Providentia

How Does COVID-19 Affect Dementia Patients?

The number of positive and death cases from coronavirus disease 2019 (COVID-19) is still increasing until now. One of the most prone individuals, even in normal situations is patients with dementia. Currently, no study provides clear evidence regarding the link between dementia and COVID-19. A new study published in the Archives of Gerontology and Geriatrics analyzes the relationship between dementia and poor outcomes of COVID-19 infection. The authors  systematically searched the PubMed and Europe PMC database using specific keywords related  to COVID-19 and dementia. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies. Statistical analysis was done using Review Manager 5.4 software. A total of 24 studies with 46,391 dementia patients were included in the subsequent meta-analysis. which showed that dementia was associated with composite poor outcome [RR 2.67 (95% CI 2.06—3.47), p< 0.00001, I² = 99%, random-effect modeling] and its subgroup which comprised of risk of COVID-19 infection [RR 2.76 (95% CI 1.43—5.33), p = 0.003, I² = 99%, random-effect modeling], severe COVID-19 [RR 2.63 (95% CI 1.41—4.90), p = 0.002, I² = 89%, random-effect modeling], and mortality from COVID-19 infection [RR 2.62 (95% CI 2.04—3.36), p< 0.00001, I² = 96%, random-effect modeling]. The authors concluded that extra care and close monitoring should then be provided to patients with dementia to minimize the risk of infections, preventing the development of severe and mortality outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

For the abstract

Why Are People So Skeptical About Psychology?

Why can't psychologists get respect?

A provocative article published a few years back in American Psychologist tackles that very question.  Written by the late Emory University psychologist , Scott Lilienfeld (also one of the co-authors of 50 Great Myths of Popular Psychology: Shattering Widespread Misconceptions about Human Behavior), the article examines why psychology has become the "Rodney Dangerfield of the sciences" with a public reputation for being unscientific. 

While the science of psychology has often faced legitimate criticism for overly depending on statistical significance testing, overly vague psychological models, and political correctness that limits legitimate scientific investigation into sensitive issues,  most of those criticisms have been raised by psychologists on the inside seeking to strengthen the discipline as a whole.  As a result, these disputes are often invisible to people outside psychology itself and public skepticism concerning psychology typically focuses on misunderstandings of what psychology is and the sorts of questions that psychologists attempt to answer.  

This pervasive misunderstanding can have far-reaching consequences.   Not only do elected politicians voting on science funding often short-change psychological research projects for not being "real science" (including omitting psychology from some funding agencies lists for  STEM disciplines), but potential mental health consumers who might otherwise benefit from psychological treatment may be reluctant to seek help due to misconceptions about what a psychologist actually does.

While psychologist advocacy groups (including the American Psychological Association and the Association for Psychological Science) have tried to fight back against these misconceptions, public attitudes concerning psychology and psychological research have been slow to change.  In 2006, the American Psychological Association Science Directorate released a pamphlet titled  Prepare Now to Prevail If Your Research is Attacked:  Self-Defense for the Psychological Scientist which basically advised researchers on how to defend themselves  against political, media, and public attacks that misrepresent their findings.   The pamphlet provides basic self-defense tips such as: 

• Be aware that the grant application abstract from your research is accessible to and searchable by the public and Congress and should describe your research in lay terms.
• Create an easy-to-understand, one-page summary of your research that illustrates why it is important to the public.
• Request media training from your university.  and
• Establish a relationship with your university’s public and legislative affairs office.

Unfortunately, as Dr. Lilienfeld pointed out in his article, efforts by researchers to fight misconceptions about their research are only mildly effective since they overlook the underlying reasons for widespread skepticism about psychology.   In addressing this skepticism, he focused on two basic questions:  a) are the negative views of psychology's scientific status held by many outsiders warranted? and b) what are the principal sources of the views?   

Negative media views about psychology date to the very beginnings of psychology itself with early psychologists such as William James who wrote uncritically about spiritualism and other pseudoscientific fads.  While other psychologists including Hugo Munsterberg and Theodore Flournoy distinguished themselves as skeptical debunkers, their efforts tended not to be so well-publicized.  Early attempts by forensic psychologists to prove the credibility of psychological research in the courtroom also helped damage the credibility of psychologists as a whole.  As one example, Harvard psychologist, Hugo Munsterberg, had a particularly troubling love-hate relationship with the media and his testimony during the 1907 Harry Orchard trial severely undermined the credibility of the fledgling science of forensic psychology for years afterward.  Regardless of the scientific merits of the research, media  controversies surrounding psychologists such as William Moulton Marston and his lie detector, B.F. Skinner' and his "Heir Conditioner", and Wilhelm Reich and orgone technology likely reinforced the view of mental health researchers as wooly-headed and unscientific.

Even in the the present day, numerous editorials and unflattering stories about psychological research are still common.  A 1982 New York Times editorial by Nicholas Wade reported on a Psychology Today survey that asked eleven psychologists to identify the most significant finding in psychology for the previous fifteen years.   The editorial, titled "If This is Consensus, Psychology Can't Be Much of a Science" used the lack of consensus among the polled psychologists and concluded that  "The results are astonishing: it would seem that there have been none".  The editorial's author added that the failed consensus "evinces a serious problem in their academic discipline".    It was during this same period that David Stockman, President Reagan's then-Director of the Office of Management and Budget justified the decision to slash behavioural science funding by declaring that psychology was a pseudo-science. 

