Providentia

How To Survive A Hostage-Taking

As seminars go, it doesn't seem as if it would appeal to many but Rocky Abramson has no shortage of journalists and aid workers willing to listen to him. Based in Israel, Abramson is a Canadian-born organizational psychologist and a former member of the Israel Defence Forces. In his four-hour seminar on the hostage experience, he stresses that the best-case scenario involves avoiding being taken hostage in the first place but, in the event of capture, following some important guidelines can increase the likelihood of survival. These guidelines include:

• If you must venture into dangerous situations where kidnapping is a possibility, do so in a group, rather than on your own, because there really is strength in numbers.
• If faced with capture, try to resist passively, a tactic that will at least buy extra time and may confuse your captors.
• During interrogation, insert a lengthy pause before answering any question, even the most straightforward – a tactic aimed at preventing your interrogators from determining which subjects you are most reluctant to address.
• Do not initiate casual conversation with your captors.
• If your captors try to chat with you, do not reciprocate until you obtain some benefit, no matter how small – a loosening of your bonds, some food or drink, anything that increases your sense of control.
• When speaking in your native language, try to enhance your control of the conversation by using lots of slang or rarefied constructions in order to make it difficult for your captors to understand you (assuming they do not speak your language well).
• You are more likely to be hit or physically abused if you slouch, so try to maintain an erect posture with your head held high.
• Make it clear to your captors that you are willing to co-operate with them but only if they do not hurt you.
• Do your best, surreptitiously, if possible, to disconnect the wires from any explosive device placed near or on you; don't worry about which wires to pull out, because it is only in the movies that bombs are designed to detonate if the hero cuts the wrong strand (real bombs don't work that way).
• Think – constantly – about a means of escape.

These tips (along with many others) are presented through four hours of role-playing, discussion and lectures and are designed to given seminar participants a sense of control over what is often seen as uncontrollable. He states that "Generally, they don't want to kill you. You'd be surprised how much of your environment you can control".

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Exorcism Case Underway in Singapore

In a bizarre trial that is currently underway in Singapore, 50-year old Amutha Valli is suing the Novena Church over an alleged exorcism. The plaintiff is claiming that the exorcism occurred on August 10, 2004 and left her traumatized and unable to work. Amutha Valli, a former national athlete, had a long-standing history of psychiatric involvement and, according to defense testimony, had been "slithering like a snake, shouting and screaming like Satan and marching like a soldier" before the alleged exorcism occurred. The priests who are at the centre of the trial contend that they have been approached by her family for help and had only conducted a "prayer session".  Defense counsel has also accused the plaintiff of fabricating the story for financial gain.

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Man Convicted For Killing Woman Carrying "Lucifer's Baby"

A 21-year old Edmonton, Alberta man who shot his pregnant childhood friend because he believed the unborn child she was carrying was Lucifer's baby was found guilty yesterday of first-degree murder Jared Baker testified at his trial that he became convinced he was the son of Satan and by "crushing the serpent's head" -- meaning killing Ms. Talbot and the fetus -- he could "walk like Jesus." Jurors were told that Mr. Baker believed the unborn baby was talking to him in his dreams, asking him to take its life and that the government had planted a transmitter in his head. He maintained that his delusions were the result of drug use.

Prosecutors determined that Baker had shot 19-year old Olivia on November 25, 2005,due to anger over her drug use which was potentially harmful to a baby that he had believed was his. On the day of the murder, he took a gun from his basement, snorted crystal methamphetamine, and then went to her house. After being invited in, he stated "Sorry, O.V." and pumped five bullets into her body. He then threw the gun into a river, went home and awaited arrest.

Jury members rejected defence arguments that Baker was not criminally responsible in bringing in their guilty verdict.

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Are Schizophrenics Better Off in Developing Countries?

Based on on a series of cross-national studies by the World Health Organization (WHO), the prevailing view in international psychiatric circles has been that schizophrenics tend to fare better in developing countries. However, in an article in the September, 2007 issue of Schizophrenia Bulletin, a review of evidence from other research indicates that the picture is far more complex. Through literature review and tabulation of data from 23 longitudinal studies of schizophrenia outcomes in 11 low- and middle-income countries, evidence examing clinical outcomes, disability and social outcomes (marital and occupational status, in particular), and untreated samples and duration of untreated psychosis, have indicated a need to reexamine the conclusions of the original WHO studies. In particular, excess mortality and suicide need to be take into account in making broad generalizations about schizophrenia outcomes in low- and middle-income countries.

