Monday, February 28, 2011

Narcoanalysis - spies, lies and truth serum

narcoanalysis - the 'truth' might set us free
The 'truth' might set us free
Permission for narcoanalysis on a spy was refused by the Pune courts a few days ago. The investigating authorities have perceived this as a setback in arriving at the ‘truth’.


In a clinical settting narocoanalysis and narcotherapy are conducted in a treatment room. The patient lies quietly with an iv line in place. While the psychiatrist recapitulates the patients history in a low monotone a nursing assistant injects thiopentone sodium to terse instructions of “push 50” or “25 slow”. Thiopentone sodium is no rare drug. It is used everyday to induce general anaesthesia. At lower doses in willing patients it produces a state of relaxation. You have to be careful the patient does not doze off or start slurring in speech. At the start of the narcoanalysis attention has to be paid to the patient's posture and eye movement. Horizontal eye movements indicate a state of sufficient relaxation to proceed with the deeper probing interview. Subsequent aliquots are adjusted with the aim of maintaining this state during the rest of the interview.

Psychiatric indications

  • The aim of narcoanalysis is to produce an abreaction in hysteria and other disorders in which there is an element of dissociation. During abreaction the patient recalls traumatic experiences and, by talking about them, discharges associated disturbing emotions. Abreaction facilitates subsequent and sometimes dramatic recovery (Breuer & Freud 1957). However, there are only anecdotal - though fascinating and highly readable - reports for the effectiveness of narcotherapy (Miller 1954, Denson 2009). The theory is based on the unconscious suppression of emotion through use of psychological defense mechanisms. It may not apply when suppression is done consciously as in most forensic cases .
  • Narcotherapy is effective in relieving catatonic mutism (McCall et al 1992).


(Jesani 2008)
  1. Narcoanalysis was never considered as a method to get at the ‘truth’. It was just the patients perception of whatever he or she believed at that time. A similiar process occurs every night in the bar when a garrulous, intoxicated person talks about whatever is bothering him or her.
  2. A person can consciously lie during the procedure and get away with it.
  3. At times it is difficult to separate actual events from fantasy.
  4. You can even plant an idea into a persons mind through leading questions and later they would have no doubt it was their own.

Present status

A PubMed search using the MeSH term ‘narcotherapy’ gives just two articles in the last ten years. There are no randomised control studies - the scientific standard - to demonstrate the reproducibility of results obtained by narcoanalysis for information gathering, abreaction, or lie detection. Randomised control studies would give us an idea of the procedures sensitivity - the number of actual cases that would not be detected; and its specificity - the number of innocents who would be implicated. Presently all we have to go on are anecdotal reports of narcoanalysis practitioners . Not enough evidence to rely on narcoanalysis for deciding the fate of an unwilling subject. Not even for spies caught in Pune. Even the judiciary is sceptical of narcoanalysis..

  1. Breuer, J. Freud, S. 1957. Studies on Hysteria. New York: Basic Books.
  2. Denson R. Narcotherapy in the treatment of post-traumatic stress disorders: a report of two cases. J Psychoactive Drugs. 2009 Jun;41(2):199-202.
  3. Jesani A. Willing participants and tolerant profession: medical ethics and human rights in narco-analysis. Indian J Med Ethics. 2008 Jul-Sep;5(3):130-5. PubMed
  4. WV McCall, FE Shelp and WM McDonald. Controlled investigation of the amobarbital interview for catatonic mutism. Am J Psychiatry 1992; 149:202-206.
  5. Michael M. Miller. Certain Factors Pertaining to the Value of Narcoanalysis in Securing Testimony. J Natl Med Assoc. 1954 July; 46(4): 238–241. PMC
  6. PubMed. PubMed MeSH search for 'narcotherapy'. Accessed 27-Feb-2011.

Thursday, February 24, 2011

Academic stress in youth

stressed youths
Stressed youths relaxing
Academic stress is a significant aspect of youth. Youth is the developmental phase between puberty and working adulthood. It is a period of continuing student-hood. This is a distinctive feature of youth - it exists only for those who undergo post-secondary education. This is for the privileged few who do not join the workforce full-time after schooling.

