For the abstract.
Two years after launching the Mental Health Gap Action program
to highlight the treatment needs of people suffering from psychiatric,
neurological and substance abuse disorders, the World Health
Organization (WHO) reports that, worldwide, over 80 per cent of people in need have no
access to psychological or psychiatric treatment. In many developing
societies, people with disorders such as epilepsy, depression, and
psychosis face tremendous stigma and are often deprived of the family
and community support necessary for successful integration into society.
The resulting neglect and abuse that mental patients face often leads to
a worsening of their condition and tremendous human rights violations. Due to their marginal status, many countries forbid mental patients from marrying, holding jobs, or even voting.
In Africa alone, nine out of ten epileptics do not receive anti-convulsant medication to control seizures despite the relatively low cost per dose. Similar findings are noted for people suffering from schizophrenia and depression. In the majority of Third World countries, only 2 per cent of health care dollars are allocated to mental health treatment with charities often being forced to raise funds to cover the shortfall. The lack of proper support is linked to negative attitudes towards mental illness which is often not regarded as a "real disease" (and often viewed as being due to lack of character or a punishment for immoral behaviour). Factors such as poverty and social unrest can worsen existing psychiatric conditions
In humanitarian crises, including natural disasters or pandemics, survivors often deal with long-term trauma that is rarely addressed by proper treatment. Refugees are also particularly vulnerable to mental illness due to the lack of a stable support network and uncertain living conditions. Combating emotional and psychiatric problems in the developing world is exacerbated by a critical shortage of mental health professionals. According to WHO statistics, the global psychiatrist rate varies from 0.4 psychiatrists per 100,000 people in parts of Africa to 9.8 per 100,000 in Europe. Some countries have no psychiatrists, psychologists, or social workers at all and psychiatric care is usually left to primary care physicians and workers with limited treatment experience. As a result, relatives of mental patients often resort to traditional medicine or religious practitioners (including exorcists) for treatment.
In her speech launching the Mental Health Gap Program, WHO Director-General Dr. Margaret Chan said that "The Mental Health Gap Action Programme gives WHO and its partners an opportunity to speak out against the neglect of these disorders with a unified and convincing voice. As I said, there is work to be done, and the voice of outcry may need to be rather shrill. But there are no excuses left. Together, we must make the case". Despite intense efforts by the WHO and aid organizations, progress remains slow.
The Tribunal also attached a series of articles to the Edict describing the various signs by which a secret Jew might be known. These signs included: anyone keeping the Sabbath following the law of Moses, i.e., refusing to light fires or work beginning on Friday evening, anyone eating meat during Lent or other holy days, anyone observing Jewish holidays (Purim was identified as "the fast of Queen Esther"), anyone reciting the Psalms without adding the words "Gloria Patri et Filio et Spiritu Sancto" (Gloria to the Father, Son, and Holy Spirit), anyone who had their male children circumcised, or who abided by Jewish dietary laws. The articles were intended to be as broad as possible to prove to the Queen that Judaizing was rampant in Seville and to justify the repression needed to weed it out. Local friars developed an efficient espionage network to monitor all conversos for suspicious activity. One friar even climbed onto the Convent roof on Saturday mornings and carefully noted which houses had no telltale smoke rising from their chimneys. Those homes not burning fires (presumably due to honouring the Sabbath) were reported to the Tribunal. No one was safe from being denounced by friends or even family members (one of the first heretics to be burned was turned in by his daughter).
Once the Tribunal was established, the trials began immediately. While using torture to extract confessions was already common in many countries, the Inquisitors raised it to an art form and all testimony obtained as a result was accepted without question. The first auto-da-fe (public ceremony of penance) was on February 6, 1481 when six convicted heretics, former prosperous conversos who had spoken out against the Inquisition, were led through the streets of Seville while dressed in yellow sacks. They were taken to the Cathedral to hear a mass, then taken to a place outside the city where they were burned at the stake. Although the auto-da-fe ceremony would later develop even more pomp and circumstance, the Inquisition would continue following the guidelines that Torquemada had laid down from the beginning. Heretics, "lapsed Catholics", witches, "sodomites", Protestants, and conversos were all fair game under the new Tribunal. The scope of the Inquisition quickly spread beyond Seville as heretics in other parts of Spain were implicated by the ones in Seville.
