There has been a very encouraging announcement from the UK government in a report titled ‘New Horizons’ where the government is now preparing to triple the funding of mental health research from £50 million to £150 million each year. This comes with recognition of the impact that mental illness has or will have on society both now and in the future.

Research in Dementia

Apathy was more likely in Dementia (Alzheimer’s Disease, Vascular Dementia or Mixed Dementia) in patients with white matter lesions in one study (n=176). Research at the molecular level has identified two compounds which when acting together have dissolved Amyloid plaque. The two compounds are DAPH-12 and a green tea component EGCG. This has taken place in the Yeast version of the Amyloid plaque but would need to be supported by positive findings in the human version and then in clinical trials and so there are several steps to go before the implications are clear. A Swedish team are taking a unique approach to the management of Amyloid plaques. This involves the construction of an artificial protein which envelopes the Amyloid plaque components – the ABeta peptides and the protein is currently being modified to avoid degradation in the circulation. The team are also working with another approach which involves stabilising oligimers intermediate in the transformation of ABeta peptides into Amyloid plaques. A team in Dundee are undertaking research into Parkinson’s Disease using the worm C.elegans!

Research in Mood Disorders

The Psydir News has a review of a number of recent phase 2 and 3 trials including a proprietary combination of Buspirone and Melatonin in this article and it will be interesting to see the results of further relevant studies and which will gain regulatory approval.

Miscellaneous Research

A research team have removed brain tissue from a man with intractable epilepsy and not only preserved this tissue but also enabled the tissue to continue to function. This allowed them to examine the tissue function in more detail to try to understand how the seizures were being generated. The researchers identified very fast oscillations which were thought to represent the precursors to seizure activity but excluded chemical neurotransmission as the basis for this activity. The researchers concluded that the seizures were likely to result from electrical transmission (which occurs across gap junctions rather than through neurotransmitters) and this might have implications for therapeutics research. The study is also covered here. There has been recent discussion of a theory that cerebral venous insufficiency may lead to Multiple Sclerosis supported by imaging and surgical evidence. However there are many questions that remain to be answered and further research will be needed.

A Belgian study looked at psychological trait in medical students over 7 years. They found that extraversion was associated with lower performance in the preclinical phase of medical school but beneficial in the clinical phase. Being conscientious was associated with success in the preclinical phase. A recent study looked at a man who had experienced damage to the insular cortex and anterior cingulate cortex but still maintained an awareness of his heart rate. The researchers concluded that there are at least two areas that are responsible for a person’s awareness of their internal body functions – interoception – one being the insular cortex and the other being unkown but likely to be the somatosensory cortex. In Missouri, USA, the National Centre for Health Statistics have developed an online training tool for separated parents to faciliate compliance with state law. They provided evidence from the parents of subjective improvement in relationships and they are intending to roll this out to other states. It will be interesting to follow the results of further studies in this area. A research team in Manchester are undertaking a study into virtual reality assisted treatment of driving phobias and it will be interesting to see if this has the same success as virtual reality based treatments for other types of phobia.  A life story conference is being held at the beginning of next year which will help to explore how life stories can be used in mental health services.

News Round-Ups

MindHacks has another installment of Spike Activity in which amongst other items he notes the recent dissection of H.M’s brain online. Patient H.M is a famous patient who unfortunately had both of his hippocampi removed and was subsequently unable to store new biographical information. The hippocampus has been shown to play a role in the pathology of some forms of dementia and there is a lot of research now underway looking at this relationship in more detail. H.M very kindly gave permission for his brain to be used after his death and the H.M blog is here. Over at the clinical cases and images blog there is a mention of loneliness spreading in social networks. The AlzForum continue with coverage of the Chicago Neuroscience conference and discuss studies which suggest the involvement of calcineurin and Nuclear Factors of Activated T-Cells (NFAT’s) in Alzheimer’s Disease. They also examine evidence that in Mild Cognitive Impairment higher brain metabolism may be protective against possible neurotoxic effects of Amyloid plaques.  In the Schizophrenia Forum, there is coverage of the Neuroscience Conference with a look at various studies comparing biological markers in Bipolar Disorder and Schizophrenia. There is a round-up of the monthly news in PTSD over at the Heal My PTSD blog which includes a look at Telehealth and trauma in the movies. Over at the Neuroanthropology blog there is an excellent round-up of recent blog articles including one on research into synaesthesia. Mental Nurse has an interesting round-up of blog articles including the Neuroskeptic’s look at a study in which psychiatrists and psychologists assessed their own response to an antidepressant.

Evolutionary Psychiatry

Subtle changes in speech can feature in illnesss and listening to the ‘music’ in a person’s voice has been suggested as very useful in an assessment (see here). Two recent studies add to the growing body of evidence showing a link between music and speech e.g (Mithen, 2005). In the first study, sad or happy affect could be described in major and minor scales. In the second study, 10 people repeated different vowel sounds with different affect. The researchers provided evidence that the most popular scales occurring in folk songs were based on vowel sounds.

Psychiatry 2.0

In a recent study, the authors looked at Facebook user profiles and compared them with personality inventories completed on those same people (n=236). They found that there was a significant relationship between the Facebook profiles and their scores on the personality tests which was most significant for extraversion and least significant for neuroticism. If there are useful relationships between facebook profiles and personality test results then there may be health applications for this but only if the appropriate applications are developed and relevant trials undertaken. MindHacks covers hallucinations in people who were profoundly deaf or deaf at birth in this article. The Neurocritic looks at the recent online dissection of H.M’s brain in this article. Dr Shock writes about a recent course in Oxford about editing journals complete with video.

References

Steve Mithen. The Singing Neanderthals: The Origins of Music, Language, Mind and Body. George Weidenfeld and Nicholson publishers. 2005.

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The Nature Podcasts reviewed here are of a typically high standard.  I thought the audio quality was very good. The hosts of the program speak clearly and slowly and there are helpful pauses between questions and answers which help the listener to take in the information that is being presented. In the Nature Podcast of November 19th 2009 (freely available here) there is a brief discussion of the works of Charles Darwin and the impact this had on his contemporary society. There is also a look at how Darwin’s theory of evolution spread throughout the world and some of the complexities of translating his works. In the Nature Podcast of November 26th 2009 (freely available here) there is a discussion of murine studies finding a relationship between osteoporosis and temperature regulation mediated through a protein Rank-L. There is also an interesting discussion of a study in which people were more likely to hear vowel sounds that sounded like a puff of air applied as a stimulus to their skin. The vowel sound involved pursing the lips which the researchers argue was analogous to the tactile stimulus that was applied to the skin and they speculate that sensory information from different modalities was being integrated before the decisions were made.

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feeling pummelled, black&blue (literally)… i sense the visceral illusion of my skull striking the ground. body memories. did you know they can do that? the things the body experiences during severe trauma are remembered so well that simply to recall it once again, years later, can mark it in your flesh. presence is a complicated thing, yes?

so this is all learning by experience. the plus side is responsiveness… energy i can use to alter what remains of the day. it’s why dance brings such a lightning charge to every fibre of naked being.

i’ve been thinking about a lot of things lately… not easy between daily flashbacks that can go on for hours sometimes. mostly in the shower. i get frozen, stuck whilst the water falls in ceaseless rhythms against my flesh. i crave that sensation. the droplets sting in the marrow, where i meet my better twin –
i come out of it, portion by portion but exhausted, after what needs must flows away.

that’s one of the things i struggle with in general. welcome to the world of dissociation — we’ll take a right turn, down an unknown street:

was always told nobody would believe me anyway. and truthfully, they didn’t. i’d tell them something hurt, they’d say it didn’t, just being stupid, that i was hurting them not that the pain was mine to feel.

mother always said that…
from the moment i was born, if i cried, she’d tell me how it hurt her and ask why i’d want to do such a thing?
i still don’t have an answer. i still seek out the best way to let her be.
there is information, facts, the skeletons of memory and mind but i’m not sure i can be upset — truly, madly, deeply — in anybody’s presence except my own. i need quiet to enter into that space. it is a private land. a place to visit and to heal because you do not have to filter what you feel. nor sit through too much of that ever-present fear that you are not enough.

i can put it into metaphor but even that, well, that wasn’t allowed when i was growing up. before i was that catatonic kid, just slipping slowly into silent realms, i wrote a few poems, in my more lucid dreams. well, part of me did. she needed a name because it’s when i started really getting into the whole online forum thing. i know her well and like her –
a study in devotion that sometimes whispers in the night. a comfortable state but only that…
a frozen piece of times gone by that holds to might and magic.

perhaps i shouldn’t tell you this. but there are plenty of things i shouldn’t and so many more i should. exultation is the summary of all those sometimes where we spell paradox again.

far too tired to fight, my mind capricious — i’ll get a sound talking to later.

there’s one way out and that’s through…
i have to find the keys. they are my companions and my clues.

i hear him more these passed few days… “stay down, bitch.” i try. i try to make it all ok.

there is too much goodness to be found in the moment, when i can get near enough to ask. questions come from the past that perhaps, as they say, i should just get over. except, now i can say yes, if i want.

yes.yesyes.
the need for answers. they may not stay for long but if you build it they will come.

i make wishes to ward off the fear, that i am as wrong as i was taught i must be, in order to do the right thing. that’s the funny thing…

i always held the right thing in mind. everything a test, though the lessons changed with the seasons, desire did not.

there are terrible notions that rise like the wind off the sea but the sea itself is my blanket of mystery.

i dive beneath the waters and i will drown as it sets me free.

