Noteworthy News Articles on Mental Health Topics, June 8-17, 2000

Child's Death During Treatment Casts Doubt on New Age Therapy
Judith Graham, Chicago Tribune- 6/8/2000

DENVER -- "I'm going to die!" the 10-year-old girl cried as she struggled for breath in the blue flannel blanket wrapping her from head to toe. Four adults surrounded her, pushing pillows down on the blanket. "You want to die? Go ahead, die right now," two therapists told her, according to a videotape of the "rebirthing" session viewed by police investigators. This kind of talk was common, the therapists later said, during the painful process of re-enacting birth, a New Age therapy used to help a child form new emotional bonds with parents. At the end of the 70-minute session, the therapists opened the blanket to find Candace Newmaker unconscious, lying in vomit. A day later, on April 19, the girl died at Children's Hospital in Denver. The 4th grader was subjected to this treatment because of her failure to attach emotionally to her adoptive mother, Jeane Newmaker, a pediatric nurse practitioner at Duke University.
    The case has thrown a spotlight on "attachment therapy," a controversial set of practices that gained in popularity across the country as desperate parents--particularly those with adopted children--search for ways to help children connect with their families and stop acting out their rage, despair and hopelessness. Evergreen, Colo., where Jeane Newmaker went for help and where she now faces felony charges of criminal negligent child abuse resulting in death, is a mecca for attachment therapy. Hundreds of youths have received this form of therapy there during the past three decades. About 40 attachment centers are scattered across the United States, with almost 500 practitioners, more than double the number only five years ago, according to Kathleen Moss, executive director of the Association for Treatment and Training in the Attachment of Children, based in Virginia. Connell Watkins, who supervised the rebirthing session at her home office in Evergreen--a town in the foothills of the Rocky Mountains, 30 miles outside Denver--is a national leader of the attachment therapy movement. She drew referrals from across the country and was known for treating disturbed children after other practitioners gave up on them. Colleagues refer to Watkins as an outstanding therapist, and several former patients have rallied to her defense in the past few weeks by setting up a legal defense fund. Watkins faces felony charges of child abuse resulting in death, as do her three co-workers, Brita St. Clair, Jack McDaniel and Julie Ponder. It's extremely rare for any kind of therapy--even those on the extreme fringe, like rebirthing--to kill a patient. This is the first time it has happened in Colorado, a hotbed of alternative therapies. But Candace's death raises many questions beyond the obvious "How could such a thing happen?"
    Is there good evidence that attachment therapies work? Are diagnoses being made properly? Are practitioners adequately trained? Are vulnerable children being exposed to coercive techniques that, in some cases, aggravate their problems? Are families at their wits' end over how to deal with severely troubled kids being exploited?  Controversy swirls on all sides of these issues. Only on a few notions is there widespread agreement among mental health experts. One is that emotional attachment is essential, providing a "secure base" from which children can grow into caring, competent adults. The intellectual father of attachment theory, British psychiatrist Dr. John Bowlby, is credited with demonstrating its importance through careful observations of infants and their mothers during the 1950s and 1960s. Another point of agreement is that children unable to form attachments--a psychological problem known as reactive attachment disorder--are severely troubled. Many appear to be without any conscience. Some are so withdrawn they are impossible to reach; others are insensitive to social boundaries, according to the official definition of the disorder.
    Virtually all of these children have been neglected, abused or mistreated in orphanages or other institutions, said Dr. Charles Zeanah, director of child psychiatry at Tulane University School of Medicine. Zeanah believes attachment disorder is being diagnosed wrongly to include children who are extremely aggressive, difficult to control and prone to lying, cheating, stealing and manipulating others. Growing numbers of attachment therapists are "defining all kinds of problems relating to relationships as attachment disorders and developing their own treatments," Zeanah said. "The problem is that there's not a shred of evidence showing that these things are effective." Often, families turn to these therapists--who are trained by like-minded colleagues, not by clinical programs in university settings--after trying many kinds of therapies and seeing them fail. Admittedly, Zeanah said, the children involved are extraordinarily difficult to treat, and "there is no single agreed-upon approach." Furthermore, most traditional treatments have dismal success rates with children who have severe behavior problems.
    Gail Trenberth of Boulder, Colo., co-founder of the Attachment Disorder Network, knows the despair that drives parents to seek their services. Her daughter, Angie, was covered with cigarette burns when Trenberth took her into her home at 8 months. As a toddler, she seldom slept and tried to torture animals. She was thrown out of kindergarten for misbehavior. By age 7, she had been through every therapy Trenberth could think of, all to no avail.  Then Trenberth heard about Watkins, then a top clinician at the Attachment Center at Evergreen, founded in 1972, the first such center in the country. Angie's two-year treatment began with "holding therapy." At the time, the technique involved placing a child across the therapist's lap and holding both arms securely while the therapist challenges the immobile child to bring suppressed emotions such as rage to the surface. At some point, children begin to cry, Trenberth said, as "they go back to where the pain began" and the therapists "nurture" them with gentle touch and words of reassurance. In 1995, the founder of the Evergreen clinic and a guru of the attachment disorder movement, child psychiatrist Foster Cline, was sanctioned by the Colorado State Board of Medical Examiners for practices similar to those described by Trenberth, after a youth claimed he was abused at the center. Yet "holding therapy" remains a staple of treatment by so-called attachment therapists, who claim they have revised the process to be less confrontational.  "Virtually everyone I know does holding therapy," said Trenberth. "It helped save my daughter's life."
    But Dr. Alan Sroufe, a researcher in attachment issues and William Harris professor of child psychiatry at the University of Minnesota, has serious doubts. "Attachment therapy is about building a relationship with a child in which he can feel comfortable and secure, safe to express any feelings they might have. I don't know how holding a child down while he struggles mightily before capitulating to adult authority serves that end." Nor does Sroufe understand how attachment therapists can claim their standard two-week therapy--which typically costs $7,000 and includes treatments such as "inner child work," psychodrama, corrective parenting (parents are involved too), eye movement therapy and cognitive restructuring--makes a significant difference. "There are no quick fixes" to attachment problems, he said.
    Forrest Lien, clinical director of the Attachment Center at Evergreen, says these therapies are well-established but distances himself from the rebirthing therapy used by Watkins, his one-time colleague. In the therapy, being wrapped in blankets is supposed to simulate being in the birth canal, and the pressure from the pillows the contractions before childbirth. "I never even heard of it until this happened," he said, while reluctantly acknowledging that its emphasis on regressing to the past to release pent-up emotions bears some superficial resemblance to holding therapy. Asked for research that supports his claims of effectiveness, Lien refers to the center's Web site, which cites three studies. None was published in peer-reviewed journals. The majority of the Evergreen center's patients, 70 percent, get the two-week model of therapy. Ninety percent are either adopted children or foster children, and their therapy is paid for by public child welfare or social services programs. California, Virginia, Minnesota and Florida, among other states, send children to the program. About half are orphans from Romania, Russia or other parts of Eastern Europe, where conditions of neglect in orphanages have been well-documented.
    Within the past several weeks, the Colorado Department of Human Services has warned child-placement agencies such as the Evergreen center that they will face child-abuse charges if they restrain children significantly in the course of therapy. But the problem is that "no one really knows what goes on behind closed doors," said Amos Martinez, program administrator for Colorado's Mental Health Licensing Section. "These people create therapies that make sense to them but aren't scientifically proven in any way. And no one really knows what happens."

Prozac Data Was Kept From Trial, Suit Says
Mitchell Zuckoff, Boston Globe- 6/8/2000

