Nomentum. No, that’s not a typo. It’s a new word.

Nomentum – the tendency to experience multiple negative events, one after the other. Or, how can so much bad stuff happen to just one person?

I think every health professional has encountered this phenomenon in some of their patients. Many people float through life with few major problems, others have one or two serious traumas but recover well, while a small subset descend into a mire of difficulty and appear to have the worst luck in the world. They don’t get just one illness but a veritable panoply of conditions. Relied-upon family unexpectedly die. Friends get jobs in other countries and move away. Acquantainces get them into serious trouble with the law. They get fired from previously stable jobs and generally descend down the socioeconomic ladder, never to rise again.

Of course, some of the above correlations can be unpicked without resorting to extraordinarily bad luck as an explanation. Genetic predispositions, poor coping mechanisms, the varied knock-on consequences of stress, and other similar confounding variables and biases can account for some of the coincidence. But there’s still a vague – if perhaps unjustified – feeling that at least some of these numerous negative events are particularly cruel twists of fate. You can’t help breathing a silent prayer of thanks, and touching wood, that you’ve had better luck.

I like the term Nomentum – a portmanteau of No and Momentum – to describe this destructive picture. To the person experiencing this drama-turned-crisis, it can feel like a train rushing headling towards them while they stand terrified, hypnotised by the headlights. Nomentum captures something of the dread and inevitability of such an encounter. The geeky part of me also likes the analogy of serious life events to momentum. Momentum is the product of mass and velocity; heavier, faster objects have greater momentum than lighter, slower ones. It is momentum that is converted to energy on impact, causing damage.

Bigger events carry more mass, while the way we cope with them (and our general vulnerability to stress) affects their impact velocity. By thinking about how we cope with events, it’s possible to formulate strategies to slow their impact. Distraction, relaxation, the support of others, positive/active planning and restructing cognitive frameworks all work to slow the impact down. A bit, anyway.

Nomentum isn’t inevitable, it’s modifiable.

(P.S. apologies to any historians reading this post on Nomentum expecting an article about the old city and had to read about a new word instead!)

What is Psychiatry for?

The Idleness of Sisyphus, Sandro Chia (currently held in MoMA, NYC)

Activity without intent borders on slavery.

Sadly, it’s a very subtle form of slavery as the master is frequently a complex system rather than an individual. It’s easy to notice a single tyrant but much harder to identify a pervasive cultural prison. Systems are created by people but rapidly gain their own momentum, feeding parasitically and autophagously, culminating in bloated rigidity. If people are unaware of their own poor insight, they will continue to toil in the service of this system, forgetting their reasons for engaging with it in the first place.

It is therefore refreshing to see the British Journal of Psychiatry actively questioning what Psychiatry is, and what it should be. Sometimes dismissed as navel-gazing obstructionism or even disloyalty to the speciality, this self-interrogation is necessary in order to remain a profession rather than a mere industry. I would like to highlight an article by Bracken et al, available here. The full text is behind a paywall, but here are some choice titbits, should you lack access:

[It has been argued] that the profession should adopt an even more technological and biomedical identity, and that psychiatrists should focus on their mastery of technology to allow progress in the development of brain research, genetics, pharmacology and neuroradiology. These resonate with calls in North America for psychiatry to become simply a ‘clinical neuroscience’. However the promise of therapeutic gains from the brain sciences always seems to be for the future, leading some to interrogate their contributions to advances in our field. Indeed, neuroscientists themselves have becomes more cautious about the value of reductionist approaches to understanding the nature of human, thought, emotion and behaviour. Furthermore, there is ample evidence that anti-stigma campaigns based on biogenetic models of serious mental illness have been counterproductive…

The ‘technological paradigm’ that now guides psychiatry… involves the following assumptions: a) mental health problems arise from faulty mechanisms or processes of some sort, involving abnormal physiological or psychological  events occurring within the individual; b) these… can be modelled in casual terms; they are not context-dependent; c) technological interventions are instrumental and can be designed and studies independently of relationships and values.

