In his classic examination of the 1929 Wall Street crash John Galbraith disabuses us of a widely held notion:

In the week or so following Black Thursday, the London penny press told delightedly of the scenes in downtown New York. Speculators were hurling themselves from windows; pedestrians picked their ways delicately between the bodies of fallen financiers.

In the United States the suicide wave that followed the stock market crash is part of the legend of 1929. In fact there was none. For several years before 1929 the suicide rate had been gradually rising. It continued to increase in that year, with a further and much sharper increase in 1930, 1931 and 1932 – years when there were many things besides the stock market to cause people to conclude that life was no longer worth living (chapter 8).

Galbraith goes on to say that in the two months following the crash the number of suicides in New York were actually comparatively low. There were in fact only two suicides on Wall Street, but these were undoubtedly dramatic. On Nov. 5, Hulda Borowski, a clerk who had been working at a Wall Street stock brokerage house for 28 years, leapt off a 40-story building; on November 16, three days after the market had taken another dive, G.E. Cutler, the head of a produce firm, climbed onto the ledge of his lawyer’s office and similarly plunged to this death.

Thankfully you can’t open the windows on tall buildings these days.

On the day Lehman Brothers was wound up I took a bus through the city and looked up once or twice from my book to see if there was anyone standing on any ledges. To my relief there was no one to be seen. Although vast sums of money have been lost, the crisis we are currently experiencing is nothing like as severe as the 1929 crash. Furthermore, thinking more broadly, predicting suicide is difficult; especially at the primary care level as depressive symptoms are common, but suicide rare. In 1998 Jenkins contended that in the UK every week 10% of 16-65 year olds report suicide depressive symptoms and 1% admits suicidal ideation, but set against this, only 0.01% will kill themselves. Previous attempts and self harm are risk factors for subsequent successful attempts; around a quarter of suicides are preceded by non-fatal self harm in the previous year (Owens and House 1994) and suicide incidence in those who have committed recent non fatal self harm is 1 in 100 over the next year, rising to 1 in 15 during 9 or more years.

The BBC has an interview with the grandson of a man who killed himself during the crash

There is one report of a banker taking his life.

Wall Street Suicides Slate

Time Magazine 80 days that changed the world - 1929

In a new report - ‘OECD (2008), Growing Unequal? : Income Distribution and Poverty in OECD Countries’ - by the Organisation for Economic Co-operation and Development, the UK has been found to have income inequality and poverty which is falling faster than any other OECD country.

Why is this interesting? Some people have plotted the prevalence of emotional distress present in the populations of different nations* against the income inequalities also present and found there to be a positive correlation between the two. The USA, which is a nation that has built its prosperity upon a high tolerance for inequality, is top of the pile, with both the greatest income inequality (ratio of top 20% vs bottom 20% of incomes) and highest presence of emotional distress; a more socially democratic nation like Germany has much lower levels of both inequality and emotional distress. So, if the UK is becoming less unequal, will we see an improvement in our levels of emotional distress the next time they are measured?

Alas it’s unlikely to be that simple. The causes for emotional distress are multi-factorial; two other possibilities for a nations’ distress are a lack of social mobility and highly invasive, dissatisfaction creating, advertising cultures. Indeed this latter influence has a name: ‘The Hello! magazine effect’, whereby despite being increasingly better off, people compare themselves with celebrities and celebrities wealthy chums and feel relatively impoverished as a result.

***

Talking of celebrities and their chums, reality Queen Kerry Katona was on This Morning this morning and caused a stir ‘looking distracted and at times confused, slurring her words and almost unable to string a cogent sentence together ‘. You can watch her here and here. She said that she was taking Chlorpromazine and this was the reason for her slurred speech. I can’t be bothered to write a full post about this, but she actually didn’t seem too bad to me. Perhaps I’ve spent too much time hanging out with crack addicts in Hackney.

What did anyone else think?

* The measurement of this sort of thing is open to some debate of course.