Along with unflattering criticisms of psychology in the media, opinion surveys have indicated that large segments of society continue to view psychology as unscientific and that daily life experiences were often sufficient to provide most people with adequate exposure to make informed opinions about human behaviour.  One 1998 survey study found that both the general population and college faculty rated psychology and sociology as being significant lower than five other disciplines (biology, chemistry, economics, medicine, and physics) in terms of their "contribution of the discipline to society".  Psychologists were specifically identified as being lower in expertise than most other disciplines and that the general population was typically better off relying on "common sense".

A 2008 marketing study commissioned by the American Psychological Association reflected ongoing public misgivings about the scientific value of psychology.  While 82 per cent of study respondents agreed that psychological research helped to improve people's lives, only a minority of participants had a clear idea of what psychologists actually did or the full range of research issues addressed by psychological research.  The overwhelming consensus was that psychology is a "soft science" with less rigour than most other disciplines as well as requiring less time to develop expertise as opposed to other sciences.   Other studies have shown widespread skepticism about psychology's value to society compared to other scientific disciplines seen as more important.

But why is this skepticism so widespread?  According to Dr. Lilienfield, the skepticism often focuses on six common misconceptions about psychology that are often cited by critics:

• Psychology is merely "common sense"
• Psychology does not use scientific methods
• Psychology can not yield meaningful generalizations because everyone is unique
• Psychology does not yield repeatable results
• Psychology can not make precise predictions
• Psychology is not useful to society

While psychologists can respond to these misconceptions effectively, Dr. Lilienfield stresses that widespread skepticism is often reinforced by the slowness on the part of psychologist to weed out those questionable practice that often still thrive.   These practices include the continuing use of treatments and tests that do not have adequate scientific support such as alternative medicine, "recovered memories" of past abuse using hypnosis or other suggestive techniques, as well as the failure of psychologists to use the best evidence-based treatments to treat emotional or behavioural problems.   Of the thousands of self-help books (many of which prominently feature the authors as psychologists), only a small percentage actually off scientifically tested information.  These books often feature oversimplified advice or make elaborate claims that go well beyond established scientific research.   Also, there seems to be widespread resistance among psychologists to test established mental health treatments scientifically which can often feed into public skepticism.

In the end, this failure to police psychology as a whole means that media psychologists such as Dr. Phil McGraw and Dr. Laura Schlessinger (whose Ph.D is in physiology) are free to present themselves as psychology's public face and to dispense unscientific advice freely.  That  the American Psychological Association invited "Dr. Phil" to speak at its 2006 annual convention to highlight the effective communication of psychology to the public reflects the problem that many psychologists face in being accepted as scientists.  Even the very word "psychologist" is often a source of confusiondue to role diffusion between psychologists, psychotherapists, psychoanalysts, social workers, and psychiatrists who often provide highly similar services.   Surveys have consistently shown that large segments of the American general population are unable to distinguish between different mental health professionals.

Along with the general role confusion facing psychologists seeking acceptance, Dr.Lilienfeld also identified cognitive biases underlying public skepticism of psychological research.   These include hindsight bias (regarding a research conclusion as seeming obvious in hindsight),  that research questions addressed by psychologists are often perceived as less difficult to answer than questions addressed by scientists in other disciplines, the failure to distinguish basic from applied research, the popularity of reductionist explanations of human behaviour (including explanations based on neuroscience, biochemistry, and human evolution),  as well as the refusal to accept that certain subjects can be tested empirically at all, a.k.a  the scientific impotence excuse. 

So where does this leave us?   While large segments of the general population are still skeptical of psychology's value, survey data suggests some cause for optimism although there is considerably more that needs to be done.   As Dr. Lilienfeld points out, psychologists cannot blame their continuing credibility problems exclusively on public misconceptions.    The failure of psychologists to embrace evidence-based practices and to keep advocating treatments that have been shown not to work effectively is definitely part of the problem.  As well, we shouldn't let flashy media psychologists continue to be seen as psychology's public face instead of the more legitimate research psychologists who can provide a more balanced view of what psychology is really about.   Since academics are often reluctant to confront pseudoscience, misconceptions continue to flourish.

In his conclusion, Dr. Lilienfeld made the following recommendations:  on the individual level,  psychologists need to make a greater effort to make their work available to the public through popular writing (Daniel Kahnemann, Steven Pinker, Dan Ariely,  Christoper Chabris and Daniel Simons are all examples of psychologists who have written bestselling books on psychology).   On the institutional level, universities and psychology advocacy groups need to make a greater effort to integrate psychological research into psychology's public face instead of simply reacting blindly to controversies as they arise.  He also stresses the need to debate the often legitimate objections that many people raise to questionable practices in psychology and to weed out those fads that are ultimately damaging to our reputations as psychologists.  Psychologists should stop feeling threatened by public skepticism and learn to recognize that this skepticism can be a useful way of identifying potential problems in our profession and how we are seen by non-psychologists.

