Leandro Herrero – “The best contribution that Neurosciences can make to Management and Leadership is to leave the room”

A while back I reviewed I Know What You’re Thinking: Brain Imaging and Mental Privacy in the Irish Journal of Psychological Medicine, and discussed a couple of studies which illustrate the dangers of what could best be called neuro-fetishism:

In 2010, Dartmouth University neuroscientist Craig Bennett and his colleagues subjected an experimental subject to functional magnetic resonance imaging. The subject was shown ‘a series of photographs with human individuals in social situations with a specified emotional valence, either socially inclusive or socially exclusive’. The subject was asked to determine which emotion the individual in the photographs were experiencing. The subject was found to have engaged in perspective-taking at p<0.001 level of significance. This is perhaps surprising, as the subject was a dead salmon.

In 2007, Colorado State University’s McCabe and Castel published research indicating that undergraduates, presented with brief articles summarising fictional neuroscience research (and which made claims unsupported by the fictional evidence presented) rated articles that were illustrated by brain imaging as more scientifically credible than those illustrated by bar graphs, a topographical map of brain activation, or no image at all. Taken with the Bennett paper, this illustrates one of the perils of neuroimaging research, especially when it enters the wider media; the social credibility is high, despite the methodological challenges.

I am becoming quite addicted to Leandro Herrero’s Daily Thoughts and here is another. One could not accuse Herrero of pulling his punches here:

I have talked a lot in the past about the Neurobabble Fallacy. I know this makes many people uncomfortable. I have friends and family in the Neuro-something business. There is neuro-marketing, neuro-leadership and neuro-lots-of-things. Some of that stuff is legitimate. For example, understanding how cognitive systems react to signals and applying this to advertising. If you want to call that neuro-marketing, so be it. But beyond those prosaic aims, there is a whole industry of neuro-anything that aggressively attempts to legitimize itself by bringing in pop-neurosciences to dinner every day.

In case anyone doubts his credentials:

Do I have any qualifications to have an opinion on these bridges too far? In my previous professional life I was a clinical psychiatrist with special interest in psychopharmacology. I used to teach that stuff in the University. I then did a few years in R&D in pharmaceuticals. I then left those territories to run our Organizational Architecture company, The Chalfont Project. I have some ideas about brains, and some about leadership and organizations. I insist, let both sides have a good cup of tea together, but when the cup of tea is done, go back to work to your separate offices.

It is ironic that otherwise hard-headed sceptics tend to be transfixed by anything “neuro-” – and Leandro Herrero’s trenchant words are just what the world of neurobabble needs. In these days of occasionally blind celebration of trans-, multi- and poly- disciplinary approaches, the “separate offices” one is bracingly counter-cultural…

Review of I Know What You’re Thinking: Brain Imaging and Mental Privacy, Irish Journal of Psychological Medicine, February 2016

Original here

I Know What You’re Thinking: Brain Imaging and Mental Privacy, Edited by Richmond , Rees  and Edwards

 

In 2010, Dartmouth University neuroscientist Craig Bennett and his colleagues subjected an experimental subject to functional magnetic resonance imaging. The subject was shown ‘a series of photographs with human individuals in social situations with a specified emotional valence, either socially inclusive or socially exclusive’. The subject was asked to determine which emotion the individual in the photographs were experiencing. The subject was found to have engaged in perspective-taking at p<0.001 level of significance. This is perhaps surprising, as the subject was a dead salmon.

This may sound like a parody, or a debunking of neuroimaging, but in fact it was intended to point out the considerable challenge of neuroimaging research, and more specifically how the vast number of potential variables inherent in this research pushes ‘traditional’ statistical methodology to its limit.

In 2007, Colorado State University’s McCabe and Castel published research indicating that undergraduates, presented with brief articles summarising fictional neuroscience research (and which made claims unsupported by the fictional evidence presented) rated articles that were illustrated by brain imaging as more scientifically credible than those illustrated by bar graphs, a topographical map of brain activation, or no image at all. Taken with the Bennett paper, this illustrates one of the perils of neuroimaging research, especially when it enters the wider media; the social credibility is high, despite the methodological challenges.

