Providentia

Epilepsy, Violence, and Crime: A Historical Analysis

In the 19th and early 20th century, epilepsy was one of the most investigated disorders in forensic psychiatry and psychology. The possible subsidiary symptoms of epilepsy (such as temporal confusion, alterations of consciousness, or increased aggression) played pivotal roles in early forensic and criminal psychological theories that aimed to underscore the problematic medical, social and legal status of epileptic criminals. These criminals were considered extremely violent and capable of committing sudden, brutal acts. Although the theory of “epileptic criminality” was refuted due to 20th‐century developments in medicine, forensic psychiatry, and criminal psychology, some suppositions related to the concept of epileptic personality have lingered. A new paper published in the Journal of the History of the Behavioral Sciences explores the lasting influence of the theory of epileptic personality by examining the evolution of the theories of epileptic criminality both in the international and the Hungarian context. Specifically, it calls attention to the twentieth‐century revival of the theory of epileptic personality in the works of Leopold Szondi, István Benedek and Norman Geschwind. The paper shows that the issue of epileptic personality still lingers in neuropsychology. In doing so, biological reductionist trends in medical‐psychological thinking are traced, and attention is drawn to questions that arise due to changing cultural and medical representations. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

When Autistic People Camouflage

Camouflaging includes strategies used by individuals to mask or hide autistic traits. Research has shown that both autistic and neurotypical individuals engage in camouflaging and that there may be sex differences in the reasons for camouflaging in autistic adults. A qualitative study recently published in the Journal of Autism and Developmental Disorders extends previous research on the lived experience of camouflaging through exploring camouflaging motivations and consequences in autistic and neurotypical adolescents through both questionnaires (n = 132) and semi-structured interviews (n = 19). Results revealed trends in camouflaging motivations and consequences by diagnosis and sex, as well as by sex within the autistic group. These findings further inform our understanding of camouflaging and why it may be reported as particularly detrimental for autistic females. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

For the abstract

Why Is There Such a Stigma About Homelessness?

Though we may never know for certain many homeless people there are at any given time, available estimates suggest there are far more of them than anyone realizes.  According to the 2019 Annual Homelessness Assessment Report (AHAR) released to Congress last year by the Department of Housing and Urban Development (HUD), there are around 568000 people currently experiencing homelessness in the United States alone.   But the term "homeless" covers a wide range of different circumstances, including the chronically homeless, i.e., "street people," intermittent homeless, and crisis or transitional homeless (such as women in shelters following domestic abuse).

While research has long demonstrated the medical and psychological consequences of being chronically or temporarily homeless, one problem rarely coming to light is the terrible stigma surrounding homelessness.  Often driven by a "not in my backyard" mentality,  this stigma has inspired numerous anti-homeless laws in many jurisdictions worldwide.   According to statistics compiled by the National Law Center on Homeless and Poverty, around 47 percent of the 197 U.S. cities studied have "anti-homeless" laws on the books, making the homeless prone to arrest for sitting or loitering in a public place for too long.   Not only do such laws help keep homeless people "out of sight,"  but they also deprive them of access to basic medical and social services that might improve their quality of life.  Still, given the popularity of these laws with voters, real change remains unlikely in the foreseeable future.  

But the abuse that homeless people face is hardly limited to municipal bylaws alone.   Along with frequent verbal and/or emotional abuse episodes, many homeless people are also targets of violent acts.  While up-to-date statistics are difficult to compile, a 2010 study by the U.S. Department of Justice indicated that 49 percent of homeless individuals surveyed state being victims of violence (including harassment and violent injury from police), compared to 2% of the general population.  Given their often-marginal status in society and perceived lack of support from the community, homeless people rarely report such episodes to police for fear of being arrested for "complaining."    Instead, such abuse leads to greater social isolation and a worsening of their mental health.

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

 

 

Australian Woman Murders Mother Who Spent Thousands For Her Exorcism

Even after the head of 57-year-old Rita Camilleri was discovered on a footpath near her home in west Sydney on July 20, 2018, hardened police investigators were still horrified by the gruesome scene they found inside the residence.   

“On the tiled floor was the body of the deceased, head decapitated, six knives broken and intact surrounding the deceased,” said Senior Constable Hayley Bennett  said in a statement read to the court during the trial of the woman's daughter,  Jessica Camilleri.   “To the right was a human tongue, further to right under the fridge was a piece of skin I believed to be a human nose.  The head … had numerous jagged and penetrating wounds exposing the cervical spine. Human eyeballs were on the tiles under the deceased’s neck.”    She added that the victim's body "was “in a prone position on floor, feet pointing towards the oven area, the legs were straight with the soles of the feet facing upward and a clump of dark hair on the right foot. The injuries on the right hand and wrist were defensive wounds; the left arm was bent at the elbow and the left hand resting on her neck area.”  According to the coroner's report, Rita Camilleri's body showed evidence of "at least 100 stab wounds over her head” and “innumerable overlapping stab wounds associated with decapitation to the neck”.  

Jessica Camilleri, 25, was reportedly covered in blood and holding a water bottle when she was taken into custody.  Though she admitted killing her mother, she insisted that it was self-defense and  reportedly asked police whether her mother's head could be sewn back on.   In the statement she provided police, she and her mother had been arguing before the killing and she wanted to  give her mother "a taste of her own medicine."   When her case came to trial, she pled not guilty by reason of insanity and the court arranged for her to be assessed by forensic psychiatrist Professor David Greenberg.   

