Providentia

Does Psychological Distress Increase Dementia Risk?

A study published in the February 2009 issue of Current Psychiatry Reports examines the role of neuropsychiatric symptoms in age-related cognitive decline.  Psychological distress, i.e., a reaction of an individual to external and internal stresses, is characterized by different psychological symptoms including depression, anxiety, and apathy. The authors examined recent evidence concerning the presence of psychological distress in healthy older adults and patients with mild cognitive impairments (MCI) in relation to risk for developing dementia. Results presented in this review show that psychological distress and depressive, anxious, and apathetic symptoms can be present in MCI and may predict progression to dementia. The implications of these results for future research and intervention strategies are discussed.

Click here for the abstract.

"Cancer Survivor" Charged After Five Years of Fraud

Five years after a "cancer scare" that proved to be groundless, 38-year old Keele Maynor has been arrested for fraud relating to the financial and social aid resulting from her pretending to be terminally ill with breast cancer. A Chattanooga grand jury has laid eight counts of theft and one count of forgery against the Tennessee woman and she may be facing a lengthy prison sentence.

In addition to receiving over $18,000 in paid leave and financial support from co-workers, Maynor also received extensive support from the cancer survivor community in Chattanooga before being exposed in December of last year. During the last five years, she walked with a cane, kept her hair closely cropped, and pleaded with friends and family members for financial support. As a single mother with three dependent children, she received considerable assistance and media attention.

Describing her "charade", Maynor reported that she had been diagnosed with breast cancer in 2000 although subsequent testing showed her to be cancer-free. Her elaborate deception only unraveled after a local hospital contacted other charities with which she had been involved warning them about inconsistencies in her story. She has yet to provide a reason for her actions although she is receiving counseling at present.

Click here for more information.

Living With Patience

It's still not certain how "Patience Worth" came into Pearl Curran's life.

Born Pearl Lenore Pollard in 1883, her childhood seemed normal enough. By all accounts, she was extremely sensitive about her appearance and wished that she were more attractive. While not a good student (who eventually dropped out of high school), she had a passion for singing. Pearl's parents arranged for voice lessons and she eventually moved to Chicago to continue her voice training. To support herself, she worked in a music company and taught music herself.Whatever dreams Pearl had for a career as a singer or actress ended when she married John Howard Curran at the age of 24 and settled down to be a housewife in St. Louis, Missouri. While John wasn't wealthy, he made enough for Pearl to have a comfortable life, a maid to do the housework, and a fair sized home. The first seven years of marriage seemed happy enough.

Except...

Spiritualism was tremendously popular during the early years of the twentieth century with countless occult believers across most English speaking countries. Mediums like Eusapia Palladino and Helene Smith regularly conducted seances for the rich and not-so-rich alike and news of "spooky" happenings definitely sold newspapers. While Houdini's anti-spiritualism crusade helped deflate spiritualist claims, there was still enough interest for ouija boards to be a common item in many homes.

Which brings us to Pearl Curran having a quiet tea with her mother and a family friend at her home in 1913. Pearl was reluctant about using the ouija board that the friend had brought to her home but, after some initial success with messages from "Pat-C", the three of them decided to keep trying. On July 8 of that year, they received the following message: "Many moons ago I lived. Again I come. Patience Worth my name. Wait, I would speak with thee. If thou shalt live, then so shall I. I make my bread at thy hearth. Good friends, let us be merrie. The time for work is past. Let the tabby drowse and blink her wisdom to the firelog."

The "entity" in question identified herself as Patience Worth who had lived in one of the American colonies between 1649 and 1694. Pearl seemed to be the main target for the messagesand she stopped using the board when she realized that the sentences were "forming" in her mind at the same time that they were being spelled out. While she would hire a secretary to keep track of Patience's messages, Pearl later just wrote them out herself.

According to Patience, she was born "across the sea" (later identified as Dorsetshire in England) and made an Atlantic crossing in a three-masted schooner to live in one of the American colonies. The details of Patience's life (and her violent death by natives) tended to be sketchy with no real details that could be independently verified. Despite initial skepticism, Pearl (and Patience) were able to gain a considerable following. During the next 25 years, "Patience Worth" would dictate an estimated 400,000 words including 5,000 poems, a play, various short stories and four novels.