To close this post, I think Dr. Lilienfeld's closing words would probably work best:

Just as former New York City Mayor Ed Koch (1981) became famous for asking his constituents “How'm I doing?” as a means of gauging his performance, we as a field should continually be asking the general public “How are we doing?” and be prepared to take their critical feedback to heart if their answers are not to our liking

For the abstract.

 

Does the Gut Microbiome Affect How People Respond to Antipsychotic Medication?

Patients with psychosis usually respond to one antipsychotic drug and not to another; one third fail to respond to any. Some patients, who initially do well, stop responding. Some develop serious side effects even at low doses. While several of the reasons for this variability are known, many are not. A new review published in the journal Behavioral Brain Research examines the potential role of intestinal organisms in response/non-response to antipsychotics. Much of the literature in this field is relatively new and still, for the most part, theoretical. A growing number of animal experiments and clinical trials are starting to point, however, to substantial effects of antipsychotics on the composition of gut bacteria and, reciprocally, to the effects of microbiota on the pharmacokinetics of antipsychotic medication. Because so many factors influence the constituents of the human intestine, it is difficult, at present, to sort out how much one or more either enhance or dampen the benefits of antipsychotics or the character/severity of the adverse effects they induce. Dietary and other therapies are being devised to reverse dysbiosis. If successful, such therapies plus the modification of factors that, together, are known to determine the composition of microbiota could help to maximize the effectiveness of currently available antipsychotic therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

For the abstract

Sterilizing the Heiress

From the day she was born, Ann Cooper Hewitt's life consisted of one legal battle after another.  Born in 1914 from an extramarital affair between millionaire inventor Peter Cooper Hewitt and Maryon Bruguiere (later Maryon Bruguiere Hewitt D'Erlanger McCarter), it took a divorce from Peter's first wife and a belated marriage to Ann's mother to legitimize her.   Even then, Peter had to formally adopt his natural daughter given the laws against illegitimacy that were in force at the time.   This would lead to a long and vicious inheritance battle after Peter's death in 1921 as his siblings disputed Ann's right to her father's money.  Still, after years of legal wrangling, Ann's legitimacy was upheld and her father's estate would remain under the control of her much-married mother.   By the time she turned twenty-one, Ann seemed assured of receiving her inheritance and taking full control of her life.

And then her mother had her sterilized...

In an incredible lawsuit filed in a San Francisco court in January, 1935, Ann Cooper Hewitt, sued her mother. two San Francisco doctors, and a State Health Department psychiatrist of being part of a scheme to seize control of her estate by having her declared mentally incompetent and subsequently sterilized.   The suit, which called for $500,000 in damages, accused Maryon (then known as Mrs. McCarter) of years of riotous living, all funded by money embezzled from Ann's estate.   Along with gambling trips and numerous affairs, Maryon had been notorious for years with her frequent trips flitting between Europe, New York, and San Francisco.

Since the rise of the eugenics movement at the dawn of the 20th century, sterilization of people  deemed to prove "genetically unfit" had been perfectly legal across numerous countries in North America and most European countries.  For anyone suffering from mental illness, criminal behaviour, low intelligence, or virtually any other quality that might be deemed inferior, compulsory sterilization remained a popular option supported by numerous lawmakers and social reformers.  In the United States, the legality of compulsory sterilization had been upheld by the landmark Buck vs Bell Supreme Court decision of 1924 as well as numerous laws such as the 1924 Sterilization Act passed in Virginia.  Though countless patients would be sterilized, often without their knowledge, critics charging that people could be sterilized for even trivial reasons tended to be dismissed.

For Ann Cooper Hewitt, however, things were very different.   In the lawsuit filed by her attorneys, she maintained that her sterilization had taken place at a San Francisco hospital on August 18, 1934.   The surgeons who had carried out the operation, Tilton E. Tilman and Samuel G. Boyd, were two of San Francisco's most prominent doctors and had apparently received permission to carry out Ann's sterilization following an assessment by social worker Mary S. Scally.   According to Ann, she had no idea that she was being sterilized and that it had taken place while she was undergoing an emergency appendectomy.  As the lawsuit pointed out, the terms of Ann's trust fund were quite clear that Maryon would only inherit her late husband's estate if Ann died childless.  And so, the sterilization took place just months before her daughter turned twenty-one.

In responding to the allegations raised by the lawsuit,  both of the surgeons named admitted to the sterilization but insisted that they had examined Ann first and found her to be "feebleminded with the mental age of a child of 11 years."    This finding was apparently based on a battery of intelligence tests that Ann had undergone in 1934, apparently at her mother's urging, though Ann  had no idea why she was being tested.   As for Ann's mother, her lawyer insisted that the operation had been carried out "for society's sake" and further hinted that Ann had been sterilized due to her "erotic tendencies," evidence of which would be brought out in the courtroom if the case came to trial.  Almost immediately, Ann's lawyers responded with an affidavit from a New Jersey psychiatrist who had been close to Ann her entire life and who verified that she was "correctly oriented in all spheres."    Not only was Ann fluent in three languages, but she was well-read and articulate.    