Opening a new front in the battle over Prozac and suicide, the children of a man who killed his wife then himself while taking the drug are accusing Eli Lilly and Co. of fraud for allegedly concealing damaging details about its blockbuster antidepressant. In a federal lawsuit filed yesterday in Hawaii, the family of William Forsyth says that Lilly ''committed a fraud on the court'' by failing to tell the family's lawyers about a patent that claims a new version of the drug eliminates side effects of the existing Prozac, including violent and suicidal thoughts among a small percentage of users. Despite consistently denying any link between Prozac and suicide, Lilly has purchased an exclusive license to market the new drug from a Massachusetts company that owns the patent.
    The suit says Lilly actively concealed the potentially explosive patent language during a trial last year over Prozac's alleged role in the couple's deaths. The trial ended with a verdict in Lilly's favor; the family has appealed. "Lilly wanted a verdict that it could herald in the marketplace as being the definitive vindication of their claims, and they were willing to get it by withholding important information from the judge and jury,'' said Houston lawyer Andy Vickery, who represents the dead couple's adult children. Vickery said he decided to file the lawsuit after reading a May 7 report in the Globe in which the patent language for the new drug was publicly disclosed for the first time.   A spokesman for Lilly declined comment on the suit yesterday, saying the company had not seen it.
    Whatever the outcome, the lawsuit seems certain to fuel the longstanding dispute over the Indianapolis drug company's efforts to blunt criticism of the popular antidepressant, a green-and-white capsule that has earned the company billions of dollars and become a totem of modern life. ''To me the new patent can be compared to the tobacco papers. It's a pharmaceutical company document that acknowledges this dangerous side effect which has been downplayed by Eli Lilly and other pharmaceutical companies for a decade,'' said Dr. Joseph Glenmullen, a Cambridge psychiatrist whose new book, ''Prozac Backlash,'' has helped to trigger the renewed controversy.  Lilly has built its defense of Prozac on a 1991 finding by the federal Food and Drug Administration that there is no credible evidence linking Prozac to suicide. Glenmullen and others have challenged that finding, alleging it was based on flawed clinical testing and marred by alleged conflicts of interest held by several members of the FDA's panel of outside experts.
    Though sales have slipped somewhat in recent years as other antidepressants entered the market, more than 35 million people worldwide have taken Prozac, and Lilly derived more than 25 percent of its $10 billion in revenues last year from the drug. The lawsuit also focuses attention on the new drug, which Lilly hopes will extend its antidepressant franchise after the last Prozac patents expire in 2004. The key patent for the new drug was obtained in 1998 by two officials at Sepracor Inc., a Marlborough-based drug company, along with Dr. Martin H. Teicher, an associate professor of psychiatry at Harvard who works at McLean Hospital in Belmont. The patent brought Teicher full circle in the Prozac debate: He had ignited the decade-long controversy with a 1990 paper about sudden, self-destructive tendencies among patients who had recently begun taking Prozac.
    The patent describes an antidepressant derived from Prozac that, the inventors assert, is formulated in such a way as to decrease the current drug's adverse effects, ranging from headaches and nervousness to ''intense violent suicidal thoughts and self-mutiliation.'' That assertion is based on Teicher's paper. Although that patent language directly contradicts Lilly's longtime position on Prozac, the Indianapolis-based drug company clearly saw great value in the drug described in the patent. In December 1998, Lilly paid Sepracor $20 million for exclusive rights to the patent, a portion of which went to Teicher and McLean. Lilly also promised the inventors $70 million in milestone payments depending on the new drug's progress through ongoing clinical trials, and a percentage of sales if the drug is approved and sold.
    Three months after that deal was struck, in March 1999, a federal jury in Honolulu began hearing a civil lawsuit Vickery filed on behalf of the two adult children of William and June Forsyth. A wealthy couple, married for 37 years, the Forsyths had been going through a rough patch in their marriage in late 1992 and early 1993. William Forsyth, 63, began suffering panic attacks, and in February 1993 his doctor prescribed Prozac. After feeling wonderful the first day, Forsyth underwent a change for the worse and admitted himself to a psychiatric hospital. After a week, while continuing to take Prozac, he checked himself out. On March 3, 1993, 11 days after he began taking Prozac, Forsyth fatally stabbed his wife multiple times with a serrated kitchen knife then impaled himself on the blade. Their children blamed the drug for what they said were their father's completely uncharacteristic acts.
    Of some 200 lawsuits filed against Lilly asserting that the use of Prozac led to suicide or violence, the Forsyth case was only the second to yield a verdict. Lilly settled many of the others, and the only other one to reach a jury, in 1994, was widely reported to have been a victory for the company. In fact, it was settled in a secret agreement between Lilly and the plaintiffs. Lilly obtained its long-sought courtroom victory in the Forsyth case when the jury said the drug could not be held responsible for the murder-suicide. In the suit filed yesterday, however, the Forsyths' children say the victory for Lilly was tainted by the failure to disclose its link to the new Prozac patent and should be set aside for a new trial.
    A key element of Lilly's defense was its assertion that if Forsyth suffered from the severe form of agitation his children said led to the deaths, he would have experienced inner and outer restlessness. No one at the psychiatric hospital noticed restlessness in Forsyth before his release, and Lilly's lawyers and expert witnesses used that to rebut his children's case. In the patent, however, the side effect is described purely as inner restlessness, a condition known as akathisia. Vickery said that difference is crucial because, if the patent had been disclosed at the trial, it would have been a powerful answer to Lilly's argument that outer restlessness characterized by relentless fidgeting was required as evidence of the side effect. It also might have challenged Lilly's overall assertions about suicide, he said. For instance, a top Lilly scientist, Dr. Gary Tollefson, testified during the trial that it was his opinion ''that there is absolutely no medically sound evidence of an association between any antidepressant medicine, including Prozac, and the induction of suicidal ideation or violence.''
    The new patent's language, and Lilly's purchase of exclusive rights to it, might have convinced the jury otherwise, Vickery said. Vickery is basing the suit partly on a 1995 ruling by the US Court of Appeals for the 9th Circuit, which includes Hawaii. That case, Pumphrey v. K.W. Thompson Tool Co. of New Hampshire, involved the death of a man who dropped a handgun manufactured by Thompson. The gun fired, sending a bullet through his heart.
    The court found that Thompson committed a fraud upon the court by failing to disclose that it had produced a video that showed the same type of gun fired accidentally when dropped. The court said the existence of the video should have been revealed by a Thompson lawyer who knew about it and attended the trial. Vickery contends that Lilly acted similarly to Thompson because a patent lawyer for the drugmaker attended the Forsyth trial but never disclosed the language on suicide in the patent that Lilly licensed from Sepracor.

Psychiatrist Suspended on Cyberstalking Charge
Raja Mishra, Boston Globe- 6/8/2000

Moving with unusual speed, the state Board of Registration in Medicine yesterday suspended a Children's Hospital psychiatrist for allegedly cyberstalking a 13-year-old girl he counseled after her recent suicide attempt, and hours later police arrested him on charges of sexually accosting another young female patient in 1999. The board acted within a day of receiving a complaint from the 13-year-old's family, calling Dr. Param Shukla, 34, of Brookline, ''an immediate and serious threat'' to the public. As his shift counseling troubled teenagers ended yesterday evening, Shukla peacefully surrendered to police outside Children's Hospital. The hospital immediately relieved him of all duties. Shukla is charged with two counts of indecent assault and battery on a child under 14, stemming from a 1999 accusation of inappropriately touching a young female patient. No charges have yet been filed related to the cyberstalking allegations.
    Children's Hospital had forced Shukla to relinquish his patients last year when the assault allegations first surfaced. However, he regained the privilege by lying on his medical license reapplication form, according to court documents. At the time, police were unable to gather enough evidence to build a case. Yesterday's new allegations of cyberstalking provided fresh reason to suspect him of the 1999 assault, said police. A bail hearing was scheduled for yesterday evening but was delayed because Roxbury District Court was backed up with numerous other arrests. Shukla is scheduled to be arraigned there this morning. The case is being investigated by the Suffolk district attorney's office, which declined to comment.
    The board of medicine has been long accused of lax enforcement, but yesterday its chief stressed that Shukla presented an unusual threat that demanded quick action. ''The board became aware of this situation after notification [Tuesday] from a local police department. We then conducted an immediate, intensive investigation,'' said Dr. Mary Anna Sullivan, the board chairwoman. Shukla will be able to contest his suspension at a hearing before the board.  Yesterday his wife, Rupal, 32, who is four months pregnant, said she was only vaguely aware that he had been in trouble before. ''I think last January a patient claimed something,'' she said, adding that her husband was a ''good man'' who rarely used his home computer. Shukla was unavailable for comment. Children's Hospital released a statement saying, ''Dr. Shukla's alleged behavior is wholly unacceptable.'' It was unclear who would treat Shukla's patients in the short-term, said a hospital spokesman.
    Medical board filings in the cyberstalking case painted a picture of a vulnerable girl who nonetheless knew enough to recognize when the man she confided in while hospitalized allegedly crossed the doctor-patient line. They also indicate that the girl appears traumatized by the incident and unable to relate the full story. She was sent to Children's Hospital in March after attempting suicide. She was depressed because her mother had cancer and was close to death, the records filed in court yesterday said. Children's Hospital cared for her for five days, much of the time spent in counseling with Shukla. The two occasionally left the psychiatric ward to go on walks. During these walks, Shukla asked her if ''she liked older men,'' according to court papers. He also allegedly made her promise not to reveal their conversations - sealing the deal by shaking pinkies. After five days, she was discharged from the hospital. On or about May 30, Shukla allegedly called her at home to ask her for her e-mail address. He allegedly sent her three e-mails. The contents of those was not disclosed yesterday. The two began engaging in realtime cyberchats, where messages are instantly sent back and forth, authorities said. During these electronic encounters, Shukla allegedly wrote ''seductive'' messages. He remarked on her good looks and begged to be her boyfriend, authorities said. The girl became concerned and electronically forwarded the conversation to two of her friends, with the comment, ''This is scary.'' One friend showed it to her mother. That mother called the 13-year-old, told her to get off-line, then informed her father. The father contacted Boston police. However, when the police began investigating on Tuesday, the girl refused to divulge more details about her relationship with Shukla, becoming ''anxious and concerned'' when asked about it, records said.  On Tuesday, police officials contacted the board of medicine, which oversees doctor conduct and licensing.
    From Feb. 8 to June 5, 1999, Shukla was under investigation by Children's Hospital, the medical board, and police for allegations that he ''engaged in misconduct in the care of an adolescent,'' according to court papers. He was limited to seminars and academic work. Police were unable to gather enough evidence to charge him. However, almost immediately Shukla reapplied for his medical license, which would enable him to see patients again. On the form, however, he allegedly lied, claiming he had never been investigated or the target of any other disciplinary action. The board of medicine yesterday also charged him with fraud on that allegation. Shukla is a 1990 graduate of B.J. Medical College in India. He started his adolescent and child psychiatry residency at Children's Hospital on July 1, 1998. He arrived from India earlier that year to escape that country's extremely tight medical job market, said his wife.

