Noteworthy News Articles on Mental Health Topics, July 1-5, 2000

Los Angeles County Foster Care System 'Broken,' Grand Jury Reports
Caitlin Liu, Los Angeles Times- 7/1/2000

Los Angeles County's foster care system is so beset by problems that the agency in charge doesn't know where all the children are on a given day, and all computerized data on troubled foster homes have been lost because of inadequate backup procedures, according to a county grand jury report. Offering a scathing view of the county Department of Children and Family Services, the report by the 1999-2000 grand jury also found that poor training, mismanagement and social workers' large caseloads have contributed to creating a "broken" system "characterized by numerous problems and flaws" that could be endangering children's health. "Despite a widely stated 'child first' philosophy, decisions made throughout the system . . . appear to be motivated primarily by cost considerations and secondarily by shifting policies and politics," states the 59-page report released last week. "The best interests of the child are rarely paramount."
    The report, which focuses on the experiences of the approximately 7,100 children served by private foster care agencies that contract with the county, comes on the heels of other studies in recent years, including one by the Board of Supervisors, that have severely criticized the children's department and the county's foster care system. But the latest message, while not new, is nonetheless important to keep the issue alive in the public's mind and to compel change, child advocates say. "People in Los Angeles should be very angry," said Andrew Bridge, executive director of the Alliance for Children's Rights. "We have a foster system in Los Angeles County that doesn't protect children but re-abuses them." The report is comprehensive and well-written, said Rita Cregg, director of the Child Advocate's Office of the Los Angeles County Superior Court. Although focusing on children placed with private agencies--the majority of the county's foster children--the findings also mirror the experiences of the 3,400 children in state foster homes, she said. "It should certainly be a call to action, and the community should demand that [the children's department] come up with a plan to better care for children in their care."
    Some problems in the foster care system can be attributed to having too few social workers, their poor training and high turnover rate, the grand jury report said. Compared to New York City, whose social workers have, on average, 12 cases each, the typical Los Angeles County social worker has 45 to 50 cases. With such a burden, county social workers often spend less than 30 minutes a month with each assigned child, the report says. County social workers sometimes fail to pass on critical information to foster families, such as a child's medical history, because of a misunderstanding of confidentiality laws or failure to process paperwork on time, the report found. For example, children on certain prescription drugs could be abruptly taken off their medication simply because they change homes. "Foster parents are not informed if children are (or potentially are) HIV-positive, have hepatitis C or other highly contagious diseases," the report says. The children's department also lacks a reliable system, computerized or manual, to track the most basic information about youngsters, such as up-to-date lists of foster families' addresses. "As a result, the department does not know in aggregate where all the children in its care are on any given day," the report says.
    The findings are based in part on interviews and surveys of social workers, children's department management, children's advocates and foster parents. Additional information was collected through visits to randomly selected agencies and homes. Anita Bock, the director of the children's department, said she had not seen the study but added, "I am sure the grand jury report is consistent with what we already know. "We take this information very seriously, and we will utilize it as we work to turn this agency around," Bock said. Part of the report detailed the grand jury's frustrations with the department while the panel tried to gather data for the study. It found that some of the most basic information--such as the number of private agencies used by the county and the number of children in the system's care--varied depending on where in the department it went for the information. There was no reliable system for tracking problematic foster families, according to the report, which said the department's unit in charge of probing complaints in foster homes had lost "all historical data" because of a computer error. The study recommends that the county develop a child-centered approach to foster care with clearly defined ways to judge performance based on the child's well-being.

New Hampshire Doctors to Question Patients About Domestic Violence
Associated Press, 7/1/2000

CONCORD, N.H.-- Patients may soon be asked to describe more than just their symptoms when they visit emergency rooms and doctor's offices as part of a program to stop domestic violence. By 2003, doctors, nurses and other health care providers will be trained to routinely screen patients for domestic violence and offer help to those at risk. ''We are giving health care providers, who are often on the front lines dealing with abuse situations, the information and skills they need to make a difference in the health and lives of victims of domestic violence,'' said Gov. Jeanne Shaheen, who announced the program Thursday. Under the program, the standardized intake forms patients fill out will include a line asking them if violence is present in their homes. Those who answer yes will be offered referrals to social workers, domestic violence professionals, shelters and other services. Dartmouth Medical School, Notre Dame College and the state's nursing schools have agreed to add domestic violence education into their curriculum. Boards that license medical professionals also will be encouraged to require continuing education on domestic violence.
    Although more than 2,000 medical professionals have completed a two-day course on domestic violence in the past three years, abuse experts said more needs to be done. ''One of the sad facts is that only about 30 percent of physicians actually screen patients for domestic violence, and some estimates are as low as 10 percent,'' said Rep. James Pilliod, a doctor from Belmont. Nearly 8,000 victims of domestic violence sought help at crisis and support centers across New Hampshire last year. The number of referrals from health care providers to shelters grew 7 percent, an increase experts credit to increased training of doctors and nurses. But Dr. Katherine Little, an emergency room doctor at Dartmouth-Hitchcock Medical Center, said many providers still aren't sure how to address abuse in the home. Making the questions part of the standard screen process will remove some of the stigma about talking about abuse, she said. ''They don't know what to do when the patient says yes ... so the health care provider is afraid to ask,'' she said.

Virtual Vietnam Helps Troubled War Veterans ''Face the Dragon''
Malcolm Ritter, Associated Press, 7/1/2000

DECATUR, Ga.-- When Randy Kemerley first tried virtual reality therapy last year, this is what he saw: A jungle clearing. Lush green trees rising in the distance on white trunks. A helicopter whirring by. It was virtual Vietnam. ''So unreal it was almost comical,'' he said. ''I couldn't see how this was going to work.'' Kemerley, now a 51-year-old painting contractor from Atlanta, had served with the Army in Vietnam in 1967-1968. He knew what it was like. Since he returned stateside, he had been haunted by a sound: The choppa-choppa-choppa of helicopters. ''A helicopter would go over the house, and it would take me back to Vietnam,'' he said. He would go on a jag, telling war story after war story for the rest of the day, hollering, angry, trapped in emotional turmoil for days to weeks. Every few days he'd bump into another cue, like the smell of diesel fuel, and that would set him off again. He tried drugs and alcohol to escape his memories. He was jumpy; he couldn't sleep well. He stayed away from people. Diagnosis: post-traumatic stress disorder, or PTSD.
    His therapist at the Department of Veterans Affairs Medical Center near Atlanta told him about an experiment there using virtual reality to treat PTSD. Now Kemerley is one of 18 veterans who have participated in the ongoing study. ''We're at the baby-steps explorations stage,'' said psychologist David Ready, who is overseeing the research. So far, it looks like the virtual Vietnam experience can help veterans reduce their PTSD symptoms like flashbacks, with the effect lasting even six months after the treatment ends, he said. The goal of the therapy, he said, is to ''take hot memories and turn them into bad memories.'' Nobody will ever look back fondly on seeing a buddy blown up. But there's a line between flashing back to a moment of terror and feeling as though it's happening again, as opposed to just recalling it as a distant, sad event. That's the line Ready is trying to get the veterans to cross.  Virtual reality is just a tool to enhance an existing, low-tech therapy in which veterans imagine particular troublesome events over and over, filling in the details, establishing context. ''You turn and face the dragon, and you grab it by the neck,'' Ready said.
    Virtual reality appears to help a veteran stick with the terrifying task of focusing on the horror. Veterans can enter either of two virtual Vietnam environments. One puts them in a landing zone. By manipulating a joystick they can move through a swamp, hearing the sound they would make. Helicopters land and take off, flying out of sight. The jungle sound is fractured by the rat-a-tat-tat of AK-47s and M-16s. A bomb explodes, they feel the thump. When they step on a land mine, everything suddenly goes white. In the other scenario, they ride over the jungle in a helicopter, feeling its vibration, hearing radio chatter and seeing tracer bullets fly in the trees.  Both scenarios are too general to reproduce the two or three traumatic incidents the veteran is supposed to focus on over and over. But they effectively set the stage.  ''All I'm doing is providing the sights and sounds of Vietnam,'' in the sequence that best mimics each veteran's traumatic experiences, Ready said. ''You don't have to recreate the whole thing, just enough stimuli to get them in touch with the memory. They do the rest.''
    Kemerley discovered it was a powerful tool. ''The gunfire would get to me, to the point where I would lock up and not be able to talk,'' he said. ''I was remembering it so well, and the sound was so identical.... I was feeling the fear, wondering where they are, what direction they were coming from.'' Each veteran enters virtual Vietnam for 30 to 45 minutes twice a week for four to six weeks. Each night during that period, they listen to a recording of the experience. ''Doc,'' one veteran told Ready, ''you're a nice guy, but coming to you is like going to the dentist and getting a tooth drilled over and over again.'' No fun. And Kemerley isn't cured. He's still in group therapy for PTSD, and when he goes to a restaurant, he still wants his back to a corner. ''I want to see what's coming. I want time to deal with it,'' he said. But the sound of helicopters no longer seizes his mind. It still makes him think of the war, but he quickly realizes it could just be some executive in a hurry. ''It doesn't have to be a 'copter bringing in troops all the time,'' he said. ''It doesn't have to be a medic helicopter coming in to pick up wounded.'' Sometimes, Sigmund Freud supposedly said, a cigar is just a cigar. For Kemerley, benefiting from a technology light-years beyond Freud's famous couch, a chopper can be just a chopper.

