Providentia

Encephalon Edition 83

Welcome, one and all, to the long-delayed 83rd edition of Encephalon.  It is a special privilege for me to return to hosting this carnival of the best psychology and neuroscience writing on the web and the lineup this time around is as strong as ever.  Maintained in an on-again off-again fashion since 2006, the carnival takes its name from the Greek enkephalos (vertebrate brain).  

First up is a post by Khalil Cassimally at Lab Coat Life with an overview of some fascinating research into how preverbal infants shape their social preferences and how they are  influenced by others' behaviour toward unrelated third parties.   And, yes, infants do pick up on that sort of thing.

Then we have Janet Kwasniak at Charbonniers.org weighing in on the complex and troubling question of free will (which I choose not to believe that I have).   Can scientists actually provide some insight into what motivates us to behave the way we do? She also provides with a post on confabulation, transparency, and the cognitive quirks that all of us have.

We also  have the redoubtable Neurocritic who shares a fascinating post which asks that perplexing question:  Do more friends on Facebook mean a larger amygdala?   (sadly, it doesn't).

Are autistic people lost in space?  That is the question posed by Michelle Dawson at Autism Crisis in a disturbing post describing some research into how autistic children perceive reality as well as the problems posed by the research methodology used.   Speaking of autism, Jacy Young of Advances in the History of Psychology provides us with a look at "Donald T.",  the now-77 year old man who was the first ever case to be diagnosed with autism in 1943.

Which bring us to Greg Downey at Neuroanthropology with a two-part post on prodromal psychosis and how subtly psychotic disorders can begin (an how frightening it can be when it happens).  Part One is here and the second part can be found here.    We also hear from Dr. Shock, MD who talks about the psychological factors that make a good bodyguard.   

Allison Goldstein of the the Wiley-Blackwell Life Sciences Blog shares this post reviewing research into video games and how they enhance visual attention skills. So World of Warcraft has some benefit after all (who knew?).

For my own blog, I weigh in a historical mystery surrounding Friedrich Nietzsche, the bizarre illness that felled him, and how a diagnosis can gain propaganda value.  The first part can be seen here and the second part is here.

Finally, we have Karen Franklin of In the News who provides us with two fascinating posts.  The post on the recent Arizona shootings and how the various media pundits are feeding on the tragedy for their own ends.  Can shooters be detected before the violence begins?   She also shares a post on the use of solitary confinement in supermax prisons which asks the provocative question:  Supermax: Hell on earth or . . . not as bad as we thought? 

The next installment of Encephalon is February and will be hosted by Janet Kwasniak at Charbonniers.org.   We're also still looking for hosts for the upcoming year!  If you're interested in hosting, check out the Encephalon page and let Mike Lisieski over at Cephalove know of your availablility.

What is Psychological First Aid?

It's become a familiar sight following disasters (both natural and man-made).     Immediately after the disaster occurs, counsellors are often brought on the scene to engage in psychological debriefing designed to minimize the impact of traumatic experiences on those affected.  Still, there is an active debate over the potential benefits of psychological debriefing (aso known as Critical Incident Stress Debriefing).  Critics often argue that re-exposing victism to traumatic memories too soon after the disaster may do more harm than good.  The popular media is filled with articles describing how improperly applied debriefing techniques can worsen long-term outcomes in some victims of traumatic stress.  Frequently,  leaving victims to recover with family and friends may be more effective.  Even scientific reviews have yielded conflicting findings concerning the actual benefits associated with psychological debriefing techniques.

In a compelling recent article, psychologist Phillip Stacey has argued that psychological debriefing does not represent the current standard of care due to lessons learned from recent disasters such as the Boxing Day tsunamic, Hurricane Katrina, and the recent flooding in Australia.  The new standard practice, known as Psychological First Aid, embraces the following core principles:

1) Respectful contact with survivors and observation of immediate needs;

2) Restoring a sense of safety to reduce distress and providing emotional and physical comforts away from trauma;

3) Stabilisation or calming of those who are emotionally overwhelmed using basic psychological interventions;

4) Gathering information for immediate action or later referral for appropriate care;

5) Planning practical assistance - survivors with favourable outcomes are characterised by optimism, confidence and resources and psychological care can help to foster these;

6) Cultivating connection with social supports to help speed recovery;

7) Providing information on psychological reactions and coping strategies; and,

8) Linking survivors to collaborative services then or in the future.   

