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Among the first people I met was a young man who believed that he might be responsible for harm coming to his family if he didn't engage in time-consuming rituals, including arranging his shoes very particularly for up to half an hour. The logic motivating this man's behaviour was notably rather magical and unrealistic, appealing to notions of spirit possession and evil, which were culturally alien to his family. My supervisor, a sensitive and empathic clinician, who believed that most issues could be addressed by attentive listening and interpretation, tended to have a single diagnostic concern. The central question for him was whether the person was experiencing anxiety or manifesting the early symptoms of a psychosis. The latter ought to receive a more thorough assessment and more support than our clinic could offer.
Because of the magical quality to this person's reasoning, my supervisor decided that this might be an early sign of psychosis. He instructed me to refer the man to a new research clinic near my training site, which specialised in treating and researching the 'at risk' state for psychosis.
Of course, sensible and cautious though this seemed to me, it entailed telling this young man that he could not be seen by us for talking therapy. Instead, he should go to a clinic that specialised in something serious and frightening-sounding. When I broke the news, he was devastated. He left our clinic, and I later learned that he never followed up with the referral.
What I failed to appreciate at the time – and what some remedial reading later painfully revealed to me – was that, rather than being an early manifestation of psychosis, this man's presentation was more likely a case of obsessive compulsive disorder (OCD), a common condition in which people develop obsessive thoughts and feel compelled to engage in actions to prevent feared harms. If I'd had the diagnostic knowledge and confidence to assert this to my supervisor during the initial consultation, the man I met would likely have received help, rather than being referred to an inappropriate clinic that led to him falling through the cracks.
Yet, a popular and longstanding wave of thought in psychology and psychotherapy is that diagnosis is not relevant for practitioners in those fields, and should be left to psychiatrists, if at all. This is not a fringe view, it has been perennially present in clinical psychology since at least the 1960s, when the iconoclastic psychiatrists Thomas Szasz and R D Laing presented a dual challenge to their profession.
Szasz, a Hungarian émigré to the United States, argued that mental illness is a 'myth', rooted in a misuse of language. Neurological diseases are real, Szasz suggested, because they can be confirmed by a postmortem examination of the brain. In contrast, he argued that psychiatric 'illness' has no such neurological basis, and is just a medicalised way of talking about problems in life that could be solved by taking responsibility for yourself and your actions.
Meanwhile, Laing, a Scot who trained at the Tavistock Institute in London, argued in The Divided Self (1960) that psychosis is a psychic response to an increasingly alienated 'false self' obscuring the true emotional core of an individual. He held that so-called 'symptoms' (hearing voices, believing unusual things) were actually attempts at recovery in the face of this alienation.
These ideas resonated and had significant influence over psychiatric thinking throughout the 1960s. They contributed to diagnostic approaches to mental health – the idea that there are illnesses called schizophrenia, bipolar disorder and depression – becoming decidedly unfashionable. Indeed Szasz's and Laing's critiques became so popular that already by the early 1970s, the influential US clinical psychologist Paul Meehl grumbled in his 1973 paper 'Why I Do Not Attend Case Conferences' about an 'antinosological' (ie, antidiagnostic) bias taking hold in his profession.
Recently, the animus against psychiatric diagnosis has become more formal and scientifically argued. The British Psychological Society's Division of Clinical Psychology (DCP) – one of the official bodies representing the profession – published two documents in 2013 and 2015 articulating the difficulties with diagnosis, and promoting instead the value of individualised 'formulations'. While it is clear that the DCP's position on diagnosis is not universally held by practitioners in the UK, British psychologists are around half as likely to report regular use of a diagnostic classificatory system as their colleagues in some other countries (for example, fewer than 35 per cent of psychologists in the UK say that they use diagnosis regularly, compared with more than 70 per cent of psychologists in the US, Germany and South Africa). This likely reflects a UK professional culture steeped in suspicion of diagnostic thinking.
The suspicion is not unwarranted. One of the most interesting recent critiques of diagnosis has come from the Belgian psychoanalyst and clinical psychologist Stijn Vanheule. He invoked the philosophy of language to argue that diagnosis necessarily draws our attention to the shared meanings conjured by diagnostic language, rather than to the individual meanings inherent to people's experiences. Thus, for example, when I say 'schizophrenia', I focus attention on a generalised, clinical definition that exists in a book, rather than on the individual, personal significance of hearing voices or believing unusual things. For psychotherapists, Vanheule argued, the former is irrelevant, the latter vital.
