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Can a shot of humanities make doctors more humane? | Charlotte Blease A course of 'medical humanities' is supposed to unlock the empathy so often missing in care, but evidence is lackingA couple of years ago posters of a corpse started appearing on campus. The sight of a (seemingly) dead man with a tag on his toes certainly grabbed my attention.Closer scrutiny revealed that the grim poster was an advertisement for a medical amateur dramatics production. Under the guidance of a theatre director, a choreographer and a medical ethicist, the production, involving third-year medical students, was an "experimental performance piece" designed to explore the topic of "body donation" to dramatic effect.The director of the production – the fruits of a joint School of Medicine and Performing Arts venture – would later clarify the importance of the event to colleagues under the jaunty title "Doctors can dance too: using devised theatre to explore a topical issue in bioethics".Performances such as these might be medical fringe but the medical humanities are burgeoning. On both sides of the pond, medical school curricula are increasingly taking seriously the role of the creative arts, English, history, anthropology, sociology and philosophy in broadening medical students' education. And the injection of "culture" is not just being prescribed to students: qualified doctors are also encouraged to dose up on the arts and gain continuing medical accreditation as a result.Last year, I attended a medical humanities conference in the US. This time the performers were humanities PhDs; the audience comprised the same but also included doctors on away days notching up some credit. The presentations were wide-ranging, from "Leonardo da Vinci's contribution to modern orthopaedics" and "Medicine as magic in Ancient Egypt" to "The creative inspiration of medicine in the writings of Arthur Conan Doyle" and the catchily titled, "A dermabiographical approach to Zelda Fitzgerald's figure paintings".While some of the talks were insightful, stimulating, and perhaps even noteworthy, there was an underlying dogma running through the majority of the contributions. It found its proudest voice in an English professor who proclaimed that reading Tolstoy's The Death of Ivan Illyich had inspired her class of interns to improve their bedside manner. With literary guidance as her beacon, she had turned these naturally (and literally) clinical young medics into sensitive human beings. Under the pressure of ER, palliative care, or even in surgery, these doctors would be better able to respond to the needs and feelings of their patients.The underlying dogma is that studying the humanities makes doctors humane. It sounds good. It might even sound intuitively right. But the "common" in common sense is often the unrefined variety. Lurking beneath the medical humanities' manifesto is a form of associative thinking – a sort of causal fallacy: it is the notion that literary or philosophical absorption, and compassion for one's fellow beings, follow a simple linear path. After a decade working in humanities faculties, my own experiences don't exactly corroborate the view.And herein lies the problem. There is no reliable evidence that studying literature improves levels of compassion among medics. This is not to say the dogma won't yet be vindicated. And it is not to say teaching or improving levels of empathy among medical students and doctors is an unimportant task. In fact the very opposite is the case: compassion and empathy form a crucial part of the doctor-patient relationship. Doctors need to be aware of the range of experiences that illnesses and personal circumstances can bring. Empathy is also crucial in creating the kind of atmosphere where patients can communicate effectively – and when patients aren't forthcoming about symptoms, doctors miss a major piece of the puzzle.The point is that nobody – least of all medical educationalists – can afford to be glib about how this facet of medical professionalism can best be found or achieved.And what about other healthcare professionals? Exponents of the literary medical humanities appear less eager to ingratiate themselves among nurses, for example. Couldn't our nurses, home helps and other healthcare workers use some of this (purported) literary elixir? An academic Google search located one publication advocating the use of (specifically) "popular literature" among nursing students. According to this reasoning, we should prescribe Danielle Steel to our nurses, while administering Dostoyevsky to the medics.Sound out of touch, condescending and (dare I say it) lacking in humanity? Perhaps the vanity of the humanities needs a dose of its own medicine.Medicine Unboxed on 23-24 November is a project that connects the public with healthcare professionals in a scientific, political and ethical conversation about medicine, illuminated through the arts. For more information on this year's event, visit our Facebook page, follow @medicineunboxed, or visit our Pinterest boardsMedical researchPsychologyMedicineHumanitiesDoctorsHealthHealth & © 2013 Guardian News and Media Limited or its affiliated companies. All rights reserved. | Use of this content is subject to our Terms & Conditions | More Feeds
