Severed, by Frances Larson

Severed: A History of Heads Lost and Heads Found, by Frances Larson, Narrated by Reay Kaplan

As soon as I heard about this book I just had to read it. I tried to convince my book club to read it for next month, but alas, the subject was too upsetting for them. So I chose to read it anyway. And I most certainly am glad that I did so.

Severed is about Western culture’s fascination with severed heads throughout history. The book begins with Larson’s own fascination with the shrunken heads in Pitt Rivers Museum at Oxford, where she worked. Apparently, they are quite an attractive exhibit there, drawing lots of fascinated people – adults and children alike.

The shrunken heads were made by Shuar and Achuar peoples from South America, ranging from Peru to Ecuador. The heads were considered to have the power of the souls of the former owners, and when the heads were shrunk, the Shuar and Achuar people were able to harvest that power. The shrunken heads were made by removing the brain and skull. The skin of the head was then put in hot water and filled with scalding sand. The sand treatment was repeated several times until the head shrunk down to the size of a fist.

Interestingly, after the heads were shrunk, they no longer had any power. Therefore when Westerners became interested in the heads as novelty items, the Shuar and Achuar people were happy to sell them. Even Westerners wanted a piece of the shrunken head profit: they would fake the heads using heads of monkeys.

Apparently, these shrunken heads are found quite fascinating by the Westerners even today. Many are in display in museums. I used to go to a museum when I was a child – it was called Woolaroc Ranch in Bartlesville, OK – and I was frightened and quite the opposite of fascinated by the shrunken heads. And even today, I searched “shrunken heads” in my stock photo source, and felt a little queasy at the results. Funny, I can read this book with fascination, but I can’t look at a picture of a fake shrunken head without feeling a little off. 🙂

Anyway, Larson’s story of severed heads did not stop there. She discussed trophy hunting during Pacific, Vietnam, and Korean Wars. It’s surprising what a soldier might do when he is in the foreign world of kill-or-be-killed. Again, the idea made me feel sad.

She discussed the sloppy ax beheadings of convicted criminals in the days before the guillotine. How an executioner would be praised by his ability to cut a head clean off, and would be shouted down, beaten, and possibly killed because of a sloppy execution. Because higher society became more “refined,” they decided that the rowdy crowds that executions attracted were disturbing – so they invented the guillotine. The crowds were disappointed by how quick and effortless the executions were, but the executions certainly became more humane.

Larson finally discussed phrenology, plastination, and dissection of heads by medical students (modern and in the old days of stolen corpses). Until she got to the plastination part, I was feeling rather fascinated but disgusted – actually a little high-and-mighty that I certainly did not find dead heads fascinating. (Yes, I recognize the internal contradiction in that sentence.) But then I realized she had a point. I was fascinated. I was fascinated by her book. And when the Bodyworlds exhibit came to the Science Museum of Minnesota, I sure did rush out there to see it. And I didn’t find it disgusting. Of course, there’s a difference between Bodyworlds versus collecting the heads of unwilling donors – the people of Bodyworlds all donated their bodies to this “art” project. In fact, I find mummy exhibits to be a little wrong.

Larson claims that our disgust at the collection of heads is rather a new concept – it isn’t inherent in humans. I find that a little hard to believe, but I recognize that some things that seem naturally right to me were not always “right.” For instance, homosexuality. Not more than a couple decades ago homosexuality was listed in the DSM as a psychological disorder. Now it’s mostly accepted as normal behavior for some people – and the idea that it was considered a mental illness is laughable (or insulting, depending on what personality type you have). So why can’t the same thing be said of my own uncomfortableness about severed human heads? But I’d like to point out my own argument against Larson’s point: if people of the past didn’t find the idea of severed human heads a bit off-putting, then why were they so fascinated by the idea?

Larson’s book was a fantastic read for the Halloween season. It was creepy, fascinating, and creative. The research seemed quite diverse and the narrative was engaging. I really think there’s a lot to learn from this book – at the very least it will make you rethink your own views on the subject of dead heads.

4.5 stars for creative subject, research, and engaging narrative.

Panic Disorder

Fear is an emotion that elicits the “fight-or-flight” response of the autonomic nervous system. It is an immediate (uncontrollable) response to a direct danger – such as a rattlesnake, a gun pointed at your head, or a fast car driving right at you. Fear is generally a helpful response that allows you to protect or remove yourself from the imminent peril.

