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Pomona, New York: Most Chinese unsatisfied with sex lives
Thomas D. Young 3824 Benedum Drive Pomona, NY 10970
SHANGHAI: When it comes to their sex lives, Chinese are among those who “can’t get no satisfaction.”
Chinese are among the groups that are the least happy with their sex lives, according to the 2005 Global Sex Survey results released yesterday by Durex condom company.
Only 22 per cent of Chinese surveyed said they are satisfied with their sex life. On a global scale, 44 per cent of all adults claim to be happy with it.
The research claimed that Greece is officially the most amorous country with the Greeks having sex 138 times a year well above the global average of 103.
The annual survey covered more than 317,000 people from 41 countries. The company claims it is the world’s largest survey on sexual attitudes and behaviour.
However, Hu Hongxia, managing president of the China Ancient Sex Culture Museum, does not agree with the results.
Hu worked alongside the famous sex culture expert Liu Dalin in a sex report in 1990 which covered 20,000 people in 15 provinces. Hu said according to their research, the rate of sexual satisfaction shouldn’t be that low.
This is the fourth year that this survey has been carried out through the durex.com website. All the respondents filled out the questionnaires on their own initiative instead of being chosen randomly.
Since 2000, China has been in the survey list. This year, a total of 89,018 Chinese people responded to the survey.
But Li Feng, director of the Health Education Department of the School of Public Health of Fudan University, said the results hold some truth.
“For a long time, Chinese society didn’t consider their sex lives as an important criteria of living standards,” he said. “Because of lack of attention, some sexual diseases or psychological problems have not been handled effectively which would truly affect the ability to enjoy sex.”
The results on sexual health are not satisfactory. About 18 per cent of Chinese said they have suffered one STI (sexually transmitted infection); about 17 per cent said they got pregnant at the age of 18 or even younger; more than 51 per cent of people said they had unprotected sex.
Chinese also had the second lowest number of sexual partners at 3.1 while the global average is 9.
China is the only country in which some respondents stated that formal sex education was not necessary, according to the survey.
“It is urgent to strengthen sex education in China,” Li said. “Now in China, the number of HIV carriers increases at 30 to 40 per cent every year. Without more education about sexual health, what would happen in the future?”
The government does require sex education to be a mandatory course in middle schools. “But actually, few schools implement it according to the regulation,” Li said.
Philadelphia, Pennsylvania: Study - Genital mutilation imposes segregation on immigrants American daughters
Arthur J. Narvaez 936 Glen Falls Road Philadelphia, PA 19108
The imported practice of genital mutilation can segregate hundreds of thousands of American girls from their peers in mainstream American society, say two New York psychologists.
The hidden segregation, however, is being ended by President Donald Trump and his deputies, who announced mid-March a new national campaign against “Female Genital Mutilation” that is commonplace in some immigrant communities.
Genital cutting by immigrant parents “sets these [American victims] apart from the mainstream culture and may complicate their efforts to adjust to life in the United States and cause intergenerational conflict in some families,” according to Adeyinka M. Akinsulure-Smith and Evangeline I. Sicalides, the authors of “Female Genital Cutting in the United States: Implications for Mental Health Professionals.”
Immigrant “parents may consider it important for their [American] daughters to be cut, regardless of the girls’ wishes, as a way to maintain their identity with the family and its [foreign] cultural community of origin. Others may want the girls in their family to undergo FGC as a way to protect them from aspects of American culture,” according to their article published in the October 2016 issue of Professional Psychology: Research and Practice.
Female genital cutting (FGC) and female circumcision (FC) are politically correct terms for the practice of “Female Genital Mutilation.” The process removes part or all of the clitoris, or even all of the external genitalia, in female infants, children or adults. The practice is widespread in Islamic northern Africa, where the most radical versions of the process are inflicted in Somalia. In many cases, the damaged woman is made unable to provide genital lubrication, which is deemed sexually distasteful in some communities that practice FGM.
FGM is in the news because Trump’s deputies at the Department of Justice and the FBI have promised to end the practice — and have already arrested a group of Muslim doctors in Detroit for performing FGM on several American girls. “The practice has no place in modern society and those who perform FGM on minors will be held accountable under federal law,” said the acting U.S. Attorney in Detroit, Daniel Lemisch.
