Providentia

Antisocial Personality Disorder and Psychopathy

Long a source of confusion, Antisocial Personality Disorder (APD) and Psychopathy are considered two distinct diagnoses by most mental health professionals.  Although often represented in the popular media as being the same disorder with different names (along with the even more confusing term "sociopath"), the terminology and how it is used by the courts can be crucial in sentencing decisions.  The confusion is usually the result of the overlap in the diagnostic criteria: APD and Psychopathy  are both associated with a history of antisocial behavior. Given the role that psychiatric diagnoses can play in sentencing decisions, the question of how an offender is diagnosed can be crucial.  For this reason, it is vital to explore the confusion in the literature resulting from continuing name and criteria changes for the “criminal personality” in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  A new paper published in a recent issue of History of Psychology examines the evolution of the Antisocial Personality Disorder diagnosis in the DSM and how the construct has changed over time. The author concludes by discussing the  unique challenges faced by the American Psychiatric Association in potential revisions of the APD diagnostic criteria in the upcoming DSM-V.

For the abstract.

Can Hyperbaric Oxygen Therapy Treat Severe Addiction?

Hyoerbaric Oxygen Therapy (HBOT) has had a controversial history.  The use of high-pressure oxygen in specialized environmental tanks has been invaluable in treating pathological conditions such as decompression sickness, air embolisms, gas gangrene, and carbon monoxide poisoning.  Despite this success, use of HBOT in treating more unconventional ailments such as autism, cerebral palsy, hearing loss, traumatic brain injury and multiple sclerosis remain less proven however.  As well, medical complications relating to potential misuse of HBOT including potential pressure damage to various organs of the body (including possible optical neuritis) have been cause for concern in the clinical literature.  Despite these drawbacks, the potential for HBOT in treating other, potentially devasting diseases continues to be explored.

One intriguing new avenue of research is currently underway at Castle Craig Hospital near Edinburgh, Scotland.  A prominent centre for the treatment and rehabilitation of addiction, the hospital has introduced the use of HBOT in treating severe substance abuse.  The program was introduced by Peter McCann, chairman of Castle Craig, based on research determining the benefit of HBOT in Korsakoff's Syndrome patients (typically alcoholics).  Given that severe alcoholism often leads to loss of brain function relating to cell death, use of HBOT to accelerate brain recovery, in conjunction with cognitive remediation programs, has shown remarkable benefit in treating addicts disabled by years of substance abuse. 

After patients are referred to the hospital by the National Health Service, they receive a comprehensive assessment and placement in appropriate treatment which can include detoxification, group and individual therapy, as well as education. HBOT at the hospital typically involves hourly sessions in the hyperbaric chamber in conjunction with more established treatment regimens.  Although health authorities in the NHS remain unconvinced as to the potential of HBOT in treating addiction, researchers at the University of Edinburgh are investigating the benefit of high-pressure oxygen therapy in treating alcohol-related liver damage in chronic alcoholics.  Clinicians at the hospital are also reporting positive benefits of HBOT in treating symptoms of posttraumatic stress disorder although little research in the area has been published to date

While preliminary research has shown that HBOT is potentially beneficial in drug detoxification and abstinence,  the potential value of this form of treatment in dealing with the devastating consequences of long-term substance abuse is still open to question.  Given the economic burden that chronic alcoholics place on public health systems around the world, it is certainly hoped that this type of treatment is more than hot air.

For more information.

Recovering in Oxford House

One of the largest examples of a community-based, mutual-help residential community for high-risk substance abuse individuals is Oxford House. In the United States, over 9,800 people live in these self-run dwellings where they obtain jobs, pay utility bills, and learn to be responsible citizens. Beginning with 1 single rented residence in the mid-1970s, Oxford Houses now number over 1,300. These rented homes are helping people to deal with drug addiction and community reentry by providing stable housing without any limits on length of stay, a network of job opportunities, and support for abstinence. A review paper published in Psychological Services examines the research on these unique settings and highlights the strengths of such a community-based approach to addressing addiction. New roles for psychologists in working with these types of support systems are identified.

