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How to Change Minds About Vaccine Safety

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Highlighting Consensus among Medical Experts Increases Public Support for Vaccines

Vaccines are one of the most effective global public health interventions. From a psychological perspective, we can view the individual decision to vaccinate as a classic social dilemma: if everyone cooperates we will all be better off but it only takes a small group of defectors to quickly ruin it for everyone. If enough individuals in a given population agree to get vaccinated, communities can protect themselves against potentially life-threatening diseases. For example, the smallpox virus was one of the world’s most devastating diseases. Thanks to a global immunization campaign coordinated by the World Health Organization (link is external), the disease was officially eradicated in 1980.

Author

Yet, when a small number of individuals decide to go against the societal norm to vaccinate, they (inadvertently) put entire communities at risk. This is so because unvaccinated people tend to cluster together geographically (link is external), which allows a virus to spread and take hold quickly. Fortunately, small outbreaks can often be controlled. What is concerning, however, is that such outbreaks are becoming more frequent. For example, the United States logged a record number (link is external) of measles outbreaks in 2014. It is one thing for people to decide that they are willing to put themselves at risk, it is another to put other communities or even the entire population at risk. The resurgence (link is external)of measles in the United States has been attributed to the impact of so-called “vaccine deniers”. To what extent should individual liberties come at the cost of others’ well-being?
Given the seriousness of the potential public health risks at stake, the psychological study of why some people decide not to vaccinate is receiving increased attention. It seems unlikely that people use religious, philosophical, or political motives to justify a concerted initiative to willingly put their fellow citizens and children at risk. We accept small risks everyday, from letting our children play outside to riding the bus. Of course, sometimes, the influence of extreme ideologies (particularly in disenfranchised communities) can trump the influence of other societal norms. For the majority, however, vaccine hesitancy is often motivated by influential misperceptions about vaccine risks. Indeed, popular examples (link is external) of misguided notions about how vaccines and the human immune system work range from the idea that vaccines cause autism and that one can catch the actual flu from the flu vaccine to conspiracy theories about “big pharma”, government “mind-control” initiatives and a “Western plot” to infect non-Western communities.
Some of these misperceptions can be influential and far-reaching. For example, about 50% of Americans indicate that they are “unsure (link is external)” about whether or not vaccines cause autism. General concerns about childhood vaccine safety have increased over the last decade as well. Although immunization rates are currently high in the United States, it is a slippery slope when people start acting on such misinformation. For example, doctors now frequently receive requests to “delay (link is external)” childhood vaccines. This trend is also evidenced by the astonishing backlash (link is external)against Mark Zuckerberg’s recent decision to vaccinate his baby. A functioning democracy requires that the public is well-informed. “If a majority believes in something that is factually incorrect, the misinformation may form the basis for decisions that run counter to a society’s best interest” (Lewandowsky et al., 2011).
Research has shown that it proves incredibly difficult to effectively communicate with the public about vaccine safety. A recent article in the Washington Post (link is external)suggests that people should stop calling anti-vaxxers “dumb” – this seems to be a rather mundane conclusion, clearly nobody likes to be called dumb!  On the other hand, so-called “meta-reviews” of pro-vaccine communication strategies are often inconclusive (link is external)about their general effectiveness. In fact, some studies (link is external)have shown that attempts to correct misperceptions can actually backfire and make people less likely to vaccinate.
Two major issues complicate these efforts:
1) First is the so-called “false media balance”. Journalists often follow a professional norm to present (anecdotal) examples about a topic in a seemingly “balanced” pro-and-con fashion. Research (link is external)by some of my colleagues has shown that such media impressions actually fail to emphasize the overwhelming amount of scientific agreement on vaccine safety, which, in turn, strongly influences how people think about the issue.
2) The other major issue is that much (if not most) of our communication efforts are  directed at trying to correct misinformation “myths” with the expectation that people will rationally respond to such a correction. However, research (link is external)in cognitive psychology has taught us that when we are trying to debunk a myth (e.g., that a long time ago, one fraudulent study incorrectly concluded that vaccines cause autism) the memory networks associated with the misinformation are activated and strengthened. Because it takes more cognitive effort for people to update their beliefs in light of new information, such strategies often just end up reinforcing the myth.
In a new study published in BMC Public Health (link is external), my colleagues and I set out to test a different approach: highlighting the level of normative agreement -or consensus- among medical scientists about vaccine safety. The benefit of communicating the extent to which medical experts agree about the safety of vaccines speaks directly to the points above: we correct the false media balance by highlighting the high degree of consensus AND, at the same time, we avoid having to repeat any type of “misinformation”.
Consensus information tells us how many experts, friends, or other people we care about agree on a particular issue of importance. We deal with consensus information all the time in daily life, from consensus on what restaurant dish is the most popular to consensus among critics about the quality of a particular movie. People are naturally inclined to pay attention to consensus because consensus cues often signal important information. For instance, think about the restaurant example. There is a good reason why a particular dish is the most “popular”, it has some quality that leads most people to enjoy it. In a complex and uncertain world, where we have limited time to decide on a particular course of action, we often have to make strategic “bets” on what decision is going to be the right one. Human reliance on consensus heuristics evolved because they are adaptive for survival. In fact, some recent neuroscientific (link is external)studies actually show that people experience a feeling of pleasure and reward when they learn that their opinions are in line with the (expert) consensus. There is a good reason for this positive association. For example, if 9 out of 10 doctors tell you that you need surgery right away, simply relying on the expert consensus will most likely be in the best interest of your health. Some of my colleagues refer to this notion as the “simple heuristics that make us smart”.
In our study (link is external), participants read one of the following treatment messages; “90% of medical scientists agree that vaccines are safe“, “90% of medical scientists agree that parents should be required to vaccinate their children” or a combination of both. In the control group, no information was provided (90% is actually a very conservative estimate (link is external)of expert consensus based on national surveys among doctors and medical scientists). In short, we found that after exposure, people (conservatives and liberals alike) were not only substantially more likely to understand that there is a strong consensus among medical experts about vaccine safety, participants were also less likely to think that vaccines cause autism or that childhood vaccines are risky, and more likely to vaccinate their children and support policies that require parents to vaccinate their children.
We generally find that people’s perception of the level of consensus among domain experts [medical scientists] functions as a “gateway” to changing other influential beliefs that people hold with regard to important societal issues. In other words, communicating consensus has the potential to correct influential misperceptions while cultivating science-based attitudes toward and public support for vaccinations.
I have written about the psychology of consensus (link is external) before. Of course, I am not suggesting that there is no need or place for people to learn exactly why vaccines do not cause autism or why you cannot catch the flu from a flu shot. The truth is that people care more about certain type of facts than about others and facts with social value (e.g., group consensus) tend to carry more weight. In an uncertain and complex world where people have limited time and attention, communicating the bottom-line is often what counts the most. In this case, that 90% of doctors all agree that approved vaccines are perfectly safe and that it is important for your health that you get yourself and your children vaccinated.

