Providentia

Alfred Russel Wallace and The Vaccination Wars

Although Jenny McCarthy and her fellow anti-vaccinationists still wage their very public crusade against vaccination, there's nothing really new about their arguments. Opposition to vaccination is as old as vaccination itself.

Smallpox was once one of the most devastating and feared diseases in history. As recently as the 18th century, frequent outbreaks killed an estimated 400,000 Europeans each year and left many survivors disfigured. Especially dangerous in children, 80% of those who contracted smallpox died of the disease. When Lady Ashley Wortley Montague arranged for her son and daughter to be inoculated against smallpox in 1717 (the practice was common in Asia but was unknown in Europe), she had no idea of the storm she would unleash as a result. Although early opposition to inoculation had a valid basis (patients undergoing the first inoculation technique, also known as variolation, had an estimated 3 percent chance of developing serious complications), much of the resistance came from religious leaders. In a July 8, 1722 lecture by Edmund Massey at St. Andrew's Church in Holborn, England, he based his sermon on a passage from the Book of Job, "So went Satan forth from the presence of the Lord and smote Job with boils, from the sole of his foot, unto his crown". Massey argued that the Biblical disease in question was smallpox and added, "With this view, I will not scruple to call it a diabolical operation, usurping an authority founded neither in nature or religion. This practice also tends to support vice and immorality, inasmuch as it diminishes the salutary terror which prevails respecting the uncertain approach of this disease".  In other words, being afraid of smallpox built character.

Although Edward Jenner's discovery of vaccination meant a safer alternative to variolation, it would still take many years for vaccination to be widely accepted. In 1840, the British Parliament passed the first Vaccination Act which banned variolation. The Act also gave local boards the power to vaccinate everyone in their districts but still allowed individual objectors to refuse. While vaccination campaigns led to a dramatic drop in smallpox cases, outbreaks continued to occur (especially in the growing city slums). Following pressure from medical authorities, Parliament amended the act in 1853 to make vaccination compulsory. Not only were all newborns required to be vaccinated within the first three months of life but any parent refusing to comply was fined. By 1867, the law became even more stringent with parents being prosecuted for refusing to have their children vaccinated.

It was these stringent laws that inspired the development of the anti-vaccination movement in the 1870s. One of the leading figures in the movement was William Tebb who co-founded the London Society for the Abolition of Compulsory Vaccination in 1880 (it later became the National Anti-vaccination League in 1896). A lifelong firebrand, Tebb had been prosecuted thirteen times for refusing to vaccinate his third daughter. Along with his supporters, Tebb pushed for the abolition of the Vaccination Act and an end to compulsory vaccination in the UK and abroad. Realizing that the movement needed an eminent scientist to support the anti-vaccination cause, Tebb recruited an unlikely champion: Alfred Russel Wallace.

Although Wallace was already famous for his role in the development of Charles Darwin's theory of evolution, his willingness to take on unpopular causes had earned him considerable notoriety as well. Wallace had not always been an anti-vaccinationist (his earlier writings praised Edward Jenner as a medical pioneer and he had his own children vaccinated) but his involvement with Spiritualism brought him into regular contact with anti-vaccinationists (especially Tebb). It was Tebb who persuaded Wallace to join the movement by presenting him with statistics that he had compiled concerning the risks associated with vaccination. Whether due to the statistics or his own concerns about the basic infringements on individual freedom resulting from the Vaccination Act, Wallace became a convert to the cause sometime in the early 1880s.

In fairness to Wallace, there was probably was some basis for his skepticism. At the time, nobody knew exactly why vaccination worked. Despite Louis Pasteur's research and the recent acceptance of the germ theory of disease, the science of immunology was still in its infancy. The fact that medical authorities were eagerly pushing for something that the anti-vaccinationists were condemning as "quackery" and prosecuted parents who refused to comply was enough for Wallace to get involved. Working with the statistics that Tebb provided, Wallace began his own research into vaccination and the government statistics on smallpox and vaccination. He also attempted to link incidence of smallpox to more general issues of sanitation.

While the Public Health Act of 1848 began to improve living conditions in most slums, progress remained slow and health problems related to sewage and industrial waste were still common. Wallace and his fellow anti-vaccinationists argued that smallpox and other infectious diseases were actually caused by contamination and that vaccination was likely dangerous in itself. There was (if you'll pardon the expression) a germ of truth in that since there was no generally accepted antiseptic guidelines in vaccinating children and doctors often reused the same needles on their patients. Wallace also argued that there were no controlled experiments showing how long the protection from vaccination lasted.

All of Wallace's findings were written up in a tract titled Forty-five Years of Registration Statistics, Proving Vaccination To Be Both Useless and Dangerous.Published in early 1885, Wallace compiled statistics from across Great Britain and continental Europe (where compulsory vaccination laws were also in place).  Not limiting himself to smallpox, Wallace examined incidence patterns for diptheria, measles, scarlet fever, and whooping cough (pertussis). He concluded that vaccination did more harm than good and that public sanitation played a greater role in disease prevention. Almost immediately, Wallace came under attack by physicians who were horrified that a scientist of Wallace's reputation would side with the anti-vaccinationists. The fact that popular opinion was turning against mandatory vaccination (helped along by graphic stories of conscientious objectors being arrested), added to the pressure for changing the vaccination laws.

In 1889, the British government appointed a Royal Commission to evaluate mandatory vaccination policies. While Wallace turned down an offer to sit on the Commission himself, he appeared as the anti-vaccinationists' star witness. The fifteen members of the Commission included some of the prominent British physicians of that time (most of whom were pro-vaccinationists which outraged Tebb and the others). The Commissions members held twenty-one meetings in 1890 and examined ten witnesses (mostly anti-vaccinationists). Wallace appeared four times before the commission and presented all of his graphs and statistics. While the commission members were initially impressed by Wallace's testimony, that changed after they had a chance to evaluate his findings more carefully.

