Providentia

Teenager Confesses to Eating Room-mate

A 19-year old Austrian man has confessed to killing his 49-year old room-mate before removing his intestines and eating parts of his brain and internal organs.  The 19-year old (identified only as "Robert A.") was living in a ground-floor flat in a Vienna shelter for the mentally ill being run by a private social care company.  Police were called in by a cleaner who had entered the premises.   She stated that Robert A. admitted to the murder and asked her to call police.  They arrived to find Robert A. sitting next to the victim lying in a pool of blood.  Body parts were spread all around the room and half-eaten parts were in a plate in the kitchen.  He is reported to have greeted the officers by saying, "Look what happened here". 

The murder is believed to have happened earlier in the week when Robert A. killed his room-mate following a quarrel.  He confessed to crushing the victim's skull with an iron bar before removing his intestines with a butcher knife.   Robert A. had only recently been placed in the apartment but they had met previously in a homeless shelter.

The officers who attended the scene will be receiving counseling

Click here for the abstract.

New Web Site Urges Teens to Step “Out of the Silence”

I just received a press release for a new youth-based initiative that I'd thought I'd share:

Teenager hopes new initiative will help teens with mental illness

BRIDGEWATER, NJ – Out of the Silence, a new web-based non-profit organization that aims to offer a safe venue in which young people with mental health problems can express their emotions through artwork, prose, poetry, photography, and graphic art, will be launched on September 9 to coincide with National Suicide Prevention Week. The initiative and web site was created by 16 year-old Caitlin Carey of New Jersey to assist teens dealing with mental health problems but who feel they have no place to express their thoughts and feelings

“It’s no secret that thousands of teens today suffer in silence, not knowing where they can voice their concerns and experiences with mental illness,” said Caitlin Carey, founder of the project. “Young people tend to rely on their peers for support in everyday situations.  However, the stigma attached to mental illness makes it difficult to reach out to friends; so many teenagers who are trying to cope with an illness such as depression or anxiety feel isolated.”

Carey, who has struggled with obsessive-compulsive disorder for nearly a decade, added, “I felt like I was the only girl in the world who experienced these horrible emotions and isolation. No one should have to feel the way I did.”

Carey’s hope is that Out of the Silence will provide a community of advocates for teenagers dealing with mental illness. She plans to eventually hold empowering events such as sponsored writing and art contests.

“While there are many networking opportunities available for adults with mental health disorders, there are very few resources that are targeted and accessible to young people who are suffering,” added Carey.  “I felt the time was right for me and my peers to become more vocal and proactive in the fight against the stigma associated with mental illness. Our voice has to count.”

“Caitlin Carey’s commitment to fighting the stigma surrounding mental health issues is truly remarkable.  Her courageous efforts will no doubt help countless teens and young adults navigate the many challenges of living with mental illness,” said Jeff Bell, author of Rewind, Replay, Repeat: A Memoir of Obsessive-Compulsive Disorder and advocate for mental health. “The mental health community is most fortunate to have Caitlin join its ranks!"

To learn more about the web site and Caitlin, visit us at http://stepoutofthesilence.org/.

Too Hot to Handle?

In a new study reported in the August 2007 issue of the British Journal of Psychiatry,  a statistical link has been found linking high temperatures and incidence of suicide.  A statistical analysis of the relationship between daily termperature and daily suicide counts in England and Wales between January 1, 1993 and December 31, 2003 showed no evidence of a spring or summer peak in suicide rates.  However, at temperatures above 18 degrees Celsius, each 1 degree increase in mean temperature was associated with a 3.8 and 5.0% rise in suicide and violent suicide respectively.  During the 1995 heatwave in the United Kingdom, suicides were found to have increased by 46.9%.  On the other hand, no change in the suicide rate was seen during the 2003 heat wave.   The implication of these results suggest that increased awareness of the potential for suicide during heatwaves is needed. 

Click here for the abstract.