… [This] is reflected in our understanding of the training needs of future psychiatrists, what gets published in journals, what topics are selected for analysis at conferences, the types of research that are promoted and how we conceptualise our relationship with the service user movement… The technological paradigm underscores a trend towards the medicalisation of everyday life, which, in turn, is associated with expanding markets for psychotropic agents.

The article goes on to highlight the paradigm’s flaws, noting the importance of the therapeutic alliance, the relatively limited effect of many psychotropic agents once the placebo effect is taken into account and the longer-term benefits of recovery and collaborative models of delivering psychiatric healthcare. It does not dismiss the undoubted value of some research into biomedical models of illness,  nor the value of psychotropic agents in particularly serious situations where there is significant distress or risk. But it argues strongly that psychiatry is not  a physical “applied neuroscience” speciality. It is not a branch of human knowledge that can be converted into causal flowcharts and administrative protocols.

It argues powerfully in favour of incorporating broader strands of thought from the social sciences & humanities. This is a topic I’ve touched upon frequently here before. Psychiatry should be a way of thinking. At its finest it blends sociology, anthropology, neuroscience, philosophy, politics and good old-fashioned intuition to craft a temporary window into that most mysterious thing: another person’s mind. It is this broad and flexible approach that allows a therapeutic alliance to be established and offers hope that changes may be implemented to effect positive change in someone’s life.

Unfortunately, the broader cultural momentum of our society is with a blame-oriented, defensive, protocolised approach to life. This is not something easy to combat; psychiatry alone cannot do it, and is itself heavily influenced by that broader cultural direction. There is no clear recipe to correct our broader way of life, as most people do not consciously perceive it as wrong anyway and even if they do, they are conflicted enough to work within that system anyway. As an individual practitioner, I’ve carved out a small, specialised niche within the wider system that allows me to work (more or less) in a milieu where I feel empowered to make decisions I can have a clear conscience about. But I’ve done this by backing away from a more typical clinical practice; it’s not a route that would work for everybody and is too narrow a role to enable treatment for the full breadth of patients in the system.

I don’t have a broader solution to the problem, apart from hoping more people begin to think more for – and about – themselves.

The painting illustrating this post is The Idleness of Sisyphus, by Sandro Chia and currently held by the Museum of Modern Art in New York. Readers are undoubtedly familiar with the myth of Sisyphus, punished to perpetually roll a heavy boulder up a mountain in Hell. Here, the artist depicts the eternal struggle as idleness as it feeds a system rather than an individual life. This theme has also been visited by Albert Camus in his The Myth of Sisyphus, with somewhat different conclusions and recommendations.

What’s Your Vote Worth?

By the time polls close in the US Presidential Election, the Obama and Romney campaigns will have spent a combined $2bn+.

Enough states are safely in one camp or the other that campaigns naturally concentrate resources on swing states and on undecided voters within those states. The New York Times calculated that that only about 5% of the electorate really decide elections and Forbes made some very reasonable assumptions to conclude that the campaigns each spend about $115 per person on snagging the votes that matter.

Not all of that is direct advertising; much is spent on adminstration & organisation such as travel costs, paying salaries and the basic logistics of a campaign. If I was to make some slightly more tenuous assumptions than Forbes did, I’d suggest that only about a third ends up in material directly designed to influence the opinion of a swing state undecided voter i.e. about $40. That’s what the campaigns think your vote is worth, even if you’re the most valuable voter out there. They value most voters far less.

It raises the question: what would be the actual value of a vote, if it could be legally sold? Are the current campaigns overpaying or getting a bargain?

We generally use money as a means to calculate value as it allows an abstraction to define the price at which both buyer and seller are willing to exchange an item. Selling a vote is illegal but we can still consider the theoretical value it would have. Some people will assign such a high value to their vote for reasons of conscience that it would be unsellable. I would suggest that more people say they’d never sell their vote than would be true if faced with the prospect of real money in their hands, but I won’t push that point here.

