Saturday, March 31, 2012

Autism is mind blindness

The young couple first approached a physician practicing in Indian system of medicine (Ayurveda) and then a Homeopath for the remedy of their only male child’s abnormality in behaviour. Both the Ayurvedic physician and the Homeopath assured the young couple a ‘complete cure’ from the curious malady of their son. But treatment which lasted for many months in both the systems failed and there was no relent in the devastating symptoms of the child. Finally they decided to seek the opinion of modern medicine and they approached a pediatrician who advised them to seek the help of a psychiatrist.
The young couple described the peculiarities of their son. Till the third birth day they did not notice any abnormality in the child. The first thing they noticed about their son is that he doesn’t like people to hold him or touch him. He often doesn’t respond when they call him. Even when they move their hand in front of his face he doesn’t respond. They had to pick him up to get his attention. His speech also is defective. The parents couldn’t often follow what he was saying. He repeats whatever he heard as echo but he doesn’t know the sense of many words he repeated. He could not follow their instructions like sit, come here, stand up etc. The most distressing behaviour was his avoiding of looking into their eyes. Evidently their son was suffering from autism. There was no medicine to cure the devastating disorder. Only special training, care and attention would improve the condition of the child. I explained the various aspects of autism to them.
Autism is a pervasive developmental disorder. It was discovered independently by two physicians, Leo Kanner in Baltimore and Hans Asperger in Vienna, in the 1940s. Both doctor had any knowledge of the other, and yet by a strange coincidence they gave the malady the same name: autism. The term was derived from the Greek autos which means self. They gave this name because the main feature of the disorder is confining to self withdrawing from the outside world.
The symptoms of the disorder can be categorized into two groups. The first group of symptoms pertains to the cognition of the child and its relationship with the outside world. Mental aloneness and lack of contact with the world, particularly the social world, as well as a profound inability to engage in normal conversation are the hallmark of this disorder. Going hand in hand with this is an absence of empathy for other which means a failure to understand others’ feelings and emotions. 
The second cluster of symptoms pertains to the sensory and muscular systems of the child. The autistic children find specific sensory stimuli highly distressing. Certain sound, for example, can set off a violent temper tantrum. There is also a fear of novelty and change and an obsessive insistence on sameness, routine, and monotony. The symptoms of motor system include to-and-fro rocking of the body, repetitive hand movements including flapping motions and self-slapping, and sometimes elaborate, and repetitive rituals. These symptoms are not quite as definitive or as devastating as the social-emotional ones, but they occur so frequently that must be connected somehow.
Mind Reading and Mind Blindness
Uta Frith
Uta Frith, leading developmental psychologist working at the Institute of Cognitive Neuroscience at University College, London put forward for the first time the cognitive theory of autism. She wrote: “Individuals with autistic disorder have occasionally commented on what they perceive as an unfathomable yet ubiquitous ability of other people to “mind read” during ordinary social interactions. Normal people indeed behave as if they have an implicit theory of mind, and this allows them to explain and predict others' behavior in terms of their presumed thoughts and feelings. To give an example: you might observe me in my office bent over a filing cabinet drawer pulling out and putting back folders. You would make sense of this behavior by mentalizing, that is, automatically recognizing that I am looking for a paper that I believe is in one of the folders and that I wish to retrieve. You would think this even if you knew that the paper was not there. To explain my behavior, it is immaterial whether the missing file is in the cabinet or really somewhere else. Suppose that you say to me “Try Debbie's desk,” and I respond with “I might have known.” Without mentalizing, this everyday exchange would seem like complete non sequiturs. Further, without mentalizing, you might come up with an outlandish interpretation of what I was doing—perhaps practicing back bending and finger moving? The important point of the example is that for an instantaneous interpretation of ordinary behavior, we automatically take account of the mental state of people, their desires, and their beliefs.” Neuron Vol. 32, no. 6, 12/20/01 pp 969-979. The difficulty in mind reading would result a condition called mind blindness which is main characteristic of autism.

Mirror neurons and mind reading
In the 1980s and 1990s, neuro scientists Giacomo Rizzolatti, Giuseppe Di Pellegrino, Luciano Fadiga, Leonardo Fogassi, and Vittorio Gallese working at the University of Pama, Italy discovered mirror neurons. They found that some of the neurons controlling the movements of muscles of hands responded when the monkey observed another monkey moving hands without moving its own hands. They called these neurons mirror neurons because they acted like mirroring other monkey’s actions. Further studies confirmed that about 10% of neurons in the lower parts of the frontal and parietal lobes of the monkey’s brain have “mirror” properties. A mirror neuron is the nerve cell that fires or becomes live both when an animal acts and when the animal observes the same action performed by another. Thus the neuron mirrors the behaviour of the other, as though the observer were itself acting. Such neurons were observed in various species of animals such as primates and bird.
V S Ramachandran
According the cognitive neuroscientist Vilayanur S Ramachandran, the mind reading ability derives from the mirror neurons situated in the various parts cerebral cortex. Ramachandran writes: “The clue comes from mirror neurons. In the late 1990 it occurred to my colleagues and me that these neurons provided precisely the candidate neural mechanism we were looking for. The discovery of mirror neurons was significant because they are essentially a network of mind-reading cells with the brain. We were struck by the fact that it is precisely these presume functions of mirror neurons—such as empathy, intention-reading, mimicry, pretend play, and language learning—that are dysfunctional in autism.”  The Tell Tale Brain pp 139,140

Wednesday, March 28, 2012

How to remember names?

