Romeo Vitelli's Blog, page 5

What is Orthorexia Nervosa?

Orthorexia Nervosa (ON) is characterized by specific behaviors frequently related to other psychopathological conditions, such as Obsessive–Compulsive Disorder (OCD) and Eating Disorders (EDs). Whereas ON can mainly be described as an excessive concern regarding healthy food, a new study published in the journal Eating and Weight Disorders examined if ON could be considered a condition related and differentiated from worry, other than OCD, EDs, perfectionism, anxiety, and depression. To achieve these aims, 302 individuals from the general population were enrolled and were divided into two groups named “High EHQ” and “Low EHQ”, based on their Eating Habits Questionnaire’s score (EHQ-21). Results showed that correlations of ON with EDs and non-adaptive perfectionism constructs emerged independently from Obsessive-Compulsive (OC) symptoms, and the same pattern was observed when comparing the High and the Low EHQ groups. The two groups also differ in the worry anxiety and depression constructs and are not affected by OC symptoms removal.  These results confirm a relationship between ON with the typical ED, perfectionistic, anxious, and depressive symptomatology, mainly when the OC features are controlled; moreover, worry constructs could be considered characteristic of the ON phenomenology. This study does not entirely exclude the relationship with obsessive and compulsive characteristics, which could be associated with or serve as a mediator of the orthorexic behavior. Future research could explore the potential mediating or collateral role of OC symptoms. Level of evidence: Level III, evidence obtained from well-designed cohort or case–control analytic studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

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Does Psychosis Play a Role in Most Mass Shootings?

Even as we reel from yet another school shooting, this time leading to the death of 21 people at an elementary school in Uvalde, Texas (and with many more since), we are still faced with the same inevitable question of how such shootings can be prevented in the future.   

To counter calls for stricter gun control, many newspapers and politicians have instead placed the blame for the Uvalde shooting on the presumed mental illness of the shooter in question, much as they have in previous shootings. For example, following the 31 deaths resulting from mass shootings in Dayton, Ohio, and El Paso, Texas in August of 2019, then-President Trump publicly stated that "mental illness and hatred pulled the trigger, not the gun." He also called for broader institutionalization of people with mental illness to prevent more shootings, regardless of any actual indication of violent behavior.

But even as budgetary concerns are leading to major cutbacks in mental health funding across the United States and elsewhere, media speculations linking mental illness with violence adversely affect how people with serious mental illness are treated. While studies consistently show that the mentally ill are far more likely to be victims of violent crime than vice versa, mass shootings such as the one in Uvalde make treating mental illness far more difficult as a result.  

To read more, check out my new post in Psychology Today

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Countering violent extremism and radical rhetoric

How do extremist sympathizers respond to counter-radicalization efforts? Over the past decade, programs to counter violent extremism have mushroomed around the world, but little is known of their effectiveness. A new study in the journal International Organization uses social media data to examine how counter-radicalization efforts shape engagement with extremist groups in the online world. Matching geolocated Twitter data on Islamic State sympathizers with granular information on counter-extremism activities in the United States, research finds that, rather than deradicalizing, these efforts led Islamic State sympathizers to act strategically to avoid detection. After counter-extremism activities, the group's supporters on Twitter who were in the vicinity of these events began self-censoring expressions of support for the Islamic State, altered profile images and screen names, and encouraged followers to migrate to Telegram, an encrypted network not viewable by the public. These findings reveal previously unknown patterns in the effects of counter-extremism programs in the digital era. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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Catholic Exorcists Complain of Overwork Due to Too Many Possession Cases

The 16th annual exorcism held recently by The Pontifical Athenaeum Regina Apostolorum in Rome has drawn in 120 attendants,  a record number according to sources.   Despite the controversy surrounding the rite, the demand for exorcists worldwide has been spurred on by Pope Francis I who has publicly endorsed the Catholic Church's role in helping "those possessed by evil."  This has helped produce a "Pope Francis Effect"  with more cases of demonic possession being reported in Europe, Africa, and South America.   

