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What schizophrenia is not

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Really, at this point a new name would be better—isolated personality disorder, or the like. Michael Byrne explains at Motherboard:

What schizophrenia is not: A state of being multiple contradictory things at once.

Feel free to chase the etymology of “schizo” all the way to its Greek origins as a prefix meaning roughly “split” or “divided.” And feel free to argue that said roots justify a billion hacky music writers calling songs and albums and bands “schizo” when what they really mean is “different things together.” (Which they will continue to do because they will continue to not have anything better to say than “this song or album or artist has ‘different things together.'”) Send me your dictionary links and examples of historical usages of the non-psychiatric definition of schizo and schism. What about schizocarp and schizogenesis? Surely psychiatry can’t take away my ancient Greek-derived deprecated slang?

No—no it can’t. But understand that by calling the new Kanye West track a“schizophrenic monster” or that Kate Nash album “thrillingly schizophrenic” or some Eminem verse “full schizo Slim Shady mode” you do nothing but hurt and obfuscate. Your misuse of “schizo” and “schizoid” and schizophrenic has only the effect of perpetuating misinformation and stigmatization. And for what?

A shitty metaphor.

A survey conducted in 2007 found that about a third of total uses of “schizophrenic” in the US press involved the metaphorical two-things-at-once slang definition rather a reference to what schizophrenia actually is (or what it is to be schizophrenic). In the German press, that share jumped to nearly 60 percent. And among music reviews, my own unscientific research suggests that the percentage of metaphorical misuse is pretty much 100 percent.

The “schiz” in schizophrenia indeed derives from schism, but not in the classic modern interpretation of cleaving between two oppositional concepts. The schism of schizophrenia is detachment—schizophrenia is very broadly characterized by an inability to correctly interpret sensory input and, in some part, to make sense of the real-world. This has a lot of seemingly disparate manifestations—delusions, hallucinations, extreme social detachment and self-isolation—but it’s basically like being forced to live in the world one step removed. This is the schism.

Patrick House, a neuroscientist at Stanford University, got this exactly right a couple of years ago in a piece for Slate called “Schizophrenic Is the New Retarded.” “The metaphorical use of schizophrenic suggests a rapid and unexpected switch from one extreme state to another, something like an embattled other self breaking through and taking over,” he wrote. “But schizophrenia is not some unexpected polarity, nor is it a disease of fugue-like dissonance or a Jekyll-and-Hyde struggle for control.”

If the whole Jekyll-and-Hyde psychiatric fiction corresponds to anything, it’d be multiple-personality disorder or dissociative identity disorder, a diagnosis thatremains (justifiably) controversial. Schizophrenia is really nothing like that—in the canonical sense, it’s a disease of disordered thinking, a partial inability to separate the signals of the everyday lived world from its noise. If anything, it’s more like being trapped in personality solitary confinement than it is sharing different personalities. A profound and profoundly disabling unrelatability.

Of course, schizophrenia is hardly alone in this problem. See also: Oh I’m just so OCD about my Gmail inbox or I’m just so bipolar! I like junk food and vegetables. Or whatever. These are like the classic tools of cheap hyperbole. . .

Continue reading.

Written by LeisureGuy

18 July 2015 at 9:37 am

Posted in Mental Health, Writing

Seattle Kids Have Lower Polio Vaccination Rate Than Rwanda

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Insanely optimistic? or just plain stupid? You decide.

Written by LeisureGuy

16 July 2015 at 5:28 pm

Posted in Medical, Mental Health

Mindfulness experiment

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In Leisureguy’s Guide to Gourmet Shaving the Double-Edge Way (the latest edition of the Guide), I discuss how shaving supports mindfulness, which I take to be a focused and non-judgmental awareness of what is happening at the the present moment—being clearly aware of what your various senses are experiencing and what you as a result are feeling, with that awareness unmediated by words or thoughts; being alert and aware and in the moment, paying attention to, and absorbed in, your immediate experience, without thoughts of the past or the future.

It’s a state of mind people often get when they are in a completely natural environment, with no mark of human activity. [Edit: It occurs to me that this state of mind has high survival value and thus is reinforced by naturaly selection: if you’re walking through a forest you are more or less evolved to pay attention closely to every sound and every smell while your eyes are constantly watchful and scanning the surroundings. And because that state of mind is rewarding (in terms of survival), it feels good and natural. – LG] And it’s a state of mind that seems to offer emotional and psychological benefits (and thus, indirectly, physical benefits).