Wallace's statistics seemed impressive but the committee members found numerous errors that seemed unworthy of someone of Wallace's reputation. Not only did Wallace and his fellow anti-vaccinationists ignore statistics that failed to support their view but many of the statistical tables were highly selective (doubly embarrassing since Wallace had accused the pro-vaccinationists of doing the same thing). Wallace was caught off-guard by the findings and was forced to admit that many of the statistics that he had presented were worthless.  While he continued to argue that sanitation was more important than vaccination, Wallace's credibility had been severely undermined by the time he concluded his testimony. Anti-vaccination activists defended Wallace throughout the entire process and accused the commission of being biased in favour of the pro-vaccinationists. One source commented that, "Dr Wallace stood an examination which proved, if nothing else, that anyone who gives anti-vaccination evidence before this commission must be prepared to keep his temper through insults which most would resent and which few would indulge".

Although the Commission issued a preliminary report in December 1890, the final report wouldn't come out until six years later. After the final report, Wallace published his most scathing pamphlet yet on the Commission's findings. Titled "Vaccination a Delusion; Its Penal Enforcement a Crime: Proved by the Official Evidence in the Reports of the Royal Commission", Wallace accused the Commission's final report as being "not only weak, misleading, inadequate but is also palpably one-sided". His critics reacted as expected and accused Wallace of simply restating all of his old arguments without providing any new evidence. Still, his crusade had some impact and the Commission's report led to changes in compulsory vaccination (penalties for noncompliance were reduced) and adoption of less risky methods of inoculation.

Wallace was hardly satisfied.  He continued to write anti-vaccinationist pamphlets until his death in 1913. As one of the most well-known scientists of his generation, he lent an air of respect to the anti-vaccination crusade that it never had since. In one of the last pamphlets that he wrote for the Anti-Vaccination League in 1904, he said that "the figures go increasing and decreasing so suddenly and irregularly that by taking a few years at one period, and a few at another, you can show an increase or decrease according to what you wish to prove".  Most of the arguments that he raised against vaccination are still being used by anti-vaccinationists today. Even in the 20th century, anti-vaccination societies continued to proliferate and attracted numerous "star" supporters including Wallace and George Bernard Shaw (who wrote that vaccination was "a particularly filthy piece of witchcraft"), as well as health faddists, anti-vivisectionists, trade unionists, etc.

While compulsory vaccination was eventually phased out in Britain with the introduction of the National Health Service in 1948, it still remains a thorny issue in many other countries today. The aggressive spread of vaccination campaigns across the world (in combination of containment of known cases) led to a drastic reduction in many communicable diseases for which vaccines are available. Although 50 million cases of smallpox were recorded world-wide in the 1950s, the last naturally occurring case of smallpox occurred in Somalia in 1977 and the World Health Organization declared the disease eradicated three years later. Despite equally aggressive vaccination campaigns for other diseases, the World Health Organization missed its target date of 2000 for the eradication of polio (although the campaign is still underway). Whether similar victories will be possible with measles, diphtheria, and other diseases largely depends on the success of current vaccination campaigns and the role that anti-vaccinationists will play in opposing them. There's also the fundamental question of why children in many Third World countries are still dying of diseases that are supposedly preventable through the use of vaccines.

The autism-vaccination link may only be the latest development but the basic arguments seem pretty much the same as ever. The battle continues.

Do Curses Work?

Belief in malignant supernatural forces causing illness or misfortune is a common tradition in cultures around the world.   The concept of "black magic", the "evil eye", curses, witchcraft, bringing down disaster on unwitting victims has inspired a host of ritual practices designed to protect users from harm. 

My mother, bless her heart, has an all-purpose prayer that she uses to protect family members against the malocchio (evil eye).  Passed down in her family for generations, the prayer can only be taught at the stroke of midnight on Christmas Eve.   While such beliefs seem harmless enough, fear of malignant cursing has inspired horrendous episodes of anti-witch hysteria through the centuries (and still does today).

But is is actually possible for belief in curses to kill victims?  In a now-classic paper titled "Voodoo Death", physiologist Walter Cannon (of Cannon-Bard hypothesis fame) explored that very question.    First published in 1944 in American Anthropologist, Cannon coined the term "voodoo death" to describe the phenomenon of sudden death brought about by emotional shock, especially fear.  Citing numerous examples from anthropological literature, Cannon presented a series of case histories including deaths occurring among Brazilian tribesmen after being cursed by local "medicine men".  One memorable citation from Arthur Glyn Leonard's classic book on the lower Niger described the phenomenon in action:

I have seen more than one hardened old Haussa soldier dying steadily and by inches because he believed himself to be bewitched; no nourishment or medicines that were given to him had the slightest effect either to check the mischief or to improve his condition in any way, and nothing was able to divert him from a fate which he considered inevitable. In the same way, and under very similar conditions, I have seen Kru-men and others die in spite of every effort that was made to save them, simply because they had made up their minds, not (as we thought at the time) to die, but that being in the clutch of malignant demons they were bound to die.

Being cursed was often the result of violating various cultural taboos or otherwise incurring the wrath of tribal chiefs or shamans.   The means by which a curse could be laid could vary from simply applying the "evil eye" to formal rituals such as the use of "pointing-bones" among Australian Aborigines.  Cannon also raised the possibility of chiefs or sorcerers reinforcing their reputation for laying curses through the discreet use of poison. 

Given the herblore available to many traditional shamans, this is not particularly farfetched although many of the cases that Cannon discussed involved curse victims wasting away even when poison or other medical explanations were ruled out.   Even in those cases where an autopsy was performed on the curse victim, no clear medical cause for death could be found (except for the curse victims who wasted away from refusing to eat or drink). 

For victims in the final stage of their illness, only the timely intervention of the sorcerer or shaman lifting the curse could save them from death.   Shamans persuaded to lift their cause often use an elaborate ritual and, in many cases, presented the victim with a visual "proof" of the curse being lifted (usually in the presence of the victim's family to impress them with his/her power).   Once the crisis is passed, recovery is usually rapid and complete.  The involvement of the victim's extended social network seems to be the key in many of the cases that Cannon reported.   Those victims who are cursed typically lose all support as family and friends distance themselves.    Once ostracized, the curse victim becomes a pariah with no real options besides death or exile.   "Shunning" of curse victims, often perceived as being responsible for their own predicament, is an effective weapon to reinforce the power of the shaman who laid the curse.  Since being part of the greater tribal community remains the cornerstone of the individual's existence in many societies, it's hardly surprising that the loneliness that can result from being cursed can be so deadly.

