Providentia

In a Flash

The nuclear explosions that devastated the city of Hiroshima on August 6, 1945 and the city of Nagasaki three days later resulted in massive destruction and loss of life. Although the precise number of casualties has never been determined, it is estimated that 70,000 died in Hiroshima due to the immediate effects of the blast with an additional 50000 in Nagasaki (mostly civilians). Estimates of the lingering effects of radiation exposure are even more problematic although it has been suggested that many thousands of casualties occurred in the decades that followed. It would be the only time that nuclear weapons would be used in war (so far). Another legacy of the bombings is far more subtle but just as devastating for the survivors. Since 1945, there has been a lingering stigma attached to survivors and their descendants that led to them being frequently ostracized by mainstream Japanese society. Termed the hibakusha (meaning "radiation-affected people" in Japanese), there are over 200,000 that have been formally registered with the Japanese government (registration being necessary to receive compensation) although many hibakusha also live in neighbouring countries such as South Korea (there were numerous Korean and other foreign nationals living in Hiroshima and Nagasaki at the time of the bombings). It would take years of activism and public awareness campaigns for the Japanese government to pass legislation subsidizing basic medical treatment for hibakusha in 1957 (the United States government was formally absolved of any responsibility for compensation in a treaty with Japan in 1951). Due to the misinformation surrounding radiation exposure including fears of it being hereditary or contagious, many hibakusha face ongoing job and housing discrimination and non-affected families even object to their children marrying into a hibakusha family. To avoid discrimination, many hibakusha conceal their status to "pass" in mainstream society.

The psychological scars involved with being a hibakusha are considerable although research into the psychosocial impact of being a survivor has been relatively neglected. In addition to the expected posttraumatic symptoms for those who survived the bombings, there is also considerable survivor guilt and a "conspiracy of silence" surrounding hibakusha discussing their experiences (although this has started to change as survivors become better organized). Survivors who emigrated to other countries after the war (including the United States) began organizing local support chapters. Despite attempts to encourage survivors to tell their stories, the lingering stigma has resulted in many hibakusha refusing to "out" themselves and sharing their experiences. As the elderly survivors die, their stories often die with them.

Stigma can take a variety of forms and people can be ostracized for all sorts of reasons. Having the wrong skin colour, creed, place of origin, medical diagnosis or sexual orientation has been used to justify horrendous discrimination over the years. Simply being in the wrong place at the wrong time seems sufficient for some. It can happen in a flash of light.

Hurting Yourself

The July, 2007 issue of the Archives of Pediatrics and Adolescent Medicine presents the results of a research project examing the relationship between self-harm behaviours and actual incidence of suicide. The purpose of the study was to determine whether self-injury acts as a coping mechanism that may occur with or lead to suicidal behaviours in individuals experiencing more stress than they can effectively handle. Using a cross-sectional data set of college-age students from two universities in the northeastern United States in the spring of 2005, a random sample of 8300 students was invited to participate in a Web-based survey. Of the respondents, only 2875 cases were usable.Demographic characteristics, history of trauma, distress, informal help-seeking, and attraction to life were also measured. The results indicated that one quarter of the sample reported self-harm behaviours, suicidality, or both; 40.3% of those reporting self-harm also report suicidality. A significant predictive relationship was found between self-harm behaviours and suicidality even when potential confounding and demographic factors were ruled out. The results indicate that young adults engaging in self-harm behaviour is an important warning sign that warrants clinical intervention.

Click here for the abstract.

Attitudes and Reality Regarding Domestic Violence in Nigeria

A recent issue of the International Quarterly of Community Health Education (Volume 25) presents the results of a cross sectional study designed to determine how prevalent intimate partner violence was among women of child-bearing age in a migrant community in southwest Nigeria.The women in the study ranged in age from 15 to 49 years and structured questionnaires were given in the local language to learn about attitudes toward domestic violence in seven hypothetical situations as well as their personal experiences with violence. Of the women surveyed, 87% reported having experienced intimate partner violence at some point in their lives while 20% reported having experienced it in the preceding 12 months. In examining attitudes towards intimate partner violence, 79.5% of the survey respondents believed that wife beating was justified in at least one of the seven hypothetical situations that were presented. Respondents who were not living with a male partner were more likely than their counterparts who were married or cohabiting to accept intimate partner violence (p = 0.03).The authors conclude that there is a critical need for health education programming to change existing cultural attitudes towards domestic violence.

