Continue reading »]]> By: Diana Elihu

http://www.streetbonersandtvcarnage.com/blog/adderall-doesnt-work/

At universities across America, students are becoming increasingly addicted to a popular prescription drug — not because they’re trying to get high, but because they hope to get smarter. The prescription drugs Adderall and Ritalin, which are normally prescribed for children with ADHD (formerly known as ADD), are under heavy abuse by students. Many of the symptoms of ADHD occur from time to time in everyone’s lives, including inattention, hyperactivity, impulsivity, difficulty focusing and frequent conversation shifts to name a few. Any of these actions may occur occasionally in any child and just because a child may show ADHD symptoms frequently does not mean they suffer from it, as other conditions have similar symptoms. Even so, the accessibility of the drug and the perception that it is relatively safe appeals to many students, and UCLA is no exception.

Since the symptoms of ADHD – short attention span, distractibility, and hyperactivity – are easy to feign, many students falsely claim to have ADHD in order to obtain a legal prescription from their physician. While some students have become convinced that Adderall will help them achieve academic success, this notion is purely a myth. Although it’s no secret that the drug can significantly affect one’s academic performance, it by itself does not make an individual smarter. The immediate effects of the drug allow students to concentrate on the task at hand, such as studying for a final or MCAT for long periods of time in complete isolation from trivial noises or stimuli. Adderall works to balance two chemicals in the brain, dopamine and norepinephrine, which allows students to focus better and pull all-nighters.

According to a recent study, which explored the motives for using prescription stimulants among college students, the most commonly reported justification for their illicit use included: to help with concentration (65.2%), to help study (59.8%), to increase alertness (65.2%), to get high (31.0%) and to experiment (29.9%) (Teter, McCabe, LaGrange, Cranford & Boyd, 4). The users of such stimulants fit two different personality types- perfectionists and those seeking to use it for recreational purposes (Low & Gendaszek, 284). This study suggests that students were mostly motivated in some way to perform better in the classroom because they believed Adderall would enhance their immediate, as well as long-term academic performance.

The reliance on prescription stimulants has become almost as commonplace as drinking Red Bull and caffeine, which use to be the customary methods for studying. Alarmingly a number of students who admitted to misusing these stimulants reported that they “were not concerned with the misuse and abuse of prescription stimulants, and a number of students felt they should be more readily available…Also other students have anecdotally reported stockpiling medication and taking a higher dose than prescribed in preparation for an exam or while writing a paper” (White, Becker-Blease & Grace-Bishop, 265). This lack of appreciation of the health risks associated with self-medicating sheds light on an ongoing and heated debate among students.

Analogous to how steroids are barred from use in professional sports, the exploitation of Adderall among college students raises issues of competitiveness and fairness. Is the use of this “study drug” considered cheating? Among those who refuse to dabble in these study drugs, the disapproval and bitterness can be high. Students who decline to partake rightly complain that by not taking them, they are at a disadvantage to everyone else, especially if students are being graded on a bell-curve. However, students who seek out these stimulants argue that the stresses of the current economic downturn, the tightening job market, and the fierce competition to get into grad-schools further compels them to seek short cuts to alleviate this Herculean pressure on their backs. While some report that it is wrong to use the drug for any reason outside of a prescription, others justify it by claiming that “I’m doing it for the right reasons” (DeSantis & Hane, 35). Students rationalize that because they are acting to promote a positive outcome, like improving their grades, their use is morally correct. Thus, the culture at schools with high academic expectations of their students, such as at UCLA, creates a competitive environment that pushes students to seek out these little orange tablets. Rather, colleges need to focus on restoring the practice of education and learning for the sake of learning, rather than for grades. This change could then also decrease the number of students running to their professors’ office hours to argue for a higher grade or for more points on every problem in the hopes that the points would add up.

