Providentia

Aktion T4

Long before the Nazis ever came to power in Germany, the importance of eugenics in purging the race of the genetically unfit was being proposed.  Not just in terms of sterilization, but execution of anyone deemed to be unworthy of life.  Even after the Nazis came to power, it was recognized that the "problem" of dealing with the intellectually and mentally disabled could not be resolved in peacetime as there would be too great an opposition to doing what must be done.  Despite the groundwork laid down by years of Nazi propaganda against the mentally disabled, it would take the outbreak of World War II in 1939 before the next step could begin in earnest.

It was in 1939 that, Action T4 (named for Tiergartenstrasse 4, the address of the building that headquarted the department that was to carry out the directive) began to carry out the eugenics program.  It was actually voluntary at first.  Parents would be asked if they wished their severely disabled children to be euthanized. A panel of doctors would assess individual cases of newborn children with various defects (real or suspected) and decide which children should be put to death.  The voluntary element vanished quickly and parents were told that their children were being sent to centres where they would receive "special care".  Afterwards, the parents would be told that their child had died of pneumonia .  The bodies would be autopsied and tissue samples taken for medical research.  As word began to spread, parents would refuse consent for their children to be taken and were often punished for it. 

As Germany moved to a war footing, the program was expanded to include older children and adults.  Lists of chronic patients were compiled from hospitals and sanatoriums (Jewish patients in particular were identifed).  They were then transferred to special factilities where they could be killed.  It would be in occupied Poland that T4 would first be implented on a broad scale with thousands of mental patients being killed by carbon monoxide gas in improvised gas chambers.  The bodies were then burned in crematoria. It was the success of the program in Poland that led to the implementation of T4 across all of occupied Europe as the Germans advanced.  Between 1939 and 1941,  75,000 to 250,000 people with intellectual or mental disabilities were executed by various means ranging from lethal injection to gas. 

The architects of T4 were medical doctors with the training to carry out the "operational" aspects of the program (including Hitler's personal physician) but countless doctors and nurses also participated.  As rumours of what was happening in the killing centres grew, many families tried to protect their loved ones by withdrawing them from hospitals and caring for them at home or arranging for doctors to "re-diagnose" them to avoid T4.   It would be the opposition from church groups and other parts of society that led to Hitler formally cancelling T4 in 1941.  While killings continued after 1941, they were less systematic and were absorbed into the broader Final Solution program for which T4 was an important first step.

In December 1946, the Doctors' trial was held to try 23 medical doctors and administrators for their role in "crimes against humanity" including human medical experimentation and their role in implementing T4.  Seven were later executed and many others would receive long periods of imprisonment.   

Coming to Terms with Grief

In a study published in the April 20, 2007 issue of the British Medical Journal, the results of a research project looking at the effectiveness of a cognitive-behavioural counseling program in treating acute grief following suicide of a family member.  A sample of 122 close relatives of recent suicides were divided into an experimental group that received family-based cognitive behavioural treatment and a control group that received regular care.  Comparisons between the two groups showed no significant difference between the two groups with respect to level of depression, suicidal ideation, or complicated grief 13 months post-suicide.  There was a significant reduction in perceptions of personal blame and maladaptive grief reactions noted in the treatment group compared to the control group.      

Click here for the study abstract.  The full-length study is also available for subscribers.

UN Releases Report on Violence Against Children

In 2003, the United Nations Secretary General's Study on Violence Against Children was launched.  Sponsored by UNICEF, the World Health Organization, and the High Commissioner on Human Rights, the study was designed to collect information on children who have been targetted by violence around the world.  In a series of regional meetings, experts gathered to share information and to plan a series of resolutions to be formally presented to the United Nations.  Numerous non-governmental organizations also participated. 

The final report, released in November 20006, presents a variety of disturbing statistics:

• An estimated 53,000 child deaths in 2002 were believed to be homicides
• 3 million girls are subjected to genital mutilation each year
• An estimated 218 million children were involved in child labour,  many under hazardous conditions
• Sexual offending against children remains prevalent with over 200 million children under 18 experiencing some sort of forced intercourse or other sexual violence

The report also lists strategies designed to combat child victimization including further promoting of data collection and research, enhancing reinforcement of existing child protection legislation, and increased accessibility to intervention and prevention resources.   

Click here to download he United Nations Secretary General’s Study on Violence Against Children.