Forty eight years old clerk working in a government department was visibly upset when he entered my office. He wanted treatment for Alzheimer’s disease. Alzheimer’s disease is the most common form of dementia. Dementia is a serious loss of cognitive ability beyond what might be expected from normal aging process. It is characterized by loss of short-term memory, inability to learn new things, defects in reasoning and problem solving. The clerk who came for treatment didn’t show any sign of such cognitive functions. So, I asked the 48 year old clerk: Mr. S., why do you think you are suffering from Alzheimer’s disease?
Mr. S. settled down in the chair and started describing his problem: Doctor, I have some memory problems. I can’t remember names of persons whom I know very well. I can recognize their faces, but I can’t remember their names. Often this causes me trouble. Some of my friends accuse me that I lack sincerity in friendship. That is why I could not remember their names. It creates some problems in work place also. My colleagues accuse that I am careless.
I tested his recent memory in the following simple way: I showed him four objects, viz. a pen, a cellular phone, a wrist watch and a paper weight. I asked him to keep them in memory. After five minutes I asked to tell the names of four objects. He recalled all the four objects in the same order. I reassured his memory power was intact.
Tim Hallbom
Tim Hallbom, a Neuro-Linguistic Programming (NLP) trainer, NLP Institute of California, author and therapist writes:  "One of the things that brain researchers have discovered in the last few years is that your internal dialogue occupies the same auditory nerve in your ear as external sound."
Researchers have established that the people forget names because they're usually involved in some other internal conversation. So, it's real hard to hear the other person saying their name when you're having an internal conversation with yourself about how you're coming across or what you're going to say next.
In remembering names, the first thing that Tim recommends is to concentrate on staying external with the person by listening to them. Then repeat their name to yourself three times while you're looking at them.
To get the visual part in, imagine that you can see their name written on their forehead. To make it more permanent, see their name in your favorite color of magic marker. This will make it stick out the entire better. Do this while you're saying their name to yourself. If you repeat this technique for some time it becomes automatic and you can do it effortlessly.
Franklin D. Roosevelt 
Franklin D. Roosevelt, the 32nd President of the United Sates was a master at recalling names. He continually amazed his staff by remembering someone's name that he had only met once, months before. Asked how he did it, he said he saw the person's name written out on their forehead. 

Tuesday, March 27, 2012

Core Beliefs in Obsessive Compulsive Disorder

An unusual obsession of “adverse remarks”
Ms. G. is a student of information technology aspiring to acquire a degree in it. But she couldn’t continue her studies because of her psychological problems. She described her mental problem hesitantly. She admitted that her problem, she feels, is silly. Hence she felt the hesitancy in presenting it to me. She was not sure that they are actually mental problems at all, because they are just thoughts intruding into her mind.
Whenever she saw a person, stranger or friend, some adverse remark about that person intruded into her mind against her will. I asked her to give some examples of such ‘adverse remarks’ and she reluctantly obliged. Following are some of the examples she gave:
This man is a bad person.
That woman is an over smart.
This boy is naughty.
That girl is ugly looking.
The thoughts are not the real problem. Whenever such an unacceptable thought intruded into her mind she felt guilty and experienced ‘tension’ out of this guilt feeling. Worsening her condition she feels a compulsion to apologize to the person for having such an unacceptable thought in her mind.  If she didn’t apologize to the person, the tension and guilt feeling doubles. There came a stage of her mental problem at she stopped going to her classes. A doctor related to he advised her to seek help from a psychiatrist.
A cursory psychological examination revealed that she was suffering from Obsessive Compulsive Disorder (OCD). Since her OCD has advanced to a severe state I decided to treat her with Selective Serotonin Re-uptake Inhibitor (SSRI) drug and cognitive behaviour therapy.
Prevalence of the disorder
Studies show that approximately 90% of people have intrusive thoughts which may not be unacceptable to the individual. People with OCD take these thoughts to a disruptive and unhealthy level. Their intrusive thoughts or obsessions force them into a series of compulsive behaviours as a kind of defensive mechanism against the obsessions. OCD is a pattern of ritualized behaviour used to cope with distressing situations.
Ms. G. developed a ritual of apologizing to the persons whom she thought badly about in her mind. A particular ritual may present relief to the obsessive individual, but eventually, the behaviour becomes distressing to the sufferer of OCD, because it disrupts everyday interactions in life.  
What are obsession?
Obsessions come to one’s mind as repeated images, impulses, or thoughts against the will of the person. These make the obsessive person feel negative emotions, the most common being anxiety, stress, revulsion or apprehension. Inability to “stop” these impulses and thoughts make the OCD person feel out of control. Though the person realizes on some level their obsession with these thoughts is irrational, they feel the need to develop mechanisms to cope with their negative emotions. These mechanisms tend to become compulsive behaviour, which is a kind of ritual which offers short term relief to the sufferer.
Possession by devils
In the Middle Ages these intrusive thoughts and compulsive rituals were thought to be due to possession of devils and evil spirits. In the Malleus Malleficarum (Hammer of the Witches) written by the two Dominican inquisitors, Heinrich Kramer and James Sprenger, there is descriptions of a 15th century patient’s intrusive thoughts:
“When he passed any church, and genuflected in honour of the Glorious Virgin, the devil made him thrust his tongue far out of his mouth; and when he was asked whether he could not restrain himself from doing  this, he answered: ‘I cannot help myself at all, for so he uses all my limbs and organs, my neck, my tongue, and my lungs, whenever he pleases, causing to speak or to cry out; and I hear the words as they were spoken  by myself, but I am altogether unable to restrain them; and when I try to engage in prayer he attacks me more violently, thrusting out my tongue.”
The inquisitors subjected the person severe torture to exorcise the devil in him and the innocent patient of Obsessive Compulsive Disorder died.
Behavioral part of treatment
The treatment technique that works best for OCD is the Exposure and Response Prevention (ER&P). The ER&P encourages patients to expose themselves to their obsessions and try to stop themselves from compulsive rituals to get rid of anxiety and tension that they are feeling. People with OCD usually avoid situations which cause intrusion of unacceptable thoughts. For example a person suffering from intrusion of blasphemous thoughts in religious places avoids church, temple or mosque. Ms. G. avoided going out and she discontinued going to classes. He/she should be advised not to avoid places of worship even if blasphemous thoughts cause mental tension. Repeated exposure to such situations may reduce anxiety in due course and obsessions may subside. The ER & P is the behavioural part of the Cognitive Behavioural Therapy (CBT)
Find out core beliefs
            The cognitive aspect of CBT is recognition of the core beliefs which causes intrusion of the unacceptable thoughts and the accompanying negative emotions such as anxiety, fear and depression. These core beliefs about the self and the world shape everything we do, including Exposure Therapy for OCD. The OCD patients entertain the following core beliefs:

  1. I must be perfect or I'm a failure and therefore worthless.
  2. I must do everything right on the very first try.
  3. I must never make a mistake.