In his testimony, Dr. Greenberg said that Jessica Camilleri had "multiple” psychiatric diagnoses, including an intellectual disability but experiencing any psychotic symptoms.   Despite having a history of repeated hospitalizations, she was generally able to function with help from her mother who acted as her primary caregiver.   According to Dr. Greenberg, the defendant described killing her mother in an “concrete, matter-of-fact tone without any emotion or emotional remorse”.   During the course of his testimony, Dr. Greenberg read an account of the killing that Jessica Camilleri provided to him.   In that account, she stated that "I wasn’t thinking.I was panicky, frustrated, enraged,”   Believing that her mother was planning to have her re-hospitalized for inpatient treatment, she attempted to grab her mother's phone.   When her mother attempted to fight back and grabbed her by the hair, she reacted violently.   “I dragged mum all the way to the kitchen by the hair. I saw red.  I remember pulling the knife (from a kitchen drawer).  I wanted to scare her at first. Mum ... got the knife off me and chucked it away... I was so agitated, I lost it. I was stabbing her ... I was so angry. I think I had sick thoughts.  I got it off horror movies ... Texas Chainsaw Massacre, Jeepers Creepers and Saw.  I remember stabbing my mum, I wouldn’t stop, was getting her everywhere.  I was getting the adrenaline going.”   She added that she "got the idea to cut her head off from the movies” and had hoped to relieve her mother's pain as a result.   Following the decapitation, she removed her mother's eyes, nose, and tongue.  

The court also heard that Rita Camilleri had been overwhelmed by her daughter's special needs  and had been warned by friends that Jessica was potentially violent.   According to one family friends, Rita Camilleri began to believe that Jessica's illness had a supernatural cause and subsequently paid thousands of dollars to a "she-wolf" medium to "get the devil" out of her daughter,   This was shortly before her death. 

Friends also testified that Jessica had a fascination for horror movies with films such as The Texas Chainsaw Massacre and Jeepers Creepers.   Both films had dismemberment scenes which she particularly enjoyed.  Police reported that she often paused and rewound these scenes whenever she watched the films on video.   She also had a history of making graphic threats of dismemberment to people who had offended her.  This included the family and staff of a random man for whom she developed a “huge crush” including  threatening to “flush their heads down the toilet”

The trial is continuing.

 

For more information. 

The Madwoman in the Cellar

The marriage of Patrick Henry and Sarah Shelton in 1754 certainly got off to a good start.  Her parents provided them both with a fine dowry including a 600-acre tobacco farm in Virginia called Pine Slash, a house, and six slaves.  Sadly, Patrick's early attempt at becoming a gentleman farmer ended due to a disastrous drought in Virginia and a fire in 1757 that destroyed their house.  He then sold the all the slaves and used the profits to open a store which also failed.  Despite these setbacks, Patrick Henry's self-taught law skills and talent for oratory earned him public attention and launched him on a political career (including becoming the first post-colonial Governor of Virginia) .  He  eventually purchased a new plantation and all seemed to be well, except...

By 1771 and the birth of her sixth child, Sarah's mental health deteriorated rapidly.  Diagnosis on the basis of historical accounts is always a tricky business and the exact nature of her illness is open to debate (post-partum depression is one possibility),   What is not in debate is that Sarah was no longer able to care for herself or her children.  Which left the question of what to do with the increasingly unstable Sarah.    Unfortunately, families with mentally ill members, had few real options in those days.  While the colony of Virginia had a lunatic asylum in operation, the standard of care for inmates left much to be desired.  Treatment was nonexistent and it was primarily a place where the mentally ill could be held against their will (and out of sight). 

To place Sarah in such an institution was unthinkable for Sarah's family and, instead, they decided to care for her themselves on the family plantation.  For her own protection, and considering the stigma surrounding mental illness (which was seen as hereditary in that era),  she was primarily confined to a large cellar room which, no doubt, worsened her condition although her family ensured that it was as comfortable as possible.  While Patrick and the children visited her as often as they dared, most of the care that Sarah received came from a female slave who attended to her constantly.   The isolation likely made her condition worse and, according to reports, she spent much of her time in a straightjacket to keep her from harming herself.   

Sarah eventually died in 1775 without ever having recovered her sanity and she was buried in an unmarked grave on the plantation.  Her death hit her husband hard and when he made his famous "Give me liberty or give me death" one month later, it was likely that the memory of his dead wife made it especially poignant.  He would later remarry and his stature as a politician would ensure him a permanent place in U.S. history but there is little to mark Sarah's life except as a footnote in her husband's biography. 

For generations after Sarah's death, families with mentally ill members would be forced to make the same harsh choices that her own family did.  Spontaneous recovery from mental illness rarely occurred, especially in the cramped, underserved hospital settings that most mental patients were forced to endure.  It wasn't until the late twentieth century that effective treatment would make hospitals into something more than a place to warehouse those considered too insane to be accommodated in society.   While the stigma of mental illness continues and downsizing of psychiatric services means that too many of the mentally ill are wandering the streets, we've hopefully moved somewhat beyond the era of madwomen locked in cellars.

At least, in this part of the world.   

Weeding Out The Immigrants

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed, to me:
I lift my lamp beside the golden door.”

While the famous lines by Emma Lazarus inscribed on the Statue of Liberty continue to proclaim the welcome offered to immigrants coming to the United States, the reality has often been somewhat different.  

Even though potential immigrants traveling in first- or second-class often managed to enter the country with only a rudimentary assessment, passengers traveling in steerage were processed through the immigration station at New York Harbour's Ellis Island.   First opened in 1892, the inspection stations of Ellis Island acted as the central processing point for  millions of immigrants arriving from Europe and other parts of the world    Thorough medical  examinations by physicians appointed by the Public Health Service were required to check for contagious diseases or other medical problems  and immigration officials often relied on medical evidence to weed out "unsuitable" candidates. Based on an 1882 immigration law, any immigrant deemed to be "likely to become a public charge" could be blocked from entering the United States.    That included any medical deformity or condition that would make an immigrant unable to earn a living.   While many physicians objected to their medical findings being used to screen potential immigrants, immigration officials often justified their decision to exclude "unsuitable" immigrants.

In that same legislation, "imbeciles" and the "feeble-minded" were included as being unfit to enter the United States.   Not only were the feeble-minded considered to be prone to various social problems including drug abuse and crime, but they also seen as a danger to the genetic health of the nation (due to their inferior genes being passed on to future generations).   Immigrants from southern and eastern Europe were regarded as a particular concern for Americans worried about the eugenics of immigration.  