Setting the Standard

On January 20, 1843, Edward Drummond, private secretary to then-English Prime Minister Sir Robert Peel, was shot in the back as he was approaching the Prime Minister's official residence at 10 Downing Street.  Drummond was able to make his way to his family's nearby bank where he collapsed.  The shooter, Daniel M'Naghten made no attempt to flee the scene and was quickly arrested.  It soon became apparent that Drummond had been shot by mistake as M'Naghten had believed him to be the Prime Minister.  After Drummond's death five days later, Daniel M'Naghten was formally charged with murder. 

The trial at the Old Bailey was held on March 3 of that year and the courtroom was packed as the charges were read.  Despite the Crown's attempts to portray him as mentally competent, evidence presented by the defense was able to establish that M'Naghten had believed Sir Robert Peel was part of a vast conspiracy against him (along with the British Tory government and Jesuit priests).  Testimony was heard from from various psychiatrists and the presiding judge concluded that enough evidence had been heard to bring in a verdict of "Not Guilty by Reason of Insanity".  Given the political nature of the crime, there was considerable public opposition to the acquittal.  Queen Victoria in particular was greatly upset (she had survived an assassination attempt by a mentally ill man in 1840) and requested that the case by reviewed by the House of Lords.

It was as a result of the House of Lords proceedings into the legal basis of insanity that the M'Naghten rule of insanity was formally enshrined into law.  Based on the rule, a defense of insanity could only be permitted if it could be proven that the offender was sufficiently impaired as to not know the nature and quality of the act that he or she was doing or did not know that the act was wrong.  The M'Naghten rule would form the standard for insanity pleas in most English-speaking jurisdictions until well into the late 20th century.   While many American states still use a variation of the M'Naghten rule, it has been largely superseded in the British court system. 

As for Daniel M'Naghten?  He was forcibly institutionalized for the rest of his life under the Criminal Lunatics Act of 1800.  He would spend twenty years at Bethlem Royal Hospital before being transferred to Broadmoor where he would die in 1865.  His own reaction to becoming part of legal history does not seem to be recorded.   

Is ADHD a Risk Factor in Children of Alcoholics?

While ADHD and parental alcoholism have been found to be risk factors in the development of alcoholism, there is little research examining the interaction between these factors  A recent study reported in the April, 2007 issue of Alcoholism: Clinical & Experimental Research examined the role of different factors in a sample of 142 adolescents with a diagnosis of childhood ADHD.  Both the ADHD group participants and a comparison group of 100 age-matched control participants were interviewed concerning negative life events and drinking behaviours.  Results indicated that the relationship between parental drinking behaviour and negative stress factors was significant for ADHD participants alone.  It was also found that ADHD may serve as a risk factor in the transmission of alcohol abuse from parent to child.  The researchers discuss the implications of the research in terms of prevention and treatment. 

Click here for the abtract.  The full-length article is also available for subscribers.

Do Hormones Affect How We Look at Sexual Stimuli?

In a study published in the April 2007 issue of Hormones and Behavior,  the results of research examining how men and women look at sexual stimuli is presented.  Using eye-tracking measures, a sample of 15 men and 30 women (15 who were on a normal menstrual cycle and 15 who were taking oral contraceptives) were shown sexually-explicit photos at three intervals to measure responding at different points in the menstrual cycle.   There was no difference between the three groups in looking at the female body and no difference was over time.  All three groups were found to differ significantly in terms of the relative amounts they spent looking at different regions of the sexual pictures.  As was expected, men and women were found to differ significantly but significant differences in eye-gaze patterns were also found between normally menstruating and contraceptive-taking women.  These results present an intriguing look at the role of sex hormones in influencing how we respond to sexual stimuli.    

Click here for the study abstract.  The full-length study is also available to subscribers.

After Mozart's Funeral

The funeral of Wolfgang Amadeus Mozart on December 7, 1791 was a modest one (but far from the pauper's burial of legend).  Along with family members were numerous friends and acquaintances of the late composer, among them was his old billiards buddy and fellow Mason, Franz Hofdemel.  Several days after the funeral, Hofdemel brutally attacked and mutilated his wife, Magdalena.  After slashing her in the face, arms, and throat,  he then cut his own throat.  A visitor found her lying in a pool of blood and came to her aid.  She survived, Hofdemel did not.  Magdalena was five months pregnant at the time of the attack and later gave birth to a son (there seems to be some discrepancies in the official account as to the child's name but it was said that she named him after both Mozart and Hofdemel).  She was granted a generous pension by the Emperor and the Empress herself expressed public sympathy for the widow and the sad circumstances of the attack.   