Further Reading
Center for Disease Control (CDC) Global Health – Vaccines and Immunization. Available from: http://​www.​cdc.​gov/​globalhealth/​immunization/​
Gellin, B.G., Maibach, E.W., & Marcuse, E.K. (2000). Do parents understand immunizations? A national telephone survey. Pediatrics, 106(5), 1097–1102.
Gust, D., Weber, D., Weintraub, E., Kennedy, A., Soud, F., & Burns, A. (2008). Physicians who do and do not recommend children get all vaccinations. Journal of Health Communication,13(6), 573–582.
Dubé, E., Gagnon, D., & MacDonald, N.E. (2015). Strategies intended to address vaccine hesitancy: Review of published reviews. Vaccine, 33(34), 4191–4203.
Dixon, G., & Clarke, C. (2013). The effect of falsely balanced reporting of the autism-vaccine controversy on vaccine safety perceptions and behavioral intentions. Health Education Research, 28(2), 352-359.
Lewandowsky, S., Ecker, U.K.H., Seifert, C.M., Schwartz, N., & Cook, J. (2012). Misinformation and its correction: continued influence and successful debiasing. Psychological Science in the Public Interest, 13(3),106–131.
Maibach, E. (2012). Knowing our options for setting the record straight, when doing so is particularly important. Psychological Science in the Public Interest, 13(3),105.
van der Linden S.L., Leiserowitz, A.A., Feinberg, G.D., Maibach, E.W. (2012). The scientific consensus on climate change as a gateway belief: Experimental evidence.    PLoS One 10(2), e0118489.
van der Linden, S.L., Clarke, C.E., & Maibach, E.W. (2015). Highlighting consensus among medical scientists increases public support for vaccines: Evidence from a randomized experiment. BMC Public Health, 15(1), 1207.

World’s Largest Wheelchair Painting

LOS ANGELES, Jan. 22, 2016 /– History will be in the making at Abilities Expo Los Angeles as hundreds of people with disabilities partake in the creation of the world’s largest wheelchair painting using innovative, adaptive art tools from Zot Artz Arts for All.
The annual expo, which takes place on February 5-7, 2016 at the Los Angeles Convention Center (West Hall A), will also feature an impressive line-up of exhibits, workshops, events, celebrities and activities to appeal to people of all ages with the full spectrum of disabilities—including physical, learning, developmental and sensory disabilities.
This artistic undertaking, named the Garden of PossAbilities, will begin as a 2300 square foot blank canvas on the Expo floor. Using unique rollers and stamps temporarily affixed to an individual’s wheelchair, the surface will be transformed into a masterpiece through layers of vibrant colors and patterns.
These adaptive art implements, designed by Zot Artz Owner Dwayne Szot, will allow people with disabilities to create art using their mobility device as a giant paint brush. In addition to participating in an historic event, artists will develop motor skills, social and emotional skills, concentration and self-esteem.
“The adaptive art events at Abilities Expo have always been enormously popular, so we are thrilled to offer this opportunity on such a grand, never-before-seen scale,” said Lew Shomer, co-owner of Abilities Expo. “Artists come away with a profound sense of accomplishment, which is a thrilling experience for them as well as for their caregivers to witness.”
The world’s largest wheelchair painting will unfold over the three-day Expo with up to 300 artists using 50 gallons of paint in a rainbow of glowing colors. Participation in creating the Garden of PossAbilities, as well as admission to the Expo, is free. Show hours are Friday 11 am to 5 pm, Saturday 10 am to 6 pm and Sunday 10 am to 2 pm.
“We at Zot Artz studio hope to create awareness and opportunities for individuals with disabilities while fostering creative expression,” said Szot. “Come and be a part of posterity, reaching beyond disabilities into abilities in a big, bold and beautiful way!”
For more information, visit www.abilities.com/losangeles.  

SOURCE Abilities Expo

RELATED LINKS
http://www.abilitiesexpo.com

Nonprofit Going the Distance to Support People With Autism

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Photo – http://photos.prnewswire.com/prnh/20160107/320070
NEW YORK, Jan. 7, 2016 /PRNewswire/ — As the New Year approaches, Special Citizens has a lot to look forward to in the year 2016. In August, Special Citizens will celebrate its 40-year anniversary of supporting people with Autism Spectrum Disorders.

 

“Operating for forty years in the human services landscape is a great milestone and this year, we are holding many special events that will commemorate this work and our future development,” says, Jessica Zufall, Ph.D. Chief Executive Officer.
How this event works is pretty simple, you register on our website. Starting on January 1st, you can walk or run one mile per day indoor or outdoors. Each day can log your workout through various apps on your phone or connect to your Garmin, Fitbit, Mapmyfitness, or Runkeeper.
If you do not have a device you can use our manual entry feature. Run or walk from anywhere in the world, even on your treadmill. As you log your workouts you will receive Google street views of the Florida Keys.
One of the most popular New Year’s resolutions is exercising in order to stay healthy and in shape. What better way to do this by participating in the challenge and supporting people with Autism at the same time?
Besides our Virtual Run, Special Citizens has a variety of events going on. There is our Sing For Autism challenge and our #askmeaboutaustism campaign. Special Citizens will celebrate their 40th anniversary on Monday August 15, 2016 with our first annual Golf outing. For more information click here.
Get registered today for the 40 Miles in 40 Days Virtual Challenge by clicking here!
Special Citizens is a non-profit organization committed to the development and delivery of a comprehensive, integrated system of services, which has as its primary purpose the promotion and attainment of independence, inclusion, individuality, and productivity for adults and children with Autism. 

SOURCE Special Citizens

Related Links

http://www.specialcitizens.org

The Aliens Have Landed!

Source: Jessica Kingsley Publishers
 

Jessica Kingsley PublishersYou can’t go far in reading what people diagnosed with an autism spectrum disorder (ASD) write about themselves before you come across aliens. You soon find them saying things like, “I felt like an alien, as though I had come to earth from somewhere else.” (p. 37 (link is external)) Other autistics have called their disorder “wrong planet syndrome,” (p. 9 (link is external)), and an autistic author who entitled her book Through the Eyes of Aliens (link is external) comments that “Many autistic people affectionately, humorously refer to themselves as aliens. They feel displaced on a vast planet, which has a code of life, and understanding they can’t ever quite subscribe to.” She calls them “mysterious Martians who don’t know the culture of the planet they have been misplaced on.” One of the world’s most eminent autistics, Temple Grandin, was described in an essay by Oliver Sacks entitled An Anthropologist on Mars, and Martian in the Playground (link is external) is the title of an award-winning book whose author recounts the fantasy of extra-terrestrials suddenly appearing to tell her that “It’s all been a dreadful mistake. You were never meant to be here. We are your people and now we’ve come to take you home.” A book for parents of “a child with Asperger syndrome or high-functioning autism” is entitled, Raising Martians from Crash Landing to Leaving Home (above). Perhaps not surprisingly then, an “online resource and community for Autism and Asperger’s” is entitled, WrongPlanet.net (below).

