Arquivo da tag: Saúde mental

Don’t Blame Autism for Newtown (New York Times)

By PRISCILLA GILMAN – Published: December 17, 2012

LAST Wednesday night I listened to Andrew Solomon, the author of the extraordinary new book “Far From the Tree,” talk about the frequency of filicide in families affected by autism. Two days later, I watched the news media attempt to explain a matricide and a horrific mass murder in terms of the killer’s supposed autism.

It began as insinuation, but quickly flowered into outright declaration. Words used to describe the killer, Adam Lanza, began with “odd,” “aloof” and “a loner,” shaded into “lacked empathy,” and finally slipped into “on the autism spectrum” and suffering from “a mental illness like Asperger’s.” By Sunday, it had snowballed into a veritable storm of accusation and stigmatization.

Whether reporters were directly attributing Mr. Lanza’s shooting rampage to his autism or merely shoddily lumping together very different conditions, the false and harmful messages were abundant.

Let me clear up a few misconceptions. For one thing, Asperger’s and autism are not forms of mental illness; they are neurodevelopmental disorders or disabilities. Autism is a lifelong condition that manifests before the age of 3; most mental illnesses do not appear until the teen or young adult years. Medications rarely work to curb the symptoms of autism, but they can be indispensable in treating mental illness like obsessive-compulsive disorder, schizophrenia and bipolar disorder.

Underlying much of this misreporting is the pernicious and outdated stereotype that people with autism lack empathy. Children with autism may have trouble understanding the motivations and nonverbal cues of others, be socially naïve and have difficulty expressing their emotions in words, but they are typically more truthful and less manipulative than neurotypical children and are often people of great integrity. They can also have a strong desire to connect with others and they can be intensely empathetic — they just attempt those connections and express that empathy in unconventional ways. My child with autism, in fact, is the most empathetic and honorable of my three wonderful children.

Additionally, a psychopathic, sociopathic or homicidal tendency must be separated out from both autism and from mental illness more generally. While autistic children can sometimes be aggressive, this is usually because of their frustration at being unable to express themselves verbally, or their extreme sensory sensitivities. Moreover, the form their aggression takes is typically harmful only to themselves. In the very rare cases where their aggression is externally directed, it does not take the form of systematic, meticulously planned, intentional acts of violence against a community.

And if study after study has definitively established that a person with autism is no more likely to be violent or engage in criminal behavior than a neurotypical person, it is just as clear that autistic people are far more likely to be the victims of bullying and emotional and physical abuse by parents and caregivers than other children. So there is a sad irony in making autism the agent or the cause rather than regarding it as the target of violence.

In the wake of coverage like this, I worry, in line with concerns raised by the author Susan Cain in her groundbreaking book on introverts, “Quiet”: will shy, socially inhibited students be looked at with increasing suspicion as potentially dangerous? Will a quiet, reserved, thoughtful child be pegged as having antisocial personality disorder? Will children with autism or mental illness be shunned even more than they already are?

This country needs to develop a better understanding of the complexities of various conditions and respect for the profound individuality of its children. We need to emphasize that being introverted doesn’t mean one has a developmental disorder, that a developmental disorder is not the same thing as a mental illness, and that most mental illnesses do not increase a person’s tendency toward outward-directed violence.

We should encourage greater compassion for all parents facing an extreme challenge, whether they have children with autism or mental illness or have lost their children to acts of horrific violence (and that includes the parents of killers).

Consider this, posted on Facebook yesterday by a friend of mine from high school who has an 8-year-old, nonverbal child with severe autism:

“Today Timmy was having a first class melt down in Barnes and Nobles and he rarely melts down like this. He was throwing his boots, rolling on the floor, screaming and sobbing. Everyone was staring as I tried to pick him up and [his brother Xander] scrambled to pick up his boots. I was worried people were looking at him and wondering if he would be a killer when he grows up because people on the news keep saying this Adam Lanza might have some spectrum diagnosis … My son is the kindest soul you could ever meet. Yesterday, a stranger looked at Timmy and said he could see in my son’s eyes and smile that he was a kind soul; I am thankful that he saw that.”

Rather than averting his eyes or staring, this stranger took the time to look, to notice and to share his appreciation of a child’s soul with his mother. The quality of that attention is what needs to be cultivated more generally in this country.

It could take the form of our taking the time to look at, learn about and celebrate each of the tiny victims of this terrible shooting. It could manifest itself in attempts to dismantle harmful, obfuscating stereotypes or to clarify and hone our understanding of each distinct condition, while remembering that no category can ever explain an individual. Let’s try to look in the eyes of every child we encounter, treat, teach or parent, whatever their diagnosis or label, and recognize each child’s uniqueness, each child’s inimitable soul.

Priscilla Gilman is the author of “The Anti-Romantic Child: A Memoir of Unexpected Joy.”

With Mental Health Issues Rising On Campuses, New Student Initiative to Maintain Balanced Mental Health Is Emerging (Science Daily)

Dec. 18, 2012 — Rates of serious mental illness among university students are drastically rising, and universities are struggling with how to respond to students who show symptoms. Traumatic situations such as academics, financial problems, family problems, intimate and other relationship issues, and career related issues are leaving students overwhelmed, exhausted, sad, lonely, hopeless and depressed.

Volume 60, Issue 1, 2012 of the Journal of American College Health includes publication of the first ever feasibility study on Psychiatric Advance Directives (PADs) for college students. PADs allow students who are living with serious mental illnesses to plan ahead with a support person, creating and documenting an intervention strategy to be used in the event of a psychiatric crisis.

The study entitled “University Students’ Views on the Utility of Psychiatric Advance Directives” was conducted by Anna M. Scheyett, PhD and Adrienne Rooks, MSW. The researchers found that students perceived PADs as beneficial.

“With a PAD, university students could give permission for the university to communicate with relevant support people, identify warning signs of relapse, describe effective interventions and give advance permission for administration of specific medications,” wrote Scheyett and Rooks. “By providing this novel intervention, we may be able to ensure that university students not only get the care they need during crises but also reduce crises through early and effective action and treatment.”

Access free articles from the issue: http://www.tandfonline.com/toc/vach20/60/7

Journal Reference:

  1. Reginald Fennell. Should College Campuses Become Tobacco Free Without an Enforcement Plan? Journal of American College Health, 2012; 60 (7): 491 DOI:10.1080/07448481.2012.716981

Bullying by Childhood Peers Leaves a Trace That Can Change the Expression of a Gene Linked to Mood (Science Daily)

Dec. 18, 2012 — A recent study by a researcher at the Centre for Studies on Human Stress (CSHS) at the Hôpital Louis-H. Lafontaine and professor at the Université de Montréal suggests that bullying by peers changes the structure surrounding a gene involved in regulating mood, making victims more vulnerable to mental health problems as they age.

The study published in the journal Psychological Medicine seeks to better understand the mechanisms that explain how difficult experiences disrupt our response to stressful situations. “Many people think that our genes are immutable; however this study suggests that environment, even the social environment, can affect their functioning. This is particularly the case for victimization experiences in childhood, which change not only our stress response but also the functioning of genes involved in mood regulation,” says Isabelle Ouellet-Morin, lead author of the study.

A previous study by Ouellet-Morin, conducted at the Institute of Psychiatry in London (UK), showed that bullied children secrete less cortisol — the stress hormone — but had more problems with social interaction and aggressive behaviour. The present study indicates that the reduction of cortisol, which occurs around the age of 12, is preceded two years earlier by a change in the structure surrounding a gene (SERT) that regulates serotonin, a neurotransmitter involved in mood regulation and depression.

To achieve these results, 28 pairs of identical twins with a mean age of 10 years were analyzed separately according to their experiences of bullying by peers: one twin had been bullied at school while the other had not. “Since they were identical twins living in the same conditions, changes in the chemical structure surrounding the gene cannot be explained by genetics or family environment. Our results suggest that victimization experiences are the source of these changes,” says Ouellet-Morin. According to the author, it would now be worthwhile to evaluate the possibility of reversing these psychological effects, in particular, through interventions at school and support for victims.

Journal Reference:

  1. I. Ouellet-Morin, C. C. Y. Wong, A. Danese, C. M. Pariante, A. S. Papadopoulos, J. Mill, L. Arseneault. Increased serotonin transporter gene (SERT) DNA methylation is associated with bullying victimization and blunted cortisol response to stress in childhood: a longitudinal study of discordant monozygotic twinsPsychological Medicine, 2012; DOI: 10.1017/S0033291712002784

Should Physicians Prescribe Cognitive Enhancers to Healthy Individuals? (Science Daily)

Dec. 17, 2012 — Physicians should not prescribe cognitive enhancers to healthy individuals, states a report being published today in the Canadian Medical Association Journal (CMAJ)Dr. Eric Racine and his research team at the IRCM, the study’s authors, provide their recommendation based on the professional integrity of physicians, the drugs’ uncertain benefits and harms, and limited health care resources.

Prescription stimulants and other neuropharmaceuticals, generally prescribed to treat attention deficit disorder (ADD), are often used by healthy people to enhance concentration, memory, alertness and mood, a phenomenon described as cognitive enhancement.

“Individuals take prescription stimulants to perform better in school or at work,” says Dr. Racine, a Montréal neuroethics specialist and Director of the Neuroethics research unit at the IRCM. “However, because these drugs are available in Canada by prescription only, people must request them from their doctors. Physicians are thus important stakeholders in this debate, given the risks and regulations of prescription drugs and the potential for requests from patients for such cognitive enhancers.”

The prevalence of cognitive enhancers used by students on university campuses ranges from 1 per cent to 11 per cent. Taking such stimulants is associated with risks of dependence, cardiovascular problems, and psychosis.

“Current evidence has not shown that the desired benefits of enhanced mental performance are achieved with these substances,” explainsCynthia Forlini, first author of the study and doctoral student in Dr. Racine’s research unit. “With uncertain benefits and clear harms, it is difficult to support the notion that physicians should prescribe a medication to a healthy individual for enhancement purposes.”

“Physicians in Canada provide prescriptions through a publicly-funded health care system with expanding demands for care,” adds Ms. Forlini. “Prescribing cognitive enhancers may therefore not be an appropriate use of resources. The concern is that those who need the medication for health reasons but cannot afford it will be at a disadvantage.”

“An international bioethics discussion has surfaced on the ethics of cognitive enhancement and the role of physicians in prescribing stimulants to healthy people,” concludes Dr. Racine. “We hope that our analysis prompts reflection in the Canadian medical community about these cognitive enhancers.”

Éric Racine’s research is funded through a New Investigator Award from the Canadian Institutes for Health Research (CIHR). The report’s co-author is Dr. Serge Gauthier from the McGill Centre for Studies in Aging.

Journal Reference:

  1. Cynthia Forlini, Serge Gauthier, and Eric Racine. Should physicians prescribe cognitive enhancers to healthy individuals? Canadian Medical Association Journal, 2012; DOI: 10.1503/cmaj.121508

Origin of intelligence and mental illness linked to ancient genetic accident (University of Edinburgh)

2-Dec-2012 – By Tara Womersley, University of Edinburgh

Scientists have discovered for the first time how humans – and other mammals – have evolved to have intelligence

Scientists have discovered for the first time how humans – and other mammals – have evolved to have intelligence.

Researchers have identified the moment in history when the genes that enabled us to think and reason evolved.

This point 500 million years ago provided our ability to learn complex skills, analyse situations and have flexibility in the way in which we think.

Professor Seth Grant, of the University of Edinburgh, who led the research, said: “One of the greatest scientific problems is to explain how intelligence and complex behaviours arose during evolution.”

The research, which is detailed in two papers in Nature Neuroscience, also shows a direct link between the evolution of behaviour and the origins of brain diseases.

Scientists believe that the same genes that improved our mental capacity are also responsible for a number of brain disorders.

“This ground breaking work has implications for how we understand the emergence of psychiatric disorders and will offer new avenues for the development of new treatments,” said John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust, one of the study funders.

The study shows that intelligence in humans developed as the result of an increase in the number of brain genes in our evolutionary ancestors.

The researchers suggest that a simple invertebrate animal living in the sea 500 million years ago experienced a ‘genetic accident’, which resulted in extra copies of these genes being made.

This animal’s descendants benefited from these extra genes, leading to behaviourally sophisticated vertebrates – including humans.

The research team studied the mental abilities of mice and humans, using comparative tasks that involved identifying objects on touch-screen computers.

Researchers then combined results of these behavioural tests with information from the genetic codes of various species to work out when different behaviours evolved.

They found that higher mental functions in humans and mice were controlled by the same genes.

The study also showed that when these genes were mutated or damaged, they impaired higher mental functions.

“Our work shows that the price of higher intelligence and more complex behaviours is more mental illness,” said Professor Grant.

The researchers had previously shown that more than 100 childhood and adult brain diseases are caused by gene mutations.

“We can now apply genetics and behavioural testing to help patients with these diseases”, said Dr Tim Bussey from Cambridge University, which was also involved in the study.

The study was funded by the Wellcome Trust, the Medical Research Council and European Union.

Saúde mental, outra vítima da mudança climática (IPS)

23/11/2012 – 10h05

por Patricia Grogg, da IPS

clima Saúde mental, outra vítima da mudança climática

As tensões e angústias acompanham toda pessoa que sofre um desastre. Foto: Jorge Luis Baños/IPS

Santiago de Cuba, Cuba, 23/11/2012 – “A cidade parecia bombardeada. Caminho para meu escritório, cruzo com pessoas que levavam em seus rostos o mesmo – diria dramático – espanto que eu. Nos olhávamos e, sem nos conhecermos, nos perguntávamos: como foi com você? Aconteceu alguma coisa com sua casa? Foi uma solidariedade afetiva muito importante para mim”. Este testemunho dado à IPS, por uma jornalista de Santiago de Cuba, coloca na balança um dos lados bons da reação coletiva após um desastre como o sofrido por esta cidade na madrugada do dia 25 de outubro, quando o furacão Sandy, apesar do alerta meteorológico e das advertências oficiais, surpreendeu boa parte de seus habitantes.

O valor econômico dos prejuízos ainda são desconhecidos hoje, quando a parte mais oriental do país cura suas feridas, graves de todos os ângulos. Mas existe também o impacto psicológico, do qual se fala menos e se vê nos olhos das pessoas quando contam: “perdemos nossa casa com móveis, eletrodomésticos, até as lembranças”. “Tive muito medo, me enfiei no armário quando o vento levou o telhado do meu quarto. Meus vizinhos me tiraram de casa e me ajudaram a atravessar a rua até onde haviam se refugiado outras famílias cujas casas estavam em muito mau estado”, contou à IPS Isabel da Cruz, de 70 anos, moradora de Guantânamo, outra área afetada.

Depressão, tristeza, angústia, desespero, incerteza e agressividade, todas estas são manifestações que acompanham as pessoas depois de um desastre em qualquer parte do mundo. “Imagine, nos deitamos com a bela e acordamos com a fera”, comparou um trabalhador do setor turístico cujo hotel onde é empregado foi totalmente destruído. “As pessoas estão deprimidas e desorientadas. Em muitas nota-se o desequilíbrio psíquico pelas perdas sofridas”, disse à IPS o sacerdote católico Eugenio Castellanos, reitor do Santuário da Caridad del Cobre, virgem padroeira de Cuba. O padre estima que 90% das casas do Cobre, localidade vizinha a esta cidade, sofreram o impacto do Sandy.

