Providentia

When Children Are In Danger

A study published in a recent issue of Psychology of Violence examines the unique effects of multiple forms of victimization, namely child abuse and neglect (CAN) and exposure to parental intimate partner violence (IPV), on children's self-blame, feelings of being threatened, self-esteem, and ability to control anger. Using a cross-sectional designs, the study researchers recruited a population-based sample of 2,062 children aged 12–17 years in Hong Kong. Structured questionnaires were used to collect data from the children. The prevalence rate of the co-occurrence of exposure to IPV and CAN in the Chinese population, and the unique impacts of exposure to IPV and CAN on children were examined. Results showed 13.1% of the children had experienced CAN, and 6.5% had witnessed parental IPV. Among those families characterized by IPV, 61.1% were involved in child abuse in the preceding year of the study. Participants who had experienced both CAN and exposure to parental IPV reported lower levels of self-esteem and higher rates of being aggressive and violent, and feeling threatened. These children also reported the highest levels of feeling that their well-being was threatened and of blaming themselves for parental violence and parental discipline. The findings reemphasize the important need for public policy on child and youth victimization that encourages social workers and Child Protective Services to screen for child poly-victimization in cases of suspected/reported child abuse

For the abstract.

South African Family Murder Becomes Stage Play

Just days after Ellen Pakkies was released from a Cape Town psychiatric hospital where she had spent a month as an inpatient following a nervous breakdown, a play based on her life is set to premiere at an national arts festival next week.  Pakkies, a 50-year old former nurse, made international headlines after killing her 20-year old son Abie following years of abuse relating to his methamphetamine addiction.  The September 2007 murder was the culmination of a long history of unsuccessful attempts to control Abie's addiction including numerous convictions for theft, drug abuse, and domestic violence.  Friends and family of Ellen Pakkies described her as a long-suffering woman who finally snapped and strangled her son in his sleep.   Abie Pakkies had been abusing drugs since he was 14 and had been terrorizing his family and neigbours for years.  She was found guilty of murder and received a three-year suspended sentence.  She also served 280 hours of community service which was interrupted by her psychiatric admission. 

The Ellen Pakkies case has become celebrated in local circles due to the domestic violence and drug abuse issues.  Crystal meth (known as "tik" in local slang due to the custom of smoking it in a light bulb) is a rampant social problem in South Africa and is often linked to violent crime.  During her trial, she testified that her son threatened her and her husband with a knife, set fire to their curtains, and stole to finance his tik habit.  In addition to the stage play scheduled to be released, Pakkies' story has already become the subject of a documentary film and a book, Dealing in Death: Ellen Pakkies and a Community's Struggles with Tik.   She also founded the Ellen Pakkies Foundation focusing on drug addiction in the local community. In discussing her recent breakdown, she simply stated that "my body couldn't take it anymore".   Family members commented that Ellen Pakkies never overcame her sadness over losing her son and was overwhelmed by the responsibilities of her community service and Foundation work. 

The play based on her life, My Name is Ellen Pakkies, is set to premier at the Klein Karoo National Arts Festival on April 2.  Intended to present her story to a wider audience, a seventh performance was planned after the first six performances were sold out.  A percentage of the play's revenues will be donated to the Foundation and the play's producers hope that the donation will help with the construction of a planned rehabilitation centre. 

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The Bedridden Activist (Part 1)

The signing of the Treaty of Paris on March 30, 1856 meant an end to the bloody Crimean War.   It also meant that Florence Nightingale, the legendary "The Lady of the Lamp", could finally return to England.   Considering her fame, she actually had to travel incognito to avoid any unwanted publicity.  Turning turned down the offer of a naval ship to bring her home directly, Florence Nightingale (traveling under the name of "Miss Smith")  and her aunt took a long overland route which finally brought them, on foot, to their family estate at Lea Hurst on August 7, 1856.  Despite her attempt at privacy, there was no getting away from the fact that Nightingale had become a national heroine.   The "Nightingale Fund" that had been established to fund her overseas hospital was formed into a trust to finance non-sectarian training programs for nurses and midwives throughout the United Kingdom.  Contributions continued rolling in from  veterans, their families, and the general public and Florence Nightingale was overwhelmed by letters begging for financial help.  

