Treatise on the Diseases of Females: Pregnancy in the 1800s

While looking through some seriously old books, I came across a medical treatise from 1853. Now this would be fascinating on its own, but even better, it's a treatise specifically about the "diseases of females" written by William P. Dewees, M.D.

William Dewees (from Wikipedia)

Having recently been pregnant, I was particularly interested in the 1800s recommendations for pregnancy.

Dewees starts out his chapter on pregnancy by explaining why it is important to scientifically determine whether a woman is pregnant or not. The reasons are essentially as follows:

1. So if the woman needs to be treated for some other disease, she doesn't get prescribed something that would hurt her or the baby if pregnant.
2. Because if she is under trial or awaiting execution, pregnancy might forestall it.
3. If the predicted date of birth might influence the 'character or property' of someone else.

So yes, clearly it is important to know if a woman is pregnant.

So how do you tell in the 1800s when no pee-sticks with plus signs were available? Not surprisingly, the first way is 'she doesn't have her period.' However there is clearly some debate in the field at this time.

Other things can 'suppress the menses' and sometimes a woman can bleed while pregnant.

Dewees spends excessive words and semi-colons defending his position on the subject:

"In declaring that women may menstruate after impregnation, I have no favourite hypothesis to support; nor am I influenced by any affectation or vanity to differ from others; neither do I believe I am more than ordinarily prone to be captivated or misled by the marvellous; for I soberly and honestly believe what I say, and pledge myself for the fidelity of the relation of the cases I adduce in support of my position." *

So you need some other signs of pregnancy other than just not menstruating. Next up: Nausea and Vomiting. Though "far from certain" as a sign of pregnancy, in conjunction with other signs, it is 'added proof'

Another sign is the enlargement of the sebaceous glands (which are on the areolae around the nipple), and the formation of milk. But milk coming in is also not certain:

"I once new a considerable quantity of milk form in the breasts of a lady, who though she had been married a number of years had never been pregnant; but who at this time had been two years separated from her husband. She mentioned the fact of her having milk to a female friend, who from an impression that it augured pregnancy, told it to another friend, as a great secret; and thus, after having enlisted fifteen or twenty to help them keep the secret, it got to the ears of the lady's brother. Her surprise was only equaled by his rage; and, in a paroxysm, he accused his sister, in the most violent and indelicate terms, of incontinency, and menaced her with the most direful vengeance." *

It turns out the lady was not pregnant, but was sick with 'phthisis pulmonalis.'

So finally the surest signs of pregnancy are the enlargement of the uterus and abdomen, and feeling the baby move "quickening".

(also mentioned are the 'pouting of the navel' and the 'spitting of frothy saliva')

*All quotes from Treatise on the Diseases of Females by William P. Dewees

© TheCellularScale

For more on historical pregnancy medicine, see some great posts from Tea in a Teacup. 

The Inadvertent Psychological Experiment

Escape from Camp 14 is deeply disturbing, and I highly recommend it.

Escape from Camp 14 by Blaine Harden

Escape from Camp 14 is a chilling tale of Shin Dong-hyuk's escape from a North Korean prison camp. What is so interesting about Shin Dong-hyuk's story as written by Blaine Harden is that he was born inside this North Korean prison camp. Apparently they allow breeding between prisoners as a reward for 'good behavior.'

Escape from Camp 14 reveals the obscene violations of human rights that occur in North Korean prison camps, and was especially poignant because I am a similar age to Shin Dong-hyuk and could directly compare my memories during the specified years to his. For example he escapes on January 2nd, 2005 and I couldn't help but think of the New Years party I was at that year and how absurdly different my life has been from his.

This book struck me in a way that reading about the horrors of the Holocaust never could. Those atrocities happened long before I was born. But the atrocities in North Korea are happening right now. I mean right this minute in a prison camp, a child is likely being beaten, a woman is likely being raped by a guard (later to be killed if she happens to become pregnant), someone may be picking undigested corn kernels from cow dung to ease hir starving belly, and maybe two lucky prisoners are getting to have 'reward breeding' time. Right now. This minute. That is just nuts.

The other thing that struck me about this whole situation is that having children born into a hostile prison environment is an inadvertent psychological experiment. These children are raised without love and without trust. One of the sharpest points in the book is the reveal that Shin Dong-hyuk turned his own mother and brother in to the guards for planning an escape. He watched his mother's execution shortly thereafter and felt nothing but anger at her for planning an escape.

When he finally escaped, it was shocking to him to see people talking and laughing together without guards coming over to (violently) stop it. In Camp 14, gathering of more than 2 people was forbidden. These prison children are being raised on fear of the guards and suspicion of each other. One of the easiest ways to be rewarded is to tattle on another prisoner for something (stealing food, for example), and the children learn this quickly.