Juan González Pérez, por sua vez, disse à IPS que dias antes do furacão houve focos de violência em alguns lugares, especialmente na hora de comprar artigos em falta. “Ficamos muitos dias sem energia elétrica e começaram a vender ‘luz brilhante’ (querosene) para cozinhar. Embora houvesse o suficiente para todos, aconteceram discussões e brigas na fila. Quando as pessoas se desesperam, costumam ficar agressivas”, observou Pérez, mais conhecido por Madelaine, líder do espiritismo cruzado “muertero”, uma expressão de religiosidade popular nesse lugar. Segundo contou, aconselha aos seus seguidores “unirem-se, se lavar bem, dar a quem não tem e não se desesperar”.

Em Mar Verde, a praia por onde o Sandy tocou o território cubano a 15 quilômetros de Santiago, a médica Elizabeth Martínez atende mais de cem pessoas, abrigadas em cabanas de veraneio que, por estarem mais afastadas do mar, se salvaram do desastre. “O impacto psicológico é grande, mas não houve mortes e nem temos pessoas doentes”, contou. Pouco mais de uma semana depois da passagem do furacão, os esforços em matéria de saúde se concentravam fundamentalmente em conter focos epidêmicos. “Estamos dando informações sanitárias aos moradores, ensinando como cuidar de doenças transmissíveis, sobre a importância de descontaminar a água antes de beber”, informou a médica.

Segundo meios especializados, estima-se que entre um terço e metade de uma população exposta a desastres sofre algum tipo de problema psicológico, embora na maioria dos casos se deva entender como reações normais diante de eventos extremos, que sob o impacto da mudança climática ameaçam aumentar em intensidade.

“Quando encontrei meus vizinhos no abrigo, estávamos em choque. Mas alguém disse: vamos limpar a entrada que está bloqueada por essas árvores caídas. Então, começamos a trabalhar, embora no começo ninguém falasse”, contou uma mulher do setor turístico. Nos primeiros dias era possível ver muitas pessoas recolhendo escombros e varrendo as ruas de suas vizinhanças.

Diante da frequência e da maior intensidade dos ciclones tropicais, as autoridades de saúde, desde a década de 1990, começaram a se preocupar com o impacto psicológico dos desastres causados por esses e outros fenômenos naturais. Em 2008, quando o país sofreu três furacões, uma indicação ministerial fortaleceu a inclusão do tema nos planos sanitários. Em um artigo sobre o assunto, o médico cubano Alexis Lorenzo Ruiz explica que os aspectos psicossociais dos desastres são considerados tanto na capacitação do pessoal como na organização dos programas que chegam a todo o país e enfatizam a atenção a setores mais vulneráveis, como menores de idade, adolescentes e idosos.

Do ponto de vista da saúde mental, nos desastres toda a população “sofre tensões e angústias em maior ou menor medida, direta ou indiretamente”, afirmaram Katia Villamil e Orlando Fleitas, que recomendaram não se esquecer que o impacto nessas circunstâncias é mais acentuado em populações de escassos recursos. Estes profissionais afirmam que as reações mais frequentes vão desde as consideradas normais, como ansiedade controlável, depressão leve ou quadros “histeriformes”, até estresse “peritraumático”, embotamento, redução do nível de atenção, descompensação de transtornos psiquiátricos pré-existentes, bem como “reação coletiva de agitação”.

O furacão Sandy causou estragos não apenas em Santiago de Cuba, mas também nas províncias de Guantânamo e Holguín, com saldo de 11 mortos. O governo de Raúl Castro ainda não divulgou as perdas econômicas, embora dados preliminares e incompletos dos primeiros dias indicassem uma estimativa de US$ 88 milhões.

Depressão na Pós-Graduação e Pós-Doutorado, artigo de Sergio Arthuro (JC)

JC e-mail 4618, de 06 de Novembro de 2012.

Sergio Arthuro é médico, doutor em Psicobiologia e divulgador científico. Artigo enviado ao JC Email pelo autor.

A imagem de nós cientistas no senso comum, como estereotipada por Einstein, é que somos meio loucos. De fato, como revelado recentemente pela revista Nature, parece que realmente não temos uma boa saúde mental, dada a alta ocorrência de depressão entre pós-graduandos e pós-doutorandos.

Os pós-graduandos são os estudantes de mestrado e de doutorado, enquanto os pós-doutorandos são os recém doutores em aperfeiçoamento, que ainda não conseguiram um emprego estável. Os pós-doutorandos são comuns há muito tempo nos laboratórios da Europa e dos Estados Unidos, já no Brasil este é um fenômeno recente.

Segundo o texto, boa parte dos estudantes de pós-graduação que desenvolvem depressão foram ótimos estudantes na graduação. Lauren, doutoranda em química na Universidade do Reino Unido, começou com dificuldade em focar nas atividades acadêmicas, evoluiu com medo de apresentar a própria pesquisa, e terminou sem nem mesmo conseguir sair da cama. Felizmente, Lauren buscou ajuda e agora está terminando o seu doutorado, tendo seu caso relatado no site de ajuda Students Against Depression, cujo objetivo é “desenvolver a consciência de que a depressão não é uma falha pessoal ou uma fraqueza, mas sim uma condição séria que requer tratamento”, segundo a psicóloga Denise Meyer, que ajudou no desenvolvimento do site.

Para os cientistas em início de carreira, a competição no meio acadêmico pode levar a isolamento, ansiedade e insônia, que podem gerar depressão. Esta pode ser acentuada se o estudante de pós-graduação tiver problemas extracurriculares e/ou com seu orientador. Já que a depressão altera significativamente a capacidade de fazer julgamento racional, o deprimido perde a capacidade de se reconhecer como tal. Aqui, na minha opinião, o orientador tem um papel fundamental, mas que na prática não tenho observado muito: não se preocupar apenas com os resultados dos experimentos, mas também com a pessoa do estudante.

De acordo com o texto, os principais sinais de depressão são: a) inabilidade de assistir as aulas e/ou fazer pesquisa, b) dificuldade de concentração, c) diminuição da motivação, d) aumento da irritabilidade, e) mudança no apetite, f) dificuldades de interação social, g) problemas no sono, como dificuldade para dormir, insônia ou sono não restaurativo (a pessoa dorme muito, mas acorda cansada e tem sono durante o dia).

Segundo o texto, a maioria das universidades não tem um serviço que possa ajudar os estudantes de pós-graduação. Não obstante, formas alternativas se mostraram relativamente eficazes. Por exemplo, mestrandos e doutorandos poderiam procurar ajuda em serviços oferecidos a alunos de graduação; já os pós-doutorandos poderiam tentar ajuda em serviços oferecidos a professores, sugerem os autores do texto. A maioria dos tratamentos requer apenas uma sessão em que são discutidas as dificuldades dos estudantes, além de sugestões de como manejar melhor a depressão. Uma das principais preocupações é com relação à confidencialidade, que deve ser quebrada apenas se o profissional sentir que o paciente tem chance iminente de ferir a si ou a outrem. Segundo Sharon Milgram, diretora do setor de treinamento e educação do Instituto Nacional de Saúde dos Estados Unidos, “buscar ajuda é um sinal de força, e não de fraqueza”.

Devo admitir que o texto chamou minha atenção por me identificar com o tema, tanto na minha própria experiência, quanto na de vários colegas de pós-graduação que também enfrentaram problemas semelhantes. Acho que o sistema atual de pós-graduação tem falhas que podem aumentar os casos de depressão, como as descritas a seguir:

1- O próprio nome “Defesa” no caso do doutorado

Tem coisa mais agressiva que isso? Defesa pressupõe ataque, é isso mesmo que queremos? Algumas pessoas vão dizer que os ataques são às ideias e não às pessoas. Acho que isso acontece apenas no mundo ideal, porque na prática o limite entre as ideias e as pessoas que tiveram as ideias é muito tênue. Mas pior é nos países de língua espanhola, pois lá a banca é chamada de “tribunal”.

2- Avaliações pouco frequentes

Em vários casos, principalmente no começo do projeto, as avaliações são pouco frequentes, o que faz com que o desespero fique todo para o final. No meu caso, os últimos meses antes da “Defesa” foram os piores da minha vida, pois tive bastante insônia, vontade de desistir de tudo etc. Pior também foi ouvir das pessoas que poderiam me ajudar que aquilo era “normal” e que “fazia parte do processo”… Isso não aconteceu apenas comigo, mas com vários colegas de pós-graduação. Acho que para fazer ciência bem feita, como todo trabalho, tem que ser prazeroso, e acredito que avaliações mais frequentes podem evitar o estresse ao final do trabalho.

3 – Prazos pouco flexíveis

Cada vez mais me é claro que a ciência não é linear, e previsões geralmente são equivocadas. Dessa forma, acredito que não deveria haver nem mestrado nem doutorado com prazo fixo. O pós-graduando deveria ter bolsa por cinco anos para desenvolver sua pesquisa, e a cada ano elaboraria um relatório sobre suas atividades e resultados. Uma comissão deveria julgar esse relatório para ver se o estudante merece continuar. Como cada caso é um caso, em alguns casos, dois anos já seriam suficientes para ter um resultado que possa ser publicado num jornal científico de reputação. Isso daria ao cientista a possibilidade de bolsa por mais cinco anos, por exemplo, para ele continuar sua pesquisa. Em outros casos, cinco anos de trabalho não é suficiente, o que pode ser por causa da própria complexidade da pesquisa, ou outros motivos como atraso na importação de material etc. Nesse caso, acho que o estudante deveria ter pelo menos mais três anos de tolerância para poder concluir sua pesquisa, caso os relatórios anuais sejam aprovados, e o estudante comprove que não é por sua culpa que a pesquisa está demorando mais que o previsto.

Senti falta no texto uma discussão com relação ao fato de que para os futuros cientistas que ainda não tem um emprego definitivo, a ausência de estabilidade financeira é também um fator que contribui para o estado de humor dessa classe tão específica e especial de seres humanos.

Sugestão de Leitura:

Gewin, V. (2012) Under a cloud: Depression is rife among graduate students and postdocs. Universities are working to get them the help they need. Nature 490, 299-301

Médicos veem relação entre vida urbana e distúrbios mentais (Carta Capital)

01/11/2012 – 10h19 – por Redação da Deutsche Welle

Barulho, trânsito, lixo, pessoas apressadas e se empurrando por todos os lados – a vida nas grandes cidades é estressante. Mas as perspectivas de um emprego melhor, um salário mais alto e de um estilo de vida urbano atraem cada vez mais pessoas às cidades. Se há 60 anos menos de um terço da população mundial vivia em cidades, hoje mais da metade mora em centros urbanos. Até 2050, a estimativa é que essa cota atinja 70%.

“Com o aumento das populações urbanas, o número de distúrbios psíquicos também tem aumentado em todo o mundo”, alerta Andreas Meyer-Lindenberg, diretor do Instituto Central de Saúde Mental de Mannheim. “Somente a depressão custa aos cidadãos europeus 120 bilhões de euros por ano. O custo de todas as doenças psíquicas juntas, incluindo demência, ansiedade e psicose, ultrapassa o orçamento do fundo de resgate do euro. A frequência e a gravidade dessas doenças costumam ser subestimadas”, afirma.

sa4 Médicos veem relação entre vida urbana e distúrbios mentais

Em 2003, psiquiatras britânicos publicaram um estudo sobre o estado psicológico dos moradores do bairro londrino de Camberwell, uma área que teve um grande crescimento desde meados da década de 1960. Entre 1965 e 1997, o número de pacientes com esquizofrenia quase dobrou – um aumento acima do crescimento da população.

Na Alemanha, o número de dias de licença médica no trabalho relacionada a distúrbios mentais dobrou entre 2000 e 2010. Na América do Norte, recentes estimativas apontam que 40% dos casos de licença estão ligados à depressão.

“Nas cidades pode acontecer de as pessoas não conhecerem seus vizinhos, não conseguirem construir uma rede de apoio social como nas vilas e pequenas cidades. Elas se sentem sozinhas e socialmente excluídas, sem uma espécie de rede social de segurança”, observa Andreas Heinz, diretor da Clínica de Psiquiatria e Psicoterapia no hospital Charité, em Berlim.

Quase não existem estudos consistentes sobre a influência do meio urbano no cérebro humano. Mas pesquisas com animais mostram que o isolamento social altera o sistema neurotransmissor do cérebro. “Acredita-se que a serotonina é um neurotransmissor importante para amortecer situações de risco. Quando animais são isolados socialmente desde cedo, o nível de serotonina diminui drasticamente. Isso significa que as regiões que respondem a estímulos ameaçadores são desinibidas e reagem de maneira mais forte, o que pode contribuir para que o indivíduo desenvolva mais facilmente distúrbios de ansiedade ou depressões”, diz Heinz.

Um dos primeiros estudos feitos com seres humanos parece confirmar essa suposição. Com ajuda de um aparelho de ressonância magnética, a equipe do psiquiatra Andreas Meyer-Lindenberg analisou o cérebro de pessoas que cresceram na cidade e de pessoas que se mudaram para a cidade já adultos.

Enquanto os voluntários resolviam pequenas tarefas de cálculo, os pesquisadores os colocavam sob pressão, por exemplo criticando que eles eram muito lentos, cometiam erros ou que eram piores que seus antecessores.

“Olhamos especificamente para as áreas do cérebro que são ativadas quando se está estressado – e que também têm um desenvolvimento distinto, dependendo da experiência urbana que a pessoa teve. Especialmente as amídalas cerebelosas reagiram ao estresse social, e de maneira mais intensa quando o voluntário vinha de um ambiente urbano. Essa região do cérebro está sempre ativa quando percebemos algo como sendo uma ameaça. Elas podem desencadear reações agressivas que podem gerar transtornos de ansiedade”, explica Meyer-Lindenberg.

Além disso, quem cresceu na cidade grande apresentava, sob estresse, em regiões específicas do cérebro, uma atividade semelhante à apresentada por pessoas com predisposição genética para a esquizofrenia.

Pesquisa melhora planejamento urbano

Em todo o mundo, as cidades estão crescendo muito e se transformando. “Mas não existem ainda dados significativos de como uma cidade ideal deve ser quando se leva em consideração a saúde mental de seus habitantes”, observa Meyer-Lindenberg.

Por isso, o especialista desenvolveu, em colaboração com geólogos da Universidade de Heidelberg e físicos do Instituto de Tecnologia de Karlsruhe, um dispositivo móvel que pode testar voluntários em diversos pontos de uma cidade. Assim, os pesquisadores podem testar o funcionamento do cérebro em lugares e situações diferentes, como num cruzamento ou num parque.

Juntamente com posteriores análises do cérebro dos voluntários, os pesquisadores esperam obter dados mais concretos de como o cérebro processa os diferentes aspectos da vida cotidiana nas cidades.

Os resultados dessa pesquisa poderão ser de grande valor para a arquitetura e o planejamento urbano, afirma Richard Burdett, professor de estudos urbanos da London School of Economics. Para ele, o neuro-urbanismo, uma nova área do conhecimento que estuda a relação entre o estresse e as doenças psíquicas, pode ajudar a evitar a propagação de doenças psíquicas nas cidades.

“Planejadores urbanos precisam ter em mente que devem encontrar o equilíbrio entre a necessidade de organizar muitas pessoas em pouco espaço e a necessidade de se criar espaços abertos”, acrescenta.

“As pessoas precisam ter acesso a salas de cinema, encontrar-se com amigos e passear nas margens dos rios. Hoje esses aspectos são, muitas vezes, ignorados quando novas cidades são planejadas na China ou na Indonésia. Os arquitetos se preocupam com as proporções e as formas, e os urbanistas, com a eficiência do transporte público. Mas muitas vezes não temos ideia do que isso faz com as pessoas.”

