Sleepwalker murder: is he responsible?

I did not study sleepwalking during my university studies and haven’t seen it since.  The medical definition of sleep walking/somnambulism is: purposeful moving while in a deep stage of sleep. Sleep-walking occurs most frequently in children, particularly boys. Sedatives tend to exacerbate rather than cure sleep-walking. The best measures are preventive: ensure that the sleepwalker is in a safe room for walking and cannot accidentally fall downstairs.

Stab in the dark: can people kill without being conscious? by Eleanor Shakespeare
The Guardian

Some types of sleepwalking are related to seizure disorders & other neurological conditions; most cases are transitory. Parasomnias/involuntary behaviours during sleep are usually harmless. But some lead to reckless or violent actions.

Law Here are some criminal cases in which the sleep­walking defence was invoked, reported in Psychology Today; Stacks Law Firm and USNews.

In 1846, Albert Tirrell cut the throat of a Boston prostitute, set fire to the brothel, then fled to New Orleans, where he was arrested. Tirrell said he was a chronic sleepwalker and perhaps committed the crime while asleep. Strangely the jury agreed and found him not guilty. Would he have been guilty if the victim  wasn't a prostitute?

In Glasgow in the 1870s Simon Fraser, disoriented from a nightmare about beasts, dashed his son’s head on the family’s bedroom floor. He was acquitted for the murder, since it was so clear to the jury that he had no desire to kill his child. The episode had probably been a night terror, with or without sleepwalking.

The Boston Tragedy referred to the murder of Maria Bickford, 1846;
Tirrell was acquitted because of sleepwalking.
National Police Gazette, 1846

Texan man Isom Bradley testified in the 1920s that he and his mistress were in bed when he heard a dangerous enemy. Fearing a secret attack, he went put a pistol under his pillow. Later he jumped up and fired shots, woke up and found his girl­friend dead in bed. Bradley was convicted of murder, but the convict­ion was reversed on appeal; he had been acting in a somnambulistic state.

In 1950 Melbourne mother Ivy Cogdon axed her only child to death; Patricia was found early in the morning, in her bed, with the bloodstained axe near her body. The mother had long been prone to psychological cond­itions which had been treated by several doctors. Cogdon’s defence was that she was sleep­walking when she killed Patricia, “protecting” her girl from invading Korean soldiers in Carnegie. She was acquitted due to sleep­walking.

In 1987, Kenneth Parks sleep-drove in Ontario to his mother-in-law’s house, stabbed her to death and strangled his father-in-law almost to death. He got back in his car, drove to a police station with blood on his hands but had no memory of the murder. Parks had a strong family history of parasom­nias (sleepwalking, enuresis and night terrors), and he was stressed, depressed and insomniac. These factors combined to make sense of his sleepwalking behaviours. No intent, not guilty of murder!

In 1994 Michael Ricksgers accidentally murdered his wife in Pennsylvania during a sleepwalking ep­is­ode, provoked by a medical condition, sleep apnoea. Ricksgers told police that he awoke to find a gun in his hand and his wife bleed­ing in bed beside him. He apparently dreamt about an intruder breaking in! But pros­ec­utors said Ricksgers was furious that his wife was leaving him, so he was sentenced to life in prison, without parole

A devout Mormon, Scott Falater stabbed his wife 44 times with a hunting knife, then dragged her into a backyard pool and drowned her in Arizona in 1997. Falater, who had no apparent motive, said he had a history of sleepwalking, was sleep-deprived and was uncon­sc­ious during his attack. Yet Falater had tried to conceal the knife and bloody clothes in his car. A jury found Falater guilty of first-degree murder!

In 2001 Stephen Reitz killed his married lover, Eva Weinfurtner, during a romantic island holiday. He smashed her head, disloc­at­ed her arm, fractured her wrist, ribs, jaw and skull, and stabbed her neck. Reitz told Californian police that he remembered nothing, though through flash-backs he recalled “fighting a male intruder”. At trial, his parents testified that their son had sleep­walked since childhood. However due to the defendant's past history of violence towards Weinfurtner, Reitz got first-degree murder.

In 2009 Brian Thomas appeared in a South Wales court on a murder charge, after strangling his wife as they slept in their camp­er van. Psychiatrists testified that locking him up would not be helpful as he had had a genuine sleep disorder, suffering night terrors for c50 years, and thus bore no responsibility for his actions.

 

Scott Falater's case

The Index-Journal, Greenwood South Carolina,
June 1999

Science  Ursula Voss’ team at Bonn University reported that even during lucid dreaming (a state in which some people can control their dreams), some areas of the brain associated with intent stayed Offline, while other areas associated with consciousness were On.

Similarly a study by Claudio Bassetti at the University of Zurich manoeuvred a sleep­walker into a brain scanner during a sleep­walking episode. He showed no activation in the areas of the brain associated with intent, though emotional areas and movement areas were active. So while judgement was Off, the ability to act out emotionally was On.

Antonio Zadra at the University of Montreal measured the brain activity of 10 sleepwalkers and 10 control subjects to det­ermine what stage of sleep they were in. Their results might event­ual­ly enable a test for genuine sleepwalkers, a big break-through.

Conclusion
When the accused was sleep-deprived, under stress or had a history of sleepwalking, he was more likely to experience para­somnia behav­iours. If he'd also been using alcohol or drugs, more so! But it's more difficult to explain away any behaviours as strictly biological in origin. Legal systems need to take science more seriously, finding explanations for the biol­og­ical and social bases of sleep behaviours, establishing who has a genuine sleep disorder and who is faking.

In Australia, a person cannot be guilty of an offence if they were unconscious or asleep when the act was committed. Courts throughout Australia have often confirmed that finding a defendant’s actions must be voluntary for a finding of guilt. If a person is asleep and therefore not conscious, they cannot have acted voluntarily.

Consumptive chic for women???

Consumptive Chic: History of Beauty, Fashion & Disease 2017 by Dr Carolyn Day examined the connection between fashion and Tuber­culosis/TB. The book was beautifully written and illustrated, but I was angry on women’s behalf while reading. In an era ignorant about TB, the tuber­cular body came to be defined cul­t­urally. During the late 18th-early C19ths this became romant­ic­is­ed i.e people actively redefined notions of the otherwise horrib­le sympt­oms as ideals of beauty.

