Computational theory of mind

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https://en.wikipedia.org/wiki/Computational_theory_of_mind

In philosophy of mind, the computational theory of mind (CTM), also known as computationalism, is a family of views that hold that the human mind is an information processing system and that cognition and consciousness together are a form of computation. It is closely related to functionalism, a broader theory that defines mental states by what they do rather than what they are made of.

Warren McCulloch and Walter Pitts (1943) were the first to suggest that neural activity is computational. They argued that neural computations explain cognition. The theory was proposed in its modern form by Hilary Putnam in 1960 and 1961, and then developed by his PhD student, philosopher, and cognitive scientist Jerry Fodor in the 1960s, 1970s, and 1980s. It was later criticized in the 1990s by Putnam himself, John Searle, and others.

The computational theory of mind holds that the mind is a computational system that is realized (i.e. physically implemented) by neural activity in the brain. The theory can be elaborated in many ways and varies largely based on how the term computation is understood. Computation is commonly understood in terms of Turing machines which manipulate symbols according to a rule, in combination with the internal state of the machine. The critical aspect of such a computational model is that we can abstract away from particular physical details of the machine that is implementing the computation. For example, the appropriate computation could be implemented either by silicon chips or biological neural networks, so long as there is a series of outputs based on manipulations of inputs and internal states, performed according to a rule. CTM therefore holds that the mind is not simply analogous to a computer program, but that it is literally a computational system.

Computational theories of mind are often said to require mental representation because 'input' into a computation comes in the form of symbols or representations of other objects. A computer cannot compute an actual object but must interpret and represent the object in some form and then compute the representation. The computational theory of mind is related to the representational theory of mind in that they both require that mental states are representations. However, the representational theory of mind shifts the focus to the symbols being manipulated. This approach better accounts for systematicity and productivity. In Fodor's original views, the computational theory of mind is also related to the language of thought. The language of thought theory allows the mind to process more complex representations with the help of semantics.

Recent work has suggested that we make a distinction between the mind and cognition. Building from the tradition of McCulloch and Pitts, the computational theory of cognition (CTC) states that neural computations explain cognition. The computational theory of mind asserts that not only cognition, but also phenomenal consciousness or qualia, are computational. That is to say, CTM entails CTC. While phenomenal consciousness could fulfill some other functional role, computational theory of cognition leaves open the possibility that some aspects of the mind could be non-computational. CTC, therefore, provides an important explanatory framework for understanding neural networks, while avoiding counter-arguments that center around phenomenal consciousness.

"Computer metaphor"

Computational theory of mind is not the same as the computer metaphor, comparing the mind to a modern-day digital computer. Computational theory just uses some of the same principles as those found in digital computing. While the computer metaphor draws an analogy between the mind as software and the brain as hardware, CTM is the claim that the mind is a computational system. More specifically, it states that a computational simulation of a mind is sufficient for the actual presence of a mind, and that a mind truly can be simulated computationally.

'Computational system' is not meant to mean a modern-day electronic computer. Rather, a computational system is a symbol manipulator that follows step-by-step functions to compute input and form output. Alan Turing describes this type of computer in his concept of a Turing machine.

Criticism

A range of arguments have been proposed against physicalist conceptions used in computational theories of mind.

An early, though indirect, criticism of the computational theory of mind comes from philosopher John Searle. In his thought experiment known as the Chinese room, Searle attempts to refute the claims that artificially intelligent agents can be said to have intentionality and understanding and that these systems, because they can be said to be minds themselves, are sufficient for the study of the human mind. Searle asks us to imagine that there is a man in a room with no way of communicating with anyone or anything outside of the room except for a piece of paper with symbols written on it that is passed under the door. With the paper, the man is to use a series of provided rule books to return paper containing different symbols. Unknown to the man in the room, these symbols are of a Chinese language, and this process generates a conversation that a Chinese speaker outside of the room can actually understand. Searle contends that the man in the room does not understand the Chinese conversation. This is essentially what the computational theory of mind presents us—a model in which the mind simply decodes symbols and outputs more symbols. Searle argues that this is not real understanding or intentionality. This was originally written as a repudiation of the idea that computers work like minds.

Searle has further raised questions about what exactly constitutes a computation:

the wall behind my back is right now implementing the WordStar program, because there is some pattern of molecule movements that is isomorphic with the formal structure of WordStar. But if the wall is implementing WordStar, if it is a big enough wall it is implementing any program, including any program implemented in the brain.

Objections like Searle's might be called insufficiency objections. They claim that computational theories of mind fail because computation is insufficient to account for some capacity of the mind. Arguments from qualia, such as Frank Jackson's knowledge argument, can be understood as objections to computational theories of mind in this way—though they take aim at physicalist conceptions of the mind in general, and not computational theories specifically.

There are also objections which are directly tailored for computational theories of mind.

Jerry Fodor himself argues that the mind is still a very long way from having been explained by the computational theory of mind. The main reason for this shortcoming is that most cognition is abductive and global, hence sensitive to all possibly relevant background beliefs to (dis)confirm a belief. This creates, among other problems, the frame problem for the computational theory, because the relevance of a belief is not one of its local, syntactic properties but context-dependent. 

