Looking at problem gambling through multi focal lenses

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Looking at problem gambling
through multi focal lenses

• National Association of Gambling Studies
• December 2008
• Rosa Billi and Paul Marden

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Looking at problem gambling through multi focal
lenses

• Overview
• Ways of seeing
• A journey towards a multi focal solution
• Single lenses
• Multi lenses
• 20/20 vision

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Ways of seeing

• WHY MULTI FOCAL LENSES?
• the importance of perspective.

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..and now for something completely different

• .. ways of seeing a journey
• In the eastern highlands of New Guinea, sudden
  bursts of maniacal laughter shrilled through the
  walls of many a circular, windowless grass hut,
  echoing through the surrounding jungle
• Time, Nov 11, 1957 pg 55

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Once upon a time.in a faraway land..

• Kuru
• the laughing sickness
• first reported in 1957
• endemic in Fore tribe of PNG
• kuru is the Fore word for trembling
• majority of victims were women children
• few adult men affected
• disease of recent origin
• symptoms headaches, joint pains, tremors,
  cross-eyed, emotional instability, euphoric
  grins, smiles and shrieks

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.. A journey begins.

• Kuru
• always fatal
• death approx 3-6 months from onset
• est. 330,000 Fore popn affected (or 1 per year)
• transmissible spongiform encephalopathy (GSS,
  FFI, CJD, nv-CJD, BSE, Scrapie, CWD-Elk)
• NG under administration of Aust Govt
• Aust Govt sent Vincent Zigas (German dr) to
  investigate.

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A journey

• Kuru
• Zigas said of his first Kuru victim
• She looked odd, not ill, rather emaciated
  looking up with blank eyes and a mask like
  expression. There was an occasional fine tremor
  of her head and trunk as if she were shivering
  from cold though the day was very warm
• Vincent Zigas, Laughing death The untold story
  of Kuru

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A journey

• Kuru
• Zigas could not determine causes
• speculated related to TB, brain tumours, measles
  or meningitis or even autosuggestion (Kuru
  victims under spell of evil sorcerer and became
  genuinely sick)
• Took 26 blood samples and a brain for testing for
  virological agents. Sent to Aust. All negative.

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And the journey continues.

• Kuru
• Enter Gajdusek-March 1957-Harvard graduate in NG
  to study ailment of children in pre modern
  cultures
• (1976 Nobel laureate- physiology and medicine-for
  his work on Kuru)
• Zigas Gajdusek- suspected an infective agent
  disease occurred in clusters..but.
• no sign of infection, no clear genetic origin, no
  environmental cause
• Gajdusek was exhaustive tried everything(intervi
  ew, bleed, preserve, ship, analyse etc) -from
  village to village.

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One way of seeing..

• Kuru
• This strange white bloke would appear out of the
  bush, jabber at you in a language you didnt
  understand, stick a needle into you, write
  something in a book, and then move on
• New Guinea Patrol Officer describing a
  visit from Carleton Gajdusek
• (cited in The Family That Couldnt Sleep DTMax)

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a multi focal solution

• Kuru
• ..what was needed was a group
• with experts in anthropology, genetics, diet
  and personal habits, and water supply
  collaborating as a team.
• Early letters and field notes from the
  collection of D. Carleton-Gajdusek- August 8 1957
  (edited by Gajdusek and Judith Farquar 1981)

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..still the journey continues.

• Kuru
• It became necessary to draw family pedigrees of
  victims and show how family members were
  related. needed someone trained in this and data
  collection
• therefore two Aust anthropologistsRobert and
  Shirley Glass..set up camp in a Fore village and
  stayed put

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AND.my favourite quote..