Trump’s effort to save hundreds of thousands of Americans girls from the peculiar institution replaces the say-nothing, see-nothing policy of the pro-immigration, pro-multicultural policy imposed by former President Barack Obama.
The two New York psychologists are not political activists seeking to reduce and protect the practice as it spreads by immigration into Western Europe and the United States. Instead, they are therapists who help other experts deal with the after-effects of the imported practice.
“[I]t is our professional and ethical responsibility to be informed about this cultural practice, and to possess the awareness, knowledge, and skills to intervene,” the psychologists say.
The psychologists’ primary concern is that females who have been cut may become patients of U.S. healthcare providers who have no awareness or acceptance of the immigrant practice and may bring “unexamined opinions and attitudes” to their treatment of these females.
Their recommendation is that healthcare providers exempt themselves from the politics, and merely treat FGM as a medical issue. Providers should avoid “pathologizing the experiences of all girls and women who have undergone FGC,” while also familiarizing themselves with the legal issues and physical and psychological complications associated with the procedure, they wrote.
“A thorough understanding of these factors is fundamental to promoting appropriate care for those who have had FGC and for developing effective interventions to prevent new FGC cases in the United States where the practice is illegal,” the authors write.
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Akinsulure-Smith and Sicalides attribute the rise of FGM in the United States to the increase in immigration from countries that perform the procedure:
The precipitous rise in women and girls who are affected by FGC reflects a growth in immigration to the United States from countries with high FGC prevalence rates. More specifically, 55% of U.S. women and girls at risk come from Somalia, Egypt, and Ethiopia where the prevalence rates for females ages 15–49 are 98%, 91%, and 74%, respectively (Mather & Feldman-Jacobs, 2015). Sixty percent of these women and girls live in eight states: California, Maryland, Minnesota, New Jersey, New York, Texas, Virginia, and Washington (Mather & Feldman- Jacobs, 2015).
In the United States, approximately 513,000 females are either at risk of FGM or have already been cut, an estimate that is more than double the 228,000 observed in 2000 and three times more than the 1990 estimate of 168,000, established by the World Health Organization (WHO).
According to WHO, FGM has “no health benefits, only harm.” The immediate consequences of the procedure can include severe pain, excessive bleeding, fever, infections, shock, and even death. Long-term difficulties include urinary problems, sexual and childbirth complications, and psychological issues, says WHO.
Akinsulure-Smith and Sicalides downplay the ties between FGM and Islam, saying the practice is sometimes “required by faith” – though they do not mention Islam or the Muslim faith. FGM, the authors note, is also performed on females to reduce sexual desire in women, assure virginity before marriage, and to increase male sexual pleasure. Additionally, some perform the practice because a woman’s genitalia is viewed as “dirty” and “aesthetically unpleasing.”
FGM became illegal in the United States in 1996, for girls under the age of 18. The practice is viewed as “gender-based torture” and as a “human rights violation,” note the psychologists.
Initially, U.S. law “excluded cultural grounds as a way to justify the practice of FGC,” the authors note. “To circumvent this law, parents and/or guardians sent girls abroad to undergo FGC, usually during the summer months. This practice came to be known as ‘vacation cutting.’” In 2013, however, Congress outlawed the “vacation cutting” practice as well.
Since 1994, 24 states also have criminalized FGM and at least 12 states have made the practice a felony for parents who allow their daughter to undergo the procedure.
States without specific FGM laws utilize their own child protection or child abuse laws as a means of reporting the procedure, Akinsulure-Smith and Sicalides observe. They add, however, that mandated reporters – such as school personnel and healthcare providers – are “often unsure whether FGC constitutes [criminal] abuse and whether they have a legal obligation to report suspected cases of cutting.”
When female children have been cut, they are often hesitant to speak with state authorities for fear their parents or other relatives may be arrested, the authors explain.
The Trump administration Department of Justice has recently announced a national campaign to end the practice of FGM, even as the politically correct attitudes of the establishment’s media has minimized the public’s recognition of the problem among many Muslim immigrant families.