These arguments are valuable, and they are correct in important ways. Their conclusions are a significant part of what inspired me to get into clinical psychology in the first place. Reading Laing as a teenager, I thrilled to the challenge he presented: to understand people as they endure the most extreme and bewildering psychic states; to try to find coherence even where it seems to be absent. This impulse is essential. Patience and careful listening can reveal that people are capable of engaging in communication more often than we tend to give them credit for. But my clinical training has shown me that, despite the importance of understanding people in an individualised way, having a knowledge of diagnostic categories is also essential.
To return to the example above, my supervisor and I were ignorant of valuable diagnostic information; we were ignorant of the ways that clinicians can distinguish magical obsessions from the early hints of delusion. We were ignorant of the fact that even quite magical ideas are well within the range of the former without shading into the latter. We were ignorant of how easy it would have been to provide effective help without raising the prospect of a terrifying psychosis down the pipeline. Our ignorance cost someone dearly.
Diagnosis is often vital for ensuring good care. Apart from the importance of ruling out organic causes for apparently straightforward instances of depression and anxiety (which can be symptomatic of a surprising range of endocrine, infectious and neurological diseases), linking psychological distress into a broader framework also helps clinicians make sense of the people they are trying to help. Certain forms of substance misuse could represent attempts at self-medication for highly treatable disorders of mood or attention, for instance. Correct identification of trauma symptoms can avert diagnosis of a psychotic illness. Proper diagnosis of depression in later life can frequently account for changes in memory and attention that might otherwise be mistaken for dementia, as unfortunately often happens. Diagnosis of bipolar mood disorder can prevent people being inappropriately treated for personality disorders.
Psychology's antinosological tendency encourages a belief that diagnostic thinking is somehow inherently unkind; that in thinking about categories you are always only 'labelling' people, and that this is an inhumane thing to do.
Conversely, it also encourages a belief that all you really need in mental healthcare is sympathy, rapport and interpretative heroics. This appeals to some of the questionable impulses of professionals: to our desire to see ourselves as people uniquely able to understand others, and to our ordinary human laziness. Who would want to engage in learning about taxonomy if to do so is both unkind and unnecessary?
Understanding people is a multifaceted enterprise. We all manifest a splendid idiosyncrasy, living out lives that could never be copied or repeated, so it makes sense to consider one another in the light of this uniqueness. But we also bear resemblances to one another. Important though it is to be seen in all your individuality, it is also helpful to know when your problems have precedent.
Psychiatric diagnoses are imperfect, sketchy theories about how people's minds can give them trouble. We know that they are largely less precise and valid than is popularly understood, but this does not render them totally uninformative. We have learned snippets of useful information by considering psychological problems in terms of categories: the effectiveness, or not, of treatments for particular groups of people; the elevated risk of suicide among others. Many symptoms can seem to 'make sense' in the context of a person's life, but we know that humans are sense-making machines, so we need to be vigilant against 'making sense' where it is only illusory. The great intellectual challenge of clinical psychology is to integrate knowledge about reasons and people with knowledge about causes and mechanisms. We should avoid relying solely on diagnostic information, but we shouldn't discard it altogether.
- Researchers from Germany use a designer protein to treat spinal cord damage in mice.
- The procedure employs gene therapy to regenerate damaged nerve fibers that carry signals to and from the brain.
- The scientists aim to eventually apply the technique to humans.
When spinal cord injuries result in paralysis, science hasn't so far been able to provide a way to repair the damage and reverse the condition. Now a team of researchers from Germany used a designer protein to help paralyzed mice to walk again, raising hopes for a cure that can extend to humans.
The study was carried out by a team from the Department for Cell Physiology at Ruhr-Universität Bochum (RUB) in Germany, led by Professor Dietmar Fischer. The scientists restored the walking ability of mice who were paralyzed in both hind legs by manipulating the supply of the protein hyper-interleukin-6 that causes nerve cells to regenerate.
"This is a so-called designer cytokine, which means it doesn't occur like this in nature and has to be produced using genetic engineering," explained Dietmar Fischer.