More Americans Say They've Been on Verge of Nervous Breakdown
CNN News, 7/2/2000

WASHINGTON -- The proportion of Americans who say they've felt the threat of a nervous breakdown provoked by stress, depression and anxiety is on the rise, according to a study released Sunday. The study, by Indiana University researchers, found that in 1996, more than 26 percent of adults surveyed said they had felt an impending nervous breakdown, up from 19 percent in 1957. In addition, another 7 percent said they had experienced a mental health problem, a question not asked in the 1957 survey. "Still," the study says, "it is unclear whether the number of nervous breakdowns has increased over the past 40 years, or whether the meaning of the term has changed so that the public's attitude toward psychological problems has become more accepting." The increase, most of which occurred in the last 20 years, could be caused by a combination of more people experiencing psychological problems and a lessening of the stigma associated with admitting to a nervous breakdown, said Ralph Swindle Jr., the study's lead author. "There's been a real change in both Americans' attitudes toward acknowledging mental health problems and in their willingness to talk to people about it," said Swindle. The survey questioned 1,444 American adults from March to May 1996 and has an error margin of plus or minus 3 percentage points. The findings are reported in the July issue of American Psychologist.

Less serious than mental illness
The study notes that its findings deal with a concept of the nervous breakdown that renders it a less serious condition than mental illness. "The way the general population uses the term 'nervous breakdown' is a mental collapse," said co-author Bernice Pescosolido. "They were talking about getting to a point in their lives where they couldn't carry on." Participants in the 1996 study saw a nervous breakdown as related to stress, depression and anxiety, which they considered much less serious than conditions such as schizophrenia. Those most likely to say they had anticipated a nervous breakdown were young, white single mothers with low incomes and no involvement with organized religion, the researchers said. As the percentage of Americans reporting a feeling of impending breakdown has increased over the last four decades, the cause of those feelings and the way they're dealt with has also changed.

Contributing factors
In the 1957 survey, most people said health problems had caused them to feel close to a breakdown. But in 1996, the most frequently cited causes were relationship problems, including divorce, separation and other marital strains. Demographic factors that consistently increased the likelihood of people feeling close to a nervous breakdown over the three study years were: Being white, being a woman, having no religion, having less family income, being younger, having children, and not being married. While 44 percent of people experiencing these feelings in 1957 sought medical help, only 18 percent did so in 1996. People instead turned to nonmedical health professionals such as psychologists, social workers and counselors. About 18 percent sought help from such sources in 1996 compared to less than 1 percent in 1957. The proportion of people seeking help from friends and family has also increased, quadrupling to 28 percent in 1996.

Policy implications
The researchers note that for an estimated 162 million Americans covered under some form of managed care plan, primary care physicians often are the initial provider of mental health services for the kinds of problems associated with nervous breakdowns.   "It seems somewhat ironic to us," they write, "that although the public appears more accepting of mental health services from nonmedical providers, they may have to access services through physicians, who they see as less appropriate sources of help for mental health problems." The authors also write that "a mental health policy emphasis that is prevention centered -- focused on building coping skills, fostering stress resilience, and strengthening ties with family and friends -- is in keeping with the present results."

Book Reviews of "Malignant Sadness" by Lewis Wolpert & "Prozac Backlash" by Joseph Glenmullen
Abraham Verghese, The New York Times Book Review- 7/2/2000