For more information.

Psychic Numbing and Genocide

One of the high points of the conference I'm attending here in Melbourne was a presentation by Paul Slovic of the University of Oregon (and president of Decision Research Group).  A leading researcher in the field of risk perception, Dr. Slovic has been one of the pioneers in the study of psychological heuristics and how they determine how humans respond in risky situations.  In his talk titled The More Who Die, The Less We Care: Psychic Numbing and Genocide, Dr. Slovic focused on the genocides of the past century and the human failure to intervene when the lives of countless others are in danger.  He also dealt with a strange quirk of human psychology:  that we are far more likely to act to save one person than we are to save thousands. 

While every instance of mass murder is different, the tendency to downplay or simply ignore deaths happening in distant countries seems remarkably consistent.  Not only has this happened during the Nazi Holocaust, but also more recently n the former Yugoslavia, Cambodia, Rwanda, as well as today in Darfur.  At the same time, media stories of individuals in distress are disproportionately more likely to stir us into helping while larger crises are overlooked. 

Failure to intervene, or even to protest, genocidal acts occurring in other parts of the world has been a  common feature in the foreign policy of many Western countries.  As journalist Samantha Power noted in her book, A Problem from Hell: America and the Age of Genocide in discussing US response to 20th century instances of genocide, "No U.S. president has ever suffered politically for his indifference to its occurrence. It is thus no coincidence that genocide rages on."   

The United States is far from the only country where this type of lapse occurs (such as with the deaths currently happening in Darfur) and as new atrocities break out in other places,   Although the United Nations formally adopted the Convention on the Prevention and Punishment of Genocide in 1948 (which was later ratified by more than 140 nations), it has never been invoked to prevent an attack or avoid a massacre.   The Darfur example demonstrates the failure of national and international foreign policy

Behavioural research studies have consistently shown the numbing effect that large numbers can have in our culture.  In one study that Dr. Slovic discussed, research participants were fond to be more likely to donate money to provide clean water to save 4,500 refugees in a moderately sized camp of 11,000 than they were to save the same number of refugees in a camp of 250,000 or more.  The tendency of moral intuition to blind us to massive loss of life remains a dangerous liability in an era when such atrocities can only continue. This problem is also apparent when we ignore issues such as anthropogenic global warming and extinctions of plant and animal species caused by human activity.

The emotional disconnection that we experience due to being presented with large numbers of victims can be partially overcome with the use of visual images of individual victims, narratives describing their plight, and putting names to faces to prevent the depersonalization that often accompanies news stories of atrocities. Dr. Slovic and his colleagues also recommend that international and domestic law should require officials to provide public deliberation to justify decisions to act or ignore new episodes of genocide as they occur.  To do otherwise means allowing the practice of genocide to continue into the future.

To download Dr. Slovic's paper, "If I Look at the Mass I Will Never Act": Psychic numbing and genocide.

When Veterans are Homeless

A study published in Psychological Services assessed differences in personal, medical, and health care use characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Statistical analysis was used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care use varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care use characteristics of homeless veterans in metropolitan versus nonmetropolitan areas.

For more informatio.

Widow Lived With Corpses Of Husband and Twin Sister

Police in Wyalusing, Pennsylvania are still investigating a bizarre case in which a 91-year old widow was found to be sharing her home with the preserved corpses of her husband and twin sister.  After her husband of 60 years, James Stevens, died in 1999, his widow Jean had his embalmed corpse dug up so it could be stored in her home.  When her sister, June, died last October, Jean had the body buried in her backyard where she then had it dug up so she could store it in her home as well.  Police were finally tipped last month and the corpses are now with the Bradford County coroner's office, and off limits to the woman who loved them both.

In describing her reasons for her actions, Jean Stevens stated that, "Death is very hard for me to take".  Being agnostic, she had difficulty with the idea that death would be final which made it extremely difficult for her to accept the deaths of her husband and sister.  She also stated that she suffers from claustrophobia (and so did her sister).  Feeling horrified that her loved ones would spend eternity in a casket in the ground inspired her to her extreme action.  When she had her husband's corpse exhumed within days of his burial, she kept him on a couch in the detached garage. 