Sometimes the fear response can occur in the absence of any obvious stimulus – this can lead to a panic attack. Panic attacks are terrifying physiological and psychological events in which your autonomic nervous system ramps you up for fight-or-flight. Often, the person becomes terrified that they are dying – usually of a heart attack. Like intense fear, the heart starts pounding, adrenaline flows, breathing races. Sometimes the victim will run from the room – perhaps to a hospital or perhaps with no direction at all – to escape the unseen threat.

A person who experiences frequent panic attacks can be diagnosed with panic disorder. A person with panic disorder is terrified of having another panic attack – and even that fear can elicit another attack. Such a disorder can be crippling. I have a friend with panic disorder that struggled in college because she’d had a panic attack during a particular class, and she was intensely afraid to go back to that class, fearing that she might have another attack. According to the DSM-5, in order to have panic disorder, a person must have 4 of 13 symptoms including: pounding heart, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, chills or heat, numbness or tingling, feelings of unreality, fear of “going crazy,” or fear of dying.

Panic attacks usually last 20-30 minutes with a peak for about 10 minutes, which is good because any longer than that could pose an immediate danger to the person’s metabolism (in case of diabetes) or cardiovascular system (heart attack).

The fear response in a panic attack originates in the amygdala, which is thought to be the central component of the “fear network.” According to the prevailing theory, panic attacks occur when the fear network is activated. Panic disorder develops in people who have a non-adaptive fear network which is overly-sensitive. Although the physiological response to a panic attack originates in the amygdala, there are also cognitive components to panic disorder (e.g. fear of another panic attack in particular situations). The hippocampus, which is involved in learning and emotional responses, is likely involved in this aspect of panic disorder. The cognitive factors in panic disorder (e.g. fears of dying or going insane) are likely controlled by higher cortical centers of the brain.

There are a couple of theories about the development of panic disorder. In the comprehensive learning theory of panic disorder, a person undergoes classical conditioning – such as Ivan Pavlov discovered when his dogs began to salivate reflexively to the sound of a metronome that was always ticking when the dogs ate. In a process called interoceptive conditioning, the person begins to unconsciously associate physiological arousal (e.g. pounding heart, head rush, increased breathing rate) with panic. Thus, when a person is physiologically aroused, such as while running, she will suddenly experience a panic attack. Panic attacks can also be induced by happy events. For instance, when something exciting happens, such as a marriage proposal, the happy person can suddenly rush into panic.

Another theory of panic disorder is the cognitive theory. In this case, the person consciously associates physiological arousal with impending doom. When his heart is pounding, he thinks he could be having a heart attack. When his breathing becomes labored, this could be lung cancer. Such thinking is called “catastrophizing.”

Panic provocation studies support the cognitive theory of panic disorder. In such a study, a subject is given a stimulant that increases heart rate or other physiological symptoms of arousal. One test group is told in advance that the stimulus will increase heart rate, and that it is completely harmless. The other test group will not receive any explanation. It turns out that people who are forewarned of the physiological arousal are less likely to experience a panic attack. This is not in line with the comprehensive learning theory, in which the panic is induced reflexively, and cognition has nothing to do with the attack.

In all likelihood, both theories play some part in the origin of panic attacks.

Many people with panic disorder are prescribed benzodiazapines such as Xanax or Klonopin. These medications are very useful for anxiety relief, but they can be addictive. Upon cessation of the medication, a patient can undergo uncomfortable side effects such as nervousness, sleep disturbance, dizziness, and panic attacks. For those of you who wonder why we are so dependent upon medications for treatment of anxiety, try undergoing a three hour anxiety attack like the one described in My Bipolar Mixed State. You will soon understand that immediate relief is necessary.

Because of the negative side effects of medication, it is good to treat panic disorder with psychological therapy, such as cognitive-behavioral therapy, as described in Contemporary viewpoints on treating mental illness – psychology. In such treatment, a patient can be exposed to internal stimuli of physiological arousal; for instance, running in place, spinning in a chair, or hyperventilating. The patient must continue this activity until he dissociates the physiological symptoms with panic. Such deconditioning therapy can be combined with education about the nature and causes of panic disorder. The patient can be taught to meditate or control their breathing. Patients are also taught about the cognitive errors that they might be making (i.e. my heart is pounding, I must be having a heart attack).

