Noteworthy News Articles on Mental Health Topics, June 1-7, 2000

Study: Media Coverage of Drugs Often Misleading
Katharine Webster, Associated Press, 6/1/2000

A study of how the mass media covers health found that many news stories on drugs fail to report side effects or researchers' financial ties to the companies that make the medications. The researchers looked at 207 newspaper and TV stories from 1994 to 1998 on three drugs: aspirin, used to prevent heart disease; pravastatin, a cholesterol-lowering drug also used to prevent heart disease; and alendronate, a drug for preventing and treating osteoporosis.  In the 170 stories that cited experts or scientific studies, half included at least one expert or study with financial ties to the drug's manufacturer. Of those, only 40 percent reported the potential conflict of interest. The study also found that fewer than half the news stories reported the drugs' side effects and only 30 percent noted their cost.  The study by researchers from Harvard University and Harvard Pilgrim Health Care, a managed care insurer, was being published in today's New England Journal of Medicine, whose incoming editor has been criticized for an apparent conflict of interest involving a drug company.
    Wire service stories were included in the study, including some by The Associated Press. Forty percent of the stories studied did not report the numbers behind the claims of medical benefits. Among the 124 stories that did quantify the benefits of a drug, 83 percent reported only the relative benefit and 2 percent reported only the absolute benefit. Just 15 percent reported both, the study found. For example, many 1996 stories about an alendronate study said the drug would cut an osteoporosis patient's risk of a broken hip in half the relative benefit. But most failed to include the absolute reduction in risk, from a 2 percent chance of a hip fracture to 1 percent.
    Reporting only the relative benefit is ''an approach that has been shown to increase the enthusiasm of doctors and patients for long-term preventive treatments and that could be viewed as potentially misleading,'' the authors wrote.  Some studies do not report absolute benefits. Others look at drugs in the experimental phase; manufacturers will not release a price until the drug is approved and on the market. In addition, while the top medical journals require researchers to report their financial ties to drug companies, some studies do not include the information because a researcher fails to disclose it. ''The financial entanglements can be essential information for these science stories, and we want to provide readers whatever details we can,'' said Mike Silverman, deputy managing editor for national news of The Associated Press.
    ''We try very hard to provide an adequate context for the readers, and sometimes the information is available in (medical) journal articles or obtainable in interviews on deadline, and sometimes it isn't,'' said Cornelia Dean, science editor of The New York Times, another of the publications studied. ''I think it makes some really valuable points,'' Rob Stein, science editor for The Washington Post, said of the study. ''I think there's a real danger of oversimplifying these things.'' The study was led by Ray Moynihan, a fellow at the Commonwealth Fund, a nonprofit organization dedicated to improving health care. Funding was provided by the Commonwealth Fund and the Harvard Pilgrim Health Care Foundation, a nonprofit organization linked to the insurer. The incoming editor of the journal this week responded to reports about an apparent conflict of interest stemming from his ties to drug companies. Dr. Jeffrey Drazen, who becomes editor in July, said he may have made a mistake last year when he praised a new asthma drug made by a company that had hired him to evaluate studies about the medication. He also said he would divest himself of any financial interests in drug companies before taking over as editor.

\ 

Gore Calls for Safety Net for Mentally Ill
Lori Montgomery, Washington Post- 6/1/2000

In an event designed to showcase his wife's personal battle with depression, Vice President Gore promised yesterday to provide more financial help and emotional support for families stricken by mental illness, particularly children.  Addressing parents, mental health professionals and Maryland Democratic activists at a Friendship Heights community center, Gore vowed to require insurance companies to cover mental health services for children the same way they cover treatment for other diseases. He also vowed to make sure school nurses and new teachers know how to spot mental illness and where to refer children for help, so the nation might end a rash of schoolhouse violence most vividly exemplified by the deaths of 12 students and a teacher last year at Colorado's Columbine High School. "As Columbine taught us, we must never again wait until tragedy strikes to reach out to troubled young people and give them help and hope," Gore said. "If I am entrusted with the presidency, I will move this country toward the day when mental illness is treated like any other illness, by every health plan in America."
    Yesterday's event--a combination speech and emotional town-hall meeting--introduced a third topic in Gore's new "family agenda," a campaign invention designed to give the notoriously wonkish Gore a legitimate way, through policy, to reveal his personal side to the voters. Gore kicked off the agenda last week in Nashville by talking about after-school programs. Today's topic in Atlanta will be cancer, which killed his sister Nancy. And tomorrow, Gore, who has four children, will talk in the District about the responsibilities of fatherhood. "The challenging part of running as the vice president is you need to break out of being the vice president and become a candidate on your own terms, with your own voice and your own ideas," said Gore press secretary Chris Lehane. The family agenda addresses "real issues that affect real families," Lehane said, but also offers "a good prism" on Gore's life.
    The most important voice yesterday did not belong to Gore, however, but to his wife, Tipper, clearly a hero to many in the audience. In an interview last year, she revealed that she underwent treatment for clinical depression after her son, Albert III, then 6, was struck by a car and nearly killed in 1989. Since then, she has become a vocal advocate for improving mental health care, speaking out in an effort to end what she and her husband repeatedly called the "shame" and "stigma" of being diagnosed with a mental disorder. She declined yesterday to elaborate on her own experience, touching on it only briefly. Instead, she offered praise for her husband, who "was personally supportive of me at a time when I needed it. "He has provided support for me and for our family at a time that was critical for us and a time of particular sacrifice in his own life in terms of aspirations, as anybody does when you have a health crisis in your family." Turning to her husband--who sat nearby on a stool, back straight, hands in his lap, watching his wife--she said, "Thank you."
    More than 51 million Americans are affected by mental illness each year, Gore said, but only one in six seeks treatment because of the barriers society throws before them. Many health plans, for example, cover mental health services differently from physical ailments, requiring higher deductibles, higher co-payments or placing limits on the length of treatment or number of visits. Insurance companies argue that "parity" for mental health coverage would be overly expensive. So Gore yesterday called on insurers to start with children, "so no child is left untreated." He also vowed to increase access to mental health care, particularly for homeless people, for the urban poor and in rural areas. That promise drew loud applause from members of the supportive Friendship Heights audience, many of whom offered sad tales about their own mentally ill children. Among them was Jan Yocum de Calderon, 66, of Columbia, who was charged with abandoning her violent daughter after Yocum de Calderon refused to retrieve the girl from an Ellicott City mental facility. The girl, 16, now lives in a foster home on the Eastern Shore. "I needed services to be able to care for her at home. But there are no services in our community," said Yocum de Calderon, who has 15 children and suffers from heart disease. "You can have parity, but if there are no services in the community, what good does it do you?

Man Held in Attack, Rape of Therapist
Los Angeles Times, 6/3/2000

IRVINE--A man who allegedly raped a therapist during a court-ordered mental health session in her Irvine office on Thursday remained in custody in lieu of $50,000 bail, police said. Thai Quoc Ngo, 23, of Westminster was arrested Thursday after police were able to get into the therapist's office, where the suspect had locked himself after the therapist escaped, said Irvine Police Sgt. Bob Richardson. The attack allegedly occurred during a 6 p.m. to 7 p.m. therapy session in the Woodbridge Lake area of the city, Richardson said.
    The therapist, who is in her 40s, was taken to Anaheim Memorial Hospital for examination and was released Friday.
She previously had conducted about seven sessions with the suspect, Richardson said. Soon after 6 p.m., the suspect allegedly struck her in the face and sexually assaulted her for about 45 minutes, Richardson said. The therapist made her way to the adjoining waiting room, where she told waiting clients to call 911, Richardson said. When police arrived, the suspect had locked himself in the office and refused to surrender, Richardson said.   The suspect is being held at the Orange County Jail on suspicion of rape.

