Providentia

Investigating Terminal Decline

The terminal decline hypothesis states that in the proximity of death, an individual’s decline in cognitive abilities accelerates. In a recent issue of Psychology and Aging, researchers aimed at estimating the onset of faster rate of decline in global cognition using Mini Mental State Examination (MMSE) scores from participants of the Cambridge City over 75 Cohort Study (CC75C), a U.K. population-based longitudinal study of aging where almost all participants have died. The random change point model fitted to MMSE scores structured as a function of distance to death allowed researchers to identify a potentially different onset of change in rate of decline before death for each individual in the sample. Differences in rate of change before and after the onset of change in rate of decline by sociodemographic variables were investigated. On average, the onset of a faster rate of change occurred about 7.7 years before death and varied across individuals. Study results show that most individuals experience a period of slight decline followed by a much sharper decline. Education, age at death, and cognitive impairment at study entry were identified as modifiers of rate of change before and after change in rate of decline. Gender differences were found in rate of decline in the final stages of life.  This study suggests that terminal decline is a heterogeneous process, with its onset varying between individuals.

For the abstract

Cycloserine, Suicide and TB

Multi-drug resistant tuberculosis (MDR-TB) has been reported in every country around the world though it remains most common in developing countries.    While usually curable with long treatment using second-line drugs,  new problems can result from adverse side effects that can make the treatment almost as dangerous as the disease it was meant to treat.

D-Cycloserine (marketed under the brand name of Seromycin) is a broad-spectrum antibiotic that has become widely used as a second-line drug for tuberculosis due to its ease of use.   Along with treating MDR-TB,  Cycloserine has other potential medical applications including treatment of chronic pain and has also been used to treat phobic behaviour over the past decade.

Medical professionals treating MDR-TB patients in developing countries have been reporting concerns due to the psychiatric symptoms associated with cycloserine use.   Among the central nervous system (CNS) side effects linked to cycloserine are: anxiety, confusion, irritability, depression, nervousness, nighmares, mood changes and thoughts of suicide.

A report by a physician working with Medecins Sans Frontieres (Doctors without Borders) has stressed the potential suicide risk associated with cycloserine treatment.     According to Dr. Emily Wise who is volunteering in Uzbekistan where MDR-TB is endemic, five  patients treated with cycloserine attempted to kill themselves in recent months.    "Each case of drug-resistant TB therefore presents our team with a dilemma," she writes.  "We must try to reconcile the conflict between saving the patient from dying from TB, and our ethical concerns about the side effects of the treatment."

Since no effective psychiatric care is available for these patients, it remains up to the primary  care staff to respond as best they can.   Dr. Wise described one patient, "Maya", who warned counselors that she was planning to commit suicide.   A hastily-assembled crisis team managed to intervene before the patient hanged herself.   Despite discontinuing her TB drugs and placing her on round-the-clock observation,  a more permanent solution will be harder to find.

Though TB patients with a history of psychological problems seem particularly vulnerable to cycloserine's psychiatric side effects,  warning patients receiving the drug may not be enough to prepare them for what they might experience.    For many users, suicidal thoughts and acute depressing may strike without any of the usual early signs and can happen at any time.  Though stopping cycloserine and placing patients on anti-depressants can relieve the depression, the problem of treating  the TB still remains.

People with TB have few alternatives, especially when dealing with one of the multi-drug resistant strains.   A daily regimen involving taking numerous pills is essential for arresting the progress of the disease.  Also, discontinuing cycloserine treatment can increase the possibility of the TB developing a resistance as it has with so many other antibiotics.   With the lack of real alternatives, physicians often have no choice but to resume the cycloserine and hoping for the best.

While the dangers associated with cycloserine are well-documented, pharmaceutical companies have been slow to develop better alternatives.   According to Dr. Wise, "We need the pharmaceutical industry and the international community to put this disease on their agenda and give doctors and patients what they so desperately need: new compounds against drug-resistant TB."    With longer delays before new antibiotics become available and the likelihood of new side effects emerging, the problems faced by cycloserine patients are unlikely to go away anytime soon.

