Providentia

AA Gunman Found Not Criminally Responsible

On March 24 of this year, Anthony John Allen walked into the Weedon Pioneer Community Hall in Cochrane, Alberta where the Alcoholics Anonymous meeting that he usually attended was being held.  According to witnesses, the 49-year old Allen then  pulled out a sawed-off shotgun and handgun and told the other members in the room that he was, "the new sheriff in town and God had told him to come to the meeting with guns".   They added that Allen told them that his gun was fully loaded and he was willing to use it.  He also pulled out a bottle of vodka and a box of shells which fell to the floor.  Another member, a former newspaperman, defused the situation and persuaded Allen to surrender without incident.

At a Calgary hearing in which the results of a forensic assessment was presented, Provincial Court Judge Judith Shriar ruled on November 23 that Allen was not legally responsible for his actions.  In handing down her decision, Judge Shrier accepted the testimony of psychiatrist Kenneth Hashman who argued that the defendant had experienced a psychotic breakdown which led to his actions.  Under Alberta legislation, Allen must appear before a Provincial review board at Alberta Hospital within 45 days for the resolution of his case.  While free on bail, a house arrest provision has been included to safeguard his behaviour.

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Going Berserk

They were the most fearsome shock troops Europe had ever known.

From the late eighth to the early eleventh century, most Europeans lived in fear of the Vikings who could strike at any point along Europe's coastlines in their warships. Although the Viking reputation for fierceness was legendary, the most terrifying of them all were the berserkers.

The actual origin of the word is open to dispute and may have referred to the hair shirts that the berserkers wore into battle (the term literally means "bear fur shirt"). They were a very special breed of warriors who became gripped with "berserker rage" and often plunged into battle without fear or armour. Known as bärsärkar-gångbb ("berserker-path"), the fit of madness that descended on berserkers caused them to be capable of almost superhuman strength and endurance. In addition to using swords, berserkers were also famed for ripping into their opponents with their teeth and fingernails. Their custom of wearing wolf or bearskins fed into many of the superstitions of the time and gave them the reputation of being werewolves or warriors possessed by an animal's spirit. Some authorities suggested that berserkers were part of a cult dedicated to the god Odin (they were commonly known as the "chosen ones of Odin") and added to their fierce image by dying their bodies, drinking wolf or bear blood, and wearing animal masks.

Descriptions of bärsärkar-gång tend to be unreliable since there were so few eyewitness accounts. According to one fascinating article on bärsärkar-gång, "This fury, which was called berserkergang, occurred not only in the heat of battle, but also during laborious work. Men who were thus seized performed things which otherwise seemed impossible for human power. This condition is said to have begun with shivering, chattering of the teeth, and chill in the body, and then the face swelled and changed its color. With this was connected a great hot-headedness, which at last gave over into a great rage, under which they howled as wild animals, bit the edge of their shields, and cut down everything they met without discriminating between friend or foe. When this condition ceased, a great dulling of the mind and feebleness followed, which could last for one or several days". Suffice it to say, berserkers were not fun to be around.

Berserker war bands seemed unstoppable and became the basis of numerous sagas and legends (which is why"going berserk" is still part of our language). Just about every Viking king had his own group of berserker bodyguards and used berserker gangs to expand territory. Berserker rage was hardly limited to the battlefield however. Vikings who were susceptible to barärsärkar-gång often became uncontrollable in any situations that caused them to lose their tempers. Viking warriors who committed murder or rape while affected by berserker rage were executed or exiled. By the eleventh century, even Viking societies had enough of their special warriors and the berserkers were banned from Iceland and Norway. Organized berserker bands were eventually outlawed and barärsärkar-gång became virtually unknown by 1200.;

Later sagas and legends often tended to portray berserkers as being superhuman and, at times, even supernatural. Descriptions of their ferocious nature were likely exaggerations (there were no real berserkers for comparison). One 13th century saga described a berserker named Otrygg who "feared neither fire nor sword" but who was killed after a Christian warrior struck him with a crucifix before cutting off his arm with a sword. The Ynglinga Saga told of berserkers who "went into battle without armor, like mad dogs or wolves, biting their shields, strong like bears or bulls, mowing down everything in their path, immune to fire and iron". Propaganda or not, it certainly made a good story.

