Providentia

Families and Veterans with PTSD

The Department of Veterans Affairs (VA) health care system's leadership has endorsed family involvement in veterans' mental health care as an important component of treatment. Both veterans and families describe family participation as highly desirable, and research has documented that having healthy social support is a strong protective factor for posttraumatic stress disorder (PTSD). Family psychoeducation has been shown to be effective in preventing relapse among severely mentally ill, and preliminary evidence suggests that family interventions for PTSD may improve veteran and family outcomes. The multifamily group (MFG) treatment model incorporates psychoeducation, communication training, and problem-solving skill building, and it increases social support through its group format. An article published in Psychological Services describes the rationale for further adaptation of the MFG model for PTSD, and it reviews issues related to its implementation as a promising adjunctive treatment as part of the continuum of PTSD services available in VA.

For the abstract.

How Useful Are GPS Tracking Devices for Sex Offenders?

While GPS ankle monitors have become a standard feature in California for use in tracking convicted sex offenders in the community, they have come under fire over reports that they are being disabled, often without any legal repercussions.   Due to overcrowding in California prisons, Governor Edmund G. Brown Jr. signed historic legislation "realigning" the prison system by transferring parole violators to local jails for handling.   In turn, many of these same jails have eased their own overcrowding problem by releasing offenders into the community with ankle monitors which supposedly restrict their movements.   Unfortunately,  many of thes same offenders have discovered that supposedly foolproof ankle monitors can be easily disabled and that the legal penalties for it can be fairly minor.   A provocative new report by the Los Angeles Times indicates that thousands of convicted sex offenders have been formally charged with disabling their ankle monitors but prison overcrowding prevents them from being sent to jail as a result.  Some of these offenders have gone on to commit further offenses including sexual battery, kidnapping and attempted manslaughter.  

Under ideal conditions, the GPS devices are attached to the ankle with a rubber strap with an alarm going off if any tampering occurs or if the offender gets too close to a school zone.   Though the signal is monitored by a private security firm, policing infractions is a growing problem.

Since October 2011, more than 3,400 warrants have been issued for monitor tampering although the state policy of sending violators to county jails means that few are likely to be reincarcerated for longer than a few days.   In some cases, violators were released within hours of being arrested.   The rise in new warrants has risen by 28% in 2012 alone and the trend is unlikely to change.  Virtually all monitor violators are sex offenders since they are most likely to be fitted with ankle monitors along with repeat offenders and others regarded as being flight risks.    Under a law passed in 2006, all convicted sex offenders must wear GPS monitors for life. 

Parole officers and prison officials are outspoken in describing the lack of real control the correctional system has over offenders in the community.  One Fresno parole officer commented on the enormous problem he and his fellow officers are seeing.  "If the public knew, they'd be shocked", he said.   While members of the California Sex Offender Managemet Board have noted that parolees "certainly are feeling more bold" due to the lack of deterrence, there is little they can do to correct the situation.

Along with the loss of control has been a rise in offenses committed by parole violators.    Convicted sex offender Rithy Mam was arrested three times in two months and was freed almost immediately each time.  After the third violation, he vanished and reappeared in nearby Stockton where he repeatedly menaced a fifteen-year old girl and her thirteen-year old sister.   He was subsequently recaptured and is now in prison awaiting new charges.   Another convicted sex offender, Raoul Levya, was rearrested last year after a brutal assault on his 20-year old former girlfriend.  After laying on the floor of her apartment for days before being found, she is now brain-damaged and confined to a wheelchair. 

Before the current prison realignment,  parole violators could often be held in jail for up to a year awaiting time, now the maximum sentence for parole violation is 180 days.  Despite calls to increase the penalty for monitor tampering to a full three-year sentence, current prison overcrowding makes that impossible to put into practice.  

 

 

Learning the Six Rs

We all take memory for granted.   Though people dealing with a family member suffering from dementia are acutely aware of how devastating loss of memory can be,  the rest of us simply ignore the issue of memory until we forget something important.   And as we grow older, we become more anxious about each memory lapse we experience along the way.

But what is memory?  And how are we able to learn and retain new information?   While a century and a half of memory research has given us some understanding of the cognitive processes that relate to memory and learning, the general consensus among researchers that we still have a long way to go.  According to Colin M. MacLeod of the University of Waterloo, one of the most beautiful things about learning is that it is never completed.  “It has been my privilege to be part of this quest to understand what makes us ourselves for 40 years, decades that have passed with the fleeting, yet inevitable quality of memory itself.” he said in a recent article in Canadian Psychology.   

