Providentia

New Orleans Mental Health System Still In Crisis 4 Years after Katrina

Despite ongoing efforts to restore emergency services to a city devastated by Hurricane Katrina in 2005, available resources for survivors dealing with serious mental illness remain at an all-time low. According to one recent report published in Psychiatric Annals, the number of inpatient psychiatric hospital beds has dropped from 487 pre-Katrina to 190. Since most of these remaining beds are reserved for psychiatric patients unable to live independently, only a fraction of those 190 beds are available for acute care.

The only state-operated mental health facility in New Orleans, the New Orleans Adolescent Hospital, is now scheduled for closing after Louisiana governor Bobby Jindal vetoed the 14 million dollars of funding needed to keep the hospital open. The hospital's closure on September 1 is expected to reduce the available number of beds to 133 leaving the city jail as New Orleans' largest psychiatric facility with 50 beds. Although state funding for mental health services has been rising, those funds have been earmarked for community-based services. Inpatient care services for the mentally ill continue to decline despite a rise in suicide rates and a sharp increase in the number of people with mental health problems, many who had been left homeless post-Katrina.

According to a World Health Organization study, the number of residents with serious mental health problems has risen from 6.1 percent pre-Katrina to 19.9 percent today due to the incidence of post-traumatic issues. The number with mild to moderate problems has risen from 9.7 to 19.9 percent. When the Federal Emergency Management Agency surveyed displaced families living in trailers and hotel rooms in February, 2006, it found that 44 percent of displaced persons suffered from some form of psychological distress. Since 2006, there have been 101 suicides and 726 suicide attempts in a population ranging from 200000 to 300000. In 2009 alone, there have been at least 24 suicides and 82 attempts.

Cecile Tebo, administrator of the New Orleans Police Department Crisis Unit that responds to 911 calls involving the mentally ill, has been outspoken in warning of the critical health care problems city has faced since Katrina.  "I've told people for so long, just don't come back [to New Orleans] right now. Don't come back if you have any kind of special needs; this is not the place to be if you have elderly that are really sick, if you have children with special needs or people in the family with mental illness or mental retardation; this is just not a good place to be right now." Mrs. Tebo added that her own staff of volunteers is just a little more than half the size it was before Katrina.

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A Tale of Two Books

Since 1258 when Pope Alexander IV first called for the prosecution of witches as heretics, the Church wholeheartedly accepted its role in stamping out witchcraft across Europe. Despite growing Protestant opposition to the persecutions, the Inquisition persisted in the arrest and prosecution of those suspected of witchcraft (usually women). Despite papal bulls and official Church pronouncements, there continued to be active dissent over how witches could be properly identified. It was only in the 15th century, when Heinrich Kramer first wrote what would later be known as the Malleus Maleficarum (the Witches' Hammer), that a true handbook for witch hunters became available. Kramer had been an active witch hunter in Austria whose anti-witch activities had been actively suppressed by the local bishop. Along with his colleague James Spenger, Kramer later arranged for a papal bull in 1484 to support their writings and their own witch-hunting efforts.

Many theologians actually opposed the Malleus at first since they viewed Kramer's methods as being unethical and illegal. Although Kramer was denounced by the Inquisition in 1490, his public lectures and widespread popularity of his handbook led to its formal acceptance. We can probably thank Johannes Gutenberg for the popularity of the Malleus since the invention of movable type made the book widely available across Europe. Between 1487 and 1520 alone, it was reprinted thirteen times and the anti-witch persecutions began in earnest.

The Witches' Hammer is divided into three sections: the first section addresses the "mistaken" belief that witchcraft didn't exist. Kramer and Spenger were emphatic in linking witchcraft to sexuality (primarily female sexuality). Since women were more "concerned with things of the flesh than men" and "all witchcraft comes from carnal lust", women were especially susceptible to the Devil's temptations. The second section deals with the powers that witches possess and how they recruit others to join them in their forbidden practices. Witches gained their power by signing their souls to Satan and their actions automatically made them blasphemers who betrayed God. The final section deals with the procedures to be following in "proving" witches and their punishment. Kramer and Spenger laid out a careful description of methods of questioning suspected witches (including different forms of torture), gathering evidence against witches, and the formal charges to be used.