In any event, such extremely conscientious voters are likely to already be strongly in one camp or another anyway, and so are not valuable to a campaign. Voters certain to vote for you already have no value as you don’t have to buy them (which is why campaigns target swing states & undecided voters in the first place). There are certainly some highly principled undecided voters who would also never sell but I suggest that their numbers would be outweighed by the number of soft “decided” voters who could be persuaded away from their party if the dollar amount paid for their vote was high enough.

Conventional theory suggests that the value of a vote should follow a set of elasticity curves. The campaigns already assign a range of values to your vote, based on how likely it is to win an election. But if votes could be sold, individual voters could set their own prices, based on whatever criteria they choose. They could price it according to their conscience, or according to how much the party is likely to cost them if elected, or, well, anything they like. The market value of an individual vote would be whatever the intersection is between your value determinants and that of the parties.

Moreover, it’s possible that enough voters in states that currently lean somewhat one in candidate’s direction would be willing to directly sell their vote, moving that state into the toss-up category. The supply of votes for sale would be greater than the current situation, but the electoral college system would disperse that supply across a larger number of states, thus empowering a larger percentage of the population than is currently the case. The number of swing states might even double. And campaigns would probably have to directly buy a higher number of votes in even safe states than they currently do through indirect means.

So what would be the net impact of letting votes be openly bought & sold on an exchange?

For voters:

• A larger number of people, across a larger number of states, would find that their vote has meaningful value.
• A larger percentage of the electorate would vote
• Election campaigns would be redistributive, transferring large sums of money from a small number of people and corporations to a wide cross-section of the population, acting as a direct economic stimulus.

For campaigns:

• They would still prioritise swing states and undecided voters, but would have a larger number of swing states and undecided voters to target.
• They would probably find they have to spend more than they currently do and that it would take several elections to figure out how much to still spend on advertising versus direct payments to voters (remember, advertising has potential to convince you to vote for a party anyway or to lower the amount required to pay you to vote for them).
• They would need some form of contract for the vote purchase, most likely transferring your voting right to them centrally to ensure it was used in the manner paid for.

There is of course a wider question here: would it – theoretically – be fair & just to allow votes to be bought & sold legally?

Most people instinctively rail against the concept, but I’d suggest that the above shows that there would be significant benefits in terms of fairness and natural justice.

• More people’s votes would matter; more people would feel enfranchised.
• The economics would be redistributive, moving money from a small number of rich people & organisations to a large number of poor ones.
• There would be a broad economic stimulus, leading to more jobs and more growth.
• There would probably be less intrusive & unwanted advertising.
• It’s more honest and open about the electoral process than the current system.

The traditional counter-arguments to vote-buying are that it puts power in the hands of those with the deepest pockets and that it therefore distorts a democracy. This strikes me as a somewhat disingenuous argument as the current situation is already a highly distorted democracy with power in the hands of those with deepest pockets. Moreover,  much current indirect vote-buying occurs through lobbying and pork-barrel deals where elected politicians can demand the most money – albeit indirectly – for their votes. If the actual election result can be traded transparently and openly, the need to lobby representatives after the fact diminishes. And as to the point that it is a distortion or sullying of the democratic process to trade votes, this already occurs through voters analysing which party will benefit them the most. Is it really logically much different to permit a more overt trading of votes? It may seem “icky” but in practice is not signficantly different to the current situation; it simply removes the fictional veneer that it doesn’t already happen indirectly and would make it a more open and cleaner process. If anything, it gives power back to individual voters to demand something concrete and real from parties instead of illusory promises and pledges. And I think campaigns would find that the cost of a meaningful vote would increase compared to the current $40-ish.

Naturally, the above is deliberately provocative and controversial, and to a large extent I’m playing Devil’s Advocate to illustrate the farce of current the current political situation. I certainly don’t expect either the US or UK (where I live) electoral systems to ever allow vote trading. But when so much money is expended by campaigns already, and with them already placing a very real monetary value on our votes, is it really such an outlandish and unremittingly negative proposal any more?