* Publicado originalmente no site Carta Capital.

Link between creativity and mental illness confirmed (Karolinska Institutet)

[PRESS RELEASE 16 October 2012] People in creative professions are treated more often for mental illness than the general population, there being a particularly salient connection between writing and schizophrenia. This according to researchers at Karolinska Institutet, whose large-scale Swedish registry study is the most comprehensive ever in its field.

Last year, the team showed that artists and scientists were more common amongst families where bipolar disorder and schizophrenia is present, compared to the population at large. They subsequently expanded their study to many more psychiatric diagnoses – such as schizoaffective disorder, depression, anxiety syndrome, alcohol abuse, drug abuse, autism, ADHD, anorexia nervosa and suicide – and to include people in outpatient care rather than exclusively hospital patients.

The present study tracked almost 1.2 million patients and their relatives, identified down to second-cousin level. Since all were matched with healthy controls, the study incorporated much of the Swedish population from the most recent decades. All data was anonymized and cannot be linked to any individuals.

The results confirmed those of their previous study: certain mental illness – bipolar disorder – is more prevalent in the entire group of people with artistic or scientific professions, such as dancers, researchers, photographers and authors. Authors specifically also were more common among most of the other psychiatric diseases (including schizophrenia, depression, anxiety syndrome and substance abuse) and were almost 50 per cent more likely to commit suicide than the general population.

The researchers also observed that creative professions were more common in the relatives of patients with schizophrenia, bipolar disorder, anorexia nervosa and, to some extent, autism. According to Simon Kyaga, consultant in psychiatry and doctoral student at the Department of Medical Epidemiology and Biostatistics, the results give cause to reconsider approaches to mental illness.

“If one takes the view that certain phenomena associated with the patients illness are beneficial, it opens the way for a new approach to treatment,” he says. “In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally there has been a tradition to see the disease in black-and-white terms and to endeavour to treat the patient by removing everything regarded as morbid.”

The study was financed with grants from the Swedish Research Council, the Swedish Psychiatry Foundation, the Bror Gadelius Foundation, the Stockholm Centre for Psychiatric Research and the Swedish Council for Working Life and Social Research.

Publication

Simon Kyaga, Mikael Landén, Marcus Boman, Christina M. Hultman och Paul Lichtenstein. Mental illness, suicide and creativity: 40-Year prospective total population study. Journal of Psychiatric Research, corrected proof online 9 October 2012

Media Violence Consumption Increases the Relative Risk of Aggression, Analysis Shows (Science Daily)

ScienceDaily (Aug. 27, 2012) — As president of the International Society for Research on Aggression (IRSA) and with consent of the organization’s elected council, Craig Anderson appointed an international Media Violence Commission last December to prepare a public statement on the known effects of media violence exposure, based on the current state of scientific knowledge.

The Iowa State University Distinguished Professor of psychology appointed 12 IRSA researchers to the commission, including Douglas Gentile, an ISU associate professor of psychology.

The Media Violence Commission’s research-based report concludes that the research clearly shows that media violence consumption increases the relative risk of aggression, defined as intentional harm to another person that could be verbal, relational, or physical. The report is published in the September/October issue of the journal Aggressive Behavior.

“Basically, the commission looked at, ‘What does the research literature say?'” Anderson said. “In addition, we asked them to make some recommendations, if they chose to do so, about public policy. It really was kind of an open-ended charge.”

Members took a fair and balanced look at the research

A well-known researcher on the effects of media on children, Gentile says commission members took a fair and balanced look at all of the existing research to see if they could achieve consensus, and then summarized what they found.

In their report, the commission wrote that aside from being sources of imitation, violent images — such as scenes in movies, games or pictures in comic books — act as triggers for activating aggressive thoughts and feelings already stored in memory. If these aggressive thoughts and feelings are activated over and over again because of repeated exposure to media violence, they become chronically accessible, and thus more likely to influence behavior.

“One may also become more vigilant for hostility and aggression in the world, and therefore, begin to feel some ambiguous actions by others (such as being bumped in a crowded room) are deliberate acts of provocation,” the commission wrote in the report.

The commission recommends that parents know what media their children and adolescents are using. Rating systems often provide too little detail about media content to be helpful, and in any case, are not substitutes for parents’ watching, playing, or listening to the media their children use.

“Parents can also set limits on screen use (The American Academy of Pediatrics recommends no screen time for children under 2 and no more than one to two hours total screen time per day for children/youth 3-18), and should discuss media content with their children to promote critical thinking when viewing,” the researchers wrote. “Schools may help parents by teaching students from an early age to be critical consumers of the media and that, just like food, the ‘you are what you eat’ principle applies to healthy media consumption.”

The commission recommends improving media ratings

While most public policy has focused on restricting children’s access to violent media, the commission found that approach to have significant political and legal challenges in many countries. For that reason, it recommends putting efforts into improving media ratings, classifications, and public education about the effects of media on children.

“Improving media ratings really has two pieces. One is that the media ratings themselves need to be done by an independent entity — meaning, not by an industry-influenced or controlled system,” said Anderson, himself a leading researcher of the effects of violent media on children. “They need to be ratings that have some scientific validity to them.

“But the other piece is education, and if parents aren’t educated — not just about what the ratings system does, but also about why it’s important for them to take control of their child’s media diet — then it doesn’t matter how good the ratings system is, because they’re going to ignore it anyway,” he added.

Anderson hopes the final report will have value to child advocacy groups.

“Having such a clear statement by an unbiased, international scientific group should be very helpful to a number of child advocacy groups — such as parenting groups — in their efforts to improve the lives of children,” he said.

Journal Reference:

  1. Media Violence Commission, International Society for Research on Aggression (ISRA). Report of the Media Violence CommissionAggressive Behavior, Volume 38, Issue 5, September/October 2012, Pages: 335%u2013341 DOI: 10.1002/ab.21443

Psychopaths Get a Break from Biology: Judges Reduce Sentences If Genetics, Neurobiology Are Blamed (Science Daily)

ScienceDaily (Aug. 16, 2012) — A University of Utah survey of judges in 19 states found that if a convicted criminal is a psychopath, judges consider it an aggravating factor in sentencing, but if judges also hear biological explanations for the disorder, they reduce the sentence by about a year on average.

The new study, published in the Aug. 17, 2012, issue of the journalScience, illustrates the “double-edged sword” faced by judges when they are given a “biomechanical” explanation for a criminal’s mental disorder:

If a criminal’s behavior has a biological basis, is that reason to reduce the sentence because defective genes or brain function leave the criminal with less self-control and ability to tell right from wrong? Or is it reason for a harsher sentence because the criminal likely will reoffend?

“In a nationwide sample of judges, we found that expert testimony concerning the biological causes of psychopathy significantly reduced sentencing of the psychopath” from almost 14 years to less than 13 years, says study coauthor James Tabery, an assistant professor of philosophy at the University of Utah.

However, the hypothetical psychopath in the study got a longer sentence than the average nine-year sentence judges usually impose for the same crime — aggravated battery — and there were state-to-state differences in whether judges reduced or increased the sentence when given information on the biological causes of psychopathy.

The study was conducted by Tabery; Lisa Aspinwall, a University of Utah associate professor of psychology; and Teneille Brown, an associate professor at the university’s S.J. Quinney College of Law.

The researchers say that so far as they know, their study — funded by a University of Utah grant to promote interdisciplinary research — is the first to examine the effect of the biological causes of criminal behavior on real judges’ reasoning during sentencing.

Biological Explanation of Psychopathy Helps Defendant

The anonymous online survey — distributed with the help of 19 of 50 state court administrators who were approached — involved 181 participating judges reading a scenario, based on a real Georgia case, about a psychopath convicted of aggravated battery for savagely beating a store clerk with a gun during a robbery attempt.

The judges then answered a series of questions, including whether they consider scientific evidence of psychopathy to be an aggravating or mitigating factor that would increase or decrease the sentence, respectively, and what sentence they would impose. They were told psychopathy is incurable and treatment isn’t now an option.

While psychopathy isn’t yet a formal diagnosis in the manual used by psychiatrists, it soon may be added as a category of antisocial personality disorder, Tabery says. The study cited an expert definition of psychopathy as “a clinical diagnosis defined by impulsivity; irresponsibility; shallow emotions; lack of empathy, guilt or remorse; pathological lying; manipulation; superficial charm; and the persistent violation of social norms and expectations.”

The researchers recruited 207 state trial court judges for the study. Six dropped out. Twenty others were excluded because they incorrectly identified the defendant’s diagnosis. That left 181 judges who correctly identified the defendant as a psychopath, including 164 who gave complete data on their sentencing decisions.

The judges were randomly divided into four groups. All the judges read scientific evidence that the convicted criminal was a psychopath and what that means, but only half were given evidence about the genetic and neurobiological causes of the condition. Half the judges in each group got the scientific evidence from the defense, which argued it should mitigate or reduce the sentence, and half the judges got the evidence from the prosecution, which argued it should aggravate or increase the sentence.

Judges who were given a biological explanation for the convict’s psychopathy imposed sentences averaging 12.83 years, or about a year less than the 13.93-year average sentence imposed by judges who were told only that the defendant was a psychopath, but didn’t receive a biological explanation for the condition. In both cases, however, sentencing for the psychopath was longer than the judges’ normal nine-year average sentence for aggravated battery.

Even though the year reduction in sentence may not seem like much, “we were amazed the sentence was reduced at all given that we’re dealing with psychopaths, who are very unsympathetic,” Brown says.

Aspinwall notes: “The judges did not let the defendant off, they just reduced the sentence and showed major changes in the quality of their reasoning.”

The study found that although 87 percent of the judges listed at least one aggravating factor in explaining their decision, when the judges heard evidence about the biomechanical causes of psychopathy from the defense, the proportion of judges who also listed mitigating factors rose from about 30 percent to 66 percent.

Psychopathy was seen as an aggravating factor no matter which side presented the evidence, but it was viewed by the judges as less aggravating when presented by the defense than when presented by the prosecution.

A Disconnect between Sentencing and Criminal Responsibility

One surprising and paradoxical finding of the study was that even though the judges tended to reduce the sentence when given a biological explanation for the defendant’s psychopathy, the judges — when asked explicitly — did not rate the defendant as having less free will or as being less legally or morally responsible for the crime.

“The thought is that responsibility and punishment go hand in hand, so if we see reduced punishment, we would expect to see the judges feel the defendants are less responsible,” Tabery says. “So it is surprising that we got the former, not the latter.”

The researchers also counted explicit mentions by the judges of balancing or weighing factors that increase or reduce sentencing. When evidence of a biological cause of the defendant’s psychopathy was presented by the defense, the judges were about 2.5 times more likely to mention weighing aggravating and mitigating factors than when it was presented by the prosecution or when no biological evidence was presented.

The data show that “the introduction of expert testimony concerning a biological mechanism for psychopathy significantly increased the number of judges invoking mitigating factors in their reasoning and balancing them with aggravating factors,” the researchers conclude. “These findings suggest that the biomechanism did invoke such concepts as reduced culpability due to lack of impulse control, even if these concepts did not affect the ratings of free will and responsibility.”

Brown adds: “In the coming years, we are likely to find out about all kinds of biological causes of criminal behavior, so the question is, why does the law care if most behavior is biologically caused? That’s what is so striking about finding these results in psychopaths, because we’re likely to see an even sharper reduction in sentencing of defendants with a more sympathetic diagnosis, such as mental retardation.”

State Variations in Sentencing

While the overall results showed a reduction in sentencing when judges read biological evidence about the cause of psychopathy, the reduction was greater in some of the 19 states surveyed and nonexistent in others. That is not surprising due to variations in sentencing guidelines, rules of evidence and the extent of judges’ discretion.

There were too few responses from eight states to analyze them individually. In three states — Colorado, New York and Tennessee — biological evidence of psychopathy actually increased the sentence, although the findings weren’t statistically significant.

In eight other states — Alabama, Maryland, Missouri, Nebraska, New Mexico, Oklahoma, Utah and Washington state — biological evidence of psychopathy reduced the sentence or had no effect, and the reduction was statistically significant in two of those states: Utah and Maryland. When just those eight states were examined, the defendant received an average sentence of 10.7 years if evidence was introduced that psychopathy has a biological cause, versus 13.9 years without such evidence.

“We saw sentencing go up in a few states and down in most, and that’s just evidence that it [the double-edge sword] could cut either way,” Brown says.

Aspinwall adds: “When you look at the reasons the judges provide, what is striking to us is the vast majority found the psychopathy diagnosis to be aggravating and, with the presentation of the biological mechanism, also mitigating. So both things are happening.”

Psychological Abuse and Youth Anxiety and Depression (Science Daily)

Psychological Abuse Puts Children at Risk

ScienceDaily (July 30, 2012) — Child abuse experts say psychological abuse can be as damaging to a young child’s physical, mental and emotional health as a slap, punch or kick.

While difficult to pinpoint, it may be the most challenging and prevalent form of child abuse and neglect, experts say in an American Academy of Pediatrics (AAP) position statement on psychological maltreatment in the August issue of the journal Pediatrics.

Psychological abuse includes acts such as belittling, denigrating, terrorizing, exploiting, emotional unresponsiveness, or corrupting a child to the point a child’s well-being is at risk, said Dr. Harriet MacMillan, a professor in the departments of psychiatry and behavioural neurosciences and pediatrics of McMaster University’s Michael G. DeGroote School of Medicine and the Offord Centre for Child Studies. One of three authors of the position statement, she holds the David R. (Dan) Offord Chair in Child Studies at McMaster.

“We are talking about extremes and the likelihood of harm, or risk of harm, resulting from the kinds of behavior that make a child feel worthless, unloved or unwanted,” she said, giving the example of a mother leaving her infant alone in a crib all day or a father involving his teenager in his drug habit.

A parent raising their voice to a strident pitch after asking a child for the eighth time to put on their running shoes is not psychological abuse, MacMillan said. “But, yelling at a child every day and giving the message that the child is a terrible person, and that the parent regrets bringing the child into this world, is an example of a potentially very harmful form of interaction.”

Psychological abuse was described in the scientific literature more than 25 years ago, but it has been under-recognized and under-reported, MacMillan said, adding that its effects “can be as harmful as other types of maltreatment.”

The report says that because psychological maltreatment interferes with a child’s development path, the abuse has been linked with disorders of attachment, developmental and educational problems, socialization problems and disruptive behaviour. “The effects of psychological maltreatment during the first three years of life can be particularly profound.”

This form of mistreatment can occur in many types of families, but is more common in homes with multiple stresses, including family conflict, mental health issues, physical violence, depression or substance abuse.

Although there are few studies reporting the prevalence of psychological abuse, the position statement says large population-based, self-report studies in Britain and the United States found approximately eight-to-nine per cent of women and four per cent of men reported exposure to severe psychological abuse during childhood.

The statement says pediatricians need to be alert to the possibility of psychological abuse even though there is little evidence on potential strategies that might help. It suggests collaboration among pediatric, psychiatric and child protective service professionals is essential for helping the child at risk.

Funders for the paper’s development included the Family Violence Prevention Unit of the Public Health Agency of Canada.

Along with MacMillan, the statement was prepared by Indiana pediatrician Dr. Roberta Hibbard, an expert on child abuse and neglect; Jane Barlow, professor of Public Health in the Early Years at the University of Warwick; as well as the Committee on Child Abuse and Neglect and the American Academy of Child and Adolescent Psychiatry, Child Maltreatment and Violence Committee.