In Motherboard Emiko Jozuka describes an experiment soon underway to see what effects mindfulness training will have on early teens:

For the last two years, 14-year-old Enaya Ali has been taking part in “mindfulness” training—a technique designed to improve attention and resilience —at her local school in the UK.

“I suffer a lot from anxieties so I’ll have moments where I’ll find it difficult. But I’ll have a mindfulness moment, and when I come back from it, I’m more in control of myself,” Ali told me over the phone.

A new trial, launched yesterday, aims to scientifically test the effectiveness of mindfulness training as a way of bolstering young people’s resilience to mental health disorders later on in life. With multiple research institutions and nearly 6,000 teenagers taking part over a seven-year period, the study is pretty epic. If successful, mindfulness training could be incorporated into UK schools.

For the uninitiated, “mindfulness” is a mental state that allows us to be able to pay attention to how our emotions and thoughts are developing in the present moment. It’s a skill that can be trained, and researchers believe that the technique helps us better navigate our social relationships, and ward off negative thoughts and feelings.

In the £6.4 million (almost $10 million) three-part study launched yesterday, researchers at the University of Oxford, University College London, University of Exeter, and the Medical Research Council (MRC) Cognition and Brain Sciences Unit, will assess whether introducing this training more widely across schools could prevent teenagers from developing mental health disorders in adulthood. The Wellcome Trust, a global medical and health non-profit, reports that over 75 percent of mental disorders begin before the age of 25 and half by 15.

“Some 50 percent of all mental health problems will emerge by late adolescence, so it’s really a key window where we could potentially do something to change the trajectory of young people’s lives,” Willem Kyuken, the study’s principal investigator and a research clinical psychologist from the University of Oxford, told me. “We could potentially prevent mental health problems, and enhance the possibility for [adolescents] to flourish.”

The trial, involving students from 76 schools, is expected to begin in late 2016. In the first part of the study, thirty-eight schools will train 11-14 year old students in mindfulness over 10 lessons within a school term, as part of the normal curriculum. Thirty-eight other schools will act as a control by teaching regular personal, health, and social education lessons.

In a second, lab-based part of the study, researchers from UCL and the MRC Cognition and Brain Sciences Unit will examine whether mindfulness training improves the emotional and self-control of nearly 600 participants between the ages of 11 to 16. The third part of the study sees researchers testing the best ways of training teachers to give mindfulness lessons to their students, and evaluating the potential challenges of implementing the training at schools. . .

Continue reading.

Written by LeisureGuy

16 July 2015 at 11:19 am

Psychologists Shielded U.S. Torture Program, Report Finds

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Not just psychologists, of course: the Bush Administration was much involved, and Obama has resisted any effort to investigate and prosecute US torturers. James Risen reports in the NY Times:

The Central Intelligence Agency’s health professionals repeatedly criticized the agency’s post-Sept. 11 interrogation program, but their protests were rebuffed by prominent outside psychologists who lent credibility to the program, according to a new report.

The 542-page report, which examines the involvement of the nation’s psychologists and their largest professional organization, the American Psychological Association, with the harsh interrogation programs of the Bush era, raises repeated questions about the collaboration between psychologists and officials at both the C.I.A. and the Pentagon.

The report, completed this month, concludes that some of the association’s top officials, including its ethics director, sought to curry favor with Pentagon officials by seeking to keep the association’s ethics policies in line with the Defense Department’s interrogation policies, while several prominent outside psychologists took actions that aided the C.I.A.’s interrogation program and helped protect it from growing dissent inside the agency.

The association’s ethics office “prioritized the protection of psychologists — even those who might have engaged in unethical behavior — above the protection of the public,” the report said.

Two former presidents of the psychological association were on a C.I.A. advisory committee, the report found. One of them gave the agency an opinion that sleep deprivation did not constitute torture, and later held a small ownership stake in a consulting company founded by two men who oversaw the agency’s interrogation program, it said.

