Providentia

Can Personality Traits Protect Against Cognitive Decline in Seniors?

Cognitive complaints and engagement in cognitive activities are two consistent predictors of cognitive aging outcomes, including risk for nonnormative decline. Though research has considered predictors of complaints and engagement in general, little work has attended to the fact that these fluctuate at the daily level. A study recently published in the journal Psychology and Aging examined individual difference predictors of means and variability for engagement and complaints across 10 days in a sample of older adults (n = 136; Mage = 70.45 years). When comparing personality traits to indicators of cognitive performance, personality differences appeared better unique predictors for these measures of daily cognitive life. Specifically, even when accounting for demographics, measures of cognitive performance, and the other personality traits investigated, older adults higher on openness to experience reported fewer daily cognitive complaints and more engagement on average, as well as greater daily variability in engagement. In addition, higher neuroticism predicted greater variability in reports of cognitive complaints across days. Implications are discussed with respect to how these findings advance our understanding of cognitive complaints and engagement in daily life. (PsycINFO Database Record (c) 2020 APA, all rights reserved)

For the abstract

Are We Facing a Post-Coronavirus Neuropsychiatric Pandemic?

While the COVID-19 pandemic has already claimed hundreds of thousands of lives around the world, mental health experts are already warning about long-term neuropsychiatric problems in survivors.   

In a recent review published in the journal, Brain, Behavior, and Immunity, a team of psychiatrists led by Dr. Emily Troyer,  at the University of California San Diego point to previous pandemics and the subsequent rise in psychiatric problems among disease survivors.   For example, following influenza pandemics in the 18th and 19th centuries, there was a sharp increase in cases of schizophrenia as well as sleep disorders, anxiety, depression, psychosis, delirium, and suicidality.    Referred to as "psychoses of influenza",  actual research results linking influenza to brain pathology remains limited.

But another epidemic, this time involving cases of encephalitic lethargica, spiked sharply in the years following the 1918-1919 Spanish Flu epidemic.   A brain inflammation condition characterized by by Parkinsonian symptoms, catatonic schizophrenia, psychosis, and excessive sleepiness, the actual causes of the encephalitic lethargica epidemic remain controversial even a century later.

More recently, survivors of the 2003 SARS-CoV-1 pandemic also showed a sharp rise in neuropsychiatric problems 21 to 50 months post-infection compared to non-infected.  One long-term followup study showed 40 percent of SARS survivors examined having one or more active psychiatric illnesses including chronic fatigue syndrome (27 percent), PTSD (54.5 percent), depression (39 percent), chronic pain syndrome (36.4 percent), and panic disorder (32.5 percent). 

Along with the psychiatric consequences of surviving a potentially life-threatening virus infection, researchers have speculated that immune responses triggered persistent inflammation that could damage neural pathways and brain chemistry over time.  Even when the virus is gone, immune responding could continue affecting susceptible individuals.   Some viruses can also lay dormant for an extended period of time, only to become reactivated when the immune system is compromised.   Recent studies looking at the "gut-brain axis" also suggests that microbes in the human digestive system can play a far more critical role in brain functioning than what was previously suspected, something that is still being explored in COVID-19 research.   

But what does this mean for the future?   For now,  have no idea at present how long the coronavirus pandemic will continue, not to mention whether we will be seeing successive waves that could be as destructive as the original outbreak.  Future studies will certainly examine long-term consequences of COVID-19 infection, including its impact on overall health, later development of serious medical problems over time, as well as lifespan.   Such research should also look at possible neuropsychiatric problems that might develop in survivors, much as they appear to have developed in influenza and SARS survivors.  

Even if a clear link between COVID-19 exposure and the development of schizophrenia and other neuropsychiatric conditions is established, explaining why such a link exists will continue to vex researchers.   Along with looking at changes in immune functioning, it is also important to look at psychological factors and lifestyle choices that could also be important.   Whether or not we will see a sharp rise in new cases of mental illness or neurological diseases over the next few decades, there's no doubt that the COVID-19 legacy will leave a long shadow on our future.   How we handle these cases will yield important lessons in how to deal with the next pandemic.

The Case of Timothy Quill

It all began with a 1991 article in the New England Journal of Medicine. 

The author, Dr. Timothy Quill, had used this public forum to explain his reasons for assisting  a 45-year-old terminally ill leukemia patient,   referred only to as “Dianne”, to end her life.   Quill, a Rochester, New York physician, was a professor of medicine at the University of Rochester School of Medicine and Dentistry as well as associate chief of medicine at the Genessee Hospital.   He had been treating “Dianne” for eight years though aggressive cancer treatments did nothing more than prolong the pain she was experiencing.