In what was gearing up to be the trial of the decade, San Francisco's district attorney announced that Ann's mother and the two doctors would be charged with "mayhem", a crime that would legal to lengthy legal sentences for all three.    Though Ann was reluctant to press charges, both doctors were ordered held for trial.   As for Maryon McMaster, she apparently panicked due to her new notoriety.   Fleeing to New York, she registered at the Plaza Hotel under an assumed name and, after a week in hiding, was found in a New Jersey hospital following an apparent suicide attempt. 

When questioned about her reasons for Ann's sterilization, Maryon defended her decision by saying that Ann had already been expelled from numerous schools for "scandalous behavior" due to her "erotic tendencies."   She also insisted that Ann was "easily infatuated by men in uniform, regardless of their station."   Two years earlier, Ann had become intimately involved with a chauffeur and Maryon had been forced to step in to break up the relationship.  She also had to buy back letters reportedly written by her daughter which contained "references to things that should not be written about."   This, along with the intelligence test results, was enough for Maryon to agree with the doctors that Ann was "feeble-minded."

As for the doctors, their defense focused on California legislation authorizing sterilization for anyone committed to a home for the feeble-minded.   While this didn't apply to Ann, Tilton E. Tilman maintained that this still applied in her case.  Speaking as a member of the San Francisco Lunacy Commission, he stated that "where the family has sufficient means, the feeble-minded person is taken care of at home, but the situation is the same."   He also insisted that there was nothing unusual about being paid $8000 by Maryon to form his diagnosis, something he justified by the need to hire special nurses and the many hours he spent assessing her.  As for Samuel Boyd, who actually performed the surgery, he justified not telling anyone about the real nature of the operation, including Ann, because "it might cause harm to the girl's future."    How Ann was able to learn the truth about what was done to her is still a mystery.

After long legal haggling and behind-the-scenes negotiating, the case was settled out of court.  The two doctors were found not guilty due to lack of evidence and all charges were dropped against Ann's mother.  It's hard to say what kind of relationship Ann had with her mother afterwards but Maryon died just a few years later at the age of 55.    As for Ann herself, she married a garage foreman just a year after the case was dropped (her mother may have had a point about Ann's fondness for men in uniform).  This marriage ended quickly on the grounds of "mental cruelty" and Ann, who would be known to the press as the "sterilized heiress" for the rest of her life, would go on to marry five more times.  She died in 1956 at the age of 42 and left her entire estate to her sixth husband.   They had no children.

Despite the brief flurry of publicity over Ann's case, compulsory sterilization would continue to be practiced for decades after her case was settled.  While the eugenics arguments that were originally used to justify sterilization were discredited due to the gruesome revelations of Nazi war crimes, thousands of people would continue to be sterilized well into the 1960s and beyond, many of them with no idea of what had been done to them.  Few of them ever received the kind of publicity that followed Ann Cooper Hewitt, but their stories were likely just as important.  

Even if they have never been told.

 For more information

Nine-Year-Old Girl Plays Piano During Delicate Brain Operation

"I played the piano for at least 6 hours, I also played mobile games. I feel better now.” 

When the parents of nine-year-old Soumeya first brought her to the Birla Hospital in the city of Gwalior in India's Madhya Pradesh province, doctors soon realized that she had a dangerous brain tumour that would require major surgery for removal.    To reduce potential damage to other parts of the child's brain affecting vision, movement, or speech,  the doctors decided that an Awake Craniotomy procedure would give them the best chance for success.

First pioneered by Canadian neurosurgeon Wilder Penfield in the 1920s for the treatment of epilepsy, an awake craniotomy involves the removal of part of the patient's skull  to allow surgeons to operate directly on the brain while patients are awake and able to communicate with the surgical team.   Given the potential risk of accidentally damaging nerve tissue in other parts of the brain, the surgical team used a local anesthetic to numb pain only in the part of the head where the surgery was being performed.  As for surgery on the exposed brain itself, no anesthetic is needed as the brain has no pain receptors.  Along with being an extremely difficult procedure, an awake craniotomy also requires extraordinary cooperation among all the members of the surgical team, including the neurosurgeon, neurologist, and anesthesiologist.   

Monitoring a patient's mental functioning during the operation often involves having that patient engaging in familiar tasks, including playing a musical instrument or doing mental exercises or video games.  Knowing that Soumeya enjoyed playing music on a synthesizer,  the surgical team decided that having her play would allow them to monitor her mental functions during the course of the lengthy operation.  “The case was challenging but the operation was successful with our team’s efforts," said neurosurgeon Abhishek Chauhan .  "When we were operating we asked her to play the piano. There were chances for the child to slip into paralysis but she was conscious throughout the operation.”   Initial reports indicate that the surgery was a success and Soumeya is expected to make a full recovery.