In 1481 alone, hundreds of heretics were burned while others who had escaped the Inquisition were burned in effigy (the actual numbers who died are still open to question). Although the early Inquisition was interrupted by an outbreak of plague in Seville, the Inquisitors were quick to blame the sickness on the heretics (despite the fact that Inquisitors and heretics alike were affected). Ironically, Alonso de Ojeda was one of the first to die of the plague not long after the first auto-da-fe (no divine protection for him) but Torqemada still reined supreme. The successful assassination of one of the Inquisitors in 1485 made things far worse for the conversos since the dead priest (who had been killed in a church no less) quickly became a martyr for the sacred cause.
It probably says something about the ferocity of the Inquisition that Pope Sixtus IV wrote to Ferdinand and Isabella in January 1482 protesting their methods. While many of the conversos who had fled Spain went to Portugal or Morocco for safety, some had fled to Italy and petitioned the Papacy for protection from Torquemada's inquisitors. In his letter, the pope revoked his earlier decree allowing the Spanish crown to control the Inquisition. A political battle followed with conversos directly appealing to the Papal courts, Ferdinand and Isabella arguing that their power was being eroded, and a general chaos due to different orders being given. At Isabella's request, Sixtus finally agreed to appoint Torquemada as Inquisitor for Aragon, Valencia and Catalonia in 1483. In the meantime, the trials continued in Seville and neo-Christians continued to flee Spain.At a formal assembly in Seville in 1484, Torquemada presented the twenty-eight articles that would eventually constitute his formal manual for guiding Inquisitors. Although other manuals for Inquisitors had been published before (including the infamous Malleus Malificarum), Torquemada's manual lay the groundwork for the Spanish Inquisition for centuries to come. Never officially published during his lifetime (the first publication was in 1576), the manual outlined the proper procedures for establishing an Inquisition in regions where none had existed before following the example of the Seville Tribunal. The thirty-day grace period was also established as a formal part of any new Inquisition as well as how the Church would deal with confessed heretics (including appropriate penalties).
Three years following a bizarre incident in Australia in which a 25-year old psychiatric patient fatally stabbed her father and sister and seriously wounded her mother, the patient's family is suing her psychiatrist for "negligence" in her diagnosis and treatment. According to the statement of claim filed in the New South Wales Supreme Court, the treating psychiatrist, Dr. Yolande Lucire failed to properly diagnose Julia Wilson's psychiatric condition. Dr. Lucire is also accused of withdrawing the patient's psychotropic medication and prescribed ineffective medication instead. She had been seeing the patient professionally since Ms. Wilson spent three weeks in a psychiatric unit in November 2006.
On July 3, 2007, Dr. Lucire diagnosed Julia Wilson (due to reasons of confidentiality, the patient and her family were given pseudonyms by the media) with depression and panic disorder. Three days later, she met with the patient in a coffee shop and advised her mother to take her home and arrange for an appointment in the following week. Later that same day, Ms. Wilson stabbed her father and 15-year old sister to death and attacked her mother when she attempted to come to her family's aid. In the statement of claim, Dr,. Lucire is blamed for the tragedy given her failure to appreciate the risk that the patient posed to herself and others and failing to arrange her admission to a mental health facility or detention centre.
Julia Wilson has since been found not guilty on the grounds of mental illness by the Supreme Court and ordered held indefinitely. Although Dr. Lucire has stated that she is bound by confidentiality not to respond to the statement of claim publicly, she has indicated that she plans to defend herself against the allegations. The New South Wales Medical Tribunal has already suspended Dr. Lucire's medical license after ruling that she has engaged in unsatisfactory conduct in treating Ms. Wilson, Dr. Lucire has announced that she plans to appeal the decision.
Dr. Yolande Lucire is no stranger to controversy given her reputation
in local legal circles as a "hired gun" in forensic cases. After
testifying in a 2007 court case about the relationship between SSRI
medications and violent crime and suicide in adolescents, she was
reprimanded by the New South Wales Medical Tribunal and ordered into
treatment due to questions relating to her professional competence.
Critics of the psychiatric profession accused the Tribunal of engaging
in a "smear campaign" intended to discredit her.
Ferdinand of Aragon and Isabella of Castile were the original power couple.
When their joint reign began in 1479, they unified their two kingdoms and helped establish the modern country of Spain. They also financed Christopher Columbus in his search for a new route to India (and, no, Isabella didn't really sell her jewels to do it), and raised six children (most of whom died before reaching adulthood). In 1492 alone (the same year that Columbus discovered the New World), Ferdinand and Isabella's army successfully drove out the last of the Moorish rulers in 1492 and annexed Granada to their other possessions, The same year saw the passing of the Alhambra decree (a.k.a. the Edict of Expulsion) that ordered all Jews to either convert to Christianity or leave Spanish territory altogether. The property of all Jews who refused to convert was seized (which enriched the Spanish treasury considerably). The edict also applied to Muslims who remained in Granada. An estimated 40,000 to 50,000 Jews chose to convert while the rest were scattered across Europe and the Middle East.
