Washington Center For Psychiatry

The Washington Post – Outlook Section

March 11, 2001

By Alen J. Salerian, MD

In the mid-1990s, the FBI sent me to a Southern city to do a psychological evaluation of one of its undercover agents. The reason: The agent was having an affair with a member of the criminal organization he was investigating.

I spent about a week there, talking with the agent in various restaurants and bars, my back always to the entrance so he could keep an eye on who came through the door. During our meetings, the agent seemed quite calm, unfazed by either his dangerous assignment or the firestorm his behavior was causing at headquarters.

He was remarkably candid about what motivated his reckless sexual conduct: anger. Behind his cool exterior he was seething, because he believed the exceptional caliber of his undercover work was not fully appreciated by his superiors. And this unnecessarily risky escapade was his way of punishing the uncaring agency.

Luckily, our work had a successful ending. The agent was gradually extricated from the assignment without arousing suspicion, and he soon retired from the bureau. His final words to me were: “I know I crossed the line and was going to do more. Thank God you came along.”

I have been thinking of that agent and what “more” he might have done since the headlines first appeared about Robert Hanssen, the FBI agent accused of betraying his country beginning in 1985. Were there signals that a professional evaluation would have picked up? Could a psychiatrist have identified Hanssen as a possible threat years before a double agent fingered him as a spy?

Very likely, the signals were there. But very likely they wouldn’t have been picked up — because the FBI doesn’t require regular psychological evaluations of its agents. This is a painfully obvious lack in bureau security. When personnel are hired, they go thorough physical and psychological screenings. After that, however, only the physical exams are routine, even though these employees are subject to stresses and pressures far beyond what most people experience. The FBI keeps regular tabs on its agents’ weight and blood pressure — but not their emotional stability.

It’s not that the bureau doesn’t believe in the usefulness of psychology — consider, for example, its use of extensive profiling to understand and identify serial criminals. And in crises involving its agents, it often relies on the tools of modern psychiatry. From 1992 to 1997, in fact, I worked regularly with the FBI; I helped develop and was medical director of the bureau’s Mobile Psychiatric Emergency Response Team. I trained many counselors and went out on assignments myself, working with agents everywhere from U.S. embassy compounds abroad to Waco, Tex. Not all the agents I have worked with were undercover, but I have evaluated dozens of men and women with secret missions and double lives.

So, while I don’t know Hanssen or pretend to understand his particular case, I understand a great deal about undercover agents. And I believe that regular evaluation of all agents might help expose threats and prevent security disasters.

Let me be clear about something: The overwhelming majority of the bureau personnel I have met are tough, intelligent and stable, with an unswerving dedication to their work. And the bureau itself is, in my view, a singularly well-managed and effective organization. My only concern here is identifying the rare potential problem.

Most secret agents I have met have two signature traits: fearlessness and a high tolerance for anxiety. Whether because of biological factors, such as an elevated level of the mood-enhancing neurochemical serotonin, or because of the influences of their early lives, these people seem to be extreme risk takers who can tolerate and manage worry, tension and stress with natural ease. Not surprisingly, their steely nerves are often perceived by others as aloofness or arrogance.

These characteristics, combined with stamina and the sharp intellect of a skilled chess player, are requirements for a profession distinguished by calculated risk taking in the face of constant danger. “It’s not about money or anything else,” the agent who “crossed the line” in that Southern city said. “It’s about the rush I get when I’m outsmarting them, having a quiet dinner with the enemy in his own home and slowly building the fire to burn him.”

“What about fear?” I asked.

He smiled. “My only fear is not building the perfect fire.”

Though unshakable on assignment, this agent nevertheless displayed a brittle self-esteem easily shattered by his superior’s disapproval or rejection. In this way, too, he was similar to many undercover agents I have known. They have an intense narcissism — the flip side of their confidence. They need constant positive input, and they can only get it from two sources. The first is self-esteem, which is provided by constant mastery of their roles; winning is very important. The second is feedback from their superiors, a need that makes them very vulnerable to real or perceived slights. Not merely criticism but the simple absence of praise can enrage them.

When most of us get angry at the people or system we work for, we vent our frustrations by talking with family or friends. If we get really angry, we might retaliate in straightforward fashion by turning against the boss or organization we perceive as abusive.

Spies, however, can’t vent about their work to their loved ones, because their profession demands absolute secrecy. Their necessarily lonely lives offer none of the safety valves that help the average disgruntled employee cope with stress.

Also, if they decide to take revenge, these people bring extraordinary knowledge, skill, intelligence and — perhaps most important — daring to their plans.

In 1996, the nation’s interest was caught by the case of Eugene Bennett, the former FBI agent who kidnapped his pastor in Northern Virginia. Bennett was angry with his estranged wife, who was intimately involved with crime novelist Patricia Cornwell. But his problems had been building long before he confronted his wife in the church where he had tied the pastor to a chair along with a phony bomb.

I know because, a few years earlier, Bennett had come to me for psychological counseling. It was a rare occurrence for an FBI employee to seek me out on his own, but Bennett clearly knew he was in trouble. Like any good spy, he had done his homework — checked out my background and security clearance, concluded that he could confide in me. Also true to form, he maintained outward control: When he called me, his voice was a monotone, his words cryptic. And during our meetings, his face would remain expressionless.

We met eight or nine times over a period of about six months. One day, something apparently spooked him, and he suddenly vanished into silence and never spoke with me again.

For ethical reasons, I cannot reveal what he told me during those meetings, or how I responded. But because his bizarre case was eventually part of the public record — he spent 12 months in federal prison on a fraud charge even before his conviction on charges including attempted murder and abduction — I can say he was a dangerously volatile character. By the time Bennett called me for help, he was already on administrative leave, in the midst of a publicly messy divorce and fraud investigation. The question is, could some kind of screening have spotted his problems while he was still working undercover in highly sensitive assignments?

It would be wrong to make my argument too simplistic — that certain agents get angry, have no outlet for their rage, and turn to violence and betrayal. These are complex people with paradoxical personalities. An inflated yet fragile ego is a highly combustible thing.

But that is exactly the challenge to the FBI: how to predict who is approaching meltdown and how to prevent that final explosion — or the hidden revenge of secret betrayal. There has been much discussion of lie detector tests, and I believe that regardless of their imperfections, such tests could help identify security risks. But they should be part of a broader, regular psychiatric evaluation.

I have been called to work with the bureau many times after an agent’s mental health was obviously in question. I remember a female agent who was beginning to get reckless and endanger her assignment. She turned out to be the only woman in a highly chauvinistic unit, repressing anger at superiors who merely urged her to “tough out” the harassment. And there was the counterterrorism expert based at a U.S. embassy in the Mediterranean, whose hidden frustrations only came to light when he became publicly abusive toward his wife and child.

Both cases had happy endings: The female agent was removed from the hostile environment and placed successfully in another assignment; the counterterrorism expert received extensive counseling and managed to keep his job. I was pleased and fortunate to be able to help an agency for which I have immense respect.

My disappointment, though, is that too often my fellow counselors and I are called in only after events seem to be getting out of control and there is a possibility of real damage. This reactive response is not enough. As the bureau looks into what might have made Robert Hanssen “turn” in 1985, it should seriously consider a systematic, proactive program to monitor all its agents’ psychological well-being. Both the agents and the country deserve it.