While the exorcism course's organizers have acknowledged the need for more support from mental health professionals to help distinguish between mental illness and genuine possession, many families remain adamant in demanding exorcisms rather than accepting that someone is mentally ill.    As a result, many exorcists attending the course openly admitted to being overworked and not receiving proper help from mental health professionals and bishops.

In one recent case, Roman Catholic priests in northern Italy conducted a nine-hour exorcism on a  26-year-old woman who became violent during confession and hurled insults in different languages, including Latin.  "The young woman had already been seen by an exorcist in Verona, but on Sunday, her parents brought her here, probably to have another go at curing an evil she had suffered for some time," said one priest to reporters.   While the woman's father insisted that her problems were due to mental illness, her mother and other family members insisted that she be exorcised instead.  

The exorcism was conducted at the Saint Mary of Mount Berico church in Vicenza, Italy,while other churchgoers and emergency crews were prevented from entering the church until afterward.   When official exorcist Father Giuseppe Bernardi failed to drive out the demon, other priests stepped in to assist.   After the ritual was over, she fell into a deep sleep which they took as a sign of success though she had undergone previous exorcisms.  The liberation can not happen immediately. It depends on the strength of the presence and on the entity of the evil one," said one priest.   

While Father Bernardi insisted that he had previously consulted psychologists about the woman's case, this is not always the case.  Other attendees at the exorcism course also described being called in to conduct exorcisms for a range of other medical conditions, including COVID-19.  

At present, Italy has 290 exorcists with some dioceses even operating exorcism hotlines for people demanding the rite.  Meanwhile cases of exorcisms being conducted worldwide by religious figures hoping to "drive out evil."  Many of these exorcisms have been carried out with the permission and even participation of family members and have led to fatalities and subsequent assault or murder trials.   Preventing such tragedies in future may require a miracle in itself.

 

 

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The nature of posttraumatic stress disorder in treatment-seeking first responders.

Approximately 10% of first responders report posttraumatic stress disorder (PTSD). Although reports within first responders suggest that they have distinct symptom presentations, there is a need to understand how the clinical profiles of first responders may differ from others seeking treatment for PTSD.   A new study published in the European Journal of Psychotraumatology compared the PTSD symptom profiles of first responders and civilians seeking treatment for PTSD. Participants self-referred to the Traumatic Stress Clinic (University of New South Wales, Sydney) for enrolment in out-patient treatment trials for PTSD. Participants comprised people of mean age 41.72 years (SD = 10.71) who met DSM-IV criteria for PTSD. The sample was composed of 128 first responders and 182 civilians. Clinician-administered interviews of PTSD (Clinician-Administered PTSD Scale) and depression were conducted, as well as measures of self-report measures of depression, alcohol use, posttraumatic appraisals, and anger. Results showed that first responders reported greater rates of dysphoric cluster of symptoms, including diminished interest, emotional numbing, and social detachment, and less psychological reactivity and avoidance of situations, than civilians with PTSD. Beyond PTSD symptoms, first responders also reported more severe levels of depression and suppressed anger. CThese findings indicate that treatment-seeking first responders present with a distinct clinical profile that is characterized by dysphoric symptoms. These symptoms can predict poor treatment response and require specific attention in treating PTSD in first responders. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

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Michael Scott and authentic leadership: What we learn about leadership from The Office.

A study recently published in the Journal of Leadership Studies examines the actions of Michael Scott, self‐proclaimed “World's Best Boss”, to determine how he communicates leadership on The Office. Using Northouse's (2020) definition of leadership, Scott's behavior is content analyzed to establish his particular message transmission tendencies. Further, given Scott's unique management style, George's (2003) dimensions of authentic leadership are used to code Scott's behavior as Scranton's regional manager. Based on a quantitative coding of shows, two main findings are advanced. First, Scott's leadership prioritizes verbal over nonverbal messages. Second, Scott's approach to leadership emphasizes the authentic dimensions of close relationships, clear purpose, and a caring heart most often with his employees. Scenes from The Office are identified that validate these findings and feature authentic leadership theory in action. Pragmatically, the current research offers trainers, managers, and teachers a resource for educating trainees and students on the role of verbal and nonverbal messages in leadership as well as a tool for developing authentic leadership in others. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

For the abstract

                    

Was There A Tesla Conspiracy?