These beliefs are deep-seated in the mind are on auto-pilot. They guide the actions of the individual even before he/she realizes it. Obsessions and the rituals are motivated by these beliefs.
Another psychological aspect of obsession is the "Feared Consequences," thoughts of which compel the patient do the rituals to avoid unacceptable thoughts. Following are usual thoughts of “Feared Consequences.”
If I make a mistake, this will prove I am worthless, and I will have no hope of peace or joy in my life.
I will implode from the pressure of my defectiveness.
I will go crazy from the anxiety caused by my defectiveness.
There are a number of common obsessions:
  • Among the most frequently reported is the fear of contamination by germs, dirt, chemicals, or diseases. People with this obsession are often overwhelmed with thoughts of harming themselves or others, so they try to avoid coming into contact with certain surfaces, contaminated objects, dirt, or bacteria. In response to this fear, these people perform compulsions such as frequently washing their hands, changing their clothes, and avoiding dirty objects like doorknobs, shoes, and newspapers.
  • Repetitious uncertainty is another common obsession. This can include doubts about whether or not the person turned off the stove, made a mistake at work, or hit someone while driving. This type of obsession leads to compulsions that are extremely time-consuming. The person is rarely satisfied with the safety or perfection of his or her actions and thus must check and recheck his or her own behaviors. Examples include returning home multiple times to make sure the oven is turned off and repeatedly turning the car around to make sure the person really didn't hit someone in the road.
  • Obsessions of perfection are thoughts that require the person to arrange objects perfectly or to perform tasks in a rigid, systematic fashion. Often, people with this compulsion can’t complete a task if they can’t perform every step of that task in a specific order.
  • Obsessions about causing harm to others lead the person to think about hurting other people, including strangers. This type of obsession may cause the person to perform reassurance behaviors, which are actions they take to make sure that other people are safe, like continuously calling someone on the phone.
  • Sexual obsessions often involve intrusive pornographic thoughts. This type of disturbing imagery may cause people to play mental games to distract themselves, like drawing pictures in their imaginations.
  • Religious obsessions tend to focus on the fear that the person isn’t doing what is morally right or the thought that he or she is going to be punished by God. Religious obsessions can also include uncontrollable, blasphemous thoughts in which the person curses God. In these cases, the person might perform a praying ritual or draw some type of religious imagery in a notebook.
  • Other obsessions include urges to do things that seem aggressive or very much out of the ordinary, like screaming at others for no reason. Afterward, the person might feel compelled to do something to relieve feelings of guilt or shame.

These are just a few examples of different types of obsessions. In all of these cases, the worries are highly unusual. They are not obsessional worries about common, daily occurrences, like paying the bills or getting to work on time. For each one of these obsessions, there are numerous types of compulsions, not just the ones listed here. In fact, a person’s obsessions and compulsions may not even be related to each other in any obvious way. A person may do anything after the intrusive thought to relieve him or her of anxiety. For example, a woman with a fear of contamination might obtain just as much relief from singing a song each time she feels dirty as she does from washing her hands. However, in all cases, the obsession and the action that follows it become habitual, time-consuming, and disturbing to the person who experiences them.

