Friday, November 29, 2013

The Phases of Shopping Addiction

The blight of Black Friday is upon us. What better time to look at a recent paper on compulsive shopping?

Sohn and Choi (2013) adopted a qualitative approach and recruited a small group of Korean housewives with problematic shopping habits via consumer news websites. These nine women ranged in age from 28 to 40. The authors identified their target group as individuals with compulsive buying disorder, who reported a "preoccupation with shopping, pre-purchase tension or anxiety, and sense of relief following the purchase defined by Faber and O’Guinn (1992)." The participants all had high scores on the Faber and O’Guinn 14 item "compulsive buying checklist."

The authors conducted in-depth 2 hour interviews with each participant and analyzed the data according to a six-step contents analysis (Kim et al. 1999) that derived concept clusters, subcategories, and categories. Of note are these Five Sequential Phases of Shopping Addiction (Sohn & Choi, 2013):

Phase 1. Retail therapy,Filling up emptiness with shopping”
Phase 2. Denial,Ignoring overconsumption”
Phase 3. Debt-ridden,Ran out of money, while nothing left”
Phase 4. Impulsive buying,Driving ones-self to hasty buying”
Phase 5. Compulsive buying,It is crazy but I cannot stop”

Accompanying these phases are 5 themes, 15 subthemes, and 43 codes (shown in detail below).

- click on image for a larger view -

Do you have a strong urge to purchase the latest Xbox One or PS4 before they sell out? Would you feel anxious if you didn't get one? If so, then you may be in Phase IV, Impulsive Buying.

But if you go to the mall every morning and shop online every day, it's all over. You've reached Phase V, Compulsive Buying.


Sang-Hee Sohn and Yun-Jung Choi (2013). Phases of Shopping Addiction Evidenced by Experiences of Compulsive Buyers. International Journal of Mental Health and Addiction DOI: 10.1007/s11469-013-9449-y

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Monday, November 25, 2013

Confessions of a Prosocial Psychopath

Many neuroscientists have been howling about the media coverage surrounding a new book written by UC Irvine Professor Emeritus, Dr. James H. Fallon. This is because unbeknownst to himself for 58 years (or apparently to anyone else, for that matter), he was secretly a psychopath. How did he finally discover this? Did he complete the Psychopathy Checklist and score over 30?


Instead, he diagnosed himself as a psychopath on the basis of his PET scan.

Compared to a control brain (top), neuroscientist James Fallon’s brain (bottom) shows significantly decreased activity in areas of the frontal lobe linked to empathy and morality—anatomical patterns that have been linked with psychopathic behavior. Image via James Fallon in The Smithsonian.

This is a case of reverse inference, assuming that a certain pattern of brain activity indicates a particular behavioral state (or in this case, a specific psychiatric diagnosis). While it may be true at the group level that activity in the ventromedial prefrontal cortex is decreased in psychopaths, it's not possible to diagnose an individual on this basis (at least not with our current state of knowledge).

In fact, Fallon himself initially doubted the ugly possibility that he's lacking in empathy, morality and self-control:
In [his book], Fallon seeks to reconcile how he—a happily married family man—could demonstrate the same anatomical patterns that marked the minds of serial killers.

“I’ve never killed anybody, or raped anyone,” he says. “So the first thing I thought was that maybe my hypothesis was wrong, and that these brain areas are not reflective of psychopathy or murderous behavior.”

Not with certainty, they're not. The Smithsonian article continues:
Eventually, based on further neurological and behavioral research into psychopathy, he decided he was indeed a psychopath—just a relatively good kind, what he and others call a “pro-social psychopath,” someone who has difficulty feeling true empathy for others but still keeps his behavior roughly within socially-acceptable bounds.

A "prosocial psychopath"? Isn't this an oxymoron? Aren't psychopaths antisocial by definition? Eventually, he came to doubt the classification scheme. Psychopathy doesn't appear in the DSM... part because it encompasses such a wide range of symptoms. Not all psychopaths kill; some, like Fallon, exhibit other sorts of psychopathic behavior.