Links for OCED

Guardian article Wealth gap narrows faster in UK than other developing countries 21 October 2008

OECD report Growing Unequal? : Income Distribution and Poverty in OECD Countries

This is Oliver James’ hobby horse

Hello Magazine effect discussed on Today 0709 and 0816

Stop Press:
Discussion (and speculation) about Olympic doping including 100m/200m results
Science of Sport
Steroid Nation

I was listening on the radio just now about UK medal hopes at the Beijing Olympics. It seems we’re doing quite well. Unfortunately I have an anti-talent at sports; at primary school I would only be picked second last if my brother beat me to the wooden spoon. Many years later I lived with a girl and she would watch football on our ancient TV, whilst I sat in my room with the door shut reading ‘The Road to Wigan Pier’.

What’s more my bag is the speculation about the scale of abuse of performance enhancing drugs and their psychiatric sequelae. There are a number of substances used by athletes in order to improve performance. and of these the most common are anabolic steroids.

In the UK anabolic steroids are class C drugs and can be sold only by pharmacists with a doctor’s prescription (most often for hypogonadism). It’s legal to possess or import steroids as long as they’re for personal use, but possession or importing with intent to supply is illegal and could lead to 14 years in prison and an unlimited fine. A UK government source states that in 2003 300,000 steroid tablets were seized.

Use of anabolic steroids in the UK is suspected to be widespread and is not just the preserve of elite athletes; in a survey of 687 students at a British college the overall rate of current or previous use was 2.8% (4.4% in males, 1.0% in females) and, of these, 56% had first used anabolic steroids at the age of 15 or younger. A BMA report in 2002 found that as many as half of the members of dedicated bodybuilding gyms admitted to taking anabolic agents, and that steroid use ran as high as 13% even in some high street fitness centres.

Anabolic steroids are synthetic derivates of the hormone testosterone and allow the user to increase both the frequency and intensity of workouts, in addition to increasing muscle capacity, reducing body fat, increasing strength and endurance, and hastening recovery from injury. Users have varied aims. The majority may wish to enhance their physical appearance in order to achieve a ‘perfect body’, whilst a smaller proportion have experienced physical or sexual abuse, and are trying to increase their muscle size to protect themselves. A further group (possibly between 5 and 10%) includes people who have a form of body dysmorphic disorder (sometimes called ‘reverse anorexia nervosa’), in which they believe that they look small and weak, even if they are large and muscular (Brower et al, 1991).

The steroids are taken orally, or by intramuscular injection and according to a number of regimes – ‘stacking’, ‘cycling’ and ‘pyramiding’.

Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of nonuse. Other work has suggested that adolescents who abuse anabolic steroids have nearly triple the incidence of violent behaviour. Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. Symptoms usually resolve in a few weeks if steroid use is discontinued, although may persist for as long as a month even if adequately treated with antipsychotics.

Steroid users have been shown to have a higher prevalence of cluster B (histrionic, narcissistic, antisocial and borderline) personality traits than community controls . Self report questionnaires and informant histories have been used to retrospectively assess the personality type of anabolic steroid misusers before their first use. Such work suggests that they start out with personalities similar to those of non-using bodybuilders, but develop abnormal personality traits that could be attributed to steroid misuse.

A study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSM–III–R criteria. They identified 5 participants (12.2%) who met the criteria for a manic episode during steroid exposure; a further 8 (19.5%) only narrowly missed the diagnosis. Significantly more participants developed a full affective syndrome during periods of steroid exposure (22%) than non-exposure (5%), and 10 were ‘stacking’ when they experienced manic symptoms.
Symptoms of steroid withdrawal include mood disorders (with suicidal depression as the most life threatening complication), apathy, feelings of anxiety, difficulty in concentrating, insomnia, anorexia, decreased libido, fatigue, headache, and muscle and joint pain. It is difficult to distinguish symptoms that may be physical in origin from those more psychological. Observing oneself to lose muscle mass, strength, performance and confidence after cessation of steroid use has a powerful negative effect on mood, and this may lead to a strong desire to take steroids again.

