more on depression

[GOLDSTEIN_David_Glas]

The references which Tom gives probably contains the "facts,"
such as they are, which Bill asks for in his post to me. I am
sure that they will not satisfy Bill because of his definition of
a fact which is, I think: A statement about people in general,
or about a person in particular, which is true almost 100% of the
time. Is this right Bill?

Would the following be a fact?: Using 20 variables of EEG
activity, Thatcher(1989) was able to correctly identify 94.8% of
the cases with respect to the question: Did this person suffer
from a mild head trauma? He was able to show this level of
identification in a number of replications across people,
research settings, different data collection equipment.

Even if this is not a fact, according to Bill's definition, a
clinician using this "false fact" could do a lot better than by
chance alone. A person in a work accident might be denied
benefits by an insurance company. The company might claim that
the person is faking or malingering. The 20 variables could be
collected in an EEG monitoring session which only needs to yield
60 seconds of artifact free EEG with eyes closed. The empirical
function which Thatcher found, which discriminates known mild
head trauma cases from known normals with 90+ % correctness,
could be applied to the data and might yield the statment: The
probability that this person suffered a mild head injury is such
and such. This "false fact" could be used to counter the equally
"false fact" that " The person has not sufferred a mild head
trauma." which the insurance companies make with no basis other
than a generalization such as: Our experts tell us that most
people who experience this kind of work accident to not take so
long to recover and do not experience the symptoms the claimant
is making.

Bill asked for the definition of cortical excitement. Thatcher
defines it as frequency of EEG. Someone showing "above normal
levels of excitement" over some particular scalp location is,
therefore, showing more components of the EEG in the higher
frequencey ranges.

In a recent workshop I attended given by Thatcher, he presented a
view of the origin of the EEG in the cortex in terms of
interactiions between the pyramidal and golgi cells. It was very
interesting, and included feedback concepts, but I need to firm
up my knowledge in this area more before trying to repeat the
explanation. Perhaps Tom or Andy will favor us with a brief
description of the origin of the EEG if they know it.

There are clinicians using EEG Neurofeedback whose clinical work
can be thouhgt of as providing a test of whether the
relationships between excitement and depression which I
summarized are correlational or causal. Sonders, a psychiatrist,
reports that 80% of the people who were given EEG Neurofeedback
based on these generalizations experienced meaningful reductions
of depression symptoms. He has not published his data at this
point to my knowledge. I will be attending a talk he will be
giving in December and ask if he has anything published.

I am sure that Bill will say: What about the other 20%? I don't
know the answer to this. Most clinicians would be happy with an
80% success rate. Clearly, if you are one of the 20% who did
not show improvement, this would not be satisfying. Bill's
attitude, which is technically correct I believe, can be
frustrating to "desperate clinicians" who are asked to help
people now, based on what we know rather than what we would like
to know.

Half joking, half serious, my father used to ask me when I came
home with a 95% on a test, which I was very proud of at the time
because most of the other children did not do as well: What
happened to the other 5%? Another favorite expression of his
was: That and 25 cents will get you on the bus. This is when
busfare was 25 cents. It was hard not to to react to these kinds
of minimizations of accomplishment with sadness and anger. I
know that he meant well, but it certainly did not feel good at
the time.

Perhaps, a person will try harder. Perhaps a person will give
up. Julian Simon conceives of depression as the result of
chronic "negative self comparisons" combined with "a sense of
hopelessness." I guess as long as we continue to have hope that
it is possible to have better facts about depression that we will
not become depressed about it. Bill's attitude about facts is "a
negative comparison." Is it a realistic standard in more
complicated circumstances? This seems to be an important question
to accompany Bill's question of Is it really a fact?

I would be happy to help 80% of the people who came to me.
However, I agree that 100% would be even better. Until I reach
the almost 100% standard, I will not fool myself into thinking
that I really know what is happening in the case of depression.
However, if I am helping a larger percentage than someone else,
I would like to entertain the fantasy that my "false facts" are
better than his "false facts."

