Category: Psychology & Medicine

Posted in Psychology & Medicine

The Man With The Golden Arm

Posted on by Jinavie

In 1954, an 18-year-old Australian man by the name of James Harrison began donating blood. This is certainly not an unusual fact – over 100 million units of blood are donated worldwide each year. Harrison required massive amounts of blood transfusion during a major chest surgery he required 4 years prior. Knowing that he owed his life to the generous gift of blood from others, he pledged to donate blood as soon as he met the required age for it.

Soon after the first few donations, it was discovered that his blood had a peculiar property. Harrison’s blood contained unusually strong, long-lasting antibodies against a protein called the D Rh group antigen, or Rh(D).

Why was this such an important discovery?

In blood transfusion, blood types are crucial as transfusing the wrong type of blood can trigger an immune reaction in the donor’s body, potentially killing them. This is because red blood cells (that carry oxygen in the blood) are coated with different proteins called antigens. Your body ignores antigens that it is used to, but if it detects any new protein, it will create antibodies and viciously attack the cell as it thinks it is an infection.

Most people know their blood type as A, B, AB or O. A and B are the two most prominent antigens for red cells. If you are type A, you have A antigens. Type B have B antigens. Type AB have both antigens, while type O have neither antigens.

So, for example, if you transfuse type AB blood into a type B person, the donor’s immune system ignores the B antigen, but since it has never seen A antigens, it attacks the new blood and can make the donor very sick (or die).

The second most prominent antigen is Rh(D) (previously Rhesus factor). If you have it, you get a “+” next to the ABO typing (e.g. B+); if you don’t, you get a “–” (e.g. O-, the “universal donor” blood).

Rh(D) was a huge issue in medicine because it resulted in many babies dying or suffering brain damage due to haemolytic disease of the newborn (HDN) – a transfusion reaction where the mother’s immune system attacks the fetus due to different blood typing.

The so-called “anti-D” antibodies that were discovered in Harrison’s blood provided scientists with a weapon to fight against HDN.

HDN happens when a Rh negative woman develops antibodies to Rh(D), then has a baby with Rh positive blood. For example, if a Rh- woman has a Rh+ baby in the first pregnancy, the body detects the baby’s blood during birth, senses the Rh(D), then develops antibodies so it can fight it next time.

If you give the woman anti-D before the body has a chance to detect the antigen, the anti-D will immediately attach to all the Rh(D) antigens, shielding it from the body. Therefore, the woman never becomes sensitised to the antigen and doesn’t make antibodies. No antibodies, no HDN.

James Harrison was well aware of the power of his blood, so he proceeded to donate blood every two weeks for 57 years – over a 1000 donations. It is estimated that his blood helped save the lives of 2.4 million babies worldwide, including his own grandchild. Hence, he is known as The Man With The Golden Arm.

Posted in Psychology & Medicine

Watching You

Posted on by Jinavie

What drives our morality? Philosophers have argued and pondered for millennia where our sense of selflessness, altruism and honesty come from. Are we inherently good or evil? Do we only help others when it benefits us? How can we motivate people to act more morally?

One interesting research reveals a startling truth about our morality.

In 2006, psychologist Melissa Bateson published a research where she experimented with eyes. Their university tea room had an honour-based coffee and tea system, where you pay the price of the beverage into a box. Because there was no one keeping guard over the box, you could choose to cheat the system by taking a free drink without paying. Bateson wanted to see if she could influence how often people paid by making a simple alteration to the notice banner.

The notice banner had the prices for tea, coffee and milk. Bateson decided to add an image above the prices: a pair of eyes, or flowers. She would alternate the image used week by week, then recorded the total earnings and the number of drinks purchased. She would use different flowers and different eyes from various genders, ethnicities and expressions, but the eyes all had something in common: they stared directly at you.

The results were fascinating: on weeks where the notice banner included pictures of eyes, people paid 2.76 times as much compared to the flower weeks.

Turns out, seeing a depiction of eyes makes us more honest and cheat less. The same effect has been seen when using cartoons or drawings of eyes, resulting in less littering, more donations, less crime and overall more pro-social behaviours. This is called the watching-eye effect.

