Thursday, August 30, 2012

Complainers Kill Neurons! How to save yourself from this menace.

"That pain you feel listening to complainers? It's real enough to peel away neurons from your brain and render it pretty much useless, reports Inc."

[That pain you feel reading ridiculous made-up articles about the brain? It's real enough to peel away neurons from your brain and render it pretty much useless, reports The Neurocritic.]

That's the worst piece of fiction I've read about the brain in quite some time. So I thought I'd complain about it. Read at your own risk!

Complainers Damage Neurons in the Brain

Entrepreneur Trevor Blake offers tips to save yourself

By Neal Colgrass, Newser Staff
Posted Aug 25, 2012 4:56 PM CDT

(Newser) – That pain you feel listening to complainers? It's real enough to peel away neurons from your brain and render it pretty much useless, reports Inc. "The brain works more like a muscle than we thought," says Trevor Blake, an entrepreneur who wrote Three Simple Steps: A Map to Success in Business and Life. "So if you're pinned in a corner for too long listening to someone being negative, you're more likely to behave that way as well."

The Neurocomplainer

Where to begin? With the distortion of scientific results beyond recognition in order to sell books? The use of such hyperbolic language? Or perhaps reliance on a business magazine as a primary source for neuroscience news. Oh but it gets worse...

But he offers tips for coping:

  • Get Away. Complainers are like chain-smokers who emit dangerous second-hand smoke, so simply move away from them.
  • Ask for a Fix. If you're cornered, suggest that the complainer find a solution. But most will just walk off because they "don't want a solution; they just want you to join in the indignity of the whole thing," says Blake.
  • Protect Yourself. When they just won't stop, delve into your bag of mental self-defense tricks. Imagining a protective, giant bell jar or invisibility cloak might work—or, like Blake, you could see yourself on a far-away island. "I could smile at them and nod in all the right places and meanwhile take myself for a walk on my private beach."
[Save me from Mr. Blake!]

Negative people are toxic, so let's abandon them. It doesn't matter if they're depressed about the foreclosure of their home or upset about being downsized due to corporate malfeasance or venting after being the target of yet another racist / sexist / homophobic insult or angry that their insurance company won't cover that critical medical procedure after all. Instead, ask them to fix the structural inequalities in society and then just move away from them.

[How to protect yourself from my complaining sarcastic blog posts: "Imagining a protective, giant bell jar or invisibility cloak might work."]

Surely the original Inc. article can't be that absurd! I'll let you be the judge...
Listening to Complainers Is Bad for Your Brain

. . .

Even worse, being exposed to too much complaining can actually make you dumb. Research shows that exposure to 30 minutes or more of negativity--including viewing such material on TV--actually peels away neurons in the brain's hippocampus.1 "That's the part of your brain you need for problem solving," he says. "Basically, it turns your brain to mush."
[30 seconds of exposure to Mr. Blake's book will basically turn your brain to mush.]

Speaking of Three Simple Steps (which -- in an amazing coincidence -- was published on August 23, 2012), there's something wrong with this picture...

While this item is available from other marketplace sellers on this page, it is not currently offered by because customers have told us there may be something wrong with our inventory of the item, the way we are shipping it, or the way it's described here.

Newser link via @TheNeuroScience.


1 The hippocampus is critical for memory, not problem solving.

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Sunday, August 26, 2012

The Art of Delicate Sadness

Sad Noh masks (from Fig. 1 of Osaka et al., 2012).

Noh is a traditional style of Japanese theater where the actors wear masks to convey facial expressions. Many of the masks are known for their ambiguity:
As it is often difficult to tell the actual feelings expressed in a noh mask, it is said to be made with a “neutral” expression. The mask carver tries to instill a variety of emotions in the mask.

It is up to the performer to imbue the mask with emotion. One of the techniques used in this task is to slightly tilt the mask up or down. With terasu (tilting upwards) the mask appears to be slightly smiling or laughing and the expression lightens somewhat. While kumorasu (tilting downwards), produces a slight frown and can express sadness or crying. Basically, by using minute movements, the performer is able to express very fully.

Three pictures of the same nō 'hawk mask' showing how the expression changes with a tilting of the head. The mask was afixed to a wall with constant lighting and only the camera moved.

Professor Michael Lyons has an excellent site explaining The Noh Mask Effect: A Facial Expression Illusion, which you really should see for yourself.

Delicate Sadness

A recent neuroimaging study by Osaka et al., (2012) set out to examine how the amygdala (a limbic structure important for emotion) would respond while participants viewed masks portraying "delicate sadness" -- "a Noh mask that is elegant and artistically polished, and designed to express sadness." To choose the most appropriate stimuli, a separate group of subjects rated a set of 70 masks on a scale of 1 (not at all sad) to 7 (highly sad). The six most "highly sad" masks were selected for comparison to six "neutral" masks. But as we already learned, the neutral masks can be ambiguous.

The amygdala (LeDoux, 2007) is predominantly known for its role in fear conditioning, but it is also activated by other emotions (e.g., Kober et al., 2008). Therefore, the comparison of viewing sad vs. "neutral" masks in the present study could yield minimal differences in the amygdala.