Nobody can dispute the fact that Nikola Tesla was a scientific genius.

Not only did his patents and technological achievements help form the basis for most modern electrical and magnetic applications (including alternating current, an early x-ray machine, the AC motor, and the three-phase rotating magnetic field), he also pioneered in robotics, ballistics, cybernetics, and theoretical physics.   Although Guglielmo Marconi was awarded the 1909 Nobel Prize for his work on radio, several court decisions would determine that Tesla deserved the real credit.   Tesla never won the Nobel Prize in his own right (according to one rumour, plans to give a joint award to him and Thomas Edison had been scrapped due to their long feud), but was widely acclaimed for his work in launching the modern technological revolution (and the standard unit for the measurement of magnetic flux density was named the tesla in his honour). 

Unfortunately, for all his scientific prowess, he was never much of a businessman.  While he attempted to launch several companies in his lifetime, most ended in failure and he was often forced to work as a common labourer to support himself while dreaming up his next invention.  Even worse, though being world famous in his old age, Nikola Tesla seemed incapable of managing his money properly and spent his final years in poverty.

Despite his achievements, Nikola Tesla may well be remembered for his reputation as a showman of science and grandiose claims that never panned out. Throughout his lifetime, he pursued seemingly impossible dreams including wireless transmission of power (the phenomenon of transferring energy without wires through the use of electromagnetic induction is still known as the Tesla effect). By the 1930s, when Tesla was in his eighties, he claimed to have developed a "dynamic theory of gravity" although his work was never published. He also scorned Albert Einstein's theory of relativity as being riddled with errors but never really developed a true alternative.

Tesla also  attempted to interest the United States military in a directed energy weapon that would "put an end to all war".    When the American military showed no interest in this so-called teleforce weapon, he also tried to interest several European countries with no success. Other plans for ion-propelled aircraft and electromagnetic ships powered from ground-based stations never materialized either.

While he may not have been viewed as a "mad scientist" as such, he was certainly well known for his eccentric behaviour. Although there is some speculation that he may have suffered from Asperger's Syndrome, the symptoms that he displayed during his lifetime may match other diagnoses as well. Tesla showed many signs of obsessive-compulsive behaviour including a pathological fear of germs and dirt of all kinds, a strange fixation on the number three (he always insisted on staying in hotel rooms with numbers divisible by three), and recurring episodes of depression throughout his life.

During these "nervous breakdowns", he would become hypersensitive to light and noise with strange twitches and shivers that defied medical diagnosis. A lifelong bachelor, Nikola Tesla was ambivalent towards women (despite numerous opportunities) and may well have died a virgin. In his old age, Nikola Tesla's oddities became even more apparent.   For the last ten years of his life, he lived in a two-bedroom hotel suite in New York City (room 3327 of course) and often raised pigeons in his suite. In addition to becoming increasingly sensitive to bright lights and loud noises, he also claimed to have communicated with beings from the planet Venus and being visited by a specific white pigeon each day. Although he had a small circle of devoted friends, Tesla often isolated himself and was verbally abrasive towards anyone who annoyed him.

Nikola Tesla died alone in a hotel room on January 7, 1943. He had been living as recluse for years although his reputation as a brilliant scientist and his grandiose claims had kept him in the public eye. With more than 700 patents to his name, enough people took him seriously for a rather lengthy FBI file to be compiled on Tesla and his claims. Within hours of Tesla's death, the various papers and files in his suite were confiscated by the Alien Property Custodian (despite the fact that Tesla was a U.S. citizen) and stored in a warehouse.

