Friday, March 14, 2008

The Journal of Truly, Truly Outrageous Medical Hypotheses

Via The Lay Scientist...
Do Sexy Shoes cause Schizophrenia?

Is there an association between the use of heeled footwear and schizophrenia?” [1]. The human mind has an almost infinite capacity to come up with unlikely ideas and connections. From the Department of Lateral Thinking in Sweden, comes a hypothesis by Jarl Flensmark that’s so crazy, it could just be true… can high heels cause schizophrenia?

Normally when reviewing a scientific paper, it’s sensible to start with the background, and explain how the idea originated as a result of hints given in a variety of previous studies and speculations. In this case I can’t, because I honestly can’t figure out what inspired Flensmark, what piece of wiring in his head made him come up with the connection between high-heeled shoes and Shizophrenia [sic]. He may be right, he may be completely wrong, but I don’t care – the man is a genius.

Well, I don't know about genius...creative, perhaps. Or is he...

In our earlier “The Key To Genius: Manic-Depression and the Creative Life” (1998) Amherst Prometheus Books we catalog the role of the disorder in the lives and careers of Isaac Newton, Ludwig von Beethoven, Charles Dickens, Vincent van Gogh and other creative geniuses.
Both of these articles appeared in the journal, Medical Hypotheses. This journal had crossed my radar screen before, enough to register as a repository of wacky ideas. But this time, I decided to investigate the review criteria and Editorial Board.
Aims & Scope

Medical Hypotheses takes a deliberately different approach to review. Most contemporary practice tends to discriminate against radical ideas that conflict with current theory and practice. Medical Hypotheses will publish radical ideas, so long as they are coherent and clearly expressed. Furthermore, traditional peer review can oblige authors to distort their true views to satisfy referees, and so diminish authorial responsibility and accountability. In Medical Hypotheses, the authors' responsibility for the integrity, precision and accuracy of their work is paramount. The editor sees his role as a 'chooser', not a 'changer': choosing to publish what are judged to be the best papers from those submitted.

From Charlton BG. Peer usage versus peer review BMJ 2007; 335: 451 :- "Traditionally, editorial review is the main alternative to peer review. A scientist editor or editorial team applies a sieve, with varying degrees of selectivity, to research submissions. Strictly, this process should not attempt to predict whether ideas and facts are "true," because truth can be established only in retrospect. Instead, editorial selection works within constraints of subject matter on the basis of factors such as potential importance and interest, clarity and appropriateness of expression, and broad criteria of scientific plausibility. Even probably untrue papers may be judged worth publishing if they contain aspects (ideas, perspectives, data) that are potentially stimulating to the development of future science.
Who is on the Editorial Board?

Editor-in-Chief: Bruce G. Charlton, University of Newcastle Upon Tyne, UK

Founding Editor: David F. Horrobin

Editorial Advisory Board:
Peter Andras, University of Newcastle upon Tyne, UK
William Bains, Hertfordshire, UK
Roy Calne, Cambridge, UK
Arvid Carlsson, Goteborg University, Sweden
Antonio R. Damasio, University of Iowa Hospitals and Clinics, USA [now at USC]
David Healy, North Wales Department of Psychiatry, UK
David L. Hull, Northwestern University, USA
J. Lee Kavanau, UCLA, USA
Mehar Manku, Stirling, UK
Andrew Miles, King's College, London, UK
Mark A. Notturno, Interactivity Foundation, USA
David Pearce, Brighton, UK
V.S Ramachandran, USA
Jonathan Rees, University of Edinburgh, UK
Jack Scannell, London, UK
Gavin Spickett, Royal Victoria Infirmary, UK
James Willis, Guildford, UK
Joon Yun, Palo Alto Institute, USA

Many of these men [yup, they're all men] are prominent, respected scientists. Some are gadflies. How many names do you recognize? I've put links on the ones familiar to me.

Now back to the manic-depressive article by Julian Lieb [2].
Two manic-depressives, two tyrants, two world wars

Napoleon Bonaparte, Adolph Hitler and Joseph Stalin were tyrants who attained absolute power, and misused it in a gargantuan fashion, leaving in his wake a trail of hatred, devastation and death. All made war on their perceived enemies and on their own countrymen. In “A Brotherhood of Tyrants: Manic Depression and Absolute power” (1994) Amherst, Prometheus Books, D. Jablow Hershman and I expose manic-depressive disorder as the force that drove them to absolute power and the terrible abuse of it. We uncover manic-depressive disorder as a hidden cause of dictatorship, mass killing and war, and show how the psychopathology of the disorder can be a key factor in the political pathology of tyranny. ... Key to the destroyers is an indifference to the suffering of others, a need to control everyone and everything, a resistance to reason, and grandiose and paranoid delusions. The paranoid and grandiose delusions of manic-depressives are as infectious and as virulent as a deadly microbe, and can easily infect those in thrall to the host figure. It is a phenomenon known as “induced psychosis” and its imprint is often to be seen on the world stage. In this article I will add Kaiser Wilhelm to the list of manic-depressive warmongers, and passages from Robert Payne’s “The Life and Death of Adolph Hitler” that are not only pathognomonic of manic-depressive disorder, but of the mixed variant.
Wow! Just wow. The level of speculation and bigotry is astounding. I've heard of the "Key to Genius" book, but not the "Tyrant" one. I searched and searched but could not find evidence of an online book review of the latter,* and only a handful of user reviews. The best is this one by a user at Barnes &

Customer Rating for this product is 1 out of 5 pop psychology at it's finest
A reviewer, not amused, 01/27/2004

Hershman and Lieb combine a disneyesque sense of morality with the literary talents of a fourth grader to bring you an original and good idea gone sour. The references used in the book are taken out of context and abused. they conclude that mania and depression are caused by external circumstances and/or at the will of the individual which couldn't be further from the truth. This book will only further the misunderstanding of a frequently misunderstood disease and as a manic-depressive I am offended.

