Inspired by last week’s post about Healthy Oils, the crew at Hirsh Library is bringing a little Health to your Hanukkah (we are the Health Sciences Library after all). Now, Hanukkah is not the time to extoll the […]

Spring Semester Internships
Impact runs action campaigns on issues that matter, like global warming, clean water and big money’s influence over our democracy, and we’re hiring spring interns!

As an intern with […]

Deadline to apply is Friday, December 12th.
Background

UNDP Environment and Energy Group (EEG) is based in UNDP’s Bureau of Development Policy (BDP) and is responsible for providing leadership and technical […]

Position: Internship – Urban
Location: New York or Paris
Application Deadline: December 12, 2014
Overview: 
The SDSN has established 11 Thematic Groups comprising leading scientists, engineers, academics and practitioners from business and civil society to promote solutions to key challenges of sustainable development. The Thematic Groups are solution oriented rather than research oriented and aim to identify practical solutions to the challenges of sustainable development. The thematic group Sustainable Cities: Inclusive, Resilient, and Connected seeks to  identify practical solutions for improving urban management. It has initiated the Campaign for an Urban Sustainable Development Goal. A dedicated and stand-alone SDG on cities is essential to mobilize local authorities and stakeholders for the SDGs, promote integrated city-level approaches, and ensure that the post-2015 goals address the specific needs of cities.
Scope of work: 
The Sustainable Development Solutions Network (SDSN) is pleased to offer a 4-6 month internship for an enthusiastic and motivated masters student, with expertise in urban development, urban policy or urban planning. Excellent written and spoken English is required.
This internship will involve assisting with the preparation of a handbook on sustainable urban development, and supporting SDSN’s managers in ongoing work related to sustainable urban policy and planning. The intern will be responsible for conducting a comprehensive literature review, facilitating consultations with leading urban planning experts, as well as drafting and editing text. Once the handbook has been finalized the intern will work to support the development of online materials and to orchestrate webinars.
Timeline & compensation: 
The intern will report to SDSN managers based in Paris & New York and may work from either office. Interns are expected to work either two days per week throughout the semester until July 2015 or full time for at least four months from January 2015. Interns will be compensated at $18 per hour.
Application process: 
Please submit a CV and cover letter to info[at]unsdsn.org by December 12, 2014, and include “Urban Internship” in the subject line. Late applications will not be considered, and only short listed candidates will be contacted.

Apply Online

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Throughout this series, I have discussed the different situations (both typical and atypical) in which we fail to demonstrate towards others what is often considered a fundamental human experience: empathy. For this last post, I plan to end with a bang and examine what I consider to be the ultimate failure of empathy: the experience of feeling actual pleasure at others’ misfortunes.

I feel as though the act of feeling positive emotions in response to other person’s malaise is perceived as relatively abnormal. There isn’t even a word for the concept in English (or many other languages). The Germans call it ‘Schadenfreude’—literally “harm-joy.” I would argue that this experience isn’t so atypical, though, if you think about it. From rival sports fans to hated politicians, you must admit that you sometimes experience even a bit of pleasure from the misfortunes of whomever these individuals are in your own life.

The origins of Schadenfreude are both affective and social in nature (Smith et al., 2009). One major contributor is an environment of competition (hence, I’m guessing, the joy displayed by the Survivor contestant below). Think about it: if you are in a zero sum situation with another individual or entity, a misfortune for them may represent a beneficial situation for you, and thus, it logically follows that you may experience a bit of pleasure. The affective aspect to Schadenfreude (though quite related to the social aspect of competition) is envy, which stems from perceptions of inferiority. I’ll just say this: I always love when a scandal befalls Georgetown University, whom I despise (as my alma mater is GW), but I will begrudgingly admit that these hostile feelings probably (maybe, possibly) stem from the fact that Georgetown is perceived to be a better school than GW.
 
Finally, people may feel some pleasure towards another person’s pain simply because they think they deserve it! Often this occurs when there is hypocrisy involved. Let me give you an example: Jimmy Swaggart is a television evangelist known very well for public derision and exposing other people’s sins, especially those sexual in nature.  In 1988, it was revealed, however, that Mr. Swaggart had been regularly visiting prostitutes. Mr. Pot, meet Mr. Kettle. Mr. Swaggart made a very public and very humiliating confession, during which the pain was clearly visible on his face (see below). The media and the public had a field day! And rightly so, in their eyes.

