Providentia

Monitoring Alcohol Use Remotely

A study published in Experimental and Clinical Psychopharmacology examined the ability of the Secure Continuous Remote Alcohol Monitoring (SCRAM) alcohol sensor to detect different levels of self-reported alcohol consumption, and to determine whether gender and body mass index, alcohol dependence, bracelet version, and age of bracelet influenced detection of alcohol use. Heavy drinking adults (N = 66, 46% female) wore the SCRAM for 1–28 days and reported their alcohol use in daily Web-based surveys. Participant reports of alcohol use were matched with drinking episodes identified from bracelet readings. On days when bracelets were functional, 690 drinking episodes were reported and 502 of those episodes (72.8%) were detected using sensor data. Using generalized estimating equations, we found no gender differences in detection of reported drinking episodes (77% for women, 69% for men). In univariate analyses, at the level of fewer than 5 drinks, women’s episodes were more likely to be detected, likely because of the significantly higher transdermal alcohol concentration levels of these episodes, whereas at the level of 5 or more drinks, there was no gender difference in detection (92.6% for women, 93.4% for men). In multivariable analyses, no variables other than number of drinks significantly predicted alcohol detection. In summary, the SCRAM sensor is very good at detecting 5 or more drinks; performance of the monitor below this level was better among women because of their higher transdermal alcohol concentration levels. Individual person characteristics and bracelet features were not related to detection after number of drinks was included. Minimal bracelet malfunctions were noted.

For the abstract.

May is Mental Health Month

To increase public awareness of the millions of Americans with mental health issues, Mental Health America is marking the month of May as Mental Health Month.   For the past sixty-five years, the month-long May campaign has been used to build public recognition about mental health symptoms, provide information on treatment programs available in the community, and give people in need the chance to learn more about their symptoms through special screenings.  The theme for the 2014 May campaign is “Mind Your Health” and Mental Health America’s goals for this year are to teach people about the ways that the mind and body work together to influence health and provide tips to help avoid the problems caused by stress and anxiety.

For people wanting more information, Mental Health America has a website listing the different ways you can participate,  screening tools for depression, anxiety, bipolar symptoms and PTSD,  and factsheets covering such topics as:

• Social support: getting and staying connected
• Health diet: eating with mental health in mind
• Supplements: weighing benefits and risks
• Stress: coping with everyday problems
• Rest, relaxation, and exercise
• Alcohol use and abuse: what you should know
• Finding help: when to get it and where to go

You can also contact one of the more than two hundred affiliates that Mental Health America maintains across the U.S. as well as related organizations in other countries.   There is also a media toolkit available for interested organizations wanting to participate including possible activities to enlist more involvement in your community.

Download the Mind Your Health Calendar(PDF)

Aging, Pain, and the Fight to Stay Healthy

As we grow older, many of us need to learn how to live with chronic pain.  

An estimated 60 to 75 percent of people over the age of 65 report having a problem with persistent pain and that rate is far higher for older people living in assisted care centres and nursing homes.    In the United States alone, there are more than 40 million people over the age of 65 and that number is expected to rise in the coming years as Baby Boomers grow older.   The majority of older Americans suffer from multiple conditions and the cost of treatment already accounts for more than two-thirds of the annual U.S. health budget.

The most common medical complains seen in older adults are osteoarthritis in the lower back and neck, musculoskeletal pain, chronic joint pain, and neuralgia linked to other conditions such as diabetes.   Not only does pain become more prevalent as people grow older, but women are generally more likely to report persistent pain than men.   While most older adults living with chronic pain tend to regard it as manageable for the most part, that can change as new medical conditions develop.

So how can we manage the pain problems that frequently arise as we grow older?   A new review article published in American Psychologist provides a comprehensive look at the numerous problems faced by older adults living persistent pain problems.    Written by Ivan R. Molton and Alexandra L. Terrill of the University of Washington Medical Center, the article identifies many of the barriers faced by older adults dealing with chronic pain and gives some directions for providing better care.

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

The Mind of Harry Orchard (Part 1 of 3)

Frank Steunenberg certainly had his share of political enemies. 