The Woyzeck Case

While many famous murder trials become the basis of books, movies, and television episodes, I only know of one that later became a famous opera. Johann Christian Woyzeck, a wigmaker and barber who was born and raised in 19^th Saxony (now part of Germany) certainly seemed to be an unlikely subject for musical immortality. Details of his early life are sketchy although he is known to have been a soldier at one point as well as an aimless individual who was never very prosperous. The only bright spot in his life was his relationship with Christianne Woost, a widow with whom he had been living. His obsessive jealousy over Christianne led him to murder her on June 3, 1821 after discovering that she had cancelled an arranged meeting between them to spend time with a handsome soldier. He was then taken into custody where he admitted to stabbing her seven times. There was absolutely no question concerning his guilt, only his state of mind at the time of the murder. The court case dragged on for years with medical doctors on both sides of the case arguing over Woyzeck's mental state and whether he could be held responsible for his actions. Legal documents on the case still exist and provide a fascinating look at the trial process. Duke Friedrich August, then-crown prince of Saxony even entered a deposition on Woyzeck's behalf arguing that the murder had been committed while Woyzeck was suffering from partial mania.  Despite allegations that Woyzeck had been suffering from hallucinations at the time of the murder, there is no way to tell if he was genuinely mentally ill or simply trying to avoid execution. In the end, it was the testimony of John Christian August Clarus, chief medical officer for Leipzig, whose report on Woyzeck concluded that he had been sane at the time of the murder that eventually led to his conviction. Clarus was asked to re-examine Woyzeck in 1823 but he refused to change his opinion in his second report. Medical professors at the University of Leipzig supported Clarus' conclusions although none of them bothered examining Woyzeck first-hand.  Despite an impassioned plea by the defence council, Woyzeck was eventually executed on August 27, 1824 by decapitation in the main square of Leipzig in front of a large crowd. A debate about Woyzeck's mental state and whether it was appropriate to execute a mentally unbalanced man continued in the medical literature for years afterwards.

The case attracted world-wide attention at the time and is now considered one of the most notable forensic psychiatry cases of the 19^th century. Still, it would be largely forgotten now except for the later play by Georg Buchner that has kept the Woyzeck case alive. In the decades since the play was first performed, it has been presented as an opera by Allan Berg, as a movie by Werner Herzog, and even as a musical.  Who knew that forensic psychiatry could be so entertaining?

Debugging the Patient

In a recent issue of the International Journal of Psychiatry in Medicine (Issue 37(1)), a series of case studies describing six patients suffering from delusional parasitosis are presented.    Also known as Ekbom's syndrome, delusional parasitosis is a form of psychosis in which patients believe that they are infested with parasites (eg, worms, insects, or bacteria).   It can be found as a stand-alone delusion or as part of a broader diagnosis such as schizophrenia.  In the presented case series, the six patients were treated with atypical antipsychotic medications including amisulpride, olanzapine, and risperidone. While non-oral administration of medication (usually intravenously) was found to be beneficial in most cases, medical complications (including one patient who had a myocardial infarction after being given amisulpride) made treatment difficult in some cases. 

Click here for the abstract.

Sexual Assaults Against Women With Disabilities

A study presented at the recent convention of the American Psychological Association in San Francisco indicated that sexual assault on women with physical disabilities tended to be more coercive and more physically severe than assaults on women with other types of problems.   The study was based on clients from a sexual assault clinic in Toronto and compared 1,091 women with disabilities to 1,120 women without disabilities.  Of the 81 victims with physical disabilities (including motor, visual, and hearing impairments), 66.7%  suffered physical trauma during the assault, compared with 63.8% of the women without disabilities; 63.3% of the women with a psychiatric disability, and 52.2% of the women with cognitive disability of developmental delay.   19.2% of the physically disabled victims were also subjected to forced anal intercourse compared to 8.4% for women without disabilities.  In presenting her findings, Theresa Kelly, a doctoral student at the University of Toronto, suggested that disabled women are more impaired in their ability to resist assault, flee, or fight back.  The study supports previous research indicating that women with disabilities are at increased risk for sexual assault. 

Click here for more information.

Burning the Library

Magnus Hirschfeld never set out to be a pioneer.