Television evangelist Jimmy Swaggart

Examining Schadenfreude from a neural perspective has been relatively untouched thus far, yet the investigations that do currently exist paint an interesting picture. As I’ve mentioned several times during this blog series, failures of empathy are often demonstrated neurally by decreased activation of certain brain regions, notably the insula and the anterior cingulate cortex (ACC). These areas are typically engaged not only when people experience pain and sorrow themselves, but also when they observe others in pain and sorrow. Thus, decreased activation of the insula and ACC represents a lack of empathic concern.

While decreased activation of areas such as the insula and the ACC may adequately explain the other failures of empathy I’ve discussed, it is insufficient in defining the neural bases of Schadenfreude. Remember: this failure of empathy is not simply not feeling empathy for another person, an act of omission, but also involves an act of commission, or feeling actual pleasure at another’s pain. Thus, there must be another neural process involved. It is plausible that the reward system of the brain, regions responding to appetitive or pleasurable stimuli, may be at work.

 The first neural investigation of Schadenfreude examined just this: Is the pleasure component of Schadenfreude represented neurally by reward system activity? Takahashi et al. (2009) focused on ventral striatum activity, one neural region heavily involved in reward processing. In the study, male participants read scenarios describing three target individuals: 1.) a male target with superior qualities than the participant 2.) a female target with superior qualities, but in domains unimportant to the participant and 3.) a female target with inferior qualities. Participants rated their level of envy of each target. Next, participants read a second set of scenarios in which each of the three targets experienced a misfortune, and indicated their level of pleasure in response to these scenarios. Results showed that ventral striatum activity, representing reward processing, increased only in response to the misfortune of the superior male, an envied target. Additionally, pleasure ratings, a behavioral measure of Schadenfreude, correlated with said ventral activity. Thus, this investigation served as initial evidence that the reward system may indeed be involved in the neural bases of Schadenfreude.

A second study utilized the fertile realm of rival sports fans to further examine the neural correlates of Schadenfreude. Cikara & Fiske (2013) had Red Sox and Yankees fans watch video clips of their favored team, their rival team, and a neutral…unimportant team (ahem, the Orioles) in situations of success (e.g. hitting a homerun) and failure (e.g. making an error on the field). While participants partook in this, the experimenters measured fMRI activity and subjective ratings of pain, pleasure, and anger.

Their fMRI analyses focused on again, the ventral striatum, as well as our old friends, the insula and ACC. Results indicated that high ventral activity occurred while participants watched successes of their favored team, and that pleasures ratings correlated with this activity– a logical result. Importantly, though, high ventral activity was also found when participants watched the failures of their rival team, which was also correlated with pleasure ratings. For ACC and insula activity, higher activity was found when participants watched their favored team fail, which was correlated with pain ratings (again a logical result—remember that these regions are activated both when one feels pain and when one observes others in pain). Importantly, again, high insula and ACC activity was also found when participants watched the successes of their rival team. This represents a related concept to Schadenfreude for which the Germans also have a word impossible to pronouce: Glückschmerz, or pain at another’s success.

Although a great deal more research must be conducted to make more definitive conclusions about the neural bases of Schadenfreude, a clear pattern has emerged via the extant literature. The neural foundation of this concept may very well be the intersection of inactivation of areas typically involved in empathic concern (e.g. insula and ACC), and activation of areas indicating reward processing (e.g. the ventral striatum). I like to conceptualize this pattern via the little angel and devil on the shoulder. Not only is the devil (representing pleasure at others’ pain) present, but the angel (representing empathy) is also not there to counterbalance the impact of the devil.

The proposed neural foundation of Schadenfreude

Thank you for tuning in over these past few weeks! I’ve had fun, and I hope you have as well.

—————–

Heider, F. (1958). The psychology of interpersonal relations. New York, NY: Wiley.

Cikara, M., & Fiske, S. T. (2013). Their pain, our pleasure: Stereotype content and Schadenfreude. Annals of the New   York Academy of Sciences, 1299, 52-59.

Cikara, M., Botvinick, M. M., & Fiske, S. T. (2011). Us versus them: Social identity shapes neural responses to   intergroup competition and harm. Psychological Science, 22, 306–313.

Hein, G., Silani, G., Preuschoff, K., Batson, C. D., & Singer, T. (2010). Neural responses to in- group and out-group members’ suffering predict individual differences in costly helping. Neuron, 68, 149–160.

Smith, R.H., C.A.J. Powell, D.J.Y. Combs & R.D. Schurtz (2009). Exploring the when and why of schadenfreude. Soc. Pers. Psychol. Compass 3: 530–546.