As the fourth governor of Idaho (and the first Democrat to hold that office), Steunenberg was first elected in 1898 with strong support from labour.    But that hardly stopped him from declaring martial law in 1899 and calling in federal troops to break up a violent mining strike.   Given the impact of strike (which continued until the end of his term in 1900), Steuenberg  chose not to stand for reelection due to the loss of his labour support).  If he and his family thought that he left his political battles behind once he left office, what happened on December 30, 1905 proved them all wrong.

While out for a leisurely walk near his home in Caldwell, Idaho, the 44-year old former governor pulled the wooden slide that opened the side gate at his family home.   What he failed to see in time was the home-made  bomb that someone had attached to the other side of the gate, apparently placed there to kill the former politician on his return.   The explosion blew him ten feet into the air and he was declared dead an hour later.   The sound of the explosion could be heard miles away and all the windows on the front of the Steunenberg house were shattered.   Some glass fragments were found protruding from inside walls.

As it happened, police found a suspect fairly quickly.   A man who had registered at a nearby Saratoga hotel under the name "Tom Goglan" had attracted suspicion after the blast.    Police investigtors found that their suspecthad a host of other names, though he preferred to be known as Harry Orchard (and I'll be using this name from here on in to avoid confusion).   Born Albert Horseley in 1866, he grew up in Ontario as part of a family of eight children.   Never getting past the third grade in school, he drifted into work as a logger before marrying and opening his own cheese business.

After an affair with a married woman, Orchard torched his business and, with the insurance money, fled Ontario with his mistress.  Though he had a wife and child by this time, he apparently gave them no further thought after abandoning them.  This new relationship was short-lived though and Orchard moved to Washington where he became involved with the mining industry there.   Making his early stake by driving a milk wagon, he became part-owner of a small mine though gambling debts and too much drinking forced him to sell his mining share.  

With a new job as a "mucker" at a nearby mine, Orchard also became part of the Western Federation of Miners.   In an era of violent strike activity, with mining companies hiring Pinkerton agents to protect their businesses from union "enforcers", Harry Orchard found his niche as a paid union activist engaging in guerrilla warfare.   Or, at least that was what he said in the  lurid confession he later provided.    According to this confession, along with being one of the miners who hijacked a Northern Pacific train in 1899, Orchard also developed considerable expertise with demolitions, including the destruction of the Vindicator mine in 1903 (which led to the deaths of two men) and the destruction of an Independence, Colorado train depot six months later.   Thirteen men died in that explosion.    

While Harry Orchard's career as a domestic terrorist was largely motivated by the money he received from union organizers for his efforts, he later claimed to have been motivated by his own outrage over how the mining company owners exploited mine workers.    In investigating the man who had become their chief suspect in Frank Steunenberg's murder, his long history as a union thug  who was likely linked to numerous other murders became apparent soon enough.    The only real question remaining was whether Orchard had been acting alone or whether Steunenberg's murder had been ordered by the Western Federation of Miners.

Under intense pressure to solve the murder as quickly as possible, Idaho's chief justice received permission from Governor Frank Gooding to call in the Pinkerton Agency to investigate the crime.    The agency had already achieved considerable notoriety by breaking up union activity and promoting their services to mining companies and they seemed well-suited to uncovering whatever conspiracy had led to the governor's death.    

 Legendary Pinkerton detective James McParland was dispatched to take over the investigation.    McParland had already become famous for infiltrating the Molly McGuires during the 1870s and breaking up their organization.   While there was already an open-and-shut case against Orchard, McParland wanted to implicate the union leaders themselves.    Accomplishing that meant pressuring Harry Orchard to turn on his presumed employers and reveal what he knew.

Whether it was McParland's reputation as "the Great Detective" (a nickname some journalists used for him) or the threat of being hanged over the governor's murder, McParland managed to get a full confession out of Harry Orchard using a diabolical strategy.   Not only did he have Orchard placed on death row in the Boise penitentiary with restricted rations and round-the-clock surveillance to prevent suicide attempts, but he met with his suspect over a "sumptuous lunch" followed by cigars (Orchard had been denied tobacco up to that time).   He flatly told Orchard that he would be hanged for the murder unless he confessed that the union leaders had ordered the bombing.    He also promised better treatment in jail, a more lenient sentence, and even a financial reward if Orchard provided the confession that the Pinkertons wanted.