Why do harmless pictures of eyes make us want to do good?

The effect is likely to be an unconscious, automatic reaction. Our brains are remarkably sensitive to eyes and gaze – which is why we can easily spot people staring at us and why we are so good at reading emotions from eyes.

Furthermore, we are social animals and thus have evolved to show pro-social behaviours so that we fit into the group and live together harmoniously.

This means that when we see even a symbol of an eye, our brain automatically thinks that we are being watched by someone, pushing us to act morally to avoid punishment or embarrassment. This suggests that our desire to preserve our social reputation plays a significant role in our morality (but by no means the only factor).

The other thing to consider is that as we grow up, we are continuously taught that we are being watched, to dissuade us from bad behaviour. God will send you to hell, Santa Claus will put you on the naughty list and Big Brother will send you to prison. All of these stories and cultural beliefs fuel our subconscious paranoia of being watched and fear of consequences.

So if your lunch keeps getting stolen from the fridge, try sending a message by putting a photo of eyes on it to see if it deters your coworkers.

Posted in Psychology & Medicine

Triage

Posted on by Jinavie

In dire times such as wars, natural disasters and pandemics, we hear news of healthcare professionals setting rules to limit medical treatment provided to certain groups of people. This can come across as shocking to people as it seems unfathomable that a hospital would not do everything within its power to save a life. However, this is a well-known and commonly practised principle in medicine known as triage.

Fundamentally, triage is a system used to prioritise who should receive what level of medical care when. The word triage comes from the French verb trier, which means “to sort“. Modern triage was first designed by a French surgeon named Dominique Jean Larrey, who served in the Napoleonic Wars. Larrey categorised wounded soldiers into one of three groups:

  1. Those who would likely die no matter what treatment they received
  2. Those who would likely live no matter what treatment they received
  3. Those whose quality of life may benefit from immediate treatment

He advised battlefield medics to quickly assess what group a wounded patient would fall under and to focus on the last group. For example, if a soldier had superficial cuts and not heavily bleeding, they would be able to transport themselves back to base. A soldier who is not breathing or lost two or more limbs would be unlikely to survive despite acute surgery (especially with where medicine was at in those times). In other words, medical care would be focussed on those who would likely survive and benefit from urgent medical care, such as the patient who is needing an amputation to stop life-threatening bleeding from an injured limb.

This may sound cruel, but it is the unfortunate reality of healthcare. Ideally, we would like to give the best care to every patient, but we live in a world of scarcity, where resources are finite and limited.

Therefore, we rely on utilitarianism, where we ask “what is the most amount of good we can do with these finite resources?”.

Modern triage is more complicated than Napoleonic times, especially in the emergency department. However, in the case of emergency situations involving mass casualty, triage returns to its simple, original form.

Let us imagine a city struck by a massive earthquake. There are tens of thousands of people with varying severity of injuries. How do we prioritise who will be taken to hospital, need on-site treatment, or left to die or find their own way to hospital?

Physicians and nurses will quickly assess a patient and their vital signs to categorise them using coloured tags, such as red for needing emergency treatment, green for does not need treatment, or black for deceased or likely to die. This is because without triage and prioritisation, the available medical resources will quickly be exhausted and no further care will be deliverable.

If multiple doctors and nurses stop triaging and focus on one patient needing complex surgery, tens or even hundreds of potentially salvageable lives could be lost. If non-urgent injuries are all taken to hospital, the hospital will be overwhelmed and will not be able to provide care to those who are critically ill. If a patient with a non-survivable injury is operated on and taken to the intensive care unit (ICU), they will have lost the opportunity to use those resources on a patient with a better chance of survival.

As harsh as it sounds, saving ten people with moderate injuries who would die without treatment is preferred over the one person who has a less than 10% chance of surviving with maximum medical care. This may be as black-and-white as choosing to not rescue a person with an obviously unsurvivable injury such as decapitation, but it may be as complicated and ethically challenging as deciding if an elderly patient with a lung infection should be intubated and ventilated (breathing machine), fully knowing that a younger, healthier patient with the same infection may need that ventilator to survive, but with a much higher chance of survival and restoring their quality of life.

