Thursday 29 November 2018

How to Feel Blue

Today's post is by Cheryl Wright.

In 1998 I gave birth to a beautiful baby girl who was missing part of her corpus callosum. She was quirky and didn’t learn to speak in a typical manner. She had echolalia for years and would only simultaneously repeat what was being said in seemingly stereo timing to what she heard. I had to spend years teaching her to answer, “I’m fine, thank you.” to the question, “How are you?” I walked around with her, and for years pointed to everything blue, telling her it was blue; hoping she would get the concept of color.

We had a blue and white checkered tile floor. I had every person that came in hop on the blue tiles and exclaim “BLUE!” At the age of seven, she finally got it. She said, “Mama, I walk blue!” and excitedly walked across the white tiles on the floor. She did understand blue and was able to demonstrate her understanding over the next week. The other colors came within the next six months.

Cheryl Wright

When she did start to share her observations of the world, I found out that she didn’t view things in the same way that I did. “Look! An airplane, Mama!” she called out to me one day as we were outside walking. Of course, I looked up. No airplanes. I looked down for a toy airplane. I even looked for a sticker of an aircraft.

Then I saw it. The shadow that made an airplane. I became observant of shadows and realized that they were very real to her. She avoided stepping on shiny tiles that reflected the ceiling. For to her, it looked like she was going to drop into a pool. She didn’t look at her reflection in mirrors, as she didn’t recognize it was a reflection of herself, only a disinterested other child. She avoided stepping on shadows as they were physical objects.

The 'plane'

Through my sincere desire to understand my daughter’s thought processes, I researched and studied. I obtained an advanced degree in Autism Spectrum Disorders and earned a Doctorate of Education. I’ve worked to advocate for individuals with disabilities and enjoy being an international educator, speaker, and author. I have worked as a life-skills coach for students with developmental disabilities in South Korea, Thailand, Kuwait, and the United States. In coordination with the wonderful educational leaders that I have met internationally, we have authored the Cultural Rainbow series of children's books about individuals with different abilities, acceptance, holidays, and cultures around the world.

Tuesday 27 November 2018

Intensity of Experience and Delusions in Schizophrenia

This post is by Eisuke Sakakibara, psychiatrist working at The University of Tokyo Hospital. In this post he writes about his paper “Intensity of experience: Maher’s schizophrenic delusion revisited” recently published in Neuroethics.

Delusion is one of the most frequently discussed themes in philosophy of psychiatry, and this is my second publication regarding delusions. In my first paper, entitled “Irrationality and pathology of beliefs,” I proposed that not all delusions are pathological, and some delusions are formed without any physical or mental dysfunction.

In my second paper, I focused on delusions accompanied by schizophrenia. As for schizophrenic delusions, it is beyond question that they are the result of dysfunction of some kind. The problem, then, is what kind of dysfunction is relevant for the development of schizophrenic delusions.

The theory of schizophrenic delusion has developed by the consecutive works made by Brendan Maher. He proposed in 1974 that schizophrenic delusions are hypotheses formed to explain anomalous experiences rather than the result of patients’ paralogical inferences. He stated that they are “rational, given the intensity of the experiences that they are developed to explain.”

But his theory was criticized by the two-factor theorists of delusion because 1) it does not explain why some patients with anomalous experiences do not develop delusions, and 2) adopting and adhering to delusional hypotheses is irrational, considering the totality of experiences and patients’ other beliefs.

In my second paper, the notion of the intensity of experience is reappraised to uphold Maher’s basic conception. Regarding 1), I propose that differences in the intensity of anomalous experience are vital to whether the patient forms delusions, while partially reforming his rationality claim regarding 2). Although adopting delusions is irrational, it is inevitable and excusable, given the intensity of the patient’s anomalous experience.

Thursday 22 November 2018

Philosophy Within its Proper Bounds

Edouard Machery is a Distinguished Professor in the Department of History and Philosophy of Science at the University of Pittsburgh, the Director of the Center for Philosophy of Science at the University of Pittsburgh, and a member of the Center for the Neural Basis of Cognition (University of Pittsburgh-Carnegie Mellon University). 

