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Medicine and Society

Medicine and Society, Mental Health

Examining House of Cards’ Frank Underwood, “a textbook case of antisocial personality disorder”

Examining House of Cards' Frank Underwood, "a textbook case of antisocial personality disorder"

Shaili Jain, MD, is a Stanford/Veterans Affairs Palo Alto Health Care System psychiatrist and a fan of the television show “House of Cards.” These two worlds come together in a recent blog entry she wrote on Kevin Spacey’s sociopathic character and the psychiatric diagnosis of antisocial personality disorder. Jain, an affiliated faculty member of Stanford’s Program on Arts, Humanities, and Medicine commented to me that the show represents a compelling example of the intersection of entertainment and medicine.

Noting in her Mind the Brain blog post that she always likes to “explain misunderstood psychiatric concepts or diagnoses, and to clarify when a psychiatric term is used incorrectly or prone to misinterpretation,” Jain writes:

While enjoying the second season of House of Cards, I could not help but notice how Kevin Spacey’s character, Frank Underwood, meets a textbook definition of Antisocial Personality Disorder (ASPD). Inspired by Spacey’s tremendous performance, I thought I would venture forth and use this example of a central character in a drama to illustrate this misunderstood and, often, underestimated psychiatric disorder. Individuals with antisocial personality disorder (or sociopaths) are difficult and dangerous; they deny, lie, and contribute to all manner of mayhem in our communities and societies. They know full well what is going on around them and know the difference between right and wrong (and hence are fully responsible for their own behaviors) yet are simply unconcerned about such moral dilemmas.

When Frank wants something or needs to manipulate someone, he is able to “switch on” the charm in an instant.  He conveys to others that he cares deeply about them by flashing an infectious smile and being gracious and attentive.

And, as season 2 showed, there were many who fell prey to his deceit…not least of all the President of the free world. Perhaps nowhere is his charisma more evident that in the perverse loyalty of those in his inner circle; all turn a blind eye to what he is capable of and appear to be utterly captivated by his personality and presence.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

Behavioral Science, Evolution, Medicine and Society, Ophthalmology, Research

Looks of fear and disgust help us to see threats, study shows

Looks of fear and disgust help us to see threats, study shows

disgustedNext time someone throws you a look, don’t take it personally: In a study of fear and disgust (the facial expressions), researchers have shown how those reactions to threat have helped us survive. Scientists studied the effects of eyes widening in fear, admitting more light and broading a participant’s field of vision, or narrowing in disgust, focusing more precisely on an object. As two-dozen undergraduate volunteers mimicked each emotion, scientists tracked their vision using using standard eye-exam equipment.

From a recent Los Angeles Times article:

Although some scientists have proposed that emotional expressions are intended primarily to communicate information, study authors argued that expressions of fear and disgust seem to perform different visual functions.

“Eye widening may improve detection and localization of a potential threat that requires enhanced vigilance, which would be consistent with the hypothesized function of fear,” wrote senior author Adam Anderson, [PhD,] a professor of human development at Cornell University. (The research was conducted by Anderson and his colleagues at the University of Toronto.)

“Conversely, eye narrowing may improve perceptual discrimination to discern different kinds of threats, such as disease vectors and contaminated foods, avoidance of which is a hypothesized function of disgust,” Anderson and his colleagues wrote.

The study was published in the journal Psychological Science.

Previously: Botox: frozen face = chilled emotional response? and Compassion, Darwin, facial expressions, the Dalai Lama – and counterterrorism?
Photo by Rachael Towne

Medical Education, Medicine and Society

From the Scope archives: My parents don’t think I’m smart enough for family medicine

Tomorrow, medical students across the country, including those at Stanford, will find out where they’ll be doing their residency. In anticipation of the exciting event, known as Match Day, we’re re-publishing an entry penned last year by then-medical student Raymond Tsai. His candid and moving post was one of our most popular of 2013 and garnered comments from across the world. For the record, Tsai matched in family medicine at UCLA Medical Center (.pdf).


Raymond Tsai and Danica Lomeli hug after finding out that both will be attend UCLA March Day at Stanford on Friday, March 15, 2013. ( Norbert von der Groeben/ Stanford School of Medicine )I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make money – why aren’t you?” Even more jolting was when they asked, “Why are you throwing away years of hard work and accomplishments?” I was flabbergasted by the line of questioning, but they’re my parents, so I had to answer the fundamental question – why family medicine?

For me, the answer is simple: I went into medicine to improve the health of my community and our society, and when I think about the most pressing health issues facing our nation, it’s preventable lifestyle disease. According to the Centers for Disease Control and Prevention, more than 75 percent of our health-care costs and 7/10 of deaths stem from chronic diseases that are largely preventable.