While most trauma victims often recover without psychotherapy, disaster survivors can experience a broad range of symptoms which may cause distress   Supportive counseling is especially beneficial for those experiencing symptoms of anxiety, post traumatic symptoms, insomnia, or depression.  Psychological First Aid strategies can also be used for children, adolescents, parents or guardians, or even first responders and other disaster relief workers.  After an individualized assessment and treatment plan, trained mental health professionals may assist trauma victims in learning to deal with painful memories and developing proper coping strategies.   To assist with proper administration of psychological first aid techniques, the United States Department of Veteran Affairs and the National Center for PTSD have developed a Field Operational Guide that can be downloaded here (PDF format).  Along with formal guidelines for first responders, primary and emergency health care providers, and disaster relief organizations, the guide also includes Handouts for Survivors and a set of appendices describing additional resources available for use.  Hardcopies of the Field Guide can also be ordered directly. 

For more information  (PDF format)

 

 

 

 

 

Saint Rose

Isabel Flores de Oliva hated being beautiful.

She was born in Lima, Peru on April 20, 1586 as one of eleven children.  Raised in a devout Catholic household, she was personally confirmed by the Archbishop of Lima.  Her nickname, "Rosa" was meant to symbolize her special relationship with God since a servant had once claimed to have seen her face transform into a rose.    Since Rosa's parents were not well-off (her father was an arms-maker for the king while her mother did needlework), they maintained the traditional hope that their daughter would eventually marry well.  Considering her beauty, they relished the thought of Rosa attracting a rich husbnd who would help their family.  Unfortunately, Rosa had other ideas about how she would devote her life.

Growing up in Lima, which had been founded by Francisco Pizarro only fifty years before, Rosa saw first-hand the work of the Spanish inquisitors.  She also saw the missionaries bringing the Catholic faith to the conquered natives (and the repression that the natives faced).   By age five, she knew the life story of Saint Catherine of Siena by heart and became determined to become a martyr to her faith.  She built a hut in her family's backyard where she spent most of her time when she was not helping to support her family with needlework.  Rosa also began imposing regular hardships on herself in imitation of Catherine of Siena.  In addition to regular fastings,  she engaged in regular self-mortification to increase her suffering.  First she cut off her hair (despite the protests of friends and family) and also began rubbing lye or lime into her hands, pepper into her face, and also  perforated her skin.    Her justification for the self-mutilation was that her beauty brought her too much attention and she wanted to discourage potential suitors. 

In addition to becoming a vegetarian, Rosa also practiced regular floggings, wore a hair-shirt, carried a heavy cross on her back, and often deprived herself of sleep.  This regimen continued for years while Rose faced ridicule and anger from her parents and other family members who tried to discourage her from a religious  life.   She also faced opposition from her confessor since Rosa refused to follow the conventional religious route by taking holy orders a nun. (which would have meant living her entire life in a religious cloister).  Rosa insisted on being a lay holy woman and insisted on her religious name of Rosa de Santa Maria.  She eventually became a tertiary, first informally associated with the Franciscan order and later with the Dominicans (like her model, Saint Catherine).  Her religious vows focused on a life of chastity, poverty, and obedience but she consistently refused to enter the cloister.

Rosa also continued with her rigorous life of prayer, work, and penance.  According to her later biographers, she "worked for ten hours, prayed twelve hours, and slept two".  To keep herself awake at night, she often hanged herself by her hair and slept in a bed made of thin planks.   Between the planks of her bed, she placed sharp ceramic shards which penetrated her skin and kept her from sleeping.  Other penances included "whipping her back bloody so hard and cruelly that blood splattered the walls, the floor and her clothing", as well as wearing a heavy crown of thorns.  Later in life, she wore a crown made of  metal spikes that pressed into her forehead, just above her eyes (she decorated this crown with a rose garland).    As part of her regular penance, Rosa engaged in religious fasting and, at times, limited herself exclusively to the Communion host. 

