Providentia

Choosing to be Homeless

A new case study published in the journal GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry  raises disturbing new questions about determining the mental capacity of dementia patients.  A 77-year-old woman with schizoaffective disorder and mild cognitive impairment, who had been homeless for much of her life, had been placed against her wishes in a locked dementia-specific hostel following a psychiatric admission for delirium. This had occurred without a formal coercive accommodation guardianship order, but with family consent. The patient was distressed by the placement, frequently expressing the wish to leave and attempting to escape. The mental health team assessed her capacity to decide where she should live. Ethical and legal issues raised by the case are presented with relevance to the burgeoning global advocacy for the autonomous rights of people with mental illness and cognitive aging shared across jurisdictions and common to many human rights frameworks.

For the abstract

Riding the Bandwagon Effect

Do you ever get the feeling that the only reason we have elections is to find out if the polls were right?  Robert Orben

During election season and even in the months before an election is even called, we are besieged by poll after poll weighing in on the relative popularity of various candidates, issues, or political parties. Though opinion polls date back to the 19th century, the rise of professional polling organizations, including the venerable Gallup poll, has made polling a crucial part of the election process in countries around the world. 

Despite the reputation for objectivity surrounding opinion polls though, there have been some legendary failures due to problems with biased questioning and how "random" some polls really are.  Though most polls, including the Gallup poll, predicted Harry S Truman's defeat in the 1948 presidential election,  he won instead.  To their embarrassment, some newspapers relied on poll results to print "Dewey Defeats Truman" headlines in their papers for the morning after the election (these papers have since become collector's items.

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

Higher Ecstasy Use and Lower Lower Alcohol Use in Teenagers Among Highlights of CAMH Drug Report

A new report released by the Centre for Addiction and Mental Health (CAMH) provides a comprehensive look at drug use in Canadian students aged twelve to seventeen.  The Ontario Drug Use and Health Survey (ODUHS) has been conducted every two years since 1977.   Administered by the Institute for Social Research at York University, the 2015 edition of the ODUHS surveyed more than 10,000 students from 220 schools across Canada.   Students in Grades 7 to 12 completed confidential questionnaires about use of alcohol, tobacco, illicit drugs, non-medical use of prescription drugs, and other substances of concern.   Their responses were compared to data from previous years to provide a long-term look at adolescent drug use in Canada over the past four decades.

When compared to the results for 2013, MDMA (also known as ecstasy) showed the most significant increase over the past two years.  Often known as a "party drug",  ecstasy use has risen by 5.4 percent overall though most of this increase appears to come from greater use by females rather than males.  The only other substances with a significant increase since 2013 involved the non-medical use of prescription medications used for treating attention-deficit hyperactivity disorder (such as Ritalin and Adderall). 

Virtually all other addictive substances, including alcohol, cannabis, cocaine, heroin, and LSD have shown a sharp decease since 2013.   Looking over a longer period,  even ecstasy use has dropped significantly since 2001 from 7.9 percent to 5.4 percent.   Other substances of concern including tobacco and energy drinks have also declined significantly.

Among the long-term patterns noted in the report were the following:

• Despite peaking in the 1990s, tobacco, alcohol, LSD, and methamphetamine use has reached an all-time low in recent years
• Binge drinking and use of cocaine, mushrooms, and inhalants is much lower than the peaks seen in the 1970s and late 1990s
• Even with recent declines, cannabis use is still higher than it was in the 1990s
• Crack and heroin abuse appears relatively stable in recent years

There are also new drug trends including the use of electronic cigarettes for "vaping" cannabis oil or wax.   The 2015 survey shows that about 5 percent of high school students report using cannabis in an electronic cigarette (this is out of 35,300 Ontario high school students.   The ODUHS started tracking synthetic cannabis (also known as "spice" or "K2") in 2013 and there is so far no sign of a rise in popularity.    Mephedrone or "bath salts" is another synthetic drug that the ODUHS has been tracking but evidence so far suggests that it hasn't really become a problem for mainstream high school students.