The book provides a thorough guide to the psychological intimidation tactics used against accused witches. Not only did the book recommend telling witches about the tortures they would face if they didn't confess freely, but also promising worse tortures as the questioning continued. As Kramer and Spenger wrote, "And, while he is being tortured, he [the witch]- must be questioned on the articles of accusation, and this frequently and persistently, beginning with the lighter charges-for he will more readily confess the lighter than the heavier. And, while this is being done, the notary must write down everything in his record of the trial--how the prisoner is tortured, on what points he is questioned, and how he answers." Any evidence obtained through torture was perfectly valid and judges were also permitted to lie to the accused by promising them leniency if they confessed. The authors also instructed jailers to stay with the accused witch at all times, otherwise "she will be visited by the Devil and tempted into suicide."

And now we come to the other book...

Reginald Scot was no Heinrich Kramer. Born in 1538, there is very little known about his life except that he came from an old English family and enjoyed caring for his  beloved hop gardens (he also wrote a book on hop farming). While he seemed like an unlikely rebel against the witch mania that gripped Europe, Scot was moved to act after seeing fourteen women in a nearby village being tried for witchcraft in 1582. After researching how evidence was gathered and used against accused witches, Scot eventually published his findings in 1584 as The Discoverie of Witchcraft. Due to the book's controversial nature, Scot was forced to publish it himself.In his book, Scot argued against the existence of witches and and denounced the prosecution of suspected witches as irrational and "contrary to Christian doctrine".  He also raised the novel suggestion that anyone claiming to be a witch was actually deluded and needed to be "guided in their religious faith" rather than executed.

Scot railed against the Malleus Maleficarum and "witchhunters" in general, stating that "because it may appear unto the world what treacherous and faithless dealings, what extreme and intolerable tyranny, what gross and foolish absurdities, what unnatural and uncivil discourtesy, what cankered and spiteful malice, what outrageous and barbarous cruelty… what abominable and devilish inventions, and what flat and plain knavery is practiced against these old women, I will set down the whole order of the Inquisition, to the everlasting, inexcusable, and apparent shame of all witch-mongers”. What made Discoverie even more remarkable was that Scot also denounced various popular superstitions including astrology, divination, charms, and witches' sabbats.He even provided a description of "harmless" conjuring tricks that were often linked with witchcraft. Not only did this make his book one of the first true classics of skepticism, but Scot is also credited with one of the earliest known treatises on stage magic.

It should hardly be surprising that the leading theologians and demonologists of Scot's time denounced his book.& Unfortunately,his greatest critic was King James VI of Scotland (later King James I of England). A Protestant convert who took witchcraft very seriously, the King's reign in Scotland was marked by some of the worst witch hunts in British history (James had personally authorized the use of torture and burnings in dealing with witches). His Royal Displeasure with Reginald Scot's book was all too apparent and, when he became King of England in 1603, James ordered all copies to be burned. It was just as well that Reginald Scot died in 1599 since he likely would have been prosecuted for his beliefs. Only a few copies survived King James' purge although the Discoverie would be heavily plagiarized in later centuries.

With critics like Scot being effectively silenced, the Malleus Maleficarum would be the primary reference for witch hunters and judges alike in dealing with accused witches for more than two centuries after it was published. Between 1480 and 1700, an estimated 40,000 (some historians put the number much higher) of convicted witches and heretics (mostly women) were executed across Europe and its various colonies. While it's easy to regard the witch trials as being a thing of the past,episodes of witch hysteria continue to occur around the world. 

The witch hunters aren't out of business yet.

Antigay Activists Misrepresent APA Statement to Undercut Support for Hate-Crime Bill

As part of their campaign to oppose the inclusion of sexual orientation in hate crime legislation, several religious-right organizations have recently claimed that the American Psychological Association (APA) has changed its position regarding the factors that influence or determine sexual orientation. They specifically claim that APA has dropped its support of a purely biological cause for homosexuality. Antigay activists Peter LaBarbera and Matt Barber had cited the claim as a reason for their supporters to call their senators and oppose the inclusion of sexual orientation in existing federal laws that punish felony violence against targeted groups of people. The underlying argument was that since sexual orientation is readily changeable, then there’s no reason for U.S. lawmakers to provide gay people with the same protection from felony violence that other groups already enjoy. The NARTH website also claims that anti-gay organizations have faced attack for promoting "traditional marriage" and accuse APA and other mental health organization of being influenced by "gay activist" organizations. Instead of aiding their readers with a link to the actual federal antiviolence legislation, Senate Bill 909, LaBarbera, Barber, and the American Family Association directed readers to far-right web sites which claim that punishing antigay felony violence punishes free speech and protects pedophiles.

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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.

