MUNCHAUSEN-BY-PROXY AND MEADOW’S SYNDROME

Posted by admin on April 20, 2009 under Allergies | Be the First to Comment

Baron von Munchausen was an eighteenth-century Hanoverian soldier who greatly exaggerated his prowess in war – and his battle-scars. ‘Munchausen’s syndrome’ is the name given to attention-seeking patients who feign illness or deliberately fabricate symptoms. There are instances, fortunately very rare, of mothers simulating illness in their children in order to get medical attention -this is known as ‘Munchausen-by-proxy’ or ‘Meadow’s syndrome’ after Professor Roy Meadows, who first described two cases in 1977. Doctors are far more aware of this possibility in children than they once were, and any parent attempting to fabricate symptoms is likely to be found out very quickly.

The question of Meadow’s syndrome in relation to food sensitivity is a difficult issue. Various doctors have described cases of children whose parents believe them to have food sensitivity, but where no consistent reaction to a food can be shown. If those parents seem over-anxious or over-protective, and have obvious emotional problems of their own, then they have often been labelled as ‘Meadow’s syndrome’.

Eleven such cases were reported in 1984, in an influential article that has coloured the outlook of many doctors, and led to the belief that Meadow’s syndrome is quite common in relation to food sensitivity. However, there were several important differences between the cases described in this article and Meadow’s syndrome proper. For one thing, the children involved all had genuine symptoms, and there was no suggestion that the parents had attempted to fabricate any symptoms. Unlike Meadow’s syndrome mothers, these women did not seem to relish their child’s hospital stay, nor were they willing to subject them to any investigation, however painful and unpleasant. Such differences are important and must raise serious doubts about the conclusions reached – was the label ‘Meadow’s syndrome’ really justified? These parents may have been disturbed or overwrought, but this does not necessarily mean that they were mistaken about their child’s illness. The elusive nature of the reactions seen in food intolerance makes it difficult to rule out this diagnosis without very thorough testing, and there seems to have been undue reliance on skin-prick tests in this study, despite the fact that these are unreliable indicators in most cases of food sensitivity. Despite the doubts over this study, the idea of ‘Meadow’s syndrome’ has become a popular one, especially among those doctors who are sceptical of food intolerance generally. This is unfortunate for parents, especially when such a diagnosis is made without proper testing for food sensitivity, and without any firm evidence of fabrication. There undoubtedly are cases of parents who exaggerate their child’s ills, and who are determined to blame them on some physical cause, when family tensions and emotional problems are actually the true source of the symptoms. But unless there is gross exaggeration or fabrication of symptoms, these should not be described as Meadow’s syndrome.

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FOOD ALLERGY: ALLERGEN AND ADJUVANTS

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An allergen is essentially the same thing as an antigen, except that it happens to cause an allergic reaction in a particular person. The proteins in cow’s milk, for example, are antigens to most of us, but for the child with cow’s-milk allergy they are allergens. The main difference between an antigen and an allergen is not in the molecule itself but in the way the individual’s immune system reacts to it.

Having said that, it does seem that some foods are more ‘allergenic’ – more likely to cause allergies – than others. Certain foods turn up again and again as the culprits in food allergy, while other commonly eaten foods are rarely en-

countered. Why this is so, no-one can say at present, but there are several possible explanations.

Perhaps these apparently more allergenic foods contain compounds with very unusual and distinctive chemical features that are ‘easily recognized’. Such compounds might induce IgE antibodies more readily than others, although it is far from certain that the structure of antigens can exert such an influence over the immune system. The whole question of how the body scrutinizes incoming antigens and regulates its response to them is still very poorly understood. As yet no-one can say what role the chemical make-up of antigens plays.

An alternative explanation is that such foods contain substances which stimulate an immune response, known collectively as adjuvants. Adjuvants are used in the laboratory as a way of inducing immune responses for research purposes. These adjuvants are mostly derived from bacteria, but there are also adjuvants found in some plants. The extent to which these occur in foods, and their potential for stimulating IgE rather than other types of antibody, is unknown.

