Monday, October 28, 2019

Film review: "Hereditary" (2018)

"Hereditary" is the debut feature film of Ari Aster, who more recently has released "Midsommar", and previously directed a number of short films, including "The Strange Thing about the Johnsons". Although Aster's work in general tends towards the scary, "Hereditary" is his film most firmly placed within the horror genre, though at its heart it is a family tragedy. Ellen, the late matriarch of the family, doesn't have a speaking role in the film. Nonetheless, her death is a catalyst for the story, or rather it is at a surface level, as the events that unfold appear to have already been part of Ellen's more long-term machinations.

Grief is a clear theme of this film, but guilt is also dealt with in some depth. In the aftermath of death, Annie (played by Toni Colette) argues not only about to whom blame should be given, but also about the depiction of the death in her own work as an artist. When her husband confronts her about how her son will react to it, she asserts that her work is a neutral or objective view of the incident. From the outside looking in, the work does appear to be reasonably objective, but of course no family member can approach such personal work without baggage. The apparent absence of guilt on Ellen's part (a note from Ellen cryptically promises "our rewards will be great") thus contrasts with her daughter's nuclear family, where guilt is deeply felt and passed from one person to the next.

Psychological disorder has been alluded to in many scary films over the years, with a differing level of flippancy, sympathy or exploitation. Annie's psychiatrist husband assumes that her fears of a supernatural evil are just manifestations of a disturbed mind, although Annie's view is ultimately vindicated. Perhaps more interesting is how Annie refers to a history of schizophrenia and psychotic depression in her family during a group therapy session. The idea of inheriting psychological disorder is always in the background, as discussed in some depth elsewhere, but given the supernatural element later in the film the viewer is left to wonder if mental disorder (at least in this family) is reified as a curse. Or perhaps paranoia and self-destruction are being framed as rational coping strategies in the face of some terrible, transcendent evil.

The film indulges in a few horror tropes while also adding some striking and original imagery. Towards the climax of the film, a sense of the uncanny is realised through the use of sound (or lack thereof) and unnaturally fluid or jerky movements. This creates a sense of unfamiliar terrain that's too often lacking in the horror genre. Small details are easy to miss-Annie appears to knock over a small bottle of paint, but on careful viewing it's clear that it falls over of its "own accord".

"Hereditary" is a rich and detailed movie that bears repeated viewing. Aster has said in interview that he wanted this film to be in the vein of modern horror classics of the 1970's such as "Don't Look Now" or "Rosemary's Baby". I think this film will be regarded as a classic of the genre decades from now. Having enjoyed "Midsommar" (though it's not quite so scary as this film), I am curious to see where Aster (who's still only 33) will go next.

Related posts
The psychology of tension and suspense

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Wednesday, October 2, 2019

Brain Health: Genes, lifestyle and dementia risk

PROBE is a free festival of science with hands-on activities and talks for the general public about research. Here's the script from my PROBE 2019 talk related to my current work, entitled "Brain Health: Genes, lifestyle and dementia risk".

Let’s imagine a women called Elizabeth. Elizabeth smokes 20 John Player Blue from the age of fifteen on, and never quits the cigarettes. She eats whatever she wants, which is mostly full of fat and sugar. After her retirement, she spends most of her days sitting on her couch, enjoying episodes of chats shows and soap operas. Elizabeth lives to be one hundred years old. On her 100th birthday, when a journalist asks her how she lived so long, Elizabeth attributes her longevity to drink a glass of Hennessy every morning, as well as her hatred of her next-door neighbour. Her theory may or may not be accurate.

Let’s imagine someone else called Grace, who has a reasonably healthy diet and gets quite a bit of exercise. After her retirement, Grace remains active in her community, taking part in classes and attending Mass every morning. Grace isn’t as lucky as Elizabeth. She develops Alzheimer’s disease at the age of 70, and dies of a heart attack at 72.

We’ve all heard stories like this. And it seems unfair. We’d like to think we live in a fair world, where  those who save up for the future always reap the benefits, rather than a world of risk and probabilities. We shouldn’t give in to fatalism about a healthy lifestyle-100 Graces will do better than 100 Elizabeths. But we still wonder why it doesn’t always work out that way. It’s likely that the difference between the Elizabeths and the Graces is at least partly due to random chance. However, besides our behaviour, our lifestyle and random chance, we all have a distinct genetic makeup.