The (largely)declassified FBI file makes for fascinating reading. The first part of the file deals with Tesla's attempts to interest the U.S. government in his teleforce weapon as well as various news clippings in which he described his "death ray for planes" as well as outlining his conditions for working for the military (he demanded total autonomy and "no interference from experts"). The main bulk of the file deals with the aftermath of Tesla's death when the representatives of the Alien Property Custodian and the Yugoslavian Consulate entered Tesla's hotel room and removed the contents of his safe. After verifying that all articles removed were placed in a local warehouse (along with more than thirty barrels of material belonging to Tesla that had already been stored there), Tesla's papers became the focus of a major squabble over who would have access.   Much of the later controversy over Tesla's legacy seems to stem from that legal battle.

There were fears that a distant relative whom Tesla had "intensively disliked" might gain access to the Tesla papers and make them available to "the enemy" (the U.S. had already entered WWII by that time) and members of the Military Intelligence Division expressed "vital interest" as well. The Bureau denied taking any direct action and left disposal of the papers to the Alien Property Custodian. That didn't stop allegations of a conspiracy springing up over the Tesla papers and the presumed scientific advances that would result from them. 

The rest of Tesla's FBI file consists of various denials that the FBI had anything to do with the Tesla papers and official responses to the polite (and not-so polite) requests for information from concerned sources.  John Jacob O'Neill probably didn't help matters when he published the first full-length biography of Tesla in 1944.   Titled The Prodigal Genius, the book accused FBI agents of confiscating many of Tesla's papers after his death and likely launched the conspiracy theory. The book was specifically referenced in many of the letters that the FBI received

After a lengthy struggle by Tesla's family and the Yugoslavian government, most of the papers were eventually released and are now part of the Nikola Tesla museum in Belgrade.  Aside from his legitimate scientific achievements, Nikola Tesla has been the focus of numerous pseudoscientific claims regarding death rays, UFOs, and other spectacular applications that were supposedly developed in secret by government agencies after the Tesla papers were taken. The fact that nothing of the sort seems to have materialized in the decades since Tesla's death has done little to lessen the conspiracy theories.

Mad scientists are always popular.

                    

Better Warfare Through Chemistry

During the closing days of World War II, the Nazi regime became increasingly desperate for soldiers given the severe casualties sustained on the Russian and Western fronts.   Since recruitment drives were failing to keep up with demand, they decided to solve the problem by using chemicals to enhance the performance of those soldiers they already had.  Despite Adolf Hitler's public stand against drug and alcohol abuse (ignoring his own bizarre dependence on amphetamines), Nazi scientists had long experimented with different drugs that could be used as performance enhancers in soldiers.  Even before the war began,  Germany began amassing millions of amphetamine tablets for use by the military though this supply was quickly exhausted.

Then came a new drug, Pervitin, that had recently been brought to market by Temmler Werke, a German pharmaceutical company that had enthusiastically promoted the drug for military use.  Basically a methamphetamine compound, Pervitin quickly caught the attention of Otto Ranke, then-director of the Institute for General and Defense Physiology at Berlin’s Academy of Military Medicine and, not coincidentally, a member of the Wehrmacht. 

After military researchers learned that Pervitin could reduce hunger, thirst, pain sensitivity, and the need for sleep in soldiers, it was soon distributed to troops fighting on all fronts, often without their knowledge.    Given the official Nazi stand on drug and alcohol use, the millions of Pervitin tablets distributed to soldiers were labeled as "Panzerschokolade," or "tank chocolate" (also known as pilot's chocolate" or "pilot's salt" when distributed to air force pilots).  Even Adolf Hitler became an enthusiastic Pervitin user and had his personal physician, Theodor Morell, prescribe the pills in large doses.   

At first, it appeared that Pervitin was a major success.   Nazi troops stormed through Europe in a Blitzkrieg made possible by soldiers high on amphetamines and other drugs.  Stories continued to be reports of soldiers, often on the verge of exhaustion or collapsing due to sub-zero temperatures,  being able to return to normal duty with large amphetamine doses.    Naturally, the drawbacks of Pervitin abuse became all too apparent soon enough.   Not only did many soldiers become addicted, but the side effects, including insomnia, psychotic behaviour, and, in some cases, heart failure grew increasingly common.   Then, there were the withdrawal effects, including sweating, dizziness, hallucinations, and depression which continued to plague soldiers long after the war ended.   Though the Third Reich's Health Leader, Dr. Leonardo Conti, tried restricting the drug, many soldiers simply turned to black market sources to feed their addiction.  