There was a time when depression (or melancholia, as it was called) was rarely mentioned in public. These days the merits of Prozac, Zoloft and Paxil are debated as often outside medical circles as within. Tony Soprano takes Prozac and the Marlboro Moment has given way to the Zoloft Day. Two very different books are part of the latest crop of works about depression. Lewis Wolpert, a professor of biology at University College, London, and a noted science writer, chose the title "Malignant Sadness" to reflect his conviction that "normal sadness is to depression what normal growth is to cancer." He begins the book with these lines: "It was the worst experience of my life. More terrible even than watching my wife die of cancer. I am ashamed to admit that my depression felt worse than her death, but it is true." That opener encouraged me to curl up with the book, expecting a Styronesque memoir of illness (though "Darkness Visible" would be difficult to surpass). What a surprise to encounter instead a text-booklike review of the subject--well written, but not the kind of book to curl up with.
    The obligatory history of depression chapter is followed by one on "Defining and Diagnosing Depression." In the "Other Cultures" chapter we learn that in developing countries depression often shows itself in somatic symptoms--headache, stomach pain, dizziness, weakness--perhaps because in these cultures it is shameful to admit to emotional distress. In the sections on psychological and biological explanations for depression, Wolpert usefully summarizes the work of important researchers in the field: "Freud assumed that all love is ambivalent in depressives…and that hostility towards the love object is turned inwards. Thus a patient who is depressed is mourning for someone who is consciously or unconsciously believed to be lost." "Edith Jacobson, for her part, emphasized that loss of self-esteem lay at the core of depression, arguing that during development the child's self-image is constantly changing and it is possible within a loving family to develop an optimal level of self-esteem." "Seligman suggests depression is thus due to the belief that action is futile, and that nothing can be done to restore the losses linked, for example, to bereavement, financial difficulties or chronic illness." "According to Beck, depressed patients have cognitive distortions about themselves. These include drawing negative conclusions without any evidence to support them ('I failed once, this means I will never be successful')."
    The book is most engaging when Wolpert describes his personal experience. But he does so only reluctantly and with great economy. We learn about a critical event in Wolpert's life almost as an aside: "It is natural for anyone who gets depressed to want to know the reasons…In my own case I am convinced, as I was then, that my depression was due to a drug (flecainide) that I was taking to control my heart arrhythmia…My wife, Jill, had a different explanation for my depression. She was convinced that my depression was linked to returning to South Africa, where my father had been murdered some years ago. That did not make sense to me as I had already been back once. Of course I preferred the drug explanation to the psychological one. But the truth may include both." We hear little else about the murder of Wolpert's father or the death of Wolpert's wife. It is these omissions, which in their own way are revealing, that make "Malignant Sadness" read like the course material for a graduate seminar: the work of many others is cited, but the author is relatively anonymous. Wolpert seems to have taken to heart the advice given at the end of Burton's "Anatomy of Melancholy," a classic treatise on depression: "Be not idle."
    We expect writers of nonfiction--particularly if it is the kind that requires lots of research--to have a thesis, a self-assertion that arises from the carrels of a library and elevates the work to another level. If "Malignant Sadness" lacks this quality, "Prozac Backlash" suffers from too much of it. Joseph Glenmullen is a psychiatrist who is in private practice in Cambridge, Mass. The use of the word "backlash" in the title refers to the reactions in the brain that are evoked by Prozac and the other drugs like Zoloft and Paxil, that act on serotonin. These reactions--rare but well documented--include the development of tics and other involuntary movements as well as a Parkinson's-like condition. Much more common are withdrawal syndromes and the tendency for the drugs' effects to diminish over time. Glenmullen uses "cases." A stable of books of this genre, to illustrate these problems. ("Maura: A Case of Disfiguring Tics"; "Leslie's Amotivational Syndrome", "Ming and Cora: Cases of Muscle Spasms"; "Ron: A Case of Neurologically Driven Agitation"). Fortunately, given the thousands, perhaps millions of people who are on these drugs, the most alarming side effects (like tics and Parkinsonism) are rare. But Glenmullen wants to make more of the risk than his own data supports; his language keeps leaning in the direction of over-statement. For example, he refers to "reports estimating thousands of cases of these serious side effects." In his extensive bibliography, however, one finds reports not of thousands of cases, but of a handful. The estimates are just that, estimates.
    Glenmullen is critical, as are many in medicine, of the excessive popularity of psychopharmacology--the use of drugs in place of talking through a patient's problem. The mystique of a biochemical imbalance at the root of every symptom has too much allure. "Psychopharmacology rests on a 'disease model' of psychiatric symptoms," he writes. "But to treat all psychiatric symptoms as though they were exclusively biological is unacceptable reductionism." Furthermore, he says, the "policy of having primary care doctors treat a significant percentage of mental health patients was facilitated by the introduction of serotonin boosters with their one-dose-fits-all-patients, ease of use, and their broad applicability for dozens of conditions, not just depression.
    As an alternative to the Prozac type of antidepressants, Glenmullen favors old fashioned psychotherapy as well as St. John's wort. His strong promotion of St. John's wort is puzzling only because it is in such striking contrast to the rigor with which he prosecutes the Prozac group of drugs. My conversations with academic psychiatrists suggest that St. John's wort is not well studied in this country, though investigations are continuing. Its mechanism of action is uncertain; it is probably better than a placebo and relatively safe. Still, its active ingredients consist of a dozen or more agents, which are found in differing strengths depending on how the dose is prepared, and we know much less about its long-term effects than we do about those of the Prozac group.
    Glenmullen's harshest criticism is reserved for Peter D. Kramer's "Listening to Prozac" (though he did not dislike it enough to find n original title for his own book), and it smacks a bit of envy: "Couched in a barrage of almost senseless data, which unfortunately looked like impregnable science to the lay reader, Kramer's endorsement of the drugs was so sweeping he even described them as making people feel "better than well.'" That statement pinpoints the very things that are disturbing about Glenmullen's own writing. He might find it instructive to reread "Listening to Prozac," as I did: whether or not we agree with Kramer's opinions, his book is still a model for how a writer can develop an engaging, intimate, reflective and believable style and how a writer can theorize and speculate without proselytizing and thereby losing the reader. Above all it shows how to wield a brush so fine that "cases" resemble real people and not talking heads.

Adult Children of Divorce Approach the Altar Warily
Donna Bozzo, Chicago Tribune- 7/2/2000

In June, Margaret Young Napier married the man of her dreams. Although she planned a storybook wedding -- complete with an old-fashioned chapel service and a traditional dress -- Young Napier knows not all marriages have fairy-tale endings. She, like many adults with divorced parents, say her parents' divorce made her think twice before even taking her vows. "As Bill and I were contemplating marriage, I would ask myself, `Do I love him for who he is or who he could be?"' Young Napier said. "Change was an issue in my parents' marriage. My dad could never be the person my mom wanted him to be, and that ultimately ended their marriage. I realized through their divorce that people don't change, and it's given me some guidelines for my own life. As I planned my wedding, I kept saying, `I know I will only do this once."'
    When their parents' vows break, many children grow determined to live happily ever after. Some say the odds are increasing in their favor. Nick Wolfinger, a sociology professor at the University of Utah, recently found after studying a random sample of 22,000 individuals ages 18 to 89 that the number of adults with divorced parents who ended their own marriage declined by almost 50 percent between 1973 and 1996. "This is good news for adults raised in broken homes who may be tentative about getting married," he said.  "I admit I was wary of marriage before I married my wife five years ago," said Dan Anderson of Mt. Prospect. "My parents divorced when I was 6 and my mother had a second marriage, which ended in divorce. Since I've seen divorce firsthand, I've seen how bad it can get. I didn't want to find myself in a similar situation."
    "Children of divorce are often wary of marriage, because they've had a little less experience of working through problems as opposed to succumbing to the problems that inevitably arise in marriage," said Frank Furstenberg, author of "Divided Families: What Happens to Children When Parents Part" (Harvard University Press, $17.50). "The experience of divorce can be a source of vulnerability and it can be a source of strength and commitment. You can learn from a negative experience rather than be destined to repeat it. It's up to the individual to be reflective and say, `This is what I can learn from my parents' divorce' rather than think `I'm controlled by this.' And, it can make you more determined to not do what your parents did."
    "My parents' divorce made me hellbent on making my own marriage work and keeping my family together," said Michelle Weiner-Davis, author of "Divorce Busting: A Step-By-Step Approach to Making Your Marriage Loving Again" (Fireside, $12). "Despite the pain, it was a blessing in disguise. Divorce became something that was just not an option for me. It forced me to keep looking for solutions in my 27 years of marriage. For Mother's Day this year, my daughter gave me a large thank-you note for providing such a wonderful family life. It's important for me to know that I instilled the value of putting family first in my own children." What fuels their desire to begin a new family tradition? Many say it's not just what they want to give their children but also what they're protecting them from. "I would never want my son to go through what I went through as a child," said Greg Pardue of Elmhurst. "I was always looking to belong to a family. I know I will work hard to stay married because I wouldn't do anything to jeopardize what I've found with my wife and son."
    Pardue's parents both remarried since their divorce -- another experience children of divorce can use in their favor. "Many children of divorce have seen their parents remarry and live happily after all," Furstenberg said. "They have the added experience of watching their parents do both -- do well in a relationship and not so well. All of this enters in the script and can be an advantage." Pardue's mother, Lesle Koepp of Downers Grove, said she recognized this in her own children when it came to selecting a marriage partner. "My sons married later in life than I did, and they had high standards when it came to finding a wife," she said. "It seemed they looked for a partner who respected family, church and education. It was almost like they were looking for a person with qualities that would assure them long-term success when it came to marriage."
    Beyond finding a partner, some say they bring the lessons they gleaned in their parents' relationship into their own marriage. "I think more than anything my parents' divorce has given me a greater awareness of my actions and consequences," said Anderson. "Your behaviors can affect your spouse and your marriage. I know what not to do." "You learn a repertoire of skills from your family, and you're at a natural disadvantage if you learned bad skills," said Linda Waite, a sociology professor at University of Chicago and author of "The Case for Marriage: Why Married People Are Healthier, Happier and Better Off Financially," to be released by Doubleday this September. "The challenge many adults face is they didn't grow up with a functional couple as their role model so they didn't learn some of the skills they need in marriage, such as negotiation skills and the ability to minimize conflict -- skills people from functional families inherently learn. The good news is couples can recognize those negative behaviors and learn to correct them."
    "Communication was an issue in my parents' marriage, and I definitely have them inside me," agreed Young Napier. "When Bill and I get into a fight, my gut reaction is to walk away. I have to train myself to stay and talk things through." Adults are not on their own when it comes to developing the skills they feel they lack. "There are many classes designed to teach relationship skills," Waite said. "These classes are designed to look behind the negative behavior and get to the core issues in the relationship," she said. "Couples will fight about the remote control, but often what's really surfacing is a doubt they have in their relationship. What may they really want to know is `do you love me?' Couples who learn how to recognize the underlying issues of conflict and how to address them have a tremendous advantage." "The thing that separates happy couples from not-so-happy couples is the ability to negotiate your differences, and that's a learned skill," said Weiner-Davis.
    Just knowing you have things to learn and a great deal to lose helps prepare these adults for marriage. "Children who witnessed their parents' divorce don't have that innocence that they might have had otherwise," Furstenberg said. "They don't take for granted that their marriage will just work out. It's important to get beyond the stage of illusion and realize that marriage is a relationship that takes work just like any other personal investment." "I tell my sons it takes a 150 percent effort on both sides -- it's not just about finding a perfect match," Koepp said. "I share the lessons I've learned. I tried to tell my sons the importance of communication in marriage. A lot of times you assume you know how the other person is thinking, and you want to know why they haven't responded to the things that are making you feel bad, when in actuality they don't know if you don't tell them. I even wrote letters to both my sons as they started their own families." Young Napier says she, too, will draw from her parents' past as she begins her life story with Bill. She hopes to see marriage through to the final chapter -- not because she expects things to be easy, but because she's willing to continue revising the script. "I think I will try harder to stay married because of my parents' divorce," she said. "I've learned how important issues like communication can affect a marriage. I make it a point to talk everything out with Bill. When we met with our pastor for premarital counseling, there wasn't anything we hadn't already discussed as a couple. There were things we haven't decided, but the important thing is there wasn't anything we hadn't discussed."