Patient A is an adolescent GCSE student at school. I went to his school to meet him and to draw him. The art teacher was very helpful and we set up an area in the art class to do the portrait. Patient A was in a very good mood when I met him. A bit shy but very happy to talk once we where sitting down. He told me that his favourite subjects where art and drama and showed me some of his art-work. He wants to go to college after his GCSEs and learn a trade rather than going to university. He has a cousin who is an artist and he told me that he has made a sculpture that he will send for thousands of pounds, Patient A seemed impressed by his cousin. We talked about being at school and  thinking that anyone over 20 is old and how that changes as you get older yourself. He had two badges on that said “CITIZEN” which had been given to him in reward for a good deed he had done for the school. He is also a sports captain and told me he loves playing basketball and football at break-time with his friends. We talked about the canteen, pizza, cheese toasties portugese custard tarts, portugal and Ireland. He sat still and really concentrated for over an hour and said he enjoyed the experience of being drawn. When I had finished the drawing he brought one of his friends into the class to show him the drawing and seemed proud and said thank-you. 

Below you can see self portraits A made in his GCSE art class.

Dr F came to the Maudsley as a medical student on a short elective and worked in the emergency clinic with a famous psychiatrist called Antony Clare and enjoyed this.When a medical student on my surgical placement her consultant noted how hopeless she was in surgery but how good she was with patients and suggested she do psychiatry. Her interests are campaigning and teaching on improving the lot of children in the UK and she is also involved in an NGO which helps asylum seekers in detentiton to get treatment and get out when necessary.

Dr F has a wonderful realtionship with her patient (Patient C). Her patient attributes her full recovery to meeting Dr F. When I asked what they had in common she replied “So much! I have just been luckier in my life experiences”.

She is a lover of nature and finds peace when walking or cycling in the country side or by the sea. She love elephants, wild animals and birds. 

She is influenced by the work of John Bowlby and his followers carrying out attachment research has influenced the way she works and is the conceptual basis for her understanding of  working with survivors of abuse and of torture.

She has a collection of miniature houses, animals and pots made by south americans, who she lived with as a kid.

When I asked her what she would change about psychiatry she said “Remove the right to section people”

Having used twitter for a few months now, I’ve begun to ask myself ”How could Twitter impact on social relationships?’. As this is a young technology there isn’t too much research in this area. At the time of writing a search of the Medline using the keyword ‘twitter’ produced 16 relevant articles (not to be confused with another strand of research into the auditory cortex) with a focus on direct health applications of twitter. Social relationships can be a proxy marker for health and a number of diagnostic criteria for illnesses refer to impairments in social relationships. Thus the question of the impact of Twitter on social relationships is a useful one to ask. There are a number of possible ways in which Twitter might impact on people’s social relationships and I have grouped them into broad categories. Most of what is written is entirely speculative but can be revisited once more research evidence becomes available.

Twitter and Face-To-Face Contact

Twitterers don’t use face-to-face contact. They rely on short messages to each other or to a wider audience. People are therefore focusing on what the person has to say rather than focusing on their appearance, their body movements or listening to their speech. This changes the dynamics of the interaction. People focus on their own appearance, movements and speech in face-to-face contacts to varying extents because they know that this impacts on the effectiveness of their message. The absence of these cues means that the time spent listening to and speaking (twittering) with a person may differ markedly from the equivalent face-to-face contact. There are so many ways in which this could occur that it is difficult to generalise. Here are a few examples of how it might change interactions.

• A person might choose to listen to another person for a longer period in the twitter environment than in face-to-face contact if the other person’s accent and attire are markedly different from people who they would usually socialise with.
• People who are anxious around others – for instance if they have social phobia – might find it more comfortable to ‘talk’ to other people using Twitter. In this way they might be able to ‘catch up’ on important social trends that help them to better join the conversations of their peers. This in turn might lead to a levelling of the ’social currency’ playing field and may have implications for social inclusion. However this is speculation and research would be needed to investigate this possibility.

On the other hand, having another internet technology that uses people’s time might mean that they spend much less time with people in face-to-face contact. This has been suggested elsewhere. The premise is that people may become deskilled in using verbal and non-verbal methods of communication in real world interactions. If they are deskilled then this might have a number of implications. Real-world interactions might take longer, they might occur less frequently or twitterers might be less likely to be included by their non-twittering peers. The opposite might also be true however. Twitterers might develop their own method of communicating in real world interactions. They might be more efficient in their dialogue, may reference material from the twitterstream or may think more about what they say before saying it. A twitter culture might develop which would be easily recognisable allowing the listener to deduce twitter users from non-twitter users in casual conversation. Twitter might also be better suited to people with certain characteristics – those that are more comfortable with information technology, those that use other similar methods of communicating (e.g Instant Messaging) or those that are more introverted. Twitter might not influence face-to-face contacts at all. Again research will be needed to better answer these questions.

Twitter and People Knowledge

Twitters give people an opportunity to better understand a person – what they like to talk about, their patterns of twittering, how they interact with other twitter users. There are a number of possible implications of this.

• People who follow a lot of twitters from diverse backgrounds could quickly build up an understanding of lots of people and this in turn would enable them with ‘people knowledge’ that would better equip them for social interactions with people. On the other hand, twittering offers a limited insight into a person since it represents a relatively small proportion of their activities.
• People may follow people in a restricted field of interest and become quickly familiarised with the current topics of discussion. This approach is facilitated by the use of twitter lists which can identify people in a certain area of interst very quickly allowing them to be added to a person’s twitter stream.
• Twitter does let certain dynamics play out. Sometimes people are insulted at what some twitterers have said and respond. Alternatively they might be insulted at what some Twitterers have not said or done (e.g not following someone who has followed them). Twitter therefore offers a microcosm of the real world in which dynamics play out in real(ish) time and where these dynamics can sometimes spill out into the real world. This gives people the opportunity to learn about how people behave.
• Twitter could help twitterers to develop a more refined ‘lay psychology’ that would not replace study of the relevant discipline but would instead increase the knowledge level of the general twitter population. If a person behaves in a certain way, twitter followers can watch their follower numbers and see if they increase or decrease. It is almost as those they are following live twitter ratings. In this way they can see what effects certain actions have on people’s willingness to follow. This in turn is raw numerical information that they are using. Although there are no accompanying statistics for changes over a unit of time or per tweet at this point in time, it means that people are getting used to assessing behaviours using numbers. However not many people may be using this approach or if they are, they may not pay too much attention to it. Additionally the follower numbers may not be helpful in some instances (e.g. where a high proportion of follower accounts have been inactive).

Again much of this is speculation and will need research to provide accurate answers.

Twitter and Offline Relationships

Twitter could be used to communicate more frequently with friends and family in much the same way as with mobile text messaging. Needing to access desktop computers makes this more difficult than with mobile phones although it is also possible to use twitter from mobile devices. Twitter could make it easier to quickly follow what friends are doing in much the same way as Facebook does when the person is running short of time. This approach could also be used by a person to update lots of their friends on events quickly and efficiently again in much the same way as Facebook and here the use of private streams makes this practical. This means that if friends and family use twitter they will be better connected, if being better connected means having timely access to information. This might be expected to benefit relationships and people might prefer to use their ‘media’ time (e.g. television, radio, twitter etc) to follow their friends twitterstreams rather than those of celebrities. This might in turn impact on the relative influence of celebrities in culture and may instead mean that people form relatively small groups that are very well connected. However the ability of twitter to enable several streams to be followed simultaneously suggests that the more influential figures are likely to remain so and perhaps become even more influential.