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Psychotic Priest-Killer Jailed Indefinitely

An untreated paranoid schizophrenic with extensive religious delusions has been jailed indefinitely for the March 14, 2007 murder of a 59-year old vicar in Wailes. Geraint Evans had been living in his mother's flat overlooking the vicarage and had made elaborate plans to murder Father Paul Bennett as part of an elaborate delusion in which the vicar was God. He made elaborate notes on Father Bennet's movements and recorded his observations and speculations on a series of CDs. On the day of the murder, Evans stabbed Father Evans to death and scattered the CDs at the scene of the murder while the vicar's wife looked on in horror. He then walked to a nearby grave to await arrest.

In a court-ordered psychiatric assessment, it was determined that the 24-year old Evans had a longstanding history of substance abuse (including inhaling lighter fluid) and was diagnosed with paranoid schizophrenia and a personality disorder. He reported delusions of being God, Jesus and the Antichrist and would save the world from nuclear Armageddon. He had apparently developed animosity towards Father Bennett whom he had accused of attempting to have him sectioned under the Mental Health Act. Despite a previous suicide attempt, he had never received psychiatric care prior to the killing.

Judge Nicholas Cooke QC ordered him to be detained indefinitely and said it was difficult to conceive when it would be safe for him to be released.

After the case at Cardiff Crown Court, the priest's family accused the authorities of failing him and demanded an inquiry into the killing. One said: "Someone must have known how disturbed this man was and could have intervened. Where were the mental health services?"

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Screening for Violence Risk in Youth

The July 2007 issue of the Journal of Psychiatric Practice describes an study designed to test whether risk factors for violence were being adequately reported in emergency psychiatric admissions . The study was based on a sample of 425 pediatric patients who were assessed by psychiatry residents in a psychiatric emergency room. Using a chart review process, it was determed that psychiatric residents rarely documented asking about important risk factors such as access to guns, gang affiliation, history of police contact, or domestic violence. When pediatric patients were specifically asked about these risk factors, most patients were open in talking about how they affected their lives. Despite being the most common method of homicide/suicide in youth, gun access was assessed by residents in only 3% of patients while domestic violence was endorsed as positive 100% of the time whenever it was documented. Pediatric patients regarded as violent were more likely to be screened for past violence than those with suicide or other complaints. Males were more likely to have a history of prior violence than females. The researchers conclude that psychiatric residents need to do a better job of documenting potential risk factors for violence in pediatric patients being admitted to an emergency setting. Identification of potentially high-risk youths is vital both for legal and treatment planning purposes.

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Setting Fires

While reports of gender differences amongst arsonists undergoing psychiatric assessment are not uncommon, many of the studies some are based on relatively small samples. The July 2007 issue of Medicine, Science and the Law presents a new retrospective study examining gender differences in a sample of 167 adult arsonists (129 males and 38 females). The information was collected from case files of a group of arsonists referred to the West Midlands Psychiatry Service over a 24-year period. The results found that female arsonists were older than males and more likely to have a psychiatric diagnosis. Women more frequently had a history of sexual abuse, while men had a more varied criminal background and more substance abuse problems. The findings largely support previous research, and also provide support for an Action System Model of arson behaviour. The researchers suggest that significant gender differences among arsonists indicates that different approaches in the treatment of male and female arsonists may be advisable, though a reliable evidence base for treatment has yet to be established.

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October 10 is World Mental Health Day

World Mental Health Day is designed to raise public awareness of mental health issues. The theme for this year's World Mental Health Day is "Mental health in a changing world: the impact of culture and diversity." The World Federation for Mental Health launched the World Mental Health Day initiative in 1992 to foster increased understanding of transcultural issues in mental health and how they impact clinical interventions around the world.

Mental health agencies around the world are marking October 10 with special presentations and symposiums to highlight the unique challenges facing persons with mental health issues and how they are regarded in different cultures. Follow the provided links or check local listings to see what is being planned in your community.

