Friday, February 28, 2014

Martin Seligman's PTSD Prevention Program doesn't work

Martin Seligman


An independent report on mental-health programs for military members and their families, commissioned by the U.S. Department of Defense, paints a bleak picture of the military's efforts to stave off depression and suicide, post-traumatic stress disorder and domestic violence among service personnel.
The Institute of Medicine report, issued Thursday, reviewed data on the programs currently in use and found that few exhibited strong evidence they work. In addition, there was little coordination within and between service branches regarding these efforts.
"There's a surprising lack of empirical evidence for the creation of and evidence for the maintenance of" prevention programs, said M. David Rudd, provost of the University of Memphis and one of 13 committee members who helped write the report. He called the findings "disappointing."
One example of this, highlighted in the report, is the Comprehensive Soldier and Family Fitness program, the Army's largest universal prevention program, which was launched in 2009. The $125 million effort, based on a program developed by the University of Pennsylvania, is designed to prevent negative consequences from exposure to trauma and improve resilience, according to the report. Components of the program include a 10-day, in-person training on positive psychology, training in assertiveness and negotiation, and a regular assessment of psychological health.
The program has been used with over one million soldiers, but the evidence for it from studies conducted by the military is weak, the committee found.
The U.S. Army said the program isn't designed to prevent post-traumatic stress disorder or depression, but rather to improve social, emotional, spiritual, family and physical strength, and called the IOM's assessment of the program flawed.

Oh yeah? Check out this 2011 interview with Martin Seligman, the guy who sold the U.S. Army this snake oil:
In November 2008, when the legendary [?] General George W. Casey, Jr., the army chief of staff and former commander of the multinational force in Iraq, asked me what positive psychology had to say about soldiers’ problems, I offered a simple answer: How human beings react to extreme adversity is normally distributed. On one end are the people who fall apart into PTSD, depression, and even suicide. In the middle are most people, who at first react with symptoms of depression and anxiety but within a month or so are, by physical and psychological measures, back where they were before the trauma. That is resilience. On the other end are people who show post-traumatic growth. They, too, first experience depression and anxiety, often exhibiting full-blown PTSD, but within a year they are better off than they were before the trauma. These are the people of whom Friedrich Nietzsche said, “That which does not kill us makes us stronger.”
I told General Casey that the army could shift its distribution toward the growth end by teaching psychological skills to stop the downward spiral that often follows failure. He ordered the organization to measure resilience and teach positive psychology to create a force as fit psychologically as it is physically. This $145 million initiative, under the direction of Brigadier General Rhonda Cornum, is called Comprehensive Soldier Fitness (CSF) and consists of three components: a test for psychological fitness, self-improvement courses available following the test, and “master resilience training” (MRT) for drill sergeants. These are based on PERMA: positive emotion, engagement, relationships, meaning, and accomplishment—the building blocks of resilience and growth.
Yup, Seligman told Casey that soldiers who end up with PTSD or die by suicide do so because they are not Nietzschean supermen (ubermenschen) who lap up psychological trauma like ambrosia. For just $145 million, Seligman promised to teach those weaklings and failures who would otherwise fall apart after combat exposure to be more resilient.

Now, there are some protective factors that reduce the probability of getting PTSD. These include higher intelligence (which is a protective factor for everything), not having been abused as a child, having good social supports, and not abusing drugs or alcohol. But the number one risk factor for PTSD is trauma exposure. Make the trauma exposure intense enough (e.g., torture) and everyone will suffer psychological consequences.

By the way, I have never met a single combat veteran, either in my clinical practice or social life, who demonstrated any signs of so-called posttraumatic growth. If some kind of psychological growth was found after a combat deployment, it would suggest to me that the individual didn't experience psychological trauma. Combat exposure is not the same as psychological trauma. It could be traumatic, but it isn't necessarily so.