So, you’re all asking yourself, what’s FP’s advice? Listen to Noam Chomsky:

‘Take, say, sports — that’s another crucial example of the indoctrination system, in my view. For one thing because it … offers people something to pay attention to that’s of no importance; that keeps them from worrying about things that matter to their lives that they might have some idea of doing something about. And in fact it’s striking to see the intelligence that’s used by ordinary people in [discussions of] sports [as opposed to political and social issues

***

Sources for this posting:

General

I have leant very heavily on Anabolic androgenic steroids: what the psychiatrist needs to know

This BBC Ethics page has a concise summary of the arguments for and against use of performance enhancing drugs in sport

The talk to Frank site anabolic steroids page

News reports:

Steroids a dangerous new trend BBC February 2 2004

BBC 8 June 2006 Body builder misuse alarm

BBC 11 April 2002 Steroid misuse widespread

Radio programmes (I can’t get these to work, but perhaps you can…)

BBC Radio 4 Diet and Drugs 24 April 2002

BBC Radio 4 The Long View 14 October 2003

Woman’s hour East German doping 7 November 2005

Background
What’s it like Man?
Drawbacks
Khat and the Psychiatrist
Socio-economics
What to do?
In the UK
Khat and The Frontier Psychiatrist
Links

Yemen has been in the news recently, due to its deteriorating security situation. I’ve long had a fascination with the Middle East, and this country is known not just for its fantastic architecture, but also for its people’s fondness for chewing khat.

Background

Khat (Catha edulis) is a slow growing evergreen shrub that grows wild in countries bordering the Red Sea and along the East coast of Africa. Its appeal is that chewing its fresh leaves and tops leads the user toward a state of amphetamine-like euphoria and stimulation. There are several names for the plant, depending on its origin: chat, qat, qaad, jaad, miraa, mairungi, cat and catha. In most of the Western literature, and this posting, it is referred to as khat.

The habit of khat chewing probably predates the use of coffee, but it has become increasingly popular of late and it is estimated that three quarters of Yemeni adults chew the leaves each afternoon, with a similar social role to that of tea, cigarettes or alcohol. Khat chewing commands a dominant place in social functions and its use so widespread that withdrawal from khat can result in social isolation.

What’s it like Man?

Yemeni homes are constructed specially to provide a warm reception room for khat chewing. For the urban chewer, khat sessions usually begin soon after lunch with men and women meeting separately; the habit is mostly practiced by males.
Drs Wijdan Luqman and T. S. Danowski describe the drug’s effects:

The chewing session starts with slightly euphoric behaviour and a friendly sense of humour. The leaves are plucked off the twigs, chewed, and stored against one or the other cheek. The mixture of saliva and extract from the leaves is swallowed. As new leaves are taken, the cheek bulges out. The euphoric effects appear shortly after the chewing begins ….. The session and the friendly atmosphere last about 2 h. These are followed by a mood of zeal that lasts another 2 h, and during this interval current subjects and problems are discussed. This in turn is supplanted by a serious mood and may be accompanied by irritability.

They also note:

The act of communal chewing promotes interpersonal interactions. For example, as passengers on public transport we observed spontaneous eruptions of group conversations among previously-mute Yemenis once khat chews began.

Writing in the guardian in 2001 Brian Whitaker is a bit more poetic

As you approach cruising altitude, the brain slips into overdrive and you discover that you’re one of the most intelligent and articulate people in the world. Thoughts have never been so clear, nor have ideas flowed so freely. No matter how difficult the problem, by the end of the session you will have either dreamed up a solution or decided that it’s not worth bothering about.

And writing in his book ‘Eating the flowers of paradise’ (buy Amazon Waterstones), Kevin Rushby makes the experience sound positively transcendental:

I passed the hours listening to the gentle lubalub of the hookah and whispered conversations about dead poets and fine deeds. In Sana’a, khat governs. Each day at three, climbing the steps to a smoky room with a bundle under the arm; then closing the door to the outside world, choosing the leaves, gently crushing them with the teeth and waiting for the drug to take effect. No rush, just a silky transition, scarcely noticed, and then the room casts loose its moorings.

In rural areas the chewing of khat starts soon after breakfast, and continues throughout the day, with the children also participating. The stimulant effect is said to lighten the daily tasks. In these poorer regions food may be lacking and the khat decreases the need for meals; on the other hand such is the appeal of the plant that people will sometimes forgo buying food for khat.

Drawbacks

Yemem’s people can spend about one-quarter to one-third of their cash income on the plant. This report has a teacher spending 44% of his salary on khat. As discussed in the Yemen Times the cultivation of khat is extremely widespread, and there is concern due to 80% of Yemen’s water being used for khat growing. One reason for khat’s popularity with farmers is the high income it provides, which can be five times that of that from growing coffee or fruit. A wikipedia source states that increasing demand has lead to the area on which khat is cultivated growing from 8,000 hectares to 103,000 hectares from 1970 to 2000.