Drunken Drivers Get Hard-Core Attention
Jon Hilkevitch, Chicago Tribune- 7/3/2000

WASHINGTON -- Amid indications that a federal goal of reducing alcohol-related highway deaths will not be met, new initiatives are being proposed to stop hard-core drinkers from getting behind the wheel. The recommendations issued by the National Transportation Safety Board follow significant progress made by state legislatures and law-enforcement agencies over the past 15 years to combat drunken driving, as well as tougher federal measures passed by Congress in 1998 that are now being implemented. But a two-year safety board investigation, released last week, has determined that without a comprehensive national program, the Transportation Department's goal to cut alcohol-related fatal crashes to 11,000 or less annually by 2005 won't be achieved. Last year, 15,794 people died in accidents in which alcohol use was a factor. The number of traffic fatalities linked to alcohol has declined from 23,646 in 1983, but the improvement has leveled off at the current annual rate since about 1993, according to the National Highway Traffic Safety Administration. For the past several years, alcohol use has been a primary factor in nearly 40 percent of all fatal traffic accidents. The 4th of July ranks as one of the year's deadliest times. With an extra-long holiday weekend this year, more than 300 people are expected to die in alcohol-related crashes, federal authorities said. To minimize the carnage, 39 states and the District of Columbia have been operating sobriety checkpoints and assigning extra police to arrest drunken drivers.
    Beyond such measures, however, the safety board suggests that a renewed campaign of strict penalties and treatment for addiction focus on hard-core drinkers, defined as motorists with at least two convictions for driving while intoxicated in the previous 10 years or who test positive for a blood alcohol concentration of 0.15 percent or greater. The threshold for being legally drunk is 0.10 percent in most states, while 18 states, including Illinois, and the District of Columbia have lowered the level to 0.08 percent. Such hard-core drinking drivers account for less than 1 percent of drivers on the road on a typical weekend night. But they are involved in 40 percent of alcohol-related fatalities, according to the National Highway Traffic Safety Administration.
    Millie Webb, national president of Mothers Against Drunk Driving, applauded the blueprint put forth by the safety board, though the plan differs some from a program that MADD released in December. "There is no single solution to the problem of drunk driving, but we're trying to get Congress to enact the 0.08 [blood-alcohol] legislation," Webb said. "We are also encouraging the Congress to adopt the NTSB recommendations," she said. "That's how we can save lives." Safety board chairman Jim Hall called the issue of hard-core drinking drivers "crime on the highways."  "For too long, we have tolerated murder on our highways by individuals who should not be operating motor vehicles," said Hall, adding that a friend in his home state, Tennessee, was killed last year by a drunken driver who had dozens of alcohol-related arrests.
    More recently in Wisconsin, a convicted drunken driver who was awaiting trial on another drunken-driving charge crashed his van into a car carrying four high school students en route home from their prom in Neillsville on May 7. The van driver, legally drunk at the time of the accident, and the occupants of the car were killed. "This hard-core drinking driver should have been removed from the road far before this tragedy," said Barry Sweedler, the safety board's director of safety recommendations and accomplishments.
    The safety board identified five key areas in which uniformity among the states is needed. The board formed a model program focusing on:
Legislation: Enacting laws that carry tougher sanctions and mandatory treatment for alcohol addiction and eliminating community service in lieu of jail time. Convicted drunken drivers would fall under a zero-tolerance policy in which any level of alcohol detected in the blood in subsequent tests is ground for arrest.
Enforcement: Conducting more frequent and highly visible sobriety checkpoints and adding resources to ensure that driver's license suspensions are being upheld. Tennessee, for example, has reduced the number of fatal crashes involving alcohol-impaired drivers by 20 percent with regular use of roadblocks--not just over holidays--to check for drunken drivers.
Vehicle sanctions: Requiring ignition interlocks for convicted drunken drivers and imposing penalties that include vehicle impoundment and forfeiture. Such steps have been shown to reduce the recidivism rate by 50 to 75 percent.
Prosecution: Limiting plea-bargaining and eliminating so-called diversion programs that allow drunken drivers to avoid license suspensions if they participate in treatment, or expunging the records of offenders if they aren't rearrested for driving while intoxicated. The safety board said diversion programs may prevent states from prosecuting hard-core drinking drivers as repeat offenders in the future and actually increase the rate of recidivism. In Kentucky, restricting plea-bargaining reduced subsequent drunken driving offenses by as much as 58 percent.
Judicial measures: Imposing a combination of jail and treatment upon conviction, or home detention with electronic monitoring, followed by intensive supervision during probation. By tailoring the sanctions to individual offenders but eliminating the option of community service sentences, the recidivism rate can be cut nearly 90 percent over four years, the safety board's research found. "Jail time alone hasn't been shown to be effective for the hard-core drinkers who drive," said Kevin Quinlan, chief of the safety board's division of safety advocacy and accomplishments. "Home detention with electronic monitoring in conjunction with treatment programs have worked."  The safety board's Sweedler said that improvements also are needed in how drunken driving offenses are reported to central clearing houses and that records of convictions should be maintained for at least 10 years instead of the 5-year period used by many jurisdictions.
    An umbrella organization representing the states agreed with the safety board study that the only way to lower the death toll further is to institute an array of new programs. But the National Association of Governors said it won't urge states to look at enhancing sanctions until next year. "We are making the NTSB report available to the states because it shows the need for a whole bunch of different tactics, from penalties against the drunken driver and immobilization of vehicles to keeping good records so that you know if a person is a repeat offender. But we aren't pushing the states to do anything right now beyond what they already are doing," said Barbara Harsha, executive director of the National Association of Governors Highway Safety Representatives, which represents state highway safety agencies. Harsha said the states already have a full plate regarding the issue. Under 1998 federal transportation legislation, states have until Oct. 1 to pass repeat-offender legislation or face the transfer of about $370 million in road-building funds to drunken-driver and other safety programs. Only 15 states have met the new federal requirements, while legislation has been introduced in about 30 other states, including Illinois. Upon a conviction for drunken driving, a repeat offender sentenced under the stricter federal rules would face at least a one-year driver's license suspension, the installation of ignition interlocks on the driver's vehicle or impoundment of the vehicle and an automatic assessment for alcohol abuse syndrome. The federal legislation, however, falls short of the NTSB proposal to eliminate community service as an alternative to incarceration.
    The governors organizations openly disagree with the safety board that individual drivers with a drunken driving conviction should be held to a zero-tolerance policy. "It is unrealistic to expect the state legislatures to pass the proposed requirement of a 0.00 blood-alcohol level and, frankly, it may be unnecessary overkill," Harsha said. "There are other ways to attack the problem, such as the ignition interlocks that prevent the motor from turning over if the driver is beyond the legal limit." Said John Goglia, a member of the safety board: "Having a hard-core drinking driver in my family, I can tell you the deep pain that the whole family feels every time this individual gets behind the wheel, with or without a license, and the fear that we are going to get the phone call that says he has killed somebody. "That is why I would like to deal with these issues harshly. This particular individual has spent at least five years in jail and continues to drink. And just earlier this week he was arrested again. I would love to put him in jail and personally throw the key away."