The title of this book alone leads one to expect that it is an exploration of one widespread popular notion about neuroimaging; that it is a way of reading thoughts. Some of the essays do explore this theme; but most don’t, at least not that directly. Notwithstanding the inclusion of an essay by the former editor of this journal, the book is something like the proverbial curate’s egg, good in parts (without any partiality, Professor Kelly’s contribution is one of the good parts).

There are four sections to the book. First, an overview of the state of the art of neuroimaging and of the conceptual questions raised. Second, a focus on medical applications of mind reading through brain imaging. Third, a section on criminal justice, and finally one on mind reading and privacy.

Among the contributors, practitioners of neuroimaging-based research alternate with (relative) skeptics of the approach. It is interesting to observe the actual researchers, rather than being zealots, are tentative and provisional in their suggestions; the skeptics are more forthright. For instance, Colin Campbell and Nigel Eastman baldly evoke the ghost of phrenology – evidently a nearby shade for many contemplating this area – in the conclusion of their essay on neuroimaging on the law. Although this is a valid point – and undoubtedly some commercially promoted ‘mind reading’ technologies are pure hokum – it is rather jarring conclusion to their essay.

There is nevertheless much useful and stimulating material here. John-Dylan Haynes provides a useful overview of brain imaging technology itself and some of the possibilities and limits of the field. The second section, rather alarmingly titled ‘Medical applications of mind reading through brain imaging’, is generally comprised of thoughtful, nuanced discussions of the issues in non-responsive patients, pain, and mental health.

However, the essays are overall quite mixed in tone and content. Some bear the hallmarks of generic essays on particular topics with relatively little directly on the topic of the book (for instance, Annabelle Lever’s chapter on ‘Neuroscience versus privacy’ which is rather an extended discussion of privacy with some mentions of neuroscience). Contributors often rehash discussions that are covered at greater length, sometimes rather tediously so, in other essays.

The Hastings Centre Report ‘Interpreting neuroimages: an introduction to the technology and its limits’ – available at http://www.thehastingscenter.org/Publications/SpecialReports/Detail.aspx?id=6841 – covers much of the same ground as this book but more concisely and more accessibly, particularly Martha J. Farah’s essay in the ‘Brain images, babies, and bathwater: critiquing critiques of functional neuroimaging’. With the Hastings Centre Report freely accessible in the public domain it is hard to advise readers to part with their money for this volume.

“Godterms”

Yesterday I came across the following tweet:

I had never come across the coinage “Godterm” before – and the meaning I ascribed to it was simply this: something that is, as the saying goes, like motherhood and apple pie; no-one wants to be seen to be arguing against it. This usually reflects that it is indeed a Good Thing, maybe even a Very Good Thing, maybe an Extremely Good Thing. However the term becomes something of a rhetorical blunderbuss – this is Patient-Centered, and YOU AREN’T AGAINST PATIENT-CENTEREDNESS, ARE YOU?

I tweeted Lorelei Lingard expressing that “godterm” was a useful find and she replied:

There are indeed godterms lurking everywhere – “innovation” is another. Note that pointing out that X is a godterm does not mean one is criticising X, but rather the use of X as a shield to deflect scrutiny.

Thanks again to Lorelei Lingard for introducing me to this term! I look forward to happy godterm excavation.

 

“Nitrazepam made dreams everydayish” – searching for “dreams” in the BJPsych

Following on from  my recent posts about dreams and psychiatry (and the changes in how psychiatrists engage in questions of the meaning of symptoms reported to them) I have just searched the British Journal of Psychiatry site using the word “dreams”. As the BJPsych is the journal of the Royal College of Psychiatrists and the third most cited psychiatry journal in the world, it is fair to regard it as reflecting contemporary psychiatry.