Chronic khat chewing can cause hypertension in young adults, with a spontaneous regression once consumption ceases. Khat’s tannins may lead to gastritis, stomatitis, oesophagitis, and peridontal disease. The tannic acids produced are also thought to be hepatotoxic. There are also concerns about the pesticides used in khat cultivation.

Khat and the Psychiatrist

There is debate as to whether khat is able to produce dependence with some researchers saying that the dependence effects are psychological. There is also debate as to whether a withdrawal syndrome exists. Physical withdrawal symptoms have been documented and may consist of lethargy, mild depression, slight trembling and recurrent bad dreams. Discontinuation results in improvement of sleep and appetite, and fewer constipation problems.

According to the WHO expert committee on drug dependence khat chewing can induce two kinds of psychotic reactions. First, a manic illness with grandiose delusions and second, a schizophreniform psychosis with persecutory delusions associated with mainly auditory hallucinations, fear and anxiety, resembling amphetamine psychosis.

Psychotic reactions to chewing khat are rare, probably due to the physical limits of leaf chewing. When seen they are related to chewing large amounts. Symptoms resolve when the khat is withdrawn and anti-psychotics are not usually needed. Khat psychosis may be accompanied by depressive symptoms and sometimes by violent reactions. It has been argued that khat chewing might exacerbate symptoms in patients with pre-existing psychiatric disorder.

Socio-economic effects

The habit of Khat chewing does manifest a number of socio-economic problems. Khat chewing leads to loss of work hours, decreased economic production, malnutrition and diversion of money in order to buy further khat. Family life is harmed because of neglect, dissipation of family income and inappropriate behaviour and khat is quoted as a factor in one in two divorces in Djibouti. Acquisition of funds to pay for khat may lead to criminal behaviour and even prostitution.

On the other hand there are a lot of benefits from the Yemeni’s love of khat and a lot of people clearly enjoy its use. The crop generates wealth for its cultivators and the need for a rural workforce has stabilized the rate of rural to urban migration. It has positive psychological effects too and many people report that it leads them to be more creative. Its energizing effects benefit the elderly especially and it serves as a medium for social discourse.

What to do?

Attempts have been made to control the use of the drug but with little success. In 1957 the Adeni political party instigated a ban, but such was the political turmoil over this issue that the party collapsed the following year. Many people complain that Yemeni authorities are not committed to combating the use of khat because the crop is such a moneymaker for senior officials and influential tribal leaders.

In contrast to Yemen, in Saudi Arabia use of the plant is completely banned and there are harsh penalties in place. One less severe approach would be to treat khat like tobacco in the West, with information campaigns about its drawbacks and restrictions on its use.

In the UK

In recent years as a result of air transport, the consumption of fresh khat leaves has expanded considerably and khat is readily and legally available in the UK. It has been estimated that about 7000 kg of khat pass through Heathrow Airport each week from where it is distributed into the UK and into other European countries.

There have been calls for it to be banned and the BBC reported Faisa Mohammed, chair of the Bromley-based Somali Well Women Project, saying that the abuse of khat was damaging many Somali families in Britain.

Back home the men were the breadwinners but they came to Britain without jobs and took up khat, which has become an addiction. They chew all night and during the day they can’t do anything.

Your correspondent’s humbling experience

As khat is legal in the UK I thought that it might make for a distracting afternoon to try to purchase some. Living near Whitechapel, as I do, I hung outside a semi-reputable Somali shop until I plucked up the courage to go in.

‘Hello, I was wondering if you sold khat’ I said. ‘You know, that plant you can chew’

‘No we don’t and I don’t approve of it’.

I panicked and told the shop keeper that I was a medical student doing a project on khat and I was trying to buy some for ‘research purposes’

Then the shopkeeper’s friend came in and starting to tell me about all the bad things that have happened to the Somali society in the UK thanks to khat, chiefly men ignoring their families and jobs in order to chew the stuff. He thought it should be banned.

Duely chastened I left.

***

Links for this article:

Adverse effects of khat: A review Advances in Psychiatric Treatment (2003), vol. 9, 456–463 - a really great review - full text available for free!

