Well, somebody had to… NY Times Bush tries to have the best of both worlds. With a fallguy in place, he wasted no time announcing that he considered the uranium issue closed (Salon). With his bullying and stonewalling ways with the press, I’m sure any reporter who tries from here on to bring up the issue at any of the infrequent press conferences Bush deigns to give will be ignored or chastised. Yet Bush has complete confidence in Tenet and the CIA (Salon); no heads have to roll… because, in reality, Bush clearly wasn’t troubled by the deception. Yet, hopefully, the credibility gap over the uranium issue won’t stop here (NY Times editorial) and, in any case, is the tip of the iceberg about mounting disillusionment with the Bush agenda (Washington Post) and the baldfaced deception used to promulgate it.

What are noctilucent clouds? “Good question. They hover near the edge of space, glowing electric blue. Some scientists think the clouds are seeded by space dust and fed by rocket exhaust. Others suspect they’re a telltale sign of global warming. Whatever causes these mysterious clouds, they are lovely, and summer is a good time to look for them. Check our gallery of recent sightings.” NASA

These are a relatively recent phenomenon, first seen in 1885 about two years after the Krakatoa eruption, which filled the atmosphere with volcanic ash worldwide., making sunsets so spectacular that evening skywatching became a popular pastime.

“Ever wanted your own first class stamps? Well now you can with Stamp It Out!

Creating your own stamps is free and easy. All you need to do is tell us which image you would like on your stamps and we’ll create them for you.” Obviously, these are illegal if used in place of official postage. But you political subversive or artistic types might want to affix them alongside a ‘real’ stamp.

MEART – The Semi Living Artist “is a geographically detached, bio-cybernetic project exploring aspects of creativity and artistry in the age of biological technologies and the future possibilities of creating semi living entities. It investigates our abilities and intentions in dealing with the emergence of a new class of beings (whose production may lie far in the future) that may be sentient, creative and unpredictable. Meart takes the basic components of the brain (isolated neurons) attaches them to a mechanical body through the mediation of a digital processing engine to attempt and create an entity that will seemingly evolve, learn and become conditioned to express its growth experiences through ‘art activity’. The combined elements of unpredictability and ‘temperament’ with the ability to learn and adapt, creates an artistic entity that is both dependent, and independent, from its creator and its creator’s intentions.

MEART is assembled from:

‘Wetware’ – cultured neurons from embryonic rat cortex grown over the Multi Electrode Array

‘Hardware’ – the robotic (drawing) arm

‘Software’ – that interfaces between the wetware and the hardware”

Common Errors in English from a persnickety (by his own admission) professor of English (“I’m just discussing mistakes in English that happen to bother me. “):

“Here we’re concerned only with deviations from the standard use of English as judged by sophisticated users such as professional writers, editors, teachers, and literate executives and personnel officers. The aim of this site is to help you avoid low grades, lost employment opportunities, lost business, and titters of amusement at the way you write or speak.

But isn’t one person’s mistake another’s standard usage?

Often enough, but if your standard usage causes other people to consider you stupid or ignorant, you may want to consider changing it. You have the right to express yourself in any manner you please, but if you wish to communicate effectively, you should use nonstandard English only when you intend to rather than fall into it because you don’t know any better.”

Bienvenue, welcome to readers pointed here from Le Monde‘s “Sur le Net” listing, which describes FmH as “un répertoire de textes glanés en ligne par un psychiatre éclectique.”

U.S. report on 9/11 to be ‘explosive’: “Government errors, Saudi ties to terrorists among highlights.” The Miami Herald

On the occasion of a new documentary about the subject, philosopher of medicine Carl Elliott writes in Slate about apotemnophilia. “The victims of a growing mental disorder are obsessed with amputation.” Apotemnophilics at times succeed in obtaining a medically unjustified amputation of a healthy limb either from a sympathetic surgeon or after intentionally damaging a limb so badly that it must be amputated. I reflected here on Elliott’s earlier thoughtful overview of the phenomenon, A New Way to be Mad, published in The Atlantic Monthly in December 2000, which he says inspired the documentary film.