As a medical profession, we’ve largely been unsuccessful at getting people to engage in healthy behaviors. Luckily that’s where family medicine doctors are uniquely positioned to succeed. For one, the family physician has the breadth of training to serve everyone in a community, and in doing so, can influence community behavior as a whole. This approach is vitally important since lifestyle choices are never made in the clinic; they’re made in communities based on social norms set by families and peers.

Second, as I’ve learned through my own journey of overcoming obesity by losing 40 pounds in the past year, so much of one’s ability to implement healthy lifestyles hinges on one’s sense of self-efficacy. Again, that’s where the family physician comes in. A family physician has the benefit of deep interpersonal relationships developed through continuity of care to more effectively cheerlead and coach a patient to success. If executed correctly, family medicine has the potential to succeed in promoting healthy lifestyles, improving community health, and actually preventing disease in ways we haven’t been able to before.

The potential for primary care to fix our society’s biggest health-care problem and to have a real impact on overall population health is why I’m choosing to go into this field. Increasingly, policy makers are turning towards primary care to fix a health-care system that’s becoming more expensive than we as a society can afford. As that happens, I want to be at the front lines leading the charge and developing impactful solutions.

When I told my parents this, their response was, “There are already a lot of smart people who trying to fix this problem and unable to find an answer – so what makes you think you can?” In essence, they don’t think I’m smart enough for family medicine. The problem that primary care has been charged to solve is so big that my parents don’t think I can do it.

Maybe my parents are right, but that won’t stop me from trying. Ignoring the issue doesn’t make it any less urgent. To communicate this to my parents, I responded with a Chinese proverb they taught me long ago, “Plugging up your ears so you don’t hear the fire alarm doesn’t mean there isn’t a fire.”

Previously: Matching into family medicine

Behavioral Science, Medicine and Society, Mental Health, Nutrition

Learning tools for mindful eating

Learning tools for mindful eating

applecakeWhat’s the ideal diet for you? Ask your body. Practicing mindful eating involves subtle work that may be easier said than done. In a BeWell Q&A, wellness advisor Patty McLucas describes a class she teaches on the topic, leading students to quiet social cues and impulses that drive a person to eat for reasons other than hunger.

From the piece:

So many factors are at play in our culture here in Silicon Valley — and in the Western world — that result in a disconnect between the body’s natural sensation of hunger and the response to feed ourselves well. In other words, food has become disconnected from its primary function, which is to fuel our bodies.

How can we reconnect our eating with our hunger?

Ultimately, the only method that works over the long term is re-sensitizing our instrument — that is, our bodies — to perceive true hunger and fullness. And we do this through learning the practice of mindfulness. 

We all know that babies cry when hungry and absolutely refuse food when full. If no longer hungry, a baby won’t eat even one extra mouthful — not even one bite of Aunt Hildegard’s prizewinning apple cake! So the good news is that we are all born with this capacity; however, it gets obscured by our upbringing and other conditioned habits. Mindfulness of the body helps us see that.

Previously: Mindful eating tips for the desk-boundSix mindfulness tips to combat holiday stress and How mindfulness-based therapies can improve attention and health
Photo by joyosity

Medicine and Society, Science

Making science accessible to scientists

Making science accessible to scientists

In a recent guest post on SciLogs, Rebecca Tripp writes about her experience working as a scientist and finding ways to engage in rigorous canopy biology fieldwork with paralysis in her lower body. She writes that after she and others had assumed her work in the world would be “done from behind a desk,” people with different ideas on accessible science changed her mind.

Tripp describes an internship at Baker University in Kansas that recruited science students with ambulatory disabilities. From the piece:

I spent that summer climbing trees, using ropes and a harness, and collecting microscopic organisms to study later on in the lab. It turned out to be a life-changing 10 weeks, and it got me thinking: How can we, as a society, promote more opportunities like this? How do we motivate employers, teachers, scientists, etc., to broaden their horizons and make the sciences more inclusive? How do we encourage the disabled community to participate in these opportunities?

When we begin excluding people due to their physical, mental or developmental limitations, we suffer as a society, and we miss out on potentially valuable contributions to science. There have been many technological advancements over the years that make life easier for all of us, and we should be utilizing these tools to promote a scientifically literate global community, to which everyone can contribute.

Science communicators, many of whom are scientists themselves, are perfectly positioned to play a prominent role in initiating change.