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Emotion Detectives Uncover New Ways to Fight-Off Youth Anxiety and Depression

ScienceDaily (July 30, 2012) — Emotional problems in childhood are common. Approximately 8 to 22 percent of children suffer from anxiety, often combined with other conditions such as depression. However, most existing therapies are not designed to treat coexisting psychological problems and are therefore not very successful in helping children with complex emotional issues.

To develop a more effective treatment for co-occurring youth anxiety and depression, University of Miami psychologist Jill Ehrenreich-May and her collaborator Emily L. Bilek analyzed the efficacy and feasibility of a novel intervention created by the researchers, called Emotion Detectives Treatment Protocol (EDTP). Preliminary findings show a significant reduction in the severity of anxiety and depression after treatment, as reported by the children and their parents.

“We are very excited about the potential of EDTP,” says Ehrenreich-May, assistant professor of psychology in the College of Arts and Sciences at UM and principal investigator of the study. “Not only could the protocol better address the needs of youth with commonly co-occurring disorders and symptoms, it may also provide additional benefits to mental health professionals,” she says. “EDTP offers a more unified approach to treatment that, we hope, will allow for an efficient and cost-effective treatment option for clinicians and clients alike.”

Emotion Detectives Treatment Program is an adaptation of two treatment protocols developed for adults and adolescents, the Unified Protocols. The program implements age-appropriate techniques that deliver education about emotions and how to manage them, strategies for evaluating situations, problem-solving skills, behavior activation (a technique to reduce depression), and parent training.

In the study, 22 children ages 7 to 12 with a principal diagnosis of anxiety disorder and secondary issues of depression participated in a 15-session weekly group therapy of EDTP. Among participants who completed the protocol (18 out of 22), 14 no longer met criteria for anxiety disorder at post-treatment. Additionally, among participants who were assigned a depressive disorder before treatment (5 out of 22), only one participant continued to meet such criteria at post-treatment.

Unlike results from previous studies, the presence of depressive symptoms did not predict poorer treatment response. The results also show a high percentage of attendance. The findings imply that EDTP may offer a better treatment option for children experiencing anxiety and depression.

“Previous research has shown that depressive symptoms tend to weaken treatment response for anxiety disorders. We were hopeful that a broader, more generalized approach would better address this common co-occurrence,” says Bilek, doctoral candidate in clinical psychology at UM and co-author of the study. “We were not surprised to find that the EDTP had equivalent outcomes for individuals with and without elevated depressive symptoms, but we were certainly pleased to find that this protocol may address this important issue.”

The study, titled “The Development of a Transdiagnostic, Cognitive Behavioral Group Intervention for Childhood Anxiety Disorders and Co-Occurring Depression Symptoms,” is published online ahead of print in the journal Cognitive and Behavioral Practice. The next step is for the team to conduct a randomized controlled trial comparing the EDTP to another group treatment protocol for anxiety disorder.

Listening to Tinnitus: Roles of Media When Hearing Breaks Down (Sounding Out!)

http://soundstudiesblog.com – 16 July 2012

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Editor’s Note: Welcome to the third installment in our month-long exploration of listening in observation of World Listening Day on July 18, 2012.  For the full introduction to the series click here.  To peep the previous posts, click here. Otherwise, prepare yourself to listen carefully as Mack Hagood contemplates how sound studies scholars can help tinnitus sufferers (and vice versa).  –JSA

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 One January morning in 2006, Joel Styzens woke up and life sounded different. Superimposed over the quiet ambience of his Chicago apartment was a cluster of sounds: pure, high-pitched tones like those of a hearing test. Loud, steady, and constant, they weren’t going away.  He walked to the bathroom to wash his face. “As soon as I turned on the water on the faucet,” he told me in an interview, “the left ear was crackling… like, a speaker, you know, being overdriven.” Joel was 24 and a professional musician, someone who made his living through focused and detailed listening.

As days passed, he grew more fearful and depressed. For two months, he barely left the house. The air brakes of a city bus or a honking horn were painful and caused his heart to race. His sense of himself, his environment, and his identity as a musician were all undermined. This man who lived through his ears now faced the prospect of a life of tinnitus (ringing or other “phantom sounds”) and its frequent companion, hyperacusis (sound sensitivity sometimes accompanied by distortion). Joel could even identify the dominant pitch of his torment: it was A sharp.

We humanistic and qualitative sound scholars—particularly those of us focused on media and technology—can learn a lot from listening to tinnitus and the people who have it. Scholars of science and technology studies (STS) often utilize moments of technological breakdown to reveal the processes and mechanisms that constitute things we take for granted. Tinnitus and hyperacusis are, in the words of anthropologist Stefan Helmreich, “moments when hearing and listening break down” (629). Because sound scholars understand sound, hearing, and listening not only as the material effects of physics and physiology, but also as culturally and technologically emergent phenomena, we can potentially contribute much to the growing public conversation around tinnitus.

“Tinnitus” by Merrick Brown

And there is a lot at stake. Tinnitus affects 10-15% of adults and is the top service-related disability affecting U.S. veterans returning from Iraq and Afghanistan. Tinnitus and hyperacusis are also fairly common among musicians who work in loud performance and media production environments. It is perhaps ironic, then, that mediated sound and music are audiologists’ primary tools in helping people recover from these conditions.

My own study of tinnitus centers on its articulation with audio-spatial media—devices such as bedside sound machines, white noise generators, and noise-canceling headphones, all used to fabricate a desired sense of space through sound. People with tinnitus are among the most avid users of these devices, carefully mediating their aural-spatial relations as tinnitus becomes more evident in quiet spaces and hyperacusis flares up in noisy ones. During my fieldwork in audiology clinics and conferences, tinnitus support groups, andonline forums, I observed that audio media were being deployed as medicine and technologies of self-care. Gradually, I came to the realization that the experience, discourse, and treatment of tinnitus is always bound up in mediation. In fact, I believe that tinnitus signals the highly mediated nature of our most intimate perceptions of sound and self. Below, I sketch just a few of the places I think aural media scholarship could go in conversation with tinnitus and hyperacusis.

The sound of media aftermath

Hearing experts do not consider subjective tinnitus to be a disease, but rather a condition in which individuals experience the normal, random neuronal firing of their auditory system as sound. Although it may be tied to various diseases and disorders, tinnitus itself is benign and does not inherently signal progressive hearing loss nor any other malignant condition.

Image by Flickr User Phil Edmonds

Nevertheless, research shows a frequent association between tinnitus and reduced auditory input, comparable to a sound engineer turning up the volume on a weak signal and thus amplifying the mixing board’s inherent noise. This “automatic gain control” theory neatly explains a classic 1953 study, in which 94 percent of “normal hearing” people experienced tinnitus in the dead silence of an anechoic chamber. Unfortunately, it also helps confirm the fear that the ringing heard after a night of loud music is due to hearing loss, known clinically as “temporary threshold shift.”

As Joel’s case suggests, when repeated, such threshold shifts lead to permanent damage. Audiologists increasingly see media-induced hearing loss and tinnitus as an epidemic, with ubiquitous earbuds often positioned as the main culprits. I have heard clinicians express dismay at encountering more young people with “old ears” in their offices, and youth education programs are beginning to proliferate. These apparent relations between aural pleasure and self-harm are an intriguing and socially significant area for sound and media scholarship, but they should also be considered within the context of moral panics that have historically accompanied the emergence of new media.

Objectifying phantom sound

For both clinicians and sufferers, one of the most frustrating and confounding aspects of tinnitus is how hard it is to objectify, either as a subject of research and treatment or as a condition worthy of empathy and activism. For both clinicians and sufferers, media are the primary tools for converting tinnitus into a manageable object.

Media marketed to protect musicians against Tinnitus, Image by Flickr User Jochen Wolters

Although media scholars haven’t yet studied it as such, the audiologist’s clinic is a center of media production and consumer electronics retail. Having audio production experience, I felt a sense of recognition on seeing the mixer-like audiometer in the control room of Joel’s audiologist, Jill Meltzer, separated by a pane of glass from the soundproofed booth where her patients sit. It was a studio where Meltzer recorded hearing rather than sound, as she attempted the tricky work of matching the pitch, volume, and sensitivity levels of tinnitus and hyperacusis. Since medication and surgery are not effective treatment options, the remedies for sale are media prosthetics and palliatives such as wearable sound generators“fractal tone” hearing aidsNeuromonics, and soundmachines that help distract, calm, and habituate patients to the ringing. Meltzer and other clinicians consistently told me that they have only two tinnitus tools at their disposal—counseling and sound.

Audiometer and testing booth, Image by the author

The subjectivity of tinnitus is most frustrating for sufferers, however, who often encounter impatience and misunderstanding from family, friends, bosses, and even their doctors. Again, media serve to externalize and objectify the sound. Joel did this through music: “A Sharp,” Styzens’ first post-tinnitus composition, represents tinnitus with chordal dissonance and hyperacusis with a powerful change of dynamics on a guitar. He eventually recorded an entire album that explored his condition and raised awareness.

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Other individuals, in an attempt to communicate the aural experience that drives their sleeplessness, depression, anxiety, or lack of concentration, create YouTube videos designed to recreate the subjective experience of tinnitus.

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The American Tinnitus Association, an advocacy group, has used broadcast and social media to raise awareness and research funding, as we see in this PSA from 1985.

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However, such dramatic uses of media may be in some ways too powerful. In fact, “raising awareness of tinnitus” might be as bad as it literally sounds.

Communicable dis-ease

In the process of externalizing their experience for others to hear, people with tinnitus can make their own perception of the sound grow stronger. They may also generate anxiety in others, encouraging them to notice and problematize their own, previously benign tinnitus.

Neuroscientist Pawel Jastreboff’s groundbreaking and influentialneurophysiological model of tinnitus postulates that tinnitus becomes bothersome only when the auditory cortex forms networks with other areas in the brain, resulting in a vicious circle of increasing perception and fear. The implication of this model, now substantiated by clinical research, is that the way people think about tinnitus is a much greater predictor of suffering than the perceived volume of the sound. As Jastreboff told me in an interview, “Incorrect information can induce bothersome tinnitus.” Information, of course, circulates through media. It may be productive, then, to think of tinnitus suffering as a communicable dis-ease, one strengthened in circulation through networks of neurons, discourse, and media.

I think there is both a need and an opportunity in tinnitus for an applied sound studies, one that intervenes in this mediated public discourse, works against moral panic and hyperawareness, and suggests the quieting possibilities that open up when we grasp the constructed nature of our aurality. Listening to tinnitus as a networked coproduction highlights the ways in which our most subjective aural perceptions are also social, cultural, and mediated—perhaps the fundamental insight of sound studies. My hope is that by listening to tinnitus we can speak to it as well.

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*Featured Image Credit: A representation of Tinnitus by Flickr User Jason Rogers, called “Day 642/365–Myself is against me”

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Mack Hagood is a doctoral candidate at Indiana University’s Department of Communication and Culture, where he does ethnographic research in digital media, sound studies, and popular music. He has taught courses on sound cultures, global media, ethnographic methods, and audio production. He and his students won the Indiana Society of Professional Journalists’ 2012 Best Radio Use of Sound award for their documentary series “I-69: Sounds and Stories in the Path of a Superhighway.” His publications include studies of indie rock in Taiwan (Folklore Forumand the use of noise-canceling headphones in air travel (American Quarterly)He recently completed an article on combat Foley in Fight Club and is now finishing his dissertation, titled “Sonic Technologies of the Self: Mediating Sound, Space, Self, and Sociality.” He hears crickets even in the dead of winter.

Concerns Over Accuracy of Tools to Predict Risk of Repeat Offending (Science Daily)

ScienceDaily (July 24, 2012) — Use of risk assessment instruments to predict violence and antisocial behavior in 73 samples involving 24,827 people: systematic review and meta-analysis

Tools designed to predict an individual’s risk of repeat offending are not sufficient on their own to inform sentencing and release or discharge decisions, concludes a study published on the British Medical Journal website.

Although they appear to identify low risk individuals with high levels of accuracy, the authors say “their use as sole determinants of detention, sentencing, and release is not supported by the current evidence.”

Risk assessment tools are widely used in psychiatric hospitals and criminal justice systems around the world to help predict violent behavior and inform sentencing and release decisions. Yet their predictive accuracy remains uncertain and expert opinion is divided.

So an international research team, led by Seena Fazel at the University of Oxford, set out to investigate the predictive validity of tools commonly used to assess the risk of violence, sexual, and criminal behavior.

They analyzed risk assessments conducted on 24,827 people from 13 countries including the UK and the US. Of these, 5,879 (24%) offended over an average of 50 months.

Differences in study quality were taken into account to identify and minimize bias.

Their results show that risk assessment tools produce high rates of false positives (individuals wrongly identified as being at high risk of repeat offending) and predictive accuracy at around chance levels when identifying risky persons. For example, 41% of individuals judged to be at moderate or high risk by violence risk assessment tools went on to violently offend, while 23% of those judged to be at moderate or high risk by sexual risk assessment tools went on to sexually offend.

Of those judged to be at moderate or high risk of committing any offense, just over half (52%) did. However, of those predicted not to violently offend, 91% did not, suggesting that these tools are more effective at screening out individuals at low risk of future offending.

Factors such as gender, ethnicity, age or type of tool used did not appear to be associated with differences in predictive accuracy.

Although risk assessment tools are widely used in clinical and criminal justice settings, their predictive accuracy varies depending on how they are used, say the authors.

“Our review would suggest that risk assessment tools, in their current form, can only be used to roughly classify individuals at the group level, not to safely determine criminal prognosis in an individual case,” they conclude. The extent to which these instruments improve clinical outcomes and reduce repeat offending needs further research, they add.

The War on Suicide? (Time)

Monday, July 23, 2012

By NANCY GIBBS; MARK THOMPSON

Leslie McCaddon sensed that the enemy had returned when she overheard her husband on the phone with their 8-year-old daughter. “Do me a favor,” he told the little girl. “Give your mommy a hug and tell her that I love her.”

She knew for certain when she got his message a few minutes later. “This is the hardest e-mail I’ve ever written,” Dr. Michael McCaddon wrote. “Please always tell my children how much I love them, and most importantly, never, ever let them find out how I died … I love you. Mike”

She grabbed a phone, sounded every alarm, but by the time his co-workers found his body hanging in the hospital call room, it was too late.

Leslie knew her husband, an Army doctor, had battled depression for years. For Rebecca Morrison, the news came more suddenly. The wife of an AH-64 Apache helicopter pilot, she was just beginning to reckon with her husband Ian’s stress and strain. Rebecca urged Ian to see the flight surgeon, call the Pentagon’s crisis hotline. He did–and waited on the line for more than 45 minutes. His final text to his wife: “STILL on hold.” Rebecca found him that night in their bedroom. He had shot himself in the neck.

Grand Praire, TX. Rebecca Morrison with some of her husband Ian’s belongings in her parents homes. Ian, an AH-64 Apache Helicopter pilot in the U.S. Army committed suicide on March 21, 2012. Ian chose ‘Ike’ for Rebecca. Peter van Agtmael/Magnum for TIME.

Both Army captains died on March 21, a continent apart. The next day, and the next day, and the next, more soldiers would die by their own hand, one every day on average, about as many as are dying on the battlefield. These are active-duty personnel, still under the military’s control and protection. Among all veterans, a suicide occurs every 80 minutes, round the clock.

Have suicides spiked because of the strain of fighting two wars? Morrison flew 70 missions in Iraq over nine months but never engaged the enemy directly. McCaddon was an ob-gyn resident at an Army hospital in Hawaii who had never been to Iraq or Afghanistan. Do the pride and protocols of a warrior culture keep service members from seeking therapy? In the three days before he died, Morrison went looking for help six times, all in vain. When Leslie McCaddon alerted commanders about her husband’s anguish, it was dismissed as the result of a lovers’ quarrel; she, not the Army, was the problem.