Not surprisingly, Rosa's devotional lifestyle made her the talk of the community.  Stories spread concerning her divine gifts (including prophecy) which were seen as a sign of her special status.  Along with the prayer group that she led, Rosa offered up regular prayers to benefit the Lima community.  They frequently asked for divine assistance for whatever disasters beset her fellow Peruvians.  Unfortunately, being a woman meant that Rosa was barred from any actual missionary work which was a special disappointment for her.  On more than one occasion, she was heard to lament that she had not been born a man so that she could be permitted to participate in the conversion of souls.   Rosa's unconventional status as a lay religious woman attracted enough attention for her to be informally investigated by the Inquisition in 1614.  Although the inquisitors eventually cleared her  of any suspicion, their three-year investigation of Rosa's fasting and extreme religious practices likely added to the stress that was being placed on her body.  By 1617, Rosa de Lima was dead, her body completed  wasted by her long years of self-abuse.

Almost from the moment of her death, the case for Rosa being declared a saint began.  Spearheaded by city officials, the Archbishop of Lima, and the Dominican order, an official council began taking testimony from Rosa's many family members, friends, clergy, and her religious circle.   The process of canonization was helped along by the cult of veneration that had arisen in Lima.  The numerous pilgrims to Rosa's simple grave were so enthusiastic in fact, that the body was later exhumed and transferred to the Church of Santa Domingo in 1619 so that visitors could see Rosa in her casket.   Not everyone supported Rosa becoming a saint however.  The Dominican order was actually divided on the question (they had other candidates in mind and Rosa's unorthodox religious life made many clerics uncomfortable).   

The cult of veneration eventually attracted the attention of the Inquisition. 

The chief inquisitor, Luis de Bilbao (who had been one of Rosa's confessors) ordered all of Rosa's writings and personal effects to be turned over to the Inquisition and formally censured several of Rosa's supporters.  Ironically, while the Inquisition was suppressing Rosa's cult in Peru, her popularity in Spain was growing.  King Philip IV became an enthusiastic supporter of Rosa's sanctity and declared her to be the patron of Spain's armed forces (despite the fact that she was not yet a saint).   Though the case stagnated for decades, the Catholic Church began a formal inquiry in 1630 which collected testimony from 147 witnesses  from all cross-sections of Peruvian society.   Despite considerable pressure from the city of Lima (which had adopted Rosa as their unofficial patron saint) and the Spanish government, the case stalled further due to Pope Urban VIII's reforms.  Responding to Protestant criticism of the Catholic practice of venerating saints, the church tightened the criteria for sainthood and declared that a candidate could only be considered after being deceased for fifty yeears or more. 

Political pressure grew for a special exception to be made in Rosa's case (and spurred on by an influential hagiography of her life which was published in 1664) and the papal bull declaring Rosa a saint was formally delivered to Lima in 1671.  Rosa was named the patron saint of Lima and Peru (later extended to all of the Americas and the Philippines).  The nationwide celebration that followed the declaration that Rosa was America's first saint including religious processions, celebratory masses and, according to witnesses "a miraculous voice that spoke to the crowd" (a further sign of God's approval).  Over the next century, there would be dozens of hagiographic pictures, books, poems, and sermons on Rosa's life and she would become an essential part of Peruvian culture.  Considering the long and often violent process of converting Peru's native population to the Catholic faith, Rosa became viewed as a "redeemer" of the New World and a sign that the old native religious practices had been firmly stamped out.  While numerous hagiographies would be written about her life, the actual testimony of the various eyewitnesses that was used in her canonization was largely suppressed with 0nly "official" details of Rosa's life being available.  It was only during the 20th century that historians were able to learn more about Rosa and the world in which she lived.

