Fig. 4 (Wexler, 2016). Lindstrom's Electro-Medical Apparatus (ca. 1895), courtesy of the Bakken.
Think the do-it-yourself transcranial direct current stimulation movement (DIY tDCS) is a technologically savvy and hip creation of 21st century neural engineering? MIT graduate student Anna Wexler has an excellent and fun review of late 19th and early 20th century electrical stimulation devices, namely the “medical battery” designed for home use.
Fig. 2 (Wexler, 2016). An advertisement for one of the few consumer medical batteries that used only direct current (1881, Frank Leslie's Newspaper). Courtesy of the Bakken.
The use of a portable electrotherapy device known as the “medical battery” bears a number of striking similarities to the modern-day use of tDCS.
Many features related to the home use tDCS—a do-it-yourself movement, anti-medical establishment themes, conflicts between lay and professional usage—are a repetition of themes that occurred a century ago with regard to the medical battery.
Viewed in historical context, the contemporary use of electrical stimulation at home is not unusual, but rather the latest wave in a series of ongoing attempts by lay individuals to utilize electricity for therapeutic purposes.
One notable difference, however, is that contemporary devices make the distinction between cranial and non-cranial stimulation, whereas the medical battery could be applied to anything that ails you: headache, backache, kidney pain, “female weakness”, “premature decline” in men, indigestion, you name it.
Old timey devices designed specifically for the head were unusual, but here are some figures from the patent for a jaunty derby hat that houses a collection of medical batteries. Alas, it never went to market.
Fig. 7. (Wexler, 2016). A medical battery mounted into a hat as depicted in a 1904 patent by George. F. Webb.
Webb (1904): “My invention relates to batteries, my more particular object being to produce a light and compact battery suitable for medical use and capable of ready adjustment without regard to the amount of current to be supplied.”
Clearly, the precursors to Silicon Valley venture capitalists missed out on a great investment. OpenBCI Derby Kickstarter, anyone?
Wexler, A. (2016). Recurrent themes in the history of the home use of electrical stimulation: Transcranial direct current stimulation (tDCS) and the medical battery (1870–1920) Brain Stimulation DOI: 10.1016/j.brs.2016.11.081
Sleek and stylish design, then and now.
Fig. 8. (Wexler, 2016). Left: advertisement for the Konzentrator, circa 1927–1928, courtesy of the American Medical Association. Right: Thync electrical stimulation device, 2015, courtesy of Thync, Inc.
Airline travel during the holidays is one big headache. But for some people, “airplane headache” is a truly painful experience. The headache occurs during take-off and landing, is unique to plane travel, and is not associated with other conditions. The pain is severe, with a jabbing or stabbing quality, and located on one side of the head (usually around the eye sockets or forehead).
A 28-year-old man developed severe headache associated with changes in altitude during ascent and descent while flying in an airplane. Jabbing pain over the forehead and between the eyes began within minutes of ascent. It resolved once a cruising altitude was reached, but then returned at the start of descent.
Six years later, another case report noted how rare it is (Domitrz, 2010):
Headache with normal examinations and imaging, occurring during an airplane flight has been rarely reported. We present a young patient with a new type of headache that appeared during flights: take-off and landing of a plane and was not associated with other conditions. This airplane headache is rather rare in population and the pathophysiology of this type is not clear.
This claim is contradicted by 240 miserable passengers who commented on The Neurocritic's 2010 post, which appeared soon after that paper was published. Granted, the comments have accumulated over six years, but they clearly show that it's not an unusual occurrence.
Now, a new Danish survey reveals that up to 8.3% of the respondents suffer from airplane headaches (Bui et al., 2016). The online survey was publicized through the Facebook pages of Scandinavian airlines and related organizations.1 The survey consisted of 14 questions. The first six asked about demographic information, including nationality, age, gender, migraine and history of high altitude headache (HAH). The other questions asked about symptoms, co-occurring medical conditions, and type of flight.