The phenomenon is of course of interest for its — shall we say — titillating gruesomeness, but for Elliott and myself another concern revolves around the significance of the attempt to make it, or the presumption that it is, a psychiatric disorder. Should it be considered so? And if so, is it its own category of disorder or should it be considered a manifestation of another, already recognized, class of disorder? Elliott notes that it is usually treated as if it is a paraphilia or displaced sexual disorder, because “many wannabes are attracted to the idea of themselves as amputees, and some are attracted to other amputees.” But, in the absence of a body of clinical experience with apotemnophilics, it is not clear to me that those who would like to see themselves with amputees are the same as those who would like to see themselves as amputees. Perhaps it is heterogeneous? If a disorder, is it closer to a body image disorder? In body dysmorphic disorder, the individual insists that one of their bodily features is misshapen or grotesque (although others do not perceive it in that way) and may seek surgical correction. Some BDD is psychotic (delusional) in degree and improves with treatments such as antipsychotic medication. And some psychotics under the influence of other kinds of delusions mutilate or injure themselves as well, sometimes grotesquely — I have seen enucleations, castrations and, yes, amputations of a hand, an arm or a leg.

Furthermore — how akin to gender identity disorder is it, and how deep may the analogy go to sufferers’ seeking sex reassignment surgery in that condition? Is it a type of obsessive compulsive disorder? Broadly speaking, compulsions are of two sorts, those which are experienced as distressing by the affected individual, who attempts to resist complying with them; and those which are not resisted and mostly cause distress only to those surrounding the individual. What relationship might it bear even to Munchausen’s Disease, in which an individual simulates or creates a medical condition in themselves presumably for the sympathy and support they aspire to?

Or is apotemnophilia on a continuum with other body modifications or mutilations — scarification, piercing, tattooing — we do not usually consider evidence of psychiatric disorders? If you come away from the film about apotemnophilics experiencing them sympathetically no matter how difficult you find it to understand their desires, will your sympathy be for them as mentally disordered and distressed or as oppressed by a society that does not allow them the gratification of desires which are not understood and sometimes abhorred but which do no harm to anyone else?

Elliott is interested in, as he puts it, “why so many people have begun to use the tools of medicine for purposes other than curing illness, such as self-improvement and self-transformation”, and I share that interest especially as it applies to the appropriation of growing dimensions of distress by psychiatry and the expanding notion of the indications for psychopharmaceutical treatment.

Obviously, if the boundary between curing illness and self-improvement is a murky and shifting one, then so will be the definition of illness. Elliott observes that it is well-known to historians of medicine that illnesses come and go, and he lists a number of conditions once seen as rare or nonexistent but then ballooning in popularity:

“social anxiety disorder, post-traumatic stress disorder, attention deficit-hyperactivity disorder, gender identity disorder, multiple personality disorder, anorexia, and chronic fatigue syndrome.”

He attempts to generalize about these conditions that:

“…(t)his is not simply because people decided to “come out” rather than suffer alone. It is because all mental disorders, even those with biological roots, have a social component. While these new conditions are very different from one another, they share several important features.

• First, the conditions are usually backed by a group of medical or psychological defenders whose careers or reputations depend on the existence of the disorder and who insist that the condition is real.
  
• Second, there is usually no hard data about the causes or the mechanism of the condition.
  
• Third, no independent lab tests or imaging devices are available to provide objective confirmation of the diagnosis, which is usually made solely on the basis of the narratives and behavior of their patients.
  
• Finally, there is often (but not always) a treatment for the condition even in the absence of knowledge about its causes and mechanism.”

The phenomenon of faddish diagnoses in psychiatry has been one of my pet interests, about which I have written, taught and lectured since soon after my training. I would quibble with the list of conditions Elliott includes but more significantly with his attempt to generalize about the phenomenon. Elliott may be, to paraphrase his first point above and turn it back on him, staking his credibility on the existence of shared generalities among a group of phenomena he insists is homogeneous but may not be.

First, a contribution of equal importance to the medical/psychological practitioners’ insistence on the reality of these diagnoses is often the incredible appeal they have to classes of patients who are deeply motivated to have them. There may be a core of ‘legitimate’ sufferers the class of whom becomes broadened by others’ insistence on joining that class. This in turn may obscure the ability, when the supposed class of sufferers are studied, to find the hard data, the lab or imaging abnormalities that could definitively define the condition. In a sense, the core findings are diluted beyond statistical significance by the influx of wannabes to the class.