In the 64-page confession he provided McParland, Orchard admitted killing Steunenberg with an carefully constructed bomb that basically involved rigging a bottle of sulfuric acid to fall on some industrial-strength blasting caps.   Harry Orchard reported that he had been hired to kill the ex-governor by William Dudley Haywood, then-member of the union's executive board.   As an ardent socialist as well as a union activist,  Haywood had long been on the list of agitators that McParland and his employers most wanted to see arrested.  

Along with Haywood, two other union leaders, Charles Moyer and George Pettibone were also implicated in Orchard's confession.   According to Orchard, not only had the union leaders ordered Steunenberg's assassination as revenge for his role in the suppression of the 1899 mining strike, but he admitted to various other union terrorist incidents, including the 1903 Vindicator mine explosion and the Independence train depot explosion.   For killing Steunenberg, Orchard claimed that he had been promised several hundred dollars and his own farm.  

But that was just the beginning.  

Orchard also claimed that Haywood and the others had ordered numerous attempted assassinations which had all failed for one reason or another.   In the signed confession he provided McParland,  Orchard concluded by writing:  "I awoke, as it were, from a dream, and realized that I'd been made a tool of, aided and assisted by members of the Executive Board of the Western Federation of Miners....I resolved, as far as in my power, to break up this murderous organization and to protect the community from further assassinations and outrages from this gang."  

Skeptics were quick to suggest that Harry Orchard's testimony against Haywood and the others was nothing more than an attempt for more lenient treatment by turning state's evidence.  Still, Orchard insisted that everything he said was the completed truth.  Adding to his confession 0n the witness stand, Orchard even broke down crying at one point as he described "what an unnatural monster I had been" and that he had been motivated to confess because of a Bible he had been sent by a missionary society in Chicago. 

But would this confession convince a jury?

Continue to Part 2

Does Childhood Intelligence Predict Health 40 Years Later?

A new study published in Health Psychology examined whether childhood general intelligence, fluid intelligence (Gf), and crystallized intelligence (Gc) predict various health outcomes in middle adulthood.  A prospective longitudinal study followed a nationally representative sample of 717 Luxembourgers. Intelligence and socioeconomic status (SES) were measured at age 12; physical, functional, and subjective health were assessed at age 52. Results showed that childhood general intelligence and fluid intelligence showed substantial positive effects on adult health outcomes, whereas the corresponding effects of crystallized intelligence were considerably smaller.  Childhood intelligence incrementally predicts various dimensions of adult health across 40 years—even in a country in which all citizens are guaranteed access to high-quality health care

For the abstract

Alzheimer's Patient Killed by her Children in Exorcism

A Polish man and woman are facing twelve years in prison after torturing their mother to death in what they claimed was an attempted exorcism.    Piotr Majewski, 38, and his sister Barbara Majewski, 39, carried out a violent ritual on their 75-year-old mother Irena in the belief that she was possessed by demons.   

In a statement provided to police, the siblings reported that they had attempted to banish the spirit of their late father from the house in Ostrowiec, Poland that they shared with their mother.    Believing that their father's spirit was acting as a channel for the Devil who wanted their mother's soul, they proceeded to tie Irena Majewski to a bed, placed a cross on her head, forced her to drink holy water, and to renounce the Devil.    Irena, who is believed to have been suffering from Alzheimer's Disease, was unable to comprehend what was happening and the siblings, belieing that her symptoms were caused by possession, took the exorcism even further.

According to local prosecutor Miroslaw Cebula in a statement to the Daily Mail, ‘When she told them she had had no contact with either Satan or her dead husband, they began beating and torturing her."   Based on a tradition that demons are unable to tolerate pain and will flee their human host as a result, they proceeded to beat and torture their mother to drive out the demons.   According to the autopsy, the violent ritual that led to Irena's death resulted from broken ribs, a shattered jaw, and severe brain trauma.  