Enjoy Election 2012!

Why technology can still save the world

Clouds yield to blue skies above a factory (photo credit: zoetnet)

It is fashionable to bewail the current state of the world. Doom merchants fill the airwaves and the digital parliaments to decry man’s shortsightedness, prophesying environmental catastrophe and economic armageddon.

An optimistic perspective, founded on a belief in man’s essential ingenuity and problem-solving skills, is frequently derided as naive and pollyanna-ish. It is perhaps characteristic of a pessimistic world that UBS Chief Economic Advisor George Magnus’ report on the Asian economies is titled “Is the Miracle Over?“.

In fact, hidden within the report is a glimpse into a remarkable and positive new future.

FT Alphaville’s Izabella Kaminska blogs about those positive aspects here. The essential thesis is that the world is on the cusp of a massive technological revolution, poised to spur economic growth and potentially have a dramatic impact on how globalisation works. I’ve previously blogged about the idea of economic supercycles called Kondratieff waves, an idea very much on the fringes of conventionally accepted theory. Kondratieff waves suggest that the economy undergoes long-term (approximately 30-50 year) alternating cycles of intense booms and relative stagnation, with the booms triggered by the introduction and subsequent dissemination of disruptive new technologies. The last boom was between 1983-1999, representing the impact of the microchip, and since then we have lived through one of the stagnant, volatile phases. Intriguingly, the theory suggests a revolutionary phase is due to commence within a few years.

Magnus is no pie-in-the-sky fantasist and yet he suggests that new manufacturing technologies like 3D printing will transform the way we build things. Instead of having to ship goods around the world to create goods in cost-effective manner, it will be possible to build them close to home again. Moreover, it will be totally on-demand and for less cost. It is a technological advance that would make it economically viable to make incredibly complex parts, cheaper and more durably than ever before, ramping up their availabily to almost anyone. The knock-on effects are almost incalculable, but cheaper complex parts will drive innovation across the economy.

Luddites will fear the potential for job losses due to cheaper manufacturing, but they should consider the positive economic impact of a highly distributed high tech manufacturing base. Large centralised factories will still exist, but a vast array of smaller scale production plants will pop up closer to home. In the further future, you may even have a 3D printer at home yourself. Imagine seeing a product online, buying it, and then being able to “print” it as a complex 3D object, complete with moving parts, on demand yourself. Imagine the new businesses that will spring up & flourish with such easy high-quality manufacturing capability.

If you think this sounds like ridiculous science fiction, just look at the following videos:

Of course, the technology is still in its relative infancy. But a world of potential self-replicating Von Neumann machines may not be that far away.

And consider this, 3D printing is just one potentially revolutionary technology. The world is not as gloomy as the doomsayers claim. Prospects for the singularity remain bright.

Norway Killings: Inside the Mind of Anders Behring Breivik

Reblogged from Beyond Anomie:

(update 1: 26 July 2011)

(update 2: 29 November 2011)

(update 3: 21 December 2012)

(update 4: 24 August 2012)

Sherlock Holmes once remarked that it was a capital mistake to theorise in the absence of data. There are few settings where this is more accurate than in attempting to understand the psychology of another human being.

Nonetheless the intense interest surrounding the tragic events in Norway has prompted much speculation on what may have motivated Anders Behring Breivik to carry out mass murder.

Read more… 1,180 more words

With the sentencing of Breivik to 21 years in prison today, I thought it appropriate to reblog this earlier post of mine to bring it to the attention of new readers since I first posted it. I've edited it to bring it up to date, closing at least this chapter of a very sad story.

That Bittersweet Feeling: Olympic Closure

Image from Closing Ceremony gallery at London 2012.com

And that’s London 2012 done.