The association’s ethics director, Stephen Behnke, coordinated the group’s public policy statements on interrogations with a top military psychologist, the report said, and then received a Pentagon contract to help train interrogators while he was working at the association, without the knowledge of the association’s board. Mr. Behnke did not respond to a request for comment.

The report, which was obtained by The New York Times and has not previously been made public, is the result of a seven-month investigation by a team led by David Hoffman, a Chicago lawyer with the firm Sidley Austin at the request of the psychology association’s board.

After the Hoffman report was made public on Friday, the American Psychological Association issued an apology.

“The actions, policies and lack of independence from government influence described in the Hoffman report represented a failure to live up to our core values,” Nadine Kaslow, a former president of the organization, said in a statement. “We profoundly regret and apologize for the behavior and the consequences that ensued.”

The association said it was considering proposals to prohibit psychologists from participating in interrogations and to modify its ethics policies, among other changes.

Continue reading.

At the link is a copy of the 542-page report.

See also the editorial “Psychologists Who Greenlighted Torture.” The editorial concludes:

The Obama administration has so far refused to prosecute the torturers. As more evidence about this program comes to light, that position becomes increasingly indefensible.

The comments to the article are quite interesting.

See also “U.S. Justice Department Must Investigate American Psychological Association’s Role in U.S. Torture Program,” a press release from Physicians for Human Rights:

Physicians for Human Rights today called for a federal criminal probe into the American Psychological Association’s (APA) role in the U.S. torture program following the release of a damning new report that confirms the APA colluded with the Bush administration to enable psychologists to design, implement, and defend a program of torture. In light of the 542-page independent report first reported by The New York Times, PHR again called for a full investigation by the U.S. Department of Justice.

“The corruption of a health professional organization at this level is an extraordinary betrayal of both ethics and the law, and demands an investigation and appropriate prosecutions,” said Donna McKay, PHR’s executive director. “Rather than uphold the principle of ‘do no harm,’ APA leadership subverted its own ethics policies and sabotaged all efforts at enforcement.”

The APA commissioned an independent review by David Hoffman, a former federal prosecutor, in November 2014 after detailed allegations of complicity emerged in New York Times reporter James Risen’s book, “Pay Any Price: Greed, Power, and Endless War.” The book documented secret coordination between APA and U.S. officials to support the spurious legal and ethical justification for the Bush administration’s torture program, which relied on health professional monitoring of abusive interrogations to claim that they were “safe, effective, and legal.” . . .

Continue reading.

Written by LeisureGuy

11 July 2015 at 5:04 pm

Things the criminal justice system has difficulty addressing

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Darryl Greer published a vivid description of a young criminal (psychopath? cyber-terrorist?) recently in Motherboard:

It begins with a phone call to a police force that could be thousands of miles away, claiming wild threats of violence and mayhem or desperate pleas for help—and then, the sound of a doorbell or a hard knock at the door.

Under the watchful eye of a webcam, victims can be seen lifting a headphone from one ear and momentarily pausing to listen. Some stand up from their computer screens to go investigate, while others go right back to gaming. Whatever the case, the outcome is always the same: well-armed police officers storm in and shout orders to get-the-fuck-on-the-floor.

The phenomenon, known as “swatting,” is not new. But some, hiding behind a shroud of internet anonymity, have taken the practice to new extremes. Such is the case of a 17-year-old teen with a knack for hacking and a penchant for terrorizing fellow gamers—mostly young women—whose fate will be decided in a courtroom in the Vancouver, British Columbia suburb of Port Coquitlam later this month.

In May, he plead guilty to 23 charges of extortion, public mischief and criminal harassment related to several swatting incidents in Canada and the US—out of 40 total charges—but as a young offender he cannot be named.

His guilty plea made international headlines, in part due to his association with a hacking group called Lizard Squad, known for its attacks on the Playstation Network and Xbox Live online gaming services, amongst other video gaming sites. In one eight-hour video, which has since been taken offline, Ars Technica reported that the teen identified himself as a member of the group, and has used the handles “obnoxious” and “internetjesusob” online (Lizard Squad denies the teen was a core member).

But, as local media has reported, the young hacker’s victims were not only the large networks and institutions that Lizard Squad targeted, but unsuspecting fans of the popular video game League of Legends, as well as other gamers who had the misfortune of crossing his path online.