Due to widespread concerns about "feebleminded" immigrants,  having the physicians who examined immigrants test for low intelligence seemed to make good sense to the immigration officials and politicians imposing limits on who could be allowed into the country.  Except for the problem of how to test for intellectual problems, that is.  Though early intelligence scales had already been developed for use with children needing special education, providing something equivalent for immigrants, many of whom could not even speak English. was more difficult.

It was psychologist, Henry Goddard, who first  traveled to Europe in 1908 to learn how to use the new intelligence test first developed by Alfred Binet and Theodore Simon.  After returning to the United States, Goddard translated and revised Binet's test for use at the training school where he worked.  He also developed an early classification system for the intellectually impaired children at his school, i.e., any children with an intelligence quotient (IQ) of less than 70.   For children with a score between 51 and 70, the term moron was used.   All children with scores between 26 and 50 were labelled imbeciles and any child with an IQ of 25 or less was labelled an idiot.   Though these are considered offensive terms today, Goddard's classification system matched his own theories about eugenics and how low intelligence should be dealt with. 

Goddard also established his credentials as an authority on feeble-mindedness through two well-known books highlighting  the genetic risks associated with allowing people of low intelligence to breed.   His 1912 book, The Kallikak Family, traced the genealogy of two branches of one family, one "feeble-minded" and the other normal.    Though modern reevaluation of Goddard's findings suggest that Goddard understated the role of environmental factors, his book proved to be highly influential, especially with early eugenicists such as Madison Grant and Charles B. Davenport.  

Given the concerns over allowing potentially feeble-minded immigrants into the country, it was not surprising that Henry Goddard was invited by the Commissioner of Immigration at Ellis Island to advise staff on the best way of assessing immigrant intelligence.  Though Goddard's initial impression was that concerns about feeble-minded immigrants were likely exaggerated, he conducted tests of his version of Alfred Binet's test for use with immigrants.   Comparing his own test results with what immigration doctors were reporting, Goddard concluded that his trained staff were more accurate in detecting immigrants with low intelligence.   On that basis, he recommended that Congress allocate funds to provide Ellis Island with sn assessment department for measuring feeble-mindedness. 

Many of the immigration doctors themselves objected to the use of Goddard's intelligence tests to weed out low-IQ immigrants.   One of them, Howard Andrew Knox, published an article in 1913 in the Journal of the American Medical Association which pointed out how inappropriate it was to use tests developed for schoolchildren on immigrants with limited English skills.   As he pointed out:

To the uninitiated using routine tests for defectives nearly all the peasants from certain European countries appear to be of the moron type; but of course this is a fallacy. If these peasants are questioned about conditions existing in the land from which they come most of them will show average intelligence.

But Knox and his colleagues were still eugenics supporters themselves and endorsed the political call to weed out the "feeble-minded".  As Knox stated in another article  published that same year, it was more important to identify morons than people who were insane since morons would "immediately start a line of defectives whose progeny, like the brook, will go on forever, branching off here in an imbecile and there in an epileptic, costing the country millions of dollars in court fees and incarceration expenses."     All that remained was to come up with a reliable method of identifying these mental defectives.

When Goddard's researchers visited Ellis Island in 1913 to test 165 immigrants, they still had to decide how to interpret those results.   After finally published his findings, Goddard stated that je and his researchers identified a disproportionately high number of immigrants  as mentally defective.    He then wrote that "one can hardly escape the conviction that the intelligence of the average ‘third class’ immigrant is low, perhaps of moron grade."  He charitably suggested that this was due to the poor environments from which they had come rather than their genetics though.

Despite the controversy over Goddard's results, there was enough political support for the idea of  IQ screening for immigrants, despite the fact that many immigrants didn't speak English and often required interpreters to make themselves understood.  That the Binet scales were primarily verbal in nature, not to mention the fact that the interpreters themselves often had difficulty understanding the concepts used in testing, did little to derail the IQ testing supporters.

Fortunately, there was already a potential solution available.  Psychologists working with hearing impaired patients and children with language deficits had developed specialized performance tests relying on nonverbal skills.   Many of these tests involved “formboards” requiring test-takers to fit geometric figures into similarly-shaped impressions in the board.   The most famous of these was developed by Edoard Seguin and it was already being used for nonverbal performance testing in children with language needs.   Other tests included jigsaw puzzles and “picture formboards” that attempted to reduce verbal testing as much as possible. 

The doctors stationed at Ellis Island  incorporated many of these non-verbal tests into the battery used with new immigrants and also developed several new tests as well.  Howard Knox developed two non-verbal tests which he described in as 1913 article.  The first of these was a “Visual Comparison Test”  using line drawings to match for size and complexity.  The second one, the "Knox Cube Imitation Test", required test-takers to tap a series of cubes in a sequence shown to them by the tester.    

In a 1914 paper, Knox wrote that he had conducted the tests on "over 4,000 suspected defectives in the last eighteen months and many more made by my associates ... all were considered sufficiently near the required standard to be allowed to pass, except 400 certified as feeble-minded and (in a few cases) as imbeciles."    Different versions were used including an "Imbecile test" for people with a  a mental age of less than six.   There was also a "Moron test"  which could only be solved by someone with a mental age less than ten.    Knox recommended that these tests be given several times to ensure that immigrants didn't pass the test by accident.

Since the number of potential immigrants identified as feeble-minded was far greater than what the doctors had detected before the intelligence testing began, this was regarded as proof for the value of psychological testing at Ellis Island.    To minimize problems caused by language and culture differences, Knox also developed an expanded testing process, including a careful interview to ensure that they had basic cognitive skills.   In most cases, immigrants received only a cursory examination with only those failing the interview being passed on for more in-depth testing.

Though Knox left Ellis Island by 1916, he continued to publish in various eugenic and public health journals and played a role in expanding the definition of mental deficiency to include paupers, criminals, epileptics, and other "persons possessing stigmata and deformities."   He also argued that male immigrants should meet fitness standards at least equal to what would be demanded by the U.S. Army.    His tests, which were later produced by commercial test publishers, set the standard for screening immigrants for decades to come.