American Journal of Clinical Psychiatry

August 2004

By Alen J. Salerian, MD

Sir: There have been numerous reports of the sexually enhancing effects of tetrahydrocannabinol (THC) (1), and this letter reports positive outcome in a female bipolar patient after dronabinol use. Dronabinol, a medication currently labeled as Schedule III, is approved by the US Food and Drug Administration (FDA) for treating nausea and increasing appetite. Δ9-tetrahydrocannabinol is the sole synthetic psychoactive ingredient of dronabinol. While dronabinol may still require additional supervision needed for a controlled substance, because of its Schedule III classification in the controlled substances list of the Controlled Substances Act, the medication is not as restricted as a medication from the Schedule II list. In practical terms, dronabinol may be prescribed by telephone with up to 6 refills in a 6-month time period.

Case report. Ms. A, a 43-year-old married African American woman employed as a midlevel manager for a federally funded organization, had a history of bipolar disorder, mixed type (DSM-IV criteria), with numerous hospitalizations triggered by noncompliance with her medications. After her last relapse, she had readily admitted that the single most important factor in her noncompliance was sexual dysfunction secondary to her psychotropic medications (olanzapine, valproic acid, and paroxetine). In the past, buproprion, methylphenidate, and yohimbine had been tried, but the patient had experienced no relief from her major complaint of anorgasmia. She had no history of substance abuse.

In November 2001, Ms. A was instructed to use dronabinol 10 mg prn 1 hour before sex. She was advised that she should not drive a vehicle for 24 hours after using dronabinol and that treatment of sexual dysfunction was a non-FDA-approved use of dronabinol.

Ms. A completed self-rating of her sexual function on a scale from 0 to 10, with 0 representing the worst and 10 representing the best, and her ratings after two and a half weeks showed remarkable overall improvement. Dronabinol improved the patient’s sexual function on all of the domains assessed, including libido, arousal, lubrication, orgasm, and overall quality of her sex life.

Two years after her last hospitalization, Ms. A remains functional, employed, fully compliant with her medication, symptom-free, and sexually satisfied. There is no evidence that she has abused dronabinol. She has been using dronabinol an average of two times weekly.

An interesting and potentially serious complication occurred during the course of treatment. In routinely administered testing at her workplace, Ms. A tested positive for THC and was immediately suspended from work, but, fortunately, after a second opinion from a university-based colleague and a medical report from me addressing the rationale for her pharmacotherapy, the medical director of her company ruled in her favor, and she resumed her job.

Dronabinol’s potential for producing sexually enhancing effects that reverse psychotropic-induced sexual dysfunction is probably multifactorial. Dronabinol caused euphoria and relaxation, and because these emotional states promote sexual pleasure, it is likely that the positive sexual response is due in part to this very avenue. Most likely, there are other unknown mechanisms involved in dronabinol sexually enhancing effects. Particular attention must be paid to patients with bipolar disorder due to the greater risk of substance abuse among bipolar patients. Further double-blind, placebo-controlled studies are needed to establish the efficacy of dronabinol as an enhancer of sexual dysfunction. The potential for abuse is a risk and must be considered. Further, because Δ9-thc is the sole psychoactive ingredient of dronabinol and cannabis, clinicians must remain aware of the adverse physiologic consequences of cannabis use (2-5), and the clinical decision to prescribe dronabinol should rest on the overall risks and benefits of side effect management of bipolar patients.

Dr. Salerian has served as a consultant for and received honoraria from Eli Lilly, Pfizer, Janssen, Wyeth-Ayerst, SmithKline Beecham, and Shire.

References

1. Powell J, Fuller WR. Marijuana and sex: strange bed partners. J Psychoactive Drugs 1983;15:269-280
2. Kolodny RC, Masters WH, Kolodner RM, et al. Depression of plasma testosterone levels after chronix intensive marihuana use. N Engl J Med 1974;290:872-874
3. Besch NF, Smith CG, Besch PK, et al. The effect of marijuana on the sevrection of luteinizing hormone in the ovariectomized rhesus monkey. Am J Obstet Gynecol 1977;128:635-642
4. Smith, CG, Moore, CE, Besch, NF, et al. The effect of marijuana on the secretion of sex hormones in the mature rhesus monkey. Clin Chem 1976;22:1120
5. List A, Nazar B, Nyquist S, er al. The effects of Δ9-tetrahydrocannabinol and cannabidiol on the metabolism of gonadal steroids in the rat. Drug Metab Dispos 1977;5:266-272

Alen J. Salerian invited his landlord to add something to his sculpture garden. He got mowed down.

Washington City Paper

October 24, 2007

By Jessica Gould

In his 30 years as a psychiatrist, Dr. Alen J. Salerian has handled some high-profile cases. In 1993, he debriefed FBI agents after the Branch Davidian siege in Waco, Texas. In 2001, he spent 30 hours interviewing FBI agent and convicted Soviet spy Robert Hanssen for Hanssen’s defense team. Now, the psychiatrist is trying to understand someone a little less famous: his landlord.

Rough Giraffe: Salerian sticks his neck out for his improvised sculpture garden.
(Darrow Montgomery)

Salerian shares his Friendship Heights office, the Washington Center for Psychiatry, with six other clinicians. Together they pay $100,000 annually in rent to the multinational property giant Grosvenor. The Baltimore-based real estate company KLNB Management oversees the building on Grosvenor’s behalf.

For five years, Salerian’s relationship with his landlord has been a good one. “They were very cordial,” he says. In the spring, KLNB even spruced up the grassy area outside Salerian’s office. But the psychiatrist didn’t like how the new landscaping looked. “I found it bland,” he says. “It was just green, green, and more green.” So he planted some flowers and installed a fountain encircled by 24 small lion heads. A couple of weeks later, he bought a rooster figurine and plopped it down on the lawn. For the next six months, Salerian kept adding to the collection, sprinkling a diverse array of sculptures, stuffed animals, and scarecrows throughout the garden. Now, the grassy area is covered with “at least 100 pieces of art,” he says, including a Buddha, several giant vases, a stuffed tiger, a metal rhinoceros, a few flamingo heads, a painting of a zebra, and a tall giraffe that he named after his son, Justin. “It was freelancing and free-riding and free association,” he says of the artistic impulse guiding the garden.

Salerian says the garden is a tribute to his mother, Kristin Saleri, an acclaimed painter who died in November 2006, and says it serves a psychological purpose as well. “I wanted to create a theme of welcoming the world to our center,” he says. “If in any way I can make neuropsychiatry accessible, it’s a good thing.” Karen Dean, one of Salerian’s patients, says the garden does just that. “For a depressed person, to come to a happy place, there’s nothing better,” she says. Janice Berry, a psychiatric social worker who shares the suite with Salerian, says the garden “has an amazing therapeutic value for scores of people.”

The neighbors like it, too, Salerian says. “I get so many thanks and presents from neighbors,” he says. In August and September, though, vandals wreaked havoc on the garden, smashing the lion heads and shattering the vases. “We were totally crushed and damaged,” he says. But the destruction spurred an outpouring of support as neighbors and patients replaced the damaged goods with new figurines and sculptures. “The vandalism invigorated us,” he says.

Now Salerian’s garden is facing another threat. Earlier this fall, he wrote a letter to KLNB inviting the management company to donate to his garden. “I thought, Wouldn’t it be nice if I wrote them a memo asking, ‘Would you like to make a contribution?’” Two weeks later, he received a response. “My good citizenship backfired,” he says. “Basically, they ambushed me.”