Teens Urged to Face Depression
Karen S. Peterson, USA Today- 6/8/2000

WASHINGTON - Tipper Gore says that when she tours the country to discuss mental health issues, she is startled by the number of young people who tell her they have considered suicide. She will ask the question in a given middle school, and "the number of hands that go up cause the teachers to gasp," Gore says. And many, she says, are reluctant to seek help because of the stigma that is attached to mental illness. That awareness prompted her to announce a campaign Wednesday aimed specifically at the nation's young, called Change Your Mind About Mental Health. It is an offshoot of the National Mental Health Awareness Campaign (NMHAC), organized by the White House. While Gore now takes on the duties of a campaign wife for her husband, Vice President Gore, she also is listed as a mental health adviser to President Clinton.
    The core of the NMHAC initiative features public service announcements created by MTV. The NMHAC also is partnering with organizations including the Ad Council and the American Psychological Association, which offers teens an informational brochure. The fast-paced spots direct young viewers to a Web site, nostigma.org, to get help. A toll-free number, 877-495-0009, is scheduled to open today. This campaign is aimed at youth, Gore says, because "one in five kids need help, and two-thirds won't get it." Suicide is the third-leading cause of death among those ages 15 to 24 and is second among the college-age population. Other experts estimate that 6 million young adults struggle with serious mental disorders.
    Gore was widely praised by mental health professionals last year when she discussed her 1989 battle with depression after a car accident that almost killed her then-6-year-old son, Albert Gore III. In her 1996 book, Picture This: A Visual Diary, she talks about her mother's bouts with depression. Some experts cite a genetic link as one of many causes of depression. In an interview before her announcement, Gore didn't indicate that she was concerned specifically for her own four children, but "for America's children." Parents need to be aware of warning signs in the family, just as they would be for a disease like breast cancer, she says. She continues to receive positive feedback about her revelations, she says, and continues to emphasize that mental illness is diagnosable and treatable. "You'd take a child with a broken leg to the doctor," or one with diabetes in for treatment, she says. Parents and teens both need to understand "there is help." Children don't get help, mostly because of fear and shame, Gore says. "Too many suffer in silence." Many end up in jail or on the streets.
    The ads will run on MTV, MTV2, VH1 and Nickelodeon. They're expected to reach an audience of 75 million, 60% of whom are 19 or younger. Later this year, a similar public awareness initiative aimed at parents and adults will be announced, says National Mental Health Awareness Campaign executive director Alfonso Guida. The ads feature brief portraits of young people making comments including "Nobody tells you to snap out of pneumonia!" and "It's easy to pretend you're OK." One youth says, "You just want to stop and get off the ride," and another explains, "It's not your fault."

The Other Freud
Robert S. Boynton, New York Times- 6/10/2000

Sigmund Freud's theory of psychoanalysis has been challenged and revised from the moment it was conceived. Now Freud's very words (at least as they have been rendered in English) are being revised in several new translations that will appear in the next few years. Like all things psychoanalytic, the Freud dispute--over copyright law, the fine points of translation and the meaning of Freud's work itself--admits of several conflicting interpretations. What is not in dispute, however, is that at the end of next year Penguin Books will begin releasing the first parts of a newly translated 16-volume edition of Freud's works. And in 2002, the Hogarth Press will publish a revised version of the 24-volume Standard Edition of Freud, translated by James Strachey and published between 1955 and 1967.
    With the copyright to the original translation expiring, Penguin Books sensed an opportunity for a more modern edition emphasizing Freud the humanist rather than Freud the clinician and scientist (the perspective that Strachey's translation favored). The tasks of editing the Penguin project fell to Adam Phillips, the writer and psychoanalyst. The author of a series of slender philosophical investigations into the vagaries of the human condition ("On Kissing, Tickling and Being Bored," "The Beast in the Nursery," "Terrors and Experts," "On Flirtation," "Monogamy," "Darwin's Worms"), Mr. Phillips is a significant literary presence in Britain. He is a regular contributor to the London Review of Books and has been described by the Times of London as "the Martin Amis of British psychoanalysis," for his "brilliantly amusing and often profoundly unsettling" work.
    But in many respects, Mr. Phillips is an unlikely candidate to edit a major new edition of Freud. A self-described "expert in the truth of uncertainty," he writes enigmatic essays replete with quietly subversive aphorisms "the psychoanalyst sustains his competence by resisting his own authority"; he learns "how not to know what he is doing and how to go on doing it") that have led some to label him the "anti-Freudian Freudian." Gazing down at St. Patrick's Cathedral from a 44th floor hotel room during a recent trip to New York, Mr. Phillips, 45, has the sad eyes and shaggy rock-star mane that make him resemble a poet more than a revolutionary. He says his misgivings about psychoanalysis are directed less at Freud than at those who have reduced his creation to a "science of sensible passions," a therapeutic form of conformism. "Psychoanalysis has become a very dreary profession indeed," he says. "It is terribly Puritanical, moralistic and coercive. The institutionalization of analysis has killed its wilder spirit. The craving for academic respectability has made analysts want to be recognized either as real scientists or real artists. They aren't comfortable sustaining the ambiguity that comes with being neither."
    An entirely different atmosphere surrounded the original, authorized translation. Advised by Anna Freud and a committee of her father's colleagues, Strachey had no doubts that psychoanalysis was a thoroughly scientific undertaking. Although his translation has been consistently praised for its magisterial Victorian prose, Strachey has been criticized for concocting an awkward vocabulary (the Greek cathexis and parapraxis, for example, or the Latin ego and id for Freud's unpretentious das Ich and das Es). Strachey is also said to have medicalized psychoanalysis by imposing a spurious scientific consistency on Freud's sprawling works. "What made the Strachy translation totally acceptable in the English-speaking world for over two decades is precisely what makes it problematic today," wrote Sander Gilman in a 1991 article in the International Review of Psychoanalysis. In contrast, Mr. Phillips says he intends to present a Freud for our times, "a secular, literary Freud who is seen to be like every other writer: endlessly re-describable and re-translatable." To this end, the Penguin Freud will be part of the Modern Masters series, which includes such writers as Joyce and Proust. To underscore the project's iconoclasm, Mr. Phillips has organized the books thematically rather than chronologically, and hired a group of literary translators, none of whom has a connection to psychoanalysis or are expected to use a uniform set of psychoanalytic terms.
    Rather than impose his editorial voice on the entire project, Mr. Phillips is writing the introduction for only one volume (on "Wild Analysis") and commissioning prefaces for the others from a distinguished group of academics, none of whom has a clinical psychoanalytic background. For example, Mark Edmundson, a professor of English at the University of Virginia, is introducing the "Repetition" volume (which includes "Beyond the Pleasure Principle," "Inhibition, Symptom and Anxiety" and "On Narcissism") with an essay on Freud and Shakespeare. "I think a literary translation will capture some of what has been lost in Freud: an unconscious and conscious ambiguity in the writing, and an interest in sentences, in the fact that language is evocative as well as informative," Mr. Phillips observes. His approach to the new Freud is consistent with his ideas about psychoanalysis, which he considers a genre of literature, a form of persuasion closer to poetry than medicine. Mr. Phillips's essays are ruminations on a variety of themes--the contingency of life, the impossibility of self-knowledge, the incompleteness of language, the power and limits of psychoanalysis; he cites "authorities" like Henry James and Ludwig Wittgenstein as often as he does Freud.
    Psychoanalytic theory, writes Mr. Phillips, is simply "a set of stories about how we can nourish ourselves to keep faith with our belief in nourishment, our desire for desire." And he believes that psychoanalysis has put too high a premium on self-knowledge itself. "The aim of psychoanalysis isn't so much to 'cure' people of their conflicts," he says, "but to help them find ways of living them more keenly. Psychoanalysis should re-ignite people's interest in the world outside of themselves and help them become more self-forgetful. Sometimes introspection is symptomatic of a problem. More information about yourself doesn't necessarily make a lot of difference, and very often it is merely a way to keep from experiencing the full range of one's emotional life."
    Mr. Phillips studied literature at Oxford and had never met an analyst before he read Jung's autobiography and was inspired to become one. He went into training soon after leaving Oxford and qualified to practice when he was 27. A child psychologist for 20 years (and the principal child psychotherapist at Charing Cross Hospital in London for eight of those), he didn't begin writing until he was 34 and published a book on the British child psychoanalyst, D.W. Winnicot. Children have always been Mr. Phillips's primary reference point, although he now divides his time between treating adults in his private Notting Hill practice and writing. Five years ago, he and his companion, the critic and Lacan translator Jacqueline Rose, adopted a Chinese orphan, Mia. "When I started as an analyst," he says, "I could listen to anything, no matter how awful. But once I had my own child, I just couldn't bear it." Despite his high profile in Britain, it is only recently that Mr. Phillips has begun receiving a similar level of acclaim in the United States. Reviewing his most recent book, "Darwin's Worms," in the Los Angeles Times, the historian Michael Roth calls him "one of the most original inheritors of Freud's legacy." Dr. Robert Coles of Harvard believes he is "one of the leading psychoanalytic thinkers in the English-speaking world," and suggests that the growth of his intellectual reputation may have been inhibited by his graceful literary style. "We're so accustomed to the heavy jargon of psychoanalytic journals," said Dr. Coles, "that we sometimes don't know what to think when confronted with such elegant and evocative writing."
    Not everyone is pleased with the prospect of Mr. Phillips's new edition of Freud. "It is a sore point and not a happy situation," says Mark Patterson, the head of the Sigmund Freud Copyright in London. The dispute over the copyright was the result of ambiguity in the European Union's copyright laws and a loophole that has opened the way for a number of new Freud translations. Whereas it had once been assumed that there would be a single English version until 2009, it now seems that others will appear. This year, Oxford University Press published a new translation of the first edition of "The Interpretation of Dream." Dr. Mark Solms and the Institute for Psychoanalysis in London have spent more than a decade revising the Strachey translation. A painstakingly scholarly project, the new Standard Edition will be heavily annotated, correcting both Strachey's mistakes and other textual errors. It will have an enormous glossary of terms, a new index, updated bibliography and essays on the translation itself. The new edition will also include four volumes of Freud's complete neuroscientific writings, and 40 unpublished Freud papers, many of which were discovered after the last one appeared.
    The economic stakes are huge. According to Mr. Patterson, the Freud estate still generates millions of dollars a year for Freud's heirs. The new edition will have a first printing of 10,000 sets, each of which will sell for just over $1,000. It is projected that the updated Strachey edition will sell 600 sets a year after that. There will also be a CD-ROM and online version. The United States edition will be published by W.W. Norton. Dr. Solms had decided in most cases to retain Strachey's vocabulary (one difference being the word "Trieb," which Strachey translated as "instinct" and Dr. Solms decided to translate as "drive") because it has become so familiar. "This is the language that we know and use, warts and all," he says. Given this approach, he is particularly dismayed that the Penguin Freud won't be internally consistent. "I don't see the advantage of having a hodge-podge of terns" he says. "If all academics start using different Freud translations, it will be a Tower of Babel. And our field is in enough of a mess to begin with."
    Mr. Phillips sighs and rolls his eyes when asked about the Standard Edition's feat of scholarship. "It is the most pointless task I can imagine," he says. "The fantasy of scholarly consensus and rigor is a symptom of psychoanalysis's problem. I don't care whether psychoanalysis survives or not--it's not a religion which we need to sustain. Psychoanalysis will be around as long as it is useful, and then it will disappear, just as everything else disappears."

