Providentia

His Last Request

Robert Baldwin is a familiar name to Canadian schoolchildren. He continues to be remembered as a bold political reformer and one of the architects of the first responsible government in Canadian history. Despite his prominence in Canadian political history, Baldwin's private life and some of the peculiarities surrounding his death in 1858 are not so well-known. His marriage to his first cousin, Augusta Elizabeth Sullivan, in 1827 was reluctantly permitted by their parents despite concerns about Eliza's chronic poor health and the potential risks of such a close genetic relationship to their children. As Baldwin's political career flourished, their family grew and they would have four children in all. Eliza's health took a turn for the worse following the caesarean birth of her last child in 1834 and she would die two years later. Robert Baldwin was devastated by her death and would never be the same afterward. His strong religious beliefs and obsession with the perfection of his life with Eliza kept him from ever marrying again. He also made yearly rituals out of the anniversaries of their marriage and her death. After spending the rest of his life in and out of politics, he ended his career in 1851 having been driven out by the very reformers he had championed. Baldwin spent the last years of his life tending to his estate in Toronto, writing letters, and brooding over the loss of his wife. He also became preoccupied with health problems which seemed primarily due to chronic depression. His eldest daughter, Maria, was his main caregiver during his last years. She had never married (probably because her father chased off every potential suitor she ever had) and became an embittered spinster who was devoted to her father. Caring for him became increasingly difficult due to his chronic headaches, memory problems and frequent "harassing and perplexing dreams" that disrupted his sleep. Still, it was only after his death on December 9, 1858 due to lung problems that things really took a bizarre turn.

Before his death, Baldwin had left a remarkable document with Maria that showed the full extent of his preoccupation with Eliza. The document contained nine requests concerning how he wanted to be buried. Not only did he ask that certain prized possessions and her letters be buried with him, he also insisted that their coffins be chained together. The most memorable request however was that "an incision be made into the cavity of the abdomen extending through the two upper thirds of the linea alba". In other words, he wanted to have an incision made on his body to match the caesarean scar that had been made on Eliza's body. Maria arranged for the other conditions to be met but balked at that last request and, believing that she had the only copy of her father's document, made no mention of it to the rest of the family. The funeral drew one of the largest crowds Upper Canada had ever known as Baldwin was laid to rest. Life went on afterward until one month later when Maria's elder brother, Willcocks, came across a second copy of the document while sorting through his father's clothes. Robert Baldwin had been in dread of dying away from home and had carried an abbreviated copy to ensure that all of his final requests be met. Being a dutiful son (and with perhaps a few harsh words to Maria), Willcocks made the necessary arrangements.

It was on a cold January day in 1859 when Willcocks, along with several family members and friends (including Dr. James Henry Richardson), entered the vault where Baldwin's body was kept to make the requested incision (as it was still winter, the body could not be buried until the ground thawed in the spring). It was definitely a grave undertaking (sorry, couldn't resist) and marked a strange end to a remarkable political life. Robert and Eliza Baldwin are now buried in St. James Cemetery in Toronto (still chained together) and their joint grave marker represents a silent testament to a story of love and grief.

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Does Childhood Suicidal Thinking Predict Later Suicide?

An article in the November 2007 issue of the Journal of the American Academy of Child and Adolescent Psychiatry presents the results of a longitudinal study examining whether childhood suicidal thinking is related to mental health problems in adulthood. The study sample was made up of 1,022 Dutch children who were 11 years or younger in 1983 and who were followed over 10 to 14 years into adulthood. The study participants were assessed with a structured psychiatric interview to identify potential adult mental health problems including substance abuse, mental illness, and suicidal behaviour. Childhood suicidal thing was identified using using parental reports of suicidal thinking. The results indicated that childhood suicidal thinking was highly predictive of suicide ideation in adulthood and lifetime history of suicide attempts. Childhood suicidal thinking was also associated with an increased likelihood of mood disorder and anxiety disorder in adulthood as well as externalizing disorders such as ADHD, conduct disorder and behavioural syndromes. The authors conclude that suicidal thinking in childhood may be remain stable over time with worrying consequences in adulthood. Children with parent-reported suicide ideation at a young age may require additional resources, age-appropriate intervention, and careful monitoring into adulthood.

