Category: Remembering

In 1992, the BBC broadcast Ghostwatch, one of the most controversial shows in television history and one that has had a curious and unexpected effect on the course of psychiatry.

The programme was introduced as a live report into a haunted house but in reality, it was fiction. This is now a common plot device, but the broadcast happened in 1992, years before even The Blair Witch Project used the documentary format to tell a fictional story and viewers were used to news-like programmes presenting news-like facts.

But despite some subtle nods to its fictional nature, the fact it was broadcast on Halloween and the ridiculous conclusion (the poltergeist eventually escapes from the house, takes control of the BBC and possesses presenter Michael Parkinson), many people believed the ‘documentary’ was real and that the programme was capturing these astounding events as they happened. You can watch it on YouTube and see how it was introduced.

Consequently, lots of people were genuinely frightened by the programme, including many children who were watching with their families. As a result, the BBC was flooded with calls and letters and were forced to start an investigation into the programme.

As the controversy raged on, an article appeared in the British Medical Journal, written by two doctors from Gulson Hospital in Coventry, reporting post-traumatic stress disorder (PTSD) in two children that was apparently caused by watching Ghostwatch.

Case 1

This boy had been frightened by Ghostwatch and had refused to watch the ending. He subsequently expressed fear of ghosts, witches, and the dark, constantly talking about them and seeking reassurance. He suffered panic attacks, refused to go upstairs alone, and slept with the bedroom light on. He had nightmares and daytime flashbacks and banged his head to remove thoughts of ghosts. He became increasingly clingy and was reluctant to go to school or to allow his mother to go out without him.

Although not without scepticism, several other cases were published as replies to these initial reports producing a small case series of PTSD caused by the TV show.

These minor cases drifted into the history of medicine until people started to debate what event should be considered a sufficiently traumatic event in order to diagnose PTSD.

At the moment, the current DSM-IV-TR diagnosis for PTSD says that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” and that the person’s response involved “intense fear, helplessness, or horror”.

It’s the “confronted with” part that allows people who have seen distressing things on TV and reacted with “intense fear, helplessness, or horror” to be diagnosed with PTSD.

At the time Ghostwatch was broadcast the criteria required that “the person has experienced an event that is outside the range usual human experience and that would be markedly distressing to almost anyone” which could similarly be interpreted to allow TV programmes to cause the disorder.

The new proposed criteria for the DSM-5 wouldn’t allow television-triggered PTSD. In fact it specifically says that exposure to traumatic events “does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.”

Ghostwatch has played a part in changing how PTSD will be diagnosed. Although a major motivation was the wave of PTSD diagnoses after watching coverage of 9/11 on TV, the fictional ghost investigation is often cited in the medical literature as an example of how the existing criteria can lead to absurd consequences.

Although the programme is more famous for its effect on the history of media, it remains a minor but significant spectre in psychiatry’s past.
 

Link to GhostWatch entry on Wikipedia.

In 2008, The Lancet published an amazing article on the ‘psychological effects of polar expeditions’ that contains a potted history of artic madness.

Unfortunately, the paper is locked, or shall we say, frozen, behind a paywall, although this snippet on the history of mental health problems on artic expeditions makes for quite surprising reading.

Accounts of expeditions throughout the 19th and early 20th centuries rarely mentioned episodes of psychiatric disturbance or interpersonal conflict, as such was not in keeping with the image of polar explorers, who were expected to have specific qualities and characteristics, such as strength and resilience. Nevertheless, equally rare was the polar expedition that did not have at least one member who was debilitated by depression, anxiety, paranoia, alcoholism, or sleep disorders. During Sir Douglas Mawson’s second Antarctic expedition (1910–14), that person was Sydney Jeffryes, the radio operator, whom Mawson believed “surely must be going off his base. During the day he sleeps badly, gets up for dinner looking bad, husky; mutters sitting on his bunk in the dark afterward.”

Frequently, the entire crew of a polar expedition would experience melancholy and depression, as was the case of the Belgica expedition to Antarctica in 1898–99. As described by the great polar explorer and expedition physician, Frederick A Cook, “The curtain of blackness which has fallen over the outer world of icy desolation has descended upon the inner world of our souls. Around the tables, in the laboratory, and in the forecastle, men are sitting about sad and dejected, lost in dreams of melancholy from which, now and then, one arouses with an empty attempt at enthusiasm.”

Cook tried to treat these symptoms by having crew members sit in front of large blazing fires. This baking treatment, as he called it, could be the first recorded attempt to use light therapy to treat symptoms of winter depression or seasonal affective disorder. Other expeditions, such as the Greely expedition of 1881–84, met a far worse fate than the Belgica exploration. In their attempt to establish a scientific base on Ellsmere Island in the Arctic, the crew of the Greely expedition was driven to mutiny, madness, suicide, and cannibalism, leaving six survivors of a crew of 25 men.

 

Link to frozen Lancet article.

The APA Monitor has an article on how ‘nervousness’ in 1800s America was treated by sending male intellectuals ‘out West’ for prolonged periods of cattle roping, hunting, roughriding and male bonding.

This, I suspect, sounded a great deal more innocent in the 1800s.

But nevertheless, this sort of intense deliberately masculine physical exercise was thought to be a genuine antidote to brain-exhausting intellectual life.