While the Catholic Church provides exorcisms for people believing themselves possessed, including the opening of an exorcism centre in Poland, formal safeguards remain in place to prevent deaths.  That includes a medical evaluation to rule out physical or mental illness as well as only allowing exorcisms to be carried out by trained priests.    Despite these safeguards, exorcism-related deaths continue to be reported in countries across Europe, particularly involving cases of mental illness.

For more information

The Nerve Trainer

Being a pioneer is never easy.  Especially if you're a woman.

For Annie Payson Call, things started going wrong on June 10, 1890.  That was the day when Dr. Edward R. Utley of Newton, Massachusetts, announced to several Boston newspapers that the nervous collapse he was seeing in two of his female patients was due to their being "hypnotised" by Call.    The two patients were day students at the Lasell Seminary for Young Woman, located in Auburndale, not far from Boston.   They had been confined to bed following nervous problems that had occurred months earlier, not long after taking part in a nerve training course Call had conducted.  While Annie Call denied using hypnotism on her students, there was still enough mystery surrounding hypnosis in general, and the "mind training" that she was providing to her young female students, that a nationwide controversy erupted over what exactly was happening at Lasell Seminary.

While largely overlooked in the history of psychology, Annie Payson Call was one of the very few female practising psychologists of her era.   Despite the warm endorsement that she received from William James himself, Call's prolific self-help books, and frequent articles in the Ladies' Home Journal never attracted the kind of following that would make her famous.   Not that there was anything particularly revolutionary about her work, at least by modern standards.   

Drawing on many different self-help philosophies, including the voice and gesture training developed by Francois Delsarte, Call established her own system of nerve training to help women and men learn to deal with anxiety and nervous exhaustion.   Given that she lived in an era in which women were routinely confined to insane asylums, subjected to mind-numbing therapies,  or forced to undergo dangerous surgical operations to cure their "hysteria", suggesting that women could take charge of their own emotional health through mental training was a revelation.

In her most well-known book, Nerves and Common Sense, she wrote:

PEOPLE form habits which cause nervous strain. When these habits have fixed themselves for long enough upon their victims, the nerves give way and severe depression or some other form of nervous prostration is the result. If such an illness turns the attention to its cause, and so starts the sufferer toward a radical change from habits which cause nervous strain to habits which bring nervous strength, then the illness can be the beginning of better and permanent health. If, however, there simply is an enforced rest, without any intelligent understanding of the trouble, the invalid gets "well" only to drag out a miserable existence or to get very ill again.

Call argued that women could learn to manage stress and relax themselves to deal with their anxiety safely and effectively using various exercises of what she termed "mind concentration.”   Unfortunately, her techniques involved methods such as guided imagery and autosuggestion which, while a standard part of stress management training today, tapped into the cultural panic surrounding "hypnotism.”  Still poorly understood at the time (not that we understand it much better today), stories of sinister hypnotists gaining control over their (usually female) victims had generated a fair amount of mistrust over any treatment program that even suggested that women were being targeted.   Since Call described her training system as "combined concentration and relaxation in connection with the art of acting into a powerful means for relieving nervous distress",  many critics promptly accused her of hypnotism and the controversy was on.

The newspaper war that began  in response to Dr. Utley's accusation seemed evenly split between pro- and anti-Call forces.  The headline for the New York Sun read. "Girl Pupils Hypnotized" while the Boston Globe headline was, "Hypnotism Not Taught at Lasell".  The Sun story stated that the girl students at the centre of the controversy had been "completely hypnotized and their nervous systems... almost shattered" which was then picked up by newspapers across the country.    Newspaper coverage sensationalized the story further by suggesting that Call's "victims" were in critical condition and unlikely ever to recover.   

