Viraj's Weblog

Awhile ago I read a book about the history of psychosurgery. The timing was good because Shutter Island came out shortly afterwards, and one thing I liked about that movie is how true it was to the so-called science of the time. It's sometimes amazing to see how well-educated doctors looked at "diseases" and "cures." I'm sure 50 years from now, people will look upon medical science of today with equivalent horror. It's all relative.

To give an idea, the book describes one look at homosexuality:

The whole presentation reminds me of a time when they used to treat homosexuality by prostatic massage. I recall such a patient who had been treated ... for two years, but he was still homosexual ... As the physician in question was a man of the highest type, I was sure he must attribute some virtue to such treatment, so I asked him how he expected to cure homosexuality by prostatic massage. He thought the massage might rub out the homosexual cells and that they would be replaced by heterosexual cells ...

The book is generally about Walter Freeman, who was widely known for performing lobotomies with an ice pick. Note this person was not even a doctor. He used to do outpatient calls and perform lobotomies in the comfort of your own home. That's how mainstream this became.

Esteemed journals like JAMA talked about lobotomies of course:

An emotional attitude of violent unreasoning opposition to this form of treatment [lobotomy] would be inexcusable. True it is a mutilating operation and it does result in certain defects in personality and behavior. However, much surgery is mutilating in the sense that some ordinary normal tissue is removed in order to achieve a beneficial result ...

Yes, similar to how building muscles involve first causing damage to the muscle to induce a strengthening recuperation right? Actually you can see some of my thoughts on that matter. But really, how did it make crazy people better? Here is an interesting experiment:

There is an obvious change in personality. The monkey loses its preoperative shyness and is less fearful of man. It appears more inquisitive than the normal monkey of the same age. In a large cage with other monkeys of the same size, such an animal shows no grooming behavior or acts of affection towards its companions. In fact, it treats them as it treats inanimate objects and will walk on them, bump into them if they happen to be in the way, and will even sit on them. It will openly eat food in the hand of a companion without being prepared to do battle and appears surprised when it is rebuffed. Such an animal never shows actual hostility to its fellows. It neither fights nor tries to escape when removed from a cage. It acts under all circumstances as though it had lost its "social conscience." ... It is thus evident that following removal of the anterior limbic area, such monkeys lose some of the social fear and anxiety which normally governs their activity and thus lose the ability to accurately forecast the social repercussions of their own actions.

Interestingly, the Catholic church took a cautious approach. As long as the doctors made sure to leave an important part in the brain:

A retreat was held to consider some of the questions raised by lobotomy for the Church and for Catholics in general. It was decided that a person should not be accepted into the priesthood after a lobotomy, and that a lobotomized priest should not hear confessions or administer the sacraments as "here the safer course must be followed." ... Much weight was given ... to an encyclical issued by Pope Pius XII, which implied that an operation that made a Catholic an "automaton" by removing "free will" would be unlawful, but did not object to lobotomy if "free will" was retained, even if there was some diminution of personality. If the soul could survive death, it could probably survive a lobotomy, one member of the Catholic hierarchy observed.

Yes, please leave the "free will" section intact. Lobotomies played a part in politics too, as mentioned by a California neurosurgeon:

The person convicted of a violent crime should have the chance for a corrective operation ... Each violent young criminal incarcerated from 20 years to life costs taxpayers perhaps $100,000. For roughly $6000, society can provide medical treatment which will transform him into a responsible well-adjusted citizen.

If you call within the next 20 minutes, you will receive a second one for free! Lobotomies are of course cheaper than mental institutions. Ever wonder where all the institutions went? There used to be a lot more. Now people who would be considered patients in the past roam society. That's because we have newer "cures".

What I found really interesting in the book is the conversion of lobotomies to today's pharmacological solutions. Actually there was a big debate between the surgical vs the pharmacological. The first was the advent of chlorpromazine. If you will recall, this was mentioned in the movie Shutter Island. This drug, like many, was found by accident:

Chlorpromazine [Thorazine] was inadvertently discovered following experimentation with antimalarial compounds and drugs to prevent surgical shock, and antidepressant drugs were discovered by their unexpected mood-elevating effects on tubercular patients.

Freeman embraced the coming drug horizon. That's because he considered it equivalent to lobotomy:

Freeman acknowledged that lobotomy was being eclipsed by the new drugs, whose effect he called "chemical lobotomy," and said that this was a "good thing as far as it concerns chronic hospital patients."

Drugs are definitely less scary than ice picks. The rest is history. The number of antipsychotic drugs out there is staggering. In some way they seek to alter the mind. Was Freeman right in equating them chemical lobotomies?