In that same article, which he titled “The Six Rs of Remembering”, Doctor MacLeod described his preoccupation with the letter “R” and the way that it underlines the cognitive processes that make memory work.

To read more, check out my new Psychology Today blog post.

How Trauma Changes Memory

The traditional static view of trauma memory holds that memories for such events are fixed and relatively unchanging over time. A more recent dynamic view proposes that memory for potential trauma, like memory for ordinary events, changes with time. A study published in Psychological Trauma: Theory, Research, Practice, and Policy examined predictions from these competing theories in repeated assessments of high exposed survivors of the September 11th (9/11) attacks. Memory was assessed using both standardized questionnaires and a free recall paradigm. These data and a measure of posttraumatic stress were obtained at 7 and 18 months post-9/11. Results showed that survivors' recollections of 9/11 varied between assessment points and were moderated by their trajectory of posttraumatic stress. Individuals who were either resilient or recovered over time created a more benign memory of the event over time, whereas individuals who experienced chronic posttraumatic stress had relatively unchanging memories.

For the abstract.

Gun-Related Suicides Ignored

Despite the oft-quoted slogan, "Guns don't kill people, people kill people",  more than half of all suicides committed in the United States involve guns.   According to Bennett L. Gershman of New York's Pace Law School, of the 38,000 suicides committed in the United States last year, more than half were gun-related.  By contrast, only 9,000 gun-related homicides occurred that same year.   The actual figures also fail to take suicide attempts into account which can push the numbers far higher.

In an opinion piece he wrote for the Journal News, Professor Gershman pointed out that gun-related suicide remains the most popular suicide method.  Despite this however, actual discussion of the role that access to guns has in suicide remains curiously muted.   "The principal cause of gun suicide relates to the increasing availability and access to guns, especially guns in homes where persons live who have psychiatric disorders, are depressed, impulsive, and aggressive. Why persons attempt suicide is a critical question", he says.  "But also critical is how people attempt suicide, which often determines whether they live or die."   While most gun-related suicide attempts are fatal, incidents of people surviving despite severe injuries have been seen as well.   I recall dealing with several cases of this when I worked in the prison system (including one prisoner missing part of his face) and the medical issues involved can be extreme.

Research which Professor Gershman describes appears to bear this out.   Suicide by gun has exceeded automobile accidents as the leading cause of injury-related death in the United States and is also the fastest-growing suicide method.     A 2008 study by the Harvard School of Public Health found a powerful link between gun ownership and suicide with persons with guns in their home being sixteen times more likely to commit suicide than non-gun owners.  States with the highest percentage of gun ownership also have the highest percentage of gun-related suicides.   According to Harvard School of Public Health professor,  David Hemenway,  “Studies show that most attempters act on impulse, in moments of panic or despair. Once the acute feelings ease, 90 percent do not go on to die by suicide.”  

Despite calls by leading medical organizations such as the American Academy of Pediatrics to remove guns from homes to prevent possible suicide use, successful lobbying by the National Rifle Association has blocked most initiatives to prevent gun deaths as well as research into gun-related suicides.   As a result, Congress has blocked funding by the Center for Injury Prevention and Control into suicide research, especially research into gun-related deaths.   In the meantime, the deaths are continuing and are likely to rise even further in the years to come.

Can Anesthesia Treat PTSD?

A specialized anesthetic procedure used for treating chronic pain disorders and symptoms associated with breast cancer may also be useful  in treating posttraumatic stress disorder (PTSD).  A stellate ganglion block (SGB) involves injecting a local anesthetic into the stellate ganglion
just below the subclavian artery on or above the neck of the first rib. Though the effects of the local anesthetic usually wears off after a few hours, SGB has already been found to be beneficial for a
range of pain-related and vascular medical conditions including complex regional pain syndrome and frostbite. 

Anesthesiologist, Eugene Lipov has also reported positive results in treating hot flashes in women as well as PTSD.  Through his research on patients being seen at his Advanced Pain Centers clinic in Hoffman Estates, Illinois, Dr. Lipov reported anxiety relief as early as thirty minutes following an injection into the stellate gangion leading to the right hemisphere of  the brain.

To learn more, check out my new Psychology Today blog post.

