Aggressive sexual behavior of alcohol dependent men in Trinidad

The purpose of this study is to report the aggressive sexual behaviour of alcohol dependent men and its implications on clinical practice. A total of thirty women of male alcohol dependent partners were taken from the psychiatric clinic and matched with a control group of spouses of healthy non-drinking men for the variables of age, gender, ethnicity and social class. These groups were tested for sexually induced marks over a one month period, areas of the body that were marked, duration of the body marks and love making experiences. Our findings indicate that the spouses of alcohol dependent men are subjected to more aggressive and painful sexual experiences, more body marks in more regions that lasted an average of 7 days and more biting of body surfaces than wives of non-alcohol dependent men. These behaviours are interpreted as subtle signs of domestic violence which should not be ignored in clinical practice.

Alcoholics Anonymous in Trinidad

Alcoholics Anonymous is well established in Trinidad and serves as an indispensable modality in the rehabilitation of alcoholics. This study seeks to investigate socio-demographic characteristics and gender differences of members attending AA groups in Trinidad. Data was collected along the following variables: age, gender, ethnicity, religion, age of onset of alcohol use, psychiatric diagnosis and intentions for seeking treatment. A descriptive study of 107 members attending AA groups in Trinidad was studied and analyzed utilizing a demographic questionnaire and the Michigan Alcohol Screening Test (MAST). The statistical package for the Social Sciences (SPSS, version 16) was used to conduct all statistical analyses. The age of the sample ranged from 22 to 78 with a mean of 48.01. Males dominated the sample, accounting for 68% (n=73), while females were 32% (n=34). In terms of ethnicity, East Indians accounted for 62% (n=65) of the sample, Africans 14% (n=15), Mixed 16% (n=17) and Other 7% (n=7). Religious constitution was dominated by Hindus 36% (n=38), Roman Catholics 21% 9n=22), other 14% (n=15), Presbyterian 10% (n=11), Pentecostal 9% (n=10), Muslim 5% (n=6) and Anglican 4% (n=5). Results utilizing the t-test showed that mean scores for males versus females differed significantly from each other (t (1,105) =2.11, p=0.036) with males having a higher score on the MAST compared to females. Overall 14% of individuals indicated to having a co-morbid psychiatric disorder of which 10.5% were depression. There was no significant difference between genders. The composition and structure of AA groups in Trinidad is fashioned on a male gender bias. There is a need to address specific gender issues in the treatment of female alcoholics.

Cannabis use: context and controversy

Cannabis and its most active ingredient delta-9 tetrahdrocannabinol (THC) are derived from the plants cannabis indica and cannabis sativa which were transported to Trinidad during the indentureship period. Locally referred to as marijuana, ganja, hashish, pot and weed, the substance was originally intended for medicinal purposes but due to its hallucinatory and euphoric effects has found a place in creativity, religion and as a street drug of abuse. The lethality of this drug is increased when the smoke is inhaled directly, facilitating easy entry into the blood stream and quick absorption into the brain. Commercial cannabis is compressed, soaked in embalming oil and spices for removal of the scent in order to facilitate smuggling and these preservatives in themselves may have adverse effects. Despite reports of its use as a drug associated with artistic creativity in the 1970's, cannabis remains today a serious drug of abuse both by adolescents and adults and a major problem in the educational system. This chapter reviews the clinical effects of marijuana use, its relationship with suicide, mood disorders, psychoses and other mental disorders and discusses controversies associated with the decriminalization and de-legalization. Those who support the latter have not looked far enough.

