Category: Psychology & Medicine

Posted in Psychology & Medicine

Process Of Elimination

Posted on by Jinavie

“How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?” ~ Sherlock Holmes

If there is not enough evidence to come to a conclusion of what is the truth, start by removing the possibilities that cannot be true. If you hack away these impossible answers one by one, you will ultimately end up with the truth. This method is highly useful in a multiple-choice type exam, where you cross off the false answers until only one remains (or take an educational guess from whatever remains). In medicine, a process of elimination can be used to narrow down a differential diagnosis, or to reach a diagnosis of exclusion – that is, a diagnosis that cannot be proven to be true but seems to be the only one that fits since all other diagnoses do not. 

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Posted in Psychology & Medicine

Identity

Posted on by Jinavie

Do you want to gain trust and build intimacy with someone? That is easy – all you have to do is recognise and accept their identity. Every person tries to define who they are by building an identity or their “self”. This identity includes their personality, experiences, philosophies and interests. If you wish to have a deep and meaningful conversation, start off with a light conversation to explore the person’s identity. What kinds of films do they like? What leisure activities do they enjoy in their free time? What occupation are they in? If you slowly learn such superficial information, an outline of their identity begins to take place. Also, observe the person’s attitude as they speak and how they respond to certain topics. You will be able to know or at least guess what their interests are.

As the person slowly becomes fond of you through conversation, simply lead the conversation towards their interests that you found out. The person will talk excitedly about their interests. Now, respond accordingly with a smile and a look of interest (better if you are actually interested). A positive conversation has been established. Steer the conversation so that the other person talks as much as possible about their “self”. The person will think that you share their interests, and nothing is as attractive as common interests.

Shall we go one step deeper? Interests give an outline and begin to add colour to the identity, but to recognise their identity as a whole you must gather more specific data. Once a sense of trust and intimacy begins to develop, the conversation can develop into a more personal one. Talk about the person’s past, their philosophies, their dreams, hopes and aspirations. The more intimate information they share with you, the deeper the intimacy becomes and the more you learn about their identity. The important point here is that you not only learn about their identity, but acknowledge it every step of the way. The greatest gesture you can make to another person is accepting them for who they are. If you talk with someone that understands you and accepts you, you will talk as if time does not matter and share your deepest secrets.

On the other hand, if you wish to attack an enemy psychologically, what could you do? As you might have guessed, you should attack their identity. Pull out all of their weaknesses and faults and attack them, while logically disproving their fundamental beliefs and philosophies. Systematically pull apart their psyche and destroy the pride they have for their identity and even the strongest enemy will fall to their knees.

Posted in Psychology & Medicine

Hypothermia

Posted on by Jinavie

A person’s body temperature is always maintained between 36.5~37.5°C. This is because enzymes, which are crucial in all physiological reactions in the body, work most efficiently at this temperature. As physiology is essentially a series of chemical reactions, it is heavily dependent on temperature. If the temperature falls, chemical reactions occur slower and vice versa. When body temperature falls below 35°C, metabolism becomes too slow and it poses a risk to the person’s health. This is known as hypothermia.

How does hypothermia affect the body? Hypothermia is categorised into three classes depending on the severity.

  • Mild hypothermia (32~35°C) leads to the slowing of bodily functions, tremors and difficulty in walking. The patient’s speech is impeded and other neurological symptoms such as decreased judgement skills and confusion start to appear. Also, blood pressure, pulse and breathing rate rise.
  • Moderate hypothermia (28~32°C) causes paralysis of muscles and extreme fatigue (they may complain of being sleepy). As blood (carrying heat) is rerouted to major organs, the skin (especially lips and extremities) become white or purple and very cold. Neurological symptoms worsen with amnesia, memory loss, severe confusion and delusion beginning to show. As sustained hypothermia leads to the tremors stopping, one should not take the lack of tremors as a good sign. Heart rate becomes irregular and arrhythmia may occur.
  • Severe hypothermia (20~28°C) leads to chemical reactions becoming so slowed that physiological functions that support life decline dramatically. Heart rate, blood pressure and breathing all lower to dangerous levels and the heart and lungs may stop functioning. As the patient’s major organs begin to shut down, they enter a state of unconsciousness and eventually, clinical death.

As you can see, hypothermia is a highly dangerous situation that can kill. There are some other fascinating facts about hypothermia.

20~50% of hypothermia death cases are associated with paradoxical undressing. This is a strange phenomenon where the person begins to take off their clothes due to confusion and a lack of judgement from the hypothermia. One theory suggests it is related to the cold damaging the hypothalamus (which controls body temperature), causing the brain to think that the body temperature is rising. Whatever the reason, it is extremely dangerous as it worsens the hypothermia.

