Providentia

The Shattered Man

The Battle of Smolensk was part of a two-month offensive in 1943 designed to drive Nazi invaders from the city that they had held for two years. Although the offensive was ultimately successful, it came at a terrible cost.with much of Smolensk being devastated.by the occupation and the battle to retake the city. Thousands were killed or seriously injured including one 23-year old lieutenant named Lev Zasetky.

Born in 1920 in the town of Kazanovka (now Kimovsk) in Russia's Tula region, Zasetsky completed his third year of courses at a polytechnic institute when war broke out in 1941. His writings contain only scattered recollections of his childhood but he comes across as a bright young man with a promising future before being sent to the western front. It was on March 2, 1943 when he received the injury that would alter his entire life. A bullet penetrated the parieto-occipital area of the cranium and left him in a coma. Despite prompt treatment at a field hospital, Zasetsky's case was complicated by meningitis and scarring of the lateral ventricles. The location of the brain damage and the progressive medullary atrophy that resulted would have far-reaching effects on him.

Describing his experiences in the field hospital following his injury, Zatseky wrote: "For some reason, I couldn't remember anything, couldn't say anything. My head seemed completely empty, flat, hadn't the suggestion of a thought or memory, just a dull ache and buzz, a dizzy feeling". Relearning language in the hospital was a long, slow process and most details of autobiographical memory were missing. He would later describe himself as having been "killed" due to his injury and living a "senseless existence" as a result. Lev Zasetsky was sent to a rehabilitation hospital and it was in May of that same year that he first met Alexander Luria.

Already a prominent brain researcher, Luria spent much of World War II as head of a research team investigating psychological assessment and treatment techniques in brain-injured soldiers. His research would lay much of the groundwork for the modern field of neuropsychology. As with his other famous patient, Solomon Shereshevsky, Luria regarded Zasetsky as an ideal candidate for a longitudinal study that continued over the course of the next twenty-eight years,

Even after his discharge from the hospital, Luria met with Zasetsky on a regular basis and would later publish his findings in the classic work The Man With a Shattered World in 1972. Not only did the book summarize Luria's findings, but it also included excerpts of Zasetsky's own writings. As a way of coping while in hospital, Zasetsky forced himself to begin writing about his injury and struggle to deal with his devastating impairments..

Based on pneumencephalography results and Luria's observations, it was determined that Zasetsky's perceptions of the world had been profoundly altered by his injury. Not only was he experiencing a form of homonymous hemianopsia (loss of half the visual field in both eyes), but he was no longer aware of the right side of his body. When asked to raise his right hand, he became confused and agitated although his motor functioning seemed unimpaired. Becoming aware of the right side of a page or a photograph meant having to move his head to place the missing information into his range of vision. Being asked to identify different parts of his body was a major challenge and he was frequently forced to "hunt" for the location of the hand, foot, or arm that he was trying to name.

The "spatial peculiarities" that Zasetsky experienced made writing a particular challenge for him. He forced himself to learn how to sit at a table and grasp a pencil properly. Not only was his concept of self affected, but his grasp of language as well. He was forced to retrain his brain to make simple logical assumptions and judgment tasks.After months in the rehabilitation hospital, Lev Zasetsky was finally sent home to the care of his family in Kimovsk. A nurse accompanied him to the railroad station and provided him with his family's address on a sheet of paper. Despite initial confidence that he could reach home on his own, his mental confusion forced him to depend on strangers for assistance. Even when finally reaching Kimovsk, he had difficulty recognizing his family home and found himself getting lost whenever he left the house for brief walks.

Simple tasks such as reading maps, and doing household chores became agonizingly difficult for him. When his family bought a new kerosene cooking stove, Zasetsky spent weeks trying to understand the instruction manual and eventually learned to operate the stove through trial and error. Although he would return to see Luria at regular intervals, the wounded soldier never regained his former independence. The promising young man who had gone to war seemed to be lost forever.

Despite Zasetsky's devastating impairments, he was forced to deal with a skeptical bureaucracy that questioned whether a veteran with no visible injuries could even be considered disabled (a common problem with neurological patients). At one point, he would have his veteran's benefits cut and needed the active intervention of family members and therapists to have them restored. In the decades that followed, Lev Zasesky continued to add to his journals (eventually running to thousands of pages which were carefully archived by Luria's assistants).