WrongPlanet.net
Source: WrongPlanet.net
 

Science fiction often portrays alien beings as immediately able to understand and to communicate with humans—even to the point of speaking English and having excellent manners! But a moment’s reflection is enough to show that in reality things would probably be very different. Human technology and material culture might be pretty much self-evident to any intelligent being able to travel here or communicate with us, simply because material culture exploits principles of science and technology which are universal. But we have no way of knowing whether the fundamental principles of human behaviour would be as self-evident to an extra-terrestrial species which might be biologically very different from us. It might take some time and careful analysis for aliens to begin to understand what are self-evident realities to us, such as the self, consciousness, or personal feelings. The very idea of the mind might be alien to the aliens, whose initial reaction to human beings might be wholly behavioural and completely lacking in the appreciation of mental factors such as intention, meaning, and emotion. In other words, extra-terrestrials might regard us as we might regard creatures very different from ourselves, such as plants, insects, or bacteria. And at the very least, actual extra-terrestrials, like human anthropologists who visit foreign cultures, would have to learn our languages and understand our cultural conventions: they would be Martian anthropologists on Earth, if you like.
Admittedly, this is just speculation about something that will almost certainly never happen. But there is a striking parallel to be drawn between alien beings and those diagnosed with ASD, as the titles and comments listed above suggest. Like real extra-terrestrials might be expected to be, many autistics are either totally mute or have serious verbal shortcomings. There is usually fluent speech in high functioning forms of ASD such as Asperger’s syndrome, but there are often also difficulties with conversation skills, such as a tendency to be pedantic or to interpret things literally. Even high-functioning autistics often have difficulty in understanding irony and metaphors, or show an inability to see what is funny in a joke—something that would almost certainly be true of actual aliens also, were we ever to encounter them. This is because irony, metaphor, and jokes rely on people’s everyday, common-sense knowledge of the world and other people, and extra-terrestrial visitors to Earth could be expected to be as deficient in this respect—if not more so—as autistics typically are.
In part, this may be because people with ASD often seem to be more interested in things, machines, facts or ideas than they are in people and their affairs, and it is not difficult to imagine that visitors from another planet might also lack the central concern with itself and its doings that is otherwise distinctive of the human race. And again like any actual aliens you could realistically imagine and who would almost certainly be physically very different from us, people with ASD are poor at recognizing and interpreting emotional expressions, gestures, and body language. Just like actual extra-terrestrial visitors to Earth would inevitably be, autistics are outsiders in relation to much of what goes on in normal human communication and are socially isolated and marginalized in their interactions with others. The result is that others perceive them to be weird, childish, or callous, and ask questions like “What planet is he from?” or “Who beamed her down?”
As a result of their unfamiliarity with our world, intelligent aliens would not necessarily show much interest in many things that we find important, but might instead focus their interest on objects that seemed to us peripheral, insignificant, or bizarre. And they might do this with an intensity and single-mindedness that we found hard to understand. Where their own behaviour was concerned, they would probably do many things with a rigour, regularity, and repetitiousness that we might not comprehend in the least—a bit like anthropologists amazing the natives by their insistence on writing everything down, taking photographs, or washing their hands. Autistic people are just like this, with single-minded interest in just one or a small number of things being typical—something which is often allied with a compulsion to stick to routines, avoid change, and engage in repetitious behaviour. This makes them seem not just alien, but incorrigible too: not only living in a world of their own, but to an often rigid time-table, and with fastidious compulsions and weird avoidances which exasperate others and alienate them further from normal human life.
And as if to underline my metaphorical parallel with aliens, Tony Attwood, a leading authority on high-functioning autism, adds that from his clinical experience he considers “that children and adults with Asperger’s syndrome have a different, not defective, way of thinking.” (p. 60 (link is external))
Autistics, in short, could properly be considered as the Earth’s resident extra-terrestrials. The aliens have landed!
(Extracted and condensed from my forth-coming book, The Diametric Mind: Insights into  AI, IQ, society, and consciousness: a sequel to The Imprinted Brain.)

The 10 Personality Disorders

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The study of human personality or ‘character’ (from the Greek charaktêr, the mark impressed upon a coin) dates back at least to antiquity. In his Characters, Tyrtamus (371-287 bc)—nicknamed Theophrastus or ‘divinely speaking’ by his contemporary Aristotle— divided the people of the Athens of the 4th century BC into thirty different personality types, including ‘arrogance’, ‘irony’, and ‘boastfulness’.