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A SELECTION OF MEDICINAL HERBS – AN EFFECTIVE REMEDY FOR ASTHMA

Posted by admin on April 8, 2009 under Herbal | Be the First to Comment

Of all the available plant remedies for asthma the various butterbur preparations stand out as being the most effective. These are Peta-stites officinalis extract, Petadolor tablets and, for exceptionally stubborn conditions, Petaforce capsules. All these preparations are made from 100 per cent plant extract and are reliable antispasmodics. A senior consultant at a Kneipp sanatorium once related the case of an asthma attack that would have killed the patient if it had not been for the doctor’s help. The strongest chemical medicine, which the doctor had reluctantly administered before, was

not as effective as the Petasites preparations he then gave the patient. Moreover, it is gratifying to know that Petasites not only provides effective short-term relief but in time will bring about a cure.

The effect is not always the same with every patient, since there are various kinds of asthma. To back up the treatment, it is often necessary to prescribe a biological calcium preparation, for example Urticalcin. One asthmatic told us that such a treatment with Asthmasan had practically rid him of his problem, even though he used to suffer from almost unsupportable attacks every time there was an atmospheric depression, or fohn, in the air.

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FOOD FOR THOUGHT

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I am often surprised to see young girls strutting along in high-heeled shoes, or else in slipper-like shoes with thin soles and no heels at all. Both extremes are harmful and inappropriate; both force the body into an unnatural position, causing it to tire more quickly and suffer damage. The blood can become congested, leading to varicose veins.

There is a natural reason why walking barefoot does not cause any problems. You simply would not walk for long along a hard and even road surface, but over meadows, fields and forest ground, all of which are uneven surfaces that support the arch of the foot, for movement acts like a massage. Judging from the standpoint of zone therapy, you will happily realise that the whole body benefits as a result. It is for this reason that walking barefoot in warm weather when you are on holiday or when working in the garden is an effective and invigorating natural treatment.

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BEAUTIFUL HAIR – A MEDICAL BOOK – STRONG AND HEALTHY HAIR

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A healthy hair is strong, being able to support a weight of about 80 g (just under 3 oz) without snapping. A diseased hair, however, will tear when a weight of 30—40 g (about IV2 oz) is suspended from it. The healthy pigtail of a Chinese or Indian woman is able to support about 2Ó2-Ç tons before it s.iaps. Of course, the resistance of a single hair depends also upon its relative thickness. People who live close to nature have thicker and stronger hair than those who do not. Generally speaking, the more refined our food and life-style, the finer will be our hair.

When a hair is pulled out, the root, held fast in the dermis, is able to manufacture another hair shaft. However, eczema and other diseases affecting the scalp can make this part degenerate and die, so that the affected areas become bald. Typhoid fever is usually responsible for the loss of all hair, but the hair bulb does not actually die and the hair has been known to grow back even more luxuriantly after recovery, when the capillary vessels and lymphatics have returned to their normal function.

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SEVEN BASIC RULES FOR THE PREVENTION OF CANCER – RULE THREE

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We must not poison our body fluids and cells with chemicals. For this reason it will be clear why it is essential to avoid all medicines used in chemotherapy that are capable of disturbing the normal cell metabolism. Watch out especially for medicines based on tar. The compulsive consumption of tablets and narcotics is also responsible for upsetting the biological balance, physically as well as mentally. Smokers may delude themselves into thinking that nicotine is not really harmful and has no influence on cancer, but it is an established fact that the phenols – tar – contained in tobacco are carcinogenic. Why be foolishly deceived and suffer the tragic consequences?

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ARTHRITIS AND GOUT – ACTH (HORMONE PRODUCTION)

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Since the pituitary holds a key position in the body’s hormone production (it manufactures a considerable number of different hormones), the hormone balance is disrupted and the resulting damage may be even more difficult to rectify than the arthritis itself. As far as hormone preparations are concerned, however spectacular their effects may be, one must always remember that only one side of the coin is seen at a time, and the other side may look quite different.

I once had the opportunity to discuss these points with a doctor who had lectured on this subject and he frankly admitted that he would not use these remedies for himself. Should the need arise, he would look for another, more conservative way of treating the disease. Of course, I do not deny that in some cases the use of the new medications may be justified, but let the doctor and patient alike consider very carefully what side effects they might produce and what the ultimate, rather than the immediate, effect might be. Careful analysis and observations have led me to conclude that all hormone and organ preparations should be viewed with the utmost caution before prescribing or taking them.