This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links:

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 6: Panic, Anxiety, Obsessions, and their Disorders. Abnormal Psychology, sixteenth edition (pp. 163-210). Pearson Education Inc.

Carmilla, by J. Sheridan Le Fanu

Carmilla, by J. Sheridan Le Fanu, narrated by Megan Follows

Spoilers. Sorry. 😦 It’s hard to discuss a book well without spoilers.

Despite the very modern look of this cover, this novella is one of the first vampire books, predating Bram Stoker’s Dracula by 26 years. It was a serial story published in the magazine The Dark Blue from 1871 to 1872. Carmilla is narrated by a sweet, lonely girl named Laura, who is stuck with her father in a castle far from any company. She is eagerly expecting the arrival of a new friend, ward of her father’s friend General Spielsdor. Just before their expected arrival, a letter informs Laura and her father that the girl has died suddenly, and the General is on a quest to discover the murderer.

Almost immediately upon reading this letter, there is a carriage accident involving a lady and her young, amazingly beautiful, daughter. The mother says that she must move on immediately, but the child is sick so she’ll have to leave her in the next town. Laura’s father insists that they keep the child as a ward – she will make a fine friend for Laura.

Sure enough, Laura and Carmilla become tight friends – in fact, creepily tight. Carmilla is almost homosexual in her adoration of Laura. It would be easy to discount such female-love because in the era in which this book was written lesbianism wasn’t really considered an open possibility. I could easily shrug it off as intimacy which was acceptable at the time the book was written. But even Laura is a little creeped out by Carmilla’s love for her.

Soon, lower-class girls in the neighborhood start dying of a strange wasting disease. Meanwhile, Carmilla mysteriously locks herself in her room at night, and doesn’t descend until afternoon. Laura is haunted by terrifying dreams of monsters at night, and begins to waste away herself.

Just in the nick of time, General Spielsdor arrives, telling a strange story of a young, strikingly beautiful, girl who was left in Spielsdor’s care after the mysterious mother needed to leave town suddenly. Spielsdor was convinced that the child was a vampire and had murdered his sweet ward, and then had left town after he’d tried to impale her with his sword. The similarities in the stories were discovered, and Carmilla was henceforth dispatched.

I think the parallels between this story and Bram Stoker’s Dracula are quite striking. They both have a vampire hunter tracing the movements of the abomination. Both vampires sneak in at night and attack the victim several times before death occurs. Carmilla turned into a large cat instead of a dog, as in Dracula, but both vampires slept in coffins. On the other hand, it’s been a while since I’ve read Dracula, but I’m pretty certain he was unable to withstand sunlight, whereas Carmilla moved freely throughout the day. The parallels are likely due to use of the same primary sources of Slavic vampire folklore.

Some consider this book to be the prototype for lesbian vampires; however, as I said above, lesbianism was considered impossible at the time – Queen Victoria declared it so in 1885 when lesbianism was about to be criminalized. So clearly lesbianism could not have been implied. (Though, I suppose, this story was written before lesbianism was royally decreed impossible.)

I enjoyed this book a lot. The narration moved along quite nicely, and the book was short and to-the-point. I would recommend it to anyone who find vampire folklore to be interesting.

References

Le Fanu, J Sheridan. (2010) Carmilla: A Vampyre Tale [BBC Audio Version. Follows, Megan (na).] Retrieved from audible.com.

Post Traumatic Stress Syndrome – the Basics

I think we all have some idea of what we think PTSD is, but it turns out PTSD isn’t as clear-cut as I thought.

Apparently, when PTSD was first introduced into the DSM, the diagnostic criteria required a traumatic event “outside the range of usual human experience” that would cause “significant symptoms of distress in almost anyone.” That fits pretty well with my own perception of PTSD. Rape, war, torture, violent experiences…these all fit into that description. PTSD is a normal response to an abnormal stressor.

However, in the DSM-IV, the nature of the “traumatic event” broadened drastically, and a requisite response was “intense fear, helplessness, or horror.” So in the DSM-IV, PTSD was a pathological response to a potentially less extreme stressor. Someone could be diagnosed with PTSD if they experienced “intense horror or helplessness” after watching a scary TV show or upon being diagnosed with a terminal illness.