Dropsy and Consumption flirting outside a mausoleum.
Credit: Wellcome Collection

Illustrated with fashion plates and medical images, this was a clear story of the rise of Consumptive Chic which described the strange link between women’s fashions and medical thinking re TB. Thus two belief systems developed in a connected fashion:

1. Women's in­herent feminine character/way of life rendered them naturally sus­cep­t­ible to contracting TB.

2.  Despite the changing fashions over decades, TB’s symptoms were believed to increase the attractive­ness of its victim over time. Once they contracted TB, patients were indeed more likely to die. But they would be increasingly beautiful as they approached death. The emaciated figure and fev­erish flush of TB victims were positively promoted as a highly desirable appearance. As were the long swan-like necks, large dil­ated eyes, luxurious eye lashes, white teeth, pale comp­lex­ions, blue veins and rosy cheeks.

Women focused on their eyes by painting eye liner and eye shadow onto their faces, even though these eye paints contained dangerous mer­cury (causing kidney damage), radium, lead or antimony oxide (a carcin­ogen). Women placed poisonous nightshade drops in their eyes, to enlargen their pupils. And they bathed in pois­onous arsenic, to make their skin desirably pale. The poison vermillion was worn on the lips as a lush red tint. How brutal, then, that medical writers knew that the fash­ionable way of life of many women actually harmed them.

What would inspire largely educat­ed classes to respond to illness through the channels of fashion? Why would people try to glamorise the symptoms of a deadly disease?? Day showed that consumption was seen to confer beauty on its victim. Yes it was a disease, but one that would become a positive event in women’s lives.

The Victorian corset was a heavy duty clothing apparatus, capable of constricting a woman's waist down to a tiny 17”;  this and an hourglass figure were all the rage in the C19th. Dresses were desig­n­ed to feature the bony wing-like shoulder blades of the consumpt­ive back, emphasising an emaciated frame. Additionally, diaphanous dresses and sandals exposed women to cold weather.

The coughing, emaciation, endless diarrhoea, fever and coughing of phlegm and blood became both a sign of beauty and also a fashion­ab­le disease. As obscene as it seems now, TB was depicted as an easy and beautiful way to fade into death. It was neither!!

Day noted the dis­ease’s connections to the Romantic poets and to scholars in the early C19th. Literary influence was important for educated women; most Romantic writers, artists and composers with TB created a myth that consumption drove male artistic genius. The link coincided with the ideolog­ies of Romanticism, a philosophical movement that opposed the En­lighten­ment through its emphasis on emotion and imag­ination. These men were the best, most intelligent & brightest members of society. Lord Byron (1788-1824), the most notorious of the Romantic poets, noted that his TB affliction caused ladies to look at him with heartbreak. The poet John Keats (1795-1821) embod­ied an example of the refined tubercular artistic genius, doom­ed to a very early death. He was a body too delicate to endure earthly life, but one whose intellect indelibly imprinted on culture.

And artistic women too. The link between TB and ideal femininity was played up by Alexandre Dumas fils whose novel La Dame aux Camélias (1848) presented redemption for immor­al­ity via the suffering of TB. The consumptive model Elizabeth Siddal, the drowned Ophelia in John Everett Millais’ pre-Raphaelite painting of 1851, became an icon for her generation.

There was less interest in the appearance of TB in the lower classes. Not because working women and prostitutes deserved a miserable and painful death, but because the lower classes showed how women real­ly suff­ered TB’s brutal realities. TB was explained away rather realistically in the working classes: miserable living cond­itions, pollution, poor hygiene, poverty, promis­cuity and drunkedness. TB was not romantic and beautiful for working women.

Tuberculosis shaped Victorian fashion
Furman News, 1888

Could the different reactions to TB, the glamorisation of the ill­ness for upper class women Vs the bleak experience of TB in impov­erished Victorian communities, be there to maintain class order in Britain? Perhaps fashion-setters elevated TB as an elegant form of suffering for the upper classes, specifically to create a psychological dis­tance from the unsavoury realities of lower-class disease? No won­der TB victims from the British upper classes were lauded while poor vic­t­ims were stigmatised.

My blog-partner-doctor wanted to know why other diseases like cholera did not have the same cultural impact? Because, Day said, in­fectious diseases followed an epidemic pattern. First they inc­r­eased very quickly; then they slowly faded in intensity and incidence. The course of TB was less flashy than other contagious illnesses, but it still followed a ve ry slow epidemic cycle of infection.

New Medical Knowledge 

A much better understanding of TB came in 1882 when germ theory was described by Louis Pasteur. In that year Robert Koch announced he'd discovered and isolated the micro­­sc­opic bac­teria that cause the disease. Koch’s discovery helped convince public health experts that TB was contagious. And that the victim’s sparkling or dilated eyes, rosy cheeks and red lips were caused by frequent low-grade fever

Preventing the spread of TB led to some of the first large-scale public health campaigns. Doctors began to define long, trailing skirts as causes of disease because they swept up germs from the street. Corsets were also believed to exacerbate TB by limiting move­ment of the lungs and blood circulation. And doctors began prescribing sunbathing as a treatment for TB. Eventually TB was viewed as a pernicious biological force requiring control. The weak and susceptible female gave way to a model of health and strength. 

NB Emily Mullin How Tuberculosis Shaped Victorian Fashion

  

Ophelia, by John Everett Millais, c1852, Tate 

The tubercular model Elizabeth Siddal became an icon for her generation.

Mentoring local medicos in Africa

We, the Ladies Who Coffee, debated the best ever tv programme. I chose The Surgery Ship, an Australian series filmed when Mercy Ships visited West Africa in 2016 & 17. Thankyou to the helpful Surgery Ship for their data.

Staff waiting to board a Mercyship

Facebook

Each human deserves access to surgical and health care solutions. But in some parts of the world, people go without. Since 1978, Mercy Ships began a mission to provide hope and healing to those in need. Each year hospital ships are filled with volunteers who provide life-changing surgeries to children and adults who’d otherwise go without. The staff confront ethical decisions as they decide who can be helped and who cannot not. This is a complex journey for the volunteer medics as they deal with serious cases, and balance the patients’ fates in their hands.

Globally, 5 billion people lack access to safe surgery. Due to this lack of access to surgical care, up to 18.6 mill people die each year. Every day, children and adults in some of the poorest communities die from causes that can easily be treated in hospitals in many nations. 1 in 8 children die before they have the chance to go to school.

With international volunteers, ship staff can deploy state-of-the-art hospital ships to treat more people. As part of the commitment, the staff also train local health-care workers so this important work can continue. c70% of the world’s population lives near the coast, and the hospital ships provide unique platforms for workers to direct medical care to these villages. A customised 3-year partnership model goes to many African countries requesting support.

Grace, 17, from the Democratic Republic of Congo

before and after tumour was removed

express.co

 

A team of volunteer staff are aboard, going to the poorest nations on earth and facing the most severe issues anywhere. The challenge is enormous but the ship makes a huge difference by supporting the silent poor and by providing life-changing surgeries to those in great need.