An Adoptee-Rights Hero Who Knows All the Arguments
Sam Howe Verhovek, New York Times- 6/3/2000

Nehalem, Ore.--In the two years that Oregon voters and courts have spent wrangling over Measure 58, the nation's first voter-approved initiative granting all adult adoptees access to their birth certificates, the legal fight here has often been cast as the most excruciating of moral dilemmas: Don't adoptees have a right to see the most basic information about where they come from? Don't women who give up their children for adoption have the right to retain their privacy? But Helen Hill, the 45-year-old adoptee who spearheaded the successful campaign for the measure in 1998 and celebrated a final victory this week when a Supreme Court justice declined to stand in its way, says she is puzzled by the notion of such a dilemma. Measure 58, this sculptor and elementary school art teacher maintains, will prove a win-win for all involved.
    "I just have never understood this notion that it could ruin somebody's life, to have the child she gave up at birth come back into her life someday," said Ms. Hill, speaking yesterday in the living room of her log home, on a bluff with a spectacular view of the Pacific in this little town on the Oregon coast. "Frankly, I mean, it's an honorable thing she did," said Ms. Hill, growing ever more animated. "She shouldn't have to hide, and we shouldn't have to go without that basic knowledge, and that medical information, because of some lingering shame from the 1950s."
    That is not a view shared by all, of course. After passage of the measure 18 months ago, a group of anonymous birth mothers sued to block the law. One said through her lawyer that the whole debate had brought her "flashbacks and nightmares," while another described the prospect of a phone call from her birth child as "a bomb held over your head." Another said her birth child, whom she never wished to see, was a product of rape. Ms. Hill has heard all those arguments, but she just shakes her head in gentle but firm disagreement. "M-58 is not about forcing relationships between unwilling people," she said of the initiative. "It's all about healing the shame, and taking adoption our of the dark ages."
    When Justice Sandra Day O'Connor on Tuesday refused a request from the birth mothers to block the law, thus letting stand a ruling by the state's highest court, Oregon officials said they would immediately begin sending applicants copies of their birth certificates, which in most cases bear the birth mother's name. For Ms. Hill, that was a final victory, even if one that offers her no practical gain: she wasn't even born in Oregon, and besides, she has already found her birth parents. Her search for them is a compelling tale, one that begins when, as a 10-year-old girl, she discovered some old adoptions manuals behind the bed of her parents' home in Kansas City. Had she been adopted, she demanded of her mother. Yes, came the answer. "That caused immediate confusion, bewilderment, even a big depression," recalled Ms. Hill, a passionate woman with long, dark hair and dark eyes. "The seeds of this whole ballot measure were probably sown right there," she added with a laugh.
    After decades and thousands of dollars spent on private investigators, Ms. Hill found herself with the information she needed, including a file that described her birth mother as a "healthy, attractive girl who wears her hair in a long bob." Ms. Hills was 41. Her birth mother, in Des Moines, was 64. So she just picked up the phone one day. "My name is Helen, and I'm calling about a very personal matter. I was born on March 24, 1955, in Kansas City." "There was a silence on the other end," she recalled yesterday. "A very long silence. And after that she said: 'I love you. I've always loved you.'" Ms. Hill soon flew to Iowa, and they met. "It's almost too much for a human being to deal with." Ms. Hill remembered. "There's an incredible amount of intimacy presupposed with this person who is a total stranger. And yet there are things frighteningly familiar about this person. Her scent, her voice. I mean, the way her fingernails looked. It blows your mind."
    That was the reunion with her birth mother, with whom she remains friendly (as she does with her adoptive mother). A bit later she sent a letter to her birth father, in Albuquerque. He was a dashing lieutenant, back from the Korean War when he met her birth mother, and the two had a brief but passionate romance. He never even knew that Ms. Hill existed. But having received her letter, he picked up the phone and called her right away. "He's this very exuberant Italian-American fellow with a voice like Al Pacino's," Ms. Hill said. "He was stunned, but he was happy. He said to me: 'Your mama was the love of my life. You were a love child.'" Not all adoptees share the intense curiosity of Ms. Hill, who drives a van bedecked with images of planets and asteroids. Experts say two-thirds of adoptees do not seek out birth parents, even when there are ways to pursue the information. (Of the third who do about 80 percent are women.)
    Critics of the Oregon law say that mutually desired reunions are wonderful, but not those forced upon an unsuspecting or even unwilling birth mother. Some have said the prospect might even so tip the scales for some pregnant women as to lead them to opt for abortion. "That's simply a fundamental misunderstanding of human nature," said Ms. Hill, who has three children of her own (a daughter, 21, and two sons, 19 and 14) and who is strongly in favor of abortion rights. "A woman doesn't go and have an abortion because she's afraid her child might find her out someday. That's not the way the heart and soul works."
    Ms. Hill, who is no longer married, estimates that she spent about $90,000 of her own money on the campaign for Measure 58. She also got a friend to lend her Max, the golden retriever who was a powerful mascot for the campaign. "Max has his papers," read the yes-on-58 ad. "We want ours." Adoptees-rights organizations hope the Oregon law will propel similar movements in other states. Ms. Hill said she just wanted to go back to her art and her teaching, and to her current campaign to build a youth center in a nearby town. But she supports the fight. "I've never believed in anything so much in whole life," she said. "I grew up steeped in the secrecy and shame that the closed-record system perpetuates, and I don't want anybody else going through what I went through. It's really as simple as that."

Controversial Therapy Worked, Patient Says
Jenny Deam, Denver Post- 6/4/2000

It was 1994, and a deeply troubled 13-year-old named LaSandra Hueston needed help. Abandoned and abused early in life, she refused to accept the love her new foster family was offering. So they took her to a therapist named Connell Watkins to be reborn. If, they reasoned, LaSandra's birth could somehow be re-created, this time into a nurturing environment, maybe they could undo some of her damage. In the basement of Watkins' home in Evergreen, LaSandra was wrapped tightly in a blanket and laid on the floor, her head uncovered. Every few minutes pillows were pressed against her body to simulate being moved through the birth canal by contractions. Her foster parents and therapist were right there, in her face, telling her how great her new life would be if she would let go of the old one. But the girl felt trapped, suffocated - overwhelmed as much by the emotional intensity as the blanket around her. "I told them I couldn't breathe," Hueston remembers. "I told them, "I'm going to die.' And they told me, "If you think you're going to die . . . then go ahead and die.' "
    Last month, Hueston's former therapist, Connell Watkins, was arrested on felony child abuse charges in connection with the death of a 10-year-old North Carolina girl who died after a therapy session that bore striking similarities to the one Hueston experienced years before. Candace Newmaker had also been brought to Watkins because the little girl apparently was unwilling or unable to bond with her adoptive mother. On April 18, she, too, was wrapped in a blanket with pillows pressed against her to simulate contractions for her rebirth. She, too, allegedly cried out that she couldn't breathe and felt like she was going to die. And, according to investigators, she, too, was told by Watkins and Julie Ponder, the lead therapist in the session, "You want to die? OK, then die." In Candace's case, she really could not breathe. Doctors say she suffocated.
    The arrest of Watkins - nationally known for her work with severely disturbed children - along with Ponder and four others in the fatal therapy session, including Jeane Newmaker, the little girl's adoptive mother, has touched off deep divisions within the world of psychotherapy. There are those, including Hueston, who call Watkins a loving, dedicated professional who was known to "never back down" in treating the worst of the worst patients. They acknowledge that her methods may seem strange or even outrageous to a layperson, but sometimes extreme measures are needed in extreme cases. Watkins declined to comment for this story. But Deborah Hage, a Silverthorne therapist who often worked with Watkins, said that when a child is severely troubled, traditional therapies simply don't work. They involve trusting the therapist, and these children do not trust anyone.  Hage said it is often more helpful to use physical methods. "The more disturbed the child, the more you have to physically arouse their senses."  Watkins' specialty was treating "attachment disorder," a relatively new diagnosis in the world of mental illness. A child with the condition fails at a very young age to form the usual bonds of trust. Usually due to abuse or neglect, he or she often grows up violent and without a conscience. Experts in the field say without proper treatment, the child could be destined to kill. "The papers make her sound like she's crazy," Hueston said of Watkins. "She's not crazy. She's a person who strongly believes in what she does."
    Hueston, now 18, is out of therapy and about to be married. She plans to begin college next fall. She says she stays in touch with Watkins, considering her both friend and mentor. "I love Connell. She's the kind of person I want to be." When prosecutors approached Hueston in the case, she said she would not willingly testify against Watkins.  Douglas Gosney also has nothing but praise for Watkins. Gosney, the California therapist who told authorities he taught Watkins and Ponder his rebirthing technique of covering the client's head, said last week: "Connell Watkins has dedicated her life to saving. It is tragic that a child has died. It is also tragic that a woman with so much heart, caring and dedication is having to endure such personal scrutiny after 25 years of service to our communities."
    There are those in the mental health field who are horrified by the events of April 18, calling the whole notion of rebirthing akin to quackery. "There is absolutely no evidence that this works, that it helps people," said Rhea Farberman, a spokeswoman for the American Psychological Association in Washington. "This is far outside what mainstream psychotherapists are doing." Larry Curry, an Aurora therapist who treats troubled children and adolescents referred to him by the courts and social service agencies, said he is gravely concerned by what he has heard about the case. "It crosses the line of professionalism. Whenever you have to use restraint, you begin to open yourself up to all sorts of liability. It's very, very risky doing this kind of work. People who come into my therapy at any time have the right to say enough is enough."
    Hueston can only speculate what went wrong on April 18. She vividly remembers how trapped she felt in her own sessions, at least in the beginning. She said most kids feel that way, and many cry out that they can't breathe. "It's just something you have to get through," she said. Hueston's theory is that when Candace began protesting, Watkins and Ponder may have ignored her, figuring the little girl's cries were part of a disturbed child's resistance to treatment. Hueston knows all about resisting treatment. She never knew her father; her mother disappeared when she was 3. Hueston was raised by her greatgreat-grandmother until age 8, when she and her brother entered the world of foster care. In all she has been in four foster families and five group homes. "I was violent, I was loud, I was a very angry child," she says. After she was diagnosed with attachment disorder, she was sent from a foster program in Tucson to the Attachment Center at Evergreen to begin intensive therapy.
    "Connell was my therapist from the second day I was there," Hueston said. "The first two weeks I didn't like her at all. I wasn't used to having someone in my face. But Connell never backed down. She would urge you to let it all out." Watkins was once affiliated with the Attachment Center but left to go into private practice. It was a tough road back to mental health for Hueston. By day she was going through intensive therapy. At night, she stayed with a "boot camp mom" to instill discipline and responsibility. One of her boot camp moms, she said, was Britta St. Clair, another of the defendants in the Candace Newmaker case who participated in the fatal rebirthing. Hueston said she was forced to do sit-ups and push-ups for food. "You had to earn your meals," she said. She slept in a cement room and had only a cot and a pillow. "It was awful. You think, "I hate it here. I don't need to be screwing up.' So you work hard to get out." Once she ran away. When she was brought back, all of the other children at the house were treated to a pizza party while she was forced to watch but given nothing to eat.
    In time, though, Hueston said she grew to enjoy her therapy sessions. In addition to rebirthing, she also did "holding" therapy, where she laid across the lap of her foster parents while wrapped in a blanket and they talked out their problems. "It was just a great, great experience," she says today. Hueston says she was so devastated by Watkins' arrest that she had to leave work for the day. She said she believes the girl's death was an accident and sees nothing wrong with the method of therapy. "I think that little girl just got too scared."