Twitter and Work Relationships

Twitter users with public streams are communicating in a way which differs markedly from informal face-to-face conversations with friends and if this is not recognised it can cause problems. On facebook there have been cases when remarks have been made about the company that employs the person or where the person has made remarks about work colleagues which have led to their dismissal. This may lead to a much tighter demarcation between work and a person’s own activities possibly resulting in a smaller percentage of time being spent talking about work in their own time. Many companies are developing their own social media policies for use by employees. Again research will be needed to clarify how this impacts on relationships with work colleagues.

Twitter Celebrity

At the time of writing there are several people with over 3 million followers on Twitter and a number of others with twitter followers in the millions or hundreds of thousands. This is obviously a continuum which extends from such large numbers to a few friends or family members at the other end of the spectrum. Somewhere towards the upper end of this continuum there are a group of people who have through the medium of twitter alone accumulated many tens of thousands of followers. Even those with a thousand or a few thousand followers will have the same experience of having sudden immense popularity thrust upon them. This can change the way that people interact and is true of other media also. As the influence of these people increases so too does the likelihood that they can be helpful to more people. This might impact on the nature of twitter exchanges although research again would be helpful here. Away from the twitter world however there may be different interactions with twitter and non-twitter users. In interactions with non-twitter users, the influence that a person has on twitter may be seen as without merit and that person will have to be able to quickly readjust. Here the argument is similar to that used previously for face-to-face interactions. If the person is used to interactions in a setting where they have a lot of influence, then they will lose the skills needed in a setting where they have much less influence and may have to use various methods to adjust to this imbalance. Others may choose to capitalise on this influence and transfer it offline and again this might impact on the nature of their relationships. Twitterers may find it easier to form new relationships in the real world if people are familiar with them on twitter before having met them.

Twitter and Business

A number of businesses have a presence on twitter and some have both a large number of followers and twitter at a prolific rate. People who twitter in their own time and for social purposes may find that a certain percentage of their ‘conversation’ is spent listening to business messages. This might also be in the form of spam in direct messages which is in effect little different from spam e-mails. At other times they might choose to listen to interesting content directly from businesses. A number of business twitters will market a product and so twitterers may find themselves being exposed to marketing messages in a greater proportion of their time. However the ability to tune out certain twitterers or simply to follow a select group means that twitterers have a sophisticated level of control over this experience. If twitterers do find an increasing percentage of their socialising time is spent listenting to marketing messages this might impact on their communication skills (because they would have less time for other social interactions), the nature of their accumulating knowledge or it might even increase their opportunities to socialise. Again this is far from clear and research would be helpful to find answers to these questions.

Conclusions

Twitter was identified as the top word in 2009 in a Global Language Monitoring Survey as well as featuring prominently in President Obama’s election campaign reinforcing the importance of this social media tool. In a recent survey 28% of twitter users were over 45 years of age and 55% were located in the USA. The interactive nature of Twitter means that people are not only consumers of information but are also able to contribute. Thus Twitter has been used for social good such as in the case of raising funds for charity. Others have written about the possible benefits of Twitter including the effects that it may have on relationships. Like any tool however it can be misused and criminal activities have also been coordinated using Twitter followed closely by police surveillance. It has also been pointed out that Twitter can be a source of a misinformation. One author has suggested that Twitter may ‘enhance peripheral attention’ and impact beneficially on self-esteem although it has been argued that full attention is not required for some activities. Professor Greenfield has argued that use of social media such as Twitter could change the hardwiring of the brain in way which impacts adversely on functions such as attention and even morals although there are those that disagree. Strategies for using Twitter vary. For instance how many people a Twitterer follows has been dichotomised into low relevant numbers versus high non-relevant numbers. With so many uses of this technology it is difficult if not impossible to draw general conclusions about the technology and as with other technologies accurate answers will most likely arise in circumscribed applications of Twitter. Once the results of such research become available they can be applied to improve the effective use of Twitter and may one day be used for those with recognised difficulties in social relationships. Twitter is just one of many emerging social media technologies which solve certain problems and there is already talk of web 3.0 applications.

Conflict of Interest

I have a twitter account.

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The blog reviewed here is ‘Practice what I Preach – A Child Psychiatrist Becomes a Parent‘. After receiving a comment on this blog from the author, an Australian Child Psychiatrist, recently, I became curious and had a look at the blog. I thought the premise for the blog was extremely interesting – what happens when a child psychiatrist becomes a parent and writes about the experience?

Appearance and Design

At the time of writing the blog has a grey background, blue title pane and white background for the articles. The articles consist of black text on a white background. On the right hand panel there are links to an About section, categories, a calendar as well as recent posts, blog statistics and a blogroll. The reader can also subscribe to the blog. There are also pictures in some of the articles which add to the presentation.

Content

The author who I will refer to as Dr D, an Australian Child Psychiatrist starts with this post explaining the motivations behind the blog. In this next article, Dr D describes the experience of being a patient and the thoughts she has about her interactions with the staff in this situation as a doctor patient. I thought this article was very interesting and reminded me of theme in the film ‘The Doctor‘. I think this will always be an interesting subject and can be very important for the introspection that contributes to the development of a speciality. In discussing this Dr D generated comments and this shared introspection was very interesting. In this post, Dr D discusses the issue of not getting enough sleep while in this article, Dr D talks about emotional attunement with the baby and mentions briefly theory in this area, an area which Winnicott wrote about (see review here). In this post, Dr D tells us about the sounds that her baby is beginning to make. What I found particularly interesting was when Dr D reviews the evidence base for when to use solid foods for feeding in coming to her own decision.

Conclusions

I found the premise behind Dr D’s blog extremely interesting and enjoyed reading through the articles which were filled with insights about the parenting process and also areas where the research or literature had something helpful to say.  Dr D writes candidly on the experience of parenting and I look forward to future posts.

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The audiobook reviewed here is ‘The Voyage of the Beagle’ by Charles Darwin and narrated by Professor Richard Dawkins. It seems fitting that Dawkins should read this audiobook by Darwin as he travels on his historic voyage around the world. Dawkins narrates with an obvious passion for the work and each sentence is read so convincingly that it became easy to imagine Darwin’s corresponding experiences. Darwin’s writing in this book was a surprise to me. I had expected a concentrated description of the focus of his studies – the varieties of life that he witnessed. However Darwin takes considerable effort to describe not just the wonderful species that he came into contact with but also his own experience on what was a fantastic voyage around the world that would hold appeal to many over 150 years later. I was impressed when Darwin takes the time to describe the injustices that he witnessed against slaves with evident compassion for their plight. He describes the joy of being surrounded by the beautiful vistas, a visit to the Beagle by the Queen of Tahiti – Queen Pomarre, the anxiety of the sometimes dangerous encounters with indigenous tribes and the incomprehensible (to me) breakfast and lunch derived from a passing Armadillo.

Another striking feature is the eloquence of Darwin’s writing and this same writing had wide appeal to his Victorian audience on his return home. He writes humorously at times and I found myself laughing at some of the situations he  described. He also painted a vivid picture of the people that he encountered on his travels. However Darwin also delivers to us a vast number of observations about the taxonomies of the witnessed species but interspersed in the text in such a way as to become almost imperceptible except on further reflection. After this further reflection however it is possible to see at work the great mind of Darwin carefully abstracting his visual and auditory perceptions, integrating those abstractions into his internalised taxonomic structures and then attaching these new labels to his descriptions of the scenery to at once transform this same scene and offer the reader a new vision of the world through the eyes of a naturalist.

Throughout the work, Darwin also refers to the ‘countenance’ of the people he met during the journey and their facial expressions are described in various passages. It was tempting for me to suspect that he had already at this stage started to think about the expression of emotions in humans long before the publication of his book ‘The Expression of the Emotions in Man and Animals’ in 1872. Similarly there are various references to the pressures on animals in different environments. For instance in one passage he conjectures that a species of bird is adapting through generations so as to learn to avoid human predators which they were unable to do as individual birds in the short term.

This is a fascinating and well narrated book which is both entertaining without being too taxing and which gives an insight into Darwin and his experiences during this historic journey.

References

Charles Darwin. The Voyage of the Beagle. Narrated by Richard Dawkins. Originally published in 1837. Published as an audiobook in 2009 by CSA Word.

Charles Darwin. The Expression of the Emotions in Man and Animals. 1872.