Given the effectiveness of prescription stimulants, clinicians who prescribe such drugs carry a heavy burden on their shoulders. The difficult task of balancing the medical necessity of drugs with their possible non-medical use reflects the greater call for more education aimed at preventing and reducing illicit behavior among students (McCabe, Knight, Teter, & Wechsler, 104). Although most agree that policies should be in place to deter students from partaking in this kind of activity, they offer no probable suggestions as to what these policies might be. As students are the future doctors, entrepreneurs, lawyers, etc. of our society, the abuse of prescription stimulants to cut corners and get ahead in school does not bode well. The ingredients for academic success are no longer going to class and studying long hours in the library, but rather on the steady flow of prescription stimulants.

Continue reading »]]> “Who lives in a pineapple under the sea?”

Most people easily pick up on the importance of television programming like Sesame Street and other educational shows for young children. Shows like these embed lessons about letters, manners, multiculturalism and more into their content. For adults, the lessons seem obvious, so we feel good about allowing our children to watch and learn from this kind of television show.

But other shows seem to hold zero promise of learning. One example might be SpongeBob SquarePants, an extremely popular cartoon on the Nickelodeon cable channel. Children, including my 4-year old son, were enthralled with this bizarre show about a sponge and his life under the sea. SpongeBob lives in a pineapple next door to a squid that plays the clarinet. He works for a crab that runs the Crabby Patty Diner and his best friend is a starfish. Besides perhaps fostering an interest in marine biology, it’s hard to understand the show’s ability to fascinate, let alone teach.

Yet after many years of watching this show with my son, I have come to believe that SpongeBob SquarePants teaches children fundamental lessons about basic human values in a non-preachy manner through the authentic actions of its characters. First, a two-second primer on values…

Some psychologists believe that human values are a dominating force in life, as values are thought to motivate human behavior and attitudes. The construct was defined and redefined by many famous psychological scientists from Lewin to Rokeach to Schwartz and Kasser. As the study of values advance, the values construct becomes more precise, and a basic list of values with a set of corresponding attitudes and behavior are generally agreed upon. Each theorist may define the overarching categories differently (i.e. intrinsic versus extrinsic, individualistic versus collectivistic, etc), but the specific value types, and their corresponding behaviors, by and large correspond across the theories. Some examples of a value and its corresponding behavior include the value of power — people who value power seek to command others or to lead. Others may value tradition and work towards honoring customs that their parents and grandparents taught them. The list of universal value types tested by the theorist Schwartz includes power, achievement, hedonism, stimulation, self-direction, universalism, benevolence, tradition, conformity and security. Kasser, drawing from Schwartz’s work, developed and tested a list of goals and values including self-acceptance, affiliation, community feeling, physical fitness, financial success, attractive appearance and social recognition.

It is these kinds of value types that are enthusiastically embraced by the characters in SpongeBob Square Pants, and this simple typology may be one of the reasons the show is still popular after ten years. My theory is that each character symbolizes one value type and behaves according to that value in the extreme. Thus, Mr. Crabs, the owner of the Crabby Patty, cares only about money; his every act in the show is motivated by his pursuit of his financial interests. Meanwhile, Squidward, SpongeBob’s neighbor, loves social status and prestige; he wants to be famous and could care less about anything in the small hick town of Bikini Bottom. Patrick Star, SpongeBob’s lovable best friend, exemplifies hedonism. He loves to eat, sleep and in general satisfy the most basic bodily desires. Sandy Cheeks, a squirrel who lives in an upside down glass bowl under the ocean, pursues intellectual achievement. She is the smartest character in the town and she also enjoys excelling at karate. Finally, Plankton, the tiny creature that owns a diner next door to the Crabby Patty, values power; he craves the satisfaction of control or dominance.

Each of these characters wrestle with the conflicts that naturally arise as they act according to their values, and while their basic value system usually wins out, the audience witnesses the choices they make in pursuit of these values and the disappointments that arise. For example, in one episode, Mr. Crabs sells SpongeBob to an evil, ghostly pirate for forty-nine cents. As he realizes he gave up his best worker and moreover, sacrificed him for a measly bit of cash, Mr. Crabs grudgingly learns that perhaps his choice was short-sighted. In the process of watching this kind of episode, children may actually absorb the intrinsic lessons in the storytelling.

