Collingwood on Magic

While discussing what connects art and magic, R. G. Collingwood writes

I am suggesting that these emotional effects, partly on the performers themselves, partly on others favourably or unfavourably affected by the performance, are the only effects that magic can produce, and the only ones which, when intelligently performed, it is meant to produce. The primary function of all magical acts, I am suggesting, is to generate in the agent or agents certain emotions that are considered necessary or useful for the work of living; their secondary function is to generate in others, friends or enemies of the agent, emotions useful or detrimental to the lives of these others.

To any one with sufficient psychological knowledge to understand the effect which our emotions have on the success or failure of our enterprises, and in the production or cure of diseases, it will be clear that this theory of magic amply accounts for its ordinary everyday employment in connexion with the ordinary everyday activities of the people who believe in it. Such a person thinks, for example, that a war undertaken without the proper dances would end in defeat; or that if he took an axe to the forest without doing the proper magic first, he would not succeed in cutting down a tree. But this belief does not imply that the enemy is defeated or the tree felled by the power of the magic as distinct from the labour of the 'savage'. It means that, in warfare or woodcraft, nothing can be done without morale; and the function of magic is to develop and conserve morale; or to damage it. For example, if an enemy spied upon our war-dance and saw how magnificently we did it, might he not slink away and beg his friends to submit without a battle? Where the purpose of magic is to screw our courage up to the point of attacking, not a rock or a tree, but a human enemy, the enemy's will to encounter us may be fatally weakened by the magic alone. How far this negative emotional effect might produce diseases of various kinds or even death is a question about which no student of medical psychology will wish to dogmatize. (The Principles of Art, OUP 1938, 66-67)

I see that tonight on BBC Radio 4 there is a programme called Metaphor For Healing about the ways linguistic phrasing may impact on medical therapy. We might say that this points to the magical (in Collingwood's sense) dimension of speech.

Social Regulation of Human Gene Expression

I will revive this blog once my current philosophy of mathematics phase wanes. For now here's an article to which Andy Fugard kindly pointed me:

@ARTICLE{Cole2009,

author = {Steve W. Cole},

title = {Social Regulation of Human Gene Expression},

journal = {Current Directions in Psychological Science},

year = {2009},

volume = {18},

pages = {132--137},

number = {3},

abstract = {The relationship between genes and social behavior has

historically been construed as a one-way street, with genes in control.

Recent analyses have challenged this view, by discovering broad

alterations in the expression of human genes as a function of differing

socio-environmental conditions. The emerging field of social genomics

has begun to identity the types of genes subject to social regulation,

the biological signaling pathways mediating those effects, and the

genetic polymorphisms that moderate socioenvironmental influences on

human gene expression.}

}

Reporting on a recent experiment, Cole explains how

Among the 22,283 genes assayed, 209 showed systematically different levels of expression in people who reported feeling lonely and distant from others consistently over the course of 4 years. These effects did not involve a random smattering of all human genes, but focally affected three specific groups of genes. Genes supporting the early "accelerator" phase of the immune response—inflammation—were selectively up-regulated; and two groups of genes involved in the subsequent "steering" of immune responses—genes involved in responses to viral infections (particularly Type I interferons), and genes involved in the production of antibodies by B lymphocytes—were down-regulated. These results provided a molecular framework for understanding why socially isolated individuals show heightened vulnerability to inflammation-driven cardiovascular diseases (i.e., excessive nonspecific immune activity) and impaired responses to viral infections and vaccines (i.e., insufficient immune responses to specific pathogens). A major clue about the psychological pathways mediating these effects came from the observation that differential gene-expression profiles were most strongly linked to a person’s subjective sense of isolation rather than to their objective number of social contacts.

Apparently,

Several studies have shown that social influences can penetrate remarkably deeply into our bodies. The nervous system plays a key role in perceiving and responding to social stimuli, and social conditions have been found to regulate the expression of neural genes such as the nerve growth factor (NGF) gene (Sloan et al., 2007) and the glucocorticoid receptor gene (Zhang et al., 2006). More surprising is the discovery that key immune system genes are also sensitive to social conditions (Sloan et al.,2007)...One recent study of women with ovarian cancer found more than 220 genes to be selectively up-regulated in tumors from women with low levels of social support and high depressive symptoms (Lutgendorf et al., 2009).

Something to ponder is how best to tell the psychological part of this story.

The Cure Within

A book I must get hold of - Anne Harrington's The Cure Within: A History of Mind-Body Medicine.

Here's a review.

Some BBC and Science Blog articles

A note of some pages of relevant research mentioned by the BBC:

How emotional pain can really hurt:

New brain scanning technologies are revealing that the part of the brain that processes physical pain also deals with emotional pain.

