The Looking Glass: Issue Eight

JUNE 2015 ISSUE EIGHT

BODY IMAGE SPECIAL FOCUS

Contents

JUNE 2015

Featured

Regular

Body Dysmorphic Disorder Perception vs. reality of our bodies

Mens Sana in Corpore Sano Psychological benefits of physical activity

6 9

Obese and Proud! 14

News & Events On the Couch With...

22

Reviews

44

Rhianna Goozee, founder of TLG

Movie: The Babadook

Controvery surroounding pro-fat movement

Body Image and the Media

16

The Image of Mental Health

26

Austism and Anorexia

29

Alice In Wonderland Syndrome

34

Stereotyping and stigma of the “headclutcher�

Commonalities between these illnesses

Neurological components of self perception

Paleo Diets 41 Secondary health benefits

Academic Research and Clinical Practice 46 The relationship between research and medicine

Contact us: Submissions:

thelookingglass.ioppn@gmail.com Facebook:

www.facebook.com/TheLookingGlass2012 Twitter:

twitter.com/ioppn_tlg

4

From the Editors

Many of the articles in this issue of The Looking Glass are concerned with body image.

Whether it be perceptions, eating, or exercise, our writers have explored a wide range of interesting avenues. It is perhaps topical, as the sun begins to shine and media outlets - both online and off - begin to push the bikini body images our way, that we are broaching a subject that people feel very passionate about. All of our writers and editors, regardless of age and gender, have expressed their resentment, joy, enthusiasm, and insight, to create pieces that have been a delight for me to read. I hope that you will enjoy the finished product as much as I have enjoyed seeing them grow. My thanks must also go to our production team who make this magazine one for the eye as well as the brain; their work is stunning. On a sadder note, I must tell you that, since our last publication, Rhianna Goozee has stepped down as editor-in-chief of the magazine. Rhianna has not only run the magazine for the last seven issues, but she is also its creator and we hope we can do her creation proud. We wish Rhianna all the best as she enters the final stages of her PhD and are delighted that she agreed to be interviewed for this issue (have a read on page 22).

So, from the new co-editors-in-chief, Sasha Walton, Maurissa Mesirow, and myself, we wish you enjoyable reading.

- Sophie Smart

Body image is a highly sensitive and controversial topic to think about, let alone discuss.

Many of us have probably been criticised about something relating to our physical appearance at least once in our lives, either by ourselves or by others. For this issue, I have chosen to design the cover art as a representation of the harsh reality of how we believe we are percieved either by society or by our own minds. The words inside the two people represent the internalisation of negative emotions, criticisms, and beliefs we have about our bodies, be them real or self-imagined. When you look at the cover, I want you to really think about what it is you are seeing, and reflect on how harsh we can be to ourselves and to each other. We at the Looking Glass believe every individual has a wealth of beauty to offer society, and the cover art in no way reflects our own opinions or those of the magazine.

- Maurissa Mesirow

News& Events News New possible risk markers for Alzheimer’s Disease

In the largest study of its kind, scientists at KCL have identified a blood protein, called MAPKAPK5, that could indicate the development of Mild Cognitive Impairment (MCI) years before symptoms appear. MCI is a disorder that has been associated with an increased risk of Alzheimer’s disease (AD) and other types of dementia. Scientists discovered that levels of the protein MAPKAPK5 was lower in people who had a decline in cognitive abilities over a ten-year period. Dr. Steven Kiddle, the lead author of this project, said their next step is to confirm whether or not this protein is specific to Alzheimer’s disease. Co-author Dr. Claire Stevens believes that their research has the potential to help people who are at risk for developing AD. Their research can be found in the Translational Psychiatry journal.

Childhood Bullying and Risk for Cardiovascular Disease

New research at the IoPPN has revealed that childhood bullying might affect more than just mental health in later life. The study, published in Psychological Medicine, was the first of its kind to investigate adverse effects of bullying on health outcomes pertaining to age-related diseases. In their research, Professor Louise Arseneault and Dr. Andrea Danese found that people who experience bullying during childhood are more likely to be overweight and have higher levels of blood inflammation - a marker for future cardiovascular disease - in adulthood. This study, founded by the British Academy and Royal Society, shows the long-term impact that early life bullying can have on future health outcomes, including higher risks of experiencing age-related ailments, including heart attacks and type II diabetes.

Genetic links to creativity may increase risk of Schizophrenia and bipolar disorder

When researchers from deCODE Genetics and the IoPPN examined a large group of people from Iceland, they found that genetic risks for Schizophrenia and bipolar dosorder were higher in creative people (i.e. those belonging to national artisitic societies of actors, dancers, musicians, writers, and visual artists) compared to the general population. It has long been thought that altered cognitive and emotional processing that occur in individuals that exhibit either creativity or psychosis are similar to one another, both of which are different from the general population. This study, published in Nature Neuroscience, is the first of its kind to lend support to the hypothesis that creativity can be influenced by genetic factors, not just environmental factors or socioeconommic status. Robert Power, first author of this paper, said that their findings “suggest that creative people may have a genetic predisposition towards thinking differently which, when combined with other harmful biological or environmental factors, could lead to mental illness.”

4 | The Looking Glass

KCL Events Stroke Reserch Symposium

This year’s Stoke Research Symposium will take place on July 22nd, 2015, at New Hunts House at KCL Guy’s Campus. Speakers in clinical practice, epidemiological and social science research, and public engagement will discuss the current state of stroke research, future research priorities, and possible challenges in the UK and across Europe. Highlights of this symposium will be the successes of Stroke Register research and its impact on the quality of stroke care and health policy. The symposium will end with a social event and the opening of a new visual arts exhibition featuring stroke survivors from the KCL Stroke Research Patients and Family Group. The symposium is free of charge and open to the public, but book as soon as possible since space is limited. For updates about this event, you can read the SLSR20 blog, or the #slsr20 tweets.

For more information, contact eleanor.stevens@kcl.ac.uk.

Film Screenings: Coriolanus (encore) When: Thursday, 24 September, 2015 at 19.00.

Where: Arthur & Paula Lucas Lecture Theatre, Strand Campus, KCL Tickets: £15 general public / £12.50 King’s staff and alumni, Northbank card holders / £10 students About: The National Theatre Live’s 2013 broadcast of the Donmar Warehouse’s production of Coriolanus, Shakespeare’s tragedy of political manipulation and revenge. Features a title role performance from Tom Hiddleston (War Horse (film), The Avengers), and directed by the Donmar’s Artistic Director Josie Rourke. Rome calls upon the hero and defender, Coriolanus, when the city is threatened by an old adversary. When Famine threatens the city, its citizens’ hunger becomes a yearning for change, and upon returning, Coriolanus must confront the presence of realpolitik, and the angry people of Rome.

Everyman When: Thursday, 16 July, 2015 at 19.00.

Where: Arthur & Paula Lucas Lecture Theatre, Strand Campus, KCL Tickets: £15 general public / £12.50 King’s staff and alumni, Northbank card holders / £10 students About: New production of one of England’s oldest dramatic plays. ‘Everyman.’ Title role by Chiwetel Ejiofor (Academy Award® nominee (12 years a slave) and BAFTA winner), and directed by the National Theatre’s new Director Rufus Norris (Broken, London Road). Everyman is about a successful and popular man. But when Death approaches, he is forced to abandon the life he had and go on a frenzied search to find someone to speak in his defence before his time runs out. Everyman is a fantastic spiritual myth, asking whether we only understand our lives in death.

Warning: contains depictions of recreational drug use and use of strong language and is suitable for ages 15 and over.

5 | The Looking Glass

BODY DYSMORPHIC DISORDER

A ‘SOCIAL DISEASE,’ OR SOMETHING MORE THAN SKIN DEEP?

lan mao Student Department of Psychosis Studies

Let’s be honest. We have all looked in the mirror with a critical eye, wishing to have that perfectly shaped nose, white teeth, and fabulous beach body. Pretty much everywhere we go,

we are surrounded by photos of models and celebrities digitally manipulated to look flawless, and whom we may size up to and then feel absolutely miserable about ourselves afterwards.

What is more, it does not help that we are living in a social networking era filled with selfies galore. The pressure of putting forward an image of our “best selves” on the internet is ever prolific, and the desire for online validation seemingly rife. Indeed, young people who frequently use social media such as Facebook tend to fall prey to “objectified body consciousness,” whereby in their minds, too much importance is placed on what other people think about their bodies. Although that might be great for those who do get enough attention for being ‘good-looking,’ it does have its drawbacks. Such a mind-set is likely to eventually provoke feelings of body-related shame, and give rise to a fragile sense that one’s worthiness must be based merely on appearance. Which begs an important question: How much responsibility does the media and society hold over the development of body dysmorphic disorder (BDD), and what might be the other contributory factors to BDD?

As it stands, no one is completely sure about the aetiology of BDD. Despite plentiful 6 | The Looking Glass

media exposure, the majority of us tend not to let thoughts of self-image interrupt our lives, and so we cannot solely blame the media for BDD. The prevalence of BDD is estimated to be around 1.7 to 2.4%.1 So while most of us would probably settle for a new haircut, or smile with smug relief at no-make-up celebrity photos, for people with BDD, there are these persistent ruminating thoughts that they look ugly.

What is striking about BDD individuals, however, is that there are no flaws in their appearance; perhaps only a slight deviance in bodily features that are disliked by themselves, and thought to be more noticeable than they really are. BDD individuals may not even show up at parties (or anywhere where there are people), because they do not want to be seen with their imagined aesthetic imperfections.

Symptoms of BDD range from the mild to the hideous. From repetitive behaviours like mirror-

checking, to fairly common yet destructive outcomes such as suicidal tendencies,2 (and in the case of one Korean model, injecting cooking oil in the face3), BDD is a major burden to all who are afflicted. All of this renders the need to consider BDD a serious issue, not one of vanity, as some may mistakenly assume. Yet the current research literature suggests that BDD is still an over-looked problem compared to other psychiatric disorders, particularly in the realm of investigating treatments.4

So what are the theories and evidence suggesting that BDD is a ‘social disease’? From a feminist perspec-

tive, it seems that body image problems - for women at least - were brought upon by a patriarchal society with desires to inhibit women from becoming increasingly liberated ever since their departure from past traditional domesticated roles.5 Arising from this socially constructed concept called ‘beauty,’ women are encouraged to aspire to youthful or ‘feminine’-like qualities, whether that would be through the latest fad diet, cosmetic products, plastic surgery, and so on. Of the many consequences caused by this poisonous construct, women may compete against each other for superficial reasons, and older women who may otherwise become wise and experienced with time (and therefore ‘threatening’) are deemed unattractive compared to younger women. Ultimately then, male dominance and control is relentlessly asserted over women through the shackles of so-called beauty ideals.5 As an avid runner myself, one anecdotal example I can think of which fits this bill is the dreadful notion of “runner’s face,” which is basically the gaunt saggy-cheeks look women could potentially get from long-distance running. The ‘solution’ (as if it were a problem) typically calls for injectable fillers from a cosmetic surgeon. Rewind back in time, and you will get a similar concept, termed “bicycle face,” a 19th century medical condition which some believe was a way of discouraging women from riding bicycles since it challenged conventional ways of womanly etiquette.6-8

Looking at the statistics on gender, the prevalence of BDD is generally higher for women than men within cosmetic services9 and research studies,10 thus loosely supporting the

aforementioned feminist theory. But contradictory to these figures, other studies have quoted close-to-equal figures between genders within the general population.11 How else can we explain BDD in males? One only has to look at the Reddit.com webpage “Am I Ugly?” to acknowledge that many men have posted photos of themselves online, asking complete strangers “Am I Ugly?”. This may be interpreted as them disclosing their insecurities,12 expressing curiosity on how attractive they appear to others, or both. This makes me wonder which other aspects of society are “oppressive” to men as opposed to women? Perhaps evolutionary psychologist Etcoff’s theory13 fits into this equation: simply that as humans, we are inherently drawn to attractive people and yearn to attain this advantageous state for ourselves, since this may be paramount for our own survival and reproductive success.

That being said, cultural factors come into play in defining the BDD individual’s problem area. In Western countries, men with muscle dysmorphia (a type of BDD) may be overly worried that their muscles are not big enough, and so they may obsessively work out in the gym and develop bulky muscles, but still fail to see any muscle gain. On the other hand this issue does not seem to bother Japanese men in the slightest. Instead, it is likely they would be gripped with anxiety that their apparent disfigurements are an insult to other people, a condition known as shubo-kyofu.