As explained above, severe hypothermia leads to death. But interestingly, hypothermia also protects organs. This is why organs for transplanting are transported in ice. Similarly, there are examples of people who “died” from hypothermia recovering with no brain damage. Because of this, medical professionals traditionally say: “they’re not dead until they’re warm and dead”. In fact, if there is something wrong with the patient’s circulation and there is risk of damage to their organs (such as in surgery), sometimes the patient’s body temperature is forced down with ice water injections and cooling blankets, known as protective hypothermia.

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Posted in Psychology & Medicine

Transactive Memory

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It is common to find couples, families or teams where someone always asks another member about a certain memory, while the opposite happens for a different memory. For example, a mother might always consult his son about computers and technical difficulties, while the father might always consult the mother about his plans for the month. This kind of “shared memory” is named transactive memory, where a group becomes organised in a way to share memory around in an efficient manner. This is usually done by the group reorganising itself so that each member specialises in a certain field, with the other members only remembering that that person is the expert. This means that instead of memorising every field, you can simply remember who is the expert in that field. It is much like learning where the reference text is rather than learning the contents.

Although it may look like dependence, transactive memory is an extremely useful tool in tight groups such as a couple or a small team. By having members specialise in certain domains of knowledge, the group is able to expand their capacity to acquire knowledge and create innovation. Transactive memory allows for a group to become efficient and effective in learning and retrieving knowledge. Overall, it improves decision making processes and the efficiency of the group, allowing for better outcomes. This is achieved by the division of responsibilities from specialising, shortening the time needed for finding the appropriate knowledge (as everyone knows the “guy” or “gal” to go to) and the shared understanding of the teammates regarding the interpersonal relations in the team. This means that everyone knows exactly who to go to for a certain domain of knowledge, while understanding their strengths and weaknesses, allowing for well coordinated interactions. Because of this, transactive memory only works in groups with limited numbers, with the maximum number being similar to the Monkeysphere (150).

Many studies prove the effectiveness of transactive memory. It has been found that couples have much better memory recollection compared to when they are paired with a stranger. In the modern technological era, transactive memory has expanded to the internet, with studies showing that people are more likely to know the source of information (such as Wikipedia) rather than the actual information. Given the ease of access to the internet and large databases containing all the information we need, sometimes it is far more efficient learning how to find these sources rather than rote learning all the information.

Posted in Psychology & Medicine

OCEAN

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A major challenge in psychology has been the question: “how do we categorise personalities?”. There have been many different approaches, one famous model being the Big Five model. This model describes five traits, summarised as OCEAN:

  • Openness: Describes a person who is creative, imaginative, abstract and curious. People with high openness scores are often skilled in the arts and inventing. They always seek new experiences. The perfect example for Openness is Leonardo da Vinci. This trait can be subdivided into the subcategories: Imagination, Artistic interests, Sensitivity, Adventurous, Curiosity and Tolerance for diversity.
  • Conscientiousness: Describes a person who is reliable, trustworthy, hardworking, plans ahead, goal-oriented, efficient, responsible and moral. The perfect example for Conscientiousness is Robocop. The subcategories are: Sense of competence, Orderliness, Responsibility, Achievement-striving, Self-discipline and Deliberateness.
  • Extraversion: Describes a person who is chatty, energetic, passionate, stubborn, social, easily makes friends and opinionated. The perfect example for Extraversion is Eddie Murphy. The subcategories are: Friendliness, Gregariousness, Assertiveness, Activeness, Excitement-seeking and Positive.
  • Agreeableness: Describes a person who likes to help others, is compassionate, friendly, forgiving, trusting, cooperative and empathetic. It is more about humanism rather than describing a spineless person. The perfect example for Agreeableness is Mother Teresa. The subcategories are: Trusting, Sincerity, Altruism, Compliance, Modesty and Sympathy.
  • Neuroticism: Describes a person who is unstable, easily depressed or worried, dark and susceptible to negative emotions. It is not the same as “neurotic”, which describes a mental disorder. The perfect example for Neuroticism is Woody Allen. The subcategories are: Anxiety, Self-consciousness, Hostility, Self-indulgence, Moodiness and Sensitivity to stress.

When the model is applied to a person, the person gets a score as a percentage for each trait. By using the Big Five score, one can compare different personalities and predict what kind of behaviour they would show in different situations.

