Providentia

"Witch Killing" Trial Underway in U.K.

When 15-year old Kristy Bamu arrived from France to visit his sister and her partner in their East London apartment, he was subjected to "unimaginable physical torture" before being drowned in December of 2010.  In testimony presented to the Old Bailey court on the opening day of their trial, Magalie Bamu and her partner Eric Bikubi were accused of murdering Kristy Bamu and torturing his two sisters, apparently to force them to confess to practicing sorcery.  

According to testimony, Kristy Bamu and his two sisters were subjected to days of sleep deprivation, starvation, and repeated attacks with metal bars, wooden sticks, a hammer, and pliers in what the prosecutor described as "a prolonged attack of unspeakable savagery and brutality".  After days of abuse, Kristy Bamu reportedly confessed to being a sorceror to end the torture.  The boy and his sisters were then forced into a bathtub and submerged in water.  An autopsy showed that he died of drowning and the 101 injuries found on his body. 

Allegations of witchcraft began shortly after Kristy and his four sisters arrived in London.   Following a few uneventful days, Eric Bikubi began accusing several of the siblings of being possessed by spirits and having an "evil influence" on the youngest child.   According to Kristy's younger sister, Kelly, the allegations of witchcraft began after Kristy wet his pants and attempted to hide them in the kitchen.  Magalie Bamu supported her partner and joined him in attempting to exorcise spirits from Kristy and his two sisters.   The children were forced to chant and pray non-stop for several days before Kristy became the focus of Bikubi's abuse.   The abuse became so bad that Kristy eventually begged for death. 

Following Kristy's death, paramedics called to the scene found deep cuts and bruises on his head, face, back and arms as well as several missing teeth.  All of the children were hysterical and soaking wet.   Although none of the children spoke English, a French-speaking paramedic was eventually able to extract "a tale of horror" from Kristy's younger sister, Kelly.    She identified the various items in the apartment that were used as weapons to torture them all into confessing to witchcraft.  Eventually, Bikubi took Kristy into the bathroom and placed him into the bathtub which he then filled with water.  Kristy was too badly injured and exhausted to keep his head above the rising water and eventually drowned.   Bikubi then placed the other children into the tub and hosed them all with cold water using the shower head.    Magalie Bamu then called emergency services claiming that her brother had drowned himself and that Bikubi was trying to revive him. Both Bikubi and Magalie Bamu called her parents several times during the younger children's ordeal and Bikubi had threatened to kill Kristy if he was not returned home.  After failing to hear further from them, the parents attempted to travel to London but the Christmas rush prevented them from arriving until after Kristy's death.   When neighbours had complained of the flooding from the apartment, the local council sent a plumber who found "nothing untoward" in the apartment and left shortly before emergency services were called. 

In testimony presented to the court, jurors were told that both Bikubi and Magalie Bamu were natives of the Democratic Republic of Congo where belief in sorcery is widespread.  Although witchcraft accusations and killings are prevalent across much of Africa, cases of anti-witch violence remain rare in Western countries.  Eric Bikubi has denied being guilty of murder but has confessed to manslaughter and pleaded guilty to two counts of actual bodily harm.  Magalie Bamu has denied all charges and the trial is continuing.

For more information

Let Sleeping Children Lie

A study recently published in Developmental Psychology presented the results of a research project examing relations between changes in children's cognitive performance and changes in sleep problems over a 3-year period.  Family socioeconomic status, child race/ethnicity, and gender were also assessed as moderators of these associations. Participants were 250 second- and third-grade (8–9 years old at Time 1) boys and girls. At each assessment, children's cognitive performance (Verbal Comprehension, Decision Speed) was measured using the Woodcock-Johnson III Tests of Cognitive Abilities, and sleep problems (Sleepiness, Sleep/Wake Problems) were collected via self-report. Individual growth models revealed that children who reported increases in Sleepiness exhibited little growth in Verbal Comprehension over time compared with their peers who reported decreases in Sleepiness, resulting in a nearly 11-point cognitive deficit by the end of the study. These associations were not found for Sleep/Wake Problems or Decision Speed. Child race/ethnicity and gender moderated these associations, with Sleepiness serving as a vulnerability factor for poor cognitive outcomes, especially among African American children and girls. Differences in cognitive performance for children with high and low Sleepiness trajectories ranged from 16 to 19 points for African American children and from 11 to 19 points for girls. Results build substantially on existing literature examining associations between sleep and cognitive functioning in children and are the first to demonstrate that children's sleep trajectories over 3 waves were associated with changes in their cognitive performance over time

For the abstract.