And that is what happened (in my estimation). However, the authors presented their results in a more positive light: a region of interest (ROI) in the right amygdala showed activation in the sad vs. neutral contrast at p<.05 (uncorrected). The ROI in the left amygdala, as well as bilateral "reward-related" ROIs in the nucleus accumbens, caudate nucleus, and putamen did not reach that level of significance. They concluded that:
...viewing Noh masks with expressions of elegant sadness effectively stimulates the right amygdala of the limbic system. Thus, the sadness evoked by such masks seems to be processed by the limbic system in a way similar to the way in which it processes negative emotions such as fear and disgust. Understanding the neurological processing of these facial expressions could effectively contribute to an appreciation of Noh performances in an artistic way.

But I'm not so sure the present finding illuminates the aesthetic and emotional experience of Noh theater. I think we need to understand more about how the brain processes basic emotions before we make neuroaesthetic claims.

I originally thought the study was interesting from the perspective of emotional ambiguity, where even the static images of those elegantly carved masks could capture multiple expressions simultaneously. A recent über meta-analysis of neuroimaging studies of emotion did not find support for the "locationist approach" where "discrete emotion categories can be consistently and specifically localized to distinct brain regions" (Lindquist et al., 2012). Hence, looking at amygdala and striatal regions in isolation will miss important aspects of emotional and aesthetic experiences engendered by viewing traditional Japanese Noh masks.


Kober H, Barrett LF, Joseph J, Bliss-Moreau E, Lindquist K, Wager TD. (2008). Functional grouping and cortical-subcortical interactions in emotion: a meta-analysis of neuroimaging studies. Neuroimage 42:998-1031.

LeDoux J. (2007). The amygdala. Current Biology 17: R868-R874.

Lindquist KA, Wager TD, Kober H, Bliss-Moreau E, Barrett LF. (2012). The brain basis of emotion: a meta-analytic review. Behav Brain Sci. 35:121-43.

Osaka N, Minamoto T, Yaoi K, & Osaka M (2012). Neural correlates of delicate sadness: an fMRI study based on the neuroaesthetics of Noh masks. Neuroreport, 23 (1), 26-9 PMID: 22113213

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Saturday, August 18, 2012

Predicting Brain Age from 231 Neuroanatomical Measures

Is your child's brain on track to reach normal developmental milestones? A paper in Current Biology reports on a new, composite neuroanatomical metric of maturity that predicts 92% of the variance in brain age (Brown et al., 2012). Structural MRI scans were obtained from 885 healthy children and young adults ranging from 3 to 20 years of age. A set of 231 different measurements, or biomarkers, were used to determine the age that provided the best "fit" for each subject. The model made the most accurate predictions at the youngest ages, and the margin of error was 1.03 years across all ages.

Figure 3 (Brown et al., 2012). Multimodal Quantitative Anatomical Prediction of Age.
For 885 individuals, estimated brain age is plotted as a function of actual chronological age. Colors correspond to different sites and scanners. Symbol size represents subject sex (larger = female, smaller = male). A spline-fit curve (solid line) with 5% and 95% prediction intervals (dashed lines) is also shown.

The 231 measures were chosen because they are "known or suspected to change over the ages" (Brown et al., 2012):
This collection of variables was derived from T1-, T2-, and diffusion-weighted imaging and included quantitative measures of brain morphology, signal intensity, and water diffusivity within different tissue types, reflecting anatomical structural organization. Specifically, we measured cortical thickness and area, volumes of segmented subcortical structures, normalized signal intensities, and measures of diffusion magnitude and directionality within cerebral, cerebellar, and white matter fiber tract regions of interest.

The data from each of these imaging modalities alone could explain 81-83% of the variance, and that number rose to 92% when the T1-, T2-, and diffusion-weighted images were combined. The relative contribution from each type of measure changed with age, as shown below.

Figure 4 (adapted from Brown et al., 2012). Age-Varying Contributions of Different Imaging Measures to the Prediction of Age. The relative contributions of separate morphological, diffusivity, and signal intensity measures within different brain structures are plotted as a function of age. Colors correspond to measure and structure type (T1 cortical area; T1 cortical thickness; T1 subcortical volumes; diffusion (FA/ADC) within white matter tracts; diffusion (FA/ADC) within subcortical ROIs; T2 signal intensity within white matter tracts; T2 signal intensity within subcortical ROIs). Contributions are computed as units of the proportion of total explained variance.

The data were from the Pediatric Imaging, Neurocognition, and Genetics (PING) Study database (, which is open access.
The primary goal of PING has been to create a data resource of highly standardized and carefully curated MRI data, whole genome SNP genotyping data, and developmental and neuropsychological assessments for a large cohort of developing children aged 3 to 20 years. The scientific aim of the project is, by openly sharing these data, to amplify the power and productivity of investigations of healthy and disordered development in children and to increase understanding of the origins of variation in neurobehavioral phenotypes.

Does it sound like the PING investigators are creating a normative database for possible diagnostic purposes in the future?
Perhaps further development of techniques to quantify the complex multidimensional nature of typical brain maturation can also help to improve the early identification of individuals with abnormal developmental trajectories. Our findings suggest that a multimodal neuroanatomical imaging assessment may hold promise for making an objective, quantitative contribution to our clinical evaluations of brain development.