If something drastic happens and North Korea dissolves, these children raised in prison camps will have a near impossible time trying to adjust to a life of freedom and will have a difficult time forming attachments and trusting others (as seen in Shin Dong-hyuk and other refugees from North Korea). Their personalities and psychological profiles could be fundamentally different from any other group on earth. These atrocities should be stopped and these people should be studied and rehabilitated.

© TheCellularScale


Lee YM, Shin OJ, & Lim MH (2012). The psychological problems of north korean adolescent refugees living in South Korea. Psychiatry investigation, 9 (3), 217-22 PMID: 22993519

Why scientists should play games

I have just finished reading Jane McGonigal's book Reality is Broken: Why games make us better and how they can change the world. It is a fascinating book which presents a strong case for games (including video games) doing good in the world.

Reality is Broken by Jane McGonigal

I have to admit, part of me wanted to read this book to make me feel better about my own video game habit. It certainly helped solidify the vague ideas I had about what good they might be doing me.

Specifically, the book made me think that scientists of all people might benefit greatly from playing games. There is one major reason why:

Games make you more resistant to failure

If there is one thing that scientists need to persist in their research its resilience in the face of failure. If you didn't know this already, just start following some 'life in academia' bloggers on twitter. Failure is a staple of scientific life.

Just yesterday I awoke to a small grant rejection. I started thinking about just how many things I had applied for during my (still new) scientific career, and just what proportion of those applications had resulted in rejections. I tallied it up on a chart (similar to a failure C.V.), and discovered that for about every 3.5 things I have applied for, only one was successful. This includes grant applications, travel fellowships, paper submissions and re-submissions, and miscellaneous things like applying to be an SfN Neuroblogger. (I did not include abstract submissions or applications to graduate school.) I actually think this is a relatively good ratio, and I expect this ratio to get worse in the future, because the competition for the things I am applying for will be even tougher.

Part of the reason I wanted to calculate my success/attempt ratio was to see how many things I had actually applied for. I was glad that the list was long, and that I applied for lots of things, even if it means that my 'ratio' is the worse for it. I would posit that having a good success/attempt ratio is not really that great if you only ever apply for a few things that are easy to get.

In science, you will fail; there is absolutely no scientist EVER who hasn't been rejected from something.

So back to games. Reality is Broken explains that games teach you to persist in the face of failure, and that games increase your optimism.

"Learning to stay urgently optimistic in the face of failure is an important emotional strength that we can learn in games and apply to our real lives. When we're energized by failure, we develop emotional stamina. And emotional stamina makes it possible for us to hang on longer, to do much harder work, and to tackle more complex challenges. We need this kind of optimism in order to thrive as human beings." -Reality is Broken, chapter 4

When I think of my own resistance to failure (which is decent, but could be better), I think of my time spent learning from games that failure is not the end of the world. Ever since I repeatedly failed to jump Mario over the first Goomba, video games were teaching me to try again, and again, and again.

Mario and Goomba level 1. (source)

Jane McGonigal brings up Tetris, one of the most popular video games of all time. Tetris is a game with no possible outcome except failure. You keep playing until you lose, and yet the game is immensely fun and ultimately rewarding. Each time you fail you want to try again, and you feel that you will probably do better next time.

In summary, games reward persistence and desensitize you to failure. When you play video games you learn implicitly that trying again is worth it and that failing isn't the end of the world. These skills are great to have in life and are essential to have in an academic career.

Reality is Broken lists 13 other ways that games 'fix' reality. Some of these fixes are about personal betterment (like persistence in the face of failure), but some of these fixes are about how games can ultimately change the larger reality. Games that combat global warming, for example, or games like Fold-It that actually further scientific progress and human knowledge. Whether you already play games or not, you can get something out of this book.

A nice addition to this book is the appendix "Practical advice for gamers" in which Jane McGonigal lays out some guidelines for getting the most out of games. For example, one rule is to never play more that 21 hours in a week. While video games have benefits, there are problems that can result from compulsive video game play, and you shouldn't think think that you are doing something healthy if you play video games for 50 hours a week and completely ignore reality. The idea is that playing games can help you function in reality. If you never venture into reality, you won't make any use of the benefits that the game might have given you.