I plan to read the references which Tom mentions. The best
single one that I am familiar with is:

     Harris, J.E. (1986). Clinical neuroscience: from
     neuroanatomy to psychodynamics. New York: Human
     Sciences Press.

···

To: Bill, Tom, Ed, Avery, others interested in topic
From: David Goldstein
Subjection: depression
Date: 11/02/93

[Tom_BOURBON3]

From Tom Bourbon [931102.0846]

To: Bill, Tom, Ed, Avery, others interested in topic
From: David Goldstein
Subjection: depression
Date: 11/02/93

The references which Tom gives probably contains the "facts,"
such as they are, which Bill asks for in his post to me. I am
sure that they will not satisfy Bill because of his definition of
a fact which is, I think: A statement about people in general,
or about a person in particular, which is true almost 100% of the
time. Is this right Bill?

David, I'm not sure what you are getting at with your latest comments to
Bill and me. Earlier, you posted some remarks about neuropsychology and
depression. I posted a reply where I did not question *you*, but I provided
references to two sources which summarize evidence challenging the
popular, but unsubstantiated, idea that there are special emotion centers
in the brain, or that each hemisphere is specialized for a different kind of
emotion. Previously, you did not post on using EEG measures to distinguish
between brain-injured and normal persons, nor did you post on the many,
many theories of the origins of EEG. Why do you challenge Bill, Andy or me
to address those other topics, which are irrelevant to your original post
and to our replies?

In the case of claims for special centers and hemispheres for emotion, the
data are nowhere near the levels you say Bill wants, or the level Thatcher
claims. Look at the sources I cited and the original work those authors
cite. Decide for yourself.

Would the following be a fact?: Using 20 variables of EEG
activity, Thatcher(1989) was able to correctly identify 94.8% of
the cases with respect to the question: Did this person suffer
from a mild head trauma? He was able to show this level of
identification in a number of replications across people,
research settings, different data collection equipment.

No problem here. It is true that the patients had already been identified
by other means and Thatcher's technique obviously missed some of them. The
important questions here are how well does his technique do when there is no
previous diagnosis, and how well does it differentiate, not between equal
numbers of normals and patients, but between patients and normals in the
general population, where there are *far* fewer patients than normals --
the classic problem of baserates. (I do not *know* how well he does in that
condition, and I do not deny that he might do well. I merely ask, because
the information in your post does not allow me to judge the effectiveness of
the procedure.)

Even if this is not a fact, according to Bill's definition, a
clinician using this "false fact" could do a lot better than by
chance alone. A person in a work accident might be denied
benefits by an insurance company. The company might claim that
the person is faking or malingering. The 20 variables could be
collected in an EEG monitoring session which only needs to yield
60 seconds of artifact free EEG with eyes closed. The empirical
function which Thatcher found, which discriminates known mild
head trauma cases from known normals with 90+ % correctness,
could be applied to the data and might yield the statment: The
probability that this person suffered a mild head injury is such
and such. This "false fact" could be used to counter the equally
"false fact" that " The person has not sufferred a mild head
trauma." which the insurance companies make with no basis other
than a generalization such as: Our experts tell us that most
people who experience this kind of work accident to not take so
long to recover and do not experience the symptoms the claimant
is making.

These are assertions (by Thatcher, not you) which can be assessed only in
light of the additional information on baserates that I mentioned above.
Differentiating between equal numbers of normals and patients is not
enough; that common practice is a sure way to produce "genuinely false
facts." If he took baserates into account, that is another matter and his
technique would be quite impressive.

By the way, did he discuss which 20 variables he enters into his analysis?
And why those 20 and no others? Given several EEG leads, there would be an
infinite number of measured and derived variables available for analysis.

Bill asked for the definition of cortical excitement. Thatcher
defines it as frequency of EEG. Someone showing "above normal
levels of excitement" over some particular scalp location is,
therefore, showing more components of the EEG in the higher
frequencey ranges.