But is there a physical basis for "voodoo death"?  Again, Cannon outlined some common characteristics in the cases that he discussed.  The effect that extreme fear and anger can have on the body is well-documented.  Cannon reviewed the "fight or flight" reaction and the opposing roles of the sympathetic and parasympathetic nervous systems in preparing us to deal with crises.   Arousal of the sympathetic nervous system results in pupil dilation, rapid heart rate, increased lung capacity and respiration, inhibition of digestion, shaking, sweating, and other autonomic responses.   Essentially, the body is prepared for action.  If that action is delayed or if we are unable to respond to the stressful situation in a timely fashion however, we experience exhaustion and become vulnerable as a result.  As Cannon himself states:

All these changes render the animal more efficient in physical struggle, for they supply essential conditions for continuous action of laboring muscles. Since they occur in association with the strong emotions, rage and fear, they can reasonably be interpreted as preparatory for the intense struggle which the instincts to attack or to escape may involve. If these powerful motions prevail, and the bodily forces are fully mobilized for action, and if this state of extreme perturbation continues in uncontrolled possession of the organism for a considerable period, without the occurrence of action, dire results may ensue

Cannon also described research on sham rage produced in decorticated laboratory animals following intense stimulation of the sympathetic-adrenal system.  The rage leads to rapid sweating, rapid heartbeat, heightened emotionality, and motor activity.  Even when the animal appears visibly calm afterward, death can result after a few hours due to exhaustion.  Sham rage has also been observed in humans, especially in cases involving damage to the temporal lobe and associated limbic system structures.  Along with other physiological effects of sham rage, large amounts of adrenaline are also produced.   Prolonged adrenaline release may lead to persistent constriction of the blood vessels which, in turn, leads to reduce blood volume and inadequate blood supply to the body's organs.    Catastrophically reduced blood pressure, in conjunction with reduced food or fluid intake, can be linked to many of the reported voodoo deaths in the medical literature. 

It is probably not surprising that sudden death has also been observed in cases involving severe shock.  Even when other medical causes have been ruled out, death can still occur.  Loss of appetite, sweating, rapid heartbeat, and other signs of autonomic distress can be important signals that the body is on the verge of exhausting its resources.  Cannon described several examples of patients who died of apparently minor injuries following emotional trauma.  While postmortem examinations may turn up evidence of brain hemorrhage, this is usually a consequence of the condition rather than a direct cause of death.    

Ultimately, Cannon didn't attempt to provide a final explanation for why voodoo death occurs and simply suggested a hypothesis for researchers to explore.   He also recommended that physicians monitoring potential cases watch for warning signs of shock including low blood pressure, rapid heartbeat, and perspiration.  In (semi) tongue-in-cheek fashion, he ended his paper by saying:

If in the future, however, any observer has opportunity to see an instance of "voodoo death," it is to be hoped that he will conduct the simpler tests before the victim's last gasp.

While voodoo death cases relating to actual curses have become rare (although anti-witch hysteria is still going strong),  research has confirmed many aspects of Cannon's ideas concerning the role of sympathetic arousal on the human body.    In a reevaluation of Cannon's voodoo death paper, Esther Sternberg expanded Cannon's model by stressing the role of the hormonal system, particularly those hormones released by the pituitary and adrenal glands when the human body is confronted by stressors.  These include catecholamines (unknown in Cannon's time) which open calcium channels, including in the heart muscle.  She also discussed the role that the amygdala plays in mediating threat responses (she referred to this as the "vision-to-fear" or "auditory-to-fear" pathway depending on how the threat is perceived).    In cases of abrupt shock, cardiac arrhythmia, chronic wasting, and disease can all occur when the body's own resources are exhausted.  

Cases of sudden cardiac death linked to psychosomatic factors continue to be reported in the clinical literature, especially in patients suffering from preexisting conditions such as chronic depression or anxiety disorders.   The complex relationship between cardiac arrhythmia and emotional stress often forms a "vicious circle" which is potentially deadly.   Increased risk of cardiac failure has also been noted following natural disasters as survivors cope with the stress of dealing with loss.   Although anthropologists still dispute Cannon's interpretation of existing cases (with some arguing that voodoo death should be considered a culture-bound syndrome), Walter Cannon's 1944 paper remains a classic in the field of psychosomatic medicine and psychophysiology and continues to inspire research into the role that emotional factors can affect the body. 

So, can curses kill?  You be the judge.

Treating Victims of Violent Crime

 Victims of violent crime are at elevated risk of developing acute stress disorder (ASD) as well as subsequent post-traumatic stress disorder (PTSD), both of which are linked to severe psychological distress. A 12-month prospective study recently published in the Journal of Affective Disorders evaluates the efficacy of cognitive-behavioral therapy (CBT) vs. cognitive-behavioral therapy with a significant other (CBT-SO), relative to usual care (UC), for the improvement of post-traumatic, depression and anxiety symptoms and the prevention of PTSD among victims of violent crime with ASD. Methods: A total of 166 victims of violent crime with ASD were assigned to CBT (n = 54), CBT-SO (n = 52) or UC (n = 60). Self-report assessments and diagnostic interviews were completed at pre-treatment and post-treatment as well as at 6-month and 12-month follow-ups. Results: CBT and CBT-SO participants had fewer depression symptoms than those in the UC group up to 12 months post-event. Significantly fewer participants in the CBT condition met criteria for PTSD than in the UC group up to 12 months post-event. The CBT group did not differ from the CBT-SO group on any variable at any assessment time. Limitations: Findings must be interpreted in light of the quasi-experimental nature of the study and limitations concerning the management of missing data. Conclusions: Further research is warranted in order to assess whether more extensive involvement of a significant other in therapy may lead to better outcomes for victims of violent crime with ASD. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

For the abstract

Happy Holidays

Merry Christmas and happy holidays to those of all faiths or non-faiths.  May this day bring you good tidings and not too much indigestion. 