The staff provides free corrective surgeries for hernias and goitres that plague unemployed adults, and children who miss school because of no accessible medical care. Doing critical eye surgeries gives patients with renewed sight and quality of life. Huge tumours left to grow unchecked, massive deformities and more; some had a 4 k tumour on the face for years, living a life of ridicule and shame.

anaesthetist prepares pre-operation

New Statesman

Many children live in pain and isolation by not having access to medical care for surgeries eg clef lip, cataracts and plastic reconstructive, and dental health care. Cleft lip surgeries are treated early in life in the West, but for many Africans, it can be years before surgery happens. This results in malnutrition and exclusion from the community. 

A child’s life can be severely impacted with poor eye health, so Mercy Ships provide corrective eye surgery and optical care for kids. Good dental health from an early stage means children are not susceptible to a myriad of other health conditions. Children and their families learn the basics of dental health and are provided with vital surgeries. Good dental hygiene prevents gum disease, cavities and teaches basic oral health education. 80% of the world’s fractures and the majority of club-feet occur in developing nations. Without quality orthopaedic surgeries, those who have these types of defects experience a life of pain and shame.

Infection control is a major issue in hospitals in both wealthy and developing nations. Mercy Ships teaches local medical staff to put safe-surgery protocols into practice but often the local environment makes it very difficult to keep even operating theatres clean and sterile. That’s where Mercy Ships projects like hospital refurbishment emerge, changing facilities that are uncleanable into areas where local staff can clean and sterilise, reducing secondary infections.

When the ship departs a country, the staff want to leave an improved healthcare system for the community. Before, during and after field services, Mercy Ships implements health care training projects that teach the medical knowledge, skills and attitude needed to heal patients long after. Infrastructure projects include renovating or expanding hospitals, helping these facilities become more available and to improve the quality of medical services. Previously, local staff struggled to care for their patients in very poor working conditions.

Dr Glenn Strauss performed the very first surgery aboard the Africa Mercy,

while mentoring local doctors

mercyships.co.za

 
The ship’s Medical Capacity Building Projects strengthen the standards of surgical care inside the local communities of the countries served. The legacy is a lasting impact that extends for years.

A child’s life can be dark because of a simple cataract. For most people in the West, a quick trip to the ophthalmologist resolves this issue, but for those who have no access to quality health care, their world dims. For 40 years, Mercy Ships has been dedicated to providing healing to those in need, via the dedicated ship volunteers.

Now to honour Dr Glenn Strauss who joined Mercy Ships in 1997 as an ophthalmologist with the Caribbean Mercy. He and his wife Kim continued to volunteer their skills for short-term missions, helping many to get care for the first time. Eventually the couple closed their practice at home and committed themselves to work fulltime on Mercy Ships from 2005. The couple developed Mercy Vision, a training programme for surgeons and paramedics from sub-Saharan Africa. Later he built a training programme in ophthalmology for regular surgeons.

Mercy Ships continues to provide essential surgery for the world’s most vulnerable people. And they also work to strengthen and support African health care systems via education, training, mentoring, equipment and supplies. Over 30 years, the staff trained 43,300+ local doctors and nurses who then trained others. The long-term impact of this medical training provides quality health care in the countries, long after the ship sails.

What is your favourite tv programme?

Brilliant Dr Alice Hamilton, USA

Alice Hamilton (1869-1970) grew up in a cult­ured family on a large Fort Wayne Ind. estate. Her fath­er wanted home-schooling for his daughters, but eventually Alice decided to become a doc­tor anyhow. She studied phys­ics and chemistry with a local teach­er, took biol­ogy and anatomy courses, ov­ercame her father’s objections and enrolled in the top class Uni of Michigan Med­ical Sch­ool in 1892. There were c4,500 fe­male doc­tors in the US then, mostly trained at women’s medical colleges.

Dr Hamilton, first-ever woman lecturer at Har­v­ard
Smithsonian

After graduating from Michigan, Dr Hamilton interned at N.W Hosp­ital for Women and Children, Minneapolis and then at the New England Hospital for Women & Children Bos­ton. Hamilton had already decided on a career in research rather than clinical med­ic­ine, but she wanted some clinical exper­ience. In 1893, Hamilt­on accepted a path­ol­ogy re­sear­ch position at Johns Hopkins Medical School. Then she taught path­ology at Women's Med­ic­al School of N.W Uni Ch­icago and was soon was appointed Pathology Prof there.

She lived for years at Hull-House Chicago, a settlement staff­ed by university graduates who helped immig­r­ants and the poor, via social research and reform. Hull-House people investigat­ed family in­come, school truancy, sanitation, TB and issues affecting community health and safety. And they helped organise Lab­our unions when many wealthy Americans opp­os­ed workers’ rights. And she later work­ed as a bact­er­iol­og­ist at Chicago’s Memorial Institute for Infect­ious Diseas­es.

Hull-House, Chicago

In the 1902 summer holidays, Dr Hamilton found Chicago in a severe typhoid fever epidemic. So she needed to explain typhoid, ident­ifying the in­eff­ec­tive sewage dis­­posal in 19th Ward, outdoor toilets, broken plumb­ing, standing water and flies. Tests on flies captured near filthy toi­l­ets ind­ic­at­ed the presence of the typhoid bacillus. But blame properly fell on broken wat­ermains that spewed sewage into water pipes, despite Chicago Board of Health denials.

That same year, when the Women’s Medical School of N.W University closed, Al­ice became a bact­er­iologist at Chicago’s new­ly opened Memorial Institute for Infect­ious Diseas­es. The U.S saw rapid industrialisation and by 1900 had become the world’s most industrialised nat­ion. The growth occur­red in mining, manufact­ur­ing, transport and commerce, enabled by cheap energy, better technol­ogy, grow­ing transport­, investment capital and cheap labour. But it al­so pro­duced low wages, job insec­urity, poor working con­ditions, ind­ust­rial accid­ents & disease.

Industrial poisoning was problematic since it could take years to emerge. Most employees & employers were ign­or­ant of the dang­ers from chemicals, and few factories emp­loyed doc­tors to mon­itor wor­k­er health. In any case, which workers would complain, risking their jobs?

Ill­inois' governor app­ointed Dr Hamilton to the Illinois Commission on Occupat­ional Dis­eases (1908-10). Indus­trial tox­icol­ogy was little und­erstood, so the commiss­ioners asked her to study diseases where high mor­tality rates were found: in painting trades, lead and en­am­el­ware industries, rub­ber production, explosives and munit­ions. The most widely used poisons were lead, arsenic, zinc and carbon mon­oxide.