Depression and psychosis associated with cannabis abuse in a developing country

Notwithstanding the increase use of cannabis among adolescents in both developing and developed countries, few studies have looked at cannabis use and mood disorders. In a series of case studies, this research project seeks to investigate patterns of clinical presentations seen among cannabis users in psychiatric outpatients in Trinidad. Five clinical patterns of presentations are identified among cannabis users and abusers based on variables of dosing, age of initial use, duration of use, tolerance and reverse tolerance and poly-drug abuse. All patients in these case studies were standardized for method of use and potency of cannabis used. Patients were screened by urine tests to determine co-morbid use of other substances. Other variables such as environmental factors and genetic vulnerability were reviewed as far as possible from historical accounts of family members. The five patterns described are low, controlled use with mild euphoria and heightened awareness, moderate use with mixed depressive symptoms and suicidal behavior, heavy, short term use with manic symptoms, long term incremental use with psychotic symptoms due to the trumping of depressive symptoms and cannabis mixed with other substances resulting in florid psychosis. Mood disorders appear to be a common finding among adolescents using cannabis. Sensitization to symptomatic presentation and early detection of cannabis use in young adolescents are necessary. Further research is needed on the effect of cannabinoids on emotions, behavior and thinking and its relationship to mental disorders. This study is useful as a guideline for the implementation of public health strategies and legislation concerning the use of cannabis in youths.

Cocaine use and social transformation

There is little disagreement that the drug cocaine extracted from the plant Erythroxylon coca has had an extraordinary effect in the transformation of economies, lifestyles and governance. Those at the higher levels who are active in the trade, often with the consent of governments are untouchable and accumulate vast amounts of wealth and prestige, while the working class, those to whom it is peddled is further pushed downwards into the poverty line and death through drug-seeking behaviour. Not only has cocaine use resulted in social transformation but has had deleterious effects on the mental and physical health of nations. This chapter traces the history, introduction, development, culture, methods of use and effects of the use of cocaine in Trinidad and Tobago and its worldwide implications. Cocaine remains a scourge to mankind.

Deinstitutionalization in the Caribbean

Deinstitutionalization, the process of moving patients from large mental hospitals into the community is new to the Caribbean region. In keeping with trends of the more developed countries, World Banks' conditionality have requested the downsizing of psychiatry hospitals in order to qualify for monetary aid. Unfortunately, in the Caribbean region, there is an absence of extramural services for patient care and this has been a major handicap. This study seeks to investigate the pattern of admission of patients to the psychiatric hospital in Trinidad and to make comparison with Jamaica, a country with a more robust community care programme. Data was collected from hospital records on gender and total admissions over a sixteen year period (1985-2000) in Trinidad and Tobago. For Jamaica, secondary data of total admissions and gender rates were extracted from published works for the years 1960-1990. Data was analyzed using SPSS Version 11. One-sample t-tests were used to test the significance of reduction in admission rates. Trinidad and Tobago experienced a 46% significant decrease in admissions from 3,076 in 1985 to 1,659 in 2000 (p<0.001), while Jamaica admissions were reduced by 58% from 3,094 in 1960 to 1,296 in 1990. Over these periods, there has been a reduction in both male and female admissions. In Trinidad, male admissions have decreased by 49% and female by 39% while in Jamaica male admissions have decreased by 52.8% and female 43.9%. In Trinidad voluntary admissions accounted for 50.6%, urgent 29.8%, court orders 16.6% and medically recommended and mental health order 1.5% each. Pearson Product Moment correlation revealed that a positive correlation existed between voluntary admission and court order (p<0.05) and negative relationship between mental health order and urgent admissions (p<0.05). Notwithstanding a greater investment in community psychiatry in Jamaica, the patterns of admissions and deinstitutionalization are similar in Jamaica and Trinidad. It seems deinstitutionalization in these countries are an unforced process with less admission to psychiatric hospitals and alternative treatment for patient care. These findings are useful in providing invaluable information for the development of community care programmes in developing countries.

Depression in Trinidad and Tobago: incidence and social trends

Depression is a major problem worldwide and ranks within the first five common burden of disease affecting mankind. Raising rates of depression among youths and its association with the use of intoxicants present a major challenge to health care policy planner and governments alike. This chapter reviews major trends in adolescent depression in secondary schools in the Republic of Trinidad and Tobago and independently in the sister isle of Tobago. Incidence rates of 14% were found in Trinidad and Tobago and 10.1% in Tobago indicative of differences in population composition and social trends in both islands. Social parameters of gender differences, age cohort, attendance to religious institutions, prayer with the family, family use of alcohol, type of school attended, ethnicity and family structures were investigated. These variables were found to be significant contributory factors to adolescent depression in the Republic. An understanding of early depression in diverse communities will be helpful in reducing the global burden of common diseases.