Though common in North America since the 1980s, the use of awake craniotomies have since spread to Europe and across Asia.    The procedure is  expected to become more widely used  in Asian hospitals given the number of potential patients that can be helped and better recovery time compared to less radical methods.  While not all awake craniotomy patients are expected to serenade their surgical team with music,  staying awake during these operations allow patients to preserve physical and mental functions that they consider vital and to return to their normal lives as quickly as possible.

The Kallikak Problem (Part Two of Two)

Continued from Part One

Despite the appeal of Goddard's book to eugenicists, not everyone was persuaded by his  findings.   One 1912 review in the British newspaper Guardian was particularly scathing in challenging the book's hereditarian bias.  In the review, the anonymous author pointed out that "One wonders, with effect how, with the most careful inquiry, anyone could obtain a diagnosis of true feeble-mindedness for past generations.  The author lays stress on the point that the two branches of the family did not differ in point of environment except insofar as the difference was due to their own difference in character.  But he does not allow for the facts:  (1) that the original feeble-minded son was illegitimate and therefore in quite a different position from the respectable normals and (2) that this difference in environment is handed on just as much as the physical heredity is handed on and goes far to determine the subsequent intermarriages.   He also talks lightheartedly of sterilization, as though the only objections to it were "sentimental" and not founded upon a rational perception of the extreme danger to society involved in treating human beings after such a fashion."

Sadly, this particular reviewer was very much in the minority concerning the potential danger of using Goddard's book to highlight the dangers of people with "inferior" genes.   Most other newspapers, especially in the U.S.., hailed the book as a "natural object lesson in heredity" that highlighted the risks of unrestricted breeding.   One editorial published on November 21, 1912 gave the panicked observation that feeble-minded individuals were multiplying at "twice the rate of the general population" and that they might eventually dominate society as a result.  

But what really made Goddard's Kallikak study so appealing to different political factions was how it could provide ammunition for a variety of different political crusades.   Vice crusaders agitating about prostitution and assorted other "immoral practices" could (and did) argue that feeble-mindednesst could lead women to gravitate or be forced into lives of prostitution and that such women needed to be protected  for their own safety.  Though Goddard himself insisted that there wasn't enough available data to prove that feeble-minded women were prone to "professional vice", other pundits, many citing Goddard's book, called for crackdowns on the red light districts found in most cities.   

On the other hand,  pundits railing against the dangers of immigration also invoked Goddard's study to show that potential immigrants needed to be carefully screened to keep out feeble-minded candidates.   Not only would it prevent them from turning to crime in the U.S. but would also prevent them from contributing their own inferior genes to America's melting pot.   Almost inevitably, Goddard himself set up an intelligence testing office at Ellis Island just a year after his study came out.  His immigration study results, released in 1917, declared that as much as eighty percent of all immigrants. particularly immigrants from specific ethic groups, met his criteria for feeble-mindedness.  That Goddard himself later revised this to forty percent did little to curb the calls for more stringent immigration laws to keep these "undesirables" out, not to mention establishing quotas that would remain in place for decades afterward.  

As for whether Goddard's study helped bolster the case for compulsory sterilization of people like Deborah Kallikak, that seems harder to establish.  Though sterilization laws were already on the books in some parts of the U.S. (Indiana had one as early as 1907), they certainly became more popular in the years following the publication of Goddard's book.   Ironically, Goddard himself was much more moderate in his own proposed solution for dealing with people he considered to be feeble-minded.  While he advocated keeping them in institutions where they could be trained to do simple work, sterilization was widely seen as a much more effective (not to mention cheaper) alternative.    

This led many overzealous medical doctors  to begin sterilizing people they considered to be feeble-minded, often without any form of informed consent and with only shaky legal justification.  One prominent sterilization advocate was Dr. Albert Priddy, long-time director of the Virginia State Colony for Epileptics and Feeble-minded.  Though sterilization wouldn't become legal in Virginia until 1924, Priddy had already conducted hundreds of sterilizations by them,  often based on his own harsh eugenics beliefs    This included sterilizing women he regarded as being "immoral" for being "too forward"  (one underage girl was sterilized because she was in the habit of "talking to the little boys").   It hardly seems surprising that Priddy often invoked Goddard's research to justify his actions, even when  this got him into trouble as families began fighting back.  

All of which led to the egregious Carrie Buck case and what Albert Priddy would regard as his greatest legal victory.  Buck, who had become an inmate at the Virginia State Colony in 1924, was deemed to be mentally unfit, largely due to her "unrestrained" behaviour with the opposite sex and giving birth to an illegitimate child.  Using intelligence tests which would be considered completely spurious by modern standards, Buck, her mother, and her young daughter Vivian were all deemed to be mentally unfit and, as a result, ideal candidates for sterilization and a perfect test case for more stringent sterilization laws.

Priddy was certainly in fine form when testifying during Carrie Buck's initial trial in fighting the sterilization order and the later case before the Supreme Court as he presented his evidence .  Many of the most prominent eugenicists of the day also testified.   Add in the fact that Carrie Buck's own mediocre lawyer (who failed to call a single witness on her behalf) and the the final verdict was no surprise to anyone.   All of which led to the appalling Buck vs Bell Supreme Court decision of 1927 in which Oliver Wendell Holmes, then associate justice of the Court concluded publicly that "three generations of idiots are enough."