Remembering The Sculptress

Camille Claudel was, without a doubt, one of the most brilliant artists of her generation.  And she paid the price for it.

Born in 1864 in Fere en Tardenois in the French province of Picardy, Camille was the second child of a middle-class family.   Although the family moved frequently during her childhood, Camille developed a passion for art at an early age and became an accomplished sculptor by the age of thirteen.     By 1881, she was training at the Academie Colarossi in Paris under the supervision of eminent sculptor, Alfred Boucher.  Whatever plans Camille had for her own future as an artist changed dramatically when she first met Auguste Rodin in 1883.  

It's hard to say for sure when the two of them became lovers but Camille was quickly established in Rodin's studio and began a professional and personal collaboration with him that would last for fourteen years.   Although they never lived together, Camille's relationship with Rodin alarmed her family (especially her mother who had never approved of Camille's artistic ambitions) and she was eventually forced to leave the family home as a result.   While Camille contributed greatly to Rodin's career as a sculptor (many of the pieces that Rodin supposedly produced during their years together were likely her work), the opposite was certainly not the case.   There are few surviving signed works produced by Camille during her years with Rodin despite it being the most fertile period of his artistic career.  

Auguste Rodin was unsupportive in other ways as well.   Details of their personal life together are limited but there is evidence to indicate that she became pregnant as many as five times.  Whether the pregnancies were terminated by abortion or the infants given up for adoption, the end result was the same.   Since Rodin was already living with Rose Beuret and showed no intention of ever leaving her,  marriage was out of the question and he certainly had no intention of being monogamous with Rose or Camille.    Throughout the years when he and Camille were lovers, there was a steady stream of models and other women fascinated by his growing fame as an artist.   At least one noted biographer described Auguste Rodin as a "serious collector of interesting women".

By 1898, Camille had terminated her relationship with Rodin, both personally and professionally (although there is some indication that the had stopped being lovers some time previously).    Working independently for the first time in her life was a major hardship for her.  Although the prosperous Rodin could afford to maintain three studios with a stable of artisans working under him, Camille Claudel had to struggle to pay her own bills.    The attitudes of the time towards independent women, especially women who actually worked for a living, needed to be faced as well.   Her unconventional lifestyle alienated her from her mother and sister (her father remained supportive, though).   Despite praise from most of the prominent critics of the time, Camille's artistic output remained slim.   The long years during which she had only produced art under Rodin's name worked against her and few patrons took an interest in her work.   While Rodin became increasingly rich and famous, Camille sank further into poverty.   Aside from a possible romance with composer Claude Debussy, there were no other men in Camille's life.

As she grew older, Camille became increasingly unstable.  In 1905, she deliberately destroyed many of her statues and began disappearing for long periods of time.  She also developed acute paranoia and accused Rodin of conspiring against her and stealing her ideas.   While she was reasonably lucid when working on her art, Camille became a recluse and often neglected her personal hygiene.  She also became an animal hoarder and kept numerous cats in her tiny, unkempt studio.   With shutters firmly drawn to keep out sunlight, Camille's entire existence focused on her art and her cats.  This eccentric lifestyle (complete with erratic outbursts and suicide attempts) certainly alarmed her family although her father continued to support his wayward daughter. 

Three days after her father died in 1913, Camille's brother Paul and her mother made arrangements to place her in the psychiatric hospital of Ville Evrard in Paris.   Two orderlies had to break into Camille's studio and drag her to the hospital by force.  The reasons for committing Camille remain controversial although the spectacle she made of herself when she was hospitalized likely didn't help her cause.  While she was certainly mentally unstable (and possibly suffering from schizophrenia), independent women who refused to accept societal restrictions on sexuality were often committed to hospitals during that era on the grounds of insanity.    In Camille's case, she settled down quickly and even her doctors came to insist that she was well enough to be released.  Despite attempts at a family reconciliation, her mother  remained adamant that she be kept in the hospital. 

With the outbreak of World War I, female patients in Ville Evrard were moved to safer quarters in an asylum near Avignon.  The certificate admitting Camille to Montdevergues Asylum described her as suffering from a "systematic persecution delirium mostly based upon false interpretations and imagination".   Despite repeated attempts by Camille's doctors, the artistic community, and the press to have Camille released from hospital, her family refused to consider the possibility.   Her mother and sister also refused to visit her in hospital and actively discouraged others from visiting her as well.  After Camille's mother died in 1929,  her brother continued to act as her guardian and steadfastly refused to allow her release.  Over the years, visitors typically described Camille as being lucid and insisted on her release but Paul Claudel opposed them.  Although he visited her every few years, he always referred to her in the past tense whenever discussing her life or art with friends.  Camille Claudel died on October 19, 1943 after spending three decades in the asylum.  Her family refused to claim the body and she was eventually buried in a communal grave in the Montfavet cemetery.  Only hospital staff attended the funeral service.  

Despite her long hospitalization, Camille's reputation as a brilliant artist remains secure.   While only ninety statues, paintings, and sketches survived her attempts at destroying them,  they show ample evidence of her artistic genius.  Paul Claudel, long notorious for his role in confining his sister, organized the first major exhibition of her work in 1951 and fascination with her complex life  has spurred the publication of various biographies over the years.     In 1988, a full-length biography of Camille Claudel's life was released starring Isabelle Adjani as Camille and Gerard Depardieu as Rodin.   Based on a biography by Paul Claudel's great-granddaughter,  the film places much of the blame for Camille's later breakdown on Rodin himself.  While feminists have criticized the film for downplaying the role that Camille's family played in the later tragedy of her life, it received numerous awards (including two Academy award nominations). 

Many of Camille Claudel's statues continue to be displayed at the Musee Rodin in Paris and traveling exhibitions have been held at numerous art galleries and museums around the world.   Rodin's various sculptures of Camille are on display as well.  Camille's artwork continues to fetch record prices at art auctions and she is regarded as being one of the greatest women artists of all time. 

Camille Claudel will not be forgotten.

 

 

Should Fathers Be Screened for Post-Partum Depression?