The genes we inherit from our parents contain information for producing the proteins that make up our bodies. Diseases vary in the extent to which genetics plays a role. Huntington’s disease, which can lead to dementia, is highly heritable-if one parent has the relevant gene, there's a 50/50 chance their offspring will have it as well. However, most types of dementia, like the Alzheimer’s disease that Grace develops relatively late in life, are generally not so strongly associated with genetics. Nonetheless, some genes can increase your level of risk.

Grace has a particular form of the apolipoprotein E gene (or APOE gene for short). The APOE protein handles fats, including cholesterol, in the body, and is responsible for cerebral clearance of beta amyloid, a chemical that builds up in Alzheimer's pathology. If you have a particular form of the APOE gene called epsilon 4 then you are more likely to develop Alzheimer’s disease. Having this version of the gene does not mean that you will develop Alzheimer’s, it just increases the probability. Among the many other differences between Grace and Elizabeth, Elizabeth has the epsilon 2 version of the APOE gene, which means that she is at slightly lower risk. Again, this does not mean that she cannot develop Alzheimer’s, just that her risk is reduced. Although the APOE gene has a noticeable effect, it is likely that there are other genes that may play a role, and this is what researchers are keen to understand better.

In the research I will be conducting with my colleagues, we will study healthy older people aged over 60. This will allow for comparisons with people with various health conditions, including dementia. We will be conducting whole genome sequencing. For each person that takes part in the study, we will examine their entire genetic sequence-every letter of the DNA which carries the genetic information. We can think of this genome as a genetic fingerprint, unique to each individual. We will take a blood sample from everyone that takes part-this allows us to examine their genetic sequence. Because most genes only have a small effect, it’s important to have a large sample of participants, and we will be studying over 2,000 people for this study.

We will also be assessing lifestyle factors like diet, smoking and level of physical activity. We will assess cognitive performance-so how well you can do on tests of memory and attention. An example of a task would be how many words beginning with “C” you can think of in one minute. We will also look at mental health. Not only can depression have a negative effect on people’s ability to think; it is a risk factor for developing dementia.

We will be following people up every year to assess how they’re getting on, including whether they have developed any problems with their mental or cognitive health. This is a four year project, but we’re hoping to extend it by another four years, which will allow for a longer follow-up with people who take part. This allows us to see which factors are predictive of a decline in health over time; although very few people will have a decline over two or three years, this figure will likely increase after five or six.

A final thought. Although curiosity-driven research can lead to wonderful things, research often gets funded for practical reasons. People want to end up like Elizabeth, not like Grace. They’re afraid of developing dementia. But we should not let fear of dementia turn into stigma of people with dementia. And sometimes the most dangerous stigma is the stigma which we apply to ourselves. In trying to reduce our risk of getting dementia, we should not lose sight of the person who is living with the condition, whether that person is in a clinic, in our community, or even if that person is, or will be, us.

Related posts
Conference review: Reserve and resilience

You can follow me on Twitter: @ArchivePsych

Saturday, September 28, 2019

Book excerpt: Essay marking

The following excerpt sees protagonist David Hector marking a rather rushed effort on an essay:

I riffled through the papers until I came to Jessica’s essay. I was curious to see how she had done.
Social Psychology: Interpersonal attraction
By Jessica Kavanagh