Takahashi, H., M. Kato, M. Matsuura, et al. (2009). When your gain is my pain and your pain  is my gain: neural correlates of envy and Schadenfreude. Science, 323, 937–939.

[Gif of Survivor Contestants]. Retrieved December 8, 2014 from http://www.reactiongifs.com/amused-survivor-smile/

[Photo of Jimmy Swaggart]. Retrieved December 8, 2014 from http://www.usatoday.com/story/money/business/2014/03/12/last-madoff-employees-trial-defense-arguments/6339569/

My previous blog posts have depicted the clear picture of schizophrenia as being a complex disease that has many unknown aspects. From its causes, onset, and most effective treatments, there is still much to be researched about schizophrenia. Though it is believed to be genetic with an onset during the 20s, there are exceptions and many unanswered questions in the onset, diagnosis and processes underlying schizophrenia.

Alfred Kamajian- Image of A Schizophrenic Brain.http://schizophrenia.com/schizpictures.html#%5B/caption%5D

In researching the cause and diagnosis of schizophrenia, there is still much left to be understood and discovered. Researchers postulate that the causes and underlying processes involved in the disease have a genetic or environmental basis. Researchers know that brain abnormalities are present in schizophrenia individuals. Whether they are of a neurodegenerative or neurodevelopmental nature isn’t clear. The neurodegenerative view holds that there is progressive deterioration in the brain, which causes/contributes to the onset of schizophrenia — deterioration of gray matter, etc. The neurodevelopmental view holds that schizophrenia stems from early events “intra utero or early childhood/adolescence, that are genetic, environmental, or a combination of the both (Pantelis, 2005).” The neurodevelopmental view has been prominent in how people view the onset and cause of schizophrenia: as being genetic or environmental or both. However, “in some patients, there is evidence of progressive brain changes (neurodegenerative process) (Pantelis, 2005).”

MRI Images of progressive Gray matter loss in the brains of boys and girls.http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1286%5B/caption%5D

Brain imaging studies by Pantelis et al. suggests that there may be “a prenatal or perinatal neurodevelopmental lesion” that makes the brain more susceptible to “anomalous late (particularly post-pubertal) neurodevelopmental processes (Pantelis, 2005).” This is highlighted by an “accelerated loss of gray matter and aberrant connectivity particularly in prefrontal regions (Pantelis, 2005).” In addition to the effects of these neurodevelopmental processes, they also interact with other potential factors that may have a role in the onset of schizophrenia like stress, substance abuse or environmental factors. Each of these factors have progressive stages as shown in the disease’s stages and can be seen as “multiple pathological processes at various neurodevelopmental stages (Buckley, 2005).” The aspects of schizophrenia, behavioral and neuropsychological, can be seen as effects of these multiple pathological processes.

MRI Images of progressive Gray matter loss in the brains of boys and girls.
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1286

Buckley sums the onset of schizophrenia in some individuals up as a time of active brain changes where: “1. An early neurodevelopmental lesion leaves the brain susceptible 2. to late neurodevelopmental processes. 3. These neurodevelopmental processes interact with causative factors associated with the onset of psychosis which together have neuroprogressive stages involving medial temporal and orbital prefrontal regions (Buckley, 2005).”

Image of gray matter loss after 5 years in the same subjects.http://users.loni.usc.edu/~thompson/J/5A.jpg%5B/caption%5D

Schizophrenia has many intricacies that are not easily explained by brain imaging studies, psychopharmacological drugs or psychotherapies. It is not definitively described as being neurodevelopmental or neurodegenerative and much is still left to be understood about most effective treatments and therapies. There is clearly much left to be discovered about this disease. Despite these discrepancies, there is agreement on the importance of studying this disease and providing treatment for individuals who have been diagnosed with schizophrenia.

References 
Buckley, P. (2005). Neuroimaging of schizophrenia: Structural abnormalities and pathophysiological implications. Neuropsychiatric Disease and Treatment, 1(3), 193-204. Retrieved December 7, 2014
Pantelis, C., Yucel, M., Wood, S., & Velakoulis, D. (2005). Structural Brain Imaging Evidence for Multiple Pathological Processes at Different Stages of Brain Development in Schizophrenia. Schizophrenia Bulletin, 31(3), 672-696. Retrieved December 7, 2014.