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www.cchrint.org psychiatrist Colin Ross, author of "The CIA Doctors" and "Military Mind Control" describes the long-standing relationship between intelligence, military, psychiatry and psychology in mind control experiments on unwitting subjects, including the use of LSD, psychiatric drugs, radiation, obtained brain electrode implants, hypnosis, reviewed by the government documents through the Freedom of Information Act (FOIA). For further information, please read Dr. Ross' blog "The CIA …

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This evening, I was in a nice restaurant and noticed one of the most prominent televangelists in America walking in. If you have cable TV, he is instantly recognizable. He drove up in a Rolls Royce with blacked out windows and had two armed bodyguards. Funny thing for a man of the cloth. You see, his empire is in the many hundreds of millions of dollars, and if a reasonable intelligent individual watched him in action, they would call BS after 3-4 minutes of watching his oily informercials for Jesus.

Another Elmer Gantry finally broke his silence tonight. Al Gore doubled down on his anthropomorphic global warming sermon and said that we have to act yesterday to prevent a global catastrophe. His visual aid,  for the event, presented by Arnold Schwarzenegger, was a map of San Francisco in 2030 showing the entire coastline inundated and the city under 30′ of water. Some  are not too unhappy about that prospect. I would miss the surf at Mavericks, though. Mr. Gore said nothing about the Climategate controversy or his massive bet on carbon futures, the big money pot at the end of his particular rainbow. Mr. Gore, you see, only takes select questions from trained monkeys these days.

On the other side of the country Larry King was on television arguing with Michael Moore, who I must say has at least a consistency of conviction on the Afghanistan war. Mr. Moore pointed out the intellectual flaws in Mr. Obama’s rationalization of the Afghanistan surge while Mr. King was an unabashed cheerleader. Sean Penn, Jane Fonda, and others on the Left have all been contorting themselves like a game of Twister gone wrong today as they try to justify the President’s pretzel logic. At the same time, the Congressional Black Caucus wants to stick up the Congress for more aid for their pet projects, including mortgage forgiveness in inner cities, pork, and a laundry list amounting to hundreds of billions for their campaign donors.

I really am not sure if I loathe the preacher or the politicians or the gandy dancers more these days.

I am acquainted with the leader of the Maryland Coalition Against Pornography, and she sent me a link to a new study on porn. It was sponsored by an organization that is affiliated with Focus on the Family, and I’m starting to feel a little out of place.  See the pic for it’s main points.

I’m not a Christian fundamentalist. I’m not even religious. You could even say I was anti-religion; in fact, I am vehemently secular. So there is my problem; I don’t fit in or agree with the anti-porn front coming from Jesusville. I’m totally on another page.

And then there’s the feminists. Goddess bless their good intentions, but they can be utterly and painfully misguided. No shit for those of you who feel that the gender movement has become so splintered that we have no more clout or cred anymore. I’m right there with you – in fact, I believe that we’re bound for an uprising.

On that note, I will share a story. Earlier this year, the University of Maryland, College Park, showed a XXX porn film for shiggles. Sure, they claimed it was all about safe sex and free speech. After all the hullabaloo, they ended up canceling the talk from Planned Parenthood and had an ACLU rep talk about free speech.

Interesting. Free speech. Funny how they didn’t host any discussion of opposition to the screening.

State legislators stepped in and managed to truncate the screening to the first 30 minutes or the university would lose tens of millions in state funding a year. Students giggled their way through a sex scene and felt very proud of themselves. After all, isn’t that why we go to college? To become mature enough to watch XXX movies like an adult?

I’d like to point out that the screening was organized by a student who was running for political office, and who was supported by the student group, Feminism Without Borders. I wrote them in protest and received no reply.

This movie featured a gang rape scene facilitated by a woman. Of course, the supposed victim decided she liked it after a few minutes. Really liked it. I’m imagining young people watching this, and I can’t help but feel, rather, know that they weren’t quite up to the task of being critical of it.

Feminism Without A Clue, more like.

This all started a huge argument over what free speech is, and is porn bad, blah blah… I even found myself as a commenter on the locally famed Kojo Naamdi Show on Washington D.C.’s NPR talking about how our university admins have the responsibility to guide us through being critical of the world around us even in the face of criticism ourselves.

Here’s the best part, folks: I called the acting director of the women’s studies department at the university, and she hung up on me. How’s that for plot thickening?

I took it upon myself to hold a screening of a movie at my own campus. No, it wasn’t the pirate movie. It was a documentary on porn by acclaimed filmmaker Chyng Sun, NYU master educator: The Price of Pleasure.

It was NOT easy to get this shown on my campus. It’s very interesting to me that the XXX pirate movie has been literally handed out for free at universities all over the country by the production agency, where it was shown without much ado, yet I try to show a documentary ABOUT porn and I run into a ton of tension and hesitation. Not to mention the occasional straight up firewall.

I wonder if the student politicians at UMCP had to have a faculty member present to moderate the discussion. I just have low expectations of them.

I finally got the thing shown, and we had a pretty good turnout for a chronically lackadaisical community commuter college. I had about 25 people, and UMCP had so many that people were sitting on the floor and standing in the back.

We also had a great discussion, something we at Montgomery College can be extremely proud of. Go us! That IS what going to college is all about; critical inquiry into our world, using critical thinking skills and honing them. And yet we play approximately 300% less per credit hour. Sheesh.

The problem here isn’t that government was trying to intervene in free speech matters. And it wasn’t even that the film was shown; it was about the circumstances under which it was screened, and the pathetic response from the school (case in point: my brief and truncated call to the women’s studies department). It’s also just about porn and people’s feelings towards it.

Porn is so much more than just sex. And who are we to say that the lack of repressive sexualities is bad for society, as suggested by the study’s interpretation? Sexual openness is a fine and normal part of natural human behavior. For those that have strict religious dogma, they may disagree, but I am speaking purely from a secular frame of mind, and my intent is for its application to be purely secular in a very general way also.

People are going to explore every facet of their being (if they know what’s good for them, of course), and that includes sexuality. Sex has a dark side that is welcome to be explored, but with all philosophy aside, once an individual or a society condones the act of inflicting suffering, there is an inherent evil within the mindset of the perpetrators. This is really the problem with it all – it is indicative of the selfishness within society – a symptom of a much more broad problem – self-absorption.

The selfless man will be far less likely to indulge himself in a video of a woman being humiliated or hurt. He will be equally unlikely to take part in its production. It is those who cultivate the very opposite of compassion that do so, as it is so easy to do here and now.

Exploring the innermost desires of one’s sexuality is normal, even if it’s “weird,” uncomfortable, or unusual. But capitalizing on the systematic dehumanization of women is an entirely different story, and that is truly the basis of the problem.

I wonder if there is anything to be done about perhaps replacing pornography with its unequal alternative: erotica. Erotica, ideally, is a perfectly normal and natural expression and exploration of sexuality in terms that many people are comfortable with. It’s not a lot different from sex scenes in movies, save for the fact that the sex acts are actually performed. There is the main differentiation  between porn and erotica, however, which is that it does not degrade, but rather, represent.

On top of that, let me make an important distinction between porn and erotica. Pornography is derived from the Greek word “pornae,” a term for the lowest class of street whores. Erotica is derived from the Greek word “Eros,” or the name of the Greek god of sexual love and beauty. Whores and love/beauty – try not to confuse the two – I know, I know, porn makes that very challenging.

Porn main page; #1 result on google for "porn"

Take a look at these compressed screencaptures. I searched “porn,” and “erotica,” respectively, in google, and these were the first of each. Notice the difference of representation. The erotica website clearly has a well-developed seductive appearance, while the porn site is just repetitive fucking.

The erotica website - #1 result on google for "erotica"

Granted, when one wants to do one’s business, one wants to just do the business. But what of this systematic degredation? It may not be visible in the image, but the descriptions and titles of the videos in the porn site call women all kinds of horrible things, such as “slut, mom I’d like to fuck, twat, weird chubby chick, weird, bitch, monkey, etc.” Keep in mind, folks, this is not some obscure hard porn website. It’s the number one hit on google for porn.

It’s a good bet that plenty of guys in your life visit this website and click on, oh, maybe the one with the teenager banging an old man. Or the one with five dudes and one girl. This is not representative of common sexuality. It is astonishing that something so far from reality is the most popular form of porn; how do we condition ourselves to be turned on by something so unfamiliar and, in fact, cruel and unusual?

I think the main issue with replacement is that people do not pursue erotica specifically because of the main difference; that is to say, it doesn’t degrade women in the same way that has been so highly and effectively sexualized in porn. People have let  this media dictate their psycho-social responses and desires, making it perhaps pathological.

Consider the high rates of mental issues and substance abuse of porn actors, and you have an even clearer, if sadder, picture of the place porn has in our world. It’s a last resort option for the people who enter the field. Very, very few become well-respected and highly paid; there are also high STD and pregnancy rates. Don’t even pretend like you’ve ever seen a condom in a porn.