Almost immediately, speculation arose as to what could have caused the attack and how it related to Mozart's death.  Magdalena had been a pupil of Mozart's and lurid accusations portrayed Hofdemel as attacking his wife and killing himself out of rage after learning that they had been lovers and that she was carrying the composer's child.  It was even speculated that Mozart's untimely death had been due to his being poisoned by the jealous Hofdemel.  There seemed little doubt that the story was widely believed and Magdalena would later leave Vienna to escape the rumours.  Even years after Mozart's death, Ludwig van Beethoven would refuse to play in Magdalena's presence because "too great an intimacy had existed between her and Mozart". 

The true story was probably less dramatic (it usually is).  Mozart had been a notorious womanizer but he seemed reasonably devoted to his wife, Constanze.  Hofdemel on the other hand, had been a chronic gambler whose debts exceeded the income he earned as a minor government official.  Mozart had borrowed money from Hofdemel and his premature death made it highly unlikely that it would ever be repaid.  Had it been the shock of Mozart's death and what it would mean to him financially that pushed Hofdemel over the edge?  Had there been an affair between Amadeus and Magdalena?  Or was it merely suspicion of an affair that made Hofdemel attack her?  We will likely never know the truth.

UK Suicide Rate Declines

A progress report released by the National Institute for Mental Health in England is reporting that the overall suicide rate for the last 12 months is the lowest on record.  The reports also notes a substantial drop in suicides in young men which has been showing a continuing downward trend over a number of years.  Suicides in prisons has fallen 17 percent since last year and the rate of suicides in mental patients has also declined significantly.  Overall, the report suggests that the Government target of a 20 percent reduction in suicides by 2010 is on the way to being met. 

While the report findings are positive, cautions are raised about the need to do more to decrease the suicide rate further.  As part of the National Suicide Prevention Strategy for England, government-sponsored initiatives, protocols and community outreach services to high-risk individuals  including mental patients in the community have proven to be effective.  New legislation seeking to give further powers to mental health agencies to provide treatment services to those in need is also being proposed.

More information can be found here.

Shifting the Blame

One of the most consistent findings in research into violence and psychopathy has involved the nature of violent offending.  Psychopaths have been found to be far more likely than non-psychopaths to engage in instrumental or goal-oriented violence while non-psychopaths are far more likely to engage in reactive or situationally determined violence.  In a study published in the February, 2007 issue of Law and Human Behavior, research comparing 50 offenders incarcerated for homicide have made an intriguing finding: while psychopaths were found to have commited instrumental homicides more often than non-psychopaths, there was little difference between the two groups in terms of how they explained their actions.  Despite the actual circumstances as detailed in the official account, psychopaths were far more likely than non-psychopaths to distort the details that led to their offending and to portray their offense in a way that minimized responsibility for their actions.  Virtually all homicides committed by psychopathic offenders in the study were instrumental in nature and psychopaths were far more likely to rely on deception to present themselves in a better light even in the absence of potential benefit.  The researchers discuss the results in terms of the relationship between self-report and official accounts of criminal offenses.

Click here for the abstract.

New Childhood Trauma Diagnosis Proposed For DSM-V

A working group of child psychiatrists and psychologists have proposed a new diagnosis for inclusion in the next Diagnostic and Statistical Manual of Mental Disorders (due out in 2011).  Child clinicians have experienced problems due to the inadequacies of current diagnoses designed to assess children suffering from repeated and frequently serious traumas.  To address this lack, the working group is proposing a new diagnostic category:  developmental trauma disorder (DTD) to be used for children who face repeated traumas while their brains are still developing.   The proposed criteria for DTD include:

1. Exposure:   Multiple or chronic exposure to one or more forms of adverse developmental traumas
2. Triggered dysregulation  Dysregulation in response to specific, situational triggers.  Can involve affective, somatic, or behavioural patterns of responding 
3. Persistently altered attributions and expectancies  Loss of trust in protectors, negative self-attitude, perception that future victimization is inevitable
4. Functional impairments  Educational, familial, legal, or vocational impairments

The working group, led by psychiatrist Bessel van der Kolk and psychologist, Julian Ford, are building their case for inclusion through a series of research studies as well as investigating potential treatment regimens for DTD children. 

Click here for more on the proposed diagnosis.