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Prodigies and idiot savants Wonders of human intelligence

Sergei Karjakin -The youngest Grand Master 

Comedy screen writer Andrew Marshall wrote in TIME magazine: “When he was nearly three years old, Nguyen Ngoc Truong Son would watch his mother and father playing chess in the family's ramshackle home in the Mekong Delta, and, like any toddler, pester them to let him play, too. Eventually they relented, assuming the pieces would soon wind up strewn around the kitchen, a plastic bishop stuffed into a teapot. To his parents' astonishment, Son did not treat the chess set as a plaything. He not only knew how to set up the board, which was crudely fashioned with a piece of plywood and a felt-tipped pen. He had, by careful observation, learned many of the complex rules of the game. Within a month, he was defeating his parents with ease. By age 4, Son was competing in national tournaments against kids many years older. By age 7, he was winning them. Now 12, he is Vietnam's youngest champion and a grand master in the making.” ("Small Wonders": TIME Monday, Feb. 17, 2003)

Nguyen Ngoc Truong Son is, no doubt a child prodigy. In the game of chess the youngest grandmaster is Sergei Karjakin of Ukraine. The standard definition of a prodigy is a child who by age 10 displays a mastery of a field usually undertaken only by adults. Prodigies are, by this definition, extraordinary ones whose standout accomplishments are obvious. Ellen Winner, a psychologist in Boston and author of Gifted Children: Myths and Realities says: "I always say to parents, 'If you have to ask whether your child is a prodigy, then your child isn't one.'"

Brains of prodigies

American psychologist Michael O'Boyle in Melbourne has been scanning the brains of young people gifted in mathematics. O'Boyle found that, compared with average kids, children with an aptitude for numbers show six to seven times more metabolic activity in the right side of their brains, an area known to mediate pattern recognition and spatial awareness—key abilities for mathematics and music. Scans also showed heightened activity in the frontal lobes, believed to play a crucial "executive" role in coordinating thought and improving concentration. This region of the brain is virtually inactive in average children when doing the same tasks.

O'Boyle believes prodigies also can switch very efficiently between the brain's left and right hemispheres, utilizing other mental resources and perhaps even shutting down areas that produce random distractions. In short, while their brains aren't physically different from ordinary children's, prodigies seem to be able to focus better—to muster the mental resources necessary to solve problems and learn. O'Boyle says: "For the longest time, these kids' brains were considered the same as everyone else's; they just did twice as much, twice as fast. It turns out those quantitative explanations don't fit. They're doing something qualitatively different."

Neuro-cognitive basis

What is the neuro-cognitive basis of this extraordinary brilliance? Are prodigies born different, gifted by genetic accident to be mentally more efficient? Or is the management of mental resources something that can be developed? Scientists aren't sure. Studies have shown that raw intelligence, as measured through IQ tests, is highly (though not completely) inheritable. But the connection between high intelligence and prodigious behavior is far from absolute. So-called idiot savants, for example, show unusual mastery of specific skills—they could even be described as prodigies were it not for their overall low intelligence. And many very creative children don't necessarily register high IQs because they don't test well on standardized intelligence tests and examinations, says McCann, the education specialist at Flinders University. Creative kids "are looking for different ways to answer the questions," she says. "They're looking for the trick questions."

Unlimited storage capacity of memory

Mauro Pesenti

In a pioneering study in this issue, neuroscientist Mauro Pesenti and colleagues have now used functional brain imaging to examine the calculating prodigy Rüdiger Gamm, and to compare his brain activity with that of normal control subjects as they perform mental arithmetical calculations. Gamm is remarkable in that he is able to calculate 9^th powers and 5^throots with great accuracy and he can find the quotient of 2 primes to 60 decimal places. The authors found that Gamm’s calculation processes recruited a system of brain areas implicated in episodic memory, including right medial frontal and parahippocampal gyri, whereas those of control subjects did not. They suggest that experts develop a way of exploiting the unlimited storage capacity of long-term memory to maintain task relevant information, such as the sequence of steps and intermediate results needed for complex calculation, whereas the rest of us rely on the very limited span of working memory.