Click here for the abstract.

Reining in the Prodigy

There seems no question that William James Sidis was a genius. Born in New York City in 1898, his parents, Boris and Sarah, were Russian immigrants and intellectuals who had fled to the U.S. to escape persecution.Boris earned his M.D. and Ph.D. degrees at Harvard University and taught psychology there. He was a close friend of William James who was his son's godfather (William was also named for him). Sarah was an M.D. whose family fled the Russian pogroms ten years before William's birth. She gave up her medical career to be a full-time mother to her son (and later daughter). They both held radical notions concerning early child education (radical for the time anyway) and encouraged William to learn without using the discipline that characterized education in that era. The results were nothing less than spectacular: William could read the New York Times by the age of 18 months and taught himself eight languages by the time he was eight (he also invented a new language and a new logarithm table). At the age of 11, he entered Harvard as part of an experimental program along with other promising prodigies including Norbert Weiner and Buckminster Fuller. He excelled in higher mathematics and language and a brilliant future was predicted for him. Intelligence testing was still in its infancy (and Boris dismissed IQ tests as "pedantic and misleading") but later estimates would put William's IQ in the 250 to 300 range. He graduated with a Bachelor of Arts Degree with full honours at the age of 16.

And then things went downhill from there...

His lifelong feud with the press began with an interview before graduation in which he stated that he planned to remain celibate and that women did not appeal to him. Publicity over the interview may have been the cause of his being threatened by a gang of Harvard students and which led to his leaving Harvard to go to Rice University in Texas. After some time, he abandoned mathematics and enrolled in Harvard Law School in 1916. He withdrew three years later without finishing and became involved in political causes including being a conscientious objector to the World War I draft.

His arrest in 1919 for participating in a socialist rally that turned violent caused him to be sentenced to 18 months in prison for rioting and assault (there is some question concerning the legitimacy of the charges). His father made a special arrangement with the District Attorney to keep William out of prison by having him sent to his private sanatorium instead. This seemed to be an especially dark time of William's life and he never forgave his parents for "kidnapping" him and holding him against his will for more than a year. He accused them of subjecting him to various forms of "mental torture" including scolding and nagging for hours at a time. He was frequently threatened with transfer to a regular insane asylum where his prospects for an eventual release would be slim.

William eventually managed to escape in 1921 but he never reconciled with his parents. His experience in the sanatorium had left him "scared of his own shadow" and his parents' efforts to have him returned to their care made him extremely paranoid about his privacy and intrusions into his life. He spent the rest of his life apparently drifting between menial jobs although he continued to publish a range of eclectic works (mostly under pseudonyms) that still attracts a cult following. He especially resented intrusions into his life by the press (who regularly presented him as being an unhappy and burned-out product of his forced acceleration) and even sued one paper for what he considered to be a libelous article about him that caused "grievous mental anguish and humiliation". The stress from the lawsuit may have contributed to his death from a cerebral hemorrhage in 1944.

What do we make of William Sidis? Despite his early death and failure to live up to his early potential, his case is still followed in educational circles. Would things have turned out differently had his parents not intervened in his jail sentence as they did? Some questions can't be answered.

Killer Boasts of Tricking Psychiatrists

"It's really not hard to make up stuff," grinned David Weightman, 28, talking about how he had convinced psychiatrists he was hearing voices to receive a lighter sentence for the murder of his adoptive parents in their Sydney. Australia home. Weightman received 25 years on the grounds of "diminished responsibility" rather than the life sentence he would have otherwise received. Appearing in the Supreme Court jury murder trial of his alleged accomplice, Terry Donai, Weightman reported that he and that he and Donai had discussed the fact that as he was an only child and would inherit from his parents' deaths. The murder plan involved Weightman drugging his parents and that Donai would then smother them.