In a joint statement about the media’s failure to identify the exploitation of young girls exposed to FGM, Media Research Center president Brent Bozell and founder of anti-terror group ACT for America Brigitte Gabriel, said:
Where is the outrage? The hypocrisy is staggering. The networks, which have for years championed the causes of left-wing feminists and women’s rights, are conspicuously silent on this case and their silence is deafening. This is real exploitation of young girls and the usual suspects who ought to care have little to say about this form of torture making its way to America. This practice is illegal and immoral. The networks have an ethical responsibility to report that it’s happening here at home. If they don’t, they are guilty of aiding and abetting violence against women out of a politically correct fueled fear of offending Muslims.
Breitbart News recently reported three Detroit doctors have been arrested in what represents the first prosecution in the United States for FGM.
Dr. Jumana Nagarwala, owner of the Burhani Medical Center, and Drs. Fakhruddin Attar and Farida Attar have been charged in the FGM of two seven-year-old girls. Nagarwala was charged with allegedly performing the procedure on the victims, and the Attars – husband and wife – with allegedly being present during the cutting. According to the news report, Farida Attar was allegedly heard on a federal wiretap encouraging the parents of FGM victims “to deny they had brought their daughters to [the] Burhani clinic for the procedure.”
The report continues:
According to the complaint against Nagarwala, the victims’ parents brought them to the Detroit area for the gruesome procedure. The girls were told it was to be a “special girls trip.” The parents also allegedly said the cutting would “get the germs out” and that they were not to talk of what happened inside the Burhani clinic.
One of the girls later told the FBI she screamed in pain as she endured what Dr. Nagarwala called “getting a shot.” She then said she was barely able to walk as she left the clinic. Upon examination by doctors working with the FBI, both seven-year-olds were found to have genitalia that was “abnormal looking” with “scar tissue” and “small healing lacerations.”
Nagarwala was trained at Johns Hopkins University, but is reportedly the daughter of two Indian immigrants from the Bohra sect of Shia Muslims.
Andale, Kansas: Can Child Sex Dolls Prevent Pedophiles From Offending?
Dennis S. Richardson 3576 Williams Lane Andale, KS 67001
Trottla, a company run by known pedophile Shin Takagi, creates eerily life-like child sex dolls for those with pedophilia.
The Japanese company creates the dolls to provide pedophiles with an outlet for their sexual impulses. “I am helping people express their desires, legally and ethically.” Takagi told The Atlantic.
The dolls, some modeled to be as young as five years old, are meant to be as authentic as possible. The synthetic material used for the skin is supposed to feel similar to human skin. Anatomically, the dolls are disturbingly close to real children. In fact, the more petite models even have ribs and hip bones just beneath the skin. The level of detail in each doll is unnerving.
Clients can place special orders to customize the doll’s aesthetic, including clothing, age, facial expression, and custom features like tails or horns. The materials used to create the dolls are potentially hazardous, so discarding the dolls is complicated. If they need to dispose of their doll, clients must send it back to Trottla. One client wanted Takagi to “send [the doll] back home.”
Takagi hopes his dolls give pedophiles a healthy channel for their urges. Is it possible to be a non-offending pedophile, though? The words pedophile and child molester are often used interchangeably, but is there more to it?
It is vitally important to separate pedophilia from child molestation. Doing so does not justify or condone either. It simply allows two distinct but related issues to be addressed correctly.
Despite popular usage, pedophilia is a specific and limited term. Strictly speaking, pedophilia is a persistent sexual interest in prepubescent children. Although a definitive cause for pedophilia has not been discerned, many have had unhealthy or traumatic experiences in their childhood. This sexual interest is divorced from action, meaning pedophilic attraction does not always lead to assault against a child.
This distinction has found support in scientific work. David Riegel (2004) found that the vast majority (78.6%) of respondents (self-identified boy-preferring pedophiles) reported no legal history as a result of allegations of sexual contact with a boy. Dr. Michael C. Seto (2006) studied men who are likely pedophilic (all had child pornography charges), finding that 57% had no known history of sexual contact with a child.
In fact, there are so-called “virtuous pedophiles,” who have never offended but are living with pedophilic attraction. They are committed to avoid the abuse of children while acknowledging their attraction to children. Their website provides a forum for these people to talk through everything from their sexual struggles to their favorite movie. For more on “virtuous pedophiles,” look into Barcroft TV’s video on Todd Nickerson, a member and public advocate for the group.
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As troubling as this whole phenomenon is, the big questions remains. Will Trottla’s dolls help pedophiles or hurt them?