There have been different theories relating to bärsärkar-gång and what triggered the incredible berserker rage. The most commonly accepted theory relates to the use of the fly agaric mushroom (amanita muscaria). According to one source, the mushrooms would be fed to sacred reindeer where the mushroom. After the reindeer metabolized the mushrooms, the urine became a powerful natural amphetamine which the berserkers would drink just before going into battle (don't try this at home kids). Modern researchers examining amanita muscaria poisoning have reported episodes of irrational violence, profuse sweating, disorientation, vertigo, and a subsequent "crash" very similar to accounts of berserker range. Other psychoactive substances that have been suggested include bog myrtle, bufotenin, or just plain alcohol. Although explanations such as epilepsy, hysteria, or genetic predisposition to violence have also been suggested, the lack of any modern berserkers for comparison makes the question academic.

It's tempting to suggest that bärsärkar-gång may have been a culture-specific psychosis similar to amok syndrome but, again, we'll never know for sure. While there is a recognized psychiatric condition known as episodic dyscontrol syndrome characterized by episodes of impulsive violence and irrational behaviour, there's no way to link it to bärsärkar-gång. It's ironic that countries populated by descendants of the same berserkers who once raged across Europe now have some of the lowest rates of violence in the world. Whether their ancestors would approve or not is another story.

How Does Alcohol Affect Adults with ADHD?

The acute impact that alcohol can have on controlling inhibitions has been well documented in healthy drinkers. On the other hand, there has been little research into the effect of alcohol on individuals with disorders characterized by poor impulse control, such as those with attention-deficit/hyperactivity disorder (ADHD). A study published in a recent issue of Experimental and Clinical Psychopharmacology tested the impact of alchohol on subjects with ADHD (n = 10) and controls (n = 12) using the cued version of the go/no-go task (a measure of implicit social cognition). The task requires quick responses to go targets and suppression of responses to no-go targets following the presentation of cues. Prior research on healthy adults has shown that valid cues can protect against alcohol impairment. Performance was tested under 3 doses of alcohol: 0.65 g/kg, 0.45 g/kg, and 0.0 g/kg (placebo). Alcohol dose-dependently increased inhibitory failures in controls in the invalid, but not the valid, cue condition. By contrast, those with ADHD displayed significant alcohol impairment regardless of cue condition. Thus, unlike controls, valid cues offered little protection from the disinhibiting effects of alcohol in drinkers with ADHD, suggesting an increased sensitivity to alcohol impairment of inhibitory control. The authors conclude that adults with ADHD exhibit an increased sensitivity to alcohol impairment of basic acts of inhibitory control, and this may contribute to the high incidence of impulsive behaviours observed in individuals with this disorder.

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The Lanfray Murders

It was a crime that nobody would have expected in peaceful Switzerland.

Jean Lanfray was a 31-year old labourer who lived with his pregnant wife and two children on the second floor of a farmhouse in Commugny, Switzerland. His parents and brother lived downstairs. A burly, ex-soldier (he had served three years in the French army), Lanfray would later be described as a devoted family man who worked hard to support his growing family.

At 4:30 am on August 28, 1905, Jean Lanfray got up from bed as usual. He then began his day with his regular shot of absinthe mixed with three parts of water. He and his wife quarreled briefly as he insisted that she wax his boots (they had been quarreling fairly frequently over the past year about his drinking). Jean then went to join his father and brothers in the vineyards where they worked. Despite his heavy workload, he still managed to find time to stop off at a local tavern and down more alcohol (the police would be very conscientious about later documenting all the alcohol he had that day).