Why yes it does. We already know this promise is not right around the corner (Where Are the Clinical Tests for Psychiatric Disorders?), and we know about the possible hazards of premature commercial ventures that make bold claims not supported by solid scientific evidence (The Dark Side of Diagnosis by Brain Scan). Returning to the first sentence of this post ["Is your child's brain on track to reach normal developmental milestones?"], you can see I was already anticipating franchised scanning facilities in strip malls ready to give worried parents the verdict on their child's neurodevelopment. Kind of like genetic testing outfits that make silly claims:
...unscrupulous businesses like My Gene Profile (which offers the "Inborn Talent Genetic Test" for the low low price of $1,397) have capitalized on the public's desire for simple explanations. Now you can find out whether your child has the Split Personality Gene! The Propensity for Teenage Romance Gene! The Self Detoxifying Gene!
The article in Biopolitical Times is highly recommended, especially since the url seems to be defunct.1

To conclude with some important points about the Current Biology paper, the predictive accuracy of 92% is very impressive. The authors suggest there is a "latent brain phenotype that is tightly linked to chronological age." But they also issue a caveat about psychological maturity, which cannot be inferred from their measurements:
Brain scans, though informative about anatomical and physiological states, cannot be used to make inferences about an individual’s psychological maturity. Rather, these results speak only to the degree to which typically developing children differ among each other in their fundamental structural brain properties.


1 Biopolitical Times also mentioned the "sprawling website" that sells the "Inborn Talent Genetic Test", which you can still view via the Wayback Machine. [NOTE: EVERYONE wants their child to be the next Tiger Woods!]


Brown, T., and 21 others. (2012). Neuroanatomical Assessment of Biological Maturity. Current Biology. DOI: 10.1016/j.cub.2012.07.002

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Monday, August 13, 2012

The Dark Side of Diagnosis by Brain Scan

Daniel Amen: Pioneer or profiteer?: Psychiatrist Daniel Amen uses brain scans to diagnose mental illness. Most peers say that’s bonkers.

Right on the heels of a Molecular Psychiatry paper that asked, "Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it?" (Kapur et al., 2012) comes this provocatively titled article in the Washington Post about neurohuckster Dr. Daniel Amen and his miraculous SPECT scans:
Daniel Amen is the most popular psychiatrist in America. To most researchers and scientists, that’s a very bad thing.

By , Published: August 9.

NEWPORT BEACH, Calif. — Daniel Amen is, by almost any measure, the most popular psychiatrist in America.

. . .

He has arisen, like a modern-day American myth, from the fields northeast of San Francisco, where he ran a small-town clinic, to become the creator, chairman and CEO of the Amen Clinics, an empire that includes a string of psychiatric practices, a line of nutritional supplements, book publishing, DVD sales, and television and speaking engagements.

. . .

Amen’s career is very troubling, for one of two things must be true.

One, Daniel Gregory Amen, born in 1954 in Encino, Calif., son of Lebanese immigrants, is 20 years ahead of virtually the entire psychiatric field (he says about three dozen other clinics use SPECT scans, but few as profusely as he does), and the establishment has failed to recognize a historic breakthrough.

Or, two, the man has grown fabulously wealthy — he lives in a $4.8 million mansion overlooking the Pacific Ocean — by selling patients a high-priced service that has little scientific validity, yet no regulatory body has made a move to stop him.

SPECT (single photon emission computed tomography) is a relatively inexpensive cousin of PET scanning (positron emission tomography) with lower spatial resolution.1 There is no peer reviewed literature that establishes SPECT as a reliable method of diagnosing psychiatric disorders.

Amen is well-known to regular PBS viewers, because his informercial "Change Your Brain, Change Your Life" [and others] is on regular rotation during fund raisers.2 In a critical piece by Robert Burton, one neuroimaging expert was quoted as saying:
"SPECT scans are not sufficiently sensitive or specific to be useful in the diagnosis of A.D.," neurologist Michael Greicius , who runs the Stanford University memory clinic, and has a special interest in the use of functional brain imaging in the diagnosis of A.D., tells me. "The PBS airing of Amen's program provides a stamp of scientific validity to work which has no scientific validity."

In his Washington Post article, author Neely Tucker assembled an impressive list of naysayers:
No major research institution takes his SPECT work seriously, none regards him as “the number one neuroscience guy,” and his revelations, which he presents to rapt audiences as dispatches from the front ranks of science, make the top tier of scientists roll their eyes or get very angry.

“In my opinion, what he’s doing is the modern equivalent of phrenology,” says Jeffrey Lieberman, APA president-elect, author of the textbook “Psychiatry” and chairman of Psychiatry at Columbia University College of Physicians and Surgeons. (Phrenology was the pseudoscience, popular in the early 19th century, that said the mind was determined by the shape of the skull, particularly its bumps.) “The claims he makes are not supported by reliable science, and one has to be skeptical about his motivation.”

“I think you have a vulnerable patient population that doesn’t know any better,” says M. Elizabeth Oates, chair of the Commission on Nuclear Medicine, Board of Chancellors at the American College of Radiology, and chair of the department of radiology at the University of Kentucky.

“A sham,” says Martha J. Farah, director of the Center for Neuroscience & Society at the University of Pennsylvania, summing up her thoughts on one of Amen’s most recent scientific papers.

“I guess we’re all amateurs except for him,” says Helen Mayberg, a psychiatry, neurology and radiology professor at Emory School of Medicine and one of the most respected researchers into depression and brain scanning. “He’s making claims that are outrageous and not supported by any research.”

“I can’t imagine clinical decisions being guided by an imaging test,” says Steven E. Hyman, former director of the National Institute of Mental Health and current director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard.

But wait! Didn't The Neurocritic just write a post that expressed some degree of optimism about the prospect of a "stratified psychiatry" of phenotypic or genotypic subtypes at some unspecified future date?

