Providentia

How To Survive A Hostage-Taking

As seminars go, it doesn't seem as if it would appeal to many but Rocky Abramson has no shortage of journalists and aid workers willing to listen to him. Based in Israel, Abramson is a Canadian-born organizational psychologist and a former member of the Israel Defence Forces. In his four-hour seminar on the hostage experience, he stresses that the best-case scenario involves avoiding being taken hostage in the first place but, in the event of capture, following some important guidelines can increase the likelihood of survival. These guidelines include:

• If you must venture into dangerous situations where kidnapping is a possibility, do so in a group, rather than on your own, because there really is strength in numbers.
• If faced with capture, try to resist passively, a tactic that will at least buy extra time and may confuse your captors.
• During interrogation, insert a lengthy pause before answering any question, even the most straightforward – a tactic aimed at preventing your interrogators from determining which subjects you are most reluctant to address.
• Do not initiate casual conversation with your captors.
• If your captors try to chat with you, do not reciprocate until you obtain some benefit, no matter how small – a loosening of your bonds, some food or drink, anything that increases your sense of control.
• When speaking in your native language, try to enhance your control of the conversation by using lots of slang or rarefied constructions in order to make it difficult for your captors to understand you (assuming they do not speak your language well).
• You are more likely to be hit or physically abused if you slouch, so try to maintain an erect posture with your head held high.
• Make it clear to your captors that you are willing to co-operate with them but only if they do not hurt you.
• Do your best, surreptitiously, if possible, to disconnect the wires from any explosive device placed near or on you; don't worry about which wires to pull out, because it is only in the movies that bombs are designed to detonate if the hero cuts the wrong strand (real bombs don't work that way).
• Think – constantly – about a means of escape.

These tips (along with many others) are presented through four hours of role-playing, discussion and lectures and are designed to given seminar participants a sense of control over what is often seen as uncontrollable. He states that "Generally, they don't want to kill you. You'd be surprised how much of your environment you can control".

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Shell Shocked, part 1

The "Great War" that raged from 1914 to 1918 added a new dimension to warfare with modern artillery fire raining down on troops as they dug into their trenches. An estimated ten percent of all troops deployed were killed (compared to 4.5% in World War 2) with countless more being severely wounded. With the modern way of fighting wars came a new awareness of how troops were being affected. While troops of previous wars had presented symptoms of the extreme stress they were facing (eg., soldier's heart), it was in 1914 that a British medical officer named Charles Myers first coined the term "shell shock". The term was used to describe the impact of battle on even experienced soldiers who displayed a range of bizarre symptoms that medical doctors on both sides of the conflict were at a loss to treat. While many of these cases were observed in soldiers who had faced the heat of battle, cases were also being found in soldiers who had never been deployed in the field. There was a range of medical opinions offered as to the cause ranging from physical explanations to accusations of cowardice. Soldiers sent to hospitals for treatment were overcome with shame over their lack of bravery with four out of five soldiers being unable to return to fighting afterward. Soldiers were often urged to face their trauma in a "manly way" and rarely received sympathy from commanding officers or fellow soldiers. A distinction tended to be made between the symptoms reported by common soldiers and what officers developed and they would often be sent to different hospitals.

Given the high casualties that were occurring during the war and the need for soldiers to fight, the priority was given to methods that would get soldiers back into action. Different therapists advocated radically different approaches ranging from simple talking cures to "torpillage" or electroshock therapy (especially popular in the French army). Advocated by Clovis Vincent, a French neurologist, for use with cases of hysterical paralysis, the treatment involved Vincent applying a sharp current to the patient's body to provoke involuntary movement. The treatment fell out of favour after a soldier received a court-martial for punching Vincent A similar approach was followed for the treatment of German soldiers and was known as the "Kaufman Cure" after its primary exponent, Fritz Kaufman. The treatment involved "surprise" methods including shock and physical intimidation and resulted in the deaths of an estimated twenty patients.

In 1915, a British Army directive was issued stating that "Shell-shock and shell concussion cases should have the letter 'W' prefixed to the report of the casualty, if it were due to the enemy; in that case the patient would be entitled to rank as 'wounded' and to wear on his arm a 'wound stripe". If, however, the man's breakdown did not follow a shell explosion, it was not thought to be 'due to the enemy', and he was to be labelled 'Shell-shock' or 'S' (for sickness) and was not entitled to a wound stripe or a pension". By 1917, all British cases of shell shock were separated into "commotional cases" (due to physical causes) and "emotional" cases who were increasingly kept in their units unless the cases were extreme. The treatment of shell shock cases in their units by counsellors (not necessarily medical) gave rise to the PIE principles for treating shell shock cases. Treatment focussed on (P)roximity to the fighting, (I)mmediate treatment (as soon as possible), and the (E)xpectation that shell-shocked soldiers would be returned to active service following treatment. These same principles would be adopted in American and Commonwealth armies following the war (although their effectiveness in preventing PTSD has since come into question).