By 1921, the U.S. government established a quota system and shifted responsibility for immigrant screening to U.S. embassies or consulates around the world.   While Ellis Island continued to be used for immigrant detention and deportations (including thousands of "enemy aliens" being held there during World War II), the facility was finally closed in the 1950s.   It eventually reopened to visitors as a tourist site in 1976 and the Ellis Island Immigration Museum opened in 1990.   Visitors to the museum can still see many of Knox's intelligence tests on display, along with other reminders of the countless thousands of immigrants who passed through the system during its heyday.

So what can I say about Howard Knox?   While his intelligence tests had a significant influence on the early history of intelligence testing, his name has been largely forgotten except by psychology historians.   Many of the nonverbal test elements he developed continue to be used in different intelligence tests and he is rightly regarded as a pioneer in non-verbal intelligence testing.  Still, while some of his ideas about how language and cultural barriers can interfere with intelligence testing are valid enough, his beliefs about eugenics are hard to defend.  Though he was certainly not the only eugenicist of that era, the critical role he played in how potential immigrants would be screened made him one of the most influential.

As for the human cost of Knox's work, that is harder to determine.   We will likely never know what became of  the many immigrants identified as feeble-minded by Knox and his fellow testers.   Certainly many of these same "feeble-minded" immigrants were routinely allowed into the country before intelligence testing became the norm and without the dire predictions of the eugenicists coming to pass.   That a disproportionately high number of immigrants regarded as being inferior came from non-English speaking backgrounds and cultures only helped reinforce the prevailing belief in the genetic superiority of "true" Americans.   

Along with rigid quota systems in place for potential immigrants, the eugenics movement would claim other victims as well.   Many of the same policies advocated by Knox and his fellow eugenicists would be used to implement compulsory sterilization on thousands of "inferior" men, women, and children in the United States and Canada.  It would take decades, and the horrendous example of the Holocaust in Europe, to eventually overturn the eugenics laws although many still remained in place until the 1960s or later. 

The price of these laws, including restitution payments made to the victims, would ensure that their influence would continue even today.   In an era of anti-immigration furor and calls for deadly force to be used to prevent even immigrant children from entering the country,  the xenophobia that turned Ellis Island into a proving ground for racial  politics a hundred years ago is still alive and well today.

 

The Kinsey Revolution

One of my favourite I Love Lucy scenes features Lucy going door to door pretending to be taking a public opinion poll.   At one door, the woman answering looks at Lucy with suspicion and asks, "Your name isn't Kinsey, is it?". 

Though situation comedies during the 1950s could only get away with snide references like this, the social and cultural revolution launched by Alfred Kinsey's groundbreaking studies into human sexuality was already shaking American society to its roots. 

In a real sense, there was nothing new about exploring sexuality from a scientific perspective.  Along with early sexologists such as Richard Krafft-Ebbing, Havelock Ellis, and Magnus Hirschfeld, various psychoanalytic and anthropological researchers attempted to present sexuality as a natural part of human behaviour although they tended to be largely ignored by the mainstream culture.   While Margaret Mead's Coming of Age in Samoa was a bestseller when first published in 1928, her (now controversial) findings seemed to have little relevance for the Americans of her generation.   Various animal behaviour studies showing similar findings were also largely dismissed as not being generalizable to human beings.

The Research Begins

And then came Alfred Kinsey...

Although his early devout Christian upbringing showed no indication of the path he would later take in life,  Kinsey's fascination with science and nature led him to pursue an academic career in biology.  While this meant defying his father, an engineering professor who insisted that his son study engineering as well, he eventually managed to graduate magna cum laude from Bowdoin College with degrees in biology and psychology.   Continuing on to Harvard University, Kinsey did his graduate work almost exclusively in entomology (specializing in gall wasps) and received his Sc.D. degree in 1919.   

Over the next few years, Alfred Kinsey expanded the gall wasp collection at the American Museum of Natural History in New York and wrote a widely-used high school textbook in biology which he published in 1926.   He also married Clara McMillen in 1921 and they would eventually have four children together.   

Though at the height of his career during the 1930s, Alfred Kinsey's abrupt transition from entomology to the study of human sexuality may not be as surprising as it seems.   In his private life, he was bisexual with numerous affairs with both men and women (apparently with his wife's full consent given the open nature of their marriage).   Part of his research into gall wasps focused on mating strategies which, combined with his own fascination with human psychology, led him to speculate on how scientific methods could examine human sexuality as well.  Delivering his first public lecture on human sexuality in 1935, he denounced the "widespread ignorance" surrounding sex and the psychological harm stemming from "delayed sexuality", i.e. abstinence.  

In a real sense, Kinsey's transition to sexology may have been spurred on by changes happening at Indiana University where he taught.   When the university introduced a new course on marriage in 1938, Alfred Kinsey acted as the course coordinator with professors from different faculties (who all happened to be men) providing insights.    In running the course, Alfred Kinsey added to his own knowledge of human sexuality by interviewing his students about different aspects of their sex lives.  That included age of first sexual experience, number of partners, frequency of sexual activity, etc.   It was during this same period when he first developed his classic Kinsey scale ranging from 0 for exclusive heterosexuality to 6 for exclusive homosexuality (X for total asexuality was added later).   The concept that all humans fell somewhere on a continuum of sexual orientation was only the first of the startling revelations that Kinsey would reveal during the course of his research.

Along with interviewing students, Alfred Kinsey also read extensively on the subject of human sexuality and built an extensive library on available works relating to the scientific study of sex, many of which were extremely hard to find (sexuality being a largely taboo topics in those days).   One of the most valuable libraries on sexuality in the world, which was part of Magnus Hirschfeld's Institute of Sexual Research in Berlin, Germany, had been destroyed by the Nazis just a few years earlier, in 1933.    

