Providentia

In a Flash

The nuclear explosions that devastated the city of Hiroshima on August 6, 1945 and the city of Nagasaki three days later resulted in massive destruction and loss of life. Although the precise number of casualties has never been determined, it is estimated that 70,000 died in Hiroshima due to the immediate effects of the blast with an additional 50000 in Nagasaki (mostly civilians). Estimates of the lingering effects of radiation exposure are even more problematic although it has been suggested that many thousands of casualties occurred in the decades that followed. It would be the only time that nuclear weapons would be used in war (so far). Another legacy of the bombings is far more subtle but just as devastating for the survivors. Since 1945, there has been a lingering stigma attached to survivors and their descendants that led to them being frequently ostracized by mainstream Japanese society. Termed the hibakusha (meaning "radiation-affected people" in Japanese), there are over 200,000 that have been formally registered with the Japanese government (registration being necessary to receive compensation) although many hibakusha also live in neighbouring countries such as South Korea (there were numerous Korean and other foreign nationals living in Hiroshima and Nagasaki at the time of the bombings). It would take years of activism and public awareness campaigns for the Japanese government to pass legislation subsidizing basic medical treatment for hibakusha in 1957 (the United States government was formally absolved of any responsibility for compensation in a treaty with Japan in 1951). Due to the misinformation surrounding radiation exposure including fears of it being hereditary or contagious, many hibakusha face ongoing job and housing discrimination and non-affected families even object to their children marrying into a hibakusha family. To avoid discrimination, many hibakusha conceal their status to "pass" in mainstream society.

The psychological scars involved with being a hibakusha are considerable although research into the psychosocial impact of being a survivor has been relatively neglected. In addition to the expected posttraumatic symptoms for those who survived the bombings, there is also considerable survivor guilt and a "conspiracy of silence" surrounding hibakusha discussing their experiences (although this has started to change as survivors become better organized). Survivors who emigrated to other countries after the war (including the United States) began organizing local support chapters. Despite attempts to encourage survivors to tell their stories, the lingering stigma has resulted in many hibakusha refusing to "out" themselves and sharing their experiences. As the elderly survivors die, their stories often die with them.

Stigma can take a variety of forms and people can be ostracized for all sorts of reasons. Having the wrong skin colour, creed, place of origin, medical diagnosis or sexual orientation has been used to justify horrendous discrimination over the years. Simply being in the wrong place at the wrong time seems sufficient for some. It can happen in a flash of light.

Hurting Yourself

The July, 2007 issue of the Archives of Pediatrics and Adolescent Medicine presents the results of a research project examing the relationship between self-harm behaviours and actual incidence of suicide. The purpose of the study was to determine whether self-injury acts as a coping mechanism that may occur with or lead to suicidal behaviours in individuals experiencing more stress than they can effectively handle. Using a cross-sectional data set of college-age students from two universities in the northeastern United States in the spring of 2005, a random sample of 8300 students was invited to participate in a Web-based survey. Of the respondents, only 2875 cases were usable.Demographic characteristics, history of trauma, distress, informal help-seeking, and attraction to life were also measured. The results indicated that one quarter of the sample reported self-harm behaviours, suicidality, or both; 40.3% of those reporting self-harm also report suicidality. A significant predictive relationship was found between self-harm behaviours and suicidality even when potential confounding and demographic factors were ruled out. The results indicate that young adults engaging in self-harm behaviour is an important warning sign that warrants clinical intervention.

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Attitudes and Reality Regarding Domestic Violence in Nigeria

A recent issue of the International Quarterly of Community Health Education (Volume 25) presents the results of a cross sectional study designed to determine how prevalent intimate partner violence was among women of child-bearing age in a migrant community in southwest Nigeria.The women in the study ranged in age from 15 to 49 years and structured questionnaires were given in the local language to learn about attitudes toward domestic violence in seven hypothetical situations as well as their personal experiences with violence. Of the women surveyed, 87% reported having experienced intimate partner violence at some point in their lives while 20% reported having experienced it in the preceding 12 months. In examining attitudes towards intimate partner violence, 79.5% of the survey respondents believed that wife beating was justified in at least one of the seven hypothetical situations that were presented. Respondents who were not living with a male partner were more likely than their counterparts who were married or cohabiting to accept intimate partner violence (p = 0.03).The authors conclude that there is a critical need for health education programming to change existing cultural attitudes towards domestic violence.

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Killer Boasts of Tricking Psychiatrists

"It's really not hard to make up stuff," grinned David Weightman, 28, talking about how he had convinced psychiatrists he was hearing voices to receive a lighter sentence for the murder of his adoptive parents in their Sydney. Australia home. Weightman received 25 years on the grounds of "diminished responsibility" rather than the life sentence he would have otherwise received. Appearing in the Supreme Court jury murder trial of his alleged accomplice, Terry Donai, Weightman reported that he and that he and Donai had discussed the fact that as he was an only child and would inherit from his parents' deaths. The murder plan involved Weightman drugging his parents and that Donai would then smother them.

