A Tale of Two Scientists

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I haven’t posted here in a while, as I’ve been busy building my new site, designed for the support of caregivers. I invite you to check it out at http://www.exploringdementia.com

In 1907, two very important papers were published. The author of one paper went down in history, as the saying goes, while the other eventually faded into relative obscurity until just recently.

The first of these two men was Dr. Alois Alzheimer, famous for his work in helping to define the disorder that now bears his name. He was born in Bavaria, and earned his medical degree at Wurzberg University in Germany. Soon after graduating, he began work in the Asylum for Lunatics and Epileptics in Frankfurt. In 1901, he observed a patient who exhibited symptoms very similar to those observed in someone with senile dementia. However, Auguste Deter was only 51 years old.

Alzheimer spent a great deal of time in the ensuing years observing Frau Deter and chronicling the development of her disease. Eventually, he moved to Munich, and in 1902 began work at the Royal Psychiatric Clinic there. When Frau Deter died in 1906, he requested that her medical records and her brain be sent to him for further study. Upon autopsy, he discovered the now-characteristic shrinking of the cerebral cortex as well as the presence of neurofibrillary tangles and neuritic plaques.

Going on to publish a paper on the subject, in 1907, Alzheimer described Deter’s case at some length. He was not the one to name this newly-discovered disease after himself, however. That honor fell to Dr. Emil Kraepelin, Director of the clinic where Alzheimer worked at the time of his discovery, when he published his textbook “Psychiatry” in 1910. Kraepelin is a well-respected name in the scientific community, in his own right, for his work in the fledgling field of neuropsychiatry – specifically in the study of schizophrenia and other disorders.

At around the same time period that Alzheimer was doing his research, a scientist named Dr. Oskar Fischer, was working at the German University in Prague. From 1900 to 1909, he worked first in the Department of Pathological Anatomy, and then later moved to the Department of Psychology. He investigated sixteen cases of senile dementia – particularly the cerebral cortexes of these patients – using a number of different staining techniques. He not only described the presence of plaques in 12 of these individuals, but also was the first person to describe what is now known as the neuritic plaque. Plaques were not observed in the brains of 10 control cases, 10 psychotic individuals, and 45 patients with neurosyphilis.
Fischer went on to describe the appearance of these plaques, both as he initially observed them and also as they grew in size. His use of the word “neurofibrils” to describe the appearance of certain components of the plaques has persisted to this day, found in the modern term “neurofibrillary tangles.”

Moving on in his research, Fischer then began to investigate whether the clinical symptoms of these 12 individuals with senile dementia differentiated them from the other test cases. He linked the presence of plaques with a diagnosis of presbyophrenia, a diagnosis commonly used in the early years of the 20th century. This was considered to be a form of dementia, including behaviors such as confabulation, significant memory loss, hyperactivity, disorientation, elevated mood, and a preservation of “social graces.” It was thought to be either a form of Korsakoff’s psychosis or senile dementia. However, the term has vanished from current usage. Those four individuals who did not have plaques were considered to have exhibited senile dementia, thus identifying the two conditions as separate diseases.

In subsequent research, Fischer went on to describe eight stages of plaque development. He likened plaque formation to the inflammatory process, especially interesting now in view of the current research in that vein. (It was only when the state of immunohistochemistry had evolved sufficiently that Fisher’s theories were able to be validated.)

The work of Alzheimer and that of Fischer are considered to complement each other, with their use of staining techniques to identify the neuritic plaques and neurofibrillary tangles being the major point that made their work stand out over that of others. Interestingly, Alzheimer also discovered what later became known as “Pick’s bodies” in what later became known as Pick’s disease or frontotemporal dementia. (The director of the clinic where Fischer did the bulk of his work was Dr. Arnold Pick, now famous for his work in the definition of FTD.)

The two scientists disagreed on a number of matters. For instance, Alzheimer took issue with Fischer’s theory that the plaques had a link with presbyophrenic dementia. While he agreed that plaques were a distinctive feature of senile dementia, he did not think that they actually caused the disease, as Fischer did. Alzheimer did actually give Fischer credit for helping to draw attention to plaques in the diagnosis of senile dementia. He considered that the cases of presenile dementia that he and Fischer had both described to be a sub-type of senile dementia, rather than an entirely new disease. Fischer also disagreed that a new disease was being reported. The two men differed in their opinion on the formation and the significance of the tangles.