So why do some people develop BDD and others do not, despite ubiquitous influences from the media? Perhaps it is in the way BDD 7 | The Looking Glass

individuals process visual, interpersonal, semantic, and emotional information. Compared to controls, self-assessment in the mirror and putting on make-up seems to be driven by the way BDD individuals feel about themselves, rather than what is seen in their reflection,14 re-emphasising the significant role of emotions on BDD mirror-checking behaviour. Moreover, when unknowingly having the same picture of a face presented repeatedly, BDD individuals were inclined to spotting supposed facial changes that had not actually occurred.15 Interestingly, deviations in semantic processing were demonstrated

feelings of shame and rejection from others.

BDD tendencies may be moulded by personal experiences involving some form of social rejection or humiliation, such as childhood bullying.

By viewing BDD problems in terms of normal responses to threat, this may create an empathetic framework for practitioners and patients to work from. Since thoughts and behaviours integral to BDD are widely seen as illogical by lots of people, and even inadvertently within certain therapeutic contexts, an empathetic framework may be well suited for helping BDD patients.

Is society to blame for the emergence of

BDD? To some degree, one might say yes,

particularly in determining the body feature of concern and setting the benchmark for what is beautiful or not. But equally, and without sounding cheesy, it is what is on the inside that counts: BDD individuals process certain types of information differently, though these characteristics are likely to be influenced by past negative interpersonal experiences. v

in a small sample of BDD individuals. They were remarkably good at discerning between accurate and inaccurate statements about the world, but struggled to correctly produce words that were categorically assigned to animals, food, and the body within a minute.16 According to the authors of this study, these findings may explain the delusional aspects of BDD, and there is ample evidence pointing towards disrupted semantic systems in other delusional disorders like schizophrenia.17

In another experimental study, more often than not, BDD individuals tend to misconstrue facial expressions as looking angry and scornful when told to assume that the photo of the face in question was looking directly at them, and not at someone else.18 This latter finding partially ties in with evolutionary and functional accounts that BDD individuals are highly attuned to threat-related cues, especially social disapproval, which is intricately associated with perceived bodily defects.

As a result the BDD individual may attempt various ‘safety’ behaviours, such as covering up problematic body features, to evade 8 | The Looking Glass

References 1. Fang A, Matheny NL, Wilhelm S. Body Dysmorphic Disorder. Psychiatr Clin North Am, 2014;37:287-300.

2. Phillips KA. Suicidality in body dysmorphic disorder. Prim Psychiatry, 2007;14:58.

3. Evans B. “Woman who injected cooking oil into her own face after doctors refused to give any more plastic surgery,” in: Daily Mail, UK, 2013.

4. Phillips KA. Body dysmorphic disorder: Common, severe and in need of treatment research. Psychother Psychosom, 2014;83:325-29.

5. Wolf N. The beauty myth: how images of beauty are used against women.

1990, Great Britain: Vintage.

6. Bailey J, et al. Negotiating with gender stereotypes on social networking sites: From “bicycle face” to Facebook. J Commun Inq, 2013;1-22.

7. Aronson SH. The sociology of the bicycle. Soc Forces, 1952;30:305-312.

8. Popova M. A list of don’ts for women on bicycles circa 1895. n.d.; http://www.brainpickings.org/index.php/2012/01/03/donts-for-women-on-bicycles-1895/.

9. Ehsani A, et al. Prevalence of body dysmorphic disorder in patients referred to Razi hospital cosmetic clinic with complaints of cosmetic disorders [Fasi (Iranian)]. Tehran Univ Med J, 2013;71:164-70.

10. Phillips KA. The broken mirror: understanding and treating body dismorphic disorder. 2005; New York: Oxford University Press.

11. Winter A, Bulmann U. Mirror, mirror on the wall... Clinical features of body dysmorphic disorder [German] [abstract only]. Z Psychiatr Psych PS, 2013;61:167-74.

12. PsychGuides. Am I ugly? An examination of body image insecurity [website]. n.d.; http://www.psychguides.com/interact/am-i-ugly/#main.

13. Etcoff N. Survival of the prettiest: the science of beauty. 1999, New York: Doubleday.

14. Baldock E, Anson M, Veale D. The stopping criteria for mirror-gazing in body dysmorphic disorder. Brit J Clin Psychol, 2012;51:323-44.

15. Buhlmann U, et al. Seeing “changes” that aren’t there: Facial and object discirmination in body dysmorphic disorder. Compr Psychiat, 2014;55:468-74.

16. Rossell SL, et al. Using theories of delusion formation to explain abnormal beliefs in body dysmorphic disorder (BDD). Psychiatry Res, 2014;215:599605.

17. Rossell SL, Batty RA, Hughes L. Impaired semantic memory in the formation and maintenance of delusions post-traumatic brain injury: a new cognitive model of delusions. Eur Arch Psychiatry Clini Neurosci, 2010;260:571-81.

18. Buhlmann U, Etcoff NL, Wilhelm S. Emotion recognition bias for contempt and anger in body dysmorphic disorder. J Psychiatr Res, 2006;40:105-11.

Mens Sana in Corpore Sano Exploring the hidden benefits of exercise on mental health and cognition

By Zara Goozee

“A

sound mind in a

sound body” - this is the first

carbohydrates, fats, and sugars, it is not hard to see why approximately 62.1% of the UK adult population is overweight or obese.1 In addition, our longer life spans contribute to rising levels of age-related diseases, such as cardiovascular disease, arthritis, type II diabetes mellitus, and cancer. But while the physical side effects of our modern lifestyle are obvious, it is harder to see the effects it has on our mental health.

ingredient listed in the Roman poet Juvenal’s recipe of what is desirable in life. Written around 2,000 years ago, its emphasis on the importance of both mental and physical health for living a happy, healthy life is still relevant today; perhaps even more so given our modern lifestyles and increased life expectancy placing higher demands on our physical and mental wellbeing.

Our fast-paced world places

In any given year, 1 of higher pressures on us, send4 UK adults will suffer from at ing our minds into multi-tasking least one mental health disoverdrive. order, and 1 in 5 of these ailments will be related to anx Whilst our minds perform iety or depression.2 The advice multiple tasks, such as reading for maintaining physical health emails, checking social media is relatively clear cut, but recsites, paying bills, and orderommendations for mental health ing the weekly shop – all from are much more complex. What the comfort of our desk chairs advice can be given to allevi– our daily physical activity is ate the debilitating symptoms of substantially lower than that of depression, the most common our ancestors. Add to this the mental disorder?2 Or to help abundance of easily accessible, the 800,000 elderly individuals energy-dense but nutrient-poor in the UK suffering from foods that are packed with

10 | The Looking Glass

dementia?3 Furthermore, what steps can the healthy population take to best protect them from developing mental health or age-related problems?

Pharmacological and behavioural treatments have revolutionised mental health services, but they are not always effective, and are certainly not appropriate for healthy-aging or sub-clinical populations. In addition, there is a lack of mental health services, as evidenced by the low satisfaction rates of treatment provision by sufferers who use these services.

In contrast to these forms of treatment, exercise is one alternative that is gathering a large interest, suggested to go above and beyond improving physical health to also improve mental health and wellbeing.

The anecdotal evidence for use of exercise as a therapeutic treatment is overwhelming, but what exactly are the benefits of exercise on mental

health, and what changes in taking into acthe brain are associated with count a numthese benefits? ber of studies, have attempted

Experimental work ex- to find an overploring the cognitive benefits of all answer.4-6 exercise can be traced back They concluded to simple psychomotor exper- that in general, iments initiated in the 1930s, physical activity culminating with the first sys- has a positive tematic studies from the 1970s effect on both onwards. These early investi- healthy-aging gations used tasks that mea- and early-stage sured rudimentary reaction time. dementia parThe results showed improved ticipants. This performance in individuals who effect dependwere physically active, com- ed on a numpared with sedentary control ber of factors, subjects. The cognitive benefit including age, of physical activity was specific gender, type of to older adults, leading to the exercise, and now long-held belief that the duration of the positive effects of exercise on exercise procognition only become apparent gramme. during the general cognitive decline seen with aging.

Exercise, therefore,

Since this initial finding, may not only have a protecassociations between exercise tive role against the undesirable and the maintenance of cogni- cognitive effects of “healthy” tive function in the elderly has aging, but additionally, mayslow been replicated numerous times. down the onset of dementia.

Despite these findings, it can Physical activity offers a simbe questioned if this relation- ple, first-line intervention that ship is merely a correlation, or can be taken to improve one’s whether exercise actually plays quality of life among the ela causal role in maintaining derly, but also save the NHS cognitive abilities. vital funds that could be spent elsewhere.

A few studies have tried to answer this question by im- The next step is to invesplementing an exercise regime tigate whether this can be exin sedentary older adults, some tended to the disordered brain. of whom are in the early stages A number of studies have found of Alzheimer’s disease. When an association between deprescompared to non-exercising sive symptoms and obesity or or non-aerobic (i.e. stretch- inactivity. Participants that reing) control groups, the results ported regular physical activity are mixed. Some studies find showed a decreased prevalence a positive effect of exercise on of major depressive and anxiety cognition, but other studies find disorders overall, but not other no improvement following phys- psychiatric ailments (e.g. subical activity. Meta-analyses, stance use, affective or psych-

otic disorders). Similarly, links have been found between depression and body weight or BMI, though the relationship is not a simple one. Although these studies link together exercise and improved mental health, they did not investigate causal hypotheses.

However, countless patients describe the feelings of escape, empowerment, and control obtained from exercise, be it running marathons or going for a walk. This anti-depressant effect has now been supported by experimental data.

Dunn et al. reported that a “dose” of exercise – equivalent to the US Government recommendations – significantly reduced depression symptoms compared with a lower level of exercise or a control “stretching” condition.7 11 | The Looking Glass

While Dunn et al. claim that exercise may be an effective treatment for major depressive disorder, the general consensus is mixed. Different experimental designs and limitations prevent more unanimous recommendations on therapeutic uses of exercise from being made. A meta-analysis of studies comparing exercise to either no treatment or a control condition revealed only a modest improvement in depression symptoms.8 However, when exercise treatment was compared with the efficacy of antidepressants, four studies reported no difference between the two treatments, indicating a positive role for exercise in depression treatment.

The meta-analysis revealed large variations in participants and experimental designs, and highlighted a number of ongoing problems faced by the field of exercise research.

For example, implementing a controlled “dose” of exercise to a group of volunteers is challenging, particularly for longterm studies. Currently, attrition rate in these studies is high, predominantly within stretching or non-aerobic control groups.

It is impossible to keep participants unaware, or “blinded,” to their treatment, resulting in subjectivity and biases in post-treatment self-report questionnaires. Lastly, there is no agreement on the amount and type of exercise that would be both effective and healthy – too much strenuous exercise could potentially exacerbate symptoms in some patients through exhaustion rather than improve their conditions.

12 | The Looking Glass

Exercise may improve mental health outcomes through changes in the brain. We still

have a long way to go before we can comfortably prescribe exercise as a treatment for depression. Before this can happen, it is vital we understand the neurological changes that occur in the brain during exercise, and the mechanisms responsible for these changes.

A handful of animal studies are beginning to reveal exciting changes in the brain that happen during exercise. Such evidence could possibly explain some of the therapeutic effects exercise may have in humans.

When we begin to exercise, the brain interprets the physical actions as a stress response, and initiates mechanisms to protect itself against any damaging effects the exercise could cause.

One of the neurological changes that happens is the release of Brain Derived Neurotrophic Factor (BDNF) a molecule that plays a role in many important brain processes, including production and maintenance of new neurons, learning, and memory. The increase in BDNF in response to physical activity, particularly in areas of the brain associated with memory, may explain the therapeutic effects of exercise in the aging brain, and Alzheimer’s disease in particular. Similar changes in brain biochemistry may be associated with, and help explain, the antidepressant effects of exercise. Interestingly, BDNF levels have been found to be significantly higher people treated with antidepressants and exercise compared to using either treatment in isolation.

Exercise has also been shown to increase levels of the neurotransmitter serotonin in both human and animal studies.

Low levels of serotonin have long been associated with low mood, anxiety, and depression.

Antidepressants commonly attempt to reverse these reduced serotonin levels. Exercise may offer an alternative approach for increasing serotonin levels in people with mild depression or patients for whom drug treatment is not appropriate.

The evidence for a positive effect of exercise on the brain is mounting. Despite a lack of comprehensive studies

and methodological limitations, it is easy to see that exercise does have a positive effect on the brain. By making small changes in our everyday lives to include some form of physical activity, we can reap major benefits. We would see improved physical and mental health at indivudal and national levels, and reduced social and financial burdens of disease.

In 2011, the Lancet reported dementia rates had actually increased at a slower rate than what was originally predicted in 1991. The authors suggested that “lifestyle changes – e.g., diet, exercise, and

smoking – might reduce the risk of dementia and promote more general health and wellbeing.”

So next time you walk to work, avoid the lift, or try out your local gym. Not only will you improve your physical fitness, you will also be giving your brain a boost, protecting yourself from cognitive decline, depression, and dementia. This is the benefit of having, as Juvenal would say, “mens sana in corpore sano.” v

References 1. UK and Ireland Prevalence and Trends. Public Health England Obesity Knowledge and Intelligence Team.

