Providentia

Chronic Pain and Traumatic Brain Injury

Chronic pain conditions are common sequelae of traumatic brain injury (TBI). Unfortunately, the incidence of TBI among personnel deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) is significant, and there is growing evidence that ongoing pain, particularly headaches, will be a primary concern for these individuals. In a recent paper published in Rehabilitation Psychology, the authors examined empirical data from civilian and veteran populations and clinical experience with OEF/OIF personnel with multiple traumas to provide recommendations for the assessment and treatment of chronic pain among those with TBI. The available data signal the need for the incorporation of early and aggressive pain management strategies into existing treatment models. Challenges to providing effective pain management for OEF/OIF veterans are numerous and include comorbid cognitive, medical, and emotional impairments that complicate readjustment to civilian life. It is likely that the problem of polytrauma pain and associated comorbid conditions such as posttraumatic stress disorder and postconcussive syndrome will require the development of integrated approaches to clinical care which bridge traditional subspecialty divisions.

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Dealing with Animal Hoarders

As part of a new initiative to cope with the problems associated with animal hoarding, a workshop sponsored by the Central Arizona Animal Cruelty Task Force will be held in Casa Grande to provide a public forum to address the complex mental health and animal welfare issues involved. The workshop is intended to provide an overview of the problem of animal hoarding on a national basis and will include mental health professionals and representatives from animal welfare agencies. The workshop arose following a recent case in a nearby town where 185 animals were forcibly removed from a home and the owners were subsequently charged with neglect.

Defined as having a higher than usual number of pets without the resources to care for them, animal hoarding is a growing problem in many jurisdictions in the United States, Canada, and Europe. Animal hoarders begin taking in pets with good intentions, but develop an inability to recognize that their pets are being neglected. Linked to compulsive hoarding disorders such as Diogenes Syndrome and Obsessive-Compulsive Disorder, animal hoarding has also been associated with certain forms of dementia and delusional disorder.  In addition to problems with neglect and malnutrition, animal hoarding has led to significant health risk for humans including sanitation concerns (including the spread of parasites and dangerous ammonia levels), possible epidemics of animal-borne diseases such as toxoplasmosis, rabies, and bubonic plague, and the potential link between animal hoarding and other forms of abuse (i.e, child and elder abuse).

While most jurisdictions have no clear legal definition of animal hoarding, humane societies and animal welfare agencies across North America and Europe have organized "Hoarding Prevention Teams" to work with hoarders to deal with their pets. Stronger legislation is also being proposed in many jurisdictions to help control animal hoarding.

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Saving Civilization (Part 3)

Continued from Part Two

With the outbreak of the war, Lothrop Stoddard began working as a foreign correspondent in Nazi Germany. Although he was definitely not a Nazi supporter, his racist credentials helped him to get interviews with Adolf Hitler and Joseph Goebbels which were later published in Time magazine.Through his newspaper articles and a book that he released in 1940, Stoddard tried his best to distance himself from the Nazis. The Holocaust still lay in the future but news reports about Aktion T4 and similar excesses placed him in an awkward position. In trying to defend his own ideas while denouncing the Nazis for pursuing similar goals, all that he could say was that, while the Nazi ideals were justified, their methods were too severe.

By the end of World War II, the rest of the world was stunned to discover just how far the Nazis had been willing to go to support their ideology. Revelations surrounding Aktion T4, the Holocaust, and the vicious persecution directed against Jews, Roma, and other racial groups in the name of racial purity robbed the eugenics movement of what little support it had. It probably didn't help that testimony from the Nuremberg War trials showed the powerful influence of Madison Grant and Lothrop Stoddard on the early Nazi movement. During his trial, Karl Brandt particularly cited American racist theorists as an inspiration for the Nazi euthanasia program and as proof that the Nazis were hardly unique in their beliefs. Brandt's defense wasn't very effective (he was executed) but the Nazi connection conferred a stigma on the eugenics movement that it never lost.