The final chapter of Luria's book is simply titled "The Story That Has No Ending" and shows Zasetsky continuing as before. His condition never improved and he remained dependent on his family for care. He himself would write that "Over two decades have slipped by and I'm still caught in a vicious circle. I can't break out of it and become a healthy person with a clear memory and mind". For all that his case inspired generations of treatment professionals, there was little help for him.

I have no idea what became of Lev Zasetsky in later life (Luria himself died in 1977) or even if he is still living in Kimovsk, writing his journal. As an epilogue to his book, Luria speculated on the cost of war and the number of lives that have been destroyed as a result. It's a lament that still has relevance today given the rising number of brain-damaged veterans who need treatment more than ever.

"Ignorance and Shame" Blamed For Psychiatric Patient's Captivity

Acting on an anonymous tip, police discovered that a woman had been held in her family home in Santa Maria Capua Vetere, near Naples, for the last eighteen years of her liife due to the stigma associated with her psychiatric problems and her out-of-wedlock pregnancy.

Maria Monaco, now 47 years of age, spent the last 18 years of her locked in a bare room and watched over by her elderly mother and siblings as she slept in a filthy bed. Experts say this is only one recent example of a widespread stigma attached to mental and physical disability in many backward parts of Italy.

Monaco, in addigtion to her out-of-wedlock pregnancy, had a history of psychiatric problems when her family decided to lock her up.  Investigating police found the woman in the room with a bed with soiled sheets, a filthy toilet and sink, as well as plastic bottles of water and a metal dog bowl used to feed her.

The woman's brother, a farmhand, and sister, have been arrested and her 80-year-old mother is under house arrest. They are being investigated on suspicion of mistreatment and kidnapping.

Monaco's now 17-year-old son grew up with relatives and knew she was his mother, though he was told that she was too sick for visits, said prosecutor Antonio Ricci. The same was told to inquisitive neighbors or distant relatives.

"This is a particularly horrible case," the prosecutor told The Associated Press by telephone. "But this measure is often taken with the mentally ill, also because there is little access to health care in the most isolated areas."

They are also probing why authorities were not alerted earlier. The woman has been receiving a monthly disability check since the late 1980s and should have been paid occasional calls by health officials, the prosecutor said.

A lawyer for Monaco's family denied that the woman was locked up because of the pregnancy and maintained that her "deplorable" condition was due to  refusal to let anyone wash her or change her.  He blamed the family's refusal to call in professional help on "ignorance and shame."

Similar cases have been reported in recent years across Italy including a case of a woman in Pescara, central Italy, who lived for 30 years in the bathroom of the home of her mother and stepfather because she was mentally retarded and was born from a previous relationship.

Elvira Reale, a psychologist and director of a women's mental health center in Naples, said the stigma of disability can mask prejudice against women who display behavior considered too bold in the country's more conservative backwaters. Women who behave unconventionally, particularly sexually, can be branded as mentally ill.

Until the late 1970s, it was common for such women to end up spending their lives in a mental institutions upon doctor's orders, she said. A 1978 reform shut down mental institutions, and hospitalization in psychiatric wards must be limited in time. Monaco's case appears to conform to this age-old pattern, Reale said.

"Since the family could not have her committed, they created their own little madhouse at home," the psychologist said.

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When Mothers Kill Their Children

A recent issue of the Journal of Forensic and Legal Medicine provides a review of a disturbing new forensic trend in the Jamnagar region of India's Gujarat state. While Gujarat has an overall low incidence of homicide compared to other parts of India, a series of murder-suicides involving mothers killing their children has been noted. In the 5 year period from 2000 to 2004, 8 mothers committed a total of 13 murders involving 3 male and 10 female children and, in every case, the murder was followed by suicide of the assailant mothers. The annual incidence of murder-suicide was about 1.8 cases per year and the ages of the victims ranged from 6 months to 7 years.Five incidents occurred in rural areas and three in urban areas. Socio-economic status appears to be a factor since the killings only occurred in low income families. Methods both for killing and suicide were either burning or drowning. All the mothers were legally married and living with the family. Family and family related matters were the main motives for killing. In one case there was history of depression of the mother due to her previous miscarriage. Substance abuse was not a significant factor. The need for better intervention strategies to identify high-risk families is discussed.

