The Psychology of Survival

I read this BBC story recently about the Chilean miners trapped for 17 days, who now face months of waiting underground while a rescue tunnel is dug. Although they are all physically well and expected to survive, they face the psychological challenge of waiting for rescue from the cave.

This story resonated with me because lately I've been hearing a lot about a new book, No Way Down, which was featured on NPR along with some other mountain disaster books. No Way Down covered the story of several teams of mountain climbers who were stranded on K2 when an icefall cut their ropes. Most of the climbers died although a few managed to pick their way back to base camp.

Survival stories have always been popular. Entire television series now feature teams of people pitted against one another to overcome some test or challenge. Disaster movies were popular back in the '70s, when the Towering Inferno, Airport and the Poseidon Adventure let us watch people get picked off one by one.

Why do we love this stuff?

I think it's because these stories reflect humanity's greatest strength, the power of adaptation. Whether we're talking about natural disasters, accidents, the exploration of Colonial American wilderness or longterm science expeditions to Antarctica, the psychology of survival is fascinating because we like the idea that one's mental attitude can make the difference between life or death.

A search of Amazon reveals a surprising number of books about survivor psychology. Most focus on outdoor adventurers, but others were based on interviews with survivors of accidents like plane crashes or fires.

The survivors in these books lived because they were trained and experienced in outdoor living. They weren't "survivalists" per se, people who stockpiled food and weapons for the future fall of civilization. These survivors were people who were able to stay calm and reason in the face of fear, people who retained their optimism and determination in spite of great odds. Survivors focussed on others rather than themselves, either thinking about their families or their fellow survivors.

Sitting in a prison cell for several years seems like nothing compared to surviving a high altitude mountain disaster, but I think there are some principles that apply in both cases. The prisoners who do well are the ones who are future-oriented and determined to "work the time" for self-improvement. They have external family they care about and plan to return to. And yes, previous prison experience helps too.

Oh Poo!

This a blog post about vulture poop. It's a long story, but let me just say that when you're a rock climber there are certain hazzards of the sport that you just have to accept: bats sleeping in crevices, nasty long spinning falls, copperhead snakes and, yes, vulture poop.

Vulture poop is probably the most vile smell I have ever come across, and that includes a four month stint crouched over a formaldehyde-soaked corpse in anatomy lab. It's bad.

The trick with writing a blog post about this is that you have to tie it in somehow with psychiatry. This is problematic since I haven't had any patients with delusions about vultures, vulture obsessions or vulture phobias (does anybody know the word for vulture phobia? Ornithophobia is for birds as a whole). I'm left grasping at nasal straws, so to speak.

I have had patients who smelled bad and patients who suffered from bad smells. If the smell doesn't actually exist, it's an olfactory hallucination. Olfactory hallucinations are rare, much less common than visual or auditory hallucinations. Typical olfactory hallucinations are very unpleasant experiences and are often described as resembling rotting meat, burning rubber or excrement (although not necessarily vulture poop). I've seen olfactory hallucinations in a patient with major depression and in one or two psychotic patients. Another "bad smell" illness is a rare but interesting delusional disorder known as olfactory reference syndrome. In this disorder the patient is convinced that he or she smells bad and that others around them can also smell them. Olfactory reference patients may shower multiple times a day to get rid of the "smell", or may seek repeated medical consultations to find the source of the problem. Like most delusional disorders, olfactory reference syndrome tends to be resistant to medication. I've seen two cases of this disorder and they both improved (but didn't get completely well) on neuroleptics.

Olfactory hallucinations can be seen in other medical conditions, specifically in migraine sufferers and in people with seizure disorders. In this case the smell generally precedes the onset of the headache or seizure and is sometimes described as a 'burning rubber' smell. Treatment of the odor depends upon control of the underlying condition.

So there's my vulture poop post. I even made it relevant to psychiatry. Climb on!

And for those without cathartophobia (my proposed name for vulture fear, after the genus cathartidae):

The Turkey Vulture Society

Let Me Be The Judge Of That

So here I am, juror number 206, sitting in the juror assembly room. I have not been called for a case but I am patiently waiting, having read the New York magazine from cover to cover and learned all about the best new restaurants of 2009, the new Mamet play and the latest exhibit opening at MOMA.

It's been a pleasant---or at least not odious---experience so far. The parking was plentiful, free and easy to locate. The chairs are comfy, the court house is within walking distance of several decent restaurants and I even have free WIFI. It's kind of like a better version of an airport terminal, without the screaming babies. (Oh yeah, and no mildew.)

After checking in, the morning started with an orientation video that reminded me of those black and white Bell Lab films they used to show us when I was in high school. It did a good job of explaining who works in the court room, the trial process and the job of the jury. I'd like to get a copy of it for my beginning forensic students. It ended with the chief judge telling us that he hoped our jury experience would be "educational and rewarding". Then they turned on the movie, title forgotten, starring big name actors in a G-rated film I had no interest in watching. They told us if we didn't want to watch the movie we could go to the designated 'quiet area' in the snack room, so here I am. The young dude slacker sitting at the table next to me doesn't get the concept of a 'quiet area'. I really didn't need to hear the story about him seeing an alligator eat a dog.

It feels a little weird knowing that I've spent more time in front of a jury than in a jury box.

It's a little weird knowing that any of the ninety criminal trials scheduled today could involve one of my former, current or future patients. In my jury qualification form I clearly documented that I work in a prison, that I evaluate criminals, that I'm greatly needed and would be missed if called away for several days. I'm hoping somebody reads this.

Obviously, if I actually get empanelled I won't be blogging about the experience or talking about the case. Also obviously, if one of my patients shows up at the defendant's table I'll let somebody know I can't serve. I just hope he doesn't holler out in the court room, "Doc, I really need my medicine upped!"

(There's a guy here reading a Climbing magazine. Small world. I wonder if he's reading about Chris Sharma's new 5.15 route---the first in history---that he did over three months and after several 90 foot falls.)