Thursday, December 8, 2016

Patagonia & Nudibranch: Einstein, Music & Memory!



©2015 Am Ang Zhang

No I did not do any diving in Patagonia!


We were having dinner at our Ecocamp in Patagonia with a very interesting couple.
The husband is aiming to climb the Matterhorn and somehow in the conversation we talked about their other adventures that included Diving. I show them some of my underwater pictures. Somehow Nudibranch was mentioned and as it turned out we exchange email addresses and became good friends.

Nudibranch reminded me of Aplysia and Kandel:







Nudibranch © 2009 Irene Man


Nudibranch is so named because of its naked gills.
Here is a description in The National Geographic:

Nudibranchs crawl through life as slick and naked as a newborn. Snail kin whose ancestors shrugged off the shell millions of years ago, they are just skin, muscle, and organs sliding on trails of slime across ocean floors and coral heads the world over.

Found from sandy shallows and reefs to the murky seabed nearly a mile down, nudibranchs thrive in waters both warm and cold and even around billowing deep-sea vents. 


So why, in habitats swirling with voracious eaters, aren't nudibranchs picked off like shrimp at a barbecue? The 3,000-plus known nudibranch species, it turns out, are well equipped to defend themselves. Not only can they be tough-skinned, bumpy, and abrasive, but they've also traded the family shell for less burdensome weaponry: toxic secretions and stinging cells. A few make their own poisons, but most pilfer from the foods they eat. Species that dine on toxic sponges, for example, alter and store the irritating compounds in their bodies and secrete them from skin cells or glands when disturbed. Other nudibranchs hoard capsules of tightly coiled stingers, called nematocysts, ingested from fire corals, anemones, and hydroids. Immune to the sting, the slugs deploy the stolen artillery along their own extremities.


Memory & Knowledge: Talmud & Taxi

In 2001 I was fortunate enough to be in New Orleans for the American Psychiatric Association Annual Conference. One of the lectures attracted a long queue and it turned out that the Nobel Laureate Eric Kandel was giving his lecture. I was fortunate enough to be able to secure a seat.

"Different forms of learning result in memories by changing that strength in different ways. Short-term memory results from transient changes that last minutes and does not require any new synthesis of proteins, Kandel said. However, long-term memories are based in more lasting changes of days to weeks that do require new brain protein to be synthesized. And this synthesis requires the input of the neuron’s genes." Eric Kandel.

In his book In Search Of Memory, he remembered his arrival in New York in 1939 after a year under the Nazi in Vienna:

“My grandfather and I liked each other a great deal, and he readily convinced me that he should tutor me in Hebrew during the summer of 1939 so that I might be eligible for a scholarship at the Yeshiva of Flatbush, an excellent Hebrew parochial school that offered both secular and religious studies at a very high level. With his tutelage I entered the Yeshiva in the fall of 1939. By the time I graduated in 1944 I spoke Hebrew almost as well as English, had read through the five books of Moses, the books of Kings, the Prophets and the Judges in Hebrew, and also learned a smattering of the Talmud.”

Eric Kandel/Amazon


“It gave me both pleasure and pride to learn later that Baruch S. Blumberg, who won the Nobel Prize in Physiology or Medicine in 1976, had also benefited from the extraordinary educational experience provided by the Yeshivah of Flatbush.”

In Hebrew and English!!! That did not seem to have done him and Blumberg much harm. Right now some governments seem hell bent in doing away with rote learning and that includes some medical schools.

Lord Brain:
When I was training in London in the 70s, I spent some time at Queen Square. Those in the know will recognize it as the place for neurology this side of the Atlantic. It was drilled into us then that sadly we were given a number of brain cells when we were born and it was all downhill from then on or something to that effect. It was well known that neurologists were great diagnosticians but for most neurological conditions, not much could be done. How depressing indeed. Even as recently as four weeks ago, I heard a young doctor told his father that there was nothing he could do with his brain cells. One is given so many at birth and no more can be expected. Lord Brain (1895-1966) would have been so proud.


Knowledge:

Yet it was also London that shook the world with new discoveries about the brain, and the study was on the most unlikely group of people: Taxi drivers. Their “KNOWLEDGE” was the basis of our knowledge on brain plasticity today. The “KNOWLEDGE” is a term officially used to describe the test the Taxi Drivers had to take to get the license to drive Taxis in London. Streets in London have evolved over time and are not on any grid system at all. Early postmortem examinations led some pathologists to note the small size of the Taxi drivers’ frontal lobes. Yet actual weight measurement showed that size was all relative. It was the enlarged hippocampal region that created that impression. Later work using modern scanning techniques confirmed the early impressions.