Lothrop Stoddard's popularity didn't survive the Nazi association. By the time of his death in 1950, he was largely forgotten. Oher eugenicists managed to adapt to the new era by changing their message to escape Stoddard's fate. While never really abandoning his eugenicist leanings, Paul Popenue is largely remembered today as the father of marriage counseling. His warnings about the decline of masculinity and the need to assert traditional roles in marriage are still quoted in conservative circles though. Despite die-hards like Carleton Coon, the use of racial theories in social sciences were largely abandoned (with some high-profile exceptions). Most of the researchers who had been known for racial studies in previous decades either retired or shifted to other fields of research entirely. Advocates of hereditarian theories of human intelligence still managed to carve out a niche for themselves (controversies notwithstanding).;

That's not to say that the laws that the eugenicists and scientific racists  helped foster weren't still in place, though. The last of the anti-miscegenation laws in the United States weren't repealed until 1967 following the Loving v. Virginia Supreme Court ruling (South Carolina and Alabama didn't formally remove anti-miscegenation language from their constitutions until much later). Involuntary sterilization laws remained in force for numerous countries around the world including Sweden, Japan,Switzerland, India, and many Warsaw Pact nations. While the eugenics argument had been discredited, other rationalizations for sterilization were typically adopted (which usually focused on "protecting" patients regarded as mentally disabled). In the U.S., involuntary sterilization continued in some states until the 1980s while in Canada, cases of sterilization continued as recently as 1972. Despite a few high profile compensation cases, the identity of most involuntarily sterilized patients remains unknown.

While the eugenics movement (and scientific racism in general) seem unlikely to regain its former popularity, the debate surrounding the role of heredity and environmental factors in human traits seems unlikely to go away. Controversies have a way of springing up as new books are released for popular consumption. There are also organizations such as the Pioneer Fund that continue to support research into racial differences in intelligence despite widespread condemnation by mainstream scientists. The complex ethical issues surrounding eugenics may well become more heated as genetic screening techniques become more widely available and key markers for "undesirable" traits are identified. Only time can tell what new controversies genetic engineering will bring in future.

As a postscript to this series, there have been a number of articles of late that have attempted to invoke the specter of eugenics and Nazism in discrediting Charles Darwin and the theory of evolution. The crux of the argument seems to be that Darwin's theory had a heavy influence on Nazi philosophy and can thus be held responsible for the Holocaust and other Nazi crimes. Whatever role that biologists played in the early eugenics movement, it's hard to dismiss the fact that scientists were also the most vocal critics of the eugenics movement from the very beginning. In the meantime, even church leaders in some countries supported various eugenics policies over the years. There is enough blame to go around for every political or ideological group and nobody has a valid reason to be smug.

Responding to Medication and Therapy in Depression

A study reported in the August 2009 issue of Journal of Consulting and Clinical Psychology examined the relative success rates for medication and cognitive therapy in depression. Previous research has shown the two treatments to be roughly equivalent in alleviating chronic depression although evidence suggests that patient factors may affect relative treatment success. A randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In the study, the authors attempted to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks in both groups. Factors such as chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three patient variables—being married, unemployment, and having experienced a greater number of recent life events—were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Overall, six 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 client variables identify groups who appear to respond particularly well to cognitive therapy. The authors suggest that there are different mechanisms at work in both treatment modalities which can interact with client factors to affect outcome.

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Gunman Howard Unruh dies at 88

It has been six decades since Howard Unruh's shocking mass murder but surviving family members of his victims still remember the terror of that day on September 6, 1949 when Unruh's rampage claimed thirteen lives.  Many of those family members expressed satisfaction on learning that the 88-year old Unruh died yesterday at a Trenton N.J. nursing home following a long illness.  Diagnosed as a paranoid schizophrenic and confined to the New Jersey Hospital for the Insane (later the Trenton Psychiatric Hospital)  after the rampage, Howard Unruh had been a model patient who lived for decades without incident.

Howard Unruh had been a returning veteran of World War Two who had become alienated in his civilian life in Camden, New Jersey.  Deeply affected by his wartime experiences, he lived in an apartment building with his mother.  Despite being a war hero, he remained unemployed and seemed to have little to do with his time except look at the medals and other war memorabilia decorating his bedroom walls and care for his considerable collection of firearms. He also maintained a target range that he set up in the basement of his apartment building which didn't prevent him from getting into trouble with his neighbours.The spectacle of a grown man being financially supported by his mother who worked at a local factory made him the target of considerable teasing as a "mama's boy".  In his diaries, he kept careful note of every personal grievance (real or imagined). When the diaries were later examined, it was found that he had written the word "retal" (short for retaliate) next to the name of every neighbour whom he had thought deserving of special consideration.

On September 6, 1949, Howard came home from a local movie theatre to find that the new gate that he had built onto the front of the apartment building had been stolen.  That was the apparent trigger that led to his rampage.  After dressing up in his best suit and arming himself with a German luger and thirty-three rounds of ammunition, Unruh went hunting for those he felt had wronged him.  In the twelve-minute rampage that followed, Howard shot at over twenty-six people, killing thirteen and wounding a number of others.Most of the victims were from his list but many others were apparently just in the wrong place at the wrong time. Hearing the approaching sirens, he returned to his mother's apartment and prepared to make a final standoff.  After being wounded, he was convinced to turn himself in. He was eventually charged with thirteen counts of murder and three counts of "atrocious assault and battery" According to the two psychiatrists who examined him before his trial, Unruh stated that "I'm no psycho. I'd have killed a thousand if I had bullets enough".