Death Spurs Warning
Carol Kreck, Denver Post- 6/4/2000

Following April's "rebirthing" death of a 10-year-old girl, state authorities are threatening to pursue child-abuse charges against mental-health professionals who physically restrain children as part of psychotherapy. "When you start restraining kids who can't protect themselves and they panic, you're in trouble," said Jane Beveridge, director of child welfare for the state Department of Human Services. The department's warning puts scores of licensed and unlicensed mental-health practitioners who specialize in so-called aversive therapies on notice.  And many are furious at the state's tactics.
    "Oh, that is so crazy," said clinical psychologist John Dicke. He practices "holding" therapy for children diagnosed with "attachment disorder" like Candace Newmaker, the little girl who died in April. Dicke said state and county social service agencies regularly use restraints for punishment and containment. He also said if the state tried to pursue charges against therapists who use restraint methods, "they would have to file hundreds of thousands of complaints a year." Kathy Sasak, an assistant district attorney in Jefferson County, said the state's aggressive posture won't necessarily result in prosecutions. Use of restraint techniques in therapy may not rise to the threshold of criminal child abuse as alleged in the Candace Newmaker case, she said.
    Candace was undergoing "rebirthing" treatment at the Evergreen home office of Connell Watkins. The treatment is designed to cure "attachment disorder," in which a young child fails to form the usual bonds of trust with a parent or caregiver. Mental-health professionals generally attribute the disorder to abuse or neglect and say those who suffer from it can grow up violent. "Rebirthing" is one of several alternative therapies involving holding or restraint to treat reactive attachment disorder. Colorado is considered a hotbed of alternative therapies for attachment disorder, most of which involve restraint and are collectively called aversive or coercive therapies. For Candace's rebirthing session, she was tightly wrapped in a blue blanket in an effort to simulate the womb. But she suffocated, authorities say, and died the next day at a hospital.
    Jefferson County prosecutors have charged Watkins - an unlicensed, unregistered psychotherapist - and three others who participated in the session, plus Candace's adoptive mother, Jeane Newmaker, with child abuse resulting in death. The other three are: unlicensed, unregistered psychotherapist Julie Ponder; office manager Brita St. Clair; and former drywall hanger Jack McDaniels. While the state now is threatening to pursue criminal charges against therapists who employ restraints, state officials also could take action - including revocation - against a therapist's license, said Amos Martinez, program administrator in the mental-health section of the state Department of Regulatory Agencies.
    Dicke said the state's stance won't affect his practice in any way. "Clear Creek County's Department of Social Services hires me all the time to do attachment work on their severely attachment-disordered kids," Dicke said. "They have a social worker in the room to hold the kid with me." Other fans of aversive therapies are outraged at the state's position. "There's been one death!" protested Gail Trenberth of Boulder, who represents the Attachment Disorder Parents Network. "Why are they throwing the baby out with the bathwater? "This Connell (Watkins) was my daughter's therapist. She has been doing attachment therapy for years and has helped hundreds of kids, including my daughter."
    But the state's Beveridge said there have been other deaths involving therapeutic restraint. In 1998, Roberta Evers, a 6-year-old from Durango, choked to death in vomit after her adoptive mother put her in a four-point restraint.  Candace Newmaker vomited in her blanket before dying. Beveridge also pointed to the 1993 death of 17-year-old Casey Collier in a six-point restraint at the Cleo Wallace Center in Colorado Springs. Casey also vomited, aspirated and suffocated. Legislators had Casey Collier in mind last year when they passed a bill that established guidelines for restraints of children and adults. But that bill, carried by Reps. Moe Keller, Marcy Morrison and Sen. Dottie Wham, only protected people in facilities, not those in offices of private practitioners.
    Aversive therapies date to the 1960s when a California therapist named Robert Zaslow started Z therapy, which involved knuckling a child's sternum and ribs while he was held down, said associate professor of psychiatry Don Bechtold at the University of Colorado Health Sciences Center. Similar therapies have been called "holding therapy" and "rage reduction therapy." Rebirthing itself emerged from the explosion of alternative therapies in California in the 1970s; its founder was a therapist named Leonard Orr. He was a strong believer in the theory of birth trauma, or that many psychological problems can be traced to some trauma either in the womb or during labor and delivery. Orr reportedly had an epiphany one day while taking a bath. He is said to have reexperienced his own birth while soaking in the tub. Orr now lives in upstate New York and did not return phone messages. He developed a series of specialized breathing exercises that could help others re-experience their own births. The idea was to release repressed traumas. He called it rebirthing.
    "Birth is when we took our very first breath. At some point in the therapy, they (clients) will all re-experience their own birth, but before that, they will re-experience any trauma they've gone through in their lives," explains Franceen King, a licensed mental health counselor in Florida who runs the Tampa Self-Awareness Institute. "Rebirthing is a very effective tool for many, many problems." She said she has been using rebirthing techniques for about 20 years to help clients "clear their traumas." However, her therapy methods are quite different from the rebirthing session done that night in Evergreen. "In classic rebirthing, there are no restraints whatsoever," King said. And, she adds, it is rarely done on children. Since there is no set of criteria on what constitutes rebirthing, the techniques vary widely. Some people use breathing exercises, some use massage, some use water, some re-enact the birth. All call it rebirthing.