Thursday, February 27, 2014

Lexicon of Madness -- Insanity Defense

Insanity Defense: More formally, the Not Guilty by Reason of Insanity (NGRI) defense. "Insanity" is a legal, even moral, concept, rather than a clinical one. (Clinicians do not determine a defendant's "insanity," only judges or juries do.) The intent of NGRI laws is to prevent the punishment of someone who committed a "bad act" due to a mental disease or defect. A person whose actions were influenced by a psychotic disorder or other mental problem is not considered as blameworthy or culpable as a normal adult. The NGRI defense is rarely used, and is not always successful when it is used. NGRI defenses are more likely to be successful if the defendant is female, has a clear psychiatric history (bipolar disorder or schizophrenia), and is tried by a judge (not a jury). A typical NGRI case might involve a 35 year old woman with a history of hospitalizations for schizophrenia who came to believe that her children are possessed by the Devil. In order to free them of Satanic influence, she threw them off a bridge, before jumping herself. In most cases of "successful" NGRI acquittals, the accused end up spending more years in a psychiatric institution than they would have spent in prison had they been convicted. John Hinckley, Jr., who shot President Reagan and three others in 1981 has been hospitalized at St. Elizabeth's in Washington, DC ever since. In contrast, the Federal sentencing guidelines for a person convicted of Assault with Intent to Commit Murder, in which a victim sustains life-threatening injuries, suggest 16 to 20 years of incarceration.

Wednesday, February 26, 2014

Lexicon of Madness -- Hypomania

Hypomania: A hypomanic episode is marked by increased energy, decreased need for sleep, enhanced self-esteem ("I can do anything"), distractibility, high levels of physical and mental activity ("My mind is racing and I can't sit still"), and excessive pleasure-seeking. The patient's mood may be elevated, expansive, or irritable. Grandiose delusions (e.g., "I am on a mission from God") or other psychotic symptoms are unlikely to be observed during hypomania. This mood state must persist for at least four days. People with Bipolar II Disorder experience alternating episodes of hypomania and major depression. People with Cyclothymic Disorder experience frequent alternating episodes of hypomania and mild depression. Intoxication with cocaine or other stimulants (including caffeine) can mimic hypomania. High achievement and overcommitment to multiple pursuits might reflect a hypomanic personality pattern, especially in late adolescents or young adults whose parents value them more for what they achieve than for who they are.

Tuesday, February 25, 2014

Lexicon of Madness -- General paresis

General paresis: Short for "general paresis of the insane." General paresis is the tertiary stage of neurosyphillis, which was the most prevalent mental disorder of the late 19th century, accounting for up to 10% of all asylum inmates. The symptoms of general paresis include psychosis, dementia, paralysis, and, at that time, inevitable death. In 1917, Austrian psychiatrist Julius Wagner-Jauregg injected the blood of a soldier infected with malaria into nine patients with general paresis. One died, two were sent to asylums, and six showed significant improvement (although four of these later relapsed). Of the 200 patients who first received this "fever-treatment," 50 eventually improved. For this pioneering work with severely ill patients previously thought to be beyond hope, Wagner-Jauregg was awarded the Nobel Prize in Physiology or Medicine in 1927, one of only three psychiatrists to receive that honor. Flushed with this success, biological psychiatrists happily set off to discover somatic treatments for other mental illnesses. Unfortunately, because schizophrenia and other psychiatric disorders do not have any simple, identifiable organic cause (such as the bacterial infection that causes neurosyphillis), no more miraculous treatments have been discovered. The advent of penicillin, which made malarial treatment obsolete, as well as Dr. Wagner-Jauregg's late-life admiration for the Nazi Party (he applied twice for membership), have caused him to become a generally forgotten figure in the history of medicine.