While the names of the patients were never released to the public, the Sun described them both as being fifteen years old and having been forced to take Call's course against their will.   The Sun also interviewed prominent neurologist and psychoanalyst, Dr. Frederick Peterson, who declared the Call system as being "full of danger" and that "compelling the girls to concentrate the mind intently on the various  muscles which they are taught to train to obedience."    Peterson went on to stress that the nerve training provided by Call was "sure to produce injurious results."   In what he likely thought would be helpful advice, Peterson concluded that "“girls in school shouldn’t be taught that they have any nerves.”

Call's defenders were somewhat saner in her defense.   The president and principal of Lasell Seminary, Charles D. Bragdon, stood by Annie Call and her training.   He reasonably pointed out that having one or two students developing problems later was almost inevitable considering the large class sizes Call was obliged to teach.   Following on that theme, one of Call's student told the press, "Would you abolish gymnasiums just because one or two persons sprained an ankle?”   Parents and teachers all stood by Call as well and dismissed any concerns about her nerve training.

All that remained was for Annie Payson Call to speak out in her own defense.   In a letter to the editor published in the New York Sun, Call emphatically denied using or teaching hypnotism to her students.   She produced an impressive list of experts who  all endorsed her nerve training, including eminent neurologist James Jackson Putnam.   As for her archnemesis, Dr. Utley, she pointed out that he had no special training in hypnotism and had even turned down an invitation to come to the school and see her class for himself.    Her letter also pointed out that the purpose of her nerve training was "to free the pupil’s body from tension and overstrain, and this only by securing the obedience of the organs of the body to their owner’s will, not the will of another.”  

Though the various testimonials Call produced from experts and students helped defuse some of the tension, newspapers were reluctant to tone down their crusade against her.   As far as they were concerned, Lasell Seminry had adopted "a vigorous description of mind culture closely resembling hypnotism" which could only result in harm to impressionable young girls.   

Given the era in which they lived, the curriculum at Lasell was largely intended to prepare girls for their presumed future as wives and mothers.   Training focused on domestic science and all the other arts that would supposedly lead to success in managing their own homes and children.   Annie Payson Call's nerve training was part of the "New Departure" curriculum offered at Lasell to set it apart from other "finishing schools" for girls by training them to  handle stress, something with which  "vulnerable women" presumably had difficulty.

As the story unfolded further, most newspapers became more accepting of Call and her nerve training.   The Boston Globe concluded that Call could not be reasonably blamed for the “little unpleasantness” at Lasell.   The paper even added that Lasell was "“not afraid to experiment in the new psychological sciences that are opening up such wide and interesting fields of inquiry.”    Other papers even suggested that Call's nerve training should be adopted at seminaries across the country since "the country needs women of nerve."  

While there was still demands that nerve training be discontinued, Call continued writing self-help books which made her methods more widely known.   Her 1891 book, Power Through Repose, was written as a direct response to the Lasell controversy.  Many of the exercises she described in her book have had a strong influence on the development of relaxation training and stress management techniques throughout the 20^th century (even though her name has been largely forgotten).  

Many of the therapists that Annie Payson Call trained in her workshops would go on to become influential in their own right.   Whether directly through her own teachings or through the teachings of her students, Annie Call’s nerve training and concentration exercises would play an important role in the development of mind-body interventions.   Many of the stress management techniques used in modern cognitive-behavioural therapy bear a strong resemblance to the techniques that she taught.

Despite lingering suspicions about Call’s nerve training, her course continued to be taught throughout the thirty-two years she spent at Lasell Seminary.   By the time of her death in 1940, Annie Payson Call’s “Gospel of Relaxation” had been largely overshadowed by other therapeutic techniques (not to mention the rise of Freudian therapy as a cure-all for hysteria).   Still, she remains an important pioneer in many ways and her life’s work lives on in one form of another.   Though her books addressed women of an earlier era, the message she conveyed seems as relevant as ever today.  

