Saturday, October 8, 2016

BONOBOS Among us

The evolution of our human species teaches a lot about our selves, not just our overt behavior patterns but fundamental drives and motivations; like sex, aggression, dominance and empathy.
BONOBOS are Central African apes said to be our closest genetic relatives, more so than their neighboring chimpanzee relatives . They are highly intelligent and can learn 500 words and how to communicate by computer.  They form communities marked by high levels of sexual behavior governed by strict rules. Both heterosexual and homosexual patterns occur. They are not monogamous.

In short, many human behavior patterns occur, both social and antisocial, including  pedophilia, dominant sexuality and random acts of aggression and violence.
But interestingly, it is mainly the females in Bonobo culture who control most of this antisocial male behavior. Their society is matriarchal unlike their genetically close chimp relatives. Empathy for children is largely the role of females. Though physically weaker, the females band together, to control violence and protect the babies.

What's the difference of Bonobo culture and our own? One important feature is the greater human social controls over impulsive and violent behavior. Dominant sexual behavior by males is regulated by strong social and legal rules in all human societies. Strong punishments are mandated for impulsively breaking mores regarding dominating male sexual behavior.
No surprise that even very powerful figures among us receive universal condemnation when breaking the rules regarding behavior to females.

Stay tuned to further debates to see the effects of impulsive uncontrolled dominant sexuality.

Monday, September 26, 2016


Recently a study appeared showing that a common drug used in treatment of diabetes was a risk factor for ADHD in pregnant mothers taking the drug compared to mothers with diabetes but not taking the drug.

In mothers treated with antidiabetic medication (n = 7479), there was a small but significant increased risk of ADHD (HR, 1.20, adjusted to 1.16; P = .03), compared with children from mothers with diabetes [gestational or type 2 diabetes] who did not take the drug.

A journalist dismissed the importance of this effect on the overall prevalence of ADHD: "the increased risk for this (presumably) very small group of women can't have that much effect on the ultimate numerator of ADHD."

I believe this response may reflect the common assertion that most of the elevated prevalence is due to non medical factors such as pressure from pharmaceutical companies.

While partially true, the assertion incorrectly dismisses the relevance of multiple medical causes of ADHD. As I responded, "The numerator for prevalence of ADHD may be small but it shows how a particular causative effect is in play, along with numerous other pre and perinatal causes. I would count it in toto to be highly significant. We don't know the impact of numerous other pills being ingested by pregnant women. Samples of numerous pills are found in large swaths of waste water in the country."

To this must be added known risks of ADHD from organophosphate pesticides, lead in house paint & drinking water; low birth weight; brain trauma from a variety of sources, including infectious, radiologic, or immunologic factors in prenatal or perinatal environments.

In other words, ADHD has many causes related to early neurodevelopment, as well as the well-established hereditary or temperament causes. It is important to beware of "simple & sovereign theories," as Gordon Allport  warned long ago.

Sunday, September 25, 2016



Andras Angyal was an American-Hungarian psychiatrist who died in 1960, the same year I started my career as a psychologist at Johns Hopkins  hospital. Now At 83 my mind returns to this forgotten genius who I only knew through his writing as a student while a graduate student at Harvard.
Late at night, awake in my "segmented sleep" cycle, my thoughts about the events of my past life somehow bring him to mind. Before I tell you of those thoughts I want to quote a succinct summary of his ideas from Wikipedia.
"Angyal ... coined the word biosphere. The word refers to both the individual and the environment, 'not as interacting parts, not as constituents which have independent existence, but as aspects of a single reality which can be separated only by abstraction.'[...]
The biosphere is seen as a system of interlocking systems so arranged that any given sub-system of the biosphere is both the container of lesser systems and the contained of a greater system or systems. The interplay of the interlocking systems creates a tension which gives rise to the energy, which is available to the personality. Moreover, the biosphere as a whole is characterized by a fundamental polarity which gives rise to its most fundamental energy. This polarity arises from the fact that the environment pulls in one direction and the organism in the other.
To these fundamental yet opposed pulls of the biosphere, Angyal has given the names of autonomy and homonomy, respectively. Autonomy is the relatively egoistic pole of the biosphere: it represents the tendency to advance one's interests by mastering the environment, by asserting oneself, so to speak, as a separate being. Homonomy is the relatively 'selfless' pole of the biosphpere: it is the tendency to fit oneself to the environment by willingly subordinating oneself to something that one perceives as larger than the individual self. In place of the words autonomy and homonomy, Angyal has also used the terms self-determination and self-surrender to describe these opposing yet co-operating directional trends of the biosphere, and he has felicitously summed up the individual's relationship to them with the remark that, 'the human being comports himself as if he were a whole of an intermediate order'"
As I review my own life, I now clearly see that there are ego-driven periods as well as those self-surrender or homonomy periods. Moreover, as Angyal described, these very distinct functions are like those Gestalt illusions which can 'flip' back and forth, where you experience one side of your personality without conscious awareness of the other.
These are not necessarily 'good vs bad' experiences as commonly judged by others.For some of the ego moments are positive and others negative; and some of the selfless periods display either good or bad behaviors. But I see my most secret and undeniably bad actions as a part of my self which can succumb to that conscious state in which I am a selfless and admiral part of the larger society.
When it is possible, as you scan over your past thoughts and actions, especially those you keep most secret from view, you may discover a more unified, larger picture of yourself. There is then a relief of the tension between opposite views, and according to that wise psychiatrist I never met, there remains a holistic unified vision of a peaceful self.