But beware! This is not the same thing as using a SPECT scan to devise a treatment plan. In his NIMH Director's Blog, Dr. Thomas Insel singles out Amen and warns, Brain Scans – Not Quite Ready for Prime Time.

Where Are the Clinical Tests for Psychiatric Disorders?

In their paper, Kapur, Phillips, and Insel (2012) were careful to distinguish their projections for the future from diagnostic tests:3
The prospects of ‘diagnostic tests’ for DSM entities remain distant for reasons articulated above, and it seems unlikely that we will replace the 300-disorder taxonomy of the DSM-5 with an alternative biologically based classification system anytime soon. Therefore the real opportunity for psychiatry is to use the emerging advances in genetics, molecular biology, imaging and cognitive science to supplement, rather than replace, the symptom-driven diagnosis.

Dr. Amen is not so circumspect, in fact he's rather bullish:
He says he has taught himself — by scanning 45,000 people a total of 70,000 times — to apply SPECT, alongside clinical evaluations, as a diagnostic tool in 90 percent of his patients.

The brain activity he says he sees in these scans — areas of high and low activity — allows him to target those areas with specific treatments and medication, he says. A full initial session, including two scans, costs about $3,500.

Amen says this method has helped him identify new subtypes of anxiety, depression and attention deficit disorder, categories far more specific than even the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the benchmark of the field.

This is heady stuff — using brain imaging to find biomarkers for mental illnesses has been the great hope of psychiatry for at least two decades...

And what are those treatments and medications? Exercise, healthy diet, supplements from his product line [e.g., Serotonin Mood Support], and prescription refills in some cases.

"Due to overwhelming popularity we are now offering the Brain on Joy Bar by the case (18 bars)."

Am I blue, Dr. Amen?

The SPECT scans often seem to be used as either a scare tactic or a form of reassurance:

Amen’s first scan patient, back in the early 1990s, was Sandy.

She was 40, had ADD and had tried to kill herself the night before their initial meeting. In his telling — it is his Genesis story, and he has told it many times — the resulting scan showed a precipitous drop in activity in her prefrontal cortex, the brain’s decision-making center, when she tried to concentrate.

When he showed her the scan, she wept. “You mean it’s not my fault?”

Realizing it was a “biological, not moral” problem, she accepted the diagnosis, took her medications and was greatly helped.

“I thought, ‘Whoa. Pictures matter. You get great compliance,’ ” Amen says.
Another patient said, “The results [of the scan] were a little disconcerting, but I’m glad to have it.”

And here's Amen's colleague Earl Henslin: “If at all possible, I’m motivating my patients to get that scan at the first session. They see that scan and they’re willing to take responsibility.”

A Picture Is Worth a Thousand Dollars

That's the title of a 2009 editorial by Dr. Martha Farah in the Journal of Cognitive Neuroscience. She argues that cognitive neuroscientists have a responsibility to speak out when clinical [and legal] applications of brain imaging are being misrepresented by for-profit companies such as the Amen Clinics:
Tens of thousands of individuals, many of them children, have been exposed to the radiation of two SPECT scans and paid thousands of dollars out of pocket (because insurers will not pay) against the advice of many experts... The Amen Clinics are now marketing their services outside the medical arena, advising couples with marital problems and even “prescreening” couples.

People are swayed by colorful brain images, whether they're in the classroom, the courtroom, or the clinic. Or on reality TV. SPECT scans should not be used for diagnostic or entertainment purposes; there's no scientific evidence for the former and the latter is unethical.

Further Reading

This Is the Presidential Candidates' Brains On...

On Amen's Dec. 2007 editorial in the Los Angeles Times advocating SPECT scans for presidential candidates.

Celebrity Neurostigma
On celebrity SPECT scans from celebrity patients in the reality show Celebrity Rehab with Dr. Drew. Also a lesson in medical ethics. Special guest appearance by Dr. Amen.

Dennis Rodman-Mindy McCready Mind Meld
On the startling similarities in the SPECT scans of Celebrity Rehab participants Dennis Rodman and Mindy McCready.


1 In case you're interested in learning more about how the method works, this review chapter (by the Committee on the Mathematics and Physics of Emerging Dynamic Biomedical Imaging, National Research Council) is one place to start.

2 In fact, I can tell when there's a PBS fundraiser because the number of visitors from a search of daniel amen quack increases.

3 However, new research applies machine learning algorithms to neuroimaging data in an attempt to classify patients with neurological and psychiatric disorders (Orrù et al., 2012).


Farah MJ. (2009). A picture is worth a thousand dollars. J Cogn Neurosci. 21:623-4.

Kapur S, Phillips AG, & Insel TR (2012). Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Molecular psychiatry PMID: 22869033

Orrù G, Pettersson-Yeo W, Marquand AF, Sartori G, Mechelli A. (2012). Using Support Vector Machine to identify imaging biomarkers of neurological and psychiatric disease: a critical review. Neurosci Biobehav Rev. 36:1140-52.

WaPo link via @vaughanbell.

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Saturday, August 11, 2012

Where Are the Clinical Tests for Psychiatric Disorders?

Examination room, World War 1 (Otis Historical Archives Nat'l Museum of Health & Medicine).

