Saturday, October 28, 2006

Marijuana Protects against Alzheimer's?

This just popped up on the Psychiatric Times:

As the boomers hit the age where Alzheimer's begins to show itself, it may be that if "they smoked marijuana in the '60s and '70s they don't get the disease, because of that behavior," said Dr. Wenk.

He based the assertion on research he and colleagues have done with rats, not usually known for developing Alzheimer's, nor for that matter, for smoking marijuana.

But as the animals age, Dr. Wenk said, they develop inflammation in parts of the brain analogous to the parts damaged by inflammation in people with Alzheimer's.

Recent research in other fields suggested that cannabinoids -- the active ingredients in marijuana -- can cross the blood-brain barrier, even at low doses, and can reduce inflammation, Dr. Wenk said.

So, in young rats, Dr. Wenk and colleagues created brain inflammation by infusing nanogram quantities of lipopolysaccharide and then treated them with a synthetic cannabinoid called WIN-55212-2.

"We saw an 80% to 90% drop in the inflammation in the brain," he said, "and also the impairment in memory that inflammation produces could be reversed."

There are so many good jokes here, I don't know where to begin....

Friday, October 27, 2006

Distrusting Experts

Judith Warner has had two recent posts (the first here and the second here) in her New York Times blog, Domestic Disturbances, reporting on studues on overscheduling children. In her second post, she states,

When I first read about Mahoney’s study, in Newsweek and then in the Boston Globe, I slipped the stories into a file folder I’ve kept in my office for some time now, labeled “Meaningless Social Science.” Mostly, it is filled with studies on day care. You know the kind: Day Care Causes Aggression, followed two weeks later by Day Care Causes Tooth Decay, followed two weeks later by Day Care Does Nothing Much at all.

This fall brought a wide variety of new entries: Time magazine had a story on whether TV causes autism, while Child had one saying that – contrary to popular belief – TV doesn’t cause attention deficit disorder. The American Educator had an interview with a cognitive scientist debunking everything other scientists have told us is true about left/right and girl/boy brain-based learning styles.

Reading these stories together, and bearing in mind all the contradictory “scientific” studies I have read over time about all kinds of aspects of childhood, motherhood and the interaction of the two, I thought: all these earnest, tightly structured, controlled, peer-reviewed, gleamingly scientific studies don’t have much meaning. Not individually, not reliably, for what they say (or dispute) about TV or A.D.D. or boy/girl cognition or after-school activities.

One commenter to her blog also made a sneering reference to "experts." Since, I guess I'm an expert, I take offense to all this.

It bothers me that the term "expert" has become a synonym for "fool." There has always been an anti-intellectual trend in America, and attacks on expertise (and, by extension, scientists) are a classic part of anti-intellectualism. These attacks seem to become particularly nasty during political eras dominated by demagogues. The McCarthy era of the 1950's was one example. Today is most certainly another. Why? That brings me to my main point.

In one sentence: Reality is not simple. Experts know this; most people don't want to believe it. They want good and bad to be be clear. If you do these things, you're a good parent; if you do this you're a bad parent. We are the good guys; they are the bad guys. My religion is good; your religion is bad. Demagogues play on this desire for simplicity. Unfortunately, if social science has taught us anything, it's that almost everything is open to qualification.

For example, we all agree that divorce is undesirable. Right-wing demagogues often decry the high divorce rate and declare that we have to go back to the good old days and make divorce harder. That way, people will just stay in their marriages, work harder at them, and everything will be fine. A nice, simple solution. But then the scientist says,

"Wait a minute. That nice simple solution won't work. Marriages are more complicated than that." Then the research starts to unfold, yielding complicated, conflicting results, raising more complicated questions:

Yes, children from divorced families are often more depressed and anxious than children from intact households. Hey, but some children do better after divorce when there's a lot of conflict prior to the divorce. But, wait a minute, how do you define conflict? How much is too much conflict? How about the ages of the children at the time of the divorce, how does that affect how well they do? And don't forget about the socioeconomic status of the parents.

All of this challenges the nice, tidy solution of the demagogue. So, it's not surprising that demagogues attack expertise. Today, they have so many outlets on radio, television, and the internet, that their ideas have wide distribution, and it's hard not to be influenced by it. But if you distrust experts, ask yourself this: Who do you want to design a bridge? Who do you want to operate on your heart? Who do you turn to if you're getting depressed?

In the social sciences, experts can inform and make recommendations about social policy and about personal choices. The data is always sloppy and conflicting because research is conducted at the fringes of our knowlege. The perfect answer is never clear. People read stories about the conflicting research in magazines and newspapers and become confused. How does one decide what to do when the experts don't know? This is when they often turn to demagogues and anti-intellectualism. But, those answers are the worst answers.

My answer to this problem is simple: Consider the data. Look in your heart. Then make the best decision you can. That's good enough.

Tuesday, October 24, 2006

A New Look

A new look to the blog. It's called having too much free time.

Thursday, October 19, 2006

Internet Addction or Compulsive Behavior?