“I’m obnoxiously competitive. I won’t let my grandchildren win games. I’m kind of an asshole, and I do jerky things that piss people off,” he says. “But while I’m aggressive, but my aggression is sublimated. I’d rather beat someone in an argument than beat them up.”

This is psychopathy??

(Perhaps) in response to a snarky query on Twitter ("There goes Hare's PCL" [to paraphrase]), Dr. Fallon noted:

But he looks like such a genial fellow!

Taking a quick look inside The Psychopath Inside (p. 26), we learn that Fallon viewed himself as a "nice, regular guy" who was popular and able to form close friendships with women.1 Should we rely on his brain scan, or on his behavior, when applying such a stigmatizing label?

Confessions of an Extremely Antisocial Female Psychopath

Another book published this year would make an interesting pairing with Fallon's personal discovery neuroscience / memoir: Confessions of a Sociopath, by the anonymous "M. E. Thomas". If you want narcissistic antisocial [but nonviolent] braggadocio, this is the book for you.2 For starters, the author is female, placing her in the minority of those with antisocial personality disorder. She's also a Mormon law professor in California.

"Ms. Thomas" wears the stigmatized behaviors as a badge of pride, although she erroneously calls herself a "sociopath" (which doesn't exist as a diagnostic label). But what do I know? She's SO brilliant – she passed the bar exam without even studying (while everyone else was crying):
I loved getting high marks in school; it meant I could get away with things other students couldn't. When I was young, what thrilled me was the risk of figuring out just how little I could study and still pull off the A. It was the same for being an attorney. During the California bar exam, people were crying from the stress. The convention center where the exam took place looked like a disaster relief center; people made desperate attempts to recall everything they had memorized over the prior eight weeks—weeks that I spent vacationing in Mexico. Despite being woefully ill-prepared by many standards, I was able to maintain calm and focus enough to maximize the knowledge I did have. I passed while others failed.

And she's oh so charming!
You would like me if you met me. I have the kind of smile that is common among television show characters and rare in real life, perfect in its sparkly teeth dimensions and ability to express pleasant invitation. I'm the sort of date you would love to take to your ex's wedding—fun, exciting, the perfect office escort. And I'm just the right amount of successful so that your parents would be thrilled if you brought me home.

But the best take on the book comes from Patrick Bateman, who reviews it for Slate:
I take the elevator up to my apartment and wash my hands and sit in my cream leather chair and chase an Adderall with a J&B and read the book in one sitting. It begins with a psychological evaluation that describes M.E. Thomas as a “prototypical psychopathic personality” manifesting “a ruthless and calculating attitude toward social and interpersonal relationships, and a relative immunity to experiencing negative emotions.” ...
. . .

...She’s into “the fine art of ruining people,” according to the title of Chapter 7. She seduces with charisma, and she cunningly covers her hollowness with superficial charm. She’s a “Nietzschean machine.”

And she violates social norms like it’s her job. Emotionally she takes no prisoners: The high school teacher she falsely accuses of harassment, the friends whose boyfriends she sleeps with just because she can, the colleagues she mind-fucks—they’re all just roadkill...

I'd much rather read Fallon's memoir. He sounds like an upstanding and sympathetic guy, despite the fact that he's related to Lizzy Borden.

Further Reading

The Disconnection of Psychopaths

Born This Way?

I Feel Your Pain... and I Enjoy It

Can Brain Activity Predict Criminal Reoffending?

Are Cognitive Factors Related to Criminal Reoffending?

"None of us are saints"

The Stylized Neuroscience of Psychopaths


1 Interestingly, on page 28 we learn that he developed OCD in junior high, in particular an obsession with Catholicism and morality.

2 Confessions of a Glib Blogger: I haven't read either book.

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Thursday, November 21, 2013

New Deep Brain Stimulation System Measures Neurotransmitter Release

Wireless Instantaneous Neurotransmitter Concentration Sensing System (WINCS) Patient Module printed circuit board & sterilizable case. (Fig. 1, Kimble et al. 2009).

