Although sexual abuse of children is recognized as a serious problem, sibling incest has received... more Although sexual abuse of children is recognized as a serious problem, sibling incest has received relatively little attention. A distinction has been made between power-oriented sibling incest and nurturance-oriented incest. The authors review the relevant literature and present four clinical examples. The cases illustrate the broad range of sibling incest and demonstrate its effects, including the long-term consequences for the perpetrator. Lasting difficulties in establishing and maintaining close relationships, especially sexual ones, are prominent features of each case. Without denying the occurrences of benign sex-play between siblings, the authors emphasize exploitation and abuse as pathogenic aspects of sibling incest.
The current study re-examines an exceptional case of a serial killer incarcerated since a decade ... more The current study re-examines an exceptional case of a serial killer incarcerated since a decade ago. "Jacob" is the first serial killer apprehended in Israel. His known actions were committed during the eighties of the last century, and continued for eleven years. The victims were elderly individuals, including both his parents. Shortly after incarceration he became overtly schizophrenic and underwent five hospitalisations. The case is re-examined in view of changes, both in the perpetrator's diagnosis and criminal legislation. Was Jacob doomed to become a serial killer, or could his fate be avoided through early professional intervention? Were the killings presenting symptoms of a psychotic or pre-psychotic phase? Should he be eligible for a retrial? What would have been his position with the current law in view of the new 300A(a) clause ("Reduced Punishment") of the Israeli Criminal Code? Could he ever be released back to the community? These are some of t...
The Russian landscape painter Alexey Savrasov lived in the middle of the 19th century. He was ove... more The Russian landscape painter Alexey Savrasov lived in the middle of the 19th century. He was overwhelmed with grief at the loss of several of his children and he used alcohol to blunt the pain and anguish. The effects of psychoactive substances and especially alcohol have been linked closely to creativity. His life story demonstrates the bitter relationship between the bottle and the muse. He became dependent on alcohol, his family broke up and he was fired from work, his creativity declined and his health deteriorated. At death, he was a lonely and a forgotten man and only two persons attended his funeral.
Three cases of highly publicized political assassinations, which occurred during the twentieth ce... more Three cases of highly publicized political assassinations, which occurred during the twentieth century, are described. In two of them (Tsafendas and Amir) a head of a state was assassinated. In both cases the second author (A.Z.) was involved in the psychiatric evaluation of the perpetrator. A third case, in which a head of state was badly wounded (Hinckley) is referred due to its overwhelming impact on public opinion and legislation. Few similarities are found between the perpetrators, who came from different cultures and acted in different eras. The psychiatric examination had a crucial role in the outcome of their trial. In spite of different milieus the forensic psychiatrist found himself amidst a highly charged event. There is no single common denominator characterizing the psychopathology of the political assassin. It is suggested that there is a spectrum of psychiatric diagnoses ranging from the psychotic perpetrator who targets the victim due to his intrapsychic delusional w...
This study explored the association of ethnocultural background (Ashkenazi vs Sephardi origin) wi... more This study explored the association of ethnocultural background (Ashkenazi vs Sephardi origin) with antecedents of religious conversion among Israeli Jewish penitents who applied for psychiatric help in an outpatient clinic. A basic assumption underlying the comparison was that Sephardic Jews in Israel are more inclined toward Jewish tradition and collectivistic than Ashkenazim. The interview data indicated that for both groups emotional factors were more dominant in the conversion process than cognitive ones; however, cognitive factors were more strongly present in the conversion process of the Ashkenazim whose prepenitence cultural orientation had been more secularized and individualistic. In both groups a high prevalence of problematic relations with the father (but not with the mother) during childhood was noticed. Over-all, conversion tended to be gradual rather than abrupt and devoid of mystical experiences.
Differences in diagnostic approaches between psychiatry and other medical specialties were examin... more Differences in diagnostic approaches between psychiatry and other medical specialties were examined and problems resulting from misdiagnosis are presented. The labelling and stigma resulting from misdiagnosis have severe implications and there is inherent difficulty in correcting misdiagnoses of major psychiatric disorders. We present a 38-year-old man who underwent numerous psychiatric and psychological examinations in order to change a previous misdiagnosis. The difficulties examiners had in accepting the possibility of misdiagnosis, and its severe consequences, are described.