Florida’s Polk County Sheriff’s Office first identified the teen after he placed several threatening calls to locations in the area in late 2014, including threats to shoot and blow up a high school where one of his targets attended. According to a report in The Province, “when [targets] would not acknowledge friend and follow requests or send him things that he wanted, such as photos, he would harass them and their families.”

There was a woman in Arizona, swatted repeatedly and terrorized to the point of dropping out of university for a semester, and the Minnesota parents whose credit was in shambles after the teen swatted their child and posted the parents’ personal information online. In other instances, the teen would call in hostage situations, murders, bomb threats, and threatened to kill police, The Province reported, and would then hack and harass targets and their families for months with “phone calls, texts and by spamming social media accounts.”

In the case of the Arizona woman, the teen even “cancelled utilities, phone and Internet accounts, called her parents in the middle of the night and released their financial information online.” . . .

Continue reading.

He’s now gone to trial, and from this report I don’t think the system really has an effective approach. He will be sentenced on 9 July.

Written by LeisureGuy

30 June 2015 at 10:35 am

Addiction: Not a disease, but an example of the brain’s plasticity in learning

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Very interesting article in Salon by Laura Miller. The whole thing’s worth reading, but note this:

. . .  This conception of addiction as a biological phenomenon seemed to be endorsed over the past 20 years as new technologies have allowed neuroscientists to measure the human brain and its activities in ever more telling detail. Sure enough, the brains of addicts are physically different — sometimes strikingly so — from the brains of average people. But neuroscience giveth and now neuroscience taketh away. The recovery movement and rehab industry (two separate things, although the latter often employs the techniques of the former) have always had their critics, but lately some of the most vocal have been the neuroscientists whose findings once lent them credibility.

One of those neuroscientists is Marc Lewis, a psychologist and former addict himself, also the author of a new book “The Biology of Desire: Why Addiction is Not a Disease.” Lewis’s argument is actually fairly simple: The disease theory, and the science sometimes used to support it, fail to take into account the plasticity of the human brain. Of course, “the brain changes with addiction,” he writes. “But the way it changes has to do with learning and development — not disease.” All significant and repeated experiences change the brain; adaptability and habit are the brain’s secret weapons. The changes wrought by addiction are not, however, permanent, and while they are dangerous, they’re not abnormal. Through a combination of a difficult emotional history, bad luck and the ordinary operations of the brain itself, an addict is someone whose brain has been transformed, but also someone who can be pushed further along the road toward healthy development. (Lewis doesn’t like the term “recovery” because it implies a return to the addict’s state before the addiction took hold.)

“The Biology of Desire” is grouped around several case studies, each one illustrating a unique path to dependency. A striving Australian entrepreneur becomes caught up in the “clarity, power and potential” he feels after smoking meth, along with his ability to work long hours while on the drug. A social worker who behaves selflessly in her job and marriage constructs a defiant, selfish, secret life around stealing and swallowing prescription opiates. A shy Irishman who started drinking as a way to relax in social situations slowly comes to see social situations as an occasion to drink and then drinking as a reason to hole up in his apartment for days on end.

Each of these people, Lewis argues, had a particular “emotional wound” the substance helped them handle, but once they started using it, the habit itself eventually became self-perpetuating and in most cases ultimately served to deepen the wound. Each case study focuses on a different part of the brain involved in addiction and illustrates how the function of each part — desire, emotion, impulse, automatic behavior — becomes shackled to a single goal: consuming the addictive substance. The brain is built to learn and change, Lewis points out, but it’s also built to form pathways for repetitive behavior, everything from brushing your teeth to stomping on the brake pedal, so that you don’t have to think about everything you do consciously. The brain is self-organizing. Those are all good properties, but addiction shanghais them for a bad cause.

As Lewis sees it, addiction really is habit; we just don’t appreciate how deeply habit can be engraved on the brain itself. “Repeated (motivating) experience” — i.e., the sensation of having one’s worries wafted away by the bliss of heroin — “produce brain changes that define future experiences… So getting drunk a lot will sculpt the synapses that determine future drinking patterns.” More and more experiences and activities get looped into the addiction experience and trigger cravings and expectations like the bells that made Pavlov’s dogs salivate, from the walk home past a favorite bar to the rituals of shooting up. The world becomes a host of signs all pointing you in the same direction and activating powerful unconscious urges to follow them. At a certain point, the addictive behavior becomes compulsive, seemingly as irresistibly automatic as a reflex. You may not even want the drug anymore, but you’ve forgotten how to do anything else besides seek it out and take it. . .