Those who work in the Field of Psychology have long had been interested in studying interpersonal attraction for many years. Indeed, this is something of great interest to many people in the modern era as well. How do a man and a woman fall in love, and what are the social psychological processes involved in this?
Just what is attraction? This question has been the subject of major fascination to the great philosophers of our time, from Plato of classical philosophy up to modern experts such as Jordan Peterson. Oxford English Dictionary defies attraction as “The action or power of evoking interest in or liking for someone or something” and they give an example: “the timeless attraction of a good tune”. However, we are focused on attraction between humans, and in order to study this in a psychological matter we need a theory from leading psychologist who specialise in the area. The tripartite theory of love is an important and timely theory, a theme dealt with so properly by Robert Sternberg that I shall discuss it herein. 
First, we have passion. Sexual lust is an intense feeling, causing the person to become aroused. It may cloud people’s judgment; for example, an attractive woman with a sexy body will cause the men to make decisions that do not adhere to logical standards of rationality, or indeed to violate social codes, such is the intensity of his attraction. Every Saturday night one sees the streets of town full of young people hoping to engage in sexual intercourse with physically attractive members of the opposite sex. Nonetheless, passion entails with it an important component for romantic love as well. For example, a married couple may still be sexually attracted to each other and engage in passion.
Evolutionary theories of interpersonal attraction draw on the work of thinkers such as Darwin and Richard Dawkins. These are important for passion. Interpersonal attraction is important for the human species to spread it’s genes. A man aroused through passion will pass his genes onto a woman through intercourse with her. Future studies of the genes will help to unravel the mysteries of evolution. However, we should also be aware that some spiritual people believe that evolution is not true. This is all a big debate.   
Second, we have intimacy. This is an important concept, similar to friendship, related to feelings of intimacy in general (not just sexual feelings). People engage in social cognition in order to determine whether another person shares similar feelings and opinions to them. For example, they might see what music the other person likes in order to understand whether it is something they can share together. Such experiences incorporate the greater sense of intimacy between two people.  
Thirdly, and perhaps most importantly, commitment is an important component of love in Sternberg’s theory of love. Commitment is a big decision that couples make, for example moving in together or getting married. A survey of couples in the United States that up to 70% feel moving in together is an indication that they are ready to spend more time together. This could lead to the greater intimacy, as the couple are prepared to share more time with each one another. However, such commitment may also undermine passion, as the couple settle into a more routine relationship. Conversely, greater passion may result from people violating the rules and norms of their society, for example an extramarital affair, a workplace romance, or even through incest, although the last case is truly extreme!!! Having sex with one’s cousin is a taboo that societies would frown upon. 
Different types of love can be formed through a combination of the presence or absence of these three different components. I.e., the empty love is where there is commitment without intimacy or passion. This could happen in an arranged marriage, such as those that happen within the Muslim or other Asian communities. Another example is a companionate love, which is where there is intimacy and commitment, but not passion. This is typical of elderly couples who love each other very much, but are no longer sexually active due to the ageing process, which prevents them from engaging in intercourse. Thus the passion component is not present.
This essay is an opportunity for me to engage in personal reflection on the relevance of this topic for my own lifestyle. I am fortunate in that I have found a man for whom I have passion and intimacy, and perhaps with time there will be commitment, though there are obstacles in this case.
All in all, interpersonal attraction is important psychological process. Social psychology will help us to understand, though understanding the psychology underpinning social processes such as love and attraction. This is important for the propagation of our species, as well as for happiness in relationships. Many people struggle to find someone who loves them (these people are sometimes called “incels”-short for involuntary celibate, some of these have engaged in mass shootings in the United States, which some say is a mental disorder and others is a politically terrorist act, perhaps against feminists in the case of the incel cause). It will have a positive effect on them and on society if we can understand better how they can become more attractive to appropriate partners. It will be truly inspiring to see the future efforts of social psychologists to understand the forces of attraction, and perhaps help the incels with clinical psychology.

Oxford English Dictionary 
Peterson, Jordan (various). Lecture series (retrieved from youtube)
Plato (various).
Sternberg, Robert J. (present day). Website article outlining theory of love. 

Wednesday, September 11, 2019

Conference review: reserve and resilience in cognitive ageing and dementia workshop 2019

Having had the good fortune of receiving a generous travel award from its committee, I visited Washington D.C. for the Reserve and Resilience workshop. The meeting is the first of three annual meetings that aim to create a consensus around definitions of key concepts in this area, such as cognitive reserve, brain reserve, and resilience.

The conference had a very focused structure, with keynote speakers giving very brief presentations restricted to three PowerPoint slides. Each was required to give the definitions they used for key terms relevant to the meeting, such as cognitive reserve, brain reserve and resilience. This made visible some of the distinctions between how people in the field had somewhat different conceptualisations of the same words. To give just one example, in defining resilience, Catherine Kaczorowski included the repair and replenishment of the brain in response to damage, whereas Emrah Duzel was working with a definition of resilience as preventing a decline in neural resources in the presence of manifest pathology.

Such differences in how the same concept may be understood or operationalised could undermine replicability of research. For any given study, larger researcher degrees of freedom allowed by different definitions of the "same thing" could lead to Type 1 errors, and even if a further piece of research is labelled as a conceptual replication at one level, if the concept in question is being operationalised in different ways then it may not be that findings relating to specific outcomes are as reliable as we might think.