Social and cultural psychiatry experience from the Caribbean Region

Within recent years there has been an upsurge of research in psychiatry in the Caribbean region, particularly Trinidad, Tobago and Jamaica. This development has resulted in the need for sharing information across and about the Caribbean region, noting that there are as many Caribbean people abroad as there are at home. The Caribbean is not a homogenous society, but showcases a unity in diversity. This book the first of its kind in social psychiatry discusses a number of contemporary social issues in the Caribbean. it has a uniqueness of its own with an inter-mixture of superstition, religion and third world traditional practices superimposed on a microbiological basis of medicine. It is here defined as Carib-being Psychiatry. In this text a historical perspective of medicine is reviewed, the practice of psychiatry both at the institution and at the hospital, the roles of culture and its effect on behavior especially at Carnival time. Suicide, depression and substance abuse are common problems especially among the adolescent population. These issues are everyday problems that are in need of urgent public health policies. This book is intended to serve as a foundation text for the purposes of teaching, research and education for those at home and abroad with interest in Caribbean people. It is guaranteed to be a source of interest and discussion.

History of medicine in the Caribbean region: a medical association perspective (1938-2008)

Two thousand and eight (2008) remains a landmark in the history of the Medical Association. We celebrate seventy years (70) of publication of the Caribbean Medical Journal (CMJ), first published in 1938 by the government printery under the editorship of the indefatigable Dr. James Waterman. It was indeed an arduous task in sifting through the pages of 70 years of publications, but this was sustained and motivated by the genius, enthusiasm, eloquence and debates of the medical men of the West Indies who in the early years outshined their colonial counterparts in every possible way. Past independence we have witnessed a fall out in medical interests as we became more insular in our practice. More recently, there has been a resurgence of interests in medical matters as we battle a vindictive government in a failing health system promulgating draconian legislations in health care to cover their inefficiencies. A review of our history indicates that doctors have survived the wrath of the imposing British Empire and no government present or future will have the ability to superimpose their will on learned men of multimodal distinctions. A limitation of this review is that many volumes of the journals are lost or packed away in boxes in some obscure, darkened, termite ridden room at Xavier Street. This is indeed a loss of the most valuable treasure of the Association. This may have resulted in the omission of important historical occurrences in the Association's history. It is hoped that this review will serve as a landmark for the Association to further build upon, as we continue to document our trials and tribulations, hopes and aspirations in an ever changing environment.

Defining Caribbeing psychiatry

Caribbeing psychiatry is a novel concept borrowed from the Caribbean film industry and applied here to Caribbean psychiatry. Caribbeing psychiatry is eclectic in nature, it is distinctly different to western psychiatry and there is a need for psychiatrists and psychologists to analyse the pictures, styles, language and culture of Caribbean psychiatry. The emphasis on international classificatory systems of mental disorders does not represent the nature of Caribbeing psychopathology. Caribbeing psychiatry examines supernaturalism and magical realism and the trans-generational linkage of these life forces with reference to their influences on emotions, behavior and thought. The aim is to articulate a Caribbeing identity and self definition in a post colonial society devoid of references to Eurocentric and North American standards. Secondly, to apply culturally appropriate treatment modalities (Caribbeing therapy) not aligned to the irrelevance of western psychological theories. It is necessary to harness the uniqueness of the Caribbeing experience and environment, the multicultural, plural and syncretic elements and the aesthetic style of psychological hybridity. Three cases are presented here that captures the exotic salience of Caribbeing people closely knitted into a web of witchcraft, priestcraft and mental illness.