Putnam himself (see in particular Representation and Reality and the first part of Renewing Philosophy) became a prominent critic of computationalism for a variety of reasons, including ones related to Searle's Chinese room arguments, questions of world-word reference relations, and thoughts about the mind-body problem. Regarding functionalism in particular, Putnam has claimed along lines similar to, but more general than Searle's arguments, that the question of whether the human mind can implement computational states is not relevant to the question of the nature of mind, because "every ordinary open system realizes every abstract finite automaton." Computationalists have responded by aiming to develop criteria describing what exactly counts as an implementation.

Roger Penrose has proposed the idea that the human mind does not use a knowably sound calculation procedure to understand and discover mathematical intricacies. This would mean that a normal Turing complete computer would not be able to ascertain certain mathematical truths that human minds can. However, the application of Gödel's theorem by Penrose to demonstrate it was widely criticized, and is considered erroneous.

Pancomputationalism

CTM raises a question that remains a subject of debate: what does it take for a physical system (such as a mind, or an artificial computer) to perform computations? A very straightforward account is based on a simple mapping between abstract mathematical computations and physical systems: a system performs computation C if and only if there is a mapping between a sequence of states individuated by C and a sequence of states individuated by a physical description of the system.

Putnam (1988) and Searle (1992) argue that this simple mapping account (SMA) trivializes the empirical import of computational descriptions. As Putnam put it, "everything is a Probabilistic Automaton under some Description". Even rocks, walls, and buckets of water—contrary to appearances—are computing systems. Gualtiero Piccinini identifies different versions of Pancomputationalism.

In response to the trivialization criticism, and to restrict SMA, philosophers of mind have offered different accounts of computational systems. These typically include causal account, semantic account, syntactic account, and mechanistic account. Instead of a semantic restriction, the syntactic account imposes a syntactic restriction. The mechanistic account was first introduced by Gualtiero Piccinini in 2007.

Notable theorists

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• Daniel Dennett proposed the multiple drafts model, in which consciousness seems linear but is actually blurry and gappy, distributed over space and time in the brain. Consciousness is the computation, there is no extra step in which you become conscious of the computation.
• Jerry Fodor argues that mental states, such as beliefs and desires, are relations between individuals and mental representations. He maintains that these representations can only be correctly explained in terms of a language of thought (LOT) in the mind. Further, this language of thought itself is codified in the brain, not just a useful explanatory tool. Fodor adheres to a species of functionalism, maintaining that thinking and other mental processes consist primarily of computations operating on the syntax of the representations that make up the language of thought. In later work (Concepts and The Elm and the Expert), Fodor has refined and even questioned some of his original computationalist views, and adopted LOT2, a highly modified version of LOT.
• David Marr proposed that cognitive processes have three levels of description: the computational level, which describes that computational problem solved by the cognitive process; the algorithmic level, which presents the algorithm used for computing the problem postulated at the computational level; and the implementational level, which describes the physical implementation of the algorithm postulated at the algorithmic level in the brain.
• Ulric Neisser coined the term cognitive psychology in his book with that title published in 1967. Neisser characterizes people as dynamic information-processing systems whose mental operations might be described in computational terms.
• Steven Pinker described language instinct as an evolved, built-in capacity to learn language (if not writing). His 1997 book How the Mind Works sought to popularize the computational theory of mind for wide audiences.
• Hilary Putnam proposed functionalism to describe consciousness, asserting that it is the computation that equates to consciousness, regardless of whether the computation is operating in a brain or in a computer.

Scientific community

The scientific community is a diverse network of interacting scientists. It includes many "sub-communities" working on particular scientific fields, and within particular institutions; interdisciplinary and cross-institutional activities are also significant. Objectivity is expected to be achieved by the scientific method. Peer review, through discussion and debate within journals and conferences, assists in this objectivity by maintaining the quality of research methodology and interpretation of results.

History of scientific communities

See also: History of science

The eighteenth century had some societies made up of men who studied nature, also known as natural philosophers and natural historians, which included even amateurs. As such these societies were more like local clubs and groups with diverse interests than actual scientific communities, which usually had interests on specialized disciplines. Though there were a few older societies of men who studied nature such as the Royal Society of London, the concept of scientific communities emerged in the second half of the 19th century, not before, because it was in this century that the language of modern science emerged, the professionalization of science occurred, specialized institutions were created, and the specialization of scientific disciplines and fields occurred.

For instance, the term scientist was first coined by the naturalist-theologian William Whewell in 1834 and the wider acceptance of the term along with the growth of specialized societies allowed for researchers to see themselves as a part of a wider imagined community, similar to the concept of nationhood.

Membership, status and interactions

Membership in the community is generally, but not exclusively, a function of education, employment status, research activity and institutional affiliation. Status within the community is highly correlated with publication record, and also depends on the status within the institution and the status of the institution. Researchers can hold roles of different degrees of influence inside the scientific community. Researchers of a stronger influence can act as mentors for early career researchers and steer the direction of research in the community like agenda setters. Scientists are usually trained in academia through universities. As such, degrees in the relevant scientific sub-disciplines are often considered prerequisites in the relevant community. In particular, the PhD with its research requirements functions as a marker of being an important integrator into the community, though continued membership is dependent on maintaining connections to other researchers through publication, technical contributions, and conferences. After obtaining a PhD an academic scientist may continue through being on an academic position, receiving a post-doctoral fellowships and onto professorships. Other scientists make contributions to the scientific community in alternate ways such as in industry, education, think tanks, or the government.