Last month, the New York Times reported that the Defense Advanced Research Projects Agency (DARPA) will spend $70 million to further the development of technologies that use deep brain stimulation (DBS), which has been highly successful in treating Parkinson's Disease (PD). The SUBNETS program (Systems-Based Neurotechnology for Emerging Therapies) is part of the BRAIN Initiative that aims to "revolutionize our understanding of the human mind."

DARPA issued their call for proposals on October 25. My original take was that the goals were overly ambitious and nearly impossible to achieve within the specified time frame:
To elaborate, over a 5 year period, the successful applicants must conduct clinical trials in human patients with 7 specified psychiatric and neurological disorders (not including PD), some of which have never been treated with DBS. The successful teams will use devices that both stimulate and record neural activity, and provide real-time data that can be decoded as reflecting a particular behavioral state... basically, a futuristic implant that can adjust its own stimulation parameters based on how the patient is doing. At least, that's how I interpret it. 

How close are we to seeing a DBS implant that not only stimulates neural tissue, but also records electrical or chemical signals and then uses this information to adjust the stimulation parameters? Closer than I originally suspected. A recent Nature News article reported on the Mayo Clinic's efforts to develop a DARPAesque, state-of-the-art implant that aims to track brain signals in real time:
Researchers hope that the device will identify the electrical and chemical signals in the brain that correlate in real time with the presence and severity of symptoms, including the tremors experienced by people with Parkinson’s disease. This information could help to uncover where and how DBS exerts its therapeutic effects on the brain, and why it sometimes fails, says Kendall Lee, a neurosurgeon at the Mayo Clinic in Rochester, Minnesota, who is leading the project.
. . .

...Using a method called fast-scan cyclic voltammetry, the device applies a localized voltage change in the brain. This transiently pulls electrons off certain neurotransmitters — the brain chemicals that activate or inhibit neurons — giving rise to electrical currents that can be measured. Each neurotransmitter molecule produces a different electrochemical signature, which can be used to identify it and estimate its concentration every 10 milliseconds.

Studies in awake behaving rats have used fast-scan cyclic voltammetry to measure phasic dopamine release associated with burst firing (Robinson et al., 2003).

Fig, 3 (Robinson et al., 2003). Heterogeneity of electrically evoked dopamine release in the nucleus accumbens of a freely moving rat.

Further information about the device is provided in this article from the Mayo Clinic, which indicates that the WINCS has already been tested in 15 human patients with Parkinson's disease or essential tremor. The study registered in is described as an Efficacy Study whose primary purpose is basic science:
Neurotransmitter Measurements Using Wireless Instantaneous Neurotransmitter Concentration System (WINCS) During Deep Brain Stimulation Neurosurgery

In this study, the investigators will monitor extracellular neurotransmitter levels using a probe that is able to perform real time electrochemical detection during deep brain stimulation surgery. The overall question this study is designed to answer is: Are there neurotransmitters released during deep brain stimulation?

Interestingly, the primary outcome measure is adenosine1 release recorded by WINCS, and the secondary outcome measure is dopamine release (pre-, during, and post-DBS, over a time frame of 30 min). Adenosine A2A antagonists may extend the duration of action of L-dopa, a primary treatment for PD. Preliminary studies in rats were able to detect subsecond dopamine and adenosine release at an implanted sensor in the striatum during high-frequency stimulation of ascending fibers (Kimble et al., 2009). It seems the early results in patients were also successful in measuring neurotransmitter release.

The WINCS will be integrated with another device, the MINCS (Mayo Investigational Neuromodulation Control System), which is optically linked to WINCS. The entire system is being tested in animal models to deliver brain stimulation wirelessly.