No more idiot-savants

Human Calculator: Rüdiger Gamm   

Savant syndrome was first recognized by Dr. J. Langdon Down. He also originated the term Down’s syndrome. In 1887, he coined the term "idiot savant" to describe someone who had "extraordinary memory but with a great defect in reasoning power." Idiot is a person with low intelligence. Savant is derived from the French, savoir, meaning wise. The term idiot-savant is now little used because of its inappropriate connotations, and the term savant syndrome has now been more or less adopted. Another term, autistic savant, is also widely used, but this can be somewhat misleading. Although there is a strong association with autism, it is certainly not the case that all savants are autistic. It is estimated that about 50% of the cases of savant syndrome are from the autistic population, and the other 50% from the population of developmental disabilities and CNS injuries.

Savant talents usually appear spontaneously, without warning. The first encounter with a savant is often very charged. Perhaps because the gift is so extraordinary and so at odds with assumptions about the disability itself, it can sometimes seem as if the talent is being revealed, for the very first time, to a viewer's eyes. 

Although savants often take an immediate interest in their instrument or special skill, their fully-formed talents do not necessarily blossom overnight, contrary to the Hollywood notion of a savant. Musical progress is often non-linear. Some aspects of the talent may emerge before others (such as memory or technical ability); although, when the skills come together, there is a quantum leap in overall ability. Once that happens, savant talents can progress quite rapidly.

Nadia’s drawings

 One of Nadia’s drawings

“Nadia” was an autistic savant artist who, by her sixth year, demonstrated an astonishing ability to draw in what was described as ‘Renaissance-style’ perspective. Nadia was the subject of a widely-quoted 1977 book by British psychologist Lorna Selfe. As Nadia gained communicative speech later in childhood, she apparently lost her artistic talent. Selfe suggested a trade-off between language and artistic skills: that as language skills were refined, special artistic skills waned or disappeared. 

In fact, Nadia's loss of interest in drawing came in a shift in her care environment, and mostly in the wake of her mother's death. It is possible that Nadia simply lost her main source of encouragement, and that her artistic gift withered for a lack of praise and reinforcement. Fortunately, such trade-offs are rare. Savant skills are a very useful ‘conduit toward normalization’ in and of themselves, and when they exist, can be helpful in developing many other skills that allow the savant to communicate with the larger world.

A new explanation

The Indian born American neuroscientist V. S. Ramachandran writes: “Consider the possibility that savants suffer brain damage before or shortly after birth. Is it possible that their brains undergo some form of remapping as seen in phantom limb patients? Does prenatal or neonatal injury lead to unusual rewiring? In savants, one part of the brain may for some obscure reasons receive a greater than average input or some other equivalent impetus to become denser and larger—a huge angular gyrus, for example. What would be the consequence of mathematical ability? Would this produce a child who can generate eight-digit prime numbers? In truth, we know so little about how neurons perform such abstract operations that it’s difficult to predict what the effect of such change might be. An angular gyrus double in size could lead not to a mere doubling of mathematical ability but to a logarithmic or hundred fold increase. You can imagine an explosion of talent resulting form this simple but “anomalous” increase in brain volume. The same argument might hold for drawing, music, language, indeed any human trait.”

He continues: “a similar argument can be put forth to explain the occasional emergence of genius or extraordinary talent in the normal population, or to answer the especially vexing question of how such abilities cropped up in evolution in the first place.” (PHANTOMS IN THE BRAIN by Sandra Blakeslee & V. S. Ramachandran p. 192)

Recognition of the False Epidemic of ADHD by a Major Newspaper Its About Time

Finally, there has been recognition by at least one major metropolitan newspaper, the New York Times, about the phony “epidemic” of ADHD diagnoses among both adults and children. Not that doctors pushing the disorder would ever admit to it. (News to some: a high percentage of these diagnoses are made by non-psychiatrist physicians such as pediatricians).

An e-mail newsletter from the American Psychiatric Association contained the following story on 12/10/2013:

 “The Centers for Disease and Control and Prevention (CDC) reports that there has been a 42% increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses in children aged 4 to 17 from 2003 to 2011. Data were published in the Journal of the American Academy of Child and Adolescent Psychiatry. The study included 2011 data from a randomized, cross-sectional national survey of more than 95,000 U.S. households known as the National Survey of Children's Health. …The results showed by 2011, 11% of children—or 6.4 million children nationwide—had received a diagnosis of ADHD. Among those with a diagnosis for ADHD, approximately 70% were currently taking medication for the disorder—increasing by 28% from 2007 to 2011. Nearly 1 in 5 high school boys was diagnosed with ADHD, compared with 1 in 11 high school girls. ADHD-diagnosis frequency was most prevalent in Kentucky, at 15 percent, and least prevalent in Nevada, at 4.2 percent.