Majority of Americans with Mental Disorders Do Not Seek Help

Just got back from Science Online 2012 which was an awesome experience.  A big hat tip to all my fellow science bloggers and online science mavens.  More on that later.  In the meantime:

A new report released by the Substance Abuse and Mental Health Services Administration (SAMHSA)  indicated that the majority of Americans experiencing some form of mental disorder do not seek professional help.  According to the SAMHSA report, while 20% of American adults (45.9 million) experienced some form of mental illness in 2010, only 39.2% received some form of treatment.  The report is based on an annual survey of 67,500 people across the United States stratified according to age and the results appear almost identical to reports from previous years.  For the purpose of the study, mental illness is defined as a diagnosable condition meeting diagnostic critera as laid out in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).  Of the study participants, the rate of mental illness was more than twice as high among participants aged 18 to 25 than those participants 50 years or older (29.9 vs 14.3 per cent).  Overall, adult women were far more likely than men to have experienced mental illness in the last year (23 per cent vs. 16.8 per cent).  Twenty per cent of the study participants reporting some form of mental illness also met criteria for substance abuse.

For the participants in the study, 3.8 per cent of women and 3.7 per cent of men reported serious thoughts of suicide in the past year with adults in the 18 to 25 year age range being the highest risk for suicidal thoughts.  The  results also showed that 1.1 million adults (0.5 per cent of all Americans) attempted suicide or made suicide plans in the past year.   More than 8.7 million adults had serious thoughts of committing suicide.  Poverty and employment status appeared to be a significant factor with 27.8 per cent of Americans reporting some form of mental illness in 2010 being unemployed and 22.7 per cent being part-time employees.  Only 16.7 per cent of study participants reporting mental illness were fully employed.  A significant percentage of study participants fell at or below the federal poverty level (29.5 per cent). 

Serious mental illness was defined in the study as meeting DSM-IV-TR criteria with a severe functional impairment interfering with major life activities.  Based on  findings, there are an estimated 11.4 million American adults with serious mental illness and the overall figures appear unchanged from the 2009 survey.  Of those study participants who sought treatment for mental illness, 60.7 reported seeing a family doctor while 33 per cent reported seeing a psychiatrist or psychotherapist.   In terms of type of treatment, 46.6 per cent received psychiatric medication and/or talked to a medical doctor.   

The study also examined mental health patterns in youths aged twelve to seventeen and found that the prevalence rate for a major depressive episode in 2010 was 8 per cent (suggesting an estimated 1.9 million youths across the United States).  Of these youths, 19.9 per cent had a substance use disorder in the past year while only 6.1 per cent of youths without a major depressive episode reported substance abuse.   Depressed youths were also more likely to be heavy alcohol abusers and daily cigarette smokers than non-depressed youths.

The report also noted that treatment cost remains the primary barrier for seeking treatment for mental health problems.  Use of mental health services was highest among adults receiving Medicaid or other government health coverage (14.9 per cent) as opposed to adults with private health insurance (13.4 per cent).  Only 9.2 per cent of adults without medical coverage sought mental health services.  Between 2002 and 2010, percentage of adults using outpatient services declined from 7.4 to 6.6 per cent while percentage using prescription medication rose from 10.5 to 11.6 per cent.

For those adults who experienced some form of mental illness but did receive treatment, the primary reason for not seeking treatment was cost (43.7 per cent) while an additional 32.2 felt that they could handle the problem without treatment.   Other reasons for not seeking treatment include not knowing where to go for services (20.5 per cent), not having the time (14.6 per cent), and not wanting others to find out (10.0 per cent).  Concerns about confidentiality, insufficient health coverage, and potential stigma were also identified as factors stopping people from getting help.