While Dr. Quill had advised Dianne about the remaining options open to her, including chemotherapy and bone marrow transplants, she declined them all due to the limited chance for success and the debilitating side effects involved.   She had already seen the brutal effect of chemotherapy on other family members and friends who had undergone it and feared what her own protracted death would do to her  family.  Instead, after agonizing discussions with Dr. Quill and her own family, she asked his help in ending her life peacefully at home.   While Dianne told Dr. Quill  about her own sense of outrage over physician-assisted suicide being illegal, she knew that getting his help would be difficult.   He suggested that she contact the Hemlock Society, a national organization that advocates for terminally ill patients seeking to end their own lives as an end to pain.  Founded in 1980, the Society is dedicated to providing terminally ill patients with information on death and also advocating the legalization of physician-assisted suicide. 

Based on the information she received, including different methods by which she could end her life, Dianne asked her doctor to prescribe barbiturates for “insomnia” though both she and Dr. Quill were aware of their potential use to commit suicide at a time of her own choosing.   Along with being powerful central nervous system depressants,  barbiturates are also potentially lethal when taken in high doses (and have been used by some U.S. states for executing convicts in capital punishment cases).   After numerous meetings with Dianne and her family to discuss the ethical questions involved, Dr. Quill then arranged to have her talk to a psychologist to ensure that she not motivated by depression and understood the full implications of what she was requesting.  Based on the psychologist's findings, he then prescribed the barbituates and told Dianne how much would be needed for a lethal dose. 

When Dianne’s illness grew worse, her suffering increased as well.  Her friends and family, along with Dr. Quill, did everything they could to care for her but it wasn’t enough.  Just days after the barbiturates were prescribed, Dianne finally decided to end her pain by taking the lethal dose alone.   In reporting her death to the medical examiner, Dr. Quill reported the cause of death as acute leukemia without mentioning suicide to avoid any police investigation. 

As you might expect, Dr. Quill’s public admission to assisting a suicide provoked a major legal and media firestorm.   Interviewed in 1991 by the New York Times, he stated that he had never assisted a patient to commit suicide before or since but he was aware of other cases in which doctors had hastened death at a patient's request.  Timothy Quill was invited onto all of the news-related programs that were exploring the question of physician-assisted suicide.   That included “Dateline”, “20/20”, and “Nightline.”   He also reprinted his journal article in his first book, Death and Dignity:  Making Choices and Taking Charge, which was published in 1994.   This book also included vignettes featuring other terminally-ill patients as well as information on the Hemlock Society and how to cope with death and dying. 

Though his public revelation of assisting in a suicide stunned the medical community, Timothy Quill  was never charged for his role in Dianne’s death.  Still, the question of physical-assisted suicide remained given New York legislation that makes it a crime to give lethal drugs to dying patients.  While no physicians have been prosecuted under this legislation, the penalty for a successful conviction can be as much as four years in prison.

At the same time, Michigan pathologist Dr. Jack Kevorkian was already making headlines for his own advocacy of physician-assisted suicide (though Kevorkian was not  a treating physician,  his involvement in patient suicide would later lead to his second-degree murder conviction in 1999).   It was the mixed reaction to Kevorkian's crusade, as well as  the active opposition to physician-assisted suicide in many U.S. states that convinced Quill to publish his article.  

Legal cases began springing up in different states, beginning in Washington, to challenge the constitutionality of laws banning physician-assisted suicide.   This would eventually set the stage for the groundbreaking Quill vs. Vacco legal decision in 1997.   

Soon after the 1991 article came out, Timothy Quill and a coalition of doctors and terminally-ill patients filed suit to have New York's ban on physician assisted suicide overturned.   The suit specifically named New York's then-Attorney General Dennis Vacco and argued that the law violated the Equal Protection Clause of the Fourteenth Amendment.   In other words, if patients could refuse potentially life-saving treatment, why couldn't they receive active assistance from their doctors to end their lives? 

When the District Court ruled in favour of the New York legislation,  the decision was overturned on appeal and the question was eventually passed on to the U.S. Supreme Court.   Finally in a rare 9-0 legal decision, the U.S. Supreme Court ruled to uphold the state's right to protect patient life and had a compelling interest in opposing physician-assisted suicide. Still,  the decision also left the door open for individual states to pass laws allowing physician-assisted suicide  

In handing down the ruling, the Court  recognized that terminally ill patients have a constitutional right to medication to ease their pain, even if their death might be hastened in the process.  The Supreme Court justices concluded their decision by stating  “Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in a democratic society.”

In the meantime, the fight to allow physician-assisted suicide was being won in other states.   In Oregon, for example, the passage of the Oregon Death With Dignity Act in 1994 legalized physician-assisted suicide (with certain restrictions).   According to the Oregon act, physicians could prescribe medication for ending a life though patients needed to take the medication themselves.   Patients also needed to be Oregon residents to prevent "suicide tourism" by patients from other states seeking to end their lives.   Other states that have enacted similar laws include Washington, Vermont, and possibly New Mexico depending on the success of a recent court case.   