Ex-Wife of Former GE Executive Forms Divorce Institute
Associated Press, 7/3/2000

STAMFORD, Conn.--Lorna Wendt was in the throes of an ugly and very public divorce from former General Electric executive Gary Wendt when she got a phone call from a stranger seeking advice on how to handle her own divorce. Wendt, who made headlines by insisting that as a corporate wife she deserved 50 percent of her husband's fortune, said it was the first of hundreds of calls that would spur her to form the Institute for Equality in Marriage. ''I began searching myself. Maybe I have been given the job to use this case and bring out to the public what can happen,'' she told The Advocate in a recent interview at the institute's Stamford office. Wendt, 57, has appealed a 1997 decision that granted her an estimated $20 million. She also filed another suit against her former husband last year, seeking part of unvested benefits that Gary Wendt claimed were valueless during their divorce proceedings. He left his job as chief executive of GE Capital, the Stamford-based financial arm of General Electric Company on Dec. 31, 1998.
    Wendt said the institute encourages couples to discuss their finances, ideally before marriage, and to form prenuptial agreements, which she calls marriage contracts. ''Couples today need to go into marriage with their eyes wide open to what could happen during divorce,'' she said. ''You don't get a roofer to fix your roof without a contract. A marriage is the biggest social contract you'll ever make.'' The institute also responds to questions Wendt receives from around the world about how to navigate the frequently unfamiliar and disorienting terrain of divorce. Operations Manager Sarah Emond field hundreds of phone calls, answers letters and responds to e-mail questions. Most are from either people about to marry or in the process of divorcing, she said. Executive Director Ellen Sabin used to work for a nonprofit public health organization. She said she views Wendt's efforts to promote frank, premarital discussions and contracts as a promotion of public health.  ''I think (divorce) is a very ignored social issue,'' Sabin said. ''Millions of people who are going through it are ashamed or uneducated.  Andrew Nemiroff, one of Gary Wendt's attorneys, said he knows nothing about Lorna Wendt's institute and could not comment on it.
    Despite her divorce, Lorna Wendt said she believes in marriage. She does have someone special in her life, she said, and she would consider remarrying. A prenuptial agreement doesn't have to be viewed as evidence of a lack of confidence in the marriage, she said.   ''It's really the ultimate in trust,'' Wendt said. ''It's saying, 'I love you so much. We're going to make this work.' '' The institute's Web site gives people a place to seek information while avoiding the embarrassment that many people feel about divorce, she said. Eventually it will include a mock marriage contract and items such as five or 10 ways to bring up the conversation of signing such a contract, Wendt said. ''What you and your partner or spouse do is up to you,'' she said. ''It doesn't matter to me. But I want you to have conversations about what marriage means to you emotionally, legally, spiritually and financially ...You have to be responsible for what's going on in your life."  The Institute's website is www.equalityinmarriage.com

Relaxation Techniques Help Kids Cope With Pain
Daryn Eller, CNN News- 7/3/2000

When 10-year-old Amanda Mellencamp recently awoke in the middle of the night complaining of a tummy ache, her mother Ann didn't offer her Pepto-Bismol or simply invite her to snuggle up. Instead, she made a rather unorthodox suggestion: "Why don't you practice your imagery?" she asked. So Amanda did. First she pictured a big, orange balloon inflating in her stomach and causing her stomach to hurt. Then she imagined herself drinking hot cinnamon tea to melt the balloon. As the imaginary balloon slowly disappeared, so did Amanda's pain. Twenty minutes later she was fast asleep, and the next day she felt fine.
    Amanda is one of a growing number of children who are using mind-body techniques like guided imagery to cope with physical ailments. These therapies have become increasingly popular with adults in the past few years; now researchers are examining how well they might work with kids. In fact, some experts say that kids may be even better than adults at using their imaginations to ease pain. "Adults will say, 'What do you mean there's a kitten? I don't see a kitten,'" says Susan J. Nathan, a Laguna Hills, California, psychologist who specializes in guided imagery. "Kids will jump right in and say, 'Oh yes, I see it -- and it has a white tail.' This type of play helps them relax, and we know that when people are in a relaxed state, they experience less pain." Amanda learned how to practice guided imagery and relaxation techniques as part of a University of Arizona study investigating how these therapies might relieve recurrent abdominal pain (RAP). The university recently won a $5 million grant from the National Institutes of Health to establish the nation's first research center on alternative therapies for children. The RAP study is being run jointly by the university's Children's Research Center and the Program in Integrative Medicine, headed by Dr. Andrew Weil.

The mind-body connection
RAP afflicts as many as 5 percent of all kids and is notoriously difficult to cure. About half the cases can be attributed to treatable ailments like lactose intolerance, gastroesophageal reflux (known as heartburn in adults), and constipation, says Dr. William Cochran, a pediatric gastroenterologist at the Geisinger Clinic in Danville, Pennsylvania. As for the other half, he says, it's difficult to tease out the cause. Many experts, though, believe that there are some psychological factors at work. "The cause probably has something to do with stress, which can affect the nerves connected to the intestines and cause cramping," says Dr. Thomas M. Ball, an assistant professor of clinical pediatrics at the University of Arizona and principal investigator of the study. That's one reason why researchers suspect that mind-body techniques might make a difference. Another is that guided imagery -- which can be as simple as visualizing a beautiful beach or as complex as picturing immune cells attacking cancer cells -- has already been used successfully to help people cope with various types of pain. For instance, among a group of 94 adult cancer patients, those who received imagery training reported less pain than those who didn't, according to a study published in the November 1995 issue of the journal Pain. What's more, a study in the October 1996 issue of the Journal of Developmental and Behavioral Pediatrics found that guided imagery lowered postoperative pain in children. The use of guided imagery or relaxation techniques to treat the stubborn symptoms of RAP, however, has never been studied.