In summarizing the 2010 study findings, the reports concludes that a strong link exists between mental illness and demographic factors such as age and low socioeconomic status.  While study participants with severe mental illness were most likely to receive the help they need, a large percentage of Americans with mental illness are not receiving any form of treatment.   Generalizing from the study results, an estimated 45.9 million American adults experienced some form of mental illness last year with only 40 per cent of them receiving some form of help for their problems.  The most common barrier to seeking treatment appears to be financial cost.  The trends noted in this report appear largely unchanged from the 2009 report and suggests that current initiatives for improving access to health care for Americans without coverage don't go far enough in allowing the most vulnerable segments of American society to receive the help that they need.

Results from the SAMHSA 2010 survey.

When Offenders Commit Suicide

Offenders are at elevated risk for interpersonal violence victimization (IVV), which is a risk factor for suicide-related outcomes in some populations, suggesting the importance of examining risk associated with IVV in offenders. A study published in a recent issue of Crisis: The Journal of Crisis Intervention and Suicide Prevention examined the association between IVV and suicidal ideation (SI) among criminal offenders in a pretrial jail diversion program in the United States. A sample of 266 offenders were screened for ten common Axis I psychiatric disorders along with current SI and past-year IVV. Results showed that past-year IVV was significantly associated with current SI, and the association remained significant after adjusting for symptoms of ten Axis I psychiatric disorders, respectively and simultaneously. Gender did not moderate the IVV-SI association. The researchers concluded that their findings support a connection between interpersonal violence victimization and suicidal ideation in criminal offenders.

For the abstract.

Providentia-Year Five

This post marks the fifth anniversary of this blog of mine (I'm not quite sure what that is in blog years).  It's been a strange journey to date and I have managed to attract a certain amount of notice which is somewhat gratifying.  I seem to have a blogging routine that works for me and I even have time to do some guest blogging on other sites, not to mention maintaining a presence of Twitter and Facebook.   I could do an in-depth analysis of blogging statistics to date or planned future posts but I'll defer that and simply invite any comments or suggestions regarding what kind of posts you'd like to see me write about in future. 

No SEO or spam please.  I'm not that easygoing. 

p.s.   I'll be away for a few days attending the Science Online conference in Raleigh, N.C.  I'll try to provide some live-tweeting and a summary for next time.    Until then. 

In Praise of Pain

Human beings have always had a love/hate relationship with pain.

While pain and suffering have always been viewed as something all humans had to endure (including Biblical stories such as  childbirth pain being due to the sin of Eve or Job being afflicted with suffering to test his faith), the idea that bearing pain stoically was a sure sign of virtuous living was rarely far behind.  The very word “stoic” stemmed from a philosophical school that viewed pain and suffering as essential to being truly human. In St. Paul's First Letter to the Colossians, he wrote that: "I fill up that which is behind the afflictions of Christ in my flesh".     Virtually every organized religion has regarded pain as a necessary evil.   At the same time, herbal remedies for dealing with pain are as old as medicine itself.   While physicians and other healers often viewed pain as being an important sign of disease and that masking it with medication  interfered with treatment, they were also quick to dispense whatever pain-relieving agents that they had at their disposal to patients in agony.   That usually included the familiar standby, papaver somniferum (a.k.a., the opium poppy), which was cultivated for its analgesic properties as far back as neolithic times in most of Eurasia.

Even with the advent of anesthesia in the 19^th century, new  innovations including morphine, chloroform, and nitrous oxide were greeted with mixed feelings, especially among religious leaders who viewed such innovations as somehow being a subversion of God’s plan.  Queen Victoria’s very public decision to use chloroform to ensure a painless delivery of one of her children in 1853 was greeted with alarm at first although it also helped spread the word that anesthesia was safe and effective.  Despite religious qualms, the era of painless dentistry and surgery had begun.

By the dawn of the 20^th century, anesthesia was already widely used in surgery.  While pessimistic philosophers such as Arthur Schopenhauer stressed the inescapable nature of pain in their own writings,  improvements in medicine, including the wide availability of powerful analgesics,  made pain relief universally available (at least to those who could afford it).   Even familiar remedies such as morphine seemed to be superseded by better and stronger alternatives, including heroin which was available in numerous locations without a prescription.