Like most of my fellow countrymen, a vague feeling of concern about whether Britain could really manage the mega-project organisational nightmare of hosting the modern Games gave way to delight at how London surpassed all expectations. Great sport, near-perfect logistics, spot-on branding design, and of course the magnificent achievement of British athletes storming to third place in the Gold Medal table, all combined to lift the mood and create a sense of fun and light-heartedness about the Olympics. That slightly cheeky and occasionally self-deprecating approach to hosting the Games made them truly British. Nowhere was this exemplified better than by the use of music as a backdrop to the Games. What other nation would dare to play the Benny Hill theme during the changeover of ends during the women’s beach volleyball, or the fight music from The Matrix at Taekwondo?

Last night’s closing ceremony continued to mine this rich source of musical cheese: Take That, the Spice Girls, One Direction, George Michael, Eric Idle plus somewhat more credible acts like Annie Lennox, Freddie Mercury from beyond the grave, half of Oasis, and a surprisingly good finale by The Who. The music fit the bill of providing a happy ending to a hugely successful games, but nonetheless an inevitable bittersweetness hung over the moment of the extinguishing of the Olympic Flame.

When the moment was announced, you could hear a few shouts of “no!” from the crowd, and as the flames flickered their last a noticeable “ahhh” could be heard. It was a moment of satisfaction at a job well done mixed with a sad feeling that a special time had passed. That bittersweet blend of happiness and sadness is a very unique, very human emotion. It represents closure.

It’s the same feeling you get at ending school, graduating from university, at the end of a holiday, or even at the close of a good funeral eulogy. It’s the feeling of a challenging pre-occupying chapter in life being successfully resolved and represents the momentary pause of reflection that accompanies the turning of that page. It’s one of the few times we allow ourselves to experience two dissonant emotions without feeling conflicted by the blend. Closure is a rare emotion.

Many people, especially those I see professionally, have never experienced bittersweetness in their personal lives. Whether because of childhood trauma or challenges later on, they’ve never had a healthy attachment to someone followed by a healthy end to that relationship. Instead, relationships are either passionate and destructive, or soulless and empty. Fear of loss is expressed either through holding too tight or by refusing to hold at all.

Endings aren’t unhealthy or painful; in fact, a good ending is one of the most satisfying human experiences. If you ever need to remember what that feels like, remember how well Great Britain hosted the Olympic Games, how you felt at the end, and allow yourself a moment of national pride at a job well done.

The Limits of Antipsychotics

Space-filling representation of a haloperidol molecule. Haloperidol is an antipsychotic medication. (Photo credit: Wikipedia)

I sense the beginnings of an interesting cultural shift in my profession.

For decades, psychopharmacology has held sway over psychiatry, to the point that it seemed as if new diagnoses were promulgated simply to facilitate new drug licensing opportunities. However, I have never laid the blame for this at the feet of pharmaceutical companies; they at least are open about an ultimate need to satisfy shareholders. Rather, my concern is the willingness of many – clinicians and patients – to seek solace in a prescription, rather than to seek a deeper, more individual, philosophical basis for distress and misery.

Of course, in many cases of severe illness, medication is necessary to alleviate suffering enough to permit that process to begin. It would be cruel and unfair to deny that psychiatric medication has made a major positive difference to many lives. But when it is reached for unthinkingly, it risks creating as much suffering as it treats.

For years, this position has been a relatively isolated one. Sure, in theory this point has always been acknowledged, but in practice the trend was for ever more psychopharmacology, at ever earlier stages and for ever milder episodes of illness.

The exciting thing for me is that the mainstream of the profession are now actively questioning this trend. In this month’s British Journal of Psychiatry a guest editorial by Morrison et al directly questions the value of antipsychotics. Moreover, as the BJPsych‘s editor Peter Tyrer points out, “this is not a wild cry from the distant outback, but a considered opinion by influential researchers who help to formulate NICE guidelines”.

He goes on to summarise, “… the reasons for the change in view are… an increasing body of evidence that the adverse effects of treatment are, to put it simply, not worth the candle. The combination of extrapyramidal symptoms, dangers of tardive dyskinesia and the neuromalignant syndrome, weight gain and the metabolic syndrome, sedation, postural hypotension, and interference in sexual function… would need to be offset by massive symptomatic and social functioning improvement to make the benefit/risk ratio positive. Of course, it often is, at least in the short term, but for many the risks outweigh the benefits”.