To supplement his growing library and the information from his students, Kinsey conducted field trips to Chicago in 1939 to conduct more interviews and also interviewed inmates at the Indiana State Penal Farm and their families.   Though the university backed his research (with some reservations),  Kinsey already faced controversy from several colleagues who had decidedly different views on sexuality.  One of them, Thurman Rice, was a professor of bacteriology at the same university where Kinsey taught.   Rice had written extensively on sexuality and eugenics and regularly lectured to students on sex as part of a mandatory course in hygiene taught at the university.Very much part of the old mentality when sex was concerned, Rice's lectures on sex focused on issues of morality including the harmful nature of masturbation and premarital sex.  He even provided separate lectures for male and female students.   As you might guess, Thurman Rice was outraged by Alfred Kinsey's more liberal take on sexuality and argued that his new marriage course violated academic standards. 

Rice also opposed Kinsey's attempt at a scientific analysis of sexuality since it maintained that it was a purely moral issue.   Not only did he accuse Kinsey of inappropriate behaviour (such as asking female students about the length of their clitorises) but also demanded the names of his students so he could question them himself about possible infractions.   His complaints helped stir up controversy and parents of students began asking awkward questions as well.   Indiana University president Herman Wells finally offered Alfred Kinsey a choice: either continue teaching the marriage course or end his sexology research.   Kinsey chose the second option.

Kinsey's Research

Armed with a research grant from the Committee for the Research in Problems in Sex,  Alfred Kinsey launched what would be a revolutionary research project into human sexuality.   As far as the Committee was concerned,  Kinsey seemed the perfect candidate for such a project.  Not only was he an established scientist, but he was also married with children (his bisexuality being a carefully guarded secret).  The Committee chairman,  Robert Yerkes,  was especially open to Kinsey's reputation as a serious researcher who could be counted on to carry out such a project to completion.    Kinsey, for his part, had very definite ideas on how his sexual research should be carried out.   He felt that most previous research studies were either grounded in abstract theories with little real-world value (including Freud) or too afraid of offending morality to ask the hard questions.

In many ways, it was an ideal pairing.  Both Kinsey and the Committee were a perfect fit and Alfred Kinsey's ambitious research project was fully funded.   As the Committee's lead researcher, he would eventually receive more than half the research money in their budget and the sexual revolution that Alfred Kinsey would launch was underway.

Ultimately, it was the development of safe and effective antibiotics that helped spur the sexual revolution Alfred Kinsey documented in his research.   Fear of syphilis and gonorrhea had contributed to the repressed sexual culture  characterizing much of American society up to that time.   When sulfa drugs were introduced in 1935 (followed by penicillin after World War 2),  the stigma associated with "loose living" began slowly lifting.   There was still the risk of pregnancy though the release of the first oral contraceptive in 1960 helped change attitudes about that as well.  

Alfred Kinsey's research study began at the perfect time to catch the slow evolution of American society along with the birth of the sexual revolution.    And he was definitely a pioneer.    Not only did Kinsey insist on treating sexuality as a serious scientific subject (and not the object of moralizing that many of his predecessors did), but he would eventually create one of the world's great resource libraries on the subject. 

The key to his research rested on the more than 18,000 in-depth face to face interviews that he and his research assistants collected.   To ensure absolute confidentiality and to provide a permanent home for his interview data,  the Institute for Sex Research was founded in 1947 with Alfred Kinsey as Director.   Still affiliated with Indiana University,  the Institute was housed on campus in the Biology Hall.    After selling all of his research materials to the Institute for the sum of one dollar,  Kinsey carefully trained all of his interviewers in the rigorous interview methodology he developed.  

Knowing the sensitive nature of the questions he and his interviewers would be asking and sensitive to the likelihood of deception, Alfred Kinsey set up a careful coding system to detect fraud or exaggeration.   Despite later criticisms of his research methods (especially by conservatives),  many of these  innovations are still used by researchers today.    Kinsey also insisted on face-to-face interviews since he felt that mail surveys were not as reliable in measuring sexual behaviours.   Through direct interviewing,  participants could be carefully questioned about inconsistencies or possible exaggerations in their sexual histories.    He also developed a procedure for cross-checking responses over time by interviewing the same subjects on different occasions (with an average of four years between interviews).    When married couples were separately interviewed, the responses were also cross-checked between spouses.

Recognizing that interviewer bias could skew the results, all interviews were conducted by four interviewers:  Kinsey himself, Ward Pomeroy, Clyde Martin and Paul Gebhard.   Not only did Kinsey train the other interviewers but they met regularly to ensure they all followed the same rating scheme.   Though Kinsey had originally intended to gather 100,000 interviews,  his Institute would only complete 18,000 during his lifetime. 

The basic interview covered  anywhere from 350 to 521 items depending on the sexual history of the respondent.   No question sheets were used since the interviewers memorized all of the items and asked their questions as directly and non-apologetically as possible (a major innovation in itself).   Beginning with simple demographic questions, the interview shifted to more personal questions about sexual history with numerous redundant items to check for consistency. 

Since  some of the items dealt with homosexual behaviour (which was still illegal at the time), special delicacy was needed with extra questioning for participants admitting to repeated same-sex experiences.   That also meant longer interviews with extra questions to cover less conventional aspects of sexuality.     Though children were interviewed as well, the questions were different and one parent was always present. 

The longest interview involved an admitted pedophile and required both Kinsey and Pomeroy asking questions (it was over seventeen hours long).    That was an unusual case since Kinsey had deliberately included him in the study due to his sexual proclivities.   At one point, having expressed skepticism over the participant's claim of being able to masturbate to ejaculation in ten seconds from start to finish,  the interviewee in question provided them with a spontaneous demonstration.   Pomeroy would later add that it was the only actual demonstration of sexual behaviour ever occurring during the thousands of interviews conducted.    That particular interview would also generate severe criticism afterwards since Kinsey and his colleagues failed to provide the information to police (having promised the participant confidentiality). 