And then there was the Spanish Inquisition..
First established as a formal tribunal in 1478 by Ferdinand and Isabella, the Tribunal of the Holy Office of the Inquisition was intended to replace the Inquisition that had been under Papal control for centuries. Although the Inquisition had functioned in many of Spain's former separate kingdoms, Ferdinand and Isabella's joint reign over Castile and Aragon allowed the establishment of a formal inquisition over all of Spain (there had never been an inquisition in Castile for instance, just Aragon). Placing the Inquisition under the direct control of the Spanish crown had a number of advantages, most notably allowing the speedy confiscation of the property of convicted heretics. It was actually Alonso de Ojeda, Prior of the Dominicans of Seville who first convinced Isabella that a strong Inquisition was needed to root out the "Judaizing" influence of converted Jews who were supposedly practicing their religion secretly and undermining Christianity. Not the actual Jews, mind you. They were never the direct target of the Inquisition (of course there were none left in Spain after 1492). Incidents of fanatical persecution certainly took place over the years and those Jews who managed to survive by either converting or going into hiding came to enjoy a certain protection, courtesy of the Crown. The pressure was on them to convert though and stories of "relapsos" who converted to Christianity and then secretly returned to Judaism spurred clerics into taking stronger measures.
That's not to say that Spain was the only country engaging in religious persecution during that era. The Papal-run Medieval Inquisition was still going strong in most Catholic countries. The Protestant reformation of the 16th and 17th centuries had sparked bloody wars of religion with Protestant leaders persecuting Catholics (i.e., in England and parts of Germany) and vice versa. Jews were hardly welcome anywhere, including Portugal which began its own Inquisition just a few years after Spain did (as the Jews who had fled there from Spain discovered to their dismay) and the anti-witch hysteria that would kill thousands was just beginning. Despite the widespread persecution, the Spanish Inquisition definitely stands out in the annals of history and much of the credit for that goes to its chief architect: Isabella's confessor and the first Inquisitor-General Tomas de Torquemada.
Finding an impartial historical account of Torquemada's life and times is probably impossible. Between early Spanish sources that praised him and his Inquisition and later writers who denounced Torquemada as a monster, there is no clear picture of who he was and how he was able to persuade Ferdinand and Isabella to give him the power to carry out his vision of a proper Inquisition. As Prior of the Dominican Convent of Holy Cross of Segovia and nephew of the late Cardinal of San Sisto, Frey Tomas de Torquemada was eminently placed to become a powerful influence on Isabella. Described as "tall and gaunt and stooping slightly at the shoulders, mild-eyed of a cast of countenance that is gentle, noble, and benign", Torquemada was an impressive figure in the white habit and black cloak of the Dominican Brotherhood. By all accounts, he was the very picture of a religious figure to be trusted.
Born in Valladolid in 1420, he followed in his uncle's footsteps by entering the Dominican order at a young age. Later historians have argued that several of Torquemada's ancestors were converted Jews (if you can appreciate the irony) but there was no indication that this had any influence on his later actions. With his reputation for austerity and piety (he was said to have remained true to his vows of poverty all his life and never ate meat), it hardly seems surprising that he was named the confessor to the Infanta Isabella. From a young age, Torquemada was her friend and confidante and his control over her became absolute. No matter how reluctant she might have been to carry out Torquemada's plan to root out heresy, he could always persuade her. After she gave her permission, Torquemada and Ojeda received authorization from Pope Sixtus IV in 1481 to set up their tribunal and the Spanish Inquisition began with a vengeance.
It started with a single Tribunal in Seville where the "Jewish problem" was felt to be strongest. The rumours about the new Inquisition were unnerving enough for the neo-Christians of Seville. Actually seeing the white-robed black-hooded Inquisitors in a formal procession (headed by a Dominican carrying a white cross) on their way to the Convent of St. Paul where the Inquisition was to be based was enough for thousands of converted Jews to flee to other regions for safety. Of course, simply fleeing the Inquisition was assumed to be evidence of guilt and was used against them in their eventual trials. An edict published in January 2, 1481 was sent out to all parts of Spain ordering the return of refugees with stiff penalties for anyone harboring them (including excommunication). Any nobles rash enough to ignore the edict would have their lands confiscated. The threats were effective and many refugees were forcibly returned to Seville (often in chains). The edict was so successful in fact that the Convent was overwhelmed by the number of prisoners and the Inquisitors then moved to a larger castle.