This is the ultimate asymmetrical war, and the Pentagon is losing. “This issue–suicides–is perhaps the most frustrating challenge that I’ve come across since becoming Secretary of Defense,” Leon Panetta said June 22. The U.S. military seldom meets an enemy it cannot target, cannot crush, cannot put a fence around or drive a tank across. But it has not been able to defeat or contain the epidemic of suicides among its troops, even as the wars wind down and the evidence mounts that the problem has become dire. While veterans account for about 10% of all U.S. adults, they account for 20% of U.S. suicides. Well trained, highly disciplined, bonded to their comrades, soldiers used to be less likely than civilians to kill themselves–but not anymore.

More U.S. military personnel have died by suicide since the war in Afghanistan began than have died fighting there. The rate jumped 80% from 2004 to 2008, and while it leveled off in 2010 and 2011, it has soared 18% this year. Suicide has passed road accidents as the leading noncombat cause of death among U.S. troops. While it’s hard to come by historical data on military suicides–the Army has been keeping suicide statistics only since the early 1980s–there’s no denying that the current numbers constitute a crisis.

The specific triggers for suicide are unique to each service member. The stresses layered on by war–the frequent deployments, the often brutal choices, the loss of comrades, the family separation–play a role. So do battle injuries, especially traumatic brain injury and posttraumatic stress disorder (PTSD). And the constant presence of pain and death can lessen one’s fear of them.

But combat trauma alone can’t account for the trend. Nearly a third of the suicides from 2005 to 2010 were among troops who had never deployed; 43% had deployed only once. Only 8.5% had deployed three or four times. Enlisted service members are more likely to kill themselves than officers, and 18-to-24-year-olds more likely than older troops. Two-thirds do it by gunshot; 1 in 5 hangs himself. And it’s almost always him: nearly 95% of cases are male. A majority are married.

No program, outreach or initiative has worked against the surge in Army suicides, and no one knows why nothing works. The Pentagon allocates about $2 billion–nearly 4% of its $53 billion annual medical bill–to mental health. That simply isn’t enough money, says Peter Chiarelli, who recently retired as the Army’s second in command. And those who seek help are often treated too briefly.

Army officials declined to discuss specific cases. But Kim Ruocco directs suicideprevention programs at the nonprofit Tragedy Assistance Program for Survivors, or TAPS. She knows what Leslie McCaddon and Rebecca Morrison have endured; her husband, Marine Major John Ruocco, an AH-1 Cobra helicopter-gunship pilot, hanged himself in 2005. These were highly valued, well-educated officers with families, with futures, with few visible wounds or scars; whatever one imagines might be driving the military suicide rate, it defies easy explanation. “I was with them within hours of the deaths,” Ruocco says of the two new Army widows. “I experienced it through their eyes.” Their stories, she says, are true. And they are telling them now, they say, because someone has to start asking the right questions.

The Bomb Grunt

Michael McCaddon was an Army brat born into a uniquely edgy corner of the service: his father served in an ordnance-disposal unit, and after his parents divorced, his mother married another bomb-squad member. McCaddon entered the family business, enlisting at 17. “When I joined the Army I was 5’10” and weighed 129 lbs,” he blogged years later. “I had a great body … for a girl.” But basic training made him stronger and tougher; he pushed to get the top scores on physical-fitness tests; he took up skydiving, snorkeling, hiking. If you plan to specialize in a field in which a single mistake can cost you and your comrades their lives, it helps to have high standards. “Ever since I was new to the Army, I made it my personal goal to do as well as I can,” he recalled. “I thought of it as kind of a representation of my being, my honor, who I was.”

The Army trained him to take apart bombs. He and his team were among the first on the scene of the 1995 Oklahoma City bombing, combing the ruins for any other devices, and he traveled occasionally to help the Secret Service protect then First Lady Hillary Clinton. He met Leslie in 1994 during a break in her college psychology studies. They started dating, sometimes across continents–he did two tours in Bosnia. During a Stateside break in January 2001, he married Leslie in Rancho Santa Fe, Calif. They had three children in four years, and McCaddon, by then an active-duty officer, moved with his family to Vilseck, Germany, where he helped run an Army dental office.

He was still ambitious–two of Leslie’s pregnancies had been difficult, so he decided to apply to the military’s medical school and specialize in obstetrics. But then, while he was back in Washington for his interview, came a living nightmare: his oldest son, who was 3, was diagnosed with leukemia. Just before entering med school, McCaddon prepared for his son’s chemotherapy by shaving his head in solidarity so the little boy wouldn’t feel so strange. McCaddon may not have been a warrior, but he was a fighter. “I became known as a hard-charger,” he wrote. “I was given difficult tasks, and moved through the ranks quickly.” He pushed people who didn’t give 100%; he pushed himself.

The Apache Pilot

Ian Morrison was born at Camp Lejeune in North Carolina, son of a Marine. An honor student at Thomas McKean High School in Wilmington, Del., he sang in the chorus, ran cross-country and was a co-captain of the swimming team before heading to West Point. He had a wicked sense of humor and a sweet soul; he met Rebecca on a Christian singles website in 2006 and spent three months charming her over the phone. One night he gave her his credit-card information. “Buy me a ticket, because I’m going to come see you,” he told her before flying to Houston. “The minute I picked him up,” she recalls, “we later said we both knew it was the real deal.” He proposed at West Point when she flew in for his graduation.

Morrison spent the next two years at Fort Rucker in Alabama, learning to fly the two-seat, 165-m.p.h. Apache helicopter, the Army’s most lethal aircraft. He and his roommate, fellow West Pointer Sean McBride, divided their time among training, Walmart, church, Seinfeld and video games, fueled by macaroni and cheese with chopped-up hot dogs. Morrison and Rebecca were married two days after Christmas 2008 near Dallas. The Army assigned him to an aviation unit at Fort Hood, so they bought a three-bedroom house on an acre of land just outside the town of Copperas Cove, Texas. They supported six African children through World Vision and were planning to have some kids of their own. “We had named our kids,” Rebecca says.

Morrison was surprised when the Army ordered him to Iraq on short notice late in 2010. Like all young Army officers, he saluted and began packing.

Triggers and Traps

One theory of suicide holds that people who feel useful, who feel as if they belong and serve a larger cause, are less likely to kill themselves. That would explain why active-duty troops historically had lower suicide rates than civilians. But now experts who study the patterns wonder whether prolonged service during wartime may weaken that protective function.

Service members who have bonded with their units, sharing important duties, can have trouble once they are at a post back home, away from the routines and rituals that arise in a close-knit company. The isolation often increases once troops leave active duty or National Guardsmen and reservists return to their parallel lives. The military frequently cites relationship issues as a predecessor to suicides; that irritates survivors to no end. “I’m not as quick to blame the Army as the Army is to blame me,” Leslie McCaddon says. “The message I get from the Army is that our marital problems caused Mike to kill himself. But they never ask why there were marriage problems to begin with.”

As McCaddon made his way through med school in Maryland, he encountered ghosts from his past. He was reaching the age at which his biological father had died by suicide, which statistically increased his own risk. But he wasn’t scared by it, Leslie says; he told associates about it. What did bother him was that he was gaining weight, the physical-training tests were getting harder for him, and the course work was challenging to juggle with a young family. He hid the strain, “but inside it is killing me,” he blogged. He called Leslie a hero “for not kicking me out of the house on the several times I’ve given her reason.” And he told her he sometimes thought of suicide.

“But he would tell everyone else that he was fine,” Leslie says. “He was afraid they’d kick him out of medical school if he was really honest about how depressed he was.” McCaddon sought counseling from a retired Army psychiatrist and seemed to be turning a corner in May 2010, when he graduated and got his first choice for a residency, at Tripler Army Medical Center in Honolulu.

“He loved being a soldier,” Leslie said, “and he was going to do everything he could to protect that relationship.”

Leslie had relationships to protect as well. He was increasingly hard on her at home; he was also hard on the kids and on himself. “He was always an amazing father–he loved his children–but he started lashing out at them,” Leslie recalls. “He wasn’t getting enough sleep, and he was under a lot of stress.” Leslie began exploring options but very, very carefully; she had a bomb-disposal problem as well. “When I was reaching out for help, people were saying, Be careful how you phrase this, because it could affect your husband’s career,” she says. “That was terrifying to me. It made me think that by advocating for him I’d be making things worse.”

The Pilot’s Pain

Captain Morrison headed to Iraq in early 2011. Once there, he and Rebecca Skyped nearly every day between his flight assignments. When he took R&R leave in early September, they visited family in Dallas, then San Antonio, and caught concerts by Def Leppard and Heart.

There were no signs of trouble. “He was so mentally stable–he worked out every day, we ate good food, and we always had good communication,” his wife says. “Most people would say he was kind of quiet, but with me he was loud and obnoxious and open.”

Morrison never engaged the enemy in direct combat; still, some 70 missions over Iraq took their toll. His base was routinely mortared. After one mission, he and several other pilots were walking back to their hangar when a rocket shot right past them and almost hit him; he and his comrades ran and dived into a bunker, he told Rebecca once he was safely home. He impressed his commander–“Excellent performance!” his superior raved in a formal review of the man his buddies called Captain Brad Pitt. “Unlimited potential … continue to place in position of greater responsibility.”

It was not the war that turned out to be hard; it was the peace. Morrison returned to Fort Hood late last year and spent his month off with Rebecca riding their horses, attending church and working out. He seemed unnerved by slack time at home. “He said it was really easy to fall into a routine in Iraq–they got up at the exact same time, they ate, they worked out, they flew forever and then they came back, and he’d talk to me, and then they did it all over again,” Rebecca says. “When he came back to Texas, it was really difficult for him to adjust.”

Morrison was due to be reassigned, so he and his wife needed to sell their house, but it just sat on the market. His anxiety grew; he was restless, unable to sleep, and they thought he might be suffering from PTSD. The couple agreed that he should see a doctor. Military wives, especially those studying mental health, have heard the stories, know the risks, learn the questions: Is their spouse drinking more, driving recklessly, withdrawing from friends, feeling trapped? Be direct, they are told. “I looked him right in the face and asked, ‘Do you feel like you want to hurt or kill yourself?'” Rebecca recalls. “He looked me right in the face and said, ‘Absolutely not–no way–I don’t feel like that at all. All I want to do is figure out how to stop this anxiety.'”

The Stigma

When troops return from deployment, they are required to do self-assessments of their experience: Did they see people killed during their tour? Did they feel they had been at risk of dying? Were they interested in getting counseling for stress or alcohol use or other issues? But a 2008 study found that when soldiers answer questions anonymously, they are two to four times as likely to report depression or suicidal thoughts. Independent investigations have turned up reports of soldiers being told by commanders to airbrush their answers or else risk their careers. A report by the Center for a New American Security cited commanders who refuse to grant a military burial after a suicide for fear that doing so would “endorse or glamorize” it.

The U.S. Department of Veterans Affairs (VA) and all the services have launched resiliency-training programs and emergency hotlines, offering slogans like “Never leave a Marine behind” and “Never let your buddy fight alone” that try to speak the language of the unit. Last year the Pentagon released a video game meant to allow soldiers to explore the causes and symptoms of PTSD from the privacy of their homes. “We want people to feel like they are encouraged to get help,” says Jackie Garrick, who runs the new Defense Suicide Prevention Office. “There are a myriad of ways you can access help and support if you need it.”

But faith in that commitment was shaken this year when Army Major General Dana Pittard, commander of the 1st Armored Division at Fort Bliss, Texas, complained on his official blog that he was “personally fed up” with “absolutely selfish” troops who kill themselves, leaving him and others to “clean up their mess. Be an adult, act like an adult, and deal with your real-life problems like the rest of us,” he continued. He later said he wanted to “retract” what he called his “hurtful statement,” but he didn’t apologize for what he said. Many soldiers and family members believe Pittard’s attitude is salted throughout the U.S. military.

Just a Lovers’ Quarrel

In August 2010, Leslie went to McCaddon’s commanding officer at the hospital. She didn’t tell Michael. “It was the scariest thing I’ve ever done,” she says. She recalls sitting in the commander’s office, haltingly laying out her concerns–McCaddon’s history of depression, his struggle to meet his high standards while doing right by his family. She was hoping that maybe the commander would order him into counseling and defuse the stigma somehow: he’d just be following orders. She watched the officer, a female colonel, detonate before her eyes. “No one at the medical school told me he had a history of depression, of being suicidal,” Leslie recalls her shouting. “I have a right to know this. He’s one of my residents. Why didn’t anyone tell me?” The commander was furious–not at Leslie, exactly, but at finding herself not in command of the facts.

The colonel called several colleagues into the room and then summoned McCaddon as well. Leslie registered the shock and fear on his face when he saw his wife sitting with his bosses. “I was shaking,” she says. “I told him I continued to be concerned that his depression was affecting our family and that I was really concerned for his safety but also for the well-being of our children and myself.”

The commander encouraged McCaddon to get help but wouldn’t order him to do it. He left the room, livid, and Leslie burst into tears. “Honey, don’t worry,” Leslie remembers the commander saying. “My first marriage was a wreck too.”

Can’t you make him get some help? Leslie pleaded again, but the colonel pushed back. McCaddon was doing fine at work, with no signs of a problem. “‘Leslie, I know this is going to be hard to hear, but this just doesn’t sound like an Army issue to me,'” McCaddon’s wife recalls the colonel saying. “‘It sounds like a family issue to me.'” Leslie felt her blood run cold. “No one was going to believe me so long as things were going fine at work.”

McCaddon did try to see an Army psychiatrist, but a month or more could pass without his finding the time. “I’d say, ‘He’s in the Army,'” Leslie recalls telling the doctor, “‘and you make him do everything else, so you should be able to make him go to mental-health counseling.'” But McCaddon was not about to detour from rounds to lie on the couch. He barely ate while on his shift. “Everybody here is under stress,” he stormed at Leslie. “I can’t just walk out for an hour a week–I’m not going to leave them when we’re already short-staffed.”

The marriage was cracking. Back in Massachusetts, Leslie’s mother was not well. Leslie and the kids moved home so she could take care of her. She and Michael talked about divorce.

The Waiting Room

Early on Monday, March 19, Ian Morrison showed up at a Fort Hood health clinic, where he sat waiting in his uniform, with his aviation badge, for three hours. Finally someone saw him. “‘I’m sorry you had to wait all this time,'” Rebecca says he was told. “‘But we can’t see you. We can’t prescribe you anything.'” He had to see the doctor assigned to his unit. When Morrison arrived at the flight surgeon’s office, he told Rebecca, the doctor was upset that Morrison hadn’t shown up at the regular daily sick call a couple of hours earlier.

“He told me this guy was so dismissive and rude to him. ‘You need to follow procedure. You should have been here hours ago,'” Rebecca says. “Ian wanted to tell the doctor he was anxious, depressed and couldn’t sleep, but this guy shut him down.” Morrison acknowledged only his sleeplessness, leading the doctor to give him 10 sleeping pills with orders to return the next week. He’d be grounded for the time being.

But that didn’t seem to affect his mood. Morrison toasted his wife’s success on a big exam that day–she was close to earning her master’s in psychology–by cooking a steak dinner and drawing a bubble bath for her that night. “He was dancing around and playing music and celebrating for me,” she remembers. “He seemed really hopeful.” He took a pill before bed but told Rebecca in the morning that he hadn’t slept.