But why did a woman whose severe life of self-denial and extreme self-mortification become so important in colonial life?  In many respects,she happened to live at the right time and be in the right place.  Considering the social unrest of the time and the often bloody necessity of suppressing the native population, religion become an important part of Peruvian life and local examples of extreme saintliness were needed to promote church policies of self-sacrifice and obedience.   Rosa wasn't the only Peruvian of her generation to be canonized (there were three others) although she was definitely the most prominent.   There was also a certain irony given Rosa's  refusal to take holy orders, and the self-administered physical trauma which shortened her life.   While she was presented as a role model, clerics actively discouraged girls from following her example too closely.    Only one of the various women who modelled themselves after Rosa was ever canonized (and not until centuries after her death).

While voluntary suffering (also known as mortification of the flesh) continues to be practiced in many religions,  its use remains controversial.   That Rosa was allowed to inflict such damage on herself in the name of religion may have seen less remarkable in her time but more modern interpretations are less forgiving.  Current mental practice views all self-harm as pathological, regardless of the religious motives.  Although Rosa de Lima's life was useful  for  religious and political propaganda, she likely would be dealt with far more differently today.

Do Age and Work Experience Improve X-Ray Screening Efficacy?

In recent years, research on cognitive aging increasingly has focused on the cognitive development across middle adulthood. However, little is still known about the long-term effects of intensive job-specific training of fluid intellectual abilities. In a study presented in a recent issue of Geropsych:  the Journal of Gerontopsychology and Geriatric Psychiatry examined the effects of age- and job-specific practice of cognitive abilities on detection performance in airport security x-ray screening. In Experiment 1 (N = 308; 24–65 years), the researchers examined performance in the X-ray Object Recognition Test (ORT), a speeded visual object recognition task in which participants have to find dangerous items in x-ray images of passenger bags; and in Experiment 2 (N = 155; 20–61 years) in an on-the-job object recognition test frequently used in baggage screening. Results from both experiments showed  high performance in older adults and significant negative age correlations that cannot be overcome by more years of job-specific experience. The authors discuss the implications of their findings for theories of lifespan cognitive development and training concepts

For the abstract

Attending Science Online 2011

I stared writing this post while sitting in one of the lecture rooms at the Sigma Xi Scientific society headquarters in Durham, North Carolina during the lunch break last Saturday afternoon.  I was attending the annual Science Online conference for the first time and it was quite an experience.   Getting to meet science writers like Carl Zimmer, David Dobbs, Ed Yong, Greg Gbur, Sheril Kirschenbaum, and a host of others is a thrill for me (despite feeling distinctly intimidated at first).  Although a lot of the talks were livestreamed, there is nothing quite like being there in person.  I also attended the workshops on Friday and got a chance to socialize a bit as well  as listen to readings by various authors.    They also had guided tours to various science and culture sites in the area although I wasn't able to get on the list for the Duke Lemur Center.  Oh well, maybe next year.

 The festivities on Saturday were especially enjoyable including a formal banquet,  an awesome presentation by Margaret Lowman, the Filmfest awards, and  a comedy performance by Brian Malow.   Sadly I had to miss the last day of the conference since I went home Sunday but the various twitters gave me an idea about what went on.

As an extra note, I should add that January 16 is the 4th anniversary of my blog but this time around I get to talk about something else besides rehashing my various blog statistics (just to prove I'm not obsessed with my numbers despite my own misgivings about that).   Things should get back to normal in a couple of days.

 

Caring for Nietzsche (Part 2)

Continued from Part I

Despite the occasional lucid episode, Friedrich Nietzsche never regained his sanity and his visitors seldom stayed long.  His growing fame inspired renewed curiosity about the ailing genius but Franziska limted all access.  Caring for her invalid son must have been a tremendous burden for Franziska and she was only seventy-one when she died on April 20, 1897.  Afterward,  her daughter, Elizabeth. became Friedrich Nietzsche's new caregiver.   Having already gained control over her brother's estate and all of his writings,  Elizabeth moved her brother to Villa Silberblick near the city of Weimar.   The large villa also housed the Nietzsche Archives, carefully maintained by Elizabeth (she was also his literary executor) and is still a major pilgrimage site by Nietzsche's admirers.  He and Elizabeth lived there until his death on August 25, 1900 at the age of fifty-five.  In a move which would have appalled the self-styled "Antichrist", Elizabeth had him buried with a traditional Lutheran funeral with a church choir and a coffin bearing a silver cross.   