The protein works by taking on a key feature of spinal cord injuries that produce disability – damage to nerve fibers known as axons that transport signals back and forth between the brain, the muscles, and the skin. When these fibers stop working, the communication ceases as well. What's more, the fibers don't grow back if severed, leaving patients paralyzed and numb, with no current treatments available.
This is why advancements in this field are so vital, underscoring the achievement of the Bochum team. The researchers used viruses to make nerve cells in the motor-sensory cortex to produce hyper-interleukin-6 on their own. The viruses injected into the brains of the paralyzed mice were specially-tailored for gene therapy, carrying blueprints for protein production to nerve cells known as motoneurons. These motoneurons used axonal side branches to transport the proteins to cells involved in movement functions like walking, explained the press release from the University. Normally these key cells are very hard to reach.
The technique succeeded and in a few weeks, the paralyzed mice began to walk.
What is a spinal cord injury?
"Thus, gene therapy treatment of only a few nerve cells stimulated the axonal regeneration of various nerve cells in the brain and several motor tracts in the spinal cord simultaneously," elaborated Fischer. "Ultimately, this enabled the previously paralyzed animals that received this treatment to start walking after two to three weeks. This came as a great surprise to us at the beginning, as it had never been shown to be possible before after full paraplegia."
Next the team plans to investigate further regenerative effects it can achieve with hyper-Interleukin-6, while striving to understand how these advancements in treatment can be applied to humans.
Check out the study published in Nature Communications.
- When we feel anxious, the brain's fight or flight instinct kicks in, and the blood flow is redirected from your extremities towards the torso and vital organs.
- According to the CDC, 7.1% of children between the ages of 3-17 (approximately 4.4 million) have an anxiety diagnosis.
- Anxiety disorders will impact 31% of Americans at some point in their lives.
Here's what you may not know about anxiety...
There's a fine line between stress and anxiety - and many people don't know what the difference is.
Both stress and anxiety are emotional responses, but stress is typically caused by an external trigger and can be short-term (a looming deadline at work, for example). People under stress experience mental and physical symptoms such as irritability, anger, fatigue, muscle pain, digestive troubles, insomnia, and headache.
Anxiety, on the other hand, is defined as a persistent, excessive worry. Even in the absence of the thing that triggered it, anxiety lingers. It can lead to a nearly identical set of symptoms, which is why they are often confused. Feelings of anxiety then differ from an anxiety disorder - an anxiety disorder means your anxiety typically persists for months and negatively impacts your daily functioning.
There are five major types of anxiety disorders:
- Generalized anxiety (GAD) is characterized by chronic anxiety, exaggerated worry, and tension, even when there is little or nothing to provoke it.
- Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, unwanted thoughts (or obsessions) and/or repetitive behaviors (compulsions).
- Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, dizziness, and/or abdominal distress.
- Post-Traumatic Stress Disorder (PTSD) is also an anxiety disorder, and it can develop after exposure to a terrifying event in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include things like personal assaults, natural and/or human-caused disasters, accidents, or military combat.
- Social Anxiety Disorder (also known as 'social phobia') is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations.
Anxiety disorders can impact 31 percent of Americans at some point in their life.
According to the American Psychological Association, 19 percent of Americans over the age of 18 have had an anxiety disorder in the past year and 31 percent of Americans will experience an anxiety disorder at some point in their lives.
Anxiety may be genetic.
According to HealthLine, anxiety may be genetic but can also be influenced by environmental factors. It's possible to have anxiety without it running in your family, however, there is speculated to be some genetic component that makes anxiety more prevalent in some individuals. Research has indicated some link between genetics and anxiety, though much more research is required in this area.
Anxiety often begins in childhood.
According to the CDC, 7.1 percent of children between the ages of 3-17 (approximately 4.4 million) have an anxiety diagnosis. Six in ten children (59.3 percent) between the ages of 3-17 have received anxiety therapy or treatment.
Having an anxiety disorder can increase your risk of other physical health complications.
According to research from Harvard Medical School, anxiety has been indicated in several chronic physical illnesses, including heart disease, chronic respiratory disorders, gastrointestinal conditions such as IBS, and more.
Cold hands and feet? Anxiety may be the reason.
If you're someone who constantly struggles with having cold hands or feet, it could be a result of your anxiety. When we feel anxious, the brain's fight or flight instinct kicks in, and the blood flow is redirected from your extremities towards the torso and vital organs.