But physician-assisted suicide has also become a major issue in other countries as well.   Although Belgium, the Netherlands, and Luxembourg have all passed laws allowing assisted suicide under specific conditions, other countries continue to grapple with the complex legal and moral issues involved.    This has led to the establishment of "suicide clinics" in countries such as Switzerland though their legal status is still being questioned. 

In my own country, Canada, the ban on physician-assisted suicide has just been struck down with the historic Carter v Canada decision by the Supreme Court of Canada.  Since the Federal government has been slow to respond (and has actively opposed physician-assisted suicide in the past), it is still unclear at this point whether the current government will be tackling this issue in an election year.  In all likelihood, this issue will ultimately be left up to individual provinces to deal with on their own.

As for Timothy Quill, he remains active in the palliative care movement and the American Academy of Hospice and Palliative Medicine included him in their list of 'Hospice and Palliative Medicine Visionaries' in 2013.   At this time, physician-assisted suicide is still illegal in the state of New York.

Can Curses Kill?

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 it 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.

How Does the Immune System Impact the Brain?

A new article published in the Journal of Neuroimmunology outlines the conditions required for effective immune responses to viral or bacterial organisms and chemicals of exogenous origin and to intrinsic molecules of abnormal configuration.  This is followed by a discussion of endocrine and environmental factors that can lead to excessive continuation of immune activity and persistent elevation of inflammatory responses. Such disproportionate activity becomes increasingly pronounced with aging and some possible reasons for this are considered. The specific vulnerability of the nervous system to prolonged immune events is involved in several disorders frequently found in the aging brain. In addition of being a target for inflammation associated with neurodegenerative disease, the nervous system is also seriously impacted by systemically widespread immune disturbances since there are several means by which immune information can access the CNS. The activation of glial cells and cells of non-nervous origin that form the basis of immune responses within the brain, can occur in differing modes resulting in widely differing consequences. The events underlying the relatively frequent occurrence of derangement and hyperreactivity of the immune system are considered, and a few potential ways of addressing this common condition are described. (PsycINFO Database Record (c) 2020 APA, all rights reserved)

For the abstract

Health Experts Warn of "Parallel Pandemic" of Fake Coronavirus Cures

The World Health Organization has warned of a sharp rise in fake medicines purporting to cure COVID-19, many of which are potentially dangerous in their own right.   In what one expert described as  a "parallel pandemic, of substandard and falsified products",  many desperate consumers are turning to online hucksters offering coronavirus "cures" as well as substandard face masks and other protective gear.  

Interpol has reported that their global pharmaceutical crime fighting unit, Operation Pangea, made 121 arrests across 90 countries in just seven days, including the seizure of dangerous pharmaceuticals worth over $14m U.S.  "The illicit trade in such counterfeit medical items during a public health crisis, shows a total disregard for people's lives," said Interpol's Secretary General Jurgen Stock in a recent media interview.   

Operating primarily in developing nations,  many drug counterfeiters are selling medicines which can be contaminated, contain the wrong or no active ingredient, or may be past the recommended expiry date.   According to WHO sources, sales of these medications has brought in more than $30bn in low and middle-income countries.

"Best case scenario they [fake medicines] probably won't treat the disease for which they were intended", said Pernette Bourdillion Esteve, who is part of the WHO team dealing with falsified medical products.  "But worst-case scenario they'll actively cause harm, because they might be contaminated with something toxic."   

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

Police Warning About New COVID-19 Frauds

With the COVID-19 pandemic spreading worldwide, police are warning about scam artists taking advantage of public health fears to spread misinformation and sell various "services" to unsuspecting consumers.    While the different scams being purveyed are pretty much limited only by the imagination of scam artists, the following have become especially common in recent weeks:

• Private companies offering ‘fast’ covid-19 tests for sale;
• Fraudulent and deceptive online ads offering cleaning products, hand sanitizers and other items in high demand;
• Malicious email campaigns that capitalize on the public’s fears about COVID-19,
• Door-to-door offering fake decontamination services;
• Fraudsters may urge you to invest in hot new stocks related to the disease.

In the United States, many states have started Coronavirus Fraud task forces which have partnered with the  Criminal Investigation branch of the Internal Revenue Service (IRS-CI) to warn the public of being targeted by scammers.   The IRS-CI has specifically warned taxpayers about  scammers trying get people to sign over their stimulus checks to them by asking for filing information that would enable them to steal this money directly.   Given that these scams specifically target older adults and immigrants with limited English, many of whom are particularly vulnerable, authorities worry that victims may be too ashamed or intimidated to complain afterward.