And what about SpongeBob? He seems to me to represent a child, someone who lives for the moment, has no idea about the value of money or power and could care less about social status or physical pursuits. He enjoys hanging out with his friends, blowing bubbles and working hard at his job because he is excellent at grilling patties, not because he wants to earn a salary. His attitude is infectious, and his wonderful enthusiastic qualities usually trump those of the other characters.

So in our household, we wholeheartedly embraced this television show and its wacky characters and story lines. When watching with my son, I celebrated the mini lessons about values (whether intended or not by the show’s creator), and underscored the values that resonated with mine as the characters lived, learned and modeled behavior that illustrate through simple storytelling how humans behave.

First posted in Huffington Post.

Continue reading »]]> Dr. Matt Lieberman and former Psych in Action blogger Dr. Emily Falk are getting a lot of attention for their paper in Psychological Science that found that the specific brain regions that were activated while viewing health related advertisements predicted the ad’s success in the population at large — even though the viewers were not aware of the neural activation and were expressing different opinions about the ads.  Read about the implications of these findings in this Science Daily article and this press release.

Continue reading »]]> Many dating sites advertise that they will match you with a partner who is highly compatible. Those signing up for Chemistry.com, eHarmony, or similar other websites, are asked to complete prescreening information about their background and personality, and then are given matches with similar others based on this information. But how much does background and personality really predict successful relationships?

Professor Eli Finkel at Northwestern University and UCLA’s own, Professor Benjamin Karney, discussed the “Dubious Science of Online Dating” in a New York Times Review. Finkel and Karney argue that while similarity on background information, such as race and religion, does predict positive relationship outcomes, most people already do this on their own. As a result, the main appeal of these dating sites is their capacity to match based on similarity in personality. Yet, similarity on the major dimensions of personality (e.g., neuroticism, impulsivity, extroversion) accounts for only 0.5 percent of how satisfied spouses were with their marriages, according to a 2010 study of over 23,000 married couples.

Finkel and Karney point out that relationship-specific interactions (e.g.,  communication patterns, physical attractiveness) and environmental factors (e.g., experiences with stress, financial strain) have been left out of the dating sites’ equations, but are crucial predictors of relationship satisfaction. They do not argue that dating sites are a worse method than traditional methods for seeking new partners, but they do call to question how successful these matching algorithms really are.

To read the full New York Times Review, visit: http://www.nytimes.com/2012/02/12/opinion/sunday/online-dating-sites-dont-match-hype.html.

So, to online date or not? Despite this research, online dating sites have reported having a lot of success in making matches, and are continuing to receive new visitors seeking relationships. If dating sites are successful, but their algorithms questionable, perhaps the main capacity of these websites is not in making “matches.” Rather, they allow visitors to focus their efforts on pursuing eligible partners who are actively looking and motivated to find a long-term partner themselves. This may be better than what one can get in traditional methods for meeting a new partner, such as a visit to the local bar. Maybe online dating sites are selling access to motivated people, not necessarily compatible matches.

Continue reading »]]>

fMRI does not work like viewing a lightbulb

I wrote a post a few months ago about some common misconceptions about functional magnetic resonance imaging (fMRI), and one of my main points was that the term  ’lights up”, which is often used when describing the areas of the brain that respond to a task, is misleading. Here is what I said on the subject:

First, fMRI does not detect electrical changes in the brain, as ‘lights up’ would imply.  Neurons in the brain communicate via electrical and chemical signals; fMRI does not measure either of these.  Rather, fMRI measures changes in the amount of oxygenated blood flowing to an area, which is an indirect measure of the metabolic effort needed for neurons to send those electrical and chemical signals.  fMRI does not tell us what areas are firing, it tells us what areas are active as a result of firing.  Second, the brain is active at all times, doing all sorts of basic cognitive functions, and oxygenated blood is always flowing.  While individual neurons might fire on and off, blood flow to areas of the brain do not turn on and off in such a binary fashion, again, as ‘lights up’ implies.   With fMRI we attempt to detect what areas are more active for a task (what it is more active than is an important part of fMRI design).