Just finished the excellent book How Pleasure Works. Here are some interesting quotes.

What kind of pictures would you expect monkeys to like looking at? One is very obvious, the other is not:

In a recent study, male rhesus monkeys were put into an experimental setup where they could choose, by moving their heads, to either receive some sweet fruit juice or to get to look at a picture. There were two sorts of pictures that monkeys would give up the juice for - female hindquarters and the faces of high-status male monkeys. Two major vices - pornography and celebrity worship - are not exclusively human.

Another interesting topic is how we tend to treat pictures as the real thing.

My colleagues and I recently did a series of studies in which we took pictures of people's precious objects - their wedding rings, say - and asked them to cut the pictures up. They were willing to do so, but measures of skin conductance showed that they were in a state of mild anxiety, as if they were destroying the precious things themselves. And if you ask people to throw darts at pictures of babies, they tend to miss.

Then there is the idea of why we like to watch horror films, or gawk at anything where someone is in a bad predicament. It's the same reason why we play-fight:

We are drawn, then, toward worst-case scenarios. The details of the scenarios are often irrelevant. It's not that we enjoy zombie films because we need to prepare for the zombie uprising. We don't have to plan for what to do if we accidentally kill our fathers, or marry our mothers. But even these exotic cases serve as useful practice for bad times, exercising our psyches for when life goes to hell. From this perspective, it's not the zombies that make zombie films so compelling, it is that the theme of the zombies is a clever way to frame stories about being attacked by strangers and betrayed by those we love. This is what attracts us; the brain eating is an optional extra.

And what about chili peppers or other foods no other animal would eat?

.. it is hard to see why we would need to practice eating spicy foods or taking hot baths. These Rozin cases might have a more utilitarian explanation, something along the line of the awful old joke about the guy who was banging his head against the wall; when asked why he was doing it, he said, "It feels so good when I stop." For some of Rozin's examples, the initial pain might be worthwhile because it is outweighed by the later pleasure. We might grow to like the pain of stepping into a hot bath, because it is always followed by the bliss of when the temperature becomes just right.

Another interesting quote from Eating Animals spoken by a factory farmer. This is perhaps the best argument for factory farms I've heard:

I've told you the drawbacks because I'm trying to be up-front with you. But in fact, we've got a tremendous system. Is it perfect? No. No system is perfect. And if you find someone who tells you he has a perfect way to feed billions and billions of people, well, you should take a careful look. You hear about free-range eggs and grass-fed cattle, and all of that's good. I think it's a good direction. But it ain't gonna feed the world. Never. You simply can't feed billions of people free-range eggs. And when you hear people talking about small farming as a model, I call that the Marie Antoinette syndrome: if they can't afford bread, let them eat cake. High-yield farming has allowed everyone to eat. Think about that. If we go away from it, it may improve the welfare of the animal, it may even be better for the environment, but I don't want to go back to China in 1918. I'm talking about starving people.

Granted, it's a bit one-sided. Of course people could stop eating meat, but the idea of feeding billions any type of food that they can afford is going to result in large-scale factories of some sort. Quality is going to suffer, and problems like long-term effects of genetic engineering of foods will arise, but to feed the population of the world, family farms likely won't cut it. It's a huge demand for cheap food, and that demand grows with the population.

Do you think family farms are going to sustain a world of ten billion?

Step your mind into a crowded elevator, an elevator so crowded you cannot turn around without bumping into (and aggravating) your neighbor. The elevator is so crowded you are often held aloft. This is a kind of blessing, as the slanted floor is made of wire, which cuts into your feet.

After some time, those in the elevator will lose their ability to work in the interest of the group. Some will become violent; others will go mad. A few, deprived of food and hope, will become cannibalistic.

There is no respite, no relief. No elevator repairman is coming. The doors will open once, at the end of your life, for your journey to the only place worse (see: PROCESSING).

The quote could be talking about overpopulation, but it's referring to the use of 'battery cages' by chicken farmers. I'm reading Eating Animals, a wittily written book on, well, eating animals.

Another good quote about KFC:

Formerly signifying Kentucky Fried Chicken, now signifying nothing, KFC is arguably the company that has increased the sum total of suffering in the world more than any other in history.

Heh, reminds me of an old KFC commercial, where Kernel Sanders tries to cater to 'urban' audiences by yelling "Booyah!"

Another good quote from Genetic Rounds:

It was not because I'm a brilliant diagnostician or because I'm a sensitive listener that I happened to make the diagnosis of acute intermittent porphyria in Nicole and her mother (a diagnosis that was ultimately confirmed through the demonstration of a deficiency of the enzyme uroporphyrinogen I synthase in the girl's red blood cells). Had I seen this family one year before, I'm sure I would have failed, just like the dozen other specialists who had seen Nicole in the past. No, in the case of Nicole Ludlow, I was able to come up with the correct diagnosis simply through dumb luck: the Ludlows and I had managed to run into each other in exactly the right place at exactly the right time.