Previously: Using personal robots to overstep disability and In motion: Accessible Icon Project moves forward

Cardiovascular Medicine, Medicine and Society, Stanford News

A heartfelt story about a young aspiring doc and a famous transplant surgeon

ShumwayFor anyone who had a childhood passion (medical or otherwise), take a few minutes to read a terrific narrative piece in the current issue of Stanford Medicine magazine.

The story begins in the archives right here at the School of Medicine’s communication office and describes a true tale of an 11-year-old boy who, inspired to begin practicing medicine, wrote to heart-transplant pioneer Norman Shumway, MD, for surgical advice. Intern Jerome Macalma was scanning documents when he came across the handwritten note, and he used Facebook to solve the modern-day mystery of the letter-writer’s identity.

It turns out that once-aspiring doctor Robert Wise had become a real one. In the piece, Wise, MD, fleshes out details of the letter’s story and his journey to become an emergency medicine physician with a clinical interest in cardiovascular emergencies. I’ll save the rest for you.

Happy reading!

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questionsMiddle school students get brainy and Doc McStuffins: A pint-sized inspiration for girls of all colors
Related: Norman Shumway, heart transplantation pioneer, dies at 83

Cancer, Events, Medicine and Society

Tig Notaro: Using comedy to deal with cancer was a “godsend”

Tig Notaro - smallStand-up comic Tig Notaro brought her unique brand of comedy to Stanford early this week, and she didn’t disappoint the standing-room-only audience of students, faculty, staff and community members gathered on campus.

Notaro, a fairly successful stand-up comic before 2012, exploded on the national scene when she greeted an audience at the Largo in Los Angeles with the words, “Thank you, thank you, I have cancer, thank you, I have cancer, really, thank you.” She then told the audience: “Tragedy plus time equals comedy. But I don’t have the benefit of time. So I’m just going to tell you the tragedy and know that everything is going to be okay.”

In that now legendary comedy set, Notaro went on to share the tragedy of her bi-lateral breast cancer diagnosis, the unexpected early death of her mother, and the ending of a romantic relationship: all within a four-month span. Well-known comedian Louis C.K. was in the audience that night, and he tweeted: “in 27 years doing this, I’ve seen a handful of truly great, masterful standup sets. One was Tig Notaro last night at Largo.”

During her Stanford performance, which was sponsored by the Stanford Storytelling Project, the Stanford Arts Institute and ITALIC, Notaro gave a hilarious impression of a TSA agent trying to pat her down in the front. Notaro chose not to have reconstructive surgery after her bi-lateral mastectomy, so the agent had a hard time deciding if Notaro was a man or a woman. Laughing, Notaro said, “I had small breasts before, and I would joke about them all the time… how small they were.” Pausing for a moment, she grinned and said, “You know, I think my breasts heard me and decided to get revenge.” Notaro’s statement, and the audience’s responding laughter, illustrated what Louis CK has said about her comedy: “It is an amazing example of what comedy can be. A way to visit your worst fears and laugh at them.”

In a Q&A session after her performance, Notaro said using comedy to deal with her cancer was a “godsend. I hadn’t planned to talk about it as part of my act, but it just came out.” And today, she says, she’s glad it did. “I get letters every day from people who have been diagnosed with cancer, or people who have lost a loved one to cancer. If my comedy can help just one person who has to travel the same journey I have traveled, it is worth it.”

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Saying thank you with art: Stanford undergrad pens one-woman play on cancer
Photo courtesy of Tig Notaro

Events, Medical Education, Medicine and Society, Stanford News, Technology

Stanford-hosted AMA Medical Student regional conference focuses on health-care technology

Stanford-hosted AMA Medical Student regional conference focuses on health-care technology

AMA photoStanford med students Nuriel Moghavem and Trishna Narula co-chaired an AMA Medical Student Section Regional 1 conference last weekend at the Li Ka Shing Center for Learning and Knowledge. Ninety students, including 40 from Stanford, participated in the two-day event, which involved meetings, breakout sessions with industry leaders and social outings, plus an optional trip to a local winery the following day. Moghavem shared his thoughts on the weekend’s proceedings in the Q&A that follows.

How did you decide to focus on healthcare technology innovation?

When we were putting together the proposal, we thought a lot about what makes Stanford different from other schools that might host this conference, and how we could add educational and inspirational value to the trips of students coming from other states. Stanford obviously has many things that set it apart, but we thought that the energy of the health tech field would really capture the imaginations of our attendees.

What were some key takeaways from the sessions?