"The authors [of the study] speculate that 'better detection of underlying ADHD, due to increased health education and awareness efforts' may be the reason for the increase of ADHD diagnoses among American children."

BETTER RECOGNITION?? REALLY?!?  A story in the New York Times by Alan Schwarz on December 14, 2013 had a far more reasonable explanation.  It said that even the person most responsible for recognition of ADHD in children, Keith Conners, questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

Keith Connors, Ph.D.

The Times story continues:

“The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

… The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.

Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.”

The story was followed by an editorial on 12/18/13, An Epidemic of Attention Deficit Disorder.  Hooray for the New York Times!!  Some of what it said:

“The hard-sell campaign by drug companies to drive up diagnoses of attention deficit hyperactivity disorder, or A.D.H.D., and sales of drugs to treat it is disturbing. The campaign focused initially on children but is now turning toward adults, who provide a potentially larger market…Many of these children, it appears, had been diagnosed by unskilled doctors based on dubious symptoms…

“Shire, an Irish company that makes Adderall and other A.D.H.D. medications, recently subsidized 50,000 copies of a comic book in which superheroes tell children that “Medicines may make it easier to pay attention and control your behavior!” Advertising on television and in popular magazines has sought to persuade mothers that Adderall cannot only unleash a child’s innate intelligence but make the child more amenable to chores like taking out the garbage…

“The potential dangers should not be ignored. The drugs can lead to addiction, and, in rare cases, psychosis, suicidal thoughts and hallucinations, as well as anxiety, difficulty sleeping and loss of appetite…So many medical professionals benefit from overprescribing that it is difficult to find a neutral source of information. Prominent doctors get paid by drug companies to deliver upbeat messages to their colleagues at forums where they typically exaggerate the effectiveness of the drugs and downplay their side effects. Organizations that advocate on behalf of patients often do so with money supplied by drug companies…

“Curbing the upsurge in diagnoses and unwarranted drug treatments will require more aggressive action by the F.D.A. and the Federal Trade Commission, which share duties in this area. It will also require that doctors and patients recognize that the pills have downsides and should not be prescribed or used routinely to alleviate every case of carelessness, poor grades in school or impulsive behavior.”

Initial Reactions to the Return of Major Depressive Disorder

Please note - this article is about major depressive disorder, which is different from the most common form of depression, which has a variety of different causes, and is a normally an isolated, one-off episode.

Do Not Blame Ourselves

A reaction we may have to major depressive disorder’s return is to blame ourselves for its return, asking ourselves questions like, “What have I done to cause this relapse?”

When depression was forcing its way back into my life in 2010, I kept going through this issue, wondering if I was doing too much, not exercising enough, and so on. Here’s such an entry from my diary:

3.11.10 – Here I am, making lists again.
I believe the primary cause of what I’m going through now is a combination of the following:
1. Was not eating properly for a few months due to throat problems, and lost 6kgs
2. Add to that getting sick repeatedly throughout winter, perhaps seven illnesses in a row...
3. As a result of getting sick so many times, I did not exercise regularly.
4. Pushed myself way too hard practising the the piano.
5. Though of course, it could be my damaged, epilepsy ridden brain simply misfiring, with no rhyme or reason at all.

However, major depressive disorder, which is also known as recurrent depression, is called that because it re-occurs, and does not need anything to trigger it. Instead, it is a malfunction of the brain and nervous system, and new episodes may trigger from time to time, as sufferers can have several episodes during their life. We can have months, years, or decades free of it before it triggers again.

Succumbing to another episode of major depressive disorder in 2010 was none of my doing, it was simply another episode caused by the disorder. And it followed the same pattern it took back in 1989 - 1994. Therefore must not blame ourselves or feel guilty when it returns. We are not a failure. We cannot prevent such episodes, but by responding to them correctly, for example by trusting entirely in God, keeping our eyes fixed upon Jesus, using Dr Claires Weekes techniques of facing, acceptance, learning to live with it, and letting time pass; medication, counseling, exercising, etc, we can reduce the severity and duration of the episode.

Do Not Feel Guilt if Previously Dealt with Fears Return

When I suffered an emotional/mental collapse during my first major depressive episode in Dec 1989, a fearful thought/doubt entered my mind that became an obsessive fearful thought, which terrorized me night and day, week after week, for months. I received significant relief when the fear was addressed by my counselor, but it continued to plague me until the end of that depressive episode. After I recovered, it popped up a few times but was easily dispatched. So to all intents and purposes, it had been dealt with.

