Providentia

Suicidal Ideation and Spousal Abuse

A study examining factors influencing suicidal ideation in a sample of victims of partner abuse living in shelters is presented in the May 2007 issue of Health Care for Women International.  Fifty women were recruited from a regional shelter for battered women in a Midwestern city in the United States.  Of the women sampled, fifty-eight percent reported having experienced intimate partner rape.  More than one-third of the sample confirmed experiencing suicidal ideation at least "some of the time" within the previous week. Experiencing intimate partner rape was significantly associated with suicidal ideation and symptoms of post-traumatic stress disorder (PTSD) and depression. Results also revealed that both PTSD and depressive symptoms mediated the relationship between intimate partner rape and suicidal ideation.  The study results highlight the importance of assessing suicide risk in victims of spousal abuse.

Click here for the abstract.

Worm Running

On September 15, 1985, a seemingly innocent package was delivered to the home of Dr. James V. McConnell, then-professor of psychology at the University of Michigan.  His assistant, Nicklaus Suino, opened the package as Dr. McConnell looked on.  The resulting explosion resulted in Suino sustaining injuries to his arms and abdomen.  Dr. McConnell was more fortunate although he suffered a hearing loss as a result of the blast.  It remains unclear exactly why Theodore Kaczynski (a.k.a. the Unabomber) targeted Dr. McConnell as he had others in the scientific community but Dr. McConnell's colourful career may provide a clue. 

Considered a maverick in his time, James V. McConnell's career was marked by his unconventional research and outspokenness.  In his most famous research project, he classically conditioned Planaria (flatworms) to react to bright lights using electric shocks.  He then cut up his research subjects and fed them to other Planaria and he found that the cannibal Planaria learned to respond to the bright light more rapidly than control Planaria did.  In his classic paper Memory transfer through cannibalism in planaria which was published in the Journal of Neurophysiology, he suggested that memory was chemically based and that the memory transfer had been accomplished through what he termed memory RNA.  While it was an intriguing finding at the time, other researchers have not been able to replicate his results and the concept of memory transfer fell by the wayside. 

Despite the failure of his memory transfer research,James McConnell's tenure at the University of Michigan from 1956 to his retirement in 1988 was marked by his candour on issues that mattered to him as well as his quirky humour.  In addition to launching the Journal of Biological Psychology, he also started the Worm-Runner's Digest (a humour magazine with a planaria theme).  It may well have been McConnell's views on human behavioural modification as outlined in his textbook Understanding Human Behavior that led to his being targeted by the Unabomber. 

I have a personal anecdote about James V. McConnell that I feel inclined to share (it's my blog, after all).  When I was a first year psychology student at the University of Windsor (just across the river from Michigan), Dr. McConnell gave a lecture on classical conditioning that was distinctly memorable.  He explained the difference between a conditioned stimulus (CS) and an unconditioned stimulus (UCS) by firing off a starter's pistol whenever he shouted the phrase "CS" in a crowded auditorium.  The idea was to condition us to flinching whenever he uttered that phrase (it was a more innocent time).  We picked up the finer points of classical conditioning pretty quickly, let me tell you.  I wanted to compliment him afterward on an excellent lecture but I was a shy undergraduate then (plus he had a gun). 

Dr. McConnell passed away in 1990 and psychology became a little less colourful with his death.  I have often thought that modern psychology tends to be a little too serious for its own good.  Mavericks like James V. McConnell are all too rare these days.   

Autoerotic Asphyxia Death Due to Full Body Wrapping

While cases of autoerotic asphyxiation involving accidental death arising from the use of various breath-stopping techniques for sexual gratification have long been reported in the research literature, a recent case reported in the July 2007 issue of the Journal of Forensic Sciences takes things somewhat further.  The authors report on the case of a 34-year old man who apparently died of asphyxiating from wearing an extremely complex plastic full-body wrap.  The authors conclude that it is the "the largest and most complex plastic bag ever involved in a published case of autoerotic death". 

Click here for the link.

DSM-V Task Force Members Named

The American Psychiatric Association has announced the members of the task force chosen to oversee the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).  The new task force is made up of 27 members including researchers, clinicians, and consumer advocates. 

During the teleconference in which the task force members were revealed, DSM-V Chair David J. Kupfer, M.D. stated that "As the nation's dictionary of mental illnesses, the Diagnostic and Statistical Manual plays a vital role in assuring that patients get proper diagnoses and treatments for their mental health concerns. The APA has entrusted the revision of the DSM to world-renowned scientists who have vast experience in research, clinical care, biology, genetics, statistics, epidemiology, public health and consumer advocacy. They have interests ranging from cross-cultural medicine and genetics to geriatric issues, ethics and addiction."

The DSM-V revision process is expected to continue over the next five years and is scheduled for publication in 2012.  The current version, the DSM-V, came out in 1994 and has remained essentially unchanged since that time except for a textual revision in 2000.    