The keynote presenters talks were kept unusually short in order to allow more time for questions from the floor. Although this sometimes fell into people trying to plug their pet projects rather than grappling with the key problem of the meeting, there was some very productive discussion. One  point that influenced a lot of subsequent discussion is how the definitions we work with can be looked at at a conceptual, operational, and mechanistic level. There was also some discussion about whether to combine some terms, such as brain and cognitive reserve, although my impression was that by the end of the meeting the delegates felt that it still be useful to have the distinction between brain and cognition (notwithstanding the occasional statement that came close to endorsing a simplistic one-to-one correspondence between the brain and cognition).

The meeting closed with a commitment to continue working together between now and next year's meeting. The organisers are keen to promote data-sharing between people involved at the meeting to further collaboration. They have also helpfully made the presentation slides available online.

At larger conferences it can be easy to get lost when their range of topics are so broad and aims so diffuse, but this was a smaller and intensely focused meeting. The inclusion of three key papers to read posted in advance on the conference website was surely a statement of intent, and the organisers were careful throughout to keep pushing for the key aims of the meeting to try and sound out how we should talk about these concepts. By the close of the third meeting it is hoped that there should be some broad consensus on reserve and resilience-for anyone working in this area it will be worth feeding into this process in the coming two years.

Related posts
Conference review: APS Young Investigator colloquim

You can follow me on Twitter: @ArchivePsych

Saturday, August 24, 2019

Book excerpt: University 1

Here we see David Hector at the university where he works, sitting in on a gender studies lecture. We also get an introduction to David's enemy.

The novice lecturer in gender studies had taken the lectern; she resembled a frumpy bank manager. She was delivering introduction to gender studies; a module where students continued the time-honoured tradition of reading Andrea Dworkin as if she were the leading intellectual in social theory. For most of the preamble, the lecturer crossed her arms defensively in front of her, and she spoke straight into the microphone. She relied heavily on a PowerPoint presentation. Large blocks of text indicated quotations from various leading lights of postmodern thought. I was pretty sure I had seen these same slides being delivered verbatim by the Head of Department who had previously taken this module.

Nonetheless, compared to the Head of Department, this shrew seemed boringly sane. However, she hit her stride while “discussing” intersectionality, basically decrying racism without actually stressing anyone out by suggesting that women might actually have fewer rights in the Middle East. The students around me were making notes or checking phones; no one particularly put out by this weak, transparently poor content. I could have blended in more easily among my introduction to psychology students; this crowd all seemed under 25.

The lecturer asked if we had any questions thus far. I raised my hand, and spoke in a rather affected tone.

“Yes, I have a question that I would like to ask. Well, it’s really more of a comment. I am a trans woman who has been biologically male throughout my life. And I notice that in your lecture as a whole you don’t once mention trans issues. Giving that one of your learning objectives is ‘a deeper theoretical understanding of gender’, it seems that trans issues would be something worth exploring in your module?”

The lecturer began to flub, indicating that of course this was of importance. It was a topic we could cover in more depth in a later lecture. A few students were gazing at me impassively.

“If we can cover it in a later lecture, that’s fine. I just wanted to point out to you, and to all my fellow students here, that none of your radical feministic theory is valid unless it also accommodates myyyyy experiences. Not only am I not a cis person, but I also identify as non-ethnic, which I think speaks to the negation of intersectionality, when there is no identity to bisect.”

The lecturer was fumbling with her papers as I voiced this steaming heap of mumbo-jumbo, though a hint of irritation was creeping over her visible embarrassment. She thanked me for my comments and asked in as open a manner as possible if there were any further comments or questions on this matter. With silence from the actual students, she quickly got back to her script, mentioning that this first lecture was an overview, and not intended to be an exhaustive account of the relevant issues. Yet another temporary member of occasional teaching staff. Exploited for a cheap bit of teaching (and why not when you’re supposed to be fighting for better lives for women), she probably was scarcely a part of the department, and therefore no doubt was unaware that the head of the department was a trans-exclusionary radical feminist, and therefore pretty vulnerable to this kind of goading.

Someone walked past me down the steps at the centre of the lecture theatre. He reached the front row and turn to face me; I recognised him as a senior HR manager. Presumably he had been sitting behind me when I made my comments. He sat at a right angle to the lectern, side-eyeing me as the lecture continued. I stood up and walked briskly out of the theatre, the HR man approaching as I glanced back over my shoulder. He cornered me in the corridor and mentioned that this didn’t look good as a character reference for myself. 

“Oh, just a little prank. Academic freedom, you know.”