Schizophrenia revisited: consensus and confusion

There is no consensus on the rates of schizophrenia among ethnic groups at home in the Caribbean and abroad. Investigations of gender and ethnic differences on the rates of first contact outpatients with schizophrenia in two geographically different areas in Trinidad are reported. In a prospective study, 134 first contact patients with a diagnosis of schizophrenia were selected from two catchment areas in east and Central Trinidad. Almost fifty seven percent (56.7%) of the tested population was of African origin, 32.1% of Indian descent. Gender differences were significant with males accounting for 66.4% 9n=89) of patients with schizophrenia (Chi-square =14.448, df = 1, p=0.0001). Further analysis by age categories revealed significant male predominance at the 20-24 (p=0.0001) and 25-29 (p=0.002 age groups. There was a predominance of young African males (15-19 years, p=0.049) in the east compared to central. The findings revealed an excess of Afro-Trinidadian men in both outpatient clinics (p<0.05).

Somatization disorders among Indians in Jamaica and Trinidad and its association with social and psychological factors

Data on presence of somatization disorder, depression, anxiety, distress, stigma associated with having somatic symptoms, having a female somatizing relative, a history of domestic violence, sexual abuse and the presence of an alcoholic spouse was collected from Indo Trinidadians and Indo Jamaicans. Within the entire sample elevated somatization was reported by 27.5% of the sample. Thirty percent (30%) had elevated scores of distress, 26% for depression, 10.5% for anxiety and 15.5% gave history of domestic violence, 7.5% reported stigma and 9% had a history of sexual abuse. Chi-square analyses revealed a significant moderate relationship exists between depression and somatization, there was a P value of .000 (Chi-square (1) = 45.580. p<0.05). There was also a significant relationship between somatization disorder and anxiety for the entire sample ( Chi-square (1) = 22.710, p<0.00). A moderate relationship existed between somatization disorder and distress (chi-square (1) = 28.691, p<0.00). A statistically significant relationship was found between persons feeling that they are weak or worth less than others if they have somatic symptoms and the presence of somatization disorder (Chi-square (1) = 8.591, p=0.03).

Forensic psychiatry in the colonial and post colonial eras

In this chapter, the concepts of common and statue laws are reviewed with respect to their application and the duties of the psychiatrist. The history, development and practice of forensic psychiatry in the colonial period in Trinidad are explored and later following independence during the establishment of a Mental Health Act and the introduction of the Sectorization Plan in 1975. Three case histories are presented: the first investigates liability in a mentally ill offender, the second is a court report intended to assess mental illness in a man charged with murder and the third examines the role of the Psychiatric Tribunal in discharge from prison following illegal detention. Defenses available for these individuals are briefly discussed. Despite a PAHO's expert finding of human abuse in the Forensic system in Trinidad, the assessment of mentally ill offenders in developing countries with different social and cultural imperatives is no easy task.

Lunacy, time of the year and absconding from a psychiatric hospital

Personal characteristics of patients and environmental factors at psychiatric hospitals have been identified as predictors of absconding. In this chapter we seek to establish a relationship between time of the year and absconding. All characteristics of absconders were taken over a two-year period from hospital records (N=104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calender. Fridays was the most popular day of the week for absconding. Males were more likely to escape on the weekends while females tended to escape during the wet season. Christmas was the most popular holiday season for absconding. The largest percentage of absconding was at the full moon phase. It is recommended that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase.

The effects of multiculturalism and multi-ethnicity group dynamics in a Caribbean setting

The ethnic and racial composition of the Caribbean is a convergence of many cultures that were brought together through slavery and indentureship. The region holds similar characteristics among the islands because of similar history and subsequent settling of migrants. This heterogeneous lifestyle has produced new cultures distinct to the Caribbean which to some extent acts unifying forces among the migrant population. The reality is the social, economic and political structures are still realms which serve as opportunities for discriminating against the Indian race and Indians which the financial advantage are easy targets for criminal attack. Women of the two main races are still characterized by stereotypical characteristics of their history. African women are seen as strong black women and Indian women as passive and docile independent of circumstance. These self appraisals and natural competitiveness among individuals of a country or group highlights the negative aspect of multicultural societies. The Caribbean today remains a hot pot of multiculturalism rather than a melting pot.

Do Trinidadians have a carnival mentality?