And in the same way that in some people injury can cause long-lasting chronic pain, science now reveals why some will never get over such heartbreak.

Autism parents 'infection risk'

Caring for children with developmental problems such as autism or Down's syndrome can weaken parents' immune systems, research suggests.

Researchers at Birmingham University found they had a poorer immune response to a vaccine against pneumonia.

Anti-depressants' 'little effect'

New generation anti-depressants have little clinical benefit for most patients, research suggests.

A University of Hull team concluded the drugs actively help only a small group of the most severely depressed.

Drugs for ADHD 'not the answer'

Treating children who have Attention Deficit Hyperactivity Disorder (ADHD) with drugs is not effective in the long-term, research has shown.

A study obtained by the BBC's Panorama programme says drugs such as Ritalin and Concerta work no better than therapy after three years of treatment.

The findings by an influential US study also suggested long-term use of the drugs could stunt children's growth.

It said that the benefits of drugs had previously been exaggerated.

Stressed parents 'make kids ill'

Parents with stressful lives may be making their children as well as themselves vulnerable to illness, research suggests.

A University of Rochester study, reported by New Scientist, found sickness levels were higher in children of anxious or depressed parents.

It also found links between stress and immune system activity in the children.

'Healthier hearts' for cat owners

Cat owners appear to have a much lower risk of dying from a heart attack than their feline-spurning counterparts, a study suggests.

Researchers looked at nearly 4,500 adults and found that cat ownership was related to a 40% lower risk of suffering a fatal heart attack.

And some stories from Science Blog,

Abused kids lose two years quality of life

Childhood maltreatment—which includes physical, sexual and emotional abuse and neglect—has been linked to an increased risk for ailments ranging from heart disease, obesity and diabetes to depression and anxiety. Corso said there are two reasons why. First, childhood maltreatment increases the likelihood of unhealthy behaviors such as smoking, substance abuse and sexual promiscuity. And recent studies suggest that repeated exposure to the stress caused by maltreatment alters brain circuits and hormonal systems, which puts victims at greater risk of chronic health problems.

Stress cuts blood flow to heart in patients with gene variation

University of Florida researchers have identified a gene variation in heart disease patients who appear especially vulnerable to the physical effects of mental stress — to the point where blood flow to the heart is greatly reduced.

Fear that freezes the blood in your veins

"The blood froze in my veins" or "My blood curdled" – these common figures of speech can be taken literally, according to the latest studies. Indeed, more literally than some of us would like. For it turns out that intense fear and panic attacks can really make our blood clot and increase the risk of thrombosis or heart attack.

Immune system may target some brain synapses

A baby's brain has a lot of work to do, growing more neurons and connections. Later, a growing child's brain begins to pare down these connections until it develops into the streamlined brain of an adult.

Now researchers at the Stanford University School of Medicine have discovered the sculptor behind that paring process: the immune system.

Theoretical Medicine and Bioethics

I've only just realised that I have access to the journal Theoretical Medicine and Bioethics, a treasure trove of interesting articles. For example from Volume 19, Number 3 / June, 1998 we have Norbert Paul:

Incurable suffering from the “hiatus theoreticus”? Some epistemological problems in modern medicine and the clinical relevance of philosophy of medicine.

And from the next issue, Volume 19, Number 4 / August, 1998, we have Edmund Pellegrino

What the Philosophy Of Medicine Is.

Essential reading when I finally get around to preparing my Philosophy of Medicine course.

Our Genes are Not Our Fate

Dean Ornish tells us in 3 minutes how lifestyle matters.

Two items

Posting has been terribly thin of late. I've swung back for a time to my mathematical phase.

We have sold the translation rights to the book to publishers from four countries - Finland, Japan, Portugal and Brazil. The Portuguese edition - Porque Adoecemos? - looks like this.

Mind, the mental health charity, shortlisted us for their Book of the Year.

The Risks of Football

A report into the risks of watching football:

Ute Wilbert-Lampen et al. Cardiovascular Events during World Cup Soccer, The New England Journal of Medicine, Volume 358(5): 475-483, Jan 31, 2008.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.

and BBC report.

Interesting to see that immune system cell functioning is suggested as a possible mechanism. From our research, this struck us as highly relevant in many cases of chronic heart disease.

It's also worth thinking about why people get so emotionally involved in football matches. Perhaps Nick Hornby's Fever Pitch offers the best insight from fiction.

Anger and wound healing

We've discussed wound healing before. Now more interesting research from the laboratory of Kiecolt-Glaser in Ohio State University.