Anxiety can be related to anger issues and memory loss.
A lesser-known side effect of anxiety is anger. When you feel powerless over a situation, expressing anger is a natural way to feel as though you have some kind of control. With chronic sufferers of anxiety, depression is the most common issue to develop, but anger is close behind. As Discovery Mood explains, "anxiety is often connected with overstimulation from a stressful environment or threat, combined with the perceived inability to deal with that threat. In contrast, anger is often tied to frustration. When anxiety is left unacknowledged or unexpressed, it can turn into frustration which then easily leads to anger."
Anxiety can also cause memory problems.
According to Mayo Clinic, stress, anxiety, or depression can often cause forgetfulness, confusion, and difficulty concentrating. VeryWellMind explains further, "memories can be affected when you are under periods of stress or experience some sort of disturbance in mood. Having a significant anxiety disorder like GAD can create some of these problems routinely, leaving you operating below your normal level of memory functioning."
Anxiety can even impact your sense of smell.
People who struggle with anxiety may be more likely to label natural smells as bad smells, according to research published in the Journal of Neuroscience. When processing smells, typically it's only the olfactory system that is activated. However, in people with high anxiety levels, the emotional system can become intertwined with the olfactory system, which can slightly alter our perception of smells.
- As the US commences its early stages of COVID-19 vaccinations, Michael Dowling, president and CEO of Northwell Health, argues that now is not the time to relax. "There are lessons to be learned by systems like ours based upon our experience," says Dowling, adding that "we know what these lessons are, and we're working on them."
- The four major takeaways that Dowling has identified are that the United States was unprepared and slow to react, that we need a domestic supply chain so that we aren't relying on other countries, that there needs to be more domestic and international cooperation, and that leadership roles in public health must be filled by public health experts.
- If and when another pandemic hits (in the hopefully distant future), the country—and by extension the world—will be in a much better place to deal with it.
- Archaeologists used new methods to identify contents of Mayan drug containers.
- They were able to discover a non-tobacco plant that was mixed in by the smoking Mayans.
- The approach promises to open up new frontiers in the knowledge of substances ancient people consumed.
Ancient Mayans have been a continuing source of inspiration for their monuments, knowledge, and mysterious demise. Now a new study discovers some of the drugs they used. For the first time, scientists found remnants of a non-tobacco plant in Mayan drug containers. They believe their analysis methods can allow them exciting new ways of investigating the different types of psychoactive and non-psychoactive plants used by the Maya and other pre-Colombian societies.
The research was carried out by a team from Washington State University, led by anthropology postdoc Mario Zimmermann. They spotted residue of the Mexican marigold (Tagetes lucida) in 14 tiny ceramic vessels that were buried over a 1,000 years ago on Mexico's Yucatan peninsula. The containers also exhibited chemical traces of two types of tobacco: Nicotiana tabacum and N. rustica. Scientists think the marigold was mixed in with the tobacco to make the experience more pleasant.
"While it has been established that tobacco was commonly used throughout the Americas before and after contact, evidence of other plants used for medicinal or religious purposes has remained largely unexplored," said Zimmermann. "The analysis methods developed in collaboration between the Department of Anthropology and the Institute of Biological Chemistry give us the ability to investigate drug use in the ancient world like never before."
The scientists used a new method based on metabolomics that is able to pinpoint thousands of plant compounds, or metabolites, in residue of archaeological artifacts like containers and pipes. This allows the researchers to figure out which specific plants were utilized. The way plant residue was identified before employed looking for specific biomarkers from nicotine, caffeine, and other such substances. That approach would not be able to spot what else was consumed outside of what biomarker was found. The new way gives much more information, showing the researchers a fuller picture of what the ancient people ingested.
PARME staff archaeologists excavating a burial site at the Tamanache site, Mérida, Yucatan.
The containers in the study were found by Zimmerman and a team of archaeologists in 2012.
"When you find something really interesting like an intact container it gives you a sense of joy," shared Zimmermann. "Normally, you are lucky if you find a jade bead. There are literally tons of pottery sherds but complete vessels are scarce and offer a lot of interesting research potential."
The researchers are negotiating with various Mexican institutions to be able to study more ancient containers for plant residues. They also aim to look at organic materials possibly preserved in the dental plaque of ancient remains.
Check out the study published in Scientific Reports.