As the dangers associated with opiate addiction became better understood, an inevitable backlash set in.  Many commercially available analgesics were eventually banned under international narcotics laws.  Prohibition became a dominant movement in the United States while, in other countries, medical doctors, theologians,  and social critics viewed the addictive properties of many popular narcotics with increasing alarm. This alarm was spurred by the thousands of wounded veterans of World War I, many of whom were left addicted to the pain medication that had been prescribed to them.   This public alarm led to attempts at reconceptualizing how pain should be treated.  Rather than viewing pain as something to be eliminated by any means possible,  wasn't it possible that resisting pain was actually a virtue and that giving into pain by demanding medical relief was actually a form of cowardice? 

By 1935, French writer and journalist, Julien Teppe, became the leading force in what had already been named the "dolorism" movement.  Taken from the Latin word for pain, dolorism basically exalted the value of pain, both medically and philosophically.  The two books that Teppe wrote, Apologie pour l'anormal (a.k.a. the "Dolorist manifesto") in 1935 and Dictature de la douleur in 1937 justified dolorism as a reaction against what Teppe called the "tyranny of the fit".  He viewed pain as  a way of learning about onself (essentially arguing that "I am suffering, therefore I am").  He also wrote that, "Pain, of all the psychological states, is the one which takes over the entire being, both the flesh and the spirit, with the greatest urgency and force.  It is a disposition which sweeps away, blots out, and annihilates all the rest."   Through pain, humans learn about compassion for other human beings and inability to understand suffering was the root cause for hostility and intolerance.  Not only did Teppe argue for a better understanding of pain, he also suggested that students in all programs be required to visit hospitals and sanatoriums as part of their education. 

While not an original concept (existentialist philosophers such  as Karl Jaspers and Martin Heidegger had made  similar arguments years before), Teppe's movement quickly took root.   Along with his influential books, Teppe also launched the Revue Doloriste, an episodic journal that was meant to be the standard for the entire dolorist movement.   On its first publication in 1946, the French conservative paper, Le Figaro, a tongue-in-cheek endorsement to the new journal and to dolorism in general:  "No school ever chose its hour better than this one.  Every French citizen is an unknowing Dolorist.  And [then-premier] Monsieur Gouin, perhaps, is one".   While never the financial success that Teppe had hoped, the first issue sold 5,000 copies and eventually included original essays from such prominent writers as Andre Gide and Colette.

That dolorism became a hotly debated subject before and after World War II is perhaps not surprising given the political and economic struggle to rebuild Europe.   Theologians continued to advocate pain as a necessary evil while neurologists and physiologists weighed in on the medical aspects of pain.  Teppe's chief opponent was prominent surgeon, Rene Leriche.  Having gained his experience in treating pain associated with battlefield injuries in World War I,  Leriche's book La Chirugie de la douler (the Surgery of Pain) quickly became a classic in treating "pain disorders" after its publication in 1937.  As a militant humanist as well as a surgeon, Leriche avidly fought any attempt to glorify pain and argued against the idea that pain could be beneficial or useful in any way.    Ironically, Leriche actively spoke against the use of pain medications such as morphine and argued that surgical approaches were the ideal method for pain relief. 

Another prominent dolorism opponent, prominent neuropsychiatrist Jean L'hermitte, argued that "the first duty of medicine is to heal when it can, to relieve often, and to comfort always.  As a result, a physician's role is not only to relieve moral suffering often but also, insofar as it is possible, to alleviate pain and its repercussions on the different organs."    As an important example of pain's importance, L'hermitte described cases of syringomelia in which patients with interrupted sensory nerve fibres injure themselves due to their inability to feel pain.  He also saw analgesics such as morphine as being effective in preventing suicides among chronic pain sufferers. 