Members of the same community do not need to work together. Communication between the members is established by disseminating research work and hypotheses through articles in peer reviewed journals, or by attending conferences where new research is presented and ideas exchanged and discussed. There are also many informal methods of communication of scientific work and results as well. And many in a coherent community may actually not communicate all of their work with one another, for various professional reasons.

Speaking for the scientific community

Solvay Conference of 1927, with prominent physicists such as Albert Einstein, Werner Heisenberg, Max Planck, Marie Curie and Paul Dirac.

Unlike in previous centuries when the community of scholars were all members of few learned societies and similar institutions, there are no singular bodies or individuals which can be said today to speak for all science or all scientists. This is partly due to the specialized training most scientists receive in very few fields. As a result, many would lack expertise in all the other fields of the sciences. For instance, due to the increasing complexity of information and specialization of scientists, most of the cutting-edge research today is done by well funded groups of scientists, rather than individuals. However, there are still multiple societies and academies in many countries which help consolidate some opinions and research to help guide public discussions on matters of policy and government-funded research. For example, the United States' National Academy of Sciences (NAS) and United Kingdom's Royal Society sometimes act as surrogates when the opinions of the scientific community need to be ascertained by policy makers or the national government, but the statements of the National Academy of Science or the Royal Society are not binding on scientists nor do they necessarily reflect the opinions of every scientist in a given community since membership is often exclusive, their commissions are explicitly focused on serving their governments, and they have never "shown systematic interest in what rank-and-file scientists think about scientific matters". Exclusivity of membership in these types of organizations can be seen in their election processes in which only existing members can officially nominate others for candidacy of membership. It is very unusual for organizations like the National Academy of Science to engage in external research projects since they normally focus on preparing scientific reports for government agencies. An example of how rarely the NAS engages in external and active research can be seen in its struggle to prepare and overcome hurdles, due to its lack of experience in coordinating research grants and major research programs on the environment and health.

Nevertheless, general scientific consensus is a concept which is often referred to when dealing with questions that can be subject to scientific methodology. While the consensus opinion of the community is not always easy to ascertain or fix due to paradigm shifting, generally the standards and utility of the scientific method have tended to ensure, to some degree, that scientists agree on some general corpus of facts explicated by scientific theory while rejecting some ideas which run counter to this realization. The concept of scientific consensus is very important to science pedagogy, the evaluation of new ideas, and research funding. Sometimes it is argued that there is a closed shop bias within the scientific community toward new ideas. Protoscience, fringe science, and pseudoscience have been topics that discuss demarcation problems. In response to this some non-consensus claims skeptical organizations, not research institutions, have devoted considerable amounts of time and money contesting ideas which run counter to general agreement on a particular topic.

Philosophers of science argue over the epistemological limits of such a consensus and some, including Thomas Kuhn, have pointed to the existence of scientific revolutions in the history of science as being an important indication that scientific consensus can, at times, be wrong. Nevertheless, the sheer explanatory power of science in its ability to make accurate and precise predictions and aid in the design and engineering of new technology has ensconced "science" and, by proxy, the opinions of the scientific community as a highly respected form of knowledge both in the academy and in popular culture.

Political controversies

President Clinton meets the 1998 U.S. Nobel Prize winners in the White House

The high regard with which scientific results are held in Western society has caused a number of political controversies over scientific subjects to arise. An alleged conflict thesis proposed in the 19th century between religion and science has been cited by some as representative of a struggle between tradition and substantial change and faith and reason. A popular example used to support this thesis is when Galileo was tried before the Inquisition concerning the heliocentric model. The persecution began after Pope Urban VIII permitted Galileo to write about the Copernican model. Galileo had used arguments from the Pope and put them in the voice of the simpleton in the work "Dialogue Concerning the Two Chief World Systems" which caused great offense to him. Even though many historians of science have discredited the conflict thesis it still remains a popular belief among many including some scientists. In more recent times, the creation–evolution controversy has resulted in many religious believers in a supernatural creation to challenge some naturalistic assumptions that have been proposed in some of the branches of scientific fields such as evolutionary biology, geology, and astronomy. Although the dichotomy seems to be of a different outlook from a Continental European perspective, it does exist. The Vienna Circle, for instance, had a paramount (i.e. symbolic) influence on the semiotic regime represented by the Scientific Community in Europe.

In the decades following World War II, some were convinced that nuclear power would solve the pending energy crisis by providing energy at low cost. This advocacy led to the construction of many nuclear power plants, but was also accompanied by a global political movement opposed to nuclear power due to safety concerns and associations of the technology with nuclear weapons. Mass protests in the United States and Europe during the 1970s and 1980s along with the disasters of Chernobyl and Three Mile Island led to a decline in nuclear power plant construction.