Morrison et al‘s conclusions are gripping reading:

Given that mental health services appear to have overestimated the strength of the evidence base for antipsychotic medication, while underestimating the seriousness of the adverse effects, it seems sensible to re-evaluate the risk–benefit ratio of such drugs. This risk–benefit profile may be a factor in the high rates of non-adherence and discontinuation of medication found in patients with psychosis; thus, some decisions to refuse or discontinue antipsychotic medication may represent a rational informed choice rather than an irrational decision due to lack of insight or symptoms such as suspiciousness.

Given accurate and honest assessments of both risks and benefits, it should be possible to prescribe antipsychotics in a more thoughtful and collaborative way, and these considerations should involve explicit discussion of the possibility of not prescribing at all. Provision of such choices may help to engage people who might otherwise reject services; for example, patients with low levels of insight and/or high levels of internalised stigma might resist medication but consider that talking to someone is acceptable.

To facilitate informed choice and decision-making, we require a much better evidence base to help address questions such as how and when medication might be required, who is most likely to respond and what alternatives exist. There is some evidence for different trajectories of response, with a small proportion of patients demonstrating a rapid and dramatic favourable response to certain antipsychotics, but more research is clearly required to inform our ability to predict those most (and least) likely to respond to antipsychotics…

It may be time to reappraise the assumption that antipsychotics must always be the first line of treatment for people with psychosis; rather, this should be a collaborative decision that is balanced with provision of informed choices and the offer of evidence-based alternatives. These decisions should be negotiated with service users on the basis of the likely positive and negative consequences and the prioritisation of their goals and values; such a collaborative approach might also result in better response for those who choose to take antipsychotics, since the quality of relationship with the prescribing clinician is associated with attitudes and adherence to medication.

This is a model of practice that resonates with my own attitudes; there is little more conducive to a positive outcome than attempting to have an open and frank discussion about a problem. Acknowledging the limits of medical science empowers both clinician and patient, enabling better quality decision-making. It might even force both parties to think a little deeper about what is really going on, and why.

For those with subscriber access to the BJPsych, the full Morrison editorial can be found here.

How Doctors Die: A Shrink’s Reply

Hippocrates, the father of medicine, famous for a quote frequently attributed to him: “first, do no harm” (Photo credit: Wikipedia)

How will you face death?

Ken Murray, clinical assistant professor of family medicine at the Keck School of Medicine at the University of Southern California recently wrote a thought-provoking essay, How Doctors Die, comparing how doctors approach end-of-life decisions to how an average layman does.

It’s a lovely piece; I strongly urge you to take five minutes and read it.

My favourite excerpts:

What’s unusual about [doctors] is not how much treatment they get… but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone…

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.”

They mean it.

Modern medicine is a marvellous thing. It is excellent at reducing the risk of illness or preventing further deterioration. But it is not good at managing death. Murray accurately describes how an unwitting constellation of medical, patient and systemic factors frequently work to prolong terminal misery. He is speaking of medical practice in the USA, but it is certainly true in the UK as well, and I suspect true for whatever country you practice in.

It is in the nature of humanity to fear death; we tend to avoid thinking deeply about such things. Much of the existential suffering that humanity experiences is related to the reality of mortality. As a psychiatrist, I see its distant shadow looming behind many of the apparently unrelated fears and anxieties of patients. Mortality sets a countdown on life, restricting freedom and choice.

Healthcare professionals gain a familiarity with death that the average person lacks; we know what a good death is, and what a bad one means. This influences our own choices. The challenge is how to pass this wisdom on without coming across as uncaring. Being open about the realities of death with others, especially our patients, can be challenging to them.

Murray’s essay is an excellent start.

What does Coke taste of?