Ephedrine has both alpha- and beta-adrenergic activity, and both direct and indirect effects on r... more Ephedrine has both alpha- and beta-adrenergic activity, and both direct and indirect effects on receptors. Its stimulatory effects on the central nervous system are more prolonged, though less potent, than those of adrenalin. It raises blood pressure both by increasing cardiac output and inducing peripheral vasoconstriction. It is still commonly used as a bronchodilator. However, since prolonged use leads to decreased effectiveness, patients tend to increase the dose themselves. The clinical picture of ephedrine psychosis resembles that induced by amphetamines: primarily a paranoid psychosis with delusions of persecution and auditory and visual hallucinations in a setting of unclouded consciousness. We present a 57-year-old woman who had been taking a usual dose of ephedrine for bronchial asthma (50 mg 3 times a day) for more than 30 years. When her husband died she developed depression, for which she tried to use ephedrine as an antidepressive, increasing the dose to 500 to 1000 mg a day over the course of half a year. She developed paranoid psychosis with delusions of persecution and auditory hallucinations, despite a clear sensorium. Recovery was rapid after ephedrine was gradually reduced to 200 mg a day and a small dose (200 mg) of the neuroleptic thioridazine was added.
The Israel journal of psychiatry and related sciences
This paper describes a rare forensic psychiatric syndrome which has been the subject of massive p... more This paper describes a rare forensic psychiatric syndrome which has been the subject of massive publicity in the last decade. Despite the widespread interest, the psychodynamic process whereby a person becomes a serial murderer remains largely unknown. "Jacob" was convicted of a series of murders that he carried out over a decade. The case material is based on the psychiatric reports that were presented to the court and the many articles published in the local press at the time. Despite the limitations imposed by the material, the available information on "Jacob" bears some similarity to the phenomenological and psychodynamic models described in the literature. An attempt is made to understand the transformation of a person into a serial killer considering the life events, psychopathology and stressors that lead to the emergence from the world of imagination and fantasy of a potential murderer to the deeds that comprise the syndrome.
Lately an increasing number of physicians are asked to diagnose and treat physical and mental dis... more Lately an increasing number of physicians are asked to diagnose and treat physical and mental disorders caused by alcohol abuse, a phenomena which had been quite rare in Israel until recently. Early diagnosis and efficient treatment are essential for the management of alcohol-dependent patients. Primary care physicians and hospital personnel should be more alert to the growing numbers of alcohol abusers and to their appropriate diagnosis and treatment. This article describes and summarizes the symptoms of alcohol withdrawal in general, and alcoholic delirium in particular. Problems in diagnosis and treatment are illustrated by typical cases, pointing out early clinical warning signs and suggesting some treatment guidelines.
Although sexual abuse of children is recognized as a serious problem, sibling incest has received... more Although sexual abuse of children is recognized as a serious problem, sibling incest has received relatively little attention. A distinction has been made between power-oriented sibling incest and nurturance-oriented incest. The authors review the relevant literature and present four clinical examples. The cases illustrate the broad range of sibling incest and demonstrate its effects, including the long-term consequences for the perpetrator. Lasting difficulties in establishing and maintaining close relationships, especially sexual ones, are prominent features of each case. Without denying the occurrences of benign sex-play between siblings, the authors emphasize exploitation and abuse as pathogenic aspects of sibling incest.
The current study re-examines an exceptional case of a serial killer incarcerated since a decade ... more The current study re-examines an exceptional case of a serial killer incarcerated since a decade ago. "Jacob" is the first serial killer apprehended in Israel. His known actions were committed during the eighties of the last century, and continued for eleven years. The victims were elderly individuals, including both his parents. Shortly after incarceration he became overtly schizophrenic and underwent five hospitalisations. The case is re-examined in view of changes, both in the perpetrator's diagnosis and criminal legislation. Was Jacob doomed to become a serial killer, or could his fate be avoided through early professional intervention? Were the killings presenting symptoms of a psychotic or pre-psychotic phase? Should he be eligible for a retrial? What would have been his position with the current law in view of the new 300A(a) clause ("Reduced Punishment") of the Israeli Criminal Code? Could he ever be released back to the community? These are some of t...
The Russian landscape painter Alexey Savrasov lived in the middle of the 19th century. He was ove... more The Russian landscape painter Alexey Savrasov lived in the middle of the 19th century. He was overwhelmed with grief at the loss of several of his children and he used alcohol to blunt the pain and anguish. The effects of psychoactive substances and especially alcohol have been linked closely to creativity. His life story demonstrates the bitter relationship between the bottle and the muse. He became dependent on alcohol, his family broke up and he was fired from work, his creativity declined and his health deteriorated. At death, he was a lonely and a forgotten man and only two persons attended his funeral.