Monday, February 24, 2014

Sedating Kids in Foster Care with Antipsychotics

Wall Street Journal

Overseen by state and local governments, foster care provides temporary placement for minors unable to remain in their own homes. They can live in individual foster homes, in group homes, or other institutional settings. Nationwide, there were approximately 400,000 children in foster care in 2012, according to the Department of Health and Human Services.
Antipsychotics, drugs dispensed for a broad array of diagnoses, have ignited a wave of debate—most recently over their use in poor children and the billions that they cost the Medicaid and Medicare systems annually.
Most scrutiny centers on a new class of antipsychotics sold under such brand names as Abilify, Seroquel, Risperdal and Zyprexa.
Based on 2009 data from Medicaid and private insurers, Stephen Crystal, a professor of health-services research at Rutgers University, estimates that 12% to 13% of kids in foster care take these medicines. That compares with about 2% for children on Medicaid but not in foster care and about 1% for those with private insurance.
While originally hailed as safer and more tolerable than predecessor drugs such as Thorazine and Haldol, the newer generation of antipsychotics, often called atypicals, has spawned a growing body of research about potential side effects. These, say researchers, can include sudden and severe weight gain, increased risk for diabetes and movement disorders.
Atypicals, with their strong sedative powers, were originally intended for the narrow segment of adults with psychotic conditions like schizophrenia.
The Food and Drug Administration only sanctions their use for kids diagnosed with schizophrenia and conditions such as bipolar disorder and irritability associated with autism. But physicians can also prescribe these medicines "off label" to combat behavioral issues in children—some as young as two years old.
Some doctors stress that the drugs are helpful in treating children with certain aggression and behavior illnesses. Yet many are concerned that the use of antipsychotic drugs, particularly among those in custodial care, has gone too far.
According to Prof. Crystal's research, the largest diagnostic groups receiving the drugs in foster-care in 2009 were those with disruptive-behavioral disorders and attention-deficit/hyperactive disorders.
"These diagnoses involve difficulty focusing attention or controlling behavior—but that is different from not being in touch with reality," a key element of psychosis, he says.
To be sure, some doctors see considerable value in the use of antipsychotics on children in custodial care. Dr. Christoph Correll, professor of psychiatry at Hofstra University's Zucker Hillside Hospital, maintains that antipsychotics can effectively combat the violent, aggressive behavior some foster kids display. The drugs "generally work fast, which is often desired when kids are at risk of being suspended from school for their behaviors," says Dr. Correll. "In these situations, having to wait for a therapy appointment is not an option." [Let's be clear that this is merely managing behavior by administering a heavily sedating drug, and not anything therapeutic.]
The popularity of such drugs helps to account for their blockbuster sales. In 2011, antipsychotics rang up $18.5 billion in U.S. revenues, according IMS Health, rising from $12.9 billion in 2007. Sales dipped in 2012 as cheaper generics came on the market.
Of all prescription drugs sold in the U.S., Otsuka Pharmaceutical Co.'s Abilify boasts the biggest sales by dollar, ringing up $5.87 billion in sales in 2012, according to IMS Health.
In September, the American Psychiatric Association urged its members to prescribe antipsychotics only to kids with serious psychotic disorders.

Fifty years from now, I sincerely hope that the abnormal psych textbooks treat our society's widespread drugging of children with as much contempt as we regard the forced sterilization of Carrie Buck.

Sunday, February 23, 2014

The Call -- Earl H. Emmons (1939)

Did you ever have a longin’ to get out and buck the trail,
And to face the crashin’ lightnin’ and the thunder and the gale?
Not for no partic’lar reason but to give the world the laugh,
And to show the roarin’ elyments you still can stand the gaff.

Don’t you ever feel a yearnin’ just to try your luck again
Down the rippin’ plungin’ rapids with a bunch of reg’lar men?
Don’t you ever sorta hanker for a rough and risky trip,
Just to prove you’re still a livin’ and you haven’t lost your grip?

Can’t you hear the woods a-callin’ for to have another try
Sleepin’ out beneath the spruces with a roof of moonlit sky,
With the wind a sorta singin’ through the branches overhead
And your fire a gaily crackin’ and your pipe a-glowin’ red?

Don’t you often get to feelin’ sorta cramped and useless there,
Makin’ figgers and a-shinin’ your pants upon a chair?
Don’t you yearn to get acquainted once again with Life and God?
If you don’t, then Heaven help you, for you’re a dyin’ in yer pod.

Saturday, February 22, 2014

Tom Waits -- A Little Rain

This is the fourth song I have posted from his 1992 album, The Bone Machine.

The Ice Man's mule is parked
Outside the bar
Where a man with missing fingers
Plays a strange guitar
And the German dwarf
Dances with the butcher's son
And a little rain never hurt noone
And a little rain never hurt noone

They're dancing on the roof
And the ceiling's coming down
I sleep with my shovel and my leather gloves
A little trouble makes it worth the going
And a little rain never hurt noone

The world is round
And so I'll go around
You must risk something that matters
My hands are strong
I'll take any man here
If it's worth the going
It's worth the ride

She was 15 years old
And never seen the ocean
She climbed into a van
With a vagabond
And the last thing she said
Was "I love you mom"