Click here for the abstract.

Jekyll, Hyde and Brodie

When Robert Louis Stevenson first published The Strange Case of Doctor Jekyll and Mister Hyde in 1886, it was an immediate success and became one of his most memorable classics. Through numerous movies, television dramatizations, and plays, the story has entered the cultural mainstream. Although Stevenson had originally meant the book to explore his fascination with the duality of good and evil (which he had briefly touched on in his early short story, Markheim), he was largely inspired by a famous case that had rocked eighteenth century Scotland.

Born in 1741 in Edinburgh, Scotland, William Brodie was the son of a prominent cabinetmaker and was likely considered quite a disappointment to his parents. From an early age, he was reportedly a gambler and a playboy who was off gambling even while his father lay dying. He had a knack for charming family and friends into forgiving his excesses, though. After his father died, Brodie apparently straightened out his life to become a successful cabinetmaker in his own right. Not only was he a member of the Edinburgh city council, he was also elected deacon (chairman) of the local trades guild. He socialized frequently and was a well-known figure in Edinburgh society.

During the evening hours, things were very different. His gambling had continued and, finding himself running short of money, decided to supplement his income through crime. Brodie's legitimate work gave him the opportunity to take wax impressions of the main doors of the various houses that he would later burglarize. Teaming up with an English locksmith named George Smith, his criminal career was impressive (he and his gang once stole the silver mace from the University of Edinburgh).

The energetic Brodie certainly needed the income from his criminal activities. In addition to fueling his chronic gambling, he also maintained two mistresses in separate households (neither of whom knew about the other), and had numerous children. While his gang continued to terrorize Edinburgh, Brodie maintained his image as a prosperous businessman. As a respected cabinetmaker and carpenter, he was in a position to install locks and security devices in businesses and private homes across the city (while checking out places for his gang to rob).

It all came to an end with a disastrous armed raid on a government Excise office in Chessel's Court, Canongate in 1786. Although Brodie planned the operation himself, too many things went wrong and the gang only barely escaped. The city council posted a huge reward and one of the newer gang members (there being no honour among thieves) decided to turn King's evidence. Brodie managed to get word that the other gang members had been arrested and fled to Amsterdam. Things still grew too hot for him there and he was arrested by Dutch police just before he could board a boat to America.

Extradited back to Scotland, William Brodie went on trial on August 27th, 1788. The trial records are still available and make for fascinating reading.  He pled not guilty and his testimony was filled with righteous indignation against the "designing villain John Brown" (the gang member who had turned him in). Building a case against Brodie would have been difficult if a careful search of his house hadn't turned up assorted burglary tools. William Brodie and George Smith were sentenced to be hanged on October 1, 1788.

There still seems to be some confusion as to what happened with the actual hanging at the Tolbooth prison in Aberdeen. At least one account maintains that Brodie had arranged to wear a steel collar to the gallows (and had bribed the executioner to ignore it) so that he could survive the hanging. Despite the arrangements that he had made to have his body quickly removed, he could not be revived and was later buried in an unmarked grave in a churchyard in Buccleuch. There were later rumours of his having cheated the hangman and fleeing to Paris but no real evidence exists of this.

It's not hard to see what inspired Stevenson to base his novel on William Brodie's double life. On one hand, he was a prosperous businessman and respected craftsman (who, among other things, made much of the scaffolding on the gallows that was later used to hang him). On the other hand, he was the notorious leader of a gang of thieves that plagued Edinburgh for years. Much of the resemblance ends there though. Brodie was never a saintly Henry Jekyll, or even a thuggish Edward Hyde. He was just a full-time criminal who was particularly good at pretending to be law-abiding.

For all that there was no evidence of the psychological conflict that marked Stevenson's title character, the novel gave William Brodie a curious literary immortality. Along with a pub and alleyway named for him on Edinburgh's Royal Mile (which I plan to visit the next time I'm there), the novel is a strange monument to this once-feared master criminal.

What is the Difference between Violent and Non-violent Stalkers?