Mysterious pain
Amanda became part of the University of Arizona study early this year. Her experience with RAP was fairly typical. She first suffered cramping and bloating last Thanksgiving weekend, then continued to have stomachaches once or twice a week. Several weeks later she started having pain every other day. "It really began to dig into her activities like Girl Scouts and gymnastics," says Ann Mellencamp. "She used to love to go to sleepovers, but now she's more reluctant." When a battery of tests ruled out the usual suspects, Amanda was diagnosed with RAP and referred to the researchers at the University of Arizona. During the study, the children have four sessions with a health psychologist. Half of them learn deep-breathing relaxation techniques, while the other half are schooled in guided imagery and muscle relaxation. The children are then instructed to practice the guided imagery twice a day, every day, and during times of distress. They also keep a diary of their daily occurrences of pain. "The daily practice is aimed at preventing abdominal pain, but they can also use guided imagery to cope when they get in a stressful situation and have the pain," Ball says. Exactly how it works is uncertain, he says, but it may be that stress inhibits food from moving smoothly through the digestive system, and that relaxation techniques, by relieving the stress, may ease digestion and thus ease the pain, too. Based on his own experience treating RAP, Cochran -- who sometimes refers patients to therapists who teach them relaxation techniques -- thinks the Arizona study makes a lot of sense. "It's a reasonable approach to treating RAP," he says. "I look forward to the results of the study." Since the study will continue through fall of 2001, the answers are still some time away. In the meantime, guided imagery may already be helping patients like Amanda. So far, the balloon-and-hot-tea scenario has been working pretty well for her. Her stomachaches occur less often now, and they upset her less because she knows how to cope. "Instead of crying," she says, "I'm taking care of the pain."

Sleep Disorder Clinics in Michigan
Detroit Free Press, July 4, 2000

Virtual Reality Finds a Real Place as a Medical Aid
Jim Robbins, New York Times- 7/4/2000

SEATTLE--James Pokorny sat upright in bed in his room at the University of Washington Burn Center at Harborview as a nurse prepared to unwrap his bandages. Working on a car when the fuel tank exploded, Mr. Pokorny received third-degree burns on about 42 percent of his body. Despite pain-killing drugs, Mr. Pokorny was in agonizing pain, which intensified when his bandages were changed. So doctors tried a new approach. Wearing a black plastic helmet with a computer monitor inside, headphones and a tracker that monitored the position of his finger, Mr. Pokorny entered a virtual world. Multicolored three-dimensional graphics, along with sound and tactile input created a realistic virtual kitchen, with a stove, teapots, cabinets and clouds outside a curtained window. There was also a virtual spider. The tracker on his finger allowed him to chase the spider with his hand, force it down the sink and grind it up by switching on a virtual garbage disposal. All of which, Mr. Pokorny said, made his wound care seem far less painful. You're concentrating on different things rather than your pain," he said. "The pain level went down significantly.
    Dr. Hunter Hoffman, a cognitive psychologist at the Human Interface Technology Laboratory at the University of Washington, conducted the experiment with a colleague at the university, Dr. David Patterson, a professor of rehabilitation medicine, surgery and psychology. Dr. Hoffman said that conscious attention was like a spotlight. With this therapy, he added, "we are attracting that spotlight to the virtual world and away from pain." Virtual reality, the name for the interactive artificial worlds created by computers, is finding a place in health care, especially among psychologists. It is being used for treating fear of flying or thunderstorms, helping diabetics warm their hands and mitigating the crippling memories of war.
    Although virtual reality for entertainment received much attention in the early 1990's. the systems were too expensive--nearly $200,000--for most applications. But the systems, which are now driven by desktop computers, cost as little as $20,000, making them more practical in a growing number of medical and psychological disciplines. "You're not watching something, you're in something," said Dr. David Ready, a clinical psychologist at the Atlanta Veteran's Administration Medical Center, where a virtual reality system is being used to treat post-traumatic stress disorders in combat veterans. "All you see is what's in the goggles and all you hear is what's on the headphones." This does not mean the virtual world looks extremely realistic. The one in use at Harborview is a cartoon representation of a kitchen. But nothing else is visible and the scene changes realistically as the user's head swivels, giving the patient a strong sense of being somewhere he or she is not.
    In the study by Dr. Hoffman and Dr. Patterson, published in the March issue of Pain, a British medical journal, patients with skin grafts at the burn treatment center either played Nintendo or wore the kitchen virtual reality gear during the painful removal of surgical staples. One patient thought of his pain 95 percent of the time while playing Nintendo, but just 2 percent of the time while using the virtual reality gear. The other patient went from 91 percent in video to 36 percent in virtual reality. The preliminary findings are exciting," said Dr. mark Jensen, a professor of rehabilitation medicine and a specialist in pain at the University of Washington. "I think it can be widely used for chronic pain. But it needs to be tried with a variety of painful procedures--dentistry and dialysis for example--to see how well it works for those applications."
    The capacity of virtual reality to convince the mind is also effective in the treatment of phobias. The virtual kitchen with the spider that Dr. Hoffman uses to treat pain can be adapted to treat spider phobias. For more than 20 years, for instance, Joanne Cartwright suffered a debilitation fear of spiders. "I washed my truck every night before I went to work in case there were webs," she said. "I put all my clothes in plastic bags and taped duct tape around my doors so spiders couldn't get in. I thought I was going to have a mental breakdown. I wasn't living." Twelve sessions of spider virtual-reality treatment with Dr. Albert Carlin, a professor of behavioral psychology at the University of Washington, greatly eased her fear. "I'm amazed," she said, "because I am doing all this stuff I could never do--camping, hunting and hiking."
    Dr. Brenda Wiederhold, the director of the Center for Advanced Multimedia Psychotherapy at the California School of Professional Psychology, uses a virtual reality system to treat several kinds of panic and phobia disorders, including fear of flying. For the treatment at the school, which in real airplane seats wearing the head-mounted displays that surround them with realistic airplane interiors. The seats vibrate as the sound of engines is heard. As the sweat and rapidly beating heart that accompany panic start to increase, the patient is taught to stop the cascade of negative thoughts by yelling "stop" or by using a distraction technique like counting back from 1,000 by 7. Dr. Wiederhold also teaches clients how to rein in their anxiety by taking deep slow breaths to slow pounding hearts and reduce the sweating.
    Dr. Larry Hodges, an associate professor of computing at the Georgia Tech College of Computing, developed the fear-of-flying equipment that Dr. Wiederhold uses, and he has created virtual reality software that allows people to experience thunderstorms. He is also working on a virtual audience for people who fear public speaking. Using a system Dr. Hodges build, Dr. Barbara Rothbaum, an associate professor of psychiatry and director of the trauma and anxiety recovery program at the Emory School of Medicine in Atlanta, conducted a study of what is known as exposure therapy to treat fear of heights. The 10 people who received the treatment all reported a substantial reduction in their fear of heights, while there was no improvement among the 7 in a control group, according to the study results published in the American Journal of Psychiatry in 1995.
    The systems have also proven useful in treating the lasting shock caused by violent wartime experiences. For the last year and a half, Dr. Ready of Atlanta has been treating those with post-traumatic stress syndrome with virtual reality on an experimental basis. The work, so far, is promising in reducing the severity of flashbacks, he said. Veterans with stress syndrome put on virtual reality goggles and re-experience violent wartime events, complete with helicopter rides, gunfire and jungle walks. During the therapy, Dr. Ready progressively exposes the patient to realistic simulations of the situations that affected them. "I'm like a movie director," Dr. Ready said. "If a guy says, 'I was walking through the jungle and mortars came in,' I bring in the mortars with the computer." During all 12 of the 90-minute sessions, the experiences increase in intensity until the patients begin to experience the stress with increased heart rates and sweating. As the clients begin to react, Dr. Ready talks them through it. "During a flashback, a veteran has both feet in Vietnam," Dr. Ready said. "With virtual-reality therapy, he has one foot in Vietnam and one foot in the laboratory. And he's got a buddy there talking to him." So far, Dr. Ready has seen the severity of the symptoms reduced by a third in all 10 people who have completed the training, on par with other therapies. Early indications are that the effects last for months.
    The realistic nature of virtual reality, the feeling of being there, is also helping to increase the effectiveness of traditional kinds of biofeedback. Dr. Alan T. Pope, a researcher at the Langley NASA Research Center in Langley, Va., has devised a virtual reality system to treat restricted blood flow to the hands, a problem that afflicts people with diabetes and Raynaud's disease. The patient wears sensors on the hand and arm that provide data to a computer, which converts the information into a simulation of the blood-vessel network. The three-dimensional blood vessel graphics are displayed on a computer monitor in a pair of goggles that he patient wears. "They see these blood vessels expand and contract in keeping with the temperature at their fingertips and their pulse," Dr. Pope said. Because the subjects are immersed in virtual worlds and their conscious attention is solely devoted to hand-warming, the tasks becomes easier. Hand monitoring is one of the most widely used types of biofeedback for cold extremities, anxiety, migraine and headaches. And now, the approach with virtual reality gear is being tested at the Eastern Virginia Medical School and the University of Virginia for symptoms of diabetes. "If you provide a compelling and engaging display," Dr. Pope said, "it's more motivating." And, he added, the patients stay with it.