And a little rain
Never hurt noone
And a little rain
Never hurt noone

Friday, February 21, 2014

Lexicon of Madness -- Formication

Formication: A tactile (or "haptic") hallucination in which there is a false perception of a crawling sensation either on or under one's skin. Most commonly associated with heavy use of cocaine or methamphetamine ("meth mites"), or during withdrawal from alcohol (delirium tremens). The patient may report feeling "bugs crawling under my skin" or seeing "ants all over my arms." People will scratch vigorously at the affected areas, causing excoriations or even deep gouges in their skin. Psychotic drug users have used knives or other sharp implements in order to get at what they perceived to be insects burrowed under their skin. The condition was first reported among chronic cocaine users in 1889. "Formication" is derived from the Latin word for "ant," formica. Another condition, delusional parasitosis, is more commonly found in non-drug using middle aged women. These patients come to believe that their bodies have become infested with tiny parasites or worms. They will often collect "evidence" of the infestation in small plastic bags and bring them to their physicians. To the doctor's eyes, the bags usually contain nothing but lint or dust, but the patient insists that these are parasite body parts. The women are not reassured by physical examination or negative test results. In many cases, the husband is also convinced of the presence of his wife's parasites (folie a deux, the madness of two).

Thursday, February 20, 2014

The Mass Murderer Triad

People used to talk about a "serial killer triad" -- behaviors observed in children that "predicted" future nasty behavior. These were bedwetting (enuresis), fire setting, and cruelty to animals/other children. Like most models like these, the predictive power is vanishingly small, mostly because most of these behaviors are commonly found among children who do not grow up to become serial murderers.

To show how easy it is to come up with a model that purports to predict an extremely low base rate (rare) complex behavior, I made the Venn diagram below. The components are: 1) Mother was a nurse; 2) Parents divorced; and, 3) Played video games. I plugged in the names of some notorious mass murderers. For example, Marc Lepine's mother was a nurse, and Tim McVeigh's parents were divorced, while Cho was rumored to play video games. The Aurora, Colorado movie theater shooter played video games AND his mother was a nurse. The Sandy Hook shooter played video games AND his parents were divorced. And the (arguably) most notorious of all these murderers, played video games, had a mother who was a nurse, and had parents who were divorced.

(If someone out there could get me the name of a mass murderer whose mother was a nurse and whose parents were divorced, but who didn't play video games, I'd be much obliged. That empty section of the Venn diagram really bugs the compulsive side of me.)

Now, let's be clear -- I don't think that these factors are causative to any significant degree. But when I arrange them like this, they appear to be causative. To most journalists, I think this would be the basis for feature article. It certainly reflects the same level of scientific thinking evidenced in most journalistic accounts of these type of crimes. It could probably also convince the same congressmen who want to ban violent video games to prohibit divorced mothers from obtaining nursing degrees.

Wednesday, February 19, 2014

Lexicon of Madness -- EMDR

Eye Movement Desensitization and Reprocessing (EMDR): A form of exposure therapy for posttraumatic stress. The patient is instructed to relate the details of his traumatic experience while following with his eyes the rhythmically waving index finger of the therapist. It has been suggested by Francine Shapiro, the charismatic developer of EMDR, that eye tracking somehow aids "information processing," although the neuroscientific basis for this claim is dubious. Regardless, patients in clinical trials are more likely to experience reduced PTSD symptoms if they are randomly assigned to receive EMDR, versus being assigned to a wait-list control group (i.e., receive no treatment). In fact, EMDR appears to be just as effective as other trauma therapies. Interestingly, in studies in which therapists deliver EMDR either with or without the finger-waggling/eye-tracking, patients seem to improve the same amount no matter what group they are in. In other words, the finger-waggling doesn't seem to be an active ingredient in the treatment. EMDR has been compared to Mesmerism, in which the power of suggestion was the only therapeutic agent; this does not seem quite fair, however. It seems that what patients are getting is simply a variant of exposure therapy, but with a quasi-neurological facade. Because EMDR sounds to laypersons more "scientific" than traditional "talk therapy," some patients may be more amenable to trying it.

Tuesday, February 18, 2014

Presidential Reading Habits

Business Insider:
In contrast to his reputation, George W. Bush was a prolific behind-the-scenes reader. Despite the fact that he was regularly derided as incurious and unread, Bush has long read a great many books. Karl Rove wrote in 2008, “In the 35 years I’ve known George W. Bush, he’s always had a book nearby.”
Bush read 186 books between 2006 and 2008, mainly history and biography. By way of comparison, the typical American reads four books annually and 27 percent of Americans report reading no books over the course of a year. Bush, in contrast, read fourteen biographies of Lincoln alone while in the White House. This was in addition to his annual reading of the entire Bible, along with a daily devotional. In another surprise, Bush read both liberal and conservative authors without appearing to discriminate. Clinton and Obama, by contrast, read almost exclusively liberal authors, while Reagan favored conservatives.