Gouin, J.-P. et al., The influence of anger expression on wound healing, Brain Behav. Immun. (2007) doi:10.1016/j.bbi.2007.10.013.

Abstract:
Certain patterns of anger expression have been associated with maladaptive alterations in cortisol secretion, immune functioning, and surgical recovery. We hypothesized that outward and inward anger expression and lack of anger control would be associated with delayed wound healing. A sample of 98 community-dwelling participants received standardized blister wounds on their non-dominant forearm. After blistering, the wounds were monitored daily for 8 days to assess speed of repair. Logistic regression was used to distinguish fast and slow healers based on their anger expression pattern. Individuals exhibiting lower levels of anger control were more likely to be categorized as slow healers. The anger control variable predicted wound repair over and above differences in hostility, negative affectivity, social support, and health behaviors. Furthermore, participants with lower levels of anger control exhibited higher cortisol reactivity during the blistering procedure. This enhanced cortisol secretion was in turn related to longer time to heal. These findings suggest that the ability to regulate the expression of one’s anger has a clinically relevant impact on wound healing.

They conclude

...this is the first study showing that difficulty in anger regulation can lead to delayed healing. Furthermore, an exacerbated cortisol response to stress appears to explain the relationship between lower anger control and wound repair, although other physiological pathways may mediate the association between anger regulation and healing.

Media report here.

Whitehall Revisited

More on the health of Whitehall Civil Servants (article, BBC report):

This study adds to the evidence that the work stress–CHD association is causal in nature. We demonstrate, within a population of office staff largely unexposed to physical occupational hazards, a prospective dose–response relation between psychosocial stress at work and CHD over 12 years of follow-up. We confirm, during the same exposure period, the plausibility of the proposed pathways involving behavioural mechanisms, neuroendocrine and autonomic activation, and development of risk factor clustering, represented by the metabolic syndrome. Further, those who are older (and are more likely to be retired and less exposed to work stress) are less susceptible to the work psychosocial effect, presenting a coherent pattern in our findings. This study demonstrates that stress at work can lead to CHD through direct activation of neuroendocrine stress pathways and indirectly through health behaviours.

This is part of the Whitehall II study, which I've mentioned before. Long-term, large-scale, prospective studies of this kind are, of course, very welcome. But naturally we'd like to see these balanced by lifelong individual studies, so that we can get beyond the non-specificity of the stress construct.

The New Black

Apparently, 44 is the age at which we're most vulnerable to depression. That gives me 6 months to put up the defences. Something I might do is to (re-)read Darian's book - The New Black: Mourning, Melancholia and Depression - which appears on Thursday.

The publisher's (Hamish Hamilton) blurb:

What happens when we lose someone we love? A death, a separation or the break-up of a relationship are some of the hardest times we have to live through. We may fall into a nightmare of depression, lose the will to live and see no hope for the future. What matters at this crucial point is whether or not we are able to mourn.

In this important and groundbreaking book, acclaimed psychoanalyst and writer Darian Leader urges us to look beyond the catch-all concept of depression to explore the deeper, unconscious ways in which we respond to the experience of loss. In so doing, we can loosen the grip it may have upon our lives.

Pain and fortitude

Yesterday I went under general anaesthetic for the first time, to have a dental cyst removed. While waiting to be called to the theatre I read these comforting words by the great Oxford philosopher, R. G. Collingwood:

I would go so far with the hedonist as to say that anything good is pleasant. Any activity which I definitely choose to go in for, so far as my experience goes, yields me feelings among which there is pleasure, And I will add that although the pleasure sometimes comes as a surprise, a by-product which I had not expected, this happens more and more rarely as I become more and more experienced and acquire (as I hope I do acquire) more and more savoir vivre. Experience of life teaches me to expect the unexpected; in this case, to expect that I shall get pleasure out of things which, if I had been less experienced, I should not have thought likely to prove pleasant. A child may undergo dental surgery and find little in it except pain; when more advanced in years, he will find that bearing the pain gives him a curious and seemingly perverse but unmistakable pleasure; still later, he may learn to expect and reckon on the pleasure. This is not masochism. It is not a pathological enjoyment of merely being hurt. Being hurt is one thing; fortitude under pain is another. So the masochistic enjoyment of pain is one thing; the pleasure of finding that a certain degree of pain does not destroy one's fortitude is another. (pp. 426-7, 'Goodness, Rightness, Utility', The New Leviathan, Clarenden Press 1992)

With modern anaesthetics and pain-killers, in my case little fortitude was required.