Fig 1B (Chang et al., 2013). Photograph of the MINCS-WINCS hardware showing relative size, optical connection, and recording and stimulating electrode leads. ADC = analog-to-digital converter; DAC = digital-to-analog converter; LPF = low-pass filter; MC = microcontroller; TIA = transimpedance amplifier; V/I Sense = voltage/current sense. Numbers 1 and 4 indicate the microcontrollers; 2 and 3 are the Bluetooth modules.

These developments in DBS devices for Parkinson's disease are very impressive indeed, but DARPA wants to go 7 steps further by developing similar closed-loop systems for use in Post-Traumatic Stress Disorder (PTSD), Major Depression, Borderline Personality Disorder (BPD), General Anxiety Disorder (GAD), Traumatic Brain Injury (TBI), Substance Abuse/Addiction, and Fibromyalgia/Chronic Pain. As I said previously:
To the best of my knowledge, there is no published literature on DBS for PTSD, BPD, GAD [as opposed to OCD], or TBI [except for minimally conscious state]. At, a Pilot Study of DBS of the Amygdala for Treatment-Refractory Combat PTSD was withdrawn prior to enrollment. There's one DBS trial for TBI that aims to enroll 5 patients over a 4 year period. I couldn't find anything for BPD or GAD (although these disorders might possibly be comorbid in some patients treated for depression or OCD).

Although there is a tremendous amount yet to learn about Parkinson's, much more is known about the pathophysiology of PD than of any of the disorders listed above. But given the list of speakers at a recent Society for Neuroscience symposium on the Mechanisms of Deep Brain Stimulation Efficacy in Neuropsychiatric Disorders, scientists and clinicians at Mayo, Emory, Butler/Brown, and Case Western are certainly working on these problems. $70 million from DARPA would sure come in handy, even if the ambitious endpoints are unattainable within 5 years.


1 Caffeine is an adenosine antagonist, but the drugs used as adjunct therapies in PD are istradefylline and preladenant.


Chang SY, Kimble CJ, Kim I, Paek SB, Kressin KR, Boesche JB, Whitlock SV, Eaker DR, Kasasbeh A, Horne AE, Blaha CD, Bennet KE, & Lee KH (2013). Development of the Mayo Investigational Neuromodulation Control System: toward a closed-loop electrochemical feedback system for deep brain stimulation. Journal of Neurosurgery. PMID: 24116724

Kimble CJ, Johnson DM, Winter BA, Whitlock SV, Kressin KR, Horne AE, Robinson JC, Bledsoe JM, Tye SJ, Chang SY, Agnesi F, Griessenauer CJ, Covey D, Shon YM, Bennet KE, Garris PA, & Lee KH (2009). Wireless Instantaneous Neurotransmitter Concentration Sensing System (WINCS) for intraoperative neurochemical monitoring. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2009, 4856-9. PMID: 19963865

Robinson DL, Venton BJ, Heien ML, Wightman RM. (2003). Detecting subsecond dopamine release with fast-scan cyclic voltammetry in vivo. Clin Chem. 49:1763-73.

Nature News link via @GholsonLyon

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Saturday, November 09, 2013

Now Is That Gratitude?

Now is that Gratitude,
Or is it really love?
Some kind of reality
That fits just like a glove

--Danny Elfman, Gratitude

Praise and condemnation serve a powerful purpose in our social and internal lives. They prop us up and tear us down. We reward ourselves (and others) when we perform good deeds, give a pat on the back for a job well done. Conversely, we punish bad behavior. Some people are more vengeful than others when they're wronged; other individuals might be more inclined to blame themselves, even when it's not their fault.

Laws and religions and etiquette and complex ethical systems enforce the rules of behavior. For most human beings of a certain age, moral emotions are the result of abiding by or violating these social norms. Moral emotions can be defined as “those emotions that are linked to the interests or welfare either of society as a whole or at least of persons other than the judge or agent” (Haidt, 2003). They can entail reacting to events that don't directly involve the self, as in the case of sympathy or contempt.