I had often seen this man driving (not reversing) his family hatchback into whatever non-disabled parking space was nearest the building, affording me a view of his Premier League team’s crest, as well as his pro-life stickers (tastefully small and free of toddler-like embryos). He was generally the first non-academic member of staff to show up for work. On occasions when I arrived around the same time, I would hear something like Coldplay or Nickelback pulsing behind his closed windows.

He had appeared at the afters of a departmental Christmas party one year, squeezing his seat between myself and one of my actual colleagues, his tie loosened and a single shirt button undone. He spoke above the din of the late bar, voicing cliché upon cliché about political correctness gone mad through his breath of mass-produced beer. His pauses and hand gestures conveyed disillusionment with his chosen job at some ethical level. I replied just loud enough to be audible to him.

“You seem to be saying that you’ve sold out some of your own values. And yet your current behaviour is consistent with your chosen career of inserting yourself into others’ business.”  

Outside the gender studies lecture, he literally wagged a finger at me as he warned me to watch myself. Where did they get this man from? I swept his wagging finger away with my hand and walked off.

Related posts:

You can follow me on Twitter: @ArchivePsych

Saturday, August 17, 2019


Media doesn't come to us from without- we get the media we demand. Stories tap into the fear and neurosis of our times sell.

I'd rather raise questions than level accusations, but it's worth thinking about the number of times dementia has come up in recent and not-so-recent TV shows. While the older Sherlock Holmes sketch in Mitchell and Webb show has a high degree of pathos, a sketch from a reunion of The Fast Show is played more for laughs, albeit there is pathos (I think) here as well. Besides comedy, the Black Mirror episode Playtest plays dementia for the horror genre.

It is perhaps not surprising that the horror and comedy have dealt with dementia-these genres often trade on the collision between our subjective sense of self and the objective world around us, seen at a distance from a third person's perspective. What could be a more intense version of this than the juxtaposition of a person's subjective life story and their sense of autonomy with the undermining of this by structural or functional damage within their brain?

Where does entertainment or even raising awareness etc. start to descend into exploitation? There are many facets to this, but one point I'll make is that although depictions of dementia can be used to inject an emotional punch into a story, this isn't so great if it just leaves the viewer with a sense that dementia is the worst thing that could happen to anyone, as if there were no help whatsoever. People with dementia can have a good quality of life. The understand together campaign is aiming to tackle stigma towards people with dementia:

Related posts
Stigma "goes meta"
The loved ones

You can follow me on Twitter: @ArchivePsych

Sunday, July 28, 2019

It's all in your body, mind or soul: causal attributions for depression

Given how depression can manifest in different ways, and the multiple methods of intervention from talk therapy to pharmacological to lifestyle change to ECT, it is hardly surprising that people hold mixed opinions on where depression "comes from", and what the best choices are for help-seeking and therapeutic intervention.

A cool new study employed an online survey platform to run an experimental study of how different vignettes emphasising different causal attributions for depression might affect attitudes towards intervention, both in terms of help-seeking and treatment options. Although lifestyle interventions or psychotherapeutic treatment were generally preferred to medical intervention, a vignette that emphasised biological attributions (compared to social or biopsychosocial attributions) for depression reduced the perceived efficacy of less biological treatments

The results suggest that encouraging a less Cartesian, body OR mind understanding of the etiology of depression might affect attitudes towards different intervention modalities. Such an approach may help to overcome ethical concerns the authors raise of "manipulating" patient's attitudes/causal attributions towards major depression. Of course, it can be easier to say this than it is to achieve it, when it is so easy to lapse into traps such as, for example, using phrases like "medical treatment" to mean pharmacological treatment, even though many physicians prescribe things like exercise or going to a therapist for cognitive behavioural therapy.  

Interestingly, a clear majority of respondents to the online survey reported a history of major depression. Those with a personal history tended to rate a more medical approach to treatment more highly than people with no personal history of depression. Having a high proportion of respondents with a personal history of depression is not unusual or surprising, particularly as the study was advertised as examining treatment preferences for depression. It might nonetheless be interesting to see whether one would observe similar results in a large cohort of more clearly "naive" respondents (e.g. with no personal history of depression or history of depression in family/close friends, and who report no training/particular interest in major depression).

Nolan, A. & O'Connor, C. (2019). The Effect of Causal Attributions for Depression on Help-Seeking and Treatment Preferences. Journal of Affective Disorders.

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