Three cases of highly publicized political assassinations, which occurred during the twentieth ce... more Three cases of highly publicized political assassinations, which occurred during the twentieth century, are described. In two of them (Tsafendas and Amir) a head of a state was assassinated. In both cases the second author (A.Z.) was involved in the psychiatric evaluation of the perpetrator. A third case, in which a head of state was badly wounded (Hinckley) is referred due to its overwhelming impact on public opinion and legislation. Few similarities are found between the perpetrators, who came from different cultures and acted in different eras. The psychiatric examination had a crucial role in the outcome of their trial. In spite of different milieus the forensic psychiatrist found himself amidst a highly charged event. There is no single common denominator characterizing the psychopathology of the political assassin. It is suggested that there is a spectrum of psychiatric diagnoses ranging from the psychotic perpetrator who targets the victim due to his intrapsychic delusional w...
This study explored the association of ethnocultural background (Ashkenazi vs Sephardi origin) wi... more This study explored the association of ethnocultural background (Ashkenazi vs Sephardi origin) with antecedents of religious conversion among Israeli Jewish penitents who applied for psychiatric help in an outpatient clinic. A basic assumption underlying the comparison was that Sephardic Jews in Israel are more inclined toward Jewish tradition and collectivistic than Ashkenazim. The interview data indicated that for both groups emotional factors were more dominant in the conversion process than cognitive ones; however, cognitive factors were more strongly present in the conversion process of the Ashkenazim whose prepenitence cultural orientation had been more secularized and individualistic. In both groups a high prevalence of problematic relations with the father (but not with the mother) during childhood was noticed. Over-all, conversion tended to be gradual rather than abrupt and devoid of mystical experiences.
Differences in diagnostic approaches between psychiatry and other medical specialties were examin... more Differences in diagnostic approaches between psychiatry and other medical specialties were examined and problems resulting from misdiagnosis are presented. The labelling and stigma resulting from misdiagnosis have severe implications and there is inherent difficulty in correcting misdiagnoses of major psychiatric disorders. We present a 38-year-old man who underwent numerous psychiatric and psychological examinations in order to change a previous misdiagnosis. The difficulties examiners had in accepting the possibility of misdiagnosis, and its severe consequences, are described.
Ephedrine has both alpha- and beta-adrenergic activity, and both direct and indirect effects on r... more Ephedrine has both alpha- and beta-adrenergic activity, and both direct and indirect effects on receptors. Its stimulatory effects on the central nervous system are more prolonged, though less potent, than those of adrenalin. It raises blood pressure both by increasing cardiac output and inducing peripheral vasoconstriction. It is still commonly used as a bronchodilator. However, since prolonged use leads to decreased effectiveness, patients tend to increase the dose themselves. The clinical picture of ephedrine psychosis resembles that induced by amphetamines: primarily a paranoid psychosis with delusions of persecution and auditory and visual hallucinations in a setting of unclouded consciousness. We present a 57-year-old woman who had been taking a usual dose of ephedrine for bronchial asthma (50 mg 3 times a day) for more than 30 years. When her husband died she developed depression, for which she tried to use ephedrine as an antidepressive, increasing the dose to 500 to 1000 mg a day over the course of half a year. She developed paranoid psychosis with delusions of persecution and auditory hallucinations, despite a clear sensorium. Recovery was rapid after ephedrine was gradually reduced to 200 mg a day and a small dose (200 mg) of the neuroleptic thioridazine was added.
The Israel journal of psychiatry and related sciences
This paper describes a rare forensic psychiatric syndrome which has been the subject of massive p... more This paper describes a rare forensic psychiatric syndrome which has been the subject of massive publicity in the last decade. Despite the widespread interest, the psychodynamic process whereby a person becomes a serial murderer remains largely unknown. "Jacob" was convicted of a series of murders that he carried out over a decade. The case material is based on the psychiatric reports that were presented to the court and the many articles published in the local press at the time. Despite the limitations imposed by the material, the available information on "Jacob" bears some similarity to the phenomenological and psychodynamic models described in the literature. An attempt is made to understand the transformation of a person into a serial killer considering the life events, psychopathology and stressors that lead to the emergence from the world of imagination and fantasy of a potential murderer to the deeds that comprise the syndrome.
Lately an increasing number of physicians are asked to diagnose and treat physical and mental dis... more Lately an increasing number of physicians are asked to diagnose and treat physical and mental disorders caused by alcohol abuse, a phenomena which had been quite rare in Israel until recently. Early diagnosis and efficient treatment are essential for the management of alcohol-dependent patients. Primary care physicians and hospital personnel should be more alert to the growing numbers of alcohol abusers and to their appropriate diagnosis and treatment. This article describes and summarizes the symptoms of alcohol withdrawal in general, and alcoholic delirium in particular. Problems in diagnosis and treatment are illustrated by typical cases, pointing out early clinical warning signs and suggesting some treatment guidelines.
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Papers by Ely Witztum