 

 

 

Living With Intolerance

It’s hardly a revelation that adolescents belonging to visible minorities often face racial/ethnic discrimination.   Cases such as the Trayvon Martin shooting have polarized American society and generated anger that will likely take years to die down.   Many African American,  Hispanic, Oriental or other visible minority adolescents across North America can describe experiences from their own lives in which they experienced discrimination, whether from teacher, police officers or even people of their own age.  

But what kind of psychological toll can this kind of unfair treatment have on young people?  Whether it takes the form of police accusing them of acting “suspiciously” in public places, being harshly disciplined at school, or receiving verbal or physical abuse from peers, the impact lingers over time.    Though psychologists have long studied the impact of discrimination on minority adolescents, there are still  unanswered questions about what causes the discrimination to happen and the how adolescents can deal with it.

Ironically,racial and ethnic tension in schools and neighbourhoods often rises with increased ethnic diversity.    As more minority groups come in and the proportion of established minority group populations change, cultural clashes create a negative racial or ethnic climate.  This triggers greater tension as well as incidents of verbal or physical abuse.  Since teaching staff  are often unable to keep up with these changes, minority group members often see themselves as being “on their own” and not being able to rely on authority figures to help.

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

Raising The Dead

Whatever else you might say about the early experiments with electricity, they were certainly rough on birds.

One of Benjamin Franklin's first electrical experiments involved killing birds to demonstrate the lethal power associated with electricity.  In 1749, he sent out tongue-in-cheek invitations for a "Party of Pleasure" to be held near his home in Pennsylvania.   The highlight of the evening would involve electrocuting a turkey which would then become part of the evening meal.   In fairness to Franklin, the poor bird was likely doomed anyway and electrocution would be more humane than the other butchering methods of the time.    In describing the festivities, Franklin wrote:

A Turkey is to be killed for our dinner by the Electrical Shock; and roasted by the electrical Jack, before a fire kindled by the Electrical Bottle; when the healths of all the Famous Electricians in England, France and Germany are to be drank in Electrified Bumpers, under the Discharge of Guns from the Electrical Battery

According to Alex Boese in his book Electrified Sheep,  an "electrical jack" was a crude electrical motor while "electrical Bottle" was another name for Leyden jars.   An "electrified bumper" was an electrified glass that gave the drinker a shock when drinking from it.     Whether or not he actually intended to hold this party, skeptics called his bluff and Franklin was obliged to carry out the turkey electrocution (which he had never actually done before).    After working his way up from a hen,whose cooked flesh he declared to be "uncommonly tender" afterward,  Franklin electrocuted another hen but managed to revive it afterward by "repeatedly blowing into its lungs."   While the revival attempt worked, the poor hen was apparently blinded.    Though this makes Benjamin Franklin the first to use artificial respiration to revive a victim of electrocution, history seemed to have denied him the credit up to now.  

Moving on to turkeys, Franklin found them to be more of a challenge than chickens.  On December 23, 1750, he finally held his turkey-shocking party  though it didn't work out to well for the earnest Franklin.   Whether because of being distracted by his guests or imbibing a little too much of his own wine, Franklin accidentally electrocuted himself.  He later described it as "like a universal Blow throughout my whole Body from head to foot which seemed within as well as without."    The shock left him dazed and his arms and neck being number for days afterward.   He frankly admitted that a shock through his head might have killed him on the spot. 

Undeterred, Franklin went back to his turkey-killing experiments, but more cautiously.  Among other things, he discovered that two large Leyden jars were not enough to kill a 10-pound turkey and neede to added more jars before he finally succeeded in killing one of the birds.    The Royal Society congratulated him on his achievement which was duly noted in their proceedings (though not as famous as his legendary kite experiment). 

But Benjamin Franklin was hardly the only scientist killing birds with electricity.   Killing chickens and turkeys using electrical current was a common parlour trick throughout the 18th century though scientists began looking for more constructive uses to show electricity's value.    The still-mysterious nature of electricity  made the prospect of discovering new ways of healing seem like a tantalizing prospect.    Along with spawning  quack remedies,  serious medical researchers made new discoveries suggesting that electricity could accomplish far more than killing birds.