Despite evidence of a downward trend for tobacco use since 1977, this appears to have leveled off in recent years.   Since 2011, about 9 percent of adolescents have reported smoking cigarettes in the past year and 3 percent report smoking on a daily basis.   Cigarette use appears about even for males and females and increases significantly with age (reaching 15 percent among 12th graders).

While alcohol use has declined since 1977, it is still quite popular with adolescents with 47 percent of males and 45 percent of females reporting alcohol use in the previous year.    Twenty percent of Grade 9 to 12 students reported drinking hazardously in the previous year.

For more information

Remembering the Resurrection Men

Still on holiday, here's an old favourite to tide you over until I get back.

The Resurrection Men

"Up the close and down the stair, In the house with Burke and Hare. Burke's the butcher, Hare's the thief, Knox, the boy who buys the beef."

One of the highlights of my recent trip to Edinburgh was a visit to the Surgeon's Hall Museum that's part of the University of Edinburgh Medical School campus.  Among the exhibits to be found there was a display dedicated to one of the most notorious episodes in Edinburgh history: the Burke and Hare case (also known as the West Port murders). Selling seventeen murder victims to Dr. Robert Knox of the University of Edinburgh medical school for dissection earned William Burke and William Hare a permanent place in forensic history and popular folklore.

Actually, only William Burke was hanged for the crime (Hare turned King's evidence and testified against his partner). After Burke's body was dissected at the medical school, his death mask and a book bound with his skin were placed in the museum where they can still be seen by visitors. William Hare managed to vanish into obscurity after the trial (or tossed face first into a lime pit by an angry mob depending on which story you want to believe). Unfortunately, that left only one target for public outrage over the murders: Dr. Robert Knox.

A well-known physician, anatomist, and zoologist, Robert Knox was one of the most popular lecturers at the University of Edinburgh's medical school. Since joining the faculty in 1822, Dr. Knox distinguished himself with writing on a diverse range of topics including anthropology, zoology, epidemiology, and anatomy. He also took over the Surgeon's Hall Museum and expanded the collection. Visitors to the dissecting theatre where Knox gave his anatomy lectures often found him "dressed with an overgown and with bloody fingers" from dissecting cadavers for medical students.

Due to the limited number of available corpses (only executed criminals who had been specifically condemned to death and dissection by the courts could be legally used), anatomy professors who wanted to teach human anatomy to students were forced to rely on illegal sources to meet the demand. Beginning in the 18th century, "resurrection men" or "body-snatchers" began to offer bodies to medical schools, no questions asked. The actual source of the bodies varied, whether stolen from cemeteries or simply indigents who had died in poorhouses (resurrectionists would often pretend to be relatives to claim the bodies). Trafficking in dead bodies was extremely profitable and cases occurred throughout the United Kingdom and other countries.

The ghoulish reputation and the stigma associated with dissection led to a certain hysteria among friends and relatives of the newly dead. Many of them actually stood watch over the grave sites to ensure that the bodies were left alone. There was also a market for "burglar-proof grave vaults" with lurid advertisements playing up the body-snatching trade and corpses "mutilated every year on dissecting tables in medical colleges". Despite successful prosecution in many places, body-snatching was often considered a misdemeanor offense and helped ensure a steady supply of cadavers.

There was nothing unusual about Knox agreeing to buy bodies from Burke and Hare (and they had actually approached another professor first). When they were finally caught in 1828 and the body of their last victim was found in Knox's possession, his medical career was ruined. Although a thorough investigation showed no evidence that he had known about the murders, public opinion in Edinburgh turned against him. "Burking" became a new slang word for suffocation and local folklore helped feed the mob frenzy. Whatever hope Robert Knox had of his involvement being forgotten quickly faded as rumours of "mob justice" made him afraid for his life. While the passing of the Anatomical Act of 1832 expanded the number of cadavers available for medical school and finally put the body-snatchers out of business, it was too late to help Knox.

