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Is Bipolar Disorder Chronic?

Bipolar spectrum disorders have traditionally been thought to be chronic in course. However, recent epidemiological research suggests that there may be developmentally limited forms of bipolar disorder. An article published in the August 2009 issue of Journal of Abnormal Psychology presents the results of two large, nationally representative studies that challenge existing perceptions about the prevalence of bipolar disorder over time.   The results reveal a strikingly high prevalence of bipolar disorders in emerging adulthood (5.5%–6.2% among 18–24-year-olds) that appear to resolve substantially during the latter half of the 3rd decade of life (3.1%–3.4% among 25–29-year-olds). There is potential bias due to early mortality, institutionalization, incarceration, and homelessness that may account for some of this reduction, the prevalence distribution suggests a high incidence in late adolescence and emerging adulthood that appears to resolve spontaneously in most cases. There were very few differences across age groups in symptom endorsement and comorbid diagnoses, suggesting that 18–24-year-olds that meet criteria for bipolar diagnoses experience clinically significant impairment and associated consequences of the disorder. Better longitudinal research is needed to determine whether developmentally limited forms of bipolar disorder exist and, if so, what markers might distinguish these forms of the disorder from more chronic courses.

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Self-help Course Linked to Fatal Psychosis

In 2005, 34-year old Rebekah Lawrence signed up for a four-day course titled, "The Turning Point" that had been recommended for her by friends.  The course, promoted as a "journey to the core of the human spirit" was run by People Knowhow in the Sydney suburb of Cremorne.  Designed to help participants establish a dialogue between their adult and child selves, the course instructors trained the participants in childhood regression therapy.  Her husband, David Booth, reported that she came home from the course in a "dreamlike state-almost like someone on drugs" and that the usually gentle woman began to show alarming behavioural changes Despite her worsening psychological problems following the course, the instructors running the program, none of whom had professional training, were unable to help her.

On December 20, two days after the course ended, Rebekah Lawrence arrived late for work at her job as assistant for the CEO of the Royal Australasian College of Physicians in Sydney, Australia.  A coworker later described her as "quite unstable in a manner in which I had never seen before".  After stripping naked, she then screamed and acted "like a child having a tantrum".  She began screaming, "I love you David", climbed out a second-story window and then jumped. There was no history of mental illness and no trace of drugs or alcohol was found in her system.

At a recent inquest into Rebekah Lawrence's death, Deputy State Coroner Malcolm MacPherson ruled that her psychotic state and subsequent suicide could be linked to the self-help course and called for greater regulation and training to oversee the content of counseling or psychotherapy-oriented courses  He called for the health minister to enact legislation to set up a system of registration, either at the national or state level.  During the course of the hearing, the director of the Turning Point program conceded that the program had "inadequate" safeguards both in screening participants or in following up with them afterward.  Although the course provider's lawyers suggested that preexisting mental problems may have been to blame for Ms. Lawrence's death, there was little evidence to support the claim.  Mr. McPherson concluded that childhood regression therapy was "intrinsically unsafe" and played a clear role in the death.

Members of Rebekah Lawrence's family, including her husband David Booth, expressed satisfaction with the inquest's findings and urged that proper legislation be enacted to prevent future tragedies.  David Booth has not ruled out litigation against People Knowhow and the Turning Point program.

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Singing The Body Electric (Part 2)

Continued from Part 1

The dean of 18th century electrotherapy was undoubtedly Dr. James Graham.  Also known as an early pioneer of sexology, he received medical training in Edinburgh but left before completing his degree.  After studying electricity in Philadelphia, he left America before the American Revolution to return to England.  A determined self-promoter, Graham advertised his electrotherapy services to cure a vast range of diseases and quickly attracted numerous celebrity patients.  While conventional physicians dismissed him as a quack, Graham opened a clinic in one of the most exclusive London neighbourhoods which he dubbed the "Temple of Health".  Patients to Graham's clinic were often awed by the elaborate electrical equipment on display, not to mention the various "trophies" of former patients.  This included the various walking-sticks, crutches, spectacles and ear-trumpets prominently displayed on clinic walls.  Graham proudly claimed that grateful patients had left them behind after he cured them of their ailments.