From 1911-20, she became a special investigator for the U.S. Bureau of Labour Statistics, examining the manufacture of white lead and lead ox­ide in paint pigments. The team visited factories, read hospital rec­ords and interviewed unionists to uncover lead poison­ing cases. She discovered 70+ dangerous processes that caused high lead poisoning. During this time, Hamilton became a noted expert in industrial medic­ine. Harvard Uni quickly placed her on fac­ulty in the School of Public Health in In­dustrial Medicine, making her the first-ever woman lecturer at Har­v­ard. This made Dr Hamilton a famous expert in industrial medic­ine.

The Illinois report on industrial disease led to state legisl­at­ion, Oc­c­upational Disease Law (1911), requiring employers to: end work­ers’ ex­posure to risky chemicals, offer monthly medical exams for work­ers in dangerous trades, & report diseases to the Dept of Fact­ory Inspection. Soon Charles Neill, Comm. of Labour in Dept of Comm­erce asked her to do nationally what she’d done in the state, first in the lead trades, then in other poisonous trades.

Workers trimming and binding the felt hats
leading to mercury poisoning
Connecticuthistory

In WWI she also investigat­ed the pois­onous effects of man­­ufacturing expl­os­ives on workers, as requ­ested by National Research Council. Factories had sprung up to produce TNT, picric acid and merc­ury fulminate. Her rep­or­ts on the dan­gers in war-industries led to the adoption of many safety proced­ures. After the war, Hamilton discussed mercury poisoning in the felt-hat industry, the mercury causing wild jerk­ing of limbs, and mental ill­ness. And workers who made matches were subject to an industrial dis­ease that result­ed from fumes of white or yellow phosphorous which pierced the jaw bone.

Hamilton’s impressive work was soon recognised abroad. From 1924 she ser­ved a 6-year term on the Health Committee of the League of Nations. She was invited by the Soviet Public Health Ser­vice, and toured a Moscow hospital that was the first-ever facility devoted to occup­at­ional disease. Appropriately she wrote Indus­trial Poisons in U.S (1925). And she pub­lish­ed Ind­ustrial Toxicology (1934), studying anil­ine dye, carbon mono­xide, mercury, benzene and other toxic chemicals for the Dept of Lab­our. Over the years, her many reports for the Federal gov­ernment dram­at­ised the high mortality rates for industrial workers, bringing major legislative changes.

Alice Hamilton wrote Industrial Toxicology re workplace safety, in 1934.
Radcliffe Institute

Dr Hamilton first encountered carbon disulfide years earlier when she had stud­ied rubber making. Then in 1935, Hamilton conduct­ed a study of vis­c­ose rayon manufacture. This new ind­ustry used two dan­g­erous chem­icals: 1] carbon di­sul­fide, which poisoned the central nervous system, leading to mental disease, blindness and paral­ysis. And 2] hydrogen sulfide, a pow­er­ful asphyxiating toxin. Car­bon disulfide received lit­tle Amer­ican attention until Hamilton examined serious illness­es am­ong U.S viscose rayon workers. The Dept of Labour appointed her Ch­ief Med­ical Consultant, with her results pub­lished in Occ­upational Pois­oning in the Viscose Rayon Industry 1940. What an amazing career.

Finally she retired to write her autobiog­raphy, Expl­oring the Dangerous Trad­es (1943). Hamilton celebrated her 100th birthday in 1970, then passed away. Congress immediately passed the Occupational Safety and Health Act.

The guest writer Dr Joe, recomnends reading Alice Hamilton & Development of Occupational Medic­ine, 2002.

Thank you Neil Diamond, from my family

My beautiful mother was elderly (89) but much involved in bridge tournaments, Sunday concerts and family lunches in coffee shops near her retirement village. Her physician gave her white blood cell transfusions each week because of her low white blood count, and she coped well. But suddenly life changed tragically when a family member asked mum’s hospital physician “to withdraw mum’s medical services and to let her die quickly and painlessly. Euthanasia was necessary, the relative said, because of elderly people who used up medical resources that younger people deserved”.

Mum begged us to save her. In fact her physician, rabbi and staff at the retirement village tried very hard to protect her, but she died/was euthanased within 4.5 weeks. I didn’t sleep for a year, during which time there was a funeral, minyanim, 30 days religious services, selection of the tombstone, memorial speeches and the 12 month end-of-mourning service. Soon after that, I had heart surgery, permanent medication and weekly therapy sessions. 

Neil Diamon, I am... I said.

Discogs

The therapist was very helpful but I still heard my late mother talking to me overnight, saying “save me, save me”. One question the therapist asked me was “do you remember any song from your youth that reflected the singer’s pain and his ability to reclaim a good life for himself”. I immediately jumped on Neil Diamond whose 1971’s song was my saver.

Diamond was serious about getting into the movies in 1970, though he hadn’t done much acting. When producer Marvin Worth discussed a Lenny Bruce biopic with him, the singer threw himself into it. In 1970 Diamond auditioned for the lead role in the film about the comic; he didn’t get the part, but he finally ended the sad experience with a classic song, I am, I Said. While his hits had been universally themed love songs, this was the first to tell exactly what was on his mind.

Diamond apparently did well at the audition, but Lenny Bruce’s mother was present and the singer felt uncomfortable using a deceased artist’s words in the mother’s presence. And Bruce’s material was more risque than Diamond’s, and as the song later pointed out, he disliked swear. As he told Rolling Stone: He was just saying all those things he had been holding in. It was all the anger that was pent up in me. Suddenly here he was, speaking words that he had never spoken before. He went into therapy almost immediately after that. 

The song took Diamond 4 months to compose, one of his most intense efforts, referring to both Los Angeles and New York. Diamond admitted to Mojo Magazine that the song came from he was in therapy in Los Angeles! Author David Wild interviewed Diamond for a later book and he discussed how his efforts to channel Lenny Bruce evoked such intense emotions that it led him to spend time in therapy. It was an attempt on his part to express what his dreams and his aspirations were about. The lyric also referred to the sense of dislocation he felt at leaving his N.Y birthplace for Los Angeles where he felt like an outsider.

Some of the classic Diamond songs were written quickly but I am, I Said was slowly written, taking 4 months of constant work. Even the song’s complex rhyme scheme made it difficult to complete. Still, his song was released in Mar 1971 and became a radio favourite for months.