Heroin Resurges among Teenagers
Associated Press, 6/11/2000

BRIDGEPORT, Conn. Leigh was 16 the first time she stole a syringe from her grandfather, a doctor, to experiment with heroin. Lucinda was also 16, and read up on the dangers of the drug before trying it to feel ''normal'' and lose weight. They came from good families in the suburbs. There were no traumas in their lives, no abuse. Their friends didn't use heroin. Drug counselors say their stories are not unusual. Young people have reported using the drug to help focus on schoolwork or sports, or just because it was available at parties and clubs.
    The rise in heroin use among teen-agers has been blamed, in part, on the increased purity of the drug, which allows users to snort or smoke it, police and drug counselors say. The drug has become more socially acceptable and easier to use. ''The history of methadone programs was that you had to be 21 to get in, which wasn't a problem because clients, on average, were in their 30s,'' said John Hamilton of programs based in Stamford. ''But now we're getting a lot of 18- and 19-year-olds with three- or four-year histories of heroin use.'' Drug counselors say that alcohol, marijuana and amphetamines are still the drugs of choice among most preteens and teen-agers. But about 80,000 12- to 17-year-olds and 303,000 18- to 25-year-olds admitted using heroin in 1998, according to a survey by the U.S. Office of National Drug Policy. In 1990, the average age of someone trying heroin for the first time was 26.5 years old, according to the Drug Enforcement Administration. In 1999, the typical first-time user was 17.5 years old.
    Judging from the statistics, Lucinda and Leigh, whose names have been changed, closely fit the current profile of addicts. ''I was raised right, treated well,'' said Lucinda, now 19. ''I'm just like everyone else, except I got into heroin.'' And as long as she had the drug she could go to school, run errands and attend family functions.  Leigh, too, was raised in a good family, she said. No one noticed that she had drained several thousand dollars from her savings account to pay for the drugs. The account, along with a part-time job at a library, helped her spend several hundred dollars a week on heroin. Both women ended up at methadone treatment clinics, where addicts get a dose of the synthetic opiate to prevent withdrawals while being weaned from heroin. For Lucinda, it was a last resort after rehab, detox and Narcotics Anonymous meetings. Leigh needed treatment after checking into and getting kicked out of several rehab centers across the country. A common denominator that led the women to the drug was the desire to feel good. Leigh had suffered with depression as long as she could remember. Lucinda was an insomniac who had trouble concentrating.
    The desire to feel normal and the ability to do so with the help of heroin is often expressed by addicts, said Dr. Charles Morgan, a psychiatrist who works with drug addicts at Norwalk Hospital's substance abuse program.  ''But once they become physically dependent, it changes their focus then becomes getting the drug to avoid becoming sick,'' he said. Leigh is working full time at a job she's not happy with and living at home with a mother who doesn't know that she relapsed last year. She hopes to get a job as a graphic artist, a field in which she was working when heroin consumed her life. Lucinda isn't working now and isn't sure what she wants to do. For now, she and her counselor agreed, she has to direct all her attention to not using heroin. ''I have every intention of living a full, productive, normal lifestyle,'' she said. ''Before, I thought my destiny was to be on the streets forever. Now, I actually think I can be something."

Littleton Massacre May Have Influenced Oklahoma Shooter
The Associated Press- 6/12/2000

Muscogee, Okla.— A 13-year-old boy who opened fire on his school, wounding five classmates, was deeply influenced by the Columbine High School shootings, according to the boy’s case file and testimony at a court hearing. The boy also took numerous prescription medications, had been receiving psychological counseling and was obsessed by military tactics, according to records obtained by the Tulsa World. Authorities said at least 15 shots were fired during the Dec. 6 attack at Fort Gibson Middle School, hitting four students directly. A fifth student was hit by a ricochet bullet and another boy found a bullet embedded in a book inside his backpack. The shooter didn’t fit the anti-social mold of Eric Harris and Dylan Klebold, who killed 13 people and then themselves at Columbine High School in Littleton, Colo. But he was strongly influenced by media accounts of their April 20, 1999, rampage, said Dr. Shreekumar Vinekar, a psychiatrist who testified in the boy’s defense at a March 29 hearing. "He started wondering what he would do if he were placed in the role of the perpetrators that were previously depicted on TV and the media," Vinekar said.

Drugs May Have Been a Factor
The boy was taking the prescription drug Inderal for severe migraine headaches and had been referred to a psychologist for stress management and biofeedback training, the World reported. Inderal can cause depression, Vinekar said, although that was never diagnosed in the boy. And three weeks before the shooting, he was given a large injection of the prescription poison ivy drug Kenalog, said Dr. William Banner, a toxicologist and medical director of the Oklahoma Poison Center. Kenalog is a steroid alleged to have psychotic effects on some users, according to the three medical experts who testified at the hearing. "Even in routine doses, these drugs can produce a psychotic break," Banner said.

Testing Himself
Several psychologists who interviewed the boy said that what pushed him to act was his obsession with military tactics and his identification with World War II Gen. George Patton. Vinekar said the shooting may have been his way of testing himself under fire. "His fantasy was to see whether he would ... have the disposition of a general, where he would not become anxious in the field, where there is killing going on, and whether he could keep his anxiety under control," he said. One of the boy’s attorneys, Jim Wilcoxen, would not comment on the hearing transcript, but said the boy’s family feels compelled to lend credence to theories about the military obsessions and possible drug effects as reasons for the shooting. "That’s an area we want the experts to look at and get to the bottom of," Wilcoxen said. Following the March 29 hearing, Muskogee County Associate District Judge Tom Alford found the boy guilty of six counts of shooting with intent to kill and one count of having a weapon on school property, and recommended the teen receive clinical counseling at a state-run facility for juvenile offenders. That means he could be back in school in less than two years.

With Grim Frequency, High Schools Confront the Trauma of Teen Suicide
David Crary, Associated Press, 6/12/2000

Like many high school principals, Mike Warbel had a plan ready when the bad news came. It proved useful yet of scant consolation after two student sweethearts committed suicide. Grief counselors deployed at East Knox High School in Howard, Ohio; teachers read a message in their classrooms; students were encouraged to vent their emotions. In the days following last month's suicides, Warbel faced some tough decisions. Should the prom be canceled? Should he speak at memorial services? His choices the prom was held, he did give a memorial speech weren't based on any formal training. ''You have a sense of how to react to your kids,'' Warbel said. ''You can't be afraid of making a mistake.''
    A sadly high number of his peers confront similar dilemmas. About 2,000 American adolescents kill themselves each year. After accidents and homicides, suicide is the third-leading cause of death for teen-agers. According to federal estimates, one of every five high school students has thought seriously about attempting suicide, and one in 14 has made an actual attempt. Faced with this toll, school personnel are struggling to find effective ways to prevent suicide and cope with its aftermath. Many schools lack full-time staff trained to detect mental illness, and experts offer conflicting advice about suicide-prevention strategies. Post-suicide procedures also are a challenge; administrators try to accommodate grief without glamorizing a death in a way that might encourage copycats.  ''In our decision-making process, we were keeping two things in mind,'' Warbel said. ''We wouldn't do anything to tarnish the images of these two kids, or intensify the grief of their families.''
    East Knox High, like many schools, doesn't have a distinct suicide-prevention course; it addresses suicide in the broader context of mental health. Many experts counsel against overly specific courses, saying they could backfire among students already harboring suicidal thoughts. ''When you're talking to a big class and saying a lot of things about suicide, different people listen to different words,'' said Dr. David Shaffer, a Columbia University psychiatrist who heads the American Foundation for Suicide Prevention. ''In the disturbed kids, you probably reawaken bad thoughts and bad memories and set them off again,'' he said. ''We recommend teaching teen-agers about depression, how to recognize the symptoms, and give that lesson without mentioning suicide.''
    Other experts, while agreeing that caution is warranted, say teachers shouldn't shy from explicit mention of suicide.  ''Adolescents are smarter than we give them credit for. If you're dancing around something, they know it,'' said Lindy Garnette, director of child and family services for the National Mental Health Association. ''People don't commit suicide because somebody mentioned it. It can be a huge relief to hear the word, and be able to talk about it.'' Some critics say suicide should not be broached at all in school. The Eagle Forum, led by conservative activist Phyllis Schlafly, complains that ''death education'' pervades U.S. high schools and urges parental skepticism of suicide-awareness programs. But prevention advocates say such objections often fade when suicide strikes close to home. Programs that increase awareness of depression are widely supported; so are initiatives encouraging young people to advise an adult if a friend reveals suicidal thoughts.
    ''It's too often the case that students feel they can deal with this stuff themselves,'' said Dr. Alan Berman, executive director of the American Association of Suicidology. Screening for Mental Health, an organization in Wellesley, Mass., is recruiting 500 high schools nationwide for a program next fall aimed at identifying students prone to depression. Barbara Kopans, the group's vice president, outlined how students will complete a questionnaire anonymously and score themselves. The goal: Enabling students to recognize danger signs in themselves and their friends. ''We want to empower young people to take action,'' Kopans said.
    At East Knox High, a 560-student school in central Ohio, Warbel regretted that suicide victims Joseph Hall and Rachel Hanna didn't seek help. ''They had more lifelines than 95 percent of the kids in this country, and didn't use them,'' Warbel said. ''The most important message to our kids is don't be afraid to express yourself. If you think things are so dire that you might consider harming yourself, get up on my desk or your teacher's desk and stomp your feet until someone hears you.'' If suicide prevention remains an uncertain science, so-called postvention handling a suicide's aftermath is even more improvisational. After learning that Hall and Hanna killed themselves by setting their car ablaze, Warbel decided against holding a school-wide assembly. He asked teachers to break the news in their classrooms. ''You have the kids in a familiar setting, and then if you drop a bomb in their laps it's a little easier for them to respond,'' Warbel said. ''You go through your daily routine... The bells still ring. But the students are free to go anytime to counselors, or just sit around in groups and talk.''
    Warbel initially felt anger toward Hall and Hanna, who were popular Honor Roll students and varsity athletes, because of the pain they caused their schoolmates. By the time he spoke at Hanna's memorial service, the anger eased. ''We all loved these two kids, we miss them tremendously,'' he said. ''That should never change, no matter what caused their death.'' Warbel, in his first year as a principal after 28 years as coach and assistant principal, was determined to restore some semblance of normality. ''We went ahead with the prom,'' he said. ''We encouraged our kids, told them they should come without remorse... They came early, stayed late. It might have helped in the healing process.''
    Berman, of the American Association of Suicidology, empathized with administrators facing such traumas.  ''It's a thin line to walk, to be sensitive and responsive to the need to mourn,'' he said. ''It needs to be done in a downplayed way.'' Mark Kuranz, president-elect of the American School Counselors Association, recalled using a crisis plan after a suicide at Case High School in Racine, Wis. A girl died in a car crash, he said, and was remembered with a memorial and a tree planting. Soon afterward, a student committed suicide, and the victim's friends wanted a comparable commemoration ''We struggled to communicate to the kids why that wasn't appropriate,'' Kuranz said. ''I felt fortunate to have a well thought-out plan.'' To reduce the risk of copycat suicides, experts recommend stressing that most suicides result from mental illness and inflict deep pain on families.  ''Someone may pick up on the notoriety, the attention resulting from a suicide, but they don't apprehend the downside. The headlines won't say how the family is devastated,'' said David Brent, professor of child psychiatry at the University of Pittsburgh School of Medicine.
    Yet sometimes conflict arises between a school and a grieving family. Mary Margaret Kerr, another University of Pittsburgh professor, recalled an incident where a bereaved father moved a memorial stone onto a campus against school board wishes. Another recurring dilemma is whether to award a posthumous diploma to seniors who commit suicide. ''I say, 'Be generous give the family the diploma,''' Kerr said. ''But every now and then, you hear: 'Why should we give it?''' As East Knox High's students dispersed for the summer, Warbel was unsure what legacy the suicides would leave. ''We're all trying to say it's over,'' he said. ''And I'm not sure that's the right answer either."