A study in a recent issue of the Journal of Forensic Sciences examines different factors that differentiated between physically violent and nonviolent stalkers. Using a statistical analysis of 103 Canadian cases of "simple obsessional" stalking, a model was developed that showed an 81% success rate in discriminating between the two types of stalkers. Overall, physically violent stalkers are more likely to: (a) have a stronger previous emotional attachment toward their victim; (b) be more highly fixated/obsessed with their victim; (c) have a higher degree of perceived negative affect towards their victim; (d) engage in more verbal threats toward the victim; and (e) have a history of battering/domestic abuse towards the victim. The variables that best differentiate between physically violent and nonviolent stalkers appear to characterize underlying themes of anger, vengeance, emotional arousal, humiliation, projection of blame, and insecure attachment pathology.

Click here for the abstract.

Roman Holiday

Just writing to let you know that I'll be attending a conference in Rome for the next few days and taking a bit of a vacation afterwards. I hear tell that this Rome place has some nice architecture and nightlife (not that I ever believe travel brochures). If I have some free time, I'll try to keep you posted on what's happening. Otherwise, I prepared some posts to keep you happy while I'm gone (the things I do for you people!).

Ciao for now.

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Pleasing Yourself

I remember a few years back attending a meeting and hearing sex therapist and media figure, Sue Johanson give a talk on sexuality. At one point, she had us in stitches by saying, “Surveys show that 97% of men reported that they have masturbated at some time in their life and the other three per cent are LIARS” (O.K., not an original joke but her delivery was superb). On the list of topics that are guaranteed to make an audience squirm, masturbation must be close to the top. The very word makes people uncomfortable and has led to a long list of often-bizarre euphemisms ranging from “abusing the usual suspect“to “zipper surfing” (I’ve always been partial to “choking the chicken” myself).

The history of masturbation is long and colourful with artistic portrayals dating back to Ancient Egypt and Sumeria. I won't even try to get into the different religious views on masturbation over time (along with homosexuality, contraception, adultery and other forms of non-procreative sex, masturbation was routinely denounced as a mortal sin), although Judeo-Christian teachings have strongly influenced philosophical and medical opinions on the subject.

The earliest medical treatises on masturbation referred to it as "onanism" after the Biblical story of Onan who incurred God's wrath by "spilling his seed". The fact that the practice described in Genesis was closer to coitus interruptus than masturbation failed to prevent the term's widespread use (then again, the people of Sodom probably didn't actually practice sodomy either).

It was in 1716 when a pamphlet titled Onania was anonymously published in England. Denouncing the heinous sin of "self-pollution", the pamphlet provided a long list of medical complaints that would afflict abusers including epilepsy, venereal disease, and impotence. Swiss physician Samuel-August Tissot followed up with his own work, L' Onanisme, in 1760 in which he maintained that abnormal loss of semen would lead to a host of problems such as rheumatism, nervous disorders, headaches, and blurred vision (yes, this is where "Stop it or you'll go blind" originated).

Despite the absence of anything resembling empirical evidence, Tissot's pronouncements were echoed by numerous other medical authorities and the perception of masturbation as a debilitating illness continued well into the twentieth century. Philosophers,theologians, social thinkers and physicians alike weighed in on the evils of "self-abuse" and an estimated 60 per cent of all illnesses were linked to masturbation.

Various remedies were proposed including mechanical restraints (chastity belts), physical discipline, and circumcision. Between 1856 and 1932 alone, the U.S. Patent Office gave out 33 patents for "anti-masturbation devices". Some of the more incredible inventions included a "spermatorrhea bandage" to restrain the penis at night and avoid erections, spike-lined penis rings, and "the Cage", a metal cage to be placed around a boy's genitala.

While Havelock Ellis and other early researchers into sexology attempted to reverse the negative stigma associated with masturbation, the entrenched attitudes persisted. A popular text on sexology by William Walling published in 1904 railed against masturbation as a "shameful and criminal act" that was "the most frequent, as well as the most fatal, of all vices". Second only to "libertinism" (whatever that is), "it is from the age of fourteen to twenty that its ravages are most frequent and most deplorable."

