Providentia

Fighting Mental Illness Stigma in the Workplace

The majority of people experiencing mental-health problems do not seek help, and the stigma of mental illness is considered a major barrier to seeking appropriate treatment. More targeted interventions (e.g. at the workplace) seem to be a promising and necessary supplement to public campaigns, but little is known about their effectiveness. A new systematic review published in BMC Psychiatry provides an overview of the evidence on the effectiveness of interventions targeting the stigma of mental illness at the workplace.  Sixteen studies were included as part of the literature review. The effectiveness of anti-stigma interventions at the workplace was assessed by examining changes in: (1) knowledge of mental disorders and their treatment and recognition of signs/symptoms of mental illness, (2) attitudes towards people with mental-health problems, and (3) supportive behavior. The results indicate that anti-stigma interventions at the workplace can lead to improved employee knowledge and supportive behavior towards people with mental-health problems. The effects of interventions on employees’ attitudes were mixed, but generally positive. The quality of evidence varied across studies. In conclusion, the review highlights the need for more rigorous, higher-quality evaluations conducted with more diverse samples of the working population. Future research should explore to what extent changes in employees’ knowledge, attitudes, and supportive behavior lead to affected individuals seeking help earlier. Such investigations are likely to inform important stakeholders about the potential benefits of current workplace anti-stigma interventions and provide guidance for the development and implementation of effective future interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

For the abstract

British Man Sentenced for Drug-Related Murder of his Mother

In June 2014, Margaret Evans, a 69-year-old hairdresser was found brutally murdered in her home in Portstewart, Northern Ireland.   Known as "Margo" to friends and customers, Margaret Evans had run the Madam Margo beauty salon in Portstewart for decades before retiring just months before her death.  Though her son, Alun Kinney Evans, initially refused to admit to killing his mother, he eventually pleaded guilty.  He also maintains that the murder occurred while he was under the influence of methoxphenidine (MXP), a designer drug known to cause serious hallucinations and other cognitive symptoms.   Now banned under the Psychoactive Substances Act which came into effect earlier this year, MXP could be legally obtained as a recreational drug at the time of Margaret Evans' murder.

The 34-year-old Alun Evans had a longtime history of drug use and psychiatric problems but was living with his parents when the murder took place.   His mother reportedly had a loving and supportive relationship with her son despite his chronic drug use.   In the days leading up to his mother's death, Alun had been taking MXP and alcohol. He told the court that he had purchased the MXP online because he was looking for a drug that could treat his depression.    

Though he reported that he "felt like Superman" after first taking MXP, he developed severe hallucinations and his behaviour became increasingly bizarre.  His mother advised him to drink water to flush the drug from his system but his condition deteriorated instead.   On June 4, 2014, neighbours saw Alun Evans naked on the family patio.  When they investigated further, they found the body of his mother with severe trauma to the chest and head.  After police arrived on the scene, Alun told them, ""I think I killed her, I think I've killed my mum. I had to kill my mum today - she's a witch."  

When found by the police, he was covered in cow manure which he had been eating.   He  had physical injuries due to trying to cut his wrists and neck with barbed wire and was also drinking out of a bird bath.  Following hospitalization to treat his injuries and to undergo a forensic assessment, he was then remanded to Maghaberry Prison. 

During the trial, the court heard autopsy results showing that Margaret Evans had been kicked, punched, stamped on, and struck repeatedly with a piece of wood before dying of blunt force trauma to the head and chest.  Alun's sister, Samantha Scott, filed a victim impact statement which read:  "Sometimes I feel angry and other times I worry about how he is coping with knowing what he has done.  "I feel very grieved for him as I know he wasn't in his right state of mind when he did this awful thing.   We don't wish to see him rot in a prison cell and then be sent on his way. We would rather see Alun receive the help that he has needed for so long."

In handing down his decision to sentence Alun Evans to an indeterminate custodial sentence, the judge declared him to be a significant threat to the community though he also ordered that he receive treatment.  Under the terms of his sentence, Alun Evans will serve a minimum of five years in prison for manslaughter.    

The online site where Alun Evans purchased MXP is still active at this time.