Thursday, March 22, 2012

Soul in the brain

When the old man entered my office I recognized him. He was a professor in the Arts College. I attended his lecture on the soul an year ago. He asserted that originator of the concept of immortality of the soul was none other than Plato. That was true. One of the main themes in Phaedo, Plato’s last dialogue, which depicts the final days of Socrates, is immortality of soul. But the professor asserted that Aristotle also faithfully followed Plato’s concept. At the end of his lecture I pointed out that Aristotle did not take up the Platonic project of proving the soul’s immortality. Indeed by defining the soul as the first actuality of an organic living body (On theSoul II) he seems to have precluded the possibility that any soul can survive the dissolution of the body whose actuality it is. The professor did not refute my point. 
I remembered all these when the professor was sitting in front of me. Professor’s wife complained that he forgets everything, even the food he has had taken a short while ago and asks for it again. Evidently he is suffering from dementia. Dementia is characterized by loss of memory and gross impairment of cognitive functions such as thinking, reasoning, problem solving etc. I asked the professor whether he remembered the lecture he gave in the city hall an year ago. The prompt answer was ‘yes’. Then I asked what the subject of his lecture was. He just said history! He was a professor of history, indeed. Other things he forgot. I asked him again what soul is. He fumbled and just repeated the word ‘soul’.
I asked: What you know about the soul?
Professor: The soul?
I repeated: Yes. What is soul?
Professor: I don’t know.
A rationalist may argue that the soul ceases to exist on the death of the body, but the neuro-cognitive evidence shows that the soul may disappear even before the death of the individual if dementia grapples him/her. Presently the professor could not say a word about his own soul.
The renowned Indian psychiatrist the late Dr. Venkoba Rao once said: “the relationship between brain and mind is that of dancer and dance.”  His statement implied that with the death of the individual's brain the mind ceases to exist. Dr. Venkoba Rao's statement was opposite of what RenĂ© Descartes, the seventeenth century French philosopher, who is often designated as the father of modern philosophy, said. Descartes’ main conclusion is that the mind is really distinct from the body. In the book Principles he explains that a real distinction is perceived when one substance can be clearly and distinctly understood without the other and vice versa.  Descartes was ultimately arguing for the possibility of minds existing without bodies. By the term 'mind' Descartes meant the soul.
According to the Hindu faith soul is Brahman itself, the very self of the universe part of which descends down into the elements of nature through self projection and participates itself in the game of grand illusion or Maya. In the Hindu belief system there are two kinds of souls, viz. the individual soul or Jeevatman, and the Supreme Soul or Paramatman, the originator of universe and human souls. In Semitic religions the soul is created by the god and supplied to the individual while in the womb. After the death of the individual the soul continues to live independently in the eternity. (And the dust returns to the ground it came from, and the spirit returns to God who gave it. Ecclesiastes 12:7). All these prove that the soul is only a subject matter of religious faith.
But, I do not dismiss the human soul as nonexistent as some rationalists would do. So long as a human brain functions in full it manifests itself as a mind wherein a soul exists. In other words the human soul is a part of the human consciousness.  
The intriguing question is: Where is that part of the consciousness called the soul situated in the brain? This question still remains unanswered. The question became less puzzling with recent discovery of "mirror neurons".
Giacomo Rizzolatti 
In the 1980s and 1990s neuro scientists Giacomo Rizzolatti, Giuseppe Di Pellegrino, Luciano Fadiga, Leonardo Fogassi and Vittorio Gallese were doing research on the brain of macaque monkey at the University of Parma, Italy. These neurophysiologists placed electrodes in the ventral premotor cortex of the macaque to study the nerve cells (neurons) specialized for the control of hand and mouth actions such as taking hold of an object and manipulating it. During each experiment the researchers allowed the monkey to reach for pieces of food and recorded from a single neuron in the monkey’s brain, thus measuring the neuron’s response to certain movements. They found some of the neurons they recorded from would respond when the monkey saw a person pick a piece of food as well as when the monkey picked up the food. The discovery was sent to the renowned science magazine Nature but was rejected for its “lack of general interest.”
A few years later the same group of neuroscientists published another paper, discussing the role of the mirror-neuron system in action recognition, and proposing that the Broca’s region in human brain was the corresponding region of the ventral premotor cortex of the monkey. Since then reports on mirror neurons have been widely published and confirmed with mirror neurons found in both inferior frontal and inferior parietal regions of the brain. The studies with imaging technologies of human brain in function have established mirror neuron systems.
Broca's area shown in blue
New born Macaque imitates human action
Cognitive neuroscientist V S Ramachandran wrote in  Edge: Giaccomo Rizzolati and Vittorio Gallasse discovered mirror neurons. They found that neurons in the ventral premotor area of macaque monkeys will fire anytime a monkey performs a complex action such as reaching for a peanut, pulling a lever, pushing a door, etc. (different neurons fire for different actions). Most of these neurons control motor skill (originally discovered by Vernon Mountcastle in the 60's), but a subset of them, the Italians found, will fire even when the monkey  watches another monkey perform the same action. In essence, the neuron is part of a network that allows you to see the world "from the other person’s point of view," hence the name “mirror neuron." Researchers at UCLA found that cells in the human anterior cingulate, which normally fire when you poke the patient with a needle ("pain neurons"), will also fire when the patient watches another patient being poked. The mirror neurons, it would seem, dissolve the barrier between self and others. I call them "empathy neurons" or "Dalai Lama neurons". (I wonder how the mirror neurons of a masochist or sadist will respond to another person being poked.) Dissolving the "self vs. other" barrier is the basis of many ethical systems, especially eastern philosophical and mystical traditions. This research implies that mirror neurons can be used to provide rational rather than religious grounds for ethics (although we must be careful not to commit the ‘is/ought fallacy’).
A better other name for mirror neuron is not “Dalai Lama neuron” but “soul neuron”. Human soul has two parts; viz. altruistic or empathic part and a religious part. I propose that the altruistic or empathic part of the human soul is the creation of the mirror neurons of the prefrontal cortex and the godly aspect of soul is installed in the temporal lobe. The neuroscientist V. S. Ramachandran suggested that absence of the mirror neurons may explain the cruel malady of autism. Without these neurons the child can no longer understand or empathize with other people emotionally. If this suggestion is accepted one has to admit that autistic persons are devoid of altruistic part of soul. Another devastating inference is that the monkeys having mirror neurons in their brains are also having souls, of course lesser ones than human souls. 

Tuesday, March 20, 2012

Cognitive aspects of gambler’s fallacy

Gambler’s fallacy refers to the mistaken belief that future toss of a coin or drop of the ball in roulette or roll of the dice in craps is dependent of past events. For example, if you toss a coin and head comes up three times in a row, you may bet against a head coming up for the fourth toss. Similarly, if you see seven rolled on the dice five times in a row, then you are likely to bet against another seven coming up again on the next roll.
People expect events to even out in the short run because they know that events even out in the long run. If the coin is tossed ten thousand times, then, about fifty percent of falls would have been with head up. This is due to the result of even out of events in the long run. People, using their commonsense, think that this even out is applicable in the short run of events also.  This is an informal fallacy. It is also known as the law of averages in the common parlance.
If a coin is tossed repeatedly and tails comes up a larger number of times than is expected, a gambler may incorrectly believe that this means that heads is more likely in future tosses. Such an expectation could be mistakenly referred to as being due, and it probably arises from everyday experiences with scheduled and non-random events such are arrivals of trains, flights etc. For example, when a scheduled train is late, it can be expected that it has a greater chance of arriving the later it gets. In the case of random events such as tossing of coins what is true instead is the law of large numbers. In the long term, averages of independent trials will tend to approach the expected value, even though individual trials are independent.

Child birth and gambler’s fallacy

As in the case of all other sexual species, the sex ratio of humans is approximately 1:1. Naturally, childbirth is a random event as far as the gender of the child is concerned.  A very real-world example of gambler’s fallacy is that mothers and couples trying for another child tend to think that if they have had several children of the same sex previously, it is more likely of finally having a child of the opposite sex. This is similar to what people tend to think of with Henry VIII of England trying so desperately for a son. It is almost always a 50% chance of either sex, despite what parents may hope for their next child.