The impact of qat chewing on health: A re-evaluation by Nageeb Hassan, Abdullah Gunaid and Iain Murray-Lyon British-Yemini Society

Al-Bab.com qat page
Pages about the Middle East run by the Guardian’s Middle East Editor Brian Whitaker

The Curse of Yemen Ian Black Guardian August 12 2008

Here’s Kevin Rushby’s book again:

Also:

Lonely Plant Yemen page

High in hell An Esquire article by Kevin Fedarko September 1 2006

That darned khat Village Voice article 14 November 2006

The Curse of Yemen Guardian 12 August 2008

theguardian online today has a story on its main page which is titled ‘Why smiles are better than Prozac’

On closer inspection, it’s less an article, more an advertorial for a book called ‘Beating stress, anxiety and depression’ by Jane Plant and Janet Stephenson.  The  article says that the book is ‘new’ but the amazon.co.uk page says that it came out at the beginning of May this year.  I can only imagine that they were short of copy and rehashed a press release that they found knocking around the office.

Be this as it may, this is the sort of thing that catches my eye.  The introduction is available for perusal online, and Plant and Stephenson say some sensible things - like advising us to ignore celebrity culture - but I am concerned about some of the things they say particularly when they assert that levels of neurotransmitters should be assessed in patients suffering from depression.  The neurotransmitter hypothesis is problematic, as discussed by Badscience.net and Mindhacks.com, and this sort of test are likely to be more expensive than meaningful.

Daily Mail article on the same book title: ‘How the wrong drugs could be causing your depression’.

Best read it before I comment further.  If anyone has read it and would like leave a comment below I would be most grateful.

Also in the paper today Rachel Cooke has this to say about reality TV and meeting Jodie Marsh

What strikes you most about Marsh when you meet her is not her pleasure at the unexpected turn her life has taken, but her implacable anger…..(about four paragraphs)….I’ve lost count of the number of times youth workers and criminologists alike have made the connection, as they discuss knife crime, between low self-esteem and anger. Well, there is an awful lot of anger among those who participate in reality TV, the majority of which, it seems to me, is the result of low self-esteem, and Marsh is no exception.

Cognitive dissonance is a psychological theory which was first described by Leon Festinger and, simply put, is the state of having two cognitions (ideas) that are mutually inconsistent.  It is held that the state of cognitive dissonance is a very unpleasant one, characterised by psychological tension and discomfort.  The theory holds that we are as motivated to change our behaviour due to cognitive dissonance as we might be to act to reduce hunger. 

An example of this might be a person who has always been very opposed to extra-marital affairs.  If he or she found themselves having such an affair, this would be inconsistent with this attitude causing cognitive dissonance. At this point he or she would have two choices: stop the affair, or justify the affair.  We are more likely to change our attitudes and justify our behaviour, than alter our behaviour.  

This makes sense from an evolutionary point of view as we are programmed to develop a set of beliefs to guide our lives.  It is not beneficial to be so open minded that we would be constantly changing our minds as this would make swift action difficult.  To avoid cognitive dissonance in the first place we are programmed to have an in built confirmation bias; this is where we notice, seek and remember information that confirms what we already believe and disregard or minimize information that conflicts with our world view. 

For a gentle introduction on this subject listen to this clip on cognitive dissonance on the Today Programme 

*** 

Frontier Psychiatrist has just returned from the Hay Festival and in retrospect I can see confirmation bias at work in my choices of speaker meetings.  I almost entirely went to see people with whom I knew I already agreed, and justified this to myself on the basis that their ideas would useful as a source of further ammunition when arguing on the rare occasions when I get invited to parties. 

The only real exception to this was Cherie Blair,  wife of the former British Prime Minister, for whom I had a free ticket.  She makes me feel conflicted, which is hardly surprising as she’s rather conflicted herself.  She hates the press, but she wishes to use it to have her side of the story told.  She protects her privacy vigorously, but divulges cringing personal details in her autobiography.   She calls this autobiography ‘Speaking for Myself’ as if, as a highly successful barrister, she’s such a victim that she’s never had the chance before.  She’s a socialist, but she owns three houses.  And she makes her problems with being the wife of a head of state so painfully obvious; she publishes a book called ‘The Goldfish Bowl’ about previous spouses in Number 10.   Psychoanalysing this woman is too easy.  She also gave a really boring speech.