She turned down numerous offers from the rich and famous and focused all of her efforts on establishing a new royal commission.  Her experiences in Turkey had demonstrated the need for a thorough investigation of the sanitary conditions in military hospitals.  She had been slow to accept that her own failure in preventing patient infections in her hospital had likely caused numerous deaths (leading to her confrontation with James Barry and other outraged surgeons).   To prevent further deaths, Florence Nightingale spearheaded the forming of the First Royal Commission of the Army.   After meeting with Queen Victoria at Balmoral Castle, she and her supporters lobbied for months before the commission was finally announced.   Once the commission actually began, she worked tirelessly preparing medical statistics (including some pioneering work with pie charts which she developed with the help of statistician William Farr), interviewing witnesses, and writing many parts of the commission's final report.

Despite Florence Nightingale's tireless work during the months that the commission was in session, her own health began to worsen.    Since many of the symptoms that she described have no precise definition (including "dilation of the heart" and "neurasthenia")  the actual diagnosis remained a mystery during her lifetime   All that was known for certain was that she grew progressively weaker during the months that she worked on the commission although the cause was a matter of speculation.  By 1859, she was almost completely bedridden and remained an invalid for the rest of her life. 

Not that her poor health prevented her from being a tireless crusader.  In addition to publicizing the conclusions of the royal commission report which came out in 1859, she also published Notes on Nursing in that same year.    Quickly becoming an introductory textbook for her newly established school, the slim 136-page volume is now considered a classic in the history of nursing.  Florence Nightingale also threw herself into the establishment of a new royal commission on India (stemming from the Sepoy rebellion of 1857).   Although she offered to go to India herself to aid with relief efforts, she was refused (and her declining health would likely have prevented her from going anyway).   Largely working from her bed, Florence Nightingale and her assistants sent out questionnaires that she had developed to investigate sanitary conditions in various parts of India.  After analyzing the results, she released a ninety-two page paper summarizing her findings which was eventually published as an appendix to the final royal commission report.   Her public advocacy of statistical analysis led to her election to the Royal Statistical Society in 1859 (the first female to be so honoured) and she later became an honorary member of the American Statistical Association as well.

Being a total invalid called for some radical changes in Florence Nightingale's life and working style.  She mainly stayed in her rooms in London and only saw visitors by appointment (and usually one at a time).  That didn't stop her from carrying on a massive correspondence with medical experts, politicians, and policy makers of all kinds (she would have loved email).   She rarely traveled except to visit family or friends at various country homes near London.  While occasional remissions allowed her to leave her sickroom at times and make public appearances, they were relatively rare and she never left England again.  Although she once loved attending art museums and the opera,  all of these activities were eventually cut back so she could focus on her work and her small social circle.  When her mother became ill in 1866, Nightingale went to Embley to care for her but quickly threw herself into a new project examining mortality statistics for several nearby towns.  She also agitated on social reform involving Poor Laws as well as greater rights for women seeking careers outside the home. 

Although Florence Nightingale opposed the Contagious Diseases Act, it was not because she opposed the germ theory of disease (as some critics later argued).  Even though germ theory was not taken seriously before Joseph Lister and Louis Pasteur made the theory acceptable, Nightingale actually pioneered the need for sanitation and antiseptic conditions.  Her opposition to the legislation that was eventually passed stemmed from the intrusive nature of the Act (including mandatory screening of prostitutes for syphilis and detaining infected women).   When the act was passed in 1864, she campaigned for its repeal.  