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The Snakeroot Remedy

Rauwolfia serpentina is an evergreen shrub with large leaves and flowers and tiny fruit that turn purple-black when ripe. It grows wild in India and is mainly found on the slopes of the Himalayas. The first recorded mention of rauwolfia roots (known as snakeroot or "sarpagandha" in Indian medicine) was in 600 BC although oral tradition describes it as a mainstay of Indian Avuredic medicine for thousands of years before that. Snakeroot gained its name as a treatment for the effects of snake venom but it was also used for treating insomnia, diarrhea, dysentery and uterine complications. Traditional healers also used it for the sedation of mental disturbances and it became known as the "insanity herb" for that reason. Rauwolfia serpentina was given its scientific name in the 17th century by a French botanist who named the shrub in honour of 16th century botanist and physician Leonhard Rauwolf. Still, its medical properties weren't formally identified until 1933 when Rauwolfia's value in combating hypertension was first discovered. The active alkaloids derived from the rauwolfia root (more commonly known as reserpine) were first isolated and synthesized in 1952 and research into reserpine began in earnest. Researchers found that reserpine affected norepinephine uptake, activated dopamine receptors and depleted brain serotonin. The calming effect that reserpine had on patients suffering from acute psychosis was first identified in 1954 and the psychopharmacological revolution in psychiatry was on.

It was reserpine, along with chlorpromazine (which was actually first used in psychiatric patients) and haloperidol that triggered the massive deinstitutionalization of psychiatric patients that followed. In the United States alone, the number of hospitalized psychiatric patients went from 500,000 in 1960 to an estimated 100,000 at present. While the introduction of psychiatric medications gave rise to an irrational optimism about the treatability of mental illness in the community, the reality proved to be considerably bleaker for all too many psychiatric patients. Sadly, while psychiatric medications prove useful in controlling mental illness in institutions, using them for outpatient treatment is far more problematic. I won't go into the various economic, social and political dimensions of the tragedy but the end result has been a widescale shift in patients from psychiatric hospitals to homeless shelters, prisons and alleyways throughout most of the industrialized world. Ironically, reserpine has long since been phased out as a treatment for mental illness in favour of more effective medications due to the serious side effects associated with it (including neuroleptic malignant syndrome and parkinsonian symptoms). It's mainly used as a treatment for hypertension these days (except by traditional healers). The social upheaval that it helped spark is still unfolding though and the political and social will to deal with this health care crisis is sorely lacking.

The intricate details of how Indian herbal medication led to this current situation mean little to the former mental patients who find themselves locked in prisons or freezing on the streets this winter. All that I can say is that I am thinking about them this holiday season. I wish there was an answer for them.

What Causes Postconcussion Syndrome?

The causes, diagnosis and outcome of postconcussion syndrome (PCS) remain controversial, especially following mild traumatic brain injury (mTBI) . An article in the August 2007 issue of the Journal of Neurology, Neurosurgery and Psychiatry describes the results of a prospective study examining the role of preexisting psychiatric disorders, demographic factors, injury-related characteristics, neuropsychological and psychological variables in shaping acute PCS. Using a sample of 90 traumatic brain-injured admissions to a Level 1 trauma hospital and 85 non-brain injured trauma controls, participants were given a battery of neuropsychological and psychological tests and a PCS checklist. Statistical analyses were used to predict acute PCS after 5 days postinjury. The results indicated that diagnosis of acute PCS was not specific to mild traumatic brain injury (mTBI 43.3%; controls 43.5%). Pain was found to be a significant factor but the the strongest predictor for acute PCS was previous history of affective or anxiety disorder. Females were 3.33 times more likely than males to experience acute PCS but the role of acute posttraumatic stress and neuropsychological function was relatively small. Higher IQ was also associated with acute PCS. The authors concluded that there is a high rate of acute PCS in both mTBI and non-brain injured trauma patients and that PCS was not found to be specific to mTBI. For this reason, the use of the term PCS may be misleading as it incorrectly suggests that the basis of PCS is a brain injury.