Although he was found mentally fit to stand trial, Unruh was sent to a psychiatric hospital to serve his life sentence.  Other returning veterans had committed acts of violence following the end of the war but Howard Unruh certainly stood out as the first spree killer in U.S. history. 

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Saving Civilization (Part 2)

Continued from Part 1

While not implicitly racist in itself, eugenics certainly played a role in "racial purity" policies. Although laws banning interracial marriage (i.e., miscegenation) date back to the 18th century in North America, both in French and British colonies, the eugenics movement helped give new impetus to preventing racial mixing in the United States. When Madison Grant published his highly influential The Passing of the Great Race in 1916, he railed against the changing "stock" of immigrants to the U.S. and the decline of the "Nordic" race that had made the country great.  As a dedicated eugenicist (who, like Galton never had children of his own), Grant pushed for stronger restrictions on immigration laws and despaired of the prospect of racial mixing which would undermine "Nordic purity". In addition to immigration controls, sterilization of the unfit, and anti-miscegenation laws, Grant also advocated placing inferior races in separate "ghettos" where they could be controlled more thoroughly.

Grant's influence almost certainly played a role in attempts to include an anti-miscegenation clause into the U.S. constitution during that same period (leading to the "one drop of blood rule" for defining race). Between 1913 and 1948, thirty states enacted laws enforcing racial purity while the Immigration Act of 1924 enacted a quota system to exclude Asians and other "inferior" racial groups from immigrating to the U.S. Grant also helped draft racial purity legislation in several states. While Madison Grant was strongly opposed by a coalition of social scientists led by Franz Boas, his work was widely read around the world and helped inspire the growing Nazi movement in Germany (Adolf Hitler personally praised Grant's book as his "bible").

For all his influence, Madison Grant never had great popular appeal and his work was quickly overshadowed by the 1930s. Another prominent name in scientific racism was Charles B. Davenport. As director of the Eugenics Record office at the Cold Spring Harbor Laboratory, Davenport became famous for his reporting on the dire consequences of racial mixing.& Although he admitted that sufficient research had not been done in the area, that didn't stop him from making outrageous conclusions about the mental and physical abnormalities resulting from miscegenation. He concluded that,"hybridized people are a badly put together people and a dissatisfied, restless, ineffective people. One wonders how much of the exceptionally high death-rate in middle life in this country is due to such bodily maladjustments".

The true dean of scientific racism was undoubtedly Theodore Lothrop Stoddard. Born in 1883 of an old New England family, Stoddard graduated from Harvard Law School in 1908 but quickly converted to the

eugenics cause, particularly the dangers posed by Nordics being overwhelmed by "inferior" races with higher birthrates. Stoddard blamed Jean Jacques Rousseau for undermining Western civilization with his idea of the Noble Savage as well as the notion of "equality between all men".While Madison Grant had at least tried to base his racist ideas on scientific principles (more or less), Stoddard was far less patient. He viewed the threat posed by the low Nordic birthrate as being too critical to wait for more scientific research to be done. An active propagandist, Stoddard wrote twenty-two books and numerous articles in popular magazines.;

Throughout his books, there was one common theme:  that the Nordic race had "clean, virile, genius-bearing blood, streaming down the ages through the unerring action of heredity, which, in anything like a favorable environment, will multiply itself, solve our problems, and sweep us on to higher and nobler destinies." Stoddard viewed World War I as being a disaster for the Nordic race since it was mainly the Nordic soldiers who fought and died while the "inferior Mediterraneans stayed placidly at home". He also warned of the growing Communist threat since, "in every quarter of the globe...the Bolshevik agitators whisper in the ears of discontented colored men their gospel of hatred and revenge. Every nationalist aspiration, every political grievance, every social discrimination, is fuel for Bolshevism's hellish incitement to racial as well as to class war."; Traveling widely, Stoddard took keen interest in foreign policy and wrote about the dangers arising from the geopolitical ambitions of the "coloured" people of Asia, Africa and Latin America.; He also sounded an early warning against the rise of Islam and the dangers of Muslim fanatics. Although a few reviewers had the courage to speak out against Stoddard's books, he was far too popular to be ignored. While hardly the only apostle of scientific racism and eugenics during the 1920s and 1930s, Stoddard was the most well known.