After her sister, June, died of cancer, she had the body exhumed "so I could touch her, look at her and talk to her".  She dressed the corpse in her "best housecoat" and kept in on an old couch in a spare room near her bedroom.  She applied makeup and tried her best to make the corpse as it appeared in life and also sprayed it with perfume to mask the odour.  Jean stated that she often enjoyed talking to both corpses much as she had when they had been alive. 

It is not immediately clear who contacted authorities although Jean Stevens suspects one of her husband's relatives.  She described the action of calling in the police as "dirty, rotten".  Neighbours who had helped her care for her lawn and took her grocery shopping had either not known or not told about her macabre secret.  She is now investigating the possibility of building a crypt on her property so that the bodies might be returned to her.

No charges have been laid to date but police are still preparing their findings for a final determination to be made.  She may be charged with misdemeanor abuse of a corpse and violation of state provisions regulating the disinterment of corpses.

For more information.

Unmaking the Disease (Part 3)

Continued from Part 2

By the time of the 1972 convention in Dallas, enough progress had been made for activists to avoid the confrontation tactics of previous conventions.  Kent Robinson, who by then had become the unofficial APA liason with the gay community, arranged for a booth to be displayed in the exhibit area.  The booth was run by several gay activists with the logo of "Gay, Proud, and Healthy" designed to win support for the removal of homosexuality from the DSM.  A panel chaired by Robinson included Judd Marmor, gay activist Frank Kameny, as well as "Dr. H. Anonymous", a gay psychiatrist who chose not to reveal his name openly (he wore a mask for the panel presentation).  "Dr. Anonymous" was the most memorable speaker and he announced that there were over two hundred gay psychiatrists attending the conference.  He stated that, "As psychiatrists who are homosexual, we must know our place and what we must do to be successful. If our goal is high academic achievement, a level of earning capacity equal to our fellows, or admission to a psychoanalytic institute, we must make sure that we behave ourselves and that no one in a position of power is aware of our sexual preference and/or gender identity."  His presentation, along with the other speakers of the panel, made a powerful appeal for greater tolerance and acceptance among psychiatrists in dealing with their patients and the community at large.  It would be a major turning point in changing orthodox views on homosexuality.

Although critics later argued that the disruptive tactics of the gay lobby had done more harm than good, the formal panel seemed a vindication of its success.  As Barbara Gittings pointed out, the event would likely have taken decades longer to be held "if gay people had politely waited to be asked".   In a provocative article published in 1972 in the International Journal of Psychiatry, Richard Green argued against the disease interpretation of homosexuality and invited six formal responses.  On the six, only the responses by Charles Socarides and Lawrence Hatterer supported the traditional psychiatric perspective and rejected the reopening of the question of homosexuality's status as a disease.  Although Socarides continued to fight against any attempt at normalizing homosexuality, other mental health organizations, including the National Association for Mental Health urged that homosexual behaviour be decriminalized.  Meanwhile, the protests continued at the 1972 conference of the Association for the Advancement of Behavior Therapy (which the protesters accused of torture over the use of aversion therapy to change sexual orientation).  It was at this conference where Robert Spitzer, a then-member of the APA's Committee on Nomenclature, agreed to allow them to make a presentation before the committee at the 1973 APA conference.  

Despite an internal split among gay groups over  the presentation, Charles Silverstein of the Institute for Human Identity was chosen to organize it.  Along with prepared statements from a number of gay-positive psychiatrists and psychologists, Silverstein called for the removal of homosexuality from the DSM in his presentation on February 28, 1973.  The lengthy case statement surveyed research findings and documented how the psychiatric diagnosis of homosexuality reinforced existing social and legal restrictions on homosexual behaviour.  In his final summation, Silverstein pointed out the psychological consequences of maintaining that homosexuality was a disease:  "We are told, from the time that we first recognize our homosexual feelings, that our love for other human beings is sick, childish and subject to "cure." We are told that we are emotional cripples forever condemned to an emotional status below that of the "whole" people who run the world. The result of this in many cases is to contribute to a self-image that often lowers the sights we set for ourselves in life, and many of us asked ourselves, "How could anybody love me?" or "How can I love somebody who must be just as sick as I am?""