The survey participants were 254 Scandinavian air travelers. Among those, 89 (35%) said they suffer from headaches attributed to airplane travel. However, only 21 (8.3%) met the International Headache Society's diagnostic criteria for airplane headache (e.g., headache lasts less than 30 min, is not due to sinus congestion, etc.).2
The authors defined two groups: the AH group (n = 21; 12 female, 9 male) and the non-AH group (n = 233). The mean age of the AH group was 39 ± 14 years (range 19–67 yrs).
The majority of AH participants (91%) described their headache as unilateral, fronto-orbital or fronto-parietal. The headache was described mainly as “pressing” (43%), but also pulsating (29%) and stabbing (29%). The intensity of headache was described as severe (57%) or moderate (43%).
When asked to provide a possible cause for their headache, changes in cabin pressure during take-off and landing was reported as the most possible cause of their AH (95%).
The AH group was further divided into two subgroups: A medicated-group (n = 5) and a non-medicated-group (n = 16). One person took paracetamol (acetaminophen) and four used triptan drugs (used to treat migraines and cluster headaches). An earlier paper found that triptans may be effective in preventing airplane headaches (Ipekdal et al., 2011).
One caveat of the present study is that the respondents were self-selected: they visited the Facebook pages of airlines and were (probably) more inclined to complete the survey if they suffer from airplane headaches.
What causes airplane headaches? One idea is that reversible cerebral vasoconstriction syndrome (RCVS) could be involved in some cases of AH (Hiraga et al., 2016). The most prominent hypothesis suggests that barotrauma is involved, with pressure changes affecting the trigeminovascular system (Berilgen & Müngen, 2006). The most comprehensive explanation of sinus barotrauma comes from Mainardi et al. (2012), who discuss “the physical changes in the paranasal sinuses due to the modification of external ambient pressure according to Boyle’s Law.”
But why is it that relatively few people experience this excruciating pain during ascent and/or descent? Mainardi et al. (2012) again:
...the most likely AH physiopathology seems to be related to a variety of multimodal contributing factors: anatomic factors, such as acquired or congenital abnormalities of sinus outlet, environmental factors (cabin pressure, aircraft speed, angle of ascent/descent, maximum altitude), concurrent factors that act by reducing the sinus ventilation, such as a temporary mucosal oedema, possibly worsened, in predisposed individuals...
Headache Classification Committee of the International Headache Society (IHS). (2013). The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia, 33 (9), 629-808. DOI: 10.1177/0333102413485658
Headache, often severe, usually unilateral and periocular and without autonomic symptoms, occurring during and caused by aeroplane travel. It remits after landing.
A. At least two episodes of headache fulfilling criterion C
B. The patient is travelling by aeroplane
C. Evidence of causation demonstrated by at least two of the following:
1. headache has developed exclusively during aeroplane travel
2. either or both of the following:
a. headache has worsened in temporal relation to ascent after take-off and/or descent prior to landing of the aeroplane
b. headache has spontaneously improved within 30 minutes after the ascent or descent of the aeroplane is completed
3. headache is severe, with at least two of the following three characteristics:
a. unilateral location
b. orbitofrontal location (parietal spread may occur)
c. jabbing or stabbing quality (pulsation may also occur)
D. Not better accounted for by another ICHD-3 diagnosis.
10.1.2 Headache attributed to aeroplane travel occurs during landing in more than 85% of patients. Side-shift between different flights occurs in around 10% of cases. Nasal congestion, a stuffy feeling of the face or tearing may occur ipsilaterally, but these have been described in fewer than 5% of cases.
The presence of a sinus disorder should be excluded.
Phrenology was the pseudoscience of identifying a person's character and mental abilities on the basis of skull morphology (“bumps on the head”). The enterprise was based on four assumptions (Gross, 2009):
intellectual abilities and personality traits are differentially developed in each individual
these abilities and traits reflect faculties that are localized in specific organs of the cerebral cortex
the development or prominence of these faculties is a function of the activity and therefore the size of the cortical organ
the size of each cortical organ is reflected in the prominence of the overlying skull (i.e., in cranial bumps).