Continue to Part 2

Caring for Others

Lifetime parental caregivers of adults with intellectual disabilities (ID) may also become caregivers to other family members. A study published in Rehabilitation Psychology investigated caregiver experiences of compound caregiving (i.e. additional caregiving roles) and its association with caregiver quality of life.  Ninety-one older caregivers living with their adult son/daughter with ID were interviewed for the study. Mean age of the caregivers was 60 years and their sons'/daughters' mean age was 29 years. The outcome measures used were: compound caregiving status, physical and mental health, life satisfaction, depressive symptomatology, and desire for alternative residential placement for their co-residing son/daughter. Results showed that thirty-four (37%) reported being current compound caregivers to an additional care recipient, predominantly a mother, father, or spouse. Caregivers averaged 39 hours per week fulfilling their primary caregiving tasks, an additional 12 hours per week on the compound caregiving role, and the median duration of compound caregiving was 3 years. Compared with the non-compound caregivers, the compound caregivers had increased desire to place their son/daughter into residential care, though no group differences were apparent in life satisfaction, depressive symptomatology, physical health, or mental health. The most problematic issues reported by compound caregivers were having little personal time and a lack of adequate help from others. The authors concluded that compound caregiving was often experienced, and may galvanize these lifetime caregivers to start making future plans for their sons/daughters. Future research is warranted to refine more homogeneous groupings of compound caregivers, who may be at greater risk for adverse outcomes.

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Japan Needs to Learn from Chernobyl Lessons

As Japan slowly copes with  the devastating March 11 earthquake and tsunami, as well as the nuclear catastrophe that followed, psychologists warn that the mental health toll may be worsened if authorities fail to learn from the lessons of the 1986 Chernobyl disaster.   According to Valery Krasnov, director of Moscow's Research Institute of Psychiatry, "Insufficient information (on the risks after a nuclear accident) can generate tensions that destroy the health of people submitted to extreme conditions".  In his book, Psychological Problems for Liquidators after the Chernobyl Catastrophe, Krasnov revealed that the "liquidators" who were sent in to clean up after the Chernobyl nuclear power station were deliberately misled concerning the true extent of the danger that they faced. 

In the aftermath of the disaster, the Soviet Union kept the explosion and resulting contamination under wraps for days until international monitoring of radiation levels forced authorities to be more open.    When the Soviet Union sent thousands of liquidators into Chernobyl in the months following the meltdown,  neither the liquidators or their families were given sufficient information concerning the health risks involved.  In addition to the  thirty liquidators who died due to radiation sickness, many of those who survived often experienced long-term mental health problems resulting from their exposure.  Psychologists dealing with liquidators have reported that a "victim syndrome" is often found with the prevalent belief that they sacrificed their health and received nothing in return.  The stigma resulting from radiation exposure has left liquidators increasingly isolated from friends and family.  Suicide and substance abuse are common.

Although the nuclear disaster in Japan is not as severe as what happened in Chernoboy, Krasnov and other trauma specialists are warning that failure to warn emergency workers about the dangers that they face can have long-term consequences.   Observers have criticized Japanese authorities for presenting incomplete and, at times, contradictory information concerning nuclear contamination and the likelihodd of a reactor meltdown.  According to Krasnov, "Japan is keeping information back just like we did at Chernobyl. It's 1986 all over again". 

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Arresting Offenders with Serious Mental llness

A study published in Psychology,Public Policy, and Law examined patterns and correlates of arrest/re-arrests among offenders with a serious mental illness over a 4-year period. County criminal justice records and health and social service datasets were used to identify and describe inmates jailed in Pinellas County, Florida, between 7/03 and 6/04. A total of 3,769 participants (10.1% of arrestees) had a serious mental illness. Participants averaged 4.6 arrests (SD = 3.9, median = 4) and 150.6 days in jail (SD = 175.0, median = 90).Working from the trajectories of offending theory and literature, the study authors used latent class growth analysis to identify three classes of offenders with consistent numbers of arrests over a 4-year period and nearly parallel arrest trajectories; a sporadic arrest class (n = 469) with minimal arrests, a low arrest chronic class (n = 3,090, about one arrest/year); and a high arrest chronic class (n = 210, about four arrests/year). Analysis of arrests by age group within each of the classes suggested that for the low and high arrest chronic classes arrest rates persist throughout adult life. Statistical analysis showed that homelessness, a co-occurring substance abuse diagnosis, fewer mental health outpatient service contacts and more mental health emergency room/inpatient contacts were associated with being in a class with more arrests. Arrests among offenders with a serious mental illness appear to be unusually high, to be firmly established in late adolescence and to persist over time. Successful strategies to reduce the arrest rates of this population must address the needs of these offenders early in their criminal careers.