Immigration is essential (according to the science) | Dean Burnett The Daily Express has started an anti-immigration petition, the latest example of ongoing propaganda against immigrants. But the actual data shows that this could be a disastrous move, because immigration is essential in many ways."Just because a dog is born in a stable, doesn't make it a horse". The implication of this cliché being that being born in a country doesn't make you "of" that country; you have to be part of the culture and history or something (it's never really made clear). But the claim that being born in a stable doesn't make a dog a horse is scientifically correct. Similarly, being born in a stable doesn't make a horse a horse; genes resulting from millions of years of evolution make a horse a horse. Birth location does not alter DNA to the extent that it changes species. Ergo, people born in a country are essentially biologically identical to those who arrive there later. Humans are humans, wherever you go. But immigration is an important issue to many, in the UK and elsewhere. Many see a hard-line anti-immigration stance as a vote winner. Anti-immigrant feeling is regularly encouraged and exaggerated by the media, most recently with the Daily Express's definitely-not-racist-who-said-it-was? anti-immigration petition.Of course limitless, unmonitored immigration would be a bad thing. A countries infrastructure could collapse due to confusion alone. But it seems many in the UK want strong action taken against immigrants. Ergo, people think immigration is bad overall.Does this hold up to scientific scrutiny? Does the data support this view though? Can so many people be wrong? Yes, they can. There are many arguments against immigration, and they're generally wrong.SPACEThe most basic anti-immigration argument stems from the belief that Britain is "full". Firstly, Britain has more of a surface area than a volume, so it would be fairer to say it's "covered", but that's just semantics. The argument implies Britain doesn't have the capacity to sustain any more people, so every immigrant who arrives makes things worse for everyone by stretching our meagre resources further. However, recent data suggests that just 2.2% of Britain is "developed" in any way, and that's a generous estimate. Arguably it would be very helpful to build more, construct new homes and expand further, rather than pay increasingly high amounts for existing property. Some more room to breathe and grow might be good for everyone, immigrant or not. Of course, building thousands of new homes would require a lot of affordable labour, and traditionally there's one place to get that...ECONOMICSThe most common modern argument against immigrants is the economic burden they cause. Politicians play this card depressingly often, but it's a common claim. You'll often hear complaints about immigrants "coming over here, claiming benefits and taking our jobs", a mutually-exclusive scenario loudly complained about by the misinformed, bigots, or the extreme of both combined, Richard Littlejohn. It makes little logical sense in either case. Anyone willing to leave their country of birth, travel thousands of miles and go through the process of gaining citizenship probably has a work ethic that wouldn't settle for £50 a week. And as for taking your jobs, if you lose out on a job to a recently arrived individual from a war torn country who can't speak English, perhaps your own CV needs some serious updating? Actual data shows that immigration has a generally positive impact on a county's economy, what with immigrants doing work, paying taxes, spending their money in the country and all that. Even parts of our infrastructure on which the economy depends are owned by foreigners. Places where strong anti-immigrant policies have been enacted usually suffer economic downturns as a result. It seems like stopping immigration to improve the economy is like hacking your foot off because you've got a stone in your shoe; you've caused a lot of needless suffering, and it still hurts to walk.CULTURESome people argue that immigration is bad because it's not "British", or ruins "Britishness". It's very hard to scientifically assess something based on someone's subjective interpretation of an unspecified term, as some have noticed. Immigration has been part of British culture for millennia. If people do want to travel to other