Obsessive Internet Use Poses Risk of Isolation, Depression, Researchers Say
Barbara Jamison, CNN- 6/13/2000

How long have you been sitting there, staring at this screen? Are you spending more and more of your time clicking and typing, typing and clicking? Is there nothing else you'd rather do? Think carefully about the answers to these questions, say psychologists; they may tell a lot about your mental health. A growing body of research suggests that excessive Internet use carries some of the same risks as gambling: It can lead to social isolation, depression and failure at work or school. Some people -- particularly those who were isolated to begin with -- have forged healthy friendships by meeting kindred souls online. But using the Internet too much can hurt face-to-face relationships. And psychologists say an increasing number of people are using the Internet so obsessively that they are ruining their marriages and careers.
    In one survey of 1,700 Internet users, presented August 24, 1999 at a meeting of the American Psychological Association, 6 percent of those surveyed met the criteria for addiction: They felt a building tension before the act, a rush of relief afterwards and distortions of mood and bingeing. Many get hooked on Internet pornography. "We're a nation of puritans," says Dr. Kimberly S. Young, the survey's author and executive director of the Center for On-Line Addiction in Pennsylvania. "And this is the first time in our history we've had something so uncensored in our homes. You can get to very objectionable material in a few keystrokes -- even by accident -- and then it's hard to get out of the site."
    Dan Moore (not his real name), a self-defined compulsive personality-type and workaholic from a Midwestern state, says the Internet destroyed his life. This middle-aged professional is currently going through divorce proceedings from his wife of nine years and has been denied visitation rights with his two children due to his addiction to sex sites. According to Dan, his wife claims that some of the "soft porn" sites he regularly logged on to used minors. "She became obsessed with the thought that I was getting involved in child pornography. She even accused me of molesting my children." Although Dan vehemently denies both charges, he admits that determining the age of women on the plethora of available pornography sites is virtually impossible. "It's like having access to a million adult videos, all for free. It's seductive. You get mesmerized." Dan, who has recently begun treatment with an Internet addiction specialist and is taking antidepressant medication, rid his home of both PC and modem. "When I finally realized how it has affected my life, I felt like smashing it, throwing it out the window. Now my compulsion is to try and understand what I've done to myself and my family."
    But it isn't only pornography that attracts addicts to the Internet, says Paul Gallant, a licensed addiction counselor at the Sierra Tucson Center for Addiction in Arizona. Some people are lured by the appeal of creating new identities for themselves. Other users make a habit of online gambling, auctions or stock trading. "Your life may be really boring in reality, but online you're a competitive superhero," Gallant says. Even innocent inquiries can become obsessions in a medium where information is limitless, he adds. "Say you're a wine connoisseur, you find this great site and it's linked to another great site. Fine, you've learned a lot more about wine. Then all of a sudden you realize six hours have gone by. You're obsessed with getting more and more information."
    Experts are still debating nearly every aspect of the Internet's effect on mental health. Advocates argue that the new medium's social benefits outweigh its risks. They point to studies like one in the February 2000 issue of the journal American Psychologist that found that many people draw comfort from anonymous discussions with others who share their medical conditions. But these studies are balanced by others that reveal a strong link between excessive Internet use and serious mental disorders. For a study in the March 2000 issue of the Journal of Affective Disorders, researchers interviewed 20 people like Moore whose lives had been disrupted by the Internet. Nearly all of them were diagnosed with serious mental illness, such as bipolar disorder. Many were sacrificing sleep to spend an average of 30 hours a week online outside work.
    But does the Internet cause the mental illness, or does mental illness lead people to abuse the Internet? Researchers tried to answer that question in a 1998 study by providing Internet access to 169 people who previously had not been able to log on from home. The researchers reported in American Psychologist that the more time these people spent online, the less time they spent with their families, the smaller their social circles became and the more depressed and lonely they felt. "Even for people who don't manifest addictive behavior, the Internet is almost an invitation to obsession," says Young. Many psychologists who accept that the Internet can be abused still hesitate to use the phrase "addiction." University of Florida psychiatrist Dr. Nathan Shapira, -- who co-authored the Journal of Affective Disorders study -- prefers "internetomania." But whatever you call it, he says, it's clear that the problem needs more attention. "It concerns me that we're bustling along blind. ... There is a tremendous amount of money going into the development of this technology and almost nothing going into understanding how it affects people. That may spell trouble ahead."

Mental Patients Cut Off, Study Says: Improper Treatment and Support Claimed
Wendy Wendland-Bowyer, Detroit Free Press- 6/14/2000

A new report paints a grim picture for Michigan residents with a serious mental illness, saying they are often hospitalized only for a few weeks and then unable to get into one of the few residential programs in the community. As a result, many who aren't being properly treated for their illness commit crimes and end up in jail. Some statewide research shows that as many as 34 percent of all county jail inmates are mentally ill. The report, to be released today, was organized by the Mental Health Association in Michigan more than two years ago to study what happened to the patients who once relied on the 10 state-run mental health hospitals that closed in the 1990s. The report does not advocate reopening the state mental health hospitals. Rather, it stresses that there are not enough hospital beds for people who need to stay 90 days or more, and not enough programs in the community to fill the void. It blames part of the problem on funding.
    In 1998, about 41 percent of the $1.5 billion spent on community mental health programs went toward adults and children with mental illnesses. That worked out to about $3,900 per adult, $2,600 per child. That's less than the cost of one year of some psychiatric medications. "I get very concerned that people are getting very little treatment and support other than medication," said Kathleen Gross, executive director of the Michigan Psychiatric Society, whose organization helped prepare the report. "We know that for people's lives to really improve, they need regular supports." But Geralyn Lasher, spokeswoman for the state Department of Community Health, said it is difficult to compare spending between people with a mental illness and people with a developmental disability, who consume most of the rest of the state mental health budget. Many disabled people have physical ailments that require costly medical treatment, she said. Lasher also said the state has a variety of community programs for people with a mental illness, and she downplayed that getting into them was a problem. "We feel there absolutely are long-term care options at the community level," she said.
    But many families disagree. Joanne Froh of Oakland Township said there were no programs that her brother, Jim Plagens, could immediately turn to when he was discharged from a Macomb County hospital after a month of treatment last year. Plagens, who was in and out of hospitals for years, had paranoid schizophrenia. He was sent to a hospital after setting his motel room on fire. The hospital released him and he was homeless, his sister said. He left with several medications that had to be taken at precise times, and he was told to come back in a week to discuss being admitted into a longer-term community program, Froh said.  But Plagens, 40, didn't make it that long. Within eight hours of being discharged from the hospital, Plagens wandered aimlessly onto 15 Mile Road near Van Dyke, was struck by a van and died. "It was so unconscionable to me to think they would release somebody who is severely mentally ill with five different prescription medications ...knowing full well this man can't even take a shower on his own, much less take these medications on a fixed schedule," Froh said. "It's like giving an Alzheimer's patient medication, sending him alone out the door and saying, 'Go take care of yourself and take your medicine as prescribed.' "  What Froh needed was a structured residential program, Froh said. Many in the state need such a service, said Mark Reinstein, public policy director of the Mental Health Association. "If we keep spending so little on mental illnesses, the problems are going to stay.... You get what you pay for," he said.