Several months after the onset of this new depressive episode which began in 2010, I suffered another emotional/mental collapse, and that same fear, which had previously been dealt with, resurrected, and with almost as much power as it had back in 1989-94.

One reaction to the return of previously dealt with fears is to feel guilty, to think we have regressed to falling prey to those fears again, perhaps even thinking our walk with the Lord is going backwards. However, we have to remind ourselves that the only reason these fears have returned is because of depression. For when we are depressed, our mind typically loses its flexibility and resilience. If we were not depressed we would have got rid of the fears with ease.

So we must must not feel guilt if any previously dealt with fears return, but remember that those fearful thoughts will reduce in severity and duration as we recover from this depressive episode.

However, we may need to receive prayerful/Biblical counseling or therapy to help us deal with and overcome those fears. At the very least, we need to speak to someone wise to help us see the true perspective about what we fear, and learn to see things as they see them.

“There is now no condemnation for those who are in Christ Jesus,” Romans 8:1

Maintain Hope

Regardless of how bad a new major depressive episode becomes, we must NOT lose hope. We need to keep reminding ourselves that we recovered from it last time, and we will recover from it this time.

We need to remember that our hope in Jesus gives us the strength we need to persevere and endure whatever trials come our way. ‘We continually remember before our God and Father your work produced by faith, your labor prompted by love, and your endurance inspired by hope in our Lord Jesus Christ.’ 1 Thessalonians 1:3

Set Realistic Recovery Goals

We also need to set ourselves realistic goals for recovery if we enter a new episode of recurrent depression. Unrealistic goals create time pressure, which only makes things worse. It took me five years to recover from a major depressive episode last time, so when I was diagnosed with it again in 2010, I mentally set aside five years to recover from it again. That means five years of doing less, of reduced responsibilities, of never feeling guilty for not doing as much as I was before the onset of this depressive episode. And Jesus understands exactly what we are going through, and is there to comfort and strengthen us.

‘For we do not have a high priest who is unable to empathize with our weaknesses, but we have one who has been tempted in every way, just as we are—yet he did not sin.’ Hebrews 4:15

A brief history of anxiety

One of the books on my reading list is A Brief History of Anxiety, by Patricia Pearson, reviewed here. In it, the author explores her own history with anxiety:

Ms. Pearson married and had children. She has a successful writing career. But the woman she describes can barely hold her life together. One night she dreams that she is lying on a cushioned bench admiring the Grand Canyon. Suddenly she realizes that the bench is attached at one end to a cliff face but is otherwise suspended in midair.

“If I moved even an inch in any direction, I would fall for miles,” she writes. “The choking panic that I felt was extraordinary. I felt a perfect — a Platonic — sense of terror.”

That, in a nutshell, is her situation, one that she addresses through therapy, pull-up-your-socks willpower and a blend of religion and the insights of writers like the cultural geographer Yi-Fu Tuan.

In addition, Pearson uses the book to explore the broader cultural history of anxiety:

Her subject is elusive. Unnamed until Freud coined the term “anxiety neurosis,” the uninvited stranger lurks at the margins of history. When King David, in the Bible, says that “fearfulness and trembling are come upon me,” is he suffering an anxiety attack? Ms. Pearson cites an 18th-century English treatise blaming city living for “a class and set of distempers, with atrocious and frightful symptoms, scarce known to our Ancestors,” that is, “nervous disorders” afflicting a third of the population. Could this be it?

Everywhere and nowhere, anxiety, Ms. Pearson writes, is “unbearably vivid yet insanely abstract.” In many cases it is the fear of fear itself, a free-floating, nebulous entity that, like a mutant virus, feeds on any available host. Reason is powerless against it. Ms. Pearson argues, in fact, that rationalism, intended to banish superstition and fear, has instead removed one of the most effective weapons against anxiety, namely religious faith and ritual.

Even worse, the worship of reason and science, by encouraging the notion that human beings can control their environment, has created a terrible fault line in the modern psyche, although not all societies suffer equally. Mexicans have lots to worry about but don’t. The World Mental Health Survey, conducted in 2002, found that only 6.6 percent of Mexicans had ever experienced a major episode of anxiety or depression. Meanwhile, to their north, 28.8 percent of the American population has been afflicted with anxiety, the highest level in the world. Mexicans who move to the United States adapt, becoming more anxious.