On Tuesday, March 20, Morrison tried to enroll in an Army sleep study but was told he couldn’t join for a month. “Well, I’ll just keep taking Ambien and then go see the flight surgeon,” he told the woman involved with the study. She asked if he felt like hurting himself. “No, ma’am, you don’t have to worry about me at all,” he said. “I would never do that.” That day, Morrison typed an entry in his journal: “These are the things I know that I can’t change: whether or not the house sells, the state of the economy, and the world … these are things that I know to be true: I’m going to be alive tomorrow, I will continue to breathe and get through this, and God is sovereign over my life.”

Rebecca awoke the next morning to find her husband doing yoga. “I’m self-medicating,” he told her. She knew what that meant. “You couldn’t sleep again, huh?” Rebecca asked.

“No,” Morrison said. “I’m going back to the doctor today.” Given the lack of success with the medication, she told him that was probably a good idea. She left the house, heading for the elementary school on post where she taught second grade.

A System Overwhelmed

The Army reported in January that there was no way to tell how well its suicide-prevention programs were working, but it estimated that without such interventions, the number of suicides could have been four times as high. Since 2009, the Pentagon’s ranks of mental-health professionals have grown by 35%, nearing 10,000. But there is a national shortage of such personnel, which means the Army is competing with the VA and other services–not to mention the civilian world–to hire the people it needs. The Army has only 80% of the psychiatrists and 88% of the social workers and behavioral-health nurses recommended by the VA. Frequent moves from post to post mean that soldiers change therapists often, if they can find one, and mental-health records are not always transferred.

Military mental-health professionals complain that the Army seemed to have put its suicide-prevention efforts on the back burner after Chiarelli, a suicide fighter, left the service in January. “My husband did not want to die,” Rebecca says. “Ian tried to get help–six times in all … Think about all the guys who don’t even try to get help because of the stigma. Ian was so past the stigma, he didn’t care. He just wanted to be healthy.”

The Breaking Point

On March 15, McCaddon gave a medical presentation that got rave reviews. Then he called Massachusetts to speak to his children and sent Leslie that last e-mail. He regretted his failures as a husband, as a father. Don’t tell the children how I died, he begged her. “Know that I love you and my biggest regret in life will always be failing to cherish that, and instead forsaking it.” Leslie read the e-mail in horror. “In the back of my mind, I’m saying to myself, He’s at work–he’s safe,” she recalls. “It never occurred to me that he would do what he did at work.” But she immediately dialed the hospital’s delivery center. She had just received a suicide note from her husband, she told the doctor who answered, and they needed to find him immediately. The hospital staff fanned out.

“They’ve sent people to the roof, the basement, to your house. We’re looking everywhere,” a midwife told Leslie in a call minutes later. As they talked, Leslie suddenly heard people screaming and crying in the background. Then she heard them call a Code Blue. They had found him hanging from a noose in a call room. It had been less than 30 minutes since McCaddon had sent his final e-mail to his wife. Among the voices Leslie thought she recognized was that of McCaddon’s commander, whose words came rushing back. “Does it seem like a family issue to her now?” Leslie remembers thinking. “Because it looks like it happened on her watch.”

It took 15 minutes for the first responders to bring back a heartbeat. By then he had been without oxygen for too long. Leslie flew to Hawaii, and Captain McCaddon was taken off life support late Tuesday, March 20. He was pronounced dead early the next day.

That same day, Wednesday, March 21, Morrison saw a different Army doctor, who in a single 20-minute session diagnosed him with clinical depression. He got prescriptions for an antidepressant and a med to treat anxiety but hadn’t taken either when he called his wife. Rebecca encouraged him to stop by the resiliency center on post to see if he might get some mental-health counseling there. Just before noon, Morrison texted Rebecca, saying he was “Hopeful :)” about it. She wanted to know what they told him. “Will have to come back,” he responded. “Wait is about 2 hrs.” He needed to get back to his office.

Rebecca was still concerned. At about 4 p.m., she urged her husband to call a military hotline that boasted, “Immediate help 24/7–contact a consultant now.” He promised he would. “I said, ‘Perfect. Call them, and I’ll talk to you later,'” Rebecca says. “He was like, ‘O.K., bye.'”

That was the last time she ever talked to him. Their final communication was one more text about 45 minutes later. “STILL on hold,” he wrote to her. Rebecca responded moments later: “Can’t say you’re not trying.”

Morrison called Rebecca at 7:04 p.m., according to her cell phone, but she was leading a group-therapy session and missed it. He didn’t leave a message.

Two and a half hours later, she returned home from her grad-school counseling class. She threw her books down when she entered the living room and called his name. No answer. She saw his boots by the door; the mail was there, so she knew he had to be home. “I walked into our bedroom, and he was lying on the floor with his head on a pillow, on my side of the bed.” He was still in his uniform.

Rebecca stammers, talking softly and slowly through her sobs. “He had shot himself in the neck,” she says. “There was no note or anything. He was fully dressed, and I ran over to him and checked his pulse … and he had no pulse. I just ran out of the house screaming, ‘Call 911!’ and ran to the neighbors.”

The Next Mission

At a suicide-prevention conference in June, Panetta laid down a charge: “We’ve got to do everything we can to make sure that the system itself is working to help soldiers. Not to hide this issue, not to make the wrong judgments about this issue, but to face facts and deal with the problems up front and make sure that we provide the right diagnosis and that we follow up on that kind of diagnosis.”

But what makes preventing suicide so confounding is that even therapy often fails. “Over 50% of the soldiers who committed suicide in the four years that I was vice [chief] had seen a behavioral-health specialist,” recalls Chiarelli. “It was a common thing to hear about someone who had committed suicide who went in to see a behavioral-health specialist and was dead within 24, 48 or 72 hours–and to hear he had a diagnosis that said, ‘This individual is no danger to himself or anyone else.’ That’s when I realized that something’s the matter.”

There’s the horrific human cost, and there is a literal cost as well. The educations of McCaddon and Morrison cost taxpayers a sum approaching $2 million. “If the Army can’t be reached through the emotional side of it–that I lost my husband–well, they lost a $400,000 West Point education and God knows how much in flight school,” Rebecca says. (The Army says Morrison’s pilot training cost $700,000.) Adds Leslie: “They’d invested hundreds of thousands of dollars into this asset. At the very least, why didn’t they protect their asset?”

Captain McCaddon was buried with full military honors on April 3 in Gloucester, Mass. A pair of officers traveled from Hawaii for the service and presented his family with the Army Commendation Medal “for his selfless and excellent service.” Leslie and their three children also received the U.S. flag that had been draped over his casket and three spent shells fired by the honor guard. They visited his grave on Father’s Day to leave flowers, and each child left a card. After two years of chemotherapy, their oldest child’s leukemia remains in remission.

Captain Morrison was buried in central Texas on March 31. The Army had awarded him several decorations, including the Iraq Campaign Medal with Campaign Star. There were military honors graveside, and a bugler played taps. At his widow’s request, there was no rifle volley fired.

As linguagens da psicose (Revista Fapesp)

Abordagem matemática evidencia as diferenças entre os discursos de quem tem mania ou esquizofrenia

CARLOS FIORAVANTI | Edição 194 – Abril de 2012

Como o estudo foi feito: os entrevistados relatavam um sonho e a entrevistadora convertia as palavras mais importantes em pontos e as frases em setas para examinar a estrutura da linguagem

Para os psiquiatras e para a maioria das pessoas, é relativamente fácil diferenciar uma pessoa com psicose de quem não apresentou nenhum distúrbio mental já diagnosticado: as do primeiro grupo relatam delírios e alucinações e por vezes se apresentam como messias que vão salvar o mundo. Porém, diferenciar os dois tipos de psicose – mania e esquizofrenia – já não é tão simples e exige um bocado de experiência pessoal, conhecimento e intuição dos especialistas. Uma abordagem matemática desenvolvida no Instituto do Cérebro da Universidade Federal do Rio Grande do Norte (UFRN) talvez facilite essa diferenciação, fundamental para estabelecer os tratamentos mais adequados para cada enfermidade, ao avaliar de modo quantitativo as diferenças nas estruturas de linguagem verbal adotadas por quem tem mania ou esquizofrenia.

A estratégia de análise – com base na teoria dos grafos, que representou as palavras como pontos e a sequência entre elas nas frases por setas – indicou que as pessoas com mania são muito mais prolixas e repetitivas do que as com esquizofrenia, geralmente lacônicas e centradas em um único assunto, sem deixar o pensamento viajar. “A recorrência é uma marca do discurso do paciente com mania, que conta três ou quatro vezes a mesma coisa, enquanto aquele com esquizofrenia fala objetivamente o que tem para falar, sem se desviar, e tem um discurso pobre em sentidos”, diz a psiquiatra Natália Mota, pesquisadora do instituto. “Em cada grupo”, diz Sidarta Ribeiro, diretor do instituto, “o número de palavras, a estrutura da linguagem e outros indicadores são completamente distintos”.

Eles acreditam que conseguiram dar os primeiros passos rumo a uma forma objetiva de diferenciar as duas formas de psicose, do mesmo modo que um hemograma é usado para atestar uma doença infecciosa, desde que os próximos testes, com uma amostra maior de participantes, reforcem a consistência dessa abordagem e os médicos consintam em trabalhar com um assistente desse tipo. Os testes comparativos descritos em um artigo recém-publicado na revista PLoS One indicaram que essa nova abordagem proporciona taxas de acerto da ordem de 93% no diagnóstico, enquanto as escalas psicométricas hoje em uso, com base em questionários de avaliação de sintomas, chegam a apenas 67%. “São métodos complementares”, diz Natália. “As escalas psicométricas e a experiência dos médicos continuam indispensáveis.”

“O resultado é bastante simples, mesmo para quem não entende matemática”, diz o físico Mauro Copelli, da Universidade Federal de Pernambuco (UFPE), que participou desse trabalho. O discurso das pessoas com mania se mostra como um emaranhado de pontos e linhas, enquanto o das com esquizofrenia se apresenta como uma reta, com poucos pontos. A teoria dos grafos, que levou a esses diagramas, tem sido usada há séculos para examinar as trajetórias pelas quais um viajante poderia visitar todas as cidades de uma região, por exemplo. Mais recentemente, tem servido para otimizar o tráfego aéreo, considerando os aeroportos como um conjunto de pontos ou nós conectados entre si por meio dos aviões.

“Na primeira vez que rodei o programa de grafos, as diferenças de linguagem saltaram aos olhos”, conta Natália. Em 2007, ao terminar o curso de medicina e começar a residência médica em psiquiatria no hospital da UFRN, Natália notava que muitos diagnósticos diferenciais de mania e de esquizofrenia dependiam da experiência pessoal e de julgamentos subjetivos dos médicos – os que trabalhavam mais com pacientes com esquizofrenia tendiam a encontrar mais casos de esquizofrenia e menos de mania – e muitas vezes não havia consenso. Já se sabia que as pessoas com mania falam mais e se desviam do tópico central muito mais facilmente que as com esquizofrenia, mas isso lhe pareceu genérico demais. 
Em um congresso científico em 2008 em Fortaleza ela conversou com Copelli, que já colaborava com Ribeiro e a incentivou a trabalhar com grafos. No início ela resistiu, por causa da pouca familiaridade com matemática, mas logo depois a nova teoria lhe pareceu simples e prática.

Para levar o trabalho adiante, ela gravou e, com a ajuda de Nathália Lemos e Ana Cardina Pieretti, transcreveu as entrevistas com 24 pessoas 
(oito com mania, oito com esquizofrenia e oito sem qualquer distúrbio mental diagnosticado), a quem pedia para relatar um sonho; qualquer comentário fora desse tema era considerado um voo da imaginação, bastante comum entre as pessoas com mania.

“Já na transcrição, os relatos dos pacientes com mania eram claramente maiores que os com esquizofrenia”, diz. Em seguida, ela eliminou elementos menos importantes como artigos e preposições, dividiu a frase em sujeito, verbo e objetos, representados por pontos ou nós, enquanto a sequência entre elas na frase era representada por setas, unindo dois nós, e assinalou as que não se referiam ao tema central do relato, ou seja, o sonho recente que ela pedira para os entrevistados contarem, e marcavam um desvio do pensamento, comum entre as pessoas com mania.

Um programa específico para grafos baixado de graça na internet indicava as características relevantes para análise – ou atributos – e representava as principais diferenças de discurso entre os participantes, como quantidades de nós, extensão e densidade das conexões entre os pontos, recorrência, prolixidade (ou logorreia) e desvio do tópico central. “É supersimples”, assegura Natália. Nas validações e análises dos resultados, ela contou também com a colaboração de Osame Kinouchi, da Universidade de São Paulo (USP) em Ribeirão Preto, e Guillermo Cecchi, do Centro de Biologia Computacional da IBM, Estados Unidos.

Resultado: as pessoas com mania obtiveram uma pontuação maior que as com esquizofrenia em quase todos os itens avaliados. “A logorreia típica de pacientes com mania não resulta só do excesso de palavras, mas de um discurso que volta sempre ao mesmo tópico, em comparação com o grupo com esquizofrenia”, ela observou. Curiosamente, os participantes do grupo-controle, sem distúrbio mental diagnosticado, apresentaram estruturas discursivas de dois tipos, ora redundantes como os participantes com mania, ora enxutas como os com esquizofrenia, refletindo as diferenças entre suas personalidades ou a motivação para, naquele momento, falar mais ou menos. “A patologia define o discurso, não é nenhuma novidade”, diz ela. “Os psiquiatras são treinados para reconhecer essas diferenças, mas dificilmente poderão dizer que a recorrência de um paciente com mania está 28% menor, por mais experientes que sejam.”

“O ambiente interdisciplinar do instituto foi essencial para realizar esse estudo, porque eu estava todo dia trocando ideias com gente de outras áreas. Nivaldo Vasconcelos, um engenheiro de computação, me ajudou muito”, diz ela. O Instituto do Cérebro, em funcionamento desde 2007, conta atualmente com 13 professores, 22 estudantes de graduação e 42 de pós, 8 pós-doutorandos e 30 técnicos. “Vencidas as dificuldades iniciais, conseguimos formar um grupo de pesquisadores jovens e talentosos”, comemora Ribeiro. “A casa em que estamos agora tem um jardim amplo, e muitas noites ficamos lá até as duas, três da manhã, falando sobre ciência e tomando chimarrão.”

Artigo científico
MOTA, N.B. et al
Speech graphs provide 
a quantitative measure of thought disorder 
in psychosis. PLoS ONE (no prelo).

Strange History: Mass Hysteria Through the Years (Discovery)

Analysis by Benjamin Radford
Mon Feb 6, 2012 05:28 PM ET

The news media has been abuzz recently about a seemingly mysterious illness that has nearly two dozen students at LeRoy High School in western New York twitching and convulsing uncontrollably.

Most doctors and experts believe that the students are suffering from mass sociogenic illness, also known as mass hysteria. In these cases, psychological symptoms manifest as physical conditions.

Sociologist Robert Bartholomew, author of several books on mass hysteria including The Martians Have Landed: A History of Media-Driven Panics and Hoaxes, explained to Discovery News that “there are two main types of contagious conversion disorder. The most common in Western countries is triggered by extreme, sudden stress; usually a bad smell. Symptoms typically include dizziness, headaches, fainting and over-breathing, and resolve within about a day.”

In contrast, Bartholomew said, “The LeRoy students are experiencing the rarer, more serious type affecting muscle motor function and commonly involves twitching, shaking, facial tics, difficulty communicating and trance states. Symptoms appear slowly over weeks or months under exposure to longstanding stress, and typically take weeks or months to subside.”