There was also the question of how representative the participants were of the general population.  Since all the participants were volunteers,  there was no way to be certain whether they were as "typical" as Kinsey would later claim.   Considering the sensitive nature of the questions being asked,  there was likely no practical way of getting a more representative sample based on the interviewing method that Kinsey used (and it is still a major problem for sex researchers today).

To avoid concerns about his unrepresentative studies, Kinsey pioneer what he terms "100 percent sampling" where all members of organized groups he approached for his sex studies would be interviewed, including college fraternities, residents of a particular building, etc.  That helped counteract critics who argued that Kinsey's researchers were only interviewing "less inhibited" members of society and skewing the research results.    Kinsey also carefully described the sampling methods in his books and he also eliminated some of the controversial data that he obtained from prisoners. 

Whatever the scientific issues surrounding his sampling methods, it was his insistence that homosexual and bisexual behaviour were part of the normal range of human sexuality that likely provoked the greatest controversy.    With the publication of Sexual Behavior in the Human Male in 1948 and Sexual Behavior in the Human Female in 1953 (both books later became known as the Kinsey Reports), Alfred Kinsey became a public figure and the best-known sexologist of the 20th century.   

Not only were both books best-sellers but Alfred Kinsey and his Institute immediately faced a storm of controversy over the results of their research.   Not only was homosexuality far more prevalent than anyone previously admitted but many heterosexual men and women were shown to experiment with homosexuality as well.   The Kinsey Reports also provided considerable ammunition for early gay rights activists, many of whom used the research as part of their own campaign for full civil rights.    Depending on how the Kinsey statistics were used, the proportion of homosexuals in society could range from one in twenty to one in ten (though these statistics were far lower for women than men).   Still, the "one in ten" statistic became a staple of gay liberation campaigns for decades afterward. 

Along with his radical reinterpretation of homosexuality, Alfred Kinsey and his researchers also challenged many of the common myths surrounding sexuality up to that time, particularly female sexuality.    With nearly 25 percent of female respondents reporting having at least one orgasm before the age of fifteen and more than 64 percent before the age of marriage, the prevailing view of sexuality as  being something restricted to married couples suddenly seemed antiquated.   Especially since nearly half of the orgasms reported by men and women occurred outside of marriage.

Still, the sexual behaviour that Kinsey included in his research was hardly as varied as it could have been.   He specifically excluded sado-masochism, voyeurism, "swinging singles" and transsexuals, among others, possibly because he considered them to be statistically insignificant.   He also downplayed many of the consequences of greater sexuality such as pregnancy and sexually transmitted diseases. 

Whatever the limitations, the revelations provided by the Kinsey Reports were earth-shattering enough.   That rampant homosexuality and extramarital intercourse were happening despite the diligent efforts of a society that supposedly frowned on such things seemed like heresy.    For Alfred Kinsey to insist that the premarital abstinence urged by religious and moral authorities was actually unhealthy was essentially a declaration of war against the conservatives who opposed him. 

The Backlash Begins

Though Alfred Kinsey's findings were well accepted by the general public with both of his books being best-sellers, the conservative reaction to his research was even more vicious than he had anticipated.   Along with legitimate criticisms about his sampling and statistical methods, he was also vilified by religious and moral authorities condemning him as a serious threat to public decency.    

Considering the far-reaching implications of his research and his own tendency to provide editorials about the harm that conventional morality could have, it seems surprising that Alfred Kinsey was so upset by the criticism he received.    While his funding was never jeopardized by the criticism (the Committee continued to support Kinsey's research despite political pressure),  Kinsey was never comfortable over the new notoriety his research brought him.

He was also uncomfortable with the media interest that his first book generated.    By the time his book on female sexuality was ready to come out in 1953, more than 150 magazines and newspapers asked for advance copies.  Of these, Kinsey and his colleagues picked thirty to receive advance galleys on the understanding that nothing would be published before the release date of August 20.

If anything, the second book was met with even more outrage than the first book (women were seen as being held to a higher moral standard than men did).   Even some of Kinsey's earlier supporters, including Karl Menninger, abruptly switched sides and denounced the second book. 

At the same time that the book was released, other changes were happening as well.  Although the Rockefeller Foundation and the Committee had been supporting Kinsey and his researchers prior to the release of his second book, both organizations became new targets for Kinsey's opponents.   The Rockefeller Foundation had previously discouraged Kinsey from naming them as a financial supporter of his work but he insisted on mentioning them in his acknowledgements for the new book.  

Since the Rockefeller Foundation was a tax-exempt organization, this was enough for a cabal of Republican politicians to call for a formal Congressional investigation of the Foundation and its decision to fund Alfred Kinsey's research.   The House Committee to Investigate Tax-Exempt Foundations was chaired by Congressman B. Carroll Reece and carefully avoided any attempt at attacking the moral implications of Kinsey's research (which exceeded their formal mandate).  Instead, the Committee focused on the appropriateness of funding such research using a tax-exempt foundation.   

The outcome of the Committee was largely predetermined and the report that was eventually released did little more than repeat the original charges against Kinsey and the Rockefeller Foundation with little actual supporting evidence.   Two members of the committee opposing the report even went so far as to release a minority report saying that the  hearings were carefully staged and the witnesses who appeared had all been preselected by Congressman Reece to support his claims. 

In the end, the Committee hearings cost Alfred Kinsey his Rockefeller Foundation support.   Though he continued to receive funding through Indiana University and royalties from the two books,  his ambitious research project had to be whittled down to fit the reduced budget.  But the research continued despite the opposition.  

And Alfred Kinsey faced new challenges as well.   To expand his library and the range of his research materials, Kinsey collected materials from all over the world.  Or, at least he attempted to collect them.   Since anything that arrived overseas by mail needed to be inspected by the U.S. Postal Service, Kinsey learned firsthand how rigid postal inspectors could be.     In 1950, Indianapolis customs collector Alden H. Baker, seized some of the incoming materials which he declared to be "Damned dirty stuff" and refused to release them.  