So, why do we speak of Alzheimer’s disease, and not Fisher’s disease? In the years immediately following the work of both men, we do find references in the literature to “Fischer’s plaques.” Alzheimer himself actually used the term in a paper he wrote in 1911. The terms presbyophrenic dementia and Alzheimer’s disease were both in usage as late as 1949. However, by 1955, textbooks that had previously used Fischer’s name to denote the disease had been changed to use the term Alzheimer’s disease exclusively. Fisher’s work was reported as being obsolete.

Some credit other factors as playing a part in Fischer’s legacy. Despite teaching there for 17 years, Fischer was never awarded tenure at the German University, and in fact his appointment was revoked in 1939 as the university began to quietly remove all Jewish faculty in anticipation of the Nazi take-over. Fischer attempted to continue a private practice until 1941, when he was arrested by the Gestapo. This eventually led to his imprisonment and death in a Nazi concentration camp in 1942. The German University, where he had done so much work, was likewise closed down in 1945. Fischer did not have any students who continued his work, as Alzheimer did.

By contrast, Alzheimer worked under Dr. Kraepelin, who not only named the disease after him, but was also one of the most influential psychiatrists of his time. The Munich institute continued for many years, and when Alzheimer ceased his work there in 1912, he was succeeded by Spielmeyer, one of the most respected histopathologists of his time. It has also been speculated that, because the schools where the two men worked were rivals, Kraepelin was quick to gain recognition for his school as well as for Alzheimer. However, even though Kraepelin coined the term Alzheimer’s disease in 1910, it was not until the 1970s that the term became widely used to describe patients with senile dementia.

http://www.ncbi.nlm.nih.gov “Presbyophrenia: the rise and fall of a concept”
“Oskar Fischer and the study of dementia,” by Michel Goedert, in Brain, 2009, 132.
“Oskar Fischer,” Wikipedia
“Prague: What Say You, Alois – Should it be ‘Alzheimer-Fischer’ Disease?” Gabrielle Strobel, http://www.alzforum.org

Breaking news: Live from a mental institution

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Breaking news: Live from a mental institution

sickAn anchor woman holds her microphone steady as she reports live from ‘We have the power’ , an old mental institution where the walls should have been painted decades ago. Her voice intermingle with twenty other reporters looking seriously into the camera, pointing occasionally to the building behind them. The anchor woman turns her voice dramatically down when she arrives at the conclusion.

“Sources tell us that in this mental institution, often just keep patients long enough to give them medication before they send them back. They sometimes don’t arrive at the right diagnose, and it is rumored that they don’t take enough time with traumatized victims or that they even consciously decide not to talk about what they have experienced. Only 30% report that they felt better or had hope for the future after being released, and surveys show that staggering 20 % of the patients will be readmitted after not receiving the help they wanted”

Her face is now full of rage. Her mother killed herself after being hospitalized in a mental health clinic. When she had read through her mother’s journal she saw how many pills she was on, barbiturates strong enough to knock out a mammoth. When she tried to find therapy notes where her mother could process her traumatic past, she only found short conversations where the doctors wanted to know if she slept well, eat what she should or if she felt a bit better after taking another pill. She shouldn’t even be reporting, but she manages to do her job, t is important for her to get it all out there.

Another reporter talks with the direction, who promises that they will do everything to make this right. They will look into their routines and see what they can do to make sure this will never happen again.

The news report goes viral. Oprah dedicate her next show to the cause, and Internet users on Twitter have started protest demonstrations, venturing into the street with their fists pumping in the air as they chant: ‘Stop this, stop this, stop this’. They bring posters where with personal accounts: ‘My mother only got three days in the institution, when her depression intensified they said they have done everything they could so she was not prioritized. Take mental health seriously!” Some write messages to the government. ‘We want that our tax payers money go to mental health care for the 450 billions who needs better treatment” or “Why only research on drugs?”.  The protesters don’t make to much of a fuss. They don’t shout out obscenities, but they gather in every city, staying put and showing their support. They have started a peaceul war.