2. Mental Health Statistics: UK & Worldwide. Mental Health Foundation.

3. Dementia. Age UK Group.

4. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci, 2003;14:125–130.

5. Etnier JL, Nowell PM, Landers DM, Sibley BA. A meta-regression to examine the relationship between aerobic fitness and cognitive performance.

Brain Res Rev, 2006;52:119–130.

6. Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehab, 2004;84:1694–1704.

7. Dunn AL, Trivedi MH, Kampert JB, et al. Exercise treatment for depression: efficacy and dose response. Am J Prev Med, 2005;28(1).

8. Cooney G, Dwon K, Grieg C, et al. Exercise for depression. Cochrane Database Syst Rev, 12 September 2013.

Zara Goozee Student

13 | The Looking Glass

OBESE AND PROUD! A PRO-FAT MOVEMENT

hannah deen Student Department of Neuroscience

Finally! The foundations of body image shaming are starting to crumble, body image activism is picking up speed, and anti-photoshop-pro-real-shape-variety is permeating everyone’s Twitter feeds, blogs, and Facebook statuses. The unexpected tidal wave of objections to the latest ‘beach body’ ad prove that people’s minds are changing about what they are willing to accept. Healthy bodies come in a myriad of shapes and sizes, there is no one unattainable ideal that must cripple the confidence of every man and woman out there.

We are all beautiful. This promising movement, however, seems to have a dark side. Fat activism.

Fat activism, or Fativism, is a movement that started with all the best intentions: to fight against the incessant body shaming that overweight and obese people are victims of the world over. But over time, the anti-body shaming has become conflated with a pro-obesity attitude, labeling obesity as just another healthy genetic trait to be accepted with open arms.

Lindy West, body image blogger for Jezebel, equates being overweight with skin colour and being flat-chested.1 I simply cannot agree. The 14 | The Looking Glass

blatant difference is that those other body image associated attributes have no negative effect on your health, for they are the result of healthy genetic variation. What they have in common is that they are defined by the fashion industry and media as unattractive. Fativism is a reaction to an unattainable and unhealthy body image ideal portrayed by the media that is then picked up and propagated by society. However, the Fativism movement has taken the principle - that what is considered as a healthy body weight and shape differs from person to person - to an extreme, and champions that there is nothing wrong with being obese. On the contrary, obesity lies at the root of numerous serious health problems, including heart disease, diabetes, and osteoarthritis, and its encouragement should not be condoned.

West waxes lyrical of a “magical obesity-glorifying wonderland” in which the president is a wheel of cheese. She has no problem advocating a sedentary lifestyle and over-eating, suggesting that it is not just the aesthetic that she is promoting. She does not stand alone in this attitude either; it is a stance adopted by

“Fativism is a reaction to an unattainable and unhealthy body image ideal portrayed by the media [...] and propogated by society.”

numerous influential fativists and appears to be central to the movement. Kath ‘Fat Heffalump’ is a feminist and prominent fativist blogger. One of her responses to the ‘fat-haters’ argument that ‘being fat is unhealthy,’ is that “health is arbitrary – what is ‘healthy’ for one person is not necessarily the same for the next,” and that “thin people suffer health issues too.” The difference being that the illness thin people suffer is generally not inherent to their thinness, unless of course we are talking about anorexia, which we cannot promote as a healthy lifestyle option either.

There are some extremely pressing issues surrounding fat discrimination that are not limited to the playground. In the US, overweight and obese workers are paid less than their thinner counterparts,2 and 20% people who are 50% or more above their ideal bodyweight have reported being fired or forced to resign because of their weight.3 This casts light on a troubling presence of work discrimination, and tackling this is an urgent necessity. Under-the-table discrimination of people based on any kind of trait or disease is unacceptable and should be eradicated.

However, the desire to remove these kinds of prejudices against people with a disease akin to addiction or anorexia is not at the heart of the Fativism movement. Rather it seems to be steeped in ignorance and denial: “The notion that people can be fat and okay — that fat people are not broken, not worksin-progress […] — is still entirely radical.”

Because being fat is not okay.

Obesity is a disease with serious consequences on physical and mental health, and is costing us billions annually. The 2010 National Obesity Observatory’s (NOO) examination of the economic burden of obesity predicted that by 2015, direct and indirect costs of obesity in the UK could total £27 billion. And that is nothing compared to the US, where 35% of the population is classified as obese, and is costing the healthcare system between $147210 (£93-133) billion per year.

I do not, for one second, deny the importance of body acceptance. But equally important is that obesity not be romanticised or disguised as a healthy lifestyle option. Shaming and discriminating based on any trait is always wrong and has extremely detrimental consequences. But as with addiction and eating disorders, obesity should be recognised as a disease, not a body image that should be strived for in any way. Being comfortable in your skin is something that every human should have the pleasure of experiencing, but obesity is a global epidemic. It has serious health consequences, and poses a crippling financial burden to the NHS, and thus, should not be encouraged. v

References 1. West L. Thin Women: I’ve Got Your Back. Could You Get Mine? Jezebel.

21 Aug, 2013.

2. Baum CL. Ford WF. The wage effects of obesity: a longitudinal study.

Health Econ, 2004;13:885–899.

3. Rothblum ED, Brand PA, Miller CT, Otejen HA. The relationship between obesity, employment discrimination, and employment-related victimization. J Vocat Behav. 1990;37(3):251-266.

15 | The Looking Glass

Body Image and the

Media

By Emma Quinlan & Sophie Smart

E

very day we are exposed to images of people who are paid to sell, promote and advertise an endless amount of products.

These people are usually models or celebrities who are thin, beautiful, and appear “flawless.” This has become such a normal part of our external environment, that the concept of using half-clothed “genetically blessed” individuals to advertise anything from mascara to a car does not seem strange.

Despite the aim being to sell and promote, the media can have a harmful effect on people such as developing a negative self-image or becoming obsessed with looking a certain way. According to the All-Party Parliamentary Group (APPG) for body image, 40% of children under 10 years old worry about their weight.1 In the APPG 2015 progress report, they describe body image as relating to the way people experience their bodies in the world, including how confident they feel about their appearance and how much they invest their self-worth in how others judge their appearance. They also report that the consequences of having a poor body image can

have a negative impact on many areas of life, such as reduced social activity, engaging in risky sexual behaviour in order to attain the feeling of self-worth, and mental-health problems such as depression.

Whether it is through an advertisement on the television, a billboard, or through social media, images can be created and used to falsely represent reality. Most of the time we are not seeing the full picture (no pun intended), but now people are fighting back and determined to reveal the truth behind images used in the media.

The power of the media

There is no denying the power of the media. When Kate Middleton was seen wearing a polka-dot dress from ASOS, it sold out in 30 minutes. In the 1950’s, it was Jackie Kennedy who women aspired to look like and even now, 50 years later, she still influences fashion.

However, it is not just fame and beauty to which people are drawn. Some of the most popular American chain stores, such as American Apparel and Abercrombie and Fitch, promote themselves using highly sexualised images. Lynx body spray

for men is hugely sought after, and has the concept of “using sex to sell” down to a fine art. One advert in particular showed hundreds of very attractive women running desperately toward a guy using the spray.

According to Professor Reichert from the University of Georgia, we are “hard-wired to notice sexually relevant information,” which explains why companies that want to sell products use this knowledge to their advantage. It has always been the case that sex, beauty, and power sell because they create the false idea that having a certain product can help you gain the positive feelings associated with feeling beautiful, loved and sexy. But at what cost?

The adverse effects of the media

The fact is, every day, we are exposed to images of a subgroup of society - thin, beautiful, “flawless” celebrities, who may well be blessed with good looks, but I bet they do not look like that first thing in the morning. Most men and women do not look like these images, and even if your best friend is beautiful, or the barista serving you coffee has the most chiselled jaw line you have ever seen, they still do not look like the images you see in magazines. It is not just grown men and women who are subjected to seeing mass media images

Image depicting the use of Photoshop to alter the physical appearance of a celebrity for a magazine cover.

Far left: untouched picture of a celebrity from a photoshoot for the cover of ‘Redbook’ magazine.

Left: final photoshopped image of the same celebtrity on ‘Redbook’ magazine cover, depicting thinner arms shoulders, and waist; smoothing of wrinkles; and altered skin color and face structure.

18 | The Looking Glass

on a daily basis; children and adolescents only have to look at the TV or on the side of a bus and see a nearly naked model selling the latest “must-have” product. There are pictures of Cara Delavigne, a model and London’s current “it” girl, popping up all over the city. Not only is she very petite and very pretty, but any supposed “flaws” she may have can be easily air-brushed out, creating

conducted in 1995 reported that when television was introduced to the island of Fiji, the rate of dieting among the population took an enormous leap from 0% to 69%, with people referencing the popular American sitcom Beverly Hills 90210 as their weight loss inspiration.2

Nowadays we have constant access to all types of media, so it comes as no surprise that from 2009-2014 there has

diet pills, and exercise.5

In reality, we are all different shapes and sizes. But in the media, we only see the super skinny. There have always been celebrities and icons for people to admire. However, nowadays there is no getting away from images and pictures of celebrities due to social media. With Facebook, Twitter, Instagram and the internet alone, the “celebrity world”

Victoria’s Secret advertisement for their “body” bra. Customers and non-customers alike criticised the ad for featuring unrealistic body expectations. Due to the backlash, the company has since changed the slogan, but this original slogal can still be found around the UK.

an unrealistic and enhanced image. Although this is done with the goal of selling products, these images will no doubt make some women feel inferior, and give younger people unrealistic ideas about how they are meant to look.

The use of media images to sell or promote something can unfortunately have an adverse effect on peoples’ views of themselves, particularly teenagers. One infamous study

been an increase in emotional problems in girls between 1113 years old, but no change in boys.3 It is a well-known fact that young females often try to attain unnatural and unhealthy body shapes, frequently transmitted by the media.4 Dysfunctional attitudes towards one’s weight, shape, and body size are further known to promote negative affect, restrictive dieting, self-induced vomiting, and abuse of laxatives, diuretics,

is no longer mysterious and far away. Instead, it is in our own homes, accessible at the click of a button. We can see who has put on weight, what they have eaten for dinner, what they look like in a bikini, and what everybody else thinks. There is scientific evidence that a mere 5 minutes of being exposed to images of thin and beautiful people resulted in women reporting a more negative body image.6 19 | The Looking Glass

However, what makes some people more sensitive to these media images? According to this same study, women who were prone to internalising their feelings (i.e. idealising models/famous people and comparing themselves) were more affected than women who were not prone to internalising their feelings.6 Remarkably, the adverse effects of these images were reduced when women were given information about the media images, such as informing them that the majority of women are genetically predisposed to being heavier than the women seen in the media. Also, that the flawless appearance of these people has been created by experts such as make-up artists and professional photographers. This supports the idea that if people were told the truth about air-brushing, studio lighting, and the various other techniques that are used to “create” an image, they would be less affected by it.

Russell. In 2012 she gave a TED talk7 where she openly admitted that she had “won the genetic lottery.” She spoke about how her looks have made life easier for her in some ways (such as getting out of a speeding ticket). On the other hand, she says that she is also very insecure because she has to think about what she looks like every day. She describes

Cover of Australian ‘Men’s Health’ magazine

Speaking out about the falsity of how her modelling pictures are the media “not pictures of me, they are

Honesty is key to ensure that people do not take what they are being shown through the media as the complete truth. Instead, a lot of the images we see are strategically produced for advertising.

One model who is speaking out about the dishonesty behind her modelling pictures is Cameron 20 | The Looking Glass

constructions” due to the endless amount of work that goes on behind the scenes.

The debate over the use of photo-shopping to change how a person looks in a picture has been going on for a long time. Julia Bluhm and Izzy Labbe are two American teenage girls who were so shocked

by the negative self-image possessed by so many of their peers, that they convinced Seventeen magazine to reduce the amount of photo-shopping that they do and feature a more diverse range of girls.

Every year, once the evenings start to get brighter and the winter coats are put away, we start to see an increase in gym advertisements and diet tips on how to be “beach ready.” The company Protein World have caused a major backlash this year with their advert for weight loss pills which feature a girl in a bikini with the caption “Are you beach body ready?” (pictured on the next page). Men and women took to Twitter to voice their concern and anger, and UK comedienne Luisa Omielan put a picture of herself on social media in a bikini with the caption “I was born beach ready.” There have been so many complaints, and even vandalism of the images, that the Advertising Standards Authority (ASA) started an inquiry and ruled that the advert “cannot appear in its current form.” (This is not the first time the ASA has pulled Protein World up on false advertising). These small acts of rebellion against the media paid off, and fair enough; life can be stressful as it is without companies like this exploiting our anxiety and putting added pressure on us to conform to

their ideal image before we even think of enjoying the sun!