On the night of January 8, 2000, Weightman put several sleeping tablets into his parents' tea and was outside their house when he heard his mother scream from her bedroom. Donai had emerged from the house "stinking like death", sweating and breathing heavily. He said Donai told him: "That really took a lot out of me. I'll need a hand with your dad."Weightman then held his father down as Donai smothered him with a pillow. He and Donai then pushed a car with the bodies inside over a nearby embankment to make their deaths appear accidental.

After the murders, Weightman refused to pay Donai the $18,000 he had promised him. "I was angry and mad and I didn't feel like he deserved to be paid," Weightman told the jury. He confessed to his part in the murders in 2004 after years of badgering by his aunt and uncle. While in jail waiting to be sentenced, he was told by another inmate that if he could convince psychiatrists he was insane then he could go to a psychiatric hospital rather than jail.

Weightman said he told "numerous lies" to psychiatrists while being assessed, including hearing voices, and seeing bubbles and "little gremlins". In 2005, when Justice Peter Hidden sentenced Weightman to 25 years in jail, with a minimum of 19 years, he said he lowered the sentence from life because of Weightman's confession and the help he gave police. Justice Hidden also stated that he believed Weightman suffered from schizophrenia at the time of the murders and was sorry for having killed his parents.

Donai has pleaded not guilty. He was arrested last year.

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Does Staying Active Keep Us Alive as We Get Older?

A study reported in the August 2007 issue of Journal of Aging and Health provides a look at the important role of regenerative (e.g., resting), productive (e.g., housework), and consumptive (e.g., meeting friends) activies in helping people aged 70 and older stay alive. An observational study of 473 persons aged 70 to 103 years stratified by age and sex was carried out in the former West Berlin, Germany. Study participants lived in the community as well as in facilities for the elderly. Using structured interviews in the participants' homes to study activity levels from 1990 to 1993, the rate of survival time from time of interview to a target date (August 1, 2003) was determined. Using regression measures to examine the role of different types of activity on survival, it was found that consumptive (stimulating) activities were significantly related to survival after several confounding factors were ruled out. The effect was found to diminish over time. The authors discuss the idea that daily activities are linked to survival through a psychosocial pathway that might involve perceived quality of life. Consumptive activities (e.g., meeting friends, reading a novel) may contribute significantly to maintaining health and achieving longevity because they are performed on a daily basis and their effects may accumulate over the life course.

Click here for the abstract.

Killing President Garfield

It was on July 2, 1881, as he was walking through a Washington, D.C. railroad station that President James Garfield was shot in the arm and lower back by a disturbed loner named Charles Guiteau. As the President slumped to the ground, Guiteau cried out "I am the Stalwart of Stalwarts" before being taken into custody. President Garfield was taken to the White House where doctors worked to save his life. Unfortunately, the sixteen doctors who were called in to tend the president had no notion that their own unsterilized hands and instruments were a danger to their patient (this was years before sterilization became common practice in medicine). The actual shooting had left no more than a minor wound but the doctors and their relentless poking and probing did the rest. After Garfield finally died on September 19, an autopsy determined that he likely would have lived had the doctors simply left him alone. Although the lead surgeon later made a public apology , it probably didn't help that the doctors submitted a bill for their services afterwards (the bill was only partially paid).

As the first presidential assassin ever to be put on trial (or at least the first successful one), Charles Guiteau's case riveted public attention although defending him proved to be a nightmare for his legal team (led by his brother-in-law). Throughout the trial, Guiteau was housed at the St. Elizabeth's Psychiatric Hospital although he opposed any attempt to have him declared insane. His bizarre behaviour during the trial remains the stuff of legal legend. He systematically abused his defenders, wrote his testimony in the form of epic poems which he recited in court, composed his autobiography (including an advertisement for a future bride), and repeatedly defended himself. While his argument that he didn't kill Garfield and that the doctors were really responsible for his death was true enough, it failed to sway the jury. Both prosecution and defence attempted to bring in medical experts to testify concerning Guiteau's mental state but the jury was put off by the spectacle of "duelling credentials" It was also one of the first American trials in which the newly adopted M'Naghten Rule was applied and Guiteau's appearance of sanity probably helped seal his fate. Guiteau's insistence that he was "legally insane but not medically insane" worked against him and swayed the jury into thinking that he was only faking insanity. Guiteau seemed incapable of realizing the hatred that the American public had for him despite being nearly killed on two occasions during the trial. He honestly seemed to see himself as the Hand of God in bringing down the president and seemed genuinely astonished when the jury brought in a verdict of guilty (nobody else was). His appeal was later denied and Guiteau was executed on June 30, 1882. To the end, he tried to make the execution into a media spectacle and used the occasion to recite a poem that he composed. His request to have an orchestra at the hanging was denied. The body was never returned to the family to be buried and the current whereabouts of Guiteau's skeleton is somewhat of a mystery.