Youth is a valuable time for serious experimentation. The young person is not fettered by long-term commitments. In contrast to adolescence, youth is a period of independence - the peer group is no longer a dominant influence. There is greater freedom to develop as an individual. The young person evolves a personal perspective on life and develops a sense of direction before tackling the duties of adulthood.

However this stage of life is by no means stress-free. By definition youth is associated with academics. Academic demands are perceived as significant stressors by youths (Rao 2000, Goff 2011). These demands include workload and time constraints (Jungbluth and colleagues 2011). On entering college the youth is suddenly exposed to an unsupervised life of parties, college events, projects, and an intense curriculum, all of which make demands on time.

Why do academic stressors acquire such significance in youth? Why do students who have done well in their 12th and got into good courses find it difficult to cope with the academics? Well, until high school the student has a limited syllabus. Students in good schools rely almost entirely on the notes dictated by their teachers. Also the exam system is designed so that most students can achieve high scores with minimal time spent on study. All this changes in college. When the youth enters college, he or she is confronted with the entire gamut of knowledge in a particular field. Without the skills to filter, assimilate and reproduce information in context the youth experiences stress.

There is also the problem of youths whose career path was chosen by their parents despite their protests or otherwise. These youth may find themselves completely out of their depth in a course for which they have little interest or aptitude.

Students cope with academic stressors using a combination of emotion-focused strategies like self-blame, or bunking, and problem-focused strategies like reading guide books, and cheating. Study skills training and the acquisition of good learning habits are essential life-skills for students. We have already shown that study skills are effective and can be successfully acquired.
Study skills training should be a part of every freshers curriculum.

  1. Jungbluth C, Macfarlane IM, Veach PM, Leroy BS.Why is Everyone So Anxious?: An Exploration of Stress and Anxiety in Genetic Counseling Graduate Students. J Genet Couns. 2011 Jan 25. [Epub ahead of print]. PubMed
  2. Goff AM. Stressors, academic performance, and learned resourcefulness in baccalaureate nursing students. Int J Nurs Educ Scholarsh. 2011;8(1):Article1. Epub 2011 Jan 24.
  3. Rao K; Moudud S; Subbakrishna DK. Appraisal of stress and coping behaviour in college students . Journal of Indian Academy of Applied Psychology. 2000 Jan- Jul; 26(1-2):5-13

Sunday, February 20, 2011

Study skills - effective learning habits for students

study skills
Effective study skills are essential learning habits for students. Some students have a knack of learning much in a short time. Others study for hours without much progress. An important differentiating factor is the method of study. Effective study habits can be learned (Barry L. Richardson and Murray Saffran 1985, D F Alexander 1985). The good student must not rely on “study drugs” as these are associated with addiction, panic reactions, confusion, and medical complications including heart attack and stroke (Steve Sussman and colleagues, 2006).

Habit No 1: Apply book learning to daily life

Those who learn rapidly apply their imagination freely to their studies. They see that every subject of study deals with something vital in the affairs of the world, and probably of personal relevance.
Allow the knowledge you are acquiring to become an active part of your daily life, with some bearing on normal activities. Thinking about studies in this way will help build greater interest and also help you to understand and remember things better.

Habit No 2: Think of the long term reasons for studying

Imagine yourself as the CEO in a multinational company; as an internationally acclaimed designer; as an architect creating the perfect city, as the next software entrepreneur, or picture yourself as the valued management expert. Hold that image in your mind and add some detail to it every day.
Visualising these ultimate goals, will give you fresh energy to keep going, because whatever your dreams; your studies are a necessary step towards achieving them.
Many students don’t know what they want to do after their board or other graduation exams. I’ve found Aptitude Testing to be a great way to get them thinking and motivate them to study. Parents usually get this done after the exams. Aptitude assessment before the exams has the added advantages of motivation for study, as also reducing anxiety related to making career choices.

Habit No 3: Organise your work

Successful study is largely a matter of good organisation.
  • Establish a regular routine. As far as possible study at the same time and place each day. A quiet, well-lit room, free from distractions is best.
  • Work out a daily timetable, to guide your activities. Do not be over ambitious with your timetable. Keep it flexible and do not try to learn more than you can comfortably manage.
  • Begin your major assignments well in advance of the required finishing dates to avoid having to complete them in a rush.