Many consumers are also complaining about price-gouging for items such as medical supplies, hand sanitizer, personal hygiene products, food, water, medicine, automobile parts, and,  even baby formula.  This is in addition to familiar scamming tools such as robocalls, phishing schemes,  and other scams using COVID-19 keywords.    Protection agencies warn all consumers targeted by these scams to: 

• Check anti-fraud websites.   In the United States, check out the Department of Justice site at;  https://www.justice.gov/fraudtaskforce/report-fraud/chart   In Canada, consumers are directed to:  www.antifraudcentre.ca.
• Find the latest health information at the World Health Organization website at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019:  In Canada, check out:   he World Health Organization at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Finally, beware of unauthorized or fraudulent charities requesting money for victims or research. You should never be pressured into making a donation.

But consumers are also being besieged by cyberattacks which use concerns about the pandemic to spread computer viruses using a new rash of malicious software and scams.  In mid-March, email messages purportedly from the World Health Organization carried an attachment ostensibly containing official information about COVID-19 and how people can protect themselves.  Instead, the attachment contained a hidden installer allowing cybercriminals to detect keystrokes on personal computers to steal passwords and other important information.   Other phishing schemes attempt to entice users to official-seeming websites where they are asked to login and view safety information (making them vulnerable to identity theft).   

As the pandemic continues, more of these scams are expected to crop up as scammers shift from their usual routines to exploit popular fears.   All users are urged to be cautious about clicking on attachments or following links to potentially dangerous sites.   They are also advised to keep all anti-virus and firewall software up-to-date as well as regularly using anti-scam software such as Malwarebytes.   

 

The Boltzmann Mystery

In September of 1906, the eminent physicist Ludwig Boltzmann was enjoying a brief holiday with his wife and youngest daughter, at the Hotel Ples in the Italian village of Duino near Trieste.   Although he was scheduled to return to Vienna on the following day to begin a new series of lectures on theoretical physics,  the deep depression that Boltzmann was experiencing did little to 
set his mind at ease.  Prone to episodes of despondency and in chronic poor health, Professor Boltzmann regarded his lectures with increasing dread.  

While his family and colleagues worried about the great scientist's declining mental state, nobody could have predicted what would happen next:  as his wife and daughter were enjoying the Adriatic weather with a swim in the ocean, Boltzmann took a short cord from the crossbars of a window casement and hanged himself in his hotel room.  It was his daughter, Elsa, who found the body.

Though shocked by Boltzmann's suicide, not all of his colleagues were completely surprised.  Along with his long history of emotional problems, he had also made at least one previous suicide attempt.  As early as May of that same year, the Dean of the Philosophical Faculty of the Imperial-Royal University where Boltzmann was  a faculty member notified the Ministry that Boltzmann was suffering from a "serious form of neurasthenia"  which made him unable to engage in any scientific activity.   Boltzmann had been concerned enough about his own mental health that he admitted himself in a mental asylum near Munich in late 1905 although he quickly reconsidered and returned to Vienna.

Among his various students and colleagues, it was an open secret that Ludwig Boltzmann's academic career was quickly drawing to a close.  Ernst Mach, among others, commented that Boltzmann had to be kept under constant medical surveillance since the possibility of suicide was ever present.   He and his family had actually gone to Duino at Henriette Boltzmann's insistence:  she was worried about her increasingly agitated husband and wanted a pleasant holiday to distract him.  If she had any qualms about leaving him alone while she went out with her daughter, she showed no sign of it. 

So who was Ludwig Boltzmann?  And what eventually led to his suicide?   

Despite numerous tragedies in his early childhood (including his father's death from tuberculosis when Ludwig was only fifteen), he was a gifted student who enrolled at the University of Vienna at the age of nineteen and earned his doctorate three years later.   Becoming an Assistant Professor a year after graduating, Boltzmann quickly distinguished himself with a series of papers on thermal equilibrium of gas molecules from which the celebrated Boltzmann equation was derived.  He was also one of the first advocates of the atomic theory of matter despite stiff opposition from Ernst Mach and other prominent Viennese scientists.

Boltzmann's equilibrium work, as well as his proof of the irreversibility of macroscopic phenomena established him as one of the great physicists of the 19th century.   Not only was he revered for his theoretical work, his research into the relationship between dielectric permittivity and refraction established him as a brilliant experimental physicist as well.  While spending most of his time in Vienna, he took numerous sabbaticals which enabled him to travel to Heidelberg and Berlin to work with other eminent scientists such as Robert Wilhelm von Bunsen, Gustav Kirchhoff, and Herman Ludwig von Helmholtz.  The range of Boltzmann's research and theoretical speculations led to his being offered a position as a professor of mathematics at the University of Vienna, largely on the strength of his physics work which showed the mark of a "decided mathematical talent".

It was during the course of his academic wanderings between different faculties that he met Henriette von Aigentler.  Impressed with her intellect as well as her beauty,  Ludwig proposed marriage to her (in writing) and she accepted (in writing).  When her application to audit classes in physics and mathematics was rejected (women were barred from higher education at the time), Ludwig urged her to appeal and she eventually received an exemption to the men-only rule. 

