Providentia

Homelessness, Mental Illness and Criminal Activity

A study in the December 2008 issue of the American Journal of Community Psychology examined whether street homelessness, sheltered homelessness, and the severity of psychological symptoms predicted non-violent and violent crime among 207 mentally ill participants who were homeless at baseline. Participants were interviewed at 9 time points over 4 years. Statistical modeling  was used to examine whether changes in homelessness status and symptom severity predicted changes in criminal activity over time. Results indicated that homelessness both on the streets and in shelters and psychological symptom severity predicted increases in non-violent crime. Sheltered homelessness and symptom severity predicted increases in violent crime, although street homelessness did not. A separate analysis with 181 participants showed that the relationship between diagnosis of a psychotic disorder and both non-violent and violent criminal activity was partially mediated through the severity of psychotic symptoms. Implications for research and intervention are discussed.

Click here for the abstract.

Inquest Concluded in Chainsaw Suicide

A recent inquest in southern England has concluded that a British man committed suicide by cutting off his own head with a chainsaw. 50-year old David Phyall was apparently "irrationally opposed" to leaving his home, which had been repossessed, Deputy Coroner Simon Burge said at Winchester Coroner's Court in southern England. He added that "In the 15 years I have been sitting as a deputy coroner, this is the most bizarre case I can recall." Phyall, who had been intoxicated at the time, apparently tied the chainsaw to the leg of a snooker table with a string, covered the "on" button with tape, and plugged it into a timer normally used to turn lights on and off. He then lay down under the table face up and placed the tool against his neck. The chainsaw sliced three-quarters through his neck, only stopping because his t-shirt became caught in the blades. Police were called to his apartment on July 5 when his parents were unable to contact him. The police told the parents to stay the property when they broke in. They found the walls and floor covered in blood, with Phyall's partially decapitated body in the lounge. Phyall - who had a history of mental illness and suicide attempts - had been agitated over the loss of his home as the apartment block where he was living was set to be demolished. Despite various efforts from the local housing authority, he had refused several offers to be relocated and a court eventually repossessed his apartment.

Click here for more information

AIDS in South Africa

While statistics remain hard to collect, current estimates place the number of people living with AIDS in South Africa at 5.7 million people (out of a population of 47.9 million) with nearly a thousand AIDS deaths occurring daily.  Various reasons have been blamed for the skyrocketing number of AIDS cases including government inaction, cultural beliefs concerning AIDS prevention, and scarcity of anti-retroviral medication.

When the first AIDS cases were identified in South Africa in the 1980s, the apartheid government of the time was slow to launch prevention and treatment programs. Even when these programs were finally established across the country, there was fierce opposition by anti-apartheid activists who viewed them as an attempt to control population growth (a popular parody of the time labeled AIDS as "Afrikaner Invention to Deprive us of Sex"). Some critics even found it easier to blame the rising number of cases on witchcraft.

By the time Nelson Mandela became President of South Africa in 1994, the AIDS rate had climbed to 2.2 percent of the population. The new government declared AIDS as a high-priority issue and the National AIDS Convention of South Africa (NACOSA) was formed to combat the crisis. As new cases arose, critics dismissed the NACOSA plan as being poorly organized and underfunded. In one controversial move, then-health minister Nkosana Dlamini-Zuma announced in 1998 that azidothymidine (AZT) would not be made available due to costs involved despite the proven value of the drug in reducing HIV transmission from pregnant mothers to their infants. When Nelson Mandela stepped down in 1999, official estimates of AIDS cases were estimated at 4 million people (10 per cent of the population) with 500 thousand AIDS deaths to date.

As Thabo Mbeki succeeded Nelson Mandela, he also took the country's AIDS strategy in an unexpected direction. While maverick AIDS researchers had always maintained that HIV was unrelated to AIDS, their views were held in low esteem by more mainstream researchers. President Mbeki, along with his health minister, Manto Tshabalala-Msimang, embraced the contrarian views and accused large pharmaceutical companies of falsifying evidence to sell anti-retroviral medications to Third World countries.

Mbeki established a "Presidential International Panel of Scientists on HIV/AIDS in Africa" in 2000 and invited numerous well-known dissident researchers to present their findings. While national and international agencies protested this decision, Mbeki and his supporters insisted that the dissidents were victims of scientific persecution.Anti-AIDS activists who pushed for anti-retroviral medication distribution in hospitals were accused of "poisoning black people". Mbeki dismissed the medications as "dangerous and toxic" and compared them to the "biological warfare of the apartheid era". He also insisted that AIDS was part of a CIA plot to unseat him.