Triage is a classic example of when the rational solution to a problem such as scarcity challenges ethics and emotions. It may sound as if doctors are playing god when they are declining ICU level of care for an elderly patient, but we must also consider that they have a duty to provide the most effective care for all of society, not just the one patient. These kind of ethical dilemmas are an everyday occurrence in the medical field and can cause significant guilt, anger, pressure and resentment for the healthcare provider.

To simulate the weight of triage, consider the following scenario. Following an explosion in your neighbourhood, you respond to a scene with four patients:

  1. Your 28-year old co-worker with heavy bleeding from a laceration of their leg
  2. Your 83-year old mother who is bleeding from their head and unresponsive, breathing very irregularly and poorly
  3. Your neighbour’s 8-year old child who is not breathing despite straightening their airway and applying rescue breaths
  4. Your 45-year old who is screaming in pain from a broken arm but not bleeding and able to walk
    You have the capability to treat and transport one patient. Who do you choose?

As much as we would like the save the life of our loved ones or a young child first, the principles of triage dictate that the first patient demands the most immediate response.

Triage does not account for emotional connections, personal biases or even justice necessarily. It is a cold, hard rule system that we use so that we can separate our emotions and instincts out amongst a horrific situation.

The algorithm for the START triage system – a widespread system used in many modern mass casualty scenarios
Posted in Psychology & Medicine

Thunderstorm Asthma

Posted on by Jinavie

In November 2016, emergency departments of Melbourne, Australia, were overwhelmed by a sudden surge of patients with asthma exacerbations. There was a 672% excess of breathing-related emergency presentations, with 992% more asthma-related admissions than normal. Many of these patients had never had asthma attacks before (72%), but most had a history of hay fever (95%).

The dramatic flood of patients put significant strain on hospital systems, highlighted by some hospitals running out of stocks of inhaled medicines for asthma exacerbations or rooms to treat patients in.

The cause of this bizarre epidemic – dubbed thunderstorm asthma – is still not clear, but it has been theorised to be related to pollens. It has been known for over 30 years that thunderstorms can pick up large volumes of pollen from one area, then dumped on an urban area far away. Because the pollen were exposed to high levels of moisture, they can burst into very small fragments that make it easier to be inhaled into the lungs, bypassing the natural filter systems in the nose.

There is also a possibility that these thunderstorms introduce pollen from species such as rye that are more allergenic than typical pollen found in residential areas, causing worse reactions.

The drastic increase in pollen density and increased penetration to the lungs can trigger a severe asthma attack, particularly in people whose immune systems are sensitive to pollen (hay fever). In the case of the 2016 Melbourne event, ten people ended up dying, while more than 500 excess people were admitted to hospital compared to the normal asthma admission rate.

Instances of thunderstorm asthma have been recorded throughout the world, but scientists have not been able to prove the exact cause. It is a staunch reminder that nature and the environment have direct impacts on our health, in ways we may not even be able to imagine.

Posted in Psychology & Medicine

Motion Sickness

Posted on by Jinavie

Why do we get motion sickness when we are riding a moving vehicle?

Our sense of balance relies on an elaborate system. Our eyes give us visual information about head position and if it is moving in relation to our surroundings. Our inner ear contains delicate tubes (vestibular system) that act as gyrometers, indicating if our head is tilted or moving. Our brain synthesises the data from these two systems to know where we are in three-dimensional space and how we are moving within it.

The problem is that these two systems give conflicting information sometimes. For example, when you read in a car, your vestibular system senses that you are moving, but your eyes tell your brain that you are still. Conversely, when you watch a fast-paced action movie or playing a virtual reality game, your eyes will sense movement but your head will feel no movement.

When your brain receives conflicting information, it becomes confused; which information should it trust? The brain assumes that one of them must be wrong, possibly because you have been poisoned. The sensory mismatch results in nausea and you may start to vomit because the brain tries to get rid of whatever “poison” may be causing the problem.

In essence, motion sickness is caused by a mismatch between what the brain perceives and expects versus the reality.