The Characters exerted a strong influence on subsequent studies of human personality such as those of Thomas Overbury (1581-1613) in England and Jean de la Bruyère (1645-1696) in France.
The concept of personality disorder itself is much more recent and tentatively dates back to psychiatrist Philippe Pinel’s 1801 description of manie sans délire, a condition which he characterized as outbursts of rage and violence (manie) in the absence of any symp- toms of psychosis such as delusions and hallucinations (délires).
Across the English Channel, physician JC Prichard (1786-1848) coined the term ‘moral insanity’ in 1835 to refer to a larger group of people characterized by ‘morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions and natural impulses’, but the term, probably considered too broad and non-specific, soon fell into disuse.
Some 60 years later, in 1896, psychiatrist Emil Kraepelin (1856-1926) described seven forms of antisocial behaviour under the umbrella of ‘psychopathic personality’, a term later broadened by Kraepelin’s younger colleague Kurt Schneider (1887-1967) to include those who ‘suffer from their abnormality’.
Schneider’s seminal volume of 1923, Die psychopathischen Persönlichkeiten (Psychopathic Personalities), still forms the basis of current classifications of personality disorders such as that contained in the influential American classification of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders 5th Revision (DSM-5).
According to DSM-5, a personality disorder can be diagnosed if there are significant impairments in self and interpersonal functioning together with one or more pathological personality traits. In addition, these features must be (1) relatively stable across time and consistent across situations, (2) not better understood as normative for the individual’s developmental stage or socio-cultural environment, and (3) not solely due to the direct effects of a substance or general medical condition.  
DSM-5 lists ten personality disorders, and allocates each to one of three groups or ‘clusters’: A, B, or C
Cluster A (Odd, bizarre, eccentric)
Paranoid PD, Schizoid PD, Schizotypal PD
Cluster B (Dramatic, erratic)
Antisocial PD, Borderline PD, Histrionic PD, Narcissistic PD
Cluster C (Anxious, fearful)
Avoidant PD, Dependent PD, Obsessive-compulsive PD
Before going on to characterize these ten personality disorders, it should be emphasized that they are more the product of historical observation than of scientific study, and thus that they are rather vague and imprecise constructs. As a result, they rarely present in their classic ‘textbook’ form, but instead tend to blur into one another. Their division into three clusters in DSM-5 is intended to reflect this tendency, with any given personality disorder most likely to blur with other personality disorders within its cluster. For instance, in cluster A, paranoid personality is most likely to blur with schizoid personality disorder and schizotypal personality disorder.
The majority of people with a personality disorder never come into contact with mental health services, and those who do usually do so in the context of another mental disorder or at a time of crisis, commonly after self-harming or breaking the law. Nevertheless, personality disorders are important to health professionals because they predispose to mental disorder, and affect the presentation and management of existing mental disorder. They also result in considerable distress and impairment, and so may need to be treated ‘in their own right’. Whether this ought to be the remit of the health professions is a matter of debate and controversy, especially with regard to those personality disorders which predispose to criminal activity, and which are often treated with the primary purpose of preventing crime.
1. Paranoid personality disorder
Cluster A comprises paranoid, schizoid, and schizotypal personality disorders. Paranoid personality disorder is characterized by a pervasive distrust of others, including even friends, family, and partner. As a result, the person is guarded and suspicious, and constantly on the lookout for clues or suggestions to validate his fears. He also has a strong sense of personal rights: he is overly sensitive to setbacks and rebuffs, easily feels shame and humiliation, and persistently bears grudges. Unsurprisingly, he tends to withdraw from others and to struggle with building close relationships. The principal ego defence in paranoid PD is projection, which involves attributing one’s unacceptable thoughts and feelings to other people. A large long-term twin study found that paranoid PD is modestly heritable, and that it shares a portion of its genetic and environmental risk factors with schizoid PD and schizotypal PD.
2. Schizoid personality disorder
The term ‘schizoid’ designates a natural tendency to direct attention toward one’s inner life and away from the external world. A person with schizoid PD is detached and aloof and prone to introspection and fantasy. He has no desire for social or sexual relationships, is indifferent to others and to social norms and conventions, and lacks emotional response. A competing theory about people with schizoid PD is that they are in fact highly sensitive with a rich inner life: they experience a deep longing for intimacy but find initiating and maintaining close relationships too difficult or distressing, and so retreat into their inner world. People with schizoid PD rarely present to medical attention because, despite their reluctance to form close relationships, they are generally well functioning, and quite untroubled by their apparent oddness.
3. Schizotypal disorder
Schizotypal PD is characterized by oddities of appearance, behaviour, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia. These latter can include odd beliefs, magical thinking (for instance, thinking that speaking of the devil can make him appear), suspiciousness, and obsessive ruminations. People with schizotypal PD often fear social interaction and think of others as harmful. This may lead them to develop so-called ideas of reference, that is, beliefs or intuitions that events and happenings are somehow related to them. So whereas people with schizotypal PD and people with schizoid PD both avoid social interaction, with the former it is because they fear others, whereas with the latter it is because they have no desire to interact with others or find interacting with others too difficult. People with schizotypal PD have a higher than average probability of developing schizophrenia, and the condition used to be called ‘latent schizophrenia’.
4. Antisocial personality disorder
Cluster B comprises antisocial, borderline, histrionic, and narcis- sistic personality disorders. Until psychiatrist Kurt Schneider (1887-1967) broadened the concept of personality disorder to include those who ‘suffer from their abnormality’, personality disorder was more or less synonymous with antisocial personality disorder. Antisocial PD is much more common in men than in women, and is characterized by a callous unconcern for the feelings of others. The person disregards social rules and obligations, is irritable and aggressive, acts impulsively, lacks guilt, and fails to learn from experience. In many cases, he has no difficulty finding relationships—and can even appear superficially charming (the so-called ‘charming psychopath’)—but these relationships are usually fiery, turbulent, and short-lived. As antisocial PD is the mental disorder most closely correlated with crime, he is likely to have a criminal record or a history of being in and out of prison.
5. Borderline personality disorder
In borderline PD (or emotionally unstable PD), the person essentially lacks a sense of self, and, as a result, experiences feelings of emptiness and fears of abandonment. There is a pattern of intense but unstable relationships, emotional instability, outbursts of anger and violence (especially in response to criticism), and impulsive behaviour. Suicidal threats and acts of self-harm are common, for which reason many people with borderline PD frequently come to medical attention. Borderline PD was so called because it was thought to lie on the ‘borderline’ between neurotic (anxiety) disorders and psychotic disorders such as schizophrenia and bipolar disorder. It has been suggested that borderline personality disorder often results from childhood sexual abuse, and that it is more common in women in part because women are more likely to suffer sexual abuse. However, feminists have argued that borderline PD is more common in women because women presenting with angry and promiscuous behaviour tend to be labelled with it, whereas men presenting with similar behaviour tend instead to be labelled with antisocial PD.
6. Histrionic personality disorder
People with histrionic PD lack a sense of self-worth, and depend for their wellbeing on attracting the attention and approval of others. They often seem to be dramatizing or ‘playing a part’ in a bid to be heard and seen. Indeed, ‘histrionic’ derives from the Latin histrionicus, ‘pertaining to the actor’. People with histrionic PD may take great care of their appearance and behave in a manner that is overly charming or inappropriately seductive. As they crave excitement and act on impulse or suggestion, they can place them- selves at risk of accident or exploitation. Their dealings with others often seem insincere or superficial, which, in the longer term, can adversely impact on their social and romantic relationships. This is especially distressing to them, as they are sensitive to criticism and rejection, and react badly to loss or failure. A vicious circle may take hold in which the more rejected they feel, the more histrionic they become; and the more histrionic they become, the more rejected they feel. It can be argued that a vicious circle of some kind is at the heart of every personality disorder, and, indeed, every mental disorder.
7. Narcissistic personality disorder
In narcissistic PD, the person has an extreme feeling of self-importance, a sense of entitlement, and a need to be admired. He is envious of others and expects them to be the same of him. He lacks empathy and readily exploits others to achieve his aims. To others, he may seem self-absorbed, controlling, intolerant, selfish, or insensitive. If he feels obstructed or ridiculed, he can fly into a fit of destructive anger and revenge. Such a reaction is sometimes called ‘narcissistic rage’, and can have disastrous consequences for all those involved.
8. Avoidant personality disorder
Cluster C comprises avoidant, dependent, and anankastic personality disorders. People with avoidant PD believe that they are socially inept, unappealing, or inferior, and constantly fear being embarrassed, criticized, or rejected. They avoid meeting others unless they are certain of being liked, and are restrained even in their intimate relationships. Avoidant PD is strongly associated with anxiety disorders, and may also be associated with actual or felt rejection by parents or peers in childhood. Research suggests that people with avoidant PD excessively monitor internal reactions, both their own and those of others, which prevents them from engaging naturally or fluently in social situations. A vicious circle takes hold in which the more they monitor their internal reactions, the more inept they feel; and the more inept they feel, the more they monitor their internal reactions.
9. Dependent personality disorder
Dependent PD is characterized by a lack of self-confidence and an excessive need to be looked after. The person needs a lot of help in making everyday decisions and surrenders important life decisions to the care of others. He greatly fears abandonment and may go through considerable lengths to secure and maintain relationships. A person with dependent PD sees himself as inadequate and helpless, and so surrenders personal responsibility and submits himself to one or more protective others. He imagines that he is at one with these protective other(s), whom he idealizes as com- petent and powerful, and towards whom he behaves in a manner that is ingratiating and self-effacing. People with dependent PD often end up with people with a cluster B personality disorder, who feed on the unconditional high regard in which they are held. Overall, people with dependent PD maintain a naïve and child-like perspective, and have limited insight into themselves and others. This entrenches their dependency, and leaves them vulnerable to abuse and exploitation.
10. Anankastic personality disorder
Anankastic PD is characterized by excessive preoccupation with details, rules, lists, order, organization, or schedules; perfectionism so extreme that it prevents a task from being completed; and devotion to work and productivity at the expense of leisure and relationships. A person with anankastic PD is typically doubting and cautious, rigid and controlling, humorless, and miserly. His underlying anxiety arises from a perceived lack of control over a world that eludes his understanding; and the more he tries to exert control, the more out of control he feels. In consequence, he has little tolerance for complexity or nuance, and tends to simplify the world by seeing things as either all good or all bad. His relationships with colleagues, friends, and family are often strained by the unreasonable and inflexible demands that he makes upon them.
Closing remarks
While personality disorders may differ from mental disorders like schizophrenia and bipolar disorder, they do, by definition, lead to significant impairment. They are estimated to affect about 10 per cent of people, although this figure ultimately depends on where clinicians draw the line between a ‘normal’ personality and one that leads to significant impairment. Characterizing the ten personality disorders is difficult, but diagnosing them reliably is even more so. For instance, how far from the norm must personality traits deviate before they can be counted as disordered? How significant is ‘significant impairment’? And how is ‘impairment’ to be defined?
Whatever the answers to these questions, they are bound to include a large part of subjectivity. Personal dislike, prejudice, or a clash of values can all play a part in arriving at a diagnosis of personality disorder, and it has been argued that the diagnosis amounts to little more than a convenient label for undesirables and social deviants.