Postpartum depression negatively affects the whole family and its prevalence in Sweden ranges between 6–10% for fathers and 13–16% for mothers. However, only mothers in Sweden are currently routinely screened. But a new study published in the Journal of Affective Disorders  examines if a postpartum depression screening for fathers in Stockholm County could be cost-effective.  National Swedish databases were used to find registry data and a literature review was undertaken to identify the model data inputs associated with postpartum depression in Sweden. The generated evidence was used to build a Markov model in TreeAge. One-way and probabilistic sensitivity analyses were performed to account for parameter uncertainties. Alternative scenario analyses were further undertaken to test the assumptions in the base case analysis. Results showed that a postpartum screening for depression in fathers is cost-effective in base case and alternative scenarios. The results indicate that the screening program is associated with lower costs and higher health effects. The results were sensitive to variables of quality adjusted life years for the depressed fathers, probabilities of remission in treatment and no treatment groups and start age and productivity losses. The probabilistic sensitivity analysis resulted in a 70% probability of the postnatal depression screening intervention being cost-effective. Still, the current study only uses secondary data; therefore future research should assess the cost-effectiveness of screening fathers for depression.   In conclusion, the postpartum screening intervention for fathers could be cost-effective compared to no screening. Future research should replicate the potential cost-effectiveness for screening fathers for postpartum depression. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

For the abstract

Missouri Woman "Stunned" By Her Mother's Bizarre Death Scam

The memorial service held at the Ferguson Church of Christ in Ferguson, Missouri on November 10 was likely quite moving for the people who attended.   Held for 21-year-old Brittany Johnson-Webster who died in an automobile accident on October 27, the memorial had been organized by Brittany's estranged mother who spoke at the service and described how her daughter had died.   

The only problem was, Brittany wasn't dead and the accident in which she had supposedly died had never happened.   In reality, Brittany lived over three hours away and had very little contact with her mother who is a chronic drug addict.   Having been raised by her grandparents in another town, the very-much-alive Brittany only became aware of what her mother had done when an aunt sent her a copy of one of the obituaries that had run in local newspapers.    The obituary, which featured her picture, read:  "Brittany finished her story on October 27, 2018. She was called to meet all the loving animal babies on the other side of the rainbow."

As Brittany explained in a media interview, "I was kind of stunned. It was a whole rush of emotions," she said.   "My brother actually died and here my mom is faking my death. You know I was upset, I was angry, but more than anything, I was sad,"   

Though she tried to contact her mother repeatedly, Brittany stated that she has had no success and is worried about her safety.   While she feels that the death hoax may have been motivated by greed, she is urging anyone with information on her whereabouts to contact Ferguson police.

 

 

Punishing With Silence

The assassination attempt should have been expected.

King Umberto I of Italy was strongly criticized for his harsh conservatism and his role in the brutal suppression of various reform movements during his reign. As a symbol of hated oppression (and despite his personal popularity), it seemed only natural that he be targeted by various left-wing and anarchist factions. On November 17, 1878, the king and queen were in the city of Naples taking part in a lavish royal procession through the city (paid for by a special tax). While King Umberto and Queen Margarita rode in an open carriage, Giovanni Passannante approached the royal couple and jumped onto the running board. His left hand was covered with a red handkerchief and, after he came within reach of the king, he pulled it off to reveal a small box cutter knife. The queen screamed at the sight of the knife which alerted the Prime Minister, who had been sitting with the king in his carriage. Prime Minister Cairoli threw himself forward to protect the royal couple and was wounded in the thigh.The king in turn, was cut in the arm as he attempted to pummel Passannante with his sword while the queen beat him over the head repeatedly with the bouquet of flowers in her hands. Eventually, the police managed to restrain Passannante and took him into custody.

The 29-year old Passannante had grown up in poverty and eventually found work as a cook. After becoming involved with the anarchist movement (and already spending time in prison for his political activities), he decided to assassinate the king. Selling his jacket to buy the small knife, Passannte inscribed it with the statement, "Death to the King, long live the Republic Universal". Although he had almost certainly been acting alone, the arresting officers subjected him to brutal interrogation and torture to make him confess to being part of a conspiracy and to name the others involved. He insisted that he had not intended to kill the king and that no one else was involved in his plan. As part of the massive investigation while awaiting trial, his mother and most of his siblings were placed in a lunatic asylum (only one brother managed to escape). The rest of his family was harassed and eventually forced to move out of their home town of Salvia Lucania (which changed its name to distance itself from the would-be assassin). While pro-monarchists held protest marches against the would-be assassin, anarchists rallied to Passannante's defense with attacks across the country.

After spending nearly a year in prison, Passannante's case finally came to trial. Although assassination attempts involving royalty would become much more common later, the attempt on King Umberto's life attracted international attention.  His defense was half-hearted at best and the outcome was a foregone conclusion (all those associated with the trial, including the judge and his defense counsel, were monarchists). He was sentenced to death in court (despite the fact that attempted assassination wasn't a capital offense under Italian law). It was only as a result of international pressure that the king personally intervened with a Royal Decree changing the sentence to life imprisonment. This was little comfort for Passannante who flatly stated that he would rather have been executed. Given his brief taste of what life in prison would be like, he may well have been right...

Giovanni Passannante was taken to a prison in the town of Portoferraio (the main town on the island of Elba).His cell was below sea level with a ceiling so low that he couldn't even stand upright. There was no latrine or light and he was shackled to the wall with a heavy chain. The attendants were under strict orders not to speak to him under any circumstances. It was there that he spent the next ten years of his life. Aside from the attendants who watched him carefully and the occasional screams that even the sailors on nearby boats could hear, there was no other contact with the outside world.

As you might expect, the horrendous prison conditions left him broken mentally and physically. Not only did he waste away to the point that his kidneys were severely damaged by the weight of the chain he was forced to wear, but his mental deterioration left him catatonic. While left-wing politicians and sympathizers argued for his release, right-wing politicians opposed any attempt at lightening his sentence. After a psychiatric assessment was ordered by the government, it was determined that Passannante had gone insane and he was finally transferred to the criminal asylum at Montelupe Fiorentino.

