Providentia

What Make An Expert Witness Credible?

Trial consultation has become a quickly growing domain of professional practice for psychologists.  By evaluating cases from a psychological perspective, trial consultants prepare expert witnesses prior to testifying, developing strategies to improve their credibility and even taking part in jury selection  A wealth of evidence shows that developing expert confidence and credibility are important goals for witness training. However, research has yet to articulate a list of testimony delivery skills needed to bolster perceptions of credibility and agreement with the expert. Research into witness preparation has been limited by ethical concerns surrounding that witness [preparation or "coaching" .  A study published in a recent issue of Consulting Psychology Journal: Practice and Research examines the theory behind  expert credibility and how it can be used during trial consultations.   Based on a sample of more than 300 university students and use of videotaped scripts, study results empirically validated a confidence-credibility mediation model of expert witness persuasion. The research also showed a strong effect between expert witness confidence, credibility, and positive jury decisions.  It is argued that the proposed model, grounded in credibility and confidence theories, can be integrated with existing methods of witness preparation training

For the abstact.

Sudanese Immigrant Beheaded in Saudi Arabia for Sorcery

In a case that has generated international condemnation, a Sudanese man was executed in Saudi Arabia  for using "sorcery and witchcraft".  Abdul Hamid bin Hussein Mostafa al-Fakki, a 36-year old migrant worker was arrested on December 8, 2005 by members of Saudi Arabia's Committee for the Propagation of Virtue and Prevention of Vice (CPVPV) and accused of practicing sorcery.   According to evidence against him, Abdul Hamid had reportedly agreed to provide a member of the CPVPV with a spell designed to ensure that the man's father would leave his second wife and return to his first wife (the man's mother).  He was said to have agreed to cast the spell in exchange for 6,000 Saudi Arabian riyals (approximately $1600 US).    Following his arrest, Abdul Hamid was reportedly questioned and beaten until he confessed to acts of sorcery.  During the time that he was awaiting trial at Medina Prison, his elderly parents attempted to appeal the case to Sudanese authorities to no avail. Following a trial was held without legal representation and behind closed doors, he was sentenced to death on March 27, 2007.

Despite letter-writing campaigns by international advocacy groups such as Amnesty International, the execution took place on September 19.  Abdul Hamid's execution is one of 44 that have occurred in Saudi Arabia this year (15 in May alone).   While capital punishment can occur for a range of offenses under Saudi law, executions for witchcraft or sorcery remain rare in the Middle East.   Anti-witch accusations are far more common in Africa and India. 

 

 

When Mount Pelee Exploded (Part 2)

Continued from Part 1

Leon Compere-Leandre was a shoemaker who had the good luck to live in a house at the very edge of the pyroclastic flow.   He was able to survive by throwing himself into the ocean although the superheated water nearly scalded him to death.  In describing the disaster, he stated that: 

"I felt a terrible wind blowing, the earth began to tremble, and the sky suddenly became dark. I turned to go into the house, with great difficulty climbed the three or four steps that separated me from my room, and felt my arms and legs burning, also my body. I dropped upon a table. At this moment four others sought refuge in my room, crying and writhing with pain, although their garmets (sic) showed no sign of having been touched by flame. At the end of 10 minutes one of these, the young Delavaud girl, aged about 10 years, fell dead; the others left. I got up and went to another room, where I found the father Delavaud, still clothed and lying on the bed, dead. He was purple and inflated, but the clothing was intact. Crazed and almost overcome, I threw myself on a bed, inert and awaiting death. My senses returned to me in perhaps an hour, when I beheld the roof burning. With sufficient strength left, my legs bleeding and covered with burns, I ran to Fonds-Saint-Denis, six kilometres from St. Pierre"

While he was initially believed to be insane when he arrived in the nearby town of Fort-de-France, Compere was eventually deputized and sent back to the ruins of Saint Pierre to help protect it from looters.  He later survived  two other deadly eruptions that occurred that year (he was one of the few survivors of the eruption that destroyed the town of Mourne Rouge on August 30).  Withdrawing almost completely from the public eye after 1902, Leon Compere-Leandre lived in relative obscurity until his death in 1936.