Neel Burton M.D.

Neel Burton M.D

Mind, Emotion, and the Spectrum of Autism

Daniel J.  Siegel M.D. 

Daniel J. Siegel M.D.
Last month was Autism Awareness month and I’m writing today to remind us that autism continues to be a compelling global issue that consumes the tireless efforts of families and professionals throughout the year.
In our human family, there are many ways the now seven billion (and rising) of us live in the world.  Our culture shapes our communication with each other interconnecting us across the planet in our fast-moving digital age.  Human societal change unfolds as cultural evolution influences us by way of how our interactions with each other shape us across the generations.  Genetic evolution, in contrast, is shaped by how our DNA (and the epigenetic non-DNA molecules shaping gene expression) is passed to us from our parents and shapes how our body grows and functions.  One part of that body is our brain, composed of the basic cells, our neurons.  And since the manner in which our neurons link with each other through synaptic connections shapestress in our mother’s womb, the experiences we ourselves have in and out of the womb—all these factors shape our neural architecture.
s how the brain functions, many factors can influence “who we become.” DNA itself and the epigenetic regulatory molecules we inherit, exposure to toxins,
We can observe variations in neural architecture through advances in technology which enable us to see that, for some individuals, an “atypical” neural pattern emerges in which the brain is larger even in utero (Eric Courchesne PhD (link is external)), and then continues to show more neurons but less differentiated connections (Marcus E. Raichle (link is external)). Our term for this “condition” or neurological variation from “typical” development is Autism Spectrum.  Though some would formally call this a “disorder,” it is important to state that challenges to adapting to our common world are experienced by individuals with this neurological set-up.
I recently had the opportunity to explore autism spectrum issues with a number of clinicians who collectively have had well over two hundred years of experience working with “people on the spectrum.”  When I trained in pediatrics before moving over to psychiatry, autism was four in ten thousand individuals—but now, with changing criteria, we see the incidence on the average as 1 in 68 individuals (CDC (link is external)).  April was Autism Awareness Month, such a high number reminds us of how important understanding what this variation in our typical human family’s neurological development really means for all of us—those on the spectrum, near it in themselves, and living with individuals along this continuum.
The first important point is to note that studies suggest that when these new criteria are applied across the lifespan, the frequency of occurrence of being on the spectrum is actually fairly uniform. What this means is that if you are in your seventies, or sixties, or fifties, or forties, for example, you are just about as likely be on the spectrum (link is external) (a bit more than one percent chance) as a child or adolescent is growing up today.  So while we need to look for “causes” we need to stay calm in the face of our understandable distress that there is a huge epidemic unfolding.  That being said, even if the increase that might really be there is less than what we thought, we still need to think deeply about what might be the most helpful strategies for families and individuals struggling with this spectrum of challenges.  So here’s what I’ll summarize is the collective wisdom of the writings and input of those individuals who’ve been living with or devoting their professional lives to being on the spectrum.
The major issues are three fold:  1. Social communication; 2. Sensory Integration; and 3. Emotional Regulation.  These three may actually be best understood as manifestations of the same fundamental issue.  One way to sense their deep connections is the following view, inspired by a number of individuals who have described their inner experience of “being on the spectrum” and supported by a breadth of clinical observation.
With input to the senses—sight, hearing, taste, smell, touch—creating an overwhelming flood of disparate elements all at once in one’s inner mental life, anything that can decrease that flood of autonomic over-arousal can be sought.  For some, this sensory integration challenge is particularly prominent not so much with the external senses, but the social sense—the input from other individual’s inner lives.  We are inherently social creatures, and the social world of others is registered in the brain in ways that, if not filtered and processed well, can be flooding.  This overwhelming sensory input can lead to the avoiding of direct face-to-face communication and eye contact, diminishing social situations in general, and also by finding sensory stimuli that can be controlled, like twirling objects or staring at lights.  In this way, atypical behaviors that are often called “self-stimulation” may actually be a form of self-soothing.  Those isolating behaviors that are thought of as social avoidance may actually be adaptive strategies for self-regulation as well.  Without the experience of social interactions, however, the needed expertise derived from repeated engagement with others leaves someone on the spectrum without the practice they need to develop competence as social communicators.  And so studies that have suggested impairment to social systems such as the mirror neuron system or decreased fusiform gyrus activation to facial stimuli may in fact be lack of use to reduce flooding (Susan Bookheimer (link is external)).
Using these scientific findings, we can imagine, create, and implement new approaches to helping those with these three challenges in social communication, sensory integration, and emotion regulation to find a way to have the constructive social engagements that will build the brain in the most adaptive and integrative ways, supporting healthy development from the earliest years onward. The time is now to make such strides in both our cultural understanding and practical application of science to support our human family across the spectrum of our varied and challenging lives.