Along with his numerous books and philosophical writings, Friedrich Wilhelm Nietzsche also left behind a medical mystery.  What was the illness which struck him down when he was at the height of his intellectual powers?  Although neurosyphilis is the most commonly accepted diagnosis, there was no real evidence to support it.  Reliable tests for syphilis didn't exist in Nietzsche's lifetime but it was still common practice for autopsies to examine the brains of suspected syphilis cases for the tell-tale lesions that might confirm the diagnosis.  Not only was this not done in Nietzsche's case, Elizabeth would later state that she had been unaware of the "disgusting accusation" of her brother's syphilis.    As rumours grew about the cause of Nietzsche's mental breakdown, she recruited neurologist Paul Julius Mobius to review all available medical records.    A prolific science writer and researcher who is best known today for giving his name to Mobius syndrome, Mobius examined all the medical notes by Nietzsche's doctors at Basel and Jena and concluded that the syphilis diagnosis was correct.  He also dismissed questions about the atypical nature of  Nietzsche's illness by stressing how variable the disease could be. This despite the fact that Nietzsche surviving nineteen years following the initial diagnosis was virtually unprecedented in true syphilis patients (and he might well have survived longer given that he died of pneumonia).   The book that Mobius later wrote about Nietzsche was hardly flattering and ended with the outrageous statement "Beware!  This man has a diseased brain".

Suffice it to say, Elizabeth was not pleased and eventually wrote her own biography about her brother to refute Mobius' "vile insinuations".   Desperate to preserve her brother's memory, Elizabeth's book portrayed him as being saintly and chaste (she included numerous testimonials from prominent Germans).  Not being a medical doctor herself, she attributed his illness to drinking "Javanese tea" similar to cannabis.  Medical experts were not impressed with her explanations and the syphilis explanation persisted for decades.   Despite her distress over the lingering rumourse, Elizabeth Nietzsche carefully controlled her brother's legacy long after his death.   She is also largely credited with promoting the "Nietzsche myth" concerning his life and writing and may not have been the best choice to act in that capacity given her own very, clear ideas on how her brother deserved to be remembered.  

By the time of her own death in 1935,  Elizabeth's support for Adolf Hitler ensured that her brother's philosophy would be permanently associated with the growing Nazi and Fascist movements (Adolf Hitler personally visited her in 1934 and had a photograph taken of him gazing reverently at a bust of Nietzsche).  Even before the outbreak of World War 2,  Nietzsche became known internationally as the "Nazi" philosopher with his "Ubermensch" ideas playing into Nazi propaganda.  As a result, the notion of Nietzsche dying of syphilis became increasingly popular with anti-Nazi writers as a means of discrediting him.  Neurologist Wilhelm Lange-Eichbaum was especially scathing in promoting the view that Nietzsche was to blame for Nazism and the resulting war.  His books on Nietzsche probably did more to promote the syphilis story than any other source despite serious questions relating to the "evidence" of Nietzsche's syphilis that he presented (and which could never be confirmed by later reviewers).

But how plausible an explanation was it?   Aside from his extremely long survival, there were additional details that made the syphilis diagnosis less likely.  Even when Nietzsche was first examined in Jena, the attending physician noted some atypical medical signs including the lack of characteristic tremors normally associated with neurosyphilis cases as well as uneven pupil dilation.   Based on Nietzsche's  lifelong migraine headaches and his family history of stroke (which had killed his father at a relatively young age), more recent medical authorities have argued that Nietzsche's illness was likely due to an undiagnosed brain disease with various alternative diagnoses being suggested. 

While a final determination of what caused Nietzsche's dementia will likely never be possible, this case represents a graphic example of how controversial some diagnoses can become.  Especially when it can be used for propaganda purposes.

 

Who Should Carry out Suicide Assessments?