© TheCellularScale

Here are further reviews of Reality is Broken:


Ferguson, C. (2011). Reality is broken, and the video game research field along with it. PsycCRITIQUES, 56 (48) DOI: 10.1037/a0026131
 
Farhangi, S. (2012). Reality is broken to be rebuilt: how a gamer’s mindset can show science educators new ways of contribution to science and world? Cultural Studies of Science Education, 7 (4), 1037-1044 DOI: 10.1007/s11422-012-9426-y

The Optimism Bias in Science

"I have always believed that scientific research is another domain where a form of optimism is essential to success: I have yet to meet a successful scientist who lacks the ability to exaggerate the importance of what he or she is doing, and I believe that someone who lacks a delusional sense of significance will wilt in the face of repeated experiences of multiple small failures and rare successes, the fate of most researchers"     -Daniel Kahneman

The Brain: Irrational, Positive, Deceptive

I just finished reading The Optimism Bias by Tali Sharot.  The book explains that most people have an "Optimism Bias," a tendency to over-estimate how smart, good-looking, and capable they are as well as the likelihood that good things will happen to them. 

Sharot points out that in a 1981 study (Swenson O) 93% of participants rated themselves as in the top 50th percentile (i.e. 'above average') for driving ability.  Other studies have shown that this "Better than Average Effect" applies to many aspects of our self-image.  Think about yourself right now... do you think you are smarter than average? better looking than average? nicer than average? etc.  You probably do.  And even though it is logically impossible for 93% of people to be better than the 50% mark, you probably still think that you are actually  better/smarter/nicer. 

So even though you think you are smarter than most people, the reality is that most people think they are smarter than most people.

Similarly people under-estimate the likelihood that bad things will happen in their life and over estimate the likelihood that good things will happen. Ask any newly engaged couple what they think their chances of divorce are, and if not too offended by such a rude question, they will probably rate the chance of divorce as very low or even zero.  However reality says that they actually have a 41-50% chance of divorce. 

divorce cake (source)

But as Sharot claims, this optimistic skew to reality is actually beneficial. Which newly engaged couple would actually get married if they fully realized and believed that their chances of staying married were no better than the chance of flipping heads or tails on a coin? The irrational belief that we are somehow exceptional is motivating. Sharot even suggests that the optimism bias is so prevalent in our species and culture that people who realistically evaluate their situation are not the norm, and may even be clinically depressed. 

While The Optimism Bias has a great premise and recounts some exciting research, I thought the book in general was way too long.  Some very simple concepts (like that people have an optimism bias) were repeated over and over and over, and some (interesting) concepts were introduced that had pretty much nothing to do with optimism (like that memories are unreliable). 

The book didn't really teach me much about how the brain works, but it did set me thinking about how a strong optimism bias is an essential trait in academia.  As the Kahneman quote above states, most scientists face critique after critique and failure after failure.  Successes are few and far between and the same sense of realism that would prevent many a marriage, would also prevent a potential scientist from entering a Ph.D. program. Who would even apply to graduate school if they fully understood and believed the dismal statistics about finishing Ph.D. programs and the subsequent tenure-track job search. 

We have to believe that we are special, that our work is crucial, and that our contributions are significant.  No scientist will succeed if they get their peer-reviewed paper back from a journal and immediately think: 'yep, the third reviewer is correct, this work is flawed and has little impact, I should quit and become a cab driver.' A near-delusional sense of significance and an "it's not me, it's them" attitude is required to stand by your ideas and abilities in the face of these kinds of criticisms. 


© TheCellularScale



Sharot T (2011). The optimism bias. Current biology : CB, 21 (23) PMID: 22153158

Mirror Neurons in the Sociopath

Seriously Creepy Eyes

What is a sociopath? A killer? A raging lunatic?
Martha Stout has written a relatively short book (though not as short as it could have been) defining the sociopath and arguing that sociopaths are surprisingly common, 4% of the population in fact.

There are two things I liked about this book and two things I really did not like about this book.

First the good:

1. Dr. Stout effectively argues against the stereotype that sociopath=serial killer.  She defines a sociopath as someone without a 'conscience' who is incapable of real empathy. If this is combined with 'bloodlust' the person very well may turn out to be a serial killer. But if it is combined with 'preferring inertia', the person will manipulate their way into a situation where they are taken care of and don't have to do anything. 

2. A very powerful insight that Dr. Stout has is that the very fact of having a 'conscience' is what keeps 'normal' people from identifying and stopping sociopaths. A person with a 'conscience' will easily take the point of view of the sociopath and try to justify or explain their actions in terms of 'having a conscience'. "they are just depressed", "they didn't know this or that", "there must have been a miscommunication".  It is almost impossible for a person with a conscience to comprehend someone doing something manipulative or cruel for essentially no reason, so they try to invent a reason that would make the sociopath's actions comprehensible to them. The very thing that the sociopath is lacking: the ability to empathize and identify with the wants and needs of others, is the thing that prevents 'normal' people from identifying them. 