Monte Carlo Casino

The most famous example happened in a Monte Carlo Casino in Monaco in the summer of 1913, when the ball fell in black 26 times in a row, an extremely uncommon occurrence and gamblers lost millions of francs betting against black black after the black streak happened. Gamblers reasoned incorrectly that the streak was causing an "imbalance" in the randomness of the wheel, and that it had to be followed by a long streak of red.

Psychology behind the gambler’s fallacy

Daniel Kahneman
Cognitive psychologist Amos Tversky and Nobel laureate Daniel Kahneman proposed that the gambler's fallacy is a cognitive bias produced by a psychological heuristic. 
Amos Tversky 
In psychology, heuristics are simple, efficient rules, hard-coded by evolutionary processes or learned, which have been proposed to explain how people make decisions, come to judgments, and solve problems, typically when facing complex problems or incomplete information. These rules work well under most circumstances, but in certain cases lead to systematic errors or cognitive biases.
A cognitive bias is a pattern of deviation in judgment that occurs in particular situations, leading to perceptual distortion, inaccurate judgment, illogical interpretation, or what is broadly called irrational thinking. Implicit in the concept of a "pattern of deviation" is a standard of comparison with what is normatively expected; this may be the judgment of people outside those particular situations, or may be a set of independently verifiable facts. A long and ever-growing list of cognitive biases has been identified over the last six decades of research on human judgment and decision-making in cognitive science, social psychology, and behavioral economics.
According to this view, after observing a long run of red on the roulette wheel most people erroneously believe that black will result in a more representative sequence than the occurrence of an additional red, so people expect that a short run of random outcomes should share properties of a longer run, specifically in that deviations from average should balance out. When people are asked to make up a random-looking sequence of coin tosses, they tend to make sequences where the proportion of heads to tails stays closer to 0.5 in any short segment than would be predicted by chance. Kahneman and Tversky interpret this to mean that people believe short sequences of random events should be representative of longer ones.

Hot-hand fallacy

Another psychological perspective states that gambler's fallacy can be seen as the counterpart to basketball's Hot-hand fallacy. In the hot-hand fallacy, people tend to predict the same outcome of the last event - that a high scorer will continue to score. This is positive recency. In gambler's fallacy, however, people predict the opposite outcome of the last event - that, for example, since the roulette wheel has landed on black the last six times; it is due to land on red the next. This is negative recency. Peter Ayton, City University, London and Ilan Fischer, University of Haifa, Israel have theorized that people display positive recency for the hot-hand fallacy because the fallacy deals with human performance and that people do not believe that an inanimate object can become "hot" like human hands. 

Thursday, March 8, 2012

Possession by spirits

Possessed by father’s spirit

Ms. V. is a higher secondary student. She is a bright student, but recently she became gloomy and moody without paying much attention to her studies. One evening she started talking in her father’s tone and behaved just like her father who committed suicide six months ago. He was diagnosed in the work up in a cancer centre as having lung cancer. He became depressed when he came to know about the killer disease gnawing his lungs. Psychiatric treatment was of no avail and he committed suicide. This was a great shock to the whole family but, the only daughter Ms. V. was made virtually numb by father’s unexpected demise.
Her mother took her to the priest of the nearby Hindu temple and told the story. The priest immediately concluded that she is possessed by her father’s spirit. The Hindus believe that the spirits of those who die of unnatural causes like suicide and homicide wander in the premises until they are pacified and settled finally in the ethereal world by elaborate religious rituals.  If the rituals are not done in time the spirit would get into the body of somebody who was near and dear in former life; that is common belief among the Hindus all over India. This was the reason for the priest to jump into conclusion that Ms. V. is possessed by her own father’s spirit, because she was emotionally very much attached to her father.   The priest proposed usual elaborate and costly religious rituals which were duly carried out by a team of priests. The chief of the priests assured the family that the spirit is laid to rest in the ethereal world eternally.
But to the amazement of everybody in the family a few weeks later Ms. V. once again started talking in her father’s voice. This time the spirit possessing Ms. V. was angrier and shouted at her mother for involving the priests to exorcise him from the body of his beloved daughter.  Ms. V. possessed by the spirit tried to assault when the mother contacted the priest again. The priest expressed his inability to pacify the angrier spirit and advised to take her daughter to a psychiatrist.
When I saw Ms. V. there was no spirit in her. She co-operated with psychiatric interview. She admitted that she became very sad and lacked any motivation to study. She even thought of ending her life. When I requested her to communicate with her father’s spirit she started meditating. At the end of ten minutes’ meditation she started talking in an imitated male voice. She told me in the male voice: “I will never leave my daughter. I want her with me. I will take her with me.”
For me these imitated male voice appeared to be the girl’s own suicidal ruminations. Obviously she was in depression of severe degree. So, she required medication combined with cognitive behavioral therapy. It took nearly six months to bring her depressed mood to normal levels. When she got rid of the depression, the “spirit” stopped annoying her. She restarted her studies and is now preparing for the examination.