In the last decades or so, both global warming and stem cells have placed the opinions of the scientific community in the forefront of political debate.

Abilene paradox

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Abilene_paradox

The Abilene paradox is a collective fallacy, in which a group of people collectively decide on a course of action that is counter to the preferences of most or all individuals in the group, while each individual believes it to be aligned with the preferences of most of the others. It involves a breakdown of group communication in which each member mistakenly believes that their own preferences are counter to the group's, and therefore does not raise objections. They even go so far as to state support for an outcome they do not want.

A common phrase related to the Abilene paradox is a desire to not "rock the boat". Like in groupthink, group members jointly decide on a course of action that they would not choose as individuals. However, while in groupthink, individuals undergo self-deception and distortion of their own views (driven by, for example, not wanting to suffer in anticipation of a future they sense they cannot avoid by speaking out), in the Abilene Paradox, individuals are unable to perceive the views or preferences of others, or to manage an agreement.

Overview

The term was introduced by a management expert Jerry B. Harvey in his 1974 article "The Abilene Paradox: The Management of Agreement". The name of the phenomenon comes from an anecdote that Harvey uses in the article to elucidate the paradox:

On a hot afternoon visiting in Coleman, Texas, the family is comfortably playing dominoes on a porch, until the father-in-law suggests that they take a [50-mile (80-km)] trip to Abilene for dinner. The wife says, "Sounds like a great idea." The husband, despite having reservations because the drive is long and hot, thinks that his preferences must be out-of-step with the group and says, "Sounds good to me. I just hope your mother wants to go." The mother-in-law then says, "Of course I want to go. I haven't been to Abilene in a long time."

The drive is hot, dusty, and long. When they arrive at the cafeteria, the food is as bad as the drive. They arrive back home four hours later, exhausted.

One of them dishonestly says, "It was a great trip, wasn't it?" The mother-in-law says that, actually, she would rather have stayed home, but went along since the other three were so enthusiastic. The husband says, "I wasn't delighted to be doing what we were doing. I only went to satisfy the rest of you." The wife says, "I just went along to keep you happy. I would have had to be crazy to want to go out in the heat like that." The father-in-law then says that he only suggested it because he thought the others might be bored.

The group sits back, perplexed that they together decided to take a trip that none of them wanted. They each would have preferred to sit comfortably but did not admit to it when they still had time to enjoy the afternoon.

The Abilene Paradox consists of five components:

1. The first component refers to mutual agreement of a group that the current situation is not acceptable. However, on the individual level, the members may be satisfied with the existing setting after they have compared it with proposed alternatives.
2. The second component stands for ineffective communication within the group when several members express considerable support for a decision because they assume that is the desire of others. This process of communication reinforces assumptions that individual thoughts are a minority in the group.
3. The third component of the Abilene Paradox is the vocalisation of group sentiment which arose from inaccurate assumptions or incorrect interpretation of the "signals" given by other members.
4. The fourth component refers to the decision-maker's reflections on the actions taken, usually in the form of questions as follows: "Why did we do this?", "How can we justify our decision to others?".
5. The fifth component refers to the defeat of the group leader to poor decision making in order to avoid making similar decisions in the future.

There are several factors that may indicate the presence of the Abilene Paradox in the decision-making process:

• Leaders who publicly do not fear the unknown. Such arrogance leads them to go along as they do not possess sufficient understanding of complex problems. Rather, they stick to the "that sounds good to me" attitude.
• A group with no-conflict or no-debate type of decision-making. When such views are supported in the cohort, the lack of diverse opinions becomes the foundation for mismanagement of agreement. This can be visible by the emergence of the "I will go along with that" attitude.
• Overriding leaders and a strong organisation culture. A strong leader and solid organisation may become a powerful asset, it may also intimidate other members of subordinates to the point of submission. This results in the inclination of supporting more dominant ideas.
• Lack of diversity and pluralistic perspective in a group. Homogeneous groups tend to be conformal. Such groups tend to achieve consensus rather than searching for the "right" decision.
• Recognition of a dysfunctional decision-making environment. Management in this environment has lost control, as the directional prerogative of management has succumbed to wanting to be liked by avoiding conflict.
• The feeling of a "messiah" in the organisation and action anxiety on the part of management. When the group handles complex tasks, there is usually one person or a small cohort within the group who has required expertise to manage in this situation. As a result, there is a tendency to acquiesce to them.
• The development of a "spiral of silence" in the organisation. The spiral of silence occurs when one's perception of the majority opinion in the organisation suppresses one's willingness to express any challenging opinion against the most visible point of view.

Research

Based on an online experiment with more than 600 participants, being prosocial and generally caring about the implications of one's actions on others (measured by the social value orientation measure) has been shown to increase the likelihood that an individual finds themselves in an Abilene Paradox with others, especially if they are not the first to have a say.

The study at Makerere University Business School described the case of the Abilene Paradox in the process of decision-making in 2006: The institution was in a dispute with its parent institution, Makerere University, over its status as an independent university. A meeting of the MUBS Academic Staff Association (MUBASA) was called to discuss the issue, and the attendees voted to support MUBS council's decision to sue the Ministry of Education for interfering in a high court pronouncement. Each member of the association was to contribute towards the legal costs. By interviewing 68 employees, the researcher found that the majority of them never considered it a solution but thought that others strongly support the idea of starting the trial.