I am, I Said was the song to open and close the 1971 album Stones, his homage to the singer-songwriter movement. With only 3 original songs, Stones found him interpreting classic numbers by Leonard Cohen, Joni Mitchell and Randy Newman. Stones opened with the single version of I am, I Said and closed with a reprise, which began with the 2nd verse and continued after the single fades, with Diamond shouting I am! with only strings behind him. This moment was touching as the single itself.

But the definitive version of I Am, I Said was on the 1972 live album Hot August Night. It was actually more intimate than the single, beginning with just the acoustic guitar. Diamond’s delivery displayed all the emotional turmoil that birthed the song, along with its toughness and confidence. 

My beautiful parents, both in their late 80s

I Am... I Said Song by Neil Diamond ‧ 1971 

L.A.'s fine, the sun shines most the time
And the feeling is lay back
Palm trees grow and rents are low
But you know I keep thinking about
Making my way back

Well I'm New York City born and raised
But nowadays I'm lost between two shores
L.A.'s fine, but it ain't home
New York's home
But it ain't mine no more

I am... I said
To no one there
And no one heard at all
Not even the chair

I am... I cried
I am... said I
And I am lost and I can't even say why
Leaving me lonely still

Did you ever read about a frog
Who dreamed of being a king
And then became one
Well except for the names
And a few other changes
If you talk about me
The story is the same one

But I got an emptiness deep inside
And I've tried
But it won't let me go
And I'm not a man who likes to swear
But I never cared
For the sound of being alone

I am... I said
To no one there
And no one heard at all
Not even the chair
I am... I cried
I am... said I
And I am lost and I can't
Even say why

UK's National Health Service, slow & vital development

Queen Elizabeth Hospital Birmingham, originally built in 1933
and replaced by the new hospital in 2010.
It is one of the largest single-site hospitals in the UK

After the Boer War, a Committee on Phys­ic­al Deterioration (1903) was created to study Br­itain’s health, to determine why so many army men were ill. This Committee promoted the 1906 Lib­erals’ re­forms in public health, including the first Nat­ional Health Insurance scheme (1911). Not universal in cover­age to be sure, but a modest start.

Then examine the Minority Report of the Royal Commission on the Poor Law in 1909. Headed by socialist economist Baroness Beatrice Webb, the report urged a new sys­tem to replace the Poor Laws that had existed since the Vic­t­or­ian workhouse era. Vic­torian politicians had upheld a narrow-minded app­roach, exp­ecting the impoverished to be totally accountable for th­em­selves. So the Report was unsucc­essful; its ideas were disreg­ar­d­ed by the new government.

4 years of WW1 ravaged British society, greatly increasing morbidity and mortality rates. So the Interwar Period pushed the gov­ernment into reorganising public healthcare. The Min­ist­ry of Health Act was passed in 1919, giving Britain its first-ever Health Minister! In the int­er­war era, spec­ialist clinics were established to treat dis­ease and to advise on nutrition and fit­ness. And breakthroughs were made in treating pneum­onia. Britain recog­­nis­ed the need for greater government involvement, to improve social sec­ur­ity and public health.

The 1929 Local Government Act dissolved Poor Law Unions, estab­l­ish­ing Public Assistance Committees in the County Councils instead. By integrating medical serv­ices, the LGA allowed for many old infirm­ar­ies to be developed into gen­er­al hospitals with acute care. And in 1930 London County Council took over re­s­ponsibility for 140 hospitals & medical schools, after the Metropolitan Asylums Board ended.

The Emergency Health Service/EHS was created in 1938. Pre-WW2, the EHS was tasked with planning for possible mass bombing of cit­ies. It rev­ol­utionised healthcare in Britain, mainly by re­quiring all hospitals and clinics to coordinate for the first time eg sharing sup­p­l­ies. Thus the British government was learning from evolving wartime heal­th­care prac­tices.

The book Fighting Fit charted the develop­ment of Britain’s pub­lic health measures in WW2. It began in 1939 with the threat to Atlantic convoys, dealing with rat­ion­ing and ended in 1947 when Reg­ul­ation 33B (re control of venereal disease) was rep­ealed before the Nat­­ional Health Service Act started. To keep Brit­ain war fit, the gov­ern­ment mobilised adults in its services eg to supply blood transfus­ion service.

Church­ill’s stir­ring speeches ran th­roughout Fight­ing Fit as the P.M (1940-5) saw the strategic impor­tance of im­p­r­oving Britain’s health. It was not surprising that the NHS inh­erited im­portant el­em­ents of wartime projects: co-ordinated hos­pitals, nat­ional pathol­ogy, integrated blood-banks.

Sir William Beveridge was asked to investigate British soc­ial security and in Dec 1942, the Committee’s Report on Social Insurance and Allied Services identified 5 major issues in British soc­iety: want, squalour, ignorance, idleness and especially disease. Each is­sue played a major part in estab­l­ishing the Welfare State post-war & in the creation of the NHS. There was a growing consensus that the exist­ing heal­th insur­ance system should be extended to include dep­end­ents of wage-earners and that private hospitals should be integ­rated. The Bev­er­idge Report finally made its final recommendations, supported in Parliament by all parties.

Eventually the Cabinet endorsed the White Paper proposed by Minister of Health Henry Willink in 1944, setting out NHS guidelines eg how it would be funded from general tax­ation and not national insurance. Ev­ery­one was entitled to treatment and it would be prov­ided free at point of delivery.

Alas some of the key lessons of WW2 were soon forgotten, espec­ial­ly that to be effective, public health had to consider community, diet, social class, mental health, preventative medicine and work­place health. Presumably this was due to the growing post-war belief that most problems could be solved by modern technology. Plus how many doctors resisted the intrusion of government into medicine?

 Aneurin Bevan, Health Minister

A guide to the National Health Service Act, 1946
Published by The Labour Party.
Pinterest

Finally Labour's Clement Attlee became Prime Minister in 1945 and Aneurin Bevan became Health Minister. It was Bevan who campaigned to bring about the NHS in modern form, based on 3 essent­ial values ideas which Bevan expressed in the launch July 1948: 1] that the services helped all citizens; 2] health­care was free and 3] that care would be provided based on need rather than ability to pay.

The Birth of the NHS by Jessica Brain was a great book. The launch of the NHS in July 1948 came from decades of work from those who felt the current healthcare system needed to be revolutionised. It was launched at the Park Hospital Man­ch­ester, providing free health­care and med­ical services for ordinary families. The NHS’ work­ers, main­ly G.Ps, were paid large­ly through taxation. But as equipment and tech­nology advanced, fin­an­cially stability became harder.