On the night of January 8, 2000, Weightman put several sleeping tablets into his parents' tea and was outside their house when he heard his mother scream from her bedroom. Donai had emerged from the house "stinking like death", sweating and breathing heavily. He said Donai told him: "That really took a lot out of me. I'll need a hand with your dad."Weightman then held his father down as Donai smothered him with a pillow. He and Donai then pushed a car with the bodies inside over a nearby embankment to make their deaths appear accidental.

After the murders, Weightman refused to pay Donai the $18,000 he had promised him. "I was angry and mad and I didn't feel like he deserved to be paid," Weightman told the jury. He confessed to his part in the murders in 2004 after years of badgering by his aunt and uncle. While in jail waiting to be sentenced, he was told by another inmate that if he could convince psychiatrists he was insane then he could go to a psychiatric hospital rather than jail.

Weightman said he told "numerous lies" to psychiatrists while being assessed, including hearing voices, and seeing bubbles and "little gremlins". In 2005, when Justice Peter Hidden sentenced Weightman to 25 years in jail, with a minimum of 19 years, he said he lowered the sentence from life because of Weightman's confession and the help he gave police. Justice Hidden also stated that he believed Weightman suffered from schizophrenia at the time of the murders and was sorry for having killed his parents.

Donai has pleaded not guilty. He was arrested last year.

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Does Staying Active Keep Us Alive as We Get Older?

A study reported in the August 2007 issue of Journal of Aging and Health provides a look at the important role of regenerative (e.g., resting), productive (e.g., housework), and consumptive (e.g., meeting friends) activies in helping people aged 70 and older stay alive. An observational study of 473 persons aged 70 to 103 years stratified by age and sex was carried out in the former West Berlin, Germany. Study participants lived in the community as well as in facilities for the elderly. Using structured interviews in the participants' homes to study activity levels from 1990 to 1993, the rate of survival time from time of interview to a target date (August 1, 2003) was determined. Using regression measures to examine the role of different types of activity on survival, it was found that consumptive (stimulating) activities were significantly related to survival after several confounding factors were ruled out. The effect was found to diminish over time. The authors discuss the idea that daily activities are linked to survival through a psychosocial pathway that might involve perceived quality of life. Consumptive activities (e.g., meeting friends, reading a novel) may contribute significantly to maintaining health and achieving longevity because they are performed on a daily basis and their effects may accumulate over the life course.

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'Vampire' Robs Blood Bank

Hong Kong police arrested a 29-year old suspect following a September 13, 2007 incident in which closed-circuit cameras recorded him stealing three blood vials from a hospital blood bank and apparently drinking the contents. According to the camera evidence, the suspect apparently reached in through the drop-in window of the blood bank, located on the fourth floor of a local hospital, and removed the three vials. While he appeared to drink the contents on camera, it remains uncertain whether he actually did so. The vials were from three women patients awaiting testing for stomach complaints. Psychiatrist Chan Chung-mau, chairman of the Hong Kong Association for the Promotion of Mental Health, said the suspect could be suffering from a mental illness and may believe that drinking blood can charge him with energy. His current arrest status and whether he has a psychiatric history has not been reported.

Police sources indicate that the suspect was under the influence of alcohol at the time of his arrest. Security at the blood bank has since been increased.

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Delusional "Pseudotranssexualism" in Schizophrenia

The Summer, 2007 issue of Psychiatry described a case history of a 40-year old male patient with chronic schizophrenia who developed a preoccupation with changing his gender. The authors review relevant literature and concluded that twenty percent of all schizophrenic patients experience sexual delusions at some point during the evolution of their illness (including becoming convinced that they are actually the wrong sex). While true coexistence of schizophrenia and gender identity disorder is rare, disentangling them can be extremely tricky. Considering the irreversible consequences of gender reassignment surgery and the medical and legal implications implications, it is important that these patients be properly diagnosed.

Click here for the abstract.

Does Trauma Lead to Hoarding?

In a paper published in the June 2007 issue of Behavior Research and Therapy, a study of individuals diagnosed with obsessive-compulsive disorder (OCD) suggests that traumatic life experiences may be a catalyst for the abrupt onset of OCD symptoms (including compulsive hoarding). The study researchers analyzed the interview responses to the Posttraumatic Stress Disorder module of the Structured Clinical Interview for DSM-IV, (SCID) in 180 individuals diagnosed with OCD. Compared to individuals with OCD who did not meet criteria for hoarding, participants classified as hoarders (24% of the sample) were significantly more likely to have reported at least one traumatic life experience in their lifetime. Patients who met criteria for hoarding and who had also experienced traumatic life experiences had significantly greater hoarding symptom severity than those hoarders not exposed to trauma. The relationship between traumatic life experiences and hoarding symptom severity was found to be independent of other factors such as age, age of OCD onset, depressive symptoms, general OCD symptomatology, or related mood and anxiety problems. The researchers also found that it was cluttering (and not collecting or failing to get rid of possessions) that was most strongly associated with traumatic experiences. These results provide insight into the hoarding behaviour observed in some trauma victims as well as the extreme hoarding behaviour in cases of Diogenes syndrome.