Peter Christian Abildgaard was part of this new wave of medical research.   Born in 1740, he trained in medicine at the University of Copenhagen before traveling to France to study veterinary diseases.   After returning to Denmark, he founded a veterinary school in Copenhagen which is now one of the oldest schools of its kind in the world.   Abildgaard conducted research into veterinary medicine and natural philosophy.   That included experiments in electricity as well.    In 1775, Peter Abildgaard announced what seemed to be his most grandiose discovery.   Not only did he kill birds using electricity, but he also succeeded in using electricity to bring them back to life!  

According to Abildgaard's description of his experimental setup, he would run an electrical current through a hen's head using a bank of Leyden jars until the hen fell over dead.   He even left the hen's body overnight to ensure there was no mistake about the hen being dead.     Trying the experiment again with another hen, Abildgaard then attempt to revive it with another electric shock to the head.   As he later described, "I tried an electric shock directly through the chest to the back and not without success."   The bird rose up and, set when loose upon the ground, "walked aboot quietly on its feet."   

To test the effectiveness of his technique, Abildgaard took the same hen and repeated his results, killing the hen and then reviving it, "rather often".   He only stopped when the hen appeared to have difficulty walking.  He saw the hen make a complete recovery after a few days (it even laid an egg).     Abildgaard's next experiment, with a rooster this time, didn't work out so well since the rooster aggressively resisted being shocked again after being revived.  While Abildgaard had apparently discovered the principle of cardiac defibrillation,  his successful experiment was attributed to the mysterious power of electricity.   Best known for his contributions to Danish science, his medical discovery would be largely forgotten until the end of the 19th century.   

Apparently independently, British physicians also began using electrical shock to revive apparently dead patients.    When the Royal Humane Society was first established in 1773,  it was known as the Royal Humane Society for the Apparently Dead and focused on developing ways to revive cases of sudden death.    One of their first experiments, described in a 1774 report, involved using electric shock to bring an apparently dead child back to life.    The success of this approach inspired eminent surgeon John Hunter to comment that "Electricity has been known to be of service and should be tried when other methods have failed.  It is probably the only method we have of directly stimulating the heart."  

The first use of a Leyden jar as a portable "defibrillator" was reported by Charles Kite in 1788 when he used his device to revive a three-year old child who had fallen out a window.   His "Essay on the Recovery of the Apparently Dead" described his research into hundreds of cases of drowning and suggested that the key to succesful revival was the rapid application of resuscitation techniques as soon after death a possible.   Kite was already a prominent member of the Humane Society and had regularly used artificial respiration using a bellows to force air into the mouth or nostrils of drowning victims.    

While his success with defibrillation (the term would actually be coined much later) earned Kite a Silver Medal from the Society, there was tremendous social resistance to the idea of reviving dead corpses.   Part of that resistance stemmed from attempts by the Humane Society to change the very definition of death itself.   Kite even suggested that putrefaction was not enough to  have a corpse considered permanently dead(since it might be a sign of advanced scurvy).  Although  conventional physician grudgingly accepted the use of artificial repiration to revive drowning victims,  using Leyden jars and other electrical devices never really caught on.

But the idea of using electricity to revive corpses was hardly forgotten .  Along with the research by Luigi Galvani and Giovanni Aldini,   Glasgow physician Allan Burns recommended the use of electrical shock for all cases of sudden death.   As part of his directive for reviving patients, he stated that "Where however the cessation of vital action is very complete and continues long, we ought to inflate the lungs, and pass electric shocks though the chest."   He also stressed that physicians should never give up until there is no hope of success.    In his 1820 Medical Guide, Richard Reece described a "reanimation chair" into which a corpse could be placed.   The chair featured a voltaic pile for electric shocks as well as a bellows to force air into the lungs.  A metallic tube inserted in the esophagus acted as an electrode in administering the electric shock.   Actual details on how effective the chair was do not seem to be available. 

The macabre potential of electricity to revive the dead may even have inspired Mary Shelley in her seminal science fiction novel Frankenstein.    First published in 1818, the novel featuring a young scientist tampering in God's domain seemed to reflect the mistrust the general public had for  altering the boundary between life and death (though Shelley didn't actually mention the use of electricity in the novel  

Whether due to natural resistance on the part of doctors or the general sinister association between electricity and "mad scientists",  reluctance over the use of more extreme measures delayed the development of portable defibrillators for decades.  Though medical researchers demonstrated  the principle of ventricular defibrillation on animals throughout the 19th century, its value in reviving medical patients would not be recognized until the 1930s when William B. Kouwenhoven developed the first portable cardiac defibrillator.    In the decades that followed, portable defibrillators moved out of hospitals and automated external defibrillators (AED) can be found in many public buildings to allow people with little or no training to provide lifesaving treatment.