Similarly, we can experience a form of “mental motion sickness“. Our brains are designed to predict the future, but the side effect of this is that we tend to form idyllic, simplified expectations. A good example is our tendency to hang our happiness on a future moment.

When we are unhappy or going through a hard time, we are prone to thinking that changing something will result in happiness. Some people change jobs or escape to another city (the “geographic solution“). Some people eagerly await for a holiday or for a deadline to be over. Some people start or end a relationship. We expect a drastic change in the future, even though the reality is that most things in life take time to change and happiness is not a switch you turn on, but a steady state that you build up to.

Eventually, when we realise that we are still unhappy, our brains become confused why reality is so different from our expectations. It makes us nauseated and want to reject our reality, frustrated that we are still miserable. But reality will not change just because we will it to.

The only solution is to manage our expectations. We need to accept that change happens gradually and that changing our environment will not necessarily change our headspace and perspectives. Our miseries will not disappear without us trying to improve our wellbeing. Instead of expecting a magical fix, we need to be mindful of our reality and find peace with the fact that it is okay not to always be okay.

We have evolved to improvise, adapt to and overcome changes and challenges. So instead of wallowing in self-pity that things did not turn out as expected, we must accept that things are as they are and keep fighting on to find our inner peace and happiness.

Posted in Psychology & Medicine

Priapism

Posted on by Jinavie

The penis is an interesting organ that has the ability to harden, despite being made of spongy material. Contrary to the popular slang for erection (boner), the (human) penis contains no bone.

Instead, it is made of a pair of cylindrical, spongy tissue called the corpus cavernosa, and a smaller spongy tube that surrounds the urethra called the corpus spongiosum. An erection happens when the body redirects blood flow to fill these spongy tissues, engorging them with blood. As it expands, the corpora become rigid and tense as they are wrapped by a thick, dense tissue called the tunica albuginea. The tension compresses the surrounding veins, trapping the blood and keeping the penis erect. Once stimulation slows and less blood flows into the penis, the blood drains via the venous system and the erection withers.

A common problem with erections is that of erectile dysfunction (unable to become erect or sustain it), which is well-known to the lay person. However, a lesser-known, opposite problem is priapism.

Priapism refers to an erection that will not die down even when the stimulation has ended, or with no stimulation at all. Although this may not sound like a medical problem other than causing embarrassment, priapism can be a very painful condition and depending on the cause, the penis can become starved of fresh blood (ischaemic), resulting in permanent damage to the cells and tissue.

Priapism is named after the Greek god, Priapus. He was a minor god worshipped in rural Asia Minor as a god of fertility, livestock and gardens. Priapus is depicted as having a permanent erection to symbolise fertility, but ironically, was cursed with impotence by Hera while still in the womb. His massive, erect penis was a popular theme for Roman erotic art and can be seen in various pieces of ancient art.

Priapism can arise from various causes such as blood disorders, medications and spinal cord damage. The problem is usually due to blood being trapped in the penis, or the nervous system continuously stimulating blood flow into the penis. As the main issue is engorgement with blood, the acute treatment for priapism involves decompressing the penis by using a needle to aspirate (draw out) blood directly from the corpus cavernosa.

Posted in Psychology & Medicine

Availability Cascade

Posted on by Jinavie

We live in a complicated world that constantly throws complex issues at us. Because it is impossible for one person to be an expert in every field, we have to employ different strategies and tactics to navigate through these issues.

A fascinating way that our brain tries to solve a current issue is the availability cascade. This is a self-reinforcing cycle, where an idea essentially “infects” a group of people, displacing individual thought and opinion and overwhelming critical thinking.

The way this happens was described and modelled by Timur Kuran and Cass Sunstein.

First, a new idea that seems to be a simple and elegant solution or explanation to the current issue starts to gain traction. People easily adopt and embrace this idea because it sounds plausible and because it is easy to process.

Secondly, people who adopt these ideas spread it themselves, making it more available in the social network. Particularly, nowadays we see this in both reported and social media.

