Posted in Psychology & Medicine

Phineas Gage

On September 13, 1848, a 25-year-old foreman named Phineas P. Gage was working on a railroad with his work team. In an unfortunate turn of events, as he was using a tamping iron (large iron rod with a pointed end, measuring 3 feet 7 inches in length and 1.25 inches in diameter) to pack gunpowder into a hole, the powder detonated. The forceful explosion drove the metal pole skyward through Gage’s left cheek, ripped into his brain and exited through his skull, landing dozens of metres away. His workmates rushed to Gage’s assistance (who they presumed to be dead at the time of the accident), and to their surprise, found that he was still alive.

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In fact, Phineas Gage spoke within a few minutes of the incident, walked without assistance and returned to his lodging in town without much difficulty – albeit with two gaping holes in his head, oozing blood and brain everywhere. He was immediately seen by a physician who remarked at his survival. In fact, it is reported that he was well enough to say: “Here is business enough for you” to the doctor. Another physician named Dr John Harlow took over the case, tended to the wound, fixed up the hole and recorded that he had no immediate neurological, cognitive or life-threatening symptoms.

By November, he was stable and strong enough to return to his home, along with the rod that nearly killed him. His family and friends welcomed him back and did not notice anything other than the scar left by the rod and the fact that his left eye was closed. But this was when things started to get interesting.

Over the following few months, Gage’s friends found him “no longer Gage”, stating that he was behaving very differently to the man who he was before the accident. Dr Harlow wrote that the balance between his “intellectual faculties and animal propensities” had seemingly been destroyed. Gage became more aggressive, inattentive, unable to keep a job, verbally abusive and sexually disinhibited. He would frequently swear using the most offensive profanities and would be as sexually suggestive as a March hare. How did the iron rod cause such a dramatic change in Gage’s personality?

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Phineas Gage would go on to be one of the most famous patient case histories in the history of modern medicine. His case was the first to suggest some sort of link between the brain and personalities. Neurologists noted that the trauma and subsequent infection destroyed much of Gage’s left frontal lobe – the part of the brain that we now attribute to a person’s logical thinking, personality and executive functions. It is in essence the “seat of the mind”. Ergo, Gage’s loss of one of his frontal lobes meant that his control of bodily functions, movement and other important brain functions like memory were undisturbed, while his “higher thinking” was essentially destroyed (he was essentially lobotomised). This explains Dr Harlow’s observation of his “animal propensities”.

Thanks to this case, a great discussion was sparked and the idea that different parts of the brain govern different aspects of the mind was conceived. We are now able to localise almost exactly where the language area is, what part controls movement and how a certain piece of the brain converts short-term memory into long-term memory.

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Posted in Psychology & Medicine

Child Prodigy

At the age of 6, Wolfgang Amadeus Mozart toured Europe to astound audiences with his mastery of the violin, organ and keyboard. At the age of 11, Judit Polgár defeated a Grandmaster in chess, later becoming a Grandmaster herself at the age of 15. By the time he finished elementary school, Saul Kripke had taught himself ancient Hebrew, finished the works of Shakespeare and mastered the works of Descartes and complex mathematical problems.

Each of these people is considered a child prodigy – person who develops and shows extreme talent in a skill at a level far beyond the norm for their age. The term wunderkind (German for “wonder child”) is also used. For some unexplained reason, these people are far beyond the average level of children at their age in terms of intelligence or a certain talent.

Prodigies are actually a subset of a condition known as precocity, where a young child shows unusually early development or maturity, especially in mental aptitude. For example, a German child called Christian Friedrich Heinecken is known to have talked within a few hours after his birth, learnt the key events of the first five books of the Torah within a year, mastered the Bible at age 2 and had a working knowledge of universal history and geography, Latin and French at age 3. Unfortunately, he was struck ill at the age of 4, and shortly after predicting his death, passed away. Heinecken’s case is an extreme example of precocity, but nonetheless most precocious children show at least an outstandingly advanced level of mental maturity compared to other children. Along with prodigies, savants and children with extraordinarily high IQ (over 160) are also considered precocious.