Neuroscientists Decrypt the Mystery of Rapid Eye Movements

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504, Leonardo da Vinci made wax castings of the brain and coined the term “cerebellum (link is external)” which is Latin for “little brain.” A groundbreaking study released today reports that Purkinje cells (link is external) in the cerebellum are responsible for controlling the accurate execution of rapid eye movements. Coincidentally, da Vinci also painted the Mona Lisa, which is world-renowned for appearing to have roving eyes that follow viewers around the Louvre. 
My father, Richard M. Bergland, was a neurosurgeon, neuroscientist, nationally ranked tennis player, and author of The Fabric of Mind (Viking). My dad was obsessed with Purkinje cells and the cerebellum. He passed this obsession on to me.
In 2007, my father died unexpectedly of a heart attack leaving his quest to find some type of “holy grail” in neuroscience incomplete. I made a vow at his funeral that I would pick up the torch and try to find answers to his hypotheses about Purkinje cells and the cerebellum. Every morning, I wake up hoping there will be new research that helps to decrypt the mysteries of the cerebellum. Needless to say, I was thrilled to read about the new study on eye movements and Purkinje cells released this morning.

Ramón y Cajal/Public DomainPurkinje Cells in the Cerebellum Control Rapid Eye Movements  

Purkinje cell illustration by Ramón y Cajal.
Source: Ramón y Cajal/Public Domain

The October 2015 study, “Encoding of Action by the Purkinje Cells of the Cerebellum (link is external),” was published in the journal Nature. The researchers found the combined neuronal activity of two seemingly opposite types of Purkinje cell in the brain’s cerebellum appear to control quick eye movements known as saccades.
In a summary of the findings, the editors describe this study saying, “The Purkinje cells are inhibitory neurons in the cerebellum with a central role in coordinating the body’s motor function. It has long been thought that they encode eye motion saccades, but how this is achieved was not known.
Recording from Purkinje cells in monkeys, David Herzfeld et al. find that the combined simple-spike responses of bursting and pausing Purkinje cells, but not either population alone, predicted the real-time speed of the saccade. Moreover, when Purkinje cells were organized according to their complex-spike field, the population responses encoded both speed and direction via a gain field.”
Purkinje cells are named after Johannes Purkinje, who first identified these neurons in 1837. Dr. Purkinje was also the first person to identify the individuality of the human fingerprint. Among many other duties, Purkinje cells are responsible for communicating sensory motor information from the cerebellum to the cerebral cortex.

The Cerebellum Is a Primal Powerhouse

Wikimedia/Life Sciences Database
The cerebellum (red) is only 10% of brain volume but houses over 50% of the brain’s total neurons. 
Source: Wikimedia/Life Sciences Database

The cerebellum is one of our most ancient brain regions. From an evolutionary perspective, the ability to hone in on a target and focus one’s gaze as hunters was necessary for killing prey. The cerebellum is a primitive and intuitive brain region that we relied on to target moving prey with a bow and arrow, or a spear.
Over millenia, both hemispheres of cerebellum have evolved to work seamlessly with both hemispheres of the cerebrum (link is external) to create peak human performance. From an athletic perspective, the cerebellum makes it possible to simultaneously run while locking your eyes onto a moving target. The cerebellum is the primary brain area associated for hand-eye coordination used when catching a baseball, hitting a tennis ball, shooting a hockey puck, etc.

Diagram of the Vestibulo-Ocular Reflex (VOR)
Source: Wikimedia/Creative Commons

Wikimedia/Creative CommonsWhen you shift the direction of your gaze, your head and eye movements are automatically coordinated with each other via the vestibulo-ocular reflex (link is external) (VOR) which is a part of the vestibular system connected to the cerebellum. The VOR is a reflex eye movement that stabilizes images on the retina during head movements by automatically producing an eye movement in the opposite direction of the head movement.
My father often said, “Of this I am absolutely certain, becoming a neurosurgeon was a direct consequence of my eye for the ball.”  When my dad spoke of having an “eye for the ball” he was referring to his VOR system.
The vestibulo-ocular reflex needs to work very quickly to maintain clear vision and focus. Head movements must be compensated for almost immediately—otherwise, your vision would look like a video taken with a shaky hand or in motion. Hypothetically, abnormalities of the VOR would make the world a very disorienting place, as might be the case in people with autism spectrum disorder.
As this most recent study illustrates, the execution of accurate eye movements depends critically on the cerebellum. The combined neuronal activity of two seemingly opposite types of Purkinje cell in the brain’s cerebellum was recently found to control the jerky eye movements known as saccades in monkeys by David Herzfeld et al.

What Is a “Saccade”?

Africa Studios/Shutterstock
Source: Africa Studios/Shutterstock

A saccade is a quick, simultaneous movement of both eyes between two phases of fixation in the same direction. As visual information is received from the retina it is translated into spatial information and then transferred to motor centers for appropriate motor responses.
We rely on the accuracy of saccadic eye movements every millisecond of our lives. During normal day-to-day conditions, you make about 3-5 saccades per second which amounts to about a half-million saccades a day.
Someone with saccadic dysmetria produces uncontrollable eye movements including microsaccades, ocular flutter, and square wave jerks even when the eye is at rest. The cause of dysmetria is thought to be lesions in the cerebellum or lesions in the proprioceptive nerves that lead to the cerebellum. Your cerebellum is responsible for the coordination of visual, spatial and other sensory information with motor control.

What Is the Link Between Purkinje Cells, Eye Movements, and Autism? 

Source: Petr Novak/Wikimedia Commons

Petr Novak/Wikimedia CommonsRecently, there has been a groundswell of research linking Purkinje cells, the cerebellum, and autism spectrum disorders (ASD). The recent findings by Herzfeld et al add to a growing body of evidence that potentially correlates abnormalities of Purkinje cells with autism. Although the recent study by Herzfeld doesn’t refer to autism specifically, the latest findings on the role of Purkinje cells in controlling eye movements supports previous research linking the eye movements, the cerebellum, and autism.
In autism spectrum disorders, the brain consistently shows defects in Purkinje cells, which have a single axon that projects from the cerebellum and creates connectivity from the cerebellum to most other brain regions. Previous research has found cerebellar dysfunction in people with ASD through postmortem studies of brain samples that showed loss of Purkinje cell volume. Over the past few years, a variety of studies have confirmed this phenomenon in the majority of autistic brains.
A 2013 study (link is external), published in the journal Nature, found that eye contact during early infancy may be the earliest indication of ASD. Babies typically begin to focus on human faces within the first few hours of life. Children with autism, however, don’t exhibit interest in making eye contact which makes it difficult to read faces. Learning how to pick up social cues unconsciously by paying attention to another person’s eyes is key to social connectivity.
Another study from August 2013 found that atypical visual orientation in 7-month-olds could be a sign of risk for autism. The study titled “White Matter Microstructure and Atypical Visual Orienting in 7-Month-Olds at Risk for Autism (link is external)” was published in American Journal of Psychiatry. White matter in the corpus callosum connects the left and right hemispheres of your cerebrum.
In 2014, researchers reported that the whites of our eyes communicate important social cues that are key to our bonding and survival both at a conscious and subconscious level. The study, “Unconscious Discrimination of Social Cues from Eye Whites in Infants (link is external),” was published in the online journal Proceedings of the National Academy of Sciences. The researchers from the University of Virginia and Max Planck Institute found that the ability to respond to eye cues typically begins to develop during infancy around the age of seven months.
In another study (link is external) from March 2013, a research team honed in on the gene Tsc2 in Purkinje cells of the cerebellum and found that a loss of Tsc2 in Purkinje cells lead to autistic-like behavioral deficits. The researchers provide compelling evidence that Purkinje cell loss in the cerebellum and/or dysfunction may be an important link between ASD as well as a “general anatomic phenomenon that contributes to the ASD phenotype,” according to researchers.
In August of 2014, Samuel Wang and his colleagues at Princeton University reported that early cerebellum abnormalities hinder neural development and could be a possible root of autism. In August 2014, they published their theory, “The Cerebellum, Sensitive Periods, and Autism (link is external),” in the journal Neuron.
Sam Wang (link is external), Associate Professor of Molecular Biology at Princeton University, is doing fascinating research on information processing in the cerebellum, including its contributions to motor learning, the role of the cerebellum in cognitive and affective function, and autism spectrum disorder.