Mass hysteria cases are more common than people realize and have been reported all over the world for centuries. Here’s a look at some famous — and bizarre — cases of mass hysteria in history.

The Mad Gasser of Mattoon

Many cases of mass hysteria are spawned by reports of strange or mysterious odors. One of the most famous cases occurred in 1944 when residents of Mattoon, Ill., reported that a “mad gasser” was loose in the small town.

It began with one woman named Aline Kearney, who smelled something odd outside her window. Soon she said her throat and lips were burning, and she began to panic when she felt her legs becoming paralyzed. She called police, and her symptoms soon subsided. Her husband, upon returning home later, reported glimpsing a shadowy figure lurking nearby. The “gas attack” (as it was assumed to be) on Mrs. Kearney was not only the gossip of the neighborhood but also reported in the local newspaper, and soon others in the small town reported odd odors and experiencing short-lived symptoms such as breathlessness, nausea, headache, dizziness and weakness. No “mad gasser” was ever found, and no trace of the mysterious gas was detected.

The French Meowing Nuns

Before 1900 many reports of mass hysteria occurred within the context of religious institutions. European convents in particular were often the settings for outbreaks. In one case the symptoms manifested in strange collective behavior; a source from 1844 reported that “a nun, in a very large convent in France, began to meow like a cat; shortly afterwards other nuns also meowed.

At last all the nuns meowed together every day at a certain time for several hours together.” The meowing went on until neighbors complained and soldiers were called, threatening to whip the nuns until they stopped meowing. During this era, belief in possession (such as by animals or demons, for example) was common, and cats in particular were suspected of being in league with Satan. These outbreaks of animal-like noises and behaviors usually lasted anywhere from a few days to a few months, though some came and went over the course of years.

The Pokémon Panic

A strange and seemingly inexplicable outbreak of bizarre behavior struck Japan in mid-December 1997, when thousands of Japanese schoolchildren experienced frightening seizures after watching an episode of the popular cartoon “Pokémon.” Intense flashes of light during the show triggered relatively harmless and brief seizures, nausea, and headaches. Doctors diagnosed some of the children with a rare, pre-existing condition called photosensitive epilepsy, in which bright flashing lights used in the cartoon can trigger the symptoms.

But experts were unable to explain what had happened to the remaining thousands of other children who reported symptoms; the vast majority of them did not have photosensitive epilepsy. Finally, the mystery was solved in 2001, when it was discovered that the symptoms found in most children were caused by mass hysteria, triggered by the initial wave of epileptic seizures.

The McMinnville School Poison Gas Episode

Nearly 200 students and teachers were hospitalized during a mysterious outbreak of illness at Warren County High School in McMinnville, Tenn., in November 1998. A local newspaper, the Southern Standard, ran the headline “Students Poisoned: Mysterious Fumes Sicken Almost 100 at High School.” It began when a teacher reported smelling a gasoline-like odor in her classroom that made her sick. A few of her students then also became sick, and the school was closed for testing.

No contamination was found, nor any medical or environmental cause for the symptoms, which included headache, dizziness, nausea and drowsiness. Following a clean bill of health, the school reopened, and soon a second cluster of students fell ill and closed down the school a second time. All recovered from the attack.

As these cases show, the LeRoy high school incident is only one of many strange episodes of mass sociogenic illness — and there will be more.

Human brains unlikely to evolve into a ‘supermind’ as price to pay would be too high (University of Warwick)

University of Warwick

Human minds have hit an evolutionary “sweet spot” and – unlike computers – cannot continually get smarter without trade-offs elsewhere, according to research by the University of Warwick.

Researchers asked the question why we are not more intelligent than we are given the adaptive evolutionary process. Their conclusions show that you can have too much of a good thing when it comes to mental performance.

The evidence suggests that for every gain in cognitive functions, for example better memory, increased attention or improved intelligence, there is a price to pay elsewhere – meaning a highly-evolved “supermind” is the stuff of science fiction.

University of Warwick psychology researcher Thomas Hills and Ralph Hertwig of the University of Basel looked at a range of studies, including research into the use of drugs like Ritalan which help with attention, studies of people with autism as well as a study of the Ashkenazi Jewish population.

For instance, among individuals with enhanced cognitive abilities- such as savants, people with photographic memories, and even genetically segregated populations of individuals with above average IQ, these individuals often suffer from related disorders, such as autism, debilitating synaesthesia and neural disorders linked with enhanced brain growth.

Similarly, drugs like Ritalan only help people with lower attention spans whereas people who don’t have trouble focusing can actually perform worse when they take attention-enhancing drugs.

Dr Hills said: “These kinds of studies suggest there is an upper limit to how much people can or should improve their mental functions like attention, memory or intelligence.

“Take a complex task like driving, where the mind needs to be dynamically focused, attending to the right things such as the road ahead and other road users – which are changing all the time.

“If you enhance your ability to focus too much, and end up over-focusing on specific details, like the driver trying to hide in your blind spot, then you may fail to see another driver suddenly veering into your lane from the other direction.

“Or if you drink coffee to make yourself more alert, the trade-off is that it is likely to increase your anxiety levels and lose your fine motor control. There are always trade-offs.

“In other words, there is a ‘sweet spot’ in terms of enhancing our mental abilities – if you go beyond that spot – just like in the fairy-tales – you have to pay the price.”

The research, entitled ‘Why Aren’t We Smarter Already: Evolutionary Trade-Offs and Cognitive Enhancements,’ is published in Current Directions in Psychological Science, a journal of the Association for Psychological Science.

Tratamento à base de tortura (Correio Braziliense)

JC e-mail 4394, de 29 de Novembro de 2011.

Durante vistorias em 68 comunidades terapêuticas espalhadas pelo país, psicólogos encontraram pacientes que são surrados com pedaço de madeira e vítimas de cárcere privado.

Cavar uma cova da dimensão do próprio corpo, escrever reiteradamente o Salmo 119 da Bíblia ou ser surrado com um pedaço de madeira em que está escrita a palavra gratidão são algumas das terapias oferecidas a usuários de drogas em tratamento no país. As violações estão documentadas no relatório da 4ª Inspeção Nacional de Direitos Humanos, uma pesquisa realizada periodicamente pelos conselhos regionais de psicologia sob a coordenação da entidade federal da categoria e com o apoio de parceiros, como o Ministério Público e a Ordem dos Advogados do Brasil. Em todos os 68 locais de internação para tratamento de dependentes químicos visitados, especialmente clínicas e comunidades terapêuticas, houve flagrantes de desrespeito. Entre os problemas mais frequentes estão isolamento, proibição de falar ao telefone com parentes, trabalho não remunerado e punições físicas e psicológicas para atos de desobediência.

As denúncias, que serão levadas à ministra dos Direitos Humanos, Maria do Rosário, surgem a uma semana do lançamento oficial de um plano de combate às drogas, quando a presidente Dilma Rousseff anunciará a inclusão das comunidades terapêuticas na rede de tratamento, com financiamento do Sistema Único de Saúde (SUS). “Não nos deram a oportunidade de participar do debate sobre esse plano, ao contrário de outros segmentos da sociedade. A simples possibilidade de financiar tais instituições já representa um retrocesso em tudo o que a reforma antimanicomial conquistou”, disse Clara Goldmann, vice-presidente do Conselho Federal de Psicologia. Ao destacar que encaminhará o documento à ministra, o ouvidor Nacional dos Direitos Humanos, Domingos Sávio Dresch da Silveira, destacou as medidas cabíveis. “Vou conhecer o relatório e, havendo indícios de violações, caberá um procedimento coletivo de apuração”, disse.

Casos de locais já investigados pelo Ministério Público, como a Casa de Recuperação Valentes de Gideão, em Simões Filhos, na Bahia, apresentaram problemas graves, como espaços inadequados e até exorcismo para tratar crises de abstinência. “É assustador que o clamor por tratamento silencie até mesmo a voz de autoridades que já foram notificadas, quatro anos atrás, sobre o tratamento desumano. Não estou dizendo que todas as comunidades terapêutica têm esse padrão, mas assusta ver a Valentes de Gideão aberta”, destaca Marcus Vinícius de Oliveira, integrante da Rede Nacional Internúcleos da Luta Antimanicomial.

Para o diretor da Federação Brasileira de Comunidades Terapêuticas (Febract), Maurício Landre, a amostra considerada pelo relatório é tendenciosa e não representa o universo das instituições. Ele também questiona a competência dos conselhos regionais de psicologia para fazerem inspeções. “É lamentável que uma classe tão conceituada, com profissionais que realizam trabalhos extraordinários dentro de comunidades terapêuticas, faça denúncias tão irresponsáveis”, afirma. “Existe comunidade terapêutica, clínica e até hospital que deve ser fechado? Existe. Mas não se trata de todos. Vamos ajudar na capacitação, vamos trabalhar em vez de ficar reclamando”, afirma. Segundo o dirigente, a real intenção com os ataques é financeira. “Tem a ideologia e também o capitalismo. Tratar em comunidade é mais barato do que ficar fazendo redução de dano, que eles defendem.”

Ligações monitoradas – O tema escolhido para a inspeção deste ano foi álcool e drogas. Só não foram feitas visitas em Amapá e Tocantins. No DF, a única instituição que participou foi a Fazendo do Senhor Jesus, em Brazlândia. O monitoramento de ligações dos familiares, bem como de visitas, é um ponto criticado no relatório. A violação das correspondências trocadas pelos pacientes também foi destacada no documento. Além disso, há relato de um homicídio e de uma denúncia por cárcere privado.

Aumento da expectativa de vida faz surgir novos problemas nas pessoas com deficiência mental (FAPESP)

Pesquisa FAPESP
Edição 189 – Novembro 2011

Ciência > Envelhecimento
O preço da longevidade

Carlos Fioravanti

As pessoas com deficiência intelectual, que há 40 anos morriam na adolescência, hoje podem viver mais de 60 anos. Como estão vivendo mais, outros problemas orgânicos estão surgindo. Reunidos durante dois dias em agosto na Associação de Paes e Amigos dos Excepcionais (Apae) de São Paulo, médicos e pesquisadores da Universidade Federal de São Paulo (Unifesp) e da Universidade de São Paulo (USP), psicólogos, terapeutas, advogados, assistentes sociais e outros profissionais da saúde reconheceram um dos graves problemas emergentes, a possibilidade de envelhecimento precoce.

Em um levantamento preliminar feito em 2009 em seis instituições da cidade de São Paulo, de um grupo de 373 pessoas com deficiência intelectual (ou DI; a expressão deficiência mental não é mais recomendada) e mais de 30 anos de idade, 192 apresentavam pelo menos três sinais de provável envelhecimento precoce, de acordo com um questionário que avaliava eventuais perdas de memória, de autonomia nas tarefas do dia a dia, de interesse por atividades ou de visão e audição. Para dimensionar esse problema, está sendo preparado um levantamento mais abrangente e detalhado, com cerca de 500 pessoas com DI e idade entre 30 e 59 anos da Grande São Paulo.

Os estudos em andamento são essenciais para “vermos o que pode ser feito, em termos de atendimento médico e de políticas públicas”, diz Regina Leondarides, coordenadora do grupo de estudo de envelhecimento precoce das pessoas com deficiência intelectual, que reúne 10 instituições de atendimento. “Temos muitas políticas de saúde voltadas para a criança, mas as políticas para o envelhecimento estão começando a ser construídas”, comenta Esper Cavalheiro, professor da Unifesp e presidente do conselho científico do Instituto Apae de São Paulo. “Estamos atrasados, em vista do envelhecimento acelerado da população brasileira.”

Um estudo da Espanha publicado em 2008 indicou que as pessoas com DI envelhecem prematuramente – as com síndrome de Down, de modo mais intenso. Para chegar a essas conclusões, os pesquisadores acompanharam a saúde de 238 pessoas com DI e mais de 40 anos de idade durante cinco anos. Não se trata, aparentemente, de um fenômeno inevitável. O envelhecimento precoce das pessoas com DI leve e moderada resulta da falta de programas de promoção de saúde e do acesso reduzido a serviços médicos e sociais. As pessoas com DI se mostraram com maior tendência à obesidade (apenas 25% tinham peso considerado normal), à hipertensão arterial (25% do total) e a distúrbios metabólicos, como diabetes e hipotireoidismo (10% do total).

“O envelhecimento precoce, se confirmado, pode ter causas genéticas ou ambientais, independentemente da deficiência intelectual”, comenta Dalci Santos, gerente do Instituto Apae de São Paulo. Matemática de formação, com doutorado em andamento na Unifesp, ela acrescenta: “Não conseguiremos avançar muito até esclarecermos melhor a origem das deficiências intelectuais”. As causas podem ser genéticas, como na síndrome de Down, ou ambientais (causas não genéticas), incluindo infecções, baixa oxigenação do cérebro do feto, alcoolismo, radiação, intoxicação por chumbo durante a gravidez ou prematuridade – muitas vezes, vários fatores em conjunto.

Causas ambientais ou genéticas
Em um artigo no primeiro número da Revista de Deficiência Intelectual DI, publicação do Instituto Apae lançada em outubro, João Monteiro de Pina-Neto, médico geneticista da Faculdade de Medicina de Ribeirão Preto da USP, apresenta os resultados de um estudo sobre as causas da deficiência intelectual em 200 pessoas atendidas nas Apaes de Altinópolis e Serrana, dois municípios da região de Ribeirão Preto. Esse estudo faz parte de um levantamento maior, com cerca de mil pessoas com DI atendidas em quatro Apaes, que Pina-Neto e sua equipe pretendem concluir em meados de 2012. Os resultados obtidos até agora indicam o predomínio de causas ambientais (42,5% do total), seguidas pelas genéticas (29%) e indeterminadas (20%).

Um estudo similar feito com 10 mil pessoas na Carolina do Sul, Estados Unidos, apresentou o mesmo percentual de causas genéticas, mas apenas 18% de causas ambientais e 56% de causas desconhecidas. Alguns contrastes chamam a atenção. Enquanto a deficiência intelectual causada por falta de oxigenação cerebral responde por 5% do total das causas de DI nos Estados Unidos, em São Paulo é 16,5%; a prematuridade, de 5% nos Estados Unidos, foi de 14,5% no estudo paulista; o efeito das infecções, de 5%, é quase o dobro aqui, 9%.

A conclusão que emerge dessa comparação é que o número de nascimentos de bebês com DI poderia ser reduzido por meio de algumas medidas preventivas. “Melhorar o atendimento pré-natal e a qualidade do parto são uma prioridade”, ressalta Pina-Neto. “Ainda temos casos de deficiência causada por sífilis, rubéola ou toxoplasmose contraída durante a gestação e meningites pós-natais”, lamenta. Segundo ele, outro problema que pode ser controlado é o alcoolismo. “De 20% a 30% das mulheres da região de Ribeirão Preto consomem bebida alcoólica em excesso e, como resultado, de cada 100 gravidezes, nasce uma criança com DI causada por síndrome alcoólica fetal”, diz ele. “Não fazemos ainda a adequada prevenção das causas da deficiência intelectual.”

As causas genéticas podem ser controladas, já que o risco de uma criança nascer com síndrome de Down aumenta muito com a idade dos pais. “As mulheres estão tendo filhos após os 35 anos de idade, portanto mais propen­sas a terem filhos com Down, e os homens estão se casando várias vezes, tendo filhos em cada ca­samento”, diz Pina-Neto. Segundo ele, homens estéreis que procuram as clínicas de reprodução deveriam ser mais informados sobre a possibilidade de terem alterações genéticas que podem ser transmitidas aos filhos caso se tornem férteis.