Ironically, Goddard's Kallikak study wasn't introduced as evidence at the trial, largely because Goddard himself had come to accept that the study was obsolete due to the many scientific errors that had been made.   This included many of the same points raised by that anonymous Guardian reviewer in 1912 as well as questions concerning the actual paternity of Martin Kallikak Junior.   To Goddard's credit, he was often horrified at how his research was being used by eugenicists and he dedicated much of his remaining life to reforming special education for intellectually disabled children as well as recognizing the role that environment played in mental development.  He died in 1957 with much of his early eugenics research being largely forgotten.  

But while the end of World War II and the horrendous example of Nazi persecution helped doom the eugenics movement worldwide, the existing laws concerning sterilization remained on the books for decades afterward.   Though the rationale was often changed, the end result was still the same and thousands continued to be sterilized well into the 1980s. For that matter, compulsory sterilization continues to be seen in other countries, usually directed against minority groups lacking the resources to fight back.  

Though the "Kallikak" name still crops up at times in news stories and opinion pieces as a byword for "white trash" (including being the name of an ill-considered situation comedy in 1977),  it has been largely forgotten except as a warning about he dangers of  this kind of research and easily such research can be used to promote misinformation.   It is a warning that remains relevant even today.

The Kallikak Problem (Part One of Two)

It's relatively rare for a research study to get much attention in non-academic circles.  Still, when the 121-page book titled, The Kallikak Family: A Study in the Heredity of Feeble-Mindedness, came out in 1912,  even the book's author, Herbert Henry Goddard,  didn't expect to see it become a best-seller.   But it was likely not that surprising for a book that Stephen Gould  would later call the “primal myth of the eugenics movement”.  

Goddard, the director of the psychological laboratory at the Vineland Training School  in Vineland, New Jersey, was already well-known for his work in eugenics and intelligence, a reputation that would be firmly cemented when his book came out.   When the Vineland School was founded in the 19th century as the "New Jersey Home for the Education and Care of Feebleminded Children", it quickly became one of the principal training centers for training children deemed incapable of functioning in normal schools.  Often dismissed as "cretins" and "imbeciles" throughout the late 19th and early 20th century, such children typically faced extreme hardship and abuse, something that Henry Goddard was determined to fight when he first took over the school's psychological laboratory in 1906. Already well-known for translating Alfred Binet's intelligence test into English and standardizing the test on Vineland's students, Goddard also established himself as a prominent eugenics researcher through his research into the genetic background of the students he dealt with at Vineland. (he would also introduce the term "moron" to the English language).  

As for his most famous work, it apparently began in 1898 when an eight-year-old girl identified only as "Deborah" first came to the Vineland Training School.   In describing Deborah to his readers, Goddard was emphatic in portraying her as having  " the mentality of a high-grade feeble-minded person, the moron, the delinquent, the kind of girl or woman that fills our reformatories. They are wayward, they get into all sorts of trouble and difficulties, sexually and otherwise."    To bolster his case for Deborah's feeble-mindedness, his verbal description of her included numerous references to the kind of "abnormal" behaviours to which she was prone, i.e., jerking movements while walking and a tendency to stare blankly when people spoke to her.

Additional proof of Deborah's feeble-mindedness came the newly-translated Binet Test which he had administered to all the Vineland students,   As Goddard wrote, "By the Binet Scale this girl showed, in April, 1910, the mentality of a nine-year-old child with two points over; January, 1911, 9 years, 1 point; September, 1911, 9 years, 2 points; October, 1911, 9 years, 3 points. (p. 11)."   He also added that, "Here is a child who has been most carefully guarded. She has been persistently trained since she was eight years old, and yet nothing has been accomplished in the direction of higher intelligence or general education. To-day if this young woman were to leave the Institution, she would at once become a prey to the designs of evil men or evil women and would lead a life that would be vicious, immoral, and criminal."  

But children like Deborah were hardly limited to training schools where they could be properly helped.   Under Goddard's guidance, the Vineland Training School sent out field workers to investigate the families of these children to learn more about their backgrounds.   Though these field workers were highly-trained, they were often ill-prepared to deal with the kind of deep-rooted poverty and social problems the families they studied often faced.   Instead, all they could do was make reports about what they found without any attempt at explaining why the families were as backward as they reported.  And, as Goddard himself concluded from these reports that: "The surprise and horror of it all, was that no matter where we traced them, whether in the prosperous rural district, in the city slums to which some had drifted, or in the more remote mountain regions, or whether it was a question of the second or the sixth generation, an appalling amount of defectiveness was everywhere found."  In other words, feeble-minded children came from feeble-minded parents.

As for Deborah, Goddard's investigators managed to trace her ancestry back for generations and discovered something that, to them, seemed remarkable.   Deborah's great-great-grandfather was a man identified only as "Martin Kallikak"  (I'll get into the significance of the name a little bit later.)   Prior to fighting in the American Revolution, Martin had become the father of an illegitimate child who would become Deborah's ancestor.   The boy's mother had given the child the same name as his father despite his illegitimate status and he passed this name down to his children.   During the course of Goddard's research into Martin Kallikak Junior's descendants, one hundred and forty-three of the nearly five hundred known descendants  they traced "were or are feeble-minded, while only forty-six have been found normal. The rest are unknown or doubtful."