The lack of laboratory diagnostic tests for mental disorders, along with the shady marketing practices of the pharmaceutical industry, are often viewed as the most fatal flaws in the medical practice of psychiatry. This is especially true among critics of psychiatry, but doctors in other medical specialties tend to have a dismal opinion of psychiatry1 as well (Fazel & Ebmeier, 2009). Widespread perceptions that the field is relatively low in scientific precision, and that the patients have a poor prognosis, are among the possible reasons for this. An interesting comparison of medical students in two Spanish-speaking countries revealed greater respect for psychiatry in Barcelona than in Medellín (Pailhez et al. 2010; PDF):
The differences can be partly explained by the sociocultural contexts of Barcelona and Medellín. For example, students from Barcelona (where the neuroscientific model has greater influence) agreed more with a medically oriented position of psychiatry and that psychiatry is scientific, precise, and a valid branch of medicine.

This lack of respect from other medical professionals, not to mention from consumer/survivor advocates, puts neuroscientists in an awkward position. We believe in neurobiological explanations for the full gamut of human behavior,2 yet we're left to defend a specialty that relies on clinical interviews and a disputed classification system. There is in fact a large and growing literature on structural and functional differences between the brains of those with and without psychiatric disorders, but these discoveries have not yet translated into reliable diagnostic tests.

Why has it taken so long for biological psychiatry to develop clinical tests?

A new perspectives paper by three prominent figures in biological psychiatry (Kapur, Phillips, & Insel, 2012)3 asks this precise question. They begin by describing the scope of the problem:
Biological psychiatry aims to understand mental disorders in terms of the biological function of the nervous system. By several measures it has been a tremendous success—thousands of scientific papers and hundreds of books devoted to this subject; legions of dedicated scientists and over 60 dedicated professional societies worldwide; and a profound impact on the public's perception of mental disorders. Despite these successes, it has not led to clinical tests that can be routinely used in the diagnosis and treatment of mental disorders. In the early 2000s, a series of white papers expressed hope that the advances in genetics, imaging and new technologies might lead to a biologically supported psychiatric classification and diagnostic system. But a decade later, as we stand at the threshold of a new version of the DSM, there are few biological clinical tests central to diagnosing psychiatric illnesses (other than those used to exclude physical illnesses). This article explores why this journey has been difficult for psychiatry and what can be done about it.

The question of "why" revolves around the "missing gold standard" - a biologically valid concept of a specific mental illness. During the Decade of the Brain (1990-1999) there was considerable optimism that advances in neuroimaging and genetics would lead to improvements in the validity of psychiatric diagnoses. However, that didn't happen. Many of the genetic association studies in schizophrenia failed to replicate, for instance. Readers of this blog (and others) know the problems and limitations inherent in contemporary neuroimaging, no less the methods of 15-20 years ago. In the Decade after The Decade of the Brain, Dr. Thomas Insel noted that 90s-era research in biological psychiatry focused on how treatments work, rather than the causes of disease. Looking ahead, he sees new views of mental disorders as circuit disorders are one reason for renewed optimism.

In the present commentary, Kapur et al. (2012) discuss how the ongoing issues with DSM-5 hinder the search for clinical tests:
On the one hand, these successive editions of DSM and ICD lead to increasing psychometric precision. On the other hand, the ever increasing fractionation of mental distress into smaller and more numerous categories, without a priori biological validity, makes it harder to find specific biomedical tests that diagnose or predict the disorders.

Additional problems fall under the heading of Underpowered Studies and Approximate Replications:
One might expect that failure to replicate the findings would induce scientists to lose interest in the given area and to move on to findings with more robust effects. Unfortunately, an initial underpowered study is often followed by another study of similar size but with a few additional measures and variables to give it some novelty and distinction. These subsequent studies usually have only modest statistical power to decisively confirm or refute the original finding, but do have sufficient multiplicity of new measures to generate some significant finding—even though not precisely the one observed in the first study—thus providing an ‘approximate replication’.26 As a result, the ‘literature’ in the field grows without decisively replicating/rejecting the precise original finding, but instead creates a penumbra of ‘P<0.05’ findings around the first.

What can be done about it?

Not much, if the search is for screening tests like mammograms and Pap smears in healthy women:
Few biological screening tests have been developed without a plausible and understandable link to the aetiology or pathophysiology of the disease—thus biological screening for most psychiatric disorders seems distant.

How about diagnostic tests? Here, too, don't hold your breath:
The prospects of ‘diagnostic tests’ for DSM entities remain distant for reasons articulated above, and it seems unlikely that we will replace the 300-disorder taxonomy of the DSM-5 with an alternative biologically based classification system anytime soon. Therefore the real opportunity for psychiatry is to use the emerging advances in genetics, molecular biology, imaging and cognitive science to supplement, rather than replace, the symptom-driven diagnosis. It is often like this in the rest of medicine [e.g., asthma, arthritis].

Instead, the goal should be to create a "stratified psychiatry" of phenotypic or genotypic subtypes - although they caution that the promise of "personalized medicine" has not been obtained in other specialties either. But they point to discovery of the gene mutation resulting in overexpression of HER2 in breast cancer, and the development of monoclonal antibody treatments, as one success story. This type of stratification doesn't require a complete understanding of the etiology of breast cancer.

Within psychiatry, one can view the diagnostic category of schizophrenia (for example) as a collection of symptoms or disorders that can vary across individuals (Bakker et al., 2004, 2007; Cobia et al., 2011; Hallmayer et al., 2005; Jablensky, 2006; Williams et al., 2007), despite the DSM-5 recommendation to eliminate the DSM-IV schizophrenia subtypes.