On Sept. 25, KLNB sent Salerian a letter, an e-mail, and a fax instructing him to dismantle the sculpture garden. “At this time, the Landlord requests that you remove any and all personal property installed in the landscaped beds,” the letter read. He was told he had 10 days to remove the items.

Salerian says he’s baffled by the landlord’s response. “This is a whimsical garden dedicated to my dead mother,” he says. “It’s absolutely harmless. It’s just a bunch of sculptures and animal figures mixed in an arbitrary and random fashion.” He calls the letter “absurd,” and he’s vowed to do all he can to protect his sculptures.

To that end, he’s posted a note near the garden, encouraging his neighbors to contact KLNB and express their concerns. “Dear Neighbours,” it says, “Please help to save the sculpture garden and our animal friends from extermination.” He says KLNB has decided “to cleanse the garden of art and animals” and advises neighbors to contact property manager Reda Duffy with their objections. Duffy declined to comment for this article. Salerian also contacted the D.C. Tenants Advocacy Coalition (TENAC) for help, and on Oct. 12, TENAC sent out a press release about the psychiatrist’s situation. “Usually, the evictions we are concerned about involve real live people,” the statement read. “This time, however, statuary is involved. But whether the matter involves flesh and blood or polished marble, we believe an important issue is at stake here.”

Jim McGrath, TENAC’s chairman, says defending the garden is a departure for the organization, which typically fights “gravely serious problems” like skyrocketing rent hikes, tenant evictions, and threats to affordable housing. Still, he says, the “memorial garden struck us as a fairly nice thing. It isn’t Versailles, but the neighbors around there like it.” McGrath calls KLNB’s decree “highhanded and precipitous.” Plus, he says, the amount of money Salerian is paying in rent should afford him some rights. And if the dispute goes to court? “We’re willing to go to bat for him,” he says.

That at-bat might come. Perry Reith, Grosvenor’s D.C.-based senior asset manager, says, “We spelled out our position very clearly in our letter. Our official position is he has placed personal property in an area that he doesn’t have a right to do so. We have a lease arrangement with Dr. Salerian.…According to his lease, his premises is the space inside.” Reith says the garden area is common space and Grosvenor doesn’t “allow anybody to have exclusive use of that space.” He points out that allowing Salerian to maintain his sculpture garden might set a problematic precedent. “Grosvenor has thousands of tenants in cities around the world. If we were to allow tenants to personalize every property we own, it would compromise the integrity and appeal of our properties.” Furthermore, Reith resents the insinuation that the garden was bland. “Grosvenor recently renovated the entire area in question, which was once simple concrete, with the new landscaping beds you now see, complete with a garden-bed rotation program.” And it wasn’t cheap. “We probably spent…in excess of $100,000,” on the garden renovations, he says, adding that the company hasn’t considered what actions it might take if Salerian doesn’t comply with its wishes.

Salerian, however, is undeterred. He says he’s “touched by the positive response I received from my patients, from my neighbors, from my colleagues, from my friends, and from the tenant association.” He says the response has convinced him that “art is a very powerful, unifying language.” And as for KLNB, he says, “I’m hopeful that reason will prevail.”

Never Say Die
Conde Naste Portfolio
December 2007

Alen J. Salerian, MD quoted

Medical Hypotheses (2008) 70, 497-500

By Alen J. Salerian, MD, Nansen G. Saleri, PhD, Justin Salerian

Summary
Lowering core body and brain temperature has been shown to be beneficial for multiple sclerosis, cardiovascular accidents, traumatic brain injuries and myocardial infarction. Svante Arrhenius’ rate law – governs human thermoregulation and all biochemical reactions including complex chemical processes involved in mood disorders.

We reviewed the studies on core body and brain temperature’s influence on mood, mood disorders and their treatment. Our review suggests the majority of therapeutic strategies against mania are hypothermic while thermogenic strategies are used to combat depressive disorders.

We hypothesize that therapeutic manipulation of brain temperature may represent a key mechanism in the treatment of mood disorders possibly because of brain temperature’s profound influence on human biology governed by Svante Arrhenius’ rate law. We postulate that brain temperature may rise with mania and fall with depression

Introduction
The influence of temperature in the physiopathology of various neurodegenerative and psychiatric disorders has been of increasing scientific interest in the last decade. Two areas in which brain and body temperature may have a crucial impact are neurodegenerative and mood disorders. Salerian and Saleri have proposed a temperature-dependent biochemical system in humans governed by the Arrhenius rate law. We postulated that due to the exponential relationship between temperature and biochemical reactions, a relatively minor alteration in core body or brain temperature may be of significant therapeutic benefit in combating neurodegenerative disorders and prolonging lifespan (1). We further speculated that this small alteration may be as little as a drop of 1°C in core body temperature.

Many failures in temperature control have been observed in psychiatric disorders. It has been reported that patients with schizophrenia exhibit dysregulation of body temperature, including different baseline temperatures, abnormal daily range of temperatures and diurnal variation showing an early peak, an impaired ability to compensate to heat stress and compensating more effectively to cold stress (2).

”Wehr, et al (1989) suggested that chronic treatment with antidepressants decreased hypothalamic temperature in Syrian hamsters resulting in a cold defense reaction (thermogenesis) that may contribute to the behavior-activating properties of antidepressant drugs (3). Evidence suggests the antidepressant effect of sleep deprivation can be influenced by psychotropic medications (antidepressants or neuroleptics) and by ambient temperatures (3). Wehr hypothesized that the antidepressant effect of these diverse factors may be because of their common thermoregulatory influence.
In this review, we examine the brain temperature’s influence on mood, mood disorders and their treatments. The premise of our review is stated in the form of a hypothesis, hereafter referred to as the Salerian Mood Hypothesis (SMH), is that: The therapeutic manipulation of brain temperature may represent a key modality in the treatment of mood disorders as brain temperature may rise with mania and fall with depression.

Lithium is Hypothermic
1. Studies with rats suggest that lithium increases heat shock proteins that are hypothermic (4).
2. Studies with rats suggest that lithium increases brain cholinergic activity that is
hypothermic (5).
3. Lithium toxicity in mice is associated with severe hypothermia prior to death (6).

Neuroleptics are Hypothermic
Experimental studies with cats, mice and rats have shown that various neuroleptics are hypothermic and that clozapine, olanzapine and Risperdal produce a dose-dependent drop of colonic temperature in adult male Wistar rats (7). Similarly, it has been demonstrated that chlorpromazine induces a drop in colonic temperature in monkeys (8).

Neuroleptics, with a few exceptions, seem to be hypothermic in humans (9). Haloperidol, olanzapine and risperdal reduce axillary temperature of psychotic patients (9). It has been show that neuroleptic-induced hypothermia is associated with amelioration of psychosis in schizophrenic patients (9). Clozapine decreases core body temperature, improves BPRS and displays a linear but weak relationship between the degree of hypothermia and improvement of psychosis (9).