The previous blog posts detailed what deep brain stimulation (DBS) is, how it developed, and how it is thought to cause its antidepressive effects. It appears that the future for this procedure is bright. However, any discussion of DBS would be remiss to overlook the ethical implications of the use of what is still considered an experimental surgery on human subjects. In medicinal ethics, the three main considerations are beneficence, non-malfeasance and autonomy (Delaloye et al., 2014).  Let’s break these down one by one.
Beneficence. As discussed in previous posts, DBS in treatment resistant depression has very good outcomes, with conservative remission rate around 25% higher than standard treatment. (Kennedy et al., 2011). There is a tricky extension to this statistic though. DBS causes changes in mood based on electrode parameters. So, as Delaloye (2014) asks, should we aim for patients to have joy or the neutral state of euthymia? The authors conclude that we should aim for neutrality but go on to caution of the dangerous  potential for drug-like abuse of DBS, if control of the stimulator is passed from researchers to patients.

“Should we aim for patients to have joy or euthymia?”

A more cynical benefit is the return of patients to productivity. Grant et al. (2014) argue that the monetary costs of DBS, around $80,000, is offset by the billions of dollars in losses due to absenteeism related to psychological issues. That is, an amelioration of declines in efficiency due to mental illness. Additionally, they argue that there are psychological benefits of patients return to work.

Non-malfeasance. One side effect not mentioned in my first posts is a common feeling of a significant personality change, to the point where patients reported not recognizing themselves, or feeling controlled by the device, “like an electric doll”  (Johansson et al., 2014). It  speculates that this is a psychological rejection of an invasive implant. Patients also reported feeling severe discomfort around their families and when returning to work, which may serve as opposition to Grant’s (2014) idea that a return to work is always beneficial to patients.

“Patients reported feeling like a robot […] like an electric doll.”

Delaloye et al.  (2014) also mention that DBS has received a large amount of press recently, often selling the treatment as an almost miraculous cure. The failure of these expectations can be psychologically damaging to patients, especially when in a study they have the potential to be classified as a “non-responder.” Researchers need to be careful; they want to avoid the negative view the public has with useful treatments such as electro-convulsive therapy but need to avoid overselling the positive effects.
Autonomy. In medical ethics autonomy is related to the decision making capability of a patient, specifically their ability to give informed consent to treatment. A common concern is that due to the psychological nature of depression, patients can not give proper consent as their decision making process may be impaired. A milestone study addressing this issue was conducted by Fisher et al. (2014). Their results show that on measures relating to the perception of therapeutic benefits and risks of DBS,  patients scored well on these measures. Interestingly, they found a non-significant trend showing that the more depressed a patient was the fewer misconceptions they had about the therapeutic nature of the study. That is the research aspect of the study was not as salient, leading to a stronger belief that the procedure was focused on their personal relief instead of scientific gains.
Overall, the risks to the patient are outweighed by their benefits and the use of DBS for depression should continue. However, the concerns over informed consent are valid. All the papers cited here agree that a panel, consisting of neurologists, neurosurgeons, psychiatrists, and nurses, needs to be able to examine every patient being considered and asses whether all aspects of the procedure, especially its experimental nature, are understood. Additionally, post-treatment therapy needs to account for failures of expectations from the procedure as well as managing patients discomfort and other feelings relating to feeling “robotic” or uncomfortable with the procedure. If these precautions are rigorously met, clinical trials of DBS should expand and start to be considered as a true, non-experimental treatment.
Works Cited:
Delaloye, S., & Holtzheimer, P. (2014). Deep Brain Stimulation in the Treatment of Depression. Dialogues in Clinical Neuroscience,16(1), 83-91. Retrieved September 26, 2014, from PubMed.
Fisher, C., Dunn, L., Christopher, P., Holtzheimer, P., Leykin, Y., Mayberg, H., .Appelbaum, P. (2014). The ethics of research on deep brain stimulation for depression: Decisional capacity and therapeutic misconception. Annals of the New York Academy of Sciences, 69-79.
Grant, R., Halpern, C., Baltuch, G., O’Reardon, J., & Caplan, A. (2014). Ethical considerations in deep brain stimulation for psychiatric illness. Journal of Clinical Neuroscience,21, 1-5. Retrieved September 26, 2014, from PubMed.
Johansson, V., Garwicz, M., Kanje, M., Halledenius, L., & Schouenborg, J. (2014). Thinking Ahead on Deep Brain Stimulation: An Analysis of the Ethical Implications of a Developing Technology.Neuroscience,5(1), 24-33. Retrieved September 26, 2014, from PubMed.
Kennedy, S., Giacobbe, P., Rizvi, S., Placenza, F., Nishikawa, Y., Mayberg, H., &  Lozano,A (2011). Deep brain stimulation for treatment-resistant depression. American Journal of  Psychiatry,168, 502-510. Retrieved September 26, 2014, from PubMed.