1 Boring Old Man

Those of us coming into adolescence in the 1950s were too young to be Beatniks, but we knew something about the rules. It was kind of hard work. Go to the coffee house and talk about the really deep things in the universe, expressing unique and novel opinions without being committed to doing anything except keeping the conversation going. And even though you knew you weren’t going to be actually involving yourself, you couldn’t just say that. You actually had to know the topic pretty well so you could say wise things along the way, otherwise, you were labeled as the worst thing imaginable – a pseudo-intellectual. [which was as bad as working at DOW Chemicals]. In the coffee house, you had to know your stuff to go nowhere. After all, the point wasn’t to say or do anything that mattered – but just sound that way. The point was to fit in and keep up with the other unique and clever people at the coffee shop.

We have a lot of coffee house science, particularly in psychiatry – people who take the results of clinical trials [they didn’t design] on patients [they haven’t seen] and give presentations of papers [they didn’t write] that sound wise and novel – fitting into a world that always ends the same way, needs further study. They don’t look like Beatniks, but they play the same game. They’ve stayed in the coffee house for years by knowing the rules about how to stay, but accomplish little of note. There are some prime examples in my recent posts about STAR*D [a whole lot better than this…] or Vortioxetine [way past time…, the squeaky wheel…].

Decreased Cortical Representation of Genital Somatosensory Field After Childhood Sexual Abuse
^{by Christine M. Heim, Ph.D. Helen S. Mayberg, M.D. Tanja Mletzko, M.S. Charles B. Nemeroff, M.D., Ph.D. and Jens C. Pruessner, Ph.D.}
American Journal of Psychiatry. 2013 170:616–623.

Objective: Sexual dysfunction is a common clinical symptom in women who were victims of childhood sexual abuse. The precise mechanism that mediates this association remains poorly understood. The authors evaluated the relationship between the experience of childhood abuse and neuroplastic thinning of cortical fields, depending on the nature of the abusive experience.

Method: The authors used MRI-based cortical thickness analysis in 51 medically healthy adult women to test whether different forms of childhood abuse were associated with cortical thinning in areas critical to the perception and processing of specific behavior implicated in the type of abuse.

Results: Exposure to childhood sexual abuse was specifically associated with pronounced cortical thinning in the genital representation field of the primary somatosensory cortex. In contrast, emotional abusewas associated with cortical thinning in regions relevant to selfawareness and self-evaluation.

Conclusions: Neural plasticity during development appears to result in cortical adaptation that may shield a child from the sensory processing of the specific abusive experience by altering cortical representation fields in a regionally highly specificmanner. Such plastic reorganization may be protective for the child living under abusive conditions, but it may underlie the development of behavioral problems, such as sexual dysfunction, later in life.

I can’t tell you what their data was because it wasn’t there, at least not in any way an expectable reader of the American Journal of Psychiatry might understand. I’m afraid an expert would be in the same boat. So all I can do is tell you what they did. They recruited 51 women some with abuse histories and some not. With this group, it’s been traditional to recruit from the Grady Hospital [Atlanta Georgia] waiting room or from bus advertisements, but in this paper they don’t say. The women filled out questionnaires about childhood abuse and had structured interviews to rate the extent of the abuse. Structured DSM-IV Interviews provided Psychiatric Diagnosis. They had MRIs ["a high resolution T1 three-dimensional magnetization-prepared rapid gradient echo sequence (TR=2,600 ms, TE=3.02 ms, flip angle=8°, field of view=2563224 mm, in-plane resolution isotropic, 1 mm3)"]. All of this happened in Atlanta, GA, US. Here’s my new hobby – a world map of the study:

^{Cortical thickness analysis was performed using the automated analyses pipeline developed at the Montreal Neurological Institute. In brief, anatomical MRIs are corrected for nonuniformities, registered into standard stereotaxic space, and classified into gray matter, white matter, and CSF using a neural-net classifier. At the core of the cortical thickness analysis, a constrained Laplacian anatomical segmentation using proximities is applied to determine white and gray matter surface boundaries using a surface deformation algorithm. This procedure computes 40,000 vertices of white and gray matter surfaces that are linked. Cortical thickness is computed as the distance between these linked vertices. In a final step, individual cortical thickness data were smoothed using a blurring kernel of 20 mm.}

^{"… emotional abuse specifi cally affects the areas of the left (x= -3, y= -61, z=45; F=7.8, p , 0.05) and right (x=6, y= -49, z=51; F=6.2, p , 0.05) precuneus and the left anterior (x= -4, y=40, z=11; F=6.9, p , 0.05) and posterior cingulate cortex (x= -2, y= -47, z=28; F=8.1, p , 0.01). We also observed thinning in the face region of the somatosensory cortex (x= -56, y= -12, z=45; F=22.7, p , 0.001). Hence, emotional abuse, which likely represents experiences of parental rejection and is often considered most detrimental in terms of altered concept of ‘self,’ is associated with the cortical thinning of regions implicated in mediating self-reflection, self-awareness, and first-person perspective."}