The concept of possession by spirits

The renowned forensic psychiatrist Dr. Ralph B. Allison MD writes: 
The concept of possession by disincarnate spirits as a cause of mental illness is as old as mankind itself. This is still extant in regions of the world where European and American psychiatric belief system have not replaced older, ritualistic patters of belief. Scientifically trained observers have reported such cases in modern literature from exotic locations such as India, Egypt, New Guinea and Ceylon. The most common explanation for such observations is that ‘spirit possession is a culturally sanctioned, heavily institutionalized and symbolically invested means of expression in action for various ego-dystonic impulses and thoughts’. Closer to home, similar cases of apparent possession have been reported in Latin American countries, such as Columbia. Cases occurring in the United States may be given the Greek label of “cacodemonomania” that is having the delusion of being possessed by demons. The cases described by Schendel and Kournay were of families involved in the charismatic branches of both the protestant and Catholic religions, leaders of which believe that spirit possession is a major cause of all physical and mental diseases. 
‘The possession syndrome on trial’ American Journal of Forensic Psychiatry Vol. VI Number 1, 1985 p.46-56

In the history

Possession by spirit was considered as a form of hysteria in the past. The term hysteria is derived from the Greek word hysteron which means uterus. It was believed that hysteria was caused by ‘wandering of uterus in the body’. Naturally the hysteria was designated as a disorder of women. But later on it was established that men also suffered from different forms of hysteria such as hysterical paralyses and hysterical loss of memory etc. Sigmund Freud published the book Studies in Hysteria in 1893 and thereafter hysteria was designated as ‘conversion reaction’. It was thought by Freud that various symptoms of hysteria are produced by the conversion of conflicts in the unconscious mind into physical and mental symptoms. Hence the name conversion reaction was given to hysteria.

Modern concepts

The diagnostic and Statistical Manual of Mental Disorders, IV edition, Text Revision (DSM – IV-TR) published by the American Psychiatric Association include possessions by spirits under Dissociative Disorders.
Normally human mind is the integrated function of consciousness, memory, identity and perception of the environment. The DSM-IV-TR states: “the essential feature of the dissociative disorder is a disruption of in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic.”
Following are the dissociative disorders listed in the DSM-IV-TR:
  • Depersonalization disorder: periods of detachment from self or surrounding which may be experienced as "unreal" while retaining awareness that this is only a feeling and not a reality.
  • Dissociative amnesia: noticeable impairment of recall resulting from emotional trauma
  • Dissociative fugue: physical desertion of familiar surroundings and experience of impaired recall of the past. This may lead to confusion about actual identity and the assumption of a new identity.
  • Dissociative identity disorder: the alternation of two or more distinct personality states with impaired recall, among personality states, of important information.

Location of spirit in the brain

Recent research has focused on clarifying the neurological basis of symptoms associated with dissociation by studying neurochemical, functional and structural brain abnormalities that can result from childhood trauma.  Functional imaging studies established that the orbitofrontal cortex of the brain plays a crucial role in possession of spirits and other dissociative identity disorders.  One of the least explored and least understood regions of the primate cerebral cortex is the orbitofrontal cortex, a part of the frontal lobe that lies on the roof of the orbit.

Case of Phineas Gage

Phineas P Gage
Phineas Gage (1823-1860) was an American railroad construction foreman now remembered for his improbable survival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain's left frontal lobe, and for that injury's reported effects on his personality and behavior – effects so profound that friends saw him as "no longer Gage".
In recent years, diverse functional studies have identified activations in the orbitofrontal cortex, suggesting that this prefrontal field is a component of brain systems critically engaged in memory, reward and decision-making mechanisms. These functions may well be considered as basic components of higher emotional and social behavior presumably involving this part of the cortex. 

Tuesday, March 6, 2012

Cognitive aspects of fugue state

A young man who disappeared for 20 days

A professor working in an arts college requested an appointment for psychiatric consultation for his son. Over the phone he gave me a brief account of the situation which entailed a psychiatric consultation. His son, a final year medical student disappeared suddenly and reappeared after twenty days. His son could not remember what he was doing all these twenty days. The professor wanted to know what was wrong with his son. I asked him to come to my office with his fugitive son for psychiatric examination. The professor came to my office in an agitated state of mind. He wanted to know what happened to his son during the three weeks while he was in anonymity. Many “unwanted” thoughts haunted him. He wanted to know whether his son was involved in any criminal offence committed by gangsters during the days of memory loss.
The young man could recollect that he was traveling to Bangalore city in an air conditioned coach of the superfast express train alone, on an invitation from a friend who was working in an IT company in the city. The medical student intended to spend two or three days with his friend in the Bangalore city. As the train approached the metropolis the young man suddenly lost memory. He remembered that when he regained memory he was working as a dish washer in a hotel in the suburban area of Bangalore city. He could not narrate how got the job and how many days he was working there. He says he could not meet his friend who assured him to come to the railway station to pick him up. He recollected that he became very upset because the friend didn’t turn up to receive him as assured. Suddenly he lost memory. He tried to regain it but failed. The professor verified the story of dishwashing at the hotel. The proprietor of the hotel vouchsafed the story true. He felt sympathy for the young man who was found in a pitiable condition without food and shelter. So he gave him shelter and food; that was all, according to the hotelier. The friend who invited him to the city told me over phone that he was a little late to arrive at the railway station as promised because of the traffic jam. But when he arrived at the station the train had left and there was no trace of his guest.  He tried to contact him over the mobile phone but the reply was ‘out of reach’.

Agatha Christie disappeared

Agatha Christie, the world renowned crime story writer disappeared on 3 December 1926 and reappeared eleven days later in a hotel in Harrogate, apparently with no memory of the events which happened during that time span. Vanessa Thorpe, the arts correspondent of the Guardian and Observer writes: “For 11 days the country buzzed with conjectures about the disappearance…. Christie was eventually discovered, but in circumstances that raised more questions than they answered. Alone, and using an assumed name, she had been living in a spa hotel in Harrogate since the day after her disappearance, even though news of her case had reached as far as the front page of the New York Times…. Norman, a former doctor, believes the novelist was in a fugue state, or, more technically, a psychogenic trance.”

Fugue state is caused by loss of memory

The son of the professor, who was brought for psychiatric examination, evidently suffered from a condition called dissociative fugue. According to Jason Brandt, Director of Medical psychology, John Hopkins Hospital (USA) fugue state is a memory disorder characterized by complete memory loss that is caused by psychological stress and that cannot be attributed to a known neurological cause.