Also recommended: Read anything by Kay Redfield Jamison. She seems to be among the select few who have a firm grasp on the subject

Here's a lovely excerpt from the book:

Because, of course, it's been scientifically proven that bipolar disorder has a 100% inheritance rate...

* After reading the Lieb article, I noticed he cited a review by Dr. Jerrold M. Post [3].
These three leaders have been analyzed to a fare thee well, including medical historians (who are not cited) among the scholarly analysts. The diagnosis of manic-depressive illness, however, has not previously been raised. The reason is that the diagnostic conception of the authors is overly sweeping and broad. Many of the behaviors they describe as indicating manic-depressive illness are consistent with personality disorders and by no means pathognomonic of manic-depressive psychosis. In particular, many of the behaviors described seem to reflect significant narcissistic and paranoid traits. Others seem insufficiently to attend to the political and historical context...
But Lieb just whines in reply to Post's 12 year old review:
As far as I know, no one has explained how the egotism of the manic differs from the narcissism of the narcissist, or how the grandiosity and paranoia of the narcissist differs from the grandiosity and paranoia of the manic-depressive.
And thus ends his 2008 paper in Medical Hypotheses. Are the members of the Editorial board proud to have their names affiliated with such complete dreck?

But there's more. On February 16, 1996, Lieb wrote an editorial that appeared in the Los Angeles Times. I found the entire text online, and here's how it starts...
Hatred Often Lurks in the Shadows of Mania

by Julian Lieb

Mental illness: Society should understand the role of manic-depressive disorder and paranoia in crimes of genocide

WHILE MENTAL HEALTH PROFESSIONALS and patients yearn to see mental illness destigmatized, it is contrary to society's interests to ignore or minimize the role of emotional disorders in bigotry, hate crimes, and genocide.

Consider the perpetrators of the most terrible hate crimes in history. Those who knew or studied Adolf Hitler and Josef Stalin offer vivid descriptions of the paranoid, delusional form of manic depressive order both men experienced.
...ironically, by instilling the hatred of millions of law-abiding citizens with bipolar disorder and by propagating stigma. This was duly noted by the person(s) who posted the editorial:
It is horribly ironic that the first sentence of this poisonous missive mentions how much those afflicted with mental illnesses want to see their conditions destigmatized. Just so. And equating manic-depression with evil incarnate certainly accomplishes that goal doesn't it? Telling people that the seeds of evil are to be found in manic-depression, and that it is as infectious and virulent as a deadly microbe seems to this reader to be a good example of what the writer purports to deplore - acts of hate.
But fortunately, the person(s) also notes:
I am pleased to say that a couple of days later it got the scathing denunciation in a letter to the editor that it so richly deserved.
Outrageous! And that was just one article in Volume 70, Issue 4, Pages 709-904 (2008). I'd hate to go through the archives.

But hey, why don't we consider Stimulating revolutionary science with mega-cash prizes?


[1] Flensmark, J. (2004). Is there an association between the use of heeled footwear and schizophrenia?. Medical Hypotheses , 63(1), 740-747. DOI: 10.1016/j.mehy.2004.05.014.

[2] LIEB, J. (2008). Two manic-depressives, two tyrants, two world wars. Medical Hypotheses, 70(4), 888-892. DOI: 10.1016/j.mehy.2007.07.036

[3] Post, J. (1996). Review of “A Brotherhood of Tyrants: Manic Depression and Absolute Power.” Journal of Nervous and Mental Disease 184(10), 647–648.

Truly, truly outrageous!

[One can only try to laugh in such a situation...]

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At March 15, 2008 9:18 AM, Anonymous Anonymous said...

Thanks for quoting my article on LayScience, nice post.

I agree that the journal is a bit nuts, but from time-to-time nuts is quite useful, nothing like a bit of random creativity. I blogged the High Heels post because it was a fun article to read, and I felt that Flensmark had pursued things seriously (even consulting a shoe historian - finding one of those must be a feat of research in its own right!) and presented a serious, testable hypothesis. Even if he's completely wrong, the guy has come up with a valid, testable hypothesis.

Having said all that, since posting it turns out some in the media got hold of it and predictably attempt to present it as a solid theory (the Daily Mail I believe). It's a shame, because good hypotheses should be allowed to have a public space to grow in, free from media attention.

Anyway, nice blog, keep up the good work.

At March 15, 2008 8:05 PM, Anonymous Anonymous said...

I like to read Medical Hypotheses once in a while because some of their articles make you wonder what drug the person was on when they came up with that, while others make you think their idea is curiously plausible.

I'll need to read this high heels/schizophrenia article, but I have an idea it fits into the first group.

At March 16, 2008 2:05 AM, Blogger The Neurocritic said...

Thanks, Martin. Your post got me started on the Medical Hypotheses road to ruin. I could start a whole new blog devoted to ridiculing the most outlandish papers.

Flensmark was definitely creative, if not a bit loose (and inaccurate) with the references. On the other hand, the Lieb article was especially toxic, and deserved to be trashed.

Nimravid - you might want to check out A book of ideas collected from Medical Hypotheses: Death can be cured by Roger Dobson.

At March 19, 2008 7:40 PM, Anonymous Anonymous said...

So why did I just know that Ramachandran would be on the editorial board of this journal?

At March 19, 2008 7:46 PM, Blogger The Neurocritic said...

Yes, and he's actually published there quite a lot: 13 papers according to PubMed.


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