His health minister, Manto Tshabalala-Msimang, was an long-time political crony who added to the outrage by urging the use of "natural" remedies for the treatment of AIDS without any evidence that they were effective.; Her emphasis on the use of fruits and vegetables such as beetroot, lemon and garlic as AIDS remedies made her the target of international scorn. Critics also found ammunition in her links vitamin entrepreneurs such as Matthias Rath who pushed "natural" remedies in lieu of convention medications.

Since South Africa was hosting an international AIDS conference in July 2000, the confusion took on worldwide significance. Before the conference, a declaration stating that HIV caused AIDS was issued with signatures by 5000 scientists (including Nobel prize winners and prominent researchers). Tshabalala-Msimang dismissed the declaration as an "elitist document" and that it would "find its place in the dustbins of the office" if presented to the South African government.

By 2001, health department surveys showed that up to 25 per cent of women receiving support from public birth clinics were HIV-positive and AIDS had become the leading cause of death in South Africa. The Medical Research Council issued a warning that AIDS would kill 5 to 7 million South Africans by 2010 if the disease was left unchecked. Finally, in that same year, an anti-AIDS organization took the government to court to force nevirapine distribution to pregnant women. Despite a lengthy battle, the South African Supreme Court ruled against the government in 2002 and ordered the medication to be provided in public hospitals free of charge "without delay".

The decision represented a major turning point for Mbeki and his government although the delays in implementing an AIDS drug programme would drag on for years. Only with the replacement of Thabo Mbeki as president in September 2008 by interim president Kgalema Motlanthe would real change begin. The appointment of Barbara Hogan as the new Health minister has left AIDS activists and government critics cautiously optimistic; especially since she has already announced that AIDS would be a top priority.

Despite Hogan's determination, the immensity of the task of reshaping government policy to deal with the pandemic is all too apparent. Anti-retroviral medications are only available in urban areas and are impossible to obtain in the rural townships. The financial burden on government agencies is aggravated by World Trade Organization drug patent rules limiting import of low-cost patented drugs to Third World Countries. While Canada and other countries have enacted trade agreements designed to overcome the import barriers, little progress has been made.

And the deaths are continuing.  Despite a renewed push towards AIDS prevention programs (including sex education) and innovative new strategies in the fight against AIDS, the death toll is likely to rise in the years to come.

Disclosing HIV Status During Pregnancy

HIV-positive pregnant women often do not disclose their infected to partners, family or friends, creating potential barriers to preventing sexual transmission to partners and mother-to-child transmission through breastfeeding. A study published in the October 2008 issue of AIDS Care examines recently diagnosed HIV-positive pregnant women and their reasons for disclosure and non-disclosure of seropositive status to various members of their social networks, as well as the consequences of their disclosure. Using a semi-structured interview format,  293 recently diagnosed HIV-positive pregnant women were recruited from pregnancy clinics in two townships in Tshwane, South Africa. A content analysis of responses showed that women weighed fear of abandonment and discrimination against their desire to raise risk awareness and their need for support. Partners most often responded to disclosure with disbelief and shock, whereas parents frequently exhibited emotional distress, but were still supportive, as were other relatives and friends. The women subsequently experienced low levels of adverse consequences after disclosure. The results can assist healthcare providers in understanding the complexity of pregnant women's decisions to disclose to various members of their social networks and emphasize the need for continued counseling and support.

Click here for the abstract.

Arresting Mental Ill Suspects

When police went to arrest Christopher Paul Klim at his Vernon, British Columbia apartment, they found him holding a knife in his hand. Klim, a 24-year diagnosed schizophrenic, was shot with a Taser when he refused to put down the knife. After the Taser failed to subdue him, police then shot Klim twice as he lunged towards them with the knife.  He died of his injuries later that day in Vernon's Jubilee Hospital.

Police testifying at an inquest into the December 27, 2007 shooting reported that they had been called to Klim's apartment after being told that he was cutting himself and was suicidal. Klim had a history of noncompliance with psychiatric medication and previous suicide attempts. After obtaining a mental health warrant, police entered the apartment with the help of fellow tenants. They described Klim as being highly agitated and refusing to go to hospital.