The documentary I mentioned earlier presented a university study where the top-selling porn films of 2008 were categorized and qualitatively coded. They found that the vast majority of these films contained aggressive and especially violent actions and language towards the females in the films. For example, making a woman go down on a man after he was just having anal sex with her – no washing. It’s got a term in the adult industry – ass-to-mouth (ATM). You get an award for this now at the AVN awards, but it used to be obscure. Why so popular now?

In the documentary, a behind-the-scenes tape showed an actor vomiting after shooting that very act; how are women able to feign arousal while eating their own feces off a penis?

It’s a shame, for so many reasons. I believe that a part of pornography addiction therapy would be the use of erotica as a healthy alternative during detoxification. I wonder if other psychologists support that theory?

What do you think? Can porn be replaced with erotica? Will porn continue to be such a huge force in our world, or will it begin to reflect a less imagined and more real form of human sexspression?

The article reviewed here is ‘Patterns and Changes in Prescriber Attitudes Toward PDA Prescription-Assistive Technology’ by Arun Vishwanath and colleagues. The authors look at the characteristics of ‘early’ and ‘late’ adopters of PDA prescription-assistive technology. Their interest in attitudes is explained in the introduction when they cite research suggesting that attitudes towards new technology is correlated with adoption of this same technology.

They selected 244 clinicians  from an American academic tertiary care children’s hospital representing different professions but accounting for 90% of prescribers in the inpatient service. This high percentage suggests that the sample is likely to be representative of the inpatient prescribers. The prescribers had recently undergone training in the use of the PDA software. Commercial software was used and supplied by the company producing the software. Hospital and staff-owned PDA’s were used with the software and all PDA’s used in the course of the study were inspected to ensure that they met specific hardware standards. These standards in turn would ensure that the software was appropriately ‘responsive. Details of the training were given.

Assessments of clinician’s attitudes towards the technology before and after implementation were assessed using a Likert-scale questionnaire. The authors then state that the questionnaire design and administration was conducted by an external company that had previous experience with this type of research. Regarding the various tools that were used pre and post-implementation, the authors write that

‘All the measures used in the study were valid measures drawn from prior technology acceptance research and modified to suit the clinical context‘

I wasn’t sure of the type of validity that was being referred to and how the previous research tools were modified.  They also wrote that

‘All multi-item measures were reliable and achieved an acceptable alpha level‘ (alpha greater than 0.85).

A number of questionnaires were used and most used closed-questions but one gave the option for open-ended responses. Although I might have missed this I couldn’t find a clear definition of early and late adopters but the authors state that these groups can be distinguished on the basis of the results of a ‘five-item measure of the clinician’s attitude twoards PDAs, and a measure of the clinician’s likelihood to adopt the PDA within the next year’. Under the statistical analysis the authors write that

‘The data were analy(s)ed using the combination of multivariate techniques…..Segments were derived by applying a two-step clustering algorithm. The resulting segments were validated statistically using t-tests (Boneferroni adjustments) and theoretically compared to the EA and LA profiles suggested by diffusion theory‘

This excerpt is quite information dense and contains lots of different and complex statistical processes which would involve judgments as to their suitability. I would be interested to learn more about the analysis that took place at this stage. The use of the Boneferroni adjustments reflects that multiple comparisons were taking place on the dataset and that relationships were being explored rather than primary hypotheses tested. Another question I asked on reading this section is what was diffusion theory and why was it being used in this analysis?

The difficulty that I had with this analysis was that it led to the stratification of the sample into early and late adopters of the technology. I  would argue therefore that it is difficult to know how to apply this term in an intuitive way. For instance if I were to ask if a person were a late or early adopter I would need to refer to their exploratory statistical analysis of this group – I would argue that it becomes difficult to translate into other populations. If this is the case, then I would add that it means I don’t really know how meaningful this is to me. While intuitively we might know what early and late adopters of the technology might be this statistical meaning is very specific and defined by several layers of abstraction. If as a result I just say that early adopters are people that adopt the technology soon after its advent and late adopters otherwise, I will perhaps be able to apply this knowledge to other scenarios but as a result of the above arguments my conclusions may be markedly inaccurate.

Taking into account the previous arguments there are a number of observations that the authors have made about their groups of LA and EA’s. They identified the EA group as significantly younger than the LA group and tending to be residents rather than attending. On a number of measures the researchers found that after the intervention there were still significant differences between the EA’s and LA’s in their attitudes towards PDA’s. Essentially even after training early adopters generally had more positive attitudes towards PDA’s than late adopters.

In conclusion, I found it difficult to conceptualise the constructs of EA and LA’s. Even so, I could see that here was a method to create potentially useful categories on the basis of the statistical analysis and to identify significant associations which could then be used qualitatively. What I found interesting and to some extent predictable is that with interventions, people within one category tended to remain in that category. Perhaps this suggests that to have any impact particularly with attitudes there should be a sustained intervention, that such impact should be intended and that the systems have some advantage over contemporary systems. It is difficult for me to extrapolate further other than to say that attitudes do not necessarily have a direct translation into behaviours and triangulation can be helpful. As for the clinical utility of the PDA’s, this is a topic in itself and will be dependent on the hardware and software as well as the setting. Rapid changes in technology can also have an impact on the application of such studies.

References

Vishwanath A, Brodsky L, Shaha S et al. Patterns and changes in prescriber attitudes toward PDA prescription-assistive technology. International Journal of Medical Informatics. 78. 2009. 330-339.

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The posts I wrote yesterday got me thinking about marginalization–particularly of indigenous people, but certainly not stopping there. The specifics may be different, but marginalization is marginalization.

It occurred to me that my automatic perception that nobody else–save, perhaps, some very few people in similar boats–will be interested in reading what I have to write about a lot of topics comes straight from marginalization. Women’s issues, disability-related issues, neurodiversity, my particular set of racial and ethnic interests, how I see history and the ways of thought behind what’s happened in the world still playing out, human rights concerns for goodness’ sake: all these and more are marginalized. We’re supposed to think that they’re irrelevant, and nobody else is interested. We’re supposed to think that any interest we do have in these things is unusual, maladaptive, and very possibly crazy.

I was struck by the evidence of marginalization again, looking for various Native American–especially urban Indian, almost 2/3 of us now–health statistics for the Schizophrenia, epidemiologists, and race? Not a good mix. post.

What did I find?

It’s hard to tell how they get those figures other than for suicide rates, since “Native Americans are routinely omitted from many studies. Two major US prevalence studies—the Epidemiologic Catchment Area Study 1 and the National Comorbidity Survey 2—do not report data on Native Americans, or indicate that statistics on this group are difficult to specify (Duran et al., 2004). In the National Healthcare Disparities Report, only 42% of the measures could be used to assess mental health disparities among Native Americans (Moy et al., 2006).”# We are not even supposed to be around anymore, so there’s no need to study our health. If that’s not marginalization, I don’t know what is.

From the excellent Reconceptualizing Native Women’s Health: An “Indigenist” Stress-Coping Model, which helped me make an awful lot of connections when I read it a couple of years ago:

There are few comprehensive reviews of Native women’s health (e.g., Kauffman and Joseph-Fox1 and Joe11)…

However, Native women have higher death rates due to diabetes (45.4 vs 22.4), all types of accidents combined (38.1 vs 22.0), motor vehicle accidents (22.7 vs 10.5), chronic liver disease and cirrhosis (20.5 vs 6.1), alcohol abuse (20.3 vs 3.5), and suicide (5.2 vs 4.4). Native women are second only to African American women in terms of death rates due to homicide (4.8 vs 9.0) and drug abuse (4.7 vs 4.8).

So, again, most of the information available concerns our deaths. “The only good Indian…” lives on, if by now it’s morphed into “The only Indian…”, period. It’s harder to pretend a dead body is not right in front of you.

High rates of psychiatric problems and related comorbidity have been reported in many Native communities (with frequency estimates ranging from 20%–63% of adult populations), often higher than rates exhibited by non-Native groups. 20 Depression is among the most prevalent psychiatric disorders in Native communities,21 and it has been associated with living in urban areas and with substance abuse.22,23…

Although more than 60% of Natives live in urban settings, only a handful of studies provide any relevant data on the health-related concerns of such individuals, and none, to our knowledge, have focused specifically on women…

Absent a fourth world context, interpreting epidemiological data such as these leads to problematic interpretations of Native women’s health statistics. As noted by Browne and Fiske,27 failure to account for socioenvironmental contexts can lead to pathologized perceptions of Natives, reinforce power inequities, and perpetuate paternalism and dependency in regard to health care.28 Many of the behavioral health problems (e.g., diabetes, alcoholism) of Native women are directly connected to their colonized status and to associated forms of environmental, institutional, and interpersonal discrimination.