Click here for more information.

More information on the DSM-V revision can be found at  http://www.dsmv.org.

Scapegoats, Then and Now

We may never know the actual number of people who died in the Great Fire of London.  The colossal blaze that raged from September 3 to September 5, 1666 left more than 80 percent of the city in ruins and destroyed an estimated 70,000 homes.  While only a few verified deaths were recorded, the absence of any formal listing of London's residents and the sheer heat of the flames which likely cremated many of the fire's victims makes it impossible to know the real death toll.  Almost as soon as the fire was finally extinguished, the murmurs began regarding the true reason for the blaze.  Numerous conspiracy theories sprang up over who set the fires.  England was then at war with France and the Netherlands so any nationals from those countries were targeted.  Catholics were a familiar target ("papists" usually were).   Even King Charles II was believed by some to have ordered the fire to punish the people of London for the role that they played in his father's execution.   Foreign residents were attacked in the street and lynchings occurred. 

And then came Robert Hubert...

His confession to starting the Great Fire was never very convincing.   He was a (possibly mentally ill) French immigrant who kept changing his confession as inconsistencies were pointed out to him.  It isn't certain at this date why he confessed at all, whether it was mental illness or torture (or a combination of the two).  While he mentioned having 23 other co-conspirators who helped him start the fire, there was no evidence to implicate anyone else.  All that mattered was that he was an ideal scapegoat who would satisfy the conspiracy theorists.  His trial was almost a foregone conclusion, especially with a biased jury.  Contemporary accounts reported that "'Neither the judges, nor any present at the trial did believe him guilty; but that he was a poor distracted wretch, weary of his life, and chose to part with it in this way".   Despite the doubt concerning the case, his hanging was well-attended by an angry crowd.  As his body was taken down for dissection, it was literally torn to pieces by the mob.   A later inquiry determined that Hubert had not even been in the country when the fire started but it was much too late by then.  He passed into English history as an embarrassing footnote and the Great Fire was written off as an "Act of God".      

The institution of scapegoat is an old one.  The ancient Greeks had a tradition in which two men, known as Pharmakoi, would be led out on special holidays following a natural disaster and ritually stoned (and perhaps executed) to lift whatever misfortune led to the tragedy.  The pharmakoi were usually slaves, crippled, or otherwise considered undesirable.  According to tradition, Aesop met his death this way since he was both a slave and physically deformed.  The word pharmakos entered the English language to become pharmacology through a long, tortuous route that I won't describe here (ask your pharmacist).

Through centuries of pogroms,  blood libels, and inquisitions, the scapegoat process remains the same: identify the outsiders, attribute whatever social problem or disaster you like to them, and then remove them from our midst to take the evil with them.  Much like with the Tripoli 6, for those of you who are following the story.  In their case, they are being used as scapegoats by the Libyan government to divert attention from the negligent hospital practices that are really responsible for the estimated 500 HIV-infected children for whom they were blamed.  The accused doctor and nurses were given death sentence that was upheld by the Libyan Supreme Court, but this has since been changed to life imprisonment.  Their possible transfer to Bulgaria has been made a little more likely by a sizable financial settlement by the European Union, ostensibly to help the infected children (with a substantial overhead, no doubt).  Unfortunately, there is considerable opposition to any transfer by the enraged families of the children who hold the medical team personally responsible for their plight and who are demanding that they be punished. 

Robert Hubert would find it all very familiar. 

Is Megan's Law Working?

The July 2007 issue of Behavioral Sciences and the Law Community presents a study examining the impact of community notification about known sex offenders (also know as "Megan's Law") on the lives of registered sex offenders.  Interviews of two hundred and thirty-nine sex offenders in Connecticut and Indiana indicated frequent problems such as job loss, threats and harassment, property damage, and suffering of household members. A minority of the surveyed sex offenders reported housing disruption or physical violence following community notification.  Most of the sampled offenders reported problems with psychosocial distress, including depression, shame, and hopelessness.  Given the impact that community notification has had on successful community reintegration, the researchers recommend that community notification policies would function better by relying on empirically derived risk assessment classification systems to better inform the public about sex offender danger and to combat the misinformation that frequently arises.

Click here for the abstract.

When Spouses Kill

The July 2007 issue of Trauma, Violence and Abuse presents an overview of risk factors associated with intimate partner homicide.  While current rates of intimate partner homicide of females are approximately 4 to 5 times the rate for male victims, the rates for both have notably decreased in the past 25 years. Regardless of whether a female or male partner is killed, the major risk factor for intimate partner homicide appears to be prior domestic violence. Other risk factors for intimate partner homicide in general, and for intimate partner homicide of women (femicide) in particular are discussed including: presence of guns, relationship estrangement, stepchild in the home, forced sex, threats to kill, and choking.  The review also examines demographic risk factors and the related phenomena of pregnancy-related homicide, attempted femicide, and murder-suicides involving intimate partners. 