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World Mental Health Day Project

In the Saint’s Name

While cases of religious ecstasy are hardly unusual, there are definitely examples that tend to stand out. In 1728, in the Parisian cemetery of St. Medard, a phenomenon began that quickly became the talk of France. Following the burial of a pious, Jansenist bishop named Francois de Paris in the cemetery, stories arose of miraculous cures being worked at the bishop's tomb. Pious female parishioners, who later became known as St. Medard's convulsionaries, were described as engaging in "contortions and convulsive movements, attended by cries, shrieks and groans, all of which were regarded as manifestations of divine power". The adherents would work themselves into states of religious ecstasy and engage in acts of severe torture which they either inflicted on themselves or through the actions of assistants known as Secouristes. They would then reportedly work miracles and cure all forms of disease. The massive hysteria that arose led to a crackdown by the police under orders of the King and the eventual closure of the cemetery in 1732. Thousands of convulsionaries were arrested and the movement was driven underground. It eventually split into different factions and faded into obscurity (although it would briefly reappear in Paris in 1759). The police action gave rise to a famous epigram: "De par le roi, defense a Dieu De faire miracle en ce lieu. (Louis to God: To keep the peace, here miracles must henceforth cease)." The convulsionaries of St. Medard gained a literary immortality through the writings of Voltaire and Diderot.

A less famous but longer-lasting example of religious convulsionaries occurred in the northern Spanish town of Jaca. This small town was known for centuries for the annual pilgrimage to commemorate its patron saint, Orosia (also spelled Eurosia). Different accounts of Orosia's life exist (and she may have never existed at all) and it remains unclear why she was named patron saint of the demonically possessed but she became the patron saint of Jaca after her relics were brought there in the eleventh century. From that time until the Church banned the practice in 1947, St. Orosia's convulsionaries took part in a bizarre procession each year on June 25 (the Saint's feast day).

The procession involved the "demonically afflicted" (eg, epileptics, mentally ill, physically handicapped, and other stricken) and took place in front of the Saint's sarcophagus. The pilgrims would gather to find healing for their various afflictions through participation in the procession and exorcism rituals. In a description of the procession by a medical observer in 1881 (and bear with me here since my Spanish is rusty), the bishop and retinue of friars would start off the procession accompanied by music and dancing. "Paralytics, madmen, epileptics and hysterics would gather during the night before the chest containing the saint's relics. Their infirmity is attributed to possession by a devil and they seek the devil's elimination. Cramping, muscle contractions, spasmodic grins, and howling are the preamble of the convulsions. They would fall to the ground until they were black and blue, blood spurting from their mouths". At this point, the exorcism would begin with multiple applications of the rosary and cross which the convulsionaries would kiss repeatedly. Once the demon was deemed to have fled, the newly healed convulsionaries would jump for joy and scream loudly. It is doubtful whether any actual "cures" took place (there were certainly no follow-up studies) but the sight of the newly-exorcised praising the saint for their healing made for quite a spectacle by all accounts and drew pilgrims from all over the region.

The banning by the Church in 1947 brought an end to St. Orosia's convulsionaries and marked the last example of recurring mass motor hysteria in Europe. Sadly, the use of exorcism in dealing with mental illness continues even today with tragic results When proper mental health care isn't available and families seek for a cure for their loved ones, what solutions might they turn to in desperation?

Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome(NMS) is a rare, life-threatening but potentially treatable condition that is most often associated with adverse reactions to antipsychotic drugs. First identified in 1956 with the advent of modern psychiatric medications, the fever, rigidity, elevated enzyme levels, and brain pathology associated with the syndrome has been typically found to have a mortality rate in the 10-15% range.A study described in the April-June, 2007 issue of Neurology India examines the identification, treatment and outcome in fourteen NMS patients admitted to the Neurology department of a large teaching hospital of North India. The cases were detected and treated during a three-year period (May 2000 to April 2003).The incidence of NMS was 1.40/ 1000 patients treated with neuroleptics and mortality rate was 14.28%. Among the medications associated with development of NMS, Haloperidol (parenteral) was implicated as the most common drug for NMS in 57% of patients. An association with coexisting precipitating illness was clearly recorded in 71.4% patients. 85.7% responded to dopaminergic drugs along with supportive treatment and showed partial or complete recovery within 7-14 days. In partial recovery cases, residual deficits were found including Parkinson-like features, depression and excessive sweating (diaphoresis) in a small percentage of patients.

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