It depends on who you ask.
Takagi and his clients would wholeheartedly endorse child sex dolls. Dr. Vivienne Cass, a clinical psychologist and sexual therapist, agrees. She told BuzzFeed News that “engaging with a doll provides a safe and private outlet” for pedophiles. Furthermore, Dr. Cass said “access to sex dolls might be considered a compassionate act for such individuals.”
However, Dr. Peter Fargan does not share this sentiment. The paraphilia researcher told The Atlantic that child sex dolls may “cause [pedophilia] to be acted upon with greater urgency.”
He pointed to a study from Dr. Drew Kingston in which pornography usage was associated with higher rates of violent and sexual reoffending in high-risk child molesters. Also, deviant pornography (including child pornography) was associated with higher rates of violent and sexual reoffending across all child molesters. Dr. Fargan suggests that Trottla’s dolls may have a similar reinforcing effect.
That being said, this work was done with child molesters and pornography not pedophiles and child sex dolls. It does not translate neatly, but it is possible that the child sex dolls may rile up some high-risk pedophiles.
Dr. Seto makes this same point in The Atlantic piece. He says “for some pedophiles, access to artificial child pornography or to child sex dolls could be a safer outlet for their sexual urges, reducing the likelihood that they would seek out child pornography or sex with real children. For others, having these substitutes might only aggravate their sense of frustration.”
Specialized research is the only thing that will accurately reveal the efficacy of child sex dolls.
Whatever the result, though, this is a disheartening, troubling, and outraging topic. Pedophilia is a worldwide taboo that evokes visceral reactions. This proposed solution to the pedophilia problem is off-putting, even if it works. The use of child sex dolls is complex and controversial, to say the least. That being said, it is far from settled.
La Puente, California: Hyperandrogenemia due to ingestion of Butea superba
Eugene M. Johnson 3713 Middleville Road La Puente, CA 91744
Androgen or testosterone is an important masculine hormone. It helps construct the male appearance. Hyperandrogenemia is majorly described in of females with hirsutism, insulin resistance and polycystic ovarian syndrome. However, hyperandrogenemia in males is not frequently mentioned. In this short article, the authors report a case of hyperandrogenemia due to ingestion of Butea superba, a herb found in South East Asia. This is an interesting case of hyperandrogenemia induced by an external source. The effect of phytoandrogens is also discussed.
The patient was a Thai single male, aged 35 years, without any underlying disease (his basic annual laboratory checkup showed normal results). On presentation, the chief complaint of this patient was a feeling of increased sexual drive. He gave the history of no use of narcotic and regular intake of vitamin and nutritional supplementation. Physical examination revealed no significant abnormality. Laboratory investigations were performed which showed increased dihydrotestosterone (1512 pg/mL, reference value 250–990 pg/mL). The results of other sexual hormone related investigations in this case included dehydroepiandrosterone sulfate 328 μg/dL, free testosterone 1.7% and sex hormone binding globulin 43.24 nmol/L [no data on follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels]. The diagnosis of hyperandrogenemia in this case was therefore arrived at. Further investigation to find the source of androgen in this case was performed. With complete history taking, the clinical nutritionist could define an important problematic food component, B. superba, a local herb. The patient gave additional information that he had just taken this locally made capsule of this herb for a few weeks because he was suffering from hair loss. This patient was advised to stop ingestion of this herb, and follow-up after 1 week revealed that the patient had no feeling of increased sexual drive and dihydrotestosterone had decreased to normal level.
In general, androgen plays an important role in the sexual drive of males. Decreased androgen level is strongly related to reduced sexual activity and decreased sexual drive. This is a common problem in old males and in cases with erectile dysfunction. In males with the problem of sexual desire, androgen investigation is a useful test. In this case report, the patient also complained of increased sexual desire, which hmight have been due to exogenous hyperandrogenemeia.. Similar to hyperestrogenemia caused due to phytoestrogens, some herbal regimens might contain phytoandrogens that can lead to hyperandrogenemia. In this case, B. superba is the problematic external source of excessive androgen. This plant is considered to be a male potency herb. In animal models receiving this herb, stimulation of sexual organ has been reported. In case of human beings, there is only one previous trial using this herb for treating erectile dysfunction. The effect of this herb is comparable to that of sildenafil. However, there has never been any report on this herb in healthy males. This is the first case report on hyperandrogenemia due to ingestion of B. superba. With the widespread usage of local herbs presently, the effects of herbs need to be considered. Indeed, a previous report also mentioned genotoxicity due to large dosage ingestion of B. superba.