Recently, a mum of three and a blogger named Rachel Hollis posted a picture of herself in a bikini on Instagram which generated a lot of attention. Her intention was to show that she is happy in a bikini despite having stretch marks and a “flabby belly.”

Some people commented on the

stomach, because despite what the media portrays, that is the way the human body is made.

What we should be teaching young people is to be healthy.

Not for cosmetic reasons, but because we should all look after our bodies so that we increase our longevity and reduce the risk of illness.

As we all know, advertisements are a necessary part

Of course we all like to feel good about the way we appear, but the key factor here is to have realistic ideas of what “looking good” actually looks like. If it looks like the super thin models with no blemishes or scars, then the majority of us will never “look good.” We will have unrealistic and unobtainable goals, and never feel satisfied with ourselves.

The solution is not to criticise models, who are as human as any of us, or people who are naturally thin. It simply means that we should encourage further diversity in the media. We should acknowledge that when it comes to our bodies, there are multiple shapes, sizes, and styles, and we should embrace the beauty of all of them equally. v

Advertisement by “Protein World,” promoting the use of their weight-loss product to get a “beach body.” After numerous complaints, the ad has since been banned from the London Underground.

fact that she is describing herself as “flabby,” when actually she has a great figure. However, I think these people are missing the point - it is not about trying to show pictures of people who do not have “good bodies,” it is about showing pictures of people who are healthy and exercise and still do not look like the air-brushed models depicted by media.

Appreciate - not depreciate yourself!

In reality, even if you work out and eat a well-balanced diet, you are still going to have a “flaw,” whether it is cellulite, stretchmarks, or a saggy

of consumerism for sales and promotions, and are a huge part of our modern world. We are also in an era of social media, where our personal lives are no longer as private, and we are allowed a greater insight into the lives of others. These are not bad things; they allow us to connect with people all over the planet, and to become more knowledgeable and informed on world news. However, there is a dark side to the media: the negative impact it can have on our mental health. It can allow people to feel inferior and develop a negative self-image, and even contribute to the development of eating disorders.

References 1. All Party Parliamentary Group on Body Image, Progress Report 2015.

2. Becker AE, Burwell RA, Gilman SE, Herzog DB, Hamburg P. Eating be-haviours and attitudes following prolonged exposure to television among ethnic -Fijian adolescent girls. Br J Psychiatry 2002;180:509–514.

3. Fink E, Patalay P, Sharpe H, et al. Mental Health Difficulties in Early Adolescence: A Comparison of Two Cross-Sectional Studies in England From 2009 to 2014. J Adolesc Health. 2015;56(5):502-7.

4. British Medical Association, 2000. www.bma.org.uk 5. Stice E, Marti CN, Durant S. Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther.

2011;49(10):622-7.

6. Yamamiya Y, Cash TF, Melnyk SE, et al. Women’s exposure to thin-and-beautiful media images: body image effects of media-ideal internalization and impact-reduction interventions. Body Image.

2005;2(1):74-80.

7. TED talk by Cameron Russell

21 | The Looking Glass

On the couch with...

Rhianna Goozée Founder of “The Looking Glass”

sasha walton

Student Department of Neuroscience

“Following her decision to step down as Editor-in-Chief, I had the honour of interviewing the founder of The Looking Glass, Rhianna Goozée. Here I had an opportunity to explore her experiences of starting The Looking Glass, her best moments, and her hopes and aspirations for her own, as well as the magazine’s, future. Having started The Looking Glass in late 2012, Rhianna has created a legacy that brings joy to many of the students and researchers at the IoPPN.” -Sasha Walton So, where did you get your inspiration for The Looking Glass?

Basically, when I got here, I wanted to do some writing for a magazine, but when I looked there wasn’t anything. There are some King’s based ones, but I didn’t feel we were particularly part of King’s in some ways, and there was nothing that was specific for Psychiatry, Psychology, Neuroscience-type stuff. So, I thought maybe I should just start a magazine. I mentioned it to a few friends, and they thought it was a really good idea. They were really positive about it, and said that they would like to write for something as well. Once I had mentioned it to people, I felt kind of committed.

That is where it came from really.

What was your initial idea of what the magazine would be like?

What I wanted to do was to create something for people like me, who would come in to the IoPPN and would like to do some writing that wasn’t academic writing necessarily, 22 | The Looking Glass

on a platform that is non-intimidating and accessible - learning and developing how to write those sorts of things, in a way that is amongst peers. I wanted something that when I started a few years ago, I would have thought, great, I want to get involved with that.

What were your first steps for creating the magazine?

One of the first things I did was talk to people about it, and getting other people involved. I knew I would need help because it would be a lot of work. Once I had a few people who were interested in getting involved, I arranged a meeting, and was like right, let’s brainstorm, and let’s come up with an idea.

We started thinking about the name, columns, what would be involved. Once we had that together, it was more a matter of commissioning people to submit articles. The first issue was written mostly by people who were on the editorial board and wanted to get involved, because we needed to produce something that was going to entice people to submit articles.

Where did you get your inspiration for the title ‘The Looking Glass?’

What images does it invoke for you?

It was actually one of my friends who was on one of the first Editorial Boards who came up with it, and I liked it straight away. I didn’t really think at the time why I liked it, but I think it is good because it has an element of reflection. Reflecting what is going on, and reflecting the research here.

Also the mirror aspect, taking a look at ourselves, and what is going on.

I also like the Alice in Wonderland link to the unusual, which kind of fits in with the mental health theme.

I think it has different aspects to it like that. It caught on and flowed nicely, so I was quite lucky.

What topics are you most passionate writing about?

So, since I was little I have liked writing about anything and everything.

There wasn’t really a particular topic I was passionate to write about when I first started the magazine. I just wanted to write about something. But as I was doing that, I also had a parallel interest developing in women in science and feminism. And I guess now that is the thing I enjoy writing about the most because I am passionate it. I guess when you are passionate about something you are writing about, it makes it so much easier to write. But also writing about any kind of science. Being able to take something that is quite complicated and trying to portray it in such a way that anyone would be interested in reading about it, can be a fun thing to do. Writing academic papers is something that you have to do as a researcher, and I enjoy it because I enjoy writing, but I prefer the more science communication or magazine-style writing.

Writing for a magazine is a completely different style from academic writing, as you have to hone your skills for different audiences. Do you think learning one can improve the other?

Well, often you use some of the same skills and there are things that translate across, so I think this sort of writing can improve your academic writing. It is very easy to get into a set formula when you are writing a paper, and it can be really boring. But if you writing it in a way that is more creative, and more aimed at describing your work for people who don’t necessarily work in that area, then when you come to write your academic papers it changes the way you look at it a little bit. You try to come up with more of a story, rather than, this is what we did, this is what we found. It is pretty dull and dry when we talk like that, so I think they play into each other as well.

23 | The Looking Glass

You previously used The Looking Glass as a platform to protest the staff cuts. Do you think the magazine has a role to play in the politics and development of the IoPPN?

I never started it as a political venture, but I think it is incredibly important to have ways that the students can have a voice, and can communicate and debate their views. Not all students are going to have the same opinions, so anyone can contribute and get their view out there. I also think it is important, as it is mainly post-graduate students here, and we are partially disconnected from the rest of the King’s site, and there aren’t a lot of student societies. So I think it is more about the importance of having an activity that students can do together, and can unite people, and give them a voice.

So if the powers that be are suggesting things that people don’t agree with, it is a good way of being able to say, look, we have all these people who have written these articles that say they don’t agree with what you are doing. So it can be a good way of communicating. But I never started it as something political.

What did you find most challenging when starting the magazine?

It took up a lot of time, but at the same time, it probably kept me sane during my PhD. I really enjoyed it, and I wouldn’t have given

24 | The Looking Glass

up so much time for it if I didn’t enjoy it. I think it is really important for anyone who is studying to have something that is different and that they enjoy, even a sport or something, so that you can switch off a bit from your PhD.

What have been your fondest memories of creating The Looking Glass?

Getting positive feedback has been one of the great things. When the first couple of issues went out, I had people who would just send me an email saying they had seen The Looking Glass and it looks amazing, well done.

So, it was nice to have some kind of vindication that what I was doing was worthwhile.

Also, with the interviews it has been great to meet some of the senior researchers and have half an hour of their time to just chat to them.

In the first issue, I had the opportunity to interview Robin Murray, who is obviously the don of psychiatry here, and everybody knows him.

And he was just a lovely person to talk to, so down to earth and accessible, that it didn’t feel like you were interviewing a professor and a Sir.

What do you hope for the future of The Looking Glass? Where do you see it progressing?

I just hope it carries on, that is the first thing. I guess when it is like your baby that you have created, you are worried that it will all fall apart if you are not there. So, it is nice to be able to step down and give it to people that I trust are going to carry it on. In terms of how I see it progressing, I wouldn’t like to see it as a fixed formula that I have produced and it stays the same. What I would like is for you to go and make it your own, and that it is an opportunity to express yourself and be creative in your own way. So, it develops and progresses in the way that you think it should, rather than being stuck to however I started it out. I think it is such a good opportunity for people to get involved and to develop and learn their own skills. It should more be a platform for that, rather than something that needs to have any more influence from me.

About Rhianna...

Rhianna joined the IoPPN in 2011, pursuing a 1+3 combined MSc and PhD in the Psychosis Studies department. Her MSc was in Psychiatric Research, and she is currently finishing her PhD in Psychosis Research, with her thesis titled: ‘The neurobiological basis of treatment response in psychosis.’ After completing her studies, Rhianna is thinking about moving away from academia and entering the world of science communication, whether it be writing, editing or publishing.

Do you have any advice for people who are interested in writing, or who want to get involved in The Looking Glass?

Just do it. If you really want to do it, you will just sit down and write something. It is just a matter of doing it. And I guess, not being afraid that it will be bad. Even if you aren’t great at the beginning, getting feedback from other people is a major way to improve your writing.

Someone else has to read your writing, so getting that feedback about where it is good or where it is bad helps you to get better. So, just do it.

What is your experience of the IoPPN as a whole?

I think I am lucky that I have had a good experience of it in general, because it really depends on your team. I work in a great group, and I have a nice supervisor, so I have been very lucky to have support. I think that there is a danger at the IoPPN of getting a little lost, and being a little bit lonely if you don’t have that good team. So if you are in a small group of busy academics who are not there that often, as there isn’t a particularly student feel to the IoPPN, you can get a bit lost. I think people in that situation should get involved in activities like this. It can be quite difficult to find places to bump into people and have a chat, but I think if you do make that effort to chat to people in the canteen or wherever, people are generally quite receptive. It is a great way to meet new people and find out what is going on. Also going to seminars and things, there are so many events that go on at the IoPPN, so if you are on the mailing lists, that is another great way to get involved.

Do you have any last words for us?

Good luck! v

From everyone at The Looking Glass, we wish you the best of luck in your future endeavors!

We thank you for starting this magazine, and we hope we it lives up to what you dreamt for it.

25 | The Looking Glass

sophie smart Student Department of Psychosis Studies

"One in four of us will have a mental health problem in any year - and our responses are very, very varied - we don't all spend our time slumped with our heads in our hands."

- Sue Baker, director of Time To Change

When I search for

“mental health” on the BBC News website, I find hundreds of articles. The di-

versity of issues covered is vast, although many are concerned with party policies with the election so close. However, there is one thing I notice immediately when scrolling through these headlines: the repeated, stereotyped image of a person clutching their head. These images always seem to have a grey filter over them, I can never see the model’s face, and they are always alone. After a short online search, it appears these pictures have a name: “headclutcher.” Is this stark and colourless stereotype of what everyone looks like with a mental health problem? Are people reduced to grabbing their own heads in an overly dramatic manner?

No of course it does not and no people 26 | The Looking Glass

do not. Mental illness is painful and scary - the road to recovery or coping can be tough, and often many people feel like they are alone. But that is not everyone’s story, and nor does it have to be.

So why are these stock photos that only show the isolation and pain of living with a mental illness being repeatedly used? Why is it acceptable, in this day and age, to boil down such a diverse and complex array of issues into one unrepresentative image?

However, there may be a glimmer of hope at the end of the tunnel. It appears that I am not alone in thinking there is something wrong with the use of these images. The fifth article I came across in my search is entitled ‘Mental health and the death of the “headclutcher” picture.’ 1 It is nice to remember that no matter how black or bleak a problem is, it does not have to last forever.

Time To Change is an anti-stigma cam-

paign run by the charities Mind and Rethink Mental Illnesses. I have come across it before, and seen a variety of the national and regional campaigns to get people talking about mental health. Sue Baker, Director of Time To Change, told Claudia Hammond on Radio 4’s programme ‘All In The Mind’ that it was their campaigners on the ground who raised the issue and brought it to the campaign directors.2 People were pointing out how the image was negative and adding to stigma. It is a stock representation of mental health that does not reflect the diversity of ordinary people who have dealt with and/or are continuing to cope with mental illnesses.

