Noteworthy News Articles on Mental Health Topics, September 17-23, 2000

Speak, Memory
Peter Landesman, New York Times Magazine- 9/17/2000

One day last September, Samantha Fishkin sat in the hushed suite of offices of the Brain Injury Day Treatment Program, a satellite program at N.Y.Y.'s Rusk Institute of Rehabilitation Medicine. The program occupies the third floor of a nondescript building in the no man's land east of Murray Hill, between First Avenue and the East River, an area that is dominated by hospital buildings, steam plants and the incessant drone of the F.D.R. Drive. Samantha, 21, sat against the wall, wearing a lost smile, her hands curled into her body. Eleven other patients milled about her. One had almost drowned. Another had been shot through the eye. As for Samantha, she had rocketed through the passenger window of a pickup truck driven by her fiancé, hitting the concrete face-first at 70 miles per hour. All of these people should have been dead, but they were alive, in various and deceptive states of unwell. Samantha's hair had been shorn for surgery several times and had grown in unevenly. She had 15 reconstructive operations and did not have an original bone in her face. Her nose, eye sockets and chin had been refashioned out of three ribs; her cheeks and jaw were constructed from 37 titanium plates.
    "Hi, I'm Samantha," she said in greeting. "A car hit me in the head." Her voice was a high-pitched whine, a parody of a young child's. "The driver was my boyfriend, Travis. He's in college. He calls me every day. I'm brain-dead." It was a joke, and it was a warning, an act of both self-deprecation and bitterness. She didn't want to be here in New York at all. She would rather have been in Oregon, beginning her senior year at Lewis & Clark College. She would rather have been at her parents' home in Connecticut. She would rather have been in Texas, which is where she last saw the original incarnation of herself. But that first Samantha died on August 24, 1998, the morning of the accident. The new one could barely remember the old one.
    One typically comes to New York to live, to triumph or to fail in the attempt--or just to see what the fuss is all about. Samantha came to New York to navigate herself back from exile. She arrived in the city in August, moving into a place just around the corner from Rusk. It was a small studio apartment she shared with her mother, Linda, who had left her home in Connecticut to help Samantha fight her amnesia. Their apartment had the cobbled-together feel of a college dorm room, cluttered with mismatched things bought cheaply. This generic environment seemed eerily appropriate for Samantha; nothing was really hers anymore.
    "The pre-accident Samantha was scared of people," she told me. She spoke with the tone of someone repeating secondhand gossip. Samantha was sitting on a couch in her apartment, below photographs of her own art--painted figures and a sculptured flag--all with bold and vibrant brushwork. "The after-accident Samantha babbles away, tells anyone whatever they want to know," Samantha said. Her hands uncurled, her whine now replaced by a seasoned, throaty voice laced with sickly sex appeal. A new personality seemed to emerge. She described imagined sexual liaisons and drug binges that very likely had never occurred. "I feel free," she said groggily, "like I can finally be me." Then she began to cry.
    "How could Travis do this to me?" she lamented. Did she recognize herself? She looked off in the distance. "Not really. I'm out of control. I don't even know what day it is." She lapsed into the little-girl voice again. "I don't know when the day is over. I can't remember yesterday." Later that day, Samantha's father came to visit. He asked her what his name was. "Kevin?" she guessed. "George?" "Joel," her father replied dejectedly.
    Last fall, Samantha wasn't struggling to recover the nuances of her former self. She was striving simply to regain a modicum of competence--to get through the day without forgetting to get out of bed, to eat, go to the bathroom, wash. To not get lost between the closet and the kitchen. To remember her father's name, and her own. Here is what Samantha knew to be true: A little more than a year before, in Connecticut, her boyfriend, Travis, asked her father for permission to marry her. Permission granted, the newly engaged couple drove to Texas, delivered the news to Travis's grandmother in Fort Worth and set off for Denver to tell his mother. They were college juniors. Outside of Fort Worth, they stopped to make out in the parking lot of a 7-Eleven. Samantha said she was itchy to drive. "But I always drive," Travis told her. "Don't you know the rules?" he headed west on I-20.
    Her memory tape ended there. To her, the rest was just a story. Fifteen miles passed. Maybe twenty. Samantha unbuckled her seat belt to change CD's. At the same time, a truck merged into their lane from the right, cutting them off. Travis swerved. Their pickup truck flipped down a concrete embankment. Samantha shot headlong through the passenger window. When she hit the concrete, the force of impact on her face was so concentrated that she didn’t have so much as a scratch below her neck.