Drug Clinic Employees Quit, Fault Board's Hiring Practices
Tara Yaekel, Boston Globe- 6/16/2000

Their craving for heroin unraveled their lives, and at times left them living on the streets. But the nondescript red-brick building in Brighton offers them something they desperately need: stability and, more importantly, a chance to vanquish their addiction. But now many of the 300 clients of the Addiction Treatment Center of New England fear their struggle against drugs is imperiled. Employees have said a bitter feud between the methadone clinic's board of directors and employees over the board's hiring practices has triggered the resignations of 10 of the clinic's 22 workers - including the veteran therapists addicts say they've most relied on to help them stay off heroin.  Several clients have already slipped back into their drug-using ways because they've lost their support system, sources familiar with the clinic's situation said. ''I don't know what's happening there,'' said one client. ''I've come a long way, and I'd hate to go to another place.''
    The clinic's troubles began when the board hired two consultants for the clinic who have business contracts with the employers of four of the board's six members. Ex-employees claim this is a conflict of interest. ''They're draining money with these consultants,'' said Marty Paquette, the clinic's nursing director. She said she quit several weeks ago because of her frustration with new administrators. ''It's a disservice to clients. It's incredibly frustrating and sad.'' But the consultants adamantly deny that their hiring poses any conflict. ''This is positively ludicrous,'' said Paul McDevitt, one of the two new consultants, who is president of Modern Assistance Programs, a Quincy-based, for-profit managed-care firm that assists private employers with medical referrals, including substance abuse treatment. Former and current employees said the not-for-profit clinic has paid tens of thousands of dollars to the company. McDevitt said four of the board's six members work for unions or trade associations that have medical management contracts with his company. ''I know the people, but is that a conflict of interest?'' he asked. ''Who do you work with in your life? The people that you know.'' McDevitt's contract with the Addiction Treatment Center expired in March. The clinic's executive director, Paul Bonner, said a second administrator at Modern Assistance Programs, William Carlo, has been hired to work with board members on a plan to create a halfway house for addicted mothers and their children.
    The alleged conflict of interest is one reason some employees quit, they said. But many current and former staffers mentioned another dispute that further fueled tensions between longtime employees and new administrators: the board's March decision not to renew former executive director Richard Slein's contract because of an internal dispute. Employees have said Paquette's resignation, and the board's elimination of Shelley Slatus's position as clinical director, were the reasons why so many employees have resigned in the last few weeks. Bonner, however, said he is working aggressively to recruit new staff and boost employee morale. ''I'm so upset and traumatized, myself, by what's going on,'' said one former clinic worker who resigned last week. The clinic's trouble has drawn the attention of Massachusetts Department of Public Health officials, who say that in a worst-case scenario they would transfer clients to other methadone clinics. Current and former employees of the clinic have asked the state attorney general's office to investigate the board of directors for possible wrongdoing. A spokesman for the office refused comment.
    Despite the turmoil, those on both sides of the conflict say they have one interest at heart: the well-being of recovering addicts, many also battling emotional and/or psychological problems. ''The one thing that I would hope would come out of this is that, basically, all eyes and ears would be on the agency to ensure that clients' services were maintained,'' Paquette said. ''My biggest concern is the clients.'' But some of these clients say they feel confusion and despair at seeing workers they have come to trust leave a place many consider a second home. ''It's not like people are going to come picket to save a methadone clinic,'' said one client who asked not to be identified. ''I don't know what's going to happen."

Heroin Takes Deadly Toll in Maryland County
Annie Gowen, Washington Post- 6/17/2000

Today, Kristi Ziemski will not speak of the time between March 15 and April 9 of last year. The feelings she has--about killing her mother, about the days afterward spent in a drugged haze, about stepping over the corpse as she went in and out of the house--are "unexplainable in words," she said softly. But she will speak of heroin, the drug she believes imprisoned her at the Maryland Correctional Institution for Women in Jessup. Now 20, Ziemski looked pale and drawn as she sat in the visitor's room in a baggy sweater, a far remove from the pampered teenager she was, a Sunday school aide with the "face of an angel," as her father puts it. "Heroin ruined my life," she said. "It has ruined my family's life. It took me away from me. It took my mother away from me."
    Doris Ziemski was killed with a butcher knife and left sprawled for days in her foyer in what Kristi's prosecutor calls a heroin-related slaying. But her mother's life is hardly the sole one to be taken by the drug in Carroll County, Md., an otherwise tranquil place of farms and subdivisions 50 miles north of Washington. Seven of its young people have died of overdoses in the last four years. Dozens of other residents in heroin's vise have turned up in emergency rooms. The county of 152,000 people has Maryland's first and only probation officer devoted solely to helping heroin-addicted youths, and bright yellow-and-black "Heroin Kills" billboards and bumper stickers have become common as residents fight back. "It's a plague that has come upon Carroll County," said local state Del. Carmen Amedori (R). "It has really, really taken its toll." Carroll has sorrowful company, in Maryland and beyond, as heroin has migrated from its traditional enclaves in city neighborhoods to scattered suburbs and towns nationwide. Four other counties that orbit Baltimore--Anne Arundel, Cecil, Harford and Howard--have suffered double- or even triple-digit percentage increases in treatment cases, although the absolute number of addicts remains low. And nationally, opiates--overwhelmingly heroin--account for more new cases now than marijuana or cocaine. Long stigmatized as a dirty drug because it had to be injected to produce a swift and blissful high, heroin from South America is now so potent that inhaling the powder works just as well, making it easier to use and enhancing its appeal among young people looking for a thrill, experts say. On average, users are less than 18 years old when they first try it, nine years younger than in 1988, according to the National Household Survey on Drug Abuse.
    Kristi Ziemski was 14, and not even a high school freshman. She didn't know it was heroin that older boys were offering in the back seat of a car on a trip to Baltimore's gritty Park Heights neighborhood. They simply called it "raw." Whatever it was, Kristi knew she wanted a high that would obliterate her typical teenage worries. Using a straw, she snorted the powder from a dollar bill. "When I found out that it was heroin, I was shocked," she said. "I was like, 'Oh my gosh.' I thought heroin was bad. For junkies using needles." The realization didn't deter. "I don't want to glamorize it," she said, but heroin made her feel great. Warm and hazy and contented. So there came another time, and another, and soon she was expelled from Westminster High School for truancy.
    "The stereotype has been this down-and-out person with open, running sores and track marks," said Lt. Terry Katz, the Maryland State Police commander in Carroll County. "That's not what it is anymore. The face of heroin right now is a middle-class kid, race irrelevant. It's the all-American kid, except they've now done the dance with death." Said H. Westley Clark, the director of the federal Center for Substance Abuse Treatment in Kensington: "Heroin is being embraced by white suburban kids, as well as Hispanic and African American kids. That's the key message." The scope of that embrace is elusive, because studies that seek to capture heroin trends often conflict. But Clark and other experts said that although the drug is not nearly as prevalent as marijuana or alcohol, the number of heroin addicts has risen nationwide. In testimony at a Senate hearing last month, officials of the Office of National Drug Control Policy put the total at 980,000, up from 630,000 eight years ago. Surges, however, have not been universal. Heroin admissions and overdoses have dropped in Virginia. Prince George's and Montgomery counties have not experienced what Baltimore area counties have, officials say, and treatment admissions are down in Maryland outside the Baltimore area, according to a January report by the University of Maryland's Center for Substance Abuse Research. "No, there is not a statewide heroin epidemic," said Erin Artigiani, coordinator of the substance abuse center's Drug Early Warning System.
    But here and there, in Maryland and elsewhere, problems mount. In Plano, Tex., police say that since 1997, 17 teenagers have died of heroin overdoses either at home in Plano, partying in nearby Dallas or while away at college. About 15 Fairfax County teenagers a year seek treatment for heroin addiction from the county's Community Services Board, whereas "five years ago, we didn't see any," said Patrick McConnell, director of youth services for alcohol and drug abuse. Heroin remains the "drug of choice" in Baltimore, and its use is rising in Washington, particularly among the young, said Larry Siegel, the District's senior deputy director for substance abuse services. When a suburb falls victim, the cause seems as simple as bad luck and proximity to a city with a heroin problem. One, two or a handful of people import heroin into a community, and use spreads like a virus. Recovering addicts trace Carroll County's outbreak to an addicted teenager from Baltimore who introduced heroin to a circle of Westminster High School seniors in 1994.