Monday, February 17, 2014

Lexicon of Madness -- Defense Mechanisms

Defense Mechanisms: In Freudian psychology, unconscious processes that defend the ego from anxiety. Defense mechanisms are employed by both normal and pathological individuals, and can be ranked from "immature" to "mature." Denial is perhaps the most immature of ego defense mechanisms. In denial, painful aspects of reality are kept from conscious awareness. For example, a soldier under bombardment acts as if he is back in civilian life, selling shoes. In projection, undesirable impulses of the individual are projected outside the self. I unconsciously hate you but I believe instead that it is you who hates me. Displacement involves shifting a strong emotion from one object or person to one that is less threatening. I kick the cat, unaware that my true hostility is towards my boss. In reaction formation, a person transforms an unacceptable impulse into its opposite. A person with unconscious impulses to soil things or put them into disarray becomes a neat freak. A latent homosexual becomes a zealous "anti-gay" crusader. Rationalization enables people to justify instinctual, selfish, unacceptable motives. I refuse to give money to a beggar because "he'll just spend the money on drugs." Repression is the "queen of the defenses," according to Freud, for without repression there could be no civilization. Without unconscious repression of our instinctual urges, we would live in a state of nature, a war of all against all. In fact, civilization (with its courts and police) was invented by man so that we might more effectively repress ourselves. Many people mistakenly believe that Freud advocated against repression, but it is people whose defense mechanism of repression failed them who end up in prison ("There, but for my defense mechanisms, go I"). Mature defenses include altruism (serving others in a instinctually gratifying way that does not harm the self), humor (expressing unacceptable desires in a comedic manner that does not make others uncomfortable), and sublimation (channeling instinctual energies towards socially acceptable ends). Becoming a surgeon, rather than a serial killer, could allow one to sublimate a desire to cut into human flesh with sharp instruments. Becoming a teacher could allow one to sublimate an exhibitionistic desire.

Saturday, February 15, 2014

Wedding Bell Blues -- The Fifth Dimension

Another one written by the 18 year old Laura Nyro. Marilyn McCoo and Billy Davis, Jr. were engaged when they recorded the song in 1968, but had no wedding date set.

Friday, February 14, 2014

Lexicon of Madness -- Cotard's Syndrome

Cotard's Syndrome: Also called nihilistic delusional disorder. First described by 19th Century French psychiatrist Jules Cotard. The patient with Cotard's Syndrome is preoccupied with having lost status, possessions, or even internal organs. A patient might claim to have been bankrupted, evicted from his home, or abandoned by his family. He is not reassured when presented with evidence to the contrary. A patient might ask for his apparently healthy arm to be amputated surgically because "it's dead and rotting -- I can't stand the smell." He might believe that he himself has died and that clinicians are playing a mean trick on him by not burying him in a timely manner. Cotard delusions are usually associated with schizophrenia or psychotic depression. In the case of psychotic depression, electroconvulsive therapy (ECT) is indicated. Chronic Cotard's delusion may reflect the presence of a dementing syndrome such as Alzheimer's dementia.