Although the committee was impressed by Silverstein's presentation, there was active opposition.  An ad-hoc committee organized by Charles Socarides and Irving Bieber, supported by psychoanalytic societies, urged the APA not to revise the DSM-II.  By the time the APA convention was held later that year, the political forces on both sides of the debate were fully engaged in the battle over changing the DSM.  After a proposal that the matter be settled through a survey of APA's members was rejected, the Council on Research and Development met in October of that year and voted unanimously to delete homosexuality from the DSM-II.  Although there was continuing debate over whether a new diagnosis of "sexual orientation disturbance" should take its place (which could apply to heterosexuals and homosexuals alike), the final decision on December 15 was carefully worded to make the decision to delist homosexuality as a mental disorder as neutral as possible. In handing down the decision, Allen Freedman, then-president of the APA stated that the resolution would "help to build a more accommodative climate of opinion for the homosexual minority in our country, a climate which will enable homosexuals to render the maximal contribution to society of which they are capable."

Newspapers across the country announced the decision with headlines such as "Doctors Rule Homosexuals not Abnormal" and "Victory for Homosexuals".  Although critics such as Bieber and Socarides remained outspoken in denouncing the decision (and accusing APA of caving in to political pressure), the new perspective on sexual minorities was largely welcomed by the community at large.  There was enough opposition to the change for a petition to be circulated among the APA membership calling for a popular vote on the decision.  When the vote was finally held in 1974, the Board's decision was ratified. 

It wasn't a complete reversal of psychiatric thinking on homosexuality however.  When the third revision of the DSM came out in 1980 (DSM-III), a new psychiatric diagnosis was approved:  ego-dystonic homosexuality.   With diagnostic criteria including: 1.a persistent lack of heterosexual arousal and 2. persistent distress from unwanted homosexual arousal, the new diagnostic label was intended as a compromise to appease those psychiatrists who still felt that changing sexual orientation was a reasonable goal. Gay activists railed against a diagnosis which they felt helped reinforce antigay biases.  Since legal and social barriers to acceptance of homosexuals were still strong, couldn't all homosexuals be considered ego-dystonic to some extent?    Ego-dystonic homosexuality was completely removed in the revised version of the DSM which came out in 1986 (DSM-III-R).  There are still vestiges remaining in the newest version of the DSM under the heading of Sexual Disorder Not Otherwise Specified (a catch-all diagnostic label which includes "Persistent and marked distress about sexual orientation" as one of its criteria although the label is rarely used these days). 

Not surprisingly, there was continuing resistance to the changes in how the APA dealt with homosexuality.  In 1992, Charles Socarides, Benjamin Kaufman and Joseph Nicolosi founded the National Association for Research and Therapy in Homosexuality (NARTH).  Described as a "non-profit, educational organization dedicated to affirming a complementary, male-female model of gender and sexuality”, NARTH's mission statement "offers hope to those who struggle with unwanted homosexuality".   Opposing the APA reversal on conversion therapy for changing sexual orientation, NARTH remains affiliated with with religious organizations such as Focus on the Family and PATH (Positive Alternatives to Homosexuality).  Despite concerns raised by the American Psychological Association and the Royal College of Psychiatrists that NARTH "creates an environment in which prejudice and discrimination can flourish), the organization remains active.  Until his death in 2005, Charles Socarides remained a dominant voice in NARTH's policies as well as being a widely sought authority in civil rights cases opposing liberalization of anti-homosexual legislation.