So, the next time you see the familiar AED label at a train station or government building, spare a thought for the poor birds whose contribution to the cause of medical research eventually spawned a universal life-saving technique.

 

 

 

 

Interpersonal Violence and Mental Health

In a paper recently published in Psychology of Violence, researchers examined gender differences in population rates of various types of interpersonal violence in a U.S. national sample and investigate gender as a moderator of the associations between interpersonal violence and lifetime mental disorders and suicide attempts. Data were drawn from the National Comorbidity Survey-Replication study; 5,692 women and men completed interviews assessing lifetime exposure to nine types of interpersonal violence, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM–IV) mental health diagnoses, and suicide attempts. Results showed that approximately 46% of women and 42% of men reported one or more types of interpersonal violence. Women were more likely to experience kidnapping, physical assault by an intimate partner, rape, sexual assault, and stalking, whereas men were more likely to experience mugging or physical assault by someone other than parents or an intimate partner. Interpersonal violence was associated with risk for many mental disorders and attempted suicide. Although women were at higher risk for several forms of interpersonal violence, the impact of interpersonal violence on mental health outcomes did not vary by gender.  It is clearly important to identify and provide mental health treatment to women after interpersonal violence exposure. Findings also underscore the need for prevention and intervention efforts for women and men, including routine screening for interpersonal violence by health care providers and appropriate treatment to address mental health conditions.

For the abstract.

WHO Releases New Guidelines for Treating Acute Traumatic Stress

The World Health Organization (WHO) and the United Nations High Commissioner for Refugees has recently released new guidelines to train primary care health workers how to treat acute traumatic stress in people following a major traumatic event.  Developed by the WHO's Department of Mental Health and Substance Abuse and a WHO Steering Group first established in 2011, the Guidelines for the Management of Conditions Specifically Related to Stress are intended as an evidence-based approach to the management of problems and disorders specifically related to acute stress.

According to the executive summary provided with the guidelines, the problems covered include:

• symptoms of acute stress in the first month after a potentially traumatic event with the following subtypes: 

                        -symptoms of acute traumatic stress (intrusion, avoidance and hyperarousal) in the  first month after a potentially traumatic event;

                        -symptoms of dissociative (conversion) disorders in the first month after a potentially traumatic event;

                        -nonorganic enuresis (bedwetting) in the first month after a potentially traumatic event (in children);

                        -hyperventilation in the first month after a potentially traumatic event;

                        -insomnia in the first month after a potentially traumatic event;

• Posttraumatic Stress Disorder (PTSD)
• Bereavement in the absence of a mental disorder

The new guidelines are primarily intended for primary and secondary care health including physicians, nurses, clinical officers and all medical specialists working outside the area of mental health.    Programme managers responsible for primary or non-mental health secondary services are also included.  

Along with the guidelines are a series of recommendations relating to the effectiveness of different types of treatment for traumatic stress.    Cognitive Behaviour Therapy (CBT) is endorsed as being moderately effective in treating symptoms of traumatic stress in adults.   Other treatments, including eye movement desensitization and reprocessing (EMDR), standalone problem solving counseling, relaxation training and psychoeducation are not endorsed because the evidence for their effectiveness is not as strong.     No treatment recommendations were made about use of any of the established treatment methods for treating children or adolescents dealing with traumatic stress.   The guidelines also recommend against the use of benzodiazepines and antidepressants for treating traumatic stress in adults, children or adolescents. 

For treating  PTSD (chronic traumatic stress persisting longer than six months), there appears to be moderate support for use of individual CBT and EMDR in treating symptoms.  Other other treatment methods such as group CBT and relaxation training  appear to be less effective.  Individual CBT can also be effective for children and adolescents though other treatments such as EMDR and group CBT had less evidence for their effectiveness.    The guidelines also recommended against the use of antidepressants, especially SSRIs and tricyclic antidepressants, in either children or adults unless other methods have been shown to be ineffective. 