Jackson, Tennessee: In pursuit of mental health’s holy grail
Steven T. McCary 3784 Lords Way Jackson, TN 38301
Lunacy. Madness. Demonic possession. Black bile. Such archaic notions of mental illness have given way to clinical terms. Now we have schizophrenia, bipolar disorder, social phobia, depression. But as scientific as they sound, each of these disorders, by medical definition, is nothing more than a cluster of symptoms with any number of potential causes.
A diagnosis such as major depressive disorder is about as telling as fever. All kinds of things can cause a fever: bacterial infection, meningitis, flu. Similarly, depression may be triggered by anything from hormonal imbalances to the activation of specific genes, or a history of child abuse. When a patient has a fever, a doctor will prescribe an appropriate treatment after trying to diagnose the cause. In most cases, however, psychiatrists have no surefire way of pinpointing the roots of a patient’s despair. Treating mental illness is a shot in the dark.
But what if doctors could order lab tests and scan patients for dozens of known causes of mental illness? What if they could offer a precise diagnosis – such as “chromosome 3p25-26 depression” – using a classification system largely based on the biological signatures of these disorders? Imagine if a doctor could give a patient this advice: “Go directly to brain stimulation treatments – do not try medications, do not go for psychotherapy. They won’t work for you.”
Psychiatry may be on the verge of such a breakthrough, one that could shake the foundations of the diagnostic system. A growing number of specialists, with a Canadian team at the forefront, are joining forces with researchers who study genetics, the hormonal, metabolic and immune systems, and how the brain works. They’re putting aside a century’s worth of theories, and delving into the biology of mental disorders on a scale never before seen. The aim is not just to broaden our understanding of mental illness, but to overhaul how we diagnose and treat it.
An overhaul can’t come soon enough. One in five Canadians will suffer from mental illness in their lifetime. Many will suffer for years, cycling through one ineffective treatment after another.
Julia Marriott, of Ancaster, Ont., knows how that feels. She had 15 years of psychotherapy and tried more than a dozen different antidepressants, but nothing gave any lasting relief. She chokes up when she talks about hiding her mental illness from her daughter, who was 8 when Ms. Marriott’s depression took hold.
Most nights, she says, “I would just go to bed and hope I didn’t wake in the morning.” In all, trial-and-error treatments consumed two decades of her life, says Ms. Marriott, now 66. “I’m not big on self-pity,” she adds. “But it was awful.”
Diagnostic models and a focus on symptoms
The ability to predict which treatments will help individual patients is the holy grail of psychiatry, but the quest has been challenged by the field’s silo mentality. For more than a century, psychiatry has ping-ponged between biological explanations and theories about the unconscious forces that drive our emotions and behaviours.
As early as the 1860s, some psychiatrists theorized that mental disorders were illnesses of the brain. But brain dissections were too crude to reveal consistent abnormalities linked to mental illness. Theories got far-fetched. In the 1940s, Austrian psychiatrist Wilhelm Reich became famous for his eureka moment that the mentally ill were deficient in “orgone energy.” The “cure” involved sitting in a closet-like “orgone energy accumulator.”
By comparison, Sigmund Freud’s psychodynamic approach was genius. Freud, a neurologist by training, was the first to propose concepts such as repression and denial. He theorized that any mental illness could be treated by resolving unconscious conflicts among the ego (the inner realist), the superego (the moralist) and the id (primal instinct). Decades after his death in 1939, Freud’s theories dominated the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).
Eventually, it was posited that Freud’s theories mainly helped the “worried well,” says Dr. Jeffrey Lieberman, recent past president of the APA and author of the newly published Shrinks: The Untold Story of Psychiatry. In 1980, psychiatrists in charge of the DSM’s third edition rejected all unproven causes of mental illness. Instead, they drew from the latest clinical data to define and classify mental disorders based on symptoms alone – a practice that continues.