Despite a lengthy campaign of harassment, including attacks on his home, burning in effigy, and crowds gathering at his lectures, Knox continued to teach and do research although his career slowly went downhill. He never dissected another human cadaver despite writing numerous papers on human anatomy and was eventually forced out of all of his positions at the medical school. It was only after the death of his wife and one of his children in 1841 that he left Edinburgh for a medical school in Glasgow. Due to problems there, he searched for another teaching position and found that he had been essentially banned from every medical school in Scotland due to his presumed involvement with the West Port Murders. Despite being legendary for his medical knowledge, he had difficulty finding a job as a surgeon as well.

After eventually relocating to London and years of hardship (despite some success as a popular science writer),Robert Knox was appointed as a Pathological Anatomist at the Cancer Hospital at Brompton in 1856. He also had an extensive obstetrical practice and made numerous public lectures. Knox also continued writing on a vast array of science topics including medicine, comparative anatomy and anthropology.; While there was the lingering effect of his Burke and Hare involvement to deal with, he remained immensely popular with his friends and patients despite his failing health and the death of all but one of his six children. After slipping into a coma on December 9th, 1862, he died 11 days later without regaining consciousness.  Robert Knox is buried in Woking Cemetery near Surrey. Even in death, he never returned to Edinburgh.

Although most of his papers on ethnic differences can rightly be condemned as racist today (he was definitely a man of his time), Robert Knox left an enormous legacy of writing including books on science, anatomy, and medicine. His books on fishing and art were popular sellers as well. Dr Robert Knox dealt with the (typically anonymous) gossip surrounding his supposed involvement with the West Port Murders with unusual grace and managed to keep it from overshadowing his life.

That can be a major accomplishment in itself.

Who Mothers Mothers?

Developmental science is replete with studies on the impact of mothers on their children, but little is known about what might best help caregivers to function well themselves. In an initial effort to address this gap, a new article published in the journal Developmental Psychology describes an Internet-based study of over 2,000 mostly well-educated mothers, seeking to illuminate salient risk and protective processes associated with their personal well-being. When women’s feelings in the parenting role were considered along with dimensions of personal support as predictors, the latter set explained at least as much variance—and often much more—across dimensions of mothers’ personal well-being. Within the latter set of personal support predictors, findings showed that 4 had particularly robust links with mothers’ personal adjustment: their feeling unconditionally loved, feeling comforted when in distress, authenticity in relationships, and satisfaction with friendships. Partner satisfaction had some associations with personal adjustment outcomes, but being married in itself had negligible effects. Findings are discussed in terms of implications for future research, and for interventions aimed at fostering resilience among mothers facing high level of stress in their role as parents.

For the abstract

Cambodian Factory Shut Down By Mystery Illness

Da Vy is still not certain why she fainted.

In a media interview, the 36-year-old factory worker described what she experienced immediately before her collapse in early December.  “I just finished sewing 20 bras and I started not feeling good…. I went to the bathroom and my hands and legs became weak and I fainted,” she said. “I still feel in shock over this incident, because I have been working for 10 years in the garment sector and I have never experienced this before.”

Officials in Cambodia's Kompong Speu province are still investigating the mysterious epidemic striking workers at the newly-opened Cerie Cambodia Garment factory.   After forty workers collapsed on December 7, health authorities blamed it on improper ventilation following the factoryt's fumigation over the weekend.   On the following day, seventy workers reported similar symptoms which the director of the provincial labor department suggests may be due to psychogenic illness.

“One person had difficulty breathing and became weak and was carried out. When they saw this, they subsequently fell down,” said Chek Borin. “It has nothing to do with the pesticide anymore but they still felt shocked and scared inside the factory.”   Affected workers were rushed to hospital and most were able to return home within only a few hours.

Factory managers decided to close operations for several days and have scheduled a Buddhist ceremony to reassure workers that conditions were safe to resume work.   Incidents of mass psychogenic illness have become increasingly common in Cambodian and similar outbreaks have been reported in neighbouring countries.   Factory workers are felt to be especially vulnerable because of substandard work conditions and extreme poverty.   Lax labour laws allow employers to ignore health problems and rumours of toxins in the air or water spread easily among workers.

