What is the hardest part of research? Getting a grant to study an area in the first place? Gaining ethical approval for one’s study? Publishing a paper on one’s work? Although tricky, none of these make the number one slot. This spot has to be claimed by the devilish difficulty of resisting the urge, when doing literature searches, to probe into the completely tangential papers and areas which such searches inevitably throw up.
Today I had to struggle with werewolves.
As I was trawling through search results relating to the most recent papers on hearing voices, with a search string pretty specific to this area, up popped a paper on werewolves.
Thank you Twilight.
This was not an idiosyncratic, rambling paper from many years gone by either. This was a new 2012 review paper published in a psychiatry journal. For the interested reader (and how could you not be) the abstract of the paper is here: http://www.ncbi.nlm.nih.gov/pubmed/22261984. This looks a really fascinating area, slapbang at the intersection of psychiatry and culture.
A wild struggle then ensued in which I tried to stop myself from doing out-of-hours research into werewolves. This pretty much succeeded. However, this led into another digression as I don’t know what you think of when you hear the term ‘werewolf’ but the exploding tuba of genius that was the Bonzo Dog Doodah Band springs to my mind, due to their version of the Monster Mash (‘the guests included wolfman, Dracula and his son…’). If you haven’t heard of the the Bonzo’s before, you must check out their album ‘Tadpoles’.
Although the Brainiac device in the Bonzo’s video is (thankfully) nothing like the effects of low frequency repetitive Transcranial Magnetic Stimulation (rTMS), which is painless and typically doesn’t lead to seizures, this started my mind on this area and I remembered a recent paper I had found (before the werewolf digression) on TMS for hearing voices, but with the TMS not focussed over the left temporoparietal junction as usual, but over Heschl’s gyrus.
Given that activation of Heschl’s gyrus doesn’t appear in that many fMRI symptom capture studies of auditory verbal hallucintions (AVHs: sorry the acronyms are coming thick and fast now), this area had (understandably) not been probed specifically before with TMS. I would have been somewhat skeptical of the likelihood of TMS in this area being effective for AVHs, and indeed, the authors reported that TMS over this area was ineffective.
In fact, at present the evidence base in general for TMS for AVHs is somewhat contradictory.
On the one hand a recent review of treatments, just published, argues that TMS “is capable of reducing the frequency and severity of auditory hallucinations” and goes on to “recommend low frequency rTMS directed at the left temporoparietal area for the treatment of AVH”. This conclusion is based on earlier studies and meta-analyses (e.g., Aleman et al., 2007). Yet, three of the authors of this review paper recommending TMS for AVHs have recently published a large 62 patient trial of TMS which reported it to be ineffective for AVHs.
As I argue in my book, I think it likely that there are some voice-hearing people for whom TMS may be helpful, potentially individuals with a specific subtype of AVHs (based on some of Ralph Hoffman’s findings in this area, see this paper).
However, the authors of the large 62 patient trial concluding that TMS is ineffective for hearing voices argue that “It might be time for a change of paradigm and for a search for more effective treatment regimens”.
So I don’t think I’m howling at the moon when I say, Neurofeedback anyone?