Chen and Chang conducted a study about the effects, causes, and influences of the Abilene paradox, if any, on their elementary school; and this study involved twelve faculty members. Results of this Abilene paradox study showed a negative effect on the school’s operation, through poor communication, inadequate interaction, isolation, exclusion, and rising gossip.

Applications of the concept

The theory is often used to help explain poor group decisions, especially notions of the superiority of "rule by committee". For example, Harvey cited the Watergate scandal as a potential instance of the Abilene paradox in action. The Watergate scandal occurred in the United States in the 1970s when many high officials of the Nixon administration colluded in the cover-up and perhaps the execution of a break-in at the Democratic National Committee headquarters in Washington, D.C. Harvey quotes several people indicted for the coverup as indicating that they had personal qualms about the decision but feared to voice them. In one instance, campaign aide Herbert Porter said that he "was not one to stand up in a meeting and say that this should be stopped", a decision that he attributed to "the fear of the group pressure that would ensue, of not being a team player".

Another notable example of applying the Abilene paradox to the notorious real-world event can be seen during and in the aftermath of the 1989 United Kingdom Hillsborough tragedy and its cover-up by the authorities, which was characterised by individually hesitant, but otherwise compliant, government agents and the narrative and available information moulded and manipulated by the state. The other frequently cited example is the case of Challenger disaster, thought in that case researchers use both the concepts of groupthink and the Abilene paradox as possible explanation of the events.

The phenomenon of the Abilene paradox can also be used in information systems development, to conceptualise and operationalise the relationship between systems analysts, users, and other organisational stakeholders in situations of illusory agreement.

Related concepts and explanations

Other theories add to the Abilene paradox’s explanation of poor decision-making in groups, notably, such phenomena as groupthink and pluralistic ignorance.

The concept of groupthink posits that individuals correctly perceive the preferences of others, undergo some form of motivated reasoning, which distorts their true preferences, and then willingly choose to conform; hence, they generally feel positively about the resulting group decisions. The success of groupthink also hinges on the long-term homogeneity of the group, which seeks to keep that same cohesiveness and therefore to avoid all potential conflict. However, while groupthink, to some extent, depends on the ability of individuals to perceive attitudes and desires of others, the Abilene paradox hinges on the inability to gage true wants and intentions of group members.

The concept of pluralistic ignorance, on the other hand, is also defined as the situation where an individual underestimates the extent to which their views are shared by the other members of the group or organisation. In some ways, pluralistic ignorance can be considered as a factor inciting situations where the Abilene paradox occurs — individuals’ inability to correctly estimate the share of potential supporters lead to the assumption of ‘the worst case scenario’ and in-advance mitigation of potential risks of dealing with the opponents. Some researchers consider pluralistic ignorance to be a wider-ranging concept: while both groupthink and the Abilene paradox are usually discussed as the detriments to successful group decision-making, pluralistic ignorance is sometimes evaluated neutrally.

Rat race

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Rat_race

Artist's depiction of the modern day rat race

A rat race is an endless, self-defeating, or pointless pursuit. The phrase equates humans to rats attempting to earn a reward such as cheese, in vain. It may also refer to a competitive struggle to get ahead financially or routinely.

The term is commonly associated with an exhausting, repetitive lifestyle that leaves no time for relaxation or enjoyment.

Etymology

In the late 1800s, the term "rat-run" was used meaning "maze-like passages by which rats move about their territory", commonly used in a derogatory sense.

By the 1930s actual rat races of some sort are frequently mentioned among carnival and gambling attractions.

By 1934, "rat-race" was also used in reference to aviation training, referring to a "follow-the-leader" game in which a trainee fighter pilot had to copy all the actions (loops, rolls, spins, Immelmann turns etc.) performed by an experienced pilot.

From 1939, the phrase took on the meaning of "competitive struggle" referring to a person's work and life.

Historical usage

The Rat Race was used as a title for a novel written by Jay Franklin in 1947 for Colliers Magazine and first published in book form in 1950. It is dedicated To those few rats in Washington who do not carry brief-cases.

The term "rat race" was used in an article about Samuel Goudsmit published in 1953 entitled: A Farewell to String and Sealing Wax~I in which Daniel Lang wrote:

Sometimes when his sardonic mood is on him, he wonders whether the synchrotrons, the betatrons, the cosmotrons, and all the other contrivances physicists have lately rigged up to create energy by accelerating particles of matter aren't playing a wry joke on their inventors. "They are accelerating us too," he says, in a voice that still betrays a trace of the accent of his native Holland. In protesting against the speedup, Goudsmit can speak with authority, for in the course of only a few years, he, like many other contemporary physicists, has seen his way of life change from a tranquil one of contemplation to a rat race.

Philip K. Dick used the term in "The Last of the Masters" published in 1954:

"Maybe," McLean said softly, "you and I can then get off this rat race. You and I and all the rest of us. And live like human beings." "Rat race," Fowler murmured. "Rats in a maze. Doing tricks. Performing chores thought up by somebody else." McClean caught Fowler's eye. "By somebody of another species."

