Akinetic Mutism

Akinetic Mutism

  • First described by Cairns et al. (1941)
  • Patient tend not to move (akinetic) or speak (mute)
  • Show Apathy
  • Their eyes usually fixate on and follow objects
  • They usually do respond to repeated auditory commands
  • Their level of alertness otherwise is normal (although can have hypersomnolence)
  • The symptoms are rather experienced as a lack of will to do anything
  • If they ‘will’ to do something and opposing ‘will’ develops to counteract it
  • It is one of the diagnostic criteria for creutzfeldt-jakob disease
  • Two anatomical types of Akinetic Mutism (AM) are described:
    • Apathetic AM (also known as Mesencephalic AM)
    • Hyperpathic AM (also known as Frontal AM)


Reference and Resources:

Lishman’s Organic Psychiatry Fourth Edition
Otto A, Zerr I, Lantsch M, et al Akinetic mutism as a classification criterion for the diagnosis of Creutzfeldt-Jakob disease Journal of Neurology, Neurosurgery & Psychiatry 1998;64:524-528.
Medscape, Wikipedia

The Classification of Typical and Atypical Antipsychotic Drugs

Typical Antipsychotics Classification (also known as First generation Antipsychotics):

  • Phenothiazines:
    1. Chlorpromazine
    2. Promethazine
    3. Fluphenazine
    4. Perphenazine
    5. Perazine
    6. Prochlorperazine
    7. Trifluoperazine
  • Butyrophenones:
    1. Haloperidol
  • Di-phenyl-butyl-piperidines
    1. Pimozide
    2. Penfluridol
    3. Fluspirilene
  • Thioxanthenes
    1. Flupenthixol
    2. Zuclopenthixol
    3. Clopethixol
    4. Thiothixene
  • Other
    1. Loxapine

In-between: Sulpride

Atypical Antipsychotics Classification (also known as Second generation Antipsychotics):

  • Di-Benzo-Diazepine
    • Clozapine
  • Thieno-Benzo-Diazepine
    • Olanzapine
  • Di-Benzo-Thiazipine
    • Quetiepine
  • Benzixazole
    • Risperidone
    • Paliperidone
  • Benzisothiazoles
    • Ziprasidone
    • Lurasidone
  • Quinolones
    • Aripiprazole
    • Brexipiprazole
  • Benzamide
    • Amisulpride
  • Other
    • Zotepine

What Extrapyramidal Symptoms and Side Effects Mean

What does Extra-pyramidal mean?

The brain exerts Motor control via two types of pathways:

  1. Pyramidal
  2. Extrapyramidal

The Pyramidal is a direct type of pathway. It starts in the cortex and through a long axon passes all the way through the Internal Capsule, decusating (85%) at the Medulla and then down the spinal cord. In the spinal cord it synapses with the lower motor neuron, which goes on to innervate muscles. Hence it is a mono-synaptic system (i.e. only one synapse occurs in-between the cortex to muscle connection) .

The Extrapyramidal on the other hand is polysynaptic and more complex, it is involved in modulating movements and controls things such as coordination, timing, force, start, end of movements etc. A number of nuclei within the brain are involved in this extrapyramidal system and these include:

  • Corpus striatum: Lentiform nucleus (Putamen + Globus Pallidus) and Neo-striatum (Putamen + Caudate)
  • Substania nigra
  • Subthalmic nucleus
  • Red nucleus
  • Reticular formation of the mesencephlon
  • The Cerebellum is also involved

What are Extrapyramidal Symptoms and Side Effects then?

Extrapyramidal symptoms (EPS) and side effects (EPSE) arise as a result of a disturbance to the function of the extra-pyramidal system (i.e motor control, timing, force etc). If this disturbance happens because of a disease process (for example Parkinson’s Disease or Lewy Body Dementia etc.), the are termed as Extrapyramidal symptoms. If this happens as an adverse effect of medications they are termed as Extrapyramidal Side effects.  These include the following:

  1. Acute dystonia: Earliest to appear; there is simultaneous contraction of opposing muscles (agonist and antagonist muscles) causing posturing and slowing twisting movements. Examples include Torticollis and oculo-gyric crisis.
  2. Parkinsonism: Similar to Parkinson’s disease symptoms (as the same brain nuclei are involved) i.e Bradykinesia, Ataxia, Rigidity, tremor
  3. Tardive Dyskinesias: Tardive means slow, the movements are repetitive, involuntary and purposeless. These include; grimacing, lip smacking, lip puckering and pouting, excess blinking and tongue movements.
  4. Akathesia: Motor restlessness, the person cannot stay still, there is a constant desire to move e.g putting the left leg on top of the right and then vice versa repeatedly in a short time span.

Extrapyramidal symptoms / side effects occur mostly due to dopamine blockage in the Extrapyramidal system. Antipsychotics are the main class of drugs which have this effect.  These are not the only type of side effects caused by anti-psychotic medications as anti-psychotics exert effects on other receptors as well such as Muscarinic, Histaminic, alpha-adrenergic etc.



