All the different kinds of mind reading – does it exist?

The ability to read minds is a superpower often portrayed in many forms of popular media. The idea of being able to understand our peers, down to the most minute detail, is both seductive and a credence to our innate desire to understand one another. It is our perception, of the understanding of others’ minds, that we use to shape our views of the world. Mount Rushmore, in the United States, for example, only holds meaning because of our collected understanding of the grandeur of the monument, and an appreciation of what/who we gaze upon.

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All humans sort of read minds – it’s called intuition. Based on the feelings, actions and behaviours of another person, someone with well practiced intuition can often tell when something is wrong, or when someone is excited. Believe it or not, these functions are encoded directly into our brain, in an area called the posterior superior temporal sulcus, an area dedicated to recognizing facial expression. The ability “read ones feelings” is so integral to our survival as a social species in fact, that many animals exhibit this level of intuition, dogs being the most obvious example. Have you ever had your pet dog come and comfort you on a difficult day? Ever have your German Shepherd start barking at a stranger when you start to look alarmed and panicked? Ultimately, this phenomenon comes from a profound ability to react to subtle nonverbal communication, like facial expression and body position, on a seconds’ notice.

People have different degrees of intuition. For some people, they are able to “read a room” without ever having met anyone in it. For others, they have a difficult time guessing a loved ones’ thoughts, despite their best effort. There are likely genetic and environmental reasons for this, although they are not well-defined.

Someone practicing as a psychic shows a high level of human intuition and understanding of the human experience, for example. By reading your face, body language, reaction to their readings, and with a little context, they are often able to provide spookily relevant advice to you about, for example, the death of a loved one.

Anxiety and mind reading

A psychic is a great example of a person using an innate ability to their advantage for their profession. Not always, however, does strong intuition on the feelings of others provide us an advantage. Many people with an anxious disposition find themselves hyper-aware of situations, and consequently, it can become overwhelming. Seeing a young group of teenagers for example might set off the anxious persons “spidey sense” and prevent them from walking by the group, whereas someone else may find themselves less preoccupied by this group of people.

An anxious person may also find themselves taking too much responsibility for keeping the flow or a party, group, or conversation comfortable, because they are more sensitive to the various social cues sent out by the attendees. An anxious person would be the first to recognize when Tim was getting bored or when Siobhan is feeling uncomfortable. They might be the first to recognize when dad has had too much, or when the hostess is getting tired. Obviously, having some degree of this behaviour shows high social intelligence. If you find yourself being unable to enjoy your own birthday party for the same reason, it might fall under the umbrella of a disorder.

Cognitive mind reading and depression

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“Everyone hates me.”

“My friends think I’m boring.”

“I know everyone is looking at the weight I put on when I go to work.”

“I give a bad first impression.”

“They all think my clothes is lame.”

One of the most common forms of pathological mind reading, is cognitive mind reading. See the examples above. We have all, probably, had a thought at least something like that at some point in the past. We might even be having those thoughts now.

The above examples represent cognitive mind reading, a phenomenon common to many forms of depression. Cognitive mind reading involves someone often making a negative assumption about someone’s thoughts, as it relates to themselves, out of keeping with reality. “Everyone hates me,” for example. Everyone does not hate you. Most people on the street don’t know you! These thoughts are actually a reflection of a depressive process.

When you become depressed, you put on some “gray-coloured glasses.” What this means is you often view things in a more negative light. The skies are grayer, video games are less fun. And seem esteem deflates. The social intuition discussed at the beginning of this post is no exception. When you’re depressed, this part pf your brain becomes hijacked, and all of a sudden, you may find yourself thinking that the world is thinking a lot more negative of you, even though it isn’t. In reality, those negative mind reading assumptions (where you believe that all of the negative things you worry people are saying about you are true) are a reflection of your brain being depressed. When you’re depressed, your brain colours everything gray. It sucks!

But it’s not all doom and gloom. Cognitive mind reading is one of the most common forms of cognitive distortions seen in depression, and physicians and therapists are well positioned to help you handle this. One of the first steps to this is understanding what cognitive mind reading is, why it’s happening, and importantly, that it’s very common in situations like your own. You’re not going crazy.

And not everybody hates your jacket.

Thought reading

While cognitive mind reading is extraordinarily common, with many depressed and non-depressed people experiencing some degree of this on any given day, thought reading is relatively rare.

Thought reading is a delusion, and is actually one of the more classic features of a

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psychotic (not psychic) illness called schizophrenia. When someone is experiencing thought reading, they literally believe that they are privy to the thoughts of others. I can literally hear your thoughts. This can be differentiated from cognitive mind reading in a few different ways.