Dumb luck is an important factor in the lives of clinical geneticists. Dumb luck and hunches, and a little bit of knowledge of weird rare facts, are pretty much all that keep me in business.

The author gives a harrowing story about an infant born with a debilitating disease, to its possible association with vampires:

... After repeated exposure to light, people with CEP [congenital erythropoietic porphyria] become more and more disfigured: their skin becomes covered with scars, and some areas on their scalp lack hair whereas some areas on their skin sprout hair indiscrimately.

Interestingly, it is the presence of these clinical features that has led some medical historians to speculate that individuals with CEP served as the origin of the legend of the vampire, an ancient myth that is present in a large number of diverse cultures. Vampires are portrayed as deceased individuals who find themselves rejected by the hallowed earth of cemeteries because they have been cursed in some way. Unable to achieve a state of peace in their own graves, they metamorphosize into the undead or the living dead, trapped between the worlds of the living and the dead. Hideously ugly and constantly in need of sustenance, vampires are destined to walk the earth after dark, looking to feed on the blood of the innocent.

Now consider individuals with CEP. Because the porphyrins in their bloodstream result in photosensitivity, these people's faces are scarred. And because of the photosensitivity, coupled with their psychological sensitivity, they learn early in life to leave their homes only at night. Finally, because of the deposition of the abnormal red porphyrins in the structure of their teeth, people with CEP develop erythrodontia (literally, "red teeth"), giving the uninformed the impression that they have been drinking blood. It's not difficult to understand how, in an age when superstition and ignorance ruled, the birth of an infant with CEP might have led to the beginning of a tale of the undead that ultimately grew into today's legend.

He goes on:

It's never difficult to figure out when Edwin has been admitted to the hospital: he's the one in the room in which the shades have been drawn, the lights have been turned out, and the light switch has been taped into the off position. In his hospital crib, Edwin lies behind an orange Plexiglas sheet that blocks out most of the wavelengths of light that would prove most harmful to his skin. Because of the careful precautions taken by his parents, Edwin's skin is not terribly scarred at this point. But how can a child live like this? How can he grow and develop, make friends, go to school, and live in society with a condition that allows him to exist outside his home only in the dark?

However, the postscript to this story has a happy ending. Through a bone marrow transplant this boy was eventually cured.

I'm reading another fascinating book called Genetic Rounds about a medical geneticist's experiences. In one chapter, the author describes a mother who comes in with her baby, Jarett, suddenly not wanting to eat any more and whose body is becoming floppy. The discussion steers towards his sibling, Shadow, and her oatmeal breakfast:

"We let her use honey," she replied. "Never more than one or two teaspoons."

"Refined honey?" I asked, again knowing the answer before I asked the question.

"Of course not," the mother replied, repeating that angry look. "The refining process strips the honey of all its natural goodness. We allow only pure, unrefined honey in our house. Everything we put into our bodies is pure and natural. That's why our family has always been so healthy."

I continued: "Ms. Fox, we have to do some tests, but I think Jarrett's going to be okay. I'm pretty sure he's got botulism."

The doctor then imagines a scenario where the older sibling spoonfeeds her little baby brother some honey-laced oatmeal. A possibility. He then goes on:

Like Ms. Fox, most Americans believe that when applied to foods, terms like pure and natural are synonymous with healthy and nutritious. Although this thinking may be accurate for many foods, in the case of honey, eating it in its natural state can lead to serous disease or even death. Because of the environment in which it's produced, unprocessed honey often contains spores of Clostridium botulinum, the bacterium that causes botulism. In most humans, the presence of these spores presents no significant problem: the environment of the stomach and intestinal tracts of older children and adults readily destroys the toxin. But in children under one year of age, infants whose intestinal tracts are still immature, the presence of the toxin, which can survive its stay in the gut unscathed, spells big trouble: after traveling through the gut's lining and entering the bloodstream, the spores are carried throughout the body, where they bind to peripheral nerves and thus prevent them from being able to carry messages from the central nervous system to the muscles. Within hours of ingesting even tiny amounts of contaminated honey, these previously healthy infants become profoundly floppy, lethargic, and placid, unable to smile or cry or suck. If the dose of spores is large enough, every muscle, including those involved in breathing, becomes paralyzed. If not recognized quickly, affected infants may simply stop breathing, suffering respiratory failure so severe that death occurs within minutes.

Think twice about so-called natural foods.