The most well-known survivor, Louis-August Cyparis (also spelled Ludger Sylbaris), seemed an unlikely candidate for surviving one of the worst disasters in history.  Believed to have been born in 1876,  he was working as a labourer in Saint Pierre up to the time of the Mount Pelee disaster.  Due to his fondness for rum, Cyparis was often in trouble with the law.   After being involved in a drunken brawl, he was placed in an underground solitary confinement cell on the evening of May 7.  This is probably what saved his life following the eruption since he was at least partially protected from the pyroclastic flow that passed  overhead. As he would report later, he was waiting for his breakfast when his cell became extremely dark.  Ash entered his cell through the door grating and he held his breath due to the intense heat.  Although his clothes remained unsinged, his hands, arms, legs, and back were badly burned by the hot ash that managed to enter his cell.  With only a container of water to drink, he managed to stay alive long enough for rescue parties to find him after four days.    One American reporter who interviewed him while he was still hospitalized in critical condition described Cyparis as being "more frightfully burned, I think, than any man I had ever seen". 

Cyparis eventually recovered and was granted a full pardon.  In later life, he joined the Barnum and Bailey circus as a living attraction, touring the U.S. and telling the story of the eruption and his  survival.   Appearing under the title of "The Man Who Survived Doomsday" (a.k.a. "The Most Marvelous Man in the World"),  Louis-August Cyparis had star billing with the circus.  Not an inconsiderable achievement given the racial segregation of the time which made him the first man of African descent to star in the show.  Often appearing in a replica of his Saint Pierre cell while he told his story to paying audiences,  "The Prisoner of Saint Pierre" would also display his scars as proof.    He died in 1929.

Even after the destruction of Saint Pierre, Martinique experienced a series of later eruptions and aftershocks including periodic ash clouds throughout much of 1902.  A massive eruption occurred on May 20 but there were no further casualities (since there were no inhabitants left in Saint Pierre).   American geologists arriving on Martinique on May 21 were astounded by the sheer devastation that the eruptions had caused.    There was no evidence of lava flow and all of the death and destruction occurred due to superheated sulphur gas and ash alone (geologists now refer to this as a Pelean eruption).  While there have been later Pelean eruptions (including the 1980 eruption of Mount St. Helens in the U.S.), none of them came close to the loss of life that occurred in 1902. 

After Saint Pierre's destruction, Fort de France became the economic hub of Martinique.  Although the town of Saint Pierre was eventually rebuilt on the site of the old city, the old glory was never restored.  Visitors to the small town of Saint-Pierre today will find only a huddle of houses surrounding a twin-spired church on the bay.  There are only two main thoroughfares which are often deserted and the current population is 4,590 (based on the 2007 census).   While still the district capital, Saint Pierre's current claim to fame rests on its designation as a "city of Art and History", the ruins of the old city, and the Volcanological Museum to commemorate the 1902 eruption. 

The "Paris of the Antilles" is no more.

 

 

 

 

How Dangerous are "Birthday Blues"?

Socioculturally meaningful events have been shown to influence the timing of suicide, but the influence of psychiatric disorder on these associations has seldom been studied. In a study recently published in Crisis: The Journal of Crisis Intervention and Suicide Prevention, researchers investigate the association between birthday and increased risk of suicide in the general population and in a national sample of psychiatric patients. Using demographic methods comparing the 50,160 people who died in England and Wales between 1997 and 2006 and who had received either a coroner's verdict of suicide or undetermined death.  The researchers also compared general population suicides to suicides by individuals in recent care of mental health services with respect to day of death in relation to one’s birthday.  Using Poisson regression analysis, results showed that an increased risk of suicide was observed on day of one’s birthday itself for males in both the general population (IRR = 1.39, 95% CI = 1.18–1.64, p < .01) and the clinical population (IRR = 1.48, 95% CI = 1.07–2.07, p = .03), especially for those aged 35 years and older. In the clinical population, risk was restricted to male patients aged 35–54 and risk extended to the 3 days prior to one’s birthday. The researchers concluded that birthdays are periods of increased risk for men aged 35 and older in the general population and in those receiving mental health care. Raising health-care professionals’ awareness of patient groups at greater risk at this personally significant time may benefit care planning and could facilitate suicide prevention in these individuals

For the abstract.

Medical Malpractice Suit to Proceed in Georgia Homicide Case

When Dr. Derek Johnson O'Brien began treating Victor Bruscato in January 2001, the patient's potential for violence was well understood.  The 38-year old Georgia resident had a long history of psychiatric involvement with numerous diagnoses including schizophrenia, mental retardation, intermittent explosive disorder and pedophilia.  Bruscato also had a lengthy history of assaultive behaviour with attacks on his parents, hospital staff, and a young girl.   He often reported auditory hallucinations commanding him to kill people and to molest girls.

