A miscarriage is any pregnancy that spontaneously ends before the fetus can survive. Food-borne bacterial infections are one potentially preventable cause of miscarriage and stillbirths, so pregnant women are advised to be careful about what they eat while they are expecting, especially during the first few months of pregnancy. The bacterial strains associated with miscarriage are Listeria, Salmonella, Toxoplasma, and E. coli.

Listeria

Listeria species are the bacteria that cause the disease listeriosis. In non-pregnant people, the most common signs are abdominal pain, nausea/vomiting, diarrhea and fever. In pregnant women, a non-specific flu-like illness is the most common sign. Symptoms may include fever, chills, body aches and malaise. However, pregnant women are more susceptible to complicated infections, and in the U.S., Listeria infection during pregnancy occurs most often in the third trimester, so is more likely to be a cause of a stillbirth than an early miscarriage.

Foods that may harbor Listeria include:

• Unpastereurized milk and cheeses
• Imported soft cheeses, such as Brie, Gorgonzola, feta, and Roquefort (non-imported soft cheese made from pasteurized milk should be safe)
• Deli meats
• Refrigerated, smoked seafood eaten on its own (not as an ingredient in a well-cooked meal)
• Refrigerated pate or meat spreads

Salmonella

Salmonella bacteria species cause a disorder called Salmonella enterocolitis, also called Salmonellosis. Symptoms include diarrhea, abdominal pain, nausea, vomiting, and fever or chills. The primary culprits are undercooked poultry products:

• Chicken
• Turkey
• Eggs

Cook all eggs thoroughly during pregnancy in order to best reduce risks; one survey in the early 1990s found pathogenic Salmonella in 24% of eggs sampled from U.S. hen houses. Incidence in more recent surveys has been lower, but cooking eggs carefully is a good precaution.

Toxoplasma

The bacterium Toxoplasma gondii is the culprit in the disease toxoplasmosis. People tend to associate toxoplasmosis with cat litter boxes, but it can also be a food-borne infection. Symptoms of toxoplasmosis are enlarged lymph nodes, muscle pain, headache, mild fever, and sore throat; the disease is often confused with the flu.
The major food to avoid is:

• Undercooked raw meat

E. Coli

Reports of Escherischia coli poisoning tend to hit the media now and then, and certain forms of the bacteria do pose a risk for miscarriage. (E. coli is also a normal inhabitant of the human intestinal tract; only certain species cause problems.) Poisoning with E. coli causes the disorder E. coli enteritis. Symptoms include abdominal pain, diarrhea, fever, gas, cramping, and rarely vomiting.

Foods that pose risk include:
• Undercooked, unsanitary food (be careful in restaurants)
• Contaminated water in certain countries
• Unwashed fruits and vegetables

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Neurosis is a class of mental disorders that involves persistent distress (but neither delusions nor hallucinations) where behavior does not fall outside of socially acceptable norms. Neurotic people suffer from a variety of psychological ills, including experiencing persistently negative feelings, including anxiety, sadness, depression, anger irritability, confusion and feelings of low self-esteem. In an effort to avoid the source of anxiety or upset, neurotic people often engage in symptomatic behaviors such as phobic avoidance, vigilance, impulsive and compulsive acts, obsessive thoughts, habitual fantasizing and persistent negativity. Neurosis can have a negative impact on the interpersonal relationships of the neurotic, and may be manifested in inappropriate or excessive dependency, aggression and/or socially isolating behaviors.

On a fundamental level, neurosis represents a poor inability to adapt to one’s environment, an inability to change negative life patterns and the failure to develop a richer and more mature adult personality. Neurosis was once a common psychiatric diagnosis, but it gradually fell out of favor in most mainstream psychological circles because of its ambiguous etiology. However, most mental health professionals agree that heredity, temperament, upbringing, culture, education and life experience can both contribute to and mitigate the development of neurosis.

People grapple with new challenges by harnessing their arsenal of personal experience and inherited capacities to solve the problem presented as efficiently as possible. If a person is up to the task (or believes it so), then the emotional response can be kept within healthy limits. However, if an individual is not up to the task (or if they believe it so) than they experience anxiety. This anxiety can crystallize into neurosis if an individual begins to cope with repeated occasions of stress with behavior patterns aimed at avoiding or otherwise mitigating their anxiety, such as hyper-vigilance, escapism and defensive thinking. Thus, stress, anxiety and neurotic behaviors can form an unhealthy loop that can stifle personal growth and development.