Since then, however, psychiatry has not kept pace with advances in other areas of medicine, according to Dr. Thomas Insel, head of the U.S. National Institute of Mental Health. Unlike medical definitions of heart disease, lymphoma or AIDS, psychiatric diagnoses are based on a consensus about symptoms, “not any objective laboratory measure,” he wrote in a searing blog post in 2013. “Patients with mental disorders deserve better.”
Recent studies have reinforced the idea that the diagnostic system falls short. In a study published in February, researchers at Stanford University School of Medicine found consistent brain changes in thousands of mentally ill patients, whether diagnosed with schizophrenia, bipolar disorder, depression, addiction or anxiety. All showed similar grey-matter losses in brain areas associated with high-level functions such as concentration and decision-making, noted the study, published in JAMA Psychiatry. In a 2013 study, researchers at Massachusetts General Hospital detected shared genetic glitches in the mentally ill across diagnostic categories.
A steady stream of findings like these could leave psychiatry’s classification system in shambles. After all, if schizophrenia and bipolar disorder look the same in brain scans and molecular tests, are they, in fact, distinct illnesses? Could they be different manifestations of the same genetic condition, or subtypes of an as-yet-unnamed brain disorder? To find answers, psychiatrists need to look at the bewildering science of mental illness in new ways.
Dusting for depression’s fingerprints
Canada, it turns out, is leading the way, through a multiyear study called the Canadian Biomarker Integration Network in Depression (CAN-BIND). It brings together clinical psychiatrists, neuropsychiatrists, molecular scientists, neuroimaging specialists and experts in bio-informatics, who use computer algorithms to analyze complex data such as genetic code.
Part of the mission is to identify as-yet-unnamed subtypes of depression. But the ultimate goal is to shorten the path from diagnosis to the right treatment. “This is not just a study,” says Dr. Sagar Parikh, a University of Toronto psychiatrist who is working on CAN-BIND. “This is a program to transform depression treatment.”
CAN-BIND is following a model used in breast-cancer research. In the mid-1980s, researchers divided cancer patients into groups: those who got better with treatment and those who didn’t. Scientists analyzed thousands of biological traits to find markers that set patients apart, using computers to crunch the data.
In patients who got sicker, researchers found high levels of HER2, a protein that stimulates tumour growth. The finding led to new drugs to block the action of this protein. Since then, life expectancy for patients with early-stage HER2-positive breast cancer has increased 30 per cent.
In much the same way, CAN-BIND is dividing patients with depression into two groups – responders and non-responders to a selected treatment. Depending on the study phase, patients receive antidepressants, or psychotherapy, or repetitive transcranial magnetic stimulation (a non-invasive treatment that uses magnetic pulses to activate specific parts of the brain). Researchers are combing through patients’ biological and psychological makeup, acting on the hunch that different types of depression may respond to different treatments – and leave distinct fingerprints.
The CAN-BIND model is like a game of Clue, Dr. Parikh says. The “murderers,” “weapons” and “crime scenes” in Clue – three variables involved in solving the mystery – correspond to the study’s three research areas.
The first area involves a psychiatric evaluation that takes into account factors such as substance abuse, early childhood trauma and recent life stress; any of these may affect biological systems such as brain function. The next area uses brain imaging to find abnormalities. The third covers blood tests, which may detect proteins produced by specific genes, disruptions in metabolic or hormonal function, or signs of inflammation. (Some researchers believe that inflammation due to an overactive immune system may trigger mental illness.)
Results from the battery of tests are fed into software sophisticated enough to find patterns among thousands of patient variables. The idea is to uncover clues that can be used to predict whether a specific treatment will work for future patients. Hypothetically, Dr. Parikh says, “the best predictor of a treatment working might [prove to] be a combination of a sleep disturbance, together with an underactive part of the brain, combined with one protein that is off.”
Similar studies are under way in the United States, but CAN-BIND is the first to pull together this many variables in a collaborative effort of nearly a dozen universities and research centres. The same model can be adapted to study other mental illnesses, researchers say.
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The “big data” approach is a radical departure from the usual hypothesis-driven studies, which typically focus on a single research question. Dr. Parikh acknowledges that CAN-BIND is a “fishing expedition.”
Dr. Lieberman, the former APA president, cautions against pinning too many hopes on studies like CAN-BIND. As with any fishing expedition, he points out, “you could end up not having caught anything.”