All 4 U.K countries provided the following services: hosp­it­als and specialists, local health authorities, GPs and dentists. Since then the NHS has gone through many changes, dev­eloping and expan­d­ing. In the early years of the NHS, expend­iture was already exceeding exp­ectations and prescriptions ch­ar­ges were con­sid­er­ed to meet the rising costs. By the 1960s these ear­ly adjustments were altered and it was considered to be a strong era of growth for the NHS, especially in drug devel­op­ments. And new re­or­g­anisations occ­urred in 1974 as the econom­ic op­tim­ism of the earlier decade waned. By the 1980s and Margaret Thatcher’s gover­n­ment (1979-90), modern manage­ment methods were int­r­o­duced. But ev­en Thatcher saw the necessity for the NHS to remain a core of British life.

Conclusion
WW2 had a major impact on the development of pub­lic health. But not just the war. The NHS created in 1948 marked the most import­ant moment in British social and medical hist­ory, with new ideas about health, servic­es, med­ical ethics and soc­iety. Yes it faced crises and economic changes in its 70 years of op­er­at­ion, but the questions of funding and demand still continue.

The History of the NHS by by Geoffrey Rivett

Nuttfield Trust

Chocolate lovers: visit Malta

I loved holidaying in Malta but now I know there was much more to learn.

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Malta Chocolate Factory

Built by the Knights of St John in the mid-C16th on the centrally located Mediterranean island of Malta, Valletta quickly became a very important and cosmopolitan harbour city, and a perfect place through which foreign culinary practices and new exciting ingredients would have been able to enter the island. And, through the influence and strong links that the multi-national Knights enjoyed with overseas regions, some ingredients were able to come into Malta relatively earlier when compared to other parts of Europe. One example of this was chocolate. Malta was among the pioneering countries to have introduced the drinking of chocolate in Europe. Originating in Mexico, cocoa beans were introduced into Malta by the Spanish knights.

Born in Valletta Francesco Buonamico was a medical doctor, but as was usual for clever men, he was also a specialist botanist, antiquarian, linguist, scientist, poet, writer and theologian, a post-Renaissance genius. Buonamico was best known for his travelogues, written over a decade that he spent visiting 70 cities across Europe. While studying in France in the mid-1600s, Francesco Buonamico wrote the Trattato della Cioccolata, claiming that the island could boast of having been a forerunner in the coffee and chocolate drinking crazes that swept Europe in the C17th.  Buonamico wrote extensively and is best known for his travelogue, written in a decade that he spent visiting 70 cities all over Europe.

It was while studying in France, aged 19, that he wrote what was seen as one of the earliest treatises on chocolate. In his 8-page manuscript, Buonamic claimed that South American Indians resorted to chocolate drinking because they had no wine; so chocolate was clearly a drink then. The treatise provided a drinking chocolate recipe that included orange peel, spices, nuts and aniseed. In Malta, cocoa beans were used as the main ingredient for cold drinks and even ice creams. By late 1700s, Maltese chocolate wrapping paper started to be printed, indicating that by then chocolate was being consumed also as a solid. We also know that in Malta, cocoa beans were used as the principal ingredient for the preparation of a cold drink, granita, sorbet and icecream. 

But despite its limited market, it continued to attract the attention of scientists interested in discussing its nutritional benefits. It was still recognised as a precious treat, one that was given to dignitaries visiting Malta.  Grand Master Pinto gave chocolate as a reward to a group of men who infiltrated a network of organised smuggling from the Order’s bakery. Grand Master de Rohan had a personal chocolatier who worked at the palace, while a number of Inquisitors of Malta are also known to have treated their high-ranking guests with this luxury. In 1798 the Inquisitor’s Palace listed copper chocolate pots and other specialised equipment, just to meet the Inquisitor’s cravings!

Maltesers are a British confectionery product made by Mars Inc, first sold in UK in 1937. Originally described as energy balls and aimed at women, Maltesers consisted of a spheroid malted milk centre surrounded by milk chocolate. Their first logo was The chocolates with the less fattening centre. Ads claimed Maltesers malted milk centre was 1/7 as fattening as ordinary chocolate centres, leading marketers to value it for weight loss. In a later poll, they were the most popular sweet in the UK. They have since been sold in Europe, Australia, New Zealand, Canada, U.S and Middle East. In Australia, Mars signed up with MacRobertson's in 1954 which bloggers will remember if they were at school in the mid 1950s. Only in Jan 2017 did Maltesers officially became available in U.S. In fact the factory in Ontario, Canada produces 80% of its Maltesers for the U.S market.

Chocolate coconut balls

Credit: I love Maltese food

 

Due to its expensive market value and exotic nature, chocolate was primarily consumed by the nobility, but despite its limited market, it continued to attract the attention of scientists interested in discussing its nutritional benefits, if any existed. It was still recognised as a precious treat, one that was offered to dignitaries visiting Malta. Grand Master Pinto presented chocolate as a reward to a group of men who infiltrated a network of organised smuggling from the Order’s bakery. Grand Master de Rohan had a personal chocolatier who worked at the palace, while a number of Inquisitors of Malta are also known to have treated their high-ranking guests with this luxury. In 1798 the Inquisitor’s Palace listed copper chocolate pots and other specialised equipment, just for the Inquisitor’s cravings!

Few Maltese salt pans/salini remain today. This chocolate bar comes from the timeless, age-old craft of salt farmers, who have harvested salt traditionally for 400+ years. Hand harvested sea salt from the Salt Pans is lightly sprinkled over Dark Chocolate. Its delicate texture and gentle saltiness bring out the complexities of the dark chocolate blend.

Taste traditional Gbejniet cheese in Gozo; delicious, round white cheese made from sheep’s or goat’s milk, dried in ventilated boxes and later spiced in wine vinegar & topped with crushed pepper. Taking inspiration from the obsession with cheese, embraced goats’ milk to create an alternative to milk chocolate. Peppered cheese chocolate is grassy, creamy, fresh and slightly sour.

tasting tables and drinking area

Malta Chocolate Factory

At the Malta Chocolate Factory, look through the kitchen viewing window into the factory to see artisanal chocolates being handmade. Adults then sit tasting wine, beer, cocktail and chocolate pairings.

Each important Maltese holiday has a special chocolate item that families always buy or make. Before Lent, the Maltese celebrate Carnival with prinjolata, a traditional cake made of sponge, almonds, cherries, pistachios & chocolate. Feast of St Joseph is connected to fried choux pastry balls, filled with sweet ricotta and topped with chocolate. Christmas Eve is celebrated with hot, spiced cocoa drink with chestnuts, orange rind, cinnamon, nutmeg and cloves.