Graham's electrical devices included an enormous Leyden jar (for display only) and a vast prime conductor nearly three meters high.  Not only was there a large throne where as many eight patients could sit at a time for their treatment sessions but also a metal shelf for the various medicines that Graham "electrified".  He made these potions in his own laboratory and testified to the purity of the ingredients that he used.  Once electrified, the medicines were used to "enter patients and work medical miracles".  There were other prime conductors throughout the clinic as well as discreet alcoves where Graham and his assistants could meet with patients privately.  James Graham also maintained a free clinic where poor patients could be treated (usually in full view of more well-to-do visitors and prospective patients).  Graham was definitely a showman.

The most well known feature of Graham's clinic was his "Great Apollo Apartment".  A large domed chamber, stunningly decorated, the dominant themes were fertility and bliss. Patients sat on magnetic seats with their bare feet resting on sulfur while music played in the background.  Graham himself said of the Apartment that, "words can convey no adequate idea of the astonishment and awful sublimity which seizes the mind of every spectator".  The truly multi-sensory experience that patients received guaranteed return visits and Graham declared that, "there is no fever, rheumatism, cramp, spasm, or convulsion” that would not yield to this treatment, often in less than a minute".   For infertile couples who could afford his fee, he also offered a "Celestial Bed" which was, basically, a canopied bed where couples could “bask in a genial, invigorating tide of the celestial fire, ” where, he insisted, they could not fail to produce “strong, healthful, and most beautiful offspring".

As you may have gathered, the conventional medical establishment wasn't happy with James Graham and the feeling was mutual.  He often condemned conventional medicine and maintained that most treatments advocated by physicians were "fundamentally and in their nature wrong".  He accused these doctors as being corrupt as well as incompetent.  Considering the often brutal treatment methods that 18th century physicians were capable of inflicting on patients, Graham's criticisms won him even more praise, except for the fact that his own treatments didn't really work (suggestion can only get you so far).  By the time of his death in 1797, James Graham was largely discredited and deeply in debt.  Even the electrical apparatus at his beloved Temple of Health had long since been sold off.

While traditional physicians may have breathed a sigh of relief at Graham's passing, electrotherapists were still practicing their trade (if not as flamboyantly as Graham).  In addition to pain treatment, they offered relief for a variety of "women's problems" including hysteria, depression, menstruation problems and, possibly, even induced abortions (for obvious reasons, this particular service was never advertised).  It wasn't all quackery though since the value of electrotherapy in resuscitating some heart attack and drowning victims made it a standard tool for medicine (the actual work of resuscitation was usually left to "medical assistants"-possibly the earliest version of paramedics).   Specialized electrical devices were developed for use in cases of "suspended animation" which eventually evolved into our modern heart defibrillators - with considerable trial and error along the way. 

Despite the growing legitimacy of electrotherapy, the quacks still practiced their trade  (just not as flamboyantly as James Graham).  As electrical technology improved, electrical devices became more portable and affordable.  While devices such as my Davis & Kidder machine were usually harmless, they were often marketed in ways that were anything but harmless.  One famous 19th century vendor of patented electrical devices was "Professor" Isaac Lewis Pulvermacher who sold products under the slogan, "Electricity is Life".  Pulvermacher's most memorable invention  was the "Electro-Galvanic Chain" - basically adjustable belts which supplied "mild, continuous currents" for eight to twelve hours a day while the patient wore them.  When not in use, the belts were immersed in a weak vinegar solution to generate a current.  At a cost of twenty dollars U.S. apiece, the belts were hardly cheap but still more affordable than most medicines at the time.  Better yet, Pulvermacher's products were sold as "self-applicable for the cure of chronic disease without medicine".  Pulvermacher's methods spawned numerous imitators and his ads sternly warned customers to  "accept no substitutes".

Which brings us to the dawn of the 20th century...

Searching versus Surfing: Is there a difference?