But Martin Kallikak Senior had other children later in his life after marrying a "respectable girl of good family."   Despite having the same surname as the other Kallikak family branch, the descendants of Martin's legitimate children were much more illustrious.  As Goddard pointed out, "All of the legitimate children of Martin Sr. married into the best families in 
their state, the descendants of colonial governors, signers of the Declaration of Independence, soldiers and even the founders of a great university. There are doctors, lawyers, judges, educators, traders, landholders, in short, respectable citizens, men and women prominent in every phase of social life. There have been no feeble-minded among them; no illegitimate children; no immoral women. There has been no epilepsy, no criminals, no keepers of houses of prostitution."    It was the comparison of these two family branches which inspired the Kallikak pseudonym that Goddard assigned to Martin and his descendants (the name came from the Greek words καλός (kallos) meaning good and κακός (kakos) meaning bad).

In comparing these two family branches, Goddard concluded that feeble-mindedness, criminal behaviour, and immorality were basically genetic in nature, a finding very much in vogue at the time given the popularity of eugenics   In Martin Kallikak's case, having a child with a feeble-minded woman led to generations of crime, poverty, and social disorder, not to mention hundreds of descendants who ultimately became wards of the state (including Deborah Kallikak).   Goddard bolstered his arguments with elaborate family trees showing each family branch along with how the proliferation of positive and negative traits matched Gregor Mendel's own conclusions about genetic inheritance.   

Along with the elaborate family trees and verbal descriptions of the "feeble-mindedness" found in Deborah Kallikak and her relatives, Goddard also included numerous photographs presenting the "bad" Kallikaks in a menacing light. Later authors such as Stephen J. Gould would argue that the photos had been deliberately retouched to highlight their defectiveness though this remains controversial.   In all, Goddard's book was intended to be a searing indictment of the dangers of unrestricted breeding.   

While hardly the only study of its kind published up to that time, Goddard's book would prove to be the most influential.    It also established Goddard as of the the country's leading authorities in eugenics, the book would prove enormously influential in boosting public support for eugenics, both in North America and in Europe.  

Continue to Part Two

The Last Alchemist

Alchemy has a very long history.

First believed to have been practiced in Ancient Persia, the ancient dream of endless wealth and immortality has enticed practitioners for thousands of years. While attempts to transmute lead into gold or create the elixir of life have always ended in failure, the lure was enough to entice famous scientists such as Roger Bacon, Tycho Brahe and Isaac Newton to give it a try. Still, by the 18th century, there was enough skepticism for alchemy to be dismissed as a fantasy by the scientific community.

Which brings us to James Price...

Born in 1752, his original name was actually Higginbotham but he changed it to Price when a wealthy relative left him a legacy. After distinguishing himself at Oxford by earning various degrees, he became a member of the Royal Society at the age of 29. Although Price seemed set for an eminent career in science, he began to concentrate a more unconventional line of research: transmuting base metals into precious metals (particularly turning mercury into gold). 

Unfortunately for Price, whatever respect alchemists claimed in previous centuries had long since evaporated by his time. After telling a few of his friends that he had been successful in his strange research, Price became the subject of some fearful whispering among fellow chemists. It was this public skepticism that caused him to begin a series of public demonstrations of his transmutation process. The process centered on a special "powder of production" that could transform mercury and other base metals into gold or silver "under special circumstances".   He conducted seven public experiments beginning on on May 6, 1782 and ended on May 25th. With various peers, baronets, clergymen and chemists in attendance, Price mixed borax, niter, mercury, and other assorted chemicals and produced small amounts of gold and silver that he later presented to King George III.

The initial reaction was certainly positive. Oxford University bestowed a Doctor of Medicine degree on Price and there was tremendous demand for the written account of his experiments. Anyone remembering the cold fusion debacle some time  back can appreciate the tremendous enthusiasm resulting from the news of Price's discovery. The notion of endless wealth being produced for England through alchemy was certainly intoxicating (setting aside the fact that gold was mainly valuable because it was scarce). Since James Price was a respected and wealthy scientist who came from a distinguished family, the possibility that he might have faked his results seemed unthinkable.

But the Royal Society wasn't quite so accepting.  When Price refused to provide additional details about his discovery, they then insisted that he repeat his experiments under controlled conditions to rule out the possibility of error.   Instead, downplayed his earlier success and insisted that his powder of production was too expensive to make in large quantities.  He added that the process of creating gold wasn't as cost-effective as he had previously assumed and that the cost of ingredients was greater than the cost of the gold produced. While insisting that his experiments were of scientific value, he argued hat there would be no point in repeating them.