Providentia-Year 2

January 17 marks the second anniversary of this crazy blog of mine.  I seem to be managing my current output so that's not likely to change in the near future.  At some point this year, I should hit the 500 post mark and I've try not to drift too far from my original mandate.  If I've shown a bias towards some topics, well, I never claimed differently.  I'll try not to check my stats so fervently in future but, over the past year, I've had over 19,000 visitors from 146 countries around the world so I assume I'm attracting a little attention with my scribblings.  Hopefully, you'll continue to tune in to see what I have to provide. 

Saartjie's Homecoming

It must have been a exciting idea for Saartjie Bartman.

Born in 1789 into the Griqua tribe of South Africa's eastern Cape, the Khoisan woman was orphaned in an early raid and was later baptized Saartjie Baartman (her name means "little Sarah" in Afrikaans). She was working for a local farmer near Cape Town, South Africa when her unusual appearance attracted the attention of a visiting ship's surgeon, William Dunlop. Saartjie's enlarged buttocks and oversized labia intrigued Dunlop and he suggested that he take her to England to be studied. Hendrick Cezar, brother of Saartjie's employer, saw an opportunity for fame and fortune and was able to overcame any resistance that she might have had to the idea of being put on display. Given her life of poverty, the prospect of escaping it and traveling abroad must have seemed impossible to resist. Dunlop and Cezar asked Lord Caledon, then-governor of the Cape, for permission to make the trip (to the governor's credit, he would later regret giving his permission). Saartjie had no idea when she left South Africa that she would never see her homeland again.

Arriving in England in 1810, Saartjie was examined by some of the leading anatomists of the time. Her unusual genital condition was formally termed the "Hottentot apron" (Hottentot being an archaic name for Khoisan). Seen by the public as nothing more than a sexual freak, she was placed on public display in Piccadilly and quickly dubbed the "Hottentot Venus". According to contemporary accounts, Saartjie was often "exhibited like a wild beast" (usually in a cage) and forced to parade almost naked before gawking audiences. Many spectators poked her with sticks to ensure that she was "all real" and she was often left in tears due to the pain and humiliation.

Complaints over the outrageous nature of Saartjie's exploitation led to a court hearing. After Saartjie testified in perfect Dutch that she was not being abused and would receive half of all the profits from her showings, the case was dismissed. The publicity of the trial and continuing controversy of her exhibition led to Sartjie being taken to France in 1814 where things worsened quickly (slavery was still legal there). Whatever Saartjie's handlers may have promised her, she ended up getting very little money for herself.

At some point, Dunlop and Cezar dropped out of the picture and Saartjie became the property of an animal handler named Reaux. Her showings in Paris were as popular as they had been in London and she was examined by many French anatomists, including Georges Cuvier. Numerous scientific papers were written about the "Hottentot Venus" that emphasized prevailing notions of racial superiority. Saartjie's "primitive anatomy" was contrasted with the "refined" European anatomy and reinforced the idea that Europeans were naturally more advanced. A comic opera was even written about her titled "The Hottentot Venus".

Despite her popularity, Saartjie's misery and humiliation caused her to sink into alcoholism. Returning home was out of the question due to the travel expenses involved. Due to her poverty, she eventually worked as a prostitute to support herself. Saartjie's health deteriorated and she died on January 1, 1816 (probably of pneumonia) but the exploitation didn't end with her death. Her body was dissected by Georges Cuvier and a wax replica of her body was made. Saartjie's skeleton,brain and genitalia went on exhibit in Paris' Musee de l'Homme and remained there until 1974 when they were finally removed from public view.

Over the years, there were repeated pleas for the return to Saartjie's remains to South Africa but interest in the case intensified after Stephen Jay Gould wrote an article on her in 1985. Finally, following pressure from the South African government and debates in France's National Assembly, permission to return the remains was given in 2002. On May 6 of that year, Saartjie Baartman's remains were returned to South Africa and, in a moving ceremony, she was laid to rest on August 9 (National Women's Day in South Africa) in the Gamtoos River valley of the Eastern Cape.

In 1999, the Saartjie Baartman Centre for Women and Children was first opened in Capetown, South Africa as a multi-disciplinary centre for abused women and children. One of the high points of my recent trip to South Africa was a visit to the Centre to talk to the staff and hear the story of one of the women who had overcome domestic abuse with the centre's help. In addition to providing a residential shelter for women and children, the centre supplies vocational and medical assistance for dealing with trauma, AIDS, substance abuse and sexual assault. They also have the only support program for transgendered people in all of Africa.

The centre was named for Saartjie Baartman to highlight her status as an icon to the Khoisan and also as a symbol for the abuse and exploitation that women often experience. It represents a fitting tribute to one of the most memorable victims of 19th century racism.