countries and exploit their resources, they probably got the idea from the British Empire. And the most iconic British hymn of all is arguably Jerusalem, a heartfelt celebration of the possibility that a middle-eastern man may have visited the country, and a fervent hope that he does so again and builds a massive home here. So yeah, immigration isn't at all British.LIFEI've heard some claim that immigration is against our way of life. I don't really know what that means, really. Saying that, life as we know it wouldn't exist without immigration. Not just due to the importance of cultural diversity; on a literal, ancient bio-molecular level. It is believed the first cells formed due to endosymbiosis, where a primitive cell incorporated other, smaller cells to the mutual benefit of both. E.g. a larger cell engulfed a smaller, different cell which eventually became mitochondria. Forget our African origins, imagine how bigots will feel when told that every human is made up of billions of examples of immigrant communities. Should cause a nose bleed, at the very least. SCAPEGOATSEven the most hard-line xenophobe can't deny one use for immigrants; they make great scapegoats. The scapegoating of vulnerable groups by the larger group or culture during times of economic hardship (e.g. the present) is a well-studied phenomenon. And it's not limited to frustrated rants either. Studies revealed that there was a correlation between cotton harvests and frequency of lynching in southern USA states in the late 19th/early 20th century. Consider this if anyone invokes "the good old days" when complaining about immigrants. When people are experiencing hardships due to factors beyond their control (e.g. the weather, disease, a corrupt economic system screwing over whole countries etc) it is inevitable that they will find something or someone to bear the brunt of their impotent frustrations. It's a darker element of human nature that needs to find someone weaker to victimise. And as has been discussed before, people have worrying tendencies to find reasons to blame victims for their own suffering. Sure, there are undoubtedly immigrants who are exploiting the system or behaving generally badly, but that's not behaviour exclusive to immigrants. Far from it. All the despicable efforts to play up to or enhance this anti-immigrant bias people are feeling are worryingly short-sighted. If we do stop all immigration and find all the problems we'd blamed on them haven't gone away but have in fact gotten worse, it's a question of who we blame next. For further examples of irrational anti-immigrant viewpoints, you may want to keep an eye on the comments below. For articles like this, they tend to be as persistent as mould on a shower curtain, albeit less pleasant and more ill-informedDean Burnett wrote this purely to wind-up the Daily Express and other immigrant-bashing organisations. He is, unfortunately, on Twitter, @garwboyPsychologyEconomicsImmigration and asylumAusterityDean © 2013 Guardian News and Media Limited or its affiliated companies. 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Science Weekly podcast: the problem with drugs for mental illness This week on Science Weekly Alok Jha meets Dr Joanna Moncrieff from University College London to discuss her book The Bitterest Pills: The Troubling Story of Anti-psychotic Drugs. Joanna believes her extensive survey of research into psychiatric treatments points to a flaw in the dominant clinical paradigm that mental illness can be treated like any other illness – with drugs.Alok is also joined by Observer Tech Monthly commissioning editor Nicola Davis and Observer science editor Robin McKie to discuss this week's science news, including a frustrating day at the lab for scientists hunting dark matter; a look at the complex, controversial legacy of Fritz Haber's discovery of a way to synthesise ammonia early in the 20th century; the problem posed by unpublished clinical trial data; and new evidence of the link between bats and the 2002 outbreak of the Sars virus.Don't miss the latest edition of Observer Tech Monthly on Sunday 10 November, chock-full of awesome science and technology features and news. Subscribe for free via iTunes to ensure every episode gets delivered. (Here is the non-iTunes URL feed).Follow the podcast on our Science Weekly Twitter feed and receive updates on all breaking science news stories from Guardian Science.Email Science is now on Facebook. You can also join our Science Weekly Facebook group.We're always here when you need us. Listen back through our archive.Alok JhaNicola DavisRobin McKieJason Phipps
Statement in Response to the Report of the Task Force of the Institute of Medicine as a Profession and the Open Society Foundation