For the abstract

Indian Lawmakers Seek Ban on Witch Accusations

"The villagers, especially the women, call me a witch.  They insult me, torture me, and beat me up.  They wanted me to leave the village.  A couple of days back, they tied me around a tree and I was beaten badly.  I am scared.  How can I live in a place where people are after my life?"

In  filing a complaint against five of her fellow villagers, Kamla Bairwa of Jhalra village in Rajasthan's Tonk district described the horrendous pattern of abuse that she and many other women accused of witchcraft frequently endure.  While police have launched an investigation, the process is slow and frustrating and prosecutions remain elusive.  In July 2010, another woman, Vimla Devi of Nimera village was threatened when a gang of men tried to break down her door and kill her because a child in the village had suddenly become ill.   She was only saved after other villagers intervened and urged that the child be taken to a doctor instead.  Vimla had been attacked on previous occasions and was once so badly injured that she spent time in an intensive care ward at a local hospital.  Villagers accused her of learning witchcraft from her deceased mother-in-law, who had also faced similar accusations.

Despite India's attempts at modernization, belief in witchcraft remains strong in Rajasthan province and many other parts of the country.  Women such as Bairwa and Devi (who are often members of the untouchable Dalit caste or otherwise ostracized) are frequently targeted for verbal and physical abuse for being suspected witches.  Many women are accused as witches due to being mentally ill, widowed, infertile, or otherwise considered "ugly" or abnormal.  Any misfortune happening in the village, whether illness or natural disaster is blamed on them. The ill-treatment they receive often results in further isolation, murder attempts, and suicide.  Being socially ostracized also makes them unable to work or travel and fear of retaliation prevents many victims from laying charges against their attackers.

In one horrific case in 2009, an accused witch in her seventies was assaulted, stripped, and dragged to the village centre where she was forced to eat excrement as punishment.  Despite a large gathering, none of the other villagers came to her assistance. When her son attempted to lay a complaint with the local police, he faced opposition from village elders.  Only the intervention of India's National Commission of Women (NCW) forced the police to make arrests in the case.   Between 2004 and 2009, as many as 137 women were killed for being witches and service agencies suspect the actual number as being much higher.

In an attempt to curb the witch hysteria,the women's commission in Rajasthan has prepared a draft bill to make witchcraft accusations a criminal offense.  Titled the Rajasthan Prevention of Witch Practices Bill, it was first put forward in 2006 although there has been little action to date.   Government officials and police representatives continue to obstruct legislation and insist that anti-witch violence is not a significant problem.   Although the Rajasthan Home Department introduced a directive in 2004 to make witch-hunting illegal, it is rarely enforced and many police officers are unaware that the order exists.  Those few complaints which are laid are typically prosecuted as assault cases.  If Rajasthan does pass the Witch Practices Bill, it will be only the fourth province in India to ban witch accusations and prosecution of women for witchcraft.

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Burton's Melancholy

"THE/Anatomy of/Melancholy,/what it is./With all the Kindes,/ Cavses, Symptomes, Prog-/nostickes, and seve-/rall cvres of it./In Three Maine Partitions/with their seuerall Sections, Mem-/bers, and Subsec-/tions./Philosopbically,Medici-/nally, historically, ope-/ned and cvt vp./By/Democritus Iunior./ With a Satyricall Preface, conducing to/the following Discourse./Macrob./Omne meum, Nihil meum./At Oxford,/Printed by Iohn Lichfield and lames/Short, for Henry Cripps./ Anno Dom. 1621"

It's hard to imagine from that unwieldy title page that the book published by Robert Burton in 1621 would become a revolutionary best-seller.   Divided into three parts, The Anatomy of Melancholy was intended to provide a serious overview of a subject that had been largely neglected up to that time.  In his book, Burton avoided providing a precise definition of melancholy (depression) which he felt would "exceed the power of man".   He also stated that "the letters of the alphabet makes no more variety of words in divers languages" than the various symptoms that melancholy could produce in serious sufferers.    He considered melancholy to be a universal illness ("Who is free from melancholy? Who is not touched more or less in habit or disposition?" No man living is wholly free, no stoic, none so wise, none so happy, none so patient, so generous, so godly, so divine that he does not at some time or other experience its transitory forms. No other misery is so widespread").