Of course things were changing by then. Despite a greater crackdown on immigration (with the help of eugenics supporters such as Calvin Coolidge and Warren Harding), the actual science on which  eugenics/scientific racism was supposedly based became increasingly flimsy. Franz Boas continued his crusade to undermine scientific racism while the mental testing movement began to question whether racial differences in intelligence actually existed. C.C. Brigham, who had written on the superiority of Nordic immigrants on intelligence during the 1920s later reversed himself completely stating that, "comparative studies of various national and racial groups may not be made with existing tests". On the biology front, genetic research completely undermined the concept of race and racist theories in general.

Things were changing on the world front as well. By the late 1930s, Hitler's Germany was showing the entire world what a racist ideology was really capable of doing if taken to extremes. Adolf Hitler and his fellow Nazis hardly needed to depend on Lothrop Stoddard and Madison Grant to support their ideology though. Many of their policies relating to racial theory, antisemitism, and Lebensraum could be traced back to homegrown social scientists such as Alfred Rosenberg and Otto Weininger. While German propaganda films such as Erbkrank were shown by eugenics societies around the world, rumours of what was happening in Germany made even the true believers uncomfortable. Despite reports of forced sterilization, ghettoes, and persecution, the full extent of the Nazi eugenics program didn't become apparent until after the end of World War II.

Continue to Part Three

New Study Finds High Rates of Childhood Exposure to Violence and Abuse in US

A new study published in a recent issue of Pediatrics is reporting that nearly half of all children in the United States are being exposed to violence or abuse. Jointly sponsored by the U,S, Department of Justice, Office of Juvenile Justice and Delinquency Protection, and the Centers of Disease Control and Prevention, the study was conducted by a team of researchers from the University of New Hampshire. Based on a nationwide sample of 4,549 children up to the age of seventeen as well as caregivers, the researchers collected information of victimization experiences through direct interviewing. Their results indicated that three out of five children were exposed to violence, abuse, or criminal victimization in the past year. These numbers include 46 percent who had been physically assaulted, 10 percent who had been abused by a caregiver, 6 percent who had been sexually victimized, and 10 percent who had witnessed an assault in their family. More than a third of the children had two or more different kinds of violent exposure in the past year and 11 percent had five or more. In outlining their results, the researchers urge child care workers, teachers, and parents to be more aware of the range of potentially violent situations that children may face, including dating violence and bullying.

In addition to the journal publication, the results have also been released in an Office of Justice Programs/OJJDP bulletin titled "Children's Exposure to Violence: A Comprehensive National Survey."

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To download a copy of the OJJDP Bulletin.

NFL Players Union Forms Concussion Committee

In a bid to deal with the problem of head injuries in professional football players, the National Football League Players Association (NFLPA) has formed a new committee. The purpose of the new concussion and traumatic brain injury committee will be to address the diagnosis, prevention and treatment of concussions and traumatic brain injury in active players. The committee will also be examining evidence concerning potential long-term effects of cumulative head injuries in players. The committee will be headed by Arizona Cardinals wide receiver, Sam Morey, as well as NFLPA medical director, Dr. Thom Mayer.p>

Support for the establishment of the committee grew following a recent study commissioned by the NFL showing that retired players have an elevated risk of debilitating neurological conditions including Alzheimer's Disease. While the cumulative effects of repeated head injuries has been well documented in professional boxing and wrestling, the potential for similar problems arising in other sports where head injuries occur have only recently been explored. Recent statistics suggest that as many as 300,000 sports-related traumatic brain injuries of varying severity occur in the United States alone each year.

Potentially fatal brain syndromes that have been linked to repeated head injuries include dementia pugilistica and second-impact syndrome. While both syndromes have been primarily diagnosed in boxers, cases involving professional football and hockey players have gained significant media exposure in recent years.

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Saving Civilization (Part 1)

When Francis Galton first coined the term "eugenics" in his 1883 book, Inquiries into Human Faculty and Development, he intended it to describe his theories concerning the importance of "good breeding" in shaping human development. A cousin of Charles Darwin, Galton drew upon evolutionary theory and

his own observations in animal breeding to propose that ability was shaped almost exclusively by heredity.In an earlier work, Hereditary Genius, Galton traced the ancestries of eminent Englishmen and concluded that almost all of them could be traced to a small number of interrelated families.

In forming his conclusions about heredity, Galton dismissed social and economic conditions and stated that "eminence" could not be affected by environmental factors and that; "no social hindrances" could keep a genius from rising to prominence while no amount of social advantage could enable someone of moderate ability to become prominent. Galton was unashamedly elitist in his views and wrote that, "I am sure that no one who has had the privilege of mixing in the society of the abler men of any great capital, or who is acquainted with the biographies of the heroes of history,can doubt the existence of grand human animals, of natures pre-eminently noble, of individuals born to be kings of men."