I'd never heard anything like the bit about anxiety rates in Americans, Mexicans, and Mexican-Americans. I'm skeptical; I wonder how much of the result is due to cultural difference. I.e. Are Mexicans culturally less likely than Americans and Mexican-Americans to admit to mental health problems? But the idea that American culture skews towards "the worship of reason and science", and that anxiety rates are higher than they might be otherwise as a result, is an interesting one. In any case, this sounds like a book that's both intelligent and entertaining; I'm looking forward to reading it.

COGNITIVE PSYCHOLOGY FOR DAILY LIFE Disorder of attention

COGNITIVE PSYCHOLOGY FOR DAILY LIFE: Disorder of attention: The only disorder of attention is attention deficit. Persons suffering from from generalised anxiety disorder often complain that they c...

Want to break the cycle of anxiety Hop on your bike

Just came across an recent article from a small-town paper about a local resident who's using cycling as a tool to fight anxiety disorders. And I quote:

STRATHMORE resident Justin Sacr can't drive a car for fear he has knocked down someone every time he hits a bump.

The 33-year-old has lived with anxiety and obsessive compulsive disorder since age 14 and, because of the phobia, his bicycle has become a 'lifeline'.

"I cycle to work every day. It has been a blessing in disguise because exercise helps me a lot," he said.

"It releases chemicals in your brain, like antidepressants, but in a natural way. It helps with your thoughts. You might look normal on the outside, but on the inside you're going through hell."

From experience: This guy's spot on. Cycling can have a hugely positive impact on your quality of life if you deal with anxiety. It's an especially good way to battle the shrinking-of-your-world of agoraphobia. The lightheaded feeling and elevated heart rate? That's what's supposed to happen when you exercise. Just push yourself to go a bit farther out of your comfort zone each time out. You'll feel better about yourself, more able. Guaranteed.

My Side Of Paradise

I have always had a love for horses. A connection, an awe, an intense wonder.

I love to just sit and watch them in the pasture grazing and swishing their tails. I love the sound of their hooves pounding on the grass as they run and buck as a storm rolls in.

The way they interact with each other, their intelligence, and the unique character each one has.

The curve of their necks and the set of their clean jawlines, flowing manes and flaring nostrils, and beautiful deep eyes.

But they are also bold, and strong, and spirited and sometimes easily frightened.

Many people say that horses are adept at mirroring who we are and how we are feeling at a particular moment. I am finding that I am learning to use this as a means of understanding my own fears and anxiety.

These beautiful creatures are helping me to gain emotional control and to confront and work through my fears, anxiety and panic.

Dr Allens Book for Therapists about Treatment of Borderline Personality Disorder Now Available in Paperback

Now available in paperback at http://www.amazon.com/Psychotherapy-Borderline-Patients-Integrated-Approach/dp/1138012750/ref=mt_paperback?_encoding=UTF8&me=

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Six tell-tale signs of depression in teenagers

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A suicidal young man. Australian researchers unveiled on Tuesday a Twitter tool to map moods around the world in real-time to help improve the allocation of mental health services. PHOTO/FILE 

In Summary

• A teen who is depressed is vulnerable to alcohol and substance abuse, unplanned pregnancies, violence, self-mutilation or, even worse, suicide.
• Here are some tale-tale signs that your teen may be depressed.

By REBECCA MUTHONI
More by this Author

TEENAGE DEPRESSION runs deeper than just occasional mood swings.

It is a serious mental problem that can destroy the very essence of a teen’s personality and cause a devastating sense of despair, sadness, and anger.

A teen who is depressed is vulnerable to alcohol and substance abuse, unplanned pregnancies, violence, self-mutilation or, even worse, suicide.

Here are some tale-tale signs that your teen may be depressed.

1. Difficulty or inability to concentrate and focus. A teen who is depressed may find it difficult to concentrate and focus.

This might make it difficult for him or her to finish school work, be attentive to the teacher, remember lessons, or even pay attention to what others are saying.

2. Disinterest in food, even meals  they previously loved.

Loss of interest in food or development of eating disorders such as bulimia and anorexia nervosa, which can make a teen either gain or lose weight rapidly, can also be a sign that your teen is depressed.

3. Little energy or motivation for hobbies or activities.

A depressed teen may feel exhausted, tired, and drained most of the time and take longer to complete chores. With such feelings, a teen may have trouble motivating him or herself to care or do anything.