Passannante was in good company there since he was later joined by another would-be assassin, Pietro Acciarito. After attempting to kill the king in 1897, Acciarito also went insane while serving a life sentence. By contrast, the anarchist who actually succeeded in assassinating the king in 1900, Gaetano Bresci, died in prison less than a year after being given a life sentence (Italy had abolished the death penalty by then). Passannante and Acciarito were likely in no condition to appreciate the irony.

When Giovanni Passannante died on February 4, 1910, an autopsy was held and his brain and skull were sent to the Superior Institute of Police at Regina Coeli Prison in Rome. Although the criminologists who examined the brain attempted to find some physical basis for his "deviance" (Cesare Lombroso's theories were still in vogue), no real evidence was found.The remains were later placed on display in Rome's Criminological Museum until May 11, 2007 when they were finally transferred to his hometown for burial.

The fact that there is an ongoing controversy over whether to restore the town's name to "Salvia Lucania" in Passannante's honour helps demonstrate the local determination to remember the man who is still regarded as a hero in many circles.

Remembering the Fruit Machine Saga

Dealing with homosexuals in the public service was a familiar problem for Western governments during the 1950s and early 1960s.   A criminal offense in most countries, homosexuals were often punished with imprisonment and/or mandatory psychiatric treatment, that made closeted homosexuals especially vulnerable to blackmail or recruitment by hostile governments.  At least, that was the argument used to justify the security campaigns rooting out any homosexuals (real or suspected) in sensitive positions.    Although the anti-homosexual crusades in the United States and Great Britain are well-documented,  that the Canadian government did the same was largely shrouded in secrecy for decades.   It was only during the 1990s that the Canadian Press used the Freedom of Information Act to obtain many previously classified documents outlining how thoroughly Canadian security forces managed to destroy the lives of countless gay men and lesbians working in sensitive positions.  They also demonstrated some of the bizarre methods by which gay men and lesbians were identified. 

The Problem of Homosexuality

Beginning in 1959 with a Special Panel on "Security Cases involving Character Weaknesses with Special Reference to the Problem of Homosexuality", the question of what to do with homosexuals and lesbians in the public service became a critical issue for Canada's security forces.   According to one declassified memo:

Sexual abnormalities appear to be the favourite target of hostile intelligence agencies, and of these homosexuality is  most often used.  The nature of homosexuality appears to adapt itself to this kind of exploitation.  By exercising fairly simple precautions, homosexuals are usually able to keep their habits hidden from those who are not specifically seeking them out.  Further, homosexuals often appear to believe that the accepted ethical code which governs normal human relationships does not apply to them.  Their propensity is often accompanied by other specific weaknesses such as excessive drinking with its resultant instabilities, a defiant attitude towards the rest of society, and a concurrent urge to seek out the company of persons with similar characteristics, often in disreputable bars, night clubs, or restaurants....From the small amount of information we have been able to find out about homosexual behaviour generally, certain characteristics appear to stand out - instability, willing self-deceit, defiance towards society, a tendency to surround oneself with persons of similar propensities, regardless of other considerations - none of which inspire the confidence one would hope to have in persons required to fill positions of trust and responsibility.

Weeding out the Homosexuals

Although the anti-homosexual purge was inspired by the Cold War hysteria prevalent in most Western countries during the 1950s (spurred on by Joseph McCarthy's anti-Communist crusade in the United States),  the Canadian security agencies took a special zeal in weeding out homosexual men and women wherever they could be found.   Not only were homosexuals arrested and prosecuted throughout Canada but Canadian immigration laws were passed in 1952 banning known homosexuals from entering the country.   While never as public as the anti-homosexual purges in other countries (and lacking high-profile victims such as Alan Turing in the United Kingdom),  the continuing spy trials and sex scandals from other countries helped fuel the perception that homosexuals were inherently dangerous, both to themselves and to their country.     Lesbians were not initially pursued with the same ruthless intensity although criminal laws were revised in 1953 to make female homosexuality a crime in Canada.   After 1953, both men and women faced the risk of being labelled a "Criminal Sexual Psychopath" whenever evidence of homosexual activity (consensual or not) found its way into the courts.     For Canada's military, proven homosexual conduct was grounds for dishonourable discharge for both men and women.  While the focus was on male recruits, lesbianism was also seen as a threat to military discipline due to the "unfeminine" activities of lesbians in the service.   For cases of suspected homosexuals, military procedure called for a formal investigation (later enshrined under the 1967 Canadian Forces Administrative Order (CFAO) 19-20, Sexual Deviation - Investigation, Medical Investigation and Disposal for the "proper" handling and dismissal of serving men and women found guilty of homosexual conduct).  Throughout the 1950s and 1960s,  Canadian and American security agencies freely shared information on all perceived high-risk individuals (including possible homosexual activity of people in "sensitive" positions). 

With consultation of security agencies on both sides of the border, a more formal procedure went into place in 1963 with the drafting of a new Cabinet Directive on "Security in the Public Services of Canada".   While not referring to homosexuals specifically, the new directive referenced "illicit sexual behaviour" and called for an "attitude of much greater frankness whose reliability or loyalty is in doubt".   Any prospective employee who openly admitted to homosexual conduct would either not be hired or else transferred to a less "sensitive" position (usually with less importance).    For employees who were not forthcoming about their sexuality, the security agencies made little actual distinction between hidden homosexuals who were actually disloyal or who simply the potential of being disloyal.   Since the RCMP was in charge of all security investigations, their agents had the primary responsibility of investigating suspected homosexuals in virtually every branch of the Canadian government (except for the military which had its own intelligence division).  There was no independent review of the RCMP’s operation and accused homosexuals had no chance of defending themselves against accusations. 

Over time, the RCMP investigations eventually affected thousands of men and women, whether they were civil servants or not.   The total number of RCMP reports of suspected homosexuals rose from 1000 in 1960-1961 to 7500 in 1965-66.   Since few statistics were kept, the actual number of men and women whose lives were destroyed by relentless RCMP investigations and accusations of homosexuality can only be estimated.   For every high-profile case such as David Johnson, former Canadian ambassador to Moscow and his predecessor, John Watkins (who died of a heart attack following an RCMP interrogation), countless others were either fired, transferred or blacklisted based on suspected sexual improprieties. 