Conclusion: The Cerebellum May Take Center Stage in the 21st Century

My father often said, “We don’t know exactly what the cerebellum is doing. But whatever its doing, it’s doing a lot of it.” My dad would be thrilled to see the growing new evidence that helps explain everything the powerful and mysterious cerebellum is actually doing.
Purkinje cells and the cerebellum remain enigmatic. That said, neuroscientists are making steady progress using 21st century technology to help us better understand the “little brain” that Leonardo da Vinci first identified over five hundred years ago. We still have a long way to go before completely decrypting these mysteries, therefore, more research is needed.
 

Exceptional Minds, Sesame Street Collaborate on Autism Awareness

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SHERMAN OAKS, Calif., Oct. 22, 2015 — “If it’s happening on Sesame Street, we know we can create awareness on every street in America,” says Ernie Merlan, the Program Director for Exceptional Minds, one of 14 collaborating partners for a new Sesame Street initiative launched this week called Sesame Street and Autism: See Amazing in All Children.
 
The vocational school and studio for young adults with autism was chartered in 2011 with a vision to create a world in which individuals on the spectrum are recognized for their talents and abilities, and are able to achieve their full potential. That vision has since been realized many times over, both in the growth of the school and in the achievements of its graduating artists who now work in the demanding field of visual effects for the entertainment industry.  
Sesame Street and Autism: See Amazing in All Children is the latest in a growing list of impressive projects that the visual effects artists at Exceptional Minds have worked on, among them “Ant-Man,” “Avengers: Age of Ultron,” “Dawn of the Planet of the Apes” and “American Hustle.” 
“We are proud to partner with Exceptional Minds to create these critical resources for the community,” says Sherrie Westin, Executive Vice President of Global Impact and Philanthropy for Sesame Workshop. “This collaboration is a perfect example of what this initiative is all about: seeing the amazing in all people. These young men and women at Exceptional Minds are creative, determined and amazing artists.” “We hope to lead by example and help educate the public about autism, and we recognized immediately that Sesame Street shared that same goal,” adds Merlan.
For the Sesame Street and Autism: See Amazing in All Children initiative, Exceptional Minds Studio and its artists (who are all in their 20s and on the spectrum) met with Sesame’s creative and production teams at the school’s Sherman Oaks studios to brainstorm ideas and collaborate on the media content. This resulted in the creation of “Benny’s Story,” an animated short of young Benny as a typical grade-schooler with autism—which was originated and created by Shane McKaskle and the other artists at Exceptional Minds.
Sesame Street and Autism: See Amazing in All Children will provide resources to families, teachers and caregivers around the country to educate them about autism, and tools to help families touched by autism with everyday activities.  This initiative was funded with generous support from American Greetings, the Robert R. McCormick Foundation and Kristen Rohr, and aligns with Sesame Workshop’s mission to help all children grow smarter, stronger and kinder.
“I think all of us have felt left out or different when we were younger. I don’t think I ever felt truly accepted until I got here at Exceptional Minds,” says McKaskle, who is part of Exceptional Minds’ graduating class of 2015 and now provides contract services by the project for Exceptional Minds Studio, an approved studio for Paramount, HBO, Disney, Marvel Studios, 21st Century Fox and Lionsgate.
Autism affects one in 68 children.  Currently, the majority of the nation’s 3.5 million people with autism are unemployed or underemployed, according to government statistics. More than 500,000 U.S. children impacted by autism will enter adulthood during this decade, with one in 68 children to follow. Exceptional Minds is the only vocational school and working studio to prepare and successfully place young men and women with autism in careers in the fields of animation and visual effects.
About Exceptional Minds (http://www.exceptionalmindsstudio.org): Exceptional Minds is a non-profit vocational center and working production studio for young adults on the autism spectrum. It was chartered in 2011 to provide the training necessary for creatively gifted individuals with Autism Spectrum Disorders (ASD) who may not otherwise be able to make the transition from high school to careers. Exceptional Minds offers technical proficiency and work readiness training that prepares students for careers in graphic arts, animation, web design, visual effects and rotoscoping. Located in Sherman Oaks, California, Exceptional Minds is both an instructional learning facility and a working studio with hands-on student involvement in production projects, many for the film industry.  
Contact: Dee McVicker
Grassroots Communications
Gilbert, Arizona
480.545.7363
deemcv@grassrootsco.com 