The guidelines also recommend against the use of structured psychological interventions for treating simple bereavement that does not meet the criteria for a mental disorder (DSM-V bereavement disorder diagnoses were not included).   For treatment of enuresis related to traumatic stress in children, caregivers need to be warned against using punishment on children since there is no evidence that this is effective.    With hyperventilation related to acute stress,  folk remedies such as breathing into a paper bag is not effective, whether for children or adults.

Though this is only a sample of the treatment recommendations in the 273-page report,  the new guidelines are intended to overcome problems with pre-existing guidelines that were developed for industrialized countries with comprehensive health-care systems.   Developing evidence-based guidelines for treatment also means that treatment providers need to be competent, including training in psychological first aid and CBT with a trauma focus.    Due to the weak evidence supporting the effectiveness of psychological or psychiatric treatment for children dealing with acute stress (within one month of the traumatic event), the guidelines do not include any treatment recommendations at this time.

Along with the treatment recommendations are a comprehensive review of the clinical research that went into preparing the guidelines.  Highlighting the lack of strong evidence for many of the treatments that are often used for adults and children experiencing traumatic stress, the guidelines also stress the need for new research to fill some of the critical gaps.   The guidelines also highlight what not to use to avoid making the trauma worse for patients.   That includes different types of medication and forcing psychological counseling on bereaved patients who should be simply allowed to grieve in peace.

Finally, the new guidelines outlines WHO plans to monitor how the new recommendations are put into practice.   Working with mental health agencies around the world, the WHO has also attracted research funds from governmental and non-governmental organizations to improve the quality of treatment services available.    The WHO is planning to review their recommendations and evidence base within the next five years.

To download the new Guidelines (PDF)

Are Video Games Addictive?

In 2005, Shanghai gamer Qiu Chengwei stabbed a friend to death when he found out that he had sold a virtual sword belonging to Chengwei on eBay for 7,200 yuan ($738).   After narrowly avoiding a death sentence, Chengwei was sentenced to life imprisonment.

In 2009, an Ohio court sentenced 17 year-old Daniel Petric to 23 years in prison for the fatal shooting of his mother.  Petric had shot both his parents after they took away his copy of Halo 3.    During his trial, the court was told that Petric had become addicted to the game after being left housebound following a jetski injury. 

In 2011, Rebecca Colleen Christie was sentenced to 25 years in prison by a New Mexico court for allowing her 3 ½ year-old daughter to die  of malnutrition while she spent hours playing World of Warcraft.  

Is it possible to become addicted to video games?

While addiction remains a prime concern in most societies, whether drug addiction, alcohol addiction, gambling addiction, etc., becoming addicted to video games seems more controversial despite high-profile cases like the ones listed above.    Media stories about extreme cases of video game addiction, especially online games, goes back to at least 1993 when Wired ran a story on MUDs (multi-user dungeons) and the players who become addicted to them. 

In the newly-released Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Internet Gaming Disorder has been included among the conditions being considered for future study and possible addition to later DSM editions.    At this time, however, video game addiction (GA) is not considered to be a mental disorder.  Still, research suggests that 0.5 percent of all gamers and 1.7 percent of ninth graders experience symptoms associated with excessive video game use.    Along with Online Gamers Anonymous in the United States, clinics for video game addicts have been established in countries around the world including China, the Netherlands, and Australia.   Even conventional addiction treatment clinics have been noting a rise in referrals for gaming addiction.

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

The Corregio Soap Maker

Rome's Museo Criminologico [Criminological Museum]  may not be to everybody's taste,  but it's definitely worth seeing.  The museum's collection features photographs and memorabilia from some of the most gruesome forensic cases in the long history of Italy.   From Renaissance murders to the Mafia, this museum has it all.  

It was there that I first learned about Leonarda Cianciulli, a.k.a. the "Soap Maker of Corregio" and her bizarre criminal career.    While almost unknown outside of Italy, Leonarda's career as a serial killer is still unparalleled in many ways, both for her unique method of concealing bodies and her rather odd motive for killing.

