Providentia

Chronic Pain in Elderly Patients

In the November 2007 issue of the International Journal of Geriatric Psychiatry, an article presents the result of a study examining chronic pain in depressed geriatric inpatients.  By examining the medical charts of patients who were admitted to a geriatric psychiatric unit over a two year period, 148 patients with a depressive disorder were identified. Of these depressed patients, 62% of patients were found to reports problems with chronic pain. Further analysis found that depressed older adults with chronic pain were more likely to report suicidal ideation, be diagnosed with personality disorder, have chronic care needs, and experience less total sleep time compared to depressed older adults without chronic pain. The results match those of previous studies identifying chronic pain as a possible suicide risk factor in the elderly, particularly when depression is involved.  : Chronic pain-common in depressed older adults-may influence clinical features of depression and should be assessed as a possible suicide risk factor. Prospective studies should examine causal relationships and determine the effects of adequate pain treatment on depression course and suicide risk in older adults.

Click here for the abstract   

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Stayner Kidnapper Dies in Prison

Kennth Eugene Parnell who became the focus of worldwide attention for the bizarre kidnapping of Stephen Stayner has died in prison at the age of 76.  Parnell kidnapped Stayner in 1972 and kept him a prisoner until Stayner escaped with another kidnapped child in 1980.  The ordeal became the subject of a television movie, "I Know My First Name Is Stephen". Parnell served five years for the double kidnapping before being released on parole. He was later sentenced to an additional sentence in 2004 following an attempted abduction of a child that prosecutors described as the "last hurrah of an aging pedophile".

Stayner died in a motorcycle accident in 1989 at the age of 24. His brother, Cary, is in prison awaiting execution for the murder of four women.

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Marrying Too Young

Those of you who have seen UNICEF's picture of the year will remember the expression of fear on 11-year old Ghulam's face as she gazes at her 40-year old fiance, Mohammad. The practice of child marriage continues unabated in various parts of the world including Afghanistan, Egypt, Ethiopia, Nigeria, Pakistan, India and the Middle East. The girls (often as young as 11 and sometimes even younger) are routinely married off as part of "arrangements" made by their family and usually without their consent. Unwanted girl children are often treated as second-class citizens and are denied access to basic education or even information concerning contraception. Despite being illegal in many countries, secret illegal weddings continue and have even been carried out in Western countries. In addition to issues of basic human rights such as forced sex, child brides face horrendous medical risks including increased risk of death from childbirth (early pregnancy is a leading cause of death for girls between the age of 15 to 19 in developing countries), anal and vaginal fistulas, domestic abuse, chronic anemia and obesity. The psychological trauma associated with these forced marriages can impact on their self-esteem and contribute to a pattern of lifelong poverty and early death.   

Despite ongoing education programs to warn of the dangers of child marriage, the practice is proving notoriously difficult to root out. For too many girls like Ghulam, it may already be too late.

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What Causes Schizophrenia?

Given that stigma surrounding mental illness is largely shaped by popular assumptions about how mental illness is caused and treated, there is surprisingly little research investigating those assumptions in the general population. A paper presented in the January 2008 issue of Comprehensive Psychiatry shows the results of a preliminary study examining the most commonly reported causes of schizophrenia in a sample of 127 urban African Americans. The study participants were asked to endorse items from a list of 30 factors, some of which are congruent with current psychiatric views of schizophrenia, whereas others are not. The results tended to complement previous research in finding that the five most commonly reported causes were: disturbance of brain biochemistry (49.6%), drug/alcohol abuse (42.5%), hereditary factors (40.9%), brain injury (40.2%), and avoidance of problems in life. Approximately 47.9% of the participants endorsed one or more unorthodox or supernatural factors as a cause with possession by evil spirits (28.3%), radiation (20.2%), and punishment by God (19.7%) being the most common. Unorthodox causes of mental illness were more commonly chosen by male participants, those with 12 years of education or less, and participants who reported never having known someone with schizophrenia. The researchers recommend that further research by carried out to provide a better understanding about how unconventional beliefs about the causes of mental illness affect attitudes towards the mentally ill and acceptance of the need for mental health treatment. There is also a strong need for improved education to counter discredited beliefs that re-stigmatize the mentally ill.

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Sick Doris

Long before Sybil and the Three Faces of Eve, there was Doris Fischer and her case is still considered a classic (although little-known these days). It was in 1910 when she first came to the attention of Walter Franklin Prince, then-rector at an Episcopal church in Pittsburgh, Pennsylvania. Prince, who was born in 1863, received degrees in theology at Yale and Drew Theological Seminary. He would go on to become a prominent psychic researcher and psychotherapist but it was the Doris Fischer case for which he was best known. When he met the twenty-one year old "Doris Fischer" in his congregation, she appeared to be an extremely unhappy and lonely individual who was prone to odd mood and behaviour shifts. She also seemed to experience bouts of amnesia in which she would forget what she had previously said or done.