Shadows in Wonderland

From the press release of a book coming out next month:

When television producer Colin Ludlow is admitted to hospital for an operation, he expects to be home in ten days. In the event, he ends up staying for five months, nearly dies on several occasions, contracts MRSA and is still recovering from his operation more than four years later.

His perceptive and frightening new book - said to be ‘memorable’ by The Bookseller - Shadows in Wonderland: A Hospital Odyssey is a moving account of how Ludlow pieces together the shattered fragments of his life and seeks to make sense of them again.

Shadows in Wonderland does not only recount Ludlow’s personal struggle for his health in many poignant passages:

“In the days following my surgery, I have a series of unexpected complications and my temperature soars. Eventually I am carted off to the hospital’s Intensive Therapy Unit where I spend several days unconscious on a ventilator. I have a second operation and then suffer massive internal haemorrhaging. Over one tumultuous weekend, I am given 45 units of blood in transfusions. Eventually, the doctors decide to try a rare clotting agent in a desperate attempt to staunch my bleeding, and Anna is told that if this fails to work by the second dose then there is no further hope for me. My children respond to the warning of my imminent death with storm-hardened calm. They are used to grim news by now.”

The book also takes a philosophical and questioning journey through chronic illness as Ludlow explores its wider significance. It is the record of a quest - which we all face - for health and wholeness in a fractured, disjointed world.

In the account of his blistering experience with chronic illness and the NHS Colin Ludlow manages to write masterfully and credibly about the institution, the culture and its history. With its amalgam of one man’s heart-rending experience within the NHS and its illuminating, witty digressions on the place of hospitals and health within Western society, Shadows in Wonderland enlarges our understanding of how it feels to become a long-term hospital patient.

Colin Ludlow also runs a blog.

Placebos and body shape

My friend John Baez pointed me to an interesting news story. This reports research on the effects of explaining to hotel maids that they do more exercise than the recommended daily amount. The odd thing is that many such workers' bodies don't reflect this physical activity, and at the same time they report themselves as doing little exercise. When one randomly selected group had the truth explained to them, there was a decrease in their weight and waist-to-hip ratio - and a 10 percent drop in blood pressure.

Naturally, one might think that this information must have altered other aspects of the maids' lives. Perhaps they were now behaving in a healthier way. An expert is wheeled in to suggest this must be so as the placebo effect only alters subjective aspects of health.

With all the evidence available (some touched on here, here, and here), could it be that the belief that placebos only effect one subjectively is a defense against the troubling thought that language can have an effect on our body?

Running up against orthodoxy

There is much food for thought in Brian Martin's Dissent and heresy in medicine: models, methods and strategies:

An orthodoxy that draws on the full range of resources, namely which exercises unified domination, is incredibly difficult to challenge. Many challengers subscribe to the myth of scientific medicine as being based on open-minded examination of evidence, and thus handicap themselves, since in practice they are ignored or attacked. In order to have a chance, they need to understand that science and medicine are systems of knowledge intertwined with power, and that if their alternative relies entirely on knowledge, without a power base, it is destined for oblivion.

Strategies for dissidents and heretics are offered, including this advice:

Although rejection of dissent and heresy is the standard mode of operation of science, the establishment normally trades on a belief that ideas are treated on their merits... If challengers can reveal the reality, for example by showing that defenders of orthodoxy use double standards, lie, unfairly block publications, harass opponents, destroy documents, withdraw grants or dismiss researchers, this can lend credibility to the challengers and attract support for fairer treatment.

Book News

Hanif Kureishi kindly chose our book as his best book of the year.

The American edition is now advertised at Amazon (May 2008) with the title Why People Get Sick, and a very different cover.

The cover of the paperback of the UK edition (Feb 2008) is also advertised.

Another psychosomatic book

Jean Benjamin Stora, psychoanalyst and psychosomatician, head of teaching for Integrative Psychosomatics at the Faculty of Medicine at La Pitié-Salpêtrière (Paris), has written When the Body Displaces the Mind: Stress, Trauma and Somatic Disease.

When the human being is overwhelmed by excitations, tensions and frustrations, and the psychic apparatus is no longer able to absorb them because of its fragility and its weaknesses, it is the body that takes over.

Stora updates Freud's economic model:

This new psychosomatic approach fosters the economic and energic dimension of psychic functioning and its role in somatisations. In formulating the economic principle, Sigmund Freud referred to Carnot's theory in order to justify his viewpoint scientifically. Now, as Carnot's theory applies only to closed mechanical systems, it is no longer appropriate today; this book proposes replacing Carnot's theory with the 'open dissipative energy systems' theory (Ilya Prigogine) adopted in medicine and adapted here to the economic principle of psychoanalysis.