Music, poetry & anatomy:

Playing musical instruments requires both manual dexterity and memory work, and musicians are often good mathematicians, possibly because of the proximity of the areas in the brain for these functions, although it may not be that clear cut. Making children recite poems is not a bad idea either, nor indeed the study of Latin, or anatomy work for medical students, as these activities all help to exercise their brain.
Einstein loved his violin!

He played the violin with passion and often performed at musical evenings. He enchanted audiences, particularly women, one of whom gushed that "he had the kind of male beauty that could cause havoc."

He also empathized with Mozart's ability to continue to compose magnificent music even in very difficult and impoverished conditions. In 1905, the year he discovered relativity, Einstein was living in a cramped apartment and dealing with a difficult marriage and money troubles.

That spring he wrote four papers that were destined to change the course of science and nations. His ideas on space and time grew in part from aesthetic discontent. It seemed to him that asymmetries in physics concealed essential beauties of nature; existing theories lacked the "architecture" and "inner unity" he found in the music of Bach and Mozart.

In his struggles with extremely complicated mathematics that led to the general theory of relativity of 1915, Einstein often turned for inspiration to the simple beauty of Mozart's music.

"Whenever he felt that he had come to the end of the road or into a difficult situation in his work, he would take refuge in music," recalled his older son, Hans Albert. "That would usually resolve all his difficulties."


Now lessons in music instruments are no longer offered in most state schools in the U.K., nor is Latin. Medical schools are moving away from rote learning. Good intentions may indeed have major drawbacks that could affect generations to come.

By the way, if you have been trained to have a good memory, that ability will transfer easily to the remembering of the taste of wine! Think about it, the brain is very economical in its application, and is still the best computer around.

Mmmm….perhaps that is why two of my friends started learning the piano when they retired. And they joined wine clubs too. They too might know a thing or two.

If we want our children to have a future, bring back music, rote learning and poetry, and let medical students toil through anatomy.

For us, learn a new instrument & drink wine!

  


Monday, October 24, 2016

Chicago: From Magritte to Amanda



Could the Cockroach Catcher have missed this exhibition?


Art Institute of Chicago’s new special exhibition, “Magritte: The Mystery of the Ordinary, 1926-1938.”

 “Magritte was an amazing artist who has much to offer us today,” said Stephanie D’Alessandro, the Gary C. and Frances Comer Curator of Modern Art at the Art Institute, who was instrumental in assembling this exhibition of nearly 80 paintings, plus collages, objects, photographs, periodicals and examples of the artist’s work in advertising.
“I think that living in an age of mobile phones, in which we are so used to acquiring all sorts of information with great speed — and assuming it is ‘correct’ — has resulted in a loss of the ability to let a picture really take us into its own world, with all its unique habits and customs. So working with installation designer, Robert Carson, I’ve tried to create a series of small, initially quite dark spaces that should help make the experience of each art work more intense and intimate, and will let your imagination tell you where you want to go.”
The Magritte show, awash in images at once grotesque and erotic, mundane and mysterious, unspools in more or less chronological order. It begins with the crucial body of work, both paintings and paper collages, that he created in 1926 and exhibited the following year in his first one-man show at the elegant Galerie Le Centaure in Brussels — a show greeted by mostly negative reviews. It moves on to his subsequent time in Paris, where he lived for three years, becoming part of the Surrealist circle led by the French poet and theorist, Andre Breton, and such artists as Salvador Dali and Joan Miro.

 Magritte reminds me of Amanda.

Amanda
         My old secretary Karen went to work for a plastic surgeon in the local hospital specializing in burns. Out of the blue she gave me a call. 

         “It is about Amanda. You should see her. She has all these scars on her.”

         It had been over two years since I last saw Amanda. It was rather sad as she had a real talent in art and I managed to secure the last ever support from the Education Authorities for accommodation for her at the Art College. But she dropped out after a year.  Nevertheless she still managed to make appointments to see me a couple of times before disappearing.  

         “Why don’t you ask her to arrange to see me next time she has a follow up at the clinic.”

         “That should not be a problem.”
         “But only if she wants to.”
         “I think you may still be of some help.”

         Well, Karen actually drove Amanda to my clinic late that afternoon and I stayed on to see her. Luckily Karen was still in the room with me when Amanda simply decided to lift her T-shirt. She was not wearing anything else underneath and what she revealed was a body covered in a number of three to four inches long keloidal scars. Some were actually over her breasts.

         Karen stayed as chaperone and Amanda did not seem to mind. In our work there are certain risks when you see young people on their own and more so when you see someone like Amanda. I sometimes felt rather unsafe with some of the mothers too.