Although precocious children enjoy their extreme talent (for which they usually have deep passion for) and may even become famous for it like Mozart, they are almost always at risk of certain problems. One common issue is that they tend to be placed on pedestals as people constantly praise their ability. This can quickly evolve into narcissism, setting a major expectation that the child battles with throughout his or her life. Children with advanced intellect are often unable to fit in to society as they are far more intelligent than their peers. Not only do other children shy away from them, but they feel too bored and unstimulated by other children and choose to alienate themselves. Furthermore, although they may have the intelligence and maturity to comprehend philosophical concepts, they still have the emotions of a child, meaning they are tormented by the dissonance between the rational mind and their emotions. All of these factors combined lead to a great increase in risk of depression in precocious children.

Essentially, the main conundrum for child prodigies is trying to balance their amazing talent with a happy life in a “normal” society. This could be achieved by parents keeping things real and not placing excessive expectations on the child, and giving the child a way to vent their genius in some way. For example, chess has been a classic way of keeping children with high intellect engaged. Having this kind of vent allows the child to still engage with other members of his or her society (other children), while honing their great skills for an even brighter future. The child must stay engaged and passionately practise and advance their skill so that they do not stay in a perpetual rut all their life.

With great power, comes great responsibility.

Posted in Psychology & Medicine

Berry Aneurysm

Stroke is a disease often associated with the elderly, but this is not necessarily true. As much as 5% of the population carry a ticking time bomb in their brain, known as a berry aneurysm. An aneurysm is a weakening of the arterial wall, causing a localised ballooning of the vessel. A berry aneurysm is a common type of aneurysm where the ballooning resembles a berry. What is most troubling is that a large proportion of these aneurysms can present very early (usually congenital, meaning you are born with it), with one research suggesting that 1.3% of the population in the age group of 20 to 39 has a berry aneurysm. If this berry aneurysm was to burst, no matter how young and fit you are, you will bleed into the area around your brain (subarachnoid haemorrhage), suddenly develop a severe, crippling headache (“thunderclap headache”), become confused, show signs of stroke such as speech or movement problems, or simply drop dead.

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Fortunately, only 10% of people carrying a berry aneurysm suffer a ruptured aneurysm and subsequent brain bleed. The other 90% will carry on living their lives, without ever knowing that they had a time bomb in their brain.

Certain factors make the risk of the aneurysm bursting go up, such as high blood pressure, which can be caused by a stressful lifestyle or smoking. But in some cases, as explained above, even a healthy teenager could suddenly drop to the ground with a massive brain haemorrhage.

Berry aneurysms are only one of many ways death could strike unnoticed, no matter how young you may be. You could live a long and healthy life and die peacefully in your sleep when you are 90 years old, or you may have a stroke and drop dead in a few minutes’ time. For all you know, a bus might run you over tomorrow, with no warning whatsoever. Ergo, youth is not an excuse to waste the day you are given. You do not have to achieve something great, or be productive, but at least spend your day knowing that you are doing everything in your power to make yourself happy, without harming your health, your future or other people.

Carpe diem. Seize the day.

Posted in Science & Nature

Vision

Consider this: if you see something that is not there, or not see something correctly, is that due to a problem in your eyes or your brain? An interesting anatomical fact is that the eyes are part of the brain. They originally evolved from the brain and drifted further and further forwards, connected to the brain by the optic nerves. If you lift a brain out from the skull, the eyes would be pulled backwards too. But technically speaking, eyes are distinct organs by themselves that have merely originated from a portion of the brain. It does not think or make decisions by itself. Just like a camera, an eye records things as it sees it and transmits it to the brain via the optic nerve via electrical signals. The brain then processes the signals in the occipital lobe, located at the back of the head (this is why you “see stars” when you bang the back of your head).

This means that vision can be altered anywhere along the pathway. If you have cataracts, where the lens of the eye becomes clouded, you lose portions of your visual field. If you have a large pituitary gland tumour, it presses on the optic nerve and causes double vision (diplopia) or vision loss. If you have a stroke in the occipital lobe, you can lose your vision. The brain’s role in producing vision can easily be demonstrated in the form of optical illusions. The eye merely records and transmits what it sees, but the brain becomes confused by what information it receives and tries to make sense of it. In the process, we experience bizarre illusions such as static images moving by themselves.