Gall originally identified 27 such faculties on the basis of rather flimsy and idiosyncratic evidence. His protege Johann Spurzheim upped the ante to 35 (or 37), which is what is seen on most phrenology heads.
A new article by Eling, Finger, & Whitaker (2016) reviews Gall's organology (as he called it)1 and summarizes the “history of discovery” of the 27 faculties in a handy table.2
Eling et al. consulted the 1835 English translation of Gall's original work (Sur les fonctions du cerveau et sur celles de chacune de ses parties) entitled, On the functions of the brain and of each of its parts: with observations on the possibility of determining the instincts, propensities, and talents, or the moral and intellectual dispositions of men and animals, by the configuration of the brain and head. Like its French counterpart, this tome is available from archive.org.
Oh here's a highlight. During a lecture, Gall realized the analogy between the skulls of monkeys and women, thereby christening “love of offspring”.
- click on image for a larger view -
In the rest of the paper Eling et al (2016) focus on musical ability, in particular how a five year old girl known as Bianchi influenced Gall's thinking.
1“Organology; or, An exposition of the instincts, propensities, sentiments, and talents, or the moral qualities, and the fundamental intellectual faculties in man and animals, and the seat of their organs.”
2The original table included a column with volume and page numbers for extended descriptions of each of the faculties. In the interest of space, I omitted this.
Eling, P., Finger, S., & Whitaker, H. (2016). On the Origins of Organology: Franz Joseph Gall and a Girl Named Bianchi Cortex DOI: 10.1016/j.cortex.2016.11.010
Delusional misidentification syndromes have fascinated filmmakers and psychiatrists alike. Afflicted individuals suffer under the false belief that persons or things around them have changed their identities or appearance. Classification schemes have varied, but a general outline includes:
from Table 1 (Ellis et al., 1994). Classification and description of the four principal delusional misidentification syndromes (DMS).
Bugs Bunny isn't delusional in the image above, because the mild mannered Dr. Jekyll has actually morphed into the monstrous and hideous Mr. Hyde. Or has he?
Ever have one of those days?
Cartoon interpretations of Strange Case of Dr. Jekyll and Mr. Hyde portray the mad scientist's transformation as literal, and why not? It's visually arresting. We needn't dwell on the duality of good vs. evil within, or the harmful effects of repressive Victorian [or 1950s American] mores (although Kevin McCorry makes a convincing case that Hyde and Hare is An Overlooked Masterpiece).
We present here a woman who, not content with seeing doubles, sometimes has the delusion that people around her are transformed physically and psychologically into other people.
Sylvanie G., 49 years of age (nothing to note from her family history) was admitted to Vaucluse on 9 February 1924 for melancholic depression and paranoia with ideas of persecution. She improved and was discharged on March 1924 but was readmitted 8 years later on 9 March 1932, never having lost her delusions, says the record.
. . .
Objects and animals which she owns appeared to her to be altered or simply displaced: ’They have changed my hens, they’ve put two old ones in the place of two young ones, they had large combs instead of small ones.’ People were transforming her clothes, she goes out in a brand new coat, and everyone around her looking at it is saying that she has a dirty and ripped coat (that is what she perceives). The people that she met were also changing: ’They stretch their ears... I have seen women change into men, young women into old men...’
Here's an incident involving transformation of Sylvanie G.'s husband, who reverted to his actual self just in time to repair the electrical supply:
Her husband changed in appearance, in behaviour, facially and took on the characteristic expression of some neighbour or other; it was this neighbour who had become embodied in him. “In a second my husband is taller, smaller or younger. It’s the individual into whom he is transformed who lives, who is in his skin, who moves. It’s as if you put yourself into his skin, it was you and not him. It was not merely a change, but a true transformation: 'I have changed with age, but have not transformed, I am still the same person.' One day, he changed into young M. Panier. He took on his mannerisms and face, spoke like him; but there was an electricity breakdown and M. Panier, who is not an electrician, tried in vain to repair it.”