Born in 1894, she was raised in one of the most poverty-stricken regions of Italy.   Her mother, Emilia di Nolfi,  had become pregnant due to rape and was later forced to marry her rapist,, Mariano Cianciulli, when she realized she was pregnant.   By most accounts, Leonarda's early childhood was a grim one.     Her father died when Leonarda was young but her mother's later remarriage did little to ease the situation at home.  Due to emotional abuse by her mother, she would make two suicide attempts.   Leonarda compounded her woes by marrying a man of whom her parents disapproved (they had a more prosperous suitor in mind).   She would later claim that her mother had placed a curse on her as a result of her 1914 marriage of Raffaele Pansardi and the tragedy she later endured seemed to bear that out.  

Along with being imprisoned for fraud and later seeing her house destroyed by an earthquake, she also lost three of her children in childbirth and another ten as children.   Of her seventeen pregnancies, only four survived to adulthood and she was especially protective of all of them as a result.  Despite these troubles, she and her husband eventually settled in the town of Corregio, near Naples, and Leonarda apparently settled into a normal life as a shopkeeper and part-time fortune teller.   A long-time believer in the supernatural, she had once consulted a Gypsy fortuneteller who, among other things, predicted that all of her children would die before her.  A different fortuneteller  told her that she faced either a future in prison or in a criminal asylum though Leonarda seemed not to take that warning seriously.    Her neighbours would later describe her as a gentle soul with a fondness for poetry.   Nobody suspected what would be coming next

For Leonarda, everything changed in 1939 when Benito Mussolini began drafting young men to prepare for Italy's entry into World War II.   Il Duce's popularity had slipped during the 1930s and the prospect of Italy entering the war on the side of Nazi Germany alarmed most Italians.    Leonarda became mentally unbalanced at the thought of her favourite son, Giuseppe, being drafted and possibly dying in combat.    The prospect of losing Giuseppe apparently led to her decision to carry out human sacrifices to preserve her son from death.  As she would later state during her testimony, killing others would keep her own children safe by providing God with other deaths in place of her own children.   Since she had four remaining children, she would need to sacrifice four others to keep them safe.

Her first victim was a 50-year-old spinster named Faustina Setti.   Recruiting Leonarda as a fortune-teller and matchmaker, Faustina paid her 30,000 lire to find a suitable husband.     Telling her that she knew of a good marriage prospect in a nearby village, Leonarda persuaded Faustina to write letters and postcards to relatives that she would later post from out of town to reassure them she was fine.    She also instructed Faustina not to tell anyone about her marriage plans.    On the day Faustina was to leave Corregio, she visited Leonarda's home for the last time.   There, Leonarda gave her drugged wine and then chopped her body inito nine pieces with a hatchet.  According to the official statement she gave to police afterward,

I threw the pieces into a pot, added seven kilos of caustic soda, which I had bought to make soap, and stirred the whole mixture until the pieces dissolved in a thick, dark mush that I poured into several buckets and emptied in a nearby septic tank. As for the blood in the basin, I waited until it had coagulated, dried it in the oven, ground it and mixed it with flour, sugar, chocolate, milk and eggs, as well as a bit of margarine, kneading all the ingredients together.  I made lots of crunchy tea cakes and served them to the ladies who came to visit, though Giuseppe and I also ate them.

After pocketing the money Faustina had brought with her, Leonarda selected fellow-villager Francesca Soavi.   After telling Francesca that she had found her a job a school in Piacenza, Leonarda persuaded her to keep the job offer secret.   She also persuaded Francesca to write a series of letters and postcards that would be mailed at a later date.   Copying the murder of Faustina Setti almost exactly, Leonarda drugged Francesca and dismembered the corpse with an ax on September 5, 1940.    She also pocketed her life savings (only 3,000 lire this time).   Once again, no suspicion attached to her and Leonarda was free to find another victim. 

It was this last victim who would prove to be her undoing.   Virginia Cacioppo was a former soprano who had sung opera professionally at La Scala in Milan.  She was also wealthier than Leonarda's other victims with more than 50,000 lire in cash and jewelry.   After Leonarda lured Virginia to her house with the promise of finding her a job with a mysterious impresario, she was killed like the other victims.   In a last, ghoulish touch, Leonarda added cologne to the soap she made from Virginia's remains to make it more appealing to friends and neighbours.  