What is needed is a change in research culture that looks beyond DSM-5. Psychiatric disorders often do not display clear diagnostic boundaries, and co-morbidity is common. The authors take this opportunity to promote the Research Domain Criteria project, a topic I covered extensively in a previous post:
The National Institute of Mental Health (NIMH) in the U.S. is starting to take a different approach to the classification of psychiatric disorders, one that incorporates dimensions of observable behavior as well as neurobiological measures. The aim of the Research Domain Criteria (RDoC) project... to define basic dimensions of functioning (such as fear circuitry or working memory) to be studied across multiple levels of analysis, from genes to neural circuits to behaviors, cutting across disorders as traditionally defined.

Other recommendations include longitudinal studies, data sharing (e.g., 1000 Functional Connectomes Project, Psychiatric GWAS Consortium), and a shift from reporting P-values to effect sizes (i.e., minimal significance testing vs. identifying a meaningful clinical effect). Ultimately, the complexity of the brain is a stringent limitation, but in their opinion is one that can be overcome:
The delay is understandable given the later start than the rest of medicine, the complexity of the brain, the nascence of neuroscientific techniques and the evolving nature of psychiatric nosology. On the other hand, the opportunity afforded by the progress in genomics and imaging combined with the computational abilities is unprecedented and could deliver useful clinical tests. These tests will identify homogenous populations for whom one could develop targeted new therapeutics thus realising a vision of a new stratified psychiatry that cuts across the traditional diagnostic boundaries while simultaneously transforming them.

NIMH paylines are now at the 15th percentile for established investigators and the 18th percentile for new investigators, which is better than in recent years [and better than the anemic 7th percentile at the National Cancer Institute], so perhaps there is some reason for optimism after all.


1 For a defense of psychiatry as a profession, see the wonderful Shrink Rap blog post on Why Psychiatry is a Wonderful Medical Specialty.

2 However, to quote my previous post...
This is not to say that society, culture, environment, and personal experiences play no role in the manifestation of "psychopathology".
3 Dr. Kapur is the Dean of the Institute of Psychiatry at King’s College London, Dr. Phillips is the Director of the Canadian Institutes of Health Research's Institute of Neurosciences (Mental Health and Addiction), and Dr. Insel is the Director of NIMH.


Fazel S, Ebmeier KP. (2009). Specialty choice in UK junior doctors: is psychiatry the least popular specialty for UK and international medical graduates? BMC Med Educ. 9:77.

Kapur S, Phillips AG, & Insel TR (2012). Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Molecular psychiatry PMID: 22869033

Pailhez G, Bulbena A, López C, Balon R. (2010). Views of psychiatry: a comparison between medical students from Barcelona and Medellín. Acad Psychiatry 34:61-6. {PDF}

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Sunday, August 05, 2012


“Language is power, life and the instrument of culture, the instrument of domination and liberation”

-Angela Carter

Let me state at the outset that I am neither a clinician nor a social scientist. I'm not in the business of diagnosing patients OR developing critical theories on the concept of mental illness as a social construct. As a neuroscientist, I believe that learning about human brain function is essential to learning about "the mind," that the latter can be reduced to the former, and that "psychiatric disorders"1 are indeed caused by faulty brain function. This is not to say that society, culture, environment, and personal experiences play no role in the manifestation of "psychopathology".

What Is Mental Illness? Who gets to define it? Who gets to apply a label to another human being, and what does this mean? An ongoing debate over revisions to the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5) has been covered extensively elsewhere, so I won't discuss that here. Another classification system, the ICD-10, is also used to define a whole host of mental illnesses.

The ability to label and categorize something (or someone) implies a certain degree of power and mastery over them. In the domain of psychiatry, several groups or movements have rebelled against not only labels, but against current treatments designed to "normalize" the problematic thoughts and behaviors. Below is my non-expert attempt to understand a few of these groups, which (by necessity) requires an effort to label them.


Classic grassroots anti-psychiatry has its origins in the consumer survivor movement and is largely based on perceived (or real) abuses and negative side effects of psychotropic medications.2 It is anti-medical model, anti-label, anti-diagnosis, and anti-stigma. The Antipsychiatry Coalition is one example. The Icarus Project might be another:
The Icarus Project envisions a new culture and language that resonates with our actual experiences of 'mental illness' rather than trying to fit our lives into a conventional framework.

We are a network of people living with and/or affected by experiences that are commonly diagnosed and labeled as psychiatric conditions.

The Citizen's Commission on Human Rights (CCHR), run by the Church of Scientology, could be considered an extremist fringe member. Dr. Dave Touretzky maintains an excellent site on The Secrets of Scientology, and his 1998 SfN Poster is required reading for neuroscientists:
In a pamphlet called Psychiatry: Education's Ruin, CCHR urges concerned parents to write their elected representatives to demand:

  • a) that the practice of psychology or psychiatry be declared illegal in schools or colleges;
  • b) that the funding for all mental health programs, tests, research or administrative costs in schools be cut, and re-appropriated towards proven non-psychological/psychiatric teaching methods; and
  • c) that the government funding to mental health research institutes such as the U.S. National Institute of Mental Health be cut.

In the distant (and not-so-distant) past, I've been accused of lumping together various adherents of anti-psychiatric thought, from the academics to the quacks to the loons. Part of this stemmed from a foul-mouthed troll who used to haunt my blog, but those days are over [hopefully!]. Below is more nuanced look.