Olduvai Man and The Cradle of Mankind Controversy

Trying to dig up controversial claims on the origins of mankind is akin to opening a can of worms. At stake is our own history and there are 3 ferociously opposing views.

The Story of Oldoway Man

Lets take the case of the discovery of Olduvai Man (also known as Oldoway man), in 1913, by Prof. Hans Gottfried Reck who was a German volcanologist and paleontologist. The discovery was made in the Olduvai Gorge, Tanzania. He had discovered and excavated a modern human buried in ancient bedrock. From the circumstantial evidence he estimated the age at 150,000 years. The one difference it has comparing to modern humans is 34 teeth as opposed to 36.  This he thought was a sign of some primitivity and perhaps it made this site the cradle of mankind.

Such a date was against the prevailing narrative of the time and was off by around 50,000 years. This made it controversial and Reck knew this so he tried to look at alternative explanations. He couldn’t find any evidence of the overlying strata being disturbed, which would have indicated a recent burial. And after careful analysis he could not find any other explanations either.

World war 1 was just around the corner and this site soon fell from German to British hands. Reck was taken prisoner for some time. Unfortunately, all his notes got destroyed as well. The British weren’t interested in finding the cradle of mankind in Africa and were looking for a European origin. They had already found it in the Piltdown man (which would turned out to be an embarrassing stain on the integrity of archaeology – but that’s a story for another post).

In 1931, Reck revisited the site in a joint expedition with Louis Leaky (famous Archaeologist and Paleoanthropolgist). Leaky had initially been skeptical and this was the reason for his interest, his own estimate had placed the fossil at roughly 20,000 years old based on the evidence he himself had been gathering at a nearby site.

However, after their joint study of the site, Leaky came to accept Reck’s claim of it’s antiquity. In fact, the bedrock was even more ancient than Reck had thought. Both of these scientists and Arthur Hopwood, another paleontologist, sent a letter to Nature stating that they had confirmed the fossils to be 500,000 years old !

At the time, the Olduvai man was being kept in Munich, Germany. Unfortunately during bombings in World war 2 most of the bones except a skull were destroyed.

The Cradle of Mankind Controversy

There seem to be 2 vehemently opposing sides in the argument as well as one relatively cautious side.

It perhaps wouldn’t have been that much of a controversy. Now that mainstream science has put modern human origins back to 200,000 – 300,000 years. However, that wasn’t the accepted scientific position at the time of this discovery (although 0.5 million does not fit the bill even today).

One side of this argument is people who believe in ancient human origins and forbidden archaeology. Most of them are creationists who in some form or another deny evolution and see such finds (this one is only the tip of that iceberg) as evidence  that humans existed alongside the hominids. That humans existed as far back as other animals so they couldn’t have evolved from them. There is a group of fundamental Christian creationists and also one of fundamental Hindu creationists. Some of these Hindus creationists believe in human devolution as opposed to evolution and their estimates go well beyond (in the 100s of million to billions of years) what mainstream archaeology purposes. This view is contradictory to the Christian creationist view. However, both seem to use similar arguments to make their case.

The cautionary group also falls towards this side of the argument but they don’t deny evolution. They don’t endorse any particular views either. This group is only skeptical of a ‘scientific dogma’ or ‘orthodox view’ in the formulation of these theories.

The other side is some scientists and skeptics who deny there is any controversy at all. They claim that this is a resolved matter and the conspiracy theorists haven’t been doing their research properly. Yet, looking at the arguments from the other side, the matter doesn’t seem to have been conclusively resolved.

So, is Olduvai man the cradle of mankind?

Here’s what each side has to say:

Scientists and Skeptics
Forbidden Archeologists
1. Later investigation revealed that it was in-fact an intrusive burial from a higher layer, making it a much younger specimen. Reck and later Leaky were serious scientists and experts. Reck had made an effort to look at whether there was any evidence indicative of an intrusive burial but he found the overlying strata undisturbed.
2. It is very rare to find a complete skeleton from that time  as was the case with this one, especially with it being deposited in water. It is rare but not impossible. It could actually have been an ancient burial which would make it normal to find the complete skeleton.
3. At the time the researchers were unable to appreciate archaeological stratigraphy. That is untrue and contradicts their original report.  Archaeological stratigraphy was well established by that time and the researchers were experts in doing that analysis.
4.  later geological analysis of the sediment surrounding the skeleton showed that it contained red pebbles and limestone chips which were not otherwise found in the bedrock and were from a higher layer, hence it got there due to a geological fault. The archaeologist who conducted the latter analysis was biased because he was writing a book which this find totally contradicted. Reck and Leaky did not find these red pebbles and limestone chips in their original analysis and report.

Leaky faced a hostile peer review if he did not accept the later studies.