Click here to read more about the Saartjie Baartman Centre or to make a donation

South Africa Today

I just completed an extremely long flight from South Africa to Toronto (15 hours plus) and jet lag has delayed this post a bit.

What can I say about a country that is a mass of contradictions? With 11 official languages, almost 50 million people, and a land mass greater than France, Italy and Germany combined, South Africa remains the economic powerhouse of the African continent. Despite a strong infrastructure and a commodity-rich economy, poverty and unemployment are still endemic. As one delightful professor explained to our intrepid group, economic disparity and the legacy of a horrendously racist system of government still overshadows South Africa's future. Add in the health problems associated with AIDS (South Africa has one of the highest number of cases in the world) and refugees from neighbouring countries and the challenges definitely pile up.

Our high-powered group of 16 psychologists (and guests) managed to visit Johannesburg, Capetown, and parts in between and sampled much of what this beautiful country has to offer. You can check out my pictures online to get an idea of what we managed to see in our brief time there. Along with seeing the country, we were also able to talk with representatives from South Africa's primary universities, psychology organizations, and health care facilities. I'll include a link to the proceedings from the delegation when they become available.

When I have more time, I'll write some posts over the next few weeks on specific issues facing psychology in South Africa as well as some fascinating stories that I heard.

Keep reading.

Canadian HIV Drugs En Route to Africa After Years of Delay

After a four year delay since Canada launched its Access to Medicine initiative, an emergency shipment of antiretroviral medication has been shipped to Rwanda. The pharmaceutical company, Apotex, markets the medication under the name Apo-TriAvir, A triple-combination HIV/AIDS fixed-dose medication, TriAvir combines three drugs to control HIV-1 infections in settings where more preferred therapies cannot be used. The shipment contains sufficient medication to treat 21,000 Rwandans.

While Apotex is scheduled to send a second shipment in September of next year, the bureacratic delays that have hampered efforts to provide low-cost medication to Third World nations has met with fierce criticism. Apotex has indicated that the Canadian government and the World Health Organization need to reform their procedures for exporting medications to countries where they are needed.

While Canada's Access to Medicine Regime (CAMR) was design to streamline the importing of generic versions of patented drugs and medical devices to developing nations, there have been critical delays in implementing the legislation. The current emergency shipment was secured through with the aid of Medecins Sans Frontieres (MSF). Sources for MSF and Apotex have expressed strong pessimism over future medical shipments being arranged given the three-year legal battle required to secure the current shipment.

The death toll for AIDS has already exceeded 30 million with an additional 40 million currently living with the infection.

Click here for more information.

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Providentia- Year 1

This post marks the one year anniversary of this crazy blog that I started on January 17, 2007. I have completed more than 200 posts, had 80 comments, and 16 trackbacks. Since my first post, I have had 11,613 visits to my site and visitors have come from every continent on Earth (except Antarctica- are there no web providers down there?). I have been contacted by various memorable people and I'd like to think that I have had some impact. I have yet to break into the Technorati 100,000 but that may change in time. My site usage stats appear respectable and there does seem to be decent penetration but my bounce rate.., er, not that I spend a lot of time checking my stats (that would be silly).

This blog began as just a hobby for me and that isn't like to change for the forseeable future. I enjoy having a forum that I can use to rant about things that matter to me and just to pass on the interesting tidbits that I have learned. If there are those who feel a little bored by the historical posts that I keep cranking out, all that I can say is that there are episodes from history that shouldn't be forgotten. Not without running the risk of having history repeat itself, anyway.

So, happy anniversary to me and I hope there will be many others. Feel free to drop me a comment sometime (especially if you're in Antarctica).

December 1 Is World AIDS Day

This December 1, spare a thought for the estimated 33.2 million people around the world living with HIV/AIDS (95 per cent of them in the developing world). This year alone, some 2.5 million people will become newly infected with HIV (including countless children). The World AIDS Campaign's slogan in marking World AIDS Day is "Stop AIDS: Keep the Promise". Leadership is the theme for this year as a special plea towards governments and non-governmental organizations to provide the leadership needed to overcome ingrained resistance to strategies that have proven effective in preventing the spread of AIDS including condom distribution and providing retroviral drugs to prevent the transfer of HIV from mothers to their unborn children.

Despite numerous promises from industrialized nations to provide low-cost generic medications to combat AIDS, tuberculosis and malaria, they have routinely failed to deliver. Sadly, it does not appear to be a political priority as new causes crowd out old ones. In the meantime, people are dying and the resources in many Third World countries are strained to the breaking point trying to deal the patients and their families (this includes an estimated 14 million AIDS orphans). This problem isn't going away.

Click here for more information on how you can get involved.