Jim Bishop used the term rat race in his book The Golden Ham: A Candid Biography of Jackie Gleason. The term occurs in a letter Jackie Gleason wrote to his wife in which he says: "Television is a rat race, and remember this, even if you win you are still a rat."

William H. Whyte used the term rat race in The Organization Man published in 1956:

The word collective most of them can't bring themselves to use—except to describe foreign countries or organizations they don't work for—but they are keenly aware of how much more deeply beholden they are to organization than were their elders. They are wry about it, to be sure; they talk of the "treadmill," the "rat race," of the inability to control one's direction.

Merle A. Tuve used the term rat race in a 1959 article entitled "Is Science Too Big for the Scientist?", writing:

There is a growing conviction among many of my friends in academic circles that the university today is no place for a scholar in science. A professor's life nowadays is a rat-race of busyness and activity, managing contracts and projects, guiding teams of assistants, bossing crews of technicians, making numerous trips, sitting on committees for government agencies, and engaging in other distractions necessary to keep the whole frenetic business from collapse.

David Foster Wallace used the term rat race in his 2005 commencement speech entitled "The Most Precious Freedom":

The really important kind of freedom involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, (unglamourous) ways every day. That is real freedom. That is being educated, and understanding how to think. The alternative is unconsciousness, the default setting, the rat race, the constant gnawing sense of having had, and lost, some infinite thing.

Solutions

"Escaping the rat race" can have a number of different meanings:

• Movement from work or geographical location into (typically) a more rural area
• Retirement, quitting or ceasing work
• Moving from a job of high strenuosity to one of lesser strenuosity
• Adopting a Buddha-like mindset
• Changing to a different job altogether
• Remote work
• Becoming financially independent from an employer
• Living in harmony with nature
• Developing an inner attitude of detachment from materialistic pursuits
• Alienation from the norms of society

Music

• "Rat Race" by British rock band Enter Shikari (2013)
• Have a Blast Periphery II by Periphery (2012)
• "Slave to the Wage" by English alternative rock band Placebo (2000)
• "Escape (Free Yo Mind From This Rat Race)" by American singer Prince
• "Rat Race" by English ska band The Specials (1980)
• "Mice Race" by British anarcho-punk band Rudimentary Peni (1982)
• "Rat Race" by Billy Idol (2005)
• "Rat Race" by Bob Marley (1976)
• "Rat Race" by Babbu Maan (2020)
• "The Clockwise Witness" by DeVotchKa describes the futility of the rat race (2008)
• "Even if You Win, You're Still a Rat" by British metalcore band Architects (2012)
• RatRace by English metal band Skindred (2007)
• "The Racing Rats" by English rock band Editors (2007)
• Mentioned in the song "Country House" by English rock band Blur (1995)

Status epilepticus

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Status_epilepticus 

 

Status epilepticus
Generalized 3 Hz spike-and-wave discharges on an electroencephalogram

Status epilepticus (SE), or status seizure, is a medical condition consisting of a single seizure lasting more than 5 minutes, or 2 or more seizures within a 5-minute period without the person returning to normal between them. Previous definitions used a 30-minute time limit. The seizures can be of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions, such as absence seizures or complex partial seizures. Status epilepticus is a life-threatening medical emergency, particularly if treatment is delayed.

Status epilepticus may occur in those with a history of epilepsy as well as those with an underlying problem of the brain. These underlying brain problems may include trauma, infections, or strokes, among others. Diagnosis often involves checking the blood sugar, imaging of the head, a number of blood tests, and an electroencephalogram. Psychogenic nonepileptic seizures may present similarly to status epilepticus. Other conditions that may also appear to be status epilepticus include low blood sugar, movement disorders, meningitis, and delirium, among others. Status epilepticus can also appear when tuberculous meningitis becomes very severe.

Benzodiazepines are the preferred initial treatment, after which typically phenytoin is given. Possible benzodiazepines include intravenous lorazepam as well as intramuscular injections of midazolam. A number of other medications may be used if these are not effective, such as phenobarbital, propofol, or ketamine. After initial treatment with benzodiazepines, typical antiseizure drugs should be given, including valproic acid (valproate), fosphenytoin, levetiracetam, or a similar substance(s). While empirically based treatments exist, few head-to-head clinical trials exist, so the best approach remains undetermined. This said, "consensus-based" best practices are offered by the Neurocritical Care Society. Intubation may be required to help maintain the person's airway. Between 10% and 30% of people who have status epilepticus die within 30 days. The underlying cause, the person's age, and the length of the seizure are important factors in the outcome. Status epilepticus occurs in up to 40 per 100,000 people per year. Those with status epilepticus make up about 1% of people who visit the emergency department.

Signs and symptoms

Status epilepticus can be divided into two categories: convulsive and nonconvulsive (NCSE).