So why is this image so popular? Claudia Hammond explains that when she has submitted articles about mental health online, she has explicitly asked the picture editors not to use a negative image, because she knows it is almost a default decision. “The image is reductionist,” says Adam Goldberg from the stock photo agency Alamy. He summarises the issue succinctly: news outlets need readers to immediately gage the content of the article from the illustrating photo, and these photos need to be chosen quickly, sometimes in seconds, to meet the quick turn-around deadlines of newspapers.

If the consensus is that these images are unhelpful, what is to replace the “headclutchers?” Claudia Hammond has admitted that

Left: a typical example of the “headclutcher” picture seen on the internet when searching for images related to mental health.

Right: ‘Two women holding hands.’ Photograph taken

by Time To Change as part of their campaign to destigmatise mental illness.

Credit: Newcastle Online

The real damage, Sue Baker argues, is the fact that the image looks so bleak and unhopeful - it promises no recovery or positive coping. It would hardly inspire me to seek help, but then the consequences of me not seeking help are relatively low. I imagine my friend, at the lowest point of her existence and constantly trawling the internet for anything associated with how she was feeling. I am sure repeatedly viewing depictions of “headclutchers” would not help her mental state. What these images are doing, without anyone who publishes them being aware of it, is facilitating people to stigmatise mental illness as an unresolvable problem, and allowing people to pigeon-hole themselves into a category of those with no hope.

before the Time To Change campaign, she would not have known the answer, but Time To Change has come up with a great solution: a collection of pictures, available to the media at no cost. Not only do these stock photos feature models, as is traditional in the trade, but they also feature real people. These are people who have experienced mental health problems, and who volunteered to take part. What I consider astounding, and a beautiful example of humanity at its finest, is that all these people have agreed that the images may be used with any article by any news outlet for the rest of their lives. Wonderful, wonderful people, thank you for actively making this world a better place.

27 | The Looking Glass

These images are refreshingly different. People’s faces can be seen, and they are often not pictured alone. One photo shows two women by the water cooler. The implication, that they are talking about the mental health issue discussed in the article. The message: it is normal to talk openly about these issues. Another image shows two people holding hands, looking anxious, as they talk to a third person. The implication is that this third person is a mental health professional and that they are seeking help. The message: seek help, seek help with the support of someone close to you. And all of a sudden, the future does not seem so bleak.

‘A group therapy session takes place.’ Time To Change organization.

Credit: Laura Lean

The campaign has been one about change. It has been about improving a little portion of the world, it has been about hope. But the most inspirational aspect of this campaign, in my very personal opinion, is that it is driven by real people.

Real people who saw a problem and cared about an issue, and none of them said “that’s not my problem” or “I can’t do anything about that.” They saw a problem, and they went out and fixed it. v

This campaign has really struck a chord with me, and clearly with many other people. Not only has the public initiated and powered this campaign but it is also gained the support of the UK Pictures Editors Guild, and will be the first charity campaign they have supported in the last 40 years. The campaign is also being supported by Stephen Fry, who suffers from bipolar disorder and is a huge campaigner for mental health charities. He has been clutching his own head in promotional images.

‘Two young men talk to an older woman.’ Time To Change organization

References 1. Kathleen Hawkins, 13 April 2015 2. ‘Psychology of voting, media portrayals of mental health, designer asylum’ first broadcast 7th April 2015

28 | The Looking Glass

Separate illnesses, or one and the same?

ANOREXI&A

AUTISM

By Sasha Walton

Anorexia Nervosa: Current Treatment Methods

As a severe and enduring psychiatric disorder, living with anorexia can be a relentless battle for those affected, as well as for their friends and family. In a tumultuous struggle with body image and food consumption, individuals often suffer from psychological and physical complications that continue for a long time. With extended states of malnutrition, health problems such as osteoporosis are not uncommon, and anorexia has the highest mortality rate of any psychiatric condition. It hardly needs to be said that finding effective treatments for anorexia is essential for reducing recovery times in order to minimise physical stress on the body, and increase quality of life for those affected. Currently, there are a wide variety of treatments available for anorexia, which can be combined together to enhance their therapeutic benefits. Physical therapies targeting weight gain are often coupled with psychological therapies which aim to encourage patients to have greater autonomy in their recovery process.

Cognitive behavioural therapy (CBT) helps patients to change any maladaptive behaviour that perpetuates their eating disorder, by encouraging them to acknowledge that their current thoughts and beliefs are not beneficial to their health. This can be combined with other therapies such as cognitive analytic therapy (CAT) and focal dynamic therapy (FTP), which aim to identify any previous negative experiences that could have contributed to feelings of low self-worth or anxiety, and ultimately to their condition.

Antidepressants or anti-anxiety medication, such as selective serotonin reuptake inhibitors (SSRIs) or Olanzapine, may also be taken during periods of intensive therapy, in order to reduce any related negative emotions during this critical period of recovery.

Although these strategies sound promising, many studies have indicated poor response rates in many trials for current treatments.1 Although different theories exist for why this resistance may exist, it is clear that there is still more to be understood about the aetiology of the disorder, and more work needs to be invested in finding more effective treatment strategies. One of the current issues with developing effective treatments is that the diagnosis of anorexia is widely heterogeneous; each individual will have a unique combination of causal factors, which could include neurobiological susceptibility, maladaptive coping strategies, or sensitivity to stressful social environments.

It would therefore seem more effective to identify different patient subgroups with similar casual factors, to better predict recovery outcomes and to develop more targeted forms of therapy.

30 | The Looking Glass

Anorexia Nervosa Anorexia is a serious mental health condition characterised by abnormally low body weight, coupled with distorted perception of body image, and an intense fear of gaining weight. Sufferers of anorexia tend to severely restrict their diet, and engage in activities (e.g. purging after eating, compulsive exercise, and misusing laxatives and diet aids) in the hopes of preventing weight gain.

Autism Spectrum Disorder (ASD): Associations with Anorexia

Autism Spectrum Disorder (ASD) ASD describes a group of developmental conditions characterised by problems with social interaction (e.g. not being able to respond to others emotions), communication, having a restricted and repetitive collection of interests and activities, and rigid routines and rituals.

One interesting new avenue of research explores the similarities between anorexia and autistic-spectrum disorders (ASD), which could be important for creating more specific, and hopefully effective, treatment plans for eating disorders. There are noticeably high levels of comorbidity between anorexia and ASD, with an estimated 15-20% of anorexic patients having previously been diagnosed with an ASD.2 This suggests that there are some similar underlying factors in these two conditions, which could be cognitive or neurobiological. Particular similarities in cognitive styles between anorexia and ASD suggest that the two conditions may be more closely related than previously thought.

Specifically, converging evidence suggests that individuals with anorexia or ASD tend to perform poorly on specific socio-cognitive tasks, including set-shifting and Theory of Mind (ToM) tasks, as well as displaying weak central coherence.

Set-shifting refers to the ability to flexibly move back and forth between multiple cognitive tasks, which allows for dynamic responses to different situations, and helps us to cope better with unforeseen events. Difficulties in set shifting may account for high levels of cognitive rigidity, as well as the need for strict systems for dayto-day living. In anorexia, this may manifest as strict diet and exercise plans, which if broken may cause significant distress. This lack of flexibility may make adopting new treatment strategies particularly difficult and stressful for people with anorexia, and hinder their recovery. Theory of Mind refers to the ability to identify the mental states of others, including their thoughts, emotions, and beliefs.

People with anorexia and ASD tend to score poorly on Theory of Mind tasks, often finding it difficult to empathise with those around them. This quality can be particularly detrimental to close family and friends, as patients may not be able to process the emotional impact of their condition on others.

These strict routines in anorexia may also be accompanied by states of hypervigilance, where small changes to routine can produce a disproportionate emotional response. This in part could be due to a trait known as weak central coherence, which refers to difficulties in ‘seeing the bigger picture,’ despite performing well on tasks that require close attention to detail. Sensitivity to slight errors or mistakes can perpetuate obsessions with rigid routines, as well being overly vigilant to weight gain and food contents. Negative events may be valued disproportionately, and an inability to rationalise the situation could add to feelings of anxiety and low self-worth.

31 | The Looking Glass

In a recent study, Renwick and colleagues2 found that 17% of out-patients with anorexia scored poorly on emotional Theory of Mind and set-shifting tasks, whilst 55% were found to have weak central coherence. This suggests that there may be subtypes of anorexia: those who have disrupted socio-cognitive functions, and those who do not. This also means that there may be a proportion of patients who may benefit from supplementary treatments aimed at increasing their cognitive flexibility. These findings have been met with criticism, arguing that the autism-like cognitive patterns observed in anorexia are actually induced by a state of starvation, and are therefore more of an artefact of reduced food intake than a cognitive correlate. However, increasing evidence suggests that these distinctive patterns of cognition are present before and after starvation periods, although in more muted forms.

So maybe we should reconsider the way we define anorexia and ASD. By altering the boundaries by which we see these disorders, we can better understand their aetiological relationship, and provide a stronger framework for exploring potential biological similarities between to two. Many theories are beginning to emerge, which aim to challenge our current perspectives of diagnosis. For example, one theory speculates that some cases of anorexia may actually be an alternate clinical presentation of ASD. According to Dr. Bonnie Auyeung, females with ASD may actually be misdiagnosed, as they present to professionals as though they have anorexia nervosa.4 Indeed, ASD is considered an inherently more masculine disorder, whilst more females present with anorexia. Such misdiagnosis could, in theory, be possible, as those with ASD have been found to adopt rigid eating behaviours and often have a low body weight, reminiscent of anorexia. If females with attenuated forms of ASD present with most strongly with food-restrictive tendencies, it is possible to see how this may happen. Although this theory may represent only a tiny proportion of patients, it could be that they are receiving an ineffective treatment plan for a disorder that they may not have.

Another compelling theory suggests a common neurodevelopmental pathway in both disorders, where the cognitive styles appear to have developed in parallel, which could account for the high rates of comorbidity.

However, whether these cognitive styles develop in parallel due to underlying neurological or genetic factors, or are determined by similarities in developmental environment, are unknown. At present, there are no studies identifying any common risk genes, although high rates of co-occurrence for these disorders in families would suggest the presence of some factor which increases susceptibility to developing either condition. Identifying these common neurodevelopmental risk factors, whether biological or cognitive, could help with identifying children at risk of developing anorexia, as well as formulating targeted preventative measures.

At present, the biological correlates between these two disorders is largely unknown, although some studies are beginning to reveal findings that could suggest differences in the way that social information is processed. Interestingly, a recent functional magnetic resonance imaging (fMRI) study reported similar decreased activity in the right temporoparietal junction (rTPJ) when carrying out Theory of Mind tasks, in both patients with anorexia and those with ASD.5 This underlying reduction of activity may be linked to disruptions in Theory of Mind in anorexia, and could reveal potential future targets for pharmacological therapies, with the hope of improving socio-cognitive performance.

32 | The Looking Glass

One potential pharmacological therapy that aims to improve socio-cognitive scores is oxytocin nasal spray, which is currently being researched by Janet Treasure at King’s Institute of Psychology, Psychiatry and Neuroscience (IoPPN). Oxytocin is a neurotransmitter known for playing an important role in social function, and reduced levels have been observed both in anorexia and autism. In her 2014 study, Treasure found that using an intranasal oxytocin spray was able to reduce attentional vigilance to eating and fat shape stimuli, revealing an exciting potential treatment for anorexia.6

New cognitive-based treatments for anorexia are also beginning to emerge. These aim to target reported rigid and repetitive behaviours and thought processes by helping to increase cognitive flexibility in patients, and improve their responsiveness to other conventional treatments. One of the most successful of these strategies is known as Cognitive Remediation Therapy (CRT).

CRT primarily addresses emotion processing difficulties in the self and others, and includes strategies to manage emotions and the practice of emotion expression. This may target patterns of rigidity and weak central coherence, leading to better cognitive flexibility, and increased responsiveness to complementary therapies. Interpersonal Therapy (IPT) is another strategy that aims to improve social relationships by encouraging adaptation and flexibility to interpersonal roles and situations. Similarly, the Maudsley approach aims to improve relationships between patients and their families, by making the family an integral part of recovery. Both of these therapies aim to improve the support groups available for patients, and reduce feelings of isolation.