    A recovering addict, now 21, said two Westminster seniors approached him on Halloween night when he was 14. Soon he and a friend, Scott Payne, also 14, were using daily and trying to enlist friends old enough to drive into Baltimore to buy. "I'd be like, 'Want to make money real quick? I'll give you $15 to take me into town,' " said the addict, who agreed to be interviewed only on condition he not be identified "I'd peer-pressure 'em into going, because we needed a ride." Eventually, he said, the drivers would end up hooked, too. "We're a very rural area, and you have kids who don't have a lot to do," said Linda Auerback, founder of Carroll County's anti-heroin group, Residents Attacking Drugs, whose Web site (www.heroinkills.com) and video are now used nationally. "It's such a trusting community and still kind of quaint in a lot of ways. . . . We had no public awareness of heroin at the time. Heroin was introduced, and you had kids who had money and had cars and were looking for something to do. These are the kids who are easily infiltrated by anything." Another recovering addict and former student at the county's Liberty High School said she had barely even tried beer when a boyfriend gave her heroin two years ago. Like Kristi Ziemski, the girl did not know what the drug was. Despite warnings from other high school-age junkies, she became an addict in three weeks, driving to Baltimore before school to buy. She would return to school, but only for weight training and lunch, and then leave to do more drugs. "I didn't care about anything," said the addict, who also agreed to be interviewed only on condition she not be identified. "All I cared about was heroin."
    "When you first start out," Kristi Ziemski said, "you think you're going to have fun and like the feeling, but it takes you over, it's so powerful. I've been in rehab after rehab and detox after detox, and I always went back to it." As Ziemski's addiction deepened, she became pathetically skinny. Black circles as big as 50-cent pieces underscored her eyes. She slept until 3 p.m. nearly every day at the family home in Finksburg, came and went as she pleased, and took to scribbling her dealer's phone numbers on her bedroom wall. Her parents, Lee and Doris, knew the cause was drugs but never suspected heroin, Lee said. They didn't learn the truth until Doris found a note her daughter had written but had thrown in the trash. "Mom," it said, "I'm on heroin. I need help." The parents fought. Doris wanted to be lenient; Lee didn't. Eventually, he moved out and they divorced. Then Scott Payne died in his sleep on June 5, 1996, just a day after giving his mother a urine sample and saying, "Now do you love me?" His mother, Shirley Andrews, a nurse, said Carroll County considered his death a fluke, not evidence of a county problem. But it hit Kristi hard, because Scott was a friend with whom she had used heroin. Clutching his photograph, she entered her first rehab program. The photo didn't help: She relapsed within days of leaving. There was another rehab effort, and another. None worked. Such failure is common among heroin addicts, officials say, because most programs are not long enough or intense enough. Finally, Kristi entered a facility in 1997, emerged clean 30 days later and did not relapse, at least not immediately. "By then," she said, "I had had a whole lot more bad experiences. I'd gotten raped, and gang-raped. I had done prostitution. Just terrible, bad things. I was really tired of the lifestyle." She moved in with a sympathetic cousin in Dundalk, Md. She got a job as a waitress. She met a guy and fell in love. They got an apartment. The future looked better.
    Beyond her world, Carroll County was finally awakening to heroin's pull. In January 1998, Liam O'Hara, 15, a Westminster sophomore and soccer player, died in his sleep, having bought heroin at a Burger King where he worked. Cory O'Hara, a Westminster graduate who is now 21, later told lawmakers that until his brother died, he did not even known heroin was available in Carroll County. "I was later to learn that someone from my homeroom had died of a heroin overdose," Cory told a state hearing, "that one of my soccer teammates was struggling with a heroin addiction and that another classmate and neighbor had overdosed."
    After Liam's death, county prosecutor Jerry F. Barnes, using $4,000 of his own money, launched the "Heroin Kills" publicity campaign, and Auerback and other parents formed Residents Attacking Drugs, or RAD. Lt. Gov. Kathleen Kennedy Townsend (D) came to the county to announce a plan to combat the epidemic in a variety of ways, including funding the position for the probation officer. Lee Ziemski began helping RAD make a video, "Heroin Kills," a tale of a fictional youngster who dies after snorting heroin. He recalled thinking that the video might help his daughter. He imagined her pitching in to make it. What he didn't know was that, by then, Kristi had relapsed.
    She and her boyfriend had stopped at a friend's house one day in February 1998. He was sitting on a couch with 10 clear capsules of heroin on a coffee table. In the kitchen, Kristi saw another capsule. She went home with one. She snorted the powder. And the spiral began again. She lost the boyfriend, then the apartment, and began living on the street. To support her $100-a-day habit, she stole money from the restaurant where she worked. Now injecting the heroin, she used veins in her feet, where no one would see marks. In November, she slashed her wrists. "I didn't know any other way out," she said. "I was totally out of it at that point. I totally lost my whole world. I didn't care about anything anymore." She was arrested for prostitution on March 15, 1999, and it was her mother, now 52 and deeply involved in a religious group, who came to get her out of jail. Living in Hampstead, Md., after her divorce, Doris Ziemski was "overboard with religion," Kristi later told Maryland State Police investigators. At her town house, Doris began reading the Bible to Kristi, interrupted only by trips to church and visits from Doris's prayer group, who "laid hands" on the girl and prayed in tongues. Kristi's father recalled that in a telephone conversation, Doris told a relative that she had finally saved Kristi. "She's a different person," Doris reportedly said. "You'll see her. Maybe on Easter."
    On Palm Sunday, March 28, Kristi and Doris began arguing about religion. The mother said the daughter would have to move out if she did not read the Bible and accept religion, according to a police report. Kristi said she was sick of religion. They pushed, shoved. Kristi picked up an Army bayonet--a souvenir from her father's military days--and brandished it. Doris fled downstairs. Eventually, Kristi grabbed a butcher knife and stabbed her mother in the chest as Doris "continued to scream that K. Ziemski was the devil," according to the police report. Doris tried to flee, but Kristi followed, knocked her mother to the floor and stabbed her five more times. Kristi later told police she was high on heroin, having bought that day from a friend. Barnes, who prosecuted the case, said he does not think she was. "There was no indication she didn't possess the requisite criminal intent," he said. But Barnes does believe the killing was drug-related, because Kristi was suffering "severe heroin withdrawal" that produced physical sickness and edginess. Kristi washed off her mother's blood. She stole her mother's purse and drove off in her mother's car. A few streets away, she stopped, because she was crying too hard. She sat for a long time, then drove to Park Heights to buy heroin. She remembers little about the next 12 days, she said. She stayed in motels in Baltimore, doing heroin she bought with money from her mother's bank account and returning to her house a couple of times.
    The week after the killing, Lee Ziemski had trouble reaching his daughter and ex-wife by phone. He went to the town house to check. Through a back door, he could see a body on the floor in the front hall. It appeared to have Doris's fluffy blond hair. Maryland State Police detectives caught up with Kristi the next day, April 9, at a seedy motel in Baltimore. She told them she had no idea why they were there. Next, she found herself in a bare room in the Carroll County Detention Center. She had a paper gown, a cot, a mattress with no sheets or blankets, a Bible and overwhelming guilt. When she next saw her family, in a courtroom, "hate was all I could see," she said.
    Doris's service was held at the Pritts Funeral Home in Westminster. Lee had been there just three months earlier, filming the climactic scene of RAD's anti-heroin video, the funeral for the dead addict. There are signs the county has checked its heroin wave: Hospital overdose admissions held steady last year. But problems keep coming: The seventh death was April 3, and the son of a Maryland state senator overdosed March 15 but lived. In November, Kristi Ziemski pleaded guilty to murder and was sentenced to life in prison. She spends her days in the prison sewing shop, learning how to make Maryland state flags. She dreams about her mother. In the dreams, Doris is alive. "She's just normal. She's my mom," Ziemski said. The daughter was weeping quietly as she spoke, wiping her eyes with both hands. "I really, really believe she forgives me." She added: "I feel terrible about myself. I feel so much guilt and shame. I wish I could go back and change things, but I can't. I think about it all the time. If I wouldn't have been high, would it have happened? I just know that heroin turned me into a different person."

