Shortly after Harold II became King of England in January 1066, William, Duke of Normandy, declared war on Harold to depose him. In March 1066, the pope allied himself with William, and the war became a holy war. Harold was now a heretic who lost the possibility of having his soul saved, or an afterlife in heaven. With the pope's blessing, the crusade against Harold brought other rulers to support William. In contrast to his past behavior as an able administrator as the under king to King Edward the Confessor for 13 years, and more than 20 years as a successful military leader, he was inept against William in strategy, tactics, initiative, and leadership. This suggests that Harold felt helpless and hopeless due to being a heretic fighting against the pope and God, and that his markedly different behavior in his war against William was symptomatic of a major depression due to religious feelings about loss of his soul. It seems that this led to his defeat at the Battle of Hastings 6 months later.

Successful management of HIV requires patient understanding and ability to act on treatment information. We examined the relationship between patient literacy and understanding of HIV treatment. Literacy, knowledge of CD4 count and viral load, and correct identification of HIV medications in regimen were evaluated in 204 patients receiving care in Shreveport, Louisiana and Chicago, Illinois. One-third of patients had limited literacy skills. These patients were less able to describe CD4 count (p < 0.001), viral load (p < 0.001) and to correctly identify medications in their regimen (p < 0.001). In the multivariate analysis, limited literacy was an independent predictor of poor understanding of CD4 count (OR 2.9, 95% CI: 1.3 - 6.3) and viral load (OR 4.1, 95% CI: 1.9 - 8.8). For correct medication identification, a significant interaction was found between number of HIV medications and literacy level. Among patients taking only 1 - 2 HIV medications, 100% of higher literate patients were able to identify their medications, compared to none of the lower literate patients prescribed three or more HIV medications. Patients with limited literacy skills may lack essential knowledge related to their HIV treatment. Clinicians may require additional training for improving communication with these patients.

United States law requires that immunization providers use Centers for Disease Control Vaccine Information Statements (VISs) and inform parents about vaccine risks and benefits prior to every childhood immunization. A recent national survey found that public health clinics (PHCs) reported high compliance with this law. To further investigate these findings, we conducted an immunization time-motion study in two PHCs in Kansas and Louisiana. Research assistants observed a convenience sample of 246 child immunization visits to record distribution of the VISs and content and time of vaccine communication. Thirty percent of parents read below a ninth grade level, 53% had Medicaid insurance, and 56% were Black. VISs were given with every dose of vaccine administered in 89% of visits. Public health nurses (PHNs) frequently discussed potential vaccine side effects (91%), treatment of side effects (91%), and the vaccine schedule (93%). Contraindications were screened in 71% of visits. Benefits were discussed in 48% of visits and severe risks in 29%. The national Vaccine Injury Compensation Program (VICP) was never discussed. The immunization visits lasted for a mean of 20 min. Vaccine communication of side effects, risks, benefits, screening for contraindications, and the next visit lasted for an average of 16 s for all vaccines. PHC compliance with mandated VIS distribution and practical vaccine communication was high. Room for improvement exists in discussion of benefits, serious risks, and the VICP.

Studies of combat veterans from the wars of the 20th century have raised many questions. Are those who develop combat PTSD vulnerable due to having a preexisting condition, less resilience to stress, or a problem in their emotional stability or character? Alternatively, is it possible that combat PTSD occurs regardless of premilitary status? There are many proponents with persuasive notions for each of these views (Boman, 1982). Because most combatants are older adolescents or young adults, these questions are of particular interest to adolescent psychiatrists. An examination of the ways in which the adolescent developmental process itself might contribute to vulnerability to combat trauma may suggest answers to some of these questions.

In this chapter, we seek a further view of data about these eight conditions and other possible explanations for their regional diversity. This begins with an attempt to understand the variations in education achieved in the four regions.

This chapter focuses on the pervasive and persistent cultural influence of the four earliest British colonies in North America on the present and on eight biopsychosocial conditions or issues: education, births to unwed mothers, gonorrhea, syphilis, alcohol-related deaths, homicides, child sexual abuse, and child physical abuse.

In the eleventh century, William the Conqueror initiated a castle-building process along the Welsh border to protect England from incursions by the Welsh. Henry I (1100–1135) established English and Flemish planters in the southwest of England (Graddol, Leith, and Swann, 1986, p. 186).

Early in my general psychiatry residency, a patient justified her behavior by the following analogy: “When you’re raised in a town where everybody is a horse thief, you grow up thinking it’s okay to be one.” Later on, another patient explained a relative’s personality by saying that the person was from a certain town! Further, similar events aroused my curiosity about geographical variations in values and ethics.

Although regional identity is hypothesized to be based on colonial cultural patterns and regional identities, that does not imply that all those patterns have been transferred to the present in wholesale fashion. Instead, a mixed outcome has occurred, with some patterns that have endured, and others that have disappeared, or declined, in importance or frequency. Our concern here is with those patterns that have endured.

From a detailed view of the myth of the binding of Isaac, a speculation emerges that Isaac may have had incest with his mother, Sarah. This would explain the death of Sarah shortly thereafter, his absent virility for twenty years, and his blindness. The commonalities with the Oedipus myth are outlined, along with the themes of filicide, patricide, guilt, punishment, and expiation. This suggests that they are the same myth, with some slight variations. The continued interest in both myths may be due to their utility as cautionary tales to teach control of hostile impulses in parents and children. While the outcome in the Oedipus myth is tragic, it is hopeful in the Isaac myth.

England went through the greatest revolution in its history in the half-century between the founding of Massachusetts in 1630 and Pennsylvania in 1682. Quakerism grew out of the turmoil of that period.

This chapter adds to, and coalesces, material to clarify the distinctive regional culture embodied in each colony. Henretta (1973) provides excellent data about the colonies, quite similar to that of Baltzell (1979) and Fischer (1989), and additional details that help us understand more about colonial life. He states that despite allegiance to, and origin in, England, with similarities in language and political institutions, the colonies in British North America diverged markedly in social development. The economic base, population composition, value systems, and character structure of the colonists varied from one colony to the next.

The border area between England and Scotland had been the scene of war and invasion for seven centuries, from 1040 to 1746. The people fought on either side, or raided each other. Loyalty was fluid, and the side people embraced was determined by who was in power, strongest at the time, and which lord paid the most.

To further assess the possibility of a legacy emanating from the regional identity of 300–400 years ago, it seems that an exploration of the rates of these same eight conditions in present-day England might be of interest. Presumably during the colonial era in England, the sites of origin of the four earliest groups of colonists to British North America had cultural features and regional identities that were significantly distinctive and varied enough to merit such consideration. The descriptions in the earlier chapters about their origin indicate that such differences were present.

The first page of the New Orleans Times-Picayune of July 28, 1999 (Stern, 1999) listed the rankings for the best and worst states in which to raise a child. The criteria for the rankings were the rates of juvenile crime, abuse and neglect, high school dropouts, children living in poverty, child mortality, infant mortality, divorce, teen birth rate, immunization of children less than two years of age, and children not receiving pre- or postnatal care. The best-ranked five states were in New England—Connecticut, New Hampshire, Maine, Massachusetts, and Vermont; the worst-ranked five were Arizona, California, Louisiana (fiftieth), New Mexico, and Texas, but Washington, DC was worse than Louisiana. Why should this be? In the following pages I hope to provide some understanding of this.