Finding a Better Drug

Even as Pervitin was being distributed to German troops across Europe,   Nazi scientists began searching for even better performance-enhancing agents to help the war effort.  It probably helped that they had an unlimited supply of involuntary research subjects in death camps such as Dachau and Auschwitz.   At Dachau, for example, scientists explored the "mind control" effects of mescaline by administering large doses to French and Jewish prisoners.   To their disappointment, they found that mescaline made prisoners even harder to control since they became incapable of following even simple orders. 

For that matter, Nazi scientists even conducted drug experiments on themselves, largely to help deal with the pressures of wartime service.    One of the doctors, Dr. Franz von Wertheim, a medical officer stationed near the Western Wall, wrote the following in his diary entry dated May 10, 1940: “To help pass the time, we doctors experimented on ourselves. We would begin the day by drinking a water glass of cognac and taking two injections of morphine. We found cocaine to be useful at midday … as a result, we were not always fully in command of our senses.”   As you might expect, addiction became a major problem for military doctors with morphine addiction rising more than 400 percent over the course of the war.

By early 1944, as the German war effort was becoming even more desperate, Vice-Admiral Hellmuth Heye asked German scientists to develop a new drug that could work even better than Pervitin.  Something that, in a sense, would make them into "super soldiers" able to overcome fatigue, boost self-confidence, and make them better at fighting.   Soon afterward, pharmacologist Gerhard Orzechowski announced a new drug, available in pill form, that combined cocaine, methamphetamine, and a morphine-based agent to increase pain tolerance.

This new drug, code-named D-IX, was first tested on Jewish prisoners at Sachsenhausen, a Nazi concentration camp in Oranienburg, Germany.    The prisoners who took part in the tests were all required to take the experimental drug and then forced to march up to 50 miles (75km) without resting, carrying 50-pound (20kg) packs.   In describing the experiments, one prisoner later wrote "At first the members of the punishment battalion whistled and sang songs. [But] most of them had collapsed after the first 24 hours."   Though many of the prisoners who participated in the "Pill Patrol" later died due to physical exhaustion, the Nazi doctors overseeing the experiment hailed it as a success, and plans were soon made to mass-produce D-IX tablets and distribute them to all Nazi troops.  These plans fell through when the war ended and D-IX quietly faded into obscurity.  

Not that Germany was unique in providing amphetamine tablets for military use during the war.   Whether inspired by their German allies or not, the Imperial Japanese armed forces also distributed amphetamine tablets to their own troops.  For soldiers sent on special missions, including kamikaze pilots, there was Philopon which basically consisted of tablets containing methamphetamine and green tea powder (the Emperor's crest was stamped on each tablet).    As for American and Allied troops, amphetamine use was just as pervasive with millions of tablets being distributed to soldiers with little real warning of the potential dangers.   In a real sense, amphetamines were a major part of every soldier's "first aid kit" as a way of countering exhaustion.   

The Alcohol Alternative

And then there was that familiar standby, alcohol, which, along with amphetamines, was widely available for all troops, German, Japanese, and Allied, alike.   The Nazi high command was especially motivated to keep their soldiers well-plied with alcohol considering that the shortage of older recruits meant bringing in new soldiers who were little more than adolescents.    To ensure they maintained the necessary "courage", Nazi officers often distributed alcoholic beverages as a special reward whenever possible. 

Walther Kittel, a general in the Nazi medical corps defended the use of alcohol by saying that only a fanatic would refuse to give a soldier something that can help him relax and enjoy life after he has faced the horrors of battle, or would reprimand him for enjoying a friendly drink or two with his comrades.   Along with the liquor supplied by the officers, there was also the bootleg variety supplied from local bootleggers, or even the occasional still run by soldiers themselves. 