Death Spotlights Therapies of Desperation
Adam Pertman, Boston Globe, 6/5/2000

EVERGREEN, Colo. - Like all the parents who bring their children here for treatment, Jeane Newmaker was desperate. For four years, the North Carolina nurse practitioner looked for one conventional solution after another - through therapy, drugs and counseling - to control her daughter's explosive behavior. Maybe something, Newmaker prayed, could make Candace a happier person, well enough that the 10-year-old would, for the first time, let her adoptive mother hold her. Nothing worked. And so, a couple of months ago, Newmaker traveled to this mecca of attachment disorder clinics, a serene Rocky Mountain town where for three decades hundreds of troubled children like hers had been treated.
    Today, Newmaker is awaiting trial on charges of criminal negligence child abuse for standing by as Candace died while undergoing a controversial technique called ''rebirthing.'' In that procedure, Candace was wrapped in a blanket to simulate the birth canal, and four people pushed against pillows surrounding her to imitate contractions. Those four, two therapists and a couple of office workers who were asked to assist, are charged with felony child abuse resulting in death. This case is far more than a personal tragedy for those involved, however. It also opens a door into the rarely examined world of American families riven by their efforts to deal with children who cannot connect emotionally or physically with their parents, and into the sometimes extreme remedies they are willing to try. Mental health specialists believe there may be tens of thousands of such children nationwide.
    ''I'm most concerned because there are people across the country doing bizarre, nonproductive, nonsensical sorts of witchcraft like this rebirthing that took place in Evergreen, and passing it off as therapy,'' said Ronald Federici, a psychologist who specializes in neural development and is a leading authority on attachment disorders. Members of the therapeutic, adoption, and child-welfare communities nationwide are also abuzz about the implications of Candace's death. They say that parents are becoming wary of seeking aid for children who need it, and that too many adoptive parents may assume their children suffer from attachment disorder when the problem is often a different condition or just a matter of readjustment. ''I think it's worrisome on a big scale for all those reasons and more,'' said Federici. ''There's going to be a lot of fallout across this country as a result of this.''
    A court in Colorado has sealed the videotape that the clinic in Evergreen, Connell Watkins & Associates, made of the procedure that ended Candace's life. But a police report based on an investigator's viewing, as well as his interviews with the participants, provides a vivid picture of what took place. On April 18, as the culmination of an intensive two-week treatment program for which Newmaker paid $7,000, Candace began her rebirthing. The fourth-grader was told to curl into a fetal position on a flannel blanket in the office of Connell Watkins, a therapist who has accumulated both ardent fans and harsh critics during two decades of dealing with attachment disorders. The blanket was wrapped around Candace, gathered at the top, and surrounded by four pillows. Connell and a fellow therapist, Julie Ponder, ran the session; they were assisted in simulating contractions by the office's business manager, Brita St. Clair, and an intern, Jack McDaniel. ''You got to push hard if you want to be born, or do you want to stay in there and die?'' one of the therapists replied when Candace said she could not breathe, a complaint she repeated seven times during the first 24 minutes of the 70-minute videotape. At another point, after the girl insisted she wanted to die, the response was: ''OK, then die. Die right now.'' When Watkins and Ponder unrolled the blanket, more than a half-hour after Candace had stopped talking, they found her lying motionless in her own vomit. She was taken to a local hospital, where she was declared brain dead the next morning.
    Watkins's defenders, particularly parents who say her methods have helped their sons and daughters, assert that the words to Candace about dying weren't meant literally but were intended to prod the child - in a ''tough love'' way - to confront her fears so she could work through them. The rebirthing, in principle, is meant to induce such an intense emotional experience that the child undergoes a catharsis and forms new emotional and physical bonds with its parents, who have shared the experience with them. Most of the boys and girls with attachment disorders have endured a combination of abuse, neglect, and neurological, genetic, or developmental problems. About 90 percent are adoptees from orphanages overseas and from the US foster care system; while only a minority in these categories need more than routine help, such as counseling or medication, mental health specialists say the overall number of those with serious attachment disorders has risen steadily in recent years as the rate of foster and foreign adoptions has soared. ''The parents who come here are usually demoralized, disgruntled, and at wit's end with children who are angry, defiant, and sometimes violent,'' said Terry Levy, codirector of Evergreen Consultants in Human Behavior and the author of two books on attachment disorders. Attachment therapists in Evergreen ''are the last stop; if we don't succeed, the adoptions disrupt and the children go back to foster care, to institutions, to somewhere.''
    Few mental health or child-care professionals consider rebirthing to be a legitimate technique, but dozens of therapists are thought to be practicing it around the country in various forms. Douglass Gosney, a therapist in California who taught Ponder the procedure, told police he had undergone rebirthing himself and had performed it on 300 to 500 people. Many specialists familiar with the issue blame the US medical establishment, as much as they do the practitioners involved, for the apparent proliferation of unorthodox and even potentially dangerous therapies. They say parents often turn to alternative treatments - which are increasingly easy to find as a result of the Internet - because traditional therapists and doctors seldom receive specific training on how to deal with attachment disorders and other adoption-related issues. ''That's absolutely a major, major problem,'' said Federici. ''These parents are looking for a rescue ... and most of the medical community doesn't know how to provide it for them.''
    While nearly everyone interviewed for this story decried rebirthing as invasive and coercive, even some therapists who disagree with Watkins's methods described her as a well-meaning professional who wanted nothing more than to help her young clients. ''Connell was always known as the therapist who took the worst of the worst kids,'' said Forrest Lien, clinical director of the Attachment Center at Evergreen. The center was the first facility to specialize in attachment disorders when it opened almost in 1972; a handful of similar operations have opened here since, most begun by people who, like Watkins, had worked for the center or been trained by its personnel. ''She would do anything to reach one of these kids,'' added Lien. ''But this way of doing it was really bizarre, and look what it caused. Now I'm afraid it's going to drive off other people who really need help. I already see that happening.''  Watkins's lawyer did not return phone calls, but he has publicly described Candace's death as ''a tragic accident'' and not a crime.
    The only lawyer in the case who agreed to be interviewed by the Globe was H. Michael Steinberg, who represents St. Clair, the office business manager. Steinberg said St. Clair had only been following instructions in an effort to help a girl who clearly needed it. ''She has dedicated her life to ... caring for children the world has discarded,'' said Steinberg, who added that his client is a longtime foster mother who has adopted two children with severe attachment disorders and one who is blind. All the defendants are free on bond, with court appearances scheduled for September. Watkins and her colleagues face 16 to 40 years imprisonment if convicted, while the potential prison time for Newmaker is 4 to 16 years. Last week, the Colorado Mental Health Grievance Board banned Watkins and Ponder from practicing in the state. A spokesman for the board said that, whatever the final disposition of the criminal charges against them, Watkins and Ponder had been practicing illegally because neither had licenses, nor had they registered with the state as psychotherapists. Both have registered in the past, so their failure to do so may have been an oversight. But Colorado is one of the few states that permit people to work as therapists simply by registering, without any formal qualifications or monitoring. Critics cite that as one reason so many set up shop here. ''It's dangerous, what's happening here in Colorado,'' said Michael Orlans, who runs Evergreen Consultants with Levy. ''When you don't have licensing or monitoring, anything can happen."

Study Suggests Surge in Kids with Behavioral Problems
Lindsey Tanner, Associated Press, 6/6/2000

CHICAGO (AP) The number of U.S. youngsters with emotional and behavioral problems has soared in the past two decades in part because of more poor and single-parent households, a new study suggests. The researchers found that problems such as attention deficit/hyperactivity disorder, depression and learning disabilities more than doubled from 1979 to 1996. Such conditions were identified in 6.8 percent of all doctor visits in 1979 and in 18.7 percent of visits in 1996. The findings, which appear in the June issue of the journal Pediatrics and echo those in other recent studies, are based on surveys of pediatricians on more than 21,000 patients.
    Differences in doctor training in identifying such problems did not account for the increases, said Dr. Kelly Kelleher of the University of Pittsburgh and Children's Hospital of Pittsburgh, the study's lead author. In fact, the highest identification rates were for doctors who trained in the 1970s and before. The findings suggest instead that most of the change was due to ''an increase in problems and the kinds of patients they're seeing,'' said Kelleher. The changes were associated with increases in the proportions of single-parent families and Medicaid enrollment from 1979 to 1996, the researchers said. Fifteen percent of patients in the 1979 study lived in single-parent homes, compared with 22 percent in the 1996 study. Just 6 percent of the earlier patients were on Medicaid, compared with 18 percent of the 1996 patients. However, pediatricians are geared primarily to deal with ''acute'' problems in which ''children come in, the doctor gives them medicine, the children go away,'' Kelleher said. Doctors will be ineffective unless the system is restructured to allow pediatricians to act more like mental-health professionals and spend more time with chronic ailments, he said.
    The authors examined data from a 1979 survey of 30 Rochester, N.Y.-area pediatricians, and compared the results with 1996 data from a government-funded study of 395 pediatricians nationwide. A total of 21,065 patients ages 4 to 15 were involved. The largest changes were in attention deficit/hyperactivity, which increased from 1.4 percent to 9.2 percent, and emotional problems such as anxiety and depression, which increased from a negligible amount to 3.6 percent. John Lavigne, chief psychologist at Children's Memorial Hospital in Chicago, said that despite the researchers' findings, some of the increase can probably be attributed to pediatricians getting better at recognizing the problems. The study ''means that doctors before must have been underestimating the problem,'' Lavigne said. ''Chances are they've increased their ability to recognize them."

Experts See Limited Impact for Grandparents Ruling
Jacqueline L. Salmon, Washington Post- 6/6/2000