The next documented case of intermetamorphosis wasn't published until 1978 (Malliaras et al.). Note the co-occurrence of several delusions, a common theme in these case reports.1
Ms. A, an introverted, shy, and stubborn woman of 19 with high moral standards, is the eldest of two children born to an introverted farmer and a cyclothymic housewife. Her childhood was uneventful and free from neurotic symptoms.
Her illness began when she was 18; she had difficulty in concentration, thought blocks, loosening of associations, and deterioration in scholastic achievement, followed by overt anxiety with psychomotor restlessness, insomnia, feelings of depersonalization and derealization, false memories of familiarity, auditory hallucinations, religious ideas of grandeur, and erotic delusions. Her behavior became strange and unpredictable. Later, delusional misidentifications of the intermetamorphosis type appeared and dominated the clinical picture. They consisted of her conviction that various persons (a taxi driver, a salesman, a pedestrian, a priest) were in fact Mr. B, her theology instructor, who she believed was in love with her. She insisted that these persons were physically and psychologically identical with Mr. B, and her delusional misidentifications continued even after Mr. B left the town to work elsewhere.
The patient was treated with “high doses of [unnamed] major tranquilizers” and started to improve after 6 weeks. Then after 3 months of inpatient treatment, “she was symptom-free and had developed insight into her past psychopathology.” Routine laboratory investigations were considered normal, but her neuropsych testing and EEG were not normal. Her verbal IQ was 120 but her performance IQ was only 82. This 38 point discrepancy strongly suggested that her visual perception, reasoning, memory, and other visual abilities went awry. These deficits are presumably related to her propensity for visual misidentification.
Her EEG showed diffuse abnormalities and frequent paroxysmal slow and sharp waves, especially in the temporal lobes. Stimulation with light produced high amplitude spikes, “associated with jerky movements of the upper and lower extremities (photomyoclonic response).” So even if she wasn't having frank seizures, her EEG activity was similar to what is observed in epilepsy. The authors discussed an organic contribution to her delusions, which was an era-appropriate but now quaint way of saying that something “neurological” was wrong with her brain (as opposed to something purely “psychiatric”). Although delusional misidentification syndromes can occur after brain injury and substance abuse (Silva et al., 1991), they are most often observed in the context of schizophrenia.
Silva and colleagues (1991) reported on 15 cases of intermetamorphosis, which were often accompanied by violent behavior — including murder (n=2), attempted murder (n=1), and other physically harmful behaviors (n=9). In one detailed case report, the authors described a 30 year old male who was recently jailed for violent behavior. He had been experiencing psychotic symptoms for several years. He held the delusional belief that...
...physical duplicates of his family who had different minds wanted to kill him and turn him into robot. ... The beings that inhabited the bodies of his parents and 2 sisters often transformed themselves into animals, including werewolves, vampire bats, snakes, dogs and monkeys. Frequently, he believed these animals wanted to kill him.
The poor man stabbed his sister when he believed she was transformed into a half-sister, half-snake hybrid — truly a living American Horror Story.
After the attack, he indicated that his sister was both a demon and spirit as well as a space creature that wanted to devour his head and replace it with an animal's head. He also reported that she had the power of possession.
Fortunately, his sister survived the attack. But unfortunately, the man didn't respond to antipsychotic medications. He had a history of alcohol abuse, including drinking on the day of the incident. His diagnosis was chronic schizophrenia, paranoid type.
Also fascinating are cases of reverse intermetamorphosis, where individuals believe they themselves have undergone transformation. Clinical lycanthropy, the delusion that one has been transformed into a wolf or other animal, is a special instance of reverse intermetamorphosis.
In Silva et al.'s clinical series, three of the 15 patients believed they were changing their own physical and psychological identities. Religious, social and cultural factors almost certainly influence the content of self-shifting, as is the case for other types of delusions.
What initially started as a group of 38 neuro/psych blogs in September 2010 grew to a list of 8597 independent blogs in November 2012. You can read about the history of why I initiated the neuroghetto project in this post:
An updated list of the neuroscience and psychology blogs included in the @neuroghetto feed is long overdue. Some of them are no longer active, others may have have updated their url or moved to a different site.