So, researchers don’t actually bother to find out what’s going on with us–not just with mental health, but straightforward physical stuff–yet still come up with all kinds of negative explanations for whatever problems we may be experiencing. BTW, I got irked at the inclusion of diabetes among “behavioral health problems”, which just tends to reinforce some of the too-common “you brought this on yourself, you fat lazy slob” thinking.

Moreover, problems associated with racial misclassification may result in serious underestimations of HIV rates among Native women.

It’s not just HIV rates. This is part of the reason there are so few health stats available.

Native people are not supposed to exist, for a variety of reasons, so any individual must be White, Black, Hispanic, Asian, Pacific Islander, etc. Pacific Islanders get lumped in with Asians, but there seems to be far more information available on the health of this composite group in the U.S. Most studies which focus on racial/ethnic/cultural differences and special concerns ignore American Indians. Even now that they’re starting to investigate racial differences in responses to medications, we are not included, nor do any “nonstandard” reactions get recorded much. (This is not to say that any of the other groups of people they do focus on have it good!)

I wonder why some groups of people have so much worse health outcomes, compared to the Default.

Disempowerment of Native women specifically was a primary goal of the colonizers, with the intent of destabilizing and, ultimately, exerting colonial domination over each indigenous nation…For example, among the Cherokee, a traditionally matriarchal society, the British decreased the power of women by “educating” Cherokee males in European ways, encouraging marriage to non-Native women, and privileging mixed-blood male offspring in nation-to-nation negotiations.

This is still happening, though the specifics have changed a bit. Rendering us invisible is a preferred tactic these days. Other marginalized groups get other tactics used against them, but it’s much of a muchness.

A post at Sociological Images also helped spotlight the particular Indigenous Women brand of marginalization: “Poca-Hotness” (NSFW). It’s hard to get away from that kind of thing, but it still makes me queasy.

Like one commenter, I do have to get darkly amused:

WOW. I’m kind of surprised they used an actual First Nations woman in this, I was expecting dark haired white chicks, however most of them look to be more … asian? Some kind of asian, I can’t say and I wouldn’t try.

It’s almost funny seeing my heritage get sexualized, because the rest of the time they’re calling First Nations fat and hideous.

Painfully accurate, that.

Thanks largely to decades of activism, blackface photo spreads and the like are generally seen as unacceptably offensive in the U.S. If nothing else, the people running media outlets are very aware that scads of people will complain, very visibly; it’s not good for business. They don’t expect us to be able to make as much fuss. Anybody who protests is an angry ghost, and probably an impostor at that.

The marginalization theme was also brought home recently by Kahentinetha Horn’s darkly hilarious and incisive account:

AT THE LAST MINUTE on Tuesday, 7 November, we Iroquois found out there was an exhibit opening at the Pointe-a-Calliere Museum in Old Montreal. It was on the “Mysterious Disappearance of the St. Lawrence Valley Iroquois.” They wish! Four of us from Kahnawake, Kanehsatake and Tyendinaga decided to go and look it over.

We were curious as to how they got the idea that we had “disappeared” or that there was any mystery to be solved. How would anyone feel if their so-called demise was advertised and put on exhibit? It’s like finding yourself invited to your own wake when you’re not dead. It really bugged us. Can you understand? It felt like a death threat. It reminded us of the way we were all told at school that our moms, dad, brothers, sisters, grandparents, everyone were all going to die out. We cried. By now we know a terrorist threat when we see one…

We were almost the first visitors there. Instead of welcoming us as the long lost Iroquois, they treated as though we were spoiling their party. The man at the front desk told us we had to pay $12 to go into the wake. We suggested that since we had disappeared and were ghosts in their eyes, we should be allowed in for free. Suddenly he started to speak only French to us. This is when we started to talk only in Mohawk to him.

She goes on to describe some of the dehumanizing ways in which you can present other people when you have convinced yourself that they aren’t able to contradict you: a theme which crops up anytime a group of people is marginalized.

Going back to yesterday’s posts, why might anyone develop mental health problems under these conditions? Also, why might anyone who does not hide the marginalized characteristics–which make them who they are–get perceived as crazy at a very high rate? Why might any anger or despair we show be interpreted as a need for numbing medications?

Might we suffer further health problems as a result of this? Bear in mind that “the life expectancy of those treated in community mental health centers has plunged to an appalling 25 years less than average”, attributed largely to heavy use of neuroleptics, which can directly cause diabetes and other problems. When you’re already prone to that kind of thing from chronic stress, you sure don’t need drugs that will cause the same health conditions. I’m sure that’s a frequently overlooked cause of physical problems, through more marginalization and stigma.

As Paula Gunn Allen put it, “Yes, this IS how it goes: I’m NOT crazy, I’m just Indian.”* I would extend this to being a woman, autistic, disabled, etc.

I’m not crazy, I’m just who I am. And I’m not some kind of inexplicably angry ghost.

Yesterday, I read a very good piece: Bruce Levine’s Liberation Psychology for the U.S.. Approaches more like this would probably help an awful lot of people.

All this comes back to a classic question: How do we resist being marginalized, besides refusing to be properly silent and doing our best to advocate for ourselves and other marginalized people? We need to figure out some approaches that work, with our own tools rather than the Master’s. It’s quite the conundrum, and it’s hard not to get bogged down in despair and frustration.
_____________

* This was in her foreword to Barbara Mann’s Iroquoian Women, which brought out the same response from me. Major consciousness raising, through witty analysis and an awful lot of information. That’s one of the reasons I keep mentioning this book.

The urge to cut is rising again.  Can I fight it this time?  I don’t know what triggers it anymore.  Am I really addicted to the feeling I get afterwards?  What’s wrong with me and why do I get enjoyment out of self-injury?  I guess that I still have alot to learn about myself.  I’m not as hopeless as it seems.  This is just how I think.  It’s not like I act out every single thought that pops into my head.

Why is that people hurt themselves?  I don’t understand it.  Why do people feel the need to punish themselves?  I guess that we’re not as advanced as we say we are.  How pathetic is that?  We talk about how sophisticated we are and there are people that cut themselves.  I guess I’ll never understand psychology.  Even though I am curious about it.  Should I really go back to school?

Anorexia is a high-profile psychiatric disorder; most people know about it – or at least, they think they do. Today’s lecture on eating disorders challenged many of my pre-concieved notions about anorexia nervosa. Here are a few points that I found interesting/significant:

1. 12% of people with anorexia will die from the disorder. This disease is far more serious than just low self-esteem about body weight/shape.
2. Some anorexics engage in binge-eating and purging (such as self-induced vomiting). This behaviour is not restricted to just bulimia, but is seen in anorexia also.
3. There’s an element of “psychosis” in anorexia. Psychosis is believing/perceiving something that isn’t real. Most anorexics will deny that they are underweight. When asked to outline her reflection in the mirror, one woman with anorexia drew the line three inches too wide on either side. Anorexics truly perceive (see and feel) that they are overweight!
4. The prevalence of anorexia is not increasing. Although Western culture’s preoccupation with beauty in thin-ness contributes to the maintenance of anorexia in already ill patients, it has not driven up the incidence.
5. Gay men are particularly susceptible. There are ten times as many women with anorexia nervosa as men. But a particular sub-group, gay men, are especially susceptible to this disease. The reason is presumably gay culture’s preoccupation with body shape/size.
6. There’s a strong genetic component. If you have an identical twin who has anorexia nervosa, there’s a 70% chance that you’ll get it too. That’s pretty strong for a disease that we usually consider as having environmental triggers.

I feel an impending sense of burnout. Today, my mother told me that she is proud of me for all the steps that I am taking to tackle this illness head-on. I thought that was really nice of her to say, and it made me feel good and helped me believe that what I was doing was still on the right track. So thank you mom. Although, according to her, I’m not even supposed to have this blog. She would probably be angry with me if she knew I was doing this. But oh well. What’s done is done, and it helps me to cope with the ups and downs of bipolar disorder. Anyways. Burnout. Yeah. I’m afraid that I will suddenly get tired of always doing the right thing…the thing that is best for me and my mental health. Having bipolar disorder basically means I get to kiss my future drinking days of my twenties goodbye. Adios. One thing I know for sure is that anti-psychotics and hard alcohol do not mix well. And as of right now, at this moment in time at least, I don’t want to die just yet. I don’t want to die in my sleep in a pool of vomit.