Because of this intricate pathway, some pathologies present with fascinating symptoms. A condition called Anton’s blindness (or Anton-Babinski syndrome) causes a patient to “see” despite being blind. Patients with Anton’s blindness are adamant that they can see perfectly clearly, and will even describe what they are seeing. However, what they “see” is completely different to what the object actually looks like. For example, if the patient looked at a blonde woman wearing a yellow blouse and a red skirt, they may describe her as a brunette woman wearing a blue shirt and black jeans.

The reason for their blindness is that their occipital lobe was damaged (usually by a stroke), leading to an inability to process the information from the eyes. Although the eyes are pristine and record what they see in perfect detail, the brain is incapable of interpreting the signals. The brain then goes on to confabulate, where the brain fills the gap by conjuring up false information. This makes Anton’s blindness quite hard to pick up on as the patient will not complain of it. It is only found when someone pays close attention to the patient and notices subtle cues like the patient bumping into furniture or talking in the direction where they think a person is at (even after they move). Ergo, the patient adamantly believes that they can see as their brain thinks it is seeing things (even though it is not receiving the information from the eyes properly).

Seeing is not believing. You see what you believe.

Posted in Psychology & Medicine

Reaction

If you were walking along the street and found a bird lying on the ground, how would you react? You would probably poke the bird to see if it is alive. We have a peculiar habit since we are children of poking living things that we see for the first time. Through poking, we discover whether it is alive or dead, soft or hard, slimy or furry, docile or aggressive.

Prompting a reaction and observing the reaction is a surprisingly useful way of learning. In chemistry, we react an unknown substance with other chemicals to discover its identity. In medicine, we stimulate parts of the brain with electricity to discover what each part does. In physics, we build giant accelerator to crash particles together to find out their constituents and properties. If you fell into a cave so dark you cannot see even one foot ahead of you, the best way to find out if there is a wall or a hole or water ahead of you is throwing a rock in that direction.

This principle can be applied to psychology. To learn how people around you behave, provoke them. Human beings are extremely sensitive to stimuli and even when they consciously try to hide it, they will subconsciously react. If you keep (subtly) poking the person, you will soon be able to predict how they will react to something, what actions they will take, and you may even discover what is on their mind.

We cannot see the wind, but we can infer that it exists because the leaves blow. The best way to prove something that you cannot see inducing and looking for reactions.

Posted in Life & Happiness

Yellow Ball

If I was to put a yellow ball in front of you and ask what colour the ball is, you would confidently say “yellow”. As you say, the ball appears yellow, but the answer is technically wrong. Strictly speaking, the ball itself is not yellow – it is merely reflecting the colour yellow. The ball only appears yellow because we see the yellow part of the natural light spectrum bouncing off the ball. We cannot say that the essence of the ball is “yellow”. For example, if you were to look at the ball through a red lens, the yellow light would be filtered and you would see a black ball. A person with a certain kind of colour blindness would say the ball has a bluish hue. A butterfly, which sees the ultraviolet spectrum as well, would see a colour we cannot even name.

Human beings judge objects using the vision. We describe an object as we see it and store that information in our brain to define the object. For this purpose, the fact that a colour blind person or a butterfly sees the ball a different colour is irrelevant to us. All we need to know is that object appears yellow to us. But this is only the case for objects. Let us imagine the ball is a person. If everyone in the world sees you as a yellow ball, would that make you a yellow ball? Of course not. However, people worry too much about how others see them. Although other people’s perception does not change our true nature in the slightest, we even go as far as erasing or abandoning our nature to look good in front of another person. Thus, whether our essence is white, black, red, blue or technicolour, when others see us as yellow, we have a tendency to try desperately to become yellow. 

If the world says you are a yellow ball, act crazy and be a red ball. There is not a single reason you should have to hide your true nature. Have confidence in your essence. There is nothing wrong with that.

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Posted in Psychology & Medicine

Hanging

Hanging is one of the most popular methods of execution and suicide throughout the ages. It is typically performed by fashioning a noose (most commonly with the eponymous hangman’s knot), placing it around the victim’s (or own) neck. The person then falls from a short height (e.g. dropped from a stand or stepping off a stool), upon which the force of the body pulling down causes the noose to tighten. This can kill a person via two ways. Firstly, if the force of the drop and the knot is strong enough, the sheer force of the noose tightening and the person being suspended by their neck will cause their neck to break. This causes spinal cord injury at the cervical level, where the brainstem lies. When the brainstem is damaged, the person loses control of autonomic processes such as breathing, causing instant death. Secondly, if the neck does not break, the person will be strangulated by the noose. This will kill the person through either choking (from airway obstruction) or brain ischaemia (as the carotid arteries are cut off). Pressure on the carotid artery may also cause something called a carotid reflex, where powerful nervous signals cause the heart to beat so slowly that it stops.