Seed Magazine has published an article on Internet addiction . I'm always skeptical about new addictions, whether they be Internet addictions or sexual addictions. To illustrate my skepticism, look at this quote:

Stanford researchers interviewed 2,513 adults in a nationwide household survey. Because Internet addiction has not been clinically defined as a medical condition, study questions were based on established addiction disorders.

Research indicated that nearly 14 percent of the respondents found it difficult to stay away from the Internet for several days and that slightly more than 12 percent often remained online longer than expected.

More than eight percent of the people surveyed said they hid "non-essential" Internet use from family, friends or employers and nearly the same number went online to flee from real-world problems.

Nearly six percent of the respondents felt that their personal relationships suffered as a result of their excessive Internet use.

Substitute "television" for "Internet." What percent of the population, (a) finds it difficult to stay away from TV for several days; (b) watches TV longer than expected; (c) hides non-essential TV use from others; (d) watched TV to flee from real-world problems; and (e) felt their personal relationships suffered from excessive TV-watching?

The last one may be a little iffy, but I've heard a lot of women complain their husbands sit in front of the TV all day, while the husbands rationalize it by saying "I've worked hard all week and I need a little relaxation." I've heard alcoholics rationalize their drinking the same way.

Are we a country of TV "addicts?" I doubt it, although we obviously watch TV too much. I do think that in the social and behavioral sciences, we tend to take concepts and stretch them too far. This is a good example of it.

Never forget that people can do anything compulsively. That includes eating, sex, and (I kid you not) counting. Let's leave "addiction" to substance abuse.

Tuesday, October 10, 2006

A New/Old Look at Psychoanalysis

The New York Times has an interview with Owen Renik, a psychoanalyst who has just written a book entitled, Practical Psychoanalysis for Therapists and Patients. It controls this wonderful interchange:

Q. You place great emphasis in the book on symptom relief as the central measure of the effectiveness of therapy. Shouldn't that be obvious?

A. Not necessarily. There is a tendency among psychoanalysts to pursue self-awareness as a goal in itself, rather than a means to an end. Originally, the idea was that the self-understanding that arose as a result of psychoanalysis was unique and impressive and valid because it afforded relief from symptoms that were otherwise impossible to treat.

If you don’t require that self-awareness be validated by symptom relief, there are two destructive consequences. The first is scientific. You have no independent variable to track; you set up a circular situation in which it’s the analyst’s theory that determines what is found in analysis. Many critics of psychoanalysis have recognized this.

But an equally important consequence is that you relieve the analyst of any accountability. The process can go on forever, and there are all kinds of temptations to extend it, including the therapist’s vanity, his inability to admit failure, his narcissism — and nobody likes lost income. The therapy then becomes an esoteric practice of proselytizing, rather than a discipline, and the proof of that is everywhere in the world, where fewer and fewer people go to analysis at all. If the therapy worked, people would be going.

This issue actually goes back to 1952 when H. J. Eysenck had argued that psychotherapy was ineffective (a 1957 paper is available here). At the time, psychoanalysis was the dominant form of psychotherapy. Although deficiencies with his research have been well documented, his paper touched off the field of psychotherapy research, and such studies continue to this day. Generally, it has been concluded that certain forms of problem-oriented psychotherapy (e.g., cognitive therapy, behavior therapy, and interpersonal therapy) are effective for treatment of anxiety, depression, and other specific psychological problems. Psychoanalysis, and other psychodynamic therapies have not fared so well, although I have seen a few positive studies in the past.

The issue is not just whether or not psychotherapy "works;" it's also whether or not this particular client is benefiting from a particular therapy, from this particular therapist. This is what we call accountability, and psychologists have not taken it seriously enough. I'm particularly impressed with Renik's eloquent comments about the dangers of not addressing symptom relief in therapy, i.e., not being accountable.

Today, it is becoming more common for therapists to begin sessions with a fairly straightforward questioning of a client about his or her level of symptoms. A quick minute of asking about mood, sleep, appetite, frustration tolerance, and so forth can provide adequate data for accountability. It also helps discourage the conduct of endless, directionless therapy, whose sole hallmark is to keep the client coming back for another fully paid session.

Sunday, October 08, 2006

The Lancaster School Shootings

Like most of my colleagues and neighbors, I've been following the Lancaster school shootings with great interest. I've been wanting to blog about it, but I'm hesitant to jump in with both feet.

So far, I don't know what to make of it. When the news first hit, a friend of mine and I both assumed that the motivation for the shooting was that the shooter had been sexually molested, probably at a school. Instead, the information coming out makes no sense.

The shooter left a message that he had molested two children about 20 years ago, and the memory has always been very exciting and vivid to him. The women, who at the time were 4 and 5 years old, have no memory of this. That's not surprising. At that age, they might not. However, it's very unlikely that he didn't offend for another 20 years, and it's even more unlikely that this would motivate this kind of behavior. Instead, he would be expected to reproduce the same events a second time. Not this kind of bizarre, carefully planned act.

A second explanation left in his messages was that he was angry at God for the death of his daughter soon after birth. Again, his current behavior has no link with that past trauma. I can see suicide, perhaps even a dramatic suicide, but not one connected with assault on children, most of whom he apparently knew.

No, I'm afraid we're still missing some pieces of the puzzle. I'll keep an eye out for more information.