Zahn and colleagues (2013) refer to these feelings and reactions as moral sentiments, “following philosophers of the Scottish enlightenment who pointed to their role as key motivators of moral behaviour (Bishop, 1996).” In a recent study, they conceptualized four of these moral sentiments in a 2 x 2 grid, depending upon whether the emotion involved praise or blame, of oneself or of another (Zahn et al., 2013).

                          SELF        OTHER    
PRAISE      Pride       Gratitude
BLAME      Guilt        Indignation

Their goal was to determine whether there are individual differences in regional gray matter volumes associated with self-reports on the Value-related Moral Sentiment Task, which attempts to quantify personally felt human emotions.

Moral Phrenology

Does the tendency to experience each of these moral sentiments correlate with the size of different regions of the brain? The strong form of this question assumes the brain is modular and divisible into separate regions that oversee distinct processes. It also reflects a belief in the “brain is like a muscle” analogy, with discrete regions growing larger with use and smaller with disuse. In Franz Gall's original formulation of phrenology, there were 27 “organs” or mental faculties that could be measured by palpating bumps on the skull. The list of faculties was further refined and developed by Spurzheim (1815), Combe (1834 & 1847), and Lundie (1844). 1

Phrenological Chart, via Wikimedia Commons

For example, the organ of Benevolence is “situated at the upper part of the frontal bone... When it is large, the frontal bone rises with an arched appearance; when small, the forehead is low and retreating.”

Zahn et al. (2013) didn't palpate bumps on the skull, of course. Instead, they used voxel-based morphometry (VBM) to quantify regional gray matter (GM) volumes in 63 participants. In turn, these GM volumes were related to scores for each moral sentiment, controlled for positive and negative valence (Zahn et al., 2013):
We examined the effects of each moral sentiment measure (e.g. pride-proneness) on GM volume across the whole brain while using the other moral sentiment of equal valence (e.g. gratitude-proneness) as a covariate of no interest to control for effects of valence. We thus used two separate models to test for positive and negative emotions. All reported results were thus partial effects of one moral sentiment controlled for the adjusted effect of the equal-valence moral sentiment.

The Value-related Moral Sentiment Task (VMST) consists of 180 descriptions of positive or negative interactions between a participant and their best friend in which either they (self-agency, N=90), or their best friend (other-agency, N=90), acted in accord with (N=90) or counter to (N=90) social and moral values. The four conditions thus measured proneness to:
  1. Pride (POS_SELF): positive self-agency (e.g. ‘Yourself acting in a generous way towards Sam [best friend]’)
  2. Gratitude (POS_OTHER): positive other-agency (e.g. ‘Sam acting in a generous way towards you’)
  3. Guilt (NEG_SELF): negative self-agency (e.g. ‘Yourself acting in a stingy way towards Sam’)
  4. Indignation (NEG_OTHER): negative other-agency (e.g. ‘Sam acting in a stingy way towards you’)
The task was to choose the most fitting label (pride, gratitude, embarrassment [not examined here], guilt, indignation/anger, or none/other) for what they'd feel in response to each example. Participants then rated the unpleasantness or pleasantness of their projected feelings on a scale of -4 to +4.

Based on the authors' previous studies, the set of a priori brain regions of interest (ROIs) included anterior temporal lobes, posterior superior temporal sulcus/temporo-parietal junction, frontopolar cortex, dorsolateral prefrontal cortex (PFC), ventromedial PFC, lateral orbitofrontal cortex, dorsomedial PFC, insula, amygdala, basal ganglia, septum, hypothalamus, and ventral tegmental area.

However, there was no relationship at all between gray matter volumes in these predicted regions and any of the moral sentiments. Therefore, the correlations between 13 ROIs and scores for 4 moral sentiments yielded no significant results.

Instead, larger right inferior temporal cortex volumes were associated with the propensity to experience Gratitude (Fig. 1c), while smaller precuneus and cuneus volumes were associated with greater Pride-proneness (Fig. 1d). This is very surprising, since the cuneus contains primary visual cortex (Area V1, aka Brodmann area 17 in primates). Why would humble people have larger primary visual cortices? Because they spend more time looking at the outside world?