Despite the concerns of some grandparents, legal experts say they believe the Supreme Court's decision to strike down the state of Washington's child visitation law will not have a big impact in most other states, where laws are generally more narrowly drawn. "The court moved very cautiously in this delicate area and, as far as we can tell, did the right thing," said Cheryl Matheis, director of state legislation for the AARP, the politically powerful senior citizens' lobbying organization. "Yes, it struck down the Washington state statute, but the court made pains to indicate that they were not ruling on less broad statutes that they recognized existed in other states."
    In their decision, the justices said the Washington statute was too broad because it allowed any person at any time to petition the court for visitation rights with a child over the objections of the parents. But they did not rule on whether a state law must require proof that a child would be harmed by refusing visitation--a stiffer standard for grandparents and others seeking to spend time with the child. That leaves the decision in the hands of trial judges, said Gerard Wallace, director of the Grandparent Caregiver Law Center at Hunter College in New York City. "This is not a defeat for grandparents' rights," Wallace said.
    Still, some grandparents said yesterday they were disappointed by the ruling. Richard and Valri Roeben of Heber Springs, Ark., for example, had been waiting months for the decision, hoping that it would bolster their efforts to win court permission to see their three grandchildren. Their daughter had cut off all contact between her three children and the Roebens after a falling-out two years ago. Richard Roeben, 65, fears he and his wife will have a more difficult time asking their local court for visitation privileges because of the Supreme Court's decision. "Grandparents have rights, and grandchildren have rights," he said. "It just isn't fair. We're not trying to take [the children] away from their parents." "I'm absolutely, positively sick," said Lillian Giosa, a Florida grandmother, who founded a grandparents' rights group in 1994 after using the court system to gain the right to visit her two grandchildren. Since then, the Florida law has been narrowed considerably by several state Supreme Court decisions.
    The Washington grandparents' rights case had become an important legal battle for some of the 60 million U.S. grandparents struggling to cope with the tangled relationships of the modern American family. With half the nation's marriages ending in divorce and 1.3 million children born out of wedlock each year, today's generation of grandparents is increasingly battling their adult children's ex-spouses or former lovers--and sometimes their own sons and daughters--for the right to see their grandchildren. Their efforts have been aided by the states: All 50 have passed widely varying statutes that permit grandparents to petition the courts for an order awarding visitation with their grandchildren. The Washington state law was the most broad, granting anyone, including grandparents, the right to ask the court for permission to visit a child.
    In its decision, the Supreme Court called parental rights "perhaps the oldest of the fundamental liberty interests recognized by this court." The ruling, said the American Center for Law and Justice in a statement, "represents an important victory for the family unit." Locally, the effect of the ruling is expected to be negligible, experts said yesterday. Maryland's law is considerably narrower than Washington's, said a spokesman for the state attorney general's office. Virginia's statute, said local matrimonial attorney Sanford Ain, is narrower than Washington state's because it specifies that the parent-child relationship is primary and the person seeking visitation must show "clear and convincing evidence" that the best interests of the child would be served by awarding visitation to grandparents, stepparents and other blood relatives. The District has no grandparents' rights statute, said a spokesman for the D.C. Corporation Counsel's office. Grandparents' rights groups, which have been monitoring the case carefully, say they were bombarded with calls yesterday by frightened grandparents who had heard that the Washington law was struck down and feared they would lose the right to see their grandchildren. "Grandparents in Washington have lost their broad law," said Ethel Dunn, executive director of the Wisconsin-based Grandparents United for Children's Rights. "But that doesn't mean that grandparents all over the country have lost."

She was Shocked
Ann Lewis, Washington Post 6/6/2000

I've been asked over and over again whether undergoing electroconvulsive therapy -- also known as ECT or shock therapy -- was a good decision. And whether I would have ECT again under the same circumstances. The only honest answer I can give is that I have no idea. To say whether ECT was the right treatment for me, I would have to compare my life before ECT to my life now. And I simply cannot remember life before ECT. In particular, I cannot remember much about the two years leading up to my ECT treatments. That period, along with much of the preceding years, is memory that I lost in exchange for the hoped-for benefits of ECT. That loss was huge and painful and potentially crippling. And yet, when my therapist describes how I was just before ECT, I believe that ECT was probably the best option at the time. He says that I was spiraling down into a depression that wouldn't lift. He says that I was contemplating suicide. And I believe him. While I don't remember that particular depression, I remember others -- many paralyzing episodes of depression in my 37 years of living with mental illness. My therapist also says that I was failing to respond to medications. And that I also believe. While I cannot remember specific experiences with the plethora of drugs I've tried over the years, I do know that I tried so many because I was constantly searching for one that would finally work.
    I had 18 ECT treatments over a six-week period beginning in May 1999. Based on some vague recollections and on what I've been told, here's what happened: Three times a week I rose at dawn to be at the hospital first thing; I sat in a crowded waiting room until my name was called. Then I put on a hospital gown, lay down on a gurney and was wheeled into an operating room designated for ECT patients. Full anesthesia was administered intravenously, and the next thing I knew I'd be waking up in the recovery room, ready to be taken home, where I'd sleep for the rest of the day. My boyfriend and my mother shared the burden of caring for me. On the days between treatments, she says, we sometimes went to museums, malls and restaurants. She says that I was a zombie, unable to make even the smallest decisions. My boyfriend says I asked the same questions over and over again, unaware that I was repeating myself. Right after my last treatment--my mother made a note of this in her diary for July 8--I woke up. I can liken this only to what I expect a person coming out of a coma experiences. I felt like a newborn, seeing the world for the first time. But unlike the common notion of first sight as a thing of splendor and awe, for me it was complete frustration. While I couldn't recall how I had felt before ECT, I couldn't imagine it was any worse than what I was experiencing now.
    Every little thing told me that I had no memory. I couldn't remember who had given me the beautiful picture frames or the unique knickknacks that decorated my home. My clothes were unfamiliar, as were the jewelry and trinkets I had owned for years. I didn't know how long I had had my cat or who my neighbors were. I couldn't remember which foods I liked or what movies I had seen. I didn't remember people who greeted me on the street or others who called me on the telephone. A former news junkie, I was especially frustrated to realize that I didn't even know who the president was or why someone named Monica Lewinsky was famous. I was floored when I found out about the impeachment hearings. And I couldn't remember my boyfriend, although he practically lived with me. There was evidence all over the apartment that we loved each other, but I didn't know how or when we had met, what we liked to do together or even where we liked to sit while watching television. I didn't even remember how he liked to be hugged. Starting from scratch, I had to get to know him again while he had to accept the frustrating loss of what we once had together. While continuing to battle my mental illness--ECT is no instant cure--I had to relearn how to live my life. I didn't know my parents had moved. I had to be "reminded" about that great sub shop in Bethesda and about my favorite restaurant, the Lebanese Taverna. I spent 15 minutes in the cracker aisle in Safeway until I recognized the box of my favorite crackers, Stone Wheat Thins. I retrieved some clothes only by going to seven different cleaners to ask if they had an overdue order belonging to Lewis. Just yesterday I lost a contact lens: I've been wearing contacts for at least 10 years, but I have no idea who my eye doctor is, so replacing the lost one will be another tedious challenge.
    Socializing was the hardest part of my recovery, since I had nothing to contribute to a conversation. While I had always been sharp-tongued, quick-witted and sarcastic, I now had no opinions: Opinions are based on experience and I couldn't recall my experiences. I relied on my friends to tell me what I liked, what I didn't like and what I'd done. Listening to them trying to reconnect me to my past was almost like hearing about someone who had passed away. Before ECT I had been working for a legal concern in the District where the environment was exciting and the people were fun. That's what I've been told, anyway. Just before undergoing my treatment I informed my employer of my disability and requested time off. I estimated that I would need two weeks, unaware that the ECT would eventually stretch on for six weeks and that I would need months to recover. As the weeks passed, I missed going to work, though I realized I had forgotten the names of major clients I had dealt with daily and even the names of the computer programs I had used routinely. And I couldn't recall the names--or the faces--of the people I had worked beside--people who had been to my house and with whom I had traveled frequently. I didn't even know where my office building was located. But I was determined to get my life back on track, so I dug up all my work materials and began studying to catch up with my old life. Too late: My therapist's request that the firm accommodate my extended absence failed. The company claimed that for business reasons it had been obliged to put someone else into my position and asked where my personal belongings should be sent.
    I was devastated. I had no job, no income, no memory and, it seemed, no options. The thought of looking for a job scared me to death. I couldn't remember where I had saved my resume on my computer, much less what it actually said. Worst of all--and this is probably the most familiar feeling among those who suffer from depression--my self-esteem was at an all-time low. I felt completely incompetent and unable to handle the most minor of tasks. My resume--when I finally found it--described a person with enviable experiences and impressive accomplishments. But in my mind I was a nobody with nothing to hold onto and nothing to look forward to. Perhaps due to these circumstances, perhaps due to my natural biological cycles, I fell back into depression. Those first months after ECT were horrible. Having lost so much, I was facing another bout of depression--just what the treatments had been intended to correct. It wasn't fair and I didn't know what to do. Restoring my memory--or trying to accept its permanent loss--became the focus of my therapy sessions. I couldn't recall how badly I had felt before the treatment, but I knew now that I was desperate and completely demoralized.
    At the edge of hopelessness, I somehow committed myself to hanging in there--not for me, but for the family members and friends who were working hard to make my life better. Daily thoughts of suicide were something I learned to ignore. Instead, I focused on making it through each day. I managed to get out of bed each morning and drive to the coffee shop, where I forced myself to read the entire newspaper, even if I couldn't remember much of what I had read. It was exhausting, but after a few weeks I was reading books and running errands. Soon I re-entered the world of computers and e-mail and the Web. Little by little, I was reconnecting to the world. I also attended therapy religiously. The therapist's office was a safe place where I could admit just how bad I was feeling. Thoughts of suicide were a normal part of my life, but I felt it would be unfair to share those dark feelings with family and friends.
    Through the Depression and Related Affective Disorders Association, I joined a support group, which became central to my recovery. There I realized that I was not alone in my plight and for once I had friends to whom I could talk honestly. Nobody was shocked to hear what the voice in my head was telling me. And I began to run and exercise again. Before ECT I had been training for my first marathon. After, I couldn't run even a mile. But within a few months I was covering long distances, proud of my accomplishment and grateful for an outlet to deal with my stress.
    In October I tried a new medication for depression, Celexa. Maybe it was this drug, maybe it was my natural cycle, but I began to feel better. I experienced days where death wasn't on my mind, and then I experienced days where I actually felt good. There was even a turning point when I began to feel hopeful, like something good could actually happen in my life. The most poignant moment occurred a month after I changed medications. My therapist asked, "If you always felt the way you do today, would you want to live?" And I honestly felt that the answer was yes. It had been a long time since I had felt like living instead of dying.
    It's close to a year now since I finished my ECT treatments. I am working full-time. I see my therapist only once every two to three weeks. I still attend DRADA meetings regularly. My memory is still poor. I cannot recall most of the two years before ECT, and memories prior to that time must be triggered and dug out of my mental archives. Remembering requires a great deal of effort, but my mind is sharp once again. Friends and family say that I am less gloomy than I was, cheerful and less brash. They say I've softened a bit, though my basic personality has indeed returned. In part I attribute my gentler attitude to the truly humbling experience of having my self disappear. In part I attribute it to the loss of my well-honed vocabulary: I was reluctant to speak up when I couldn't find the right words. But in greatest part I attribute my change to a renewed desire for peace in my life. I am now dedicated to managing my depression and living a satisfying life day by day. I feel that if I can make the best of the moment, then the future will take care of itself. As for my boyfriend, we're getting to know each other again. I'll be forever grateful for how he cared for the sudden stranger he met after my treatments.
    Would I undergo ECT again? I have no idea. Where medication does not work, I believe the doctors' judgment that ECT is still the most effective treatment. For people who are sick enough to be considered for ECT--as I was--I believe the benefits justify the potential loss of memory. Losing my memory, my career, my connections to people and places may seem too much to bear, but I see all that as not a huge price to pay for getting better. What I lost was enormous, but if it is health I have gained, that is obviously far more valuable than what I lost. While this year has been the hardest of my life, it has also provided me with a foundation for the next phase of my life. And I truly believe that this next phase will be better. Perhaps it will even be great. With a medication that seems to be working, a strong network of support and the ability to move forward, my life looks promising. I've learned to hang in there when it seemed impossible and to rebuild from a significant loss. Both are difficult. Both are painful. But both are possible. I am living proof.