People have different ways of finding information online. Whether searching for specific information or simply coming across new facts while surfing at leisure, the end result should be the same in terms of how that new information is perceived. Or is it? A recent study published in a 2009 issue of Journal of Media Psychology describes a mixed-design experiment exploring differences between searching and surfing on cognitive and emotional responses to online news. In a sample ofninety-two participants recruited from an undergraduate marketing class, the participants were asked to read three unpleasant news stories from a website. Half of the participants acquired their stories by searching, meaning they had a previous information need in mind. The other half of the participants acquired their stories by surfing, with no previous information need in mind. Heart rate, skin conductance, and EMG measures were while participants read each story. Self-report measures of article relevance and accuracy in a later recognition trial were also measured. Stories acquired by searching elicited greater heart rate acceleration, skin conductance level, and EMG activity during reading. These stories were rated as more unpleasant, and their details were recognized more accurately than similar stories that were acquired by surfing. The authors conclude the paper by discussing the implications of these results for understanding how people process new information online.

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Mental Illness Linked to Shocking Family Murder

It was a shocking crime that was never supposed to happen in peaceful Merritt, British Columbia.  On April 8, 2008, Darcie Clarke found her three children dead in their family trailer.  Her daughter Kaitlynne, 10, had been stabbed to death while her 8-year old brother Max and 5-year old brother Cordon had been smothered.  After the murders, the children's father, 40-year old Allen Shoenborn, fled into the local woods and evaded capture until April 16.  He was later charged with three counts of first-degree murder while police were left baffled over his motive for killing his children. 

The police investigation and repeated forensic assessment have slowly unraveled a complex story of mental illness and domestic violence.  When questioned over his reasons for killing his children, Allen Shoenborn has maintained that his children were being sexually abused and was forced to kill them for their own protection.  Based on evidence presented by forensic psychiatrists, Shoenborn`s defense attorney maintains that his client is suffering from a delusional disorder that contributed to the killings.  The Crown is arguing that the killings occurred in a jealous rage due to fears that Darcie Clarke would leave and take their children with her.  Due to his long history of paranoid delusions and hallucinations going back years, social workers expressed concern at Shoenborn's escalating pattern of threatening behaviour toward his children.  They warned Darcie Clarke three days before the killings that they would intervene if she failed to take steps to protect them from their father. 

While Shoenborn is being held for trial at Kamloops Regional Correctional Centre, the nature of his charges require his placement in solitary confinement for his own protection. He told examining psychiatrists that he still speaks to his children wishing them a good morning when he wakes up and a good evening when he goes to sleep.  He also maintained that it was his duty to kill his children when they were threatened,  Due to his bizarre outbursts during the trial to date, he is kept in a Plexiglas-enclosed prisoner box while in the courtroom.  While he has pled not guilty, his attorney is attempting to have him declared not criminally responsible.

The trial is continuing.

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Singing The Body Electric (Part 1)

While I'm usually a sober type, I have to confess to one insidious addiction: online auctions. Not that I actually buy things that often, but I'm always scouring various auction catalogs for unusual items that I might want to bid on (or not). As it happened, a recent auction featured an item that I knew I had to have and, after some time, I found myself in possession of a vintage Davis & Kidder Patent Magneto-Electric Machine for Nervous Diseases. The machine is designed to administer electric shocks through two hand-held electrodes with the current being generated by a manual crank on the outside. While it doesn't generate an actual current that I've been able to find, it's in excellent shape otherwise. The 1854 patent (and signature) by patent holder W.H. Burnap are still clearly legible, as are the testimonials by Benjamin Silliman, Sr. of Yale University and physicist, Charles Grafton Page attesting to the scientific and medical value of the machine. There's also the usual boilerplate warning promising to prosecute any infringements of the patent.

Even better, I quickly found an authentic instruction manual for this classic example of early quackery on-line. Published in four languages, the manual explains the proper care and usage of the machine as well as more testimonials to its effectiveness. The long list of diseases "in which Magneto-Electricity may be applied with Beneficial Results or Certainty of Cure" include: asphyxia, apoplexy (stroke), asthma, angina, the medical problems resulting from abortion, impotence, constipation, heart and liver disease, "critical periods or turn of life in females", consumption, diabetes, "genital debility", delirium tremens, and too many other diseases to list here.