Robert Burton was certainly qualified to write the book.   Born in Leicestershire in 1577, he studied at Christ Church, Oxford and was appointed a vicar in 1616.  Despite having a diverse range of interests, including mathematics and astrology, he also devoted much of his time to the serious study of melancholy.  By all accounts, Robert Burton suffered from frequent episodes of lifelong depression although actual clinical details are lacking.  Hewas one of nine children and his early childhood was apparently an unhappy one.  There also seems to be a family history of melancholy as well since his uncle, Anthony Faunt, died following a "passion of melancholy" in 1588.  Despite being a brilliant student, Burton's academic career was marked by long periods during which his studies were interrupted.  He finally graduated from Christ Church at the age of twenty-six (nineteen or twenty would have been more typical).  Although the gaps in his education are unaccounted for, his lifelong depression seems to be the most obvious explanation. 

There is still little known about Burton's private life aside from a few anecdotal accounts.   He never married and he socialized infrequently although he spent his entire academic life at Oxford.    While he was frequently depressed, he was also known as "very merry, facete, and juvenile," and a person of "great honesty, plain dealing, and charity." He also loved gardening as well as reading in his chambers at Oxford which were "sweetened with the smell of jupiter (incense)"  While he hardly ever travelled, he was an avid cartographer and, in virtual fashion, explored much of the world. Despite being a scholar his entire life, Burton was extremely cynical about his  fellow academics and academia in general.  His reclusive nature didn't prevent him from being well-regarded by his colleagues and he received prestigious appointments to vicar positions at Oxford and Leicester.    Burton also published various Latin verses as well as works in mathematics and a satirical play in  when which was well received when it was produced in 1617.  

It was The Anatomy of Melancholy which made Robert Burton a success though.  Written when the author was in his late forties,  the book had a boisterous tone which antagonized many critics (one of whom dismissed it as "an enormous labyrinthine joke").   Serious reviewers were also likely put off by the "phantastical title" which Burton had included to attract "silly passengers that will not look at a judicious piece".   Beginning with the "satyical preface"  that vigourously attacked many of the prevailing views on melancholy, the book quickly led into discussing the topic in earnest.  The first part of the book was dedicated to discussing the causes, symptoms, and prognosis of melancholy, the second part was dedicated to treatment, and the third part focused on the melancholy often associated with love or religion.  Filled with an astounding number of  anecdotes and quotations (including quotations by hundreds of medical writers, theologians, classical writers, historians, and poets) , readers of the book often found Burton's reasoning to be hard to fathom (I certainly did).   It likely doesn't help that up to a fifth of the book is in Latin and Burton also used  numerous obscure terms that often mystify modern readers (including words like "stramineous", "obtretration", and "amphibological"). 

Burton's theories on melancholy reflected much of the prevailing medical thinking of the time.  Along with attributing the disease to an excess of "black bile" (humour theories were popular at the time), he also suggested that melancholy could be linked to heredity, lack of affection in childhood, and sexual frustration.   Although it was a more credulous era (witches were still being executed for cursing people into madness), Burton avoided supernatural explanations for melancholy.  That's not to say that he didn't have his own personal biases though.  He was openly misogynistic and frequently denounced women in general and their "unnatural, insatiable lust" in particular.   Many of his anecdotes focused on the melancholy caused by men pursuing women, material pleasures, and worldly success although he was more cynical than puritanical.   Burton freely admitted that his motivation in writing the book stemmed from his own need to "write of melancholy, by being busy to avoid melancholy.  There is no greater cause of melancholy than idleness, no greater cure than business".  