Signs identifying the frequent masturbator include: "downcast, averted glance, and the disposition to solitude. Prominent characteristics are loss of memory, aversion, indifference to legitimate pleasure and sports, mental abstractions, and morose disposition". The consequences of persistent masturbation are given to be severe. "Those who persist will surely die the most horrible of all deaths." He also describes "youths who stood high in their classes who suddenly, without obvious cause, became stupid as dunces, or losing their vivacity, seemed to fail rapidly in intelligence and to disappoint the high hopes which had been entertained of them" due to masturbation.

If anything, Walling was even more negative regarding female masturbation (after first reassuring his readers that such a thing did indeed exist).  Signs of such "degradation" occurring include: madness or melancholy, solitude or indifference, an aversion to legitimate pleasures, vaginal inflammation, and "nymphomania". Parents and health professionals were warned to stay vigilant and to instruct girls in the destructive nature of masturbation and its "horrible consequences".

Later sexologists including Alfred Kinsey,William Masters and Virginia Johnson have managed to remove much of the medical stigma surrounding masturbation but the taboo remains. It was as recently as 1994 when Jocelyn Elders, then Surgeon-General of the United States, was fired from that position for, among other things, daring to suggest that masturbation was a normal aspect of sexuality. Unfortunately, the shame and guilt that many adolescents are made to feel over being caught "playing with themselves" is likely to continue.

How Prevalent is Physician Suicide?

An essay in a recent issue of Annals of Family Medicine examines the complex issues surrounding physician suicide. Best estimates place the number of physician suicides in the United States at 250 per year. The essay's author expresses her personal grief and guilt over the recent suicide of a colleague while discussing the unacknowledged problems associated with physician suicide and the stigma that prevent it from being adequately addressed. While physicians are as vulnerable to depression as the general population, fears regarding loss of professional stature and respect often prevent depressed physicians from accessing needed mental health services. This same stigma can also compound the mourning process of the colleagues and family of those physicians who complete suicide. The medical profession must provide greater access to existing resources for affected colleagues and work collaboratively to destigmatize treatment for mental illnesses.

Click here for the abstract.

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John Hinckley's Doctors Seeking Easing of Restrictions

The medical team overseeing treatment for John W. Hinckley Jr. have petitioned for an easing on his current restrictions including obtaining a driver's license, spending more unsupervised time in the community and having extend visits to his mother's home in Virginia.  Hinckley, 53, has been held at St. Elizabeth's Hospital in Washington, D.C. since his March 30, 1981 shooting of President Ronald Reagan. In addition to the shooting of the President, Hinckley also severely injured Press Secretary James Brady and wounded two Secret Service agents.

At present, Hinckley is allowed to visit his mother in Williamsburg, Virginia area for six-day periods and is also allowed to leave the hospital with groups of patients. Doctors are seeking to extend these visits to ten-day periods and to double the time Hinckley is allowed to spend unaccompanied in the Virginia community each day, according to prosecutors. The doctors have asked for Hinckley to be allowed more time to do volunteer work in Virginia and take driving lessons in that area,

Prosecutors are opposing the eased restriction on the grounds of Hinckley's "continued inappropriate and unrealistic relationships with several women as well as a reluctance to accept responsibility for his own behavior," Assistant U.S. Attorneys Thomas Zeno and Sarah Chasson wrote that doctors provided no reason to extend Hinckley's visits to Virginia because he already has enough time to do volunteer work and take driving lessons there. They argued that Hinckley should not be granted unsupervised time in the District, the chance to get a D.C. driver's license or be allowed to have more daily free time in Virginia because Hinckley "continues to maintain inappropriate thoughts of violence."

Hinckley's lawyers, Barry W. Levine and Adam Proujansky, wrote that Friedman should grant the doctors' request because prosecutors have offered "no evidence that Mr. Hinckley will be a danger to himself or others under the conditions proposed."

"In every prior instance, the Government's prediction of doom has proved to be utterly baseless," they wrote, citing Hinckley's "perfect record of successful conditional release".

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Lincoln’s Avenger

The assassination of President Abraham Lincoln on April 14, 1865 shocked the nation and sparked an intense manhunt for his killer. A detachment of twenty-five Union soldiers led by Lieutenant Edward Doherty pursued John Wilkes Booth and fellow fugitive David Herold across Maryland and eventually tracked them to a farm in Virginia. On April 26, troops set fire to the barn were Booth and Herold were hiding. While Herold eventually surrendered,Booth was fatally wounded in the spine and died three hours later.