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The Problem with Richard Ivens (Part One of Two)

On January 12, 1906, the body of an attractive woman was found lying face downward in a large yard located near Belden Avenue on the outskirts of Chicago.  Half covered by trash, it had been dumped onto a refuse heap.  The body was discovered by twenty-four-year-old Richard Ivens who had been caring for his father's horse in the barn nearby.  Police were called after Ivens immediately rushed home and told his father about the body and it didn't take long for the dead woman to be identified.

Elizabeth Martha Hollister was the thirty-year-old wife of a local printer who had lived just four blocks from where the body was discovered.  She had left to sing at a friend's funeral on the previous day and her family, alarmed when she failed to come home, organized a search for her before hearing that the body had been found.   Police investigating her death found no evidence of a scuffle at the crime scene though copper wire was wrapped around her neck.  While there were signs of bruising, the cause of death was strangulation.  Whoever had killed Elizabeth Hollister dumped the body and tried to conceal it with trash.  Though her hat was there at her feet. several rings were missing from her fingers.  Her purse, shopping bag, and her muff were also missing leading police to suspect that robbery was the motive for her murder.   Based on their reconstruction of the crime scene, the dead woman was had been killed at some point during the daytime before her body was dumped in the lot during the evening.

Facing intense pressure to solve the case, a large force of police detectives were assigned to find whoever was responsible and they managed to find a suspect almost immediately.    It's hard to say exactly what led the police to suspect Richard Ivens in the first place.  While he had been the one to discover the body, the fact that it been dumped so close to his father's business likely made police suspicious.  He had absolutely no criminal history or any history of violence whatsoever but Ivens had a reputation in the neighbourhood of being gullible and absent-minded.  His apparent nervousness and indications that he hadn't had  a good night's sleep was likely all that the police had to go on in naming him a suspect.  Or perhaps they simply needed somebody to interrogate to make it seem as if they were doing their jobs. 

After arresting and charging Richard Ivens with murder (to the astonishment of everybody who knew him), police then subjected him to the "third degree" that was common police procedure in those days.   This basically meant mercilessly interrogating Ivens for hours at a time, all the while telling him that he was guilty.   Whether due to nervousness or simply because he had been manipulated by the police interrogators, Ivens eventually broke down and confessed to the crime.  He also signed a somewhat lengthy confession stating that he had assaulted Elizabeth Hollister as she passed his father's shop on Belden Avenue.  When she resisted, he dragged her into the shop and killed her by typing wire around her neck.   After dumping the body, he went home to supper and stayed there all night before pretending to find the body on the following day. 

Within hours, newspapers across the country were reporting that Ivens was guilty of murder (even though he had not even been tried yet).   Despite being widely seen as an open-and-shut case however, there were troubling details about the confession.   While the confession stated that Ivens had been drunk at the time of the murder, his mother insisted that he had been sober when he came to supper(and he certainly had no history of alcoholism).  There were also people willing to swear that he had an alibi at the time of the killing.  But these objections were largely ignored as the newspapers and police declared the case solved.

At the coroner's inquest, which was held just days after the body was found, Richard Ivens described how he killed Elizabeth Hollister. Newspaper reporters were quick to describe how unconcerned Ivens seemed as he gave his testimony.  This so enraged the victim's brother-in-law that he attempted to shoot Ivens right in the courtroom (a police officer spotted the weapon and restrained the gunman).   During the cross-examination, Ivens basically repeated everything that had already gone into the signed confession.   This was essential for court cases of the time since, knowing the kind of interrogation tactics police used, having the defendant repeat the confession in open court eliminated any accusations of police intimidation. 

Newspapers had no problem denouncing Ivens and his crime.  One reporter wrote that the defendant was a "ruffian" whose confession "for moral depravity, has no parallel in police records."   He also added that Ivens was "big and brutal looking", something that apparently proved his guilt.   It hardly seemed to matter that Ivens had no previous criminal history or that there had been other recent attacks on women in Chicago, including several murders very similar to Elizabeth Hollister's.   Although there was no attempt to link Richard Ivens to the other crimes (he had a solid alibi), women were warned to be careful when walking in the streets and to avoid displaying money or jewelry. 