The controversy over Pearl Curran and her writing quickly polarized into two camps. On one side, the skeptics picked up on the various inconsistencies of her story. Not only was there no evidence that Patience Worth had ever existed but at least one of the novels was set in Victorian England,long after Patience "lived". On the other side, Pearl's supporters stressed her limited education making it unlikely that she could have written everything on her own.

One researcher in particular who took an interest in Pearl's case was Walter Franklin Prince (who had already made a name for himself through the Doris Fischer multiple personality case). He first began studying Pearl Curran in 1926 and, after a thorough investigation, published The Case of Patience Worth in 1927. Prince described the case as representing "an unexpected display of literary genius, ability to carry on complex mental operations, together with apparent divination of other minds". While he was ambivalent about whether Pearl Curran was actually "channeling" Patience, Prince wrote an article that was published in the 1926 issue of Scientific American titled The Riddle of Patience Worth.In the article, he specifically asked anyone with information that could related to the case to come forward. Nobody took him up on the offer.

Whatever reservations John Curran had about his wife's link to a long-dead women, he would keep careful records of the sessions until his death in 1922. Afterward, Pearl supported herself and her family through lecturing and financial help from friends but the sessions went on. She received her final communication from Patience in November, 1937, a little more than a month before Pearl's death from pneumonia (which Patience reportedly predicted). While later mediums would claim to receive messages from Patience over the years (Pearl didn't seem inclined to make contact herself), nobody would ever match the quality of the original writing.

Although Patience Worth is still considered to be a genuine example of spirit writing by true believers, skeptics tend to regard the case as being an example of dissociation (if not an outright hoax). Although automatic writing has long been recognized as a clinical tool by Freudian psychoanalysis, its value has been hotly disputed by other clinicians. Research into automatic writing tends to be limited although the phenomenon has been linked to hypnosis and suggestibility. There have been more recent examples of literary works being produced through automatic writing but the case of Pearl Lenore Curran is still the most well-known of its kind.

In the meantime, ouija boards continue to be sold (Parker Brothers still owns the trademark) but they're not as common as they used to be. Fledgling writers hoping to get published would probably be better off with a good writing class.

Does Bullying Lead To School Shootings?

A paper published in the December 2008 issue of the Journal of School Nursing provides an extensive review of the literature surrounding the impact of peer bullying on adolescent male victims in terms of somatic and emotional consequences of being victimized. Research into school shooters has been limited to date but available studies have found that a significant number of them were adolescents who were targets of bullies and claimed their shootings were in response to their victimization. While there is no consistent profile of the school shooter,  research has suggested various dynamics that contribute to an environment that can predispose a community to a school shooting. No published nursing research has examined the relationship between bullying and the school shooter or that of adolescents who experience peer bullying. Despite findings from other disciplines, such as law enforcement, education, sociology, and psychology, school nurses need to be part of the team to recognize the bullied teen and intervene before there are serious life-threatening consequences.

Click here for the abstract.

Can A Head Injury Trigger Musical Ability?

For Derek Amato, it all began in October, 2006.

Although he had dabbled in music when younger, he never took lessons and went on to have a business career. Although he had always dreamed of being on stage, his musical career only began at the age of 40 following an accident. After jumping into his mother's pool to catch a football, he sustained a concussion when he struck his head on the bottom of the pool.

The concussion affected his hearing but there appeared to be no other cognitive problems as a result. It was only while sitting at a friend's piano that he discovered that he had he could play music by ear. As he would report later, "I just sat down at the piano and, by chance, started playing," he remembered. "Obviously, I could never play piano so it was kind of surprise." Amato discovered that he could play kind of music. He has since left his business job and started a career as a recording artist.

While cases of savant syndrome involving unusual cognitive abilities have been recorded in the neurological literature, they are usually linked to autism spectrum disorders or other developmental disabilities. Examples of acquired savant syndrome developing later in life are considerably rarer.   Development of savant-like skills have even been observed in cases of frontotemporal dementia.  Derek Amato's case suggests a preexisting musical aptitude that was forcibly stimulated by the concussion, available neurological information remains limited. 

As for Derek Amato,his music career is definitely underway.  He views his music as "a reminder that gifts can come out of the most of the painful of circumstances".

Click here for more information.