Still, the spectre of addiction to pain medication was ever present.  Even L'hermitte was quick to argue that some physicians gave out morphine "too freely" and that it should only be prescribd by physicians who were certain that their patients were genuinely suffering.  He advocated that morphine only be administered through injection and at the doctor's discretion.   While he denounced dolorism as a dangerous trend, he still advocated an extremely conservative approach to pain treatment which often meant that patients were expected to "suffer in silence" rather than admit that they were unable to bear their chronic pain "maturely".  Many religious hospitals, though recognizing the need to deal with pain, often stressed the virtue of endurance and advised doctors and nurses to train patients to resist pain rather than to plead for better analgesics.   As formal treatment shifted towards specialized hospital wards to deal with chronic pain patients, pain clinics have become an integral part of most tertiary care hospitals.

Although today's physicians are no longer expected to allow patients to "suffer for their own good", the old dolorist arguments have never completely faded away.  The reluctance to prescribe pain medications due to addiction risks, however legitimate, often masks an expectation that patients overcome pain on their own rather than rely on chemical aids.  That there is an obvious economic component to this argument (medication costs money, after all) makes it all the more appealing to rein in rising health care costs.   Many of the moral dilemmas and problems raised by Julien Teppe and his supporters have yet to be resolved and the stringent regulations that physicians often face in prescribing medication means that pain management remains one of the most contentious issues facing medicine today. 

And that is unlikely to change any time soon. 

 

 

 

Are There Gender Differences in Veterans Suffering PTSD?

Though the broader literature suggests that women may be more vulnerable to the effects of trauma exposure, most available studies on combat trauma have relied on samples in which women's combat exposure is limited and analyses that do not directly address gender differences in associations between combat exposure and postdeployment mental health. Female service members' increased exposure to combat in Afghanistan and Iraq provides a unique opportunity to evaluate gender differences in different dimensions of combat-related stress and associated consequence for postdeployment mental health. A recent study published in the Journal of Abnormal Psychology addressed these research questions in a representative sample of female and male U.S. veterans who had returned from deployment to Afghanistan or Iraq within the previous year. As expected, women reported slightly less exposure than men to most combat-related stressors, but higher exposure to other stressors (i.e., prior life stress, deployment sexual harassment). No gender differences were observed in reports of perceived threat in the war zone. Though it was hypothesized that combat-related stressors would demonstrate stronger negative associations with postdeployment mental health for women, only one of 16 stressor × gender interactions achieved statistical significance and an evaluation of the clinical significance of these interactions revealed that effects were trivial. Results suggest that female Operation Enduring Freedom/Operation Iraqi Freedom service members may be as resilient to combat-related stress as men. Future research is needed to evaluate gender differences in the longer-term effects of combat exposure.

For the abstract.

Is Deep Brain Stimulation Useful In Treating Depression?

Considering the long controversy over the use of electroconvulsive therapy (ECT) in treating mental illness, it hardly seems surprising that new approaches involving deep brain stimulation to treat depression are being viewed with suspicion by mental health critics.  While use of electrodes surgically placed in the brain to modify brain functioning in humans and animals has a relatively long history, deep brain stimulation (DBS) involving the implantation of a brain pacemaker sending electrical currents to specific parts of the brain first became an established procedure in the 1990s. Since that time, DBS has been formally approved by the Food and Drug Administration in the United States for a range of neurological disorders such as Parkinson's Disease, essential tremor, chronic pain, and dystonia,

Although the use of DBS in the treatment of treatment-resistant depression has faced resistance from anti-ECT groups, a recent study by a team of researchers has indicated that the procedure is safe and effective.  Led by Dr. Helen Mayberg, professor of psychiatry and neurology at Atlanta's Emory University, the researchers tested DBS on seventeen patients, including one from Canada, and found that half of the patients were still in remission after two years of continuous stimulation.    The study follows up on similar research in Canada by Dr. Mayberg and Toronto neurosurgeon, Dr. Andres Lozano as well as psychiatrist Dr. Sidney H.  Kennedy which had previously shown that DBS could be useful in treating depression.