Ending his work at 4:30 pm (there had been two more wine breaks in the meantime), Lanfray and his brothers dropped into a local cafe where he had black coffee mixed with brandy. After finally going home, he found his wife in an extremely bad mood. The fight began with Lanfray refusing to milk the cows and ordering his wife to milk them herself. Although his father tried to head off the worsening argument, Jean Lanfray exploded with rage. Despite his father`s desperate protests, he got his rifle and shot his wife in the head. She died almost instantly while his father ran out of the house screaming for help. When four-year old Rose ran into the room, she screamed at the sight of her dead mother. He shot her in the chest and went to the crib where one-year old Blanche was sleeping. After killing the infant as well, Jean Lanfray then attempted to shoot himself in the head. He made several clumsy attempts (due to the length of the barrel, he needed to use a string to pull the trigger) and finally managed to fire the gun. The bullet missed his brain completely and lodged in his lower jaw. Tucking Blanche`s corpse under one arm, he went into the barn and laid down on the ground to sleep. He had obviously hoped to bleed to death before the police arrived.

The police reached Jean Lanfray in time and took him to a nearby hospital where the bullet was removed. Described by the police as "dazed and incoherent", he fell asleep after the surgery and denied any knowledge of the murders when he regained consciousness  After being taken to see the bodies of his wife and daughters, he became inconsolable.& A nurse later reported that Lanfray moaned over and over again, "It is not me who did this. Oh God, tell me please that I have not done this.; I loved my wife and children so much".

Almost from the beginning, people searched for an explanation of why such an inconceivable crime could have happened. The autopsy results that showed Madame Lanfray being four months pregnant with a boy roused the townspeople even further. A town meeting was held on September 5th of that year where the people on Commugny heard speaker after speaker linking Lanfray's violence to a single culprit: absinthe.

Distilled from the flowers and leaves of artemisia absinthium (wormwood), absinthe is a green liqueur-like alcohol drink that was the basis of a 100 million dollar industry at the time of the Lanfray murders. Through its long association with "bohemian" culture, artists, and intellectuals, absinthe (also known as the "green fairy") had always been viewed with suspicion by conservatives.; Despite efforts to ban its use, consumption in France alone rose fifteen-fold between 1875 and 1913 alone. Since some absinthe manufacturers also used unusual (and occasionally toxic) additives to give their product an extra "kick", the results were often unpredictable. Temperance movements particularly targeted absinthe for its psychoactive properties and the addiction problems that it supposedly caused. Medical researchers produced studies showing the potentially destructive effects of absinthe and even proposed a new term, "absinthism" resulting from prolonged absinthe use. Symptoms of absinthism included seizures, hallucinations, speech impairments, and eventually death. Although these early studies often lacked real validity, they were enough to help the anti-absinthe temperance movement push for a total ban.

The primary factor for absinthe's notoriety seems to be one of the chemicals found in absinthe. A GABA-receptor antagonist, thujone is a; ketone found in wormwood that has been believed to cause psychedelic effects in those taking it. While absinthe only contains small amounts of thujone, early researchers were quick to link the chemical to the various psychiatric symptoms associated with absinthism.

The fact that Jean Lanfray had consumed absinthe on the day of the murders (along with numerous other alcoholic beverages) seemed enough to implicate it's role in the tragedy. During Lanfray's 1906 trial, his attorneys certainly attempted to lay as much blame as possible on his absinthe use. A Swiss psychiatrist, Dr. Albert Mahaim, was called in to testify about Lanfray's absinthism although the judge and prosecutor remained skeptical. Jean Lanfray was found guilty on all three counts of murder and sentenced to thirty years in prison. Although he was found hanged in his cell three days after the verdict, the closing of the case did nothing to stop the hysterical anti-absinthe crusade that Lanfray had helped set in motion.

In 1906, following a petition with 82,000 signatures, the Swiss government banned the sale and use of absinthe. Despite efforts by absinthe manufacturers to reverse this decision, the Swiss Constitution was changed to make absinthe illegal in 1910. Publicity over the Lanfray case and efforts by temperance activists led to similar bans across Europe and the United States (only the United Kingdom, Sweden, Denmark, Austria and Spain failed to follow suit). There is a certain irony in the absinthe ban considering it occurred at a time when heroin and cocaine were still legal (although the trend towards banning all addictive substances was only just beginning). Absinthe continued to be sold by bootleggers and it gained a reputation as a dangerously addictive substance that would take decades to shake. By the 1990s, the trend towards legalizing absinthe began as it became clear that absinthe's dangers were greatly exaggerated. Since 2000, Switzerland and other countries have reversed their ban and the United States began allowing the importation and manufacture of absinthe in 2007.