The charming letters that Ludwig and Henriette exchanged during their courtship years have been published in an independent volume (edited by one of their grandchildren) that reflects that deep intimacy of their married lives.   The newly-married Boltzmanns spent fourteen years in Graz where Boltzmann managed to secure a position.  His time at Graz was the most productive period of his professional life and he eventually earned a long list of academic honours both at Graz and at various foreign universities where he lectured on occasion.  He and Henriette also had five children, two sons and three daughters of whom only the youngest, Elsa, was not born in Graz.   

So when did his psychiatric problems begin?  His years at Graz seemed idyllic enough aside from growing problems with myopia which made reading increasingly difficult for him.  It was in January 1888 that he first began showing signs of deep restlessness that caused him to become increasingly dissatisfied at Graz.  Embittered by the politics that came with his new position as University Rector, Boltzmann took advantage of an opportunity to move to Berlin and assume a new position there.  Accepting a post in another country without asking for permission from the Austrian government was a major mistake which Boltzmann quickly came to regret.    He renounced the position in Berlin but the damage was already done.

n 1889, his oldest son, Ludwig, died of  undiagnosed appendicitis.  Along with the guilt that he felt for failing to recognize how serious his son's illness was, Ludwig Boltzmann also became increasingly isolated and insecure in his own department despite being one of the world's most eminent physicists.  When a colleague secured a position for him at the University of Munich, Boltzmann gratefully accepted (although he was careful not to burn any bridges behind him when he left Austria).  While he enjoyed his new work in Munich, the lack of any formal pension left him increasingly worried about what would happen to his family if he became disabled.  This was a special concern for him due to his deteriorating eyesight.  Although his wife regularly read scientific papers to him to spare his eyes, Boltzmann was terrified by the prospect of going blind completely.    He also became homesick for Austria and eventually accepted a position at the University of Vienna in 1894 after years of waffling (the deciding factor was the prospect of complete pension in case he became disabled).

Despite international recognition (including an honorary degree from Oxford where he was revered), Boltzmann felt increasingly isolated in his native country.  He traveled frequently and gave guest lectures across Europe and North America but was prone to intermittent episodes of depression.  His frequent scientific arguments with other physicists (especially Ernst Mach) left him exhausted and he soon found himself in a new position at the University of Leipzig in 1900.   It was shortly after arriving in Leipzig that he made his first suicide attempt and he officially retired a year later due to a stroke.  While he was able to return to Vienna in 1902, the rumours concerning his mental health made life uncomfortable for him.  Boltzmann had to make a promise in writing that he would not attempt to leave Austria again. 

By then, Ludwig Boltzmann's health problems severely impaired his ability to function as a lecturer.  In addition to severe asthma attacks and poor eyesight (he hired an assistant to read all of his course material to him), he also experienced severe headaches and what appears to be angina episodes as well.   These health issues didn't stop him from frequently working until early in the morning and travelling abroad giving lectures.  His last lecture  tour of the United States was in 1905 and the problems that Boltzmann was experiencing were readily apparent to his American colleagues.  Not only was he plagued by repeated asthma attacks but his hosts at Berkeley were somewhat disgruntled by the odd manic behaviour that he was displaying.  Still, he gave more than thirty lectures and newspaper reporters described his American tour as a triumphant success.  Boltzmann was not so enthusiastic and he was openly disappointed that his lecture tour was not as successful as previous ones had been.

Shortly after returning from California, Ludwig Boltzmann committed suicide.  Despite his chronic depression, his jovial description of his trip to California seemed enough to reassure friends and family that things were under control.   Since he left no suicide note, his exact reason for killing himself remains unknown.  Life managed to go on for Boltzmann's family and colleagues.  While lectures in theoretical physics at his university were suspended for eighteen months after the suicide, Boltzmann's position was eventually filled by Friedrich Hasenohrl who dedicated his inaugural lecture to Ludwig Boltzmann and his research.  Erwin Schrodinger and Ludwig Wittgenstein were particularly devastated by the great physicist's death since they had both been hoping to study with him.  As for Henriette Boltzmann, she outlived her husband by more than thirty years before finally dying in 1938.   Of all the Boltzmann children, it was Elsa, the daughter who discovered the body, who lived with the memory of her father's suicide the longest.   Until her death in 1966, she steadfastly refused to talk about the trauma she experienced that day. 

While the usual caution about attempting to diagnose historical figures based solely on available accounts certainly applies here, the question of the exact nature of the psychiatric problem that Ludwig Boltzmann experienced still remains.   In addition to the "neurasthenia" diagnosis he received during one of his repeated hospitalizations (a catch-all psychiatric label that was popular at the time), several biographers have speculated on the possibility that he suffered from bipolar disorder, primarily due to the apparent mood swings that he demonstrated at times.  He often showed manic enthusiasm for his research work which could abruptly shift to deep depression.  Even Boltzmann observed these mood swings and  joked that they were due to his being born on the night between Mardi Gras and Ash Wednesday.  