Often, in particular, the controversial syndromes are on the borderline between psychiatry and other medical areas (consider attention deficit [neurology], fibromyalgia [rheumatology], TMJ [orthopedics or dentistry], hypoglycemia [endocrinology], spastic colon [gastroenterology], chronic fatigue [originally considered to be chronic Epstein-Barr virus infection]) and relate to shifting conceptions on the part of both medical science and the lay public about the mind-body boundary. Certain classes of patients have long been interested in having their distress defined “medically” instead of “mentally”, to whatever extent the zeitgeist draws a distinction. This, of course, bears on Elliott’s third point, that the diagnosis “is usually made solely on the basis of the narratives and behavior of … patients.” This is no less true of the vast majority of ‘legitimate’ psychiatric disorders; the CNS is still a black box. No definitive tests or imaging studies exist for any psychiatric disorder. The more important thing about the faddish or dubious diagnoses may be, in a way, how similar they are to, rather than how different from, the universe of the rest of psychiatric diagnoses.

And Elliott’s fourth generalization too is true of most psychiatric diagnosis as well — that there is often “a treatment for the condition even in the absence of knowledge about its causes and mechanism.” For example, the universe of psychiatric patients began to be ‘carved up’ differently between those with schizophrenia and manic depression (bipolar disorder) after the arrival in the early ’50’s of lithium carbonate on the scene as a treatment for the latter, and again after the entrée of chlorpromazine (Thorazine), the first of the so-called antipsychotic medications. More recently, I have written here in the past about the much-observed (and ongoing) redefinition of the scope of antidepressant-responsive conditions after the introduction of Prozac in the early ’80’s ushered in the SSRI era and made antidepressant prescribing so much easier. One may argue that the most important influence of new drug developments on diagnosis is exerted via the pharmaceutical companies’ inexorable marketing pressures, or it may be the prescribers’ pull to the novelty of new agents. In any case, in deriving principles that apply generally to psychiatric diagnosis, Elliott has failed to identify what may be distinctive about or explanatory of the controversial diagnoses.

Furthermore, one must not focus on the social factors in the rise of a diagnosis to the exclusion of the medical-scientific ones. Disparate diagnoses may balloon through their own unique balance between being better recognized (it was there, but we didn’t see it before), being reclassified (it was there but we referred to it as or lumped it in with something different before) or being created (it wasn’t there until people began to shape their behaviors to the newly-promulgated definition). It’s like the old joke about the umpires and the strike — “I calls ’em as they are”; “I calls ’em as I sees ’em”; and “They ain’t strikes ’til I call ’em.”

To return to apotemnophilia, it is not clear where it will fit with these other faddish diagnoses, but we will probably get an opportunity to see, as interest in it appears to be burgeoning, both among the wannabes and among clinicians.

Here is a site to which Elliott points from “a group of medical, psychological and psychiatric professionals committed to increasing the knowledge about this disorder, particularly within the medical and psychological communities”; they propose renaming it Body Integrity Identity Disorder. Elliott is troubled by his observation that mental health practitioners have so far proposed no treatment other than surgery. He seems to consider this a failing in the face of an obvious mental disturbance. I would suggest an alternate explanation. Psychiatrists and other therapists are more accustomed than the lay public to nonjudgmental toleration of a wide variety of unconventional and disturbing thoughts , beliefs and feelings in their patients. As bizarre and gruesome as the apotemnophilic’s desires are, while they are not easily understood they may be more tolerable to the mental health practitioner sitting with the patient than to others. (I have never sat with a patient with this preoccupation myself; I don’t know.) These patients, not believing they have a psychiatric disturbance, will probably present only rarely if ever for a mental health consultation. They may not be treatable when they do present, since psychiatric treatment cannot be compelled against one’s will unless a person is so disturbed that they represent an imminent danger to themselves or others, no matter how bizarre we find their symptoms. Most psychiatric practitioners are respectful of that constraint. But if a sufferer presents acknowledging their distress and its psychiatric nature and voluntarily seeking treatment, I would wager that few psychiatrists would be at a loss to treat them in any one of a variety of ways depending on how they formulated the individual case, perhaps along one of several hypotheses I suggested above about where BIID/apotemnophilia may fit; or others.The number of psychiatrists who would send such a patient for surgical intervention would, I would venture to say, be vanishingly small. Perhaps, if the condition does burgeon in popularity to an extent that mainstream surgeons (rather than the apparently marginal characters who seem to be performing the bulk of the amputations these days) have to pay attention to it, psychiatric evaluation and clearance will become as de rigeur before surgery as it has become for gender transition surgery.