The Eccentric Dr. Beddoes

Though medical history is filled with quirky characters whose eagerness to heal patients led them to experiment with remedies that are hard to believe today,  Dr. Thomas Beddoes has been surprisingly forgotten.   And that seems a pity given his own unique contribution to the annals of medical lore and, inadvertently, to science in general.

Born in Shropshire in 1760,  Beddoes was a remarkable student who not only excelled in his studies but taught himself French, German, Spanish, and Italian as well.   Along with studying at Pembroke College in Oxford, he moved on to the University of Edinburgh where he studied medicine before returning to Oxford and graduating in 1786.   He also traveled to France where he met Antoine Lavoisier and returned to become a successsful lecturer at Oxford University.  

His outspoken sympathy for the French Revolution eventually cost him his position.  Beddoes was forced to resign in 1792 after numerous complaints about his "revolutionary" views, even after prominent figures such as Lavoisier were executed.   Though his academic career was essentially over, Beddoes set up a medical practice in the city of Bristol where he specialized in treating infectious diseases, particulary tuberculosis and smallpox. 

Like many gentlemen scientists of that era, he also cultivated various scientific interests and was an avid writer with publications in science and medicine.  This includes classic essays on treating calculus (gallstones) and scurvy along with scientific papers on geometry and geology.   Among other things, he was the first writer to use the word "biology" in the modern sense.    One early book, "The History of Isaac Jenkins and Sarah his wife and three children" on the evils of alcoholism became a best-seller and he cultivated friendships with some of the greatest literary minds of his generation.   Samuel Taylor Coleridge was a close friend and Beddoes' house in Bristol attracted visitors from across Europe.  

Personal descriptions of Beddoes tended to vary widely.  He was once called "uncommonly short and fat, with little elegance of manners, and nothing characteristic externally of genius or science; extremely silent, and, in a few words, a very bad companion."    Another source called him "reserved in manner, and almost dry; but his countenance was very agreeable. . . . Nothing could be a stronger contrast to his apparent coldness in discussion than his wild and active imagination".   Along with other scientific interests, he  became involved in a controvery over rival hypotheses over how rocks were formed, i.e, whether they were created through volcanic activity (plutonism) or in the oceans (neptunism).    Beddoes also became interested in the problem of Earth's age and was one of the early supporters of the concept of an ancient Earth (as opposed to the young Earth suggested by creationists). 

The most radical idea for which Beddoes is remembered was his endorsement of pneumatic medicine and treating disease by having patients inhale different gases.  The late 18th century saw new developments in gas chemistry with oxygen, carbon dioxide, and hydrogen, among others, being studied in laboratories across Europe.    Collecting anecdotes about patients being cured of diseases through inhaling specific gases, Beddoes began making grandiose claims about using oxygen and carbon dioxide to treat various diseases including tuberculosis, scrofula,palsy, diabetes, ulcers, and various venereal diseases.    That he had no actual scientific evidence to support these claims seemed hardly relevant.  

Supporting himself and his medical experiments through the high fees that he charged to his patients (this was pre-National Health Service), Beddoes also had no hesitation in using patients as test subjects for the various alternative remedies he devised.   His most notorious innovation stemmed from his noticing that people in certain occupations seemed less likely to develop tuberculosis than others.   Butchers, in particular, very rarely developed tuberculosis which they often attributed to the "slaughterhouse vapours"  they breathed in while they worked.   Deciding to try this on his patients, he set up a treatment clinic adjoining a cattle stable so that the cows could poke their heads through a curtain and breathe directly onto the patients as they lay in bed.  

Though Beddoes enthusiastically reported that the new remedy seemed to work about half the time with his consumptive patients, it was not particularly popular with the patients or their families.  Along with the radical nature of the treatment, they also complained about the smell and proximity to barnyard animals.   Undeterred, Beddoes' research experiments with gases continued with animalexperiments where he would actually timed how long it took rabbits to die when breathing pure carbon dioxide or the amount of oxygen needed to intoxicate kittens.   He also experimented on himself to see what effect breathing pure oxygen would have on humans, he was forced to stop when he developed nosebleeds.   Collecting assorted case studies from sympathetic physicians as well as what he learned from his own patients, Beddoes published extensively on the value of pneumatic medicine.  His books and monographs focused on the apparent miracle cures that could be possible by having patients inhale oxygen, hydrogen, and carbon dioxide. 

But he was convinced that even more could be made possible with the proper research.   Assisted by Richard Lovell Edgeworth (who later became his father-in-law), Beddoes established the  Pneumatic Institution in 1799 where he could study pneumatic medicine in depth.   It was an amazing scientific collaboration with most of the laboratory equipment being developed by James Watt with Humphry Davy being in charge of the laboratory.