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Russian Activist Being Held in Psychiatric Hospital

In a disturbing development by the Russian government, opposition activist Artem Basyrov was detained by two plainclothes officers and sentenced to be held in a psychiatric hospital in the central region of Mari El. The November 23 arrest is the latest in a series of psychiatric committals directed against political figures and journalists critical of the current regime. The psychiatric board that reviewed the 20-year old Basyrov's case alleged that he had "harassed" a woman and was suffering from "some sort of mental illness". Basyrov's supporters dismiss the allegations as "idiocy" and maintain that his arrest was designed to punish him for running as an Other Russia candidate in the local legislature. Basyrov was one of the organizers for a "Dissenter's meeting" that was scheduled to take place on November 24th. The other organizer, Mikhail Klyuzhev, was arrested on November 22 for "hooliganism" and held for three days. While his Basyrov's is scheduled for review in a few weeks, international organizations such as the Global Initiative on Psychiatry have been monitoring the increasing use of psychiatric hospitals for jailing dissidents and accuse the Russian government of engaging in Soviet-era tactics to crush opposition.

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Victims Behind Bars

The August 2007 issue of Psychiatric Services presents the results of a study examining rates of sexual victimization among prison inmates with and without a mental disorder. Using inmates aged 18 or older in 13 prisons within a single mid-Atlantic state prison system (12 facilities for men and one for women), a total of 7,528 inmates completed the survey which was administered by audio-computer-assisted technology. Of the 6,964 male respondents, 58.5% were African American, 16.2% were non-Hispanic white, 19.8% were Hispanic, and 5.5% were of another race or ethnicity. Of the 564 female respondents, 48.4% were African American, 30.9% were non-Hispanic white, 14.4% were Hispanic, and 7.3% were of another race or ethnicity. Determination of history of mental disorder was based on self-reported previous treatment for particular mental disorders. Sexual victimization was measured by using questions adapted from the National Violence Against Women and Men surveys. The result indicated that approximately one in 12 male inmates with a mental disorder reported at least one incident of sexual victimization by another inmate over a six-month period, compared with one in 33 male inmates without a mental disorder. Among those with a mental disorder, sexual victimization was three times as high among female inmates (23.4%) as among male inmates (8.3%). African-American and Hispanic inmates with a mental disorder, independent of gender, reported higher rates of sexual victimization than their non-Hispanic white counterparts. The authors conclude by recognzing the hazards of prison life and call for the need to protect vulnerable inmates from predators inside prison. Screening for posttraumatic stress disorder and providing trauma-related treatment are vital.

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Chaining the Wizard

An 84-year old Ghanaian is facing legal charges for allegedly keeping her 50-year old son chained up in a single room for ten years on suspicion of his being a wizard. Kofi Menka, a former businessman and member of the Dome Royal Family in Offinso, Ghana is reportedly suffering from malnutrition and mutism as a result of his long incarceration and has been placed into the care of his younger brother. Journalists visiting Menka have indicated that "his beard, mustache and head had not seen razor for several months while his nails have grown long". Authorities have advised Menka's brother (who is also the current Dome chief) to send him to a psychiatric hospital for specialized care.

While an official complaint has been laid against Menka's mother, Akua Bio, with the Offinso police, the Committee of Human Rights and Administrative Justice has yet to launch an investigation. According to family sources, she had Menka imprisoned after he had been cursed by a female trader.

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Keeping Up Appearances

One of the most memorable figures of the eighteenth century must surely be the Chevalier Charles D'Eon(or Chevaliere Charlotte D'Eon as he became more famously known). Born in Tonnerre, France in 1728 to a distinguished family, Charles Geneviève Louis Auguste André Timothée Éon de Beaumont completed his education in 1749 and began a diplomatic career. He also became a spy for King Louis XV and took part in an espionage mission to the Russian court. While dressed as a woman, he became a close associate of the then-Empress. Later, posing as the uncle of the woman he had previously pretended to be, he reportedly convinced the Empress to sign an important treaty with France. After returning from Russia in 1761, he became a military officer and fought in the Seven Years War. When the war ended in 1763, along with a decoration for bravery, he also earned the rank of Chevalier and a position with the French embassy in London. As a favourite of English society, D'Eon was in a good position to remain in England after a quarrel with the new ambassador prevented him from returning to France. He took revenge by writing a best-selling book that scandalized the English and French courts and D'Eon lived in England as an exile for fourteen years. Until the rumours started...