If he were diagnosed today, he would likely be considered to be suffering from late-onset bipolar disorder given that he was almost fifty when the first symptoms developed.   The lack of any close relatives with psychiatric problems also reflects the possible late-onset diagnosis although, again, we will likely never know for certain.  While never formally diagnosed, Ludwig Boltzmann is often listed among famous bipolar individuals.  Whatever the diagnosis, Ludwig Boltzmann's life provides a fascinating example of the surprising ways in which scientific genius and mental illness can interact.  Whether modern medical treatment would have enabled him to function longer is another question that can never be answered.

As a final postscript to Ludwig Boltzmann's saga,  a commemorative plaque in his memory was mounted at the Hotel Ples on September 4, 2006 near the site where he committed suicide.  It represents a sobering reminder of the death that rocked the scientific world so long ago.  

The Starvation Doctor

When Dorothea and Claire Williamson arrived in Seattle, Washington on February 27, 1911, they were eager to begin a radical new treatment program that would help them both overcome assorted "female troubles".   They had no idea that the "treatment" would result in one of them dying a  gruesome death and propelling them both to the centre of a bizarre medical scandal.

Born and raised in England, the sisters had inherited a fortune from their Scottish grandfather.    Being independently wealthy, the Williamsons used their money to fund a long odyssey to various medical clinics around the world as they searched for a cure to  assorted medical complaints.   Although the complaints were largely minor (and possibly imaginary), the sisters could afford the best care and try any fad cure that happened to be in vogue at the time.

In the course of their travels, they came across a new book, Fasting For The Cure of Disease, which argued that many diseases were due to the eating of meat and assorted nutritional problems that could be cured by fasting.   The author, Dr. Linda Burfield Hazzard, was one of the few women doctors of that era which made her seem even more remarkable to the Williamson sisters.    After Claire Williamson wrote to Dr. Hazzard, both sisters received a brochure describing how well-to-do patients under her care could undergo the radical fasting cure and receive the full benefits offered in her book.  

From the very beginning, there were warning signs which both women chose to ignore.   Though Linda Hazzard freely used the "Doctor" title, she did not actually have a medical degree.   Instead. she was allowed to practice medicine in the state of Washington because of a legal loophole in the licensing law "grandfathering" practitioners of alternative medicine (she was actually trained as an osteopath).    Despite her questionable credentials, Linda Hazzard was able to launch her own medical practice in Seattle beginning in 1907,   She then established herself as a "fasting specialist" offering medical treatment following the principles laid down by fasting pioneers Edward Hooker Dewey and Henry S.. Tanner.   Dewey (under whom Hazzard reportedly trained)  became famous for his "No Breakfast Plan" while Tanner was notorious for his forty-two-day fast at New York's Clarendon Hall.    

Expanding on the therapeutic fasting principles laid down by her predecessors, Linda Hazzard proclaimed in her assorted books and pamphlets that fasting could cure anything from cancer to hysteria.    That her medical colleagues were condemning her as a quack hardly deterred patients traveling from across the United States (and even as far as Europe) to try the fasting cure for themselves.    Linda Hazzard enjoyed the notoriety and wrote pamphlets describing the "organized persecution from newspaper and physicians".   She even claimed to be the victim of a colossal conspiracy by medical doctors trying to suppress the truth (sound familiar?).    Prospective patients heard nothing about the various deaths that had already been attributed to her since 1903 when she first began starving her patients. 

Not that the adverse publicity did anything to deter people desperate for a miracle.  In fact, the demand became so great that Linda Hazzard gave up her Seattle office and established a larger clinic in nearby Olalla, Washington.   There, the new clinic which Hazzard named "Wilderness Heights" could provide the fasting cure to patients to purge their body of "toxins".  

It was about this time that Linda Hazzard first took on the Williamson sisters as patients.   When they arrived in Seattle on February 27, 1911, they went straight to Hazzard's Seattle office where the treatment was explained to them.    Dorathea and Claire both enthusiastically agreed to to begin the treatments which would involve systematic fasting, enemas, baths, and vigorous massages.   At first, their treatment was at the Seattle location while they stayed in a nearby apartment and saw Linda Hazzard five times a week.

Despite the adverse symptoms that developed, including their growing steadily weaker and light-headed (which they attributed to "euphoria"), the Williamson sisters continued with their treatments and were even among the first patients at the new Olalla clinic when it opened soon afterward.    Their faith in Linda Hazzard was unshakable, even when both women became so emaciated that they could barely walk.    A full-time nurse was hired to care for them both but that was not enough for Linda Hazzard. 