Although I don’t wish to undermine the intense stress that someone with pathological responses may feel, I think this definition undermines the intensely awful experience that someone with PTSD (in my mind) has encountered. The statistics agree with my assessment of these criteria: in a community survey, 89.6% of people reported that they had been exposed to a traumatic event and had responses that could potentially qualify them for a PTSD diagnosis.

Luckily, the DSM-5 tightened the traumatic event criteria again, and broadened the range of response to the traumatic event. Now, the traumatic event must occur directly to the subject, and they can exhibit other pathological responses besides “intense fear, helplessness, or horror.”

To be diagnosed with PTSD by DSM-5 standards, a person must be exposed to “actual or threatened death, serious injury, or sexual violence.” They must exhibit one of the following symptoms: intrusive distressing memories of the event, distressing dreams reliving the event, dissociative reactions, intense psychological distress at cues that remind the person of the event, or marked physiological reactions to cues that remind the person of the event. Additionally, the person must persistently avoid stimuli associated with the traumatic event, have negative alterations in cognitions and moods associated with the event (e.g. distorted cognitions about the cause or consequences of the event), and alterations in arousal and reactivity (e.g. hypervigilance or angry outbursts).

In general, people respond to trauma with decreasing pathological symptoms. In order to be diagnosed with PTSD, the patient must have experienced these negative responses for more than 1 month, otherwise they are experiencing “acute stress disorder.”

Despite the common association of PTSD with war veterans, PTSD is actually more common in women than in men – and the traumatic events are more often domestic violence or rape than war. However, a great deal of money and time has gone into research of PTSD in war veterans.

During WWI, symptoms of PTSD were called “shell shock,” and were thought to be caused by brain hemorrhages. However, this belief slowly subsided as doctors realized that the symptoms presented themselves regardless of injury. By WWII, traumatic reactions were known as “operational fatigue” and “war neuroses,” before the terminology finally settled on “combat fatigue” during the Korean and Vietnam wars. A rigorous longitudinal study of PTSD by Smith et. al. in 2008 found that 4.3% of military personnel deployed to Iraq or Afghanistan had PTSD. Of those, the rate was higher (7.8%) in those that had experienced combat compared to those who hadn’t (1.4%). An issue that is (rightfully!) getting much attention lately is the high rate of soldier suicide. Between 2005 and 2009, more than 1,100 soldiers took their own lives – generally with a gun.

There are several risk factors that increase the likelihood of PTSD – being female, lower social support, neuroticism, preexisting depression or anxiety, family history of depression, substance abuse, lower socioeconomic status, and race/ethnicity. (Apparently, compared to whites, African Americans and Hispanics who were evacuated from the World Trade Center in 2001 were more likely to get PTSD.) There is also a genetic factor that increases susceptibility to PTSD. Preliminary studies suggest that people with a particular form of the serotonin transporter gene may be more susceptible to PTSD than those with the “normal” form of this gene.

On the other hand, there is at least one factor that promotes resilience to traumatic events: intelligence. It’s possible that people with higher intelligence are better able to make “sense” of the event by viewing it as a larger whole. Or an intelligent person may be better able to recognize and buffer cognitive distortions such as “I deserved that,” “why should I have lived when they died?” and “If I had only done _______, this wouldn’t have happened.”

Researchers have come up with several ways to decrease likelihood of succumbing to PTSD after a traumatic event.

Stress-inoculation training has proved successful with members of the Armed Forces. Soldiers can be exposed, through virtual reality, to the types of stressors that might occur during deployment. Thus they are better able to deal with the trauma when exposed to the events in real life.

Debriefing after a traumatic event can also be helpful. This allows the victim to process the event in a safe environment, before the details become internalized.

Interestingly, one study showed that subjects who were exposed to a highly disturbing film were less likely to report flashbacks if they played Tetris for 10 minutes after the film than if they sat quietly for those 10 minutes. This team of researchers also showed that simply being distracted after the disturbing video was not enough to decrease flashbacks, and that doing a verbal task actually increased the number of flashbacks. So, apparently, visio-spacial tasks decrease the likelihood of intrusive flashbacks if performed immediately after the traumatic event. I’m not sure this information is particularly useful, but it’s interesting.

As of yet, there isn’t a highly successful way to “cure” people with PTSD. Cognitive behavioral therapy, which helps the victims recognize cognitive distortions (e.g. “I deserved that,” “why should I have lived when they died?” and “If I had only done _______, this wouldn’t have happened.”), can be helpful in reducing anxiety. Antidepressant medications can alleviate some of the depression and anxiety experienced by victims.