Being Considerate Of Your Future Self In a previous post, The Problem With Reincarnation, I wrote: "The sense of self I feel and have always felt has seemed constant throughout my life, which is why I feel as if I even have a core self. But a moment's reflection reveals that what's really remained constant is the feeling of the sense of self itself, not the content of that sense. Am I even remotely the sameread more
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The Private Life: Why We Remain in the Dark by Josh Cohen – review Josh Cohen's study of our need to expose our own private lives and those of others is both perceptive and engagingThe borders of privacy have been ardently disputed in recent years. On the one hand, a public culture of openness and transparency seems a necessary good: we do not want states and politicians keeping secrets from the electorate and snooping on their citizens' every activity. Nor do we want corporate giants silencing a responsible press and preventing exposure, say, of toxic waste clandestinely dumped or of what goes into a burger.On the other hand, most who can still remember an era before intimate telephone conversations were broadcast on streets and trains feel more than a little squeamish about just how many of our private parts need public exhibition before the polity as a whole is irredeemably mired.For those whose consciousness took shape before mobiles and social networking were the norm, Paul McMullan's exclamation at the Leveson inquiry that "privacy is for paedos" had the shocking resonance of a wake-up call. George Orwell's dystopian, all-seeing Big Brother, who eradicated the possibility of any private life or unspoken thoughts, had once and for all morphed into his gameshow double. In our epoch of tabloid culture, many want nothing more than to parade for our voyeuristic delight what was once sheltered behind (self-)patrolled boundaries. Or to drag others' secrets into global public display and regale everyone in the process. The National Trust's branding of the Big Brother house as the "stately home of the digital era" is just one more sign of such times.Psychoanalyst and literary academic Josh Cohen provides a subtle and stimulating reflection on this second aspect of privacy. The unholy "alliance between voyeurism and exhibitionism" that marks our epoch's recalibration of the private is his lead subject. Our need to know, to probe secrets, he argues, is much more than an extension of the child's Alice in Wonderland curiosity. It is a punishing quest, fuelled by "envy and vindictive rage", against any who are perceived to have more than us. That more is not just financial: it's an amorphous "more" that includes pleasure, beauty and happiness, that added extra that is always there in the eye of the beholder.What envy isn't for Cohen in any simple way is the old revolutionary motor towards greater equality. He diagnoses our passion for exposure as a wish that nothing should remain unknown to us. He also recognises that the emphasis on needing to know everything about the other mirrors the suspicion that there is always something we don't know. This is the motor of our fury.One of the reasons "why we remain in the dark", according to Cohen, is that the private self is in no simple way a readily accessible accumulation of mental furnishings and known narratives. For the psychoanalyst as for lovers of literature, the self is a complicated entity always greater than the sum of its listable parts. Within the self, there is an unknown other who is inevitably lost in the translation (whether in confession or even consulting room). This inner stranger, who is also uncannily familiar, is a repository of irreducible excesses – the acts we indulge in against our own self-interest and conscious will, the bits that are too scary to acknowledge. Our epoch's frenzied attack on privacy may well be an attack on that all-too-human complexity which totalitarian states also sought to abolish.The Private Life bears an affinity with The Examined Life, psychoanalyst Stephen Grosz's bestselling tales from the consulting room. In probing the vagaries and vulnerabilities of the human, Cohen, too, gives us fascinating glimpses of cases. He weaves autobiographical fragments into his narrative, perhaps to emphasise that the analyst is not the all-seeing authority that popular culture paraded in the middle of the last century. Close to Darian Leader and Slavoj Žižek in his understanding of the uses of psychoanalysis, Cohen also engages in some astute reading of literature and popular culture. He is particularly good on the enigmatic Man Booker winner Lydia Davis.Lisa Appignanesi's Paris Requiem (Arcadia) and Losing the Dead (Virago) are out nowSocietyPsychologyPrivacyPrivacy & the mediaLeveson inquiryReality TVLisa © 2013 Guardian News and Media Limited or its affiliated companies. All rights reserved. | Use of this content is subject to our Terms & Conditions | More Feeds