Neuro-cognitive aspects of fugue state

There are two types of memory loss—global and situation-specific. Global amnesia, also known as fugue state, refers to a sudden loss of personal identity that lasts a few hours to days, and is typically preceded by severe stress and/or depressed mood. Fugue state is very rare, and usually resolves over time, often spontaneously. In most cases, patients lose their autobiographical memory and personal identity even though they are able to learn new information and perform everyday functions normally.
There are three types of memory—sensory, short-term, and long-term memory. Sensory memory lasts up to hundreds of milliseconds; short-term memory lasts from seconds to minutes; while anything else longer than short-term memory is considered to be a long-term memory. Information obtained from the sensory organs is processed in four stages - encoding, consolidating, storage, and retrieval. During encoding, the limbic system is responsible for filtering information obtained from the sensory organs. According to the type of information being processed in a given instance, the duration of consolidating stage varies drastically. The majority of consolidated information gets stored in the cerebral cortical networks where the limbic system record episodic-autobiographical events. These stored memories can be obtained by triggering the uncinate fascicle that interconnects the regions of the junction of temporal and frontal lobes of brain.

Emotions and memory

Emotion seems to play an important role in memory processing. Functional imaging of brains of normal persons reveals that the amygdala in the right brain and the ventral prefrontal regions are activated when they were retrieving autobiographical information and events.
Researchers have found that emotional memories can be suppressed in individuals via the prefrontal cortex in two stages - an initial suppression of the sensory aspects of the memory, followed by a suppression of the emotional aspect. Psychogenic amnesia is characterized by the loss of the ability to retrieve stored memory without any apparent neurological damage.
Psychogenic amnesia is a common plot device in many films and books and other media. Examples include Shakespeare’s King Lear who experienced amnesia and madness following a betrayal by his daughters

Thursday, March 1, 2012

Neuro-cognitive aspects of mystical experience

A vignette

A senior citizen of Hindu faith, aged 74, who recently has had mystical experiences and visions, was brought to me to rule out any psychological abnormalities. I interviewed the man for about 45 minutes and could not find any psychological abnormalities. He insisted that he experienced the presence of the Hindu God Mahavishnu during meditation, which he continued through the whole night some days. He started meditation a decade ago. He learned it from a guru in an ashram, a Hindu spiritual hermitage. After a few years of doing the meditation regularly he started experiencing the visions of God. At the time of visions he experienced oneness with the cosmos and it gave him intense joy.
The visionary man was at a loss to understand why others in his family were worried about his vigils, extending whole nights, in order to have godly visions and mystical experiences. He compensated the loss of sleep at night by sleeping in day time. I referred the old man to a scan centre to have an MRI scan to exclude any structural anomalies in the brain. The scan showed a normal brain with changes expected for his age. I assured the relatives of the man that his ‘visions’ and ‘mystical experiences’ were quite normal. Any normal person, who meditates, cutting off all the sensory inputs, may have such mystical experiences. A person without any religious faith also may have mystical experiences. Such experiences are called “mystical” because one cannot explain properly what it is.

What is mystical experience?

The term mysticism is derived from the Greek mystikos, meaning 'an initiate'. A "mystikos" was an initiate of a mystery religion. The Eleusinian Mysteries, initiation ceremonies in the cults of the goddesses Demeter and Persephone, were held in secret at Eleusis (near Athens) in ancient Greece. The mysteries began in about 1600 B.C. in the Mycenean period of Greek history and continued for two thousand years, becoming a major festival during the Hellenic era, and later spreading to Rome.
The present meaning of the term mysticism evolved through Platonism and Neoplatonism—which referred to the Eleusinian initiation as a metaphor for the initiation to “spiritual truths”. It is the pursuit of communion with, identity with, or conscious awareness of an ultimate reality, divinity, spiritual truth, or God through direct experience, intuition, instinct or insight. Mysticism usually centers on practices intended to inspire those experiences.

Many of the world's great religions have arisen around the teachings of mystics; and most religious traditions describe fundamental mystical experience, at least esoterically.  

Mystical experience of Prophet Muhammad

One night Prophet Muhammad, while meditating in loneliness, in the Hira Cave situated in the vicinity of Mecca city, had visions and mystical experiences on two occasions which are well documented in the Koran, in the following verses:
I swear by the star when it goes down.
Your companion does not err, nor does he go astray;
Nor does he speak out of desire.
It is naught but revelation that is revealed,
The Lord of Mighty Power has taught him,
The Lord of Strength; so he attained completion,
And he is in the highest part of the horizon.
Then he drew near, then he bowed
So he was the measure of two bows or closer still.
And He revealed to His servant what He revealed.
The heart was not untrue in what he saw.
What! Do you then dispute with him as to what he saw?
And certainly he saw him in another descent,
At the farthest lote-tree;
Near which is the garden, the place to be resorted to.
When that which covers covered the lote-tree;
The eye did not turn aside, nor did it exceed the limit.
Certainly he saw of the greatest signs of his Lord.
(Koran: 53.001-018 English Translation by Muhammad Habib Shakir)

Mystical experience induced by drugs

An easy way to induce mystical experiences is consumption of psychedelic drugs. 
Aldous Huxley experimentally took mescaline and wrote about his experiences in the famous book Doors of Perception: 
Aldous Huxley
 The change which actually took place in that world was in no sense revolutionary. Half an hour after swallowing the drug I became aware of a slow dance of golden lights. A little later there were sumptuous red surfaces swelling and expanding from bright nodes of energy that vibrated with a continuously changing, patterned life. At another time the closing of my eyes revealed a complex of gray structures, within which pale bluish spheres kept emerging into intense solidity and, having emerged, would slide noiselessly upwards, out of sight. But at no time were there faces or forms of men or animals. I saw no landscapes, no enormous spaces, no magical growth and metamorphosis of buildings, nothing remotely like a drama or a parable. The other world to which mescaline admitted me was not the world of visions; it existed out there, in what I could see with my eyes open. The great change was in the realm of objective fact. What had happened to my subjective universe was relatively unimportant.