Electricity had been little more than a curiosity prior to the 18th century but enthusiastic researchers including Benjamin Franklin, Otto von Guericke, and Stephen Grey had published radical new findings that opened up exciting new possibilities for its use in medicine and biology.  During the "first age of electricity" from 1740 to 1800 as basic research led to a better scientific understanding of the principles underlying electrical phenomena and, through the invention of the Leyden Jar and lightning rods, public acceptance of electricity grew as well.  Adventurous people even took part in "phosphene parties" involving groups of people joining hands in a circle and touching a high-voltage generator.  As one contemporary account put it, "Somehow, the completion or breaking of this people-circuit created an electrical stimulus to their brains that unleashed colorful light shows". Even Benjamin Franklin took part.

Given that electrical devices were seen as "cutting edge" technology, was it any wonder that the notion of electricity having medical benefits became popular as well?  One early physician, Christian Gottlieb Kratzenstein pioneered medical uses of electricity in the 18th century and published research demonstrating the effect of electricity on blood circulation and muscle contraction (he also may have been the inspiration for the title character in Mary Shelley's Frankenstein). As an alternative to the bloodletting, enemas and mercury compounds that were commonly prescribed by doctors of the time, the use of electrical shock to treat disease was eagerly pursued by alternative medical practitioners (who often weren't medical doctors at all). By the beginning of the 19th century, there was a dedicated community of "electrotherapists" dedicated to exploring electricity in treating disease.  They came from all walks of life including physicians, surgeons, apothecaries, ministers, gentleman farmers, etc. While some were legitimate scientists who engaged in actual research, others were obvious quacks.As early reports of "miracle cures" became widespread, patients eagerly sought out these electrotherapists hoping for better treatment than what was available from the conventional physicians of that time. Even actual researchers were besieged with requests from desperate patients who wanted to try out their electric generators (Benjamin Franklin treated several paralytics at his Philadelphia home).

In addition to paralysis, electrotherapists offered treatment for a range of other diseases including rheumatism, epilepsy, hysteria, pain, deafness, and blindness. While actual empirical evidence was lacking, testimonials from grateful patients were enough to attract more business. Electrotherapists across Europe and North America developed standardized treatment procedures for dealing with different diseases such as the use of "electric baths" to treatment hysteria and "melancholy" (depression).  These electric baths typically involved having a patient hold a metal wire connected to the generator while the patient sat on an insulating stool. The treatments often lasted for hours and left the patients sweating. Since there was little actual current flowing,any benefit was purely psychosomatic. Still, the use of electric baths and other forms of "electric furniture" was extremely popular among well-to-do patients who could afford the treatments (and yes, electrotherapists made house calls). Some manufactures even sold electric machines for home use so patients could self-medicate as needed (those patients who couldn't afford to buy the machines outright could rent them by the week- a hefty deposit was required).

While never as famous as Franz Anton Mesmer and his "animal magnetism" movement, electrotherapy quickly developed its own high priests as well. We'll get to one of them in the next post.

Continue to Part 2.

Sexual Harassment Among Male and Female Police Officers

An article published in the October 2009 issue of the Journal of Occupational Health Psychology examines the impact of sexual harassment on mental and physical health of both men and women, and to explore the possible moderating effects of gender on the relation between sexual harassment and health. Often defined as "“unwanted sex-related behavior at work that is appraised by the recipient as offensive, exceeding her resources or threatening well-being”, sexual harassment occurs frequently in many organizations. This is especially true in police forces where research has shown that 77% of policewomen from 35 countries have reported harassment from colleagues. Not only does sexual harassment impact psychological well-being, but it has been linked to health problems relating to emotional distress. The present study used a representative sample of 3,001 policemen and 1,295 policewomen in the Dutch police force who were asked to fill out an Internet questionnaire. Based on research results, it appeared that women were more often bothered by sexual harassment than men, but gender did not moderate the relation between sexual harassment and mental and physical health. In addition, victims who felt bothered by the harassing behaviors reported more mental and physical health problems than victims who did not feel bothered. The distinction between bothered and nonbothered victims is important because appraisal is an essential aspect in evaluating the impact of sexual harassment on victims.  The authors conclude that sexual harassment policies need to address male and female victims and also addresses the need to take sexual harassment seriously, even when the victims don't seem bothered by it.