Antidepressants are Hyperthermic
Sibutramine, duloxetine and bupropion increase colonic temperature in female Wistar rats (10). In support of the thermogenic effects of antidepressants, it has been demonstrated that 12 antidepressant drugs including butriptyline, protriptyline and nortriptyline were highly thermogenic in rats (11). It has also been shown that bupropion, a dopamine/norepinephrine reuptake inhibitor, increases brain and colonic temperature in rats (12). Similarly, studies indicate that many antidepressants currently in clinical use have marked thermogenic properties and could therefore cause reduction in body weight without altering the food intake in mice (11). Soubri, et al, 1989, demonstrated that food restriction decreases responsiveness to antidepressant drugs in rats (13). This study may explain the findings of Duncan, Johnson and Wehr (1995) that fluoxetine and clorgyline reduced hypothalamic and body temperature in hamsters (14). The fluoxetine-induced hypothermia may be caused by the caloric restriction and not its direct neurochemical effect.

The studies on the effects of antidepressants on humans have been contradictory; yet there is one study that suggests chronic administration of antidepressants elevates tympanic membrane temperature (15).

Single Electroconvulsive Shock is Hypothermic Whereas Chronic Electroconvulsive Shock is Hyperthermic
Investigations of the effect of electroconvulsive shock (ECS) on body temperature have been contradictory. A single ECS has been demonstrated to reduce colonic temperature in mice. However, repeated ECS attenuates the hypothermia produced by single ECS (16).

Nicotine-Induced Hypothermia, Antidepressants and Bright Artificial Light
Is there any evidence to suggest that a nicotinic mechanism is involved in the regulation
of core body temperature and mood? Although not all the interactions between nicotine, body temperature and various antidepressants are fully understood, nicotine has been demonstrated to induce hypothermia following intracerebral nicotine administration in cats, monkeys and rats (17). Further, chronic administration of nicotine induces tolerance supporting a receptor mediated process (17). Other studies suggest that nicotine-induced alterations in body temperature are influenced by genetic factors. Differential sensitivity towards dependent nicotine-induced hypothermia is identified as the key factor for different strains of inbred mice (18). A recent study in mice deficient in beta-2 and in AChR subunit reduced hypothermic response to low doses of nicotine suggesting that this subunit partially mediates nicotine-induced hypothermia (18).

Fluoxetine, phenelzine sulfate, desipramine and bright artificial light have been shown to produce reduced sensitivity to the hypothermic effects of nicotine (17). Mendelsohn, et al, in 2005, speculated that the capacity of three chemically distant classes of antidepressants and bright artificial light (a treatment for seasonal depression) to produce this result suggests that nicotine’s thermoregulatory influence may be involved in the mechanism of action in these treatments.

Clinical Manifestations Associated With Hypothermia and Hyperthermia
Transient and reversible psychosis with auditory and visual hallucinations that appear when core body temperature rises above 39°C and disappear after core body temperature normalizes and has been documented (19).

Patients with moderate (34-30°C) hypothermia experience brady cardia and hypotension (following early and brief tachycardia and hypertension) as well as progressive depression of mental functions starting with apathy, psychomotor retardation, and silence (20).

Synopsis
Body and brain temperature’s influence on mood can be summarized as follows:
1. Most neuroleptics, lithium and single ECT are hypothermic and they improve mania.
2. Chronic ECT and chronic administration of antidepressants are thermogenic and they improve depression.

Successful treatment strategies with biologically opposing influence and opposing thermal properties suggest that temperature change may represent a critical mechanism in the pathophysiology of mood disorders and may promise an avenue for therapeutic exploitation. Therefore, it is logical to induce hypothermia for mania and thermogenesis for depression.

Further studies are necessary to confirm SMH. Of importance will be studies to measure core body and brain temperature during and after treatment for various mood disorders. If clinical studies validate SMH, there could be novel approaches in the treatment of mood disorders specifically designed with temperature-altering prowess.

References
1) Salerian A, Saleri N. Cooler biologically compatible core body temperatures may prolong longevity and combat neurodegenerative disorders. Medical Hypothesis. 2005; 66:636- 642.
2) Chong T, Castle D. Layer upon layer: thermoregulation in schizophrenia. Schizophrenia Research. 2003; 69: 149-157.
3) Duncan W, Johnson A, Wehr A. Antidepressant drug-induced hypothalamic cooling in Syrian hamsters .Neuropsychopharmacology. 1995; 12: 1-37 .
4) Ren M, Senatorov V, Chen R, Chuang D. Postinsult treatment with lithium reduces brain damage and facilitates neurological recovery in rat ischemia/reperfusion model. Molecular Neurobiology Section – 2003;
100: 6210-3215.
5) Lerer B. Studies on the role of brain cholinergic systems in the therapeutic mechanisms and adverse effects of ECT and lithium. Biological Psychiatry; 1985: 20-40.
6) El-Kassem M, Singh S. Strain dependent rate of Li+ elimination associated with toxic effects of lethal doses of lithium chloride in mice. Pharmacology Biochemistry and Behavior. 1983; 19:257-261.
7) Oerther S, Ahlenius S. Atypical antipsychotics and dopamine dl receptor agonism: an in vivo experimental study using core temperature measurements in rats. Pharmacology. 2000; 292:731-736.
8) Chal V, Fann D, Lin T. Hypothermic action of chlorpromazine in monkeys. British Journal of Pharmacology. 1976; 57:1487-1495.
9) Heh, W. Herrera J, DeMet E, et al. Neuroleptic induced hypothermia associated with amelioration of psychosis in schizophrenia. Neuropsychopharmacology. 1988;1: 149-
10) Liu L, Connoly P, Harrison J, Heal D), Stock Mi. Pharmacological characterization of the thermogenic effect of buproprion. European Journal of Pharmacology. 2004; 498: 219- 225.
11) Dulloo AG, Miller DS. Screening of drugs for thermogenic anti-obesity properties:
antidepressants. Ann Nutr Meta. 1987; 31:69-80.
12) Hasegawa H. Meeusen R, Sarre S, Diltoer M Piacentini MF, Mchotte V. Acute
dopamine/norepjnephrjne reuptake inhibition increases brain and core body temperature in rats. Journal of Applied Physiology. 2005; 99:1397-1401.
13) Soubrie P, Martin P, Massol 3, Gaudel J. Attenuation to response to antidepressants in animal studies induced by reduction in food intake. Psychiatry Res 1989: 27:149-59
14) Duncan C, Johnson A, Wehr A. Antidepressant drug induced hypothalamic cooling in Syrian hamsters. Neuropsychopharmacology 1995; 12:17-37
15) Kudoh A, Tkase H, Takazawa T. Chronic treatment with antidepressants decreases intraoperative core hypothermia. Anesthesia and Analgesia. 2003; 97:275-279
16) Gleiter Cl-I, Costello M), Nutt Di. Effect of single and repeated electroconvulsive shock on body temperature in mice. Convulsive Therapy. 1989; 5:152-156.
17) Mendleson iH, Sholar MB, Goletiani N, Mello NK. Effect of low and high nicotine cigarette smoking and HPA axis in men. Neuropsychopharmacology. 2005; 30:1751-1763.
18) Marks MJ, Miner L, Burch JB, Fulker DW, Collins AC. A diallel analysis of nicotineinduced hypothermia. Pharmacol Biochem Behav. 1984; 6:953-959.
19) Okumara, A et al. Delirious behavior in children. Brain Development. 2005; 27: 1554
20) Blatteis, C,. Physiology and pathophysiology of temperature and regulation. World Scientific Printers. 2001.