The Guilt-proneness and Gratitude-proneness voxels in the dorsolateral PFC (Figs. 1a and 1b) were not significant after correction for multiple comparisons.

Fig. 1 (Zahn et al., 2013). Individual differences were depicted as increases (yellow) or decreases (blue) in GM volume that were associated with proneness to experience a specific moral sentiment on the experimental task in N=63 participants.

Since the straightforward VBM analyses were a complete bust, the authors did post-hoc analyses in the subset of subjects who participated in an earlier fMRI study, evaluating individual differences in  guilt-related BOLD responses and their relationship to GM volumes. I won't discuss that here.

How do the authors explain Figure 1? Clearly, their predictions did not pan out. 2 After ruling out low statistical power as an issue, they put forth their best explanation: neuroanatomical differences cannot explain individual variation in responses on the VMST.
An alternative explanation which we favour is that structural variability in brain regions critical for specific moral sentiments is low between healthy participants, because high psychosocial functioning may not allow for large variations in structural anatomy within brain systems critical for moral motivations.

This doesn't stop them for offering highly speculative explanations for some of their findings (namely, the claim that gratitude might recruit visual imagery to a greater extent than pride):
We interpret the finding that individuals with higher GM volume within posterior cortical areas showed lower proneness to respond with pride and higher proneness to respond with gratitude as possibly being related to differences in reliance on visuo-spatial representations of morally salient scenes associated with these different types of feelings. A well-developed posterior cortical system may facilitate construction of detailed scenes which could play a more important role for experiencing gratitude than pride.

Now Is That Gratitude?

The present study illustrates the folly of modern-day moral phrenology. You can't measure the size of the anterior insula and determine whether someone is a self-righteously indignant person, or believe that the organ of gratitude is housed in the right inferior temporal cortex. Gratitude is a complex emotion that plays a huge role in positive psychology. You can be grateful for the weather or for your standard of living. Is praise of another person a valid operational definition of Gratitude as a moral sentiment? Or is this another form of wishful thinking, like the critical positivity ratio of 2.9013 (Brown et al., 2013)?


1 For all phrenology all the time, see The History of Phrenology on the Web, by John van Wyhe.

2 The authors made the following specific predictions:
...based on evidence from patient lesion studies (Moll et al., 2011) and fMRI (Takahashi et al., 2004; Moll et al., 2007; Kedia et al., 2008; Zahn et al., 2009b), we hypothesized associations of frontopolar GM volume with guilt-proneness. Based on recent studies, we further expected the importance of subgenual parts of the anterior cingulate (Zahn et al., 2009a, b) and the septal region (Zahn et al., 2009b; Moll et al., 2011) for individual variation on guilt-proneness. In contrast, we expected lateral orbitofrontal/insular areas to be associated with indignation-proneness based on an fMRI study directly probing indignation (Zahn et al., 2009b), a study in which this region showed activation for decisions based on moral anger (Moll et al., 2006), and evidence that a lateral orbitofrontal region was selectively more activated for other-critical feelings (anger and disgust) vs prosocial moral feelings including guilt (Moll et al., 2007). Our hypotheses for pride- and gratitude-proneness were less well supported due to a relative scarcity of evidence. Our main expectations were that pride-proneness and gratitude-proneness should be related to differences within mesolimbic and basal forebrain areas, specifically the hypothalamus, ventral tegmental area (VTA) and septal area (Zahn et al., 2009b).


Haidt, J. (2003). The moral emotions. In R. J. Davidson, K. R. Scherer, & H. H. Goldsmith (Eds.), Handbook of affective sciences. Oxford: Oxford University Press.(pp. 852-870).