 

Using the “Best match” search criteria,  the top 10 results  for “dreams” are all from other decades – with the most recent being from 1974 – a paper which dealt with the impact on dreaming of then-commonly-used sleeping tablets. Haven’t read the full paper yet, but here is the abstract (and I haven’t come across the word “everydayish” before!) :

It was predicted that amylobarbitone and nitrazepam would make dreams less active, and withdrawal would make them especially intense. Dream reports were collected from subjects before, during and after chronic administration of either of the two drugs or placebo. Dreams were rated as conceptual or perceptual, and as visually active or passive. They were also rated for hostility, anxiety, sexuality, psychotic thinking, bizarreness and degree of reality. A variety of other measures of content were made, such as the number of characters, activities, social interactions and emotions in each dream report. An experienced, `blind’ judge tried to assign reports according to whether they came from baseline, drug or withdrawal conditions. Subjective estimates of dreaming were also collected.

Contrary to prediction, dreams were virtually indistinguishable under the three conditions. Two effects were that nitrazepam made dreams everydayish and its withdrawal made them bizarre, and withdrawal of amylobarbitone produced exceptionally vivid dreaming and nightmares at home but not in the laboratory. Consideration of the results suggests that these hypnotics affect the quality of thought processes in sleep, and that in clinical use their withdrawal would be expected to produce unpleasant, anxiety-filled dreams and nightmares.

 

The number 1 result is from 1962. Again I hope to read the actual paper but here is the abstract, again rather “of its time”:

Spoken personal names which were randomly presented during the rapid eye movement periods of dreaming were incorporated into the dream events, as manifested by the ability of the experimental subjects and an independent judge subsequently to match correctly the names presented with the associated dreams more often than would be expected by guessing correctly by chance alone. Incorporation of emotional and neutral names into the dream events occurred equally often. The manner in which the names appeared to have been incorporated into the dream events fell into four categories of decreasing frequency: (a) Assonance, (b) Direct, (c) Association, and (d) Representation. Perceptual responses to the stimulus names, as manifested by subsequent dream recall, occurred without any accompanied observable differential electroen-cephalographic or galvanic skin responses compared with those occasions on which no such perceptual responses were evident. The frequency of recall of colour in dreams was higher than has been previously reported.

The results are discussed in relation to the function of dreams and perception during dreaming.

Using the “Newest first” search criteria does throw up more recent results, but in most of the top 10, the word “dreams” is not referring to a subject of clinical or research interest. The number one result is an article in which a psychiatrist discusses ten books that influenced him. The next result uses “dream” in the sense of “hope” or “aspiration”:

 

The National Institute of Mental Health (NIMH), under the leadership of Thomas Insel, powerfully steered national and international researchers, policy makers and research commissioners to buy into a hopeful dream that one day the basic sciences will afford opportunities to prevent and treat mental illness at its root cause

Of the rest of the “Most recent” top ten, we have three poems, one film review, another “Ten Books” feature, one paper whose mention of dreams is in passing as an adverse drug effect, and just two papers which, from my brief reading, dreams seem to feature as a topic of clinical interest. Both are papers in child psychiatry and both deal with dreams in the context of psychotic phenomena:

 

It has been suggested that there may be shared patterns of neuroanatomical, neurochemical and neurophysiological pathways occurring in nightmares and the positive symptoms of psychosis, for example, the finding that cortical dopamine levels are raised during nightmares41 and the functional significance of sleep spindles in psychosis42 that are consistently reduced in schizophrenia.43 Some studies have also reported a continuity between dreams and psychotic experiences; with overlapping content44 and indistinct barriers between these experiences.45 This is related to the increased interest in dreams46 or REM sleep47 as a neurobiological model for schizophrenia or psychotic phenomena.

Here to, we see that interest in dreams is confined to their possible utility as a model for psychosis – an interesting topic, but one from which issues of “meaning” are excluded.One of this paper’s references is worth reviewing – and I find it  interesting that a projective test (the TAT) was used in this study:

Many previous observers have reported some qualitative similarities between the normal mental state of dreaming and the abnormal mental state of psychosis. Recent psychological, tomographic, electrophysiological, and neurochemical data appear to confirm the functional similarities between these 2 states. In this study, the hypothesis of the dreaming brain as a neurobiological model for psychosis was tested by focusing on cognitive bizarreness, a distinctive property of the dreaming mental state defined by discontinuities and incongruities in the dream plot, thoughts, and feelings. Cognitive bizarreness was measured in written reports of dreams and in verbal reports of waking fantasies in 30 schizophrenics and 30 normal controls. Seven pictures of the Thematic Apperception Test (TAT) were administered as a stimulus to elicit waking fantasies, and all participating subjects were asked to record their dreams upon awakening. A total of 420 waking fantasies plus 244 dream reports were collected to quantify the bizarreness features in the dream and waking state of both subject groups.