Despite only one-third of the RCMP investigations actually involving people in the civil service, right-wingers in the Canadian government denounced Canada’s external affairs department and embassies around the world as “a notorious cess-pool of homosexuals and perverts”.   The RCMP investigators in charge of locating homosexuals demanded and eventually got an expanded mandate and the list of suspects grew to include thousands of names.   Although the Canadian government placed some controls on the RCMP to prevent them from publicly exposing homosexuals unless they were considered to be security risks,  the RCMP often acted as judge and jury (since homosexuality was still a criminal offense at the time). 

Whatever the reality, the perception that thousands of hidden homosexuals were undermining Canadian security meant that a better way of identifying them was needed.   Fortunately, Canadian security agencies had their own expert on hand for that.   Dr. F. Robert Wake of Carleton University was already a well-known figure in forensic circles with his work on juvenile delinquency and deviancy.  As the first chair of Carleton's Psychology Department as well as a researcher for the Royal Commission on the Criminal Law Relating to Criminal Sexual Psychopaths during the 1950s, he was well known to security agencies and seemed best suited for developing a better way of finding hidden homosexuals.

And he was definitely up for the challenge...

Bringing in the Scientists

Since prevailing psychological and psychiatric thinking at the time maintained that homosexuals were either mentally ill or psychologically abnormal, depending on mental health professionals to identify closeted homosexuals in the public service made good sense.  With funding from National Health and Welfare,  Dr. Wake traveled to the United States to research methods used there to find a more "scientific" means of identifying homosexuals.  Because RCMP investigations of suspected homosexuals were long and expensive,  a more direct procedure was needed.    In a 1962 "Report on Special Project", Dr. Wake restated his own opinion that homosexuals were intrinsically unsuited for employment in the public service due to their mental instability and general unreliability.   Although he was already aware of Evelyn Hooker and her research disputing prevailing opinions that homosexuals were maladjusted, Dr. Wake was very much a traditionalist.    In explaining what caused the difference types of homosexuality that he discussed in his report, Dr. Wake argued that homosexual tendencies were produced by “a combination of environmental circumstances during the years of childhood or early youth”. 

Though there was no way of curing homosexuals based on prevailing medical science, he argued that their sexual desires needed to be controlled through medication and aversion therapy.  While he focused on male homosexuality in his report, he also included information on lesbians as well and largely drew on the Kinsey results as an estimate on the actual number of homosexuals likely to exist in the Public Service.   The most far-reaching part of his report was included under the heading of "Methods for Identifying Homosexuals".   Arguing that there was more than one homosexual type, he ruled out the possible of a single test for identifying homosexuals.   Carefully outlining the various methods used in the United States, including psychiatric interviews, medical examinations, and projective tests, he then discussed the different physiological tests or measuring sexual arousal.  

After ruling out the polygraph as having too many problems to be useful, Dr. Wake also considered the finger plethysmograph (measuring blood volume in the finger using a pneumatic tube), palmar sweat index measures (perspiration), and pupillary response tests.    In his comprehensive report, F.R. Wake proposed the development of a formal test of homosexuality (or, as he termed it, “suitability for employment”) using physiological measures of arousal.   And, thus, the “fruit machine project” was launched.

The Rise and Fall of the “Fruit Machine”

According to John Sawatsky, author of Men in the Shadows, the term “fruit machine” was coined by RCMP agents who were leery of being recruited to act as the “normative sample” in testing the proposed device.    Although the “fruit machine” was never actually developed, the project spearheaded by Wake was financed by the National Defense and Health and Welfare departments for four years.    Along with Dr. Wake, the project would eventually bring in a large team of psychiatrists, psychologists, and other researchers, all dedicated to creating a machine for diagnosing homosexuality better than any of the existing methods.  

Although descriptions of the methodology proposed by Wake is fairly limited in the surviving documents related to his project,  the machine was apparently meant to measure changes in pupil dilation in conjunction with a word association test using a list of words with a hidden homosexual meaning.   The proposed word list would include words such as:  queen, circus, gay, bagpipe, bell, whole, blind, bull, camp, coo, cruise, drag, dike (dyke), fish, flute, fruit, mother, punk, queer, tea room, etc.  Since many of the words had a double meaning that men and women immersed in the homosexual subculture would presumably know, measuring their physiological responses would presumably expose their hidden sexual identity.    The pupillary measure that Dr. Wake recommended in his report had been developed at the University of Chicago by two researchers, Eckhard Hess and James Polt.   A graduate student, Alan Seltzer had  used the Hess-Polt procedure with slides comparing nearly-nude pictures of men taken from bodybuilding magazines with “neutral” slides (paintings) and claimed to be able to tell homosexual from heterosexual subjects based on pupil dilation data alone.  As Dr. Wake argued in his report, pupillary response measures were ideal in catching homosexuals since pupil dilation was completely involuntary and “cannot be controlled by the subject”.     He was especially impressed by the report of one homosexual subject who had admitted to trying to fool the machine only to find that he could not.  

In developing his own homosexuality-detection device, Dr. Wake proposed a new experiment combining the Hess-Polt apparatus “with a suitable visual stimuli; a measure of skin perspiration… with a modification to measure pulse rate.  Subjects:  fifteen normal males, fifteen normal females, fifteen homosexual males, fifteen homosexual females.   As the experiment progresses, additional normal and homosexual subjects in unspecified numbers.  All subjects to be supplied by the RCMP".     The experimental procedure in Wake's proposal was straightforward enough:  "the experimental stimuli will be pictures designed to elicit the subjects' interest in males and females...The first sixty subjects will be processed to determine the reaction patterns of normals and homosexuals.  Then using these patterns as criteria, the experimenter will attempt to distinguish homosexuals presented by the RCMP, where nothing of the subject is known to the research team.  Those methods proving successful will be retained for continuing research."  Ultimately, the focus of Wake's research was to identify homosexual men and women by detecting "involuntary"  sexual responses to the experimental stimuli (whether using pictures, presented words or audiotapes).