At the time when treatment began, Victor Bruscato was living with his parents at their home in Gwinnett County, Georgia.  He had previously been in a group home for mental patients but had been removed due to fears that he might molest the female residents.    The parents were forced to take him in despite concerns about their ability to care for their son and the risk to their own safety.   Although their son continued to receive treatment, including medication to control his violent behaviour and sexual impulses,  it was well-understood that Victor Bruscato's parents needed to monitor him carefully.

Due to concerns that Victor Bruscato was developing neuroleptic malignant syndrome (which is potentially life-threatening),  Dr. O'Brien discontinued two of his medications, Zyprexa and Luvox, on a trial basis.   According to later testimony, Victor Bruscato's psychiatric condition worsened dramatically within two weeks of the medication being discontinued.    Along with nightmares, sweating, and panic attacks, he also experienced a worsening of his auditory hallucinations and became increasingly hostile towards his parents.   Although Dr. O'Brien met with his patient briefly in July, there was no change in his treatment.

By early August, visitors to the Bruscato home could see him rocking in his bed and pleading for the voices to leave him alone.  He also scrawled a  note stating: "[I] need prayer big time devil tormenting me".    On August 15, Victor Bruscato crushed his mother's skull with a battery charger and then stabbed her 72 times.  When questioned by arresting officers, Victor Bruscato admitted that killing his mother was wrong but that the devil had told him to do it.   While in prison, he reported continuing auditory hallucinations and speculated whether his mother would be "brought back to life".  He also asked which family member would be his new mother.   After being given Zyprexa in prison, Bruscato became more compliant and his condition improved.   He has since been found incompetent to stand trial and sentenced to Central State Hospital in Milledgeville, Georgia. 

Acting as his son's guardian, Vito Bruscato has filed a medical malpractice suit against Dr. O'Brien for discontinuing Victor's medication shortly before the homicide.   Although a DeKalb county judge had initially thrown out the lawsuit on the grounds of blocking Victor Bruscato from profiting from his homicidal act,  Georgia's Court of Appeal has reversed the ruling.   In a recent decision by Georgia's Supreme Court, the Court of Appeal's ruling has been unanimously upheld.   In the final decision, Justice Harold Melton wrote: "There has been no question that Bruscato killed his mother, that much has been admitted.  There is considerable question, however, regarding Bruscato's sanity and competency at the time the wrongful act was committed." 

The attorney for the Bruscato family, William Quinn III, has called the decision a landmark ruling stating that Victor Bruscato had been well-controlled while on medication.   "Taking those medications away, in our view, was obvious error", he added.   Although Dr. O'Brien's lawyer, Burt Satcher, declined to comment on the ruling, he stated that they were looking forward to trying the remaining issues.

The question of medical malpractice will now be decided in a jury trial to determine whether Victor Bruscato's murderous attack was due to his medication being terminated or by other causes.  While similar cases relating to medical malpractice in psychiatric treatment have been heard in other jurisdictions,  the trial examining whether Dr. Derek Johnson O'Brien deviated from reasonable standard of care provided by other psychiatrists will likely be closely followed across the country.

For more information.

 

When Mount Pelee Exploded (Part 1)

Before 1902, the city of Saint Pierre on the island of Martinique was known as the "Paris of the Antilles".  With more than 28,000 residents, Saint Pierre was the cultural and economic capital of Martinique.   More than 350 years old, Saint Pierre was a lively place with a rich Creole heritage,  schools, theatres, botanical gardens to mark its cultural importance.  Of course, it also had its share of brothels, gambling dens, and rum distilleries (it was that kind of place).   Martinique's intellectual and economic elite lived there and the vibrant social scene drew tourists from around the world.  While the overseas empire that France still had at the time was slowly dwindling, Saint Pierre was one of its economic jewels.

When the nearby volcano of Mount Pelee became increasingly active in early 1902, with disturbing signs that a major eruption was imminent, many residents of the neighbouring towns took refuge in the supposedly safe city which swelled the population of Saint Pierre to more than 30,000.  It would be a fatal mistake for the refugees.   Despite reassurances from the French governor (based in the capital at nearby Fort-de-France) that the volcano would soon quiet down again, the clouds of ash and sulphur from the volcano grew steadily worse.  Since local elections were scheduled for May 9 of that year, the government tried to maintain public order.  A mass evacuation of Saint Pierre would have been an administrative nightmare and neither of the leading political parties wanted to have the election disrupted.