Given that Ivens made a full confession, his family had little hope of saving his life except by trying for an insanity defense and his father told reporters that his son had been acting "queerly" before the killing.  In the meantime, public outrage over Elizabeth Hollister's death meant the political pressure to get a conviction was intense.   Despite repeated grilling to get Ivens to name accomplices,  including rumours that he was part of a larger gang targeting women in Chicago, police eventually concluded that he had acted alone.

In the trial that began on March 5, Richard Ivens was defended by attorney I. W. Foltz, who also happened to be a friend of his family.  Considering the public outrage, and the presence of the victim's husband who police feared would try to kill Ivens, police protection was especially tight.    While Foltz provided testimony from one witness who swore that the defendant was at her home when the murder occurred, the prosecutor managed to discredit her testimony and the case shifted to the actual value of Ivens' confession.  

After failing to keep Iven's confession from being entered as evidence, Foltz then tried another, more unusual tactic.   He argued that Assistant Chief of Police Herman F. Schuetttler, who had gotten Ivens to confess in the first place, had used "hypnotic" techniques to make him believe that he was guilty.  Despite being all the rage in vaudeville acts, hypnosis was still a mysterious and often-misunderstood phenomenon with frequent news stories describing how hypnotists robbed victims of their free will.    Given Richard Ivens' low intelligence (his own attorney called him a "half-witted boy"), he was considered to be especially vulnerable to this kind of persuasion.

To nobody's surprise, Richard Ivens then recanted his entire confession and the trial then turned to a new question:  why would someone confess to a murder that he didn't commit?

Continue to Part Two

 

 

 

 

 

 

Shell Shocked, Part 2

Continued from Part One

Long after the end of World War I, Field Marshall Douglas Haig remains a controversial figure.

As Commander-in-chief of the British Expeditionary Force during some of the most intense battles of the war, his military decisions played a pivotal role in ensuring an Allied victory. Though honoured in his lifetime, later historians accused him of recklessly throwing away the lives of countless British and Commonwealth soldiers and labeled him as "the Butcher of the Somme". While other historians have defended his actions and argued that his decisions were based on sound military tactics, what is not in dispute is that 306 British and Commonwealth soldiers under his command were executed on a variety of military charges ranging from cowardice to desertion.

Although some of the soldiers had been previously treated for shell shock, it may never be known how many of the executed soldiers (some as young as sixteen) were suffering from psychological trauma resulting from their combat experiences. The circumstances of their offending may have varied but the end result was the same: a brief trial (often as short as twenty minutes) with no appeal and subsequent execution at dawn by firing squad. Haig reviewed and approved each of the execution orders (although they represented only a fraction of the 3080 death sentences handed down by British military courts).

When public criticism arose back in England, Haig defended the executions by emphasizing the necessity of enforcing discipline and downplaying the possibility that any of the soldiers could have been suffering from a psychiatric illness. In many cases, families of executed soldiers were not told of the circumstances of how their loved ones had died although word usually leaked out. The stigma of cowardice would remain for more than ninety years until a blanket pardon was issued for the 306 executed soldiers in 2006. While the pardon did not annul the actual sentences, some closure was provided for surviving family members. By comparison, Germany only executed twenty-five soldiers during the war and had pardoned them all within a decade after the war ended.

The use of the term "shell shock" fell into disrepute over the course of the war and was formally dropped as a diagnosis by 1918. By the end of World War I, the British army alone had dealt with approximately 80,000 cases of shell shock. The problems did not end in 1918 as Allied governments were faced with the monumental task of reintegrating so many psychologically disabled soldiers into a society for which they were unprepared.  A British royal commission published a report in 1922 laying out guidelines for dealing with shell-shocked solders but the stigma surrounding combat stress remained. Germany faced the same problem with its returning veterans. The resources of the impoverished Weimar republic was strained to the breaking point trying to deal with them all (including a shell-shocked Austrian veteran named Adolf Hitler whose personality was permanently altered by his war experiences).

Few lessons seemed to have been learned from the World War I experience and it would not be until 1980 (after considerable lobbying by veterans groups) that post-traumatic stress disorder would be formally recognized as a psychiatric diagnosis. Given the ongoing psychological problems faced by troops returning from tours of duty in Iraq and Afghanistan and the struggle they face for proper treatment, it's hard not to wonder whether these lessons have been learned yet.