Lastly, as the availability increases, more and more people are pulled in and the idea seems more credible, because “everybody” seems to think it. People do less research and have less individual thoughts or opinions about the matter because the group consensus is more appealing or acceptable.

The availability cascade as a platform can be very effective at raising awareness of issues and banding people together to fight a common cause, such as when the AIDS epidemic was starting.
However, it is fraught with issues.

The availability cascade is mediated by a heuristic, which is essentially a mental shortcut. Heuristics are extremely useful in that it reduces our cognitive load and automates many of our decisions. However, because they are based on rule sets, they are not as effective for new, different situations.

We are less likely to think critically when using heuristics, meaning that we are more vulnerable to being manipulated. In this situation, people think “this is widely available information, therefore it must be important” and default to believing it (even if it is just to appear “current” and to fit in).

Because critical thinking is overwhelmed by the availability cascade, it can be extremely dangerous when misinformation spreads this way; or worse, disinformation – where people maliciously spread false information for their own gains.

A classic example is the anti-vaccination movement that spawned from a discredited, falsified article that claimed MMR vaccines increased rates of autism, despite mountains of evidence pointing towards the effectiveness and safety of immunisation. Subsequently, vaccination rates dropped and we now see outbreaks of illnesses such as measles, resulting in countless deaths and injuries that could have easily been prevented.

Information can be just as contagious and dangerous as an actual infection. Knowing about the existence of these cognitive biases and phenomena help protect us from falling victim to them.

Posted in Psychology & Medicine

Baby Talk

Posted on by Jinavie

Why do we talk differently to babies? Baby talk, also called motherese, parentese and infant-directed speech, is an almost universal behaviour where adults will talk in a special way with very young children. It is characterised by sing-songy, high-pitched voices and the use of simplified words with slow, accentuated vowels. It is seen across various cultures and languages across the globe, with some studies showing that babies show preference to baby talk over “adult talk” from as young as 7 weeks old.

As instinctive and silly as it may sound, baby talk actually serves many important purposes. Language acquisition is a complex developmental process. Language is not something we are born with, but something we learn. Baby talk happens to be an effective tool to help teach babies how language works.

There are many features of baby talk that makes it so effective.

First, there is the tonal element. High-pitched cooing voices are comforting for babies, as they associate it with positive emotions. This contrasts to grumbling, low tones and yelling, which would upset them. The musical element also attracts their attention.

Second, by slowing your speech and lengthening the vowels, babies can identify individual words easier, amongst what would sound like a “sound soup” to them. This also gives them a chance to try to imitate you and practise speaking.

Third, by using more adjectives in front of nouns, such as “big red car” or “choo choo train”, we help babies associate objects with their names, while giving them qualities to make it more memorable. The process not only helps them build vocabulary, but trains them in the art of forming associations in their head.

Fourth, we tend to state the obvious and give more of a running commentary, filling in the gaps with more descriptions. This lets the baby know what is happening and helps them be more aware of their surroundings.

Lastly, there is the social element, where by using a special voice, we mentally switch ourselves into “baby mode”. This lets us focus our attention on the baby, while conveying that we care and love for the child.

We tend to use baby talk when talking with pets and other animals as well, but there is research to suggest that in the case of dogs, it does not make much difference other than for puppies and dogs react no differently compared to “adult talk”. It is also commonly used as part of flirtation as part of acting “cute”.

Baby talk is not something that is explicitly taught, yet most people instinctively use it when interacting with a baby. It is an example of how our desire to do best for the next generation is ingrained into us – both naturally and socially.

Posted in Psychology & Medicine

Pick A Card

Posted on by Jinavie

A very common card trick involves the magician asking you to pick a card as he ripples through a deck of playing cards in front of you. Following a few misdirects, such as pretending to pick out the wrong card and burning it, the magician will reveal the card that you chose secretly in your head. How did they do this?

The solution to the trick is to simply trim the top of a card and placing it in front of a card that the magician chose ahead of time. Because of the small gap, the chosen card ends up being revealed longer than other cards to the person as the deck is being rippled. That slight increase in visibility makes it much more memorable, subtly nudging the person towards choosing it.