“On this day in 1873 Paul Verlaine shot Arthur Rimbaud in a Brussels hotel, wounding him in the wrist. Although not yet two years old, their relationship was in such sexual, emotional, financial and absinthe confusion that no specific motive seems relevant, but the Belgian courts were determined to convict Verlaine of assault, and gave him the maximum two-year sentence. Rimbaud’s attempts to testify on Verlaine’s behalf, and then to withdraw charges, were ignored; condemnations from Verlaine’s jilted wife were entertained, as were political charges relayed from Paris. Given even greater sway was the report of the police doctors; this attested, in great anatomical detail, ‘that P. Verlaine bears on his person traces of habitual pederasty, both active and passive.’ The police reports on Rimbaud also suggest that, for reasons of rhyme or lifestyle, everyone would have been happier if the two poets had managed to kill each other…” Today in Literature

“Once thoroughly bipartisan, the debate in Washington over how to reduce the flow of bulk e-mail is now pitting Democrats against Republicans–a development that threatens to complicate enactment of laws regulating spam.” — Declan McCullagh, CNET News

“…(T)he Canadian government concluded that entertainment system wiring may have caused or contributed to a fire that sent a Swissair jet into the ocean near Nova Scotia in 1998, killing all 229 aboard. The Canadian Transportation Safety Board said an entertainment system wire or another wire short-circuited, creating a fiery electric arc that ignited acoustic insulation blankets.

Despite intense scrutiny after the Swissair accident, in-flight entertainment systems continue to malfunction, and U.S. airlines are still being ordered to modify some systems.

A USA Today analysis found that since the Swissair accident, U.S. airlines have sent the Federal Aviation Administration 60 ‘service difficulty reports’ about in-flight entertainment systems, many involving fire, smoke or sparks. Airlines are required by the FAA to report within 72 hours each ‘failure, malfunction or defect’ that endangers an aircraft’s safe operation.

Pilots and flight attendants have voluntarily reported to another government database 20 incidents of entertainment system problems. It’s unknown how many of those incidents are also included in the service difficulty reports…

Manufacturers insist that the most sophisticated entertainment systems, as well as older ones, are safe and meet FAA standards. They blame the type installed on Swissair, which was banned a year after the crash, for giving everyone in the industry a bad name.

That system, built by a Phoenix company now out of the airline business, was put on to replace an existing system and pioneered interactive entertainment at each seat. But, as a USA TODAY investigation found in February, it was improperly designed, installed and certified by contractors without adequate FAA oversight. The General Accounting Office and the Transportation Department’s inspector general recently began investigating the matter.

Other systems, though, have had problems since the Swissair accident. Safety experts say the number of service difficulty reports about entertainment system problems endangering passenger safety during the past two years could far exceed the 60 received by the FAA.

“The 60 reports are probably just the tip of the iceberg,” says Alex Richman, whose company, AlgoPlus Consulting, analyzes FAA data for some aircraft operators. “More incidents probably go unreported than are reported.”” USA Today

even when holding harmless objects:

“Blacks more likely to be shot than whites even when holding harmless objects

Given only a fraction of a second to respond to images of men popping out from behind a garbage dumpster, people were more likely to shoot blacks than whites, even when the men were holding a harmless object such as a flashlight rather than a gun.

The finding comes from a study that is to be published this week in the Journal of Experimental Social Psychology. The research used a virtual reality simulation and was prompted by a number of mistaken shootings of unarmed blacks by police officers in recent years. It was directed by Anthony Greenwald, a University of Washington psychologist who examines the unconscious roots and levels of prejudice.” EurekAlerts!