One article also claimed that later carbon dating revealed the age to be around 19,000 years old. However, I could not find their source for that claim and it does not appear to be present in the other more authentic skeptical arguments. If that is true it would be quite conclusive. But I do suspect from looking at other similar disputes the forbidden archaeologist would probably respond by saying that the time lapse between the find and carbon dating taking place means the sample is likely to have been contaminated with new carbon 14 and the results of carbon dating would thus be unreliable.


What we see in this argument is a clash of world views. Neither side is contending that Olduvai man has something to do with the origins of mankind. Although this is exactly what the initial controversy was about. That debate was among scientists who were working in the field. The debate now is different.

The forbidden archaeologist’s allegation is that there is an unconscious bias in archaeological science. They are making this case as only one example (out of many more) to show that power structures (i.e. peer review and influence of certain eminent scientists) coupled with orthodox views means some evidence is being suppressed and hence the truth continues to be illusive for the mainstream.

Then there are some who go one step ahead (fundamental Christians and Hindus) and use this doubt to support their own view. That step ahead is completely unjustified. Firstly, it does not make any logical sense and secondly, they are rejecting all the other evidence (from better documented cases) which contradicts their own view and which has been accepted by most scientists in the field.

What the skeptics are arguing is that there is no controversy at all and that everything is crystal clear. They allegate that the forbidden archaeologist are heavily biased because of their prior belief system. They are making things up from nothing. However, this does not seem to be true either. There does appear to be some substance here and just because people on the other side may take things a step too far does not automatically make their original argument completely invalid.

From my point of view there are 4 perspectives here:

  1. The pure scientist – They are working in their own very specialized areas, are up-to date on new data in their area of expertise. They may recognize the nuances, the plethora of various opinions and may be able to weigh up the pros and cons of each of those views in their particular area. There must usually be opposing views which they would be aware of.
  2. The skeptic – Some of these can also be scientists in the field. However, their skeptical world view is more broadly based than their own specialized fields. Their worldview is basically of scientific orthodoxy and consistency. This view is formulated mostly on looking at what the apparent majority opinion is among different fields. However, when the scientist also becomes a skeptic this view becomes self propagating (as explained in the next view).
  3. The metascientist (for lack of a better term) – Claims that due to systemic and humanistic issues there is an orthodox bias in archaeology. They feel prior views mean some evidence gets harsher treatment than others. As a result those observation which do not fit into the emerging theme of the day are more likely to be rejected than those which do fit into it. Such a process is also self propagating as this results in more and more evidence accumulating for particular themes as opposed to others. This makes it increasingly difficult to reject or question the validity of those themes.
  4. The religious – They have a prior world view. They seem to be using this and any other examples they find to indirectly support that existing view. A lot of them may have conflicting world views to each other but are still using this same example to justify how ‘science is wrong’. This line of argument seems totally unjustified. The argument is being made on empirical evidence so there should be no room to ignore other empirical evidence which goes against their world view. Taken the previous position, at best it claims that there is room for humans to be more objective and flexible. However, science as a framework seems perfectly valid and useful nonetheless.

What do you think? Are there more sides and what stance would you take?

  1. Oldoway man: a Middle Pleistocene Homo sapiens? (badarchaeology.com)
  2.  An Examination of the Research of Creationist Walter Brown (ncse.com)
  3. Oldoway Man – Abstract (nature.com)
  4. Leakey, L. S. B; Reck, H.; Boswell, P. G. H.; Hopwood, A. T.; and Solomon, J. D. 1933. “The Oldoway Human Skeleton.” Nature. (March 18) 131:397-398.
  5. Reck, H. 1931. “The Oldoway Skeleton from Tanganyika Territory.” Man (January) 31:10-11.
  6. Boswell, P. G. H. 1932. “The Oldoway Human Skeleton.” Nature (August 13) 130:237-238.
  7. https://en.wikipedia.org/wiki/Hans_Reck
  8. Forbidden Archeology’s Impact – By Michael A. Cremo
  9. Atlantis Rising Magazine – 120 November/December 2016 – By J. Douglas Kenyon
  10. Creationism: The Hindu View – A Review of Forbidden Archeology, by Michael A. Cremo and Richard L. Thompson. Badger, CA: Govardhan Hill Publishing. 1994. ISBN 0-9635309-8-4 (talkorigins.org)
  11. Oldoway Man, a false start for Africa. (steemkr.com/science/)

Olduvai Gorge Finger – Questioning Human Origins

Researchers recently discovered of a >1.8 million-year-old little finger. They published their findings in the prestigious Nature Communications Journal. Interestingly, on extensive analysis and comparisons with known species, this bone was found to fall within the Homo Sapiens (modern man) category.

However, as the bone is dated to be >1.8 million years old in their discussion, the researchers exclude it from being placed in the Homo Sapiens category:

Collectively, these results lead to the conclusion that OH 86 represents a hominin species different from the taxon represented by OH 7, and whose closest form affinities are to modern H. sapiens (Fig. 3). However, the geological age of OH 86 obviously precludes its assignment to H. sapiens..

In the spirit of science, the discovers have left the final conclusions open to further evidence. However, others claim this finding is another drop in a growing body of evidence which challenges the conventionally accepted theories of human origins.

