Friday, May 23, 2014

Hedgehog's Dilemma

The hedgehog's dilemma, or sometimes the porcupine dilemma, is an analogy about the challenges of human intimacy. It describes a situation in which a group of hedgehogs all seek to become close to one another in order to share heat during cold weather. They must remain apart, however, as they cannot avoid hurting one another with their sharp spines. Though they all share the intention of a close reciprocal relationship, this may not occur, for reasons they cannot avoid.
From 'Studies in Pessimism' (Schopenhauer, p. 142);
''A number of porcupines huddled together for warmth on a cold day in winter; but, as they began to prick one another with their quills, they were obliged to disperse. However the cold drove them together again, when just the same thing happened. At last, after many turns of huddling and dispersing, they discovered that they would be best off by remaining at a little distance from one another.
In the same way the need of society drives the human porcupines together, only to be mutually repelled by the many prickly and disagreeable qualities of their nature. The moderate distance which they at last discover to be the only tolerable condition of intercourse, is the code of politeness and fine manners; and those who transgress it are roughly told - in the English phrase - to keep their distance. By this arrangement the mutual need of warmth is only very moderately satisfied; but then people do not get pricked. A man who has some heat in himself prefers to remain outside, where he will neither prick other people nor get pricked himself.''
Both Schopenhauer and Freud have used this situation to describe what they feel is the state of individuals in relation to others in society. The hedgehog's dilemma suggests that despite goodwill, human intimacy cannot occur without substantial mutual harm, and what results is cautious behaviour and weak relationships.
The dilemma is also used to justify or explain introversion and isolationism. The concept originates from Arthur Schopenhauer's 'Parerga and Paralipomena'. It then entered the realm of psychology after the tale was discovered and adopted by Freud in 1921.
Sometimes love can be a spiky situation.

Thursday, May 22, 2014

The Matrix: Was Neo Psychotic?

Auditory Hallucinations
Psychosis is a mental health problem that can  stop the person from thinking clearly, telling the difference between reality and their imagination, and acting in a normal way.

Morpheus: What is "real"? How do you define "real"?

It is a loss of contact with reality that usually includes delusions and hallucinations. Delusions are false beliefs about what is taking place or who one is, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. 

Neo: What did she tell you?
Morpheus: That I would find the One. 

Signs of Psychosis
The early stage of psychosis is marked by a difficulty in concentrating, depressed mood, sleep changes - sleeping too much or not enough, anxiety, suspiciousness, withdrawal from family and friends and on-going unusual thoughts and beliefs. While the later stages involve being confused and having impaired reality testing; that is, people are unable to distinguish personal, subjective experiences from the reality of the external world. This can progress onto delusions, hallucinations, disorganized speech (switching topics erratically), difficulty functioning, depression and even suicidal thoughts or actions.

Morpheus: I see it in your eyes. You have the look of a man who accepts what he sees because he is expecting to wake up. Ironically, that's not far from the truth.


A Psychoactive Aetiology?
A number of medical problems can cause psychosis, including:

- Alcohol and certain illegal drugs (or blue and red pills?)
- Brain diseases, such as Parkinson's  
- Huntington's disease, and certain chromosomal disorders
- Brain tumours or cysts
- Dementia (including Alzheimer's disease)
- HIV and other infections that affect the brain
- Some prescription drugs, such as steroids and stimulants
- Some types of epilepsy
- Stroke

Psychotic symptoms may include: disorganized thought and speech, false beliefs that are not based in reality (delusions), especially unfounded fear or suspicion, and thoughts that "jump" between unrelated topics (disordered thinking).

Neo: I thought it wasn't real
Morpheus: Your mind makes it real

Exams and tests:
Psychiatric evaluation and testing are used to diagnose the cause of the psychosis. Laboratory testing and brain scans may not be needed, but sometimes can help pinpoint the diagnosis. The type of tests may include; blood tests for abnormal electrolyte and hormone levels, blood tests for syphilis and other infections, drug screens, and sometimes an MRI of the brain.

''Yeah...ehmm...sorry about that''

Possible Complications:
Psychosis can prevent people from functioning normally and caring for themselves. If the condition is left untreated, people can sometimes harm themselves or others (or Trinity).

 Morpheus: You've been living in a dream world, Neo.
''Your 50 minutes are up young man''

Treatment often depends on the cause of the psychosis. It might involve drugs to control symptoms and talk therapy, which can help address the underlying cause of the psychosis.

For example the talking therapy cognitive behavioural therapy has proved successful in helping people with schizophrenia.  Hospitalization is an option for serious cases where a person might be dangerous to himself or others.

''Perhaps we are asking the wrong questions'' ~ Agent Brown 

Social support should also be addressed, so as to help support the person with psychosis, who may have social needs such as education, employment or accommodation.