Elsewhere: 

I was looking forward to seeing Gore Vidal, but he left me not just cold, but feeling soiled, such was his constant negativity.  He criticized John McCain for not attempting to escape from a Vietcong POW camp.  I don’t think that Vidal has any experience of such scrapes, so should hold counsel until he’s tried himself.  My brother asked him whether he had any ‘words of advice for young people‘.  ‘Grow up’ said Vidal.  Perhaps it’s too late to take his own advice.

Much smaller fry was Mark E. Smith of The Fall.  The interviewer was Jon Gower. I’ve never heard of him either.  Early on during the interview Smith accused Gower of not having read this autobiography.  Gower had to admit that he hadn’t finished it, but to show he’d read what he had carefully, asked the most in depth and convoluted questions, most of which were answered by Smith with a simple ‘yeah’ followed by tittering from the audience.  I spent most of the interview wanting to jump on the stage and wrestle the microphone away from him.  Every psychiatrist knows - the best way to get someone’s story is to ask open questions.  A breath test for Smith and full refund to the audience wouldn’t have been out of place either. That was my question about the security guards.

Christopher Hitchens did nothing to quash allegations of a drink problem by coming to the stage with a glass of wine.  Apart from his rudeness towards a audience questioner, which boarded on bullying, we were in complete agreement.  Further agreement but slight boredom accompanied talks by Naomi Klein and Joseph Stiglitz.  It’s not always a good idea to read the corresponding books before seeing a talk, as the speakers just regurgitate the same facts you’ve already read.  Will Self as ever didn’t disappoint.  My brother got further coverage in the press by asking him about his love of long and seldom used words.

For us the festival ended with Rob Brydon.  Oliver James says that he’s rarely met a comedian who’s not personality disordered or depressed.  I hope he’s wrong in Mr Brydon’s case, as he seems so very nice and so very amusing.  

People in the press have been playing one of my nasty habits - guess the diagnosis of someone you’ve never met.  In this case the beleaguered UK Prime Minister Gordon Brown.

For anyone who lives in a cave, Mr Brown came to be PM about a year ago having been the Chancellor of the Exchequer for ten years.  During this time he presided over unbroken economic growth and was well know for his prudent policies and dour demeanour.  Whilst his lack of easy charm and attention to detail made him apparently trustworthy as the head of the economy, they haven’t played out well as PM, especially as he is following the TV friendly and charismatic - but warmongering  - Tony Blair.  Incidentally, I met Brown’s private secretary, a rather attractive girl, at a party once and was thinking of trying to get off with her but regrettably she left before I could work any magic. 

Writing in The Times, GP Dr Thomas Stuttaford has speculated that Mr Brown has personality traits which might lead him to be diagnosed with a DSM-IV cluster A personality disorder.  He also says that Tony Blair would meet all the criteria for histrionic personality disorder

(If you need to brush up on personality disorders here’s a link to my previous post on the subject) 

BPS research digest disapproves

There are two issues here.  Is Dr Stuttaford proper to speculate in such a way?  Yes, in that we are in a free country, and it would be cheeky for me to say no when I have done similar myself*.  But he is very careless.  You can’t make these kind of diagnoses without meeting the patient, and it is sloppy to take a cursory glance at the DSM criteria and then imply that if someone possibly meets particular criteria and the diagnosis is likely.  He should at least have stated that what he is presenting is purely idle speculation.

Is he actually right?  Unlikely. With regards to Tony Blair, Dr Stuttaford can’t have looked very carefully at the DSM-IV histrionic personality disorder criteria.  Is he saying, for instance, that Tony Blair’s interactions with others are ‘often characterized by inappropriate sexually seductive or provocative behaviour’ or that he ‘consistently uses physical appearance to draw attention to (him)self’? (DSM IV criteria)

He says of Mr Brown:

‘He is likely to be demanding, self- absorbed, have difficulties in relationships with others, suffer discomfort in social situations with unfamiliar people, have vaguely unsettling inappropriate gestures or facial expressions and may be so focused that he finds it difficult to concentrate on subjects other than that which has caught his immediate attention’

I find it difficult to believe that anyone with these sort of characteristics could not only elevate himself to the job of PM(think of the political deals and alliances necessary), but also run the country for more than five minutes with this sort of personality.  ICD-10 states that a personality disorder is ‘usually accompanied with considerable personal and social disruption’ which sounds incompatible with any of Mr Brown’s achievements.   Dr Stuttaford is talking bollocks I fear. 