The shell shock diagnosis did not prove popular with the upper echelons of the British military and was abandoned in 1918. All too frequently, shell-shocked soldiers faced military tribunals and could be executed for cowardice. More on that next week....

Exorcism Case Underway in Singapore

In a bizarre trial that is currently underway in Singapore, 50-year old Amutha Valli is suing the Novena Church over an alleged exorcism. The plaintiff is claiming that the exorcism occurred on August 10, 2004 and left her traumatized and unable to work. Amutha Valli, a former national athlete, had a long-standing history of psychiatric involvement and, according to defense testimony, had been "slithering like a snake, shouting and screaming like Satan and marching like a soldier" before the alleged exorcism occurred. The priests who are at the centre of the trial contend that they have been approached by her family for help and had only conducted a "prayer session".  Defense counsel has also accused the plaintiff of fabricating the story for financial gain.

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Man Convicted For Killing Woman Carrying "Lucifer's Baby"

A 21-year old Edmonton, Alberta man who shot his pregnant childhood friend because he believed the unborn child she was carrying was Lucifer's baby was found guilty yesterday of first-degree murder Jared Baker testified at his trial that he became convinced he was the son of Satan and by "crushing the serpent's head" -- meaning killing Ms. Talbot and the fetus -- he could "walk like Jesus." Jurors were told that Mr. Baker believed the unborn baby was talking to him in his dreams, asking him to take its life and that the government had planted a transmitter in his head. He maintained that his delusions were the result of drug use.

Prosecutors determined that Baker had shot 19-year old Olivia on November 25, 2005,due to anger over her drug use which was potentially harmful to a baby that he had believed was his. On the day of the murder, he took a gun from his basement, snorted crystal methamphetamine, and then went to her house. After being invited in, he stated "Sorry, O.V." and pumped five bullets into her body. He then threw the gun into a river, went home and awaited arrest.

Jury members rejected defence arguments that Baker was not criminally responsible in bringing in their guilty verdict.

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Are Schizophrenics Better Off in Developing Countries?

Based on on a series of cross-national studies by the World Health Organization (WHO), the prevailing view in international psychiatric circles has been that schizophrenics tend to fare better in developing countries. However, in an article in the September, 2007 issue of Schizophrenia Bulletin, a review of evidence from other research indicates that the picture is far more complex. Through literature review and tabulation of data from 23 longitudinal studies of schizophrenia outcomes in 11 low- and middle-income countries, evidence examing clinical outcomes, disability and social outcomes (marital and occupational status, in particular), and untreated samples and duration of untreated psychosis, have indicated a need to reexamine the conclusions of the original WHO studies. In particular, excess mortality and suicide need to be take into account in making broad generalizations about schizophrenia outcomes in low- and middle-income countries.

Click here for the abstract.

The Great Deceiver

Guy de Maupassant was arguably one of the greatest writers of his generation. His short stories and novels continue to mesmerize readers with his gripping description of human nature at its best and worst. By the 1880s, his health began to decline and his writing became darker and more shocking. As his depression deepened, his friends began to be concerned by his odd behaviour. It isn't known exactly when Maupassant contracted syphilis, but the progression of the disease followed the classic pattern almost exactly. By 1892, he had become delusional and, believing that flies were devouring his brain, attempted to shoot himself. When that failed, he then attempted to drive a letter opener into his throat. He was committed to a private asylum on the following day and died raving just a few months later. He was 43 at the time of his death, a phenomenal writing career cut tragically short.