Thursday, February 13, 2014

Lexicon of Madness -- Borderline Personality Disorder

Borderline Personality Disorder: Arguably the most severe of the personality disorders. As originally conceived, people with this characterological disorder stand on the border between neurosis and psychosis. In the past, some have called the condition "ambulatory schizophrenia." Their personalities are marked by instability -- unstable mood/affect (e.g., "happy one minute and in a rage the next"); unstable relationships (e.g., "they think you are perfect one day and the next day you are the devil"); and, unstable sense of identity (e.g., "they can't maintain a stable sense of who they are, or whether they are completely worthless or not"). Borderline Personality Disorder (BDL) is found in about 2% of the general population and is twice as common in women as in men. There are high rates of comorbidity, especially substance abuse disorders and major depression. Many people with BDL are often misdiagnosed with Bipolar Disorder. BDLs have chaotic lives and their relationships are tempestuous, to say the least. Because they are both hostile and dependent, their behaviors drive people away and this results in panic over being "abandoned." They see people as either "all good" or "all bad" (i.e., they engage in "splitting"). It has been proposed that BDLs project the despised part of themselves onto other people (i.e., "projective identification"), which is why they can unload such intense anger onto those around them. Until relatively recently, self-harming behavior (e.g., cutting, or repeated low-lethality suicidal behaviors such as wrist-slashing) was almost pathognomic for BDL. Unfortunately, these behaviors have since spread more generally. Under stress, BDLs may experience psychotic symptoms (e.g., delusional beliefs, or hearing someone calling their name). Often, they simply feel empty inside. They cannot tolerate being alone, and will behave promisciously to attain superficial intimacy. They will also take dramatic action to prevent "abandonment" (e.g., "I'll kill myself if you leave me!"). They are at significantly higher risk for completed suicide and for substance abuse. A majority of BDL patients report having been sexually abused in childhood. Marsha Linehan's Dialectical Behavioral Therapy (DBT) has been shown to be the most effective treatment for these severely disturbed patients.

Wednesday, February 12, 2014

Lexicon of Madness -- Alexithymia

Alexithymia: The inability to describe one's own emotions or mood, or difficulty in being aware of what one is feeling. Alexithymia is more common in males than females. Developmental studies have shown that girls have far larger "emotional vocabularies" than boys do, and that parents are much more likely to ask their daughters about their feelings than they are to ask their sons. Depressed North American men are more likely to report feeling "fine" than to say, "I'm depressed." Anger and irritation are more likely to be reported than feelings of sadness or helplessness. When asked "How have you been feeling lately?" a depressed man might say, "Well, my wife says I've been kinda grouchy lately." Some of the reasons that women are twice as likely as men to be diagnosed with depression are 1) women are more likely to seek clinical help; and, 2) clinicians are more likely to focus on subjective reports of depressed mood. When assessing adult males, it is critical to evaluate other symptoms of depression -- even when depressed mood is denied. These symptoms included disturbed appetite or sleep, fatigue, diminished concentration, diminished interest in pleasurable activities (including sex), and suicidal ideation.

Tuesday, February 11, 2014

Lexicon of Madness -- Zeigarnik Effect

Bluma Zeigarnik Psychologist Russian in Austria

Zeigarnik Effect: Refers to the finding that uncompleted tasks are remembered better than completed ones. Russian psychologist Bluma Zeigarnik (1901-1988) had participants begin simple tasks (e.g., making clay figures, solving arithmetic problems). She let participants complete some tasks but interrupted them before they could complete others. A few hours later, she asked them about the tasks and found that the participants had better and more detailed recall for the tasks that had been left uncompleted than for those that had been completed. The Zeigarnik effect suggests that it might be best to complete your unfinished business, because unfinished tasks may be using a significant amount of your mental resources, even when you are not directly attending to them.

Monday, February 10, 2014

Lexicon of Madness -- Yerkes-Dodson Law

Yerkes-Dodson Law: The psychological "law" that suggests that performance in moderately complex tasks is enhanced by moderate physiological arousal. Simple tasks (e.g., running a race) are performed better when accompanied by high arousal (i.e., getting yourself "pumped up" before the race), while complex tasks (e.g., playing chess) are best performed when relatively calm. People suffering from anxiety are chronically overaroused -- their bodies are responding as if their environment is full of serious threats. This leads to decreased performance in life tasks, as well as chronic tension, edginess, and fatigue. People with anxiety disorders feel unable to regulate their amount of arousal. Relaxation techniques, biofeedback, and cognitive interventions (e.g., perspective taking) can all help reduce arousal. Alcohol, a depressant, is often used by anxious people to manage their levels of arousal (e.g., the socially anxious man takes a few drinks before introducing himself at a party). Benzodiazapines (e.g., Ativan, Xanax, Valium), which are not chemically dissimiliar to alcohol, are often prescribed to patients who report excess anxiety.

Sunday, February 9, 2014

Edgar Lee Masters -- Spoon River Anthology: Nellie Clark

Nellie Clark

I WAS only eight years old;
And before I grew up and knew what it meant
I had no words for it, except
That I was frightened and told my
Mother; And that my Father got a pistol
And would have killed Charlie, who was a big boy,
Fifteen years old, except for his Mother.
Nevertheless the story clung to me.
But the man who married me, a widower of thirty-five,
Was a newcomer and never heard it
Till two years after we were married.
Then he considered himself cheated,
And the village agreed that I was not really a virgin.
Well, he deserted me, and I died
The following winter.