Now the bad:

1. What the heck is a 'conscience' anyway? Dr. Stout talks about the conscience like it is some brain structure that you either have or don't have. I wasn't convinced that people are either complete sociopaths or completely normal. I assume there is a continuum, and Dr. Stout does nothing to convince be otherwise, while at the same time constantly implying that it is an either/or situation.


2. I would have been much more interested if this book had delved into the possible neural underpinnings of conscience. It is getting a reward signal from the 'happiness' of others? Getting a pain signal from the pain of others?

An example that came to mind is a scene from the movie Pan's Labyrinth that will probably haunt me forever. A man has had his mouth slit and there is a very painful-to-watch scene where he sews up his own cheek, bandages it, and then takes a shot of vodka. The vodka seeps out his cheek into the bandage. I remember having a very physical reaction to this part of the movie, literally cringing and grabbing my own cheek. 

What I want to know is do sociopaths have this same physical reaction, or would the 'not having a conscience' or 'inability to empathize' prevent something so instinctual.

Well lucky for us, someone else is wondering this same thing something similar.  A 2008 paper tested healthy individuals for degrees of 'psychopathy' with a self-report questionnaire, and then measured their responses to transcranial magnetic stimulation (TMS) of the motor cortex during videos. They claim that this is somehow measuring mirror neuron activity, but I think that it going too far since they are not measuring individual neurons.  

Figure 1 Fecteau et al., 2008

They used a nice set of controls to specifically isolate the effect of watching something potentially painful. The videos were of a qtip touching a hand, a needle touching a hand and a needle touching an apple.  They also ran all the videos stopping them early (before the contact between the objects is made).

In 'normal' people, seeing a needle poking a hand causes a reduction in response to TMS stimulation. What this reduction in cortical excitability means is not clear, so any finding in this study will be hard to interpret. They found that the degree of response reduction was not correlated with the psychopathy index when taken as a whole, but when they isolate the 'coldheartedness' component, they find that the more cold-hearted a person reports they are, the stronger the signal reduction is during TMS. Despite the nice controls, this study leaves a lot to be desired.  They have a small sample size (n=18), and even their relatively mined correlation is not very strong (R=-0.58). In addition, the increase in signal reduction is 'supposed' to indicate 'more empathy', so the meaning of this study is basically ripe for the cherry-picking. Fortunately they don't spend a ton of time speculating wildly about what this reduction might mean, they simply say that their study finds a 'link' between motor empathy and cold-heartedness and end with the classic 'more studies need to be done'. 

Unfortunately the information that can be gleaned from this study is pretty limited, and the brain of the sociopath is still a mystery.

A caveat: I assume someone has studied whether the physical reaction that I describe above occurs in sociopaths or not, but I did not find a study testing it.  If you know of one, please send it my way. 

© TheCellularScale


Fecteau S, Pascual-Leone A, & Théoret H (2008). Psychopathy and the mirror neuron system: preliminary findings from a non-psychiatric sample. Psychiatry research, 160 (2), 137-44 PMID: 18599127

Neurosexism and Delusions of Gender

On the cellular scale, it is very difficult, if not impossible, to tell the brains of men and women apart.  That is, if you zoom in on a part of the brain (like the hippocampus, cortex or striatum) and look at the morphology of a single neuron or the electrical characteristics of that neuron, you would be hard pressed to tell if the neuron you are looking at belongs to a male or a female. This is not very surprising since it is also difficult to tell if the neuron you are looking at is from a human, ape, or elephant. 

That is a cellular introduction to the non-cellular book that I am reviewing today: Delusions of Gender: How our minds, society, and neurosexism create difference by Cordelia Fine. 


My friend from undergrad who is now a philosophy professor recommend this book to me and described it in such a way that I suspected I would hate it. Upon actually reading it however, I was quite surprised at how informative and entertaining it was. 

 Let's get to it!
Delusions of Gender is a book written in response to the idea that there are inherent differences between men and women that are hard-wired into the brain by evolution and that make women naturally suited for certain activities and men naturally suited for others. 

In other words, Cordelia Fine claims that this is NOT the case, or at least that it is not nearly as much the case as people currently believe.  This is a difficult claim to make.  It's so easy to see that men and women are different in body, so why wouldn't their brains be different? And doesn't evolution make the sexes of many species 'inherently' different? For examples, look at the praying mantis, the zebra finch, and the stickleback. 

So what I found amazing is that Cordelia Fine argued this impossible claim so well that I was thoroughly convinced that everything I had heard about the differences between male and female brains and abilities was at best uncertain, and at worst completely wrong. 