         Amanda was first presented to me as a severe anorectic who more or less required immediate hospital admission. I put her in the paediatric ward rather than referred her to the hospital as at that time we were having some trouble with the quality of care there.

         At the time, her weight was dangerously low. She was the only patient that I had to keep in the hospital over Christmas. It was rather strange that she seemed quite happy to do so. There were no protests from the parents either.  It meant that I had to see her on Christmas day and I even bought her a nice soft toy for a present, something I had never done before or after.

         Her body weight gradually picked up and it was time for some trial home leave. She pleaded with me not to let her go home even for half a day.

         I did not want her to become dependent on us and there was every sign that she had now settled in on the ward.

         She came back from home leave and decided not to follow our agreed contract. It was popular in those days to have a weight gain contract and we had one too. Of course now I realise how rigidity with a contract can have drawbacks. In fact in child psychiatry too rigid an approach often causes problems one way or another and it is one of the few medical disciplines with which strict guidelines are not a good idea.

         At the time, another patient was on the ward after a serious suicide attempt. She had been abused by her step-father and step-brother over the years. She had had enough and decided to end it all.  I was trying to sort out where she could go as there were all the child protection issues.  She became very friendly with Amanda.

         One day when I arrived on the ward, the Sister-in-charge handed me an envelope and said that Amanda would like me to read it first.

         I have since used the same two pages she wrote as teaching material. Most female junior doctors could not go through with reading it aloud. It is nice to think that years of medical training do not really harden someone. Or was it something too horrible to be faced with?  It was particularly upsetting when the abuser was Amanda’s father.

         Amanda was by then fourteen but her father had been abusing her since she was about eleven. Her mother worked night shifts and father would come to her bed room to tuck her in. This had been going on for as long as she could remember. She started to have budding breasts and her father would at first accidentally brush them and Amanda would be quite annoyed with that. Then one night he started fondling with her breasts and also outside her pants. She was so scared she froze and did not say anything. He went further and further until he penetrated her. She was bleeding quite badly and told her mother, who told her that was what happened to girls when they grew up. She knew what menstrual period was but she said this was different; but mum did not want to know and gave her a box of sanitary pads. Then her period started and she started to worry about becoming pregnant. Her father said it was not a problem and asked her to suck him instead. She recorded that she was sick every time. Then one day her father decided to try her “back-side”. It caused so much bleeding it stained her school skirt and when she told her mother she was bleeding from her “back side” she just said, “Don’t be silly.  It is only a heavy period.”

         It is disturbing even for me to give you the details now. But this is what is happening to many children and is happening all around the world. If anything, I probably have toned down the content of that letter. What has gone wrong with mankind?  I cannot say I know any better since my early cockroach catching days. 

         Then on the day I “forced” her to go home he picked her up and made her go down on him in the car on the way home when he parked on a lay-by.

         In the end it was the other girl in the ward who encouraged her to write to me. She told her that she suffered the same for a long time and was stupid enough to try and hurt herself before she could tell anyone.

         There was no time to waste to report this to Social Services. However, Amanda’s father, who worked at the local mental hospital, had a “breakdown” and was admitted under the Mental Health Act the night before all of this came out. Amanda was not aware of this.  When I showed mother what Amanda wrote, she just said to me, “He is in a mental hospital,” and walked out.

         It has taken me years to grasp that maternal failure plays a major role in family sexual abuse. This mother’s action says it all. Can’t you see he is mad?

         It was a most peculiar case. His psychiatrist refused to even let me know of his problem, citing patient doctor confidentiality. He obviously had not worked with child abuse. Mother denied all knowledge of the bleeding incidents and claimed that it was all in Amanda’s imagination and it became very hard trying to place Amanda because her mother would not acknowledge that there was a problem. At this time West[2] was arrested and it helped me at least to understand the unfathomable.

Magritte:
         One of the nurses who got on well with Amanda told me that I should look at her examination portfolio for art. Every picture was morbid.  One struck me with the René Magritte[3] style of surrealism. A body of a girl with a penis floating over what looked like a classical stone grave. The head was covered in cloth and separated from the body. There were many daggers on the upper body of this half-man half-woman. There was a sort of school in the distance with small figures of school children. The sky was normal blue with white clouds which contrasted dramatically with the central theme. There was no question that the sky was a Magritte sky, and so was the cloth covered head. The rest was original Amanda.

         I knew then from what I remembered of Erickson that the picture was not just about the past with which one naturally associated but also about the future. Yet it took me a few years to realise that it was about the cutting.