Saturday, February 8, 2014

Jump Into the Fire -- Harry Nilsson (1974)

The above has the original song playing over the entire sequence from Goodfellas. Below is the straight cut.

You can climb a mountain, you can swim the sea
You can jump into the fire but you'll never be free
You can shake me up or I can break you down, oh, oh
We can make each other happy
Oh, we can make each other happy
We can make each other happy
Oh, we can make each other happy
You can climb a mountain, you can swim the sea
You can jump into the fire but you'll never be free, no no
You can shake me up or I can break you down, oh, oh
We can make each other happy
Oh, we can make each other happy
Oh, we can make each other happy
We can make each other happy, oh
You can climb a mountain, you can swim the sea
You can jump into the fire but you'll never be free, no no
You can shake me up, I can break you down, oh, oh
We can make each other happy
We can make each other happy
We can make each other happy
We can make each other happy, oh

Friday, February 7, 2014

Lexicon of Madness -- XYY Syndrome


XYY Syndrome: The result of a mutation marked by the presence of an extra male (Y) sex chromosome. These men tend to be taller (generally over six feet), have lower IQs, and have histories of severe acne. In a study of 4,139 Danish men over six feet tall, 12 were found to be XYY (which is twice the 1-in-1,000 rate seen in the general population). Five of those 12 (41.7%) had criminal histories for non-violent offenses, versus only 9.3% in a normal XY control group. In other words, men with the XYY chromosomal mutation were four times more likely than XY men to have convictions for property crimes. Because XYY is the result of a genetic mutation, it is not a heritable condition; therefore, this finding does not demonstrate the genetic heritability of criminal behavior -- twin studies are needed for that. Studies of the concordance rates of criminal behavior among monozygotic (MZ; identical) and dizygotic (DZ; fraternal) twins consistently show significantly greater concordance rates among MZ twins than among DZ twins. If you are a male, and your identical twin is a criminal, the chance that you are also a criminal is about 50%. If your fraternal twin is a criminal, the chance that you are also a criminal is only about 20%. Studies such as these generate a heritability estimate for criminal behavior of about .60, which suggests that more than half of the variability in law-abiding/criminal behavior in a population can be attributed to genetic, not environmental, differences.

Thursday, February 6, 2014

Lexicon of Madness -- Withdrawal Syndrome

Withdrawal Syndrome: A collection of signs and symptoms associated with sudden discontinuation of a substance. Contrary to popular belief, withdrawal from opioids (e.g., heroin, OxyContin) is rarely fatal. Withdrawal symptoms usually commence within 8 hours of the last dose, but only after one or two weeks of continuous use. The withdrawal syndrome is nasty and painful (especially considering that some researchers have found that heroin users have lower pain thresholds than non-users), and resembles the effects of influenza (e.g., diarrhea, vomiting, muscle cramps, abdominal cramps). Temperature dysregulation (either hypothermia or hyperthermia) and piloerection (gooseflesh) are often observed (hence the term, "cold turkey"). Withdrawal symptoms usually peak after about 72 hours and mostly resolve within one week. A repeat dose of the drug will quickly eliminate all withdrawal symptoms. Sudden withdrawal from alcohol, on the other hand, can be medically very serious, even fatal. Suddenly stopping heavy drinking can lead to tremulousness (the "shakes"), psychotic symptoms (e.g., delusions or hallucinations), seizures, and delirium tremens (the "DTs"). Delirium tremens is fatal in about 20% of untreated cases. It is marked by disorientation, visual or tactile hallucinations (e.g., seeing blood coming out of the walls or feeling insects crawling on one's skin), diaphoresis (heavy sweating), insomnia, anxiety, and hypertension. Benzodiazepines and fluid replenishment are the usual treatment for alcohol withdrawal. Withdrawal from cocaine and other amphetamines is usually marked by a physical and emotional crash -- depression, lethargy, ravenous hunger, and nightmares. There is anecdotal clinical evidence that long-term, heavy users of methamphetamine may experience permanent anhedonia after the cessation of drug use. People who drink large amounts of coffee during the workweek may experience caffeine withdrawal (headaches, irritability, and fatigue) on the weekends. The existence of a cannabis withdrawal syndrome has been controversial in the research literature. Heavy users who suddenly stop smoking marijuana may experience modest increases in irritability and restlessness, along with diminished appetite. The predominant cannabis withdrawal symptom, however, is the recovery of short-term memory abilities.