    Samantha was flown into Harris Methodist hospital in Fort Worth by helicopter. Dr. Thomas S. Ellis, a staff neurosurgeon, found himself looking at the worst head injury he had ever seen. "She was basically scalped," he said. "Her skull was shattered like an eggshell. The entire front half of her skull and upper half of her face were exploded outward. Her frontal lobes were on the gurney." After more than 12 hours of surgery, doctors told the family that Samantha would probably die, and that if she didn't, she would most likely remain in a vegetative state for the rest of her life. But her parents refused to give up. Their daughter had been stubborn in life, an artist with a ferocious temperament. They expected her to fight her way back to consciousness as she had fought them throughout her adolescence. They moved into a nearby motel and played classical music in her hospital room around the clock. For several weeks she remained unresponsive. Then one day in October 1998, Samantha's father noticed her conducting the music with her feet.
    She was transferred to a hospital near her parents' Connecticut home. Defying every prognosis, Samantha was soon speaking, hearing and seeing out of her left eye. She was unsteady, but she was walking. Though Samantha had made extraordinary progress physically, the doctors in Connecticut had no idea how to help her mentally. Samantha's frontal lobes had been destroyed, leaving her with profound memory loss. Her short-term memory had been obliterated; she couldn't remember what had happened to her five minutes ago. Trying to piece together the fragments of her life, Samantha could offer herself no clues. For answers, her family decided, she would have to go to New York.
    One of the Rusk program's goals was to help close the gap that had opened between Samantha's pre-accident personality and the personality that surfaced afterward. Before the accident, her mother, Linda, recalled, Samantha was like "a porcupine, prickly." She was razor tongued and darkly comic, a gifted artist who had scored 1,500 on her SAT's. She wasn't particularly interested in her femininity and would wear the same pair of overalls for days. But the new Samantha was savagely disinhibited. Breaks in her neural web had erased all sense of social convention. She couldn’t control her desire to talk, her anger, her sexual urges. Her behavior became excruciatingly inappropriate. She talked incessantly about sex. She exploded at people who got in her way on the sidewalk. She repeatedly asked her father and brother to make love to her. When she wasn't swearing and swaggering, she slipped into a maudlin, infantile state. There is a debate among brain-injury experts about the extent to which a victim's new personality is not purely a consequence of biological violence but also a manifestation of hidden traits and desires. Whatever the case, Samantha had become a caricature of her former self.
    The doctors at Rusk were eager to take on Samantha's case. The program's controversial founder, Dr. Yehuda Ben-Yishay, ignores even the most recent neurological advances in favor of a behavioralist approach. "The scientific community's work is irrelevant to what goes on here," he said in his office. "The rehabilitation of head-injured individuals is a clinical, creative endeavor. Can you really say how this blob of Jell-O creates all this wonderful feeling and thinking? No. The question really is, Can you reconstruct Humpty Dumpty after he has been shattered to pieces?"
    Subjected to the program's tightly scripted exercises in behavior modification and social skills, Samantha's damaged brain would, it was hoped, slowly catch up. It would figure out how to adapt to the blockages and the destruction inside her brain. If it didn't, then there was nothing more to be done. Samantha's progress at first was minimal. Ben-Yishay described her as "a grotesque, unable to interact with another person." Throughout the early fall, she remained a concoction of rebellious fantasies, wishful thinking and scraps of information she picked up from overheard conversations and snatches of TV dialogue. She wasn't just forgetting; she was forgetting to forget. She insisted that she was fine, that nothing had happened to her brain.
    "She has a devastating problem," Said Dr. David Biderman, a resident psychologist at Rusk. "If she can't understand she has memory loss, she can't even begin to work on it." On the other hand, awareness of her injury was potentially perilous. "When you find out how bad things are, you are thrown into a state of despair. She has to find a meaning in life and a reason to go on." Spaces in the Rusk program were limited and in great demand. Samantha had a year at Rusk to learn to cope with her new self and trick her brain into doing some version of what it did before. If she didn't show clear signs of benefiting from the therapy, the program's directors would not ask her back. She would be left on her own to contend with her dissolved self.
    One cold November morning, three Rusk therapists sat among the patients, whose job every morning was to restate their biggest problems. The tone was congenial and supportive, not unlike a 12-step group: "I cannot weave together information"; "I say whatever I think without thinking of other people." The walls were lined with posters, one for each patient. Below each name was listed the patient's deficits--disinhibition, adynamia, discontinuity--and strategies to combat them: take notes, repeat everything I hear, monitor my sense of calm. One woman opened a ledger notebook. It was a written record of her life; when she wanted to access her memory, she just opened it.