Even in accepted archaeological science the date for when we ‘anatomically moderns’ first came into existence has seen a constant push to earlier and earlier times. Current estimates are around 200,000 years edging closer towards 300,000 years (or even earlier). However, some archaeological evidence doesn’t seem to fit the prevailing narrative. These types of finds hint at human (modern) origins  which go back millions of years as opposed to hundreds of thousands.



Domínguez-Rodrigo, M., Pickering, T., Almécija, S., Heaton, J., Baquedano, E., Mabulla, A. and Uribelarrea, D. (2015). Earliest modern human-like hand bone from a new >1.84-million-year-old site at Olduvai in Tanzania. [online] https://www.nature.com/ncomms. Available at: https://www.nature.com/articles/ncomms8987

Gaia Theory – in a Nutshell

Gaia from Greek mythology is the primordial earth goddess. In some, interpretations she is the earth itself or a spiritual representation of it. She gave rise to all life on earth.

What is Gaia Theory

According to Gaia theory, the earth is a place where life can flourish not just because it happened to be in the right place (from the sun) and the right time (4 billion years ago). Rather life itself has shaped the planet to be more sustainable. Much like a living organism the earth maintains a degree of equilibrium over time and when this is disturbed it has buffer systems that can bring it back. This whole process is achieved through the interaction between the earth’s natural cycles and living organisms all of which are working symbiotically.

Science and criticisms of Gaia Theory

Gaia theory was developed by Dr. James Lovelock in 1965 whilst he was working for NASA researching methods to detect life on other planets, specifically on Mars. It has been received skeptically by mainstream science to this day and is only considered a hypothesis by most. Yet others claim it to be totally unscientific.

According to Dr. Lovelock, Gaia has been a successful theory and has made no less than 10 predictions which have been observed to be true. A few of the processes which it claims to have a say in explaining are (i) how ocean salinity is kept at low levels for life, (ii) Regulation of global temperatures, (iii) Regulation of oxygen in the atmosphere and the processing of CO2 etc.

One could see how Gaia theory can give us a sense of comfort and even have a spiritual dimension. Mother earth takes care of life and is able to protect and heal itself. We are a natural part of this larger organism and through us, the earth has been able to look at the universe in which it was born. (As an example, global warming due to human misadventures could also be taken care of by Gaia. Increased cloud formation, which would reflect more of the sun’s energy, controlling the global warming.)

It is precisely this sense of comfort and also as Dr. Lovelock claims the name of the Theory ‘Gaia’ (representing something supernatural) which might have caused it to garner so much criticism. A lot of criticism comes from scientists who feel the theory is ‘teleological‘ (having a sense of purpose) and against the concepts of evolution by natural selection. Dr. Richard Dawkins states “for organisms to act in concert would require foresight and planning, which is contrary to the current scientific understanding of evolution”.

Other’s like Dr. Peter Ward see it as a dangerous misconception. He feels it appeals to New Age nonsense, as he ridicules “only if we could return to nature the world would heal itself”. Claiming this would mean abandoning civilized and scientific progress. He gives examples of how then there would be a return of high infant mortality, disease, and suffering etc. This view mostly appears to be a misguided understanding of Gaia theory as no such claims appear to have been made.

The theory did find a staunch supporter in Dr. Lynn Margulis. She has argued against Dawkin’s claims and states Darwinian evolution is incomplete in that it has considered the environment a static arena, whereas the evidence suggests it is not. That the organisms shape the environment as the environment shapes the organisms.

Dr. Lovelock argues that actually Gaia theory is now widely accepted science, although with a different name of ‘Earth System Sciences‘.

What seems obvious is that the sense of purpose and comfort one could potentially drive from a theory like Gaia is exactly what is most abhorrent about it. The science and observations in support or against it seem less of an issue. One also wonders that there is this fear that we may lull ourselves into a false sense of security (as with global warming) if we were to cling to this. It seems we feel the need to remind ourselves that we have to take matters into our own hands. We alone have agency and there is nothing grander at work. Everything else is happenstance.

That being said the theory itself does not claim to propose any sense of purpose. It does not view humans as special either, rather the earth’s natural cycles and spheres, one of them being the biosphere, as being in symbiosis. In a sense, the homeostatic mechanisms of earth could rather well be working against humans much like the body tries to work against cancer.

Yet this disgust and fear of Gaia are certainly interesting.

Do You have Moral Principles Wired into Your Body ?

nature vs nuture

Morality has been a topic for philosophical, religious and scientific discussion. This current discussion is a quick philosophical and scientific perspective. People have claimed that morality is an illusion or a social construct. That there are no fundamental moral principles. That the moral principles are mostly social and cultural in origin and can be changed from one context to another.

I’ve been of a similar opinion in the past. Without trying to identify what these principles are it now seems obvious to me that there is an innate morality in humans. Noam Chomsky in his arguments on the limits of understanding makes perfect sense of this. Humans are organic creatures and no matter what environmental changes are made a human embryo does not develop to become a cat. Humans like any other creature have an innate tendency to develop into humans and have the innate ability to do what humans can do e.g. use language, walk on two legs etc.