Despite attempts to take Booth alive, Sergeant Boston Corbett, the soldier who had fired the fatal shot, claimed that he saw Booth taking aim at one of the other soldiers and shot him without orders. While his version of events was disputed by others at the scene, the charges against Corbett were later dropped by Secretary of War Edwin Stanton himself. Killing Booth meant that Corbett's place in the history books was assured (the bullet he used is still on display at the Walter Reed Army Medical Center in Washington, D.C.) but the rather unusual life that he had before and after Booth's death is not as well known.

Born in London, England in 1832, Thomas Corbett and his family immigrated to the United States seven years later. His early life seemed uneventful and he became a hatmaker in New York. Only after the death of his wife in childbirth did things start to change. Corbett moved to Boston and became a devout Christian evangelist while continuing to work as a hatmaker. As a result of being "born again", he chose the new name of "Boston" for himself (after his adopted city). Friends and family took note of his increasingly eccentric ways including wearing his hair long "to be like Jesus Christ".

Corbett's strangeness took a more alarming turn on July 16, 1858. Becoming worried about giving in to the temptation offered by the prostitutes in Boston, he castrated himself with a pair of scissors. He then went to a prayer meeting and ate a full dinner without letting on what he had done. It was only when complications set in that Corbett forced himself to see a doctor at Massachusetts General Hospital.

The outbreak of the Civil War in 1861 changed Corbett's life even further. He was a troublesome solder who frequently disobeyed orders that violated his religious beliefs and narrowly avoided a court-martial. While he was later captured and sent to the notorious Andersonville prison in 1864, a prisoner exchange returned him to his unit and he eventually became a Sergeant in the New York Cavalry. His service record was one of the reasons that he was picked to take part in the Booth manhunt. Killing Booth was the highpoint of Corbett's military career and he later returned to civilian life with his share of the reward money ($1,653.84 US was a tidy sum in those days).

Corbett became restless in Boston and moved his business to Connecticut and New Jersey but his behaviour grew increasingly bizarre. Once, at a reunion with fellow soldiers in Ohio, he overheard someone questioning whether he had actually killed Booth (there were already wild rumours that Booth had faked his death and fled to England). Corbett reacted by jumping to his feet and flashing his gun in the offending person's face.

In 1878, Boston Corbett relocated to Concordia, Kansas to live as a recluse and became a strange sight to his few neighbours. His home was basically a dugout in a hill with a brown stone front and a makeshift roof where he lived with his numerous firearms, a homemade bed, and a flock of sheep that he tended. Corbett's skill with guns and celebrity status made him a local legend and he often gave incomprehensible religious lectures. One of these lectures was at a local sporting event where he drew his gun and sternly rebuked the players for holding their baseball game on a Sunday (he later stood trial over this but was never convicted).

Largely based on his fame as Booth's killer, Corbett was appointed assistant doorkeeper at the House of Representatives in Topeka, Kansas in 1887. He didn't last long in that position. On February 15 of that same year, he overheard mocking comments about the legislature's opening prayer. Corbett pulled out his gun, jumped to his feet, and began threatening the "heretics" (some accounts say that he opened fire but nobody was hurt).

He was arrested and sent to the Topeka Asylum for the Insane but managed to escape on May 26, 1888 after spotting a horse that had been left near the asylum entrance. Aside from a brief stay in Neodesha, Kansas with a fellow veteran (and arranging for his stolen horse to be returned to its owner), he mentioned that he was thinking about going to Mexico. Nothing more is known about him although there is some evidence that he may have been killed in a massive forest fire in 1894 (Thomas Corbett is listed as a casualty from that blaze). No definite proof of his death exists and the final fate of Thomas "Boston" Corbett is still a mystery.

Diagnosing a historical figure based on limited information is always tricky. Although it has been speculated that the mercury exposure from Corbett's work as a hatmaker may have played a role in his mental problems ("mad as a hatter" is not just a figure of speech), his bizarre religious fanaticism and emotional instability can fit other mental disorders as well. There are still monuments in Kansas marking where he spent much of his later life and Corbett continues to be one of those colourfully eccentric figures that tend to be remembered fondly.

Once they're safely dead, of course.