  • Someone with thought reading may (though not necessarily) literally hear the thoughts as a form of auditory hallucination.
  • When you ask someone with cognitive mind reading to explain how they know “Yousef hates me,” they will usually give a lot of evidence, as if building an overwhelming court case. “Look at the way he did this… look at this behaviour… and I just know he does because this… he hugged me last and it seemed uncomfortable…” Someone experiencing thought reading will often reply, “I can hear their thoughts.”
  • The clinical picture is wildly different in both (though there are of course borderline cases). Thought reading is accompanied by psychosis. Cognitive mind reading is accompanied by anxiety and depression.

An important note here is that cognitive mind reading usually upsets the person and causes them problems. Thought reading has a variety of much more extreme reactions attached to it.

A twenty two year old male presents to the unit acutely psychotic and paranoid. During the course of the admission, he is very aggressive, and damages much of the furniture on the wards in a psychotically driven rage. When he’s better treated, you speak to him, and he discussed that he read the thoughts of the female nurses, and they all thought he was disgusting, which angered him.

A thirty year old male tells you about the microchip he had implanted so he can now read minds. He plans to kick some ass on the stock market with this new information. You diagnose him with a grandiose delusion.

If you are worried you have some form of mind reading, it’s most likely some degree of cognitive mind reading. If you’re concerned, see your doctor. They might help!

Dr. Travis Barron is a resident physician in Toronto, Canada.

What is Not Criminally Responsible?

You’re running, but they seem to be catching up. Guns. You think you saw them carrying guns.

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“Excuse me,” you mutter as you push up the street. You look over your shoulder and see one of them speaking into a cell phone. You mutter under your breath and dive onto a close bus. He’s calling for reinforcements. 

Salvation. You think you’ve escaped them. The bus doors shut close and the vehicle begins moving. That’s when you notice a man reaching into his pocket. He’s reaching for a gun.

You take out a knife you’ve been carrying to keep you safe, since these guys started chasing you a few months ago.

Stab him.

The voice is overpowering. You bring your arm forward and the blade sinks into the mans abdomen. The bus comes to a halt before people can even process what happens, and you make a bolt for it,

* * *

It’s a sunny day and you decide to head to the mall and meet some friends. You step out of your apartment and take a breath of fresh air. The bus soon pulls up and you step on. It’s a red light so the bus stays stopped for a little while with the doors open. You hear some commotion down the street and see a guy running.

“Oh great,” you mutter to yourself. These guys are never good company. And of course, he jumps onto the bus. You’re standing with your hands in your pocket and try and not make eye contact.

The guy gets off the bus. And your bleeding. You sink to the floor and everything goes black.

* * *

Psychosis is among the most debilitating of psychiatric illnesses. Psychosis sets in at an early age, and often rears its head in resistance to many of our best treatments.

But was is psychosis?

In broad strokes, psychosis can be defined as a severe abnormality in perception. These abnormalities can come in two forms. Delusions are fixed, false beliefs that are inappropriate in a given context. Hallucinations are sensory experiences unique to an individual not otherwise experienced by others. Psychosis is also accompanied by cognitive symptoms, which can include problems thinking, disorganization of thought, and disorganization of behaviour. Finally, negative symptoms may also occur, such as flattened emotional response, and troubles with motivation.

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It sounds nice on paper. In reality, individuals with psychosis experience a different subjective reality than most. And that’s OK. Usually. I don’t see much difference in believing you have microchips in your back than believing there are God’s in the sky. As a physician, it isn’t my job to tell you what to believe.

Many people with psychosis experience it pleasantly. They hear voices that others do not, which do not bother them. They see connections in the world that I can’t begin to compute and they love it. Sometimes, and not unusually, psychosis can be unpleasant. It can be depressing. It can be downright terrifying. It is at these points, that danger occurs.

As you can see in the scenario above, these are times we have to intervene.

Scared people act in self defense. This is true whether you have psychosis or not. When you have psychosis, you may suffer from a delusion of persecution. In other words, this would be the belief that people are after you. In the scenario above, the first person believes they’re being followed. They run up the street, they dive onto a bus and even have been carrying a knife. Finally, they commit an act of violence, and stab the person in the second scenario. Not out of malicious intent, but out of a true belief of self defense. To the second person, they were simply standing on the bus.

Even more worrisome can be command hallucinations. These are a form of auditory hallucination, or “voice,” that a person hears. These voices give orders or commands to a person, and often times, the person feels compelled to listen. This can be entirely “out of their control.” In the first scenario above, the person experiences a form of command hallucination, and this plays a role in causing them to stab the second person.

So is person one responsible for the murder?

Yes.

But this doesn’t mean they are criminally responsible.

Every few months, it appears. The latest headline and protest, lauding complaints that the most vile among us have been completely exonerated for their heinous crimes. “Not criminally responsible.” The uproar is usually dramatic. The disgust even more. From my seat, I simply try and waft away the stench of ignorance, and hope that some understanding will finally come from the news story of the day.