Watertown Daily News Tribune
May 31, 2007

By Alen J. Salerian, MD

Earlier this year, Hrant Dink, the Armenian-Turkish newspaper editor and political activist, was assassinated on the street outside his office in Istanbul by a self-described ultranationalist Turk. In the months since, Turkey has been roiled by a series of politically charged events that have caused turmoil in this beautiful, yet troubled country.

Recently, when it looked like the Turkish parliament might elect Foreign Minister Abdullah Gul to the presidency, tens of thousands of flag-waving secularist Turks took to the streets of Istanbul, Ankara and Manisa, chanting “No way for Shariah.” Despite Mr. Gul’s proclamations to the contrary, many Turks think that he has shown far too many Islamist tendencies and would lead the country down the road to becoming an Islamist state.

Even though the Constitutional Court annulled a parliamentary vote in support of Mr. Gul for the presidency, the Turkish military, which has traditionally served as a guardian ensuring that the Turkish government remains secular and which has removed four governments in the last 40 years, is now paying close attention to the latest developments.

In April, Turkish nationalists assassinated three Christian evangelicals in Malayta, a town with a reputation for nationalism.

Meanwhile, European leaders, who had been nervous about admitting Turkey to the European Union, are viewing these developments with increasing apprehension. The emergence of Islamist or nationalist factions, the assassination of Hrant Dink and the Christian evangelicals, and Turkey’s adamant de jure and often violent resistance to recognizing its history of an adversarial relationship with its Armenian citizens, are all factors that are giving pause to the EU and its thoughts of allowing Turkey to join its membership.

Mr. Dink invested his life in trying to create a world of tolerance and love in an ancient land, which cradled some of the earliest days of human civilization and which has a diverse heritage where nationalism, national pride, ethnic pride, religion, history and freedom of speech frequently clash.

It was with that idealism that in 1996 he founded Agos, the newspaper that was published in Armenian and Turkish, in hopes that he could somehow mend the chasm between the two peoples who share a common nationality and a tragic history.

But as so often happens in Turkey, goodwill, candor and efforts to bring together disparate people were repaid with violence. Mr. Dink was assassinated on Jan. 19, allegedly by Ogün Samast, a 17-year-old ultranationalist Turk.

In one of Mr. Dink’s last columns in Agos he wrote, “I feel safe because I am a pigeon and in my country they don’t kill pigeons.”

Yet the last time I talked with Mr. Dink he whispered in my ear, “I feel like a pigeon on death row. I look down, I look left, I look right and up, and I live in constant fear.”

He had provoked widespread anger in Turkey for his comments on the genocide of 1915, in which an estimated 1.5 million Armenians were killed. Indeed he had been tried and found guilty under the infamous Article 301 of the Turkish penal code for offending his Turkish nation by such comments. His sentence was later suspended and he did not have to serve any prison term.

Despite the fact that many Turks hated Hrant Dink, for what he said and for what he stood for, in the aftermath of his assassination, hundreds of thousands of them were in the streets, chanting, “We love Hrant. We are all Armenians.”

These words may not mean much to Americans, but they were about like Southern whites in the 1950s taking to the streets and shouting, “We love Martin Luther King. We are all Negroes.”

It is truly ironic that the death of Hrant Dink would galvanize so much of Turkey, bringing people to the streets to recognize the truth and the good he brought to their world.

About a year ago, I visited Mr. Dink and presented to him a proposal to build a genocide museum in Istanbul, paid and sponsored by the people of Turkey. In fact, before I could finish my first sentences, he grabbed my arm and shouted, “Let’s go find the building.” Moments later, we were in a cab on the way to the former residence of my great-uncle, Dr. Rupen Sevag. Dr. Sevag was a physician and a poet of Armenian descent, and he had served as an officer in the Turkish army in the Battle of Gallipoli in 1915. Although he was a true Turkish patriot, later that year he was targeted and murdered in the genocide of Armenian peoples in Turkey.

My great-uncle’s former home seemed like the perfect place for our genocide museum, but our idea was never to be. Violence and murder have intervened.

Hrant Dink had Martin Luther King’s spirit. While others called for violent confrontation of an unfair and unjust system that relegated some people, by virtue of their ethnic origin, to oppression, Mr. Dink called for peace and reconciliation. He believed that the chasm between Turks and Armenians could be healed through understanding.

Just like my great-uncle Dr. Sevag, he felt more Turkish than any Turk, more Armenian than any Armenian and more human than any human being. He even argued that the Armenian genocide should not be used as a political weapon against his beloved country, Turkey. Yet, just like my great-uncle, he was murdered by people who saw him as a threat to their version of Turkey, based in radical nationalist intolerance.

Mr. Dink was one of truly great heroes of our time. He had a great intellect, a great heart and a great love for his country. He believed in the brotherhood of man and freedom. It is a pity he was killed, yet it is clear that his life and his death have prompted profound changes for Turkey.

Those of us who knew and loved Hrant Dink can only hope that his legacy will move Turkey and the people of Turkey to finally embrace tolerance, equality and reconciliation with our history. If that comes to be, it surely would be a fitting reward for all of his sacrifice and courage. Let’s hope that is the case, for the good of Turkey, the Middle East and the whole world.

Dr. Alen J. Salerian is a psychiatrist and serves as the medical director of the Washington Center for Psychiatry in Washington, D.C.

‘Combustible Problem’: Psychiatric Tests Could Prevent Tragedies Such as the Tech Massacre… Richmond Times-Dispatch
May 5, 2007
By Alen J. Salerian, MD

In an America where guns are easily accessible and where there are a large number of people with psychiatric vulnerabilities, we have a combustible problem for our society.

Tomorrow’s killers are predictably going to be people suffering from severe psychiatric disorders. In the United States, which is basically an armed nation, 3% of the population suffers from a bipolar illness, one in five people will have severe depression during their lifetimes, and 30,000 people commit suicide every year. It is estimated that every year 1000 homicides are committed by people with mental illness.

The numbers are astounding. Psychiatry has learned that some mentally ill people are desperate enough to make up their minds to get rid of their imaginary or real enemies, a core dynamic that did contribute to the massacre at Virginia Tech.

This behavior is the result of a complex illness, which has predictable outcomes and, most important, which has predictable solutions to prevent those outcomes.

Today, there are some 60 million Americans who own more than 200 million firearms. We are an armed nation. Indeed, we have the largest number of guns in private ownership of any country in the world.

The fact is that this situation is not going to change soon. Moreover, the Second Amendment to the U.S. Constitution guarantees Americans “the right of the people to keep and bear arms.”

What then is the solution to preventing predictable killings by mentally ill individuals who easily get access to guns?

Federal law prohibits anyone who has been judged by a court of law to be a danger to himself or others from purchasing a gun. Yet, Seung-Hui Cho’s name was not in the federal database maintained by the National Instant Criminal Background Check System, and so he was able to buy the guns he used to go on a killing spree at Virginia Tech.

The problem is that there is frequently a disconnect between state requirements for reporting on mentally ill people and the federal requirement that mentally ill people should be prohibited from buying firearms. Some states have rules that prohibit the reporting of names of mentally ill people to a federal database. In other cases, states’ standards for reporting mentally ill people to the database are different from the federal standard. Obviously, the system that is meant to prevent mentally ill people from buying firearms does not work.