Convulsive

Convulsive status epilepticus presents an urgent neurological condition, which is characterized by an elongated and uncontrollable onsets of seizures in which a regular pattern of contraction and extension of the arms and legs will be observed from the patient. The symptoms can be managed by initially introducing a seizure suppressing medication as the first stage of the treatment, which optimally works only for that stage because any delay will reduce the efficacy of those medications. Convulsive status epilepticus commonly affects the elderly and young children, with a mortality rate of up to 20–30% of elderly patients and 0–3% of young children. Patients who survive initial onset are often left with cognitive and neurological defects.

Epilepsia partialis continua is a variant involving hour-, day-, or even week-long jerking. It is a consequence of vascular disease, tumors, or encephalitis, and is drug-resistant.

Generalized myoclonus is commonly seen in comatose people following cardiopulmonary resuscitation (CPR) and is seen by some as an indication of catastrophic damage to the neocortex; myoclonus status in this situation can usually (but not always) be considered an agonal phenomenon.

Refractory status epilepticus is defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug.

Super-refractory status epilepticus is defined as status epilepticus that continues or recurs 24 hours or more after the onset of anaesthetic therapy, including those cases where status epilepticus recurs on the reduction or withdrawal of anesthesia.

Nonconvulsive

Nonconvulsive status epilepticus is a relatively long duration change in a person's level of consciousness without large-scale bending and extension of the limbs due to seizure activity. It is of two main types with either prolonged complex partial seizures or absence seizures. Up to a quarter of cases of SE are nonconvulsive.

In the case of complex partial status epilepticus, the seizure is confined to a small area of the brain, normally the temporal lobe. Absence status epilepticus is marked by a generalized seizure affecting the whole brain. An electroencephalogram (EEG) is needed to differentiate between the two conditions.

The cases of nonconvulsive status epilepticus are characterized by a long-lasting stupor, staring, and unresponsiveness. Recent studies indicated 50% of cases involve patients that are semi-conscious in a way that they can respond but are confused spontaneously. Only 6% have shown a decelerated thought process. About 44% of cases of nonconvulsive status epilepticus are marked by a prolonged or fragmentary coma.

Causes

Only 25% of people who experience seizures or status epilepticus have epilepsy. The following is a list of possible causes:

• Stroke
• Hemorrhage
• Intoxicants or adverse reactions to drugs
• Insufficient dosage or sudden withdrawal of a medication (especially anticonvulsants)
• Insufficient dosage or sudden withdrawal of benzodiazepine(s) medication (akin to alcohol withdrawal); itself a class of antiseizure/anticonvulsant medications
• Consumption of alcoholic beverages while on an anticonvulsant, or alcohol withdrawal
• Dieting or fasting while on an anticonvulsant
• Starting on a new medication that reduces the effectiveness of the anticonvulsant or changes drug metabolism, decreasing its half-life, leading to decreased blood concentrations
• Developing a resistance to an anticonvulsant already being used
• Gastroenteritis while on an anticonvulsant, where lower levels of anticonvulsant may exist in the bloodstream due to vomiting of gastric contents or reduced absorption due to mucosal edema
• Developing a new, unrelated condition in which seizures are coincidentally also a symptom, but are not controlled by an anticonvulsant already used
• Metabolic disturbances—such as affected kidney and liver
• Sleep deprivation of more than a short duration is often the cause of a (usually, but not always, temporary) loss of seizure control
• Dehydration – moderate- to severe, especially when combined with any single factor above

Diagnosis

Diagnostic criteria vary, though most practitioners diagnose as status epilepticus for: one continuous, unremitting seizure lasting longer than five minutes, or recurrent seizures without regaining consciousness between seizures for greater than five minutes. Previous definitions used a 30-minute time limit.

Nonconvulsive status epilepticus is believed to be under-diagnosed.

New-onset refractory status epilepticus (NORSE) is defined as status epilepticus that does not respond to an anticonvulsant and lacks an obvious cause after two days of investigation.

Treatments

Diazepam that can be inserted rectally is often prescribed to caregivers of people with epilepsy. This enables treatment of multiple seizures prior to being able to seek medical care.

Benzodiazepines are the preferred initial treatment after which typically phenytoin or fosphenytoin is given. First aid guidelines for seizures state that, as a rule, an ambulance should be called for seizures lasting longer than five minutes (or sooner if this is the person's first seizure episode and no precipitating factors are known, or if said SE happens to a person with epilepsy whose seizures were previously absent or well-controlled for a considerable time).

Benzodiazepines

When given intravenously, lorazepam appears to be superior to diazepam for stopping seizure activity. Intramuscular midazolam appears to be a reasonable alternative especially in those who are not in hospital.

The benzodiazepine of choice in North America for initial treatment is lorazepam, due to its relatively long duration of action (2–8 hours) when injected, and particularly due to its rapid onset of action, which is thought to be due to its high affinity for GABA receptors and low lipid solubility. This causes the drug to remain in the vascular compartment. If lorazepam is not available, or intravenous access is not possible, then diazepam should be given. Alternatively, medication, such as glucagon, should be given through the bone (intraosseously).

In several countries outside North America, such as the Netherlands, intravenous clonazepam is regarded as the drug of first choice. Cited advantages of clonazepam include a longer duration of action than diazepam and a lower propensity for the development of acute tolerance than lorazepam. The use of clonazepam for this indication is not recognized in North America, perhaps because it is not available as an intravenous formulation there.