Then came the "Edict of Grace" offering amnesty to all heretics who turned themselves into the Inquisiton and repented of their sinful ways. Over 20,000 conversos took advantage of the edict but discovered to their horror that the offer was conditional (which the published Edict hadn't mentioned). The repentance had to be sincere, which meant that the self-confessed heretics would have to name all of their fellow heretics as well. To save themselves, those conversos who had confessed were forced to name fellow "Judaizers", often friends or family members, or else have their confessions used against them in the resulting trial. As it was, the Edict had a limited grace period. Once that expired, no mercy would be possible.Continue to Part Two
"I’m a little like Groucho Marx: He didn’t wish to belong to any club that would accept someone like him as a member. But one club won’t take my “no” for an answer. So here is what I tell it: “Do not call. Do not even whisper my name. GET ME THE HELL OUT!” If you are reading this, then you or someone you care about may have been invited into this club, too. I never asked to join. None of us does. The post office clearly got the address wrong. I exercised. I ate organic foods. Heck, I’m a health writer! In fact, for three years I served as contributing editor to a cancer magazine. How’s that for irony?"
In this compelling book, Your Brain After Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus, award-winning health journalist Idelle Davidson describes the harrowing process of surviving breast cancer and dealing with the aftermath of chemotherapy. Co-written with Dan Silverman, M.D./Ph.D., the book provides an essential guide to the "post-chemo brain" and the cognitive changes that often accompanies chemotherapy. As a primary researcher in the area of chemotherapy/brain interactions, Dr. Silverman's research has shown that chemotherapy patients can continue experiencing memory, attention, multitasking, and mood problems even years after termination of treatment. In addition to the impact of treatment, the book also provides important information on strategies for improving memory and other cognitive skills and an invaluable nine-point program to keep your brain sharp.
Along with a website that introduces the book and its authors, Idelle Davidson has also launched a blog for cancer survivors and their families to get even more information. With frequent contributions by Dr. Dan SIlverman and health psychologist, Dr. Rob Ferguson, the blog supplements the book with valuable information on dealing with chemotherapy. Please check them both out.
Since 1905, when Nettie Stevens and E.B. Wilson first identified the XY sex-determination system found in humans and many other species, it has been recognized that males and females differ in their sex chromosome arrangement. While males are heterogamic with two distinctive sex chromosomes (XY), females are homogamic with two of the same type of chromosome (XX). In approximately one out of 160 live births however, chromosomal anomalies occur with children being born with an abnormal number of chromosomes (aneuploidy). Among the more well-known sex-chromosomal disorders including Turner Syndrome (single X chromosome), Klinefelter's Syndrome (XXY syndrome), and Triple-X Syndrome (XXX chromosome karyotype).
When the 47,XYY karyotype was first identified in 1959, geneticists questioned whether it could be considered a disorder since there were no clear indications of pathology. Most XYY males develop normally and have no idea that their genetic structure is abnormal. Although research into XYY males has shown no significant difference in testosterone levels, differences have been found on other physical characteristics including physical height, impulsivity, short-temperedness, and enuresis. XYY males are also more prone to certain types of learning difficulties as well as delayed speech and language skills. Although XYY males have not been found to be more aggressive overall, early media reports (helped by a 1965 research study by Patricia Jacobs examining XYY males in institutional settings) declared that the XYY karyotype was the hallmark of "supermales" who were prone to criminal violence. The term criminal syndrome became briefly popular with some reports claiming that XYY males were 25 % more likely to be incarcerated than males with a standard karyotype.
As the mass media began publicizing existing XYY research (some stories referred to the Y chromosome as the "murder chromosome"), the legal community quickly took interest. If the XYY syndrome was linked to violent behaviour, wouldn't it be a valid defense in criminal trials? Which brings us to the Richard Speck case.