An obvious follow-up to my last post on colour vision and the consequences of mechanisms like colour opponency and lateral inhibition is to ask why our brains make it possible to manipulate what we see so easily?

Surely we should only see what’s real, without fancy modifications?

The answer is equally obvious: there is no real.

Or, if you prefer, the real would drive us mad. We create a world based on cognitive perception, not on externally verified data. To prove that, answer this simple question:

What does Coke taste of?

Everyone is familiar with its taste but none of you will agree on what it actually tastes of. This is because it exists in our minds as a construct with a singular identity. It is that created identity, reinforced by marketing and social pervasiveness, that maintains its sales. In fact, it contains water, sucrose or HFCS (depending on market), caramel colour, phosphoric acid, and a battery of natural flavours including essential oils and other spices.

We don’t taste those individual components. We taste Coke.

For those of you who remember the Cola Wars, this is why the Pepsi Challenge was initially so effective: it blinded participants to the Coke brand and forced them to only consider taste (at which point, they rather unsurprisingly favoured the sweeter drink: Pepsi). It’s also why New Coke was such a marketing disaster: Coke sales are not predicated on taste, but on the positive consensus taste construct of the Coke brand. Changing the recipe destroyed the construct, and therefore its sales.

Constructs are massively important because they free up our brains from having to constantly reprocess the world from first principles every millisecond. They act as familiar shared reference points. A continously shifting reality would paralyse us: our brains are set up to compensate for external change, and return things to normal.

For instance, take a red sofa: you will see it as red whether it’s midday or nighttime. In fact, the wavelength of light reflected off the material of the sofa changes drastically between those lighting conditions. And yet, it’s still red to you. This is Colour Constancy and is just one of the many visual perceptual biases we apply to the world to keep it making sense even as the raw data changes.

These phenomena are unconscious – we do them automatically, without effort – to the point that if we make the effect explicit, it creates optical illusions (there are a few here, if you want some fun, and some more here). We like to write off optical illusions as weird aberrations of our senses but the truth is that optical illusions represent one of the few times we actually see “correctly” by noticing the mismatch between external data and our perception of it.

The nature of truth/reality and our inability to externally verify it forms the basis of various philosophical models. On a practical level, understanding that the world is infinitely variable to individuals but much more rigid and consistent to large social groups, has significant implications to our personal happiness.

If you disagree with the group construct, and make your dissent obvious, it will be hard to flourish. Society is very good at creating new constructs to marginalise such individuals. Equally, if you have the resources (emotional/personal or material) to protect yourself from the group, being aware of the mutable nature of reality can be empowering.

Opportunities present themselves to those able to spot the wider, societal cognitive dissonance between how people perceive and interpret the world, and how it actually operates.

Colour and Fashion: A Neurophysiological Perspective

What makes some colour combinations look good?

The answer lies in the neurophysiological basis of colour vision.

Light entering through the pupil falls on the retina at the back of the eye. The multi-layered retina includes photoreceptors which translate light into neural impulses and other cells which begin the process of combining and interpreting those impulses into objects. This processing continues as the optic nerves & tracts weave through the brain to the visual cortex and is eventually completed as data in visual cortex is interpreted consciously and unconsciously by the rest of the brain.

These final processes mean that we can “learn” to appreciate certain colour combinations and is why we associate certain colour combinations with certain events (for example, red & green at Christmas or pastel pink & blue for Easter). These culturally acquired associations can be so powerful as to overwhelm any other underlying basis of colour harmony.

In the absence of a strong prior assocation, certain colour combinations will still please us more than others, because of our neurophysiology.

We have two types of photoreceptor: cones and rods. Cones predominantly exist in three types, each most sensitive to a particular set of light frequencies. This is the Trichromatic Theory of vision. The graph shows the sensitivity of different receptors to light:

Colloquially, they’re called blue, green and red photoreceptors but the graph shows that in reality the wavelengths are not so discrete. The blue is almost indigo/ultramarine, the green is a vegetal shade, and the red is muddied with yellow. This blurring is why the cones are more technically named by the S(hort), M(edium) and L(ong) wavelengths they’re most sensitive to. Evolutionary biologists have plenty of theories for why we should develop sensitivities to these colours; you can probably extrapolate some yourself, based on those peak colours and what exists in the natural world.