‘They lied.’ “The U.S. may have found the smoking gun that nails the culprit responsible for the Iraq war. Unfortunately, it’s in Dick Cheney’s office.” — Robert Scheer, Salon

The Politics of Fat: “Anti-tobacco lawyer John Banzhaf is presently building more solid test cases against food corporations for knowingly selling products that are injurious to consumers’ health. Banzhaf will send a letter to McDonald’s, Wendy’s, Burger King, Pizza Hut, Taco Bell and Kentucky Fried Chicken this month, demanding that they label their food as containing substances that may be as addictive as nicotine.

At the same time, there is talk of imposing a ‘fat tax’ and/or forcing manufacturers to put health warnings on certain foods, similar to the warnings on tobacco products. McDonalds is apparently feeling the pressure. They have recently issued a request to their meat suppliers to reduce the quantity of antibiotics in their meat, perhaps a pre-emptive measure, intended to demonstrate concern about the health impact of their products in case of future lawsuits.” AlterNet

“The government’s roundup and detention of U.S. citizens and immigrants perceived to be Arab, South Asian, or Muslim is likely fostering discrimination and prejudice above and beyond the impact of 9-11, say social psychologists.

The violent attacks of September 11 and their aftermath have created a real-world experiment for social scientists who usually develop their theories in university labs. Their research, much of which is still in progress, shows that the more positively people feel toward their country, the more likely they are to hold anti-Arab prejudices. Taken with statistical evidence of hate crimes and job discrimination, the new research suggests that while the shock of the attacks sparked bigotry against those associated in American minds with Islam, subsequent sweeping crackdowns, such as the government roundup and detention of Muslims, are sending ‘social signals’ that are worsening the biases.” The Village Voice

“A single viral protein causes behavioural changes in mice similar to those experienced by people with mental illness, reveals a study by Japanese researchers.

The effects of the protein, produced by a common pathogen called the Borna disease virus (BDV), may help scientists understand how viruses could contribute to psychiatric disease in humans.” New Scientist

In humans, evidence of infection with BDV is found in a vastly higher proportion of severely mood-disordered individuals than healthy controls. A ‘hit’ by being infected with BDV at crucial stages of CNS development appears necessary for the behavioral consequences. BDV affects not the neurons themselves but their support cells, the glia, disruption of whose functions disturb normal neural connectivity. That being said, it is a stretch to say that the behavioral changes seen in the mice in this study, in which a gene for a BDV protein was inserted into the genome and expressed in the mice’s CNS, are an analogue of human mental illness. All that can be said is that they produce generic behavioral changes. They are not a model for any specific human psychiatric disease, which is perhaps fitting, because no one can yet figure out with which human psychiatric disease BDV is supposed to be associated.

The Bush administration acknowledged for the first time yesterday that President Bush should not have alleged in his State of the Union address in January that Iraq had sought to buy uranium in Africa to reconstitute its nuclear weapons program.

The statement was prompted by publication of a British parliamentary commission report, which raised serious questions about the reliability of British intelligence that was cited by Bush as part of his effort to convince Congress and the American people that Iraqi President Saddam Hussein’s weapons of mass destruction program were a threat to U.S. security.” Washington Post

I never even logged the news about the British parliamentary commission report. Ho hum — the intelligence used to convince the public was unreliable. The current item, on the other hand, is noteworthy because of the underlying, arrogant assumption that the time is right to deflect further criticism by admitting the deception… a safe assumption given that the White House has surely noticed there has been not one — count ’em, not one — bit of serious political fallout from the lies.

This study is by my medical school thesis advisor who was ahead of the game when I studied with her in the early ’80’s and now, twenty years later, continues to make groundbreaking contributions in the neural basis of child developmental difficulties. Two Types of Brain Problems Are Found to Cause Dyslexia:

One group appeared to have what the researchers called a ‘predominantly genetic type’ of dyslexia.

These students had gaps in the neural circuitry that the normal readers used for the basic processing of sound and language, but had learned to enlist other parts of the brain to compensate for the difficulty. They still read slowly but can comprehend what they read.