A much larger outbreak of suspected mass psychogenic illness occurred in Bangladesh two years ago when more than four hundred garment workers fell ill after drinking water believed to be contaminated.   Though many workers were hospitalized over health concerns, there were no fatalities and they were usually released from hospital after only a few hours.  

 

The Happiest Inmate on Death Row (Part Two of Two)

Continued from Part Two

The outcome of Joe Arridy's trial seemed almost a foregone conclusion.  

Newspaper coverage already declared him guilty and his attorney made no attempt to question any of the evidence against him or how his confession had been obtained.   The only real sticking point was whether some so mentally challenged could be held responsible for his actions.   Testing revealed that he had an IQ of 45 and three state psychiatrists agreed that Arridy was "“incapable of distinguishing between right and wrong, and therefore, would be unable to perform any action with a criminal intent."   There was also the fact that Barbara Drain had only identified Frank Aguilar as being at the crime scene and not Arridy.  

Still, Frank Aguilar's confession implicating Arridy, along with the anger surrounding Dorothy Drain's murder, overrode any of these objections.  While there would be no question of executing someone with this kind of intellectual disability today, the 1930s was a very different time.  It only took a jury four hours to find Joe Arridy guilty and to recommend the death sentence in his case.   

Both Arridy and Frank Aguilar were held at Colorado state penitentiary where the executions would be carried out.    In Frank Aguilar's case, the execution took place on August 13, 1937, only months after his conviction.   It was a bizarre spectacle considering that a witness died of a heart attack at the same time that Aguilar died in the gas chamber.   His elderly mother died in hospital soon afterward.   Riley Drain, father of Dorothy Drain, voiced his satisfaction at watching Aguilar die.  "I am happy tonight," he told the press.  "But the job is only half done.  I want to be there when Joe Arridy goes too." 

But not everyone agreed that Joe Arridy deserved to die.  Warden Roy Best, a man who was widely known for his tough-minded stance on crime, found himself sympathizing with this condemned inmate who had the mind of a child.   He even bought a toy train for Arridy to play with and later described him as "the happiest man on Death Row."    Along with a warm bed and regular meals, Joe Arridy was happy at being treated better than he ever had been in his life.  He certainly never experienced any of the teasing or bullying he had endured for much of his life.  Guards, inmates, and the prison chaplain, Albert Schaller, went out of their way to protect him from the brutal realities of his imprisonment.  Whenever he wound up his toy train and sent it along the floor of the cell block, another inmate would wind it up and send it back to him. 

It was Warden Best who recruited Gail L. Ireland, a crusading attorney would would later become Colorado's attorney-general.  Through his dogged efforts, Ireland managed to secure nine stays of execution until the Colorado Supreme Court ruled in a three to two decision to let the execution proceed.    The end finally came on January 6, 1939, two years after Frank Aguilar's execution.  The governor of Colorado had already phoned the warden and told him to schedule the execution.  Albert Schaller and Roy Best then proceeded to explain to Joe Arridy that he was scheduled to die.   As Roy Best told reporters, the condemned prisoner seemed unable to understand that he would be executed.   At one point, he was quoted as saying, "You can't kill Joe Arridy because Joe Arridy never killed anybody."

Even on the day of his execution, Joe Arridy requested ice cream and lots of it for his final meal .  Whether he was fully aware of what was going to happen seems hard to guess at this late date though he definitely enjoyed being the centre of attention.   Albert Schaller came in and carefully read the last rites to him and Joe crossed himself before going back to play with his train.  Then Roy Best came in and read the death warrant before he was taken to the gas chamber to be executed.  To ensure that everything was in working order, a pig had been killed in the chamber one day previously.  