Although its exact origin continues to be a matter of speculation, syphilis (caused by the spirochete Treponema pallidum) was first identified in the early sixteenth century and the number of cases swelled to epidemic proportions quickly. Being a sexually transmitted disease added to the stigma and helped ensure that its sufferers remained marginalized by mainstream medicine. The actual incidence of syphilis cases remains a matter of speculation but what is clear is that there was a tremendous upsurge in admission to insane asylums in most of the industrialized world between 1800 and 1900. While different diagnoses were given to these countless patients, one of the most common causes appears to have been syphilis (earning it the title of "The Great Deceiver"). Initial infection of syphilis is often ignored following a minor flare-up of symptoms (which may well go unnoticed) but the syphilis spirochetes can remain in the bloodstream for decades afterward. While syphilis sufferers may never develop symptoms, the spirochetes often end up attacking the meningeal lining of the central nervous system. It is during this phase (also known as neurosyphilis) that the disease can manifest itself in various psychiatric symptoms. Grandiosity and mania are common features and were often misdiagnosed in the 19th century. The illness would then progress either towards primary infection of the spinal cord (tabes dorsalis) with bizarre gait and pain to the abdomen or primary infection of the brain. It was in this form (also known as General Paresis of the Insane) that dementia and psychosis would become most prominent. For every case in which a clear diagnosis could be made (such as Maupassant), there were countless others in which syphilis involvement could be only suspected (there were no reliable tests available). The disease was always terminal.

It was not until 1906 that the first truly effective test for syphilis was developed and the true incidence of syphilis cases in psychiatric hospitals was properly recognized. While syphilis cases were treated by different means (including being infected with malaria, a "fever cure" that earned its discoverer a Nobel prize in medicine), it was not until 1910 that a Berlin physician named Paul Ehrlich and his team developed a compound named "Salvarsan" that blocked the development of syphilis. Salvarsan, an arsenic compound, represented a way of preventing syphilis from advancing to the neurosyphilis stage but was only only a preventative, not a cure. It was with the discovery of penicillin in 1929 (which was not actually used to treat syphilis until 1943) that the trend towards psychiatric hospitalization of neurosyphilis cases began to be reversed. In the decades that followed, neurosyphilis cases became relatively rare and easily treated.

And yet...

Neurosyphilis hasn't gone away. In fact, there has been an upsurge of cases since the 1980s as antibiotic-resistant strains of syphilis become more widespread. It has also become more common in HIV-positive cases and may consititute one of the primary causes of HIV dementia. Neurosyphilis is also a likely factor in the skyrocketing incidence of HIV dementia that has been observed in many Third World countries where AIDS remains unchecked and proper medications are in short supply

We definitely haven't seen the last of the Great Deceiver.

Psychotic Priest-Killer Jailed Indefinitely

An untreated paranoid schizophrenic with extensive religious delusions has been jailed indefinitely for the March 14, 2007 murder of a 59-year old vicar in Wailes. Geraint Evans had been living in his mother's flat overlooking the vicarage and had made elaborate plans to murder Father Paul Bennett as part of an elaborate delusion in which the vicar was God. He made elaborate notes on Father Bennet's movements and recorded his observations and speculations on a series of CDs. On the day of the murder, Evans stabbed Father Evans to death and scattered the CDs at the scene of the murder while the vicar's wife looked on in horror. He then walked to a nearby grave to await arrest.

In a court-ordered psychiatric assessment, it was determined that the 24-year old Evans had a longstanding history of substance abuse (including inhaling lighter fluid) and was diagnosed with paranoid schizophrenia and a personality disorder. He reported delusions of being God, Jesus and the Antichrist and would save the world from nuclear Armageddon. He had apparently developed animosity towards Father Bennett whom he had accused of attempting to have him sectioned under the Mental Health Act. Despite a previous suicide attempt, he had never received psychiatric care prior to the killing.

Judge Nicholas Cooke QC ordered him to be detained indefinitely and said it was difficult to conceive when it would be safe for him to be released.

After the case at Cardiff Crown Court, the priest's family accused the authorities of failing him and demanded an inquiry into the killing. One said: "Someone must have known how disturbed this man was and could have intervened. Where were the mental health services?"

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Screening for Violence Risk in Youth

The July 2007 issue of the Journal of Psychiatric Practice describes an study designed to test whether risk factors for violence were being adequately reported in emergency psychiatric admissions . The study was based on a sample of 425 pediatric patients who were assessed by psychiatry residents in a psychiatric emergency room. Using a chart review process, it was determed that psychiatric residents rarely documented asking about important risk factors such as access to guns, gang affiliation, history of police contact, or domestic violence. When pediatric patients were specifically asked about these risk factors, most patients were open in talking about how they affected their lives. Despite being the most common method of homicide/suicide in youth, gun access was assessed by residents in only 3% of patients while domestic violence was endorsed as positive 100% of the time whenever it was documented. Pediatric patients regarded as violent were more likely to be screened for past violence than those with suicide or other complaints. Males were more likely to have a history of prior violence than females. The researchers conclude that psychiatric residents need to do a better job of documenting potential risk factors for violence in pediatric patients being admitted to an emergency setting. Identification of potentially high-risk youths is vital both for legal and treatment planning purposes.