Why don’t we see this in the real world? Where is the public outcry over the state of unsatisfactory mental health care? When someone breaks a leg, we demand full treatment until the injury is fully treated. We never take off the bandage after three weeks instead of six, telling our patient that they can come back if the leg breaks again as it will because it simply was not healed. We protest when the plumber does a bad job, demanding to sue them if they don’t come back and fix it. When politicians have done something wrong, news papers write about it for days, as they do when an actress have broken down and been sent to rehab. But where are the headlines after it thousands of citizens have been ignored by the health care system? Where are the depth interviews with families who’ve seen their loved ones break down after unsuccessful treatment?

In my future news scenario, the media would focus on mental health daily. They would write nuanced articles on every subject relating to how we suffer and what our options are when we do. There would be demonstrations to so that we get what we need.

We would all be small Ghandies, damanding justice. We wouldn’t close our eyes, we would engage and try to change things. The media would not ignore us.

In my future utopia, the mental institution ‘We have the power’ would change their ways. They would give the power back to their patients, not giving up before they had tailor made the treatment that was right for them. They would listen to them and find their resources.

They would use money on educating their employees, giving their patient the very best care. We do it with cancer patients, we even do it at Starbucks to make sure that the customers are a hundred percent satisfied with their coffees. I dream about a world where surveys about how satisfied their patient are with their treatment. Why shouldn’t we give mental health all of our attention? When almost a fourth of us have psychological issues, stigma should be lifted by never ignoring our troubled minds.

We should not be afraid to speak up.

More:

Demonstations

Mental health research in India

 Stigma | Mental Health Commission of Canada

Readmission Rates for Mental Health Patients – NBRHC

Strategies for reducing stigma toward persons with mental illness 

Creative coculus

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Creative coculus

This post is a comment from a Norwegian man, who has suffered from severe depressions through life. He is also intellectually gifted, but describes it in no such terms himself. For him, depression has been the flip coin of his gift, and I think is important to realize that no matter what abilities or Resources we have, mental illness can still have a devastating effect on us all.

The following excerpt, focus on “coculus” thoughts on creativity.

cuculus canorus
cuculus.koko@gmail.com

Creative people are like me..

This is not said lightly; it is an insight that hurts a great deal. In a way, I see the world not as it is, but as it can or should be. And I have for 30 years thought that everybody did this. Discovering that this is not so; have left me floating on a thin ice-sheet far out in an exsistential, deeply depressed sea with no land in sight.

Anyway. There are massive problems with the words used to describe creative people, and creativity: the connotations, the percieved social and cultural acceptability for “being a little off”.

“Creative” in the worst sense of the word conjures up images of slightly loopy ladies with flowing, purple togas and buckets of paint in primary colours. Or worse still: the image of my primary school “drawing teachers”. I shudder to think: how my creativity survived the lashings of those ignorant dimwits. It boggles the mind. It was a brutal fight, I can tell you that much.

To splash a little colour around is not not creative in itself. The way I see it, and much research agrees, is that creativity is essentialy to take two seemingly unconnected things and combine it in new ways. Very very often nothing happens. But sometimes there is a little magic insight … An article in the Time magazine called The hidden secrets of the creative mind points out that creativity is a numbers game. Creative people fail more. Because they try more (Therefore, creative people can easily feel like failures. Massive egos are not the norm).

I wish to stress that creativity is something equally needed in art, litterature and – and this is extremely important: science. This seems to be left out quite often, unfortunately. In science and arts you will find many of the same abilities. Or, if you like, similar eccentrics. I think Einstein said something like “If at first, the idea is not absurd, then there is no hope for it”.

At the risk of overstepping my role as commentator, I will here bring a buch of quotes by various artists, architects, scientists and other nosey, curious creators.

creativity: 1+1=3

Creativity is:

Any mental occurence simultaneously associated with two habitually incompatible contexts.

Arthur Koestler

That moment of insight becomes the creative act as a joining of two previously incompatible ideas.

Lyall Watson
The association of two, or more, apparently alien elements on a plane alien to both is the most potent ignition of poetry.

Comte de Lautrémont

Perceiving analogies and other relations between aparently incongruous ideas or forming unexpected, striking or ludicrous combinations of them.

Rem Koolhaas

Invention or discovery takes place by combining ideas.

Jacques Hadamard

The unlike is joined together, and from differences results the most beautiful harmony.