Habit No 4: Follow good study technique

Effective learning habits also minimise test anxiety.
Make notes and underline key sentences. Notes should be brief and to the point. Let notes assist your memory, not replace it.
Concentration is a necessary study habit. Resolve, for instance, to study ten pages without a break and then relax. Break up the learning of a lengthy item into sections, concentrating on each separately.
Start at the appointed time everyday. Do not make excuses – ‘I have to get into the right mood’; ‘I’ll just watch TV for 5 more minutes’. Just plunge into your work.

Habit No 5: Enhance your Memory

Memory depends on association, attention and repetition.
  1. Association can be developed by deliberately setting out to form associations or links with given words or facts.
  2. Attention is necessary for registration in the mind. Attention comes from interest in the subject, exercising the brain on it, and by focusing on one’s work in as much detail as possible.
  3. Interest can be inculcated. The more you know about something, the more interesting it becomes.
  4. Develop understanding. It is easier to remember something that is clearly understood. Aids to understanding include a wide vocabulary, good command of language, wide reading and plenty of discussion.
  5. Repetition helps in fixing memory. It is most effective if interest and understanding are involved.

Habit No 6: Build a positive attitude

Think positively. Do not picture defeat, or failure. Use your imagination to dwell upon the positive aspects of life - happiness, hard work, success, health.
People who succeed in examinations begin by believing that they will succeed. Keep telling yourself you are certain to be successful when you do the required work.
Examinations are designed for the average student to pass and the outstanding student to get a distinction.
What thousands of ordinary people have done, YOU can certainly do.
  1. Barry L. Richardson and Murray Saffran. Effects of a Summer Preview Program of Study Skills and Basic Science Topics on the Academic Performance of Minority Students. J Natl Med Assoc. 1985 June; 77(6): 465–471. PMC
  2. D F Alexander. The effect of study skill training on learning disabled students' retelling of expository material. J Appl Behav Anal. 1985 Fall; 18(3): 263–267. doi: 10.1901/jaba.1985.18-263.PMC
  3. Steve Sussman, Mary Ann Pentz, Donna Spruijt-Metz, and Toby Miller. Misuse of "study drugs:" prevalence, consequences, and implications for policy. Subst Abuse Treat Prev Policy. 2006; 1: 15. Published online 2006 June 9. doi: 10.1186/1747-597X-1-15 PMC.

Teaching, Learning, Aptitude, student

Monday, February 7, 2011

Social Networking - Psychological Effects on Teenagers

Parents worry that social networks like Facebook could have harmful psychological effects on their children. They seek consultation for social network related behaviour of their teenagers when academic grades fall due to excessive time spent on Facebook, when the teenager is subjected to cyberstalking, or when they themselves are disturbed by the online self-profile of their child. What do we know about some of these social networking behaviours that bring parents and their children to the Clinic?

Friends, self-presentation and self-esteem

Posting a profile assists the teenager in gaining self-awareness. Becoming self-aware by viewing one's own Facebook profile enhances self-esteem (Gonzales and Hanock, 2010).

A larger number of Facebook friends and  an exaggerated positive self-presentation does enhance the teenager’s well-being. However this is not necessarily associated with a sense of belonging to a supportive group. A more honest self-presentation does increase happiness and is also grounded in social support provided by Facebook friends (Kim and Lee, 2010). However, adolescents having more than 300 FB friends have increased levels of cortisol, a stress hormone, that makes them prone to depression in later life (Morin-Major et al, 2016)

Children whose self-worth is based on public contingencies (others' approval, physical appearance, outdoing others in competition) indulge in more photo sharing. People whose self-worth is contingent on appearance have a higher intensity of online photo sharing. Those with private-based contingencies (academic competence, family love and support, being a virtuous or moral person, and God's love) spend less time online (Stefanone et al 2010).

Facebook vs face-face

Impressions formed from face-to-face interaction and from personal web pages generally correspond. So, people liked in face-to-face interaction are also liked on the basis of their Facebook pages. Whether online or offline, people who are socially expressive are liked. People who express themselves non-verbally though gestures and body language in face-to-face interaction are also expressive online. The same goes with self-disclosure - when there is more disclosure offline there is more disclosure on line (Weisbuch et al, 2009).