While they were still living in Seattle, Hazzard's control over the sisters became tighter than ever.   She even convinced them to grant her control over their sizeable estate during their "recovery."   Though their nurse was alarmed enough at what was happening to go to another doctor for help, there was nothing anyone could do without having the sisters declared incompetent.    By mid-April, Hazzard had moved the Williamsons to her newly-built clinic in Olalla and her power over them became absolute.     Since both sisters were completely bedridden by this point, Hazzard arranged for their transfer to Olalla in a special ambulance. 

On arriving at the new clinic, Dora and Claire were moved to a private cabin though they continued to have contact with the other patients at Wilderness Heights.   From the outside, it appeared to be a palatial spa where well-off patients could enjoy the expensive treatment they were receiving.   Inside, the reality was very different.   Patients at the clinic were kept on a restricted diet of tomatoes, oranges, and asparagus juice which continued for  months.  They also had daily enemas and vigorous massages to accelerate the process.   Due to the odd stories about the type of treatment patients there received, local residents of Olalla gave the clinic the nickname of "Starvation Heights."  

Linda Hazzard and her husband had total control over all communications between the patients and the outside world, including their mail.   She also made it standard practice to persuade patients to grant her control over their assets (in order to "protect their property" while the patients were convalescing).     Both Hazzards even managed to convince patients to change their wills making the doctor their beneficiary.    

Perhaps sensing that she was on the verge of death, Claire Williamson managed to crawl off the property with a message asking for help which she gave to a local village boy.   The message was to a family nurse, Margaret Convey, who was in Australia at the time.   Delivered by telegram, the message said "Come SS Marama May 8th, first class. Claire."     Though there were no other details, Convey set sail for Vancouver, Washington and arrived on June 1.   It was Sam Hazzard who met her when the ship arrived telling her that Claire had died and that Dora was "hopelessly insane."    

Convey was immediately suspicious and those suspicions seemed confirmed when she met Linda Hazzard (who happened to be wearing one of Claire Williamson's dresses at the time).    When she insisted on seeing Dora, she found her reduced to skin and bones and pleading to be taken away from the clinic.    

What followed was a bizarre battle of wills with Linda Hazzard refusing to release Dora whom she insisted was insane.    She also claimed power of attorney over the Williamson sisters' assets and  was demanding payment for the medical bills both sisters had racked up at her clinic.   As for Claire's death,  Hazzard maintained that the death was the result of the treatment Claire had received before becoming her patient. 

Desperate to save Dora's life, Margaret Convey then turned to Claire and Dora's uncle who was living in Oregon at the time.    The uncle, John Herbert, had not been aware of Claire's death and, when he went to the Seattle funeral parlor where the body was on view, was so horrified at the condition of Claire's body that he refused to believe it was hers.     When Herbert investigated further, Hazzard showed him a letter supposedly written by Claire supposedly affirming her faith in Linda Hazzard's treatment.  The letter was typewritten and unsigned. 

While John Herbert returned to Seattle to plan his next move, Margaret Convey stayed at the clinic to tend to Dora who was growing steadily weaker.    Despite her alarming health, Dora continued to get her daily enemas and starvation diet.    In desperation, Convey managed to get herself assigned as Dora's full-time nurse and smuggled in extra food to keep her alive.  She also questioned other patients and learned that Hazzard was treating them much the same way.   As part of her investigation, Convey discovered that Dora had been forced to sign a note givinh Sam Hazzard $500 (Dora had been under the impression that the money was going to a relative).     Showing this to Dora finally convinced her that she was being cheated.   With the help of John Herbert,  Linda Hazzard  released Dora, but only after Dora was forced to pay another $500 which Hazzard claimed was still owing on the bill.

By July 22, 1911, Dora Williamson was free and the quest for justice began.   After getting help from the British consul, Dora and Margaret Convey convinced authorities to begin investigating Linda Hazzard's clinic.   First of all, they had to get an attorney to remove Linda Hazzard's name from legal papers assigning her guardianship, then they slowly built a case against the Hazzards.  Since the clinic was located in Olalla and had considerable political clout, persuading people to testify against Linda Hazzard was difficult.   Along with questions about Claire Williamson's death, the Hazzards were also suspected in the disappearance of more than $6000 worth of jewellry from the the sisters' property which had been returned by the clinic.  

When Dora Williamson's lawyer, Frank Kelly, went to the county prosecutor and laid out the case against the Hazzard clinic,  a new problem came up.   Though the prosecutor, Thomas Stevenson, grudgingly agreed to proceed with the case, he also pointed out that the county had very little money to conduct the type of case that would convict Linda Hazzard and her husband.   With the threat of an international incident hanging over his head (Claire Williamson had been a British subject), Stevenson agreed to lay charges if Dora Williamson subsidized the court costs involved.     Though the request for money seemed unbelievable, Dora finally agreed.   As Frank Kelley told the district attorney, "If she has to pay to stop her sister's murderer, so be it." 