Is Pathological Gambling a Substance Use Disorder?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaced the fourth edition’s (DSM–IV) diagnosis of Pathological Gambling (PG) with Gambling Disorder (GD). GD differs from PG in that it requires 4 rather than 5 criteria for diagnosis and excludes the “Illegal Acts” criterion. In a paper recently published in Experimental and Clinical Psychopharmacology, the authors examined the prevalence of GD and its characteristics and validity in a substance-use disorder (SUD) sample. Participants (N = 6,613) in genetic studies of substance dependence underwent a semistructured psychiatric interview. Individuals who reported ever having gambled $10 at least monthly (n = 1,507) were the focus of the analyses. Approximately one third of acknowledged gamblers (n = 563; 8.5% of the total sample) received PG (DSM–IV) and GD (DSM-5) diagnoses and 678 (10.3% of the total) received only a DSM-5 diagnosis, representing an increase of 20.4% relative to DSM–IV. Although the 3 groups were comparable demographically, the DSM-5-Only group was intermediate between the other 2 groups on the prevalence of comorbid SUDs, the distribution of DSM–IV PG criteria endorsed, and the types of gambling reported. Multinomial logistic regression analysis showed that the DSM-5-Only group was more likely than the No-Diagnosis group and less likely than the Both-Diagnoses group to acknowledge a gambling problem. In conclusion, there was a high prevalence of PG in this SUD sample. Analysis of non-DSM variables suggested that the increased sensitivity of the DSM-5 GD diagnosis successfully identifies a broader set of individuals with clinically significant gambling-related problems. Prospective studies of individuals with GD are needed to validate this finding.

For the abstract

Toronto Launching New Anti-Hoarding Program

The city of Toronto is set to launch a new program designed to target the safety and medical issues surrounding complusive hoarding.    The new SPIDER program, short for Specialized Interdivisional Enhanced Response, was approved by Toronto City Council after years of community activism and short-term attempts at dealing with problem hoarding cases as they arise.   Compulsive hoarding often involves accumulating enormous amounts of junk mail, newspapers, uneaten food scaps, and even animals.   The amount of material collected by hoarders can lead to cramped living space, unsanitary conditions for the hoarders and their families, and even endangerment of any animals living with them.    

While the actual number of hoarders in Toronto is unknown, studies of hoarding behaviour in U.S. college students suggest that the prevalence could be as high as five percent of the general population.    Since the extent of hoarding behaviour falls on a wide continuum, only the most extreme cases are likely to require intervention.  According to the Toronto Hoarding Coalition, the costs of cleaning up a single case of extreme hoarding can exceed half a million dollars.  In one case occurring in Davisville last November, Toronto Fire workers had to wear HAZMAT suits to enter the home and remove numerous boxes of hoarded materials.   They had been called into the home due to concerns about a possible fire hazard.    Though neighbours had been raising concerns about the house for years,  they were frustrated over the lack of action until recently.  

"This has been a problem for, I’m sure, decades,"  said City Councillor Josh Matlow who told news reporters that he had been attempting to get the city to take action until recently.  "I’ve spoken to residents who have been complaining to anyone who would listen for years and nothing’s ever been done,”     While Matlow supports the SPIDER program, the lack of a similar program at the provincial level may limit the help that will be available.  "The city of Toronto is not equipped well enough to handle these issues because it’s not just to do with the fire department getting into the house or the police being able to get into a house or municipal licensing and standards – they’re issues around mental health,” he explained. “We need reform about how the province deals with mental health case.”   

While compulsive hoarding is often linked to other diagnoses such as Obsessive-Compulsive Disorder, it is typically classified as a separate disorder.   Since most hoarders live alone and are often isolated from the community, the problems raised by compulsive hoarding often go unrecognized for years before action can be taken.

Hiring for the SPIDER program will begin this month and a program update is expected to be presented to Toronto City Council this December.    

For more information

In Search of the Mad Genius

There is no great genius without some touch of insanity.   Seneca

Are highly creative people more prone to mental illness?   Though examples of "mad geniuses" such as Vincent van Gogh, John Forbes Nash, and Vaslav Nijinsky have been invoked as potential evidence for the genius-madness link, the actual scientific evidence is still scarce despite more than a century of research.  According to James C.  Kaufman in his recently-released book, Creativity and Mental Illness,  the long debate linking creativity and mental illness is largely based on misconceptions about both creativity and madness.   Other researchers are less willling to dismiss the "mad genius" completely however. 

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