         She said she was now working as a waitress. Her teacher at college did not want her to do all the morbid paintings, so she quit. She had been sleeping with virtually any man she came across and every time she would cut herself afterwards. She wanted to feel something, she told me. What was worst was that whenever she was with a man she saw her father.

         What an outcome. I had spent so much time with this girl and this was in the end what happened. She said one day she would be in a mental hospital like her father, but she hoped to kill herself before then.

         I no longer remember Amanda as a severe anorectic but rather a very talented artist who suffered serious abuse. Yet in a society which prides itself in social care, she did not become a famous artist with a high income, telling all about her history of abuse in front of a famous chat show host. Nor did she become a movie star telling all after drug and alcohol rehab.

         Instead she was on benefits and I am struggling hard to find something uplifting to end this story.

It has taught me one thing: Anorexia Nervosa may be just a manifestation.

The Cockroach Catcher Chapter 33  The Peril of Diagnosis 


Sunday, October 16, 2016

Bipolar in Children: God & Scandal!

In The New York Times:

"In a contentious Feb. 26 deposition between Dr. Biederman and lawyers for the states, he was asked what rank he held at Harvard. 


“Full professor,” he answered.
“What’s after that?” asked a lawyer, Fletch Trammell.
“God,” Dr. Biederman responded.
“Did you say God?” Mr. Trammell asked.
“Yeah,” Dr. Biederman said.




"One million children have been diagnosed with this new and controversial diagnosis – “childhood bipolar.”  And one million children are being treated for “childhood bipolar” disorder and more and more at younger and younger ages."

After the AHRP Infomail about the ever so gentle rebuke meted out to Drs. Joseph Biederman, Thomas Spencer and Timothy Wilens by Harvard University-affiliated Massachusetts General Hospital, we received an essay (posted below) from Jacob Azerrad, PhD, a clinical psychologist. 

Dr. Azerrad notes:

" The real scandal perpetrated by Biederman has nothing to do with his consulting fee shenanigans and everything to do with the real life (and death) consequences of the methods now used by modern pediatric psychiatry to tag normal childhood behaviors with diagnoses – like “childhood bipolar” -- and the pediatric medical profession’s complicit acquiescence to such malarkey.  It has been nothing short an epic assault on our children by those who prescribe antipsychotic medications as an antidote to normal childhood behavior."


Dr. Biederman has been a forceful leader in encouraging the diagnosis of bipolar disorder in children. He has published numerous studies in scientific publications and has been funded by NIMH and pharmaceutical companies.  He and his research group at Harvard are strongly associated with the forty fold increase in office visits by children and adolescents for the treatment of bipolar disorder between 1994-1995 (20,000) and 2002-2003 (800,000) (Moreno et al, Archives of General Psychiatry).  Recently, he claimed that up to five percent of child psychiatric patients have bipolar disorder (see). The DSM-5 committee of the American Psychiatric Association has been critical of the diagnosis of bipolar disorder in children and plans to substitute a new diagnostic term for the children that have been characterized as bipolar by the Harvard group.

 


Until now…. only lithium has been approved to treat bipolar disorder in adolescents ages 12 and up.

Bipolar Disorder in Children

Recently a U.S. Senator uncovered something close to the Cockroach Catcher’s heart: bipolar disorder in children.

Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar. One grandmother recently asked me what I thought of Bipolar illness in children.

Being an experienced and seasoned psychiatrist, I was able to bounce the question back.

“Well my grandson of five has just been diagnosed. To me he is just an imaginative bright young thing and I never really had any problems with him when he spent part of the school holidays with me. But now he is on all these medications……” she told me.

Well, a few years ago I was at an American Psychiatric Association conference, where a strong case was made for diagnosing children with Bipolar and giving them the modern anti-psychotic drug. I was impressed then.

Later I was more impressed that a single person seemed to have been able to push through a whole new agenda for the diagnosis of Bipolar disorder in children and their treatment.

ADHD was the old black. Bipolar became the new black.
In the New York Times, the headline reads:Child’s Ordeal Shows Risks of Psychosis Drugs for Young

Chris Bickford September 1, 2010

At 18 months, Kyle Warren started taking a daily antipsychotic drug on the orders of a pediatrician trying to quell the boy’s severe temper tantrums.

Thus began a troubled toddler’s journey from one doctor to another, from one diagnosis to another, involving even more drugs. 

Diagnosis:

Autism, bipolar disorder, hyperactivity, insomnia, oppositional defiant disorder.

The boy’s daily pill regimen multiplied: the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines and one for attention-deficit disorder. All by the time he was 3.