Shooting Dr. Tourette

1893 was not Gilles de la Tourette's year. Not only was he rocked by the death of his son Jean to meningitis but also by the loss of his mentor, the prominent neurologist Jean Martin Charcot, to a lung disease shortly afterward. Sadly, there was even more to come for the internationally recognized neurologist.

On December 6, a young woman, dressed in black, rang the doorbell at the Rue de l'Universite apartment building where Dr. Tourette lived. His valet told her that the doctor was out but she insisted on waiting for him. After about fifteen minutes, Tourette returned from seeing a patient at a local hospital and she immediately confronted him in his consulting room. The woman, Rose Kamper, had been one of his patients at the Pitie-Salpetriere Hospital and demanded money from him for "ruining her life". He recognized that she was emotionally disturbed and offered to have her readmitted to hospital under his care. After she failed to reply, Tourette got up to leave the room when the woman took out a revolver and shot him in the back of the neck.

Rose Kamper made no attempt at escape after the shooting and simply sat in the hall until the police came. She reportedly muttered, "I know, that what I just have done was wrong, but it was necessary and now I am satisfied. At least one of them has now paid for the others (the other doctors who had treated her)".While her victim's injury wasn't life-threatening, an attempt made on the life of one of the most prominent physicians in Paris certainly made news.

Police later found that Rose had nothing in her possession but a series of newspaper clippings about hysteria (which was still a new medical term a the time). As more details became known, her story was gradually pieced together. Rose Kamper's mental problems had begun several years before and led to her being placed under Dr. Tourette's care. As she told the psychiatrists who later examined her, "Within me there are actually two different people, one physical and one intellectual, my thoughts no longer belong only to me, but also to those, who possess me. During the day my intellect allows me to resist the powers which enter me without my knowledge, but at night I am overpowered". She apparently believed that Tourette and the other doctors at the Salpetrerie had caused her mental illness through hypnosis.

Tourette's mentor, Jean Charcot, had pioneered the medical use of hypnosis in treating the emotional condition that he first termed "hysteria". In his Salpetrerie clinic, Charcot's research on the many female patients who had been sent to him for treatment had made him famous across Europe. Charcot went on to train a generation of neurologists and psychiatrists in his techniques (including Tourette and Sigmund Freud, among others) but there was still considerable controversy over what hypnosis represented.As a result of this controvery, Rose Kamper's trial quickly became a test of duelling theorists who argued about the very nature of hypnosis itself. Rose maintained that Tourette and the other Salpetriere doctors had hypnotized her against her will and her defense attorney even argued that the hypnosis had somehow caused the shooting. Following a sensational trial, the judge eventually ruled that hypnosis had nothing to do with Rose Kamper's actions and she was declared insane

Although Dr. Tourette recovered physically from the shooting, the emotional impact would linger. Rose Kamper's testimony and the heavy newspaper coverage of the trial damaged his professional reputation. Despite his fame as a physician and numerous honours, Gilles de la Tourette's condition began deteriorating with fluctuating episodes of depression, mania and mental confusion. By 1901, he was forced to give up his medical practice as his behaviour became increasingly bizarre. Alarmed over Tourette's worsening condition and threats of suicide, his family and colleagues made arrangements for him to travel to Lucerne, Switzerland for a rest. On May 28, 1901, he was called to a psychiatric hospital near Lausanne, supposedly to see a patient. Once there, Tourette was forcibly admitted and kept for treatment. His family had arranged for him to be held in a Swiss hospital because they were afraid of the publicity that would have followed his receiving psychiatric treatment in France.

Records still exist showing Tourette's outrage over being held in the psychiatric hospital and the forced restraints that were used to keep him there. Despite numerous letters to various medical and government officials protesting his treatment, Gilles de la Tourette would never leave. Over time, he became increasingly psychotic with rambling speech and convulsions. He eventually died on May 22, 1904 with his wife and surviving children being at his side. While the actual cause of death is still unclear, neurosyphilis has been advanced as one possibility (it was common enough at the time). Whatever the medical reason, Gilles de la Tourette's death at the age of 46 ended a remarkable medical career. Despite his research contributions, he is primarily remembered today for the developmental tic disorder that bears his name.