The result of this misleading term is that assumptions are made about what fMRI shows us, and when these assumptions are violated, which is inevitable, the validity of the method is called into question.  I have seen both scientist in the field that don’t regularly use fMRI methods and lay people discard fMRI after hearing about studies that highlight aspects of the method that violate the assumptions implied by “lights up”, hence my campaign against this term!  Here is a clear example of how using this term can muddle a conversation about fMRI methods:

I recently read a post by Neuroskeptic who was reviewing two very interesting articles about the statistical effects of sampling size and effect size in fMRI research (original articles: here and here).  The review and the articles discuss some of the limitations of detecting effects in the brain resulting from current statistical approaches used for fMRI analysis.

In the review the author writes:

Both studies found that pretty much the whole brain ”lit up” when people are doing simple tasks. In one case it was seeing videos of people’s faces, in the other it was deciding whether stimuli on the screen were letters or numbers.

With all that data, the authors could detect effects too small to be noticed in most fMRI experiments, and it turned out that pretty much everywhere was activated. The signal was stronger in some areas than others, but it wasn’t limited to particular “blobs”.

So conventional fMRI experiments may just be showing us the tip of the iceberg of brain activity. In a small study, only the strongest activations pass the statistical threshold to show up as blobs, but that doesn’t mean the rest of the brain is inactive. It just means it’s less active. The idea that only small parts of the brain are ‘involved’ in any particular task may be a statistical artefact.

Here we can see the danger of the term “lit up.”  The author’s first line, “studies found that pretty much the whole brain ”lit up” when people are doing simple tasks”, is highly misleading.  If we take “lit up” to mean the brain is awake and firing, then this isn’t news, we know that the brain is always doing stuff, all over the place, all the time (one commenter nice sums it up with: “Are we really surprised that the whole brain is active when we are active?” No, we aren’t).

However, if we take “lit up” to mean that activation during the task is greater then a baseline task, at a set statistical threshold, then this is an interesting finding, but a finding about how we calculate activation, not about the brain.  Its not clear what meaning of “lit up” that the author is trying to use (in fact, I’m not sure he knows himself).

Since this distinction is not clear, this leads the author to later points out: ” that doesn’t mean the rest of the brain is inactive. It just means it’s less active.”  Again, this isn’t new, research who run fMRI studies know this well.  The real interesting findings of these papers isn’t that there are areas that are less active that we didn’t know about; its that with a big enough sample size, we might be able to tease apart some meaning about brain and a task from these less active areas.

The two articles reviewed are rather interesting, and warrant a post on their own, but the review post so nicely illustrated the use of “lights up” I thought I would tackle that first.

The moral of this story is the same as it was for my other post: fMRI does not show us a lightbulb view of the brain, where we see things turning on and off, and we have to be careful not to imply that it does.  So tell your friends, stop using the term “lights up”!

Really what I’m talking about is trying to not make this any worse:

PHD comics: The science news cycle

Continue reading »]]> Most of us have gotten loyalty cards at one point or another that treated us to a free item after a certain amount of purchases at that particular establishment. Most of us have also tossed more than one of those cards after realizing they weren’t worth the space in our wallets for the amount of time it would take to reach this requisite amount. Stores continue to keep loyalty cards because allowing customers to monitor progress toward their free item goal motivates them to achieve that goal. However, the way that many of them frame goal progress may actually be counterproductive. Similarly, the way we frame progress toward our own goals may be setting us back.

A recent paper in the Journal of Consumer Research investigates how the way in which we visualize progress toward a goal affects goal adherence. They frame their proposal as the “small-area hypothesis,” or the idea that we are more motivated by whichever portion of our goal—amount attained or amount remaining—is smaller. Therefore, directing individuals’ attention toward that smaller area will be effective in motivating them to achieve their goal.

The authors tested this idea through a series of four studies. In each, they presented participants with loyalty cards that focused either on how much of the goal had been achieved or how much remained. For instance, in the example shown, the coffee shop either stamped an image of a cup to represent progress achieved or punched out a cup stamp to show how much progress remained (i.e., how many cups were left).