    Samantha had started keeping lists of her own. She carefully documented the events of her life, making new associations between her jumbled external and interior worlds. One day, Samantha said something innocuous to another female patient. Out of the blue, the girl slapped Samantha in the face. Four months before, Samantha would have struck back, but her brain had begun to locate her powers of empathy. She held back. The program was drilling into Samantha's brain a single message: your injury is forever; you will never be the same--deal with it. The point was to simulate conscious thought until it became rote. Someplace inside, she began to get it. Outwardly, though, Samantha still insisted that she was fine, that she didn't belong here.
    "I don't like New York," Samantha said after her daily session at Rusk. She sat in a taxi slaloming down Park Avenue. Outside, a cold winter rain fell in sheets. For her, New York was not a metropolis of millions but a village a quarter-mile long. The village's main street consisted of the dull, functional stretch of First Avenue between her apartment and Rusk, and the population was limited to the residents of Rusk's program, the staff and the anonymous faces she passed along the way. She didn't want any piece of what lay outside. She stared meekly out the taxi's windows at the chaos of upended umbrellas and puddle-leapers and the crisscrossing reflections of traffic lights. "There's too many people, too much stuff going on, too much noise," she said. Her walk had become a slow plod. Every day was the same: wake, shower, eat, do therapy at Rusk, come home, listen to music, talk to Travis, sleep. "I like knowing what comes next," she said. "I like knowing that in the morning I will take a shower and then go to Rusk. I don't want the unexpected anymore."
    Rather than shop around the city, Samantha ordered everything through catalogs. For her, the aisles of Macy's were mayhem. And they were depressing. Samantha had gained 50 pounds since regaining consciousness; the sight of herself in clothing-store mirrors sent her into despair. She preferred to stay at home and at the hospital, a willing prisoner. For her, New York offered not thrilling possibility but a hermetically sealed chamber of self-improvement. She focused on making lists, carefully recording the details of each day. Slowly, a dry wit began to emerge; she began punctuating her thoughts with a gentle rolling of the eyes.
    Meanwhile, her family thought this newly emerging Samantha might be an improvement over the original. Her brother said she had been "difficult and strong-willed, a real brat." Asked if her personality had changed for the better, Samantha's father, Joel, replied: "Yes, absolutely. Now she asks questions about people because she really wants to know." Samantha had been a brooding adolescent, not especially respectful to her parents. She had experimented with drugs and alcohol. Now, Ben-Yishay and others constantly reminded her to sit up straight, look a person in the eye and modulate her voice. If she couldn't be a normal, respectful person, she could at least simulate one.
    Some time after Thanksgiving, Samantha signed a release absolving Travis from any responsibility for her injuries. A week later, she received a letter. It was from Travis, breaking off the engagement. He said the woman he had proposed to no longer existed and that he had to get on with his life. The letter's timing was cruel and so was its message. But it was also accurate. "I don't have any friends left," Samantha said after putting down the letter in her cluttered apartment. In a chair opposite her sat her mother, Samantha's last contact besides her father to the world of affection. "My friends don't talk to me because they're scared of me," Samantha said. "They think I'm in my bed drooling." The last remnants of her old life had fallen away. Indeed, Travis would graduate from college without her, and so would her friends, while she stayed on a far edge of New York City learning to be a human being again. During the next few months, she steeped in grief over the death of her past.
    Samantha's despair was exactly what Rusk was waiting for. Until now, she had been at the mercy of her belief that it was just a matter of time before she returned to her old life. Now, her ego broken down, she was humbled by the revelation that she had essentially died the moment she hit that concrete embankment. Finally aware of her isolation, she gained a measure of calm. She began to connect past with present because she remained still enough to absorb the events of her day. If memory is an act of awareness and attention, then memory began to come to her. "I used to dream every night," Samantha said one day in December. For the first time since her accident, her voice was measured, adult, soulful. "Magnificent sci-fi, beautiful dreams," she said. "No more. I'm blank as a stone. I'd like to find the piece of my brain that let me dream."