The young English major who turned into a mass murderer proclaimed in his video, “I have given you billions of chances.” Indeed, he did give unmistakable warnings of his diseased mind. His writings and his behaviors scared his fellow students and his teachers. In one instance, he was psychiatrically evaluated and even hospitalized. Yet, he was allowed to purchase two guns, several clips and ammunition.

The solution that would have prevented Seung-Hui Cho from purchasing those handguns, clips and ammunition – and the solution that would prevent others with psychiatric disorders from purchasing guns in the future – would be to make a simple psychiatric test a prerequisite for the purchase of guns in this country.

Such a test would have prevented Cho from getting the guns to act out his homicidal behavior.

In order to drive a car in this country, you have to take a vision test and a driving test in order to prove that you will not be a danger to yourself or others when you drive.

True enough, many drivers, after passing the test, go out on the highways and drive recklessly and cause great harm to themselves and others. However, the driving test serves as a barrier and as a legal standard, which serve as significant limitations on bad driving.

In the case of guns and people with psychiatric disorders, we know that a simple test administered by a paraprofessional, which would take all of 30 minutes, could screen out those with psychiatric disorders and prevent them from buying guns.

A combination of the BPRS (Brief Psychiatric Rating Scale) test, which takes about 15 minutes; the Overt Aggression Scale Test, which takes about 10 minutes; and the California Risk Estimator for Suicide Test, which takes about 5 minutes, would suffice. The results of these tests are fairly reliable predictors of homicidal or suicidal behavior.

America needs to come to terms with the simple fact that the mixture of guns and people with psychiatric disorders is a predictably violent mix. If America does not take steps to prevent this mixture from occurring, we can count on more massacres in the future.

Requiring purchasers of guns, gun accessories, and ammunition to show evidence they have passed a psychiatric test would have prevented Cho from getting the guns and ammunition he needed to kill 32 people and himself. It would also prevent countless future mass killings and countless other homicides committed by mentally ill people who are now able to elude the federal law. This is a solution America needs to act, now.

Link
The Forensic Examiner. 2007. 16: 3.

Alen J. Salerian, MD, Gregory H. Salerian, MCSW.

According to United Nations Resolution 96, genocide is a crime with intent to destroy either in whole or in part a national, ethnic, racial, or religious group (Charny, 1999). In the twentieth century, genocide has been a common phenomenon, and scholarly descriptions of many crucial aspects of this uniquely human invention of menace have been described (Charny, 1999).

It has been suggested that genocide is a premeditated set of actions to eradicate partially or totally a particular group and to silence opponents (Lieberman, 2006). A common trait of genocide is the precise targeting of people with a particular shared group identity (i.e., professional or social status) or appearance, distinct from their religious, ethnic, racial, or political identity, for persecution and/or execution (Lieberman, 2006). Examples of such selective targeting include the following:

In 1933, special legislation enacted by the Nazi regime barred all German-Jewish physicians from government jobs and excluded German-Jewish students from medical school (Morse, 1967). The evidence of Nazi persecution of German Jewish professionals affecting 42% of lawyers, 50% of doctors, and 83% of government employees shows this persecution preceded the main extermination of Jews (Morse, 1967) (Table 1).

In 1942, the Ustasha pursued national purity by identifying Serbian, Gypsy, and Jewish individuals as national enemies of Croatia and then killing them systematically. The persecution of Serbs and Jews began before their mass homicides when they were excluded from work in the press, radio, theater, and other professions of cultural life (Lieberman, 2006).

In 1953, Soviet Jewish doctors and other professionals were targeted for persecution and death (Lieberman, 2006).

In 1962, during the genocide of Nuba, the Sudanese government took special measures to persecute and exterminate the educated Nuba (Charny, 1999).

In 1975, to cleanse Cambodia of the “impure,” the Khmer Rouge first persecuted, then liquidated, Cambodians with higher education and Western ties, those who were bilingual in English and French, and those who wore eyeglasses (Charny, 1999).

In 1915, during the first genocide of the 20th century, Armenian intellectuals became the early victims (Charny, 1999) (Table 2). Despite documentation that verifies the targeting of intellectuals or community leaders of a victimized minority, the genocide literature—with the exception of The Holocaust—lacks adequate statistical data of the selective mass persecutions and homicides of intelligentsia. The purpose of this article is to determine whether the mass homicides of the 140 Turkish intellectuals of Armenian heritage arrested in 1915 were a marker consistent with targeting intelligentsia before genocide or in the early phases of genocide and the implications such a discovery should have on today’s health-care professionals. This article defines the mass and premeditated extermination of intelligentsia as cerebrogenocide.

History

For almost 700 years, Armenians, as Christian subjects, lived under the Ottoman rule as a conquered people. As a minority, they were one of the millets (minority nationalities) and were given limited authority for self-government. But like other minorities, Turkish-Armenians had almost no legal rights in the Ottoman Empire. A Turkish-Armenian had no recourse in the Islamic court system, for in the religious court, non-Muslim testimony was either disallowed or accorded significantly less value. At least 1 million, and possibly more than half of the Turkish-Armenian population, was killed or death-marched by the orders of the ruling triumvirate of the Ottoman government between 1915 and 1918 (Balakian, 2003).

The ruling powers, Talat Pacha, Enver Pacha, and Djemal Pacha, viewed the Turkish-Armenian minority of approximately 2 million people as a potential threat to the survival of the empire and forced the “cleansing” of the republic of the Turkish-Armenian population.

Several strategies were used to cleanse the empire of the Turkish-Armenians:

* Massive deportations of civilian population via death marches without any regard for the safety or the survival of the deported
* Disarmament and execution of all Armenian males serving in the Turkish army
* Early arrests and executions of intelligentsia (cerebrogenocide)
* Voluntary or involuntary assimilation of a large number of Armenian survivors into the Turkish society with a new cultural religious identity (Muslim Turk) and the absolute severance of any cultural or ethnic bonds to their Armenian heritage (see the story of Sabiha Gokcen in Discussion section) (Akyol, 2004; Alpay, 2004)

Method

The authors of this article studied data from numerous sources including the official records of the U.S., British, German, and Ottoman-Turkish national archives. In addition, the Google Internet search engine (www.google.com) provided links to websites with articles and statistics about genocide such as www.genocidewatch.com and www.isg-iags.org (Institute for the Study of Genocide & International Association of Genocide Scholars).

There were four publications of paramount significance in gathering statistical data: The History of Western Armenians, The Encyclopedia of Genocide, While Six Million Died, and Ottoman Population 1830-1914: Demographic and Social Characteristics.

Review of the Killings

On April 24, 1915, in Istanbul, 140 men were taken into custody. Subsequently, without a trial or any other formal charges brought against them, they were killed. Their mass homicides occurred between April 24, 1915, and September 30, 1915, in the early phase of the genocide that lasted until the end of 1918 (Charny, 1999). None of the victims had a criminal history. All the victims were better educated than the average Turkish-Armenian of his community, with activities consistent with higher-than-average participation in civic and community affairs. Further, their psychosocial status crowned them as leaders of their subgroup.

Methods of homicides included death by hanging, gunshot, stabbing, and blunt trauma (Tuglaci, 2004). Of those 140, 62 were physicians, 10 poets, 16 congressmen, 7 pharmacists, 4 clergymen, 1 comedian, and 36 newspaper reporters.