Stereotyping characteristics of island people are well known throughout the Caribbean region. These labels often narrated in everyday humor have some hidden truths. In Jamaica, for example there is the belief that the population is homophobic. In Barbados, there is a perception that the native population is xenophobic, with a dislike for everyone not Bajan, with an exception for those with a lighter shade of black. In Trinidad, the population has been dubbed as having a carnival mentality where individuals have a very slack, laid back or don’t give a damn attitude towards work. It is thought that this non-stop party mentality is continuous throughout the year with little commitment to hard work or industry.

Dancing frotteurism or rubbing at the carnival celebrations in Trinidad

Paraphilias are sexual disorders characterized by sexual impulses, urges, fantasies or practices that are strange, deviant or bizarre. It is more common in men and attributed to fixation at one of the psychosexual phases of development, learning theory, child abuse or culture. Trinidad and Tobago has been influenced by a medley of cultures which find its greatest expression during the carnival season. During this time a local dance form of wining with suggestible sexual movements is pervasive. It is associated with distortions of normal courtship behavior with paraphilic disturbances. In a case presentation, a young male is presented showing paraphilic disturbances touching, holding, rubbing and coercive sex. This behavior of frotteurism and other parahilias are common occurrences at carnival in Trinidad and Tobago and are considered to be cultural normative practices. This case-report therefore, identifies a number of paraphilic behaviors such as toucherism, frotteurism and preferential rape during the carnival celebration and examines their relationship with the law. Professionals abroad ought to be aware of the local culture due to the recent export of carnival to metropolitan countries.

Cybersuicide and the adolescent population: challenges of the future

Cybersuicide is a term used in reference to suicide and its ideations on the internet. It is associated with web sites which lure vulnerable members of society and empower them with various methods and approaches to deliberate self-harm. Ease of accessibility to the internet and the rate at which information is dispersed; contribute to the promotion of offing one's self which is particularly appealing to adolescents. This study aims to explore this phenomenon which seems to be spreading across generations, cultures and races. Information and articles regarding internet suicide and other terminology as well as sub classifications concerning this new form of suicide were reviewed. Through search engines such as Google, Yahoo and Wikipedia differentiations between web cam suicide, net suicide packs, sites which merely offer advice on how to commit suicide and sites which are essential in providing the means of performing the act were investigated. Also, materials published in scientific journals and data published by the Public Health Services, Centers for Disease Control, and materials from private media agencies were reviewed. Resources were also sourced from The Faculty of Medical Sciences Library, UWI at Mt. Hope. Cybersuicide is a worldwide problem among adolescents and is a challenge of the future.

Forging a new dimension of black psychiatry in the Caribbean

There is a concerted effort among many black politicians, academics and writers to paint the Caribbean with a black brush, unmindful of the presence and contribution of other ethnic groups within the Caribbean region. The recent upsurge of black consciousness among Afro-Caribbean people is necessary, but not at the detriment of other ethnic groups who have also contributed to the social, economic and cultural lifestyles of the Caribbean. Attempts to foist a version of United States imported black psychiatry in Jamaica with the introduction of a curriculum in black psychology have raised some concern among Trinidadian students studying there. In this chapter, A Trinidadian Psychologist who studied in the Jamaican system discusses the concept of Black Psychiatry and its relevance to the Caribbean.

Indentureship as a contributory factor to mental and physical illnesses in the Indo-Caribbean diaspora

There is an ethnic pattern of mental and physical diseases associated with the export of Indian labor overseas between the period of 1830-1920. The establishment of Indian communities overseas emerged from the culture and civilization of the Indian sub-continent and was a direct consequence of mainly British exploitation of economic wealth overseas. This movement of Indians from their homeland with the maintenance of the practice of their religion, culture and lifestyle is referred to as the Indian diaspora. This chapter looks at the effects of the 'coolie migration' particularly to Trinidad, but with reference to other Caribbean islands and at least a dozen countries across the seas. Information is gathered from published reports but more importantly, from dozens of immigrants and hundreds of first generation Indians with whom the author has been in contact during their treatment. There appear to be a commonality of social, psychological and physical diseases in these migrant groups within the diaspora. A possible explanation is the similarity of the genetic pool and environmental influences experienced by the migrants overseas.