One up-and-coming treatment has shown promising results. Someone with PTSD can undergo prolonged exposure to the traumatic events. They can do this through repeatedly reliving the events out loud, or even by re-experiencing them through virtual reality. Unfortunately, many PTSD vitimcs drop out of such treatments because reliving the events is too difficult. However, this treatment method has proven very helpful to people who complete the process, and I hope that work in this area continues.

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 5: Stress and Physical and Mental Health. Abnormal Psychology, sixteenth edition (pp. 129-161). Pearson Education Inc.

Does the DSM-5 encourage overmedication?

Oh, the irony of life – I clicked on a link to read an article by Dr. Allen Frances (chair of the DSM-IV task-force and author of Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life) – and I was forced to wait through a 15 second advertisement on a psychiatric medication. This is exactly the type of thing Dr. Frances complains about. People have “too much” access to information that they are not trained to understand. Dr. Frances urges the public to beware self-overdiagnosis. (This could also be referred to as cyberchondria.)

Before the publication of DSM-5 Dr. Frances strongly argued against many of the changes proposed…he even admitted that there were some mistakes made in the DSM-IV. One of his main arguments is that the DSM-5 added many new diagnoses that could push people formerly considered “normal” into the disordered range. For instance, disruptive mood dysregulation disorder is a new diagnosis for children who have too many temper tantrums; internet gaming disorder is a diagnosis for hard-core gamers. The DSM-5 also rejected the bereavement exclusion, which had previously discouraged clinicians from diagnosing major depressive disorder in people who had undergone a major loss in the past two months.

At the time that DSM-5 was being written, media pounced on the omission of the bereavement exclusion, claiming that people who were going through a natural process of grief would be stigmatized by a “mental illness” diagnosis. But is this really what happens?

The 2012 study The bereavement exclusion and DSM-5 concludes that the symptoms of bereavement aren’t fundamentally different from those of major depressive disorder. If the grieving individual’s symptoms and impairments are as severe as a person with major depressive disorder, they may benefit from treatment – and treatment requires a diagnosis. The purpose is not to throw drugs at every bereaved soul that walks through the doctor’s door. In fact, most people who are bereaved will not go into their doctors because they think their symptoms are “normal.” Those that go into their doctors are most likely suffering from more severe symptoms which might need to be treated.

In his 2013 PsychCentral post How the DSM-5 Got Grief, Bereavement Right, Ronald Pies argued that clinicians will not have to diagnose major depressive disorder in grieving patients, but they will be able to if such a diagnosis would be beneficial.

On the other hand, Allen Frances argues in his 2013 Psychology Today post Last Plea to DSM 5: Save Grief From the Drug Companies that the “medicalization of grief” will provide more “normal” patients at which to fire Big Pharma’s semi-automatic pill-dispensing guns (that’s not a direct quote). It will be a huge profit to the drug companies, but will the over-medicated grievers really be helped? Frances insists that we should focus our attention on the more severely mentally ill, who are in more need of treatment, but who are being lost in the bonanza of over-diagnosis.

Frances argues (understandably, since he was chair of the DSM-IV task-force) that there was no problem in the DSM-IV bereavement exclusion, why fix what isn’t broken? We should let the bereaved grieve with respect and dignity. If they were severely impaired, they were still diagnosable for major depressive disorder, so there was no need for change.

Here’s my conundrum: Who’s right? Ronald Pie or Allen Frances? With the DSM-IV were doctors just as capable of diagnosing a bereaved individual with major depressive disorder if necessary, as Dr Frances claims? If that truly is the case, then I’d say he’s right. Allowing too much freedom in the diagnosis might encourage general practitioners – who, despite their relative ignorance of mental illness compared to psychiatrists, are the go-to doctors for anti-depressants and anxiety meds – to over-diagnose and over-medicate. Generally, allowing the natural grieving process to progress is the best way to heal.

What concerns me about the bereavement exclusion, though, is that grieving patients who have some severe symptoms of major depressive disorder (persistent insomnia, weight loss, profoundly impaired concentration), but who do not admit to suicidal ideation would not be treated for depression. It is too likely that such patients are not entirely honest about their suicidal ideations, and the doctor may therefore miss this crucial criterium for diagnosis. Are we “better safe than sorry” – providing treatment to people who might not need it? Should we risk overmedicating and supporting the “evil” Big Pharma?