And so the case against Linda and Sam Hazzard was finally underway.   After an arrest warrant was filed on August 4, 1911, Linda Hazzard was charged with Claire Williamson's death.    While waiting for the case to come to trial, Frank Kelley and Thomas Stevenson began investigating other suspicious deaths linked to the clinic.   Their efforts were helped along by the media storm over the allegations against Linda Hazzard, including newspapers in Seattle and Tacoma providing lurid headlines about the "starvation atrocities".    Records relating to all deaths linked to Linda Hazzard's practice were carefully examined and a suspicious pattern emerged with bank records and evidence of wire transfers showing that the Hazzards had systematically drained  the accounts of many of her patients after their deaths.   That was enough for the American Medical Association to pull Linda Hazzard's medical license and she was belatedly put out of business.

By the time the Hazzards' trial finally began, things had become even more bizarre.    The investigation into Linda Hazzard's history turned up the fact that Sam Hazzard was actually married to another woman and that he had committed bigamy by marrying Linda as well.    Patient deaths linked to Linda Hazzard dated back to 1902 when she was practicing in Minnesota although she had managed to avoid charges by moving to Washington.  

Funded by Dora Williamson, the district attorney brought in prominent medical experts who testified that Claire Williamson had died from starvation rather than from peritonitis as the defense claimed.  Not surprisingly, the defense insisted that the trial was an attempt by orthodox medicine to suppress the truth of Linda Hazzard's starvation treatment.   While some of her patients attempted to testify in her defense, they were not allowed to by the judge.   On the other hand, the list of names of patients who had died while in Linda Hazzard's care seemed like overwhelming evidence of her malpractice.   

Whatever else you could say about the trial, it was certainly memorable.   Appearing on Linda Hazzard's behalf were various patients and relatives of patients who believed strongly in her treatment despite the various deaths that had occurred.  One of them, John Ivar Haglund, testified that he believed in her special diet even though his wife, Daisy, had been one of the first to die in Hazzard's care.  In fact, his faith in Linda Hazzard was so strong that he allowed his young son Ivar to continue as her patient.    Other patients were not so supportive, however.   They testified that Linda Hazzard was frequently seen wearing clothing and jewelry belonging to dead patients.    Some even alleged that she and Sam had removed the gold crowns from the mouths of dead patients to be sold to a local jeweler. 

The most damaging evidence against Linda Hazzard was the discovery of a badly decomposed body on the grounds of her clinic.   The body was identified as a wealthy patient who had been shot in the head.    While the police suspected suicide, many of Linda Hazzard's accusers believed that he had been murdered so that she and her husband could control the patient's estate. 

Despite a spirited defense, Linda Hazzard was convicted of manslaughter on February 4, 1912 and sentenced to twenty years in prison.   As the sheriff came to take her away, she loudly protested her innocence and accused conventional medical doctors of conducting a vendetta against her.  "The high and mighty with the diplomas and letters after their names have done this!”, she said while being led away.   

But that was hardly the end of Linda Hazzard.  After serving two years in the Washington State Penitentiary at Walla Walla, she received a full parole on December 26, 1915.    The governor granted her a full pardon a year later.   Linda and her husband then moved to New Zealand where she was able to offer her services as a health specialist.   Though not allowed to practice medicine, she still continued to write books and attract followers.   After ten years, she had earned enough money to return to the United States and open a School of Health in Olalla.    Despite her lack of medical credentials,  Hazzard still managed to attract patients agreeing to be starved for their health.    This continued until her school burned down in 1935 and was never rebuilt.    Linda Hazzard died three years later, reportedly as as a result of prolonged fasting.

As for the total death count of patients under Linda Hazzard's care, that is still a matter of debate.    While there are fourteen known victims,  some suggest that there are far more victims still buried on the Olalla property where her clinic was located.    It seems fitting that there are local legends about the ghosts of these patients being seen walking the grounds.

Probably in search of a good meal.

How Early Does Bullying Begin?

New research published in the journal Early Child Development and Care examined prevalence, types, bully and victim characteristics, times and places bullying occur, relationship between class size and bullying, and relationship between teachers’ level of education and preschool bullying. Participants were a convenience sample of 246 Turkish preschool teachers working with children between 36 and 72 months. Preschool Peer Bullying Scale-Teacher Form was the main data collection instrument. Findings revealed that the most frequent bullying behaviours were rejecting a classmate joining in a game and hitting, slapping, punching, pinching or kicking a classmate. While preschool bullies were characterized as boys having behavioural problems, victims could be girls or boys obeying the rules. Bullying occurred when and where there was a lack of adult supervision, the number of boys increased the likelihood of early childhood bullying, and teachers having an undergraduate degree reported more bullying incidents. Implications are discussed for school counsellors and psychologists, researchers, as well as educational policy-makers. (PsycINFO Database Record (c) 2020 APA, all rights reserved)

For the abstract