It was Davy whose experiments had the greatest scientific importance.   Along with his other gas experiments, Davy was the first scientist to describe the properties of nitrous oxide (which he nicknamed "laughing gas"), including testing the gas on himself and other willing subjects.   Among the various willing volunteers were Samuel Taylor Coleridge (who was lyrical with his praise of "the great ecstasy" he felt when breathing in the gas), Robert Southey, and the rest of Beddoes' literary circle.  Though Davy was the first to notice the anesthetic possibilities in the gas and even suggested that it might be used in surgery,  he never bothered experimenting further and this lost opportunity delayed the development of anesthesia for decades. 

Focusing instead on the possibilities of pneumatic medicine, Thomas Beddoes and James Watt decided to collaborate in using a special apparatus that Watt had developed to produce "factitious air" (their name for the gas) and administer it to patients. Watt had a very personal reason for his interest in Beddoes' research.    His daughter, Jessie, was in the terminal stages of tuberculosis when Erasums Darwin (grandfather of Charles) advised him to bring her to  Thomas Beddoes' clinic.   Although the carbon dioxide treatment Jessie Watt received did nothing to save her life, Watt was encouraged by the temporary relief that some of the other patients showed (which was likely due to the placebo effect at work).   The prototype device Watt designed basically consisted of a small stove with an alembic on top (essentially a small still).   Heated by the stove, the materials in the alembic, including calcium carbonate and sulfuric acid,  would break down and release different gases that could be breathed in by the patient. 

Though Beddoes had hoped to set up a formal hospital, he could never get the widespread support he needed.   Eventually, his Pneumatic Institution was converted into a regular hospital in 1800 to handle a large typhus outbreak in Bristol.    Beddoes' ambitious plans never survived the loss of Humphry Davy who left in 1801 to join Sir Joseph Banks at the Royal Institution.  The Pneumatic Institution closed down a year later.   Losing his faith in pneumatic cures by this time, Thomas Beddoes turned to studying new methods of preventative medicine to improve health in the Bristol slums.   

Ironically, Thomas Beddoes remained an arch-skeptic concerning the amazing claims of nearby physician, Edward Jenner, whose experiments with cowpox led to the discovery of vaccination.   Sadly, along with missing the boat on discovering anesthesia, Beddoes also failed to appreciate that Jenner's discovery was one of the greatest advances in preventative medicine ever made.   While he likely saved many lives with his preventative medicine practice, Thomas Beddoes ended up fading up into obscurity by the time of his death in 1808.  

Today, he is largely remembered for being the father of eminent poet, Thomas Lovell Beddoes and his own modest contributions.   While he still merits a footnote in medical history, Thomas Beddoes' ambitious plan to transform medicine likely died with him.

 

 

Into the Mind of Marilyn Monroe

The death of movie actress Marilyn Monroe on August 5, 1962 is still controversial despite being ruled a "probable suicide" by Los Angeles coroner Thomas Noguchi. While the cause of death was due to acute barbiturate poisoning and Monroe had made previous suicide attempts using prescription drugs in the past, questions about her involvement with then-President John F. Kennedy continue to be raised.

Several police officers who arrived at the scene of her death, including Los Angeles police officer Jack Clemmons, openly speculated on the possibility that the star had actually been murdered. Clemmons even accused members of the LAPD with staging a cover-up and that the death scene had been deliberately staged.

Though Clemmons and other conspiracy theorists continue to insist that she had been murdered, one of the first psychological autopsies to be carried out ruled that the death had been suicide. Psychiatrist Robert E. Litman, a Los Angeles-based suicide authority had been the chief psychiatrist on the autopsy team examining the Monroe case would later describe the evidence used to determine that she had committed suicide.

This included the telephone calls that Monroe had made after taking the pills in which she insisted that she was "in deep trouble". According to Litman, her death could be considered "a self-inflicted death, where there is a great risk but also a good chance for rescue." He concluded that she had staged the suicide with the hope of rescue which came too late.

But could Marilyn Monroe's own writings provide clues about her suicidal intentions? Many of the letters, poems, and personal notes that Monroe wrote in the years leading up to her death were recently collected in a single book, Marilyn Monroe's Fragments, published last year.

To read more about the recent research study looking at Fragments and the linguistic evidence into her death, check out my new Huffington Post contribution.