Our keynote speaker was Atul Butte, MD, PhD, a giant in the field of big data analytics and [someone who is] incredibly knowledgeable about the process of bringing a medical discovery to the market. Everyone in that room was rapt and half probably left wondering why we all weren’t millionaires already. We then had some breakout sessions from telemedicine and technology startups that again pushed our attendees’ understanding about the future of medicine. I think the main takeaways were that technology is changing health care, and the “visibility” – if you think about it like driving a car in the fog – probably isn’t more than two to three years ahead. Technology has the promise to entirely overturn our idea of how health is fundamentally defined and approached in ways that we simply can’t anticipate at this time. It’s big stuff.

What took place at the AMA Leadership School Workshop?

The Leadership School is a national initiative to put tools in the hands of emerging leaders to empower them to expand their efforts. The workshop they led during our conference was an excellent morning icebreaker – asking attendees to share media related to their own personal “brand” (a favorite image, a Google search of themselves, etc.). Through the exercise, we all shared interesting personal details about our lives, interests, passions and hobbies, and we learned a valuable lesson in controlling one’s brand and online presence.

You are a busy medical student. Why do you feel it’s important to participate in leadership opportunities in your field?

As medicine becomes increasingly driven by public policy, it’s important that we cultivate a generation of leaders in medicine with the tools to engage in policy. This conference was, for us, an opportunity to get 70 of the brightest future physicians in our region (which spans from Hawaii to South Dakota!) in one room to discuss that very issue and to develop those skills. We don’t just think it’s important for emerging physician leaders to participate in policy matters, we think it’s critical for the future well-being of our community and perhaps our country for them to do so.

Co-organizer Trishna Narula later shared with me, “while this was a great opportunity for the AMA to benefit from the health technology hub at Stanford, it was also another large step for Stanford Med to push to the forefront of health policy and advocacy.”

Previously: Top 10 reasons I’m glad to be in medical schoolFuture doctors have a lot at stake, even if they don’t know it: A student’s take on the Affordable Care Act and Stanford Medicine X seeking students for leadership program
Photo by James Pan

Behavioral Science, Events, Medicine and Society, Stanford News, Technology

The Dalai Lama talks business, compassion and happiness

The Dalai Lama talks business, compassion and happiness

One Christmas, my dad gave me and my siblings copies of the Dalai Lama‘s book The Art of Happiness – a quick read with a valuable missive. (“Be content with this book – you didn’t need other presents” was my takeaway.) I was reminded of this when reading about a recent visit – focused in large part on happiness – by His Holiness to Silicon Valley.

During his visit, which was co-sponsored by Stanford’s Center for Compassion and Altruism Research and Education (CCARE), the Dalai Lama gave a talk at Santa Clara University on business, ethics and compassion. As Stanford News reports from the event:

In his opening remarks, [James Doty, MD,] noted that stress, anxiety and depression are the greatest health care costs to businesses – he referred to an “epidemic of depression.” Companies do not pay enough attention to the well-being of its employees, he suggested.

“Is there a different approach?” asked Doty, referencing the effects of meditation and compassion on the brain. This type of research, he said, has stimulated a revolution in science. Being compassionate increases one’s health, well-being and longevity, he said.

The Dalai Lama talked about how to become a “happy person” and build a “happy community” where people spread love and compassion.

“Everyone has the right to be a happy person, but generally we have too much of an emphasis on material values,” he said.

Doty is director of CCARE, which studies the science of compassion. (The Dalai Lama is a founding benefactor of CCARE.) More from the article:

Doty said that researchers are especially interested in ways to integrate technology and well-being.

“We’re studying the development of interventions, including web-based or smartphone-based apps that support health and well-being by decreasing stress and anxiety in the workplace,” Doty said in an interview before the Dalai Lama spoke.

Previously: Are women more compassionate than men? What the science tells usHow practicing compassion could ease or eliminate chronic stress and How being compassionate can influence your health

Cardiovascular Medicine, Medicine and Society

Transforming the rhythms of the heart into music

Transforming the rhythms of the heart into music

Back in 2000, jazz drummer Milford Graves received a Guggenheim grant and developed technology to record music based on the natural rhythms of the human heart. Graves then began experimenting with using various diagnostic tools to listen to volunteers’ hearts and parsing the data with software. This process enabled him to zero in on the micro-rhythms within a single heartbeat. If the heart sounded abnormal, he would create a counter-rhythm to use in helping the heart return to a normal pattern.

Among those who worked with Grave was drummer Greg Fox. The recordings of Fox’s heart were used to produce his latest alum titled “Mitral Transmission.” The above sample track showcases Fox’s biometric instrument.

Via Medgadget
Previously: Real-time MRI music video

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