But, much like amphetamines (which soldiers often mixed with alcohol), problems soon developed, including public drunkenness,  soldiers fighting with each other,  insubordination, and “crimes involving unnatural sexual acts.”    Between  September 1939 and April 1944, over seven hundred soldiers died in various alcohol-related mishaps (though the actual number was likely higher).   Then again, the alcohol craze was hardly limited to Nazi troops alone.    Not only were American soldiers eagerly buying up all the beer and liquor they could find, but they even resorted to making up their own "brews" mixing juice with Aqua Velva aftershave (pure alcohol was one of the ingredients).  

For soldiers who couldn't get enough real alcohol, there was also methyl alcohol which was widely available as a solvent and antifreeze.  It definitely had a " kick " with a 98 percent alcohol content leading to some soldiers being either killed or blinded.    Even with aggressive crackdowns, including well-publicized executions of bootleggers, the demand for bootleg alcohol was strong enough for it to continue being a danger throughout the course of the war.

After the War

For soldiers desperate to escape the horrors of war, even temporarily, drugs and alcohol remained an essential part of military life.   While officially discouraged by Allied and Axis commanders, most turned a blind eye to substance abuse so long as it didn't interfere with a soldier's ability to fight.    Long after the end of hostilities,  drug and alcohol addiction continued to plague many soldiers trying to return to civilian life.   It probably didn't help that many of the drugs they used were extremely common, including amphetamines and opiates, and many doctors prescribed them freely for problems ranging from depression to obesity.    As for the veterans themselves, they often had little real help available to them, especially for treating addiction given that the widespread use of drugs and alcohol during the war remained a "dirty little secret" for decades and the specter of addiction would crop up in later wars as well.

Though programs to help veterans cope with trauma and substance abuse are more widely available today, this was only after decades of political activism by veterans' groups demanding better access to mental health treatment.   Even today, however, drug and alcohol use remains far too common among active and retired service personnel, many of whom face the same issues that plagued WWII servicemen decades before.

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The Rise of Telepsychology

Mental health providers’ usage of telehealth modalities saw an exponential increase in response to the coronavirus disease 2019 (COVID-19) pandemic. Some experts have suggested that it takes considerable time, education, consultation, and/or supervision to develop the new technology-based competencies. Education is required to understand not just the technologies, but the practices (e.g., ethical, legal, safety planning), differences from face-to-face care, and workflows. Given the need for rapid transition due to COVID-19, it is unclear how providers prepared for the integration of telehealth with their traditional practices. As such, the purpose of a new study in Professional Psychology: Research and Practice  was to examine mental health providers’ educational activities prior to and post telehealth implementation. Four hundred and four practicing providers (i.e., psychologists, counselors, therapists, social workers) were assessed via an online researcher-created survey. Results indicated significant increases in telehealth usage following COVID-19, with videoconferencing being the most common modality used. Although approximately 74% of surveyed providers sought telehealth education prior to usage, approximately 26% did not. In supplement of anything learned prior, approximately 61% indicated pursuing additional education post implementation. Taken together, a significant portion of providers can be viewed as having gained information that guided ethical, legal, and safe clinical services. Nevertheless, with consideration of the breadth and duration of the educational activities pursued, many providers would likely still benefit from additional education to foster a more complete understanding of the new telehealth competencies. Details regarding usage and educational activities are discussed. Application of information is outlined. Findings can help provide direction for additional educational efforts for providers. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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The Problem with Robert Schumann

On March 6, 1854, when Robert Schumann first became a patient at a private sanatorium located in Endenich (now part of Bonn), he assumed that entering as a voluntary patient would count in his favour when he eventually decided to leave.  Instead, he would spend the rest of his life there.

Already famous for his prowess as a pianist and a composer, Schumann's seemingly idyllic life, including his marriage to Clara and the eight children they had together, was marred by his lifelong problems with depression.   By late 1853, he began developing new and even more worrisome symptoms, including auditory hallucinations of angelic voices (which may have been linked to problems with tinnitus).   This soon progressed to his experiencing visions of angels and, as his condition deteriorated, of demons as well.   The demonic voices continually told him he was a sinner and that they would be throwing him into Hell.   He also screamed at times due to the belief that he was being savagely attacked by wild animals. 