As simple as the trick may be, it highlights how often we are under the illusion of choice. As much as we hate to admit it, we are quite susceptible to suggestion and persuasion. This is the basis of subliminal messaging, hypnosis and many types of mentalism (magic tricks involving manipulation of the mind). When we make a choice, how do we know that it comes purely from our own free will and volition?

Take for example the phenomenon of fake news. One of the dangers of fake news is that by using provocative, misleading headlines and summaries, it grabs our attention and leaves an impression. This means that unless we are vigilant about fact-checking and reading news from reputable sources, we can easily be manipulated into thinking or acting in a way that benefits those who released the fake news. The results of this may range from benign, such as persuading you to choose a certain brand of product over another, to something as sinister as affecting how you vote in an election or creating discord amongst the population of a country.

The field of psychology constantly reminds us of how flawed our minds are, with its numerous cognitive biases and ways it can be manipulated. We must be constantly aware of this fact to prevent ourselves from falling victim to those who try to take advantage of our thoughts and actions.

Posted in Psychology & Medicine

The Silent Twins

Posted on by Jinavie

The story of June and Jennifer Gibbons is a fascinating case of linguistics.

June and Jennifer were twin sisters born in 1963 from Barbadian parents. They were raised in Wales, where they were bullied in school due to their dark skin. This was a traumatising event that led to the twins becoming more and more isolated as children, often choosing to hermit themselves in their own secluded world.

An interesting phenomenon that developed at the time was that June and Jennifer would talk in an unintelligible language between the two of them. At first, it started with a mix of English and Bajan Creole (an English-based Caribbean language) spoken very rapidly. However, over the years, their shared language became more and more cryptic to the point that only the two of them could understand each other (and their younger sister Rose).

To add to this, the two made a pact with each other that they would never speak to other people, based on their trauma of being ostracised by their schoolmates. Furthermore, the twins exhibited mirroring movements and mannerisms, and would become catatonic when forcibly separated from each other.

In their teenage years, June and Jennifer started writing various plays, poems and stories. They also began experimenting with drugs and alcohol, leading to them committing crimes such as arson, theft and vandalism. Instead of being sent to juvenile prison, they were admitted to a psychiatric hospital due to their mutism.

The two would be admitted at Broadmoor Hospital for a total of 12 years, where they were treated with antipsychotics despite not having objective signs of psychotic illnesses. Their institutionalisation resulted in the worsening of their “symptoms”.

Later on, it was revealed by June that this was the point that the two came to an agreement that their pact could only be broken if one of the sisters died. In other words, one person had to die for the other to live a normal life. Jennifer decided to make the sacrifice.

At the age of 30, they were finally discharged from Broadmoor to be transferred to a more open clinic. When they arrived at the clinic, Jennifer was found to be unconscious. She was transferred to a hospital where she was diagnosed with acute myocarditis (heart muscle inflammation), resulting in her demise. The cause of the myocarditis was never found and had appeared unprovoked.

After a period of grief, June started to speak to other people. Regarding Jennifer’s sacrifice, she said:

“I’m free at last, liberated, and at last Jennifer has given up her life for me”.

June would go onto give interviews detailing her and Jennifer’s life journey and suffering, giving us insight into a remarkable case of cryptophasia.

Cryptophasia is a common phenomenon in twins, where they develop a language spoken only between the two of them. This may be accompanied by mirroring actions. It is thought that up to 50% of twins invent some form of language or code between the two. Cryptophasia is possibly a result of speech delay, with the twins compensating for each other by creating a language that they find more relatable. As in the case of June and Jennifer, environmental and social factors are also likely to play a crucial role.

The desire for connection is innate to human beings. When we feel isolated in the world, we may cling to the few connections we feel comfortable with, even if it means causing further isolation and loneliness. This may manifest in a healthy way, such as investing more time and energy cultivating a fulfilling relationship with friends and family. However, it may also result in co-dependent or toxic relationships, social isolation, addiction and restricting ourselves from leading a full life.

June and Jennifer Gibbons are reminders to us of the importance of connection in our life. How far would you go to feel connected to something – anything – in life?

Cuombajj Witches by Seb McKinnon