Born in the 19th century Prussian city of Kolberg (now part of Poland) as the son of a prominent Jewish physician, it seemed only natural that he would follow in his father's footsteps .   After taking his doctoral degree in 1892, he maintained a practice as a general practitioner and naturopath as well as being an avid writer. His writings focused on diverse aspects of human sexuality and he had ample material from his own private life to draw from. While he tended to view his own sexual orientation as a "private mater", it is now accepted that he was a homosexual and a transvestite (and possibly even a foot fetishist). Rather than pursue the closeted lifestyle that most German homosexuals of his time pursued (under the German Penal code, homosexuality had been a criminal offense since 1871), he wrote a series of works proposing that homosexuality represented an "intermediate sex" (he also coined the term "transvestite).

Along with other gay activists, he founded the Scientific Humanitarian Committee in 1897 to encourage a liberalizing of laws against homosexuality. They even sponsored a bill to overturn the laws against homosexuality (the petition favouring the bill was signed by numerous prominent Germans including Albert Einstein, Thomas Mann, Martin Buber, and Richard Kraftt-Ebbing) in 1898. It failed to pass but their movement continued. While many of Hirschfeld's ideas about homosexuality would probably be scorned today (homosexual males being feminine, homosexuality being a disease that deserved pity rather than arrest, etc.), he was a true pioneer at a time when such pioneers were rare. His published works on sexology influenced many later researchers including Havelock Ellis.

On the site of a former royal palace in Berlin, Hirschfeld opened the Institut fur Sexualwissenshaft (Institute for Sexual Research) in 1919. In addition to housing Hirschfeld's immense library of books on sexology, it was a centre for medical research and consultation for patients from all over Europe. Hirschfeld continued to make public appearances and was regularly referred to in the news media as the "Einstein of Sex".  His writings were extensive and included a 23-volume "Yearbook for the Sexual Intermediates" (the first periodical for homosexuals). He also helped write one of the first gay-themed films in 1919 Anders al die Andern (Different from the Others) which was banned by the German government in 1920. It was at his public appearances that he faced the wrath of anti-gay (and anti-Semitic) activists. At one appearance in 1921, his skull was fractured and he was left lying in the street.  Despite these encounters, he was a well-recognized public figure and renowned sexual expert.  It was only natural that Einar Weigener sought him out in 1930 for help in achieving the first sex-change operation (which certainly added to Hirschfeld's notoriety). International conferences were organized and progress was being made.

And then it all fell apart...

The rise of Nazism put an end to Hirschfeld's crusading.  He went on an extended lecture tour in 1930 and decided not to return to Germany. The Nazis began to organize a campaign to purge Germany's libraries of "un-German material" and it was on May 6, 1933 that several vans with over one hundred students and a brass band (!) broke into the Institute while the band played. They seized Hirschfeld's entire library of over ten thousand books which went up in flames in a public bonfire three days later. A busted sculpture of Hirschfeld was marched through the street and then tossed into the flames. The Nazis also seized the Institute's files which listed the names and addresses of many homosexuals living in Germany. The information was used to compile their notorious "pink list" of homosexuals who were sent to the concentration camps along with other "marginal populations".  Hirschfeld eventually settled in France where he died of a stroke in 1935.  He lived long enough to see virtually all traces of the gay emancipation movement in Germany wiped out.  He is buried in Nice.

While it is tempting to dismiss the destruction of the Institute and library as a sad consequence of the Nazi rise to power, the example is an uncomfortable one. How often are modern scientists forced to defend themselves due to "unpopular" research that contradicts accepted norms and beliefs?  And how easily can extremists gain power under the right circumstances?

Any library can go up in flames with enough fuel.

How Scary is Your Stalker?

The July 2007 issue of Violence Against Women presents a study examing the responses of 8,000 participants of the National Violence Against Women Survey .  Logistical regression was used to study patterns in fear reported by female stalking victims with 25% of the sample respondents reporting feeling no fear of their stalker.  Factors such as race ( Black women were significantly less likely to report fear compared to White respondents), frequency of being stalked, stalking by an intimate acquaintance or family member, or being stalked by physical or communicative means, affected likelihood of experiencing fear.  The authors concluded that use of a fear standard to judge seriousness of stalking attempts and the need for official protection represents a significant distortion of actual incidence of stalking as well as a gross miscarriage of justice. 