Zahn R, Garrido G, Moll J, & Grafman J (2013). Individual differences in posterior cortical volume correlate with proneness to pride and gratitude. Social Cognitive and Affective Neuroscience PMID: 24106333

But when I think of you
And what you've done to me
You took away my hope
You took away my fantasy
I was set up for pride
The world was in my hands
I lived way at the top
In castles made of sand

--Danny Elfman, Gratitude

(Oooh) I dream of you sometimes

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Saturday, November 02, 2013

Ailurophobia (fear of cats) and the ability to sense their presence

Here's a leftover Halloween treat from American neurologist Silas Weir Mitchell (1829–1914).1 Mitchell was an illustrious physician known for discovering complex regional pain syndrome, coining the term "phantom limb", and prescribing the sexist "rest cure" (bed rest) for 19th century nervous maladies.2 His work on the treatment of neurasthenia and hysteria had an influence on Sigmund Freud, although the treatments were medical in nature and not psychoanalytic.

In 1902, he consulted on a case of a young female patient who had an extreme fear of cats, and claimed she could always tell if one was nearby. Mitchell was skeptical, and he wrote about his doubts in an entertaining fashion (Mitchell, 1905):
She declared that she could always detect the presence of an unseen and unheard cat. Since, however, she was constantly announcing the presence of a cat, it was not surprising that, like a clock that has stopped and tells the time correctly twice in the twenty-four hours, her occasional successes confirmed her belief. Her failures had of course no contradictory value.

Nevertheless, he became curious about this general phenomenon. Three years later, he reported the results from a self-selected sample who responded to a series of questions about cats (Mitchell, 1905). Specifically, he was searching for people who were afraid of cats.
A. 1. Have you any antipathy to cats?
     2. Are you subject to unusual feelings or symptoms in the presence of a cat?
     3. What are these?
     4. Does the presence of a tiger in a menagerie affect you as do cats?
     5. Can you account for your cat fear by anything obvious, as, for example, any incident of childhood?
     6. At what age did you first discover your peculiarity as to cats?

B. 1. Are you surely aware of the presence of a cat when it is not in sight, or known to be near?
     2. If yes, give the evidence, your own, and that of others as to the fact.
     3. What feelings or symptoms make you sure of the cat's presence?
     4. Is it the cat odor?
     5. How long have you had this peculiarity? 

Ailurophobia (the irrational fear of cats) is a type of specific phobia, one less common than the fear of spiders or snakes. Since this was 1905, Mitchell couldn't embed a poll at his LiveJournal or use SurveyMonkey. Instead, he published the questions in the journal Academic Medicine. The responses were impressive in number, in my view, but suffered from some of the same pitfalls you might expect from an internet poll:
The request was widely copied, and I received 159 replies from persons in America, England and Germany. Many were from well-known persons — professors, army officers, physicians and the like. About a third were valueless. A few were from men or women who were personally well known to me, and who I am certain may be trusted.

Some responses were thrown out because the individual suffered from asthma — a trivial explanation for the ability to sense an unseen cat. The reactions of the non-asthmatic individuals were typically immediate:
There may be only fear, terror, disgust; there may be added chilly sensations, horripilation, weakness, locked jaw, or, as in one case, fixed, open jaw, rigidity of arms, pallor, nausea, rarely vomiting, pronounced hysteric convulsions and even temporary blindness. These pass away with removal of the cat, but in a few examples leave the sufferer nervously disturbed for a day. Two report themselves as apt to have dreams of cats, what one of them calls "cat-mares."

The affliction did not differentiate between men and women, although women often suffered from more "extreme symptoms" (according to Mitchell). But even a macho military man, a big game hunter of tigers, was not spared from the terror of domestic house cats.

When asked whether there was a specific incident that caused their fear, the majority could not name a single one. Three mentioned a scary incident in childhood and one "a prenatal incident affecting the mother. Nothing of value was obtained." There was no attempt to provide a psychoanalytic explanation for ailurophobia.

Mitchell identified 27 cases of cat phobia with what he deemed a credible ability to detect an unseen cat in the room, who were without asthma and who denied any ability to smell the hidden creature. He appears to have conducted some experiments with concealed cats, but he doesn't want to bore us with any of the methodological details:
I should overload my paper if I were to relate in detail the cases in which cats were concealed in order to test the disbelieved capacity to detect them when not in sight and in which the hidden cat was at once known to be near. One or two permit of doubt; others are unassailable.

