The Pharmaceutical Journal
Vol 278 No 7436 p112
27 January 2007

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Prisons have a bearing on mental health more
Welcome to winter fragrance perfuming our woods and hedgerows more
Worries about anxiety: what and where is it? more
Moral government / People for peace more

Prisons have a bearing on mental health

Some interesting comments on the thorny relationship between legal incarceration and its effects on the health of the inmate who has to suffer it are raised in the New England Journal of Medicine for 11 January 2007.

In a letter, physicians from Providence, Rhode Island, express their belief that doctors have an often unrecognised responsibility to press for reforms of systems that are harmful to their patients. Current policies and sentencing laws, they say, result in mass incarceration that may involve great racial and economic inequity. For more than two decades, for instance, there has been a dramatic and steady increase in the number of individuals incarcerated in the US and other places, much of the increase resulting directly from inadequate treatment of mental illness and addiction in the community at large. However, prisoners have a constitutional guarantee of health care and physicians are essential to correctional institutions.

The mere fact of imprisonment may harm a patient’s mental and physical health, and a recent tendency to insist on punishment rather than rehabilitation conflicts with the therapeutic approach. Even where treatment is known to be effective its use is lacking in prisons. Although many prisoners have a record of drug abuse, their participation in remedial programmes may be as low as 15 per cent.

It is recognised that certain potential benefits arise from incarceration, including access to basic requirements such as food, shelter and a degree of protection against drug hazards but these can be provided more effectively in less expensive surroundings. The authors suggest that it is time for physicians to use their influence to alter the sentencing laws, policies and procedures that affect the health and wellbeing of society and to press for addiction and mental illness to be addressed through more humane and effective alternatives based in the community.

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Welcome to winter fragrance perfuming our woods and hedgerows

At this time of year few choice perfumes waft over us from the fields and hedgerows unless we enjoy the aroma of cattle manure. All the more reason then for us to appreciate the subtlety of the hedge violet and the winter heliotrope, which are both now in evidence in woods and hedgerows.

The violet was used in perfumes in classical Greece. In medieval Britain it was included among the strewing herbs that were sprinkled on the floor before a hearty meal.

The flowers of the winter heliotrope give off the perfume of vanilla. The plant raises its spikes of pale mauve flowers early in the new year and scents the hedgerows round about the festive season. Both plants have found wide use in folk medicine.

Hedge violet was once used to deal with insomnia, headache and depression. John Gerard commented in 1597, “the mind conceiveth a certain pleasure and recreation by smelling and handling of these most odoriferous flowers…”. The white seeds of fragrant violet have been chewed by children in Devon, a decoction of the flower has been drunk in Ireland for pains in the head, while in Kent, a poultice of the leaves has been applied to cancerous growths.

Winter heliotrope has a shorter history in Britain, since it has only been know for 200 years. It was introduced from North Africa in 1806 as a garden plant. It is regrettably invasive, spreading by underground runners and tending to suppress the growth of other lowly but native species in the process. Heliotrope leaves have been used to wrap violets for market in Cornwall.

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Worries about anxiety: what and where is it?

Anxiety is a state of chronic apprehension that is distressing to the sufferer. It differs from fear and phobia in that it has indefinite sources and outcomes, whereas fear is attributable to a defined cause and becomes a phobia when exaggerated beyond real danger.

Anxiety may be a response to a danger signal and, if this ignored, disorganisation and anger may follow.

Anxiety may be accompanied by bodily sensations. These may affect the chest and shift into the throat or bring about a sense of dizziness, while the pulse may accelerate and the skin flush.

A recently recognised phenomenon has been given the name generalised anxiety disorder. In this situation the patient feels a vague and unfocused anxiety that is apparently not connected with any recent disturbing experience. This is accompanied by a sense of threat, restlessness, irritability, sleep disturbances and tension, possibly with palpitations, dryness of mouth and sweating.

Anxiety is relatively easy to detect in primary and secondary care settings, but its interpretation brings serious problems. Its prevalence is roughly twice as high in women as in men, suggesting that it may have some connection with women’s traditional protective role. Unfortunately, it tends to be much prolonged and may affect someone for six to 12 years after an initial diagnosis.

The problems for the therapist faced with a diagnosis of anxiety are examined in an article in The Lancet for 16 December 2006. Treatment is not easy. Psychological methods are widely considered preferable to drug therapy. There is evidence that antidepressants have some limited efficacy both in generalised anxiety and the related panic disorder.

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And I quote…

Moral government
“The moral test of government is how that government treats those who are in the dawn of life, the children, those who are in the twilight of life, the elderly, and those who are in the shadows of life, the sick, the needy and the handicapped.”
— Hubert Horatio Humphrey (1911–78), US pharmacist-turned-politician and vice-president (1965–69).

People for peace
“I like to believe that people in the long run are going to do more to promote peace than our governments. Indeed, I think that people want peace so much that one of these days governments had better get out of the way and let them have it.”
— Dwight D. Eisenhower (1890–1969), US general and president (1953–61).