In the first months of 1854, he began worrying about the possibility of harming himself or his family and he warned Clara that he posed a danger to her.n On February 27, he eluded the family members keeping watch on him, and proceeded to a bridge overlooking the Rhine river near his Dusseldorf home.   Then, after throwing his wedding ring into the river, he jumped in himself.  Fortunately, two fishermen witnessed his jump and managed to reach him in their boat and bring him to safety (despite his attempting to throw himself into the river a second time).  

When the fishermen brought Schumann home, he was placed under the constant care of two physicians (Clara didn't learn about the suicide attempt until some time later).   After being kept in isolation for several days, he asked his doctors to arrange his transfer to a mental institution "because only there would he recover."    Since the Schumanns were relatively well-off, the decision was made to send him to the private sanatorium at Endenich where he would receive far better treatment than in a public hospital.    Though Clara was distraught by her husband's condition, she was helped by her mother, children, and family friend, Johannes Brahms, all of whom were present when he was transferred to Edenich with only one physician to accompany him.

The asylum at Edenich certainly had a good reputation and its director, Dr. Franz Richarz, was considered one of the top experts in his field.  Located on a seven-acre estate that had originally been built as a summer residence, it had been purchased just two years before by Dr. Richarz who had then converted it to a hospital.   Retaining much of its original splendor, including extensive gardens, the hospital seemed like an ideal setting for recovering patients.  Certainly, its policies were unusually progressive for that era with patients being allowed to walk on and off the grounds for exercise (though Schumann was constantly supervised due to his suicidal history).    Unfortunately, treatment was also extremely expensive and, despite offers of help from Brahms and other friends, was a major financial concern for Clara Schumann.

She was also concerned about the weekly reports she received from the hospital about her husband.   The doctors had asked her not to visit or communicate with her husband directly since they thought this would help him recover faster.   Even the few visitors he received weren't allowed to talk to him, only to observe from a distance.   Whether or not this made good medical sense, it certainly contributed to his feeling of isolation, especially from Clara and his beloved children.   

While the doctors continued to report on his progress, any hope for a speedy recovery was dashed by Robert's frequent relapses, not to mention his constant guilt over something that happened prior to his marriage to Clara (historians are divided over what exactly this was).   Despite his relapses, he definitely improved over time and often went on walks through the hospital's gardens.   Though he was eventually allowed visitors, his improvement was still rocky.   

The hallucinations slowly subsided but he was still prone to paranoid delusions, including the belief that his wine was poisoned.  He was also distressed over not hearing from Clara at all and he apparently didn't realize that the doctors had instructed her not to write to him directly.   After a few months, the doctors relented and asked Clara to write to him but she was still asked not to discuss any topics that might distress him.

While Clara tried to write as often as possible, her own life was going through a profound change.   She had largely been overshadowed by her husband before his hospitalization but raising her children alone allowed her to establish herself as one of Europe's finest pianists.   As a result, she was kept busy going on frequent musical tours to help pay for Robert's care as well as to support herself and her children.   Despite her worries about Robert's condition, she definitely enjoyed all the public attention she was receiving, and, ironically enough, her success as a pianist allowed her to earn far more money than Robert would likely have earned at his regular music position in Dusseldorf.  

As for Robert himself, he continued to recover and, while his letters to Clara were sporadic, he also wrote to many of his other friends, including Brahms.   In these letters, along with what he told friends during visits, Robert seemed apprehensive about his doctors and the treatment he was receiving at Endenich.    When one of his close friends, Joseph Joachim, visited Schumann December 1844,  Robert told him that he wanted to leave Edenich because "the doctors there completely misunderstood him".   There was no evidence that Joachim told Clara about this but Robert later sent her a letter in which he wrote, "My Clara, ” he wrote, “I feel as if something dreadful lies before me. What sorrow—if I never see you and the children again!”  Though his doctors took this to mean that he was considering suicide, it seems more likely that he was afraid that he would never be allowed to rejoin his family. 