Let me summarize some of the exact points that she makes:

1. You are bound to find differences when you are looking for them.
2. Differences are more likely to be reported and publicized than similarities.
3. There are glaring flaws in many neuroscience studies showing brain differences between men and women.
4. Even if all the studies showing brain differences between men and women were taken as true, that still wouldn't mean that the differences are 'hard wired' or 'inherent' or 'because of evolution'
5. Even if all the brain differences are real, and even if they are 'hard wired', that still doesn't mean that women and men actually think differently. 

To explain a little further:

Claim 1 says that when there is one difference between two groups, it is easy to think of a scientific study to determine if something else is different between these two groups.  This is important because of the 'obvious' differences between men and women (yeah, they have different junk). Since everyone knows men and women are different re: genitalia, let's test whether they are different in brain or behavior.  This may seem totally reasonable, but a counter example is finger-print pattern.  People can be grouped by their fingerprint pattern into 'loop-shape' or 'swirl-shape' people.  This fingerprint pattern is determined genetically, but since it is not an obvious difference (you probably don't even know which group you belong to), no one has ever tested whether 'loop-shape' people have bigger hippocampi than 'swirl-shape' people. 

Claim 2 says that for every newspaper headline shouting "Women are inherently totally whacked"  (see also this post) there might be several studies quietly showing "Women and men are pretty similar" This problem, research showing differences getting published and hyped, while research showing 'no difference' getting ignored or not even published to begin with is not a problem new to science, nor is it specific to gender issues. It is always more exciting and always has a 'higher impact' as they say, to show that two things are different. 

A recent paper by De Liberto et al., (2012) shows that male and female mice show no difference in the amount of DAT (dopamine transporter) in the striatum. 

De Liberto et al., 2012 figure1C

Of course this finding is not the basis for the paper, and it could never be because no journal would publish something so boring.  The point of the paper is that when you apply an estrogen-like substance, you do see a gender difference in how these cells react.

Let's do a quick thought experiment:  Imagine that the researchers had found a difference here, say "male mice have less DAT than female mice."  This could have 'meant' that men have more dopamine at the synapse (as the DAT is responsible for cleaning up excess dopamine there), and this could have been 'translated' into the idea that men are happier or women are more moody and prone to depression (Dopamine levels are implicated in moodiness and depression).  Wow! what an exciting finding!  Front cover of Time magazine: "The Secret Science Behind Moody Women." However, here in reality, these results showed no difference, so they became just a small figure panel in paper about the effects of estrogen. 

Claim 3 is the one I had the hardest time reading.  It is true that there is a lot of sloppy science out there, but I think she goes a little too far in her distrust of science.  For example, she brings up the dead fish in an MRI study as evidence for fMRI studies being flawed.  It is true that in all scientific studies there is a risk of falsely identifying a difference when there is none, but that is exactly what the correction for multiple comparisons is for.  This is a statistical correction that all scientist should know about and apply, but sometimes (maybe even often) they don't.  However, there are plenty of fMRI studies that do correct for this multiple testing problem and are scientifically sound.

Claims 4 and 5 are my favorite.  I thought I would hate this book when I thought that her claim was going to be 'men and women are not different, and neuroscience is flawed and stupid.'  However, when I saw that she was actually claiming 'we don't know enough about the brain to draw the conclusions people are drawing' I got right on board.  There is way too much "the amygdala lit up therefore the person was frightened" and "the hippocampus is bigger so the person must navigate space better" going around. These claims can get ridiculous and most are just not supported.  We don't have a full understanding of the brain, or even of any part of the brain.  We don't even have a full understanding of the single neurons that make up the brain (as you well know from reading The Cellular Scale).

In conclusion, there may be (and probably are) brain differences between men and women, some of these differences might be 'hard wired' and 'inherent' and some of them might develop as a child grows up in a gender-difference driven culture. (By the time you get a kid into an MRI machine, s/he has done a lot of developing.) These (possible/probable) brain differences might mean that men and women think differently, or they might not.
We just don't know enough about it, yet.

© TheCellularScale
There are many excellent reviews of this book out there, here are just a few:
SevenDeadlySynapses
NeuroSkeptic (who is actually cited in this book)
TheThinkingMeatProject
GenderAccrossBorders



Di Liberto V, Mäkelä J, Korhonen L, Olivieri M, Tselykh T, Mälkiä A, Do Thi H, Belluardo N, Lindholm D, & Mudò G (2012). Involvement of estrogen receptors in the resveratrol-mediated increase in dopamine transporter in human dopaminergic neurons and in striatum of female mice. Neuropharmacology, 62 (2), 1011-8 PMID: 22041555