His research focuses on the philosophical issues raised by psychology and cognitive neuroscience with a special interest in concepts, moral psychology, the relevance of evolutionary biology for understanding cognition, modularity, the nature, origins, and ethical significance of prejudiced cognition, the foundation of statistics, and the methods of psychology and cognitive neuroscience. He also works in metaphilosophy, and he has been involved in the development of experimental philosophy. Here, he introduces his new book on philosophical methodology.

Philosophy Within Its Proper Bounds has four main goals. The first three are negative: I argue first that the method of cases that is so important to some parts of philosophy (roughly, the use of thought experiments) should not be used because it elicits unreliable judgments. Second, because the method of cases plays an irreplaceable role in getting knowledge about metaphysical necessities, this unreliability supports a restricted kind of modal skepticism. 

Many metaphysical necessities and possibilities that are pivotal to resolve fundamental philosophical issues (physicalism, the reduction of causation to some form of counterfactual dependence, compatibilism, etc.) are beyond our epistemic reach. Third, I conclude from this modal skepticism that these fundamental philosophical issues (which I call “modally immodest”) should be set aside and that philosophical ingenuity should be redirected in more modest, but ultimately more important directions. The positive goal of Philosophy Within Its Proper Bounds identifies one of these directions: the analysis and engineering of concepts, psychologically understood. 

Tuesday 20 November 2018

Self-admission to Inpatient Treatment

Mattias Strand is Consultant Psychiatrist at the Stockholm Centre for Eating Disorders. He is also a PhD student at Karolinska Institutet in Stockholm, where his main research focus is on self‐admission as a potential tool in the treatment of severe eating disorders. 

In this post, he discusses the background to, and main claims of, a recent paper, co-authored with Manne Sj√∂strand, Senior Researcher at the Stockholm Centre for Healthcare Ethics at Karolinska Institutet, "Self‐admission in psychiatry: The ethics".

In recent years, self-admission to inpatient treatment has become an increasingly popular treatment tool in psychiatry in the Scandinavian countries as well as in the Netherlands. In self-admission, patients who are well known to a service and who have a history of high utilization of inpatient treatment are invited to decide for themselves when a brief admission episode – usually 3-7 days at a time – is warranted. Patients are also free to discharge at will.

Central to the concept is that the patients’ reasons for choosing to self-admit are not questioned. Participants are free to admit themselves because of deteriorating mental health, acute stress, lack of structure in everyday life, loneliness, or any other reason. In this way, the traditional inpatient admission model with a clinician serving as gatekeeper is bypassed, which means that potentially stressful repeated visits to an psychiatric emergency unit can be avoided.

The rationale behind self-admission is manifold. Proponents of the model argue that it can increase patient autonomy and agency, promote early help-seeking, reinforce the asylum function of the inpatient ward, reduce coercive interventions, and reduce total time spent in inpatient treatment.

Participants usually have a history of multiple and prolonged hospital admissions. Supposedly, encouraging self-monitoring of their mental health status and allowing swift help seeking can minimize the lag between first signs of deterioration and hospital admission, thus reducing the total time spent in hospital. Importantly, self-admission is an add-on tool rather than a replacement of other treatment options and admission through regular procedures is thus still available if needed.

Thursday 15 November 2018

Altered States of Consciousness

This post is by Marc Wittmann, Research Fellow at the Institute of Frontier Areas of Psychology and Mental Health in Freiburg, Germany. Here, he writes about his new book on altered states of consciousness.

Subjective time emerges through the existence of the self across time as an enduring and embodied entity. This is clearly revealed in everyday states of consciousness such as transiently being in states of boredom or flow. An increased awareness of the self is associated with an increased awareness of time when we are bored. In contrast, we lose track of time and the self when fully immersed in challenging activities accompanied by the feeling of enjoyment – experienced in the state of flow.

The relation between self-awareness and time is even more prominently disclosed in anecdotal reports and empirical studies on altered states of consciousness such as in meditative states, in music-induced trance, and after ingestion of psychedelic substances. In peak states the experience of ‘timelessness’ is reported together with a loss of the sense of self. This is in fact a universal spiritual experience where time is not experienced at all and the self becomes one with the world.