..no matter what environmental changes are made a human embryo does not develop to become a cat.

In a similar sense, we must also have innate moral principles which are ingrained in our biology. We are definitely not excluding the effect of culture and environment, in general, can have in shaping these principles. But it is to recognize the fact that the environment cannot shape us into something we don’t already have the capacity of becoming. Yes, there will be differences in between humans as well like with any biological characteristic. But there would be a limit to those differences e.g. a human cannot be 40 feet tall.

You could argue only humans have moral principles. Assuming that we agree then it means that only humans have the biological capacity to have moral principles. Since it is a biological capacity there will be a scope and limit to what it is.

We have to differentiate here, this does not imply that there are fundamental moral principles that are transcendental and apply to everything. A cat may have a different scope and limit to its morality equivalent. Similarly, an alien may have different moral principles given it has the capacity to have these.


Do you agree that basic moral principles are biologically ingrained to some extent? Or are they only a social construct and humans are fundamentally amoral creatures?


Do AntiPsychotics Work? A Look At Scientific Research

Being a Psychiatrist you may assume I am naturally going to be biased favorably. However, you may be surprised to learn that is not always the case. A Meta-Analysis published in Molecular Psychiatry took a very thorough look at this matter and here I am presenting a quick critical review of this study [1] and its findings.

The main author of this study is Stefan Leuchat who is a Professor at the Psychiatry & Psychotherapy Department, Technical University of Munich, Germany. All the other study authors are also German based except one JM Davis who is based in Chicago, IL, USA.
Conflicts of Interest

As an overview, it seems their university department is both Psychiatry and Psychotherapy oriented, which should bridge some gaps (hopefully) between the two approaches.

The authors also explicitly state that this meta-analysis did not receive any funding. However,  Stefan
Leucht has received speaker or consultancy honoraria (meaning being paid to speak or consult) from Sanofi-Aventis, BMS, Lilly, Janssen, Lundbeck and Pfizer. And that Lilly and Sanofi-Aventis sponsored some research projects done by Dr. Leucht. Another author Werner Kissling has also received speaker and consultancy honoraria from many of these ‘Big Pharma‘ corporations.


Some critics and recent scientific studies have challenged the usefulness of medications used by Psychiatrists. One of the studies found that anti-dementia drugs are not significantly effective and in fact, cause side effects and result in costs to the system as well as suffering for the patients [2].

Another one challenged the usefulness of Anti-depressants finding that they only made a very small difference to the symptoms as compared to a placebo [3].

In this context the authors conducted this meta-analysis to find out if Antipsychotics were useful.

Study Design and Method

The breadth and depth of their search for relevant studies seems to be impressive and done thoroughly. The authors mainly used a large database that indexes studies from multiple other databases in English and other languages, it also catalogs an extensive amount of gray literature. This database is maintained by the Cochrane Schizophrenia Group.

They do try to stick to quality studies by having robust inclusion criteriums i.e. only Randomised Placebo Controlled studies were included which met certain quality criteria. They also did some sensitivity analyses to check for the robustness of the results.

One cannot fault the method and statistical analysis used much. Except it is unclear how they ended up with the 38 studies (that they analyzed) as it seems they had numerous citations after running the searches. But they then go on to say “Of those publications that we ordered for inspection..” yet it unclear how they decided on which ones to order for inspection, they ended up excluding 107 (for design issues) even from those they ordered for inspection.

Interestingly all the final studies were conducted by (you guessed it) pharmaceutical companies.

There are some very interesting Results:

Meta-regression of antipsychotic effect size
Figure 4. Meta-regression on the effects of publication year on the effect size for the difference between second-generation antipsychotic (SGA) drugs and placebo on the reduction of overall symptoms. Slope = 0.02, Q = 6.83, d.f. = 1, P = 0.0090. Circle size reflects the weight a study. [Used under fair use provisions]

This graph is the most interesting result for me. As you can see it appears the size of effect Antipsychotics (newer) seem to have on reducing the symptoms of psychosis as compared to a placebo (i.e. fake drug) has been constantly reducing with time. In around 1983 a small study showed an enormous difference in effect size of >-1.6 (0.8 is considered to be large), whereas in 2007 a large study is showing the difference of effect size to be merely -0.2. This is a huge difference and the trend is statistically significant as well.

So how do we account for this result?

The author’s do not appear to give any satisfactory explanation for these results. They note that the placebo response rate seems to be high and also that a large number of dropouts (around 47%) overall in the studies suggests any difference that might have been observed is reduced.