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SEX THERAPY: READINESS OF PATIENTS, POSSIBLE PROBLEMS

Posted by admin on April 6, 2009 under Men's Health-Erectile Dysfunction | Be the First to Comment

Some couples are obviously not ready for sex therapy as indicated by their resistance to the exercise. Typical responses are to blame the surroundings (it was too cold, too slippery, the shower was too small), or to retreat to personal idiosyncracy (prefer baths, don’t like being touched, don’t like to wash anybody). One couple, having been told not to use washcloths, used sponges—an obvious case of resistance.

When the reported results are uniformly negative, and further psychodynamic exploration reveals significant intrapsychic pathology or interpersonal hostility, the couple is usually considered not ready for sexual therapy, and additional individual or dyadic therapy is needed. When the resistance to shower or relaxation exercises appears to be more a matter of fear of intimacy than hostility toward the partner, it is possible to proceed with sex therapy, bypassing the relaxation phase and proceeding to the intensive exercises.

In many cases, the results of the probe are not clear. Typically, the partners feel awkward, clumsy, and embarrassed, afraid of each other’s comments and fearful that they will do something wrong. Usually by the end of the second shower, the situation has eased considerably, but there still may be tension if not outright hostility. In these instances, although intimacy is desired, the tension is so great that intimacy seems threatening. Each has staked out a position in which one is “right” and the other is “wrong,” and intimacy can undermine these positions. Such dyads almost always can benefit by starting with the relaxation exercises.

When the therapy is terminated, the sex therapist reports the results to the referring therapist, and these reports, with the permission of the patients, will include discussions of any new material that may have arisen in the course of treatment. The holistic therapist, having incorporated dyadic and family therapy in the process of sex therapy, will reassess with the couple the direction in which they wish to proceed. Even unsuccessful sex therapy can help to clarify the underlying causes of the basic dyadic problem.

In the majority of referrals, treatment proceeds smoothly and there are no unusual complications. In some cases, special problems unrelated to sex therapy itself may arise. Because sex therapy per se encourages pleasure and enjoyment, positive transference to the therapist is sometimes very strong: a dyad still under treatment by a dyadic therapist may wish to leave and continue with the sex therapist; a member of the dyad undergoing individual intrapsychic treatment may wish to discontinue treatment or switch to the sex therapist. In both cases, the dyad or individual is advised to discuss his or her motives with the original therapist.

When does the sex therapist consult other therapists? The answer is, when it is in the best interests of the patient. This may occur when the sex therapist is only or primarily a sex therapist and the problem is not amenable to sex therapy, or if the dyad wishes to pursue another modality in which the sex therapist does not feel competent.

It may also occur when the patient and therapist have different priorities. Although dyadic therapists place a high priority on the stability of the dyadic relationship, they will not sacrifice the integrity or growth of the individual to the maintenance of the dyadic relationship, but they usually will try to ensure that this growth occurs within the boundaries of the relationship, if possible, and will devote considerable effort to this end. The dyad is indeed “the patient,” (as the family is “the patient” for family therapists), and the point of view of the dyadic therapist is that both partners are equally involved in the problem.

The sex therapist, on the other hand, often encounters situations in which only one member of the dyad has a dysfunction and the treatment, although pertaining to both partners, is aimed primarily at that one person. As progress is made and the dysfunction improves, the partner sometimes exhibits change in other areas (the individual ripple effect) that appears to threaten the dyad and may in fact destabilize the relationship. The sex therapist must be very sure whether he or she wishes to encourage the individual to change at the expense of the relational stability, to discourage such change, to work with the dyad on the relational problem, or to refer to another therapist. The sex therapist must be aware of his or her attitude toward extrasexual change if the therapy begins to go, as it often does, beyond the resolution of the sexual dysfunction.

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PSYCHOANALYSIS AND SEXUAL DISORDERS: MATURITY

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It is important to note that one of the presumptions of the classical psychosexual theory, namely, that the achievement of genital primacy and full genital potency was synonymous with maturity of personality development, is no longer accepted in contemporary psychoanalytic thinking. The psychoanalytic theory of personality development and the theory of the relationship between sexual functioning and personality organization have become considerably more complex since the original propositions were set forth by Freud. Contemporary psychoanalytic thinking would distinguish very carefully between genital capacity and the capacity for love relationships. In fact, the capacity to achieve mature and adult love relationships is influenced more generally by complex dimensions of personality development and psychic development, and is not simply a function of psychosexual development (Kernberg).