Mindfulness Medication: Modern Medicine Turns to an Ancient Practice
Ephrat Livni, ABC News- 7/5/2000

NEW YORK--Many moons ago, a wandering Nepalese prince sat under a tree, vowing not to rise until he attained enlightenment. After a long night of deep meditation, Siddhartha Gautama, better known as Buddha, saw the light and declared that suffering is subjective, and can be reduced through self-awareness. Today, 2500 years later, a growing number of American doctors and healthcare workers are teaching people who are ill how to apply Buddha’s epiphany to their lives. In hospitals, businesses and community centers around the country, meditation is increasingly being offered as a method of stress reduction, and to help patients better cope with the physical pain and mental strain associated with many medical conditions, including heart disease and HIV infection. Recent research shows meditation’s soothing effects can be detected in arterial walls and in the brain. Once considered outside the mainstream, today more insurers are paying for meditation, both as a form of medication and as preventive medicine.

Learning to 'Disidentify'
"Meditation is the act of disidentifying from inner thought flow and concentrating on calming and healing," explains Robert Thurman, Ph.D., a professor of Indo-Tibetan Buddhist Studies at Columbia University in New York and the first American to become a Tibetan Buddhist monk. Through meditation, doctors help patients detach from their pain and anxieties and cultivate a connection between the mind and the body, he says. While there are many kinds of meditation, the mindfulness approach, used widely in hospitals around the country, focuses primarily on breathing. Practices vary, but the basic idea involves sitting comfortably, with eyes closed, spine straight and attention focused on breathing. Practitioners aim to maintain a detached, calm awareness of their thoughts and sensations. Through mindfulness, experts say, meditators learn to pay attention to the present and cultivate clarity of mind, equanimity and wisdom.

Minor Mindfulness Miracles
All of which may sound very abstract. Unless, points out Jeff Brantley, Ph.D, Director of the Mindfulness-based Stress Reduction (MBSR) Program at the Duke Center for Integrative Medicine in Durham, N.C., you are a patient who is suffering. "We had one patient, a 40-year-old woman with metastatic breast cancer who was enrolled in the 8-week MBSR program. At her exit interview she said that before the course began 5 minutes wouldn’t go by without her worrying about what would become of her and her young family and now, after the class, she can concentrate on other things for more than hour at a time, even days," Brantley says, calling the results "a minor miracle."
    The Duke program is one of at least 70 such mind-body based courses modeled on the University of Massachusetts Medical School’s Stress Reduction Clinic, in Worcester, Mass., created in 1979 by Dr. Jon Kabat-Zinn. Taught mainly in hospitals around the country, mindfulness training is typically run as an 8-week-long outpatient program to complement other medical treatments. The aim, according to a website dedicated to Mindfulness-based Stress Reduction, is to assist people in taking better care of themselves "through a gentle but rigorous daily discipline of meditation and relaxation." Doctors refer patients to mindfulness programs for any number of diseases and disorders, including heart disease, anxiety and panic, job or family stress, chronic pain, cancer, HIV infection, AIDS, headaches, sleep disturbances, type A behavior, high blood pressure, fatigue and skin disorders. In keeping with the growing interest in preventative medicine, some insurance companies, such as Blue Cross/Blue Shield in Massachusetts and a number of insurers in what Thurman calls "the more enlightened states like Oregon and California," are now paying for all or part of these programs.

Research for Coverage
While the National Institutes of Health says it is too soon to quantify the medical benefits of meditation, Anita Greene, spokeswoman for the Institute’s Complementary and Alternative Medicine division, concedes, "It is a therapy worthy of further scientific investigation to refute or support the health claims being made." In fact, in 1999, the NIH granted Maharishi University of Management in Fairfield, Iowa, $8 million during a five-year period to study the effects of meditation in African Americans with cardiovascular diseases. Researchers at Maharishi say that relaxing and reducing stress through transcendental meditation may reduce artery blockage and the risk of heart attack and stroke, according to a study released in the March issue of the American Heart Association’s journal Stroke (see related story).
    Another recent pilot study, published in the May 15 issue of NeuroReport, by Sara Lazar, Ph.D., a Harvard research fellow in psychology at Massachusetts General Hospital, in Boston, suggests meditation activates specific regions of the brain that may influence heart and breathing rates. Using a brain imaging technique known as functional magnetic resonance imaging, or fMRI, Lazar measured blood flow changes in experienced meditators. "What we found were striking changes. There was significant decrease in blood flow and activity in specific areas of the brain," says the study’s senior author Dr. Herbert Benson, president of the Mind/Body Medical Institute at Beth Israel Deaconess Medical Center in Boston, Mass. The usual, fight-or-flight brain response liberates adrenalin and is stressful to the body, he explains, but during meditation the brain acts to quiet the body through concentrated breathing or word repetition, evoking a relaxation response that minimizes the harmful effects of stress. "It does away with the whole separation of mind and body and gives further proof to insurers that [meditation] is cost effective," he says. Ultimately, Benson predicts, medicine will be akin to a three-legged stool, leaning on pharmaceuticals, surgeries and procedures, and self-care, which includes, meditation, nutrition, exercise and health management.

A Tool for Transformation
But, Thurman points out, meditation is for more than just health benefits: It is a tool for seeking inner transformation. Meditation practices in the health field are secular, however. "We get everyone from born-again Christians to avowed atheists. We tell people we are not trying to make anyone into anything," Duke’s Brantley reassures. No matter what their religious persuasion, he says, patients find an increased awareness and appreciation of their lives. Registered nurse Shirley Gilloti, a San Rafael, Calif., health educator and mindfulness training teacher agrees, "I tell people to try to bring more mindfulness to saying their rosary if that’s what they do."