Click here for the abstract

Dying of Evolution?

The publication of Charles Darwin's seminal masterwork On The Origin Of Species in 1859 marked a turning point in the understanding of how species form and change over time. It is doubtful that Darwin himself really anticipated the storm of protest that followed the book's publication. Scientists and theologians alike became locked in a battle that lasted for decades (and still continues today). Of all the stout churchmen who were appalled at Darwin's theory, perhaps no one felt outrage more keenly than Robert Fitzroy, former captain of the HMS Beagle. Born in 1805, Fitzroy was part of one of the most illustrious families in England. After an idyllic childhood, he entered the Royal Naval College at the age of twelve and the Royal Navy a year later. His life was never the same following the suicide of his uncle, Viscount Castlereagh, in 1822. The stigma of having a suicide in the family left Fitzroy with a sense of dread over the possibility that the madness that had claimed his uncle was hereditary. This fear was made all the more real for him when he became Captain of the HMS Beagle in 1828 following the suicide of its previous captain. When the Beagle's second voyage was being planned in 1831, it seemed only natural that he arrange for a suitable traveling companion to help him stay sane on the proposed five-year voyage of exploration. After other candidates turned down his offer, Fitzroy settled on a 22-year old Cambridge naturalist and theologian named Charles Darwin (although Fitzroy was initially suspicious of Darwin due to the shape of his nose). Darwin's credentials as a naturalist appealed to Fitzroy who relished the opportunity to use the Beagle's voyage to gather evidence confirming the Biblical account of creation.

Over the course of the long voyage, Darwin and Fitzroy became fast friends despite Fitzroy's volatile temper leading to frequent clashes between them (often over matters of religion). The Beagle's voyage took them from South America to the Galapagos Islands and gave Darwin an unprecedented opportunity to learn about (and puzzle over) the diverse range of fauna and fossils to be found. On their return to England in 1836, both Darwin and Fitzroy published their research findings to critical and popular acclaim. In the years that followed, the two men drifted apart as Darwin began formulating his famous theory while Fitzroy continued to champion the Biblical account of creation. Despite an illustrious naval and political career (including a disastrous five-year term as Governor of New Zealand), Fitzroy eventually retired from active service in 1851 and was then named to the Royal Society for his prominent work in meteorology (Darwin was one of his supporters).

Fitzroy's health had taken a turn for the worse by this time and the shock that he felt when Darwin finally published his treatise on evolution contributed to his decline. His sense of betrayal and guilt over the role that he had played in furthering Darwin's research led him to oppose evolution at every opportunity. When Bishop Samuel Wilberforce attacked Darwin's theory in 1860 at the famous British Association meeting with Darwin's supporters, Fitzroy was there imploring the audience to "believe in God rather than man". There was little sympathy when he spoke of the "acutest pain" that Darwin had caused him and he was shouted down.

Following Fitzroy's retirement in 1863, his depression worsened significantly. It didn't help matters that he was passed over for an important naval post. On the morning of April 30, 1865. Fitzroy got out of bed and went to the washroom. He then used a razor to cut his throat (much as his uncle had done years before). Only after his death was it discovered that his entire fortune had been spent during the course of his long public service. His wife and daughter would have been left destitute if friends had not launched a testimonial fund on their behalf (Charles Darwin contributed one hundred pounds). He is buried in Brompton Cemetery in London.

Robert Fitzroy left a substantial scientific and political legacy behind him with his numerous discoveries in meteorology and geography. Still, his life would be little more than a historical footnote except for the role that he unintentionally played in furthering Charles Darwin's revolutionary theory. Whether that contributed to the ardent churchman's death is anybody's guess.

Setting Fires

While reports of gender differences amongst arsonists undergoing psychiatric assessment are not uncommon, many of the studies some are based on relatively small samples. The July 2007 issue of Medicine, Science and the Law presents a new retrospective study examining gender differences in a sample of 167 adult arsonists (129 males and 38 females). The information was collected from case files of a group of arsonists referred to the West Midlands Psychiatry Service over a 24-year period. The results found that female arsonists were older than males and more likely to have a psychiatric diagnosis. Women more frequently had a history of sexual abuse, while men had a more varied criminal background and more substance abuse problems. The findings largely support previous research, and also provide support for an Action System Model of arson behaviour. The researchers suggest that significant gender differences among arsonists indicates that different approaches in the treatment of male and female arsonists may be advisable, though a reliable evidence base for treatment has yet to be established.

Click here for the abstract.