At a minimum one must include the parameters of psychosocial development along with those of psychosexual development in understanding such personality potentialities. The development of the capacities for mature and mutually satisfying love relationships depends on the resolution of basic conflicts on many levels of psychological development. Kernberg has indicated the importance of such factors:

The capacity for sexual intercourse and orgasm does not by any means guarantee the capacity for being maturely in love; nor does the capacity for a total object-relation without the resolution of oedipal conflicts and the related freeing from sexual inhibition guarantee the capacity for being maturely in love and for stable relation. The capacity for falling in love indicates the achievement of important preconditions for the capacity for being in love; in the case of narcissistic personalities, falling in love marks the beginning of the capacity for concern and guilt, and some hope for overcoming deep, unconscious devaluation of the love object. In borderline patients, primitive idealization may be the first step toward a love relation different from the love-hate relation with their primary objects. This occurs if and when the splitting mechanisms responsible for this primitive idealization have been resolved and this love relation or a new one replacing it is able to tolerate and resolve the pregenital conflicts against which primitive idealization was a defense. In the case of neurotic patients and patients with relatively less severe character pathology, the capacity for falling in love should, if and when successful psychoanalytic treatment resolves the unconscious, predominantly oedipal, conflicts, mature into the capacity for a lasting love relation.

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EFFECTS OF EROTICA: STUDIES OF SOCIAL BEHAVIOR

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The behavioral effects of exposure to erotica have been difficult to demonstrate despite the oft-voiced concerns of conporns that such material leads directly to social, moral, and mental decay. There are no studies in the literature surveyed which document adverse behavioral effects of pornography on general or specific population groups. Social behavior is a complex outcome of a complex interaction of almost innumerable variables. To argue that a single factor, such as exposure to pornography, can have a profound effect on such a complex set of behavioral responses is simplistic sophistry.

Most scientific studies have attempted to isolate specific types or instances of behavior and to relate them to exposure to erotica, or they have tried to assess the relative contribution of erotica, in concert with other factors, to predict categories of behavior.

The question of the relationship between erotica and antisocial behavior is an important one. It is, however, difficult to research because of the very high levels of exposure in the general public and the relatively low levels of antisocial behavior. Retrospective analysis is highly vulnerable to ascertainment bias, and prospective studies would require unacceptable levels of surveillance of unwieldly numbers over excessive lengths of time.

Despite the difficulties of defining a relationship between antisocial behavior and erotica, both laboratory and survey studies have provided interesting data.

Kutchinsky has made several careful survey studies of the effects of easy availability of pornography on the incidence of sex crimes in Denmark. Very substantial decreases in four specific categories of sex crimes—exhibitionism, peeping (voyeurism), physical indecency towards women, and physical indecency towards girls—were noted in Copenhagen after 1964. Some detractors of Kutchinsky’s data have stated erroneously that the number of crimes decreased because dissemination of pornography was no longer counted as a sex crime; others noted that sex crimes had been declining before 1964. The first objection is patently false, since only four specific categories of crimes were considered both before and after the change in availability of pornography. The second objection has more merit, but the decline before 1964 was irregular and gradual, and the decline afterwards was steady and substantial—the data clearly show two different slopes.

The decreases in exhibitionism and voyeurism found in Kutchinsky’s data could, in part, be attributed to changes in police attitudes or in the victims’ motivation to report such crimes. The change in public attitudes toward exhibitionism, as assessed in a representative sample survey of Copenhagen residents, was sufficient to account for any change in the reported incidence. Therefore, one cannot conclude that the reduction in this category was solely because of the availability of pornography. Changes in police attitudes could have accounted for the decreased incidence of reporting voyeurism.

The decline in reported incidence of physical indecency towards women also could be due to changes in attitudes toward “nonserious” incidents. No change in reported incidence of rape was found. One should keep in mind, however, that there are fewer rapes in Copenhagen in one year than there are in one weekend in New York City.

The category of crimes against children showed a fifty-six-percent decrease (from thirty-six to sixteen) in 1965, the first year in which hard-core pornographic picture magazines appeared in Denmark. This change could not be attributed to changes in public or police attitudes, to changes in methods of reporting nor to local changes since the figures for the country as a whole dropped from 220 crimes in 1965 to 87 by 1969.

Kutchinsky concluded that “the high availability of hard-core pornography in Denmark was most probably the very direct cause of a considerable decrease in . . . child molestation”. Perhaps more importantly, the number of recidivists for all sex crimes has decreased as much as the number of first offenders.

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