Therefore, it appears that there is great promise for devising new treatments for individuals with anorexia who exhibit ASD-like symptoms. This new field can only continue to grow and improve our understanding of the biology of both disorders. It also reflects the need for tailored treatments, as anorexia is such a heterogenic disorder, and better tools for diagnosing these different patient groups. Although anorexia shares similar cognitive styles with ASD, it is also associated with high rates of comorbidity with other psychiatric disorders, including depression, anxiety, obsessive compuslive disorder (OCD), personality disorders, and substance abuse disorders. Any of these could provide equally exciting new avenues for understanding the underlying causal factors associated with anorexia, and the formulation of new treatments. v

References 1. Halmi KA. Perplexities of treatment resistence in eating disorders. BMC Psychiatry. 2013;13(1):292.

2. Oldershaw A, Treasure J, Hambrook D, et al. Is anorexia nervosa a version of autism spectrum disorders? Eur Eat Disord Rev. 2011;19(6):462-474.

3. Renwick B, Musiat P, Lose A, et al. Neuro-and social-cognitive clustering highlights distinct profiles in adults with anorexia nervosa. Int J Eat Disorder.

2015;48(1):26-34.

4. http://www.cam.ac.uk/research/news/girls-with-anorexia-have-elevated-autistic-traits 5. McAdams CJ, Krawczyk DC. Impaired neural processing of social attribution in anorexia nervosa. Psychiatry Res. Neuroimaging. 2011;194(1):54-63.

6. Kim YR, Kim CH, Cardi V, et al. Intranasal oxytocin attenuates attentional bias for eating and fat shape stimuli in patients with anorexia nervosa. Psychoneuroendocrinol. 2014;44:133-142.

For more information about Anorexia Nervosa, please visit: http://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder/anorexia For more information about Austism, please visit: http://www.autism.org.uk/working-with/health/information-for-general-practitioners/recognising-autism-spectrum-disorder.aspx

33 | The Looking Glass

A

WONDE SYND This year marks the 150th anniversry of Lewis Caroll's popular children’s tale, "Alice in Wonderland." Like Alice’s journey in Wonderland, this article takes a trip around the brain, exploring what happens when the neural processes responsible for perception and our sense of self become fragmented.

By Holly Barker

ALICE IN

ERLAND DROME

T

he moment Alice arrives in Wonderland, she goes through a series of strange metamorphic changes, becoming larger or smaller after ingesting certain foods and liquids.

These sensations are also experienced by individuals with a certain medical condition termed Alice in Wonderland syndrome (AIWS).

AIWS was first described in 1955 by a British psychiatrist Dr. John Todd,1 who noticed that many of his younger patients experienced distortions in the size of objects or body parts (metamorphopsia) as a result of their migraines. He noted a strong association between these symptoms and migraines, and determined that AIWS may constitute a rare ‘migraine variant.’ In fact, Lewis Carroll himself is reported to have suffered from migraines and manifested his experiences in his writing.

For instance, Alice being blinded by moonlight may refer to the tendency of bright light to stimulate or intensify a migraine.

AIWS is commonly experienced during childhood and tends to disappear during teenage years.

In addition to distortions of size, 36 | The Looking Glass

patients may also experience changes in the shape or distance of objects and a distorted perception of time. These sensations may be accompanied by a lingering of sensory input, such as auditory or tactile sensations, after the source has been removed.

A migraine aura is a perceptual disturbance that precedes the migraine headache, but in some cases the aura may be experienced alone. The aura typically develops over 5 minutes and can last up to 2 hours. Although its exact cause is unknown, it may be due to a slow propagation of excitation followed by a depression in neuronal activity across the cerebral cortex (the outer layer of the brain). This phenomenon is called ‘cortical spreading depression’ and often originates in the visual or somatosensory cortex, moving across the cortex at a rate of 3.5mm per minute. It is thought that when this ripple of overstimulation and subsequent depression of neuronal activity passes over the parietal lobe, it caused an altered perception of the size of objects and body parts, along with misperceptions of tactile and auditory sensations.

The parietal lobe, a brain region responsible for integrating sensory information, creates the perception of our body parts in space (proprioception). Proprioception has thus been implicated in some of the symptoms experienced in AIWS. For example, electrical stimulation of the posterior parietal cortex has been shown to produce disturbances in body image, such as hallucinations of limbs growing or disappearing. In addition, a functional MRI (fMRI) study of a 12 year-old with AIWS

"Let me think: was I the same when I got up this morning?

I almost think I can remember feeling a little different. But if I'm not the same, the next question is 'who in the world am I?'"

showed increased activation of the parietal lobe accompanied with reduced activation in visual cortical areas during an episode of metamorphopsia. This suggests that metamorphopsia in AIWS patients is a result of enhanced neuronal activity within the frontal lobe, resulting in disrupted integration of sensory information and misperceptions of body parts in space.

Depersonalisation

At several points in the story, Alice questions her own identity and feels ‘different’ in some way from when she first woke. Approximately 1% of the UK population experiences these feeling constantly, and suffer from a syndrome known as depersonalisation disorder (DPD).

DPD is characterised by a disruption in the integration of perception, consciousness, memory, and identity, producing a disordered and fragmented sense of self. This disorder encompasses

a wide range of symptoms, including feelings of not belonging in one’s own body, a lack of ownership of thoughts and memories, that movements are initiated without conscious intention, and numbing of emotions.2 Patients often comment that they feel as though they are not really there in the present moment, likening the experience to dreaming or watching a movie. These symptoms occur in the absence of psychosis, and patients are usually aware of the absurdity of their situation. DPD is often a feature of migraine or epileptic auras and is sometimes experienced momentarily by healthy individuals, in response to stress, tiredness or drug use.

There is a high association between DPD and childhood abuse, and the onset of symptoms often coincides with stressful or life-threatening situations, which indicates it may initially arise as an adaptive response to an overwhelming situation. DPD acts as a sort of defence mechanism, allowing an individual to become disconnected from adverse life events, making the situation easier to

deal with. In fact, it is estimated that 51% of patients with DPD also meet the criteria for post-traumatic stress disorder (PTSD).

The temporoparietal junction (TPJ) is involved in integrating sensory information to create the feeling of being located in a particular body in a particular space. As well as the feeling of not belonging in their body, people with DPD may also have out-ofbody experiences (the feeling that the ‘self’ is located outside the physical body) and experience autoscopy (the perception of viewing the self from another vantage point). Evidence for the involvement of the TPJ in DPD comes from studying brain lesions. It has been shown that neuronal degeneration of the TPJ produces out-of-body experiences, possibly due to a failure to integrate multisensory information from the body.

Likewise, transcranial magnetic

"'Now I'm opening out like the largest telescope that ever was!

Goobye, feet!' for when she looked down at her feet, they seemed to be almost out of sight, they were getting

so far off."/

stimulation (TMS) of the right TPJ reduces symptoms of depersonalisation. People with DPD also have reduced activity in an area of the brain called the anterior insula, which is located deep within the brain, and necessary for conscious processing of emotions and creating a sense of agency (the feeling of responsibility for your own actions).

Studies have shown that activation of the anterior insula occurs when healthy subjects are shown photos of their face or body, implicating this area in bodily representation and feelings of ownership. In a fMRI study, participants were asked to control images on a screen using joysticks. When the participant felt as though they were responsible for moving the object, there was a corresponding increase in activity in the anterior insula. However, when researchers interfered with the movement of the object, the participants showed greater activity in the inferior parietal cortex. Reduced basal activity in the anterior insula of people with DPD offers a possible explanation for the loss of agency and robotic, automated movements which are experienced by individuals with DPD. 37 | The Looking Glass

Reduced activation of the anterior insula may also be responsible for the emotional numbing experienced by these patients. For example, patients with DPD displayed a lack of response when shown emotionally-provocative images, accompanied by reduced activation in the anterior insula and a dampening of the galvanic skin response (GSR) as compared to controls. The GSR is a measure of subconscious arousal and is therefore often used as a quantitative measure of emotional response.

Another brain region implicated in emotional awareness is the amygdala, which also displays dampened activity among DPD patients.

The amygdala is thought to ‘colour’ conscious perceptions with emotion and plays an important part of how we perceive our environment. It has been suggested that the process of perception may occur by two parallel pathways. The first is concerned with the literal, semantic processing of the environment - the ‘what is it?’ pathway. The second pathway assigns emotional significance to this information. In people with DPD, the ‘what is it?’ pathway is intact, however the emotional pathway is disrupted. This may cause patients to feel that things seem somehow different and unreal. Therefore, patients with DPD are able to recognise themselves, their families and their environment. However, as the emotional ‘colouring’ of the situation is lost, everything appears foreign and lifeless.

38 | The Looking Glass

Prosopagnosia

As Alice says her goodbyes to Humpty Dumpty, he gives her a precise description of prosopagnosia, a rare form of agnosia characterised by the selective inability to recognise faces. Whether Carroll based Humpty Dumpty’s prosopagnosia on a real person or was simply a fragment of his imagination is unclear. Regardless, this account is possibly one of the earliest descriptions of this neurological syndrome in the literature.

Humpty describes his impairment in recognition of familiar faces, even though he is aware of the general organisation of a face and is able to correctly identify the position of facial features. Prosopagnosia is either caused by brain trauma (likely the result of Humpty’s great fall), stroke, neurodegeneration, or it may manifest in childhood. Prosopagnosia has been shown to be strongly hereditary, although any causative genes are yet to be discovered.

People with prosopagnosia tend to rely on discriminating features to tell people apart, such as hairstyle, glasses, and the presence of moles or the sound of their voice. Affected individuals also have difficulty

recognising themselves in the mirror, as well as following plot lines when watching films.

Due to the fact that the brain links information learnt about people to the visual memory of that person, it can be difficult for prosopagnosics to attribute specific information to the right people and socialise normally with others. This can result in social withdrawal, anxiety, and loss of confidence in social situations, which are fuelled by a lack of awareness of prosopagnosia in the general population. In one such tragic condition, a patient developed severe prosopagnosia following a stroke. His condition compelled him to isolate himself from society and move to a remote area to work as a farmer.

He learned to recognise and tell apart his sheep, but never regained the ability to recognise human faces.

"'Good- bye, til we meet again!' She said as cheerfully as she could. 'I shouldn't know you again if we did meet,'” Humpty Dumpty replied in a discontented tone. 'Your face is the same as everybody else has the two eyes, so -' (marking their places in the air with his thumb),) 'nose in the middle, mouth under.

It's always the same.

Now, if you had two eyes on the same side of the nose, for instance - or the mouth at the top - that would be some help.'"

images of people we have met throughout our lifetime. The FFA is the area affected in prosopagnosics; fMRI studies have shown a strong activation of the FFA when normal participants are shown photos of faces, as compared to other visual stimuli.

Amusingly, experimental electrical disruption of the FFA causes distortions when visualising faces, an effect similar to viewing oneself in a fun house mirror. In one such study, the participant looked at the experimenter and exclaimed, “You just turned into someone else!

Your face metamorphosed. Your nose got soggy and went to the left. You almost looked like somebody I’d seen before but somebody different.” This effect was only experienced when current was applied to the right fusiform gyrus, implying that facial recognition is dominated by the right hemisphere.

Prosopagnosia has been linked to damage in the fusiform gyrus, a brain region located in both the occipital and temporal lobes. The fusiform gyus is responsible for retaining visual memories. A localised region within the fusiform gyrus, termed the fusiform face area (FFA), retains the facial

There is evidence that the FFA may process not just faces, but any familiar visual stimuli in which the brain has to distinguish between minute features. For instance, one

study compared the facial recognition activity of car enthusiasts, expert bird watchers, and the general public. All groups showed FFA activation in response to faces. However, the FFA was also activated when car enthusiasts were asked to identify different cars, and when bird watchers asked to identify different species of birds. It appears that because we encounter so many similar faces in everyday life, the FFA has become specialised for facial recognition, but can equally adapt to distinguish small details in a variety of objects.

The recognition of faces depends not only on the ability to correctly match the visual image of a face from the catalogue of faces stored in our memory, but also on the emotions which we associate with a familiar face. Whilst the fusiform gyrus is responsible for the visual recognition of faces, it appears that other higher brain centres provide the emotional response when seeing a familiar face. Tranel and Damasio3 conducted an experiment in which patients with prosopagnosia were shown photos of family members, familiar figures, and hospital staff, interspersed with the faces of strangers. Although both patients reported an inability to recognise any of the photos, a significantly stronger GSR - indicative of an unconscious emotional response 39 | The Looking Glass

was produced when the participants were shown photos of loved ones. These findings suggest that the normal process of facial recognition occurs by two distinct circuits: the first involving the conscious awareness of a particular face due to retained imagery in the FFA, and the second being an unconscious emotional familiarity mediated by higher brain regions (particularly the frontal and parietal lobes). In prosopagnosics, the emotional circuit is intact, so the patient is able to detect familiar faces ‘unconsciously’ but the brain fails to pass on this information to higher brain centres.

Therefore, the condition of prosopagnosia appears to reflect a structural disconnection between areas of the brain involved in recognising faces.