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Wild Children

There seems to be a fond literary tradition surrounding children who were raised in the wild (usually courtesy of kindly animals).  We have the Roman myth of Romulus and Remus being suckled by a she-wolf after they were abandoned,  Rudyard Kipling’s Mowgli being raised by wolves (yes, it was a book before it became a Disney movie) and Edgar Rice Burroughs’ Tarzan being raised by apes.   Unfortunately, the actual reality surrounding feral children tends not to be so entertaining.   In 1797, France was in upheaval due to the events of the French Revolution. For that reason, news of a wild boy who had been captured near Toulouse and who vanished again after a week or so of being cared for in a local woman’s house probably escaped public notice.  He was not heard of again until three years later when he apparently emerged from the woods on his own.  While he was estimated to be twelve years of age, absolutely nothing else was known about him.  The scars on his body and his inability to speak suggested that he had lived in the woods on his own for most of his life (no kindly she-wolf for him). The discovery of a wild boy seemed like a perfect research opportunity given the ongoing scientific debate on the difference between humans and animals.  The boy was named Victor and sent to the National Institute of the Deaf both for research and to train him to speak.  Although Victor could hear, the Institute was considered the best setting for him since speech training was an important part of the education that the deaf students received.  It was at the Institute that a young medical student named Jean Marc Gaspard Itard took personal charge of Victor and attempted to train him to become human.   And it worked...  at first.  Victor made great progress in learning simple etiquette and self-care but language proved to be a major stumbling block.  Despite Itard’s patient teaching, Victor only learned the words for milk and God and never progressed to the point where he could live on his own.  He died in 1828.   

It was on the basis of Itard’s research with Victor that the idea of critical periods arose.   A critical period is defined as a specific point in a organism’s development when environmental experiences can shape the organism’s later development.  In Victor’s case, it meant that he had been deprived of the opportunity to learn language at a critical stage in his early childhood and later language training failed for that reason.  Countless introductory psychology and linguistics texts cite Victor as a case study in early language development (it was certainly in the text we used in my introductory psychology course).  Victor was even the basis for a Francois Truffaut movie that came out in 1970. 

Victor was hardly the only example of his kind.  In an appalling case that attracted widespread publicity at the time, a women entered a welfare office in California on November 4, 1970 with a seemingly autistic daughter who did not appear to be older than seven years of age.  Upon discovering that the girl (later named Genie to protect her anonymity) was actually thirteen and the victim of horrendous abuse, a full investigation was launched.  It was discovered that Genie’s father had kept her restrained in her bedroom from the age of twenty months with no access to language and even beat her whenever she tried to vocalize.  The mother, who was partially blind, was unable to protect her daughter until finally seeking help.   Genie was found to have a vocabulary of no more than twenty words at the age of thirteen.  Despite active training and placement in various foster homes (including numerous setbacks and allegations of later abuse), Genie never made a successful transition to adult life and continues to live in sheltered accommodation. 

There are numerous other examples of abandoned or neglected children who failed to develop normally.  There is also an extensive literature on issues relating to early life deprivation and the impact that it can have on a child’s later development.   While true cases of feral children are relatively rare, it's hard not to wonder about the millions of street children found the world over who live lives that are just as tenuous as what Victor experienced in the wild.  Will they ever become successfully integrated into society after being deprived of important childhood learning experiences?

Some damage never heals. 

Wrestler's Brain Showed Signs of Dementia

An examination of the brain of wrestler Chris Benoit revealed evidence of extensive neurological damage at the time of his death.  Benoit, a well-known professional wrestler, killed himself in June of this year after murdering his wife and child.  At the request of Benoit's father, Dr, Julian Bailes, head of neurosurgery at a top American university, examined the brain and concluded that the extensive damage resembled what would be found in "an 85-year-old Alzheimer's patient's brain".  Stating on American TV that the damage was "striking and maybe shocking", Dr. Bailes added that  "we think we have great anatomical damage here from previous trauma. Whether it had a psychiatric or behavioral expression, we certainly think that's most likely."

While the most likely cause of the damage is from the numerous concussions that Benoit sustained during his wrestling career in Japan and America, he was also known to be a heavy steroid user.  Dr Bailes added: "Our research has shown that three major concussions may be the threshold that serious later consequences may occur."

Michael Benoit, father of Chris, commented on the findings by stating that  "The person that did this is not the man we know and love. Now the findings have come out and I've had the opportunity to talk to the doctors, we certainly have an understanding of what could have contributed to the tragedy that took place that day. "

It still remains unclear why dementia pugilistica (also known as punch-drunk syndrome) occurs in athletes who have sustained multiple concussions.  Potential contributing factors include loss of neurons, brain tissue scarring, diffuse axonal injury, and buildup of senile plaques.  In terms of etiology, it strongly resembles Alzheimer's disease in many aspects.  While most commonly associated with professional boxers such as Muhammad Ali and Sugar Ray Robinson, athletes in other sports including football and hockey have also been diagnosed.

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