California Rethinks Drug War Strategy: Initiative Would Put Emphasis on Rehab
V. Dion Haynes, Chicago Tribune- 7/5/2000

LOS ANGELES -- Opening a new front in the war on drugs, a citizens group is pushing a California ballot initiative that aims to emphasize rehabilitation over punishment by diverting all non-violent drug users in the justice system into treatment programs.   The initiative, which recently qualified for the November ballot, would set up programs similar to an experiment launched in Arizona in 1996 that, according to a recent study, kept a vast majority of offenders off drugs and saved the state millions of dollars. And New York state's chief judge last month ordered all courts there to begin phasing in treatment programs by 2003, saying it would save the state $500 million a year.
    California's proposal comes at a time of intense debate over the war on drugs. Campaigns to legalize medicinal marijuana, an issue approved in California before passing in states including Arizona, Alaska, Washington, Maine and Hawaii, and to decriminalize illicit drugs appear to be gaining momentum. At the same time, a growing chorus has criticized efforts by the federal government and states to get tough on substance abuse. So-called three-strikes laws, mandatory prison terms and other efforts, these critics say, have resulted in overcrowded prisons and more repeat crimes from drug offenders whose problems with abuse were never treated during their incarceration.
    Amid the criticism, a movement has emerged among judges and prosecutors across the country to establish drug courts aimed at placing substance abusers under court-supervised treatment as a condition of probation. Though more than 450 drug courts have opened in the past five years, experts say they reach only about 3 percent of arrested drug users who qualify to be handled by this court system. Under the California initiative, the Substance Abuse and Crime Prevention Act of 2000, the state would allocate $60 million in 2001 and $120 million annually after that to treat 35,000 users, the majority of first- and second-time non-violent drug offenders in the state. A Field opinion poll released last week showed that 64 percent of those surveyed support the initiative and 20 percent oppose it, with the remainder undecided. Among opponents are victims groups, a prison guards union, judges, prosecutors and treatment specialists involved in drug court programs. They say the initiative would weaken anti-drug laws, reduce penalties for "date rape" drugs by diverting people possessing such a substance into treatment programs and overwhelm the court system. A state legislative analysis of the initiative indicates that the proposal, subtracting the $120 million cost for treatment, would save $200 million annually in prison and jail costs. Moreover, the program would save as much as $575 million in one-time costs by eliminating construction of a planned new prison. "This is a response to the overwhelming failure of the war on drugs," said Dave Fratello, spokesman for California Campaign for New Drug Policies, the group sponsoring the initiative. "So many people are going to jail and prison, very few are getting treatment," added Fratello, who was involved in the group behind California's medical marijuana initiative in 1996. "To focus more on treatment would really turn a lot of lives around and save a lot of money."
    But while supporting the concept of treatment, officials involved in drug courts assert that the initiative has several weaknesses. Unlike their programs, drug court officials say, the proposed law would not provide strong court supervision or funding for urine testing and would not mandate certain qualifications for those offering the treatment. "I believe in accountable treatment. This [initiative] is a drug decriminalization bill," said Helen Harberts, chief probation officer in the Butte County drug court in northern California, one of 101 such programs in the state. "As a policy matter, this will eviscerate our drug court," said Harberts, a member of Californians United Against Drug Abuse, which opposes the initiative. "Yes, [the initiative] would improve the capacity. But the quality of treatment would be diminished," Harberts said.
    Launched in 1989 by judges in Florida's Dade County, drug courts now operate in 508 jurisdictions in all 50 states, according to the Justice Department's Drug Courts Program Office. Under drug courts, judges, prosecutors, defense lawyers and probation departments agree to send certain drug offenders into treatment programs rather than to jail. In addition to staying clean, participants in many programs are required to obtain high school or GED certification, receive job training, perform community service and pay court fees.
    The program took off in 1994, when Congress began allocating money to help establish new drug courts. Over six years, federal funding has grown to $40 million from $12 million. Drug courts have succeeded in keeping offenders off drugs and out of trouble, according to a recent study by the National Center on Addiction and Substance Abuse at Columbia University. The recidivism rate for offenders in about 25 drug courts studied around the country ranged from 2 percent to 28 percent, compared to 50 percent for offenders who are incarcerated. "In the criminal justice system, people have been ordered to go into treatment for years but they never go," said Marilyn Roberts, director of the Justice Department's Drug Courts Program Office. "In drug courts, court supervision is the important link," she added. "The critical factor is the offenders are closely supervised and held accountable."
    Results in Arizona, thus far the only state mandating treatment for all non-violent offenders, are much the same. Arizona voters approved the treatment law, Proposition 200, in 1996. The law allocates $4 million a year for treatment. A 1999 study by the state Supreme Court showed the law saved $2.5 million in prison costs and that 77 percent of participants remained drug free a year after graduating from the program. The study attributed the success to the quality of treatment programs, which are customized to address offenders' individual needs. "We are having phenomenal results, we've very pleased with it," said Norman Helber, chief probation officer for Maricopa County Adult Probation Department, based in Phoenix.
    "Our drug courts are thriving and healthy," Helber said. "As I read the California initiative, I think it would do the same thing." The California initiative, whose supporters include several state legislators and city council members, is similar to the Arizona law in concept. But proponents say it would be tougher in limiting participants to offenders who face only drug possession or use charges--not those who committed other crimes while under the influence. Unlike Arizona, offenders in the California program would be subject to probation revocation if they are found using drugs while in treatment, proponents said. Only first- and second-time drug offenders would qualify for the program. Third-time offenders would go to jail. Drug dealers would not be eligible. Participants who complete the program would be able to petition a judge to dismiss their charges or have the arrest cleared from their record. "Now people with substance abuse problems are warehoused in jail. Afterward they come out and experience no intervention and treatment," said Dan Macallair, vice president of the Justice Policy Institute, a San Francisco-based organization promoting effective approaches in the nation's criminal justice system. "The public does not benefit from that," he said. "This initiative is a step toward addressing the root problem."

Yale Grad with Schizophrenia Committed to Mental Institution
Jim Fitzgerald, Associated Press, 7/5/2000

WHITE PLAINS, N.Y.-- A former Yale law professor whose battle against schizophrenia had been widely celebrated as a success story, was committed to a mental institution Wednesday, two years after he killed his pregnant fiancee. State Supreme Court Justice Daniel Angiolillo ruled that Michael Laudor, 37, ''has a dangerous mental disorder'' and should be sent to a secure treatment center for the next six months. The order can be extended when his case is reviewed. In May, Laudor was found not responsible for the death of his fiancee, Caroline Costello, 37. She was found stabbed to death June 17, 1998, in the apartment she shared with Laudor in Hastings-on-Hudson. Three psychiatrists determined Laudor killed Costello because he thought she was ''a nonhuman impostor'' conspiring to hospitalize him for torture, experimentation and death. Prosecutors conceded that with the doctors' statements, no jury would convict Laudor of murder.
    Laudor had graduated from and taught at Yale Law School despite his schizophrenia. He sold book and movie rights to his story and was considered a role model for victims who control schizophrenia through medication. But after the death of his father in 1997, Laudor stopped taking his medication, apparently believing it to be part of a conspiracy against him. His condition worsened and his fiancee, his mother and his doctor arranged a visit from a crisis intervention team. That impending visit, according to one psychiatric report, precipitated the killing. Prosecutor Robert Prisco said Wednesday that reports from two doctors at the psychiatric center where Laudor has spent the past two years argued for continued treatment. One said Laudor was ''dogged by symptoms'' even after being medicated. The other said Laudor ''continues to receive messages through songs.''
    The drugs, which can be administered only gradually, were not yet at a therapeutic level for Laudor, his attorney, Andrew Rubin, said at the hearing Wednesday. Rubin didn't contest the commitment order but said his client's symptoms might wane once the therapeutic level is reached. Outside court, Laudor's brother Daniel said the commitment was appropriate. ''We all hope that care and medication will lead to whatever improvements are possible,'' he said.