Our photoreceptor sensitivities account for the 3 additive primary colours of red, green and blue. They are drawn from sufficiently separate parts of the visual spectrum to be used to create any new colour, as this image demonstrates (the circles at the corners of triangle are the primary colours used in the sRGB monitor system):

While our photoreceptors transduce light in these sets of wavelengths, the neural impulses they generate are recombined during visual processing to create cognitive effects influencing how we perceive colour combinations, enabling us to perceive more complex colours and determine how they look against each other. This begins in other layers of the retina. Neural impulses proceed through bipolar cells to ganglion cells. Ganglion cells are not sensitive to one colour but to pairs of colours. One colour lets ganglion cells continue firing, the other stops firing. The two key types of ganglion cell are red/green and yellow/blue. We’re hard-wired to see in this Colour Opponency. We cannot see a “reddish green” or a “yellowish blue” (at least not without carrying out a very tightly-constrained experiment that makes some see “impossible” colours they can’t verbally describe). In fact, if you stare at a red square for a while, and then stare at a white wall, you’ll sometimes see an illusory green square, the afterimage being its opponent colour.

At this point, artists will point out that they use different primary colours. These are the subtractive primaries, forming the basis of the artist’s colour wheel (as explained on this art blog). It’s a hugely important device when mixing colours to make new shades, but doesn’t govern visual perception, which is based on the psychological and additive primaries. Having said that, because 2 primaries (red & blue) are the same across systems, and the position of the third primary on the colour wheel (yellow) is not far from psychological primary green, the artist’s colour wheel can still be used – with some caution – to determine what colours go well together. However, an RBG wheel can work better than the RBY one for this purpose. An RBG wheel (or star) is below:

Trichromacy and colour opponency mean that primary colours appear highly contrasting and vivid against each other. Using Red, Blue & Green together creates a bold and simple colour scheme. Because of cultural associations, it can remind us of childhood toys and naive innocence but it can also seem gauche and garish to adult eyes. Move one notch around the wheel and imagine an outfit of, say, Orange, Violet & Spring Green. Highly contrasting again, with the same risk of garishness and without the redeeming childhood association. More Halloween than anything else, perhaps. Move around again, and use Yellow, Cyan & Magenta… well, the point is clear!

Let’s try something different. Imagine an outfit consisting of some colours close to each other and one almost directly opposite each other. e.g. navy suit with paler blue shirt and yellow or orange tie. Suddenly the effect is pleasantly vibrant. This vibrancy arises because colours appear brighter when laid against their complementary colours due to a neurophysiological principle called Lateral Inhibition. Lateral inhibition suppresses neural activity from nearby cells. So if you have a yellow tie against a navy suit, you get an enhancement of the differential effect of the photoreceptors on the blue/yellow ganglion cells. Put simply, the colours brighten each other.

For an evening outfit, try picking colours all drawn from the same side of wheel e.g. keep the navy suit and pale blue shirt but swap in a dark purple tie. The more eccentric might even use a dusky pink shirt. Either way, there’s little lateral inhibition, so colours appear darker and richer, adding a touch of luxury and decadence to the outfit.

White and black also work through lateral inhibition on the colours around them. They enhance contrasts, appearing to deepen already dark colours and lift lighter colours. While our cultural associations traditionally associate black with night and white with day, because both in fact work quite similarly, black can be used to great effect in daytime outfits (see Princess Eugenie’s recent Royal Ascot teal/black outfit) and white can do the same at night (as in the gloves of this vintage Dior outfit or the shawl in this Chanel one).

The neurophysiology of vision is the basis of our colour perception. Use it to you advantage, to understand why you like an outfit, and to create new ones.

(Inline images in this post are public domain, from Wikimedia Commons)