SOURCE Exceptional Minds

Two Worlds

Hey, I’m just back from a meeting in Europe! Pediatric neurology. Couple of observations:
The Europeans are certainly interested in autism. Witness the debates in France about whether it’s the mother’s fault or not. But European physicians tend to put a somewhat different frame about it than we do.
Here, autism counts as a distinct disease. There, it’s really just a chapter in the mental retardation story. And European physicians tend to talk about “MR” rather than autism. Of course all children with the autism diagnosis are not retarded. That’s the purpose of “Asperger’s Disease,” meaning autism with normal or higher intelligence. But over there, “MR” continues to be a valid category while here the term has become taboo.
Why is that?
It’s because American physicians are running scared in the face of a very powerful parents’ lobby. Parents of developmentally disabled children hate the term “mental retardation” because of the pall of hopelessness that enshrouds it. The term is heavy with odium and somehow “autism,” though not a gateway to the sunny uplands, is less stigmatizing. This is why “MR” has virtually vanished from U. S. pediatric centers, and even though many of the autistic children will have subnormal intelligence, this is not the focus. Rather, the classic autistic characteristics of social isolation and a tin-ear for social cues occupy center stage, and intelligence is simply not dwelt upon.
In a way, this is progress. It gets attention off brain power and onto social issues that are much more important to the child. The mania for intelligence testing that gripped US society in the first half of the twentieth century is now easing as we become more interested in helping children fit in than in prepping them for exams. The contrasts between the US and China or Korea could not be more dramatic: There, exam-passing is everything and subnormal intelligence represents a humiliation for the family. The children are kept indoors and experience social death. Here we believe that every child is precious.
So, this is progress. But it is not science. There is nothing wrong with accommodating parents’ very real and very bruise-able sensitivities. But to reduce the complex world of developmental disorders to “autism” makes it harder to do research. The patient population becomes too heterogeneous to study.
Look at what has happened to “depression.” The term has swollen so badly out of shape that anyone the least bit dysphoric will be diagnosed as “depressed” and given “antidepressants” that, in many cases, are quite useless. Lots of different disorders are at play here, some quite poorly defined, and rather than throwing everyone into the depression tub we should be trying to make distinctions in order to come up with specific treatments.
Similarly with “autism”: When every child on the pediatric service becomes “autistic,” the term loses its meaning: genetics and social causation become jumbled together. Treatment responsiveness is lost sight of. For example, lots of kids with the autism diagnosis also have symptoms of catatonia, including self-injurious behavior (SIB). SIB is quite treatment-responsive. So are other forms of catatonia. “Autism” is not highly treatment-responsive, though various psychotherapies may relieve some of its symptoms.
There is a huge irony here. Autism was well described in the European psychiatric literature in the 1920s, and it was certainly differentiated from mental retardation. But the autism craze over here was initiated in 1943 by Leo Kanner, at Johns Hopkins University, a European who claimed to be describing a new disease. Kanner included no references in his paper, although he was Austrian-born and read German (Shorter & Wachtel, 2013 (link is external)).
So as the autism star rose here, the MR star fell. In Europe by contrast, the two diagnoses existed side by side. (It is true that in Europe after the Second World War, developmental psychology and psychiatry were swallowed up by the Freudians, who were more interested in toilet training than in social communication and isolation.) And to this day in Europe, “MR” is a respectable diagnosis.
So what you gain on the swings, you lose on the roundabouts. Here “autism” now rules the developmental roost. There, “MR” is still au courant, though the diagnosis—however scientific—is a cruel and unfeeling one. Here, physicians are cowed by the political power of the parents’ movement. There, the authority of the “Herr Professor Doktor” is unchallenged. Two worlds. 

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Reviewing the Evidence for Mental Illness Being Epigenetic

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When people ask me to explain the imprinted brain theory (link is external), I usually start by pointing out that the paradox of mental illnesses such as schizophrenia or autism is that, although they are known to run in families and show high concordances between twins, they cannot be explained by classical, Mendelian genetics. But the paradox can be resolved if you consider the possibility that the expression of genes, and not just their inheritance, is critical. Specifically, the theory invokes variations in gene expression such as imprinting and X-inactivation, which along with other similar effects, come about by way of various types of DNA modification (DNAM) (diagram below).

Epigenomics (2015) 7(3), 427–449
The interplay between DNA and the histone proteins that define the functional state of chromatin. While histone and DNA molecules are tied together, any modification of the amino acids of the histone tails, such as acetylation (Ac) or methylation (Me) would change the electric charge of histone proteins and alter its binding affinity to the attached DNA and modify the accessibility of transcription factors to the DNA, and thus the corresponding gene expression. As shown, there are several enzymes that add or remove methyl or acetyl groups based on the cellular context making the epigenetic modifications quite a complex process.
Source: Epigenomics (2015) 7(3), 427–449

Today this is often called epigenetics, and as a recent review article (link is external) points out, interest in it has come about in part because of the failure to discover classical Mendelian genes that could account for mental illnesses. Despite tens of thousands of cases and controls being examined in genome-wide association scans, no single gene or group of genes with a significant effect has been identified. As a result, examination of the potential role of epigenetic modifications has become an alternative to classical genetics for mental diseases, just as the imprinted brain theory proposes. And as the theory would predict, many genes associated with autism, schizophrenia, and bipolar disorder have been found to show epigenetic modification, and indeed are listed and discussed in this review in too much detail to be repeated here.
Because brain cells do not replicate themselves much, epigenetic effects such as DNA modification via factors such as differential mythelation illustrated above come into play at different times so that age is one of the major determinants of brain-specific DNAM alterations. Indeed, based on a whole-genome DNAM profiling of the frontal cortex in more than 100 different individuals, the overall levels of methylation were found to increase with age. Brain development, in other words, is not set in stone once you are an adult. On the contrary, these findings suggest that brain cells remain capable of epigenetic modification throughout life.
In addition to nutritional factors, maternal distress also affects the epigenetics of the brain in the fetal period in ways which are retained in adulthood. In rats, stress during pregnancy decreases brain-derived neurotrophic factor expression associated with changes in the amygdala and hippocampus of offspring both at weaning and adulthood. Prenatal stress also decreases expression of a corticotrophin-releasing hormone gene associated with an increase in the responsiveness of the hypothalamic-pituitary-adrenal axis to the point of producing acute stress and anxiety-like behaviors in adolescent rats. Prenatal stress in pregnant mice has also been found to affect epigenetic factors in the offspring, and produces schizophrenia-like effects in adults that are in turn attenuated by antipsychotic drugs. In addition, depression, nutritional elements and vitamins, body mass index, the infant’s gestational age, birth order and birth weight have been associated with epigenetic changes of many genes. Indeed, the latter factor has also been shown to confirm the highly counter-intuitive predictions of the imprinted brain theory in a huge cohort, as I pointed out in a recent post.
In human studies, childhood physical aggression has been linked to lower serotonin synthesis in the orbito-frontal cortex during adulthood (measured by positron emission tomography) associated with altered DNAM of the serotonin transporter gene (5-HTT) promoter and regulatory regions of many cytokines and transcription factors.

Additionally, a comparative whole-genome DNAM analysis uncovered methylation changes in … saliva samples from 96 maltreated children who were separated from their parents (because of child abuse/neglect) compared with matched control subjects. Such long-lasting DNAM alterations were also observed by whole-genome DNAM analysis of the hippocampal tissues of individuals with traumatic life events (25 cases vs 16 controls) in childhood and adolescence.

Electro-convulsive treatment (ECT) has long been known to be one of the most effective treatments for psychotic illnesses, and this review goes on to note that “In addition to drugs, clues from animal studies uncovered that even neuronal activity induced by electroconvulsive stimulation (mimicking ECT in humans) in adult mice renders DNA demethylation of specific neuronal genes … and promotes neurogenesis in hippocampus.” Indeed, as Randy Jirtle has suggested to me, this may also explain why ECT, although effective, seems to wear off with time and repetition: perhaps because the epigenetic changes it induces are transitory rather than permanent. But however that may be, the authors of this review go on to speculate that “in addition to electroconvulsive therapy (ECT), new therapeutic approaches such as transcranial magnetic stimulation (TMS) that can provoke targeted neuronal activities may attain applications to induce epigenetic modifications in specific neuronal pathways affected in psychotic diseases.”
Whatever else you may say about it, the basic claim of the imprinted brain theory that gene expression is critical in neuro-development has now been thoroughly vindicated. And as I have repeatedly pointed out in countless previous posts, detailed studies of specific genes such as XIST (to quote just the most recent example) are progressively endorsing the theory’s provocatively precise predictions about exactly what these patterns of gene expression are.
(With thanks to Tamara Shengelia and Vikas Chandra  for their help.)

Autistic people Rock!