Pre-term Birth and Later Psychiatric Problems

Preterm birth at very low birth weight (VLBW) poses a risk for cerebellar abnormalities and increased psychiatric morbidity compared with reference populations. A new study published in the journal Child and Adolescent Psychiatry and Mental Health examines cerebellar volumes (grey and white matter; GM, WM) and mental health in VLBW individuals and controls at 15 and 19 years of age, as well as changes between the two time points. Forty VLBW (≤ 1500 g) and 56 control adolescents were included in the study at 15 years of age, and 44 VLBW and 60 control adolescents at 19 years of age. The researchers had longitudinal data for 30 VLBW participants and for 37 controls. Clinical diagnoses were assessed following the schedule for affective disorders and schizophrenia for school-age children (KSADS). Psychiatric symptoms and function were further investigated with the Achenbach System of Empirically Based Assessment (ASEBA), ADHD Rating Scale-IV and the children’s global assessment scale (CGAS). An automatic segmentation of cerebellar GM and WM volumes was performed in FreeSurfer. The MRI scans were obtained on the same 1.5T scanner at both ages. Results showed that the VLBW group had higher rates of psychiatric disorders at both ages. Cerebellar growth trajectories did not differ between VLBW adolescents and controls, regardless of psychiatric status. However, VLBW adolescents who had a psychiatric diagnosis at both ages or developed a psychiatric disorder from 15 to 19 years had maintained smaller cerebellar WM and GM volumes than controls and also smaller volumes than VLWB adolescents who were or became healthy in this period. Moreover, there were no differences in cerebellar WM and GM volumes between controls and those VLBW who were healthy or became healthy. In the VLBW group, cerebellar WM and GM volumes correlated positively with psycho-social function at both 15 and 19 years of age, and smaller GM volumes were associated with inattention at 15 years. In conclusion, smaller cerebellar volume in adolescents born very preterm and with VLBW may be a biomarker of increased risk of psychiatric problems in young adulthood. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

For the abstract

 

Jamaican Author Describes Ex-Gay Ordeal and Exorcism

When author Marlon James was in his thirties, he desperately sought help from his pastors to help him "cure" his sexual orientation.   Growing up in Jamaica, which is widely recognized as being one of the most dangerous places in the world for LGBT people, he regularly encountered  anti-gay attitudes and violence and the prospect of finding a way out seemed too good to be true.  In an interview with British newspaper, The Times, the 45-year-0ld James described what he went through with the "ex-gay" conversion therapists that his pastors had directed him to see.  “I thought ‘Great, I am getting rid of demons’, until I read up on the whole ex-gay thing,"  he said in the interview.

Under Jamaican law, sex between men is a criminal offense punishable by up to ten years in prison.   Convicted homosexuals are routinely sent to labour camps where they are often targeted by guards and other inmates.   Things are little better for men even suspected of being "battyboys" (local slang for gay) and homophobic assaults remain common.   Though the "ex-gay" movement has been discredited in most Western countries, including being outlawed as child abuse in many jurisdictions, conversion therapists continue to practice in Jamaica with little oversight by professional organizations. 

For James, who became the first Jamaican author to win the Man Booker Prize in 2015, the conversion therapy meant a gruesome regime of aversion therapy, prayer, vomiting, and even an "exorcism" to drive out his "demons."   His ordeal eventually led to his fleeing Jamaica and taking up residence in Minneapolis where he now teaches literature at St. Paul's Macalester College.  

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The Case of the Pimlico Poisoner (Part Two of Two)

Continued from Part One

When the trial of Adelaide Bartlett and George Dyson opened on April 12, 1886, it was an immediate media sensation considering the lurid details.   Not only was Adelaide accused of poisoning her husband with a fatal dose of chloroform, but the (ahem) unconventional aspects of her married life with Thomas Edwin Bartlett would become prime fodder for gossip on both sides of the Atlantic.   Along with the titillating details of adultery there was also the forensic evidence provided by the prosecution experts which focused on one single question:  how did Adelaide do it? 

Ironically, while George and Adelaide went to trial together, the prosecution's only real interest was in building up their case against Adelaide.   For that reason, the acting prosecutor in the case, Attorney General Sir Charles Russell, immediately asked that all charges be dropped against George Dyson and he was promptly acquitted.  This paved the way for George to be called as a prosecution witness (as a defendant, he wouldn't have been able to testify for himself).   It was Adelaide alone who went on trial for murder (and faced a possible death sentence if convicted).  