Therapy: Positive and Negative Charges
Tom Graham, Washington Post- 6/6/2000

The extensive memory loss described by Ann Lewis in the accompanying article reinforces some of the widespread negative impressions about electroconvulsive therapy. Even supporters of ECT acknowledge that memory loss is a common side effect, though they say it is typically far less severe than that reported by Lewis. Juan Saavedra, the Bethesda psychiatrist who treated Lewis before she underwent ECT, says he generally considers this therapy only for a very old person who would have trouble tolerating medication or for a person who is "in danger of suicide [where] you really cannot wait for the antidepressants to be effective." In discussing this as an option, he says, "my approach will be to say that the most important thing is preservation of life." "There is always a lot of fears, and it's understandable" in light of publicized cases of "people who have been mistreated," says Saavedra, who adds that in his experience the majority of patients who are urged to receive ECT agree to do so. "There is no way to predict" the degree of memory loss from ECT, Saavedra says. "Every treatment has its possibilities of something going wrong," but ECT is "a very safe procedure these days."
    Not nearly safe enough, in the view of those who believe ECT remains more dangerous than it's worth. "The shock induces an electrical storm that obliterates the normal electrical patterns in the brain, driving the recording needle on the EEG up and down in violent, jagged swings. This period of extreme bursts of electrical energy often is followed by a briefer period of absolutely no electrical activity. . . . The brain waves become temporarily flat, exactly as in brain death, and it may be that cell death takes place at this time." That's the view of another Bethesda psychiatrist, Peter Breggin, in his book "Toxic Psychiatry." Breggin's Web site, breggin.com, is only one of many (ect.org, antipsychiatry.org, banshock.org, etc.) that warn about the nasty repercussions of ECT. Last year's Surgeon General's Report on Mental Health gave ECT's opponents little solace, though it did acknowledge some of the scientific mysteries and past misuses of the therapy since it was developed in the 1930s: "ECT consists of a series of brief generalized seizures induced by passing an electric current through the brain by means of two electrodes placed on the scalp. . . . The exact mechanisms by which ECT exerts its therapeutic effect are not yet known. . . . Accumulated clinical experience--later confirmed in controlled clinical trials . . .--determined ECT to be highly effective against severe depression, some acute psychotic states and mania. No controlled study has shown any other treatment to have superior efficacy to ECT in the treatment of depression." On the issue of memory loss, the report suggests that most patients are far less affected than Lewis was: "The confusion and disorientation seen upon awakening after ECT typically clear within an hour. More persistent memory problems are variable. Most typical . . . has been a pattern of loss of memories for the time of the ECT series and extending back an average of six months, combined with impairment with learning new information, which continues for perhaps two months following ECT."
    The report also reiterated the medical establishment's conclusion that ECT is a worthwhile tool for treating certain mental disorders: "Although the average 60 to 70 percent response rate seen with ECT is comparable to that obtained with pharmacotherapy, there is evidence that the antidepressant effect of ECT occurs faster than that seen with medication, encouraging the use of ECT where depression is accompanied by potentially uncontrollable suicidal ideas and actions. However, ECT does not exert a long-term protection against suicide. Indeed, it is now recognized that a single course of ECT should be regarded as a short-term treatment for an acute episode of illness."

Sex and the Therapist: Views of the Couch
Claudia Dreifus, New York Times- 6/6/2000

Dr. Susie Orbach--the therapist who treated Diana, Princess of Whales, for her eating disorders; the founder of the Women's Therapy Center of London; a former columnist for the Guardian; a visiting professor at the London School of Economics; and the author of the 1978 best-seller "Fat is a Feminist Issue":--is, aside from Sigmund Freud, probably the most famous psychotherapist to have ever set up couch in Britain. On a recent visit to New York, Dr. Orbach, 53, talked about her eighth book, "The impossibility of Sex: Stories of the Intimate Relationship Between Therapist and Patient" (Scribner).
Q.  In "The Impossibility of Sex," you own up to a great emotional involvement with you patients. Is this usual within your profession?
A.  Entirely usual. But analysts have a lot of different methods for dealing with it. Depending on their school, they'll say, "this is about my personal engagement." Or, "this is what is done to me by the patient and it has nothing to do with me." Or, "this patient is disturbing me, I'll have to send him to another therapist." At the end of the day, though, we know there are no human relationships where we do not disturb one another. And that's true for the analytic relationship, too.
Q.  In the book, you admit to feeling sexually stimulated by a patient named Adam, who kept trying to seduce you. Are you telling secrets out of school?
A.  I don't think there's any shame about that. The point is, How does one respond to the various emotional invitations of one's patients? Every person has an idiom. Some patients invite me in with their intellect. This particular man was a compulsive fornicator and he had no other way to maintain a relationship unless he was involved in seduction. To get into his heart and head, a piece of me had to surrender to that seduction to understand what that was about for him and to understand how incredibly painful, barren and problematic it was.
Q.  One gets the feeling you see psychoanalyst and patient as a kind of emotional couple.
A.  I see patient and therapist working together, creating a relationship in which you are lifting the impediments to intimacy. And you're often doing that within the relationship you have together. So in that sense you are a couple. But it's a very specialized type of couple--just like therapy is a very specialized type of relationship.
Q.  The Princess of Wales went to you for several years, did she not?
A.  I really don't know what I can say…
Q.  When Diana gave her famous 1995 televised interview where she confessed to infidelity, eating disorders and the fact that there were "three of us in this marriage," she was accused by several writers of "Psychobabble." How did you feel about that sort of critique?
A.  You know, at the time, I was accused of being the script writer, the person who put these words in her mouth. I found the accusation extraordinary. It's such a complete misunderstanding of the therapeutic process, as though therapists were Svengalis. The truth is, we don't have an easy language for emotional life. That's why we have writers. They are able to find a way to say things with subtlety. So when a phrase rings true to somebody and then gets repeated, it becomes, all of a sudden, psychobabble. I think the problem with describing emotional life is that we have to stretch ourselves to find the words to say something that is refreshing, accurate, authentic.
Q.  After Diana's death, many commentators began looking at her life as a feminist parable. Did you?
A.  Do I think the transformation of a socially privileged but emotionally neglected child to a fairy tale princess, to a woman with a problematic marriage who turns around a sense of victimization to become a real activist in the world and fighter for people's rights as a feminist parable? Sure! But is that the story of Diana? That's one story of Diana, isn't it?
Q.  Are you implying more to Diana's story than has been told?
A.  I think of hers as the story of someone who was vulnerable. And if that can be elevated into part of the feminist parable--that one has both strengths and vulnerabilities--I think that would be a welcome development to our thinking about women.
Q.  Your highly influential 1978 book, "Fat Is a Feminist Issue," posited the idea that some women had eating disorders because they had been under nurtured by their mothers. Do you still believe that?
A.  If I were writing that book today, I wouldn't write it in the same way. But I think that there still is a way in which certain aspects of female development are seriously unaddressed. I think today women are told that they can conquer the world, but I don't think they are given the emotional equipment to feel safe inside themselves. And food is the first relationship. If we look at mothers' feeding of children, well, the situation is profoundly worse than it was in the 1970s. We now have two generations of women who have been under tremendous assault about: "You can go out there and be in the world, but don't forget to look gorgeous and slim. And don't forget, you should eat this and not that and you should go to the gym." As people felt less effective collectively, politically, we've been offered our bodies as the site of change.
Q.  So the prevailing idea, in your view, now is, You can't change the world, but you can sculpt your body?
A.  I don't think that's explicit in people's minds. But I do think that people, in the face of feeling unhappy about their capacity to be effective, have found an area where they can feel they are. I think you can see progress in Western countries in terms of, certainly, certain classes of women's aspirations having been struggled with. It's sort of like there's been a very interesting price, which is an intensification in the breeding of the bodily insecurity of women.
Q.  Back to Diana. How did you personally deal with her death?
A.  I'm not really sure I can answer that. I mean, it's shocking when somebody you know and who is in the public eye has died. Mainly, I spent the day warding off journalist.
Q.  Did the harassment from the press directed at you help you identify with Diana?
A. I have never admitted that Diana was my patient, even though it's in the public record. It is not something a therapist can say. Of course, when your house is surrounded and you have a clinical practice to deal with, the other people you are seeing have a lot to deal with they didn't bargain for. They are being invaded themselves. I mean, finding pictures of us in the newspapers on a daily basis. It was not nice.
Q.  In closing, your new book consists of eight composite case histories of psychoanalytic patients. Many therapists, including Sigmund Freud, wrote in the form of case histories. Why should readers believe veracity of a form that hovers somewhere between fiction and nonfiction?
A.  My book is about emotional truth. Why should your believe me? You don't have to. The question is, Is there anything there of use to you? Any time a therapist tells a story, they are being so selective. They are privileging one bit of information over another. In the end, it isn't really the patient's story anyway. It's the story the therapist makes of the patient's. With the book, I was trying to say, "This is the therapist's experience." If you look from the point of view of the therapist--the scholarship, the learning, the knowledge, this heart--what I've written has a certain truth.