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AA Gunman Found Not Criminally Responsible

On March 24 of this year, Anthony John Allen walked into the Weedon Pioneer Community Hall in Cochrane, Alberta where the Alcoholics Anonymous meeting that he usually attended was being held.  According to witnesses, the 49-year old Allen then  pulled out a sawed-off shotgun and handgun and told the other members in the room that he was, "the new sheriff in town and God had told him to come to the meeting with guns".   They added that Allen told them that his gun was fully loaded and he was willing to use it.  He also pulled out a bottle of vodka and a box of shells which fell to the floor.  Another member, a former newspaperman, defused the situation and persuaded Allen to surrender without incident.

At a Calgary hearing in which the results of a forensic assessment was presented, Provincial Court Judge Judith Shriar ruled on November 23 that Allen was not legally responsible for his actions.  In handing down her decision, Judge Shrier accepted the testimony of psychiatrist Kenneth Hashman who argued that the defendant had experienced a psychotic breakdown which led to his actions.  Under Alberta legislation, Allen must appear before a Provincial review board at Alberta Hospital within 45 days for the resolution of his case.  While free on bail, a house arrest provision has been included to safeguard his behaviour.

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The Colorado Cannibal

Legend has it that when Judge Melville B. Gerry handed down a death sentence on Alferd Packer, he used these words, "There was seven Democrats in Hinsdale Country but you, you voracious man-eatin' son of a bitch, you ate five of them. I sentence you to be hanged ... as a warning against reducing the Democratic population of this state". According to the actual trial records, Judge Gerry was more succinct (and apolitical) in his death sentence, stressing that Packer would be "hung by the neck until you are dead, dead, dead!".

If Judge Gerry was upset with Alf Packer, he was hardly the only one. As the sole survivor of a six-man prospecting expedition that had become snow-bound in the Colorado Rockies in 1874, Packer's story was that one of the other prospectors, Shannon Bell, had gone mad and killed the others before Packer killed him in self-defense. The fact that Packer admitted to cannibalism, had changed his story several times, and had money belonging to the other prospectors with him when he was arrested counted against him, though. While in custody awaiting a hearing, Packer escaped from jail (nobody ever found out how) and spent nearly nine years on the run before being rearrested. In the meantime, the bodies of the other prospectors had been found with evidence that they had been bludgeoned to death.

On March 14, 1883, Alf Packer was arrested at Wagonhound Creek where he had been living under the name of John Schwartze. Since cannibalism isn't actually a crime in most states (only Idaho has an actual law against it on the books), Packer/Schwartze went on trial for murder. Despite his own account of killing Bell in self-defense, neither the jury or Judge Gerry found his version of events credible and Packer received a death sentence. Given the amount of public hatred directed against him, authorities arranged for him to be transferred to another jail to avoid possible lynch mobs and the execution was stayed.

It's hard to understand why Packer was so hated since accounts of cannibalism weren't all that rare. Given the brutal winters found in that part of the country and the tendency of isolated groups to be snowbound for months, desperate measures were often needed to avoid starvation (much like the famous Donner party of the 1840s). Local and national newspapers certainly played a role in shaping the way that the public viewed Packer (one described him as a "Human Ghoul who Murdered and Grew Corpulent on the Flesh of his Comrades").

While Packer was awaiting execution, the legal wrangling dragged out for years. One lawyer pointed out that Colorado was still at territory when the crime occurred and argued that the murders were not illegal at the time under territorial law. The Colorado Supreme Court overturned the murder conviction although Packer was later tried and convicted of five counts of manslaughter. He was sentenced for forty years in the state penitentiary at Canon City.