The second group had what the researchers called a ‘more environmentally influenced’ type of dyslexia. Their brains’ system for processing sound and language was intact, but they seemed to rely more on memory than on the linguistic centers of the brain for understanding what they were reading. These students had remained persistently poor readers, scoring poorly on speed as well as comprehension.

The two groups of poor readers were from similar socioeconomic backgrounds and had comparable reading skills when they began school, according to the study, which was published this month in the journal Biological Psychiatry.

But there were two differences: the students who compensated for their problems tended to have higher overall levels of learning abilities, and the students whose problems persisted were twice as likely to attend what the researchers called disadvantaged schools. NY Times

The central, and surprising finding here, is that the neural systems that subsume reading ability are intact in those with the persistently poorest reading performance. This is, essentially, an example of this society’s over-medicalization of social problems, leading to the misdirection of resources. Those with neurally based, probably genetically mediated, dyslexia will recruit compensatory brain circuitry to compensate for the deficits. Their brains will light up differently than a non-dyslexic’s on functional MRI scanning (fMRI) during reading tasks, and they will process more slowly, but they can read and comprehend, probably needing very little intervention. On the other hand, the persistently poor readers (my guess is that these are those most likely to be labelled as “dyslexics” in the classroom) might not properly deserve to be labelled with a medical diagnosis improperly imputing a neurological basis to their difficulties. Their brain lights up the same as a ‘normal’ reader’s on fMRI. They appear to have suffered for the lack of stimulation of their reading skills and the educational resources to compensate for lacking that headstart. The overreliance on memory — in other words, rote processes — is not the pathology, but the attempted compensation. If you lack the skills to figure out a new word, all you can do is try to recognize it from a repertoire of previously memorized ones. Unfortunately, the challenges of anything but simple children’s books swamp the capacity to read by rote.

In essence, most of the weighty reading problems in our society should probably not be called dyslexia in the medical, DSM-IV sense, although I suppose we might return to the literal meaning of the words, “impaired reading,” without implication of neurological deficit attached. While the study is extremely valuable, it is arguably one that points to the obsolescence of its own methods. Instead of throwing diagnostic labels, neurological consultations and fMRIs at these children, we should be throwing early intervention and other educational resources at disadvantaged children in whose social niches reading is undervalued and which are second-tier participants in society because of their seriously limited literacy skills.

Of course, equally or more absurd, even if the implications of Shaywitz’s study are taken to heart, and we stop diagnosing them as “dyslexics”, anyone who can’t attend to and comprehend the information presented to them in school these days for whatever reason gets diagnosed with “attention deficit disorder” instead (or in addition to dyslexia) and has stimulants thrown at them. Don’t get me started commenting on this harebrained craze.

Of course, learning can be neurochemically enhanced (New Scientist), but does that mean it should be?

Their Own Mental Health: “…(T)he medical profession, (15) authors contend in a recent article in The Journal of the American Medical Association, has been slow to accept that depression and other mental disorders are illnesses like any other, at least when they occur in its own members.

Many doctors fail to seek treatment for psychiatric conditions out of fear that doing so will damage their careers. And those who do get treatment can suffer very real professional penalties…

In the journal article, (the authors) , who gathered last October to discuss doctors’ mental health at a workshop convened by the American Foundation for Suicide Prevention, noted that the profession’s sluggishness in addressing the issue stands in contrast to its involvement in other public health problems.” NY Times

Neat segue to: Artist, Heal Thyself (and Then Everybody Else) NY Times

or just stupider? Boston Globe

Photojournalists Eye the War: “View hundreds of photos of the Iraq war and listen to 24 photojournalists describe the events.” Washington Post

What historian Charles G. Sellers said about Polk’s determination to go to war with Mexico remains true today: ‘The sobering fact is that. . . our representative institutions seem incapable of restraining a determined President from an unwisely aggressive foreign policy.’ — Joan Hoff, Research Professor of History at Montana State University and author of Nixon Reconsidered, Progressive Review

“The world is mourning the death of N!xau, southern Africa’s shy Khoisan (Bushman)….

N!xau, the star of the block-buster The Gods must be Crazy and the sequel, will be buried on July 12 in a tiny cemetery of his people at Tsumkwe in northern Namibia, where they live in the veld. He was found dead after going to look for wood.” News24, South Africa