The opposite scenario is reflected in a condition known as ‘hyperfamiliarity.’ In this disorder, the patient has a strong ‘gut’ familiarity with people and places due to strong activity in emotional centres, and may even go up to people to greet them as old friends, even though the individual cannot recall meeting these people in the past. A more common phenomenon of familiarity without awareness is déjà vu.

40 | The Looking Glass

Despite the fact that the fascinating as those experisymptoms of depersonalisation enced by Alice when she first and prosopagnosia in Alice in fell down the rabbit hole. v Wonderland Syndrome can be distressing, they provide insight into the neural mechanisms which produce fundamental processes such as consciousness and perception, things we References Todd J. The syndrome of Alice in Wonderland. we ordinarily take for granted. 1.CMAJ, 1955;73:701-704.

Through slight changes in neu- 2. Sierra M, David AS. Depersonalization: A selective impairment of self-awareness. Conscious Cogn, ral activity in relatively localised 2011;20:99-108.

Tranel D, Damasio AR. Knowledge without brain regions, phenomena can 3. awareness–an autonomic index of facial recognition arise which are as peculiar and by prosopagnosics. Science, 1985;228:1453-1454.

PALEO DIET:

Secondary Benefits

vera mehler

Student Department of Neuroscience

In our society, dieting or following a particular eating restriction has become more and more normal in recent decades.

obesity, dental caries, and diverticulosis.1 Astonishingly, surfing the web and looking for the search item “Paleo diet” Most people start dieting be- reveals even more benefits, cause of the promise of either such as preventing menstrual losing weight or living healthier. cramps, and it is even claiming Either way, all diets have some- to improve mental health (see thing in common: they require http://thepaleodiet.com). you to deny yourself something, either to abstain from particular Since this new diet foods or to eat less. There are seems to be all-promising and all sorts of diets with different beneficial in multiple ways, it is rationales. Diets that are par- absolutely reasonable that peoticularly "edgy" are becoming ple want to try it. Who is not more popular. The feeling is searching for persistent beauthat more extreme diets promise ty, a more exciting love life, greater and more versatile ben- and better health? But, I want efits than less extreme diets. to question the reasons behind choosing this diet.

What is the ‘Paleo Diet?’

One of the diets that has become a huge trend in America, and is also gaining ground in Europe, is the Paleo diet. The Paleo diet promises beauty, a better libido, and health. It is said to prevent “diseases of civilisation,” such as atherosclerotic cardiovascular disease, type II diabetes mellitus, chronic obstructive pulmonary disease, lung and colon cancers, essential hypertension,

The logic behind the Paleo diet

The Paleo diet has a unique rationale, which is based on the lifestyle of our ancient ancestors, the hunters-gathers.

People that follow the Paleo diet eat in a manner that is supposed to imitate the way that Stone Age people were likely to have eaten. Our ancestors lived in the Palaeolithic era - the period before the rise of agriculture and domestication

of animals - which was followed by the Neolithic Revolution.

The Palaeolithic era lasted around 2.5 million years until the Neolithic Revolution took place, approximately 20,000 to 10,000 years ago. Because of the very long time period of 2.5 million years, proponents of the Paleo diet claim that the human genome had evolved to adapt to its conditions - including the available foods - at the time of the Palaeolithic era.

This is called the ‘evolutionary discordance hypothesis,’ which further claims that modern humans are maladapted to food that has been made available since the Neolithic Revolution.2

From an evolutionary standpoint, the change that the Neolithic Revolution entailed happened too quickly, and our gene pool did not have enough time to “adjust,” which may be the cause for some common chronic diseases. Thus, the Paleo diet allows you to eat meat, eggs, seafood, fruits, vegetables, and nuts, but not foods that

were either a product of industrial processing or the domestication of animals, which includes sugar, grains, and dairy products, among others.

To simplify, people that follow the Paleo diet forego high-carbohydrate foods and eat more protein and healthy fats.

However, not everyone is in favour of the Paleo diet, or the reasons behind it. The first major counter argument is that there are many people who do not follow any particular diet, who live a healthy life, without developing any “diseases of civilisation,” Second, it is also argued that humans have evolved to be flexible eaters, which implies that we are quite capable of tolerating food other than that what was available in the Palaeolithic era.3 Furthermore, it has been shown that modern humans are genetically adapted to the selective pressures in the most recent stage of our evolution.

Concerning nutrients, one target of selection is the gene CYP3A5, which has previously been associated with saltsensitive hypertension.4 The fact that our genome – at least to some extent – has been undergoing changes in recent time undermines the rationale of the Paleo diet.

Thus, there is that the food gatherers ate wholesome for

no solid evidence that hunters and is still the most modern humans.

Self-identity on the Paleo Diet

So if these three arguments completely eradicate the rationale for choosing the Paleo diet, why are people still following it? One could speculate that attention one gets from the diets plays a role. The Paleo diet is very strict since you cannot consume standard groceries, such as pasta, bread, and milk. Therefore, it is basically impossible for a dieting person not to mention the fact that they are on a diet to their friends and family. At the very least, when you go for dinner or have been invited out for food it will become a topic of conversation and you will automatically occupy centre stage.

Catching attention is a secondary effect of all diets, but the more extreme or remarkable a diet is, the more

attention it will gain, and the Paleo diet is pretty extreme.

Attention in and of itself is not a bad thing. It is a basic human need, and it is very important for our mental health, among other things. However, the attention which comes from restricting your food supply may not be the attention you actually crave. It is not your eating habit that you want to be acknowledged, but you as a person.

People define themselves through different things, such as their personality, job, hobbies, appearance, friends, and family. The more time someone spends on one of these characteristics, the more significant it automatically becomes. When you start a diet - especially a diet as strict as this one - it becomes a big part of your life and occupies your mind regularly. This is because your food intake needs to be planned and organized throughout the day, every day, which may lend the diet disproportional importance.

Most people are looking for something in their lives that keeps their minds occupied and that they can be proud to achieve. These are the things that define us. To speak very stereotypically, for a successful lawyer, it is his job; for a mountaineer, it is exercise; for a Porsche collector, it is his cars. People that are not taken in by their job or family, or do not have a fulfilling hobby, may feel like an extreme diet is a way of filling this gap in their lives.

people suffering from anorexia who feel guilty for not keeping to the strict discipline

they have set for themselves. This religious reasoning

then, allows the

dieter to take what they perceive as a moral high ground: people that do not practice discipline, that do not restrain themselves, do not earn reward or forgiveness. Foregoing particular food is the sacrifice that you make to feel inwardly better, and to position yourself above others, which is, ultimately, a rewarding feeling.

logic behind the Paleo rationale - is still a very recent field of medicine, and gives rise to discussion about the diet’s true value.5

It would be interesting to see how the Paleo diet is more beneficial compared to other dietary fads. In the nineties, it was the low-fat diet, whereas nowadays, the Paleo diet is the new black. For any given fad, there is a certain amount of time where there is a big hype about that new, polarising ‘sexy fashion’ (or in this case, sexy diet). But with time, the hype vanishes, and something new will catch people´s attention. I wonder, will you will even remember the Paleo diet this time Final thoughts about following next year? v

the Paleo Diet

I believe it is reasonable to think that people choose such an extreme diet over an ordinary diet with no sophisticated rationale, but rather due to its secondary psychological benefits. In general, being aware of what and how much you eat is always a good thing. In that respect I have no quarrels with people following any sort of diet regime. However, I would urge people to be aware of their reasons behind choosing a particular diet, and to question the rationale behind it. With the Paleo diet, this is especially important, since evolutionary medicine - the fundamental

Another aspect of the Paleo diet, and any diet in fact, is that it requires you to forego particular foods. This means you are voluntarily restraining yourself. Voluntarily restraining or subduing oneself is a definition of chastening, and “chasten” is another word for “discipline.”

You can find many examples of personal chastening in the Bible, which all promise forgiveness of our sins and reward (Hebrews 8:12). Thus, people who keep to a diet, feel, per- haps only subconsciously, like they are doing something right by exerting discipline, which gives the diet a rather religious ideological rationale.

Think about

References 1. Konner M, Eaton SB. Paleolithic nutrition twenty-five years later. Nutrition in Clinical Practice, 2010;25:594-602.

2. Eaton SB, Konner M. Paleolithic nutrition: a consideration of its nature and current implications. New England journal of medicine (USA), 1985.

3. Leonard WR. Dietary change was a driving force in human evolution. Scientific American, 2002;287:106-116.

4. Voight BF, Kudaravalli S, Wen X, Pritchard, JK. A map of recent positive selection in the human genome. PLoS biology, 2006;4:e72.

5. Cournoyea M. Ancestral assumptions and the clinical uncertainty of evolutionary medicine. Perspectives in biology and medicine, 2013;56:36-52.

REVIEWS:

The Babado

raphael underwood

Student

Department of Psychology

The catalyst comes

The Babadook is a when Samuel pulls a book off rarity in modern horror cinthe shelf for their routine bedema: a claustrophobic chiller time read, titled The Babathat deliberately recycles dook, a pop-up book with a classic tropes to provide an simple, expressionist art style. original, fresh take on the Amelia begins reading aloud, fear of parenthood. only to discover that the playful prose and stark imagery

Single mother Amelia quickly become so cruel and (Essie Davis) is very near distressing as to cause Samuel the end of her tether. She to have yet another meltdown. works long hours in a care Thereafter, a malevolent spirhome, and struggles with her it slowly invades Amelia (or young son Samuel (Noah does it?), causing her and Wiseman), whose emotional Samuel’s world to come unoutbursts and fascination with done. weapons ensures he is contin- The fear of motherually changing schools. Samuel hood and disturbed children also suffers from night terrors have been examined before and frequently sleeps in her (The Children of the Corn, bed, pawing at her, grinding Rosemary’s Baby, etc.), but his teeth, and impeding her it is rare that the audience need for personal (and in one is asked to empathise with excruciating scene, sexual) some of society’s last taboos: privacy. In addition, we learn mothers not having a materthat Samuel’s father died while nal instinct, or that one’s child driving Amelia to the hospimight be repulsive or unlovable tal so she can give birth to (see We Need To Talk About him. This setup, steeped in Kevin). There is a psychocod-psychoanalysis, is ferlogical and emotional accuratile enough to justify the film’s cy that pervades throughout, gradual descent into full-blown, and we sympathise with both hysterical ‘madness,’ or at Amelia and Samuel, even as least, a cinematic conception the two shift places between thereof. terroriser and terrorised.

44 | The Looking Glass

Not that The Babadook is a slice of kitchen-sink drama. Rather, the film takes its cues from European and American horror cinema from the 1970’s and 80’s, with a short detour via the 1920’s. It throws a heady mix of horror standards into the pot, from the paranoia and muted interiors of Polanski’s The Tenant or Repulsion, to the excess of Italian Giallo classics like Suspiria. It also incorporates the expressionist lighting and feverish intensity of early German cinema, as in The Cabinet of Dr. Caligari, and makes explicit references to the silent films of Georges Méliès, from which the evil spirit gets its look. There is also judicious use of sound design, contributing to the visceral feeling of discomfort throughout, with scrapes, creaks, and hisses accompanying every scene, not to mention the unearthly chant of “Dook! Dook! Dook!” any time the spirit appears. In this sense, it is remarkable that the film manages to carve out its own identity. This is partly due to the fact that in a sea of jump-scare/torture-porn franchises, the classical

ook

references help The Babadook stand apart. Not that it does not contain its fair share of twitchy, shrieking jolts.

It is also refreshingly modern in being a female-centred horror (written and directed by former actress Jennifer Kent), focusing on a role women fear to openly dislike: motherhood.

Essie Davis gives an egoless, unglamorous performance as a woman who genuinely appears to be experiencing an acute episode of mental illness. In addition, Noah Wiseman, in his first role, is a perfect piece of casting; a ghostly Tim Burton-esque moppet, both sympathetic and genuinely unsettling.

Granted, this exploitation of common fears and descent into frenzied paranoia is hardly an accurate portrayal of depression and psychosis. But the intelligence of Kent’s film is that she deliberately employs these cinematic conventions as a device through which to talk about very real emotional difficulties. It is particularly impressive that the ending preserves an element of the supernatural, while nonetheless providing an emotionally truthful (and satisfying) resolution to Amelia and Samuel’s troubled relationship. A striking debut from a talented writer-director. v

Academic Research Journey Companions

simone ciufolini Student

Department of Psychosis Studies

Interacting with people from different cultures is exciting, insightful and at times puzzling, as it appears not everyone is on the same page. This feeling also describes the sometimes dysfunctional interaction between academic research and clinical practice. It seems to resemble two friends who speak in a vehicular language, expressing themselves with a combination of words that at times sound unnatural and confusing to the other. Misunderstandings of this sort, highlighted in the plenary dedicated to Mental Health at the BAP summer Meeting 2014 by our Dean Professor Shitij Kapur, increase the sense that our efforts as researchers do not have actual influence on the real world, and that research is to a great extent detached from clinical practices. In fact, the way our findings make their way into clinical guidelines is long and windy.