Honestly, I don’t know.

References:

Frances, Allen. (2010, July 08). Normality Is an Endangered Species: Psychiatric Fads and Overdiagnosis. Retrieved from: http://www.psychiatrictimes.com/blogs/dsm-5/normality-endangered-species-psychiatric-fads-and-overdiagnosis.

Zisook S, Corruble E, Duan N, Iglewicz A, Karam EG, Lanouette N, Lebowitz B, Pies R, Reynolds C, Seay K, Katherine Shear M, Simon N, Young IT. (2012).The bereavement exclusion and DSM-5. Depress Anxiety. (29):5, 425-43.

Bloodchild and Other Stories, by Octavia E. Butler

Bloodchild and Other Stories, by Octavia E. Butler

This is a book of horror / dark fantasy stories by the amazing author Ocativa E. Butler. Believe it or not, this is the first book by Butler that I have ever read, and I was amazed at her brilliance.

Her stories were incredibly creative. They covered important issues like race, slavery, sexuality, and identity, all in the guise of alien occupation or dystopic disease and other dark fantasy themes. Her prose was smooth and eloquent.

The most interesting of the stories was her novella Bloodchild, which is about a child that is about to be “sexually” adopted by some alien worm-thing. The story encompassed the feelings of the boy, his mother, and the alien – providing some very startling insight.

After each story, Butler included a short essay of what she intended the story to mean or background in her life when the story was written. These brought further understanding to the story, though I was a little skeptical when she insisted that she hadn’t intended Bloodchild to be about slavery. But, I guess, sometimes meanings creep in there unintended. And there’s also something to say for the readers’ interpretation regardless of intended meaning. To me, slavery was one of the many underlying themes of the story.

At the end of the book, Butler included a couple of essays about what it was like being an African American science fiction author, and encouraged young people to follow their dreams and become authors. Finally, there were a couple of never-before-published stories.

This little book is well worth your time if you are interested in deeper cultural issues of race, slavery, and sexuality – possibly even if you are not specifically interested in science fiction and fantasy.

For pure brilliance

This post is for R. I. P. X @TheEstellaSociety and the 2015 Halloween Reading Challenge @ReadingEverySeason. It is also for #Diversiverse, @BookLust, which is all about reading books by people of a variety of ethnic/racial backgrounds, so I will provide tell you a little about the author, Octavia E. Butler.

Octavia E. Butler was born in 1947 into an impoverished African American community to a 14-year-old girl. Despite struggling with dyslexia, she had a passion for reading and writing ever since she was very young. As a teenager, she started attempting to publish her stories, despite the extreme difficulty for African Americans publishing science fiction / fantasy. At the time she was one of only a couple African American sci-fi writers. Despite being taken advantage of by money-hungry agents, she finally published Patternmaster in 1976. This book was praised for its powerful prose, and she ended up writing four prequels. She finally became mainstream upon publication of Kindred in 1979. Butler died outside of her home in 2006.

Girl of Nightmares, by Kendare Blake

Girl of Nightmares, by Kendare Blake

After listening to the audio version of Anna Dressed in Blood, by Kendare Blake (and disliking the narrator), I decided to pick up an old-fashioned copy its sequel Girl of Nightmares.

Cass Lowood has now become used to life in Thunder Bay. He’s finished a school year in the same school for the first time in years. He has friends: the beautiful and popular Carmel Jones and nerdy voodoo teenage witch Thomas Sabin. The three have tried to move on from the devastating events in Anna Dressed in Blood. They’ve been going to school by day and killing ghosts by night. But when Anna starts haunting Cass, he becomes obsessed with saving her from whatever hell she is suffering. His quest to save her drives a wedge between him and his friends, and leads him across the ocean to follow ominous clues sent by anonymous people.

I enjoyed Girl of Nightmares even more than Anna Dressed in Blood. I began the book with an attachment to all the characters, and was genuinely concerned about Anna’s fate. Cass, Carmel, and Thomas begin to develop more rounded personalities in this book – showing sides of themselves that weren’t obvious in the first book. Girl of Nightmares had a good mixture of action and intrigue, which kept me turning the pages. I’m hoping there will be another book coming up soon.