He originally published the book under the pseudonym of Democritus Junior (Democritus being his favourite Greek philosopher) but Burton's true identity became known soon enough.  The odd mixture of scholarship, humour, and medical insights was virtually unprecedented in an academic book and Anatomy quickly became one of the most popular books of that era.   Despite the fame and wealth that his book brought to him, Burton's lifelong melancholy didn't seem any more manageable as a result.   When he died on January 25, 1640, there were widespread rumours that he had hanged himself in his rooms at Oxford.  Given that Burton had often predicted that he would die when he reached the age of sixty-three, there may be some truth to the rumour.  Considering the harsh punishment for suicides during that time (including being buried at a crossroad with a stake through the heart in extreme cases),to the suicide of  a prominent Oxford scholar would have likely been carefully concealed.   Robert Burton was buried in Christ Church cathedral with full honours.  Following Burton's own instructions, his grave was mared with the following inscription carved under his bust: Paucis Notus Paucioribus Ignotus Hic lacet DEMOCRITUS IUNIOR Cui Vitam Dedit et Mortem Melancholia ("Known to few, unknown to fewer, here lies Democritus Junior, to whom melancholy gave both life and death").  That the inscription helped reinforce the suicide rumour may well have been unintentional.  

Burton's vast collection of books (more than a thousand volumes) was left to the Oxford University library but it was The Anatomy of Melancholy that was his most lasting contribution.   Although the book fell into neglect just a few decades after Burton's death, it was frequently cited by later authors - including Samuel Johnson, John Milton, and Laurence Sterne - and came back into popularity by the beginning of the 19th century.  Not only is it considered to be one of the great works of English literature, but it was also one of the first true classics of abnormal psychology.   Digging through Burton's book may not provide the modern student of psychology with much insight into depression but Robert Burton was definitely a pioneer in his own right. 

Link to Anatomy of Melancholy (Project Gutenberg)

 

Can Suicide Bombers be Predicted?

For years, the conventional wisdom among most scholars has been that suicide terrorists are not truly suicidal, and that much like ordinary soldiers they are motivated by a selfless commitment to their organization’s cause, rather than a desire to end their lives.  In a provocative editorial  published in Crisis: The Journal of Crisis Intervention and Suicide Prevention,  Adam Lankford of the University of Alabama's Department of Criminal Justice suggests that evidence increasingly indicates that some suicide terrorists do exhibit classic suicidal traits.   While it is difficult to quantify the overall percentage of suicide terrorists who appear suicidal (because the requisite biographical and motivational data on individual attackers are often missing),  the list of suicide terrorists who appear to have displayed risk factors for conventional suicide is steadily growing. One of the remaining issues that has not received sufficient scholarly attention is the interaction between social approval and suicide, with regard to how that affects our understanding of suicide terrorism. A major reason why previous scholars have largely dismissed the possibility that suicide terrorists could be suicidal is because they have failed to control for the effects of social approval. The editorial discusses the topics of comparing suicide terrorists to typical suicidal individuals and identifying suicidal tendencies under conditions of social approval. In addition, recommendations for suicide terrorism prevention are provided.

For the abstract

Suicide Verdict in RCMP Taser Case

When RCMP officers were called to a house in Langley, British Columbia on on September 30, 2008,  they found Frank Jonathan Frechette acting in a very bizarre fashion.  Frechette, 49, had jumped naked out of his second-story window as he was bleeding from several self-inflicted wounds.   That same morning, he had robbed a local bank with a wrapped shotgun and had been followed home by a bystander who tipped off police.   When Frechette ignored police orders to lay down on the ground, he was Tasered and subsequently arrested.  According to his common-law wife, he had stabbed himself in the lung with a butcher knife and than "dove head-first out the window like he was going off a diving board".   After being taken into custody and charged with armed robbery, Frechette died that same day at Langley Memorial Hospital due to massive blood loss resulting from his stab wounds.

Following a coroner's inquest, Frechette's death has been ruled a suicide.  In reaching that verdict, the five-person jury examined testimony from the arresting officers as well as the results of Frechette's autopsy.  The presiding coroner, Lisa Graham, had previously reminded the jurors that Frechette had "directed officers to shoot him" when confronted at his home.  Toxicological evidence established that Frechette had been under the influence of heroin at the time which contributed to the behaviour he had displayed that day.  After committting the armed robbery (he stole $3500.00), he returned home where his behaviour became increasingly bizarre culminating in his stabbing.  His common-law stated that she had been unaware of his drug use. 

The jury did not offer recommendations regarding police conduct.   Following the court decision, Jody Pylpow, the estranged mother of Frechette's two children stated that there was no need to Taser him.  "He was not armed, he was nude and he was bleeding. Something could have been done.”

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