Thursday, April 28, 2011

The Trauma Bandwagon

Gee whiz.  Is it just me, or is there a "trauma" jihad going on?  I can't open my eyes without seeing the word "trauma" in bold headlines in newspapers and journals and in 4H newsletters.  Do I see a new line of Hallmark "Trauma Condolence and Get Well" Cards on the way?

Don't get me wrong now.  I fully support the idea that psychological trauma is bad and can lead to bad things, and supporting people who have experienced trauma is a good thing, but let's try to have some perspective here people.  There is a mob mentality going on.  Is it a competition?  Is that it?  That would explain why people seem to think they're going to get a special treat if they use the word "trauma" more often and louder than anyone else.  A kind of self-satisfied glow appears on people's faces every time they use the word.

Maybe I'm just an old stick-in-the-mud Scrooge.  Bah-humbug.

Monday, April 11, 2011

Two New Mental Disorders?

Researchers are forever trying to link existing mental disorders with some kind, any kind, of brain structure “abnormality.”  Even the weakest of links send people into hysterical excitement and soon we see flashy headlines claiming Researchers Find Neurological Cause . . .” for, well, just fill in the blank yourself with your favorite mental disorder.

So, this is just what I was thinking about when I came across this flashy brain structure study, published in Current Biology, which found a significant link between anatomical brain differences and certain identifiable behaviors.  It’s a headline grabber for sure.

Of course, any researcher who has an actual college degree and took Statistics 101, would never, never assume that correlation equals causation, but this doesn’t stop people from doing endless correlational studies that grab headlines and are statistically significant but are of no use diagnostically.

If you don’t know what I’m talking about, you can see for yourself.  Go to Google and do a search for:  “brain structure” +adhd

ADHD happens to be a favorite target for useless correlational brain structure studies that might be interesting but give us no immediately useful knowledge because the differences they find can never be clearly separated out from the background noise of human variation.

But, back to the topic at hand . . . this write-up from Current Biology, found a strong link between brain structure and behavior that gives us a greater neurological understanding of this behavior than we have of many mental disorders.  What I don’t understand is why the authors didn’t make that leap and suggest a couple new diagnoses.  Does it make any difference that the behavior they looked at was political identification?  Honestly, I don’t know why it should make any difference; it seems to me we have two new perfectly good mental illness labels with some statistically significant data to back it all up.  All we need to do now is develop some psychopharmacological interventions and some evidence based psychotherapies.  Then we’re in business.

Kanai, et al., found that people who say they are liberal (gee, does anyone really do that anymore?) have thicker anterior cingulated cortexes.  On the other hand, people who go around using the word conservative in reference to themselves have inflated right (wing) amygdalas.  So, the authors interpret this to mean that liberals are able to cope with conflicting information (in other words, they’re spineless elitist smarty-pants who can’t make decisions) while conservatives are more able to recognize threats (which I interpret just a little further as meaning they are neurologically closer to highland gorillas than they are to homo sapiens sapiens).

Well, that’s all very cute, but let’s turn this into a real money maker.  It’s simple.  All we have to do is turn the glass-half-full language into glass-half-empty language.  Like this:

Liberalism Not Otherwise Specified is linked to smaller than average amygdalas resulting in impaired ability to recognize threats leading to being taken advantage of by freeloaders and traumatized by bullies and obstinate foreign powers.

Conservatism With or Without Paranoid Delusions is linked to withered anterior cingulates resulting in impaired ability to process complex information leading to reactive, bellicose and sometimes violent behaviors when confronted with multifaceted ideas and situations.

See? That wasn’t so hard, was it now?  Is it too late to get them added to the DSM-5?

Reference:  Ryota Kanai, Tom Feilden, Colin Firth, Geraint Rees.  Political Orientations Are Correlated with Brain Structure in Young Adults.  Current Biology, 07 April 2011 DOI: 10.1016/j.cub.2011.03.017

Wednesday, April 6, 2011

There are Psychiatric Diagnoses and Then There is Reality

Reality is a hard thing to pin down sometimes.  Why do the stars spin in a circle overhead?  Why are the people born under the constellation of Scorpio always such jerks?

I suppose the scientific method comes in there somewhere.  But let’s face it, our empirically grounded bodies of knowledge have their limits.  We can be hopeful that we will continue to expand our horizons of knowledge, but knowing what we really know and how we know it is probably a good thing.  I mean, isn’t that part of the whole scientific endeavor?

Well, I know you agree with me, but can someone help me understand how this message got so mixed up in the field of psychology?  In psychology, “scientific findings” and diagnostic labels seem to be thrown around with about as much critical scrutiny as a gibbering glossolalic soliloquy might receive in the midst of a writhing Pentecostal congregation.

Among practitioners, it seems to me, that the diagnostic categories of the DSM are typically taken with several cobblestone-sized grains of salt.  Not so among journalists or among the ubiquitous faceless internet-based free-advice-givers with their pop-up ad business models.  Doubly not so among purveyors of “evidence-based” therapies who use flashy headlines from the world of scientific research to prove their wares (acupuncture, Blood-LettingÒ, Eye Movement Desensitization Reprogramming, etc.).

It bothers me, not a little, that DSM labels are thrown around the way they are and it troubles me that so many researchers build their research designs as if these committee-written categories are unquestionable real-world phenomena.  Does anyone really believe that there is a discrete Major Depressive Disorder that is a distinct and separate process from Dysthymia?  Even that most archetypal of mental disorders, Schizophrenia, is quite fuzzy around the edges, and there continues to be some question as to whether we are dealing with a single disease process or multiple phenomena with similar and overlapping symptoms.

It is a truism that, in young disciplines, where there is a dearth of causal understanding, we tend to fall back on simple categorization of observable phenomena.  That, in fact, accounts for every single mental health diagnosis now in use.  These are loose categories based on our sad attempts to group complex human behaviors into digestible and palatable portions that we can pretend to understand and try to get the insurance companies to swallow without puking all over us.

With the upcoming DSM-V we are going to realign our categories by shifting our bullet-item-symptoms from one list to another and rebranding our labels, but still we will end up with somewhat arbitrary diagnostic descriptions authored by compromising, wordsmithing  committees and deeply confounded by cultural assumptions, political correctness and insurance driven language games.

Some day, maybe, we will have our grand synthesis of psychology, neurology and genetics, but we are not there yet people.  Please let’s stop playing pretend.