Read the whole thing.

Written by LeisureGuy

28 June 2015 at 12:24 pm

Can the Bacteria in Your Gut Explain Your Mood?

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Pete Smith reports in the NY Times:

Eighteen vials were rocking back and forth on a squeaky mechanical device the shape of a butcher scale, and Mark Lyte was beside himself with excitement. ‘‘We actually got some fresh yesterday — freshly frozen,’’ Lyte said to a lab technician. Each vial contained a tiny nugget of monkey feces that were collected at the Harlow primate lab near Madison, Wis., the day before and shipped to Lyte’s lab on the Texas Tech University Health Sciences Center campus in Abilene, Tex.

Lyte’s interest was not in the feces per se but in the hidden form of life they harbor. The digestive tube of a monkey, like that of all vertebrates, contains vast quantities of what biologists call gut microbiota. The genetic material of these trillions of microbes, as well as others living elsewhere in and on the body, is collectively known as the microbiome. Taken together, these bacteria can weigh as much as six pounds, and they make up a sort of organ whose functions have only begun to reveal themselves to science. Lyte has spent his career trying to prove that gut microbes communicate with the nervous system using some of the same neurochemicals that relay messages in the brain.

Inside a closet-size room at his lab that afternoon, Lyte hunched over to inspect the vials, whose samples had been spun down in a centrifuge to a radiant, golden broth. Lyte, 60, spoke fast and emphatically. ‘‘You wouldn’t believe what we’re extracting out of poop,’’ he told me. ‘‘We found that the guys here in the gut make neurochemicals. We didn’t know that. Now, if they make this stuff here, does it have an influence there? Guess what? We make the same stuff. Maybe all this communication has an influence on our behavior.’’

Since 2007, when scientists announced plans for a Human Microbiome Project to catalog the micro-organisms living in our body, the profound appreciation for the influence of such organisms has grown rapidly with each passing year. Bacteria in the gut produce vitamins and break down our food; their presence or absence has been linked to obesity, inflammatory bowel disease and the toxic side effects of prescription drugs. Biologists now believe that much of what makes us human depends on microbial activity. The two million unique bacterial genes found in each human microbiome can make the 23,000 genes in our cells seem paltry, almost negligible, by comparison. ‘‘It has enormous implications for the sense of self,’’ Tom Insel, the director of the National Institute of Mental Health, told me. ‘‘We are, at least from the standpoint of DNA, more microbial than human. That’s a phenomenal insight and one that we have to take seriously when we think about human development.’’

Given the extent to which bacteria are now understood to influence human physiology, it is hardly surprising that scientists have turned their attention to how bacteria might affect the brain. Micro-organisms in our gut secrete a profound number of chemicals, and researchers like Lyte have found that among those chemicals are the same substances used by our neurons to communicate and regulate mood, like dopamine, serotonin and gamma-aminobutyric acid (GABA). These, in turn, appear to play a function in intestinal disorders, which coincide with high levels of major depression and anxiety. Last year, for example, a group in Norway examined feces from 55 people and found certain bacteria were more likely to be associated with depressive patients.

At the time of my visit to Lyte’s lab, he was nearly six months into an experiment that he hoped would better establish how certain gut microbes influenced the brain, functioning, in effect, as psychiatric drugs. He was currently compiling a list of the psychoactive compounds found in the feces of infant monkeys. Once that was established, he planned to transfer the microbes found in one newborn monkey’s feces into another’s intestine, so that the recipient would end up with a completely new set of microbes — and, if all went as predicted, change their neurodevelopment. The experiment reflected an intriguing hypothesis. Anxiety, depression and several pediatric disorders, including autism and hyperactivity, have been linked with gastrointestinal abnormalities. Microbial transplants were not invasive brain surgery, and that was the point: Changing a patient’s bacteria might be difficult but it still seemed more straightforward than altering his genes.