Without further ado, here's the list of 197 RRS feeds included in Indie Neuroblogs:
By now, those of you familiar with the “methodological terrorism” controversy (PDF) are probably sick of it. I won't go into any detail, other than to say that disagreements between the communities of (1) traditional psychologists who respect the current peer review process, and (2) reformers who advocate replication, post-publication peer review in social media, and alternate modes of dissemination, have been heated. In a nutshell, are the new media bad for science or good for science?
Here, I'd like to examine some ideas in isolation from their source(s). This is to avoid the appearance of an ad hominem attack and to maintain a civil tone. Ultimately, we may learn that abusive argumentation and incivility are less common than expected. Or not well-defined, at least.
“Attacking the person making the argument, rather than the argument itself, when the attack on the person is completely irrelevant to the argument the person is making.”
Does this really happen all that often?1 Does questioning someone's motives for maintaining the status quo constitute an ad hominem attack? If a researcher receives widespread media attention for their findings, can we find fault with their public statements, or is this ad hominem too? Off-the-cuff remarks on Twitter are the most likely place for attacks that meet the “abusive argument” definition. We should avoid it, or else it supports the trash-talk allegations.
What is the appropriate tone for online debate? Who decides? Adults have criticized the language and attitudes of youth since the beginning of time. One person's funny irreverent witticism is another's destructo-criticism.
I know I've been misunderstood. A lighthearted spoof with a bold red disclaimer (and advance apologies) was interpreted as sneering, ridiculing, and bullying (of a very senior figure). Another post, Spanner or Sex Object?, wasn't meant as methodological fetishism (so to speak). Some might say the images were objectionable, but they were included along with substantive critiques of the findings and their interpretation, not of the authors.
In the the wider world of the internet, there's no doubt that the level of hostility, trollish behavior, abusive threats, racism, and sexism have risen dramatically (just ask Leslie Jones about her Twitter experience). Let's hope that we can monitor our behavior and filter out mean spirited, personal attacks.
Peer review is more civil.
Like many others, I've suffered from the tone of anonymous peer review at journals. My very first review as a graduate student was one paragraph long. “The current work doesn't add to the literature, it detracts from it” (or something like that). The decision was made on the basis of only one reviewer. One paragraph. Overly harsh.
That was real encouraging. Enough to drive a fledgling researcher out of the field, eh? “Don't take it personally” is the recommended mantra. Don't take it personally. Don't take it personally.
Missed all the critic-bashing. Trying to settle on Methodological Terrorist, Methodological Fetishist, or Self-Appointed Destructive Critic
As Neuroskeptic wondered, when the critics of critics don't name names, how are we to know who are the objectionable ones, and who are the ones aiming to improve the field? Perhaps it's time for some self-examination, and that's true for stakeholders on both sides of the fence. My aim has always been to improve the field I love. Or else, why would I have persisted for so long?
In real life I am my own harshest critic. It's a pernicious and intractable element of my disease. I never apply the same standards to other people. I always try to frame criticism (whether in person or in anonymous peer reviews) in as positive a light as possible. “It might be better if the authors tried this...” Try to find the positive elements. Most people would say I'm very considerate.
In real life I am a self-destructive critic of the self. And this is my truth.
1 I can think of one notable exception, a very high profile public figure in the UK... and even then, much of the criticism is of her views.
2 It's mostly called The Replication Crisis in Psychology, but the strong focus has been on social psychology. Neuroimaging research (fMRI) has come under fire as well. Initiatives for data sharing (e.g., OpenfMRI and Neurovault and the fMRI Data Center well before that) and reproducibility are on the rise.
3 Hypothesizing after the results are known (Kerr, 1998)
Born in West Virginia in 1980, The Neurocritic embarked upon a roadtrip across America at the age of thirteen with his mother. She abandoned him when they reached San Francisco and The Neurocritic descended into a spiral of drug abuse and prostitution. At fifteen, The Neurocritic's psychiatrist encouraged him to start writing as a form of therapy.