By May 3, swarms of deadly fer de lance snakes flooded the streets of St. Pierre biting anything that came into their paths (likely caused by the worsening conditions of the nearby mountain).   That, along with the disturbing eruptions from Mount Pelee and other volcanoes that were part of the chain of volcanoes making up the Lesser Antilles arc, proved warning enough for many shippers who left port despite their cargo holds being only half full.   The ones living in Saint Pierre, both the long-term residents and the refugees who had fled there for safety, had no idea what would happen next.  By May 7, volcanic explosions had disrupted the local power grid and clouds of ash had blanketed much of the area.  Pyroclastic flows had already killed hundreds in more isolated parts of the country and those who couldn't leave on the steamship lines took shelter where they could.

On May 8, 1902, in what would be declared the worst volcanic disaster of the 20th century, the entire town of Saint Pierre was destroyed in a massive volcanic eruption. A gigantic mushroom cloud darkened the sky for more than 80 kilometres and a pyroclastic flow covered the entire city in less than a minute.  Those few eyewitnesses that saw the destruction from their relative safety on the boats at harbour would say that they watched the town "vanish before our eyes".  Not all the boats were spared however.  Sixteen of the eighteen vessels at port were destroyed as well.  At Fort-de-France, a telegraph operator received one final message from Saint-Pierre that fatal morning, the word "Allez".    When the Deputy Governor sent a French warship, the Suchet, to investigate, the captain and crew were horrified at the total destruction that they saw.  While they attempted to approach the city to provide assistance, the heat from the ash and the fires that would burn for days kept them back.  The total area of devastation covered more than 21 square kilometres (8 square miles) with Saint Pierre being the worst area affected.   Although there were numerous survivors from the fringes of the blast zone, many would later die from burns and smoke inhalation. 

When the Suchet finally landed,  the captain and crew found a scene of total devastation.  Not a single tree was left standing and dead bodies lay everywhere, many of whom had no time to escape.   Those bodies that could be examined seemed entire peaceful, the heat had killed them before than even had time to react or feel pain.   As the fires subsided, sanitation parties slowly entered the areas of greatest devastation but many bodies were unable to be recovered for weeks after the eruption.  Most were unrecognizable.   Boats picked up some survivors from the fringe areas although many of them died soon afterward.  International relief efforts slowly arrived.  U.S. President Theodore Roosevelt requested emergency funding from Congress stating that "one of the greatest calamities in history has befallen our neighbouring island of Martinique.  The city of Saint Pierre has ceased to exist..".   Canada, the United Kingdom, Denmark, France, Italy, Japan, and Russia also sent aid. 

While legend maintains that there were only two survivors from the destruction of Saint Pierre, the actual number of survivors was likely much higher.   It was through the descriptions of the disaster provided by survivors that a true picture of what they had experienced could be gained.    Of the known survivors, three names stand out:  Louis-August Cyparis and Leon Compere-Leandre, who were actually in Saint Pierre when the eruption occurred and Havivra da Ifrile, a young girl who reportedly escaped the eruption by jumping into her brother's boat and hiding in a nearby cave.  She lost consciousness as the pyroclastic debris entered the cave and caused the water to rise to the ceiling.   It was the Suchet that found her drifting in her charred boat two miles out to sea and pulled her to safety.  She eventually made a full recovery.

Continue to Part 2.

 

 

 

 

How is Depression Related to Mild Cognitive Impairment in Older Adults?

An article published in a recent issue of GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry reviews the relationship between depressive symptoms and mild cognitive impairment (MCI) in older adults. Evidence bearing on this relation comes from clinical findings, neuroimaging, and cerebrospinal fluid markers. Depression in elderly people is associated with a higher occurrence of cognitive impairment, whereas the decline of cognitive functions over time seems to be a predictor of the development of dementia. Further symptoms predicting a high risk of progression from MCI to dementia are: anxiety, restlessness, and low awareness of cognitive malfunction. There are controversies in the literature, however, about the connections among vascular brain lesions, depression, and MCI. Frontal and temporal brain regions seem to be at the core of functional changes in MCI patients. Several studies of cerebrospinal fluid point out the role of tau protein in predicting the outcome of MCI over time. In conclusion, diagnosis of MCI demands a complex assessment. MCI patients with and without depression need careful follow-up investigations.

For the abstract.