Defending Adelaide was prominent trial lawyer Sir George Clarke who, according to rumour, had been hired by her still-unnamed father.   While Clarke would insist that Thomas had actually taken the chloroform to commit suicide, defense and prosecution were both left with the problem of explaining exactly how the chloroform had entered the dead man's system.   One major stumbling block for the prosecution's case was that there were no tell-tale traces of the chemical burns which would certainly have been found in Thomas' mouth and esophagus if Adelaide had poisoned him.   On the other hand, George Clarke argued that the lack of burns suggested he had gulped the chloroform down rather than drinking it unknowingly the way the prosecutor claimed.

Despite the mystery of how the chloroform had entered Thomas' system, the fact that Adelaide had several bottles of chloroform in her possession, which George Dyson had purchased for her,  was certainly damning.  What made things even more suspicious was Dyson's curious decision to purchase the chloroform in small amounts at different shops rather than in one large bottle (under British law at the time, purchasing large amounts of medical poison meant having to sign one's name in a special register pharmacies were required to keep).   George Dyson insisted that he had purchased the chloroform at Adelaide's request though he claimed not to have realized until later how suspicious his different purchases would have seemed to police.  

As for Adelaide, her reason for purchasing the chloroform helped add to the sense of scandal surrounding the case.   Since Adelaide was prevented by law from testifying in her own behalf, it was left up to her family doctor, George Dyson,, and Thomas' father, to share the bizarre details of the case.  According to Dr. Leach, Adelaide had told him that she purchased the chloroform to curb her husband's "sexual passion."   While she and Thomas had apparently decided to refrain from sex following the stillbirth of her only child, Adelaide was disturbed to discover that her husband "manifested some desire to renew sexual intercourse with her."   Since she and George Dyson were already involved, she decided to purchase the chloroform so that she could wave it under Thomas' nose "lulling him into a kind of stupor, and so prevent him giving effect to his sexual passion."  

But this was only one of the lurid revelations that came out during the trial.   People in attendance audibly gasped at hearing that no less than six condoms were found in Thomas Bartlett's pocked.   Also know as "French letters",  condoms were fairly crude affairs in those days but the fact that Thomas Bartlett had them at all was considered horrifying.   Then there was the discovery of a "marriage manual" in the Bartletts' apartment.  Though  tame by modern standards,  any book containing explicit references to sexuality and birth control was deemed pornographic in Victorian times and the presiding judge, Sir Alfred Wills, devoted considerable time during his final summation about the dangers of such a book for women (he described it as "reading which helped to unsex them.")  Judge Wills also insisted that the jury would have to pity Adelaide considering her husband "could throw such literature her way and encourage her to read it"  and that "One has learned to-day what is the natural and to be expected consequence of indulgence in literature of that kind."  

Since Thomas Bartlett was, like all Victorian gentlemen, expected to protect his wife from corrupting influences, the presence of the book, as well as the condoms in his pocket, cast serious doubt on Adelaide's description of her "platonic" marriage.   Abandoning any claim to being objective, the judge seemed determined to sway the jury to find Adelaide Bartlett guilty.   He ended his summation by stating:  "When a young wife and a younger male friend get discussing, in or out of the presence of the husband, the possibilities of his decease within measurable time and of the friend succeeding to the husband's place, according to all experience of human life, the life of the husband was one that an insurance office would not like to take."

But the jury was less impressed by the available evidence than the judge and prosecutor had hoped.   It only took them two hours of deliberation to find Adelaide not guilty.   On hearing the verdict, the people in the courtroom and the corridors outside promptly started cheering, something that Judge Wills, who was likely disappointed at the trial's outcome, regarded as an "outrage."   Still, Adelaide was free to go.

Despite the evidence presented during the trial, public sympathy had largely turned against Thomas Bartlett who was regarded as being the chief villain in the case.  As the husband, it had been his responsibility to protect his wife from corrupting influences and to maintain a normal household, children and all.    Though the prosecution tried to present Adelaide as a scheming adulteress who had poisoned her husband to be with her lover,  Adelaide's lawyer convinced the jury (and the public) that his client was incapable of murder.   Simply by saying nothing (she never gave any statement regarding her guilt or innocence), Adelaide's meek appearance helped win the sympathy of everyone associated with the case.