    In April, Samantha made an announcement. After nearly two years of hollow nights, she had dreamed. She didn't remember what the dream was about, but she marveled at its other-worldly quality. She also started wearing dresses and makeup. And she was playing the piano again. It was something she had stopped doing when she went to college, paralyzed by stage fright. Her brain injury may have wiped out her social cues, but it also made her immune to nervousness. She started to spend a half-hour every night at her apartment window, listening to the sounds of the New York streets; the noise now comforted rather than irritated her. She tried to call up images and events from her past. She didn't remember much, but she treated the mental journeying as a training exercise. "I like that I can still think," she said. "I like to practice."
    At Rusk, the staff marveled over Samantha's progress. "She now has more of a clue about what she was doing early in life," Biderman said. "Is it accurate? It doesn't matter. Samantha has to reconstruct a personal life for herself. She's washed out what was unproductive and offensive. In Samantha's case, it's not a tune-up. It's really a reconstruction." In June Biderman made a surprise announcement of his own. He informed Samantha that she was ready for the world--sort of. She was given a volunteer job at the Central Park Zoo reading to out-of-school children on Friday afternoons. She would be accompanied by a Rusk staff member in case she got tired or lost control. Samantha reacted with nervous disbelief. "You sure I'm ready?" she asked. Remembering her radical disinhibition, her swearing and salty stories, she wondered aloud if she should be near children. She wondered if she felt safe with herself. "I never got along well with children," she said. "I always hated them. They smelled weird."
    Biderman and Ben-Yishay nudged her on. The zoo issued her an official khaki and green uniform. "People look at me like I mean something, like I'm important," she said. Dozens of young children sat around her in rapt attention. Her self-consciousness eliminated by her injury, Samantha had become a flamboyant performer. She read a pop-up book about bugs called "The Very Hungry Caterpillar," and she was a triumph. "I respond to children better," she explained afterward. "I can use my little kid voice and they like that. I’m cute, and I'm kind of floppy. They don't feel like they have to defend themselves against me." She paused. Something else struck her. "I've been feeling like a moocher," she said soberly. "I always had a job. Now my job is rehabilitation. My mother has to live with me. I wasn't doing much. Now I feel like I'm helping."
    The effect of her new job on her relationship with her corner of the city was instantaneous. Granted, she could not traverse Manhattan by herself, but at least she could navigate the walk to Rusk. "I have an issue with 36th Street," she said haughtily. "There are bums there now. They say things you don't want to hear." She lunched by herself at the Townhouse diner on Second Avenue. A friend of the family took her to see "Fosse." After the show, she went home not by taxi but by rickshaw, through the riot of lights of Times Square, through the serenity of Central Park, waving along the way, alone. "Everyone was waving to me," she said, marveling. As a passenger, she didn't have to worry about stumbling or getting lost or someone's shocking her from the periphery. "I could see people finally," she said.
    Late on a hot afternoon in July, Samantha slipped into a new dress, blow-dried her hair and put on her makeup. A year before, all of this would have been unthinkable. Even before her accident, she never cared what she looked like. But over the last year, the "auxiliary brains" around her told her again and again to consider her appearance, that it was important, that it would make her feel important. Now she understood. That evening, the Rusk program was having a party to celebrate the end of the rehab cycle. Patients invited friends and family and were to deliver short testimonials on where they stood that night along the road of rehabilitation. Their preparation for the party was really the point, to make them walk and rewalk their brains through the corridors of logic and repetition and the anticipation of social grace. Before the speeches, there was a potluck dinner at Rusk's main center on 34th Street at the East River.
    Samantha walked to the dinner through the murky twilight with her parents and some friends of the family, including her old piano teacher. The room was crowded and noisy; the air, bittersweet. No one, of course, really wanted to be there. While there was some cause for celebration at the patients' progress, mostly there was cause to remember those unexpected phone calls that made this get-together necessary. "If you asked me about Samantha five months ago, I'd say I was skeptical," Ben-Yishay said, holding a plate of food. Samantha had been talking hopefully of returning to college and of making art again. But Ben-Yishay said he wanted her back for another year of therapy. It would be some time, he said, before she could ever hope to live independently.
    Samantha stood at the dessert table, near the cobbler and pies she had baked for the occasion but couldn't eat herself--something about the ingredients didn't combine well with her medications. She grimaced. "I'm not dependable. I still don't know how I'm going to act in an hour." Then her expression turned exuberant. "But I am reborn," she said. Before the accident, she was doing too many drugs and drinking too much. "It's a second chance. I care about myself and what I do now. I've become a woman." On the streets now, things were different. She still couldn't wander by herself. "But when I walk down the street to Rusk, I see people in wheelchairs," she said. "I used to get annoyed, they were too slow." She sliced the air with her arm. "Outta my way. Now I say, 'Been there; done that; good luck.'"