When Richard Speck brutally tortured and murdered eight student nurses in the Chicago area during the night and early morning of July 13 and 14, 1967, the question of his mental competence to stand trial became paramount. As one of the most notorious mass murderers in Illinois history, the possibility that Speck has an organic brain syndrome that reduced his inhibitions and led to his murderous actions was addressed by an impartial panel of five psychiatrists and one surgeon (selected by defense and prosecution respectively). During this assessment phase, Speck's public defender, Gerald Getty, decided to try a new angle. Since Speck had many of the characteristics associated with XYY syndrome (physical tallness, mild mental retardation, and acne), couldn't his karyotype have predisposed him to violence? Unfortunately for Speck, the genetic profiling requested by Getty showed the normal 46,XY karyotype.
In January 1968, Gerald Getty contacted biochemist Mary Telfer about her research into XYY incarcerated males. Given her published work with XYY males in jails and prison systems in Pennsylvania, she seemed the ideal expert to explore the question of Speck's mental status. Based on Telfer's own observation that most of the XYY males she dealt with had facial acne she made the erroneous conclusion that Richard Speck was an XYY male as well. Since Speck had virtually all of the characteristics associated with the 47,XYY karyotype that Telfer had found to date (borderline mental retardation, history of impulsive violence, physical tallness), Mary Telfer made a number of statements to the popular media reiterating Richard Speck as being an archetypal XYY male. The New York Times, Newsweek, and Time magazine, among other news sources, helped reinforce the perceived link between XYY syndrome and violence. It probably didn't help that his defense attorney attempted to argue that Richard Speck was prone to uncontrollable urges and, as such, could not be fully responsible for his actions. This novel defense was quickly dropped when the geneticist who had initially determined that Speck was XY went public to refute the existing claims. Richard Speck was sentenced to death which was later commuted to life imprisonment (he died in 1991).
Despite more recent high-profile cases involving XYY males convicted of shocking crimes (Arthur Shawcross and John Wayne Gacy are two examples), research into the prevalence of XYY males in forensic populations has not yielded consistent evidence of a clear role for the karyotype in violent behaviour. Given that most XYY males in the general population never commit violent crimes (and, in fact, often remain unaware of their chromosomal abnormality), critics of research focusing on incarcerated males point out the obvious selection bias at work. These same critics also argued that XYY research led to potential stigmatizing of XYY males. While the controversy rages on, researchers continue to report significant findings for XYY males in terms of increased mortality, physical height, neurocognitive deficits and autism. Although behavioural differences are still being reported (including incidence of sexual violence), no clear consensus on the XYY-violence link seems likely to emerge at this point.
Despite the issue of whether XYY males are prone to criminal behaviour remaining unresolved, it does represent a good example of the potential dangers involved in misrepresenting behavioural genetics research in the popular media. Lingering rumours of Richard Speck being XYY still surface at times and XYY males in prison continue to risk being stigmatized as being potentially violent, regardless of their actual offending. Although the field of behavioural genetics is still in its infancy, more questions surrounding how genetics affect behaviour will certainly emerge in future.
Suicide among children is considered rare despite being a leading cause of death in children younger than 15 years of age worldwide (Pelkonen & Marttunen, 2003; Vajani, Annest, Crosby, Alexander, & Mille, 2007). Compared to other age groups, the prevalence of suicide in children is more likely to be underestimated (Beautrais, 2001; Crepeau-Hobson, 2010; Fortune & Hawton, 2007; McClure, 2001) and research in adolescent and youth suicide is growing. While previous studies provided a broad overview of the phenomenon, few focused specifically on suicide in children. A review published in a recent issue of Crisis: The Journal of Crisis Intervention and Suicide Prevention looks at child suicide and the social, cultural, and economic factors that can increase or decrease the likelihood of its occurrence. There appears to be some empirical support for the notion that children may be less exposed to common suicide risk factors, such as mental illness and substance abuse, and less likely to display predictive factors, such as prior suicidal behavior (Beautrais, 2001; Groholt, Ekeberg, Wichstrom, & Haldorsen, 1998; Pelkonen & Marttunen, 2003; Schmidt et al., 2002). There is no doubt that the phenomenon of child suicide deserves more attention. Research has shown that social, cultural and environmental factors can exacerbate or mitigate existing personal suicide risk factors in children (King, 2009; Greening, Stoppelbein, & Luebbe, 2010). An economic crisis can greatly influence, and even change, these factors, which can be intensified by the family context. A low level of child-parent communication was found to be a specific risk factor, even after controlling for familial poverty. Children are especially vulnerable to changes in family circumstances, including parental job migration and/or unemployment. Subsequently, children may become more predisposed to suicidal ideation and acts. Yet, little is known about children’s specific pathways, the developmental process that influences suicide in them, and which issues need to be addressed in future suicide prevention programs.