Alternative Therapies Not New in Evergreen
Karen Augee, Denver Post- 6/17/2000

William Goble had never seen the darkhaired woman before. The North Carolina therapist had just finished speaking at a conference about reactive attachment disorder, how it damages kids, how it can be fixed, when she approached. The woman, her arms loaded with folders and papers, said her name was Jeane Newmaker. She wanted to talk about her 10-year-old daughter, Candace. She told Goble she had adopted Candace nearly four years earlier. But the girl wouldn't let her mother hold her, look her in the eye, love her. So Newmaker had traveled from her home in North Carolina to the therapists' conference in Virginia for advice. "My sense was she finally had gathered enough information on her own to figure out what was going on," Goble said. "And she was now looking for information about how she could get help." That day last October, Goble told Newmaker about the place in Colorado where he'd first learned about reactive attachment disorder, where he'd first watched therapists treat the impossible kids who'd been diagnosed with it. He gave Newmaker the same referral he'd given to dozens of other patients. Go to Evergreen. In April, she did. Days later, a "rebirthing" therapy went horribly wrong and her daughter was dead. And Connell Watkins, the therapist Newmaker paid $7,000 to help Candace, is charged in the girl's death. Three of Watkins' colleagues and Newmaker also have been charged.
    For children across the country who can't love and won't be held, who hurt people and torture pets, who make every day a white-knuckle wild ride for their parents, Evergreen is mecca. And has been for nearly three decades.  For years, the Attachment Center at Evergreen was the place nationwide for treating children with reactive attachment disorder and for training therapists to work with them. Now, there are others, but many are run by Attachment Center proteges. The treatments developed and practiced in this little mountain town 30 miles from Denver were unconventional and controversial long before Candace Newmaker died wrapped in blankets and surrounded by pillows in a bizarre ritual that was supposed to allow her to be "reborn" to a loving mother. In fact, Candace Newmaker is not the first child to die under Connell Watkins' treatment. In 1990, while Watkins was the Attachment Center's clinical director, a 13-year-old girl died of an aspirin overdose. The death, ruled a suicide, resulted in a state investigation and a wrongful-death lawsuit. The State Grievance Board found no grounds to discipline the therapists involved, but in a letter, the board expressed concern about the "loose supervision methods" they employed.
    Evergreen started life as a logging town, but by the 1920s had become a summer hangout for anyone who wanted to slap on a cowboy hat and ride the range. In the 1970s, a psychiatrist named Foster Cline found his way here.  And New Age met Old West. As early as the 1940s and 1950s, psychiatrists had started looking at what became of babies left alone in foundling homes or separated from their parents for long periods. They found that babies who didn't get held or loved grew into emotionally detached, unloving, untrusting, withdrawn children. Or they simply died. It wasn't called reactive attachment disorder then. And hardly anybody was proposing a way to treat it.  Cline did that. For kids so severely damaged, Cline reasoned, "talk therapy," lying on a couch having a conversation with a listening therapist, wouldn't cut it. With his research, his theories and controversial new treatment, Cline and a board of directors founded the Attachment Center at Evergreen 28 years ago.
    Some of Cline's methods caught attention right away. In 1976, Cline and the center, then called the Evergreen Development Center, made headlines when Denver's Child Protection Team decided the center had abused a young girl by bruising her during something Cline called "Z therapy." During the treatment, the girl, who reportedly had threatened to kill her foster mother, was held down by four people while a psychiatric social worker from the center manually manipulated her ribs and mouth. In a 1976 interview with The Denver Post, Cline said the therapy was designed to "mobilize" a child's rage and anger. By the time kids with these kinds of problems started showing up at Goble's North Carolina office about a decade ago, Cline's work had become the center of the growing attachment disorder universe. Goble knew only a little about reactive attachment disorder. If he was to learn more, he would have to go to Evergreen. "When I got started in my training it was the only place" to learn how to treat the disorder, he said. Now, Goble said, there are a few other places across the nation, many run by former Attachment Center proteges. So eight years ago, Goble said, he came to Evergreen. He sat in on therapy sessions and talked about the center's treatment philosophy with its leaders, Cline and Watkins.
    Cline's new theories and breakthrough treatments brought a lot of people to Evergreen. Some went away repulsed; others took Cline's teachings home with them. Still others stayed and became Cline disciples. Watkins stayed.  She had graduated from the University of Denver in 1973 with a master's degree in social work. And social work is what she did for a while. But by the mid-1980s, Watkins had found her way to Evergreen and into Cline's orbit.  Ten years ago, when Cline and Watkins worked together, "She was a hot therapist. She was so hot because she was willing to do nontraditional things," said Cline, who is retired and lives in Idaho. "I think she's a real courageous therapist. Anybody who does nontraditional things in today's world has to be courageous." Colleague after colleague describes Watkins as a therapist who cares enough to get involved with her patients, who seems to thrive on the challenge of the toughest cases. "Seems like every time I'd see her, she'd have some little kid she was taking care of for the weekend or treating whose mother couldn't afford to pay or the mother couldn't handle the kid and Connell knew she could. I used to almost feel sorry for (Watkins' daughter)," Cline said, forever having to share her home with her mother's disturbed young clients.
    But during Watkins' reign at the Attachment Center, not everything went smoothly. In 1990, 13-year-old Andrea Swenson died while being treated at the Attachment Center. Andrea, from Tulsa, Okla, came to the center after years of other treatments had failed, said her mother, Greta McNac. The Attachment Center told McNac that her daughter, who had been adopted from an Austrian orphanage, was so damaged that she needed months of care and should stay in Colorado with what the center called its "highly trained" therapeutic foster parents. From the beginning, McNac said, she was skeptical, and she admits she was considered a troublemaker by Attachment Center staff. "I saw my daughter forced to run in place until she said something. She ran for an hour and a half because she didn't want to say what they wanted her to say," McNac said in a recent interview. Nevertheless, Andrea seemed to be making progress and her treatment continued fairly uneventfully, until McNac's insurance company announced it would no longer pay the $3,500-a-week treatment costs. Then Watkins and the foster parents began pressuring McNac to let the foster parents adopt Andrea so the foster parents' insurance would pay for the treatment, McNac said. McNac admits acting as if she would go along with the idea, but insists she secretly planned to come to Colorado and snatch her daughter away from the Attachment Center. "I never got to do that. She died two days before I got there," McNac said. She died, according to a medical examiner's report, of an overdose of aspirin.
    According to court documents filed as part of McNac's wrongfuldeath suit against the center, Andrea became violently ill during the night of Nov. 8, 1990. The next morning, Andrea was still vomiting and stayed home from school. Her foster father later told police she seemed incoherent and her breathing was heavy. Nevertheless, the foster parents went bowling. That afternoon, a relative of the foster parents found Andrea lying in the hall, not breathing. When paramedics arrived, the girl was dead. In depositions, the foster parents admitted keeping the anti-psychotic drug lithium and other drugs in open containers on the kitchen table.  And they acknowledged that the day before Andrea died, she asked what would happen if she slit her wrists or took an overdose of drugs. Both times, her foster parents replied that she would die, according to their depositions.   Although her foster parents said Andrea came home from school Nov. 7 and reported she had been sexually molested by schoolmates, McNac said she will forever be convinced her daughter didn't want to die, that she was upset because she had been told her mother was giving her up. "What upsets me most is that she died with the thought that another mom had just kicked her to the curb," McNac said. McNac said she agreed to settle her suit out of court for $60,000, but wouldn't agree not to discuss it publicly.
    Where once there was only the Attachment Center at Evergreen, now there are Connell Watkins & Associates and a half-dozen other treatment providers around town. But the Attachment Center has distanced itself from Watkins - its former executive director - and also from Cline, its founder. Days after Watkins, her associate Julie Ponder and the others were arrested last month, the center released a statement saying it never used anything called "rebirthing therapy." Paula Pickle, who became the center's executive director in 1994, has slowly moved the institution toward the mainstream and made sweeping changes since Watkins' departure, said current clinical director Forrest Lien.  The staff is still small - most of the center's therapists are outside contractors. And the nonprofit center couldn't handle a caseload much bigger than its current 50 children a year, Lien said. And though the foster parents who cared for Andrea Swenson remained on the Attachment Center's payroll through 1997 - tax records show the center paid them $50,000 that year - Lien says the center has severed its relationship with them.  The Attachment Center, licensed by the state to place kids in foster homes, provides extensive training to its foster families, Lien said. And each of those foster families has personal experience with an attachment disorder child, he said. The center has never done rebirthing, Lien said. But some of the other more physical treatments it did use have been discarded. While that philosophy may have brought more acceptance and may have helped mend the center's once-fractious relationships with some local social service agencies, it has caused a rift with practitioners who think the center isn't as aggressive in treatment as it should be. Those differences were what drove Connell Watkins to step down as the center's executive director in 1992. "There wasn't a mutual agreement about where we were going," Lien said. When Watkins left, a few therapists followed her. So did Brita St. Clair, whom Watkins hired as her office manager. St. Clair had been part of the center's stable of therapeutic foster parents. Soon Watkins began attracting her own consultants and staff. Julie Ponder, a California licensed therapist trained in rebirthing therapy, came to Colorado to work with Watkins. And Jack McDaniel, who two years ago was living in Loveland installing drywall, became an intern with Watkins.
    On the day four years ago that she officially adopted her only child, Jeane Newmaker took Candace around her Durham, N.C., neighborhood and introduced her "new daughter." "She was excited when she adopted Candace," recalled one neighbor who asked not to be identified. "She was like a new mother." Those neighbors didn't know much about Candace's life before she came to live with Jeane Newmaker, or whatever it was in her past that continued to trouble her. Over the years, people on Jeane Newmaker's block saw Candace riding her bike and would chat with the mother and daughter at parties and neighborhood get-togethers. Whatever problems Jeane, a nurse practitioner at Duke University Medical Center, was having with her daughter, she kept them to herself. But behind the neat doors of her two-story house, Jeane Newmaker was trying everything she could think of to fix her broken daughter. Conventional therapy and medications came first, according to Jefferson County records.  Neither worked. She consulted experts in attention deficit disorder and post-traumatic stress disorder and educated herself in bipolar disorder. Then she came across articles on reactive attachment disorder, Newmaker told police.  She found an attachment disorder workshop in North Carolina, where she heard therapists talking about kids who acted like Candace, according to police reports. And in January, Jeane Newmaker started taking Candace to a North Carolina therapist who treated her for reactive attachment disorder.
    Now that Candace is dead, some of Newmaker's neighbors said they can hardly believe that someone like her - someone so well-educated and surrounded at Duke by some of the best minds in medicine - would try something as off-thewall as rebirthing therapy. "It's hard for me to believe anyone of her intelligence would subscribe to this sort of treatment," said Ruth Dailey. "The procedure itself just seems so inhumane to me." But Susie Kernodle understands. For nearly 10 years, she and her husband had taken their foster daughter from one therapist to another, tried one treatment after another. The girl, now 13, is a textbook description of reactive attachment disorder: she tortured the family's dog, urinated around the house, spit on people. Eventually, the Kernodles, who also live in North Carolina, took her to Bill Goble. Then in January, at Goble's suggestion, the Kernodles came to Evergreen, for 10 three-hour intensive therapy sessions over two weeks with Connell Watkins & Associates. "I didn't have a clue (about rebirthing therapy)" Susie Kernodle said. "I knew a lot of stuff was non traditional but that was OK because traditional therapy didn't work." The Kernodles lived for two weeks with a Silverthorne foster family hired by Watkins.
    The rebirthing session came at the end of the first week. Kernodle remembered that the lights in the room were dimmed, and soft music played, and her daughter was wrapped in "a light blanket." Julie Ponder was there, and so was Neil Feinberg, who Kernodle said was her daughter's primary therapist during the two weeks, and the Silverthorne foster mother. "Connell was in and out, she would check on how things were going," Kernodle said.  "I was there the entire time. I could reach out and touch the blanket. We were right there, I'm talking to her the whole time," Kernodle said. "There was no reason to be scared. There was nothing that frightened me." Kernodle said her daughter pushed her way out of the blanket. Then someone wrapped the girl, like a newborn, in another blanket and handed her to her mother. "Of course I was crying," Kernodle said. "I'm a mama." The whole thing took about 45 minutes.
    In April, Jeane Newmaker made the same trip to Evergreen. She paid Connell Watkins & Associates $7,000 for two weeks of "intense therapy" and settled in with a Silverthorne foster family. Watkins and her colleagues went to work. According to court documents, Candace had at least four days of therapy, all of them videotaped. Those tapes are now evidence and have been sealed by a judge. On the fifth day, April 18, in a treatment room in Watkins' office Candace was wrapped in a blanket or flannel sheet. McDaniel and St. Clair sat beside the pillows surrounding Candace and pressed on them to simulate birth. And then, like the Kernodles' daughter, Candace was supposed to push her way out of her flannel "womb" and be handed into the arms of her waiting mother. But the therapists told police Candace struggled at first, complained she couldn't breathe, that she was going to throw up and needed to "poop." And, according to police records, she kept asking "Where do I come out?" Candace didn't come out. When Watkins and Ponder opened the blanket, they discovered that the girl had indeed thrown up. And she was unconscious. She died the next day at Children's Hospital. Watkins, who had been practicing without a state therapist's license, was ordered by the state to close her business. Neighbors say they haven't seen Newmaker since Candace died, and nobody seems to be living in the home. Someone has taken Newmaker's two dogs, and someone comes by periodically to mow the lawn. "I'm sure (Jeane) is extremely upset at what happened, more than anyone else," a neighbor said. "She lost a child. I'm sure that what she was trying to do was in the best interest of the girl - for Candace."