The Pharmaceutical Journal
Vol 274 No 7332 p60
15 January 2005

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A modest saint invoked to relieve chills and fevers more
How ordinary people can turn into torturers more
A broader approach to the problem of childhood depression more

A modest saint invoked to relieve chills and fevers

On 21 January Saint Agnes, who ranks as the patron saint of young virgins, is celebrated. She was born in Rome in the year 291 and was martyred during the Diocletian persecution of 304, at the early age of 13.

Conflicting reports claim that Agnes was burned at the stake, beheaded or stabbed in the throat. The reason given was that she had refused marriage on the ground that she had dedicated herself to the service of Christ.

Her emblem was a lamb, something she shares with other saints. Her festival is associated with bitter cold, as John Keats observed in his “Eve of St Agnes”: “St Agnes’ Eve — Ah, bitter chill it was! / The owl, for all his feathers, was a-cold.”

On the eve of St Agnes many kinds of divination were practised by virgins to discover their future husbands. John Aubrey in 1696 noted: “Upon St Agnes’s Night, you take a row of pins, and pull out every one, one after another, saying a paternoster, sticking a pin in your sleeve, and you will dream of him or her you shall marry.”

The saint was also invoked by people wishing to counteract the ague, the name formerly for any chill or fever. To protect a family from this scourge, which was sometimes lethal, the oldest woman of the household should pronounce a chant up the chimney on St Agnes Eve: “Tremble and go! First day shiver and burn. / Tremble and quake! Second day shiver and learn. / Tremble and die! Third day never return.”

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How ordinary people can turn into torturers

Recent reports of violence and even deliberate torture associated with American guards and Iraqi prisoners have drawn attention to the phenomenon of torture of one human being by another. The psychological and cultural aspects of this problem have been described by psychologists and neuroscientists in Science for 26 November 2004.

The authors, from Princeton University, state that society holds individuals responsible for their actions, as military courts-martial have acknowledged, but social psychology suggests that peers and superiors who hold control over the general social context of human behaviour should also accept responsibility.

Almost anyone can become aggressive if sufficiently provoked, distressed, disgruntled or merely overheated, and conditions of modern warfare seriously undermine morale in many individuals. People are dealing with enemies, and it is well known that individuals prefer their own particular group and attribute evil behaviour to other groups, especially if they are perceived to be threatening cherished values. For example, US citizens on the whole view Muslims and Arabs as holding different values and are therefore sincere, honest or friendly. Discrimination also arises from emotional prejudices involving disgust or contempt.

Social psychology suggests that most people believe that others would react on the same way as themselves, and conformity with the perceived reactions of one’s peers is regarded as good or bad according to locally accepted norms. So it happens that ordinary people become capable of incredibly destructive behaviour if ordered to do so by an authority that they regard as legitimate, regardless of moral scruples. After all, obedience to authority, within reason, is the basis of any stable culture.

Torture is a crime involving socialised obedience and subordinates do not only what they are ordered to do but also what they think their superiors would order them to do in accordance with the goals of an operation. Small and apparently trivial actions are followed by serious ones of humiliation and abuse, and the perpetrators may not be aware that they are committing evil deeds. More needs to be understood of the contexts that promote aggression.

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A broader approach to the problem of childhood depression

It has been suggested that unhappiness among children is on the increase. But it is also suggested that the tendency to label the condition as depression, and therefore as something that can be counteracted by the prescribing of antidepressant drugs, is worthy of criticism.

In the BMJ for 11 December 2004, a psychiatrist, Sami Timini, offers some constructive comments. The prescribing of antidepressants — usually selective serotonin reuptake inhibitors — for children younger than 18 years has recently increased, but in practice the use of SSRIs in children has been found to be ineffective and in some instances even dangerous.

Ideas concerning child rearing in western societies have changed from an emphasis on discipline and authority to an insistence on permissiveness and individual human rights. In company with their elders, children have been encouraged through commercial prompting and peer pressure to become pleasure-seeking consumers of goods and services. The mobility of families has greatly increased and less time is allotted to family life, while extended family ties are breaking down. The trend is fed by capitalist principles prompted by increasing competition in the marketplace and dissatisfaction with the status quo.

Accordingly, some childhood behaviour previously regarded as normal is seen in terms of problems calling for medical remedies. Instead of calling a child unhappy we tend to label it as depressed. However, biological features of depression in adults, such as hypersecretion of cortisol, cannot safely be used to indicate depression in children. Where a depressed adult would lose weight and appetite and suffer sleep disturbances and feelings of guilt, a child would more often demonstrate irritability, poor schoolwork and headaches.

Children in western cultures are particularly vulnerable to the effects of sociocultural changes of recent years, where crime and the abuse of drugs and other substances have adversely affected the sense of security of families.

“We need a multidisciplinary approach to both assessment and treatment of unhappy children and their families,” says Dr Timini. “Such an approach should normalise emotional responses to adverse life experiences, emphasise more positive approaches (such as building on existing strengths and resilience) and engage more systemic biopsychosocial interventions (including biological factors such as diet, exercise and cognitive abilities).”

In the absence of any evidence, we tend to assume that a remedial drug waits on the shelf for every disturbance of the human body and psyche. Such assumptions should be recognised as narrow-minded, if not arrogant.

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