Stopping only to give his toy train to his death row neighbour,  Arridy was placed in the chamber where he was strapped down and blindfolded.   Roy Best patted his hand and the chaplain gave him a simple, "Goodbye Joe" before the chamber was closed.  No members of the Drain family were in attendance though Joe' s mother had been there for one final visit before the execution.    Grinning until the very end, he took three deep gulps of the hydrogen cyanide gas that ended his life.  He was formally declared dead just minutes after the gas cleared from the chamber.   The next day, Joe Arridy was buried the next day in the Woodpecker Hill cemetery on prison grounds.

So, was he really guilty?   Or did the police take advantage of his intellectual disabilities to extract a false confession?   Decades after his execution, Joe Arridy's case has become a rallying point for opponents of the death penalty as well as disability activists.   In 1995, Robert Perske, a prominent legal activist working for the rights of the intellectually disabled, published a troubling book looking at the Arridy case and numerous others like it.   The book, Unequal Justice?,  highlighted how vulnerable people with intellectual deficits or similar disabilities are to giving a false confession during police interrogations.     Describing Joe Arridy's conviction, along with over seventy other cases in which people coerced into giving false confession, Perske's book generated renewed interest into Joe Arridy's case.   Inspired by the book, a group calling itself The Friends of Joe Arridy launched a grassroots campaign for a posthumous pardon. 

On January 7 2011, Colorado governor Bill Ritter Jr. issued an unconditional pardon for Joe Arridy, the first of its kind in Colorado's history.   The pardon came nine years after the landmark Atkins v. Virginia case outlawing the execution of prisoners deemed to be mentally retarded.   Today though, police interrogation of suspects with intellectual disabilities is still a controversial issue in many jurisdictions and cases of false imprisonment involving disabled prisoners continue to be reported by groups such as the Innocence Project.

Visitors to the Woodpecker Hill cemetery on the grounds of Colorado's state prison can find Joe Arridy's carefully tended  grave.   A new tombstone, two feet tall, was placed on the grave in 2006.  It features a picture of Joe and his toy train.

Burning the Library

Magnus Hirschfeld never set out to be a pioneer.

Born in the 19th century Prussian city of Kolberg (now part of Poland) as the son of a prominent Jewish physician, it seemed only natural that he would follow in his father's footsteps .   After taking his doctoral degree in 1892, he maintained a practice as a general practitioner and naturopath as well as being an avid writer. His writings focused on diverse aspects of human sexuality and he had ample material from his own private life to draw from.

While he tended to view his own sexual orientation as a "private mater", it is now accepted that he was a homosexual and a transvestite (and possibly even a foot fetishist). Rather than pursue the closeted lifestyle that most German homosexuals of his time pursued (under the German Penal code, homosexuality had been a criminal offense since 1871), he wrote a series of works proposing that homosexuality represented an "intermediate sex" (he also coined the term "transvestite).

Along with other gay activists, he founded the Scientific Humanitarian Committee in 1897 to encourage a liberalizing of laws against homosexuality. They even sponsored a bill to overturn the laws against homosexuality (the petition favouring the bill was signed by numerous prominent Germans including Albert Einstein, Thomas Mann, Martin Buber, and Richard Kraftt-Ebing) in 1898. It failed to pass but their movement continued. While many of Hirschfeld's ideas about homosexuality would probably be scorned today (homosexual males being feminine, homosexuality being a disease that deserved pity rather than arrest, etc.), he was a true pioneer at a time when such pioneers were rare. His published works on sexology influenced many later researchers including Havelock Ellis.

On the site of a former royal palace in Berlin, Hirschfeld opened the Institut fur Sexualwissenshaft (Institute for Sexual Research) in 1919. In addition to housing Hirschfeld's immense library of books on sexology, it was a centre for medical research and consultation for patients from all over Europe. Hirschfeld continued to make public appearances and was regularly referred to in the news media as the "Einstein of Sex".  His writings were extensive and included a 23-volume "Yearbook for the Sexual Intermediates" (the first periodical for homosexuals). He also helped write one of the first gay-themed films in 1919 Anders al die Andern (Different from the Others) which was banned by the German government in 1920.