4 stars for fluffy YA fun

Anna Dressed in Blood, by Kendare Blake

Anna Dressed in Blood, by Kendare Blake; narrated by August Ross

Anna Dressed in Blood, Book 1

Cas Lowood has always worked alone on his quest to dispatch murderous ghosts and discover the demon who killed his father. Imagine his annoyance when he moves to Thunder Bay to kill the intensely horrific ghost Anna Dressed in Blood and he accidentally picks up a couple of teenaged tag-a-longs. When he attempts to dispatch Anna, he discovers that she’s unlike any ghost he’s ever fought before. She’s frightening and mesmerizing in her power. Cas digs deeper into Anna’s story and begins, for once, to see a ghost as an unwilling victim rather than simply a supernatural murderess.

Initially, I picked up this book because of the fantastic cover art (Yup! I’m one of those people). Turns out Anna Dressed in Blood was a really good choice if you’re a fan of teen horror. I hadn’t read a good ghost story in a long time, and this one was quite refreshing. The characters were easy to like, and the mystery kept the book interesting. This book was fun and quick.

Unfortunately, I listened to the audiobook rather than reading the book. I don’t recommend this course. Ross annoyed me with his too-clear annunciations, his pauses, and his slow reading. It ruined the rhythm of the narrative, and made the dialog fall flat. There were several times I wanted to give up on the book just because the narration was annoying me. But I couldn’t do it because I was enjoying the story too much.

4 snowflakes for fluffy YA fun

Kendare Blake

Kendare Blake was born in Seoul, Korea and was adopted by her American parents when she was very young. She writes dark fantasy including, but not limited to: The Girl of Nightmares series and The Goddess War series (beginning with Antigoddess).

After enjoying The Girl of Nightmares series so much, I’ll probably be picking up Antigoddess sometime soon.

Clinical Mental Health Diagnosis – Psychological Assessment

In my post about the biological assessment of mental health diagnosis, I mentioned that there are three ways a clinician can focus a mental health assessment: biological, psychodynamic, and behavioral. In this post I will discuss the psychodynamic and behavioral assessments of patients.

I’m not sure what a psychological assessment feels like to the clinician, but I have been through several assessments as a patient. Some of them have been very grueling and embarrassing – my 2 hour long assessment for dialectical behavioral therapy comes to mind. Generally, the mental health worker will ask a series of questions to determine personality (am I maladaptive?), social context (am I from an abusive family? caring for an sick family member? a bullied teen?), and culture (I’m a WASC) .

Such an assessment can be either a structured or unstructured interview. In the structured interview, the patient is asked a set of pre-determined questions, even if some of the questions seem inapplicable. In the unstructured interview, the clinician decides which questions to ask. The unstructured interview is much less grueling than the structured one, but it is more likely to produce bias due to the direction of questions that the clinician chooses.

Generally while the clinician is giving the interview, she also assesses the general appearance and behavior of the individual. Is he well-dressed, have good hygiene, look the clinician in the eye? Does he seem to be lying? Observation can also be done through role-playing and self-monitoring. Self-monitoring is a fantastic way to get information that the clinician might miss in a one-hour interview, but it tends to be biased towards what the patient is willing and able to record.

There are also a lot of tests to determine personal characteristics. A famous one of these is the Rorschach Inkblot Test. It’s a series of 10 inkblot pictures to which the patient tells the clinician what she sees and thinks while looking at the picture. The Rorschach test takes a lot of time both to administer and to evaluate, though it can be very enlightening to a clinician who is well-trained in the system.

Another well-known personality-trait test is the Thematic Apperception Test (TAT). The TAT uses a series of simple pictures of people in various contexts. The patient tells a story about what the character is doing and why. Like the Rorschach test, the TAT takes a long time to administer and interpret. The TAT has become a bit obsolete since the pictures were designed in 1935, making them harder for the modern patient to relate to.

The Rorschach and TAT are considered subjective assessments, because they are subject to the clinician’s interpretation. There are also objective tests like the Minnesota Multiphasic Personality Inventory (MMPI), which was introduced in 1943, and revised to the MMPI-2 in 1989. The MMPI-2 is a computerized test consisting of 550 true-false questions on topics ranging from physical condition and psychological states to moral and social attitudes. From these 550 questions, several “clinical scales” are determined. Such scales quantify hypochondria, depression, hysteria, pscyhopathic deviance, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion. It also quantifies the likelihood of lying (inconsistent answers), addiction proneness, marital distress, hostility, and posttraumatic stress.