The Emory study, which included patients with depression and bipolar disorder, selected patients who had previously failed to benefit from at least four treatment regimens, including ECT and who had been diagnosed as depressed for at least four years.   The DBS procedure involved placing the patient's head in a special frame while attaching them to an operating table.  A quarter-sized incision then inserted two electrodes on either side of the brain focusing on a specific region of the brain known as Brodmann area 25 (also known as the subgenual area cingulate) which is extremely rich in serotonin transporters and has been linked by Dr. Mayberg and other researchers to treatment-resistant depression.  The area is known to be a central control mechanism to a vast neural network extending to the hypothalamus, amygdala, brain stem and insula and has been implicated in mood, anxiety, appetite, sleep, as well as self-esteem. 

Once the electrodes are in place, the surgeon tunnels under the skin to connect the electrodes to an implantable battery placed under the collarbone.  The current to the electrodes are adjusted using a handheld computer and seventy per cent of patients undergoing the procedure report a response as soon as the electrodes are switched on in the operating room.  The patient remains awake during the procedure except for a general anesthetic.   For the purposes of the study, patients were told that they would receive a real or "sham" stimulation for four weeks post-surgery when, in fact, none of them received actual stimulation during the trial period.  There was little meaningful clinical benefit suggesting no placebo effect during the no-stimulation period.  Afterward, patients received a six-month period of actual stimulation with 41 per cent of patients reporting an improvement in depressive symptoms.   After one year, 36 per cent of the study patients experienced a remission in depression while another 36 per cent reported significant benefit (meaning at least a fifty percent improvement on clinical measures of depression).  After two years of active stimulation, most patients reported significant benefit although at least 58 percent reported remission of symptoms. 

While Dr. Mayberg acknowledged that DBS was not a "happiness" treatment, she summarized her results by saying that "we seem to be removing that deep, dark negative empty sadness — that interference that is so profound that it totally hijacks your brain from doing anything else".    Patients undergoing DBS treatment seem to go through two phases, the first phase during which they realize that the severe mental pain which makes life not worth living is no longer there and the second phase when they ask themselves, "what do I do now?"    While DBS helps control deep depression, extensive rehabilitation is still needed, especially for patients who have been dealing with severe depression for a long time. 

Although the Emory study is preliminary in nature, DBS treatment is not likely to be available for most patients with depression.  There are significant medical risks associated with the necessary surgery which can include risk of hemorrhage, stroke, seizures, infection, or even death from the general anesthesia.   DBS treatment for depression has been licensed by St. Jude Medical Neuromodulation which will conduct further clinical trials in the United States and Canada.

For more information.

Joan of Arc on Trial (Part 2)

Continued from Part 1

To nobody's surprise, the tribunal found Joan guilty of heresy and wearing men's clothing.  Despite being given repeated warnings to recant (which the English insisted upon to discredit Charles), Joan refused.   After threats of torture (and a possible rape attempt by English guards), Joan signed a formal recantation after being promised that she would be removed from English custody and delivered up to Church justice.  When Joan was later sentenced to life imprisonment in an English prison, "on the bread of sorrow and the water of affliction there to mourn for your sins", she retracted the recantation and claimed that the saints had spoken to her.  She also went back to wearing men's clothing.   The retraction allowed the tribunal to declare her a lapsed heretic and ordered her to be burned at the stake.

Charles VII did nothing to intervene in the trial or her execution, despite the fact that her execution was largely meant to discredit him (he maintained that she was certainly guilty of wearing men's clothing).   On May 31, 1431, Joan of Arc was taken to the place of execution at the Old Market Place in Rouen.  Dressed in a plain white shift, she was placed on top of an enormous pyre and the executioner lit the fire.  As a final indignity, her dead body was taken from the flame long enough for witnesses to verify her sex and that she was actually guilty of being a woman wearing men's clothing.  Afterward, her body was returned to the pyre and burned to ashes.   The English made very sure that her body was completely burned to prevent any relics being taken and her remains were thrown into the Seine river.    The executioner, Geoffrey Therage, would later state that he was "greatly feared to be damned" for his role in killing Joan. 