Though each study had slightly different manipulations, the basic take-home point remained consistent. When far from their goal, customers were more likely to return if progress made was emphasized (as in the top coffee card), but that when close to their goal, customers were more likely to return if progress remaining was emphasized (as in the bottom coffee card). They interpret their empirical support for the “small-area hypothesis” to mean that focusing on the smaller area rather than the larger area is motivational because each action toward the goal has an inherently larger marginal impact. That is, acquiring your third stamp on the way to a 10-stamp card increases the ‘stamps attained’ (small-area) amount by 50 percent but decreases the ‘stamps remaining’ (large area) amount by only 12.5 percent.

By extension, the authors suggest, this strategy may be helpful in achieving personal goals as well. Trying to make it through an hour-long workout? You might try focusing on the minutes you’ve endured at the start and switching to the minutes remaining as you get closer to the end. What exactly to do in the middle remains unclear, but this preliminary set of studies nonetheless provides an important peak into the cognitive biases that can both motivate and demotivate us.

Continue reading »]]> Maybe cats and kindergartners are on to something: Recent research out of the University of California, Berkeley suggests that taking an afternoon nap might lead to increases in learning ability throughout the day! Research out of the the Sleep & Memory Lab led by Matt Walker up at UCB shows that, in general, our learning abilities decrease over the course of a day. So, when people are asked to memorize a list of words at noon, and then to memorize a different list of words at 6 PM, they perform much worse when attempting to learn the words in the evening compared to midday. However, if people were given the opportunity to take a 90 min. nap in between the sessions, they actually learned MORE at 6 PM compared to at 12 noon! Results like these suggest that sleep is important not just for memory, but also for learning abilities. Of course much more research is needed to determine how long of a nap is ideal (what if you only have 30 min. instead of 90 min. to nap in the middle of the day? will you still learn better? is there such thing as too long of a nap?) and the exact conditions under which naps are beneficial, but maybe a little mid-day shut eye would be beneficial to all of us!

Continue reading »]]> Recent research by Ralph Adolphs, a neuroscientist at Cal Tech, suggests that the amygdala, an almond-shaped brain structure buried deep within the temporal lobes, is important for maintaining a sense of personal space. When walking up to a stranger, most people prefer to keep their distance– while the precise distance depends on the individual, we usually stop about two feet away from someone to make sure they (and we!) feel psychologically comfortable. Interestingly, Dr. Adolphs found that an individual with damage to the amygdala felt perfectly comfortable invading others’ personal space. In fact, in some instances, the patient approached another person so closely that their noses touched! These interesting findings suggest that the amygdala may be important in helping us maintain our social graces and respect others’ personal space.

Continue reading »]]> He that is over-cautious will accomplish little.
Friedrich Von Schiller
German poet, philosopher, historian, and playwright

Individuals who psychologists describe as “risk takers” are generally identified as being at-risk for a number of dangerous or maladaptive behaviors, including high risk sex, gambling, substance use disorders. However, frequent or high risk takers may be a heterogeneous group, and as a result, it may be difficult to know whether a tendency to take risks is uniformly associative with negative behavior. In order to avoid confounding factors resulting from simply comparing maladaptive risk takers (e.g., antisocial individuals) to a healthy comparison group, Levenson (1990) examined three different groups of risk takers using discriminant function analysis. This study found that a group of rock climbers had high levels of sensation seeking and moral reasoning, drug unit residents were high on antisocial function (e.g., emotionality, psychopathy), and police and firemen decorated for safety had different profiles than both other groups. These results suggest that differences in risk taking behaviors may be, in part, related to the motivation for risk taking behavior. Some groups of individuals who have taken great risks have done so from an arguably purely altruistic motivation. For example, Jewish individuals who rescued others during the Holocaust were compared to bystanders and individuals who emigrated from Europe prior to World War II (Midlarsky, Fagin Jones, & Corley, 2005). The rescuers scored higher on risk taking than both the bystander and immigrant group. Notably, these individuals not only differed in risk taking, but also social responsibility, empathic concern, and moral reasoning. Thus, risk taking behavior may indeed be a positive act, and one’s tendency to engage in such behavior is likely to be context dependent. Thus, being a risk taker can be both positive and negative, and contextual, personality, and social factors may be tipping factors for how one uses such a proclivity to take risks and explore the boundaries of the environment.

