounce. He has an intuitive sense of physic, right?
When we are in school, we study how objects move and it makes sense and is easy to grasp (at least for a while). Then what happens? As older students, physics suddenly stops making any sense whatsoever, right? What was obvious became mystifying. Just as we have an innate, intuitive physics, we have an innate, intuitive psychology. In the last thirty years or so, science has studied the complexity of human nature (a somewhat taboo subject 60 years ago or so). This science has now gone way past intuitive, it’s like advance physics. So I write to try to make the advance study of human nature somewhat intuitive. It offers great insight and guidance for living life, but if it is too complex, too hard like advanced physics, no one will relate or care except for the scientists themselves.
JM This is important, I agree. To make the science understandable. I’ve found a number of your ideas on the blog very interesting. In your first post, you talk about the three gifts of consciousness – perspective, ownership and agency. Can you tell us a bit more about each of these?
CB Funny, this topic is one of next I want to flesh out. I think to set the stage for this discussion, we need to think about two different points-of-view. Our nature one is our first-person POV, the central character in our stories, the person having moment-to-moment experience. The second POV occurs when we look at the system which creates our sense of experience – our first-person POV. So think of it as a form of watching what goes on when we’re having an experience.
Right. Part of my writing (when I use the triangle images) focuses on ‘what goes on when we’re having an experience.’ The simplest explanation, is that our body changes in the presence of any significant object, and these relationships give rise to experience.
CB So the perspective you are asking about is the perspective on the relationship between the body and the object which gives rise to experience. This perspective is different from the one where we are inside the experience. The second perspective is intuitive, the first is advanced physics. Any questions about perspective before I move on?
JM Sure, i’ve got two questions. The first one is what is the place for internally generated experiences (e.g. in a sensory deprivation tank) and the second question is this second type of perspective a meta-narrative?
CB Most of our experience is actually internally generated. When I use the word ‘object’ we all think of a physical thing. But really ‘object’ is a lazy word for 1) a neural representation (a brain image) which 2) evokes a change to our body. A snake is an object and so is the notion of snakes on a plane. Both cause physiological change – the heart races, maybe we grimace or act a little more agitated. Most of our experience is from reviewing past experience and preparing for upcoming possibilities. None of these objects are objects in an external physical sense, but they are ‘objects’ in a sense that they map to a ‘image’ in the brain. At the moment at least, I’m trying to describe basic machinery, what occurs that give rise to experience. So in that sense, it’s the opposite of ‘meta,’ it’s ‘proto.’
JM ok. I’d like to clarify this last point if I may. When we have an experience, the act of taking a step back to think about the experience itself I think of as a little bit sophisticated. Do you think this is something that is important for lots of other experiences and we do it automaticcally
CB I’m trying to come up with an analogy here.. Let’s consider ‘narrative’ as a simple story. So ‘proto’ would be the relationships between the objects which we describe with sentences. We are so used to talking in sentences and framing one thing – our embodied self – as the subject – we don’t really see the relationships which give rise to sentences. Sentences are intuitive, but diagramming the grammar of sentences is hard. I have to laugh, my worst grade every in English was during the school year we had to diagram sentences. I think I was 11 at the time. A ‘meta narrative’ would be when we creatively analyse the sentences and the story and then offer sense-making explanations. So perspective really is a way of objectifying the pieces of the system which creates experience. Without consciousness, however, we cannot have perspective. I’ll toss in one interesting aside.. since our system of experience is both combinatorial and recursive – a language of images – what we see at the proto level is likely very representative of narrative and meta-narrative.
JM Can you say a bit more about recursion?
CB I’ll give you one example: “Hofstadter’s Law: It always take longer than you expect, even when you take into account Hofstadter’s Law.”
JM oh yes I see this is a paradox akin to Descartes idea of the inner homunculus
CB yes .. it’s turtles all the way down
JM and ownership?
CB After ownership, you’re welcome to ask the homunculus question.
I describe experience in this simple form: body-as-it-was, object, body-as-it-is. Both body and ‘object’ sound like physical entities. And intuitively they are. Within the brain, however, they are not physical object. They are a collection of neural patterns which map to both the body and the object. The neural patterns are basically mental property. We own them.
JM Why is mapping to the body important?
CB Our body is the ubiquitous part of our experience, and like a fish not noticing water, our experience has limited awareness of the body. Sure we might notice if we are hungry, but relatively speaking, that’s a big event in the body. When I mentioned ‘snake’ earlier, you probably had no experience of any change to your body because of the sight of the word ‘snake.’  Because body-change is part of every moment of experience, and body-state hardly ever changes, this constancy, this mapping of events through the body, providence a stable reference, like having a camera fixed in one location. This stability gives rise to the sense of self.
CB I’m groping for a clever way to connect this to ownership.
JM So i’ll just summarise to see if I’ve understood it properly
We have two types of experience the first is the experience of the objects – real or internal
We have a second experience of the experience these are all represented in the brain as patterns of neural activity which are accessed through our mind
part of these experiences are from the body which provides a predictable type of experience which acts as an anchor
we develop a sense of ownership as a result
CB So the mental images we ‘own’ (of the body and of the object) have very complex relationships and give rise to a very personalized experience. So if ownership is about an actor and a script, we own the playhouse, the actor and the script. Too often we feel we are the actor rather than the playhouse.
JM Ok and the playhouse is the experience of the body. So effectively we sculpt the experience and call it ‘I’?
CB ‘meta’ is where all the useful metaphors are. But maybe  the best way to think of it is: it’s objects all the way down, just like turtles. We rarely recognize the body as an object or the system of body-objects as an object, because our natural point of view for recognizing things comes from these objects. But only when we see everything as an object, we can start making sense of our peculiar psychology, and we can exercise agency over all the objects, not the ones found only within the narrative itself.
JM That’s very interesting
CB Now to agency.. we can manipulate all of the objects. And here is were we go ‘meta’ in a sense. We have to have a mental object before we can have agency. So part of my writing is to objectify the body-object and the system of experience. The more visceral our sense of these objects, the more our natural, innate behavior in engaged. And here is where I draw the connection to trauma, self-development and well-being.
JM Very interesting. I’d like to finish off with a few more questions. Have you been influenced by William James?
CB Indirectly, yes. When I think of systems of experience, Antonio Damasio is the greatest influence and he draws on William James a lot.
JM How did you get interested in Damasio
CB Trauma is a body-based challenge. The books and literature cited Damasio so much, I just went to the source.
JM Which work by Damasio influenced you the most?
CB He has a long list of peer reviewed articles, but when I’m looking for a sense of the overall picture, I usually turn to two books – The Feeling of What Happens first and Looking of Spinoza second.
JM What are your thoughts on Descartes Error?
CB That’s an important book too, because in a way, it brought the neuroscientific study of emotion and consciousness out of the closet and transformed it into mainstream science. A lot of the ideas he uses in Descartes Error are continued in the later two with the benefit of more study and more criticism. I have to remind myself of my goal: I want to write about the science of our complex human nature so that it makes intuitive sense to someone interested in ‘personal development.’ Within that broad goal, I write on specific topics – trauma and posttraumatic growth, resilience and well-being.
JM Well Cole thanks very much for doing this interview
CB Thanks so much :)

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