While Prince initially diagnosed her as suffering from hysteria (a common diagnosis for women patients of the time), he carefully studied her and concluded that she matched the clinical description of what was then known as "multiple personality". Over the years in which Prince followed the case, he came to identify at least five different personalities including "Margaret"- a child of about ten, "Sick Doris" who was a perpetual invalid, "Real Doris" whom Prince regarded as the core personality, "Sleeping Real Doris" and "Sleeping Margaret" who only seemed to emerge when Doris was in a hypnotic state. It was "Sleeping Margaret" who seemed to have the best insight into how Doris' different personalities worked together and often helped Prince as he attempted to get to know each personality individually.

Through sessions with "Sleeping Margaret", Prince was able to piece together some of Doris' background. She was born in 1889 of German parents and her father was an alcoholic who frequently abused her. The possibility of sexual abuse was never raised (it was a taboo topic at the time) although it was never ruled out either. It was apparently in her early childhood that "Margaret" first emerged as a defense against the abuse and alternated with "Real Doris". The third personality "Sick Doris" emerged after her mother's death when she was sixteen years old. She reported a total amnesia surrounding the five-year period between her mother's death and when she first began attending Prince's church. "Sleeping Margaret" only emerged once Prince began treating Doris.

Gaining access to Doris became much easier after Prince and his wife formally adopted her as their daughter (not the usual clinical approach, I'll admit). He published a massive 1300-page treatise on his prize patient in 1915 (he named her "Doris Fischer" in his publications although her real name after the adoption was Theodosia Prince). Prince would later publish another thousand-page treatise on the psychic experiments that he did with "Doris" (I mentioned that he was a psychic researcher) making this case the most well-documented example of multiple personality disorder on record. Over the years that he worked with Doris, Prince was able to reintegrate all of her personalities into "Real Doris" (although "Sleeping Margaret" still resurfaced at times whenever Doris/Theodosia was in hypnosis).

Multiple personality disorder (now known as Dissociative Identity Disorder) remains a controversial diagnosis, not to mention fairly rare these days. In my twenty years as a clinical psychologist dealing with trauma in various forms, I have never run across a case of it and there some researchers who are of the opinion that many reported cases are iatrogenic in nature. In the Doris Fischer case, there was a considerable blurring of the relationship between Doris and her therapist. Not only did she become Prince's adoptive daughter but she was also his prize patient (he often introduced visiting clinicians to "Sleeping Margaret") and test subject in different psychic experiments. A later clinician would report that "Doris' love for her adopted father was no ordinary love. She loved him not merely as a devoted daughter, she adored him almost as her God, in that he had saved her from hell and had, one might almost say, given her a soul". Did Prince's expectations impose demand characteristics that shaped his adopted daughter's reported symptoms? Given the current controversy over recovered memory and the potential impact of directed psychotherapy on suggestible subjects, the possibility seems all too real. Information concerning Doris/Theodosia's later life tends to be scarce although she experienced a relapse following Prince's death in 1934. Aside from the clinical report of the treatment that she received at that time, there seems to be nothing else available (if anyone has more information please let me know).

Providentia- Year 1

This post marks the one year anniversary of this crazy blog that I started on January 17, 2007. I have completed more than 200 posts, had 80 comments, and 16 trackbacks. Since my first post, I have had 11,613 visits to my site and visitors have come from every continent on Earth (except Antarctica- are there no web providers down there?). I have been contacted by various memorable people and I'd like to think that I have had some impact. I have yet to break into the Technorati 100,000 but that may change in time. My site usage stats appear respectable and there does seem to be decent penetration but my bounce rate.., er, not that I spend a lot of time checking my stats (that would be silly).

This blog began as just a hobby for me and that isn't like to change for the forseeable future. I enjoy having a forum that I can use to rant about things that matter to me and just to pass on the interesting tidbits that I have learned. If there are those who feel a little bored by the historical posts that I keep cranking out, all that I can say is that there are episodes from history that shouldn't be forgotten. Not without running the risk of having history repeat itself, anyway.

So, happy anniversary to me and I hope there will be many others. Feel free to drop me a comment sometime (especially if you're in Antarctica).

Are Compulsive Buyers Also Compulsive Hoarders?

A paper presented in the November 2007 issue of Behavior Research and Therapy follows up on previous research that has indicated that compulsive buyers often suffer from compulsive hoarding as well. The researchers examined 66 treatment-seeking compulsive buyers prior to their entry into a group therapy program for compulsive buying. The study participants were tested using selected measures of compulsive buying and related clinical scales and were included in the study based on the proposed diagnostic criteria for compulsive buying by McElroy, Keck, Pope, Smith, and Strakowski [(1994). Compulsive buying: A report of 20 cases. Journal of Clinical Psychiatry, 55, 242-248]. The study results supported previous evidence concerning the link between compulsive buying and compulsive hoarding. Specific factors linked to hoarding included clutter, difficulty discarding and obsessive-compulsive symptoms. Hoarding compulsive buyers also reported more severe buying symptoms and obsessive-compulsive symptoms and presented with a higher psychiatric co-morbidity, especially in terms of depression, anxiety and eating disorders. Suggestions for identification and treatment for compulsive buyers who also report compulsive hoarding are given.