VIrginia Cacioppo's sister-in-law became suspicious and began investigaing her disappearance.   When she learned that Virginia had last been seen entering Leonarda's shop, she went to the police superintendent.  Following an investigation, Leonarda Cianculli was arrested for murder.    She was unusually open with the police and described her crimes and how she disposed of the bodies in ghoulish detail.    Since World War 2  was still underway, putting her on trial for the murders was hardly a priority.   It was not until 1946 and Italy's defeat that Leonarda finally went on trial. 

And it was quite a trial.   Though her son Giuseppe had been arrested as well as a possible accomplice, he was later freed.    Leonarda's detailed confession of the murders, complete with descriptions of what she did with the bodies afterward generated international publicity.  During her testimoony, Leonarda was quick to correct the prosecutor on any details which she regarded as inaccurate.    At one point, she proudly pointed out that she "gave the copper ladle, which I used to skim the fat off the kettles, to my country, which was so badly in need of metal during the during the last days of the war. . . ."    She also described her reason for the murders, including her desire to help her son with human sacrifice.  Whether she truly believed what she had said in court or was hoping to avoid prison through an insanity plea, the graphic details of her crimes attracted a fair amount of public attention in a country stilll recovering from war.

Found guilty by the court,  Leonarda Cianculli was sentenced to thirty years in prison and three years in a criminal asylum.   While in prison, she wrote her memoirs, Le confessioni di un’anima amareggiata  (Confessions of a bitter soul).  Unrepentant to the last, Leonarda died of a cerebral apoplexy (stroke) on October 15, 1970.   As she would later insist, "I did not kill for greed" though her reason for killing three people seems as murky as ever.    Rome's Criminology Museum still contains numerous artifacts from the case, including the pot she used to boil her victims for soap.   

How Impressed Are Jurors with Risk Measures?

Scores from risk measures are a primary focus for scholars and forensic evaluators who attempt to estimate sex–offender recidivism risk. But do they matter to the jurors who make decisions about sex offenders in civil commitment trials? The authors of a recent paper published in Psychology, Public Policy, and Law surveyed jurors at the end of 26 sexually violent predator trials to examine the relation between risk-measure scores reported at trial and jurors' beliefs about the likelihood that the respondent would commit a new sexual offense if released. Jurors' perceptions of respondents' recidivism risk were not associated with respondents' scores on the Static-99 (R. K. Hanson & K. E. Thornton, 2000), Minnesota Sex Offender Screening Tool-Revised (D. L. Epperson, J. D. Kaul, S. J. Huot, D. Hesselton, W. Alexander, & R. Goldman, 1998), or Hare's Psychopathy Checklist-Revised (R. D. Hare, 2003). Jurors viewed respondents as less likely to reoffend and were more skeptical about the ability of experts to predict recidivism when an expert testified on behalf of the respondent. Findings highlight the incongruence between recidivism research, which identifies risk-measure scores as the strongest known predictors of sexual recidivism, and jury decision making.

For the abstract

How Effective Are Laws Against Sexual-Orientation Discrimination?

Though Title VII of the U.S. Civil Rights Act provides comprehensive nationwide protection from discrimination based on race, color, national origin, gender and religion, adding sexual orientation to that list remains a controversial topic across the United States. While 20 of the 50 U.S. states offer full legal protections and local ordinances offer some protections in 15 of the 30 states without state-wide protection, many legislators are shying away from extending legal protections further. With an estimated 33 percent of the U.S. population opposing legal protections for lesbians, gays, bisexuals and other sexual minorities, even politicians who privately support such legislation have avoided saying so publicly.

While wage studies comparing the wages of openly gay/bisexual men have consistently shown that they tend to make far less than straight men doing the same work, there is still widespread skepticism over whether such discrimination exists. Raw wages for sexual minorities tend to be lower than wages for straight people despite the fact that 1) gay men tend to be more highly educated on average, and B) gay men are more likely to live in urban areas where wages are higher. Much of this discrimination occurs in occupations that are male-dominated, including management, construction, and production. Though wage discrimination for lesbians is not as clear, lesbians, like gay men, are more likely to be highly educated than straight women. For both gay men and lesbians, however, the lack of legal protections in many states means far less job security and greater instability in their economic situations.

To read more, check out my new contribution to the Huffington Post.