Results

The review suggests that the homicides of the 140 men were premeditated. There seems to be a correlation between the death rate for a Turkish-Armenian in Istanbul and his or her occupation, gender, and age, with women and individuals younger than 17 having full immunity against death by homicide. Among the health-care professionals who were victimized, there was a striking difference of risk of homicide among physicians (45%), pharmacists (6%), and hospital executives (0%). It appeared that the risk of being a victim of homicide for any Turkish-Armenian in Istanbul in 1915 was 1.3%, whereas it was greater for Turkish-Armenian men (2.6%). The death rate from homicide increased to 100% for congressmen, newspaper reporters, poets, and comedians. Collectively, the data suggest that the victims’ potential leadership profile was of significance and indeed made them the preeminent targets for genocide.

The ethnic cleansing of Turkish-Armenians was nearly perfect. In 1915, the Turkish-Armenian population in Ottoman Turkey was estimated to be between 1,161,169 and 2,133,190, with a total population of 25 million people (Karpat, 1985; Balakian, 2003). In 2004, Turkey had a population of more than 70 million with a Turkish-Armenian population of 65,000 (Tuglaci, 2004). Before 1915, there were 2339 Armenian churches in Turkey. After the genocide, most had been destroyed or deserted. The most recent statistics suggest the presence of only 40 churches serving the Turkish-Armenian minority in Turkey (Tuglaci, 2005). In 1915, Turkish-Armenians represented 16% of the Ottoman population. After 1916, the percentage of Turkish-Armenians in Turkey dropped to 0.4%. The latest official census indicates the Turkish-Armenian population in Turkey is 65,000, or less than 0.01% of the overall population (Tuglaci, 2004).

Discussion

The Turkish-Armenian genocide, as the first genocide of the 20th century, is the template for most of the genocides that followed. Prevention of genocide poses a challenge, yet it is preventable. Passionate and unconditional commitment to defend and reinforce U.N. Resolution 96 and educational efforts to teach the history and effects of genocide are essential.

Physicians and other health-care professionals may play a key role in preventing or combating genocide with the knowledge gained from the past genocides.

Four general observations can be made about genocides of the twentieth century:

* Genocide requires secret, premeditated, methodical mass homicides of a victimized group, often followed by the premeditated destruction or alteration of evidence to cover-up the genocide.
* Genocidal killings are contrary to the Hippocratic Oath and the common ethical principles of the American Medical Association (AMA), American Psychological Association (APA), and American Psychiatric Association (APA).
* Cerebrogenocide is a common marker, not a defining one, identifiable by alert and well-informed health-care professionals.
* Many physicians, health-care professionals, and other scientists played crucial roles in the design and execution of genocides during the twentieth century.

Physicians and Genocide in the Twentieth Century

In the first genocide of the twentieth century, many physicians played key roles in exterminating Armenians. Dr. Mehmed Reshid, the governor of the Ottoman province of Diyarbekir, once raised a rhetorical question about Armenians: “Isn’t it the duty of a doctor to destroy microbes?” After the genocide, Dr. Reshid proclaimed, “My Turkishness prevailed over my medical calling.” Drs. Behaeddin Shakir and Mehmed Nazim, both Committee of Unity and Progress (CUP) party leaders, condemned Armenians as infidels (gavurs), like tubercular microbes infecting the state. During the official trials of the Armenian genocide from February 5 until April 7, 1919, a Turkish physician, Dr. Ziya Fuad, testified in writing that Dr. Ali Saib had caused the deaths of untold numbers of Armenian children with injections of morphine (Balakian, 2003).

The summer of 1915 witnessed the homicides of two Turkish-Armenian physicians by two of their Turkish colleagues. The homicide of Dr. Nerses Shabagliyan by Dr. Asaf and the homocide of Dr. Ormayan by Dr. Sani Yaver were the first documented homicides of physicians by physicians in the 20th century (Tuglaci, 2004).

In 1946 and 1947, 23 Nazi doctors stood trial in Nuremberg for crimes against humanity and were found guilty. Among them were the dean of faculty at Berlin University, Dr. Franz Six, responsible for the murder of more than 50,000 Jews; Dr. Josef Mengele, the director of the Institute of Hereditary Biology and Racial Hygiene; and Dr. August Hirt, director of the Strasburg Anatomical Institute in France, who in 1941 gassed 86 Auschwitz concentration camp victims to study their bones to prove Aryan superiority. The euthanasia program (code name T4 Unit) was the brainchild of Dr. Karl Brandt in his relentless drive to design the perfect machine for the mass extermination of the mentally ill and physically handicapped (Hogan, 2003).

From 1932 until 1945, in a quest to develop germ warfare capability, some 20,000 scientists, including doctors and nurses, participated in one of history’s most gruesome medical experiments on prisoners. Some 580,000 Chinese civilians and American, British, and Australian prisoners of war were killed under the medical leadership of Dr. Shiro Ishii, Japanese microbiologist and Lieutenant General of Unit 731, a biological warefare unit of the Imperial Japanese Amry during the Sino-Japanese War (Miller, Engelberg, & Broad, 2002).

Barriers to Education of the Public and Prevention of Genocide

For many complex psychological, social, economic, and political reasons, scholarly research and teaching of genocide have been difficult. Understandably, collective guilt or national shame may inhibit open discussion of tragic events even in the most advanced societies. After all, what American or British citizen would consider the hypothetical possibility that the terror bombings of German and Japanese civilians during the Second World War was a form of genocidal killing, particularly if financial compensation and demands may emerge as a result of such a discussion?

Perhaps similar dynamics also inhibit a country like China from studying the genocidal deaths of millions who perished under the rule of Mao in the 1950s. Politics may also influence educational efforts. If it is not for strict national interests, it is hard to explain why Israel today does not allow the education of young Israelis to include the history of Armenian genocide. Neither the United States nor the United Kingdom officially acknowledges the Armenian genocide. The Japanese government denies the atrocities of Unit 731.

The recent political storm prompted by media reports about Sabiha Gokcen, the adopted daughter of modern Turkey’s founder and first president, Kemal Ataturk, may illustrate the political obstacles that hinder educational and preventive efforts in combating genocide (Millyet, 2004; Alpay, 2004). Hatun Sebilciyan spent several years at an orphanage before her adoption at the age of 12 by Kemal Ataturk. The reality remains that her adoption helped her become an accomplished leader of the young Turkish republic, as she became the first female pilot of the country. Yet, the death of her parents and her adoption were genocidal acts according to United Nations Resolution of 96. However, public expression of this point is a crime punishable by imprisonment of up to 10 years according to current Turkish law, Article 301.

In essence, the challenges associated with any inquiry of Sabiha Gokcen’s life may represent the core challenges faced by all genocide scholars around the world. It is simply a sad reality that today the politics of power and national interests make scholarly discussions or dissemination of historically accurate information very difficult, if not impossible.

In summary, it appears that today the biggest obstacle both to educating the world about genocide and to preventing genocide is the political climate, which makes it very difficult for evidence-based teaching to investigate past genocidal acts.

Conclusion

Although genocide seems to be only a nightmare of the past, the unthinkable act has occurred in several countries throughout the twentieth century, and, considering the situation in Darfur, has extended into the present. In order to prevent future acts of genocide, it is imperative to let go of the belief that genocide is not a threat to or a concern for this era or “our” country. During the period in which genocides are born and grow, they never seem as heinous and barbaric to the people committing them as they do to other countries when remembered years later as distant historical events—if remembered by other countries at all. Genocide, with its history being such a stranger to today’s younger Western generations, could pose quite a future threat, as an unsuspected enemy is doubly dangerous.