However being more cynical we need to stop and consider several other possibilities here:

  • How much of these ‘scientific’ results have been influenced by the money politics of big pharma?
  • If placebos can also substantially treat psychosis then whats the use of antipsychotics, especially when the difference between them seems to be ever decreasing?
  • How does this then reflect on all the other schizophrenia research being conducted? where dopamine overactivity is the most favorable hypothesis so far (yet anti-dopamine drugs i.e. antipsychotics seem to work less and less now)
There is also significant publication bias:

Antipsychotic publication bias
Figure 3. Funnel plot Positive and Negative Syndrome Scale (PANSS)/Brief Psychiatric Rating Scale (BPRS) total score. Egger’s regression intercept suggested statistically significant asymmetry (d.f. = 33, P < 0.001). [Used under fair use provisions]
As you can see there seem to be a few lower quality studies (i.e. with a higher standard error) with positive results. However studies which should be expected within the red circle are missing. Studies with a higher standard error should naturally have a wider variation in results so one would statistically expect there to be negative studies as well (i.e. within the red circle), yet they seem to be missing.

This is interesting because most of the studies that were published were done by pharmaceutical companies, from there we can only assume they likely did not publish the negative ones. The authors, although agree that there is a significant publication bias and agree with the above possibility, they also suggest that it could likely be due to the heterogeneous nature of the sample studies.

So do Antipsychotics work?

Having considered the above we still need to be cautious in making premature judgments. The pooled size of the effect for antipsychotics seems to be -0.51, meaning it’s a moderate effect. This is equivalent to a minimally visible difference between two things when seen by the naked eye. The caveat here is the trend of a decreasing effect. Another caveat is that the effect size for even a fake drug is substantial in comparison and in fact, the difference in effect between the two only amounts to 18%. This means 6 people will need to be treated for 1 more person to benefit on an antipsychotic as compared to a placebo drug.

Perhaps they are better in relapse prevention then? It seems so, however again the difference from placebo is only 20%.

Furthermore in 2 studies one of the antipsychotics i.e. Olanzapine appears to improve the overall quality of life for patients.

Overall the authors rightfully point out the previous studies may have overestimated the effectiveness of antipsychotics perhaps because they were not very pragmatic in terms of what type of patients they included in the study.

What about their nasty side effects?

On a more positive note, contrary to what the general perception is among the public and professionals the newer antipsychotics don’t seem to cause any significant side effects compared to a placebo medication. In fact, few of antipsychotics led to fewer people dropping out (for any reason) compared to placebos. The older antipsychotic (haloperidol) did show significantly more side effects.

In summary

It doesn’t appear that antipsychotics are immensely useful drugs especially given their apparent reducing effect size as time goes on. However, the newer ones don’t seem to be significantly harmful either. It seems even minor effects may still be worthwhile given we don’t have any better drugs for the time being.

This study, in a more general sense, also reflects on the scientific enterprise as a whole. It goes to show that having scientific evidence in favor of some position doesn’t always amount to absolute truths and that results can vary greatly from time to time. This could in part be because of further developments in methodology or because of the nature of studying human sciences. One also has to wonder about the more cynical reasons in getting widely different results i.e. political, monetary etc.

Do share your thoughts below.

  1. Leucht, S., Arbter, D., Engel, R. R., Kissling, W., & Davis, J. M. (2008). How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trialsMolecular Psychiatry14(4), 429-447. doi:10.1038/sj.mp.4002136
  2. Bentham P, Gray R, Raftery J, Hills R, Sellwood E, Courtney C et al. Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): Randomised double-blind trial. Lancet 2004; 363: 2105–2115.
  3. Moncrieff J, Kirsch I. Efficacy of antidepressants in adults. BMJ 2005; 331: 155–157.

Overpopulation and Limited Resources – Should We Impose Control?

Just watched the movie ‘What happened to Monday (2017)’ on Netflix. It had some very interesting themes especially focusing on the crisis of human overpopulation and the moral issues this raises. These themes are of course by no means new.

Warning: The following contains spoilers.

The movie is based on a dystopian future in the year 2073. Climate change leads to a depletion of food and other natural resources. Overpopulation causes further stress on the resources leading to a dramatic global crisis and famine. This is then combated by using science and in turn a greater reliance on scientists to provide solutions. Biologists manage to modify plants to become more resistant to the harsh climate (GMOs). Food supplies are replenished but eating the modified food leads to an increase in multiple births, which starts to put further stress on the limited resources. Eventually, a renowned biologist lobbies and successfully convinces the government to pass an act which makes it illegal to have more than 1 child per family. This is enforced brutally so that any second siblings are taken away and apparently put in a state of suspended animation, awaiting better times when they can be brought back to life.

Overall this movie has multiple themes but the one which gnaws at you the most is overpopulation and the moral implication of its control. In fact, even in a recent article in NewScientist, there is talk about the notion of imposing population control as a way forward:

“Future generations risk inheriting an overcrowded, suffocating planet. Taking action may mean what was taboo is now common sense”

Given the resources on earth are finite we can safely say that we cannot go on increasing in numbers forever. The maximum limit to which we can sustain is debatable and depends on how efficiently we can live on the resources. Poorer societies have higher population growth rates but richer ones are more inefficient in resource utilization.

So whats the solution?