Click here for the abstract.

My Mother, The Wolf

The February 2007 issue of Acta Psychiatrica Scandinavica contains an interesting clinical lycanthropy case study.  While cases in which the patient believes the he/she is being transformed into an animal have been reported in the literature, belief in the transformation of another person into an animal is considerably rarer. In the presented case study, a young male patient who had been diagnosed with first-episode mixed bipolar mood disorder , developed a delusional conviction that his mother had been transformed into a wolf.  While he did not have any delusions regarding the transformation of himself into an animal, he reported drooling for months before developing a delusional belief regarding his mother.  It is suggested by the authors that this delusion represents a variation on the classic lycanthropy syndrome. 

Click here for the abstract.

The Shrinking Penis Panic

In September 2003, news sources documented numerous accounts of mysterious foreigners (origin and description varying with each retelling) in Khartoum, Sudan who were causing penises to disappear by shaking the hands of their victims in public. Details were rarely consistent but media accounts told of victims who reported that their penises began to "melt into their body" either after shaking hands or using a "penis-melting cyborg comb" that had been given to them by a mysterious stranger. One Sudan based columnist went as far as reporting in a foreign-based newspaper that ""Even though what I write today will harm 'tourism' in Sudan, I consider it my duty to warn anyone who wants to come to Sudan to refrain from shaking hands with a dark-skinned man. Since most Sudanese are dark-skinned, he had better avoid shaking hands with anyone he doesn't know…". The mysterious hand-shaker (often referred to as `Satan`s Friend`) was said to ``drain men`s virility`` through a handshake and then extort money from victims to regain their lost manhood. The accusations and recriminations were directed against numerous convenient scapegoats including ``Zionist agents`` attempting to exterminate the Sudanese by preventing men from procreating. Despite medical examinations that determined no indication of sexual abnormalities in victims, it took an active intervention on the part of the Sudanese government (including numerous arrests of alleged victims and others accused of practising `sorcery`) to bring an end to the hysteria.  While it was ultimately deemed to have been a hoax that got out of hand, the furor took a while to subside. 

Despite being the most widely reported outbreak, what occurred in Khartoum was only part of a epidemic of genital shrinking hysteria reported in six West African nations between January 1997 and October 2003. There appears to be superficial resemblances to the cultural psychosis known as Koro, but with a significant twist given the nature of the accusations that were levelled against mysterious ``others`` who were attempted to emasculate African men.   Cases of perceived genital shrinkage have been primarily reported in South-east Asian males although similar cases have been reported in non-Oriental cultures and seem to be associated with a fear of losing sexual potency.

What then are we to make of what happened in Khartoum in 2003?  It seems likely that the epidemic was fuelled by media coverage but the political turmoil resulting from a long and bloody civil war (which has since escalated) probably played a part as well. There seems to be little available information on psychological or demographic factors that may have made the victims more vulnerable to suggestion. While ``mass hysteria`` is a convenient label for outbreaks of unusual symptoms, it seems to mask the very legitimate fears that people in a given time or culture may experience and which may emerge in an exaggerated form with the right provocation. For the Sudanese males who were affected, the fear of ethnic cleansing (including the very real ethnic cleansing occurring in Darfur) may well have driven the epidemic with various scapegoats (domestic or foreign) being proposed as targets of potential retribution.

While the idea of penis-shrinking hysteria may make for entertaining reading, the paranoia that can be triggered during mass hysteria outbreaks shouldn`t be dismissed so easily.  The violence that can erupt as a result of mass hysteria has led to some tragic episodes over the years.  Witch-hunts (sometimes literally so) have claimed countless lives through the centuries and even "civilized" people can form lynch mobs under the right circumstances. 

In other words, don't believe everything you hear (especially if it involves penis-melting combs).