Stirring New Debate About Alcoholism
Rebecca Raphael, ABC News- 6/7/2000

Most Americans believe that the only way to control the devastating addiction of alcohol is total abstinence.
But now those views are being challenged and the means of treatment re-examined. In a special 20/20 hour, Dr. Nancy Snyderman offers an unconventional perspective on the 50 million Americans who struggle with alcohol, as she raises these questions: Is it a disease or a behavior? Is it possible that for some, it can be treated with moderation rather than abstinence? Are Alcoholics Anonymous and other 12-step programs the only way to sobriety? According to a growing number of researchers and others who have struggled with alcohol, the long-held views of AA and other 12-step programs are only helpful to a small segment of the population. Abstinence, these experts and recovering alcoholics say, may be the only remedy for some people, but not necessarily for others.

Alcoholism as a Disease
More than 50 years ago, the American Medical Association labeled alcoholism a disease. But there is no single key to determining who suffers from alcoholism nor is there a known underlying biological defect in alcoholism. The American Psychiatric Association, in its Diagnostic and Statistical Manual of Mental Disorders, does not use the term "alcoholism." Instead, it lays out several sets of criteria for alcohol abuse and alcohol dependence (commonly called alcoholism). For decades, Alcoholics Anonymous and most other 12-step treatment clinics have operated on the assumption that people seeking help have a disease characterized by physical dependency and a strong genetic predisposition. The goal of such treatment, therefore, is total abstinence. Indeed, millions of alcoholics who have attended AA and similar programs have found that the only treatment for their chronic and progressive disease is to follow the 12 steps of sobriety. All the steps, including admitting powerlessness over alcohol, support the ultimate goal of a lifetime of abstinence. "I work a very strong 12-step program," says Laura Baugh, 44, a recovering alcoholic. "If I don’t do that, I die. In my opinion, I have a disease. A brutal, brutal disease. It’ll kill you slowly, 100 percent it’ll kill you." "AA has literally given me a new life," says Eddie A., a recovering alcoholic for eight years who adheres to the AA tradition of anonymity. "AA has allowed me to take control of my work, my social life and I have regained my dreams. I have gained serenity. I’m happy inside my skin. Maybe for the first time in my whole life." Dr. Enoch Gordis, who heads the NIH’s National Institute of Alcohol Abuse and Alcoholism, says AA deserves all the praise it gets for transforming lives and saving millions. "The 12-step program, that is AA essentially," he says, "is one of the really incredible genius creations of the 20th century."

Alternatives to Abstinence
But many who try 12-step programs often don’t stick with them. Even AA estimates that 95 percent of those who begin going to meetings drop out. In other clinics, the relapse rate ranges from 50 to 70 percent. Dr. Alan Marlatt, psychologist and alcoholism expert at the University of Washington, says such programs are too rigid and outdated. "They’re a little resistant to those of us who are doing scientific research that might challenge or question some of the basic assumptions that they have come up with," he says. "It would be like trying to challenge the Ten Commandments or something."
    After struggling with severe alcohol and drug problems, Richard Banton followed the AA program for six years. "They told me that I had a disease and that I was powerless over alcohol and drugs and I could never drink again," he says. Although sober, he was uncomfortable with the AA methodology and the "alcoholic" label. "I just thought it was ridiculous," he says. "Any time you say anything that conflicts with their model, then you’re in denial."  Searching for his own solution, Banton found some experts who did not subscribe to the disease theory of alcoholism. Instead, they considered alcoholism a behavior that could be changed. "I strongly believed that I would be able to control myself," says Banton, who has been drinking occasionally for the last three years without getting drunk. "People can change behaviors. People do and I have," he says. "That’s an empowering message."
    Likewise, Marc Kern, whose alcohol dependence and drug problems began in college and continued for 10 years, tried AA. For him, it was not the solution. "There’s nothing medical being conveyed in there," he says of AA "It’s a social, psychological support group — what kind of disease is treated that way?" One sip at a time, Kern found that he could devise his own way out of his problem. For the past 20 years, he has been enjoying an occasional glass of wine — living proof, he says, that some, although not all, alcoholics can learn to drink responsibly. Kern, who went back to school for a Ph.D., has started a new career helping others with addictions, providing them with alternatives to 12-step programs that advocate abstinence.
    Dr. Fred Glaser, an expert in addiction medicine at East Carolina University, says the one-size-fits-all abstinence approach to alcoholism — virtually the only method of treatment offered in the United States — may be hurting people’s chances for recovery and driving away people who need help. Glaser, who runs a course that teaches problem drinkers to reduce their drinking, says his program appeals to people who might otherwise not seek treatment at all. An approach that advocates controlled drinking, he says, can reach a larger number of alcoholics and is preferable to "trying to shove abstinence goals into everybody who comes in for help with a drinking problem."
    But Eddie A., who continues to go to AA meetings twice a week, says that for an alcoholic, drinking in moderation is a "ticket to suicide." The 61-year-old says, "I’ll tip my hat to people who come up with an effective way for an alcoholic to drink moderately. But I’ll tell you something, I don’t think I’ll be touching my hat for a long time." Referring to an AA proverb, Eddie A. says simply, "If you want to stop drinking, you’ve got to stop drinking."

Addiction Alternatives:
http://www.addictionalternatives.com/
Addiction Alternatives, based in Los Angeles, practices the philosophy that one can learn how to overcome addiction and move on to enjoy life without stopping to drink forever. Marc F. Kern, Ph.D, uses personal experiences with addiction and his professional training to bring answers to people suffering with addictions and unwanted habits.

Al-Anon/Alateen:
http://www.al-anon.org/
With meetings in 112 countries, Al-Anon helps families and friends of alcoholics recover from the effects of living with a problem drinker. Alateen is a recovery program for young people. The program of recovery is adapted from Alcoholics Anonymous and is based upon the 12 Steps, 12 Traditions and 12 Concepts of Service.

Alcoholics Anonymous:
http://www.alcoholics-anonymous.org/
Alcoholics Anonymous is an international fellowship of men and women who share their experience, strength and hope with one another to solve their common problem and help others to recover from alcoholism. AA is nonprofessional, self-supporting, nondenominational, multiracial, apolitical and available almost everywhere. There are no age or education requirements.

Behavior Therapist Associates:
http://behaviortherapy.com/
Behavior Therapy Associates is an organization of psychologists providing clinical services, research, training for health care and mental health providers and consultation to organizations and businesses. Its software programs teach moderate drinking skills and its Web site offers a list of therapists across the country who practice moderation training.