While it is standard practice for patients being admitted to hospital because of self-harm to receive psychosocial assessment before discharge, many of these assessments in the United Kingdom and elsewhere are undertaken by trainee rather than specialist psychiatrists.  A paper published in a recent issue of Crisis: The Journal of Crisis Intervention and Suicide Prevention presented the results of a study comparing psychosocial assessments, aftercare, and the pattern of non-fatal repetition for patients admitted to general hospital after self-harm and whether there was a substantial difference between the assessments carried out by trainee psychiatrists or by mental health nurses with a designated role in self-harm services.  The study compared arrangements for aftercare and rates of non-fatal repetition of self-harm in 787 consecutive psychosocial assessments in a large UK city, according to whether the assessments were carried out by trainee psychiatrists or mental health nurses. Results showed that, compared with nurses, psychiatrists were much more likely to arrange psychiatric admission or outpatient follow-up. Nurses more often pointed people towards voluntary sector help—such as drug, alcohol or relationship counselling. Repetition of self-harm was equally common among those assessed by nurses or psychiatrists (33%; hazard ratio 0.93, 95% confidence interval 0.71 to 1.2). The authors concluded that despite making fewer aftercare arrangements that involved statutory mental health care services, psychosocial assessment by mental health nurses showed no sign of detrimental effects on repetition of self-harm.

For the abstract.

Commission on Child Witchcraft Begins in Nigeria

When UNICEF released its 2010 report, Children Accused of Witchcraft in Africa, it highlighted a worrying rise of cases of children being accused and punished for witchcraft in many African countries.   According to the report, the jump in child witchcraft accusations can be linked to pressures in religion, poverty, unemployment, HIV/AIDS and more.  Accused children are often "unwanted" orphans being raised by distant family members although there have been cases of even immediate family members accusing a child of witchcraft.  Once accused, a child can face a lifetime of psychological and physical abuse, first by family members and their own friends, and later by church pastors or traditional healers.   Reasons for the accusations can include suffering from medical problem, such as autism, ADHD, or behaviour problems.  Children often become scapegoats for any negative events that occur in their communities  (including any "bad luck" event).   Cases of children being killed by pastors to force them to confess to witchcraft have also occurred.

Despite the widespread belief in witchcraft across much of Africa and cases in which adults accused of witchcraft are often killed, accusations against children and adolescents is relatively recent.  The prosecution of child witches remains legal in many countries and accused children are often left to fend for themselves on the streets, exiled from their  communities.  As part of their effort to fight the rising epidemic in Nigeria, the Child Rights and Rehabilitation Network (CRARN) centre was established in 2003 in the Nigerian villge of Esi-Eket.  Beginning with three children, the centre (which consists of a small block of houses) now houses 186 children with an average of ten to fifteen new children each week.  While most of the children have been abandoned by their families, other families send children to the centre to be "cleansed" of their witchcraft.  Despite private funding  to expand the facilities to allow space for schooling, recreation, and counseling children and by initiatives by UNICEF and Stepping Stones Nigeria to eradicate the practice of child witchcraft accusations, progress remains slow.

The Nigerian government has recently launched a commission into allegations of child witchcraft in Nigeria's Akwa Iborn state where cases of accused witches are most common.  The commission is mandated to investigate witchcraft accusations and establish dialogues with the local communities.  Although the Child Rights Law passed in 2008 has criminalized child witchcraft accusations and imposed stiff penalties on offenders, there have been few convictions to date. 

For more information.

Caring for Nietzsche (Part 1)

Friedrich Wilhelm Nietzsche's health was never good.  Plagued by headaches most of his life (and being a bit of a hypochondriac as well), his reclusive bachelor lifestyle isolated him from all but his most devoted friends and family members.  Nietzsche's numerous letters to his mother, sister, and close friends were filled with frequent complaints about nausea, headaches and sleeplessness which left him unable to work for long periods of time.  One biographer suggested that his letters from that period of his life showed him as a "young, touchy, prematurely old, young man" whose medical complaints seemed to worsen whenever he failed to get his own way in something.  These health problems can't have been helped by his bizarre regimen of special diets (vegetarian or otherwise), patent medicines (he insisted on doctoring himself for his various complaints), and frequent worries with only occasional trips abroad to relax. 