If Galton was elitist in his views on individual differences, his views on racial differences were even more pronounced. He was hardly unique there considering that idea of European supremacy was common in many scientific papers of the time. Paul Broca's research into brain measurement and anthropology often stressed the inferiority of non-white brains. Other researchers, including Robert Knox and Samuel George Morton, also weighed in with their own findings on the superior cranial capacity of white skulls over non-white ones (with African and Native American skulls typically falling at the bottom). Despite later debunking of these early racist researchers, their conclusions helped shaped social and economic policy for generations afterward.

For Galton, there was no question that racial differences in intelligence were linked to heredity. While he acknowledge the existence of occasional Africans of high intelligence, he stated that, "he average intellectual standard of the negro race, is some two grades below our own."; He added that great numbers of Negroes were "half-witted" and that visitors to Africa rarely met tribal chiefs who could be regarded as their intellectual equals. Galton's pronouncements weren't limited to non-whites however. He blamed Europe's decline on earlier Church practices such as celibacy which prevented the most intelligent people from breeding as well as for the persecution of heretics who were often "the most fearless, truthseeking and intelligent". Galton argued that, as a result, Catholic countries such as Italy and Spain lost their cultural prominence. He concluded that, "the wonder is that enough good remained in the veins of Europeans to enable their race to rise to its present, very moderate level of natural ability."

As for Charles Darwin himself, he was never a major supporter of eugenics (he knew his own family's genetic shortcomings too well to accept his cousin's views on hereditary fitness). He viewed intelligence and character as being environmental in nature but, in later years, openly despaired of the less capable members of society outbreeding what he termed "the better class of men".  Darwin still spoke out against forced selective breeding however. Some cures were worse than the disease.

Regardless of Darwin's personal opinions, the eugenics movement flourished across Europe and North America. Spurred on by early heredity studies such as Dugdale's 1877 paper on the Juke family and by psychologists such as James Mark Baldwin (who coined the term organic selection), the eugenicists began to favour active intervention to encourage "fit" individuals to have more children while discouraging the "unfit" from reproducing at all. By the time of Galton's death in 1911 (he died childless by the way, make of that what you will), eugenics societies had chapters in almost every major country. Prominent eugenics supporters included George Bernard Shaw, Winston Churchill, Leonard Darwin (Charles' son), and H.G. Wells. In the U.S., Theodore Roosevelt, Margaret Sanger, and Woodrow Wilson were supporters as well.

It was Wilson who helped bring in the first compulsory sterilization law in Indiana in 1907. Another 29 states would bring in similar legislation and, after the U.S. Supreme Court Carrie Buck decision in 1927, sterilization of those deemed genetically unfit would continue for decades afterward.Although the U.K. never brought in formal eugenics legislation, other countries such as Canada and Germany certainly did. The practice of sterilization was helped along by the timely development of intelligence testing which eugenicists eagerly drew upon to identify likely candidates for their selective breeding policies.; Social scientists such as Henry Goddard (who became famous through his Kallikak study) and Paul Popenoe helped foster the development of eugenics legislation by publishing research that showed the positive results of weeding out genetic defectives. Such research would have far-reaching influence, both in the U.S. and in countries around the world.

Continue to Part 2

Does Food Advertising Affect Eating Habits?

While health advocates have focused on the role of advertising for calorie-dense low-nutrient foods as a major contributor to the obesity epidemic, research remains limited.  An experimental study published in the July 2009 issue of Health Psychology examines the hypothesis that exposure to food advertising during TV viewing may also contribute to obesity by triggering automatic snacking of available food. In the first experiment, elementary-school-age children watched a cartoon that contained either food advertising or advertising for other products and received a snack while watching. In a second experiment, adults watched a TV program that included food advertising that promoted snacking and/or fun product benefits, food advertising that promoted nutrition benefits, or no food advertising. The adults then tasted and evaluated a range of healthy to unhealthy snack foods in an apparently separate experiment.  The amount of snack foods consumed during and after advertising exposure was carefully measured. Results showed that children consumed 45% more when exposed to food advertising. Adults however, consumed more of both healthy and unhealthy snack foods following exposure to snack food advertising compared to the other conditions. In both experiments, food advertising increased consumption of products not in the presented advertisements, and these effects were not related to reported hunger or other conscious influences. The researchers concluded that the experiments demonstrate the power of food advertising to trigger automatic eating behaviors and can influence far more than brand preference alone

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