As a martyr, Joan of Arc was likely more useful to Charles than she was as a living reminder of her role in his coronation and he refused to comment publicly on her execution.  Though the Hundred Years' War would continue for decades, Charles' rule over France became increasingly secure.  The only other possible candidate, Henry VI, was only a boy and his rule over England was too unstable for any ambitious campaigns to hold on to the French territory  left in his control.    The French generals who had fought with Joan of Arc were inspired enough by her tactics to continue harassing English troops with bold assaults that weakened them further.   There was also lingering resentment over Joan being executed as a heretic since an informal cult had sprung up in France following her death.   While Charles ordered a formal review of Joan's case when he was finally strong enough to control those parts of the country where her trial had been held, there was still active resistance on the part of those churchmen who had conducted the original trial.  

It was only in 1455 that a new trial was ordered by Pope Callixtus III at the urging of Joan's mother and brothers.  After a lengthy investigation, the new tribunal declared Joan innocent on  July 7, 1456.   The verdict, which was just as political as the one that condemned her, declared Joan of Arc to be innocent of all charges.  The investigation was carefully stanged and protected as many of the witnesses to the first trial as possible (including leaving out any mention of whether torture had been used in her case).  Since the court was determined to prevent any blame being placed on the Church for its role in executing Joan, the verdict was carefully worded to ensure that the original trial had been as fair as possible and that they had simply been mistaken in convicting an innocent women.  Since Bishop Cauchon was safely dead by this time, the tribunal conducting the hearing laid as much of the blame for the wrongful verdict as they could without actually stating that he was guilty of acting improperly.   While stopping short of declaring Joan a saint, the verdict also made Charles' position safer by removing any tinge of heresy from his rule.  The tribunal, while declaring Joan a martyr, also cracked down on the cult of veneration that had sprung up after her death and made it illegal to display her image publicly. 

For all that Joan of Arc has become enshrined in history, it's hard to decide what to make of her complex legacy.  The Catholic Church was always uneasy with the example that she provided to other women (both in terms of her unwillingness to submit to Church authority and her insistence on dressing like a man).  Despite being considered one of France's patron saints with an enormous cult venerating her memory, Joan of Arc wasn't formally canonized as a saint until 1920.  There was also the matter of the "voices" that she heard and the religious visions that accompanied them.   Would she have been diagnosed as being mentally ill today?  Even in Joan's time, physicians would have recognized a simple case of madness.  Certainly Charles VI had ample experience on the subject (his own father, Charles V had been floridly psychotic) so he would little reason to support Joan if he didn't think there was more than insanity at work.    Joan's failure to crack under the brutal treatment that she received during her trial would argue against schizophrenia in her case.  Although other diagnoses, including complex partial seizure epilepsy have also been suggested, there is not enough evidence to be certain of any diagnosis.

Whatever can be made of Joan of Arc, she has certainly become a cultural and historic icon with writers from William Shakespeare to George Bernard Shaw portraying her in radically different ways.  Whether saint, heretic, or madwoman, the Maid of Orleans has left her mark on the world.

 

Did Lifetime Rates of Alcohol Use Disorders Increase 67% in 10 Years?

Two nationally representative epidemiological samples (the National Longitudinal Alcohol Epidemiologic Survey and the National Epidemiological Survey of Alcohol and Related Conditions) have been used to track changes in the prevalence of alcohol use disorders (AUDs) between 1992 and 2002 in the United States. Strikingly, estimates from these two data sets suggest that the lifetime prevalence of AUD increased by approximately 67% (from 18.2% to 30.3%) during this time frame. An article recently published in the Journal of Abnormal Psychology explored potential reasons for these discrepant estimates. Analyses indicated that a vast majority of change in lifetime AUD occurred with respect to alcohol abuse and not alcohol dependence. Most of this increase in abuse was attributable to self-reported changes in hazardous use that did not track with other archival measures of outcomes related to hazardous use in the population. Key methodological differences regarding the frequency requirements for prior-to-past-year alcohol abuse appeared to explain most of the discrepancy in lifetime AUD estimates. These findings, in conjunction with the relative lack of differences in the 12-month prevalence of AUDs, suggest that the discrepant lifetime estimates are likely due to methodological differences between the two surveys. These findings have important implications for substance use and other psychiatric surveillance and epidemiology where meaningful cross-temporal comparisons are desired.

For the abstract.