While still illegal in some countries, the green fairy definitely seems to be back.

Substance Use At The Crime Scene

Substance use has long been shown to have an effect on an individual's propensity to commit property crimes with recent studies showing substance users more likely to leave forensic material at a crime scene. A study published in the January, 2009 issue of Journal of Forensic Sciences examines property crimes solved in Northamptonshire, U.K., during 2006 with 70 crime scene behavior characteristics being analyzed for substance and nonsubstance use offenders. Statistical analysis of the results identified statistically significant crime scene behavior predictors that were found to be either present at or absent from the crime scene when the offender was a substance user. Most significant predictors present indicated lack of preparation by the offender, irrational behavior, and a desire to steal high value, easily sold property. Most significant predictors absent from the crime scene indicated more planning, preparation, and execution by the offender. Consideration is given to how this crime scene behavior might be used by police investigators to identify offenders.

The Effects of Substance Use on Offender Crime Sce...[J Forensic Sci. 2009] - PubMed Result.

What Is Salvia?

The Salvia Divinorum plant was originally native to parts of Oaxaca, Mexico. Easily identified by its large green leaves, square stems, and white flowers, it became known as Diviner's Sage due to its use by local shamans. By crushing  juice from Salvia leaves, shamans could brew a tea that they used in traditional "vision quests".

It wasn't until the 1990s when scientific analysis of Salvia plants determined that they were rich in a naturally occurring hallucinogenic known as Salvinorin A. Extremely potent even at low doses, salvia divinorum (more commonly known as Salvia) has gained popularity due to its intense "peak" lasting for a few minutes and quick return to normalcy after 20 minutes. The lack of aftereffects, versatility (it can be smoked, chewed, or used as a tincture), and low toxicity has ensured its widespread use

Salvia fans have praised its psychedelic properties and pushed for greater availability. Despite concerns about taking Salvia in concentrated form, Internet advocacy sites provide extensive advice on its use and even played up its therapeutic potential. Due to its recent introduction, Salvia remains legal in most parts of the world although this appears to be changing quickly. Increasing media attention (including YouTube videos of teenagers getting "high" on Salvia) has raised alarm over its widespread use and legal status.

A Delaware statute declaring Salvia a Schedule 1 prohibited substance was passed in 2006. Titled "Brett's Law", the statute was signed into law after the suicide of a Delaware teenager which was linked to Salvia use. Other states are pushing for similar legislation as well as regulation at the federal level. While Salvia remains legal in most jurisdictions, the backlash against its recreational use appears to be growing.

Substance Abuse and Homelessness

In the September 2008 issue oF Psychology of Addictive Behaviors, the study examining psychological and environmental factors affecting substance abuse in a sample of homeless adults is presented. The researchers assessed 664 homeless adults in terms of (a) self-esteem, social support networks, coping strategies, and emotional distress, (b) history of life on the street, and (c) substance abuse history including alcohol use and drug use (including injection drug use (IDU) and non-IDU). The results showed that lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and increased alcohol use. Quality of social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also assisting homeless clients in finding permanent housing.

Click here for the abstract.

Head Injury and Substance Use in Teenagers

A paper published in the January 2008 issue of Journal of Pediatric Surgery contains the results of a study examining the role of drug and alcohol use in adolescents suffering from traumatic brain injuries. Using trauma registry data to identify adolescent blunt trauma victims between 2000 and 2005, demographic information, injury severity, length of hospital stay, and clinical outcomes were evaluated. Of the total number of adolescent patients sampled, 9.3% tested positive for drug and/or alcohol use (the mean age of toxicology-positive patients was 17.2 years). The most commonly detected drugs were cannabis (40%), alcohol (30%), and polysubstances (23%). Substance-positive patients were more likely to be comatose, to have more significant injuries, and require emergency operations than adolescent patients who did not test positive for substance use. Length of hospital stay was was also significantly longer. In terms of outcome, mortality was found to be significantly higher and functional independence was lower. The authors conclude that substance abuse was linked to injury severity, need for medical care, and poor medical outcome for adolescent blunt trauma victims.