In my book Altered States of Consciousness: Experiences out of Time and Self, just published by MIT Press, I explore these facets of changes in consciousness awareness. After a prologue containing a warm-up with reports of extreme experiences by novelists and Nobel Prize winners, the first chapter covers phenomena under scientific investigation such as the experience of time expansion in moments of terror and accidents (the slow-motion effect), under the influence of drugs, in spiritual moments, and in near death when the heart and brain have apparently stopped functioning. In the second chapter I cover the experience of time and self in meditation.

An abundance of neuroscientific studies exist on meditation effects; and I interview a highly experienced meditator on what he can report to us about his states of “awakening”. In the third chapter I investigate the case of a puzzling psychiatric patient who has lost her emotional feelings, her bodily feelings and the sense of time. Depression and schizophrenia and the latest research on disturbed temporal processing in these patients as well as in certain individuals with epileptic auras are reported. Finally, the latest breathtaking studies on psychedelics such as psilocybin, LSD, and ayahuasca are discussed.

Tuesday 13 November 2018

Intellectual Servility and Timidity

Alessandra Tanesini is a Professor in Philosophy at Cardiff University (UK). She is the author of An Introduction to Feminist Epistemologies (Blackwell, 1999), of Wittgenstein: A Feminist Interpretation (Polity, 2004), and of several articles in epistemology, feminist philosophy, the philosophy of mind and language, and on Nietzsche. 

Her recent work lies at the intersection of ethics, the philosophy of language, and epistemology with a focus on epistemic vice, silencing, prejudice and ignorance. She is currently a co-PI on a two-year multidisciplinary research project Changing Attitudes in Public Discourse which is dedicated to reducing arrogance in debate. Open access copies of recent publications and work in progress can be found here.

Those who face discrimination, humiliation and intimidation on a daily basis suffer many harms as a result of these wrongful treatments. In my paper “Intellectual Servility and Timidity” I explore how subordination and discrimination damage the character of the oppressed. I argue that those who are repeatedly humiliated are likely to develop feelings of inferiority and a lack of pride in their achievements. They might also become extremely servile. 

I characterise this vice as a damaged form of self-esteem. It occurs when individuals have a low opinion of themselves as this self-evaluation is measured explicitly by means of questionnaires, and at the same time have a positive view of themselves as this is measured indirectly via the Implicit Association Test (IAT) or other implicit measures. These individuals are driven by a desire to fit in with a society that despises them. They are, in response, prepared to adopt the low opinion that others have of them to avoid social exclusion.

Thursday 8 November 2018

Red Hands

Today's post is by Francesco Filippi (pictured below), an Italian director, screenwriter, and animator whose work can be found here. In this post he tells us about his new film, Red Hands, which addresses the theme of domestic violence.

Can an animated film for teenagers have something to say to the readers of this very interesting blog which explores the boundaries of the human mind? Red Hands, an Italian 30' long film in stop-motion and 2D animation, had his premiere at the Rome Film Festival on October 20th, 2018.

As you can see from the trailer above, it's a story of domestic abuse. Ernesto, a 12 year-old boy, discovers that the magnificent red graffiti appeared on the walls of his street are made by Luna, a girl with a mysterious power. She can emit a blood-like liquid from her hands, but her power is a side-effect of her father's violence at home.

Tuesday 6 November 2018

What Does it Take to Be a Brain Disorder?

In this post, Anneli Jefferson, Leverhulme Early Career Fellow at the University of Birmingham summarizes her paper on the nature of brain disorder, recently published in Synthese.

A long-standing project pursued by some psychiatrists is to show that mental disorders are brain disorders and that mental dysfunction can best be explained as brain dysfunction. But what exactly is the relationship between mental disorders and brain disorders and when is a mental disorder a brain disorder? This is the question I address in my paper. Some psychiatrists believe that it follows from the acceptance of physicalism that all mental disorders are brain disorders. If all mental states are brain states, shouldn’t all disordered mental states be disordered brain states?

Many philosophers have resisted this conclusion, appealing to the hardware/software distinction to argue that even if dysfunctional mental processes are realised in the brain, this does not mean that the underlying brain processes are also disordered. Just as there can be a software problem without there being anything wrong with the hardware, there can in principle be a mental problem without any systematic problem in brain function.

This argument is often supported by appeal to multiple realizability: one mental dysfunction can be realised by many different brain processes in different individuals or in one individual over time. There may not be a stable underlying brain pattern that realises a specific psychological dysfunction.