4. Constantly harbouring negative thoughts or exhibiting pessimism.

Depression can blur everything in a teen’s life, making the world around him or her look bleak and turn thoughts into those of helplessness and hopelessness.

A teen may think that the problems they face cannot be solved and that nothing matters.

He or she may believe he/she is not worth anything, even though it is not true. Depression can cause a teen to perceive life as not worth living, which can encourage thoughts of self-harm or suicide.

5. Sadness and hopelessness. Depression can lead your teen to always feel under the weather and this can run for weeks or more.

A depressed teen may feel abnormally sad, defeated, or discouraged. He or she may feel helpless, alone, rejected, or guilty.

All these emotions are part of a depressed mood. However, not all depressed teens feel sad most times.

For others, depression may be characterised by a long-lasting mood of feeling alienated, irritable, or easily annoyed.

6. Social withdrawal. When your teen is depressed, they may tend to lock themselves up.

Because of low energy and feelings of sadness, a depressed teen may pull away from family, friends, or hobbies. This usually can make a teen feel more isolated and lonely, hence making negative thinking and depression worse.

Apart from the above signs, depressed teens may also cry for no apparent reason and change their sleep habits. 

If you are not sure whether a teen in your life is depressed or just “acting as a teenager”, consider how long he or she has been exhibiting the symptoms, their severity, and how different your teen has been acting from their usual self.

Any dramatic, lasting changes in mood, personality, or behaviour could be red flags of a deeper mental problem.

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The intriguing squirminess of cognitive dissonance

Today I am going to talk about a psychological concept I find really fascinating: cognitive dissonance. I hope, by the end of this post, you will also be fascinated by it, because heck, at the very least, it's kind of fun to slip into conversation.

First! What on earth is COGNITIVE DISSONANCE?

As I mentioned last week, cognitive dissonance is squirminess of a particular kind. It is the squirminess that happens when two conflicting yet important beliefs reside inside your skull.

You know, like:

• You believe cheating is wrong. You believe you are a good person. And then you cheat.
• You believe the lottery is a tax on fools. You think you are not foolish. Then the Powerball reaches 700 quintillion and ...
• You like the guy in the White House. You hear a political commentator saying that he could be doing a lot more to lower gas prices.
• You think being traditionally published is a mark of success. You believe you have what it takes to be a successful writer. But you've queried, and so far, no joy.
• You think being traditionally published is a mark of success. You get an agent! You get an offer from a Big 6 publisher! It's a "nice" deal. Meanwhile, you're reading tales of the self-published living off the income from their books.

Okay! Are you feeling squirmy yet? So here's the deal--cognitive dissonance itself isn't what's interesting here. What is: how people deal with it. Because, you know what we usually do? We either:

• change one of the beliefs (or associated thoughts or behaviors),
• acquire new beliefs consistent with ONE of the pre-existing beliefs, which tips the scales in favor of one, or
• forget or underplay one or both of the conflicting thoughts, reducing their importance and the discomfort.

Using the above examples: students who agree cheating is wrong but who are then induced to cheat on a task report afterward that cheating ain't so bad, or is justifiable in certain instances. People who buy lottery tickets overestimate their probability of winning after the purchase. If you like the guy in the White House, you're much more likely to decide he can't do anything about gas prices. And as for the publishing examples ...

I've been reading the articles in the Guardian and the NY Times. And the blogs (oh, the blogs!). And the Twitter. The very good points made by proponents of self-publishing, as well as those made by proponents of traditional publishing. There's been a *bit* of snipery on both sides, too.

I can't help but wonder, how much of a role does cognitive dissonance play here for writers and other industry professionals? It seems like it's much easier to demonize one side, to promote one message, to dismiss evidence inconsistent with one's argument, to two-dimensionalize the whole debate, than it is to examine it critically. Oh, and by critically, I don't mean harshly (because there's plenty of that going around!). I mean by examining the assumptions behind the arguments, the interests of the people making the arguments, and the actual facts (though let's just admit that "facts" are quite difficult to discern, because they are so very easy to spin).