Critical Psychiatry

Critical Psychiatry is a professional movement started in the UK:
The Critical Psychiatry Network is a group of psychiatrists who first got together in 1998 to discuss changes to the Mental Health Act proposed at that time. The group consists of about 80 psychiatrists, mostly based in the UK, but there is also an international Critical Psychiatry Network of psychiatrists from around the world...3

Many members believe that mental disorder is fundamentally different from physical or bodily disease, and that trying to approach mental disorder in a medical framework strips it of its meaning, and dehumanises attempts at treatment.

Personally, I do not think that the act of defining mental disorders as diseases of the brain strips these illnesses of their meaning or necessarily dehumanizes treatment. I have disagreed with the views of Dr Joanna Moncrieff, one of the chairs of CPN, about whether depression can be considered a biologically-based brain disease (see The Pseudoscience of Anti-Psychiatry in PLOS Medicine).4 There are humane ways of improving the functioning of perturbed brains, which of course exist in bodies, which move around in society and are shaped by cultural and other influences. These ideas are highly interdisciplinary in nature (see Appendix 1) but may not be especially practical yet in terms of everyday clinical implementation.

An interesting combination of Critical Psychiatry and grassroots Antipsychiatry is Mad in America:
The site is designed to serve as a resource and a community for those interested in rethinking psychiatric care in the United States and abroad. We want to provide readers with news, stories of recovery, access to source documents, and the informed writings of bloggers that will further this enterprise.

The bloggers on this site include people with lived experience, peer specialists, psychiatrists, psychologists, social workers, program managers, social activists, attorneys, and journalists. While their opinions naturally vary, they share a belief that our current system of psychiatric care needs to be vastly improved, and, many would argue, transformed.

The next movement consists of localized, interdisciplinary academic groups and departments, many of which are based in Canada. They share with antipsychiatry a strong belief against labelling and stigma, then combine it with critical theory and identity politics.

Mad Studies

Mad Studies is a recent academic offshoot of Disability Studies, akin to Women's Studies and Queer Studies [aka LGBT Studies] before it. An interdisciplinary field that incorporates social science methodologies, historical analysis and a keen political awareness, its goals are to question and critique societal norms of mental illness, insanity, and "madness." Major themes include discrimination and social inequality, the participation of mental health peers in research projects, concern with language and semantics, and of course Michel Foucault and The History of Madness.

The blog Ruminations on Madness has posted a Mad Studies Bibliography, as well as a co-authored chapter [PDF] on user/survivor led research. Here’s a brief excerpt from the chapter's concluding remarks:
User/survivors can only speak with authority if traditional researchers, policy makers and members of the general public come to agree that systems change must be guided both by the lived experience of disability and recovery and through the ongoing critical questioning of often unspoken assumptions about power, truth, and science.

Ryerson University in Toronto recently hosted an international conference on Mad Studies. According to York University professor Geoffrey Reaume:
“Throughout mad people’s history, the academic elite have literally organized against mad people through a multitude of oppressive practices and ideas,” he says.

Through their medical faculties, universities conferred “power and legitimacy to enforce imposed practices ranging from lobotomy, ECT insulin-coma shock, excessive drug treatments, discriminatory labels.

“Now that some of us are in these elite positions within academia, it is essential to ensure we use this power and privilege to organize, to promote, research, write and engage the public about a topic that has too often in our history been interpreted through the views of medical-model academics.”

You can see some overlap with the Antipsychiatry/survivor movement, as the quote above indicates. People diagnosed with mental disorders are not ill, they're just different. The psychiatric/industrial complex is a coercive force designed to oppress and abuse the mad. Also note the re-appropriation of the stigmatizing word "mad", much as some members of the LGBT community have taken back slurs like "queer" and "faggot". Although there is a focus on language and terminology, Mad Studies is against labels. This is somewhat ironic, because impenetrable postmodern academic jargon is typical of the field.5

At the Critical Inquiries 2012 workshop [agenda - PDF], presentations included Research Design and Social Justice: Can a Research Question Constitute a Violation of Human Rights? and The Material-Discursive-Intrapsychic Construction of PMS: A Feminist Critical-Realist Analysis of Women’s Madness [abstracts - PDF]:
We are consistently told that women are more “mad” than men, evidenced by women’s higher rates of psychiatric diagnosis, often attributed to the reproductive body. Competing bio-medical, psychological and socio-cultural models adopt a realist epistemology and a discourse of medical naturalism, to position madness as a naturally occurring pathology within the woman, caused by biology, cognitions, or life stress. Feminist critics argue that this medicalises women’s misery, legitimises expert intervention, and negates the political, economic and discursive aspects of experience. However, the alternative model of social constructionism may appear to dismiss the “real” of women’s distress, and deny its intersubjective concomitants. In this paper, we argue that a critical-realist epistemology allows us to acknowledge the material-discursive-intrapsychic concomitants of experiences constructed as madness, and the relational context of women’s distress, without privileging one level of analysis above the other, in order to understand women’s greater propensity to be diagnosed as “mad”. ...

The Mad Studies adherents are not going to start a movement for change by presenting at intellectually elite conferences and publishing obscure, difficult to understand articles in academic journals alone. I would even argue that the academic language makes it a fundamentally exclusionary movement, unless there is another running discourse for the "mad masses." In addition, others have noted that most of the academic work is not interested in the accessibility of services. At first glance the field appears to exclude a major segment of its constituency, namely those who are impoverished and undereducated, who are likely to be the most severely ill [or alienated].