Despite the opposition from conservative psychiatrists, the mainstream view on homosexuality and conversion therapy has undergone a dramatic shift over the past thirty years.  Pioneers such as Evelyn Hooker, Judd Marmor and "Dr. Anonymous" (who since revealed himself as John E. Fryer) lived long enough to see their once-reviled stand on homosexuality as a normal expression of sexuality become accepted.  Not coincidentally, that same era has seen a wider change in social and legal acceptance of sexual minorities.  Although the struggle still continues (with ongoing controversy over DSM definitions of gender disorders), the American Psychiatric Association and the American Psychological Association have become advocates of gay-affirmative treatment as well as supporting legislative changes.  Whether this positive voice will continue in an era of increasing resistance to acceptance of sexual minorities is something that only time will tell.

Off to Australia

I will be away for the next two weeks attending a conference in Melbourne, Australia.  I also plan to visit Sydney afterward and I'm looking forward to seeing both since I've never been to Australia before (I'm not looking forward to the 24-hour flight though).  Any readers out there with suggestions of where to visit are welcome to post them.    I'll be maintaining this blog as best I can (and a lot of my planned posts have already been scheduled to run while I'm away). 

Russian Man Charged in Psychic Assassination Plot

A former pediatrician has been charged with inciting hatred after reportedly seeking co-conspirators to join him in killing Russian Patriarch Kirill I using their "collective mind".  42-year Dmitri Shubin of Nizhny Novgorod apparently posted a number of statements on the Russian social networking site Vkontakte.ru.   In these statements, he urged users to gather at his apartment at a set time to use their egregore (collective mind) against the Patriarch due to the strong role of the Russian Orthodox church in Russian society.  Egregore is a concept developed in Rosicrucian and other occult philosophies and has been a popular concept in traditional magick (especially in Russian circles).  Shubin, who listed himself on the site as an atheist, also reported having certificates from the Moscow School of Hypnosis and the School of Practical Psychology.  Other interests which he provided on the site included "Cabala (Kabbalah), magic, and women".  He also created an on-line survey asking whether they considered "the topic of killing the patriarch relevant" (most voted no).  

Shubin has been the focus of legal attention in the past through his involvement in occult groups as well as a connection to a bizarre ritual killing in 2000.  Two teenagers who were involved with an occult group run by Shubin stabbed a twelve-year old member of that same group to death.  Although Shubin denied ordering the killing, he had recruited both teenagers while working as a pediatrician at a local hospital.  Despite being cleared of involvement in the murder, he was warned by investigators at the time not to organize any more occult groups.

Shubin's activities only came to light after police responded to local complaints about his on-line statements which first began in March 2009 and continued until January of this year (his Vkontakte.ru profile was still on-line until very recently).  In an interview with the Moscow Times, Shubin stated that, "I don't consider myself guilty.  I just wanted to express my opinion about the government's policy on religious issues".  When asked to comment on the matter, Patriarch Kyrill's office said the case was another reminder of the danger that occult groups pose to society.  "We look at their leaders with pity and pray for them", a spokesman added. 

For more information.

PTSD and Risky Sex

Little is known about behavioral and psychological mechanisms that may explain relationships between posttraumatic stress and risky sexual behaviour. As rates of HIV infection among African American women remain significantly higher than for other female subgroups, research on sexual risk among African American women is needed. The study published in a recent issue of Psychological Trauma examines the relationships of posttraumatic stress symptoms as measured by the Posttraumatic Stress Disorder Checklist-Civilian Version with sexual risk behaviors, sexual sensation-seeking, and sexual compulsivity in 30 undergraduate African American women with any reported history of sexual intercourse. Higher posttraumatic stress symptoms were associated with more sexual partners, greater frequency of vaginal sex without a condom, and endorsement of sex while under the influence of a substance.  Posttraumatic stress symptoms were negatively correlated with perceived sexual control, but were not significantly correlated with sexual compulsivity or sensation-seeking. Perceived sexual control was negatively associated with frequency of unprotected sex and sex under the influence. The preliminary evidence from this small sample suggests sexual control may mediate the relationship of the posttraumatic stress symptoms with unprotected sex. These results are generally consistent with previous findings suggesting posttraumatic stress is associated with sexual risk

For more information.