The president of the Royal Society, Joseph Banks, flatly told Price that his scientific reputation was at stake as well as the reputation of the Royal Society itself. Price, in return, claimed to be the victim of persecution and that his reputation ruled out any possibility  of deceit. By then, even Price's friends had become distressed by his refusal and finally persuaded him to produce more of his powder of production for the Royal Society to examine. He left London in January, 1783 and returned to his Guildford laboratory. Although he had promised to return in a month, nothing more was heard from him for six months when he finally returned to London. Inviting as many members of the Royal Society as he could to his Guildford laboratory, he arranged for a demonstration on August 3rd of that same year.

Price's reputation had already been damaged by his long delay and even most of his friends had deserted him by the time of his demonstration. That only three members of the Royal Society showed up on August 3rd was probably the last straw for Price. After greeting his guests cordially, he stepped away from them and drank a vial of what would later turn out to be poisonous.  When Price began to collapse, his visitors tried to help him but it was too late. Before they could arrange for medical attention, James Price was dead.

An investigation would later find that Price had recently written his last will and testament and wrapped up his affairs before calling for the demonstration. Despite intense speculation over why Price had staked his professional reputation (and his life) on his strange fixation with alchemy, no real explanation was ever found. It's probably likely that he had deceived himself into believing that he was successful and, little by little, resorted to deception to avoid disgrace. Suicide may have been the only solution for the mess that he had created for himself.

James Price's suicide marked the end of alchemy in the United Kingdom (though it lingered on in other parts of the world). His sad fate represents an object lesson in how easy it is to be seduced by the prospect of fame and fortune as well as how hard it is to admit that you're wrong. Too many other would-be discoverers have learned this the hard way.

Depletion of gut microbiota is associated with improved neurologic outcome following traumatic brain injury.

Signaling between intestinal microbiota and the brain influences neurologic outcome in multiple forms of brain injury. The impact of gut microbiota following traumatic brain injury (TBI) has not been well established. The objective of a new study in the journal Brain Research was to compare TBI outcomes in specific pathogen-free mice with or without depletion of intestinal bacteria. Adult male C57BL6/J SPF mice (n = 6/group) were randomized to standard drinking water or ampicillin (1 g/L), metronidazole (1 g/L), neomycin (1 g/L), and vancomycin (0.5 g/L) (AMNV) containing drinking water 14 days prior to controlled cortical impact (CCI) model of TBI. 16S rRNA gene sequencing of fecal pellets was performed and alpha and beta diversity determined. Hippocampal neuronal density and microglial activation was assessed 72 h post-injury by immunohistochemistry. In addition, mice (n = 8–12/group) were randomized to AMNV or no treatment initiated immediately after CCI and memory acquisition (fear conditioning) and lesion volume assessed. Mice receiving AMNV had significantly reduced alpha diversity (p < 0.05) and altered microbiota community composition compared to untreated mice (PERMANOVA: p < 0.01). Mice receiving AMNV prior to TBI had increased CA1 hippocampal neuronal density (15.2 ± 1.4 vs. 8.8 ± 2.1 cells/0.1 mm; p < 0.05) and a 26.6 ± 6.6% reduction in Iba-1 positive cells (p < 0.05) at 72 h. Mice randomized to AMNV immediately after CCI had attenuated associative learning deficit on fear conditioning test (%freeze Cue: 63.7 ± 2.7% vs. 41.0 ± 5.1%, p < 0.05) and decreased lesion volume (27.2 ± 0.8 vs. 24.6 ± 0.7 mm3, p < 0.05). In conclusion, depletion of intestinal microbiota was consistent with a neuroprotective effect whether initiated before or after injury in a murine model of TBI. Further investigations of the role of gut microbiota in TBI are warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

For the abstract

Are Dementia Rates Actually Declining?

With an estimated 47 million people l worldwide living with dementia and a rapid aging of the population in most places, researchers and health agencies have long been warning of a "gray plague" with new dementia cases tripling over the next three decades.   Along with a tripling of the socioeconomic costs of caring for these additional dementia patients, health care systems worldwide are expected to be increasingly overwhelmed as dementia care competes with the other health care needs in an aging population.   

But a new study published in the journal Neurology suggests that this projected burden of dementia care may not be as dire as previously studies have reported.   The study presents the results of a comprehensive research project, the Alzheimer Cohorts Consortium  (ACC).  combining nine cohort studies conduct across the United States and Europe examining thousands of individuals over the age of 65 between 1988 and 2015.   The countries included in the combined study were the United States, France, the Netherlands, Sweden, the United Kingdom, and Iceland.  With over 49,202 participants (59 pecent female), the ACC combined demographic and medical data including type of dementia diagnosis.  Overall, 4,253 of the study participants had developed some form of dementia by 2015 with the incidence of dementia steadily increasing with age.  

Contrary to expectation though, the researchers found a 13 percent decrease in all-cause dementia per decade since 1998.  A similar decrease turned up for cases of Alzheimer's disease alone with men showing a much higher decrease than women (24 percent vs 8 percent).   Based on these results, and assuming that this trend continues in Europe and North America over the next few decades, then 15 million fewer people may develop dementia by 2040 in high-income countries alone.  If the this same trend could be achieved worldwide, there could be 60 million fewer new cases of dementia by 2040.   

To read more, check out my new Psychology Today blog post.