• Kuru
• Anthropologists were cheaper than doctors and
  would put up with worse living conditions.
• (cited in The Family That Couldnt Sleep DTMax)

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Another way of seeing

• Kuru
• What they found..
• Custom of eating human flesh entered Fore
  practice 50 years earlier
• Cannibalism not a form of vengeance/revenge
• The meal was symbolic- ground ate body and was
  enriched by it (metaphors - common greeting in
  Fore I eat you- your best friend was your
  umbilical cord your wife was your hand etc)
• Fed corpses only to women and children
• Different parts of bodies were given out
  according to a code- if deceased was female, arms
  legs went to daughter in law etc. If deceased
  was male, the testicles went to his uncles wives
  etc.
• People invited to eat felt honoured (and well fed
  because the flesh was considered nutritious)

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..andthe journey almost ends

• Kuru
• In the end anthropologists solved the mystery of
  Kuru
• They did not have medical degrees but their
  careful talk talk sessions resulted in a road
  map. The Fore began eating human flesh at around
  time Kuru showed up.
• Their work was substantiated by Aust (Dr John
  Mathews) who epidemiologically correlated Fore
  funeral feasts with outbreaks of Kuru.
• Pattern of Kuru infections changed over time
  (1950s missionaries opposed cannibalism and Fore
  obliged- still occasional death- agent causing
  Kuru took decades to develop)

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.towards solving the Kuru problem..using a
multidisciplinary approach

• recognition of problem (i.e. laughing sickness)
• analysis of problem (using traditional medical
  approach- looking for pathogen)
• no solutions were apparent
• rethinking approach to problem
• - what questions have not been asked?
• - how can these questions be answered using a
  different discipline approach

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WAYS OF SEEING AGAIN

• So. back to problem gamblingand ways of seeing

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..different lensesdifferent views..

• Biological
• Medical
• Sociological
• Cultural
• Psychological
• Anthropological
• Economic
• Historical

• Individual V Collective
• Contextual
• Environmental
• Spiritual/theological
• Legal / Criminogenic
• Moral model V disease model

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One lensone world

• What do you see using a single lens??
• Spiritual lens
• aspects of life-existential transcendent- that
  contribute to a sense of hope, meaning and
  purpose, coherence and connectedness to others
• e.g. amotivation gambler who continues to gamble
  with no real purpose/no meaning
• (Clarke 2004)
• e.g. pg x3 more likely than non pgs to endorse
  reason for gambling as gambling gives hope and
  an opportunity for a better life
• (Clarke. Tse et al 2006)

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One lens..one world

• What do you see using a single lens??
• Sociological lens
• Sociology - study of individual behaviour in
  society- so we see gambling in terms of social
  relations, social stratification, social
  interaction, deviance and culture

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One lensone view

• Are we looking at problem gambling through middle
  class lenses?
• co-morbidities clustering effect
• do gamblers with mental health and substance
  abuse issues attend Tx or respond to campaigns?
• or do gamblers who are self-aware, educated,
  sophisticated and can respond to the community
  campaigns, attend? Where do those with bp, severe
  mental health disorders present? (acute services)
• What happens if we change our lenses?

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Ways of seeingusing more than one lens

• BIOPSYCHOSOCIAL MODEL
• What is it?
• theory of illness and healing
• developed by US psychiatrist George Engels
  (1913-1999) in 1977.
• posited that a new medical model was needed but
  there was no single definitive model available ?
  so bps
• Tx of disease processes (cancer, diabetes)
  requires a health care team to address the
  biological, the psychological and the social
  aspects of a patients functioning.

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Biopsychosocial model

• traditional, reductionist biomedical model of
  medicine
• disease process can be explained in terms of an
  underlying deviation from normal function
• e.g. a pathogen, genetic or developmental
  abnormality, or injury.

• new model
• biological, psychological (thoughts, emotions,
  and behaviours), and social factors all play a
  significant role in human functioning in the
  context of disease or illness.

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Multi focal lenses..

• BPS lenses
• Pathways model
• Behaviourally conditioned problem gamblers
• Emotionally vulnerable problem gamblers
• Anti social, impulsivist problem gamblers.
• (Blaszczynski Nower 2002)
• This model has not been empirically tested,
  but it offers a useful framework for
  understanding a variety of onset factors - and
  associations to inform intervention and
  treatment.

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Problem gambling a multi focal approach

• Public health- multidisciplinary approach to
  health conditions- with focus on prevention,
  intervention and treatment
• Kuru - reductionist approach with added, public
  health environmental contaminants- diet, water,
  bugs etc-yet solution stemmed from unexpected
  source
• Problem gambling-is there a possibility that
  solution answers could come from unexpected
  sources? Can knowledge Be gained through calling
  on experts from their respective fields to work
  in collaboration?