David Owen, former Labour minister and SDP leader, has written a book about illness suffered by heads of state, and has also coined a term ‘hubris syndrome’ which I think he is un-secretly hoping will pass into common parlance, if not into diagnostic manuals.  Rather less prestigiously, I wrote a post on a leaders and their drug problems, prompted by speculation that Moses was under the influence of psychedelic drugs. 

Other articles on this subject:

NHSBlogdoctor

*It would be hard to imagine that  Josef Fritzl is not  even a little bit anti-social though…

There’s news that Josef Fritzl, the man who imprisoned his daughter for 24 years in a dungeon of his own making, will plead insanity when his case goes to trial.  I also saw Glenn Wilson, who works at the IoP on TV speculating that Mr Fritzl is a psychopath.  

I’ve talked about personality disorders elsewhere; but in brief: your personality can be defined as ‘the characteristic, and to some extent predictable, behaviour-response patterns that each person evolves, but consciously and unconsciously as his or her style of life’ (Campbell’s Psychiatric Dictionary).  Personality disorders on the other hand relate to when the way in which an individual interacts is so rigid and fixed as to severely limit the likelihood of effective functioning and/or satisfying interpersonal relationships.  The point when a personality is sufficiently beyond the normal to warrant a personality disorder diagnosis is difficult and define and personality disorder is less a diagnosis and more a label of social non-conformity.  

Psychopathic personality disorder is synomymous with anti-social personality disorder (DSM-IV) and dissocial personality disorder (ICD-10) 

Back to Mr Fritzl.  Here’s the ICD-10 classification for dissocial personality disorder (DSPD)

F60.2 Dissocial personality disorder

Personality disorder, usually coming to attention because of a gross disparity between behaviour and the prevailing social norms and characterised by:

(a) callous unconcern for the feelings of other

(b) gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations

(c) incapacity to maintain enduring relationships; though having no difficulty in establishing them

(d) very low tolerance to frustration and a low threshold for discharge of aggression, including violence

(e) incapacity to experience guilt or to profit from experience, especially punishment

(f) marked proneness to blame others or to offer plausible rationalizations for the behaviour that has brought the patient into conflict with society

Mr Fritzl clearly has most of these in spades, so much so that it would not be entirely unreasonable if a whole new subtype of this personality disorder should be invented just for him.  People with DSPD are known to have a reduced ability to empathize with another person’s emotional state, or to recognise it from their face.  I remember a forensic psychiatrist explaining to me the response one of his patient gave when asked to name the emotion of the face of a person shown to him on a card (the emotion was fear)

‘I’m not sure what it’s called but that’s the way people look when I stick a knife in them’ 

Which still gives me the creeps. 

It’s also possible that Mr Fritzl is psychotic in some way, but this seems unlikely given how well he has been seen to function in society and how calculating and precise the planning for his deeds appear to have been. 

It will be brave psychiatrist who attempts to defend his insanity plea as an expert witness. 

***

I’ve also been very interested to learn of how Austrian society could let this sort of thing happen.  I’ve read in the press that people in general and institutions in particular are extremely reluctant to believe that anyone of social standing could do anything untoward.  Data protection laws are also weighed towards the criminal - any conviction is wiped after fifteen years, which means that the information relating to Mr Fritzl’s rape conviction was not available when he applied to adopt the children he had conceived with his daughter.  Austrian police also said almost immediately that Mrs Fritzl knew nothing of her husbands activities - more wishful thinking perhaps?

It would be easy to get snotty.  Here in the UK we’ve had our share of psychopaths whose crimes evaded the authorities for years.  Peter Sutcliff, who killed thirteen, was eventually caught because his car had false number plates.  Dennis Neilsen killed at least fifteen and was caught because his drain was blocked with flesh. 

***

And another thing, which no one else seems to be saying.  Mr Fritzl really looks like a pervert to me.  The supercilious smirk, the arched eyebrows with the right slightly higher as if in challenge.  Dogs and their owners eventually look the same people say.  Is it possible that psychopaths eventually look like their acts?