That time of the year has arrived again, as featured here, You can thank Joe Warmington

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for inspiring today’s blog post, so let’s set the record straight.

What is Not Criminally Responsible (NCR)?

The easiest way to explain NCR, is to explain what it isn’t. It is not a complete and total exoneration (sorry Donald Trump). It is not a get out of jail free card. And it is not a failure of the justice system.

When someone is found NCR, they are basically found to be guilty of their crimes, but because of their illness. Presumably, someone who commits a crime and who is found NCR would not commit a crime while well.

Why does it matter?

The NCR system is designed to get people well, so that they can exit the system, and begin reclaiming their life. From a sociological perspective, they begin, “contributing,” to society again. To achieve this, a finding of NCR allows the courts the compel you to take physician prescribed medications, and to comply with any drug safety monitoring required. You are typically detained in a high security psychiatric hospital, and given limited benefits, only titrated along with medication effect. Ideally, with the proper treatment, you achieve remission.

So how long does an NCR last? Well, that depends. And the system isn’t perfect. Unlike the traditional justice system, NCR findings typically do not carry sentences. To be released from an NCR, you need to have the approval of a board (here in Ontario, the Ontario Review Board), to be released. For them to be satisfied, your symptoms typically have to achieve remission. This can take a wildly different amount of time for different individuals, since everyone’s condition responds uniquely. The detention typically lasts years, followed by a step-down outpatient monitoring system. Eventually, you achieve an absolute discharge, and you have no more restrictions than your average citizen.

Like I said the system isn’t perfect. Vincent Li was infamously discharged after only nine years, following a gruesome bus beheading. Anecdotally, I’ve heard of NCR findings for robberies lasting decades longer than a regular robbery sentence. At the end of the day, the system usually works, and does a fairly good job at balancing victims rights, with human rights, and acknowledging the terrible impact these life changing illnesses may have on not only the ill individual, but all of us.

And it could use some tweaks.

Editor’s note: The focus of this post was NCR findings, therefore I focused on the risk of violence in cases of psychosis. Violence remains very rare in people with psychosis. Much more commonly, psychosis puts a person’s own safety at risk, through an overwhelming desire to complete suicide, and through personal neglect.

Dr. Travis Barron is a resident physician in Toronto, Canada.

How being in crowds (may have) caused psychosis

It’s Canada Day, and boy are you hungry. You have a hankering for sticky meats and while the drool begins to pool in your mouth, you remember. The Mandarin Chinese Buffet is having a free Canada Day buffet!

You hop on the subway and go to your nearest Mandarin. When you arrive at your stop, you wonder, “what’s that noise?” You exit the station and then it hits you. The noise was the massive crowd of hundreds of people who had the exact same idea as you. Just a few hours earlier.

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For me, those crowds were outside of my home, and man what a spectacle. Hundreds – maybe a thousand? – of people lined up to stuff their faces. This crowd is one thing at ten in the morning after a nice breakfast. It’s an entirely different beast at two in the afternoon with a rumbling stomach. Tensions start to build (indicated by the police presence that has slowly built up over time), and it’s easy to imagine how something could go wrong.

But it doesn’t. Against what seems tremendous odds, these events, as most do, go by without a major hitch or injury.  It leads one to wonder, what exactly allows us to do accomplish this as humans?

If you’ve grown up in a rural community like myself, you’re probably familiar with ant hills. If, like me, you essentially lived in a forest, there might be a few different ant hills around. Inevitably, as kids do, you take an ant from two different colonies and leave them together.

Spoiler: they fight to the death.

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This obviously doesn’t happen with humans. In fact, you can take two humans who couldn’t be from more different walks of life, and often times, a relationship will form. Why have we evolved this way? Well, it helps us! Humans are social animals at their very core, and our human society is the only society (think meercats, honey bees, other social animals), that have built a civilization. Civilization has allowed us as a species to thrive and master the planet like none before us. What does it take to build a civilization?

Trust, for one. Humans have needed to evolve trust of one another so that we can take full advantage of the world’s resources. We need to trust that by doing our jobs (which often times have absolutely nothing to do with the basic necessities of life), we get paid, and we need to trust that by getting paid, we are able to buy food and resources to sustain ourselves. It would be difficult to wake up every morning and be an insurance broker if that didn’t translate into food, shelter, and security for your family.

Trust, however, can only go so far. There are inevitably people among us who would violate that trust, and who would harm us, were our defenses so low. This problem has been increasingly important as humans live in denser and denser cities. It has required us to develop suspicion, to complement our trust of each other. In big cities, a mild level of paranoia keeps us safe. It makes us lock our doors at night, avoid the dark alley, and be aware of people acting strangely or dangerously around us. To simplify things, you could say all of us have inherited a little suspicion from our parents.