Heraclitus
 

The how of creativity is in most respects a complete mystery, but someone worded it thus:
how such connections spring to mind are guesswork but they seem to favour those who have a promiscuous curiosity and chronic attraction to problems.

Yeah. Promiscuous curiosity and chronic attraction to problems. That is me.

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On Learning…

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Originally posted on Rudy Oldeschulte:

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“The best thing for being sad,” replied Merlin, beginning to puff and blow, “is to learn something. That’s the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins, you may miss your only love, you may see the world about you devastated by evil lunatics, or know your honour trampled in the sewers of baser minds. There is only one thing for it then — to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the only thing for you. Look what a lot of things there are to learn.”

― T.H. White, The Once and Future King

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Meditation – our experience of self and of the world…

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Originally posted on Rudy Oldeschulte:

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“Positive emotions, such as compassion and patience, are teachable skills; and the way we think directly influences our experience of the world.”

Excerpts –

Montaigne believed that meditation is the finest exercise of one’s mind and David Lynch uses it as an anchor of his creative integrity. Over the centuries, the ancient Eastern practice has had a variety of exports and permutations in the West, but at no point has it been more vital to our sanity and psychoemotional survival than amidst our current epidemic of hurrying and cult of productivity. It is remarkable how much we, as a culture, invest in the fitness of the body and how little, by and large, in the fitness of the spirit and the psyche — which is essentially what meditation provides.

We know that the self is a social construct and the dissolution of its illusion, Harris argues, is the…

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‘Try to be a little kinder’…

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Originally posted on Rudy Oldeschulte:

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It’s a bit embarrassing to have been concerned with the human problem all one’s life and to find at the end that one has no more to offer by way of advice than ‘Try to be a little kinder.’

Aldous Huxley, quoted in The Open Road: The Global Journey of the Fourteenth Dalai Lama by Pico Iyer

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Saturday Morning: We immerse, slow down

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Originally posted on Live & Learn:

read-morning-coffee-saturday

“… to read, we need a certain kind of silence, an ability to filter out the noise. That seems increasingly elusive in our overnetworked society, where every buzz and rumor is instantly blogged and tweeted, and it is not contemplation we desire but an odd sort of distraction, distraction masquerading as being in the know. In such a landscape, knowledge can’t help but fall prey to illusion, albeit an illusion that is deeply seductive, with its promise that speed can lead us to more illumination, that it is more important to react than to think deeply, that something must be attached to every bit of time. Here, we have my reading problem in a nutshell, for books insist we take the opposite position, that we immerse, slow down.”

David L. Ulin, The Lost Art of Reading


Notes: Quote – Litverve. Photograph: Amoris-Causa

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Montaigne and the Double Meaning of Meditation

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Originally posted on Rudy Oldeschulte:

montaigne - Dali 1947

   Montaigne portrait – Dali 1947

Meditation is a rich and powerful method of study for anyone who knows how to examine his mind, and to employ it vigorously. I would rather shape my soul than furnish it. There is no exercise that is either feeble or more strenuous, according to the nature of the mind concerned, than that of conversing with one’s own thoughts. The greatest men make it their vocation, “those for whom to live is to think.   – Montaigne

“Meditation,” here, is taken to mean “cerebration,” vigorous thinking — the same practice John Dewey addressed so eloquently a few centuries later in How We Think. This conflation, at first glance, seems rather antithetical to today’s notion of meditation — a practice often mistakenly interpreted by non-practitioners as non-thinking, an emptying of one’s mind, a cultivation of cognitive passivity. In reality, however, meditation requires an active…

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Russell on thinking and societal changes…

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The great majority of men and women, in ordinary times, pass through life without ever contemplating or criticising, as a whole, either their own conditions or those of the world at large.  They find themselves born into a certain place in society, and they accept what each day brings forth, without any effort of thought beyond what the immediate present requires…they seek the satisfaction of the needs of the moment, without much forethought, and without considering that by sufficient effort the whole condition of their lives could be changed…It is only a few rare and exceptional men who have that kind of love toward mankind at large that makes them unable to endure patiently the general mass of evil and suffering, regardless of any relation it may have to their own lives. These few, driven by sympathetic pain, will seek, first in thought and then in action, for some way of escape, some new system of society by which life may become richer, more full of joy and less full of preventable evils than it is at present (p. viii).  

Bertrand Russell