There were still a few people convinced that Adelaide had gotten away with murder, however.   One skeptic, famous surgeon Sir James Paget, greeted the verdict with his now famous quip:  ""Now that she has been acquitted for murder and cannot be tried again, she should tell us in the interest of science how she did it!"  

But Adelaide  continued to stay silent about the case, and her life with Thomas.   After her acquittal, she managed to disappear from public notice completely (probably with her father's help) and nothing was ever heard about her again.   As for George Dyson, the notoriety surrounding the case and his unconventional relationship with Adelaide forced him to leave Great Britain.   Despite conflicting stories over whether he had emigrated to Australia or the United States, nothing more was really heard about him either.

But the case of the Pimlico Poisoning would continue to fascinate true crime buffs well into the present day.   Transcripts of the case are still available online and there have been various attempts at solving the mystery of Thomas' death once and for all.  Along with books and radio programs describing the case, there was at least two notable attempts to bring the story to life on the silver screen.   Alfred Hitchcock once stated that he had planned to make a movie about the case but had ultimately decided against it.    The 1986 movie My Letter to George starring Jodie Foster was loosely based on Adelaide Bartlett's story.

So, did Adelaide Bartlett kill her husband?  You be the judge.

 

Shell Shocked, part 1

As part of the awareness campaign surrounding National PTSD Awareness Month, I am rerunning this two-part post that  I first posted in 2007.

The "Great War" that raged from 1914 to 1918 added a new dimension to warfare with modern artillery fire raining down on troops as they dug into their trenches.

An estimated ten percent of all troops deployed were killed (compared to 4.5% in World War 2) with countless more being severely wounded. With the modern way of fighting wars came a new awareness of how troops were being affected. While troops of previous wars had presented symptoms of the extreme stress they were facing (eg., soldier's heart), it was in 1914 that a British medical officer named Charles Myers first coined the term "shell shock".  This became a popular diagnosis for describing the impact of battle on even experienced soldiers who displayed a range of bizarre symptoms that medical doctors on both sides of the conflict were at a loss to treat. Though many of these cases were observed in soldiers who had faced the heat of battle, even soldiers who had never been deployed in the field were showing symptoms.  There was a range of medical opinions offered as to the cause ranging from suggested medical explanations to accusations of cowardice. Soldiers sent to hospitals for treatment were overcome with shame over their lack of bravery with four out of five soldiers being unable to return to fighting afterward.  Many of these patients, typically young men under the age of twenty, were often urged to face their trauma in a "manly way" and rarely received sympathy from commanding officers or fellow soldiers. A distinction tended to be made between the symptoms reported by common soldiers and what officers developed and they would often be sent to different hospitals.

Given the high rate casualties occurring during the war and the need for soldiers to fight, the priority was given to methods that would get soldiers back into action as quickly as possible. Different therapists advocated radically different approaches ranging from simple talking cures to "torpillage" or electroshock therapy (especially popular in the French army).   Advocated by Clovis Vincent, a French neurologist, for use with cases of hysterical paralysis, the treatment involved Vincent applying a sharp current to the patient's body to provoke involuntary movement. The treatment fell out of favour after a soldier received a court-martial for punching Vincent.   A similar approach was followed for the treatment of German soldiers and was known as the "Kaufman Cure" after its primary exponent, Fritz Kaufman. The treatment involved "surprise" methods including shock and physical intimidation and resulted in the deaths of an estimated twenty patients.

In 1915, a British Army directive was issued stating that "Shell-shock and shell concussion cases should have the letter 'W' prefixed to the report of the casualty, if it were due to the enemy; in that case the patient would be entitled to rank as 'wounded' and to wear on his arm a 'wound stripe". If, however, the man's breakdown did not follow a shell explosion, it was not thought to be 'due to the enemy', and he was to be labelled 'Shell-shock' or 'S' (for sickness) and was not entitled to a wound stripe or a pension". By 1917, all British cases of shell shock were separated into "commotional cases" (due to physical causes) and "emotional" cases who were increasingly kept in their units unless the symptoms were extreme.  The treatment of shell shock cases in their units by counsellors (not necessarily medical) gave rise to the PIE principles for treating shell shock cases. Treatment focssed on (P)roximity to the fighting, (I)mmediate treatment (as soon as possible), and the (E)xpectation that shell-shocked soldiers would be returned to active service following treatment. These same principles would be adopted in American and Commonwealth armies following the war (although their effectiveness in preventing PTSD has since come into question).