Assuming "unassailable" is accurate (a strong assumption), how were these people able to know a cat was nearby? Mitchell favored the ability to detect an odor that did not reach conscious awareness:
There may be olfactory emanations distinguished by some as odors and by others felt, not as odors, but only in their influential results on nervous systems unusually and abnormally susceptible. No other explanation seems to me available...

What he cannot explain, however, is why the irrational fear of cats developed in the first place. But leave it to a Freudian psychoanalyst in the 1950s to come up with a sexual explanation...

Ailurophobia and Ornithophobia (Cat Phobia and Bird Phobia)

Mitchell made a horrible mistake with his "rest cure" (which was depicted in The Yellow Wallpaper), but at least his didn't try to blame cat phobia on Mommy or Daddy. That angle was covered by Louis S. London almost 50 years later (London, 1952). First, he reviewed the [fortunately] meager psychoanalytic literature of the day, and found two examples: a supposedly paraphilic 48 year old woman who "identified herself with the cat, an embodiment of infantile, criminal ideas, a force which repressed sexual interest" and a 41 year old man with bird phobia in "in which a large homosexual component and identification with the father were found."

London was the author of a slew of books on [supposedly] abnormal sexual behavior and sexual deviations, so you know where this is headed. His published case of interest here is that of dual animal phobia in a 25 year old female patient (London, 1952). She hated her mother, of course. In brief, "her phobias symbolized fear of genitals and constituted the cause of her marked sexual frigidity." The presentation of her sexual history is downright embarrassing (and unbelievable), so I won't recount it here. Suffice it to say that she probably made things up to please/shock/alienate her psychiatrist:
During analysis, the patient, supporting her procrastination by a plea of amnesia for sexual events, did not disclose anything about sexuality until 75 sessions had passed. She was so reluctant to give information about her sex life that she sent the analyst a letter reporting some of her experiences.

The analyst, however, ignored the letter and waited for the woman to speak freely of the matters she had described in writing.

She was married to a man who was a terrible lover. She hated being a housewife and wanted to work outside the home. However, the explanations for her unhappiness were frigidity and latent homosexuality, respectively. The history devolves and London's explanations become more and more preposterous:
She became frightened whenever she saw a strange woman. This fear, representing fear of latent homosexuality, was similar to her fear of birds... It was especially strong when she was in the presence of women who were angry.

The kicker, though, is the opinion expressed by the patient's surgeon:
In the middle of analysis she developed acute abdominal pains. The possibility of a psychogenic etiology was considered, but the acuteness of the pain, coupled with the fact that her mental condition had improved, made this improbable. She was sent to an internist who made a diagnosis of appendicitis and advised an operation. He scoffed at the psychoanalytic treatment she had been getting.

Then we have two pages about dreams (none of which contained cats or birds, but the interpretations did dwell on "sadistic and bisexual conflicts"). And then we get the final pronouncement:
The cats and birds [not snakes] were symbols of the phallus, and she feared them because she feared heterosexuality. This is interwoven with her sexual frigidity with the consequent clinical picture shown in this paper.

But there's more! There's an Epilogue. London interviews the patient 14 years later. She's no longer afraid of cats and birds, yet she's still disinterested in sex with her husband. So much for a causal connection...


1 The contemporary actor of the same name is a descendent.

2 I recommend a post by Dr. Romeo Vitelli for those interested in learning more about The Bed Rest Cure prescribed to writer Charlotte Perkins Gilman.


Louis S. London, M.D. (1952). Ailurophobia and ornithophobia. The Psychiatric Quarterly 26: 365-371.

S. WEIR MITCHELL, M.D. (1905). OF AILUROPHOBIA AND THE POWER TO BE CONSCIOUS OF THE CAT AS NEAR, WHEN UNSEEN AND UNHEARD. Transactions of the Association of American Physicians 20:  4-14.

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