Along with specific measures to prevent genocide described by Charny (1999), including the creation of an International Peace Army (IPA), teaching evidence-based history and promoting accurate dissemination of historical facts of all genocides may be the best weapon against genocide. Educating all future generations about the past genocides would be one logical first step. Another initial measure to be taken is to incorporate the genocide literature into the standard curriculum for all health-care professionals. As this article has demonstrated, in the event of a future genocide, health-care professionals would likely be targeted as either victims or perpetrators because of the valuable knowledge they possess. Given their influence, scientists and all health-care professionals may also play a key role in educating political forces. Health-care professionals can lead educational efforts to influence legislative initiatives to create and defend genocide research and scholars.

By informing the public and the media and by actively resisting the presumed governmental authority to override the ethical obligations of health-care professionals defined by the American Medical Association, American Psychological Association, and American Psychiatric Association, health-care professionals can play an active role in combating genocide.

References

Akyol, T. (2004, March 2). Sabiha Gokcen tartismasi [Debate about Sabika Gokcen]. Milliyet, 15.

Alpay, S. (2004, February 28). Sabiha Gokcen 80 yillik sirri [The 80-year-old secret of Sabiha Gokcen]. Zaman, 121.

Balakian, K. (1977). Hai golgotha [Armenian golgotha]. Beirut, Lebanon: Plenetta Printing.

Balakian, P. (2003). The burning tigris: The Armenian genocide and America’s response. New York: Harper Collins.

Boghosian, K. (n.d.). My arrest and exile on April 24, 1915: An eyewitness account of the start of the Armenian genocide. Retrieved October 12, 2005, from http://www.armenianreporteronline.com/old/21042001/c-hachig.htm.

Charny, I. (Ed.). (1999). Encyclopedia of genocide (vol. 1). Santa Barbara, CA: ABC-CLIO, Inc.

Hogan, D. (2003). The holocaust chronicle: A history in words and pictures. Lincolnwood, IL: Publications International Ltd.

Kansu, A. (2000). Politics in post-revolutionary Turkey, 1908–1913. Leiden, the Netherlands: Brill Academic Publishers.

Karpat, K. (2002). Ottoman population 1830-1914: Demographic and social characteristics. Madison, WI: University of Wisconsin Press.

Lieberman, B. (2006). Terrible Fate: Ethnic cleansing in the making of modern Europe. Chicago, IL: Ivan R. Dee, Publisher.

Miller, J., Engelberg, S., & Broad, W. (2002). Germs: Biological weapons and America’s secret war. New York: Simon & Schuster.

Tuglaci, P. (2004). Bati ermenileri [Western Armenians]. Istanbul, Turkey: Pars Yayin Tc Ltd Sti.

Yarman, A. (2001). Osmanli saglik hizmetterinde ermeniler-ana-basime [Ottoman Health Professionals of Armenian Heritage]. Istanbul, Turkey: Sanayever.

Acknowledgement

The authors would like to acknowledge and thank Mr. Ara Guler for his magical photos of old Istanbul.

About the Authors

Alen J. Salerian, MD, is a psychiatrist and the medical director of Washington Center for Psychiatry in Washington, DC. He is also a former chief consultant for the FBI and a frequent contributor to national newspapers such as, the Los Angeles Times and USA Today. Dr. Salerian has co-authored several psychiatric articles in peer-reviewed journals. He has made more than 100 appearances on various news shows including CBS’s 60 Minutes and 48 Hours and the BBC’s Panorama. He is a regular analyst and commentator on the Washington, DC CBS television affiliate WUSA-TV. Dr. Salerian is a Diplomate of the American Board of Forensic Medicine and has been a member of the American College of Forensic Examiners since 1997.

Pars Tuglaci is an accomplished historian, linguist, and author of more than 20 scholarly books, who lives in Istanbul, Turkey. A graduate of Malconian Educational Institute in Cypress (1951) and Michigan University (1955), Professor Tuglaci published the first modern Turkish medical dictionary.

Professor Tuglaci’s most recent work, The History of Armenians in the Ottoman Empire, has been the product of his lifetime research at numerous museums, libraries, and state archives in more than 30 countries dating back to the early 70’s.

Gregory H. Salerian, MCSW, LGSW, holds a master’s degree in clinical social work from the Catholic University of America and a bachelor’s degree in psychology from the University of Delaware. He is in full-time private practice at Washington Center for Psychiatry in Washington, DC. He is a member of the National Association of Social Workers as well as the Greater Washington Society of Clinical Social Workers.

Janice Berry Edwards, PhD, is an assistant professor in the School of Social Work at Virginia Commonwealth University’s Northern Virginia campus in Alexandria. She maintains a private practice with the Washington Center or Psychiatry, in Washington, DC. She holds a doctorate in social work from Catholic University School of Social Work. Her teaching areas include micro practice (advanced clinical social work practice), social justice, and psychopharmacology. Her research and scholarship interests include African American women, multiple intelligences and social work education, relational/cultural theory applied to teaching social work education and field instruction, psychopharmacology and the elderly, as well as domestic violence in law enforcement.

Antonia L. Baum, MD, is on the clinical faculty at the George Washington University School of Medicine’s Department of Psychiatry. She is in private practice in Chevy Chase, Maryland, and specializes in the treatment of athletes and eating disorders. She is a graduate of the Brown University program in medicine (BA and MD).

Barry Mendelsohn, MD, a Board Certified Psychiatrist, currently serves as the medical director of an Assertive Community Treatment Team in Prince Georges County, MD. The program has as its charge the care and treatment of a segment of the population often overlooked or underserved. Dr. Mendelsohn maintains a private practice as well, focusing on the mental health needs of deaf children and their families. He is known in the musical community through his years of involvement in opera and musical theatre.

Dr. Mendelsohn completed his medical school training at Stanford University. His internship was at UCLA in pediatrics, and his psychiatric residency was completed at the University of San Francisco.

Tragedy in the Home

WUSA9.com

April 4, 2007

Alen J. Salerian, MD quoted

By Leslie Foster

(WUSA) — Parents taking their own children’s lives, then their own. It seems unthinkable. In just over a week, two communities and two families know all two well that it can happen. Last week, a Frederick father killed his four kids then himself. Tuesday, a Montgomery County father killed his two children in Boyds, Maryland. Psychiatrists say these kinds of deaths at the hands of a parents are a common occurrence. They call them mercy killings. “It’s a package deal of suicide and homicide,” says psychiatrist Dr. Alen Salerian. “But suicide is the real intent.” Salerian says the parents who’ve decided to take their own lives wonder about the kids they would leave behind. And, he says sometimes those killings are the result of someone who wants to settle a score. “There is the intent to punish somebody,” says Salerian. While some people may wonder how these horrific crimes could take place, Salerian says there is a logical answer: mental illness. “Mental illness, suicide, murder does not happen overnight. There are some frightening sounds that this person usually gives and very often the people around them ignore it.” Salerian says people need to educate themselves about mental illness and ways to prevent tragedy before it happens. He wonders who might have seen something in the cases involving the children killed in Frederick and those found in Boyds but never intervened. To learn more about the signs of mental illness and how to get help, check out the links attached to this story.