So, if I plan on living, I have to stick to the safe plan, or plan for safety. I will say to my friends, “Oh no, drinking? No, I would much rather stay at home, take my medication and then knit until I pass out.” Knowing me, I would probably accidentally jab my eye out with a knitting needle or whatever you call them. (I should learn how to knit otherwise this plan just isn’t going to work too well.) I can knit all sorts of things…sweaters for my cat, scarves for my cat, tea cozy’s, and the like.

I shall live a sad little life. But as I stood on the edge of the lake having my “after therapy cigarette”, I realized that my psychiatrists office is right across the water. And I realized that I already have begun to feel tired about the whole process. And unfortunately…I just started…I was just diagnosed recently.

Can I really do this for more 60 years?

Two items for today that seemed important- at Trans Fried Fluff Joanne digs up an interesting definition of transsexualism from the past and I also think the death of Mike Penner deserves comment.

Fluff is a blog about the DSM rewrite mainly, and profiles a lot of the characters involved there. It is also highly critical of the utter lack of response among so-called professionals who patently ignore the thoroughly repudiated “gender” paradigm.

Most of us familiar with this topic are aware of Harry Benjamin’s contributions, but far less have probably heard of Jan Wålinder. He provides us with what Joanne calls “one of the most accurate descriptions of classical transsexualism yet devised”. I agree with her, and I’ll just quote from the article to illustrate:

1. A sense of belonging to the opposite sex, of having been born into the wrong sex, of being one of nature’s extant errors.

2. A sense of estrangement with one’s own body; all indications of sex differentiation are considered as afflictions and repugnant.

3. A strong desire to resemble physically the opposite sex via therapy including surgery.

4. A desire to be accepted in the community as belonging to the opposite sex.

It’s difficult to be more clear than that. Continuing my habit of posting my comments to other blogs on my own, I replied with this:

When the fad finally disappears, I shudder to think of all the stories of “de-transition” that will ensue among the transvestites.  Such fodder for the Blanchards and others who want to pretend real transsexualism doesn’t exist!

With any luck the shame of crossdressing that these people feel will mute most of the uproar among the “TG community” and the former “transsexuals” will quietly go about their lives and simply stop speaking of it.

A few outliers may try to sell their story but the mood in the US at least is changing and sensationalist stories like that won’t get as much play here, shortly, or have the same kind of impact as they once would have.  That’s the best case scenario for all involved anyway.

And that’s the most important reason I and others have opposed the spate of surgical approval for non-transsexual “transgenders” and other co-option of our birth condition; in the end it will be we who pay for their giant sex party.  How utterly selfish of them to impose such a burden.

Perhaps it is merely a lack of character that pushes a transvestite into claiming to be transsexual. But that lack of character among those who profess to care for our ‘mental health’ is what allows this sort of nonsense in the first place.  At this point it is impossible to assign their motives to ignorance, and the clear activity of these people mentioned in this article is arguably malicious.

The DSM V, if all goes as it seems, will be used as an object lesson by future psychiatrists of how not to practice.  That is if the profession survives the next few decades at all.

Which leads me to Mike Penner. People who were not born with the transsexual condition will not grasp the truth of what happened, and people in general will learn the wrong lessons from what happened to him.

I believe transgender dogma contributed to the suicide of Mike Penner. Now why would I say something so awful? For a true transsexual, the advice given by the TG “community” is a death sentence. This is another one of those things that they will never understand about this condition. Using the gay paradigm to “treat” the transsexual condition is a recipe for disaster. This business about “coming out”, being “honest”, living “openly”, and all the rest of the rubbish is a death sentence for a woman. Part of being born transsexual is the truth that we are women and men whose bodies are horribly deformed. We treat it as best we can, and live our lives. To be constantly reminded of our deformity for the rest of our lives is no life at all.

Mike’s public transition was no transition at all. This is the object lesson that witnessing a “transgender” type of “transition” imparts to a true transsexual. The idea of living “as a woman” while everyone knows you are a man may be titillating to the transvestites and full time drag queens who comprise the TG “community”, but it is absolutely the wrong thing for one born transsexual. I have to wonder how the few transsexual men and women in the TG ranks deal with this attitude among their chosen peers.

In the end I think Mike’s form of transition was what killed him. If I accept that he was a true transsexual, then I know what he felt. We shared this much in common; it is unacceptable to go through life with the stigma of being a man. Having a very public job and very public transition made it impossible for Mike to truly get treatment, to reach that place where his birth defect was finally healed. He felt his cure would always be out of reach. Transgender dogma told him that he needed to “come out” and bask in the glow of acceptance. By all accounts he received that acceptance- as a brave man who was pretending to be a woman. And facing that reality, he thought it better to leave this world than endure it any longer.

That’s what killed Mike Penner.

On November 9, 2009, the Medical Board of California revoked the license of psychiatrist Norman J. Lachman.  Revocation was stayed and he was placed on five years probation with terms and conditions.  This action was the result of the Board’s 2007 charges against Lachman for gross negligence, repeated negligent acts, incompetence and failure to maintain adequate and accurate records.  These charges involve two patients: then-25-year-old “M.B.” and his sister, “I.B.”

Lachman did not maintain any records of therapy sessions with M.B., whom he treated from late 2000 to April 2004 or for I.B., whom he treated from 2000 to April 2003.  Both M.B. and I.B. had been in family therapy with Lachman when they were teenagers.

Most of the therapy sessions were conducted by telephone or e-mail.  Lachman insisted on daily sessions, which lasted three to four hours each.  M.B. also met with Lachman on both Saturday and Sunday, for sessions that lasted at least three hours each.  Though M.B. worked full time and was at that time studying for the GMAT (Graduate Management Admission Test), Lachman would usually call after 9 pm and expected M.B. to prepare written analyses of their phone sessions before he went to sleep.  Lachman would then critique the analyses.  Lachman also ordered M.B. to prepare written assignments based on his notes.  M.B. asked Lachman to reduce all this homework due to his work schedule but Lachman refused.

Face to face sessions were conducted in Lachman’s home where, on occasion, he struck M.B. in the stomach, chest and legs with a cane.  On at least one occasion, Lachman struck M.B. in the testicles with his hand.  Over the course of the sessions, Lachman called M.B. stupid and crazy.  M.B.’s psychologist, “Dr. J.M.,” who attended conjoint sessions with Lachman and M.B. corroborated that Lachman called M.B. stupid and was emotionally abusive towards M.B.  Examples: Lachman made M.B. buy dog food and threatened to make him eat it; ordered him not to contact his sister I.B. without his permission; referred to M.B. by a girl’s name and told him to imagine a male orally copulating him; asked M.B. to set him up with his female friends and also to send naked photos of M.B.’s girlfriends which Lachman would keep in his possession; asked M.B. to record pornographic videos for him and made sexual innuendos regarding I.B.

According to M.B., Lachman never furnished a bill for services because he was receiving disability based on a 1994 car accident.  Lachman directed M.B. to make his checks payable to Lachman’s accountant.  Lachman directed him to not deduct his services on his tax forms as medical expenses.  During one session, M.B. mentioned he had an extra computer.  Lachman asked M.B. to give it to him and he complied.  Two years later, Lachman told M.B. it was “a piece of crap” and insisted that M.B. get him a new one, which he did, at a cost of $3,400.

At one point in M.B.’s therapy, Lachman instituted a system where fines were imposed for various “infractions” such as allowing Lachman to do most of the talking or M.B. making inappropriate comments.  Over the course of six months, M.B. incurred “fines” totaling $80,000, which M.B. was directed by Lachman to pay by obtaining a loan from a bank.  Lachman “forgave” the “debt” when M.B. failed to qualify for the loan.

The Board’s document contains more allegations of bizarre conduct.

Terms of Lachman’s probation include, at his own expenses and within 60 days, a clinical assessment and training program consisting of a two-day assessment of his mental and physical health, medical knowledge, skill and judgment relative to his clinical specialty (psychiatry) and a 40-hour program clinical education program; a Board-approved ethics course and a professional boundaries program.

SOURCE:

Decision, In the Matter of the Accusation Against Norman J. Lachman, Physician’s and Surgeon’s Certificate No. G 15903, Case No. 17-2004-161777, Medical Board of California, October 8, 2009.

Harvard psychiatrists have created a 12-session version of integrated group therapy for patients with bipolar and substance abuse disorder that can be administered by drug counselors without previous training in cognitive behavior therapy or treatment for bipolar disorder. Initial outcomes appear better than those achieved with traditional group counseling.