Ambitious as Wake's project was, it eventually bogged down over various technical snags.    That included the difficulty in finding a large enough sample of actual homosexuals and “normal” men and women to establish the actual effectiveness of the machine.   For obvious reasons, recruiting known homosexual men was hard enough (and the RCMP had no contacts at all in the female homosexual community as one rueful RCMP memo pointed out).  Even getting heterosexual men and women to participate was also a stumbling block (the reputation of the "fruit machine" project was enough to scare off any would-be volunteers in the RCMP community, none of whom wanted to be branded as "fruits" by their responses to the stimuli).    Since there were no female RCMP agents at the time, recruiting heterosexual women was deemed "inappropriate" (it was the early 1960s, after all).   Even attempting to recruit test subjects from other government departments failed to provide the needed numbers that Wake called for in his proposal.  There was also the operational problem of adapting the technology to adjust for height, eyeball size, and distance between eyeballs (all of which potentially distorted the machine's results).  

Despite some progress, Wake's research project remained stalled for years before being eventually scrapped in 1967.    For all the money spent and the years of effort, the great fruit machine project was a bust.

After the Fruit Machine

Even as early as 1967, changes in Canadian society made the RCMP's crusade against homosexuals harder than ever.   Despite a formal partnership with the morality divisions of city police forces (which allowed them to threaten suspects with arrest for failing to name fellow homosexuals),  the improving legal situation for gay men and lesbians made the paranoia surrounding homosexuals in the  public service harder to justify.  The passage of the 1967 Sexual Offenses Act in the U.K. (which effectively decriminalized homsexuality) led to a renewed fight to decriminalize homosexuality in Canada.   Then Justice Minister Pierre Trudeau defended decriminalization with his famous line that "there's no place for the state in the bedrooms of the nation".   Canada's Criminal Law Amendment Act was finally passed in 1969 despite a massive anti-gay campaign by conservative and religious groups and allegations that the new law was motivated by "communism, socialism, and atheism".   While the situation was slowly improving for sexual minorities in Canada, attitudes in the public service were slow to change and many gay men and lesbians were still fired for being "not advantageously employable". 

Even as recently as 1992, Michelle Douglas' firing for being a lesbian led to the groundbreaking legal decision removing the ban on homosexuals openly serving in the Canadian military .    Virtually all government documents outlining the anti-gay security campaign, as well as the fruit machine project vanished into government archives until the Associated Press forced their release in the 1990s.  Despite Canada's reputation as being a liberal country,  it's still hard to estimate how many thousands of lives were ruined by the RCMP's security campaign.   As Gary Kinsman and Patrizia Gentile pointed out in their gripping book, The Canadian War on Queers, it was the national security campaign that likely spurred the growth of the gay liberation movement in Canada.  

While F. Robert Wake died in 1993 (with obituaries carefully avoiding any mention of his security work), that was hardly the end of the quest to build a successful "fruit machine".   Ironically, a far better approach to measuring sexual arousal became widely available in Canada when Dr. Kurt Freund arrived in 1968 to begin a new position at the Clarke Institute of Psychiatry (now the Centre for Addiction and Mental Health).   Through the penile plethysmograph technique he pioneered in Europe, Dr. Freund created the first practical method for detecting sexual interest in males by measuring bloodflow to the penis.   Although he had initially been commissioned to develop the test by the Czech military to weed out homosexuals in the military, Dr. Freund's early research in aversive conditioning led him to conclude that homosexuals could not be "cured" in this fashion and called for the decriminalization of homosexuality in Czechoslovakia.    After coming to Canada as a refugee in 1968, he successfully resisted any attempt to use his penile plethysmography technique to identify homosexuals in Canada and pushed for decriminalization instead.  While this won him few friends in the largely Freudian psychiatric community of that time, his laboratory became one of the first in the world to use penile plethysmography (now more commonly known as phallometry)  to detect sexual arousal in men accused of pedophilia and related sexual offenses. 

Although Dr. Freund opposed attempts to use his phallometry technique to detect homosexual men during his lifetime, reports have surfaced of phallometric testing of homosexuals have surfaced in other countries (including Dr. Freund's birthplace, the Czech Republic).   As recently as last year, the European Union Commission issued a statement declaring the Czech Republic's ongoing use of sexual arousal tests on gay asylum seekers to be in direct violation of EU asylum laws.  In citing several recent cases of gay refugees being forced to undergo phallometry as part of their application for asylum in the Czech Republic, the EU's Fundamental Rights Agency has flagged the Czech Republic for being the only country in Europe to demand such testing for refugees.

Despite the Czech Republic coming under the spotlight due to being part of the European Union, the use of phallometry and other tests of sexual arousal in non-European countries is not so well documented.  Given that homosexuality is still a criminal offense in numerous countries around the world, using widely available sexual arousal testing to identify and prosecute homosexual men and women may well be far more prevalent than anyone realizes.

Perhaps the "fruit machine" saga isn't quite over yet.

How Passionate Are You About Gambling?

Do you enjoy gambling?

Whether it involves spending money on lottery tickets, making regular visits to local casinos, off-track betting, or playing the multitude of gambling-related websites currently available, there is no disputing that gambling is far easier than it ever was in the past.  In the United States alone, the gambling industry contributes an estimated 137.5 billion dollars to the U.S. economy each year.  As for the money gambling brings in around the world, the gross gambling yield (GGY) of the worldwide gambling market has been predicted to reach 495 billion U.S. dollars in 2019. 

While the gambling industry provides jobs for hundreds of thousands of people around the world, it has a dark side as well.    Even though most people who gamble rarely experience problems, a small, but significant, percentage of all gamblers develop dependency issues that can lead to serious financial and emotional problems.  A bizarre example of that came to light recently when investigators announced that the audit of a Catholic school near Los Angeles determined that two nuns, both of whom had worked at the school for decades, had embezzled money to pay for gambling trips to Las Vegas.   Though the exact sum was not disclosed, some sources put it as high as $500,000.  Stories like this are hardly uncommon and cases of embezzlement, theft, and bankruptcy linked to gambling continue to occur.

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