Thursday, September 15, 2016

Association of book Reading With Longevity

A chapter a day: Association of book reading with longevity

 Strange as it may seem, there is good empirical evidence that reading novels prolongs life. Consider this study by epidemiologists at Yale University, published in Social Science & Medicine.

Book reading provides a survival advantage among the elderly (HR = 0.80, p < 0.0001).

Books are more advantageous for survival than newspapers/magazines.

The survival advantage of reading books works through a cognitive mediator.

Books are protective regardless of gender, wealth, education, or health.
Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect.

The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline.

Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2 = 0.83, p < 0.001, HRT3 = 0.77, p < 0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression.

Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2 = 90.6, p < 0.001; tT3 = 67.9, p < 0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers.

Cognition mediated the book reading-survival advantage (p = 0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.
Why Reading Literature Matters for Psychologists.

An article in the Washington Post today by Christopher Ingraham makes the point that there is a long slow decline of novel reading in this country. It argues that novel reading is important because it increases the empathy in its readers.  This is a belief I have shared with my psychology students for many years.

Gustavo Flaubert's novel about a doctor's wife who commits adulterous affairs then commits suicide to avoid the banalities of rural life is a story that teaches much about the way an individual life transpires in an environment that is both loveless and boring. I often suggested this and other writers as important for psychologists trying to learn how to piece together the life story of their patients. Getting a person's real life story is the essence of "diagnosis" which is an art best taught by artists.

Qualities of compassion and empathy are shaped in ways not easily taught better than under the microscope of the novelist. Whether Tolstoy, Turgenev, Dostoyevsky or Sylvia Plath, the complex nature of the human story is absorbed by the reader and built into their cognitive and emotional understanding.

The same argument applies to poetry which can teach skills and emotions valuable to a psychotherapist, physician, nurse or anyone whose life enriches others. But this form of teaching has to do with emotional growth at a subtle level, which is why many programs for physicians--not just psychiatrists--recommend a background in humanistic and artistic studies.

As a patient there is an immediate connection with a primary care doctor who projects empathy at an automatic and unconscious level. Humans are remarkably astute at recognizing genuine empathy vs machine-like behavior.

It seems plausible that increasing levels of strife and conflict at the national and world level may also reflect the decline of empathy.

Sunday, February 14, 2016


I didn't plan to watch the Republican debate last night. But Time Warner Cable screwed up again and failed to record what turned out to be a thrilling basketball game, which Duke won at the buzzer by Grayson Allen's tip-in. I was mightily miffed and needed some light entertainment.  It was as expected,  a raucous slur-fest in which each debater reviled the others, a comedic display bordering on childish ranting.
But enough of my misspent evening. I have a load of impressions longing to be released about my whirlwind week in New Orleans.
Travel to and from the Big Easy via Charlotte was, like all travel these days, partly a struggle to manage maneuvering of wheel chair, walker, luggage, and airplane sardine-like seating. My intrepid wife did her usual heroic juggling of documents, carry-on of medical baggage, and equipment managing, all the while fighting a cold (as an employee of Durham public schools she is always fighting a cold).
My wife was thrilled to catch the Mardi Gras parades up close, while I was content to catch an occasional glance from our 9th floor room. The excesses of Fat Tuesday, with the drunken audiences crowded into a dangerous mix of pickpockets and wildly exuberant onlookers held little interest, except for her safety. But she managed well by engaging helpful Stewart, a bell hop whom she charmed into showing her the safer spots to view the mayhem.
On the following days she was occupied with workshops to bolster her required CEUs for her job as School Psychologist. I spent a lot of free time people-watching in the large lobby, always jammed with conventioneers and their laptops, seeking respite from their workshops before once more leaping into the fray (not actually crying "Once more for King Harry and our English dead.")
One example out of that mix was one day when I finally found an empty table for three, all else being filled up. So I sat for quite some time, until I got bored and listened to Dietrich-Fischer Dieskau lieder on my cell phone. Finishing that after an hour or so, I suddenly had a couple who asked if they could be seated at the two empty chairs at my table. Of course!
For some time they conversed as if I wasn't there, and I had no choice but to hear their conversation.  The older man was the former supervisor of the younger woman when she was a graduate student. They met for the first time in many years. He was asking her about her work now. She was telling him how easy it was to use the computerized automated report tool for the BASC ( popular Behavior assessment scale for children). He was very animated, saying, "A monkey could do that! The only thing you should focus on is being a change agent; doing something positive to enhance their lives,"and so forth.
I stood up ready to leave, extended my hand and introduced myself. "OMG! She says," and then asks if she could have a picture with me, I was flattered as always to be recognized as the old guy widely known in her field, and presumed to have passed away years ago. I told the supervisor I agreed wholeheartedly with his sentiments about the BASC. I wished them well and remarked that it was good they could still talk to each other after all the years. Laughter.
My encounters with school psychologists continued the next day when I was scheduled to sit at my publisher MHS's booth for a Q & A session by passers by.  Most of the people who stopped seemed to be young females just starting out as school psychologists.
I usually asked about their work and heard their mixture of pleasure at the variety of roles they filled, as well as the drudgery they experienced  a lot of the time, filling out reports, attending unproductive meetings, and sadness at the overwhelming disabilities among their clients and families.
I was usually positive, telling them they had a unique chance to observe the amazing variety of psychopathology that passes by them every day in their job. They had a chance to accumulate valuable insight based on their intuitive capacity to synthesize their impressions over time. I allowed that one of my great regrets was not recording those impressions in a daily journal, something whose significance I I only discovered recently in my own life.
The response to that mini-seminar was rewarding. They suddenly recognized how valuable their brain was, beyond the numbing drudgery required by the great bureaucracy they are part of. Collecting their impressions over time could elevate their profession to a higher level, seeing patterns beyond the artificial tools psychologists often become wedded to and which actually can obscure the unique qualities they see from direct impressions.
Perhaps I will give that sermon at the next NASP convention!