The inquest concluded Friday with the coroner's jury making seven recommendations to prevent further arrest-related deaths for psychiatric patients. These recommendations include the development of a provincial policy on the apprehension of mental patients, full disclosure of mental health history to arresting officers (including likely response to authority), and improved police training in managing mental patients.

Click here for more information.

Substance Abuse and Homelessness

In the September 2008 issue oF Psychology of Addictive Behaviors, the study examining psychological and environmental factors affecting substance abuse in a sample of homeless adults is presented. The researchers assessed 664 homeless adults in terms of (a) self-esteem, social support networks, coping strategies, and emotional distress, (b) history of life on the street, and (c) substance abuse history including alcohol use and drug use (including injection drug use (IDU) and non-IDU). The results showed that lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and increased alcohol use. Quality of social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also assisting homeless clients in finding permanent housing.

Click here for the abstract.

South Africa Today

I just completed an extremely long flight from South Africa to Toronto (15 hours plus) and jet lag has delayed this post a bit.

What can I say about a country that is a mass of contradictions? With 11 official languages, almost 50 million people, and a land mass greater than France, Italy and Germany combined, South Africa remains the economic powerhouse of the African continent. Despite a strong infrastructure and a commodity-rich economy, poverty and unemployment are still endemic. As one delightful professor explained to our intrepid group, economic disparity and the legacy of a horrendously racist system of government still overshadows South Africa's future. Add in the health problems associated with AIDS (South Africa has one of the highest number of cases in the world) and refugees from neighbouring countries and the challenges definitely pile up.

Our high-powered group of 16 psychologists (and guests) managed to visit Johannesburg, Capetown, and parts in between and sampled much of what this beautiful country has to offer. You can check out my pictures online to get an idea of what we managed to see in our brief time there. Along with seeing the country, we were also able to talk with representatives from South Africa's primary universities, psychology organizations, and health care facilities. I'll include a link to the proceedings from the delegation when they become available.

When I have more time, I'll write some posts over the next few weeks on specific issues facing psychology in South Africa as well as some fascinating stories that I heard.

Keep reading.

What Is A Pedophile?

It was in 2000 when a pediatrician living in the Welsh village of St. Brides was targeted by a group of vigilantes who vandalized the house that she shared with her brother. Dr. Yvette Cloete was alarmed to find that the word "paedo" had been crudely scrawled across her front porch and door. After reporting the incident to the police and cleaning off the graffiti, she moved out of the area. As she later stated, "when something like this happens, you just cannot feel safe in your own home". Police linked the vandalism to a wave of anti-pedophilia protests that had swept the United Kingdom following a tabloid campaign directed against "paedophiles". The protestors had apparently confused the words paediatrician and paedophile and attacked Dr. Cloete's home as a result. The same anti-pedophilia campaign also resulted in numerous families being driven from their homes after being accused of harbouring sex offenders. The "naming and shaming" campaign that sparked the violence, published in the U.K. tabloid News of the World, also called on the British government to allow people full disclosure concerning the identities and addresses of known pedophiles in their area. Although the furour died down eventually, anti-pedophile hysteria goes on.

The word, pedophile (also spelled paedophile), frequently generates panic and outrage but the actual meaning of the term is often misunderstood. While commonly considered to be a synonym for "child molester", clinicians tend to be more specific concerning how the term is used. The diagnostic criteria for pedophila have remained fairly stable over time since it was first included in the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). According to the latest revision (DSM-IV-TR), a diagnosis of pedophilia must meet the following conditions: a) recurrent intense sexually arousing fantasies, urges or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger) over a period of at least six months, b) the person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty, and c) the person is at least age 16 years and at least 5 years older than the child or children in Criterion A. The diagnosis can be further sub-classified depending on whether the pedophile is primarily attracted to children (few, if any, age-appropriate sexual relationships) as well as whether the attraction is homosexual, heterosexual or bisexual (this distinction remains controversial).

Based on the DSM-IV criteria, not all offenders convicted of molesting children can be considered pedophiles (although some researchers have suggested otherwise). The majority of sexual offenses against children (including incest cases) involve adults with age-appropriate sexual preferences using children as sexual surrogates. Although there is little actual difference to the victims, the question of whether or not the offender is a pedophile becomes crucially important in determining risk of reoffending and treatment needs.