Betty Ford Center:
http://www.bettyfordcenter.com/
The Betty Ford Center in Southern California provides an interdisciplinary treatment team that includes a physician, nurse, dietitian, activities therapist, counselors, continuing care counselors, case managers, pastoral care counselors, family counselors, a clinical psychologist and a psychiatrist, if needed. Gender-specific treatment and support groups are available. Groups include grief groups, senior needs, peer groups for gay and lesbian patients and reasonable accommodations for people with disabilities. Patients are encouraged to work and learn the program of living through the self-help movement of the 12 Steps.

Center for Substance Abuse Prevention:
http://www.samsha.gov/csap/index.htm  
CSAP’s mission is to provide national leadership in the federal effort to prevent alcohol, tobacco and illicit drug problems. These problems are intrinsically linked to other serious national problems such as crime, violence, rising health care costs, academic failure, HIV/AIDS, teen pregnancy and low work productivity. CSAP connects people and resources to innovative ideas and strategies and encourages efforts to reduce and eliminate alcohol, tobacco and illicit drug problems. CSAP fosters the development of comprehensive, culturally appropriate prevention policies and systems that are based on scientifically defensible principles and target both individuals and the environments in which they live.

DrinkWise:
http://www.med.umich.edu/drinkwise/
www.med.ecu.edu/pharm/frwise.htm
DrinkWise is a brief, confidential educational program that helps you eliminate drinking problems by reducing your drinking or stopping altogether. You decide which is better for you: moderation or abstinence.The program is for people with mild to moderate alcohol problems who want to eliminate the negative consequences of their drinking. DrinkWise is not for those who are severely dependent or alcoholic and requires treatment approaches rather than educational ones. DrinkWise, offered in Michigan and North Carolina, has the ability to deliver the program throughout the United States using its telemedicine capacities.

Hazelden:
http://www.hazelden.com/
Hazelden is a nonprofit organization dedicated to helping people recover from alcoholism and other drug addiction. Hazelden, based in Minnesota, provides residential and outpatient treatment for adults and young people, programs for families affected by chemical dependency and training for a variety of professionals.

Moderation Management:
http://www.moderation.org
Moderation Management (MM) is a recovery program and national support group network for people who have made the healthy decision to reduce their drinking and make other positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own recovery path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderation is an achievable recovery goal. Individuals who are not able to successfully reduce their drinking either find a local abstinence-only program to attend or remain in MM and choose abstinence as their goal.

National Clearinghouse for Alcohol and Drug Information:
http://www.health.org
The National Clearinghouse for Alcohol and Drug Information (NCADI) is the information service of the Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services. NCADI is the world’s largest resource for current information and materials concerning substance abuse.

National Institute on Alcohol Abuse and Alcoholism:
http://www.niaaa.nih.gov/
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) supports and conducts biomedical and behavioral research on the causes, consequences, treatment and prevention of alcoholism and alcohol-related problems. NIAAA is one of 18 institutes that make up the National Institutes of Health (NIH), the principal biomedical research agency of the federal government.

Practical Recovery Services:
http://practicalrecovery.com
Practical Recovery Services offers customized, private, brief or intensive treatment for any type of addictive behavior or related problem. It views addictive behavior as a bad habit not a disease. It supports both moderation and abstinence and bases treatment services on the latest scientific knowledge. Addictive behavior is learned — and that means you have the power to change it. Though based in La Jolla, Calif., it provides long-distance addiction counseling services by e-mail or telephone.

Substance Abuse and Mental Health Services Administration:
http://www.samhsa.gov/csat/csatp2.htm
The Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration works across the private and public treatment spectrum to expand the availability of effective treatment and recovery services for alcohol and drug problems. CSAT’s initiatives are based on research findings and the general consensus of experts in the addiction field that, for most individuals, treatment and recovery work best in a community-based, coordinated system of comprehensive services. CSAT supports the nation’s treatment effort to provide specific services, evaluate treatment effectiveness and utilize evaluation results to enhance treatment and recovery approaches.

Substance Abuse Treatment Facility Locator:
http://wwwdasis.samhsa.gov/ufds/welcome_m.htm
SAMHSA’s online version of the most recent National Directory of Drug Abuse and Alcoholism Treatment Programs lists federal, state, local and private facilities that provide drug abuse and alcoholism treatment services that meet your specifications.

Women for Sobriety:
http://www.womenforsobriety.org/
Women for Sobriety is a nonprofit organization in Quakertown, Pa. dedicated to helping women overcome alcoholism and other addictions. The "New Life" program, based on a philosophy of positivity that encourages emotional and spiritual growth, helps women to overcome their alcoholism and learn an entirely new lifestyle to sustain ongoing recovery.

Other Hotlines:
Alcohol Treatment Referral Hotline: 1-800-ALCOHOL
Center for Substance Abuse Treatment Referral Service: 1-800-662-HELP
1-800-662-9832 (Español)
1-800-228-0427 (TDD)
National Council on Alcoholism and Drug Dependence: 1-800-622-2255
Secular Organizations for Sobriety: 310-821-8430

Meditation Good for the Heart as Well as for the Mind
Tinker Ready, CNN News- 6/7/2000

Now that he's hit middle age, Lawson English is entering the heart-disease zone. Because he's overweight and only moderately active, the Tucson, Arizona, computer programmer is a prime candidate for problems. Factor in his family history of heart disease, and his odds of developing ticker trouble climb even higher. But English says that, at the age of 44, his cholesterol levels, blood pressure and heart rate are perfectly normal. "My blood pressure and heart rate are so low that my doctor doesn't even bother to admonish me to lose weight," he says. He may just be lucky of course, but English attributes his good heart health to his long-time devotion to transcendental meditation (TM), a practice popularized in the 1970s by the Maharishi Mahesh Yogi and the Beatles. Twice a day, TM devotees like English find a quiet place, sit comfortably and focus their minds on a single word, or mantra. For 15 to 45 minutes, they enter a state of conscious relaxation often described as "restful alertness."

Matters of the Heart
When English took up the practice in the 1970s, he had no idea that it might stave off heart disease. Neither did anyone else. But over the past few years, impressive evidence that TM can reduce heart disease risk factors has been published in mainstream medical journals. The latest finding, published in the March 3, 2000 issue of the American Heart Association's journal Stroke, found that African-Americans who practiced TM two times per day for seven months reduced the amount of fatty deposits in their arteries, as measured by ultrasound. The study was the first to look specifically at TM and atherosclerosis, or hardening of the arteries. What's more, previous studies have shown that TM can lower blood pressure, another major risk factor for heart disease. In 1995, for instance, the same group of researchers published a study in the journal Hypertension reporting that middle-aged and elderly African-Americans using transcendental meditation lowered their blood pressure more than those who adopted tried-and-true lifestyle changes such as diet and exercise programs. (These studies, which the authors describe as preliminary, focused on African-Americans because of their high risk for hypertension.) In other articles published around that time, researchers reported that people practicing TM had lower blood levels of stress-related biochemicals, including serotonin and adrenaline, and were much less likely to be hospitalized for heart problems. Although the hypertension studies did not look at exactly how TM improves cardiac health, one of the lead investigators has a theory. Dr. Robert Schneider of the College of Maharishi Vedic Medicine in Fairfield, Iowa, says that TM "may trigger self-repair mechanisms in the body."

'Medicate and Meditate'
The fact that this research was conducted by researchers at the Maharishi College might be expected to raise eyebrows in the mainstream scientific community. But the studies, says Dr. Richard Stein, American Heart Association spokesman and cardiologist, "seem to be done honorably." In fact, when Schneider's study came out, the AHA distributed a press release recommending that "People with high blood pressure may want to medicate and meditate." And Stein adds that people whose blood pressure is just beginning to rise into the danger zone might be able to avoid going on medication by practicing TM. That's good news for people who can't tolerate side effects, like drowsiness, that come with some high blood pressure medication. "There is no downside to relaxation techniques," Stein says.
    Until recently, anyone who wanted to try an alternative approach to health care had to rely on folk wisdom and anecdotal evidence. University of Michigan cardiac surgeon Dr. Steven Bolling, who is conducting a study of "qigong," a Chinese "energy healing" technique, thinks doctors will be more comfortable trying these approaches now that researchers are beginning to publish the results of well-designed clinical trials in prestigious journals.
    Grant-makers at the National Institutes of Health (NIH) think the TM findings are intriguing enough to merit further attention. In September 1999, the NIH's National Center for Complimentary and Alternative Medicine gave the Maharishi center a $7.5 million grant to study cardiovascular disease and African-Americans. New studies will examine just what TM does to the circulatory system that decreases atherosclerosis. Schneider thinks that meditation and some other forms of alternative medicine will eventually become a routine option for patients trying to dodge heart disease. Meditation's New Age patina shouldn't scare off people who might want to try it, Schneider says. The practice requires no adherence to any religious philosophy and can be performed without spending hours in the lotus position. "We found that TM is easy to learn," he says. "It's 15 or 20 minutes twice a day."  As for Lawson, the latest findings are simply one more reason to continue the practice that has been a part of his everyday life for the past 25 years. "I didn't learn TM for my heart," he says. "But I think it has made a difference."