It is said that whether a person dies a quick, clean death via neck fracture or a slow, painful death via strangulation depends on how good the knot is. A hangman’s knot is made up of a loop with a series of coils above it. The more coils there are, the more friction it adds to the knot, making the noose harder to pull closed. A true hangman’s knot is defined as thirteen coils, which provides enough resistance to cause a neck fracture when a person falls. If there are fewer knots than that, the knot will tighten too quickly around the neck and not provide enough resistance to cause a neck fracture. This leads to strangulation, which is far more excruciating and a very inhumane way to die. If there are too many knots, there will be too much resistance and there is a risk of decapitation, leading to a very messy situation.

In forensic medicine, there are certain signs that reveal a victim was hung. For example, the C2 spine (second vertebrae in the neck) will exhibit a hangman’s fracture, where there is fractures on both sides. Fracture of the hyoid bone (a small bone below the chin) is also a classic sign of hanging. There will also be bruises along where the noose was and every sphincter would be open (which leads to immediate voiding of the bowels and bladder at the time of death). If the person died of strangulation rather than neck fracture, they will show signs of asphyxiation, such as blue lips (cyanosis). Another interesting result of hanging is something called a death erection. As the name suggests, it is when a corpse is found with an erection, most likely due to hanging. This is probably caused by the noose crushing the cerebellum, causing a reflex erection. The same phenomenon has been observed in women as well.

Posted in Psychology & Medicine

Doorway Amnesia

Have you ever experienced the curious phenomenon where you walk into the kitchen and completely forget why you came there? Or why you stepped out of the house? Almost everyone is struck with this bizarre amnesia at some point in their lives. But why does it happen? Do Men in Black come in and wipe your memory because there was an alien in the room or something? The answer lies in the doors.

It has been scientifically proven that doorways have a magical property of causing memory loss. To be exact, doors do not cause amnesia, but the physical act of passing through a doorway causes the brain to lose memories. The reason for the phenomenon is this. The human brain stores information in a very unique way where it compartmentalises information by physical location. Because of this “filing system”, the thought “I really want cake from the kitchen” that you had in the living room is difficult to access when you are in the kitchen. By crossing a doorway, the brain recognises that the physical location has changed and opens a different “folder”, metaphorically speaking. This system allows for smooth mental functioning usually as it lessens the load on the brain, but also creates confusing situations where you just stand in front of the door, questioning whether you are losing your memory.

In an experiment in France, it was found that when students were told to memorise certain objects and then walk into another room, they had much worse recollection of the objects compared to the control group (students who walked the same distance but not through a door). It was even found that a person did not even have to physically walk through a door to lose their memory. When students were made to repeat the experiment in a virtual setting (i.e. moving a computer character through a door in a game), the same thing happened. The effect was so powerful that the researchers dubbed doorways event erasers.

Although it seems like an inconvenient system, the brain’s special way of compartmentalising information according to physical location can be used to harness the power of complete memory. This is done by using the method of loci, also called the memory palace. This is a mnemonic device first devised by ancient Romans to help memorise a large amount of information. To use the memory palace, you must first visualise a certain location – one that you are familiar enough with to recall with great detail. This may be your room, house, the street you live on, or even a fictional palace. The object of the memory palace is to convert a piece of information into an item which you can place in a certain location in the palace. For example, if you have to memorise a shopping list, you can conjure a mental shelf in your mental palace and put all the items in the shelf. To enhance this effect, make the image as bizarre and fancy as possible, as the mind is prone to remembering weird things more (e.g. a massive apple with eyes and a mouth is more memorable than a normal apple). Once your memory palace is complete, you can take a “mental walk” through the palace, go to the room where the memory you need is stored, and just browse the contents to recall the information. With practice and a vivid imagination, this is an infallible method of remembering anything you want, for as long as you want.