Click here for the abstract

Hunting Vampires

Even today, tuberculosis remains a fearsome disease with an uncertain outcome. How much more frightening must it have seemed in 1892 after an epidemic of tuberculosis struck the Rhode Island town of Exeter? Despite the fact that the deaths were limited to a single family, the possibility of it spreading seemed very real to the people of the region. Following the deaths of Mary Eliza Brown and her daughter, Mary Olive in 1883, the two surviving children seemed to be spared for a time. When Mercy Lena Brown suddenly died in January, 1892 and her brother Edwin began to sicken as well, the patriarch of the family, George T. Brown, became desperate for any solution to save his only surviving child. True treatment for tuberculosis would not be available for decades and all that he had to rely upon were the folk remedies that his neighbours suggested.  History does not record who first proposed exhuming the deceased members of the family and burning the heart of the relative that seemed most likely to be responsible for the deaths. The word "vampire" was never actually used in this case but the rural residents of the area had a longstanding tradition of burning the heart of those deemed to have died an "unnatural" death to cure unexplained illness. Since Mercy Brown was only recently deceased and her body was still well-preserved by the cold weather, she was judged to be the guilty party by virtue of the liquid blood that was still in her heart. Although the medical examiner in attendance, Dr. Harold Metcalf, insisted that there was nothing remarkable about Mercy's condition, her heart was removed and burned on a nearby rock. The ashes were then saved and placed in water for her brother Edwin to drink (his reaction to this "remedy" is not recorded). Sadly, Edwin still died some time later although the epidemic ended with him. Local tradition still holds that Mercy's exhumation and the disposal of her heart still "took care of the problem" and laid her spirit to rest.

Folklore surrounding vampires varies from region to region but there are still some common elements to be found in many cultures. While legends of undead creatures that feed on the living seem fantastic by modern standards, hysteria surrounding supposed vampire attacks can still occur today. The report of a vampire which was said to haunt London's Highgate Cemetery in the early 1970s seemed to be more of a media phenomenon than anything else (there were certainly no actual casualties). Occult circles still milk the legend for everything it is worth, though.  A more serious case involving anti-vampire hysteria occurred in 2002 when a number of villagers living in southern Malawi claimed to have been attacked for their blood. The resulting panic led to two men being stoned to death on suspicion of being vampires. Elements of the vampire rumour suggested that foreign aid agencies were aiding the vampires and three Catholic priests were attacked by vigilantes due to the resulting xenophobia. The Malawian government was accused of supplying blood to foreign aid agencies in exchange for food aid and one senior government official was seriously injured after being stoned by an angry mob. Much as in other cases of mass panic, it took an aggressive government media campaign coupled with arrests of "irresponsible parties" caught spreading rumours to quell the mobs and return life to normal.

Will we see other examples of vampire hysteria in future? Well, it was only last year when self-styled "vampire hunters" broke into Slobodan Milosevic's tomb and drove a stake through his heart to stop him from "returning from the dead". While the Serbian police regard the incident as being politically motivated, the legend of the vampire seems unlikely to die an easy death.

Losing Sleep

A paper presented In the February 2008 issue of Clinics in Geriatric Medicine discusses the increasing incidence of sleep disorders as people grow older. In addition to different physiologic changes that occur with aging, sleep patterns are also altered. Elderly patients frequently complain of inability to get to sleep, shorter sleep times, and general disruption of circadian patterns that impact on well being. Many common chronic conditions, such as chronic obstructive pulmonary disease, diabetes, dementia, chronic pain, and cancer, which are more common in the elderly, can also have significant effects on sleep and increase the likelihood of insomnia. This is a result not only of the chronic medical illnesses themselves, but of the psychological factors associated with the disease processes. Treatment professionals who deal with elderly patients need to be aware of the problems resulting from poor sleep and how these problems can aggravate other chronic health problems.

Click here for the abstract

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Unlawfully At Large

After William Enman escaped from the New Jersey psychiatric hospital where he had been serving his sentence, he sent a letter to the governor and hospital CEO protesting that he had earned the right to sign himself out. The 64-year old patient has been serving a sentence for a brutal double-murder hat he had committed in 1974. Although diagnosed as schizophrenic, he has consistently denied the diagnosis and refused to comply with psychiatric treatment. Enman's September 9, 2007 escape from Ancora Psychiatric Hospital sparked a nation-wide manhunt although he was recaptured without incident 48 hours later. After his rearrest, he stated that he had escaped the hospital to "clear my mind" and that he needed to "get away" from his drug problem. In his letter, he stated that he had "maxed out" the time that he had spent in hospital and was entitled to leave.

In the decades since he was first imprisoned for the brutal bludgeoning deaths of a man and his young son, Enman has committed numerous infractions including having contraband weapons being found in his cell and placing his hands around the throat of his then-wife in 2003. He has been non compliant with medication since receiving a 1991 court order to prevent forced medication. His treating psychiatrist, Dr. Elizabeth Burns, has stressed that Enman remains mentally ill and must remain in hospital.

The escape has spurred the New Jersey Human Resources Commissioner to launch a review of all security procedures for state hospitals. Escape charges are still pending but Enman has lost all earned privileges and will be held in close confinement for the indeterminate future. This is his third hospital escape attempt.

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