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In 1986, after an intensive two-year qualitative research study, Constance Mellon published “Library anxiety: A grounded theory and its development.” In this work, Mellon coined the term “Library anxiety” which described the feeling of fear and discomfort that Undergraduate students felt when they encountered an academic library. The students generally described the following four reasons for their anxiety:

• intimidated by the size of the library,
• lacked knowledge about where everything was located,
• lacked knowledge about how to begin the research process and
• lacked knowledge about what to do.

Moreover, Mellon’s studied demonstrated that “library anxiety” was often so intense that it frequently led to procrastination and undermined students’ ability to function proficiently in a library setting. Many of the students overestimated the library skills of other students and reported feeling a sense of ‘inferiority’ in the library. In response to this study, schools have developed a number of classes for new undergraduates geared towards demystifying the library, in an effort to nip anxiety in the bud before it leads to procrastination and other self-sabotaging behaviors. Recently, a number of studies on library anxiety have focused on adult learners, who are particularly susceptible to library anxiety because many of them came of age in a largely pre-computer era, and find themselves overwhelmed by the technological changes that are part and parcel of contemporary institutions of higher learning. Thus, a number of programs are being developed to improve their computer literacy before they succumb to frustration.

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Winston Churchill, widely considered to be one of the greatest public speakers in the 20th century, actually suffered from a persistent (albeit mysterious) speech impediment that he tirelessly worked to overcome. However, historians and biographers heatedly disagree with respect to whether Churchill’s mysterious speech impediment was a lisp or a stutter. Many pieces written about Churchill during the 1920s and 1940s mentions Churchill’s ‘stutter’ in terms implying that it was a well-known characteristic. A picture of Churchill graces the homepage of The Stuttering Foundation of America’s website, as an example of a role model who successfully gained mastery over his stuttering. However, the Churchill Centre adamantly maintains that Churchill did not stutter, and claim that he merely had difficulty pronouncing the letter S and spoke with a slight lisp.

On November 17, 2002, The Baltimore Sun addressed this controversy, revealing evidence that Churchill had a lisp (like his father), and had consulted notable speech therapist, Sir. Felix Semon, in an effort to overcome his impediment. Dr. Semon is said to have told the young Churchill that he did not have a physiological defect that could be corrected, and that he must practice and persevere in order to gain mastery over his impediment. After evaluating Churchill, Dr. Semon is said to have commented, “I have just seen the most extraordinary young man I have ever met”.

Both The Stuttering Foundation and the Churchill Centre have a vested interest in promulgating their side of the story; the former does not want to lose their valuable pin-up boy, and the latter is invested in downplaying any of Churchill’s flaws as much as possible. However, in light of Churchill’s formidable accomplishments, I would hazard to say it really doesn’t matter…..

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People who suffer from Tourette’s syndrome (TS) have good cause to be sensitive about the public’s misperceptions about their condition: the media tends to focus on the 10% of people with TS who suffer from coprolalia, the most mysterious and socially stigmatizing manifestation of the disorder, to the exclusion of more common manifestations of the condition. Coprolalia is the medical term for a type of tic characterized by the excessive and uncontrollable use of foul or obscene language. An inherited neuropsychiatric disorder, TS falls within a spectrum of tic disorders, and is that is characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic. These symptoms vary widely in severity and typically wax and wane.

Coprolalia is a typical symptom of TS, and is characterized by compulsive arm movements, facial tics, grunting, groaning and the shouting of culturally taboo or socially unacceptable words and phrases (such as compulsive cursing and repeated references to genitals, feces and lewd sexual acts). For people with coprolalia, these outbursts are truly involuntary in nature; they are not expressed out of anger or frustration. Outbursts of derogatory racial and ethnic slurs are not uncommon, but do not generally reflect the opinions of those with the disorder. Unsurprisingly, people with coprolalia often experience intense psychological upset as a result of their condition, and many sufferers isolate themselves in order to avoid social embarrassment.

The exact causes of TS and coprolalia are unknown, but scientists believe that both genetic and environmental factors play a role in the development of the disorder. Interestingly, coprolalia has been observed in deaf patients, where swearing in sign language has been described. Currently, there is no ‘magical’ medication that relieves all of the tics experienced by a person with TS. Thus, people with TS usually treat their condition with a combination of psychotherapy and certain medications that can relieve the manifestation of certain tics. Recently, a number of patients with coprolalia have managed their symptoms with some success by getting botox injections near their vocal cords. While these injections do not prevent the vocalizations, they help to reduce their volume; for unknown reasons, coprolalia outbursts tend to be loud and spoken in a different pitch than normal conversation.