RESULT: A “community-friendly” version of integrated group therapy for patients with bipolar disorder and substance dependence: a randomized controlled trial
Drug and Alcohol Dependence | Oct 1, 2009

It’s worth asking about previous experiences when someone starts group therapy, according to the following article. At least among patients who have social anxiety disorder, those who have never had any kind of therapy may benefit most from group therapy, according to his study of 57 patients, while those who have had positive experiences with earlier therapy appear to have the least success in the group environment.

RESULT: Does Prior Psychotherapy Experience Affect the Course of Cognitive-Behavioural Group Therapy for Social Anxiety Disorder?
The Canadian Journal of Psychiatry | Aug 5, 2008

Search: “group therapy” psychotherapy effective

____________________________________________________________________

SEARCH TIP: Jargon

The actual search term that inspired the above example was effectiveness of group work.

Many of those results had nothing to do with psychiatry, so we modified the search term considerably to find the articles above.

The word “work” has many meanings, and will generate many irrelevant results. In a psychiatry context, we guessed, the more specific term (and the one likely to appear in articles) is “therapy.”

However, even “therapy” is also used in other contents, such as physical therapy and chemotherapy. So we threw in “psychotherapy” as well, to target the search.

(Also, we guessed that someone writing an article on the effectiveness of something is more likely to use the word “effective” than “effectiveness,” so we used “effective” instead.)

________________________________________________________________________

OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: antisocial personality disorder

RESULT: NICE guidelines, clinical practice and antisocial personality disorder: the ethical implications of ontological uncertainty
Journal of Medical Ethics | Nov 1, 2009

Given the “multiple uncertainties” associated with antisocial personality disorder, argues a commentator from the University of Edinburgh, the British guidelines authority should have taken more care to address the ethical issues when issuing a guideline on its diagnosis and treatment—especially if it includes a recommendation to identify parents at risk for raising antisocial children, as this guideline did. (The guideline itself also appears on this search page.)

Search: frontotemporal dementia

RESULT: Determinants of survival in behavioral variant frontotemporal dementia
Neurology | Nov 17, 2009

Individuals who meet the diagnostic criteria for frontotemporal dementia but do not show cognitive decline (the nonprogressive or “phenocopy” variant) also do not have the same poor survival prognosis as those who have the progressive form. For the latter, the prognosis is best when there is no language impairment at the time of diagnosis.

Search: sleep and mental health

RESULT: Concurrent Associations among Sleep Problems, Indicators of Inadequate Sleep, Psychopathology, and Shared Risk Factors in a Population-based Sample of Healthy Ontario Children
Journal of Pediatric Psychology | Nov 18, 2009

In a survey based on reports from parents and teachers, 11-year-old children who sleep too much are likely to have aggression problems. Those who have nightmares or other difficulties in getting to sleep or staying asleep are more likely to have anxiety issues. But the subject is complex, the authors say, and deserves clarification.

The paper reviewed here is ‘Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia:A Meta-analysis’ by Joseph Ventura and colleagues. In the conclusion to the abstract the authors write that

‘Although neurocognition and negative symptoms are both predictors of functional outcome, negative symptoms might at least partially mediate the relationship between neurocognition and outcome‘

The authors begin with an introduction in with a discussion of the literature on cognition in relation to negative symptoms. They state their hypothesis thus

‘that the meta-analysis would support a mediation hypothesis for negative symptoms based on the strength of the relationship between neurocognition and negative symptoms, and negative symptoms and outcome‘

The authors detail the methodology. There are 12 search terms that they used in the specified databases which included pubmed and Psycinfo. These 12 search terms did not include IQ or components of standardised test batteries. They did include terms such as executive function and working memory. They also manually extracted further references from retrieved articles. They retrieved 200 articles and further analysed these according to inclusion criteria. Thus diagnoses should be specified in the papers according to DSM criterion which thus excludes those papers which use ICD-10 criteria. I thought the other inclusion criteria seemed to me to be quite sensible and pragmatic e.g. the data in papers should not have been published previously elsewhere.

The authors state their definition of neurocognition and also their use of the MATRICS initiative for structuring domains of cognitive functioning to be used in the analysis and these are ’speed of processing, attention/vigilance, working memory, verbal learning, visual learning, and reasoning and problem solving’. They excluded social cognition which they thought to be another important independent mediator of the relationship in question. PANSS, SANS and SAPS were used for the assessment of positive and negative symptoms while functional outcome was divided into three broad areas which in turn had a range of outcome measures.

I didn’t understand the next stage. The authors aggregated the data from the neurocognitive domains into a single measure of neurocognition. I didn’t understand how aggregating speed of processing and problem solving for instance was meaningful. Each of these has been identified as a separate domain and so not only is data is being lost in this aggregation. However as the authors hint at in their discussion, not all of these domains are simply defined but are products of inter-related systems – different domains may share neural substrates. Thus if these domains are not entirely separate then I would argue that an additive operation is being applied to dependent data and that the result is not meaningful. I expected that individual test results would be aggregated and that after correcting for multiple comparisons effect sizes with p-values would be identified for the individual tests. While this would produce a large number of different results, these could be grouped after the initial analysis into broader categories if necessary.

The authors have identified a large number of studies according to clearly specified criteria and listed these in the paper together with a brief summary of each paper. The authors have aggregated the data into a single neurocognitive score which I didn’t understand. I would be interested to see an analysis of the interaction between individual test scores and the relationship between negative symptoms and functional outcome.

References

Ventura J, Hellemann G S, Thames A D et al. Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: A meta-analysis. Schizophrenia Research. 113. 2009. 189-199.

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The article reviewed here is ‘The Genetic Basis of Human Brain Evolution’ by Vallender and colleagues. This is the 150th Anniversary of Darwin’s ‘On the Origin of Species’ and I thought it would be interesting to have a look at this article on the brain from an evolutionary perspective. This is a review article in Trends in Neuroscience by two american researchers, one in neurochemistry and the other in genetics. In the abstract, the authors write

‘…it has become possible only very recently to examine the genetic basis of human brain evolution. Through comparative genomics, tantali(s)ing insights regarding human brain evolution have emerged‘

The selection criteria for inclusion of studies is not stated although this is usual in a number of the reviews that I have seen. Introducing the reader to the subject, the authors then move on to look at genes which have changed in moving along the primate lineage from new world monkeys to humans. These include genes implicated in microcephaly, the Sonic Hedgehog gene (yes really!), the popular FOXP2 gene and SRPX2. There are various suggestions for why changes in these genes may be important including the possibility that the microcephaly associated genes products are important in cell-cycle control which in turn may influence the number of neuroprogenitor cells produced and hence brain size.

The authors also discuss novel genes that have arisen in evolution including the mysterious Morpheus gene the function of which is as yet undetermined, the Opsin gene (thought to be directly related to the development of trichromatic vision in catarrhines) and GLUD2. They then go on to discuss the loss of genes including members of the olfactory gene family. They also look at the difficulties in understanding changes in gene expression in the human brain during evolution as well as some changes seen in non-coding regions. They also offer the following fascinating insight

‘..mammals in general and birds to some degree, exhibit a trend of brain expansion over evolutionary time that is absent in other vertebrates‘

The authors end by suggesting that future studies should focus on testing specific rather than general theories.

In conclusion, I found this to be a concise and accessible review of a fascinating subject. On the 150th Anniversay of the publication of ‘On the Origin of Species’ there has been much progress in evolutionary theory and subsequent reinterpretation of natural world phenomenon. In evolutionary psychiatry (see review here)  there has been an emphasis on laying the foundations with reference to common mental illnesses and how they might be shaped by the pressures of natural and sexual selection. The explanations have benefitted from insights gained from  the field of evolutionary psychology (see review of book on evolutionary psychology here). Adding a genetic strand to this understanding may give neuroanatomic insights into function and pathology which tie in with the understanding of neurodevelopment and neuropsychology. As the authors point out, this field is in its infancy and although it is too early to draw firm conclusions, I suspect these will quickly develop and form the foundations for this new discipline.

References

Vallender E J, Mekel-Bobrov N and Lahn B T. Genetic basis of human brain evolution. Trends in Neuroscience. Vol 31. No 12. pp636-644. 2008.

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It’s only depression and it’s easy to understand why I became a sad person.  I was ignored as a child and I didn’t fit in anywhere.  I’m a true outcast.  At least I know what I am.  There are times when I ask myself what good will a hospitalization do for me and I can’t find the answer.  I’m not in any danger of taking my life even though I am cutting again.  Do I cut myself because I’m too afraid to take my own life?  I guess that is something I can discuss my therapist with.