Biomedical subjects
Publications and source records attributed to J Cawte.
The changes that lithium brought are most fully understood when we grasp the difficulties for management that acute mania presented. Restraint in canvas camisoles, padded cells, paraldehyde, water-baths and salts-Epsom, not Lithium-met mania in echos of Bedlam still heard in the early 1950s. It is a part of psychiatric history important to remember.
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Hyperendemic foci of motor neurone disease, and other neurodegenerative disorders, are located in the western Pacific area, in the Japanese of the Kii Peninsula of Honshu Island, the Chamorros of the Mariana Islands, the Auyu and Jakai of West New Guinea. It is suspected that there is a common aetiologic pathway from toxic metal and essential minerals in these three foci. A fourth focus of motor neurone disease occurs in an isolated tribal group living on the same Pacific longitude, at Angurugu on Groote Eylandt in the Gulf of Carpentaria, Northern Australia. This environment is also characterized by local ecological extremes, including low calcium and iron, and high manganese. The "Angurugu syndrome", described in this paper, shows dysfunction of motor neurones, including upper and lower motor, cerebellar, extrapyramidal and cranial nerves, especially oculomotor. About half the cases emerge in adult life. The others are evident in early childhood. The syndrome is viewed not as simple manganism but as manganism synergistic with accompanying mineral changes. No autopsy studies have been carried out. This paper suggests that this syndrome incurs a loss of the neurotransmitter dopamine. A case study is presented that indicates the unusual range of symptoms, including ataxia, and partial relief by L Dopa (Sinemet).
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The kava bowl, a traditional feature of Pacific Island societies, has been adopted and adapted by a number of Aboriginal (Yolngu) communities of northern Australia, where it was introduced in the hope that it would challenge alcohol. This paper reports a study of its usage at Elcho Island, Northern Territory. At the high level of intake in this community, medical effects hitherto unreported are being observed. Some, such as a condition of detachment, reminiscent of the archetypal 'blissful indolence' of the lotus-eaters of Greek tradition as limned by the poet Homer, are obvious to the lay observer. Other effects are apparently advantageous for the management of alcohol abuse and some forms of psychosis. A surprising effect is the occurrence of a pellagrinous reaction. These observations indicate that further studies of the clinical effects and the human metabolism of high dosage kava are needed. Looming over all are questions of pharmacology. Do the kava pyrones possess anxiolytic or antipsychotic properties? Do they indeed have the property for which Pacific missionaries introduced them to Australia, as an alternative to alcoholism?
Before white man brought his alcohol to the South Pacific, the indigenes were using many wild plants possessing psychoactive properties. The most prominent were betel in much of Melanesia, kava in much of Polynesia, and pituri in much of Australia. The use of each of these three drugs was widespread, institutionalised as a ritual and the occasion for extensive trade. Each was valued for its effect in reducing tension or in producing altered states of consciousness. Each was also capable of inducing intoxication. Since few physicians nowadays have had my opportunity to observe the use of all three of these substances, their main features are recalled here. Attention is paid to their traditional use and probable future use, to their pharmacological and clinical properties, and to their place in the zeitgeist of people and period. There is no indication that these substances will be espoused by the drug enthusiasts of the West as avidly as other ethno-psychopharmacological agents such as Peruvian coca leaf, the Indian hemp, the Asian poppy, or the American tobacco. The possibility, however, of some use in the West cannot be discounted.
It is important for psychiatrists to recognise that vulnerability to the trace element manganese is different in the adult, foetal and neonatal nervous systems, and that different syndromes may result from exposure.
The Aboriginal people of Groote Eylandt, in the Northern Territory of Australia, are suffering from an unusual disease complex having neurological, psychiatric and teratological features, which admits no ready explanation. The island people at various times blame it on the spirits, or accuse enemies, or take some responsibility upon themselves. In this paper, 'emic' accounts of the illness (those current among the members of the society) are described in order to compare them with 'etic' accounts of those who study the society from the outside. Since emic views regulate people's behaviours toward illness, it is suggested these views should complement and inform etic views of researchers and therapists. This principle might apply to all mysterious or poorly understood illness.
A case of so-called Capgras' syndrome occurring in an elderly woman showing several degenerative conditions is presented as a basis for questioning the value of preserving this diagnostic term. It is pointed out that the concept of the changeling has ancient provenance in man's thought down the ages, and that its occurrence in psychosis does not justify its ascription as a syndrome. 'Changeling' or 'imposture' are terms which describe this kind of delusion usually occurring in underlying schizophrenic, affective and organic syndromes.
The phenomena of dreams have been accorded significance by all branches of mankind of which there is record. Australian Aborigines in their traditional cultures are no exception, although unfortunately the printed record of their dreams is meagre. This paper reports nine dreams which were volunteered by Arnhem Landers of the present day. The subjects they dreamed about represent a mélange of traditional and introduced concerns competing for attention, including lifting a taboo, portents and auguries, a shark attack, a brake failure in a truck, a mysterious light in a cave, a visit from the dead, a disappointing love tryst, a drink problem and the Christian revival movement. The ordinary dreams of Aborigines resemble those of modern Western subjects in aspects such as frequency, duration, clarity of recall, shifts in attention and derailment of the narrative, but they differ from them in being accorded more significance and in being more reflected upon during waking hours. In this respect, Aborigines infer a closer connection between the dream and the waking life.
The cultural gap between the colonists and their indigenous neighbours was an insurmountable tracking difficulty for the young nations of Australia and New Zealand. Scattered across the island continent lived Aborigines, unappreciated; and to the north, Papua New Guinea and Indonesia. The cultural distance, one of colour, of custom, of creed, of consciousness and of cash, was too wide to cross. But cultural distances between neighbours inevitably lead to tracking failures, characterized by misconceptions, fears, and ultimately, conflict. Psychiatry has some capacity to define these tracking failures, and to assess their danger. In this paper, Australia's psychiatric approach to its neighbours is examined. Two challenges are specified. In the developing countries: it is subsistence versus surplus psychiatry--do we comprehend the distinction? In Aboriginal Australia: it is the Aboriginal mental health system--do we appreciate its existence? An Aboriginal scripture (bark painting) provides the text.
The lobby for multicultural medicine has several aims: xenophilia in health appointments; schools of transcultural psychiatry; and the training and appointment of ethnic (parochial) health paraprofessionals. Modest requests, really, and I commend them to our political leaders when they come to implement the Report on Migrant Services.