When Lyte began his work on the link between microbes and the brain three decades ago, it was dismissed as a curiosity. By contrast, last September, the National Institute of Mental Health awarded four grants worth up to $1 million each to spur new research on the gut microbiome’s role in mental disorders, affirming the legitimacy of a field that had long struggled to attract serious scientific credibility. Lyte and one of his longtime colleagues, Christopher Coe, at the Harlow primate lab, received one of the four. ‘‘What Mark proposed going back almost 25 years now has come to fruition,’’ Coe told me. ‘‘Now what we’re struggling to do is to figure out the logic of it.’’ It seems plausible, if not yet proved, that we might one day use microbes to diagnose neurodevelopmental disorders, treat mental illnesses and perhaps even fix them in the brain.

In 2011, a team of researchers at University College Cork, in Ireland, and McMaster University, in Ontario, published a study in Proceedings of the National Academy of Science that has become one of the best-known experiments linking bacteria in the gut to the brain. Laboratory mice were dropped into tall, cylindrical columns of water in what is known as a forced-swim test, which measures over six minutes how long the mice swim before they realize that they can neither touch the bottom nor climb out, and instead collapse into a forlorn float. Researchers use the amount of time a mouse floats as a way to measure what they call ‘‘behavioral despair.’’ (Antidepressant drugs, like Zoloft and Prozac, were initially tested using this forced-swim test.)

For several weeks, the team, led by John Cryan, the neuroscientist who designed the study, fed a small group of healthy rodents a broth infused with Lactobacillus rhamnosus, a common bacterium that is found in humans and also used to ferment milk into probiotic yogurt. Lactobacilli are one of the dominant organisms babies ingest as they pass through the birth canal. Recent studies have shown that mice stressed during pregnancy pass on lowered levels of the bacterium to their pups. This type of bacteria is known to release immense quantities of GABA; as an inhibitory neurotransmitter, GABA calms nervous activity, which explains why the most common anti-anxiety drugs, like Valium and Xanax, work by targeting GABA receptors.

Cryan found that the mice that had been fed the bacteria-laden broth kept swimming longer and spent less time in a state of immobilized woe. ‘‘They behaved as if they were on Prozac,’’ he said. ‘‘They were more chilled out and more relaxed.’’ The results suggested that the bacteria were somehow altering the neural chemistry of mice.

Until he joined his colleagues at Cork 10 years ago, Cryan thought about microbiology in terms of pathology: the neurological damage created by diseases like syphilis or H.I.V. ‘‘There are certain fields that just don’t seem to interact well,’’ he said. ‘‘Microbiology and neuroscience, as whole disciplines, don’t tend to have had much interaction, largely because the brain is somewhat protected.’’ He was referring to the fact that the brain is anatomically isolated, guarded by a blood-brain barrier that allows nutrients in but keeps out pathogens and inflammation, the immune system’s typical response to germs. Cryan’s study added to the growing evidence that signals from beneficial bacteria nonetheless find a way through the barrier. Somehow — though his 2011 paper could not pinpoint exactly how — micro-organisms in the gut tickle a sensory nerve ending in the fingerlike protrusion lining the intestine and carry that electrical impulse up the vagus nerve and into the deep-brain structures thought to be responsible for elemental emotions like anxiety. Soon after that, Cryan and a co-author, Ted Dinan, published a theory paper in Biological Psychiatry calling these potentially mind-altering microbes ‘‘psychobiotics.’’

It has long been known that much of our supply of neurochemicals — an estimated 50 percent of the dopamine, for example, and a vast majority of the serotonin — originate in the intestine, where these chemical signals regulate appetite, feelings of fullness and digestion. But only in recent years has mainstream psychiatric research given serious consideration to the role microbes might play in creating those chemicals. Lyte’s own interest in the question dates back to his time as a postdoctoral fellow at the University of Pittsburgh in 1985, when he found himself immersed in an emerging field with an unwieldy name: psychoneuroimmunology, or PNI, for short. The central theory, quite controversial at the time, suggested that stress worsened disease by suppressing our immune system.

By 1990, at a lab in Mankato, Minn., Lyte distilled the theory into three words, which he wrote on a chalkboard in his office: . . .

Continue reading.

Written by LeisureGuy

23 June 2015 at 3:33 pm

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