While Kinsey protested the decision under a law that granted exemptions to scientists and medical researchers requesting potentially obscene materials for research purposes, the U.S. Postal Service supported  Baker's decision.   As far as they were concerned, the material was obscene and thus had no possible scientific value.    Ordinarily, the material would have been destroyed but Kinsey and his researchers took the U.S. government to court over the issue.   The case would drag on for years before finally being settled in Kinsey's favour.

Sadly, Alfred Kinsey never lived to see the outcome of this court decision.   Exhausted by years of fighting his opponents, his health declined but he managed to stay active with interviewing reserch subjects and media interviews.   He died on August 25, 1956 at the age of 62 of heart problems and medical complications related to pneumonia.  

The Kinsey Institute Today   

Despite Kinsey's death, his Institute remained active and Dr. Paul Gebhart, one of his main researchers, took over as executive director.   Though the Institute continued to carry out sex research as it did during Alfred Kinsey's lifetime,  his dream of the Institute becoming a world centre for research into human sexuality largely ended with his death.  Sex research gradually became more decentralized with sex researchers at other universities carrying out their own studies although the Institute of Sex Research continued to be based at Indiana University.

In 1981,  the Institute of Sex Research was renamed the Kinsey Institute at a conference marking the 25th anniversary of Alfred Kinsey's death.   The name was later expanded to the Kinsey Institute for Research in Sex, Gender, and Reproduction.  Along with regular publication of research titles, the Institute also maintains an online public access catalogue and, in 1991, established medical clinics for sexual health problems.

While the controversy over Alfred Kinsey's research methods failed to end with his death, later research has tended to confirm many of his original findings and also extended the range of research questions studied by the Institute.   That includes many of the same issues that Alfred Kinsey shied away from during his lifetime, including STD, birth control, and abortion.

Alfred Kinsey's death also failed to end his being targeted by conservative groups maintaining that he corrupted the morals of an entire generation.   One prominent conservative critic, Judith Reisman, who is considered the "founder of the modern anti-Kinsey movement" has openly accused Alfred Kinsey of being a fraud and a child abuser who used pedophiles to collect sexual information from children in his research.   Along with a broader campaign against homosexuality and pornography, Reisman also attempted to sue the Kinsey Institute in 1991 over claims that they censored her work and "inflicted emotional distress".  Though the case was dismissed, that hardly ended her anti-Kinsey campaign.

While there have been later sex researchers including Albert Ellis and the redoubtable team of William Masters and Virginia Johnson, no single researcher has ever matched Alfred Kinsey for the impact that he had on the free and open discussion of sexuality.   Although critics are likely overstating Alfred Kinsey's role in launching the sexual revolution, Kinsey's books, as well as the later reports released by his Institute have captured the public attention more than any other sexologist.  

Alfred Kinsey also gave sexology new respectability and fostered the growth in sex research around the world.   Unfortunately, this also led to the rise of "pop" sexologists whose books on sex show little of the scientific rigour that Alfred Kinsey advocated.    Their popularity means that these "experts" will not be fading away any time soon and the more reputable sexologists tend to be overlooked as  result.     Still, despite  being the target of anti-Kinsey campaigners such as Reisman, the past two decades have seen a resurgence of interest in Alfred Kinsey's controversial life.   Along with the publication of several new books,  the film Kinsey was released in 2004 and starred Liam Neeson in the title role. 

Despite active opposition by conservatives and moral pundits, sexology continues to ask the same questions that Alfred Kinsey posed so long ago.   That might be the legacy that he wanted most. 

One Suicide Every Second According to WHO Report

"Despite progress, one person still dies every 40 seconds from suicide.  Every death is a tragedy for family, friends and colleagues. Yet suicides are preventable. We call on all countries to incorporate proven suicide prevention strategies into national health and education programmes in a sustainable way.”  Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General

While noting progress in the five years since the publication of the first WHO global report on suicide,  only thirty-eight countries currently have a national suicide prevention strategy in place to prevent deaths.  Though suicide rates vary widely between countries, the global age-standardized suicide rate was 10.5 per 100,000 in 2016.   Suicide rates appear highest in high-income countries although seventy-nine percent of all suicides occur in middle- to low-income countries.   Men are also three times as likely to commit suicide as women in high-income countries even though the gender disparity is more equal in poorer countries.

Suicide remains the second leading cause of death among young people aged 15-29 years (road injury is the leading cause).   For girls in the 15-19 age range, only pregnancy-related medical conditions causes more deaths annually than suicide.  For boys in that age range, suicide is the third leading cause of death (after road injury and interpersonal violence).  Popular methods for committing suicide are hanging, pesticide self-poisoning, and using firearms and government programs have reported success in preventing death by restricting access to firearms and pesticides.

Given the toxicity of most pesticides used worldwide, they remain a popular choice due to their effectiveness and the lack of adequate medical services in many places.   This means that deliberate suicide attempts are often fatal whether or not self-poisoners intended to kill themselves.   In a report recently released by the WHO titled  Preventing suicide: a resource for pesticide registrars and regulators, numerous research studies have demonstrated prohibiting the use of highly hazardous pesticides can lead to reductions in national suicide rates.

In Sri Lank, for example, government bans on pesticides have led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015.   Paraquat remains a particularly popular choice for suicide in many parts of Asia and accounted for most suicide deaths in the Republic of Korea during the 2000s.   Since the Korean government imposed a ban on paraquat in 2011-2012, the rate of suicide deaths from pesticide poisoning has dropped by half between 2011 and 2013.

Even as progress is being made, tracking suicide rates remains a major problem in many countries.  Only 80 of the 183 WHO Member States provide reliable data concerning suicide rates, largely due to the lack of a strong medical infrastructure as well as the stigma that continues to surround suicide worldwide.  

Aided by international partners such as World Federation for Mental Health, the International Association for Suicide Prevention and United for Global Mental Health, the WHO launched the 40 Seconds of Action Campaign which culminated on October 10 which is World Mental Health Day.   By working together to help prevent suicide, the WHO and its supporters are hoping for a better future for everyone.