Despite becoming a professor of philology at the University of Basel at the age of twenty-four and proceeding on to a brilliant academic career, Nietsche was forced to resign by 1879 due to health problems.    After establishing himself as an independent author and philosopher, he lived in various cities in Switzerland, France, and Italy in search of a more suitable climate.  It was also during this period when he produced some of his most remarkable works, including  Thus Spoke Zarathustra, Beyond Good and Evil, and The Antichrist.    He relished the notoriety that his writing brought him and became friends with some of the leading artists and intellectuals of his day.  Still, Nietzsche was often despondent because of his uncertain health and his own perceived sense of failure that his writing failed to win him the accolades he felt he deserved.   While his philosophical writing (with over one hundred books) would eventually make him one of the dominant intellectual figures of his era, this fame would come far too late for him.

It's hard to say for certain when Nietzsche's final illness began.  According to some sources, the breakdown occurred on January 3, 1889 when he was approached by two Turin policemen  after causing a public disturbance  and assisted in returning to his apartments (one anecdote relates that he had become agitated at seeing a horse being whipped).    In reality, however, disturbing clues as to Nietzsche's declining mental state come from a series of increasingly bizarre letters to his friends and acquaintances dating back to the final months of 1888 (and likely earlier).  The letters, now known as the Wahnbriefe ("Madness Letters") alarmed his friends greatly since they demonstrated just how disturbed the philosopher had become.   The bizarre tone of the letters (in which he frequently referred to himself as "Dionysius" or "the Crucified" and rambled at length about his grandiose delusions) spurred his long-time friend Franz Oberbeck to travel to Turin. 

Overbeck found Nietzsche in a bizarre state, being carefully watched over by his hosts.  As Overbeck would later describe, Nietzsche was "ploughing the piano with his elbow, singing and crying his Dionysian glory".    Returning with him to Switzerland, Overbeck was able to place his friend in a psychiatric hospital in Basel on January 10.  The examining physician commented on Nietsche's grandiose symptoms ("claims to be a famous man and asks for women all the time") and gave an official diagnosis of "mental degeneration".  I say official since the prevailing consensus was that the great writer was suffering from the effects of syphilis (although reliable diagnostic tests would not be available until decades later) which was largely a taboo topic in those days.  His supposedly grandiose delusions likely played a role in that diagnosis (he was still relatively unknown by that point) and there was no real evidence that he had ever been treated for syphilis in the past.

By January 13th, Nietzsche's mother arrived to take charge of her ailing son.  As the very proper widow of a Lutheran minister, Franziska Nietzsche had often been scandalized by her son's writing (including his "God is Dead" philosophy) but his surviving letters to her demonstrate the strong bond that they shared.   Franziska made arrangements for her son to return with her  to her home in Germany (over the clinic's objections).  As a compromise, Friedrich was transferred to to the asylum in Jena where Franziska could visit him regularly.  Since she was unable to afford first-class treatment for her son, only second-class treatment was available (no socialized medicine back then) although Friedrich hardly noticed the difference given his bizarre mental state.  Being in the second-class ward meant that he was left largely to himself and the original syphilis diagnosis went unchallenged.  He would remain in the Jena asylum until March 24, 1890 when Franziska discharged him to her home in Naumberg.   For the remaining seven years of her life, Franziska dedicated herself to her son's care including taking him for long walks, talking with him, reading to him, and generally tending to his every waking need.  

Continue to Part 2

Dealing with Suicide Attempts in Emergency Settings

Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings. A paper published in a recent issue of Crisis: The Journal of Crisis Intervention and Suicide Prevention evaluates the effectiveness of brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People’s Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt—the secondary outcome measure presented in the paper—were identified by follow-up calls or visits. Subsequent completed suicide—the primary outcome measure—has been reported in a previous paper. Results showed that, overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, χ² = 0.013; p = .909), but there were differences in rates across the five sites.The study authors concluded that the results do not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.

For the abstract.