Though Clara herself didn't visit Edenich, she arranged for several friends to see her husband and investigate other possible clinics.  One friend, Bettina von Arnim, visited Robert and later told Clara that she would do everything she could "to free poor Schumann as soon as possible from his imprisonment."   She was also extremely critical of the hospital and the doctors themselves, many of whom she thought were even more disturbed than their patients.

Despite Bettina's urging, Clara was reluctant to take her husband out of the hospital and, instead, met with Dr. Richarz who assured her that everything was fine and that Robert should not be moved.   This was apparently enough for Clara and she agreed to keep him at Edenich for at least another year.  Unfortunately, Robert had apparently regarded Bettina as being his last hope and his condition quickly deteriorated when nothing changed.   

By 1856,  Robert had become much worse as Brahms noted in his two visits that year.  After one of these visits, Brahms reported that his friend was largely incoherent and that "often he only babbled, something like bababa—dadada" and that he showed little sign of understanding his friend when he tried to talk.   

In June of that year, Clara received a telegram from Edenich while she was touring in England.   The telegram said that Robert was "totally debilitated" though he was still apparently conscious.   She finally went to Edenich herself on July 27 after receiving word that her husband was dying.    Even though Brahms and the doctors had tried to stop the visit (to spare her the shock), Clara was still stunned by what she saw.    As she would later report, "He smiled at me and, with great exertion placed his arm around me. I will never forget it...He spoke with spirits, so it seemed, and would not permit anyone around him for long, or he would become restless.   It was nearly impossible to understand him any longer."  

Robert Schumann died in his sleep on July 29 at 4 pm.   Clara came to his bedside a half-hour later to see her husband one last time.  "I stood by the corpse of my dearly  beloved husband and was at peace; all feelings went in thanks to God that he was finally free."  The funeral was held just four days later and the general consensus among everyone present was a sense of relief that his "miserable existence" was over.   Clara Schumann never remarried and spent the rest of her life as a concert pianist who helped to popularize Schumann's work worldwide.

As for the exact cause of  Schumann's death, that continues to be a mystery even today.   While he was only forty-six when he died, the autopsy report itself was largely inconclusive.  In an article Doctor Richarz wrote on Schuman in 1873, he claimed that Robert suffered from "incomplete general paralysis" resulting from a "slow,  but irreversible and progressive deterioration in organization and strength of the entire nervous system."   Along with his "melancholic depression",  Richarz attributed Schumann's early death to his refusal to eat and the emaciated state of his body when he died.  

Other medical historians have also suggested that Schumann suffered from schizophrenia or bipolar depression based on the bizarre symptoms he often displayed.  In recent years, another explanation that seems more widely accepted was that he suffered from tertiary syphilis (also called general paresis in those days).   Certainly, he had numerous symptoms linked to advanced syphilis, including hallucinations, speech and movement difficulties, and an eventual mental collapse.   Schumann himself apparently believed that he had syphilis due to a previous affair (which contributed to his delusions of being sent to Hell due to his "wickedness").   Still, no traces of the brain degeneration commonly seen in tertiary syphilis turned up in his autopsy, something that would have been evident if he really had the disease.   Certainly, there was no indication that he passed it on to Clara or that any of his children developed congenital syphilis afterward (though one son was committed to a psychiatric asylum years later).   

Ironically, it may well have been the treatment received at Edenich that truly led to Schumann's death.   In his own article, Doctor Richarz displayed a total lack of empathy towards his patient that reflects Schumann's own sense of despair at not being allowed to leave the hospital.  His hopes for a release were raised by visits from friends such as Bettina von Arnim, his condition only deteriorated when he felt abandoned and he began starving himself as a result.   As it happens, other patients also engaged in hunger strikes, largely in protest to the treatment they were receiving at Edenich, though little is known about what later happened to them. 

So,  was Robert Schumann's death due to despair at being abandoned or because of a still-undiagnosed medical condition?   We may never know for sure.  Despite the mystery surrounding Schumann's death, the love affair between Clara and Robert, as well as their friendship with Brahms continues to be commemorated.  With numerous books and movies written about the three of them, not to mention the musical works that Johannes Brahms and Robert Schumann completed between them,  Clara, Robert, and Brahms have become the stuff of legend.

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