I was fortunate enough to discuss these issues with two important members of the IoPPN community, Valeria Mondelli (Clinical Senior Lecturer, IoPPN; liaison Consultant Psychiatrist, Outpatient Endocrinology Clinic, King’s College Hospital; Locum Consultant Psychiatrist, Early Intervention Psychosis CAG, South London and Maudsley NHS Trust) and Professor Sukhwinder Shergill (Professor in Psychiatry, IoPPN; consultant psychiatrist in the National Psychosis Service at Bethlem Royal Hospital). -Simone Ciufolini

Simone Ciufolini: Is this a fair description of the relationship between research and clinical practice? Is a hiatus between these two disciplines useful to provide room to develop knowledge without the pressure of being immediately converted into a cure or does it leave researchers spinning in their own world?

Valeria Mondelli: I think my vision of the relationship between research and clinical practice started to take shape quite long time ago. I believe it was when I was still a medical student and I had to deal with hard reality of seeing my first patient dying because we did not have any cure for his illness. At that time, 46 | The Looking Glass

when searching for possible new treatments for patients with terminal cancer, I started to figure out that the process that lead to something that can make a significant change in one person’s life takes a long time… and this process is research. I don’t think there is a hiatus between research and clinical practice; I believe there is an illusory distance between the two, which can appear to be large or small according from where we place ourselves. Sometimes it is very important to focus on specific details when we do research, and this often leads to interpret research as something far away from clinical life. Howevever, if we stand back and start to look at exactly that same research from a wider

or

h & Clinical Practice Casual Acquaintances? prospective, we can see the importance of that little step in the long journey to a new treatment/clinical guideline. I honestly quite enjoy when the results of my research do not come out as anticipated, I think it is due to the challenge and thrill of having to find new ways of thinking about problems.

Prof. Sukhwinder Shergill: Clinical research, as with any research, is embedded in curiosity and questions. As clinicians, we have lots of questions in our daily work. What is causing these symptoms? How can we best treat this illness?

Why is this treatment not working? The great advantage of being researchers ourselves, or as part of a larger research institution, is that we have the tools to answer some of those questions. If the question is of clinical interest and the research methodology is appropriate, we

can be disappointed that our hypothesis was not supported; but not that our research is detached. There is no research that is detached from clinical questions, only research questions that have not been mapped onto clinical questions.

SC: In one of his short stories Borges wrote, “Like all those who possess libraries, Aurelian felt a nagging sense of guilt at not being acquainted with every volume in his.”1 As researchers we definitely know this feeling.

Keeping up with the increasing number of good papers and valuable researches that are published every week, is both a pleasure and a challenge. Undoubtedly this is absolutely pivotal to better understand and to move our own work forward (or at least to say something clever over lunchtime). Do clinicians share the same

About Professor Sukhwinder Shergill

Dr. Sukhi Shergill is a professor in psychiatry at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, and a consultant psychiatrist in the National Psychosis Service at Bethlem Royal Hospital (South London and Maudsley NHS Foundation Trust). People who have treatment-refractory psychosis are referred here from all over the UK. Much of his research utilises neuroimaging to understand more about the brain mechanisms involved in the symptoms of psychosis.

The aim is to use this information to develop new, effective treatments for the large number of people with schizophrenia who do not respond to antipsychotic medication.

At the IoPPN, he heads the Cognition, Schizophrenia and Imaging Laboratory (CSI Lab), comprising two-dozen academics, clinical researchers, PhD and other students. Dr. Shergill is also chair of the Masters Programme in Mental Health Studies, which every year attracts more than 100 students from around the world. Both the CSI Lab and the MSc Programme are based within the Department of Psychosis Studies. Dr. Shergill started work as a consultant psychiatrist at the Maudsley Hospital in 2000 after completing his training there, and previously at UCL. He has worked within the National Psychosis Service for more than 10 years. He was made a Fellow of the Royal College of Psychiatrists in 2008.

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need and what can be done to interest clinicians in research findings?

VM: Of course I believe clinicians share some of these feelings. However, I think that what is driving these feelings in clinicians is slightly different from researchers. It is more related to the aim of keeping up to date with new treatment/guidelines and of providing the best quality of care. Indeed, difficult and complex clinical cases usually further increase the interest of clinicians in latest research findings, always with the ultimate aim of trying to define the best suitable treatment plan. Undoubtedly, clinicians become more interested in research when they can view the possible translation of research, which shorten the distance to the application in clinical practice. However, I don’t think this depends on the stage of the research (closer or further from clinical application), I believe it just depends on how we, as researchers, explain our research findings by keeping in mind the wider prospective.

SS: Every day, clinicians are faced with patients and problems that do not fit into the standard diagnostic or treatment guidelines.

Why? Because each person is an individual – perhaps this is even more obvious in the case of mental health; where social environment and psychological make-up are intimately linked with the biology. Managing the individual difficulties of each unique patient requires the

assimilation of knowledge from across a range of research sources; cell biology, neuroimaging, pharmacology, cognitive neuroscience, neuropsychology, social science, and anthropology. As researchers know only too well, it is very difficult to keep up with the literature, even within a narrow field of interest. Thus, what the busy clinician desires is convenient access to high quality research data; presented in a digestible form – they have little time, yet great need – the kaleidoscope column in the British Journal of Psychiatry is one attempt to fulfill this need.

SC: Every research study needs inclusion criteria to identify a specific population, to guarantee internal consistency and make it replicable but this may also define samples, which does not really exemplify the clinical populations that are present in the mental health services. Do you believe this to be a reason why clinicians feel research studies do not engage with them? If so, how could this be improved?

VM: The selection of specific criteria is often needed to be able to disentangle specific biological mechanisms, in particular when we try to understand what is behind a specific disorder/ illness. I think this is again part of a bigger picture, and if in itself might not give the ultimate answer clinicians need, it can, however, inform them about an important part of the whole process. As a clinician you always try to individualize the treatment for your patient; you know that some treatment or combination of treatments, which is good for someone might not be as good as for someone else, even when two people have the same diagnosis. One thing that you learn with time as a clinician is to extrapolate what, from research findings, is relevant to your specific patient. As researchers, we should try to be clearer about what mechanisms/part of the process we are trying to inform the clinician about.

Left: “Hosptial operating theatre,” Wellcome Trust Photo Library.

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About Valeria Mondelli

Dr. Valeria Mondelli is a Senior Clinical Lecturer at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, and liaison Consultant Psychiatrist, Outpatient Endocrinology Clinic, King’s College Hospital, and Locum Consultant Psychiatrist, Early Intervention Psychosis CAG, South London and Maudsley NHS Trust. At the Outpatient Endocrinology Clinic, Dr. Mondelli assess and review patients with neuroendocrinological conditions who experienced psychiatric symptoms (including depression, anxiety, and psychotic symptoms). At the Early Intervention Psychosis CAG, she treats patients experiencing their first episode of psychosis.

She is interested in the role of stress, and biological systems involved in the stress response, in the pathogenesis of psychiatric disorders, and in the interplay between physical and mental health. Valeria has studied the role of stress – and its biological mediators, like hormones and inflammation – in the risk of developing psychosis, in its clinical outcome and in the development of metabolic abnormalities. She has also conducted neuroimaging projects, showing a role of hypothalamic-pituitary-adrenal (HPA) axis hyperactivity in both the smaller hippocampal volume at psychosis onset, and the familial liability to schizophrenia. Currently, she is leading a project to investigate the involvement of inflammation in the pathogenesis of depression by testing whether inflammation in the periphery is associated with inflammation in the brain.

She started working as a consultant after completing the training in psychiatry at the Maudsley in 2013.

SS: This is undoubtedly a hot topical question. The broad issue is one of generalisation of research results, whether mechanistic studies or therapeutic trials, to the population we wish to serve. There are few approaches that can help to resolve this tension. One idea, advocated by the NIMH in the US, is to take much broader clinical research questions, unrestricted to any specific diagnoses. An example may be to better understand the brain mechanisms underlying hallucinations; working on the premise that there is a common parsimonious system underlying this experience, the sample would include may different diagnoses, schizophrenia, bipolar disorder, personality disorder, alcoholic hallucinosis, and so on.

Another idea is to stratify our samples to identify certain sub-groups, within the broad diagnostic criteria, that represent a more homogenous sample to test a specific hypothesis, or a particular treatment. This is predicated on the idea that the sub-samples need to be better specified, but eventually we will have subtyped all the main sub-groups in the diagnosis - in order to make our research useful. An example from breast cancer is the opportunity to sub-type and treat accordingly, based on assays of hormonal sensitivity.

SC: One of the aims of good research is to help clinicians make better decisions, in order to do so it should be easy to understand, apply a paradigm which does not bear just a theoretical value, and have meaningful results (beyond a statistic significance). Do you think the way research is designed and disseminated is up for it? How could this be enhanced?

VM: I may be an optimistic on this, but I believe research is fulfilling this ambition. Researchers always tune their ears to the issues raised from clinicians, it is a continuous challenge and it is what makes research alive.

SS: This is a case of arguing for a better understanding of the data, particularly the statistics and their association with the clinical utility of any research finding. Discussion with clinicians very easily identifies studies, which attempt to oversell research findings, as having major clinically relevance. All researchers should be in regular contact with clinicians to facilitate this kind of mutually beneficial discussion. Students at a research institute, such as the IoPPN, could easily use the KHP CAG system to link with clinicians, and would be great ambassadors for this approach.

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SC: Which recent papers would you single out as good examples of studies which embrace both good research and a sensible clinical approach?

VM: The first paper which came to my mind is “A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatmentresistant depression: the role of baseline inflammatory biomarkers.”2 It is a fantastic paper, which puts together the clinical challenge of finding a new effective treatment for patients with treatment resistant depression, and the study of neuroinflammation as pathophysiological mechanism contributing to onset of depression (which is possibly the hottest research topic in psychiatry today). For me it is a masterpiece!

SS: Obviously, any of the papers from our CSI Lab at the IoPPN! I would recommend a couple of studies, which use a really very interesting mix of ideas from very different research disciplines – to better understand some clinical phenomena – I’ve taken paranoid delusions as our exemplar here, although we have done a fair amount of research on hallucinations. The first is a brave study by Dan Joyce that addresses the question “how do we develop abnormal beliefs, such as paranoid delusions?” Dan is currently one of our trainee psychiatrists, but before studying medicine, he worked for many years as a post-doctoral researcher in computational neuroscience.

His research was published last year in Psychological Medicine, and the novelty lies in the thoughtful combination of sophisticated computational behavioural methodology, used to model how decision-making goes awry in patients with schizophrenia. Another excellent example of an

“Human DNA,” Wellcome Trust Photo Library

eclectic combination of disciplines being combined was in a series of studies by Anne Fett and Paula Gromann to answer the question “how can understanding the development of trust, help to understand paranoia?” They used a mixture of techniques from behavioural economics, psychology allied to cutting edge brain imaging, to describe mechanisms used in social interactions.

In classical fashion, I’ve described the questions linking interesting clinical observation with an appropriate yet novel methodology, now it’s up to you to take this curiosity forward; look up the papers! v

References

1. Jorge Luis Borges, “The Theologians” (included in the collection: ‘The Aleph and Other Stories,’ 1933-1969).

2. Raison et al. JAMA, 2013;70(1):31-41.

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Want to write for our magazine?

We are always looking for new writers, editors, and artists from amongst university students and junior researchers at the IoPPN. If you are interested in submitting articles, joining the editorial board, or contributing artwork to The Looking Glass, contact us at: thelookingglass.ioppn@gmail.com

EDITORS-IN-CHIEF Sophie Smart Maurissa Mesirow Sasha Walton

EDITORIAL BOARD Naunehal Matharu Malvika Katarya Nishita Bhembre

CONTRIBUTING WRITERS Holly Barker Simone Ciufolini Hannah Deen Zara Goozee Lan Mao Vera Mehler Emma Quinlan Sophie Smart Raphael Underwood Sasha Walton

WITH THANKS TO Valeria Mondelli Sukhwinder Shergill

ARTWORK AND IMAGES Cover artwork:: Maurissa Mesirow; pages 6-8, 18-22: Images obtained from Google Images (Google non-commericial reuse license);; pages 9-14, 29, 32-33, 48, and 50: Images obtained from the Wellcome Trust Library, London (non-commercial reuse); pages 16-17, 27, 34-43, 45, and 51: Images obtained from Wikimedia Commons; pages 26 and 30-31: Images obtained from the J. Paul Getty Museum; pages 27-28: Images obtained from Time To Change organization, UK (free reuse). Images of Rhianna Goozee kindly contributed by her.