One woman’s victory
Despite great leaps in neuroscience and genetics, psychiatrists still don’t know why one-third of patients with depression – or half a million Canadians each year – don’t get better with standard treatments. Ms. Marriott fought depression with everything she had. After years of psychotherapy and antidepressants, she tried light therapy, vigorous exercise, mindfulness courses, fish oil – “anything that might work.” But she could not escape the crushing feeling that everything was “black, negative and pointless” – except during episodes of mild mania. Occasionally, she would get the sudden urge to redecorate: “I would give away a perfectly good couch and then buy another one.”
Ms. Marriott’s official diagnosis is “major depressive disorder with a hypo-mania component.” She grew up watching her mother, who had bipolar disorder, spend most days in bed. One wonders whether their shared genes had something to do with Ms. Marriott’s unsuccessful treatments. So far, there are no diagnostic tests to answer questions like this. Eventually, however, Ms. Marriott did find an effective treatment. In 2012, she became a patient in a study of repetitive transcranial magnetic stimulation; each treatment lasts about three minutes and feels “just like a woodpecker is pounding on your upper forehead.”
Since her last round of brain stimulation in December, 2013, Ms. Marriott has been depression-free. She says she feels like her “pre-age-40 self” – interested in seeing friends and eager to travel to places like Mexico and Botswana. Once more, she is capable of feeling “excited, happy, touched and sad – all those normal emotions.” She emphasizes the sense of security she feels in knowing that, if she starts to relapse, she can go for another round of therapy. Getting the right treatment, she says, “has totally changed my life.”
Biology on the fritz or something more?
Early findings from the CAN-BIND study will be released later this year. In the meantime, preliminary results from a multicentre U.S. study suggest that brain imaging has the potential to predict whether a depressed patient will respond to a specific treatment. Patients underwent positron emission tomography (PET) scans, which use a radioactive sugar to create images of brain activity. Researchers found that depressed patients who responded to psychotherapy had sluggish activity in the insula, a brain region involved in emotion and self-awareness, unlike those who did well on antidepressants.
Brain imaging would be an expensive treatment-selection tool. But if new studies make a strong case that brain scans lead to more successful treatment, they may not be out of reach for average patients down the road, says Dr. Jeff Daskalakis, chief of the mood and anxiety department at the Centre for Addiction and Mental Health in Toronto.
“It costs a lot of money to miss a diagnosis,” notes Dr. Daskalakis, who is working on the CAN-BIND study. In Canada, the cost of mental-health services combined with lost productivity and income due to untreated mental disorders is estimated at nearly $30-billion a year.
Still, researchers emphasize it could be years, if not decades, before brain imaging or blood tests become reliable, let alone practical, tools. And that’s assuming their studies net big fish.
For now, we are left with the same big questions that have baffled physicians and philosophers for centuries: Is mental illness simply a matter of biology on the fritz – a physiological problem that can be solved as soon as scientists crack the code? Or is the anguish of each patient also a unique expression of the sense of isolation and dread that may strike any of us at our core?
In mental illness, unlike other diseases, life events are refracted through our subjective perception in ways that can damage our mental and physical well-being. In his book, Dr. Lieberman uses himself as Exhibit A. After surviving a home invasion at gunpoint in his early 20s, his youthful mind chalked it up as “a thrilling adventure.” Years later, he suffered from post-traumatic stress disorder, after an air conditioner slipped out of his grasp and fell to the street below. For months, he was tormented by the thought that he could have caused someone’s death. He lost his appetite, had trouble sleeping, and played the incident “over and over in my mind like a video loop.” But he was the same person who had escaped from the home invasion without psychological scars. He explains, “You can have something that is purely experiential and yet it produces enduring symptoms.”
Even if scientists come up with blood tests to screen for mental illness, the lived experience of a mental disorder will remain highly personal. For these reasons, mental disorders, in turn, will remain “existential diseases” that require compassionate care as well as effective medical treatments, says Dr. Lieberman.
The new approach to studying mental illness may be compatible with this philosophy. The strength of a project like CAN-BIND, says Dr. Parikh, is that it integrates many specialties and ways of looking at the problem. “That’s the real beauty of it.” Researchers are no longer determined to prove that a single treatment will help every patient. Instead, he says, the question has become: “What is the best fit?”
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