Opiate Crackdown Planned in State of Washington

The rising financial costs involved in treating chronic pain has led to increasing confrontation between pain patients and government agencies attempting to crack down on abuse of pain medication.  With an estimated 116 million Americans suffering from pain problems as well as the billions of dollars spent each year due to lost productivity and medication costs relating to chronic pain, calls for tightened prescriptions on pain relievers such as Oxycontin, Vicodin, Methadone, and other opiates have faced stiff opposition.   Since the 1990s, physicians have been accused of overprescribing pain medications which now account for more than ten percent of all written prescriptions.   Due to lingering public suspicion concerning use of opiates for treating chronic non-cancer pain, many state medical boards have invoked disciplinary authority to discourage the prescribing of opiates for non-cancer pain due to concerns about efficacy, toxicity, and addiction.

As a reaction to a rash of high-profile cases involving pain prescription overdoses as well as the increased availability of pain medications being made available as street drugs,  Washington's State Legislature has ordered the Department of Health to crack down on prescribing practices.  Beginning in January of this year, physicians who prescribe opiates for chronic, non-cancer, pain will be required to maintain health histories for all patients requesting pain medication.  These histories will need to include information on patient psychiatric conditions, history of addictions, "risk of significant adverse events" (such as potential injuries), and "the effect of pain on physical and psychological function".    Consultation with pain specialists when prescription exceed set thresholds are also mandatory under the new legislation.   The most important aspect of the new legislation involves the creation of a computerized central database which, beginning in January 2012, will be used to identify patients who are "prescription-shopping" pain medications at multiple clinics.

While physicians acknowledge the need for monitoring pain prescriptions, concerns have been raised about the intensified record-keeping required as well as the possiblity of increased liability in the event of patient overdoses.   Both the Washington State Medical Association and the Washington Academy of Family Physicians have formally protested the "increased administrative burdens" of the new legislation.  Patient groups have also expressed concern over the possibility that increased vigilance regarding over-prescribing pain medications may lead to pain patients being undertreated for legitimate pain conditions.   They are also concerned that family physicians may avoid taking on chronic pain patients to eliminate the administrative headaches involved.  While physicians will be able to use the proposed central database to identify drug-seekers among their patients,  critics have questioned the potential value of the database in preventing overdoses and whether chronic pain patients with severe pain will be unfairly flagged as "drug seekers".

As the demand for  better pain treatment grows across the United States,  policies such as the one planned in Washington state will likely become more common.  Whether the "baby is thrown out with the bathwater" as many critics argue remains to be seen. 

For more information

Loneliness, Social Isolation, and Health Problems in Older Adults

A number of mechanisms have been proposed through which social isolation and loneliness may affect health, including health-related behavioral and biological factors. However, it is unclear to what extent isolation and loneliness are independently associated with these pathways. A recent study published in Health Psychology examined the impact of social isolation and loneliness, individually as well as simultaneously, on health-related behavioral and biological factors using data from the English Longitudinal Study of Ageing (ELSA).  Data on health behaviors (smoking and physical activity) were analyzed from 8,688 participants and data on blood pressure, cholesterol, and inflammatory markers were analyzed from over 5,000 of these participants who were eligible for a nurse visit and blood sampling. Loneliness was measured using the short form of the Revised UCLA scale and an index of social isolation was computed incorporating marital status; frequency of contact with friends, family, and children; and participation in social activities. Results showed that fewer than 2% of participants reported being lonely all the time, while nearly 7% had the highest possible scores on social isolation. Both social isolation and loneliness were associated with a greater risk of being inactive, smoking, as well as reporting multiple health-risk behaviors. Social isolation was also positively associated with blood pressure, C-reactive protein, and fibrinogen levels. The authors concluded that loneliness and social isolation may affect health independently through their effects on health behaviors. In addition, social isolation may also affect health through biological processes associated with the development of cardiovascular disease.

For the abstract

How Do People Stay Healthy?

Which psychological variables have a positive impact on health during middle age?  A research study published in a recent issue of GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry examined data collected from 393 middle-aged participants (aged 35–45 at T1 and 45–55 at T2) as part of the National Survey of Midlife Development in the United States (MIDUS) to investigate the associations between health, optimism, positive affect, social support, and a cumulative burden score. Results show a positive association of the protective factors and a predictive value of positive emotions on health over time. The burden score showed no unique association with health. Overall, the predictors explained 17% of the variance of physical health and 33% of the variance of mental health. These findings emphasize the importance of investigating protective pathways.

For the abstract.