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Tripping Out, Part II

There is no way of doing proper justice to the full range of research into LSD that occurred during the two decades following its discovery in the 1940s although some prominent pioneers tend to stand out. One of these early pioneers was Dr. Humphry Osmond. Born in 1917 in Surrey, England, Osmond trained to become a psychiatrist and later became a Senior Registrar at a psychiatric unit at St. George's Hospital in London. With his colleague John Smithies, he began researching the effects of mescaline on the human body and became one of the early advocates for a biochemical explanation for schizophrenia. Given the strong Freudian bias among British psychiatrists during that period, Osmond's determination to continue with his research meant that he would need to leave Great Britain altogether. Answering an advertisement in the Lancet for a deputy director of psychiatry at a Canadian mental hospital in Weyburn, Saskatchewan, Osmond and his family moved to Canada in 1951.

Within a year of arriving in Canada, Osmond launched his biochemical research program and joined forces with another early pioneer, Abram Hoffer. As a Canadian psychiatrist who had been hired as a research psychiatrist by the Saskatchewan department of Public Health, Hoffer had a keen interest in the biochemical roots of schizophrenia and quickly recognized the importance of Osmond's mescaline experiments. They began to work together and soon discovered that LSD was an even better drug than mescaline in producing psychotic symptoms in normal test subjects. Osmond and Hoffer decided to explore the therapeutic value of LSD in modifying behaviour and settled on alcoholics as test subjects. The hypothesis that guided them was straightforward enough: since research subjects reported increased self-awareness after taking LSD, could alcoholics develop new insight into their drinking as well? They further argued that the delirium produced by LSD in many ways resembled the experience of delirium tremens in alcoholics drying out from alcohol. If the experience of delirium tremens often forced alcoholics to accept that they had "hit bottom", could LSD delirium produce a similar outcome? In 1953, Osmond and Hoffer tested the effects of LSD treatment on two chronic alcoholic patients at the Saskatchewan Mental Hospital in Weyburn, and reported an astonishing 50 percent success rate. Osmond was emphatic in stressing that the key to their success was not LSD but rather the "insight" that the LSD provided. A second study published in 1958 involving 24 patients at University Hospital in Saskatoon also found that 50 per cent of the patients reported either total abstention or at least significant reduction in drinking over a three year period. Unfortunately, the highly subjective nature of LSD use and the difficulties involved in replicating Osmond and Hoffer's results made their colleagues reluctant to accept their conclusions. It was also noted that a minority of patients taking LSD reported negative experiences although these "bad trips" could be mitigated through the use of empathetic staff. Osmond and Hoffer would go on to treat hundreds of alcoholics under carefully controlled conditons.

The Addiction Research Foundation in Toronto (now part of the Centre for Addiction and Mental Health) challenged Osmond and Hoffer's research by questioning their methodology, particularly the lack of proper controls. ARF researchers, Reginald Smart and Thomas Storm, conducted their own LSD study in which patients were either blindfolded or restrained to control for the effect of additional stimuli that might bias the research findings. Their results were challenged by Osmond in turn and he questioned the rigidity of the methodology that ARF used in their study. A research study by Weyburn psychiatrist Sven Jensen was published in 1962 that compared alcoholics who received LSD treatment with patients receiving group or individual treatment. Jensen found that 38 of the 58 patients who had received LSD remained abstinent over the follow-up period compared to only a small minority of patients who had received conventional treatment.

While the controversy was raging, a moral panic was brewing elsewhere. The growing use of LSD as a recreational drug, aided by counterculture gurus such as Timothy Leary and Richard Alpert (a.k.a. Ram Dass), as well as its role in the student activist movement of the 1960s led to hysterical denunciations of the dangers resulting from rampant LSD use. Humphry Osmond may have unintentionally fanned the hysteria by his own actions (not only did he coin the word "psychedelic" but he was also the one to introduce Aldous Huxley to mescaline and LSD in the 1950s). By 1966, LSD was on the FDA's list of illegal narcotics and Sandoz Pharmaceutical Company (the only legal provider of the drug) voluntarily ceased production. LSD research was subsequently banned across North America by 1968.