As pessoas com DI apresentam capacidade de raciocínio bastante abaixo da média e limitações para aprender, se cuidar ou se comunicar com outras, mas atualmente são muito mais integradas socialmente, autônomas e produtivas, com mais oportunidades para expressar a criatividade do que há algumas décadas. Frequentam escolas regulares, com outras crianças e adultos, participam de competições esportivas e conquistam mais postos de mercado de trabalho. Crianças e adultos com DI não vão mais à Apae de São Paulo para aprender todo dia, mas aparecem algumas vezes por semana para atendimento educacional especializado ou para consultas médicas. O serviço de apoio ao envelhecimento atende 132 pessoas com idade entre 30 e 67 anos.

Ainda há muitas dúvidas sobre como lidar com os novos problemas. Crianças e adultos com de­­­­ficiência precisam de hábitos e horários para se sentir calmos e confortáveis. Ao mesmo tempo, hábitos imutáveis podem favorecer o surgimento da doença de Alzheimer, doença neurológi­ca que se agrava com o envelhecimento. Vem daí um impasse: manter a rotina inalterada poderia alimentar a propensão ao Alzheimer, mas quebrar a rotina pode ser perturbador.

Propensão ao alzheimer
O cérebro das pessoas com Down pode exibir um dos sinais típicos do Alzheimer: o acúmulo de placas amiloides, que dificultam o funcionamento adequado dos neurônios. Uma equipe da Universidade da Califórnia em Los Angeles, Estados Unidos, encontrou placas amiloides em quantidade mais elevada no cérebro de pessoas com Down do que em pessoas com Alzheimer já diagnosticado e em pessoas normais.

“Os sinais biológicos de Alzheimer podem surgir antes dos sinais clínicos”, observa Orestes Forlenza, professor da Faculdade de Medicina da USP. “Ter amiloide não significa ter demência futura. Qual a melhor intervenção futura? Não sabemos. Talvez via nutrição ou atividade física seja mais seguro do que por medicamentos.” Ira Lott e sua equipe da Universidade da Califórnia em Irvine fizeram um estudo duplo-cego durante dois anos com 53 pessoas com síndrome de Down para ver se a complementação da dieta com compostos antioxidantes poderia melhorar o funcionamento mental ou estabilizar a perda da capacidade cognitiva. Os resultados, publicados em agosto na American Journal of Medical Genetics, indicaram que não.

Esper Cavalheiro apresentou três perguntas ainda sem resposta. De que modo as alterações próprias do envelhecimento, como as doenças cardiovasculares, diabetes e câncer, se apresentam nas pessoas com DI? Como alterações frequentes nessas pessoas, a exemplo de demências e osteoporose, se comportam no envelhecimento? Os medicamentos usados para tratar hipertensão, diabetes e outras doenças típicas do envelhecimento funcionam nas pessoas com DI do mesmo modo que em outros indivíduos?

Outra dúvida: as estratégias de controle dos fatores de risco de doenças cardiovasculares recomendadas para pessoas normais, como o estímulo a atividades físicas, têm o mesmo impacto sobre a saúde das pessoas com e sem deficiência intelectual? “Supomos que sim, mas não sabemos ao certo”, diz Ricardo Nitrini, da USP.

Segundo Cavalheiro, as pessoas com DI com 65 anos ou mais correspondiam a 4% da população total no Censo de 2000; hoje respondem por 5,5% da população total. “Não podemos nos contentar apenas com estatísticas e diagnósticos”, alerta. “Temos de enfrentar esse problema com rapidez. Quanto mais gente dialogando e pensando nesses problemas, melhor.”

Putting the Body Back Into the Mind of Schizophrenia (Science Daily)

ScienceDaily (Oct. 31, 2011) — A study using a procedure called the rubber hand illusion has found striking new evidence that people experiencing schizophrenia have a weakened sense of body ownership and has produced the first case of a spontaneous, out-of-body experience in the laboratory.

These findings suggest that movement therapy, which trains people to be focused and centered on their own bodies, including some forms of yoga and dance, could be helpful for many of the2.2 million people in the United States who suffer from this mental disorder.

The study, which appears in the Oct. 31 issue of the scientific journal Public Library of Science One, measured the strength of body ownership of 24 schizophrenia patients and 21 matched control subjects by testing their susceptibility to the “rubber hand illusion” or RHI. This tactile illusion, which was discovered in 1998, is induced by simultaneously stroking a visible rubber hand and the subject’s hidden hand.

“After a while, patients with schizophrenia begin to ‘feel’ the rubber hand and disown their own hand. They also experience their real hand as closer to the rubber hand.” said Sohee Park, the Gertrude Conaway Vanderbilt Chair of Psychology and Psychiatry, who conducted the study with doctoral candidate Katharine Thakkar and research analysts Heathman Nichols and Lindsey McIntosh.

“Healthy people get this illusion too, but weakly,” Park said. “Some don’t get it at all, and there is a wide range of individual differences in how people experience this illusion that is related to a personality trait called schizotypy, associated with psychosis-proneness.”

Body ownership is one of two aspects of a person’s sense of self awareness. (The other aspect is self-agency, the sense that a person is initiating his or her own actions.) According to the researchers, the finding that schizophrenia patients are more susceptible to the rubber hand illusion suggests that they have a more flexible body representation and weakened sense of self compared to healthy people.

“What’s so interesting about Professor Park’s study is that they have found that the sense of bodily ownership does not diminish among patients with schizophrenia, but it can be extended to other objects more easily,” observed David Gray, Mellon assistant professor of philosophy at Vanderbilt, who is an expert on the philosophy of the mind. He did not participate in the study but is familiar with it. “Much of the literature concerning agency and ownership in schizophrenia focuses on the sense of lost agency over one’s own movements: But, in these cases, the sense of ownership is neither diminished nor extended.”

Before they began the procedure, the researchers gave participants a questionnaire to rate their degree of schizotypy: the extent to which they experience perceptual effects related to the illusion. The researchers found that the individuals who rated higher on the scale were more susceptible to the illusion.

The researchers gauged the relative strength of the RHI by asking participants to estimate the position of the index finger of their hidden hand on rulers placed on top of the box that conceals it before and after stimulation. The stronger the effect, the more the subjects’ estimate of the position of their hidden hand shifted in the direction of the rubber hand. Even the estimates of those who did not experience the effect subjectively shifted slightly.

The rubber hand illusion also has a physiological signature. Scientists don’t know why, but the temperature of the hidden hand drops by a few tenths of a degree when a person experiences the illusion. “It’s almost as if the hand is disowned and rejected, no longer part of the self,” Park commented.

The researchers were surprised when one of the patients undergoing the procedure experienced a full out-of-body experience. He reported that he was floating above his own body for about 15 minutes. According to Park, it is extremely rare to observe spontaneous out-of-body experiences in the laboratory. When they invited the patient back for a second session, he once again had an out-of-body experience during the rubber hand procedure, proving that the experience is repeatable.

“Anomalous experiences of the self were considered to be core features of schizophrenia decades ago but in recent years much of the emphasis has been on cognitive functions such as working memory,” said Park.

According to the psychologist, out-of-body experiences and body ownership are associated with a particular area in the brain called the temporoparietal junction. Lesions in this area and stimulation by strong magnetic fields can elicit out-of-body experiences. The new study suggests that disorders in this part of the brain may also contribute to the symptoms of schizophrenia.

The relationship between schizophrenia and body ownership may help explain the results of a German study published in 2008 that found a 12-week exercise program reduced the symptoms and improved the behavior of a small group of patients with chronic schizophrenia when compared to a control group that did not exercise. The study also found that the exercise increased size of the patients’ hippocampus slightly — a smaller-than-normal hippocampus is a well established symptom of schizophrenia.

“Exercise is inexpensive and obviously has a broad range of beneficial effects, so if it can also reduce the severity of schizophrenia, it is all to the good,” said Park. These findings suggest that focused physical exercise which involves precise body control, such as yoga and dancing, could be a beneficial form of treatment for this disorder.

The study was partly funded by a grant from the National Institutes of Health and the Gertrude Conaway Vanderbilt Endowed Chair.

After Pregnancy Loss, Internet Forums Help Women Understand They Are Not Alone (Science Daily)

ScienceDaily (Oct. 20, 2011) — Nearly one in six pregnancies end in miscarriage or stillbirth, but parents’ losses are frequently minimized or not acknowledged by friends, family or the community.

“Women who have not gone through a stillbirth don’t want to hear about my birth, or what my daughter looked like, or anything about my experience,” said one woman, responding in a University of Michigan Health System-led study that explored how Internet communities and message boards increasingly provide a place for women to share feelings about these life-altering experiences.

The anonymous survey of more than 1,000 women on 18 message boards opens a new window into who is using the forums and why. The findings will be published in Women’s Health Issues.

The researchers were surprised to find that only half of the women surveyed were in their first year of loss after a pregnancy. Many were still coping with the emotional impacts five, 10 and even 20 years later.

“To my family and most friends, the twins have been gone for nearly a year and are entirely a subject for the past,” another woman wrote.

A second unexpected finding was that only 2 percent of survey respondents were African American, despite nearly 60 percent of African Americans having internet access and despite black women having twice the risk of stillbirth as white women.

“This is the largest study to look at who uses Internet message boards after a pregnancy loss and it demonstrates a significant disparity between the women who experience loss and those who responded to the survey,” says lead study author Katherine J. Gold, M.D., M.S.W., M.S., assistant professor of family medicine at the U-M Medical School. “This suggests an important gap in support for African American parents that should be explored further.”

By far, the most common reason women gave for participating in the message boards was that it helped them to feel that their experience wasn’t unique.

One woman explained that the most important aspect of the forums was knowing “that I am not the only one this has happened to and that I am not alone in this horrible nightmare.” Another common theme was that the online environments provided a safe and validating space for the women to express themselves. Others appreciated the ease and convenience of the Internet and their ability to spend more time composing their thoughts than they would be able to in a face-to-face conversation.

Most participants agreed that boards should have a moderator or facilitator, and that health care professionals should participate. Of the 908 women who answered the question, 82 percent said they had learned new medical information from one of the forums.

“The fact that so many women learned new medical information from the message boards shows what an important resource they can be in this regard,” says study senior author Christie Palladino, M.D., M.Sc., an obstetrician/gynecologist with Georgia Health Sciences University’s Education Discovery Institute.

Gold and her colleagues are currently pursuing similar research with bereaved parents who attend in-person support groups and plan to compare and contrast the results.

Too Much Undeserved Self-Praise Can Lead to Depression (Science Daily)

ScienceDaily (Oct. 20, 2011) — People who try to boost their self-esteem by telling themselves they’ve done a great job when they haven’t could end up feeling dejected instead, according to new research published by the American Psychological Association.

High and low performers felt fine when they assessed themselves accurately, probably because the high performers recognized their strengths and low performers acknowledged their weaknesses and could try to improve their future performance, according to a study in the October issue of the APA journal Emotion®.

“These findings challenge the popular notion that self-enhancement and providing positive performance feedback to low performers is beneficial to emotional health. Instead, our results underscore the emotional benefits of accurate self-assessments and performance feedback,” said lead author Young-Hoon Kim, PhD, of the University of Pennsylvania. . The study involved experiments with four different groups of young people from the United States and Hong Kong. Three U.S. groups totaled 295 college undergraduates, with 186 women and a mean age of 19, and one Hong Kong group consisted of 2,780 high school students, with 939 girls, from four different schools and across grades 7-12.

In the first two experiments, one of the U.S. groups and the Hong Kong students took academic tests and were asked to rate and compare their own performances with other students at their schools. Following their assessments, all the participants completed another widely used questionnaire to assess symptoms of depression.

In the third and fourth experiments, researchers evaluated the other two sets of U.S. undergraduates with feedback exercises that made high performers think their performance was low and low performers think their performance was high. Control groups participated in both and received their scores with no feedback.

Across all the studies, results showed that those who rated their own performance as much higher than it actually was were significantly more likely to feel dejected. “Distress following excessive self-praise is likely to occur when a person’s inadequacy is exposed, and because inaccurate self-assessments can prevent self-improvement,” said co-author Chi-Yue Chiu, of Nanyang Technological University in Singapore.

The results also revealed cross-cultural differences that support past findings that Asians are more humble than Americans. The U.S. undergraduates had a higher mean response when rating their performance than the Hong Kong students, at 63 percent compared to 49 percent, the researchers found. Still, they found that excessive self-enhancement was related to depression for both cultures.

Future-Directed Therapy Helps Depression Patients Cultivate Optimistic Outlook (Science Daily)

ScienceDaily (Oct. 20, 2011) — Patients with major depression do better by learning to create a more positive outlook about the future, rather than by focusing on negative thoughts about their past experiences, researchers at Cedars-Sinai say after developing a new treatment that helps patients do this.

While Major Depressive Disorder patients traditionally undergo cognitive-behavior therapy care that seeks to alter their irrational, negative thoughts about past experiences, patients who were treated with the newly-developed Future-Directed Therapy™ demonstrated significant improvement in depression and anxiety, as well as improvement in overall reported quality of life, the researchers found.

Results were published recently in the peer-reviewed journal CNS Neuroscience & Therapeutics.

“Recent imaging studies show that depressed patients have reduced functioning in the regions of the brain responsible for optimism,” said Jennice Vilhauer, PhD, study author and clinical director of Adult Outpatient Programs for the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences. “Also, people with depression tend to have fewer skills to help them develop a better future. They have less ability to set goals, problem solve or plan for future events.”

According to the U.S. Centers for Disease Control and Prevention, an estimated one in 10 American adults meet the diagnostic criteria for depression.

Anand Pandya, MD, interim chair of Cedars-Sinai’s Department of Psychiatry and Behavioral Neurosciences, said, “Future-Directed Therapy is designed to reduce depression by teaching people the skills they need to think more positively about the future and take the action required to create positive future experiences. This is the first study that demonstrates this intervention intended to increase positive expectations about the future can reduce symptoms of Major Depressive Disorder.”

When people talk only about the negative aspects of their lives, it causes them to focus more attention on what makes them unhappy, Vilhauer said. “Talking about what makes you unhappy in life doesn’t generate the necessary thinking patterns or action needed to promote a state of thriving and create a more positive future,” Vilhauer said. “Future-Directed Therapy helps people shift their attention constructing visions of what they want more of in the future and it helps them develop the skills that they will need to eventually get there.”

In the study conducted at Cedars-Sinai, 16 adult patients diagnosed with Major Depressive Disorder attended future-directed group therapy sessions led by a licensed psychologist twice a week for 10 weeks. Each week, patients read a chapter from a Future-Directed Therapy manual and completed worksheets aimed at improving certain skills, such as goal-setting. Another group of 17 patients diagnosed with depression underwent standard cognitive group therapy. The study team measured the severity of depression and anxiety symptoms, and quality of life before and after treatment, using the Quick Inventory of Depressive Symptoms, the Beck Anxiety Inventory, and the Quality-of-Life Enjoyment and Satisfaction Questionnaire short form.

Results include:

Patients in the Future-Directed Therapy group experienced on average a 5.4 point reduction in their depressive symptoms on the Quick Inventory of Depressive Symptoms scale, compared to a two point reduction in the cognitive therapy group.

Patients in the Future-Directed Therapy group on average reported a 5.4 point reduction in anxiety symptoms on the Beck Anxiety Inventory, compared to a reduction of 1.7 points in the cognitive therapy group.

Patients in the Future-Directed Therapy group reported on average an 8.4 point improvement in their self-reported quality of life on the Quality of Life Enjoyment and Satisfaction scale, compared to a 1.2 point improvement in the cognitive therapy group.