He was sedated, drooling and overweight from the side effects of the antipsychotic medicine. ……Mother: “I didn’t have my son. It’s like, you’d look into his eyes and you would just see just blankness.”

A Columbia University study recently found a doubling of the rate of prescribing antipsychotic drugs for privately insured 2- to 5-year-olds from 2000 to 2007. Only 40 percent of them had received a proper mental health assessment, violating practice standards from the American Academy of Child and Adolescent Psychiatry.



In the New York Times, the headline reads:


Researchers Fail to Reveal Full Drug Pay

“A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.”

Who is the psychiatrist?

“By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.”
It was Dr Biederman’s presentation I heard at the conference I mentioned earlier. This is interesting!

“Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators.”

The New York Times was quick to point out that these figures were most likely an under-estimate.
“Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality…..

In the past decade, Dr. Biederman and his colleagues have promoted the aggressive diagnosis and drug treatment of childhood bipolar disorder, a mood problem once thought confined to adults. They have maintained that the disorder was underdiagnosed in children and could be treated with antipsychotic drugs, medications invented to treat schizophrenia….

Doctors have known for years that antipsychotic drugs, sometimes called major tranquilizers, can quickly subdue children. But youngsters appear to be especially susceptible to the weight gain and metabolic problems caused by the drugs, and it is far from clear that the medications improve children’s lives over time, experts say.

What is the number of children involved?
“Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager.” 


Under 6 years of age!!! Take a look at this tragedy in The Boston Globe.

A girl of 4 died. These are the words in The Boston Globe;

“Finally, it's sad but true -- the field of child psychiatry is afraid of Biederman. One can hear the worries and fears whispered in the academic halls and clinics over where Biederman has taken the profession. Yet to politely challenge Biederman in public is to risk public retribution and ridicule from him and his team. Also academic researchers in child psychiatry risk losing their funding if they criticize this darling of the pharmaceutical industry, which provides most of the money these days for psychiatric research.” Dr. Lawrence Diller
The San Francisco Chronicle 

March 27,2009
“Dr Biederman appears to be promising drugmaker Johnson & Johnson in advance that his studies on the antipsychotic drug risperidone will prove the drug to be effective when used on preschool age children.”And we do not have to wait for an eclipse. Wow! I have to declare that I have heard him at a conference and I reported this in a previous blog: Bipolar and ADHD: Boys and Breasts.

The San Francisco Chronicle article continues:


“Biederman's status at Harvard and his research have arguably made him, until recently, America's most powerful doctor in child psychiatry. Biederman has strongly pushed treating children's mental illnesses with powerful antipsychotic medicines. Diagnoses like ADHD and pediatric bipolar disorder, along with psychiatric drug use in American children, have soared in the last 15 years. No other country medicates children as frequently.”

No other country medicates children as frequently!
“Reports from court actions, along with an ongoing investigation of conflict of interest charges led by Sen. Chuck Grassley, R-Iowa, threaten to topple Biederman from his heretofore untouchable Olympian heights. Biederman has cried foul.”

“He says the drug company dollars (declared and undeclared) have not influenced him or his research. He had agreed temporarily to sever most of his financial ties with the drug industry pending the outcome of the ongoing inquiry.

“He claims his science and publications are pure, supported by a peer-review system that is supposed to verify accuracy and authenticity. Finally, he challenges as office gossip reports of his legendary anger and intolerance of those who disagree or don't support his proposals.”


Latest: 3 Researchers at Harvard Are Named in Subpoena 

Personal Experience:
Looking back at my career as child psychiatrist for over 30 years, I can count six bipolar cases, one at age 11, three between 13 and 16 and two over 16. All of them responded extremely well to Lithium.

Although the Grassley investigation did not address research quality, the New York Times article reported dissenting voices from other top psychiatrists:

“The group published the results of a string of drug trials from 2001 to 2006, but the studies were so small and loosely designed that they were largely inconclusive, experts say. In some studies testing antipsychotic drugs, the group defined improvement as a decline of 30 percent or more on a scale called the Young Mania Rating Scale — well below the 50 percent change that most researchers now use as the standard.

Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.”
This is why I have always argued that reports from parents, teachers and children cannot entirely replace direct clinical observation.

“More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.”


Money corrupts.





No risk of medication for the Cambodian children© 2009 Am Ang Zhang
Related Posts:
Lithium Bipolar and Nanking
Bipolar Disorder in Children
Bipolar and ADHD: Boys and Breasts
Statins-Harvard-Roosevelt
Bipolar Disorder: Biederman Einstein God.
Antipsychotics: Really?
Bipolar and ADHD: Boys and Breasts

Bipolar Disorder: Lithium-The Aspirin of Psychiatry?