Such computerized objective tests are helpful because they (for the most part) lack clinician bias, and they are inexpensive. However, they depend upon the patient’s ability to honestly and accurately describe themselves, which many patients are unable or unwilling to do. These tests also tend to be impersonal, and might alienate the patient.

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 4: Clinical Assessment and Diagnosis. Abnormal Psychology, sixteenth edition (pp. 101-127). Pearson Education Inc.

Clinical Mental Health Diagnosis – Biological Assessment

One of the most difficult tasks for mental health workers is to clinically assess and diagnose mental illnesses – especially when comorbidity (having more than one mental illness) is so common. It usually begins with a psychological assessment through tests, observation, and interviews so the clinician can catalog the symptoms. Then the DSM-5 is consulted to give the diagnosis.

A clinician may focus the assessment in three ways – biological, psychodynamic, and behaviorally.

Biological approach

For the sake of appropriate treatment, it is very important to make sure that the symptoms are not due to a physical rather than a mental illness. In my experience, many doctors shrug off certain types of symptoms as those of a mentally ill patient. For instance, when I fainted at work a while back I was told it was “anxiety.” (And because it was diagnosed as a mental problem, my insurance didn’t pay – but that’s a problem to discuss on another day.) Granted, my fainting spell could have been anxiety-induced, but it could have been many things.

A more extreme example that I heard of from a doctor at a large university hospital was that a foreign patient (I can’t remember his origin) kept coming in complaining that there was a worm in his head. The doctors kept shunting him off to mental health. Eventually, the man came back and said “There’s a worm in my eye!” They looked, and sure enough there was a worm in his eye. (Possibly something like this?) Yeah. Sometimes the patient knows what he’s talking about.

Of course generally there aren’t really worms in people’s heads – but symptoms that seem mental could be due to head injuries, strokes, seizures, etc. There are a number of brain scans that can be performed to check for such problems.

One is computerized axial tomography (CAT) scan, which moves X-ray beam around the head to create a 2D image of the brain. CAT scans have become more rare because of the availability of magnetic resonance imaging (MRI). MRI quantifies magnetic fields affecting varying amounts of water content in tissue, thus giving a sharp image of different structures (or lesions / tumors) in the brain.

Another brain imaging technique is the positron emission tomography (PET) scan. PET scans measure the metabolic activity in the brain, thus allowing more clear-cut diagnoses to be made. PET can reveal problems that are not anatomically obvious. However, the images in PET images are low-fidelity and the scans are prohibitively expensive.

Functional MRI (fMRI) measures blood flow of specific areas of tissues, thus providing information about which areas of the brain are active. fMRI is the scan that helps researchers discover which parts of the brain are important for certain types of thoughts or activities. At the moment, it is more important in the research than in the clinical world, but there is some optimism that fMRI might eventually be used to map cognitive processes in mental disorders.

Sometimes, a lesion hasn’t developed enough to be recognizable by brain scans. In this case, neuropsychological tests can be performed to quantify a person’s cognitive, perceptual, and motor performance to determine what parts of the brain might be affected. The neuropsychological assessment usually involves a battery of tests such as the Halstead-Reitan assessment for adults. This assessment is composed of 5 tests.

1. Halstead Category Test: Measures learning, memory, judgement, and impulsivity. Patient hears a prompt and selects a number 1-4. A right choice gets a pleasent bell sound and a wrong choice gets a buzzer. Patient must determine the underlying pattern in prompt-number combinations.

2. Tactual Performance Test: Measures motor speed, response to the unfamiliar, and the ability to use tactile / kinesthetic cues. A blindfolded patient is asked to place blocks in the correct spaces on a board. Then she draws the board from memory, without ever seeing the board.

3. Rhythm Test: Measures attention and concentration. The patient listens to 30 pairs of rhythmic beats and must determine whether the pairs are the same or different.

4. Speech Sounds Perception Test: Determines whether patient can identify spoken words, and measures concentration, attention, and comprehension. Nonsense words are spoken, and the patient must choose the word from a list of four printed words.

5. Finger Oscillation Task: Measures the speed at which the patient can press a lever.

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 4: Clinical Assessment and Diagnosis. Abnormal Psychology, sixteenth edition (pp. 101-127). Pearson Education Inc.