D'Eon's boyish appearance, absence of facial hair, and lack of interest in female companionship led to speculation that he was really a woman. Allegations concering his gender arose in England and in France and became the subject of substantial wagers. It was a trial in 1777 before Lord Mansfield that forced the rumours into the open. The grounds for the trial were straightforward enough: a surgeon named Hayes had made a substantial bet with a broker over whether D'Eon was really a woman. While D'Eon was not directly involved, the humiliation caused by the trial led him to quit England and return to France. King Louis XV had died by this time and his successor, Louis XVI was less kindly disposed towards him. D'Eon was told on arriving in France that the King had issued a decree that he "should resume the dress of his sex"

The Chevalier took the King at his word and, for the rest of his life, dressed and behaved like a proper French lady (in addition to a pension, the King also provided D'Eon with funds for a new wardrobe). He later claimed that he had been born a girl but that his father had raised him as a boy to ensure an inheritance from his in-laws. In 1779, Chevaliere D'Eon (as he was then called), published his (probably ghostwritten) memoirs La Vie Militaire, politique, et privée de Mademoiselle d'Eon. When the American Revolution broke out, D'Eon asked for permission to abandon his female dress and join the military but his offer was rebuffed. D'Eon returned to England in 1785 and stayed in London until his death in 1810. The French Revolution brought an end to the royal pension on which he had been living and he spent the last years of his life supporting himself by participating in fencing demonstrations (until an injury forced an end to his fencing career). His efforts to complete another autobiography never got past the planning stage and he died in poverty. It was only when his body was laid out for burial that (as one contemporary writer described it): "death proved the folly of those who had forced him into petticoats; for his manhood was placed beyond all doubt by an anatomical examination of his body". Even though he had lived with a woman, Mrs. Mary Cole, for the last fifteen years of his life, she had never suspected that he was really a man. He is buried in St. Pancras Cemetery in London where his grave still attracts visitors.

Despite various attempts at attaching a proper diagnostic label to describe the Chevalier's gender-bending life, he continues to defy classification. His case gave rise to an early term for cross-dressing, eonism, although it is has since fallen into disuse. Was D'Eon a transvestite or something more? His absence of facial hair and effeminate features suggest that he may have been a transsexual although there is insufficient information to tell either way. So, much like James Barry with whom he has been often compared, the Chevalier D'Eon remains a mystery long after his death. Perhaps that's the way that he would have wanted it.

Killer of Sportscaster Arrested in Border Incident

A 51-year old former patient, previously convicted for the murder of prominent Ottawa sportscaster, Brian Smith, in 1995 is being held in a Buffalo area jail following an altercation with a Peace Bridge officer on November 30. Jeffrey R. Arenberg of Barrie, Ontario had been attempting to cross the international border as part of a commercial bus filled with Canadian passengers. He had earlier been refused admission on November 5 based on a history of drug convictions. When the officer attempted to search him for weapons, Arenberg allegedly punched the officer in the face. He is scheduled to appear for a detention hearing and has reportedly pled not guilty to the felony charge.

In 1995, Arenberg went to an Ottawa television station and gunned down Brian Smith, a popular broadcaster and former hockey pro who had just finished his 6 p.m. sports show. According to police, Arenberg had killed Smith due to delusions that television stations were broadcasting messages into his head. He was later diagnosed as a paranoid schizophrenic and was found by a judge to be “not criminally responsible” for the death of Smith. He was held in a psychiatric facility unti his release in 2004. The murder shocked Canada and galvanized political support for stronger legislation to commit potentially dangerous psychiatric patients to hospital. The new Ontario legislation, passed in 2000, was named Brian's law in Smith's honour and has served as a model for similar laws across the country.

Arenberg is expected to be held without bail. It is unclear at this point whether his public defender will seek an insanity defence plea.

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Containing Ebola

The Uganda Red Cross Society has sent an assessment team to Bundibugyo District as part of a Ministry of Health initiative to contain the deadly Ebola hemorrhagic disease. Using 100 volunteers who had previously worked to contain Ebola in Gulu district in 2000, the Red Cross project will involve door-to-door sessions to identify suspected cases and report them to the Ministry of Health. The volunteers will also educate the community about the disease and to ensure that suspected cases will be successfully reintegrated into the community and not face the discrimination and stigma that such individuals have faced in the past.

First identified in 1976 following simultaneous outbreaks in Sudan and Zaire, Ebola hemorrhagic disease is transferred through direct human or animal contact. It is classified as a biosafety level 4 infectious agent and a Category A bioterrorism agent. Symptoms vary and can include high fever, severe headaches, muscle pain. No approved vaccine is yet available and treatment primarily focuses on early identification and isolation of suspected cases. In the latest outbreak in Uganda, there have been at least 16 out of a suspected 58 cases. The last major outbreak in the Congo in 1996 killed 245 people.

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