^{"we investigated the effect of age at onset of any abuse on cortical thickness in the group of women reporting moderate to severe exposure. This analysis revealed that earlier exposure was associated with thinning of the left temporal pole (x= -49, y=22, z= -26; F=19.9, p , 0.001), the left parietal lobe (x= -63, y= -32, z=45; F=18.9, p , 0.001), the left frontal pole (x= -28, y=63, z=12; F=16.8, p , 0.001), and the right frontal pole (x=11, y=69, z=4;F=18.6,p , 0.001), areas associated with autobiographic memory, as well as thinning of the anterior cingulate cortex (x= -2, y=21, z=22; F=8.13, p , 0.01). This finding is concordant with reports that abuse occurring earlier in childhood is often associated with absence of memories concerning the abuse. We did not see an effect of duration of the abuse, which supports the assumption that the observed effects reflect developmental programming rather than consequences of cumulative exposure to maltreatment over time."}

So even if we accept the methodology used to measure cortical thinning at face value and accept that the questionnaires and structured interviews actually give an accurate index of the type and magnitude of the child abuse in the subjects, we’re still left entering the world of multiple regressions with no direct access to any data other that the significance corrected in multiple ways we can’t see. Anyone who has done multiple regressions with large data sets using a statistical package knows that if you play with the data enough, you can make it sing any song. It’s where the saying, "Torture the data long enough, and it will tell you anything you want to hear." And then the authors speculate on complex abstract concepts like "self-reflection" or "parental rejection" without actually assessing these things in the subjects  of the study as if the outcome of a given experience is an index of its impact – a clinically indefensible position. We are supposed to be thinking that the childhood sexual trauma resulted in cortical thinning of the genital sensory area of the brain without asking the subjects about their adult sexual history or experience. If there are subjects with cortical thinning of the clitoral area, are they sexually anesthetic? All of that behind us, we are then teleported into the realm of neuroplasticity, the brain changing anatomically based on experience – a concept on the outer edge of our understanding at best.

So everything said in this study may be absolutely correct or it may all be a fantastic coffee house poetry reading. What’s included in this paper itself doesn’t help us make that distinction. Rather than giving us a narrative we can’t possibly vet on the way to conclusions filled with speculation, how about a scatter-plot of the various trauma indices against the cortical thickness in different parts of the cortex. Maybe we can’t grasp the methodology completely, but we could at least see something concrete that gave us a sense of what we’re being asked to believe.

I’m not sure what part Dr. Nemeroff actually played in this study, but his track record doesn’t support anyone asking us to accept things he publishes on faith alone. There’s too much consistent dodgy science in his former outings to ask us for that – particularly when the conclusion has so many conceptual ramifications. This is the kind of study where the raw data, at least the various values of cortical thickness by cortex area and the results of the associated subject data should be available for validation by some kind of outside source. I can’t imagine how a peer reviewer could evaluate this paper.

^{Neural plasticity during development appears to result in cortical adaptation that may shield a child from the sensory processing of the specific abusive experience by altering cortical representation fields in a regionally highly specific manner. Such plastic reorganization may be protective for the child living under abusive conditions, but it may underlie the development of behavioral problems, such as sexual dysfunction, later in life.}

• Critical Psychiatry Network Calls on Institute of Psychiatry to Cancel Charles Nemeroff
• Letter from the Critical Psychiatry Network
• academic psychiatry, research ethics and the pharmaceutical industry

"The Nemeroff case tells us something about how the psychiatric establishment and the biomedicine-driven research world work, and about their relationship with the pharmaceutical industry that has a vested interest in the biologisation of human experience – indeed in the disease – mongering Jonathan Gornall reprises. Nemeroff’s appointment to another chair of psychiatry as if nothing had happened and when the case against him was not closed, his receipt of substantial new grants, and the Institute of Psychiatry in London continuing to laud him as “one of the world’s leading experts”, all show how psychiatric academe sails blithely on as if such revelations beg no broader questions about its associations and supposed scientific independence, about research ethics, and specifically how conflicts of interest must inevitably contaminate the integrity of the research data informing publications in the scientific literature."

"It is worth adding that in fact no clinically meaningful “neurobiology of depression” has been discovered- and perhaps never will be, given that “depression” is merely a syndromal category, subsuming a very heterogeneous range of patients and circumstances,and whose widely differing understandings of their distress point rather more often to social space than to the space between their ears."