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The Fight To Help India's Mentally Ill

“I still recall the scene vividly,” says 61-year-old Mumbai psychiatrist Dr Bharat Vatwani. “My wife, Smitha – also a psychiatrist – and I, watched from across the street.”  What they witnessed was a young man  on a Mumbai street who had stopped to pick up a broken coconut shell.   As they watched in horror, the man then used the shell to scoop up water from the gutter and then drinking it.

Immediately afterward, the two doctors took the young man to the new clinic they had opened for medical care.   After determining that he was suffering from schizophrenia, they began treating him for free.   As the young man began to recover, he provided Vatwani and his wife with some details about his past life, clues that eventually allowed them to trace his family in Andhra Pradesh, almost a thousand kilometers away from Mumbai.

For Bharat and Smitha Vatwani, meeting this patient launched a three-decade crusade to help India's "wandering", people with mental illness who are roaming the country with no home of their own.  "We realised then, that there was no organisation in Mumbai, or for that matter in India, which rehabilitated wandering mentally ill people,”  Vatwani said in a recent media interview.  

According to one government survey, about 15 percent of India's 1.339-billion population suffer from some form of mental illness.  Due to the critical lack of mental health care and qualified mental health professionals, this means that as many as 180 million people are often left with no alternative but to wander across the cities and countryside in search of food and shelter.  “Over 80% of the government hospitals in India do not have a psychiatrist,"  Dr. Vatwani said.  "One of the main reasons being that many Indian psychiatrists prefer to move abroad, for better prospects. There are less than 4,000 practising psychiatrists in a nation of over a billion people!”   Also, considering the strong stigma against mental illness in India, even people with access to mental health services may be afraid to seek help.

To help reunited mental patients with their families, the Vatwanis established the Shraddha Rehabilitation Foundation in 1988  (the word "shraddha" means "devotion in Sanskrit).  Aimed at picking up mentally ill people living on the street (85 percent of whom are schizophrenic), workers at the Foundation then take them to the Vatwanis' residential treatment centre on the outskirts of Mumbai.  “Our medical treatment is coupled with kindness and empathy, which the patient rarely experienced on the streets,"  said Dr. Vatwani.  "Depending on the severity of the illness, the person will spend anywhere between two to three months at the centre.”

Once the patients are deemed fit to be released into the community,  Foundation workers then attempt to locate their families and to arrange for the patients to be returned there.   To help them make the adjustment, patients are accompanied to their family home by one of the Foundation social workers.   To date, the Shraddra Foundation has a 95 percent rate of reuniting patients with their families with more than 8,000 reunions.  “In seven out of 10 [reunions], the relatives are overjoyed at having their missing family member back. Occasionally, in the case of female patients, relatives are hesitant to accept them as they are concerned about what people around them will say. In such situations, the accompanying social worker will explain the importance of having the family’s support and involvement, for the patient’s recovery. We’ve mostly had successful [reunions],” says Vatwani.  Many of  these former patients have since become successfully reintegrated into the community.    

“Anyone can be afflicted by a mental illness and end up wandering the streets,” Vatwani says. “Depression, bipolar disorder, schizophrenia, addiction and other neuroses are so common nowadays. People suffering from these problems need as much love and support as those suffering from a physical illness.”

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Can Community Mental Health Initiatives Help India's Mental Health Crisis?

Despite being the second most populous country in the world and having an estimated 150 million people in need of mental health care, the lack of available treatment has left India in crisis.   According to a report by the World Health Organization,  there are only 0.3 psychiatrists, 0.07 psychologists and 0.07 social workers are available per 100,000 population across the entire country with most services being available only in the larger cities.   

Along with people dealing with major mental illness who are going untreated, India also leads the world in cases of child sex abuse and exploitation.  A 2013 study published in the Indian Journal of Psychiatry found that half of all Indian children have faced some form of sexual abuse and one in five have experienced severe forms of abuse, something that has long been ignored or overlooked due to the traditional practice of victim-shaming.  As a result, abused children carry the emotional and physical scars of their abuse long into adulthood and may also perpetuate that cycle of violence with other children.  

To combat the stigma of abuse, as well as providing much-needed mental health care, a coalition of mental health professionals, social workers, and aid organizations are forming community mental health initiatives to identify people willing to work in their own communities and reach out to victims isolated by fear or language differences.  One of these organizations, the Mukthat Foundation (muktha means liberation in English), was formed to provide mental health services as well as crusade for abuse prevention.   Founded by mental health professional Ashwini N.V, , the foundation has launched a series of initiatives to combat abuse and to help victims overcome the mental health issues that stem from that abuse.   

One of the most ambitious of these initiatives is Bhaya Muktha (liberation from fear)  which was launched earlier this year.   In a recent interview, Ashwini talked about the new programme :  "We ran the first phase of programme for three months beginning from January 1 to March 31 this year. Bhaya Muktha covered all 26 states and three union territories of India. We conducted eight programmes each in the capitals of the states and in union territories with different stakeholders including doctors, police, parents, teachers, children and healthcare professionals. We equipped participants to identify symptoms of sexual abuse in children and trained healthcare professionals to use different approaches to counsel the survivors."

But Muktha is not focusing on child sexual abuse alone.   workshops are also being launched to tackle domestic violence, interpersonal violence, dating violence,bullying and cybercrime.   Along with those public workshops, Muktha is also developing certificate programs on interpersonal violence at some of the regional colleges and universities.   Ashwini and her colleagues are also engaged in a research programme called Muktha Abhivyaktha (expressions of liberation) for developing new therapy options for trauma survivors, including using art, theatre, dance, and music to help victims tell their story.

While the Mental Health Care Act recently passed in India formally recognizes the legal right of India's people to receive mental health  care, much more needs to be done.   That includes expanding available services as well as raising public awareness concerning mental health issues and the stigma that still prevents many people from seeking help.    Organizations such as the Muktha Foundation are only the beginning.

 

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