The last sentence seems backwards. Shouldn't it read, someone showing
"more components of the EEG in the higher frequency ranges" is said to be
"showing above normal levels of excitement." Does this mean that, of the
finite number of "components" a person can show in the entire EEG, a greater
proportion of them are in the "higher frequency ranges?" (Which cutoff does
he use between higher and lower?) Or is it that of the many possible
components in the higher frequency ranges, the person "shows" more of them?
Or is it some other definition?

Over the past 60+ years, many people have tried to use "frequency of EEG" as
an index of psychological functioning. They have correlated it with IQ,
measures of manual dexterity, personality inventories, ethnic category,
educational level -- you name it, there are published correlations. Not
much has come of that work. Also, "greater amounts" of "higher frequency
EEG" have been defined as greater amounts of "neural efficiency," or
"cortical conductivity," or "cortical activation," and the list goes on.

In a recent workshop I attended given by Thatcher, he presented a
view of the origin of the EEG in the cortex in terms of
interactiions between the pyramidal and golgi cells. It was very
interesting, and included feedback concepts, but I need to firm
up my knowledge in this area more before trying to repeat the
explanation. Perhaps Tom or Andy will favor us with a brief
description of the origin of the EEG if they know it.

Theories on the origins of EEG are a penny a dozen, but no one knows, David.
No one.

There are clinicians using EEG Neurofeedback whose clinical work
can be thouhgt of as providing a test of whether the
relationships between excitement and depression which I
summarized are correlational or causal. Sonders, a psychiatrist,
reports that 80% of the people who were given EEG Neurofeedback
based on these generalizations experienced meaningful reductions
of depression symptoms. He has not published his data at this
point to my knowledge. I will be attending a talk he will be
giving in December and ask if he has anything published.

Let us know what he says. And let us know if he reports adequate studies
of baserates.

I am sure that Bill will say: What about the other 20%? I don't
know the answer to this. Most clinicians would be happy with an
80% success rate. Clearly, if you are one of the 20% who did
not show improvement, this would not be satisfying. Bill's
attitude, which is technically correct I believe, can be
frustrating to "desperate clinicians" who are asked to help
people now, based on what we know rather than what we would like
to know.

I fully appreciate the predicament facing clinicians. One reason I am *not*
a clinician is that I could never live with that constant error. But those
of us who point out the inadequacies of certain data and claims did not
produce them -- we do not deserve all the credit for the news we bear. Also,
even heartfelt desperation is no reason to accept unsubstantiated claims and
flights of fancy that go far beyond the available data like those in many
ruminations about brain specialization and emotion.

. . .

Perhaps, a person will try harder. Perhaps a person will give
up. Julian Simon conceives of depression as the result of
chronic "negative self comparisons" combined with "a sense of
hopelessness." I guess as long as we continue to have hope that
it is possible to have better facts about depression that we will
not become depressed about it. Bill's attitude about facts is "a
negative comparison." Is it a realistic standard in more
complicated circumstances? This seems to be an important question
to accompany Bill's question of Is it really a fact?

Which is more important to you: to know that "what you know" is as
legitimate as can be at the time, or to believe something even when you
know it is not genuine?

I would be happy to help 80% of the people who came to me.
However, I agree that 100% would be even better. Until I reach
the almost 100% standard, I will not fool myself into thinking
that I really know what is happening in the case of depression.
However, if I am helping a larger percentage than someone else,
I would like to entertain the fantasy that my "false facts" are
better than his "false facts."

I respect that goal. To achieve it, you need *never* appeal to, and you
need *never* accept, overblown speculations about the brain and emotion.

I plan to read the references which Tom mentions. The best
single one that I am familiar with is:

    Harris, J.E. (1986). Clinical neuroscience: from
    neuroanatomy to psychodynamics. New York: Human
    Sciences Press.

I'm not familiar with it. I do hope the ones I suggested will at least
familiarize you with some of the things to watch for when people begin
tossing around neuroscientific explanations for clinical conditions.

Warm regards, David.

Tom