For exotic, savoury tastes, see the Authentic Maltese Chocolate Collection, 6 unique chocolate bars made with local flavours. Combining Maltese ingredients the endemic Bidni olives and Sea Salt. The cultivar known as Bidni is endemic to Malta but, until a few years ago, it was rare and virtually unknown. Taste the strong, peppery, melt in this true artisan/handmade product. 

Few Maltese salt pans/salini remain today. This chocolate bar comes from the timeless, age-old craft of salt farmers, who have harvested salt traditionally for 400+ years. Hand harvested sea salt from the Salt Pans is lightly sprinkled over Dark Chocolate. Its delicate texture and gentle saltiness bring out the complexities of the dark chocolate blend.

Malta artisan wine pairing

Power Traveller

Elf Hamper 2024

Malta Gift Service

Hiroshima's Peace Memorials.

The most important Japanese tour for my grandchildren in 2024 was Hiroshima’s Peace Memorial. My children and I heard my father’s WW2 history many times, but my grand children knew nothing from the family. So they read the following from Atomic Archive before they left Australia.

Product Exhibition Hall and dome by Czech architect Jan Letzel built 1915

taken from Motoyasu Bridge in 1939

 

By late May 1945, the Manhattan Project Interim Committee  selected the Japanese city/cities to bomb. While President Truman had hoped for a purely military target, some advisers believed that bombing an urban area might break the fighting will of the Japanese people. While plans for the invasion of Japan were going ahead, preparations were being made to use an atomic bomb. The Little Boy bomb was ready for delivery by July 31

The Target Committee’s primary concern was showing off the bomb's power to the maximum effect, especially since Hiroshima was a major port and a military headquarters i.e a strategic target. Post-bomb photos could be taken and since Hiroshima had not been damaged by earlier bombing raids, these photographs would present a clear picture of Little Boy’s damage.

The Potsdam Declaration was issued by the U.S, Britain and China in late July 1945, calling for the unconditional surrender of Japan. When the Japanese military ignored their threat of prompt and utter destruction, U.S Major Gen Groves drafted orders to use the bomb and sent them to General Carl Spaatz, Commander of Air Forces in the Pacific. With approval by Army Chief Staff George Marshall, Secretary of War Stimson and Pres. Truman, the order to drop Little Boy on Hiroshima was given.

Note that some atomic bomb researchers at Met Lab in Chicago tried to stop its use. Ironically Dr Leo Szilard had led atomic bomb research in 1939 against Germany, but since the threat of a German bomb was over, he started a petition to Pres Truman so save Japan. With 88 signatures on the petition, Dr Szilard circulated copies in Chicago & Oak Ridge, only to have the petition quashed at Los Alamos by physicist Dr Oppenheimer.

Early on 6th Aug 1945 an American bomber, Enola Gay, left U.S administered Tinian Island south of Japan for Hiroshima. Piloted by Col Paul Tibbets, the 4-engine plane and 2 observation planes carrying cameras and scientific instruments, flew out. Enola Gay was the plane carrying a bomb, one that was expected to massacre everything within a 5 ks of the city centre. Measuring 3+ ms long and 75 cs across, it weighed c4.5 tonnes and had the explosive force of 18,000 tonnes of TNT. Col Tibbets told his crew that the plane was carrying the world's first atomic bomb!

By 7AM the Japanese radar-net detected the U.S aircraft, and the alert was broadcast throughout the Hiroshima area. Soon after, a weather plane circled over the city but there was no sign of bombers. The Japanese citizens began their daily work, thinking the danger had passed. Soon the Enola Gay was cruising over Hiroshima and by 8 AM, Japanese radar again detected B-29s heading toward the city. Radio stations broadcast another warning for people to take shelter! Enola Gay crew could see the city appear below and were messaged that the weather was perfect over Hiroshima. The Little Boy exploded, instantly killing up to 140,000 people and leaving up to 100,000 more to die slowly from radiation. Over two-thirds of Hiroshima's buildings were demolished. Hundreds of fires, ignited by the thermal pulse, combined to produce a firestorm that had incinerated everything within 10 ks of Ground Zero.

The Genbaku Dome, now Hiroshima Peace Memorial,

was one of the few structures left (barely) standing.

Guardian

Smoke is still hanging and the charred bodies are scattered, 

10th Aug 1945 

 

In 1945 Hiroshima was the first city in the world to be hit by an atomic bomb. Endless lives were lost, and those who barely managed to survive suffered great mental and physical damage, dying from radiation sickness. Exactly 4 years after the bomb was dropped, it was decided that the destroyed area would not be redeveloped but instead devoted to peace memorials.

The Peace Memorial Museum opened in 1955 with the aim of conveying the tragedy caused by the atomic bomb to people all over the world, contributing to the abolition of nuclear weapons and lasting world peace. This Museum collects and exhibits the belongings of survivors, as well as photos and materials showing the devastation caused by the bomb, introducing the history of Hiroshima before and after the bombing, and the nuclear age world.

Thus today Hiroshima's Peace Memorial Park is a prominent feature of the city, a large park of 120,000+ sq ms. Pre-bomb, Peace Park area was the political and commercial heart of the city; now its trees, lawns and paths starkly contrast with the surrounding central business district.

The park's main facility is the Peace Memorial Museum. The two buildings of the museum survey the history of Hiroshima and the advent of the nuclear bomb. Naturally the main focus is on the events of 6th Aug: dropping the bomb and its outcome in human suffering. The personal details displayed are very upsetting for most visitors.

The A-Bomb Dome/aka Hiroshima Peace Memorial, is what remains of the former Prefectural Industrial Promotion Hall, the building that promoted Hiroshima's industries. When the bomb exploded, it was one of the few buildings to remain standing, and remains so today. A UNESCO World Heritage Site, the A-Bomb Dome is a clear link to Hiroshima's past.

Between the Museum and the A-Bomb Dome is the Cenotaph for the A-Bomb Victims. The Cenotaph is an arched tomb for those who died because of the bomb, either because of the initial blast or exposure to radiation. Below the arch is a stone chest holding a register of these names, of which there are 220,000+. Every year on the anniversary of the bomb, a ceremony is held at the park. Speeches are made, wreathes are laid at the Cenotaph and a moment of silence is observed at exactly 8:15 AM.

Many reviewers criticised the Peace Memorial Museum’s layout. But when the visitors enter the first part of the museum, it feels as if they are cut off from the outside world; walking through the exhibition not a leisurely stroll but a rugged test, fitting the disturbing exhibition and displays. And sometimes it is extremely crowded and hard to be able to read the displays. Nonetheless the museum is a must-see in Japan, a place that changes lives.