Two-way analysis of covariance for repeated measures showed that cognitive bizarreness was significantly lower in the TAT stories of normal subjects than in those of schizophrenics and in the dream reports of both groups.

The differences between the 2 groups indicated that, under experimental conditions, the waking cognition of schizophrenic subjects shares a common degree of formal cognitive bizarreness with the dream reports of both normal controls and schizophrenics. Though very preliminary, these results support the hypothesis that the dreaming brain could be a useful experimental model for psychosis.

 

Review of An Odd Kind Of Fame: Stories of Phineas Gage. Nthposition. Mid-2004

This piece is no longer actively on nthposition. Fortunately I had previously preserved a copy on a precursor of this blog, with an entertaining typo in the heading.

I ended up having some correspondence with Macmillan subsequently – specifically about the lyrics to the Slackdaddy song (although I don’t think he like the word “primly”) His book is availble here. I think this book marked a point where I began to exhibit a certain reserve and scepticism about similarly pat, anecdotal stories.

I find that Jackson Beatty’s book seems to be rather obscure – one of the textbooks from my medical education that was perhaps less directly helpful in getting me through exams but did help provide a good quote illustrating the Official Version of Gage’s story.

jackson

Review of “An Odd KinD of Fame: Stories of Phineas Gage” by Malcolm Macmillan

At 4.30pm on 13 September 1848, the foreman of a group of railway construction workers in Cavendish, Vermont, suffered a horrendous accident that secured his later role as one of the most famous patients in the history of medicine. Virtually all humanity – famous, unknown and infamous – were, are or will be patients at some stage, but Phineas Gage is among the select few whose fame rests entirely on their status as patients. Some of Freud’s cases – “Rat Man”, Judge Schreber, Anna O – are perhaps Gage’s main rivals of this score. But while Freud and all his works have been closely examined and hotly contested over the years, Malcolm Macmillan, Adjunct Professor in the School of Psychology at Deakin University in Australia, found in 1983 that while various stories of Gage’s accident were widely known, little detail was. As the blurb puts it “almost nothing is known about him, and most of what is written is seriously in error.”

For the reader who has never heard of Phineas Gage, and may well be rather sceptical about his fame, I give a typical extract from a modern textbook, in this case the 1996 edition of Principles of Behavioural Neuroscience by Jackson Beatty:

The importance of the cerebral hemispheres for emotion, and in particular the frontal lobes, was made strikingly clear over a century ago by the case of Phineas Gage, the foreman of a railroad crew who suffered a remarkable injury. An accidental explosion drove an iron rod into Gage’s cheek and out through the top of his skull. Miraculously he survived the injury but suffered a massive lesion of the frontal lobes. Before the accident, Gage was a model citizen and employee, but the frontal damage transformed his very character. Gage’s physician described the change as follows:
“The equilibrium or balance, so to speak, between his intellectual faculty and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operation, which are no sooner arranged that they are abandoned in turn for others- His mind was radically changed, so decidedly that his friends and acquaintances said that he was ‘no longer Gage'”

That’s the textbook version in neurology books, and such a striking story has naturally entered a wider consciousness. Macmillan gives many examples of the story’s use in documentaries, novels and other unexpected places. For example, in Roger Kimball’s The Long March: How the Cultural Revolution of the 1960s Changed America, the very first figure we encounter is Phineas Gage; based on a 1994 New York Times report, Kimball writes that “pondering the sad state of contemporary American cultural life, I have often recalled the sad story of Phineas Gage. Like him, our culture seems to have suffered some ghastly accident that has left it afloat but rudderless: physical intact, its ‘moral centre’ is a shambles.” On the morning of 13 September 1848, Gage would hardly have suspected he would be drafted into the culture wars of a century and a half later.