Psychology of mystical experience 

William James
William James (1842 – 1910) a pioneering American psychologist and philosopher, who was trained as a physician, wrote two books on mystical experiences, viz. The Varieties of Religious Experience and Understanding Mysticism.  In these books, William James attempts to define mystical states of consciousness as "real" experiences, that is to say a valid topic of investigation and study, and to show them as available to most people. He stipulated four criteria for identification for identification of mystical experiences:
  1. Ineffability – the handiest of the marks by which he classified a state of mind as mystical is negative. The subject of it immediately says that it defies expression that no adequate report of its contents can be given in words. It follows from this that its quality must be directly experienced; it cannot be imparted or transferred to others.
  2. Noetic quality – Although so similar to states of feeling, mystical states seem to those who experience them to be also states of knowledge. They are states of insight into the depths of truth unplumbed by the discursive intellect. They are illuminations, revelations, full of significance and importance … and as a rule they carry with them a curious sense of authority for after-time.
  3. Transiency – Mystical states cannot be sustained for long. Except in rare instances, half an hour, or at most an hour or two, seem to be the limit beyond which they fade into the light of common day.
  4. Passivity – Although the oncoming of mystical states may be facilitated by preliminary voluntary operations, as by fixing the attention, or going through certain bodily performances, or in other ways which manuals of mysticism prescribe; yet when the characteristic sort of consciousness once has set in, the mystic feels as if his own will were in abeyance, and indeed sometimes grasped by a superior power.

A neuro-cognitive perspective on spiritual experiences

It appears that there are a variety of spiritual experiences that may seem to be different, but actually have a similar neuro-cognitive origin. These experiences lie along a continuum. On one end of the spectrum are experiences such as those attained through participating in a church liturgy or watching sunrise and sunset. These experiences carry with them a mild sense of being connected with something greater than the self. On the other end of the spectrum are the types of experiences usually described as mystical or transcendent as reported by the senior citizen presented in the vignette in the beginning of this blog-post.

A neuro-cognitive analysis of mysticism and other spiritual experiences might clarify some of the issues regarding mystical and spiritual experiences underlying brain structures and their related cognitive functions. In terms of the effects of ceremonial ritual, rhythmicity in the environment felt by the individual through vision, hearing or touch drives either the sympathetic nervous system, which is the basis of the fight or flight response and general levels of arousal, or the parasympathetic nervous system, which is the basis for relaxing the body. Together, the sympathetic and parasympathetic systems comprise the autonomic nervous system, the most primitive neuronal organization in the evolution of the nervous system of animals. This system regulates many body functions, including heart rate, respiratory rate, blood pressure, and digestion without awareness of the  individual. During spiritual experiences, there tends to be an intense activation of one of these systems, giving rise to either a profound sense of alertness and awareness (sympathetic) or oceanic blissfulness (parasympathetic). It has also been shown that both the sympathetic and the parasympathetic mechanism might be involved in spiritual experiences since such experiences contain both arousal and quiescent-like cognitive elements.
The upper portion of the hind part of the parietal lobe of brain's called posterior superior parietal lobule plays an important role in generation of the mystical experiences. The inhibition of sensory information may prevent this area from performing its usual function of helping to establish a sense of self and distinguishing discrete objects in the environment. The result of this inhibition of sensory input could result in a sense of wholeness becoming progressively more dominant over the sense of the multiplicity of baseline reality. The inhibition of sensory input could also result in a progressive loss of the sense of self.
Individual practices like prayer or meditation may also access a similar neuronal mechanism. In such a practice, a person begins by focusing the mind as dictated by the particular practice, thereby affecting higher-level processing areas of the brain and ultimately the autonomic nervous system. For example, a meditation practice in which the person focuses on a visualized object of spiritual significance might begin with activation of the brain's prefrontal cortex (PFC), which is normally active during attention-focusing tasks. The continuous fixation on the image by the areas of the brain responsible for high order visual processing begins to stimulate the limbic system, which is primarily involved in emotional processing and memory. Several scholars have implicated this area as critical for religious experience because of its ability to label experiences as profound or real and also because certain pathological conditions, such as seizures and tumors in the limbic areas, have been particularly associated with extreme religious experiences. The limbic system is connected to a structure called the hypothalamus, making it possible to communicate the activity occurring in the brain to the rest of the body. The hypothalamus is a key regulator of the autonomic nervous system, and therefore such activity in the brain ultimately activates the arousal (sympathetic) and quiescent (parasympathetic) arms of the autonomic nervous system.
The cognitive state in which there is a unity of all things, including the self, the world, and objects in the world, is described in the mystical literature of all the world's great religions. When a person is in that state all sense of discrete being is lost and the difference between self and other is obliterated. There is no sense of the passage of time, and all that remains is a timeless undifferentiated consciousness. When such a state is suffused with positive affect there is a tendency to describe the experience as personal. Such experiences may be described as a perfect union with God, as in the unio mystica of the Christian tradition, or else the perfect manifestation of God in the Hindu tradition.

New technology for studying spiritual experiences

fMRI pictures of brain in meditation
Studies of meditation have evolved over the years to utilize the most advanced technologies for studying neurophysiology. In the beginning, studies analyzed the relationship between meditative states and electrical changes in the brain as measured by electroencephalography (EEG). Proficient meditation practitioners have been shown to demonstrate significant changes in the electrical activity in the brain, particularly in the frontal lobes. Furthermore, the EEG patterns of meditative practice indicate that it represents a unique state of consciousness different from normal waking and sleep. But EEG is limited in its ability to distinguish particular regions of the brain that may have increased or decreased activity. For this reason, more recent studies of meditation have used brain imaging techniques, such as single photon emission computed tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). Since about 1990, neuro-imaging techniques have been used to explore cerebral function during various behavioral, motor, and cognitive tasks.