Particularly in children, another popular treatment choice is midazolam, given into the side of the mouth or the nose. Sometimes, the failure of lorazepam alone is considered to be enough to classify a case of SE as refractory–that is, resistant to treatment.

Phenytoin and fosphenytoin

Phenytoin was once another first-line therapy, although the prodrug fosphenytoin can be administered three times as fast and with far fewer injection site reactions. If these or any other hydantoin derivatives are used, then cardiac monitoring is necessary if they are administered intravenously. Because the hydantoins take 15–30 minutes to work, a benzodiazepine or barbiturate is often coadministered. Because of diazepam's short duration of action, they were often administered together anyway. At present, these remain recommended second-line, follow-up treatments in the acute setting per guidelines by groups like Neurocritical Care Society (United States).

Barbiturates

Before the benzodiazepines were invented, barbiturates were used for purposes similar to benzodiazepines in general. Some are still used today in SE, for instance, if benzodiazepines or the hydantoins are not an option. These are used to induce a barbituric coma. The barbiturate most commonly used for this is phenobarbital. Thiopental or pentobarbital may also be used for that purpose if the seizures have to be stopped immediately or if the person has already been compromised by the underlying illness or toxic/metabolic-induced seizures; however, in those situations, thiopental is the agent of choice. That said, even when benzodiazepines are available, certain algorithms–including in the United States–indicate the use of phenobarbital as a second- or third-line treatment in SE. Such use is adjunctive. At least one U.S. study showed phenobarbital, when used alone, controlled about 60% of seizures, hence its preference as an add-on therapy.

Carbamazepine and valproate

Valproate is available to be given intravenously, and may be used for status epilepticus. Carbamazepine is not available in an intravenous formulation, and does not play a role in status epilepticus. It was found that all of valproate, phenobarbital, fosphenytoin (phenytoin), midazolam or levetiracetam are considered to the second line drugs after benzodiazepine is used as the first line treatment. It was found that especially valproate in contrast to antiepileptic drugs is more effective to the treatment of nonconvulsive status epilepticus and more commonly used for it.

Others

If this proves ineffective or if barbiturates cannot be used for some reason, then a general anesthetic such as propofol may be tried; sometimes it is used second after the failure of lorazepam. This would entail putting the person on artificial ventilation. Propofol has been shown to be effective in suppressing the jerks seen in myoclonus status epilepticus.

Ketamine, an NMDA antagonist drug, can be used as a last resort for drug-resistant status epilepticus.

Lidocaine has been used in cases that do not improve with other more typical medications. One concern is that seizures often begin again 30 minutes after it is stopped. Additionally, it is not recommended in those with heart or liver problems.

Prognosis

While sources vary, about 16 to 20% of first-time SE patients die; with other sources indicating between 10 and 30% of such patients die within 30 days. Further, 10-50% of first-time SE patients experience lifelong disabilities. In the 30% mortality figure, the great majority of these people have an underlying brain condition causing their status seizure such as brain tumor, brain infection, brain trauma, or stroke. People with diagnosed epilepsy who have a status seizure also have an increased risk of death if their condition is not stabilized quickly, their medication and sleep regimen adapted and adhered to, and stress and other stimulant (seizure trigger) levels controlled. However, with optimal neurological care, adherence to the medication regimen, and a good prognosis (no other underlying uncontrolled brain or other organic disease), the person—even people who have been diagnosed with epilepsy—in otherwise good health can survive with minimal or no brain damage, and can decrease risk of death and even avoid future seizures.

Prognosis of refractory status epilepticus

A different prognosis method was developed for refractory status epilepticus (RSE). Prognosis studies have shown that there is no clear structure of the symptoms; since they range from gastrointestinal to flu-like symptoms, which are considered to be mild and only represent 10%, while the remaining majority of 90% of the clinical cases were unknown. It was found that it takes a period of 1 to 14 days for the patient to reach the prodromal stage in which the episode is yet to come for the first time. It was found that the frequency of those initial seizures starts from a short and inconsistent seizures that lasts for a few hours and may extend to few days. It can simply strike to hundreds of seizures per day, which is the stage that needed an urgent medical intervene in which the patient expected to be in the intensive care unit (ICU) as soon as possible. Typically focal seizures are the most common among those cases.

Epidemiology

In the United States, about 40 cases of SE occur annually per 100,000 people. This includes about 10–20% of all first seizures.

Prevalence

It was found that status epilepticus is more prevalent among African Americans than Caucasian Americans by threefold in North London, and that Asian children have recorded a relatively higher susceptibility of developing the more severe form of febrile seizures. These ethnic distribution rates indicate the genetic contribution to the susceptibility of status epilepticus. Also, studies have shown that status epilepticus is more common in males.

Aetiology

Many studies have found out that age is the most related factor to the etiology of status epilepticus, since 52% of febrile seizures was found in children, while for adults acute cerebralvascular cases was more common, side by side with hypoxia and other metabolic causes.

Research

Allopregnanolone was being studied as a treatment for super-resistant status epilepticus, but was found to have no benefit over placebo.