The inpatient evaluation and treatment of a self-professed budding serial killer

The authors present the case of a man who was hospitalized after claiming that he was about to become a serial killer. The patient presented with extensive written homicidal fantasies and homicidal intentions without evidence of actual homicidal acts. In addition to routine assessments, hospital staff members used case conferences, psychological testing, outside forensic consultation, and a forensic review process to make decisions regarding diagnosis, treatment planning, and discharge. The patient was discharged after 8 months of inpatient treatment and was apparently free of homicidal impulses or symptoms of severe mental illness. A 2-year court commitment allowed for the enactment and potential enforcement of a discharge plan that was endorsed by the patient, the hospital, and community care providers. The authors review diagnostic and risk management issues. Comparisons with known features of typical serial killers are made.     

Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

Politics and Literature: Means and Ends in Koestler

The fruitfulness of imaginative literature as source material for the student of politics has been a subject for much debate over recent years, though the impact of literature on the teaching of politics remains limited. This paper addresses by means of an example (that of the relationship between means and ends) some of the fundamental problems involved in the relationship and some of the advantages which imaginative literature might bring to our understanding of political issue and concepts. Following introductory comments about the relationship between politics and literature in general we consider the treatment of means and ends in political theory, especially Machiavelli's claim that when the 'act accuses, the result excuses'. Finally and substantively we consider the treatment of the means/end theme in Arthur Koestler's Darkness at Noon and The Gladiators and conclude with some general comments about the relationship between the study of politics and imaginative literature.     

The lost 1990s? Personal reflections on a history of participatory technology development

This article traces a history of agricultural participatory research, largely from the author's personal experience. Participatory research in the 1970s was mostly led by disciplinary scientists, and characterised by innovative activities and open academic debate, with some recognition that policy and development practice was a political process. The 1980s saw a shift to learning from past experience, and a participatory mainstream developed, seeking methods for scaling up. Meanwhile, others sought to understand and influence policy and institutional change in their political and cultural contexts, and to keep open the academic debates. The author considers the 1990s as ‘lost years’, during which mainstream participatory practitioners became inward-looking development generalists, not so interested in learning from others outside their paradigm. The late 2000s provide a chance to re-recognise the political and cultural embeddedness of science and technology; re-introduce strong, widely based disciplines; and learn from past activities that resulted in positive development outcomes (planned or unplanned).