August 1, 2022

By Don Sapatkin

Good Monday morning and welcome back, loyal readers! We have some interesting stories and dilemmas for you today: About “moral injury” that can weigh you down for years. About a mentally ill man who was held for more than two years for someone else’s crimes. And about claims of fabricated evidence in Alzheimer’s research that underpins the dominant theory about the origins and potential treatments for the disease, a finding that now threatens to upend the field. Finally, a study that looks at the impacts of requiring people to work for their government benefits finds that their mental health got … worse.


Are you suffering from a “moral injury”?

Perhaps someone died in a car accident with you at the wheel, and the memory is too much to bear. Maybe you cheated on a lover, witnessed Covid patients dying due to subpar care, or had to give a baby up for adoption. Experiences like these can lead to what some call “moral injury.” The term was introduced decades ago to describe Vietnam War veterans’ reactions to devastation caused by their side or to orders that violated their personal moral code. While it’s not a recognized diagnosis, it encompasses symptoms that go beyond guilt and shame and can be so severe that people lose a sense of their own goodness. 

A story in Knowable Magazine delves into the history and meaning – and possible interventions – for moral injury. While symptoms overlap with post-traumatic stress disorder, treatments are somewhat different. Therapy for PTSD typically helps patients reframe how they think about past traumatic events and regain control of their intrusive negative thoughts. Treatment for a moral injury, on the other hand, involves a shift of perspective that allows people to come to terms with their actions. Clinical psychologist Matt Gray calls this strategy “adaptive disclosure” in a book by the same name.


How a mentally ill man was held for 2-1/2 years in another’s name 

In a Kafkaesque scenario, an innocent man with a mental illness was jailed for years under someone else’s name – something he protested to no avail. It began when Joshua Spriestersbach, 46, a mentally ill homeless man, was arrested in Honolulu in 2017. He didn’t use drugs or alcohol and thought he’d been picked up again for sleeping on the sidewalk. After four months in jail, a state hospital psychiatrist discussed his record, which showed he’d been arrested on an eight-year-old bench warrant issued to Thomas R. Castleberry. The normally silent and uncooperative Spriestersbach perked up: “My name is Joshua.” He would not be released for two more years. 

In an in-depth Sunday magazine story about the case, the New York Times describes how yet another arrest seemed at first to be playing out as part of the expected cycle lived daily by mentally ill homeless people in the United States ─ “a slow-motion game of hot potato between the police, the courts, the jails and the hospitals.” Except, it turned out, for one weird thing: Years before, in another stay at the same psychiatric hospital, Spriestersbach had asked that an unintelligible handwritten note about “triadjunctorial assets” and a “duel” be passed on to the court. He signed it “Sergeant Wolfgang Charles Castleberry.” 

And now, the Times wrote, “Spriestersbach’s alias ‘Castleberry’ became the strange wellspring of an error ─ first made by the police and then compounded by the courts and the state hospital system and even his own lawyers ─ that would propel Spriestersbach into an entirely different bureaucratic wormhole that commandeered and consumed the next two and a half years of his life.”

The story brilliantly weaves together minute case details and the entrenched biases of a dysfunctional and siloed system to show how problems compound, one after the other, as mentally ill people are seen as less than invisible. Spriestersbach’s insistence that his name was Joshua was entered in the records five times, each of which risked his coming off as more delusional. Yet no one checked his fingerprints, Social Security number or photo against the bench warrant. 

What finally got someone’s attention? Spriestersbach told a court examiner during a brief meeting that he believed he had a right to challenge the judge to a duel.


A neuroscience sleuth claims widespread scientific fraud, throwing Alzheimer’s research into disarray

For more than 15 years, the hypothesis that Alzheimer’s disease is caused primarily by the buildup in the brain of amyloid protein clumps known as plaques has dominated research. Now a Vanderbilt University neuroscientist, Matthew Schrag, has alleged fraud in dozens of published research articles that raises serious doubts about the so-called amyloid theory of Alzheimer’s. Charles Piller, an investigative journalist for Science magazine, spent six months digging into Schrag’s claims and brought them to a number of scientists – including some who have cited the now-discredited work in their own research. All agreed there were clear signs of manipulation in images presented in the papers.

Image via Twitter

The notion that research misconduct may have played a role in acceptance of the theory is stunning and the implications for science and public health are enormous. An estimated 6.5 million people in the U.S., more than 10 percent of those age 65 and older, are living with Alzheimer’s, which kills more Americans than breast and prostate cancer combined. The NIH spent $1.6 billion on research projects that mention amyloids this year alone, about half its Alzheimer’s budget. No effective treatment is in sight. Pharma companies, which stand to make unprecedented profits on successful treatments, have been testing experimental drugs based on the amyloid theory for years, even though 99 percent of trials have failed.

The dogged sleuthing of a driven neuroscientist makes for a good read. Schragg stumbled onto the bigger problem when he was hired to investigate claims by two neuroscientists about alleged fraud by a company called Cassava Sciences that is developing an Alzheimer’s drug. In the process, he began looking into related research conducted by a scientist at the University of Minnesota. Major journals have since retracted seven papers co-authored by Cassava scientists, and several that published papers from University of Minnesota scientists have expressed concern.


In other news…

In 2016, West Virginia set up a pilot program that required most food stamp recipients in participating counties to work or do job training 20 hours a week to get their benefits. Other states established similar programs. Now the first study to examine the mental health impact of such requirements found they resulted in 13% to 14% increases in Medicaid claims for mood disorder treatment and 18% to 24% increases for treatment of anxiety. The three-year study, published in Health Services Research, examined data for 65,000 Medicaid enrollees before and after the work requirement was added and also compared the nine counties in the pilot with the rest of the state. It confirmed earlier findings that work-for-benefits requirements, strongly encouraged by the Trump administration, reduced the number of residents getting help – but did not increase employment.

The federal government has spent $75 million on gun violence research since 2020, following a two-decade federal freeze due to political pressure from the National Rifle Association pressure. USA Today outlines the dozens of studies now underway that examine some critical questions: Do firearm storage facilites outside the home prevent suicides? Does providing jobs and therapy for people at high risk of being involved in gun violence make them safer?

Higher rates of cannabis addiction and mental health problems are linked to years of increasing THC concentrations in marijuana, according to a University of Bath press release about the findings of its researchers’ systematic review in The Lancet Psychiatry. 

Spending time in nature has proven mental health benefits – but not everyone can so easily enjoy them. Many of those who could gain the most face significant hurdles ─ no car to get there, no money for boots or coats, no wheelchair access and little confidence about being in unfamiliar settings. A BBC story looked at Welsh hiking groups that aim to change that, including an Instagram group called Muslim Hikers.


If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.


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Don Sapatkin

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...