Posted in Psychology & Medicine

Question

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The word that children say the most as they grow up is probably “why?”. Children always ask this and that, seeking knowledge as if they want to understand every object and everything happening around them. This is an extremely important developmental step that trains the most powerful weapon a human being possesses: the brain. Children can use their brain’s amazing information processing abilities to start building a massive knowledge tank, absorbing information like a sponge. Furthermore, they never ask a question just once but love to repeat the same question over and over, driving an adult crazy. This is not because the child wants to frustrate the adult. Just like how you cannot fully understand all of the meanings in a good book on the first read, a child learns through repetition and ruminating knowledge. If you do not repeat something, the knowledge only lasts in short term memory and is soon deleted, making it a very inefficient study process. Ergo, famous children’s educational programs such as Sesame Street and Blues Clues teach children things by constantly repeating the same thing. After that, the children watch the same episode over and over again to acquire knowledge.

As children do not know much about the world, they need to inherit knowledge from adults. Because adults possess a vast amount of knowledge, children need to ask a series of specific questions to build their knowledge base slowly and steadily. As their basic knowledge base builds, they can start to learn through other means such as books and encyclopaedias. However, whether you are a child or an adult, if you have something that you want to know, there is no faster and effective way of finding out than asking someone that knows. If you do not ask, you cannot learn and your brain will atrophy. Curiosity is a sign that there is still something you can learn. Thus, no matter how old you are, you should have the courage to ask a question. Curiosity is progress.

On the other hand, if someone (especially a child) asks you a question, do not brush them away; calmly answer their question and try to pass on as much of your knowledge to them as possible. That is your responsibility as a member of society; a sacred duty of feeding and nurturing the future generation.

Posted in Psychology & Medicine

Weltschmerz

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There is a German word called weltschmerz, which translates into “world pain” or “weariness against the world”. This word describes sad emotions felt after realising that the material world cannot satisfy the mind and that the ideal, hypothetic utopia in your mind cannot exist. It also describes the sadness felt after realising that your weaknesses arose from physical and social conditions of the world. Weltschmerz was widely used by poets such as Lord Byron, mainly as a way of viewing the world. It is a very pessimistic view of the world that often leads to or associated with depression, resignation and escapism. In severe cases it may lead to mental disorders such as hikikomori (a social disorder where the person does not and cannot leave their room due to fear and disgust of the world, also known as agoraphobia).

Posted in Psychology & Medicine

Spinach

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Spinach is a vegetable that is excellent for your health as it is rich in nutrients such as vitamins and minerals. If you ask someone the first two things that come to mind regarding spinach, they will most likely reply Popeye and iron. Popeye is a cartoon that began airing in the 1930’s and every child knows that the man gains superhuman powers from eating a can of spinach. In fact, after Popeye began airing, US consumption of spinach grew 33%. Most people believe that Popeye gains powers due to spinach having a high iron content. Thus, adults always tell children that if they want to be as strong as Popeye, they must eat their spinach.

Unfortunately, eating spinach does not make you as strong as Popeye. In fact, it is not even related to iron either. Firstly, the reason why Popeye eats spinach was because the producers wanted to advertise the high vitamin A content in spinach. Furthermore, spinach does not have a high iron content. The spinach iron myth originated from a German scientist named Emil von Wolff. In 1870, von Wolff was analysing the nutrition contents of different foods when he, from severe fatigue, accidentally misplaced a decimal point while recording the iron content of spinach. This led to spinach being known to have ten times the amount iron it actually has (to the level of red meat).

One problem with this is that this story is not true either. There are no detailed records of von Wolff’s experiments and no one knows if he misplaced a decimal point or not. The myth most likely originates from a 1980 article in The British Medical Journal that first brought up the story. Does that mean spinach is actually is a good source of iron? Wrong. Vegetarians often claim that spinach has iron levels close to red meat, but there is something about iron that they do not know. Many plants have a high iron content (it is found in chlorophyll which is used for photosynthesis), but this is mostly non-heme iron. There are two types of iron the human body can absorb: heme and non-heme. Heme iron can be used directly after absorption whereas non-heme iron needs to be metabolised by the liver to be usable. This takes a long time and is inefficient meaning it is far more effective to eat foods rich in heme iron. Plant iron is all non-heme iron while 40% of iron in red meat is heme iron, meaning it is a much better source of iron. Furthermore, spinach has a high oxalate content, which is an iron absorption inhibiting agent, making what little usable iron it has unabsorbable. 

