Monday, May 29, 2017

Stigma "goes meta"

When Irish voters were about to go the polls for a referendum on gay marriage, something interesting happened. There were certainly people out there who were willing to express their opposition to such marriages, but within the mainstream Irish media, there seemed at times to be less debate about the referendum question itself, and more debate about whether you could voice a “No” opinion without being “labelled a homophobe”. In short:

The foregone conclusion*: full gay marriage should be legal

The controversy: Pfff, just because someone is opposed to this specific issue they are being labelled as prejudiced. Surprise surprise, here come the stereotypes about Catholics… 

I wonder if something slightly similar is happening with disclosure of mental disorder.

I daresay most people would voice their opposition to stigma of people with mental disorder (especially when phrased in such general terms as that). And yet…there is a fatigue setting in about certain things. One is famous people disclosing mental disorder. If there’s something about the person that may challenge stereotypes around mental disorder it might get a bit more attention (e.g. Bruce Springsteen is an energetic, strong and successful man of an older generation but has depression; rappers often project a tough exterior but, hey, they can have mental vulnerability as well). However, if A.N. Other Montrose kid with a trendy haircut cries on RTÉ as they disclose that they have suffered from depression, you can bet that some viewers are rolling their eyes.

The foregone conclusion: we do not stigmatise mental disorder

The controversy: here we go, another person “opening up” about how they feel a bit down sometimes and they got prescribed an SSRI by a lazy GP. You should feel a bit down, you’re a vacuous Irish sleb model! Here come the stereotypes about…

Does the analogy become a bit strained here? In the case of mental disorder, who are the perceived stigmatisers who are being stereotyped? Older people?  Some ethnic minority group? Of course, I couldn’t be stigmatising people with mental disorder-stigma is bad!

The Diagnostic and Statistical Manual of Mental Disorders generally indicates that the symptoms of mental disorder only become a disorder when it is associated with significant impairment, such as social or occupational functioning. Are we being “labelled as a stigmatiser” because we can’t work around the person who can’t come to work as they have depression? But the fact is, that person with depression is the only person on our current team who can do this specific task, and it needs to be done…

But, sorry, we were talking about public disclosure of mental disorder, not mental disorder itself. Or are we?

“Look, we know now that disorders like depression and anxiety disorders are really quite prevalent. Why do we still need to hear about how some celebrity has it?”

Perhaps we don’t need to hear them say it. But we should let them say it. Because we can’t be sure that the real issue here is freedom of speech, but rather that society has a problem with a certain group of people.

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*I realise it was actually not that much of a landslide, the “foregone conclusion” is just the vibe of a foregone conclusion coming from the mainstream media

Tuesday, May 23, 2017

Conference review: Dementia and fMRI

I am back where I did my PhD studies: Cardiff University. The research project I am newly involved in examines memory, dementia and brain imaging employing fMRI. I have come for a trip back to Cardiff for a focused meeting on fMRI and dementia, bringing together researchers and clinicians in the field from the UK and further abroad.

The talks open with some quite technical discussion of brain imaging acquisition and analysis. Although the mathematics and physics are generally beyond my level of comprehension (I’d need to learn more about the applications of complex numbers for a start), it does draw attention to how different algorithms can be used at various stages of the research process.

A big focus of the talks is on predicting who is at greater risk for developing dementia. An interesting talk by Tony Bayer discusses subjective cognitive decline as a precursor of mild cognitive impairment (which in turn precedes dementia). There is a surprising plethora of approaches in this area, although people working in this area have recently got together to try and create some consistency in how this area is investigated.

In terms of work addressing dementia directly, there is much discussion of Alzheimer’s Disease (the most prevalent form of dementia), but it’s also encouraging to see a lot of research in other forms of dementia (e.g. frontotemporal dementia, Lewy Body Dementia and rarer conditions such as posterior cortical atrophy). It’s also nice to see someone venture outside the hippocampus (a classic target for brain imaging in this area) to look at the cerebellum; Michael Hornberger highlighted that he has had trouble convincing reviewers of his research on the role of the cerebellum in dementia, although he did show interesting results from a meta-analysis in this area as well as his own data.

At lunchtime I take a tour of CUBRIC 2; a new brain imaging centre at Cardiff that builds on the success of the first phase of CUBRIC (Cardiff University Brain Research Imaging Centre). In addition to a high-resolution 7 Tesla fMRI scanner, it boasts a rare 3 Tesla connectome scanner, as well as TMS, MEG, EEG and sleep laboratories. It seems to be one of a number of new buildings coming online in Cardiff University, along with a new Innovation Centre nearby (I believe this will be more geared towards humanities and social sciences). One can only hope the Brexit fallout does not hold neuroimaging at Cardiff back from attracting the talent and research funding needed to keep a centre like this operating.

Back at the talks, it was great to see Dennis Chan (who has worked with Nobel Laureate John O’Keefe) outline some of the novel assessments of memory he has been using, including applications of virtual reality. The conference was grounded by a patient who spoke about her own experience of taking part in research. As someone who had been active in writing and teaching as a younger person, she had a great sense of loss of agency when she developed cognitive impairment. She described how taking part in research gave her the sense that she could in some way help others in the future.

The poster section is very small but very focussed and lively. Quite a few posters highlight new developments in methodology.

Next year’s meeting will be held at Cambridge. Given the level of focus, and the potential to meet researchers in the field at a relatively “intimate” meeting, it’s worth going if this is your area.

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