In the movie, they take dramatic measures. For them, population control is seen as the definitive solution. Furthermore, they go about this in a very brutal and deceiving way. The story fabricated on the media is that siblings are being put into a cryo-sleep state whilst in reality, we find out that in fact, they were being tranquilized and then burned to ashes. All this was done for the ‘higher’ purpose and obviously, the stupid public wouldn’t understand this so it had to be done secretly. In the conclusion of the movie, although this treachery is exposed and stopped the movie ends without having provided a solution to the overpopulation crisis. And the last words of the antagonist are that stopping her measures was a huge mistake.

This movie also hints at (like some others) the underlying distrust and disconnect between the ‘public’ and ‘scientists’. The people see these scientists as being fundamentalists and elitists, who think they know concrete problems and their concrete answers (and it is only they who know because of their intellectual superiority). The scientist, in general, sees the public as being too stupid to look at the broader picture and to understand the intricate details and complexities.

Having said that, for this post, I’m limiting my interest only to the overpopulation problem and its moral issues. Here’s how I see it:

Without directly going to population control measures, we should first look at living more efficiently. What should be ‘imposed’ is an efficient utilization of resources. Hence, as consuming meat is much more wasteful and environmentally damaging, reducing and eventually stopping this should be a bigger priority.

It should also be made illegal for food to be stored in warehouses or dumped into the sea (as food corporations do) to ramp up the price and maximise profits. Any excess production of food should be given to poor and starving countries for free. The economy should become more resource focused. Sustainable energy and agricultural practices should be employed. All the above should be imposed before we can look at imposing population control measures. Once we reach our maximum level of scientifically possible efficiency and if still, the earth seems to be unsustainable we may move onto population control measures.

Though, I think with proper resource efficiency the maximum sustainable number of people would be much higher than is anticipated today. Most of our estimates today get too tied in with the geopolitical and economic situation. Some scientists make a practical estimate of the maximum limit being 10 billion people but this is usually tied in with the practicalities. I think they should also look at the potentials unhindered by the economics.

If we eventually do have to think about population control, can we impose it?

This raises moral problems. Killing children certainly doesn’t seem to be in anyway justified. Furthermore, who gets to decide whether this should be imposed? We certainly can’t take majority opinion as the way forward because humans aren’t homogenous, we have all levels of group affiliations and predispositions.

Imposition seems too difficult to be justified. The best way it seems is to stick with ‘suggestion’. Perhaps there could be some minor benefits attached to having a smaller family which would further encourage birth control. However, even these benefits should be weighed against the resource efficiency of that family.

If we were to become very concrete and autistic about it (as society, in general, does seem to be becoming) then logically there is a simple straight forward equation:

Number of children = N/Resource Utilization Index

Where N would be a calculated constant. The higher the resources a family is expected to use the lower the number of children they can have. This would automatically mean more birth control for richer Western countries especially the United States. Even more so for the wealthiest families, who may not get to have any children at all.

Such a concrete system might actually lead to reduced strain on the planet and a more homogenous distribution of power and resources. But would such a system be fair? It would certainly impede personal freedom. But is that really avoidable in any other scenarios? I’m not so sure.

Let’s say we do impose some kind of a population control system and make it law. What happens when someone disobeys it? Do we punish them just for having children!?

Lastly, looking at the difficulties this issue raises, I think it might be one of the few legitimate reasons for us to explore the possibilities of inhabiting other planets. In doing so we may be able to avoid such a dystopian future. All this is assuming we continue to remain and become more and more civilized as a species. Of course looking at history we can’t be so sure.

So what do you think?

Brain Networks vs Galaxy Networks – More Evidence of Odd Similarities

When you look at microscopic pictures of neurons in the brain and telescopic pictures of the cosmic web there is a remarkable similarity which catches the eye.

Astrophysicist Franco Vazza, along with a neuroscientist colleague of his, recently published an article in Nautil.us (July 2017) describing the strange similarities in the structure and complexity of the brain and the universe. This was based on analytic studies they conducted to quantitatively compare these similarities.

Similarities in the Structure and Complexity of The Brain and The Universe

The peculiarities that they studied and presented are:

  • The number of neurons in the brain is around 100 billion. This is exactly around the number of galaxies in the universe – a 100 billion.

  • Doing a power spectrum analysis they conclude that the structural similarities between the brain and the universe are quantitatively significant. That is to say, they are not the result of human level perceptual illusions such as apophenia (though I think they actually meant pareidolia).

  • The structural similarities are not spectral in nature (like has been shown for other complex systems like clouds, tree branches, water turbulence or plasma).

  • The structural similarities are evident between the cerebellar (cerebellum) histology when observed at the scale of 0.1 to 1 mm and the cosmic web observed at the scale of ~ 100 billion light years.

  • The structural similarities are also evident between the cortical (cerebrum) histology when taken at the scale of 0.01 mm and the galactic structure on the scale of ~ 100 thousand light years.