As for Rose Kamper? Ironically, Rose probably fared better than the man she shot. After her sentencing, she was housed in different hospitals before being sent to an "Institute for the Insane" in Villejuif, France. She was later moved to another asylum after she stabbed a nurse with a fork. Following Rose's escape from the asylum in 1910, police launched an intense manhunt due to fears over her violent history. Rose was eventually found by police living under her maiden name of Lecoq and working as a seamstress. Since she appeared relatively stable, her doctors allowed her to live in the community despite later readmissions to psychiatric hospitals. She eventually died in 1955 at the age of 92.

Happy Darwin's Day

To take part in the various festivities marking the 200th anniversary of Charles Darwin's birth, I thought I'd rerun this post that was first published on October 14, 2007. To check out what else is going on today, click here.

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, Pringle Stokes.

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.

Community Outreach Program Helps the Homeless

Despite the estimated 100 million homeless people worldwide and the prevalence of homelessness in virtually every region of the industrialized world, practical strategies to combat the problem remain elusive. In a review of the Victoria Integrated Community Outreach Team (VICOT) which was formed in Victoria, British Columbia last year, the impact of reduced homelessness on police and health-care costs has shown a clear benefit. After 44 out of 55 "hardest to house" individuals were successfully moved into housing, police calls regarding the formerly homeless has dropped from 1,181 calls in the 12 months before being housed to 381 since. Hospital use has also dropped from 465 bed days in local emergency wards prior to becoming housed to 330 days in the six months afterward. While not all "hard to house" clients were successfully placed, the program has had a remarkable impact on the lives of many of its clients.

The VICOT program was started as part of a joint initiative between ministries of the British Columbia government and the Victoria Police Department to address homelessness in an integrated manner. Based on a Assertive Community Treatment (ACT) framework, the program uses a Downtown Outreach Team consisting of community outreach workers, probation officers, police officers, and mental health professionals. Since street people often cycle through the medical and legal systems, the saved financial costs are considerable.

Click here for more information.

Playing The Odds

I was in Las Vegas a couple of months ago to attend a family wedding. Although it was my first time there, I pretty much knew what to expect. Since there was a huge casino right in my downtown hotel, just getting to the wedding chapel involved running the gauntlet past rows of slot machines and various other gambling temptations. To the astonishment of everyone who asked afterward (including the border guard when I returned to Canada), I didn't do any gambling while I was there.

I can give you all sorts of reason why I don't like gambling casinos including the poor odds for winning, the tremendous profits that casinos make off of the countless gamblers who think they can "break the bank", the social and economic costs of chronic gambling, etc.; My real reason for not gambling stems from the many hours that I used to spend with a little white rat back in the day...

As a psychology undergraduate, one of the mandatory courses dealt with operant conditioning, i.e., the modification of behaviour using positive and negative reinforcement.First introduced by the legendary B.F. Skinner, his experimental approach to behaviourism (which he named the experimental analysis of behavior) introduced a range of new terms that have befuddled psychology students ever since. Positive reinforcement of an observed behaviour (also known as an "operant") involved the use of rewards to increase the probability of that behaviour occuring in future. Negative reinforcement (not the same thing as punishment) involved the removal or avoidance of a negative stimulus to strengthen recurrence.While punishment and extinction are also part of Skinner's operant model, I'll be focusing on positive reinforcement alone at this point.

Even though Skinner wasn't the first behaviourist, he rejected existing behavioural models with his Radical Behaviorism stressing the non-theoretical nature of his approach. Observed behaviour was the only focus of research with theories of unconscious determinism being totally discarded (sorry, Dr. Freud). Skinner also distinguished between primary and secondary reinforcers with primary reinforcers stemming from biological needs,i.e, food, water, sex, or sleep. Secondary reinforcers were stimuli that have a learned association with primary reinforcers (money is a good example).

To be an effective positive reinforcer, the given stimulus needed to be immediate (or as close to immediate as could be managed) and needed to be contingent on the behaviour of the organism being conditioned. As a practical test of operant conditioning, Skinner developed the operant conditioning chamber (or the "Skinner Box" as it's better known).

Which brings me back to my long hours with that white rat...

Basically, the Skinner box that I used as an undergraduate involved a long transparent chamber to hold the rat reserved for my use.The box contained one lever that the rat could push and a narrow slot next to the lever where a food pellet came out. The point of the box was to test out different reinforcement strategies to see which one worked best in training the rat to press the bar to receive food.