This comes into play in politics, too. IN FACT, just last week I was listening to an NPR feature about this very concept and its role in partisan politics! Did any of you hear it? If you didn't, it's seriously worth a listen or a read. Especially the bits about how, when it comes down to emotional connections or facts, we tend to jettison facts and cling to our emotional loyalties. The interview discussed how to "inoculate" ourselves against that, as well. It's simple, actually: people who feel good about themselves can more easily integrate uncomfortable facts that are out of sync with those emotional connections. [Again, I do urge you to skip on over to that NPR link. I promise you won't regret it, and that you will laugh if you listen to the whole thing, which is less than 5 minutes long]

How about you? Are you taking in all the information about traditional vs. self-publishing and withholding judgment? (Or do you not actually care that much about it?) Do you think cognitive dissonance is in play? Where else have you spotted cognitive dissonance in action?

ONE MORE THING: On Wednesday, I will be hosting Brigid Kemmerer, the author of STORM, a book I have read three times because it is just that enjoyable. Stop by for a chance to win a signed copy of STORM, and to learn how Brigid manages family dynamics and interpersonal tension in her stories. Speaking as a psychologist and a writer, I can tell you I'm really in awe of how she does it, and the results.

Pharma Weapons of Mass Seduction Part II

In my post of August 31, Plausible Deniability, I illustrated how Pharma-tainted psychiatrists are able to subtly make marketing points about various drugs while denying that they are doing anything of the sort.  I commented on some of the tricks that were being used.

This post will be the second in an occasional series that discuss the more subtle and insidious devises used by Pharma-connected "experts" to mislead - or should I say con - practitioners.  These "experts" are called opinion leaders by Pharma and are a major part of their psyche ops.  Their marketing departments have been scrupulously studying physician behavior - especially physician weaknesses - for decades.  I will also discuss in future posts some of the ways they have done and are doing that. 

An excellent discussion of the more obvious and better-known pharma marketing techniques can be found at http://www.abc.net.au/rn/backgroundbriefing/stories/2011/3337618.htm.  This program is from the Australian media, but the situation is much the same in the US.  I will not be focusing on those techniques much in these posts.

Pharma marketing targets all physicians, not just psychiatrists, although psychiatrists have been a leading target.  Of course, I am more familiar with the marketing of psychiatric drugs, so my main focus will be those.

Of course, it is ultimately the fault of the practitioner for not taking the time to challenge misleading ideas and to check them out with unbiased and readily available sources of scientific information such as the Medical Letter.  But that is, in a way, the point.  Pharma knows quite well that many practitioners will not have either the time or inclination to do this.  The average physician works about 60 hours per week. 

Not only that, but many are also suckers who can be easily deceived. 



BTW, did you know that 80% of antidepressant medications are prescribed by non-psychiatrists?

In this post I will discuss how Pharma-inspired or paid-off writers in psychiatric newspapers, throw-away journals, and journal supplements denigrate highly-effective drugs (antidepressants and benzodiazepines) that just happen to have gone generic, in hopes that doctors will prescribe more expensive, potentially more toxic, and less effective brand-named drugs (particularly atypical antipsychotics). 

(And yes, antidepressants and benzo's do not work for everyone, can cause severe side effects in some people, can be habit forming, may cause unpleasant withdrawal reactions, blah blah blah.  [All of these problems can be dealt with by a competent physician who follows his or her patients closely].  And a majority of patients need psychotherapy instead of or in addition to medications. No sh*t! So please don't keep writing to me to point out the obvious).

I am going to use as illustrations two articles that appeared in a newspaper called the Psychiatric Times.  I do this because two very recent articles that clearly illustrate my points appeared there, not because I want to pick on that particular publication.  In fact, Psychiatric Times tends to be rather fair in general and is one of the most pharma-critical of the publications I am talking about.

By way of definition:  Throw-away journals are official-looking medical "journals" that are mailed free of charge to all doctors who might prescribe certain drugs pushed by big Pharma.  Psychiatric Annals (Anals?) and Current Psychiatry are two examples from psychiatry. 

They are heavy on full-page and sometimes multi-page Pharma advertisements, and Pharma probably pays to produce and mail them.  The articles they contain are not peer reviewed (sent out to about three independent experts for review of the adequacy of their science prior to a decision by the journal editors about whether or not they should be published).

Journal Supplements are mini-journals mailed along with more legitimate, peer-reviewed journals (and usually having the same cover design) that consist of multiple articles which claim to review a particular topic in the field.  Most doctors are unaware that the articles in a journal supplement are not peer reviewed like the articles in their accompanying primary journal, and that the supplements are usually sponsored by one pharmaceutical company.