Posted in Psychology & Medicine

Lazarus

In the New Testament of the Bible, there is a scene where Jesus resurrects a man by the name of Lazarus back four days after his death. This “miracle” is of course a fictitious event, but nonetheless, the name Lazarus has come to symbolise resurrection after death. For example, there are two actual medical conditions named after Lazarus, both related to death.

The first is called Lazarus phenomenon, where a person who is declared to be clinically dead spontaneously returns to life. This is an extremely rare event that has only been recorded in about 30 cases. In most of these cases, the patients had suffered a cardiac arrest, with all attempts at resuscitation (e.g. CPR, adrenaline) had failed. Sometime after the person was declared clinically dead (usually around 5~10 minutes), the person’s circulatory system would suddenly start on its own and the person would be “resurrected” (quite literally). In one case, a 61 year-old woman was declared officially dead after her heart stopped and her vitals did not return after continuous resuscitation. At the morgue, however, she was found to have a pulse and breathing on her own. She later sued the hospital for the neurological and physical injury caused by oxygen deprivation during her death. There is even a case report of a patient who returned to life two and a half hours after dying (although he died again 3 weeks later).

Of course, the Lazarus phenomenon is not a miracle. In most cases, it is hypothesised that when resuscitation is attempted then stopped, there is a rare chance of the relieving of pressure causing blood to fill the heart, causing a sudden expansion and kickstarting the electrical circuit. Other factors that may influence this is hyperkalaemia resulting from ischaemia and high doses of adrenaline given to the patient during resuscitation having a delayed effect.
Because of this rare “complication” of death, doctors are advised to observe the patient for about 10 minutes after declaring them dead. Just in case.

The second is called Lazarus sign and it occurs not in dead patients, but brain-dead patients. Brain-dead patients are immobile as their higher functions such as cognition and motor functions are destroyed. However, there are rare cases where the brainstem is somehow stimulated, triggering a reflex arc from the spinal cord. This reflex is seen as the patient suddenly raising their arms and dropping them on their chest in a crossed position, much like Egyptian mummies. As the spinal cord is not usually damaged in brain-dead patients, this reflex arc is possible, similar to a knee jerk reflex. The Lazarus sign should not be misinterpreted as a sign that a brain-dead patient is conscious, as it is an involuntary movement. However, it has been mistaken for the resuscitation of a patient, or in some cases, as a miracle.

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Posted in Psychology & Medicine

Trepanation

When and what was the first surgery performed by mankind? Many would believe it to be a simple procedure such as suturing a wound. But would you believe that the earliest surgical procedure was brain surgery in 6500BC? Surprisingly, this is true.

Archaeologists have found a large amount of skulls with a large, round hole in them. Some of the oldest skulls with holes were found in France, where 40 skulls from the Neolithic era were excavated. Archaeologists believed these holes to be from a battle leading to a dent in the skull. However, these holes were actually the results of a surgery (signs of bone recovery can be seen around the edges of the hole, suggesting the patients were alive for some time even after the operation). These skulls all belonged to trepanation patients.

Trepanation is the surgical opening of the skull by drilling a hole in it. This is an ancient surgery that can be found throughout history. Hippocrates and Galen from ancient Greece both recorded detailed instructions on trepanation, ancient Incans performed the surgery and it was also common during the Middle Ages and the Renaissance in Europe. These surgeries were most likely indicated for skull fractures where fragments were embedded in the brain. During the Middle Ages when it was better known that the brain was the seat of the soul, trepanation was used for psychiatric treatments too. For example, in 15th century Netherlands, trepanation was used to excise a so-called stone of madness that was supposedly the cause of insanity. Like this, it was believed that trepanation could release the demons and insanity trapped in the skull.

Although this operation sounds hilariously misled, it is still used in modern medicine. Of course, it is not known to treat insanity, but rather to treat brain bleeds. Extradural and subdural haemorrhages occur when a rupture of an artery in the brain causes a collection of blood in the skull, compressing the brain. This is a dangerous situation which can lead to a stroke or even death. One treatment of this condition is trepanation, or a burr hole, where a small hole is drilled in the skull to relieve the pressure, lowering intracranial pressure and stabilising the patient. Trepanation is an excellent example of how we can learn from the past and how medical knowledge from ancient times is sometimes still valid.