Continue reading »]]>  

The promotional poster for the 2011 film "Take Shelter"

[Warning: The following post discusses key plot elements of the 2011 film Take Shelter.  Although the post purposefully does not give away the ending, be advised that potential spoilers abound.]

Portrayals of schizophrenia in film go back to the earliest days of the medium.  Throughout the past century, countless films have shown us individuals who are either in the process of losing touch with reality or are far past the breaking point.  Charles Boyer famously drove Ingrid Bergman to the brink of madness in 1940’s Gaslight.  Hitchcock gave us several iconic examples of delusional characters in masterpieces like Psycho and Vertigo.  Jack Nicholson checked himself into an institution filled to the brim with men suffering from hallucinations and paranoia in One Flew Over the Cuckoo’s Nest.  And in the past 15 years, several biographical films have chronicled the lives of individuals who have been afflicted with schizophrenia, including David Helfgott (the Australian pianist portrayed by Geoffrey Rush in Shine), John Nash (the Nobel Laureate portrayed by Russell Crowe in A Beautiful Mind), and Nathaniel Ayers (the cello prodigy portrayed by Jamie Foxx in The Soloist).   However, no film in recent memory has as disturbingly, accurately, or meticulously characterized the descent into psychosis as last fall’s overlooked gem Take Shelter.

The film follows a man named Curtis LaFoche, a small town Ohio construction worker played by Michael Shannon (who received an Oscar nomination for his performance in 2008’s Revolutionary Road and currently co-stars on Martin Scorcese’s Emmy winning HBO drama Boardwalk Empire) and his beautiful wife, Samantha (portrayed by Jessica Chastain, who had an unparalleled breakthrough year starring in no less than six critically lauded films in 2011, including this, The Debt, Texas Killing Fields, Coriolanus, The Tree of Life, and The Help, for which she received an Oscar nomination).  The couple is leading a fairly typical Midwestern life.  They spend their time raising a young daughter, going to church, struggling with finances, and trying to please the in-laws.   That’s at least how things appear from the outside.  Internally, Curtis is engaged in the early stages of what will soon become a full-blown war.

It begins with apocalyptic visions of violent storms wreaking havoc on his home and community.  These visions first appear to him in terrifying nightmares but quickly increase in frequency and intensity and – most troublingly – begin to affect his waking hours as well.  His response to the visions is complex.  On the one hand, he seeks out professional help, indicating that he knows what he is experiencing is not in sync with reality.  He goes to see a counselor at a free clinic, who does exactly what a responsible counselor would do in this case – provide enormous empathy, gather a detailed psychiatric history, and refer to more appropriate help.  Through meeting with this counselor, the viewer learns that Curtis’ mother is currently in an assisted living facility, having been diagnosed with schizophrenia at approximately the same age Curtis is now.

Despite this apparent insight, his delusional experiences prove too terrifying to truly discount.  He starts devoting all of his time, energy, and savings to the renovation and elaboration of the storm shelter behind his family’s house, much to the shock and confusion of his wife and co-workers.  He purchases gas masks for the family, he begins to lockout the dog (who became vicious in one of his nightmares), and he steadily distances himself from everyone in his life.  His brother try to intervene, but is met with hostility.  His irresponsible behavior incurs devastating repercussions, but he persists.  Amidst all of this, his wife stays steadfast and supportive, doing all she can to reverse the decline.  In one of the film’s most memorable scenes, she takes him to a community dinner where he is provoked into a terrifying rant, warning everyone that he will be the only one prepared for the storm that is about to come.

As art, the film succeeds spectacularly.  As written and directed by newcomer Jeff Nichols, the film is taut, riveting, and realistic.  The acting is superlative, with Shannon and Chastain giving masterful performances.  The production values resemble those of a film made for 10 times its measly $5 million budget.  It may have been overlooked by the Academy Awards in favor of films that were more heartwarming (Extremely Loud and Incredibly Close, The Help, Moneyball) or made by more high profile filmmakers (The Tree of Life, Midnight in Paris, War Horse, Hugo), but many critics agreed that Take Shelter was among the very best films of 2011.