  • The entirety of information stored in the human brain (around 2.5 Peta bytes) can just about also be stored into the distribution of galaxies in the entire universe (the estimated data capacity of which is around 1-10 Peta bytes).

The authors do bring to our attention that this does NOT mean there is a dynamic similarity between the two systems as well, especially with regards to the flow of information. This will be the focus of their future studies.

However, in the following discussion, people were suggesting this might indicate that the universe may be self-aware. As I critiqued the limitations of this (which I will discuss below), Franco Vazza gave me an insightful reply giving a sneak peek into their future article:

“That’s a perfect point! We could not write the derivation here, but according to our (still ongoing!) estimates, the Universe on the largest scales might have processed at most the same amount of information that a typical human brain can process in 0.1-1 seconds! Hence, at most, the cosmic web seems to be a “baby brain”.”

The Dynamic similarities between The Brain and The Universe

Although Franco Vazza et al. are still studying some of the dynamic similarities specifically with regards to information processing, there has been an earlier study on this phenomena by physicist Dmitri Krioukov and his team. This study was published in nature (2012). In comparing the growth dynamics and structure of the universe they found unexpected similarities to other complex networks such as biological networks (the brain), social networks and the internet:

“This equivalence suggests that unexpectedly similar laws govern the dynamics of complex networks and spacetime in the universe, with implications to network science and cosmology.”

Does this mean the cosmos is a conscious brain?

Before getting into this I want to make it clear that neither of the study authors just cited make an explicit claim of this sort.

“By no means do we claim that the universe is a global brain or a computer,” – Dimitri Krioukov

Whereas Dimitri Kriokov makes this explicitly clear, Franco Vazza has hinted at the possibility of it being a “baby brain”.

Others, however, are not so shy to make that leap. Bernardo Kastrup, a computer scientist specializing in Artificial Intelligence, makes this exact claim in support of nondualism (philosophical idealism) on his blog post and his video presentation. As he claims that the brain like appearance of the cosmos suggests that we have a second person perspective to the first person experience of cosmic inner life. Similar to how a neuroscientist has a second person perspective to our first person conscious experience.

On the other hand critics like cognitive scientist Joscha Bach (who also has a special interest in Artificial Intelligence) point towards the potential fallacies of this approach in his blog post. He points out how image comparisons can be misleading and the fundamental limitations of the amount of information processing possible by the universe, given the speed of light is minuscule compared to the size of the cosmos. The latter argument is also the one I made on Franco Vazza’s Nautilus post. The first argument, however, seems not to hold up given that a quantitative analysis was done by researchers confirming the similarity.

In a rebuttal post, Bernardo contends:

“Indeed, I feel so confident in my refutation of Bach’s straw-man arguments that I will even expose myself by speculating: the conscious inner life of the cosmos as a whole is, experientially, comparable to a brief moment of human cognition, just as Bach argues.”

Such a claim appears to be consistent with what Franco’s speculative suggestion is as well (of the cosmos being a “baby brain”).

My personal criticisms and speculations


I think we can safely say that the cosmic inner life of Bernardo isn’t the same as the conscious human experience (as I think he also agrees). This is because although there seems to be a structural similarity between the two, they are not dynamically equivalent. The dynamic similarity presented by Dimitri Krioukov is of structural evolution and not of information processing. Franco Vazza is working on the information processing type of dynamic similarity but in this, their speculation is that the amount of information processed may be equivalent to 0.1-1 sec of brain processing.

I suspect that given the enormous distances between galaxies (hundreds of thousands to few million light years) any change brought about by their intercommunication would be tiny as compared to the local changes that would have occurred in them. For example, the size of the universe is ~ 100 billion light years, this means a communication between one end to the other (at light speed) would take a 100 billion years. This is 7 times the whole life of the universe itself, hence before the communication is made much more would have happened locally. This would limit the signaling to have any meaningful impact on the morphology. Compare that to the brain, the speed of communication (action potentials) is very fast as compared to its size, hence the communication is having meaningful impacts on the morphology.

The following is extremely speculative and represents my personal ponderings rather than opinions. For the most part these haven't been validated in mainstream science.

Given that the biggest obstacle to the universe being able to process information like the Brain seems to be the maximum speed of communication i.e. the speed of light, is there a way to overcome this?

Hypothetical ways to do this may be:

  • By use of Tachyonic Antitelephones – These are based on a hypothetical particle in theoretical physics called the ‘Tachyon’ which can travel at speeds faster than the speed of life and hence enable communication into the past.
  • If Psi research in Precognition is true as I discussed in my previous post. It would allow us to imagine a paradigm in which information can be communicated transcending the barriers of time and causality.
  • Quantum entanglement could be utilized for instantaneous communication. This does not seem possible (as far as mainstream physics is concerned) as I did criticize in the Nautilus post. This is because quantum entanglement is based on random chance. However, I do see one way in which it could be possible, that is if some of the research in taking the mind outside the body is true. This will be a discussion for a later post.

So what do you think? Do the similarities in structure, complexity and specific dynamics of the Universe and Brain convey something profound?