In the paper, I suggest that when we do find an underlying brain difference that realises psychological dysfunction, we should characterize this as a brain dysfunction because it realises mental dysfunction. This means that in some cases (for example, amygdala hypofunction) the characterisation of brain difference as dysfunctional is derivative of the psychological level, because the reason the brain anomaly is characterized as dysfunctional is purely that it realises psychological dysfunction.

There is no independent, brain-internal criterion that characterizes these differences as dysfunctional, instead the characterization of brain dysfunction depends on the psychological level. This should not worry us, I argue, because the brain is the organ of thought, so it stands to reason that we look at the interaction between disordered processes of thought and feeling and brain anomaly when figuring out which brain differences constitute brain dysfunctions.

Thursday 1 November 2018

IMH Inaugural Forum

On 15th October the Institute for Mental Health (IMH) had its Inaugural Forum at Hornton Grange at the University of Birmingham. The event was live-tweeted by the Mental Elf and the IMH. The whole project PERFECT team attended the Forum and this report comes from their collective notes.

In the morning session, Eoin Killackey (Orygen) and Paul Burstow (IMH) started the day with two fascinating talks on youth mental health.

Killackey gave a very international talk, analysing a variety of interventions and forms of support available for young people across the world, reflecting on the many lessons those who wish to improve the UK youth mental health system can learn from these programs. 

Two particularly interesting focal points were on how to improve the transition from youth to adult services, and how to better separate services on the basis of demographic and developmental evidence about the prevalence and nature of youth mental health difficulties. 

Burstow spoke of the need not just to increase spending on youth mental health across the UK, but more importantly of the need to reallocate existing funding towards intervening on the causes of mental ill health, rather than simply tackling the consequences.

From Paul Burstow's talk

Before the lunch break, Karen Newbigging (IMH) and Sophie Stammers (Project PERFECT) facilitated a very interactive session asking what makes coproduction successful. Participants were divided into groups and asked to share their experiences of coproduction. 

Key themes were the need for (a) managing expectations in coproduction; (b) making young people participating in research aware of the remit and the constraints of the project they are asked to help with; (c) offering something back to people participating in research (e.g. training skills); (d) offering expertise to support good ideas coming from people with lived experience of mental health services.

Parallel to this session, Maria Michail (IMH) and Anna Lavis (IMH) facilitated a workshop on how the wide range of disciplines involved in mental health research at the IMH could break out of their own ‘silos’ and work together to better understand and prevent self-harming and suicidal behaviours in youth populations. 

Participants were divided into groups and worked together to begin to develop ways of overcoming existing personal and structural barriers to interdisciplinary research.

In the afternoon, Sophie Dix (Director of MQ) talked about the financial cost of mental illness and the cost in terms of loss of life. There is a lot in the press about raising public awareness of mental health, decreasing stigma, and improving services. But there is very little about making treatment better and research is part of the solution.

Sophie Dix

MQ raises money for research into mental illness. There is great disparity between funding for research for cancer and dementia and funding for research for mental health. And in mental health there is too much ‘trial and error’ and not enough prevention. Further, there is a lack of innovation when it comes to finding the best treatments. No huge progression has been made with psychological treatments either: those we have today were developed in the sixties.

MQ is focused on research that is: (1) multidisciplinary, (2) transdiagnostic, (3) international, (4) focused on impact, (5) aimed at investing in the future. MQ thus applauds the creation of multidisciplinary centres such as the IMH, where scientists from different disciplinary backgrounds work together from the start. 

MQ encourages international collaboration and funds the best research, whether it is based in the UK or elsewhere. Examples of the research they fund includes depression in people with HIV in Uganda; whether women are more responsive to psychological treatment for anxiety depending on where they are in their menstrual cycle; effects of folic acid for protecting people against schizophrenia.

One big focus is on youth mental health: it takes too long for people to get help since they show the first symptoms of mental illness. MQ created a consortium to address the challenges youth mental health poses and coproduce research ideas by people in the physical and social sciences. 

MQ used sandpits to attract people who had expertise in public engagement and collaborative projects. The result was people coming up with ideas (developing a screening tool for mental illness, e.g. suicide prevention and risk scores for depression in adolescents).