Macmillan even uncovers two rock bands called “Phineas Gage” and “Finneus Gauge”, and a song by Slackdaddy called “What’s the matter with Phineas Gage?”, of which he writes primly “although no one I know who has listened to the song has been able to understand more than a few words, the group neither seems to sing anything of significance about Gage nor to answer the question posed in the title of the song.”

There is no doubt that Gage suffered the accident, and that it had a dramatic effect on his life. Nevertheless, Macmillan shows, the account that has entered both scientific and popular discourse is flawed. Firstly, we know very little about Gage’s personality and habits before the accident, and secondly the after effects were not, contemporaneously, reported as being quite so dramatic.

Within twenty-four hours of the accident, a first report was (anonymously) printed in the Ludlow, Vermont Free Soil Union. Having described the accident, the paper reports that “the most singular circumstance connected with this melancholy affair is, that he was alive at two o’clock this afternoon, and in full possession of his reason, and free from pain.”

“Gage’s physician”, as cited (second-hand) by Beatty above, was Dr John Martyn Harlow. Harlow mentioned very few psychological changes in his initial report of 1848. Henry Bigelow, Professor of Surgery at Harvard, wrote in 1850 that Gage was “quite recovered in faculties of body and mind.” It was Harlow’s account of 1868 that began to introduce the changes; the passage Beatty cites is taken from this source. Later writers began to embellish even more, adding drunkenness, braggadocio, a vainglorious tendency to show off his wound as part of Barnum’s Traveling Exhibition and an utter lack of foresight where these were unmentioned by Harlow.

In 1848, Macmillan writes, there was strong resistance to the idea that function could be localised to any particular are in the brain. Bigelow’s verdict was a victory for advocates of localisation, implying that the frontal lobes served no particular purpose. By 1868 however localisation was beginning to hold sway, with Paul Broca’s work on localising language function to the left hemisphere. Macmillan shows how differing psychological and neurological theories shaped the presentation of Gage’s story.

Macmillan explicitly states that this is not intended as a work of postmodernist relativism. Rather he is simply arguing that the subsequent stories of Gage bore little relation to the original facts that were known about him. Harlow’s account is pretty much all we know about Gage, and it is important to separate it from the subsequent encrustation of myth.

Quite aside from the pressures of neurological debate, a number of other stories have clung to Gage. The various accounts of him showing off his wound in a tent on Boston Common and in Barnum’s circus seem to derived from a passing reference in Harlow’s 1869 report to Gage’s stay in New York at “Barnum’s, with his iron”, which Macmillan presumes must mean Barnum’s American Museum, and there is no evidence Gage toured with a circus.

As Macmillan writes, the textbook accounts of Gage are not wildly wrong. “If we divide the story into seven elements – rarely did a single account contain major errors in more than three of these elements”, and he finds that the more inaccurate textbooks seem to have depended on paraphrasing subsequent writers rather than Harlow’s report. This can be seen as a warning to authors in all disciplines to be wary of citing secondary sources routinely.

The story of Phineas Gage, as represented in the textbooks, is not a lie or a myth, but simply an exaggeration. Macmillan’s conclusion puts it best:

Vivid though Harlow’s description of Gage is, it is far from providing the detail we need for a full analysis of Phineas’ behaviour before and after the accident. That lack, together with the slightness of our knowledge of the specific locale and extent of the damage to his brain, provides too meagre a foundation on which to base hypotheses of the relation between the frontal lobes and their psychological functions- What has to be remembered is that his was the first case to point to a relation between brain an personality functions. That is its lasting importance.

Macmillan is exceedingly thorough and fair-minded in his approach. Some may even find the attention to detail excessive, with modern CT images of Gage’s skull, biographical chapters on Harlow, genealogical tables showing the lineage of Gage and Harlow. Macmillan, however, writes in a lively and accessible style. A book perhaps of interest only to a few, but nevertheless a fascinating example of how a medical case history “got legs”.