Naturally, the pitfall of dividing 'real' organic diseases from psychosomatic ones has been avoided:

In the context of this new approach, it is no longer a question of psychosomatic diseases but the role that the psyche plays in all diseases without actually being their cause. The psyche participates in the defence of both the organism and the immune system and it must be examined in relation to the somatic functions and organs.

Should be worth reading.

It's not what it used to be

As a busy term comes to a close, I hope to find more time for this blog now.

A couple of weeks ago my PhD supervisor, Donald Gillies, came to speak to our Reasoning group about Popper and induction. Knowing my interest in psychosomatic medicine, he brought me the details of a paper which had interested him:

Hallee JT, Evans AS, Niederman JC, Brooks CM, Voegtly JH: Infectious mononucleosis at the United States Military Academy. A prospective study of a single class over four years. Yale J Biol Med 3:182-195, 1974.

This is not available online, but a follow up is:

Psychosocial Risk Factors in the Development of Infectious Mononucleosis, S. Kasl, A. Evans, J. Niederman

It concludes:

Psychosocial factors that significantly increased the risk of EBV [Epstein-Barr virus] infection being expressed as clinical IM were: 1) having fathers who were "overachievers" (occupational status exceeding own educational level, or wife's education, or her occupational status); 2) having a strong commitment to a military career; 3) ascribing strong values to various aspects of the training and of military career; 4) scoring poorly on indices of relative academic performance; 5) having strong motivation and doing relatively poorly academically.

I was just thinking how university students might be good subjects for a similar study. However, tangible sexual behaviour seems to be the sole focus of today's researchers. In

A cohort study among university students: identification of risk factors for Epstein-Barr virus seroconversion and infectious mononucleosis. Crawford D H et al., Clin Infect Dis. 2006, Aug 1;43(3):276-82,

The authors conclude:

Our findings suggest that acquisition of EBV is enhanced by penetrative sexual intercourse, although transmission could occur through related sexual behaviors, such as "deep kissing." We also found that EBV type 1 infection is significantly more likely to result in IM. Overall, the results suggest that a large EBV type 1 load acquired during sexual intercourse can rapidly colonize the B cell population and induce the exaggerated T cell response that causes IM. Thus, IM could, perhaps, be prevented with a vaccine that reduces the viral load without necessarily inducing sterile immunity.

One day I'll write a book on changes in medical research.

The Definition of Disease

In her paper, Disease (2002) Studies in History and Philosophy of Biological and Biomedical Sciences. 33:263-282, Rachel Cooper defines disease as follows:

By disease we mean a condition that it is a bad thing to have, that is such that we consider the afflicted person to have been unlucky, and that can potentially be medically treated. All three criteria must be fulfilled for a condition to be a disease. The criterion that for a condition to be a disease it must be a bad thing is required to distinguish the biologically different from the diseased. The claim that the sufferer must be unlucky is needed to distinguish diseases from conditions that are unpleasant but normal, for example teething. Finally, the claim that for a condition to be a disease it must be potentially medically treatable is needed to distinguish diseases from other types of misfortune, for example economic problems and legal problems.

She is clearly rejecting more technical definitions, such as Boorse's 'interferences with natural functions' carried out by 'sub-systems of the body' for 'the overall aims of the organism', in favour of one couched in everyday language.

By ‘disease’ we aim to pick out a variety of conditions that through being painful, disfiguring or disabling are of interest to us as people. No biological account of disease can be provided because this class of conditions is by its nature anthropocentric and corresponds to no natural class of conditions in the world.

This definition makes an enormous difference when it comes to 'mental illnesses'. If one can be described in a way such that it is not construed as 'a bad thing', then it is not a disease. Cooper outlines Laing's account of schizophrenia:

According to this account it is us ‘normals’ who are truly alienated from ourselves. From childhood on we have been conditioned, first by our family, then at school, then at work, to act in ways that do not conform with our experiences, for example we are trained to be polite to people who offend us. Under such pressures we create a false self to present to the world. Schizophrenics are people who have refused to construct a false self and as such are better off than the rest of us. Their experiences are part of a healing spiritual journey that can potentially lead them away from normality and into a higher form of sanity. This account is also compatible with my own. Laing can be understood as claiming that schizophrenia is not a disease because it is not a bad thing and, if this were so, I would be forced to agree with him.

This conclusion is controversial to say the least, but it places our conception of what it is to thrive as a person at the heart of the matter, where it should be, rather than dressing it up in biological garb. Biology often puts in an appearance in the gaps where an author ought to be thinking in terms of ethics or politics.

A Dark Age For Mental Health

Darian wrote an article for The Guardian with this title.