The shell shock diagnosis did not prove popular with the upper echelons of the British military and was abandoned in 1918. All too frequently, shell-shocked soldiers faced military tribunals and could be executed for cowardice.  And they were.

Continue to Part Two

Sex, Seniors, and Consent

In August 2014, Iowa State Assemblyman Henry Rayhons was formally charged with felony sexual abuse.   The 79-year-0ld politician's crime?   Allegedly having sex with his second wife Donna, who was then a patient in a special care facility for people with Alzheimer's disease.    While the case would eventually end with Henry being acquitted, it still raises troubling questions about the often controversial issue of sexuality in seniors and the barriers imposed by nursing home staff.   

When Henry married Donna Young in 2007, it seemed an ideal second marriage for both of them.  Henry had four children from his first marriage to his wife, Marvalyn, while Donna had three daughters.   Even after Donna developed Alzheimer's Disease, Henry was a frequent visitor to the nursing home which she entered as a voluntary patient.   Even as Donna's condition deteriorated, Henry's visits would continue and, as her own daughter would later testify,  Donna "just lit up every time Henry would enter the room." 

They had a loving relationship and were often seen hugging or holding hands during his visits.  There was certainly nothing to indicate that he was abusive or that Donna was in any way afraid of her husband.  The only real conflict came from the different views Henry and Donna's daughter had about the kind of care she should receive.   Henry wanted to take Donna out of the nursing home for visits to familiar places but the oldest daughter objected to allowing Donna out for anything but attending church on Sunday. 

Another source of friction came from from staff members referred to as "inappropriate sexual contact" between Henry and his wife.  One social worker even wrote her concerns right into Donna's care plan with the note:  "Given Donna's cognitive state, do you feel she is able to given consent for any sexual activity?"    Dr. John Brady, medical director of the nursing home agreed and staff advised Henry that he should refrain from any sex with Donna.   As it would turn out later, Henry and staff members had different ideas about what "sexual activity" actually meant.

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

 

Only a Phone Call Away

Telephone-administered cognitive behavioural therapy (T-CBT) has attracted international recognition as a potential means of providing effective psychological treatment whilst simultaneously lowering costs, maximizing service efficiency and improving patient access to care. A lack of rigorous exploration of therapist perspectives means that little is known about professional readiness to adopt such delivery models, or the work that may be involved in ensuring successful implementation.  A new paper published in BMC Psychiatry provides a qualitative exploration of professional views of high intensity T-CBT. Semi-structured interviews with 18 UK accredited Cognitive Behavioural Therapists with nursing or allied health backgrounds were collected and analysed according to Normalisation Process Theory, a contemporary and empirically-derived theory of health technology implementation. Results showed that despite increasing research effort seeking to determine the effectiveness of T-CBT, the clinical rationale for its use remains insecure. Professional perceptions of T-CBT as a high risk delivery strategy emerge as a key factor delaying T-CBT routinisation in practice. T-CBT champions draw on experiential knowledge to demonstrate that remote services can add value, a key factor being the recognition that telephone-mediated services can provide viable access for hard to reach populations. T-CBT uptake will be facilitated by i) the modification of existing protocols to address new methods of exchanging information and data, and (ii) greater clarification of the reach and span of telephone therapies, including the most appropriate division of labour across different service levels and settings. The authors conclude that the integration and normalisation of high intensity T-CBT into mental health services demands greater recognition and redress of the existing socio-technical matrices within which nursing and allied health practitioners work. The future spread of higher intensity T-CBT is contingent upon the willingness of service managers to support staff in the delivery and governance of non-face-to-face therapy models. Clear delineation of the role and scope of T-CBT and the extent to which it will extend or replace existing provision is required. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

For the abstract