Sometimes, people can inherit too much suspicion. We may call this paranoia, or psychosis. This might make you believe people want to harm you, or that you are being monitored. You might begin to take meaning from completely innocuous things, due to hyperviligance. Think of psychosis as our natural suspicion in overdrive, suspicious traits that have become too concentrated. This perhaps lends to the fact that living in an urban environment significantly increases your risk of developing psychosis.

This theory is one of many behind the question, why does psychosis exist? We may never know for sure. What I do know, is that the human mind is fascinating, and we can often under appreciate the profound significance behind something as apparently simple as being in a crowd.

Like more on psychosis? Try this out!

Dr. Travis Barron is a resident physician in Toronto, Canada.

There’s a microchip in my head

“Hi, welcome to our emergency room, what brings you in today?”

“I need to see a surgeon.”

“And why is that?”

“I need to get the microchips implanted in my brain removed.”

What is the role of a psychiatrist? Depending on who you ask, you’re likely to get many different answers. To help people. To make me feel better. To push pills. Population control. It’s a question I myself have struggled with time and time again throughout my career, and it would be a lie to tell you I knew the answer perfectly. In reality, a psychiatrist wears many hats, and many psychiatrists view their own roles quite differently, which is reflected in how they practice.

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I was a wee-medical student in Ontario, Canada, working in the emergency department one summer. We had a gentleman come in and request to see a surgeon to remove microchips from his brain that he felt were responsible for broadcasting his thoughts to the public.

In Canada, when you go to the emergency department, the first physician to assess you would be an Emergency Medicine physician. The doctor I worked with that day, Dr. S, asked me to go see the gentleman.

When I met him, he was tall, skinny (certainly not emaciated), and appeared a little anxious. He was far from the most distressed patient I had ever met and was not agitated whatsoever. I asked him the usual battery of questions and he denied being suicidal or wanting to harm anyone. He simply kept coming back to these microchips. “When is the surgeon going to come?”

I finished my assessment and thanked the gentleman for his time. I explained to him that in my experience, what he was experiencing could be best explained by a condition called psychosis. And good news! Psychosis is a condition that responds to medicine, and we are able to arrange for him to see a psychiatrist today if he is interested.

“When is the surgeon going to come?”

I excitedly headed towards the nursing station to review with my supervisor, confident that my diagnosis was correct and that my plan was solid.

“So, what do you think?”

“I think the most likely diagnosis is psychosis, probably secondary to schizophrenia based on his presentation.”

“Excellent, I agree. What would you like to do?”

“Well, I think we should consult psychiatry, send some antipsychotic labs, call his fam-“

“Wait a minute. Does he want to see a psychiatrist?”

“No, he thinks he needs to see a surgeon.”

My preceptor smiled and asked for my reasoning for treatment, and I explained that the guy is psychotic, he needs treatment. She disagreed.

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The patient was psychotic, this is true. He was not suicidal, he wasn’t violent. He wasn’t agitated, or emaciated. There was no real visible distress – certainly not close to the amount of distress involuntary admission to hospital and coercive treatment causes. And he didn’t want to see a psychiatrist. At the time, I was somewhat mystified at the idea of not treating someone with such profound symptoms that in all likelihood would have been at least somewhat amenable to treatment. I imagined this guy’s life coming together, all his problems solved with my little pill.

Today, I know better.

People are entitled to believe and feel what they want. I have no right to tell you how to feel or what to believe. Is believing you have microchips in your head so different than believing there is someone in the sky that created the earth in seven days? I’m not sure it is. What my job is, is to intervene at moments of risk. You can believe you have microchips in your head – if that becomes so intolerable you feel like you need to kill yourself, it is my duty to intervene and keep people safe. In the absence of risk, as the old adage goes in Newfoundland, more power to ya.

There is of course the argument about treating psychosis when it begins to impact people’s lives, but does not cause an immediate risk. Someone who gradually becomes homeless over time due to functional problems as a result of psychosis, for example. Think the guy talking to himself on the side of the street. Yes, these people would (likely) benefit from antipsychotic treatment, but only when it comes from their own free will. When medications are forced on people, they quit them the first chance they get.

So what is my job as a psychiatrist? To help. To be available. To sometimes intervene and violate free will when there is a risk of harm to someone. But not to tell you what to think, how to feel, or what to believe. That’s your own choice.

 Editor’s Note: We did of course offer this gentleman ample follow up, and he politely refused everything we had to offer. What we find important here is making this gentleman feel safe when he comes to hospital so that when he does need us, he feels safe to come.

Dr. Travis Barron is a resident physician in the Department of Psychiatry at the University of Toronto in Toronto, Canada.