HOWEVER, many of these same academics are engaged in the community and lobby for systemic change. Some participate in more inclusive events such as PsychOUT: A Conference for Organizing Resistance Against Psychiatry. Although I do not agree with the mandate of CAPA, presentations such as A Supportive Housing Model provide concrete real world counterweights to How a counter-discourse to the psychopathology of ‘obsessions’ departs from the trope of ‘Mad genius’: An autoethnographic study of relationality from ‘local to universal’. This stark contrast raises an important issue that has arisen recently in the science blogosphere (see Appendix 2).

Concluding Thoughts

"Antipsychiatry is behind us!" This quote from the Critical Inquiries 2012 workshop was texted to me by an attendee. I found it very ambiguous. Does it mean that grassroots Antipsychiatry supports the academic field of Mad Studies? Or that the old guard of Antipsychiatry is over, replaced by the vanguard of Mad Studies? [The intended meaning was the latter.] Is Critical Psychiatry an elitist and esoteric professional organization with little impact on the everyday practice of psychiatry? Is the CAPA goal of dismantling the psychiatric system much different from that of Scientology's CCHR?6 As an outsider at odds with many of the views espoused there, I don't pretend to have any answers. But I have come away with a better understanding of those who basically oppose the paradigm of biological psychiatry (and more broadly, the entire research program of my field).


1 However one defines them... See Christian Jarrett on What is mental iIllness?, Scicurious on What is Psychopathology?, and the Neurocritic on the new Research Domain Criteria for Classifying Mental Disorders.

2 I'm not going to discuss Thomas Szasz here.

3 Further reading available on the Critical Psychiatry Website: What is Critical Psychiatry? and What was anti-psychiatry?

4 That August 2006 post initiated a lively discussion. I had nearly forgotten that Dr. Vaughan Bell took me to task for lumping together various adherents of anti-psychiatric thought:
This hardly puts the authors in the same category as Scientology. Your ad hominem attack on the authors really adds nothing to your argument.
5 Every academic field has specific jargon, so this is certainly not unique to Mad Studies and related social science disciplines. I'll be making an important point about that in Appendix 2.

6 However, one important distinction is that a stated goal of the Coalition Against Psychiatric Assault is building a better world, but $cientology is mostly concerned about money.

7 Granted, the line here is pretty thick.

Appendix 1 - Cultural Psychiatry (etc.)

Although not confined to critiques of psychiatry, cultural psychiatry is included as part of an interdisciplinary field exemplified by
The mission of the Foundation for Psychocultural Research (FPR) is to support and advance interdisciplinary research projects and scholarship at the intersection of psychology, culture, neuroscience, and psychiatry, with an emphasis on cultural factors as central, not peripheral.
This organization sponsors conferences, such as the 5th FPR-UCLA Interdisciplinary Conference, and funds academic centers, including the Center for Culture, Brain, and Development and the Program for Culture, Brain, Development, and Mental Health (CBDMH):
The primary objective of the CBDMH, which is co-directed by psychological anthropologist Douglas Hollan of UCLA and clinical psychologist Steven López of USC, is to establish a strong program in cultural psychiatry, with an emphasis on integrating neuroscience and social science perspectives.
The FPR also sponsored a workshop on Critical Neuroscience:
Critical Neuroscience probes the extent to which discussion of neuroscience—in ethical debates, policy texts, commercial and clinical projects—matches the achievements and potential of neuroscience itself. It examines the ways in which the new sciences and technologies of the brain lead to classifying people in new ways, and the effects this can have on social and personal life. It studies both the methods used to gain new knowledge, and the ways in which the knowledge is interpreted and used. The project aims at finding or creating a shared vocabulary for neuroscientists and social scientists in which they can talk about the potential of the tools, the analytical methods, the interpretations of the data. We also need a shared way in which to think about the barrage of media reports of all this work. Critical Neuroscience aims, more over, at drawing attention to any social or political imperatives that make certain research programs in neuroscience more attractive and better funded than others. We hope to introduce our observations into brain research itself, and to integrate them into new experimental and interpretive directions.
Since the mission of this blog has been "Deconstructing the most sensationalistic recent findings in Human Brain Imaging, Cognitive Neuroscience, and Psychopharmacology", it might informally fall under the rubric of Critical Neuroscience, although it has not specifically aspired to...
...seriously bridge the social and anthropological study of the neurosciences to the neuroscience laboratory by engaging neuroscientists and non-neuroscientists - philosophers, historians of science, anthropologists - in concrete collaborations focused on specific themes of cultural relevance.
The excellent Neuroanthropology blog is a better fit for that academic niche. Although broader in scope (with a long list of contributors), covers this ground as well.

Appendix 2 - When is it appropriate to use academic jargon?

Who gets to dictate a style of writing? Where is the line between use of technically precise but impenetrable academic jargon and fatuous tabloid oversimplification aimed at 9th graders?7 In some instances, scientists rail against churnalism and oversimplification of their results in popular media, yet want to constrain the language of other fields. Why is technical jargon necessary in biological (and harder) sciences but not in the social sciences or humanities? Those fields have their own paywalled specialty journals as well. On the one hand, science Writers should not fear jargon - "Researchers use complex language for a specific purpose." On the other, Why Don't Social Scientists Want To Be Read? You can just as easily ask Why don’t neuroscientists want to be read (except by neuroscientists)?

Audience matters.
Obviously, there's a difference between academic writing and 'popular' writing. Authors write differently for Sage Publication's Health vs. Men's Health. In my opinion, it's presumptuous to dictate the language that should be used by another academic discipline just because you don't understand it. It reveals a dangerous undercurrent of intellectual hierarchies and power (to which I am not immune).

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