The usual problem with attempting a psychiatric diagnosis on the basis of historical accounts certainly applies here although Guiteau's bizarre behaviour suggests some possibilities. One of the most intriguing theories relates to the fact that Guiteau had contracted syphilis from a prostitute years before (which had been used against him in the trial to prove his "moral depravity"). An autopsy determined that his brain showed signs of damage relating to neurosyphilis but the results were felt to be inconclusive. The flamboyance and grandiosity that Guiteau showed during the trial seem to fit with the diagnosis of syphilis-related dementia but it could fit other diagnoses as well. The question of whether Guiteau was wrongfully executed was debated in the psychiatric literature long after his death.

Was Guiteau insane? Would he have been executed had he killed anyone other than a U.S. president? You be the judge.

'Vampire' Robs Blood Bank

Hong Kong police arrested a 29-year old suspect following a September 13, 2007 incident in which closed-circuit cameras recorded him stealing three blood vials from a hospital blood bank and apparently drinking the contents. According to the camera evidence, the suspect apparently reached in through the drop-in window of the blood bank, located on the fourth floor of a local hospital, and removed the three vials. While he appeared to drink the contents on camera, it remains uncertain whether he actually did so. The vials were from three women patients awaiting testing for stomach complaints. Psychiatrist Chan Chung-mau, chairman of the Hong Kong Association for the Promotion of Mental Health, said the suspect could be suffering from a mental illness and may believe that drinking blood can charge him with energy. His current arrest status and whether he has a psychiatric history has not been reported.

Police sources indicate that the suspect was under the influence of alcohol at the time of his arrest. Security at the blood bank has since been increased.

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Delusional "Pseudotranssexualism" in Schizophrenia

The Summer, 2007 issue of Psychiatry described a case history of a 40-year old male patient with chronic schizophrenia who developed a preoccupation with changing his gender. The authors review relevant literature and concluded that twenty percent of all schizophrenic patients experience sexual delusions at some point during the evolution of their illness (including becoming convinced that they are actually the wrong sex). While true coexistence of schizophrenia and gender identity disorder is rare, disentangling them can be extremely tricky. Considering the irreversible consequences of gender reassignment surgery and the medical and legal implications implications, it is important that these patients be properly diagnosed.

Click here for the abstract.

Does Trauma Lead to Hoarding?

In a paper published in the June 2007 issue of Behavior Research and Therapy, a study of individuals diagnosed with obsessive-compulsive disorder (OCD) suggests that traumatic life experiences may be a catalyst for the abrupt onset of OCD symptoms (including compulsive hoarding). The study researchers analyzed the interview responses to the Posttraumatic Stress Disorder module of the Structured Clinical Interview for DSM-IV, (SCID) in 180 individuals diagnosed with OCD. Compared to individuals with OCD who did not meet criteria for hoarding, participants classified as hoarders (24% of the sample) were significantly more likely to have reported at least one traumatic life experience in their lifetime. Patients who met criteria for hoarding and who had also experienced traumatic life experiences had significantly greater hoarding symptom severity than those hoarders not exposed to trauma. The relationship between traumatic life experiences and hoarding symptom severity was found to be independent of other factors such as age, age of OCD onset, depressive symptoms, general OCD symptomatology, or related mood and anxiety problems. The researchers also found that it was cluttering (and not collecting or failing to get rid of possessions) that was most strongly associated with traumatic experiences. These results provide insight into the hoarding behaviour observed in some trauma victims as well as the extreme hoarding behaviour in cases of Diogenes syndrome.

Click here for the abstract.