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Norwegian painter Edvard Munch’s haunting expressionist painting, “The Scream” has often been used to describe the distorted way in which a person with depersonalization disorder (DPD) experiences their environment and themselves. DPD is characterized by periods of feeling powerfully disconnected or detached from one’s own body and thoughts. Sufferers sometimes describe these periods as “dream-like,” and feel as though they are watching themselves from outside their body. Luckily, people with the disorder remain cognizant of reality, even while experiencing the sensation of DPD. Thus, they are aware that things are not necessarily as they perceive them to be. Episodes of depersonalization can last anywhere from a few minutes to many years, and is often comorbid with depression and anxiety disorders. DPD has also been linked to obsessive-compulsive behaviors, which are often employed by sufferers as a coping mechanism to help them feel more ‘connected’ to their environment.

The diagnostic criteria defined in section 300.6 of the Diagnostic and Statistical Manual of Mental Disorders are as follows:

- Persistent or recurrent feelings of being detached from one’s mental processes or body; as if an observer;

- During depersonalization, reality testing is intact;

-Depersonalization causes significant distress, and impairment in social, occupational, or other functioning; and

-Depersonalization is not the result of another disorder, substance use, or general medical condition.

The DSM-IV-TR specifically recognizes three possible manifestations of depersonalization disorder: Derealization (experiencing the external world as strange or unreal); Macropsia or micropsia (an alteration in the perception of object size or shape); and a sense that other people seem unfamiliar or mechanical. While acknowledging that a number of genetic and environmental factors might play a role in the development of the disorder, most mental health professionals believe that DPD is usually triggered by abuse, trauma and/or drug use. Thus, DPD can be best understood as an extreme defense mechanism, which is triggered in an effort to ward off additional negative stimuli.

There are currently no hard and fast rules with respect to the treatment of DPD. The goal of most treatment plans is to pinpoint the particular stressors that trigger the episodes of disassociation, and determine ways to lessen their impact. Therefore, mental health practitioners usually employ a combination of psychotherapy, cognitive therapy and medication (which is usually administered for the purpose of treating underlying anxiety, and not DPD directly).

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Anorexia nervosa is a psychiatric condition that describes an eating disorder characterized by extremely low body weight, skewed body image and an obsessive fear of gaining weight. People with anorexia primarily control their weight through extreme caloric restriction, excessive exercise, abusing diet pills and/or laxatives and diuretics. Anorexia disproportionately affects women (90%), especially during adolescence, and causes a host of psychological and physical problems for the sufferer, often prompting an intervention from concerned family and friends. However, anorexics are notoriously stubborn and resistant to recovery, as weight gain in an inevitable outcome of ‘getting better.”

As such, it is unsurprising that the Internet has facilitated the explosion of “Pro-ana” (pro-anorexic) websites, aimed at the promotion of anorexia as a “lifestyle” choice instead of an eating disorder. While some pro-ana websites claim that their purpose is to provide an open environment for women to discuss their illness, the vast majority of these websites make no such claim. In fact, the content of most pro-ana websites are rife with crash dieting tips, advice on how to hide weight loss from parents and doctors and ‘helpful’ suggestions about how to suppress hunger pains and avoid ‘binges.’ Moreover, in an effort to encourage further weight loss, most pro-ana websites include a photo gallery of extremely thin women, often culled from popular fashion magazines, as “thinspiration” for their readers.

There is even a widely disseminated list of rules for anorexics to live by, called the “Ana Commandments”:

1. If you aren’t thin you aren’t attractive.

2. Being thin is more important than being healthy.

3. You must buy small clothes, cut your hair, take diet pills, starve yourself, do anything to make yourself look thinner.

4. Thou shall not eat without feeling guilty.

5. Thou shall not eat fattening food without punishing oneself afterwards.

6. Thou shall count calories and restrict intake accordingly.

7. What the scale says is the most important thing.

8. Losing weight is good / gaining weight is bad.

9. You can never be too thin.

10. Being thin and not eating are signs of true will power and success.

Unsurprisingly, pro-ana websites have come under heavy fire from parents and mental health professionals. However, efforts to ban these sites have just pushed them underground and made them more attractive to devotees. But as doctors and parents of anorexics should know all too well, stubbornness and tenacity are a condition precedent of the disorder. Thus, these young women will only recover when they have made the decision to forsake their isolating and unhealthy behaviors. Sadly, these websites make it even harder for them to do so.

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