Facebook and WhatsApp mostly act as an extension of face-to-face interaction. However, some users do rely on Facebook and WhatsApp for interpersonal communication more than face-to-face interaction (Kujath 2010).

Predictors of excessive use

  • Extroverted and unconscientious individuals spend more time on social networking sites and their usage tends to be addictive (Wilson K et al, 2010).
  • Shy people  also like Facebook and spend more time on it. However, they have few Facebook "Friends” (Orr et al, 2009).
  • Narcissistic personalities also have high levels of online social activity. They are recognised online  by the quantity of their social interactions, their main photo self-promotion, and attractiveness of their main photo (Buffardi LE 2008, Mehdizadeh 2010).

Needs satisfied by Facebook

The four primary needs for participating in groups within Facebook are socialising, entertainment, self-status seeking, and information (Park et al 2009). The majority of students use friend-networking sites for just that - making new friends and locating and keeping in touch with old ones (Raacke and  Bonds-Raacke 2008).

Negative outcomes

Broad claims of unwanted sexual solicitation or harassment, associated with social networking sites may be unjustified. The risk of victimisation for a teenage is more likely through instant messaging (IM) and chat (Ybarra and Mitchell 2008).

Parental supervision is a key protective factor against adolescent risk-taking behavior
Unmonitored internet use may expose adolescents to risks such as cyberbullying, unwanted exposure to pornography, and revealing personal information to sexual predators  (Pujazon-Zazik and Park 2010).
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  2. Gonzales AL, Hancock JT. Mirror, Mirror on my Facebook Wall: Effects of Exposure to Facebook on Self-Esteem. Cyberpsychol Behav Soc Netw. 2010 Jun 24. [Epub ahead of print] PubMed
  3. Kim J, Lee JE. The Facebook Paths to Happiness: Effects of the Number of Facebook Friends and Self-Presentation on Subjective Well-Being. Cyberpsychol Behav Soc Netw. 2010 Nov 30. [Epub ahead of print]. PubMed
  4. Kujath CL. Facebook and MySpace: Complement or Substitute for Face-to-Face Interaction?
  5. Cyberpsychol Behav Soc Netw. 2010 Jun 24. [Epub ahead of print]. PubMed
  6. Mehdizadeh S. Self-presentation 2.0: narcissism and self-esteem on Facebook. Cyberpsychol Behav Soc Netw. 2010 Aug;13(4):357-64. PubMed
  7. Julie Katia Morin-Major, Marie-France Marin, Nadia Durand, Nathalie Wan, Robert-Paul Juster, Sonia J. Lupien. Facebook behaviors associated with diurnal cortisol in adolescents: Is befriending stressful? Psychoneuroendocrinology. 2016. 63: 238–246. 
  8. Orr ES, Sisic M, Ross C, Simmering MG, Arseneault JM, Orr RR. The influence of shyness on the use of Facebook in an undergraduate sample. Cyberpsychol Behav. 2009 Jun;12(3):337-40. PubMed
  9. Park N, Kee KF, Valenzuela S. Being immersed in social networking environment: Facebook groups, uses and gratifications, and social outcomes. Cyberpsychol Behav. 2009 Dec;12(6):729-33. PubMed
  10. Pujazon-Zazik M, Park MJ. To tweet, or not to tweet: gender differences and potential positive and negative health outcomes of adolescents' social internet use.Am J Mens Health. 2010 Mar;4(1):77-85..PubMed
  11. Raacke J, Bonds-Raacke J. MySpace and Facebook: applying the uses and gratifications theory to exploring friend-networking sites. Cyberpsychol Behav. 2008 Apr;11(2):169-74. PubMed
  12. Stefanone MA, Lackaff D, Rosen D. Contingencies of Self-Worth and Social-Networking-Site
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  14. Weisbuch M, Ivcevic Z, Ambady N. On Being Liked on the Web and in the "Real World": Consistency in First Impressions across Personal Webpages and Spontaneous Behavior. J Exp Soc Psychol. 2009 May;45(3):573-576. PubMed
  15. Wilson K, Fornasier S, White KM. Psychological predictors of young adults' use of social networking sites. Cyberpsychol Behav Soc Netw. 2010 Apr;13(2):173-7. PubMed
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