And so it stands. Humphry Osmond died in 2004 after a long and illustrious career. Abram Hoffer remains active in the highly controversial field of orthomolecular treatment for schizophrenia. Alfred Hoffman, the Swiss chemist who started it all, is still living and continues to be frustrated by the worldwide prohibition on his discovery. While he concedes that LSD can be potentially dangerous, he also stresses its therapeutic value as reported by researchers such as Osmond and Hoffer.

Could LSD have developed into a viable treatment for alcoholism if events had gone differently? The use of MDMA ("ecstasy") in therapy has generated considerable interest but the current political climate probably ensures that LSD will stay illegal for the foreseeable future.

*A hat tip to Dr. Erika Dyck of the University of Alberta for kindly providing me with reprints of her publications on this fascinating topic.

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Tripping Out, Part I

There is a long tradition in psychology of using psychoactive substances to explore altered states of consciousness. Back in the 19th century, William James experimented with amyl nitrate, chloral hydrate and peyote to learn about mystical experiences while Sigmund Freud experimented with cocaine (and became a frequent recreational user as well). Despite the backlash against psychoactive drugs in the early years of the 20th century, new possibilities arose with advances in biochemistry. When lysergic acid diethylamide (LSD) was first synthesized in 1938 by the Swiss chemist Albert Hoffman, he actually had no idea what he had discovered. The compound was developed as part of a research program searching for ergot alkaloid derivatives that might be useful in the treatment of migraine headaches. Aside from the "restlessness" that was observed in laboratory animals that were given LSD, no particular value was found in it and Hoffman shelved his discovery for five years. It was in 1943 when he accidentally spilled some of the LSD on his skin that Hoffman slipped into a stupor and, in a dreamlike state, experienced "fantastic pictures, extraordinary shapes with intense, kaleidoscopic play of colors". That was the beginning of his research into the effects of LSD using himself as a guinea pig. Hoffman's graphic descriptions of visual illusions with bright, intense colours, multiple images of geometric patterns, distortions of body image and subsequent feelings of heightened sensitivity inspired his employers at Sandoz laboratories to perform experiments on other test subjects.

It was Walter Stoll, a psychiatrist at a psychiatric clinic in Zurich, who first began examining the effects of LSD in psychiatric patients and control volunteers. The publication of Stoll's research in 1947 electrified the psychiatric community and Sandoz began marketing LSD as a valuable psychiatric drug under the trade name "Delysid". Not only did Sandoz advertise Delysid as a potential panacea for most mental illnesses (including criminal behaviour and sexual perversions), they also recommended that psychiatrists take it themselves to "gain an understanding of the subjective experiences of the schizophrenic". The key assumption that underlay Sandoz's marketing strategy revolved around what would be known as the "model psychosis" hypothesis. The minute amounts of LSD that led to psychotic features developing in otherwise normal subjects reinforced the idea that schizophrenia and related psychiatric conditions were purely biochemical in nature. Was it not likely that mental illness was due to the human body generating LSD-like substances under conditions of extreme stress? Could research into chemical agents that interfered with the "psychosis-simulating" effects of LSD lead to new biochemical treatments for mental illness? The serotonin (5-HT) hypothesis of schizophrenia was first proposed during this period based on the observation that hallucinogenics such as LSD and mescaline functioned by acting on 5-HT receptors in the human brain. While the actual mechanisms involved appears to be far more complex than initially thought, it seemed only natural for medical researchers of the period to believe that LSD represented a powerful new tool in treating mental illness.

Delysid/LSD first became commercially available in 1947 and demand by researchers led to its wide availability around the world in a matter of months. Despite being marketed to medical doctors, early LSD advocates including Aldous Huxley and Alfred Hubbard (a.k.a. "Captain Trips") ensured that LSD would be seen as far more than a medical tool. Huxley wrote The Doors of Perception (1954) and Heaven and Hell (1955) based on his experiences with LSD and mescaline and these books quickly became classics. While no one could have ever foreseen the role that LSD would play in the counterculture movements of the 1960s, the recreational possibilities seemed clear enough.

From 1950 to 1965, research into LSD and related hallucinogenics generated over 1000 scientific papers and books and was the subject of at least six international conferences. Thousands of patients received LSD as a treatment for everything from schizophrenia to alcoholism.

More on that next week...