In short, it is true that spinach has “iron” but as we cannot absorb it or use it, it practically has no iron content. But if you tell this to your parents and refuse to eat spinach, you may get into a lot of trouble.

Posted in Psychology & Medicine

Clubbing

Posted on by Jinavie

Among the thousands of signs and symptoms in the field of medicine, there is one that every doctor and medical student knows since the development of medicine. Clubbing is an easily noticeable sign in a patient’s fingers that can have wide implications on their health.

Clubbing is essentially when the angle (gap) between the fingernail bed and finger disappears. The formal definition is much more complicated, such as “the loss of the normal <165° angle, or Lovibond angle between the nailbed and the fold”, but for all intents and purposes the simple definition is sufficient.

To see if a patient has clubbing, the physician carefully studies the fingers against light. There are a few ways to check for clubbing but the most popular methods are holding the fingers out straight and holding them parallel to the ground, checking the angle between the nailbed and finger, or the Schamroth’s window test. The latter test is done by holding two opposing fingers (such as the left and right index fingers) against each other nail to nail. The fingers are then held against the light so that the light can shine through the “window” that is made. If the window is not seen, the test is positive and the patient has clubbing.

What does clubbing suggest? Clubbing was first noticed by Hippocrates, the father of Western medicine, who observed that people with clubbing tended to grab their chest and fall dead. This is one of the most common associations to clubbing – a congenital cyanotic heart defect such as tetralogy of Fallot or patent ductus arteriosus. Other common associations are related to the lungs, such as lung cancer (one of the most common causes) and various other lung diseases such as interstitial lung disease, tuberculosis and other chronic infections. There are also a myriad of other diseases associated to clubbing, including but not limited to: Crohn’s disease, ulcerative colitis, cirrhosis, celiac disease, Graves disease and certain types of cancers (lung, gastrointestinal and Hodgkin’s lymphoma mainly). Clubbing can also be idiopathic, where there is no apparent cause for the clubbing and the person just has it (possibly just born with it).

Despite knowing about clubbing for over 2000 years, we still do not know the exact reasons for clubbing. There are theories that it is related to a fall in blood oxygen content leading to vasodilation in the peripheries. As the pathophysiology is not clear and so many diseases are associated with it, when clubbing is found in the patient the physician should investigate the related organ systems (heart, lungs, GI mainly) to narrow down the possible cause of it. As many of the causes (such as lung cancer) carry a rather morbid prognosis, it is quite important to notice whether the patient has clubbing when doing a physical examination.

Posted in Psychology & Medicine

Fugue State

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Any computer user would have had an (unfortunate) experience where their computer crashed and all the information there was destroyed in a second. You may still be able to format it and use it without problems, but the data you had on the computer and any customisation you made would be lost. But what if this exact thing could happen to a human being?

There are many types of amnesia, with causes ranging from neurobiological (where trauma to the brain, a drug or some other pathology causes memory loss) to psychogenic (where there is no apparent biological cause for the amnesia). With psychogenic amnesia, one only experiences retrograde amnesia, where they cannot recall memories from the past. However, anterograde amnesia, where you cannot form new memories and keep forgetting what happened, is absent in psychogenic amnesia. Psychogenic amnesia is often caused by extreme stress or a traumatic event. One type of psychogenic amnesia is situation-specific amnesia, as seen in post-traumatic stress disorder (PTSD) that occurs after a severely stressful experience such as war, rape, child abuse or witnessing a brutal death. In this case, the patient tends to only lose memories regarding the event, as if the brain is trying to protect the person from the hurtful memories.

A more interesting and much rarer type of amnesia is global psychogenic amnesia, also known as a fugue state or dissociative fugue. Unlike situation-specific amnesia, patients in fugue states have absolutely no memory of their original identity and personality. Simply put, they (usually) retain all their functions such as speaking and social interactions, but their persona has been wiped out like a formatted computer. Fugue states often develop after severe stress and can happen to anyone. Similar to situation-specific amnesia, the brain blocks all memories of the past in an attempt to protect the person’s psyche. Due to the “deletion” of the previous persona, patients in fugue states often generate new identities and begin wandering (sometimes even travelling to another country) away from the place they lost their memories. This is most likely the brain attempting to leave the environment to avoid the stressor that caused the event. 

Fugue states are often short-lived, lasting from days to months. However, very rarely they can last for years. Once out of a fugue state, the patient recovers all of their past memories but have no recollection of what happened during the fugue state. This creates a hole in their memory. For obvious reasons, this usually causes intense confusion and distress in the patient and treatment is often based around helping the person come to an understanding about the episode and cope with the stressor that caused it.