Among the men treated with the so-called “West Cure” were poet Walt Whitman, painter Thomas Eakins, novelist Owen Wister and future U.S. President Theodore Roosevelt.

Although the Rest and West cures involved wildly different therapeutic strategies, both were designed to treat the same medical condition: neurasthenia. First described by American neurologist George Beard in 1869, neurasthenia’s symptoms included depression, insomnia, anxiety and migraines, among other complaints. The malady was not just an illness, he said, but also a mark of American cultural superiority.

According to Beard, excessive nervousness was a byproduct of a highly evolved brain and nervous system. A “brain-worker” who excelled in business or the professions might experience nervous breakdowns if he overtaxed his intellect. His highly evolved wife and children could easily succumb to the same malady, particularly if they engaged in excessive study or “brain work.”

The famous neurologist Silas Weir Mitchell wrote of neuroaesthenia that, under great nervous stress, “The strong man becomes like the average woman.”

As a male psychologist who is regularly outclassed by his female colleagues I have learnt this, sadly, to be true, but not, I suspect, in the way Weir Mitchell meant.
 

Link to APA Monitor article on the cowboy cure.

‘Space madness’ was a serious concern for psychiatrists involved in the early space programme. A new article in history of science journal Endeavour tracks the interest in this ‘dreaded disease that never was.’

Much to the surprise of NASA mental health professionals, those who volunteered to be astronauts were neither “suicidal deviants” nor troubled by their separation from the earth, but the media ran with the ‘space travel as psychic trauma’ idea anyway.

‘In answer to the question, “‘What kind of people volunteer to be fired into orbit?” one might expect strong intimations of psychopathology’. Or so thought two Air Force psychiatrists selected to examine America’s first would-be astronauts. Researchers of the 1950s who considered the problem of human spaceflight often speculated that such work would attract only suicidal deviants, and that merely participating in such a voyage would overwhelm the human psyche of otherwise healthy people. The popular culture record of the time seemed to confirm their suspicions, with science fiction films frequently offering up megalomaniacs, egotists, and religious fanatics terrorizing planets in their cinematic space cruisers.

It is not surprising, then, that the psychiatrists working with the National Aeronautics and Space Administration in 1959 feared the worst of the men selected to be America’s first astronauts: that they would be impulsive, suicidal, sexually aberrant thrill-seekers. The examiners, though, were surprised – and a little disappointed – when tests revealed the would-be spacemen to be sane, poised professionals able to absorb extraordinary stresses. Flying jet airplanes in Cold War America had conditioned the men to control their fear, and even the most spirited among them were effective in orbit.

The idea that humans could travel into space and not be traumatized by their experiences, though, was unpalatable to large numbers of journalists and screenwriters, who expected that such journeys would produce some form of psychic transformation. By the early-1970s, popular culture depicting unhinged astronauts became commonplace, even as NASA’s astronauts demonstrated a remarkable ability to absorb the stresses of long-duration spaceflight. A Space Age malady with no incidence among human populations, ‘space madness’ is the stuff of Hollywood: a cultural manifestation of popular fears of a lonely, dehumanizing, and claustrophobic future among the stars.

Unfortunately, the article is locked, because the likes of you and me would just make the place look scruffy, but we covered some of the early discussion on what might cause ‘space madness’ previously on Mind Hacks.

And if you’re interested in the modern astronaut psychology don’t miss a 2008 article from The Psychologist on how NASA select their space travelling colleagues.

I would also like to mention that if someone from NASA is reading that I am free at *any time* to start astronaut duties. I also already own a space pen and am fully competent in its use.
 

Link to locked article. Not very space age, is it?
Link to previous Mind Hacks piece on space madness.

A summary of a fascinating 1997 article on how the practice of consuming heroin by ‘chasing the dragon‘ – inhaling vapours after heating the drug on tin foil – spread across the world.

Heroin smoking by ‘chasing the dragon’: origins and history

Addiction. 1997 Jun;92(6):673-83;

Strang J, Griffiths P, Gossop M.

The history of heroin smoking and the subsequent development and spread of ‘chasing the dragon’ are examined. The first heroin smoking originated in Shanghai in the 1920s and involved use of porcelain bowls and bamboo tubes, thereafter spreading across much of Eastern Asia and to the United States over the next decade.

‘Chasing the dragon’ was a later refinement of this form of heroin smoking, originating in or near Hong Kong in the 1950s, and refers to the ingestion of heroin by inhaling the vapours which result when the drug is heated-typically on tin-foil above a flame. Subsequent spread of ‘chasing the dragon’ included spread to other parts of South East Asia during the 1960s and 1970s, to some parts of Europe during the late 1970s and early 1980s, and to much of the Indian sub-continent during the 1980s.

At the time of writing, ‘chasing the dragon’ has now been reliably reported from many parts of the world but not from others with an established heroin problem-such as the United States and Australia. The significance of this new form of heroin use is examined, including consideration of the role of the different effect with this new form of use, the different types of heroin, and changing public attitudes to injecting.

The article also notes that the popularity of particular drugs tends to rely equally on the methods of consumption as the effects of the substances themselves.

For example, the popularity of morphine in the late 19th century was equally dependent on the development of the needle and hypodermic syringe and the development of cigarettes massively increased the number of tobacco smokers.
 

Link to locked article on the history of ‘chasing the dragon’.