First, an article about anti-depressants.  I submit as evidence for my contention in the Plausible Deniability post (that the article by Sachs and others claiming that antidepressants are ineffective in bipolar depression is being used in the field to push other medications) the CME article "Understanding and Treating Bipolar Depression" by Caleb Adler, M.D. It appeared in the July, 2011 issue of Psychiatric Times. As mentioned, there are a lot more articles like this one in various publications.

I pointed out in the previous post that drug companies did not need the folks who authored the Sachs article to recommend anti-psychotics for bipolar depression. They have a lot of other people to do that particular job for them. ("Opinion leaders" is the term Pharma uses for such people), like the authors of articles like these.

The Times article lists a variety of treatment options for bipolar depression including various atypicals and mood stabilizers, and even mentions neurontin and lamictal - both of which have both been shown to be particularly ineffective - before mentioning, at the very last, standard antidepressants.

After focusing on the red herring of antidepressants causing switching into mania - which even the author grudgingly admits can be easily prevented with drugs like lithium that true bipolar patients should be taking anyway - it speaks of the use of antidepressants as "fairly controversial," even though they have been used successfully for over fifty years.

Then the reference to the Sachs et. al. article come in: "Nonetheless, the large STEP-BD analysis did not observe improvement in patients receiving standard antidepressants. Other meta-analyses that have purported to observe an effect may be methodologically flawed."

I do not see any mention that this part of the STEP-BD study was a study ONLY of treatment-resistant subjects, or that it used only two antidepressants for that matter.

And what is the unspoken implication of that last statement about the meta-analyses, even though it may be literally true for any given study? (The reference cited for this statement, by the way, was just another article in Psychiatric Times!) It is this: that any study which purports to show that antidepressants work is probably methodologically flawed, that's what.  There are no similar caveats attached to any of the other drugs mentioned in the review.

A lot of plausible deniability built into the wording though. Brilliant marketing.

The second article concerns benzodiazepines and is titled, "Anxiety Disorders: the Anxious Bipolar Patient" by MD's Khavital Lohano and Rif S. El-Mallakh in the September 2011 issue of Psychiatric Times.  The article correctly points out that many bipolar patients also have severe co-morbid anxiety disorders like panic disorder, which often require additional meds (an instance in which polypharmacy may sometimes be legitimate and necessary). 

In one study, 21% of bipolar patients had panic disorder - a 26 fold higher incidence than in the general population. 

Interestingly, the panic attacks in manic-depressive patients do not occur when a patient is in the manic state.  They occur when the patient is in the normal (euthymic) mood state or, more frequently, in the depressed phase of the illness.

Certain benzodiazepines are, in my experience, far and away the most effective medications for panic disorder, whether it is comorbid with something else or not.  The second most effective drugs are antidepressants. 

Of course, just as with the last article, in discussing treatment options this one goes out of its way to stress that antidepressants can induce mania, without mentioning that anti-manic drugs prevent this from ever happening.

At least antidepressants were the first class of drugs mentioned.  The second?  Antipsychotics, of course.  They are actually stated to be the second line drugs for this indication!  Without FDA approval, I might add.  And the FDA happens to be absolutely right in not approving them for this indication.

Listed third was anticonvulsants like depakote.  Interestingly, the article admits, "There are no randomized controlled trials that examine the use of anticonvulsants for the anxiety component in bipolar patients."  But, naturally, it goes on to state, "However, anticonvulsants appear to have a small effect in reducing anxiety."  Side effects were not even mentioned about either antipsychotics or anticonvulsants anywhere in this article.

Next, under "alternative agents," the article discusses the anticonvulsant gabapentin, which in my experience has very mild tranquilizer-like properties but is not FDA-approved for anxiety. 

LAST, the article finally and very briefly mentions benzodiazepines.  Get this: and I quote:  "Benzodiazepines are clearly effective in many types of anxiety disorders.  However, their use is problematic, and these agents must be prescribed cautiously."  

So what, the fact that antipsychotics can cause diabetes is not problematic and did not need to be mentioned in the article like the problems with benzo's were? Or the fact that depakote can cause polycystic ovaries in females?  No caution needed in prescribing those agents, I guess.

Even in mainstream publications and in the APA Treatment Guidelines, whenever benzodiazepines are mentioned, one almost always also sees a phrase added that is something similar to, "But of course they can be addictive."  On the other hand, when antipsychotics are mentioned, one almost never sees a phrase like, "But of course they can cause diabetes, massive weight gain, higher cholesterol, and an irreversible neurological disorder called tardive dyskinesia."