Click here for the abstract.

Health Care Workers in Crisis

The April 2007 issue of the Canadian Journal of Psychiatry presents the results of a research study assessing the immediate and sustained psychological health of health care workers who were at high risk of exposure during the severe acute respiratory syndrome (SARS) outbreak. At the peak of the 2003 SARS outbreak, health care workers in two acute care Hong Kong general hospitals were assessed for stress. One year later, these health care workers were reassessed. High-risk health care workers who practised respiratory medicine were compared with nonrespiratory medicine workers, who acted as the low-risk health care worker group. The inital results showed that high-risk health care workers had elevated stress levels that were not significantly different from levels in low-risk health care worker subjects but more high-risk health care workers reported fatigue, poor sleep, worry about health, and fear of social contact, despite their confidence in infection-control measures. By 2004, however, stress levels in the high-risk group were not only higher than the year before but were also significantly higher than scores among low-risk health care worker subjects. In 2004, the perceived stress levels in the high-risk group were associated with higher depression, anxiety, and posttraumatic stress scores. Posttraumatic stress scores were found to be a partial mediator of the relation between the high risk of exposure to SARS and higher perceived stress. The researchers concluded that health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety.  It was recommeded that front-line staff receive stress management training as part of preparation for future outbreaks.

Click here for the abstract.

When Dying Becomes Fashionable

In 1980, two young girls living in northern Sri Lanka committed suicide by eating the seeds of the Yellow Oleander, a common ornamental shrub that grows in most parts of the tropics and is cultivated across Sri Lanka in gardens and hedges.   In the following year there were 23 cases of oleander poisoning, apparently spurred by the publicity of the first suicides.  There were 46 in the year after that and hundreds of cases in the following years.  Since oleander became associated with suicide in Sri Lanka, the number of deaths has risen steadily and health services across the island have been besieged by new cases.  Suicide by oleander poisoning remains a major cause of death in Sri Lanka for young and old alike despite an aggressive government campaign to eliminate oleander plants and there seems to be no end in the foreseeable future.

Copycat suicides are not a new phenomenon by any means.  In 1774, Goethe published his first novel, The Sorrows of Young Werther about a passionate young poet who commits suicide in a romantic fashion over a lost love.  The novel inspired a cultural movement called "Werther fever" with numerous young men imitating the hero any way that they could.  Unfortunately, this also led to an estimated 2,000 suicides as fans tried to imitate their hero's romantic death.  Goethe distanced himself as best he could but the novel was banned in some places due to alarm over the suicides (a fellow author even rewrote the novel with a happy ending).  Even since then, the copycat suicide phenomenon has also been referred to as The Werther Effect.

Studies examining the role that the media plays in suicide rates have continued to establish a link between publicized suicides and copycat deaths.  One recent overview determined that studies examining the effect of a well-publicized entertainment or political celebrity were 14.3 times more likely to find a copycat effect than those that did not.  Studies examining the effect of real suicides were 4.3 times more likely to find a copycat effect than studies of fictional suicides.  Recent suicides that have spurred copycat deaths include Kurt Cobain and Japanese musician Yukiko Okada.  While some countries such as Norway and Brazil have adopted formal journalistic codes to downplay suicide where possible to reduce copycat deaths, ethical issues regarding publication of information on suicides tend to be left up to individual editors in most countries. 

It is still a matter of speculation as to why copycat suicides occur.  The best answer seems to be that vulnerable people (who may be suffering from mental illness or who have already made at least one attempt) may respond to media portrayals of spectacular celebrity suicides or unintentional glorification of death.  Age seems to be another factor with young people and the elderly being vulnerable to media portrayals of death, particularly if the portrayed death is seen as relating to their personal situation.

In the meantime, the oleander deaths are continuing.   As for the next epidemic of copycat suicides? Only time (and the media) will tell.

Dealing with Diogenes Syndrome

The June 2007 issue of the American Journal of Forensic Medicine and Pathology outlines the forensic challenges associated with Diogenes syndrome deaths.  First identified in 1975, sufferers of Diogenes syndrome are typically characterized by extreme social isolation, hoarding behaviour and squalid living conditions.  Forensic evaluation of deaths is often complicated by lack of recorded medical histories, filth and clutter in  the place of residence, and pet dogs that are mistrustful of strangers. Bodies are typically filthy, with parasitic infestations, and are often in an advanced state of putrefaction due to the social isolation of the deceased and the delay in the finding of the corpse. Bodies may also be characterized by postmortem gnawing by rodents or pets (eg, cats, dogs), with injuries caused by falls resulting from terminal illnesses or alcoholism. Treatable medical conditions are often present in advanced stages, and features of hypothermia may also be found. Identification of the deceased may be compromised by decay and/or postmortem animal activity. In addition to clinical characteristics, such cases can pose special difficulties in postmortem examinations.

Click here for the abstract.