Not that the story ended there. A model inmate in prison, Alf Packer (aka "Prisoner 1389") became the focus of numerous legal appeals and applications for pardons by a string of attorneys. The "Free Packer" movement gained its greatest champion in Polly Pry, a columnist for the Denver Post, who wrote numerous columns on Packer's "unjust" imprisonment. Pry's crusade was directed at Colorado governor, Charles S. Thomas who finally gave in and ordered Packer to be paroled as his last official act before leaving office on January 1, 1901.

After his release, Alf Packer worked as a security guard at the offices of the Denver Post. Growing tired of city life and suffering from Bright's Disease (he had been diagnosed in prison), he moved back to Colorado and spent the last years of his life as a mine caretaker. Despite his notoriety, Packer was a favourite with the local children and he often regaled them with stories about the Old West (they just considered him to be a "nice old man"). His liver problems worsened and a state game warden found him unconscious near his home in 1906. He spent the last few months of his life as an invalid although he wrote a letter to the governor pleading for a full pardon (it wasn't granted). Alf Packer died on April 24, 1907. According to one local news story, his last words were, "I am not guilty of the charge". The cause of death was believed to be a stroke although his death certificate listed his condition as "senility - trouble & worry". He is buried in the Prince Avenue cemetery in Littleton, Colorado at government expense (he was a veteran) and his gravesite has attracted thousands of visitors over the years.

The actual debate over Packer's guilt dragged on for decades after his death (requests for a pardon were repeatedly denied).In 1989, the case became news again when a team of forensic scientists, led by James Starr of George Washington University, unearthed the bodies of Packer's fellow prospectors (the place where they had been buried is still known as Cannibalism Plateau in Colorado). After a forensic analysis of the bodies, Starr concluded that Packer had lied about killing Bell in self-defense and that Alf Packer was "as guilty as sin and all his sins were mortal ones".

Later forensic disputed Starr's conclusions and one determined curator, David Bailey, launched his own project to prove Packer's innocence based on a rusted Colt revolver believed to have been used by Packer to kill Shannon Bell in self-defense. In an amazing feat of forensic science, the fragments of a lead bullet found at the death scene were matched to Packer's revolver. Although the research is ongoing, the question of Alf Packer's guilt seems unlikely to be resolved.

In the meantime, Alf Packer has found his way into American folklore. Not only is he an unofficial mascot of the University of Colorado (the student cafeteria was named after him) but his bust is still on display in the Colorado state capital building. He's been the subject of several movies and musicals as well as a semi-humourous Alferd Packer Society (their motto is "serving our fellow man since 1874"). Lake City, Colorado still has an annual celebration of the Packer story and the local tourism based on Packer's cannibalism tends to be popular (not to mention macabre).

The Alf Packer legend lives on.

When Families Are Homeless

The July 2009 issue of American Journal of Orthopsychiatry presents a special issue on the complex issue of parenting and homelessness.  Families are the fastest-growing segment of the homeless population and now make up more than one-third of the overall number of homeless people.  The epidemic of family homelessness has been linked to the current economic crisis, skyrocketing foreclosure rates, and failure of social service agencies to accommodate family needs.  There is a tendency to define homeless families only in terms of family members who present at shelters and other service programs with their children,  often only a single parent—most often a mother—with one or more children, 42% of whom are less than six years old.   Many of the homeless men and women who enter shelters as individuals are also parents who, for various reasons, are not currently in possession of their children.  Family composition may also change over time, as the structures of homeless family units are fluid due to the high rates of separations of family members who are homeless.   Social agencies dealing with the homeless often ignore the broader context of the nontraditional family system and support networks that homeless people need (including providing basic necessities for their children).  Homeless parents frequently face stigma and discrimination because of their homelessness status. Mothers who are homeless describe feeling that their parenting practices are being monitored closely; if not viewed as adequate, they risk losing their children to foster care.  The authors recommend continuing research into homeless families including: identifying the range of interrelationships of family and social support networks among individuals and families who are homeless,  identifying young women who are at risk for homelessness and pregnancy, and Identifying which families will succeed in independent living and which families require long-term supportive housing interventions.

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