Agent Smith: It seems that you've been living two lives. One life, you're Thomas A. Anderson, program writer for a respectable software company. You have a social security number, pay your taxes, and you... help your landlady carry out her garbage. The other life is lived in computers, where you go by the hacker alias "Neo" and are guilty of virtually every computer crime we have a law for. One of these lives has a future, and one of them does not.

''The need to prove who you are will vanish once you know who you are''
~ Pierre
Similar to Parkinson's Disease and Schizophrenia, dopamine levels are thought to be too high during psychosis, or better, there is a 'functional excess' of dopamine in the person's brain. This can affect memory, emotion, social behaviour and self-awareness.

Bizarre delusions are often experienced during psychosis.

Examples of psychotic delusions include the paranoid type - more likely to be associated with schizophrenia - and delusions of grandeur.

''Sure ye do''

Delusions of grandeur: clearly false but strongly held beliefs in having a special power or authority - the person with psychosis may, as examples, believe that they are a world leader, very rich, that they are able to bring dead people back to life, or that they can control the weather.
While the classic hallmarks of psychosis are hallucination and delusion, other symptoms persist in disorders such as schizophrenia - known as negative symptoms. That is, cognitive and motivational impairments, which can be disabling and do not respond to drug treatment.

I think he saw me...
Paranoid delusions: these may cause the person with psychosis to be unduly suspicious of individuals or organisations, believing them to be plotting to cause them harm. Such delusions can be very frightening and may result in unusual behaviour to avoid things - for example, staying out of a room with certain devices in it, believing them to be controlling thoughts, or locking up the front door with an excessive number of padlocks.

Similar to Eric Bui and colleagues examining Borderline Personality Disorder and Darth Vader (2010), it is interesting to compare a disorder with something relevant, in an attempt to try and identify with it. While one is the work of fiction and the other a real life debilitating disorder, slight overlap can be seen and the crude comparisons hopefully elucidate the disorder a little.
Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J,    Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 28.
Katherine Darton, Mind. Psychotic experiences. London, UK: Mind, 2011. Information published online, accessed November 21st, 2013.

MedlinePlus. Psychosis. Bethesda, MA, US: National Library of Medicine, National Institutes of Health, Department of Health and Human Services.
NHS Choices. Causes of psychosis. London, UK: National Health Service.
Van Os J, Kapur S. Schizophrenia. The Lancet, 2009, volume 374, number 9690, pages 635-645 (DOI: 10.1016/S0140-6736(09)60995-8).

WHO. Chapter V: Mental and behavioural disorders. In: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva, Switzerland: World Health Organization, 2010.

''Minds that have withered into psychosis are far more terrifying than any character of fiction''
                                                                                                                                   ~ Christian Baloga

Thursday, May 01, 2014

Neuroleptic-Induced Dystonia

Dystonia is a neurological movement disorder which may affect anyone at any age. It is characterised by involuntary muscle contractions which force certain parts of the body into abnormal, sometimes painful, movements or postures. Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face, or vocal cords.

The disordered tonicity of muscles that occurs in dystonia can also be associated with neuroleptics, a dopamine antagonist drug. This secondary, or acquired dystonia, can be a problem encountered specifically with the use of antipsychotic medication (Hansen, 1997), as one side effect of these drugs is debilitating movement disorders known as extrapyramidal symptoms (Yamamoto & Inada, 2012). Drugs that decrease the effectiveness of neurotransmission are known as antagonists. Antipsychotic medication blocks dopamine receptors and this in turn can lead to the dystonic reactions.

With Parkinson’s, the disease is caused by cell death in the substantia nigra, which has dopamine producing functions. This loss of dopamine activity results in a decreased stimulation of the motor cortex which can lead to movement disruptions in the body. Similarly, the dopamine blockade effect of neuroleptic antagonists reduces the activity of transmitters in the synapse causing involuntary muscle contractions (Hansen, 1997). Therefore the severe disturbances of motor behaviour are often caused by the drug-induced dysfunction of the dopaminergic extrapyramidal system, which plays a vital role in movement control (Smelser & Baltes, 2001).

Extrapyramidal symptoms can be categorised as acute and tardive. Acute dystonia has a sudden onset and is often seen within the first five days of starting an antipsychotic course of treatment. Conversely, tardive begins after a long-term use of dopamine antagonist medication (Van Harten & Kahn, 1999).

Neuroleptic-Induced acute dystonia can result in abnormal positioning or spasm of muscles in the head, such as the eyes (oculogyric), neck (impaired swallowing), limbs, and trunk. Acute dystonic reactions generally disappear once the drug dose is lowered or there is complete cessation of the antipsychotic (Yamamodo & Inada, 2012). With tardive dystonia there is currently no established course of treatment, however administration of clozapine has been cited as the only drug helpful if it is tolerated by the patient.
''Life has many twists and turns.
But when it literally involves your body, then the above saying takes on a whole different meaning''