Children's peace memorial

Bombed areas filled with Memorial Park now

City centre in the background

The old Product Exhibition Hall is now

Hiroshima's Peace Memorial Museum

Bruno Bettelheim: a brilliant psychologist?

Bruno Bettelheim 

Tantor media

Bruno Bettelheim (1903–90) was born in Vienna, son of a middle-class Jewish lumber merchant. He entered Vienna Uni, but was forced to leave to take over his fam­ily business when his father sickened. In 1930, he married school-teacher Gina Al­stadt, a dis­ciple of Anna Freud.

During the 1930s Bruno and Gina took care of an autistic child who lived in their Vienna home for 7 years. After 10 years, Bettelheim returned to his education, earning a PhD in 1938, among the last Jews award­ed a doc­torate before the Nazis annexed Austria in the 1938 Anschluss.

In the late 1930s, Bettelheim travelled between German state hospitals during the infamous Disabled Euthanasia Programme, the st­art of his re­search in mental patients. He became an accredit­ed ther­ap­ist and return­ed to Austria. But Bettelheim was arr­ested in 1939 by the Gestapo and spent 10.5 months in­ Dachau and then Buchenwald con­cen­trat­ion camps. In the camps, he supervised the prison­ers' mental health. His rel­ease occ­ur­red just prior to WW2 but he lost everything and his wife left.

Empty Fort­ress: Infant­ile Autism and the Birth of the Self, 1967

Bettelheim married Ger­trude Weinfeld in 1941 and had 3 children. After his release, Bettelheim ?moved to Australia in 1939, and then to the U.S in 1943, becoming a naturalised cit­izen there. He sur­v­ived by teach­ing art history, German literature and psychol­ogy.

He wrote his concentration camps experiences in Indiv­idual and Mass Behaviour in Extreme Situations (1943). He analysed camp in­mat­es’ beh­aviour, studying the effects of horror on the prison­ers, prison guards and himself. Bettel­heim used psychoan­al­ytic princip­les, includ­ing Anna Freud's concept of iden­t­ification with the aggres­sor, to explain why many prisoners took on the val­ues of their tort­urers to survive. He saw many inmates falling prey to Vic­tim Guilt.

In 1945 Gen Eisenhower asked his officers in Europe to read the article, to prepare for the shock of dealing with concentration camp survivors.

Bettelheim’s work had to be analysed in the context of great soc­ial change, from the Bolshevik Revolution and WW1, to Nazism and WW2. He was greatly influenced by Sigmund Freud’s psychoanalysis, and studied the work of Carl Jung and Anna Freud. Bettel­heim was also interested in the effect of social systems on individuals.

This Prof of Psychology taught at Chicago Uni from 1944 until re­tirement (1973). The most signific­ant part of Bettelheim's career was as Director of Sonia Shankman Orthogenic School, a home for emotion­ally disturb­ed children. He wrote books on both normal and abnormal child psychol­ogy, and his milieu ther­apy was widely used at the Orthog­enic School. His world famous therapy is still widely used in treat­ing em­ot­ion­ally dist­urbed children. There he created a therap­eut­ic environment that supported severely disturbed children, gen­erally human­ising their treatments. The rooms were clean, the child­ren were free to move around and the staff had to accept ALL children’s behaviour. Via his lectures and books Bettel­heim inspired generations of parents to apply psych­ol­ogical principles to their child rearing.

In 1960 Bruno published The Informed Heart: Autonomy in a Mass Age, explaining the relationship between the external en­vironment and mental disorder. He learned from his concen­tra­t­ion camp exp­er­iences where he saw normal people going in­sane in the dehuman­is­ing environment. Bettelheim concluded that only a positive env­ir­on­ment could influen­ce one’s sanity and remedy mental disorders.

He compared his post-camp attempts to preserve a sense of autonomy, in­tegrity and personal freedom Vs life in modern, mass society. Mass U.S or Western Europe societies were dehumanising and depers­on­alising. People had to struggle to maintain their sanity, much like inmates in the camp

   

A Good Enough Parent : A Book on Child-Rearing

1987

His best selling book was Uses of Enchantment: Meaning & Importance of Fairy Tales (1976). There he used Freud­ian psychology to analyse the healthy effects of fairy tales on children’s psyches. It was aw­ar­ded the 1977 Nat­ional Book Award for Con­t­emporary Thought. [NB his psych­o­­an­alytical treatise on fairy tales was said to have been plagiarised].

Bettelheim believed autism had no organic basis; rather that autic children behaved like help­less concentrat­ion camp inmates. The main reason was the negative par­ental interaction with infants dur­ing crit­ical stages in their development. Such children learn­ed to blame themselves for their families’ negative atmos­ph­ere, and withdrew into fantasy worlds. It was mainly the result of upbringing by mothers (and fathers?) who did not want their children to live with them. This in turn caused them to restrict contact with them and failed to establish an em­otional connection.

Bettelheim pres­ented a complex explanation in psych­ological terms, der­ived from the qualitative inv­estigation of clinical cases in his book: The Empty Fort­ress: Infant­ile Autism and the Birth of the Self (1967).

His Refrigerator Mother Theory recognised the association bet­ween the lack of parental attachment and autism, and att­rib­uted childhood autism to unemotional, cold mothering. Bettel­heim’s famous theory of autism enjoyed considerable attention and infl­uen­ce while Bett­el­heim was alive.

Bettelheim's life was an example of the very pro­cess he described, the shocking effects of in­humane treat­ment on psychological hea­lth. He suffered from depression late in life, espec­ially after his wife's death in 1984. In 1987 he suffered a stroke. In 1990, he suicided in Silver Spring MD.

Post-death, some of Bettelheim's work was discredited. Controversy arose surrounding Bettelheim's psychological theories AND his per­sonality. He was known for exploding in anger at students or patients, and that he spanked his patients, des­p­ite publicly rejecting spank­ing as brut­al.

Some Freudian analysts followed Bet­t­elheim's lead and created their own methodologies reg­arding autism. Some ac­cused the mother for the child's autism, and others claim­ed that vict­ims were to be blamed for their own bad luck. When I did 2nd year Psychology at university in 1967, I read and loved all the Bettel­heim books pub­lished before 1966. So now that his theories are often dis­fav­oured, I feel retrospectively cheated. Presumably he wasn't 100% brilliant.

The Uses of Enchantment: Meaning and Importance of Fairy Tales
1976

Still, Bettelheim remains widely known for his stud­ies with autistic and emotionally dis­turbed children and made sig­nificant cont­ributions to their treatment. Orthogenic Sch­ool became a model for applying psycho­an­alytic prin­ciples in the treatment of emotionally disturbed child­ren