Wednesday, February 4, 2015


When I first trained as a clinical psychologist in the Department of Social Relations at Harvard, it seemed peculiar at first that the program required Anthropology, Sociology, Social Psychology, Behavior Theory, as well as the expected specific practicum and clinical training. The idea seemed to be that clinical work cannot be separated from broad experience with everything human.

Clinical assessment itself had the usual lectures and practicum experience on symptom-based psychopathology, but also emphasized Robert White's and Henry Murray's approach of detailed life stories. Every life is a story that has to be understood from its beginning, adhering to Aristotle's advice that, "If you would understand any single thing you must observe it from the beginning." Mental life and its accompanying behavior and environments are complex and ever-changing; something only hinted at in a single hour of gathering the story. Good preparation is like good novels, something to be read with care.

Poetry also often informs us of mental life not otherwise easily understood. How better to understand grief than Shellley's Music When Soft Voices Die, or stream of consciousness and T.S. Eliot's Lovesong of J. Alfred Prufrock? In those moments in the office when patiently listening to the story of a family or patient, everything you know or believe informs how the story is eventually put together. An awesome responsibility. Great scholarship and classical learning does not completely prevent atrocious ideas as well as some profound ideas taking over the mind, like Dawkins' concept of mental viruses (as the history of psychoanalysis abundantly shows). But our culture has always valued learning as the foundation of healthy human life.

Back at Hopkins the early 60's the clinical process seemed straightforward: gather as much information in the time allowed, using tools of the trade such as interview, psychological testing, brief consultation, behavioral strategies such as Jacobsonian Progressive Relaxation, new ideas (at the time) such as Wolpe's hierarchical fear exposure, family social work, and so on. Randomized clinical trials formed the basis of the new developments in psychopharmacology. Psychiatrists, psychologists, and social workers shared the load as a team. Some of what we learned has been proven invaluable to the lives of patients, though some of what we learned has also been committed to the dustbin of history as evidence became available.

Much has changed since that time. We had no computers, cell phones, diagnostic structured interviews, rating scales or APPs. My first study involved a checklist of referral problems gleaned from the table of contents of a Handbook of Child Psychiatry. By changing the checklist into a scale and factor analyzing the results, I created a useful scale for gathering information and tracking treatment effects. But I never envisioned that the scales would be applied without the requisite training at the professional level, as a helpful tool, not an end in itself in writing the story. Recently we read of teachers who exaggerate the symptoms of troublesome children to insure that they receive drug therapy, thus increasing the financial benefits of a reward-based special education system.

Now something has happened that we never envisioned. Rating scales and clinical applications like Cognitive Behavior Therapy,  Self Examination of symptoms,  of mood, behavior states, thoughts and related activities, drug side effects, dietary choices, and more are being recorded on APPs for cell phones. These programs act like self-managing therapy or recording devices, that can also include physiological parameters like heart rate, blood volume, or even EEG. The patient has, in a sense, become their own doctor. The APP acts like an extension of the doctor's knowledge, but knowledge applied and evaluated by the patient.

But one question is troubling: Do they work? Could they be harmful as well as helpful? We have always assumed that various forms of mental illness are by definition subject to processes that involve more than ordinary problems of living. True, this assumption may be incorrect and also needs examination by empirical data. Can the explosion of reliance on new technology turn out to be harmful to the individual, or at the least an expensive waste of time? Could they further the over diagnosis and over treatment already a disaster in much of the mental health arena? It may seem lame to say, "Go ahead, let's try it until further research answers our concerns," but perhaps we should also become more Scottish at heart and say, Caveat Emptor!

Readers of this blog are already conversant with the new technology. I am curious how you all respond to the question above.