Lexicon of Madness -- Visual Cliff

Visual Cliff: In developmental psychology, a research apparatus designed to look like a cliff, but which actually has a clear plexiglass platform so that an infant could safely crawl from one end to the other. No matter which side of the visual cliff they are placed on (i.e., "safe level ground" or "dangling over open air"), non-crawling infants do not show increased physiological response (fear). This is because they have not yet developed depth perception and so cannot be tricked by the research optical illusion. Depth perception develops as the crawling ability develops. Crawling infants placed on the "safe, high" side of the visual cliff are highly reluctant to crawl over the "edge" and off the "cliff." Crawling infants placed onto the plexiglass on the "open air" side show heightened physiological response. However, infants can be coaxed over the edge of the cliff if their mothers encourage them to crawl towards them. A smiling, gesturing mother can entice an infant to disregard all the perceptual information that is telling him that if he crawls one more foot he will tumble from a great height. (Conversely, the children of mothers who display a fearful expression will stay put on the "safe" side, even if an experimenter is trying to coax them over the edge by waving an interesting toy.) This simple research apparatus was originally designed to test the development of depth perception, but has since been used to demonstrate the power of the mother-infant attachment bond. If positive attachment can provoke such a "leap of faith," then what about the converse -- just how bad is it when children grow up without a strong attachment bond? What happens to children who never feel loved, never feel secure, never feel that there is someone in the world who will put his interest above her own? The state prisons and rehab facilities are full of them.

Tuesday, February 4, 2014

Lexicon of Madness -- Unconditional Positive Regard

Unconditional Positive Regard: A core ingredient of Rogerian client-centered therapy. Everyone needs warmth, respect, sympathy, and acceptance. Unfortunately, for most people, this positive regard is offered only conditionally. Your parents were warm towards you only as long as you behaved as they wanted you to behave. They respected you when you performed as they expected you to perform. They accepted you only so far as you met their conditions of worth. Most other people -- teachers, spouses, bosses -- also provide only conditional positive regard. Conditional positive regard can, at best, result in conditional positive self-regard, i.e. you like and accept yourself only when you are meeting other people's expectations. Psychological problems arise as we become increasingly aware of the incongruity between the values we have introjected from our other people and the values we experience as arising from our true selves. According to Carl Rogers, a therapist should provide clients with unconditional positive regard. This does not, however, entail blind acceptance of a client's despicable behaviors. Empathy and genuineness must precede the unconditional positive regard. Through careful questioning and active listening, the therapist comes first to truly know and understand the client, without trying to direct or control her. The therapist also monitors his own feelings and experiences within the counseling relationship, demonstrating congruence between his true experience and how he is thinking or feeling about the experience. When a genuine person says that he is "glad to see you," it is because he is actually experiencing gladness at the sight of you. He doesn't "think" he is glad, or "feel" that he is glad (and he certainly isn't saying it just because it seems like an appropriate thing to say) -- he is genuinely experiencing gladness. It all sounds so simple, doesn't it? Sadly, unconditional positive regard, empathy, and genuineness are vanishingly rare.

Monday, February 3, 2014

Lexicon of Madness -- Type A Personality

Type A Personality: As originally conceived, a personality type marked by impatience, hurriedness, excessive competitiveness, irritability, and hostility. The Type A won't let his 8 year old beat him at a board game and can't stand waiting in line. Type Bs are more calm, cooperative, and tolerant. Type A Personality was originally thought to be a risk factor for myocardial infarction (heart attack). However, only the hostility component seems to be predictive of cardiac problems. In one study, men who had already had heart attacks had a monitor attached to their cars' steering columns. Participants who used their car horns more frequently had an increased risk of dying from a second heart attack. Psychotherapy has been shown to be remarkably effective with men who have a heart attack, in one study reducing risk of a second heart attack by 25% compared to wait-list controls.

Sunday, February 2, 2014

Orson Welles -- The Third Man

"In Italy for 30 years under the Borgias they had warfare, terror, murder, and bloodshed, but they produced Michelangelo, Leonardo da Vinci, and the Renaissance. In Switzerland they had brotherly love - they had 500 years of democracy and peace, and what did that produce? The cuckoo clock. So long Holly."