It was during his public appearances that he faced the wrath of anti-gay (and anti-Semitic) activists. At one appearance in 1921, his skull was fractured and he was left lying in the street.  Despite these encounters, he was a well-recognized public figure and renowned sexual expert.  It was only natural that Einar Weigener sought him out in 1930 for help in achieving the first sex-change operation (which certainly added to Hirschfeld's notoriety). International conferences were organized and progress was being made.

And then it all fell apart...

The rise of Nazism put an end to Hirschfeld's crusading.  He went on an extended lecture tour in 1930 and decided not to return to Germany. The Nazis began to organize a campaign to purge Germany's libraries of "un-German material" and it was on May 6, 1933 that several vans with over one hundred students and a brass band (!) broke into the Institute while the band played. They seized Hirschfeld's entire library of over ten thousand books which went up in flames in a public bonfire three days later. A busted sculpture of Hirschfeld was marched through the street and then tossed into the flames.

The Nazis also seized the Institute's files which listed the names and addresses of many homosexuals living in Germany. The information was used to compile their notorious "pink list" of homosexuals who were sent to the concentration camps along with other "marginal populations".  Hirschfeld eventually settled in France where he died of a stroke in 1935.  He lived long enough to see virtually all traces of the gay emancipation movement he fostered in Germany wiped out.  He is buried in Nice.

While it is tempting to dismiss the destruction of the Institute and library as a sad consequence of the Nazi rise to power, the example is an uncomfortable one.  How often are modern scientists forced to defend themselves due to "unpopular" research that contradicts accepted norms and beliefs?  And how easily can extremists gain power under the right circumstances?

Any library can go up in flames with enough fuel.

Is ADHD Linked to Brain Injury?

A new study published in the Journal of Psychiatric Research describes the association between lifetime traumatic brain injury (TBI) and attention deficit and hyperactivity disorder (ADHD) among Canadian adults. A cross-sectional sample of 3993 Ontario adults aged 18 or older were surveyed by Computer Assisted Telephone Interviewing (CATI) throughout 2011 and 2012 as part of the CAMH Monitor, a rolling survey assessing the health, mental health and substance use of Ontario adults. TBI was defined as trauma to the head that resulted in loss of consciousness for at least five minutes or overnight hospitalization. ADHD was measured by the 6-item ASRS screener for adult ADHD, and self-reported history of diagnosed ADHD. Results showed that, among adults with a history of TBI, 6.6% (95% CI: 4.7, 9.4) screened ADHD positive, and 5.9% (95% CI: 3.6, 9.5) reported having been diagnosed with ADHD in their lifetime. Adults with lifetime TBI had significantly greater odds of scoring positive on the ADHD/ASRS screen (OR = 2.49, 95% CI: 1.54, 4.04), and of reporting a history of diagnosed ADHD (OR = 2.64, 95% CI: 1.40, 4.98) than without TBI, when holding values of sex, age, and education constant. The authors concluded thata significant positive associations between lifetime TBI and both current and past ADHD were observed among adults in this population. More research to understand these associations, and their significance for the etiology and management of TBI and ADHD, is needed.

For the abstract

How Secure Are Your Electronic Health Records?

The rise in telecommunications and online file sharing has had a dramatic impact on how health professionals communicate with their patients.   Though I'll be focusing on what mental health professionals are doing, this is really true for all health professionals in general.    Along with email, treatment providers are relying more and more on text messaging, videoconferencing, online chatrooms, and other ways of interacting without any need for face to face interactions.   There is even a surge of interest in online therapy with providers dealing with clients living in another city, or another country if necessary.  

But how secure is all of this electronic exchange of information, especially if it involves confidential matters?   Though ethical guidelines for mental health professionals (along with all other health professionals) call for proper security to avoid violating client privacy, how many treatment providers understand enough about this new technology to avoid problems?    Some professional organizations such as the American Psychological Association (APA) have released comprehensive guidelines for their members though they are still a work in progress and will probably need updating as the technology changes.  The Ontario Psychological Association (OPA) has just released Guidelines for Best Practices in Electronic Communication which is also useful even though they aren't binding for non-members.

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