While continuous reinforcement (a pellet each time the bar was pressed) worked the fastest in terms of the rat learning to press the bar for food, it was also most vulnerable to extinction. In other words, the rat quickly stopped pressing the bar when the food pellets stopped coming. Variable reinforcement, on the other hand, worked better. Instead of giving the rat a food pellet every time the bar was pushed, you provided the reward using a variable reinforcement schedule, so that the rat would be unable to anticipate when the pellet would be provided. It took a little longer for the rat to learn to press the bar, but it also took much longer for the rat to stop pressing.  In other words, operant conditioning using a variable reinforcement schedule meant that the learned behaviour would persist over time whether or not there was a reward. The long hours that I spent with my rat learning about operant conditioning pretty well ensured that this particular lesson was drilled into my poor head.

And now we come back to Las Vegas...

Although the venerable slot machine long predates the Skinner Box (the first mechanical slot machine was built in 1895), the underlying similarities are pretty striking. Being in the casino and staring down on row after row of slot machines, it was just about impossible not to flash back to that poor white rat and the training sessions. Slot machines work by rewarding lever pulling behaviour with a secondary reinforcer (the casino chips that the machine pays out) on a variable reinforcement schedule. The underlying principles seemed guaranteed to ensure that people keep pulling that lever.

Looking around the casino, it's also hard not to notice that there are no external time cues to be found.  No clocks, no windows showing time of day, no hint of time passing (it's a wonder that casinos don't ban wristwatches). While hunger and thirst are potential cues to time passing, the casino staff thoughtfully provides food and drink on request. Washrooms are available when needed and, as for sleep, did I mention that this was in a hotel? The gambling only stops when the gambler runs out of money (and helpful ATMs providing cash advances are all over the place).

An added factor at work in the casino setting is vicarious reinforcement, i.e., reinforcement that occurs in social settings when we see someone else getting a reward. Actually, it was Albert Bandura who first discussed vicarious reinforcement as part of his social learning model but casinos have been using it to influence gamblers for decades. News about "big wins" provides good publicity for casinos and keeps the gamblers coming. The driver of the shuttle bus that brought us from the airport to the hotel was kind enough to tell us about a recent big winner and cheerfully suggested that we try our luck in the casinos as well.

Watching people pulling the levers, it's also hard not to be struck by examples of superstitious behaviour. This is actually one of Skinner's terms involving the accidental reinforcement of a given behaviour which can occur in animals as well as people. Once an unintended reinforcer is associated with certain behaviours, unlearning it takes time and effort. Watching people wander from machine to machine hoping to find one that will "change their luck" seems common enough. The fact that various slot machines are decorated with different colourful themes and music helps this along.

Considering the lucrative business that casinos provide, is it any surprise that cities across North America are pushing to get in on the action? Not only have casinos sprung up in tourist spots around the world, but online versions are becoming increasingly popular (I don't even want to get into lotteries or other kinds of gambling). While problem gambling (a.k.a ludomania) isn't recognized as a mental disorder unless taken to extremes, the potential life-damaging consequences for people who can't keep their gambling under control can be severe. I've never been a big fan of current disease models of pathological gambling (since it's not a disease) and various treatment approaches tend to have only modest success.

People still keep pouring in hoping to win big but, if I had to lay odds, it would be on the casinos.

Cognitive abnormalities in PTSD

A review published in the January 2009 issue of Current Opinion in Psychiatry examines recent research on cognitive difficulties associated with posttraumatic stress disorder (PTSD) published between January 2007 and June 2008. The reviewed studies indicate that verbal and autobiographical memory problems are exhibited by individuals with PTSD relative to controls and may represent preexisting risk factors for PTSD rather than a consequence of PTSD symptoms. The reviewed findings also provide evidence for concentration and attention biases toward trauma-relevant information in PTSD. Although memories of traumatic events have been found to differ in PTSD patient relative to other types of memories and memories of depressed individuals, they are likely on the same continuum as nontraumatic memories rather than being qualitatively different. The author concluded that individuals with PTSD experience cognitive alterations ranging from impairments in overall memory functioning to difficulties specific to trauma-related cues. These cognitive difficulties appear to be importantly related to the development and/or maintenance of the disorder. At this point, it is unclear whether common mechanisms may account for these diverse cognitive difficulties and whether cognitive impairments are attributable to comorbid depression.

Click here for the abstract.