Richard von Krafft-Ebbing first coined the term paedophilia erotica in his 1886 work, Psychopathia Sexualis, although he regarded it as being extremely rare. Of the hundreds of case histories that he discussed in his work, only one actually dealt with a case of pedophilia. Other early sexual pioneers including Havelock Ellis and Magnus Hirschfeld touched on pedophilia briefly but the term did not appear much in the clinical literature prior to 1950. A related term, hebephilia (also spelled ephebophilia) was first coined by Hirschfeld to refer to a sexual attraction toward children at or above the age of puberty. Hebephilia is not included in the DSM as a formal diagnosis (its diagnosis is usually covered under the catch-all DSM category of paraphilias not otherwise specified). Despite attempts by researchers to include hebephilia as a distinct diagnosis in future versions of the DSM, current treatment models tend to follow those used for pedophilia.

While the ideal of child sexuality is typically viewed with repugnance, the definition of "child" and appropriate age of sexual consent has varied widely across cultures and time. Female children (often as young as 10 or 11) are frequently given in marriage to older men in spite of attempts to stamp out the practice. Until the 20th century, legislation in Western cultures established legal age of consent for females to be as young as 10 in some jurisdictions (current age of consent varies from 14 to 18 depending on local legislation). Age of sexual consent for male children remains controversial and until relatively recently, any sexual offense involving male children was prosecuted under anti-homosexual statutes (and still is in some countries both for offenders and victims).

Research into the actual incidence of pedophilia and hebephilia in the general population has yielded widely varying estimates depending on definition and methodology. In their 1993 nationwide survey on sexual practices, Janus and Janus found that 2 per cent of sampled males reported having had sex with a child (0 per cent for female respondents). A 1989 study of undergraduate males reported that 21 per cent of the sample acknowledged sexual attraction to some small children although concerns about methodology limits how these results can be interpreted.

Despite the highly-publicized existence of organization such as the North American Man/Boy Love Association (which seems to be defunct at present), rumours of pedophile rings that routinely abduct and abuse children have rarely been proven true. Moral panic over child sexual abuse (typically associated with satanic ritual abuse) has inspired horrendous examples of false accusation and persecution. The McMartin Preschool case and the Wenatchee Sex Ring, among other cases, have led to the forming of support organizations for victims of false abuse accusations. Known or suspected pedophiles have been frequently targeted by vigilantes who consider their actions justified.

Anti-pedophile hysteria remains the greatest barrier towards successfully reintegrating convicted sex offenders into society. The existence of publicly accessible sex offender registries in many jurisdictions has spurred neighbourhood activist campaigns designed to drive real or suspected pedophiles away from their homes (and the treatment programs that might have helped prevent reoffending). The counterproductive nature of these campaigns is doubly tragic: not only is the risk to children in other neighbourhoods increased, but parents who obsess over pedophiles are often caught off guard when their children report being abused by "safe" adults who were considered trustworthy.

Staying vigilant is the only real protection for children.

PTSD in Earthquake Victims

While various studies have examined rates of post-traumatic stress disorder (PTSD) following natural disasters including earthquakes, samples were often non-representative or small or both. A study published in the October issue of Social Psychiatry and Psychiatric Epidemiology provides a comprehensive look at the prevalence of PTSD and predictors of PTSD 6 months after an earthquake in a rural region of Italy. Using questionnaires, approximately 3,000 people were assessed in the region of Molise in Italy 6 months after an earthquake in October/November 2002. The questionnaire assessed socio-demographic characteristics, aspects of the event, the experience of symptoms immediately after the earthquake, and symptoms of PTSD. The results were based on the 2,148 questionnaires that were returned (a response rate of 73.7%). The results from the final analysis1,680 people showed a PTSD prevalence rate of 14.5%. Socio-demographic factors such as male gender, age under 55 years, and better school education predicted lower rates of PTSD but psychological symptoms experienced immediately after the event were also strong predictors. The researchers concluded that findings on predictive variables are consistent with the literature. Although personal characteristics explain only a small part of  PTSD varianc esix months after the event, early psychological distress allows a better prediction of who is likely to have PTSD 6 months later.

Click here for the abstract.

Still In South Africa

I haven't had a lot of time for posting since I'm tied up in meetings and events all day long. I'm posting this from Johannesburg and we're leaving for Cape Town tomorrow. We've had a fascinating look at the tremendous social changes in this country as well as the problems that still need to be resolved. If I have time, I'll provide more detail. Otherwise, it'll have to wait until I get back to Canada next week.

Either way, sizobonana (see you later)