As a portrayal of a distinct phenomenon in clinical psychology, the film also succeeds remarkably well.  It portrays mental health professionals as well intentioned, compassionate, and competent.  It portrays hallucinations with stunning vividness, helping viewers understand why they are so difficult for individuals to distinguish from reality.  And most notably, it accurately portrays the clinical phenomena at its core, prodromal schizophrenia.

As evidenced by the opening paragraph of this article, the experience of losing touch with reality has gone by countless names over the past century alone.  Terms such as “insanity” and “madness” are outdated terms for the presently preferred construct of “psychosis,” a mental state characterized by symptoms that indicate impaired contact with reality.  Such symptoms include “delusions” (a fixed false belief that is resistant to reason or confrontation with actual fact) and “hallucinations” (a sensory experience of something that does not exist outside the mind).  Such symptoms can be found in several mental disorders, including severe mood disorders, substance use disorders, and personality disorders, but are most commonly associated with “schizophrenia.”

Schizophrenia is a severely impairing disorder that is characterized by a constellation of positive symptoms (such as delusions and hallucinations) and negative symptoms (such as lack of speech, motivation, or affect) that have been present for at least six months.  It affects a portion of the population that is small relative to other disorders (0.3-0.7%), but is associated with profound suffering, health care utilization, social strife, and economic burden.  Thus, research has long been interested in how the disorder can be detected early and possibly prevented.  Much of this research has focused on the “prodrome,” the period of decreased functioning that is postulated to correlate with the onset of psychotic symptoms.  A key aspect of the prodrome is that the individuals still retain some degree of insight into their symptoms.  In other words, an individual in the prodrome is still somewhat able to see their symptoms as an aspect of an illness not as objective reality.  Approximately one-third of individuals who meet current diagnostic threshold for the prodrome convert to schizophrenia (or a related disorder marked by psychotic features) within a few years.  The work of researchers in this field, including those at UCLA’s Center for the Assessment and Prevention of Prodromal States, is rapidly evolving and immensely promising.

The film gets several aspects of the prodrome correct.  The afflicted protagonist is male (males are approximately 1.4 times more likely to be diagnosed with psychosis than females), has a family history of schizophrenia (the heritability rate of schizophrenia is around 40%), and is rapidly deteriorating cognitively, emotionally, and socially despite retaining some degree of insight (as evidenced by the fact that he seeks out mental health services).  The film not only gets the facts right, but the feelings, too.  Curtis is living in abject terror, first of the fact that he might be losing grip with reality and later that doomsday is nigh.  The film manages to exquisitely evoke the pain and fear of existing in the prodrome without exploiting it.

It should be noted that Shannon and Nichols have publicly stated the film is not about mental illness.  To me, their comments seem more to highlight that the film is about larger and more ambiguous questions than “Is Curtis insane or not?” and with that I wholeheartedly agree.  For me, the film is ultimately about gaining insight into a very human experience that most of us find perplexing and terrifying.  Many of those who have seen the film (or hopefully will see the film after reading this article) will undoubtedly have doubts about the “twist” ending, which remarkably complicates both the narrative arc of the plot and the accuracy of the film’s portrayal of the mental illness at its center.  I, for one, am still not sure what I think of the ending weeks after seeing it.  What I do know, however, is that I have never looked at an individual telling me they are worried about whether or not what they are experiencing is in fact real the same way again.

[This is the 3^rd post in Richard LeBeau’s series on Portrayals of Psychology in Film.  Additional articles will be added in the coming weeks.

For past articles see:

http://www.psychologyinaction.org/2011/12/12/hauntingly-accurate-portrayals-of-severe-mental-illness-at-a-theater-near-you/

http://www.psychologyinaction.org/2011/10/24/new-movie-portrays-cancer-perceptively-but-psychology-offensively/]