    Toward the end of the dinner, people began to notice that someone was playing a piano. The notes were soft, but liquid and fast, and slowly, table by table, the room quieted down and turned toward the music. There sat Samantha, her back turned to the room, playing. What she was playing had no name. It was something she had written herself years ago, it turned out, in high school. Whatever it was, it was assured and pleasant. And when she stopped, the entire room--patients, family and Rusk staff alike--erupted in applause. Samantha stood, clutching her sheet music to her chest and gave a deep bow.

Doctors' Group to Document What It Calls Abuses by HMOs
Associated Press, 9/18/2000

NEW LONDON, Conn. (AP) A New London County doctors' group says it wants to improve the health care system by documenting what it calls abuses by HMOs. The New London County Medical Association claims HMOs are interfering with the practice of medicine by refusing to pay for legitimate medical expenses, for valid hospital admissions and for other important services. Arthur Schuman, executive director of the association, says the group will share complaints it receives with state Attorney General Richard Blumenthal, who filed a class action lawsuit earlier this month against four managed-care insurers.
    In his lawsuit, Blumenthal accuses HMOs of trying to boost profits by sacrificing patient care. He is the first attorney general in the county to take that step. ''We all know these abuses occur,'' said Phyllis Darby, assistant executive director of the New London County Medical Association. ''Doctors see it every day in their practices. The problem is that it is not organized at the moment. We want to put it in an organized fashion.'' Dr. Mithlesh Govil, president of the association and a New London oncologist, said the campaign to create a record of alleged HMO abuses will begin over the next week or two. ''Reform is overdue,'' Govil said. ''They (HMOs) grind down the physicians and they grind down the patients.''
    The four HMOs named in Blumenthal's lawsuit are Physician Health Services Inc., Anthem Blue Cross & Blue Shield of Connecticut, CIGNA Health Care of Connecticut, and Oxford Health Plan. The HMOs say Blumenthal did not review their standards, practices and quality-care initiatives before filing the lawsuit. They insist that a courtroom is not the best place to address problems in the health care system. Maria Shydlo, a spokeswoman for Oxford, says HMOs must control costs to hold down premiums, which sometimes means challenging medical procedures that are not appropriate. ''We give our doctors a lot of latitude and work with them to make sure the patient gets appropriate care in a timely fashion,'' Shydlo said. ''We track customer service issues and how quickly we respond, and we feel it is quite timely.''
    Dr. John P. Bigos, a New London doctor who treats lung disease, suspected in July that one of his patients, Arthur ''Hap'' Murano of Old Saybrook, had internal bleeding. Bigos wanted Murano admitted to the hospital. But the insurer, Physician Health Services of Connecticut, said Murano could be treated in the doctor's office and wanted Murano to recover at home. The HMO refused to approve hospital admission even after a second doctor agreed that Murano needed to be hospitalized. Bigos eventually had Murano admitted to the hospital, where doctors determined that Murano had a bleeding ulcer and lungs damaged by asbestos. Murano was treated for two days and released.
    PHS has refused to pay for the admission and for many tests that were conducted. Murano's doctors are fighting the decision. ''These doctors did the right thing,'' Murano said. ''But it is still incredible to me that I was sick enough to be in a hospital, and I had two specialists agree on that, and still they say they ain't going to pay. Well, I'm not going to pay, I'll tell you that.''

How Fathers Can Help Daughters in the Body-Image Battle
Abby Ellin, New York Times- 9/18/2000

Joe Kelly was mad. Very mad. His eyes darkened as he held up a copy of Seventeen magazine and waved it in front of the crowd. "Look at this cover model, Rachel Leigh Cook," he said, referring to the lissome 20-year old actress who has appeared in such teenage-centric movies as "She's All That." "If Rachel Leigh Cook showed up here, you'd see she's an anomaly by how she looks. She has no pores." He clicked on a little button and magazines popped up on a screen: YM, People, the Sports Illustrated issue with the United States women's soccer team on the cover. "Sports Illustrated does this great story on female athletes, but then you open it up," Mr. Kelly continued, flipping to the article and flashing it around, "and it's not about the game. It's about their looks, boyfriends and exercise habits." He shook his head. The group nodded emphatically. "To me, the tragedy is the vast number of girls who feel lousy about their bodies," Mr. Kelly concluded. "It's our job to stop it."
    If the message sounds familiar (blasting the news media for causing women's eating and body-image disorders), it is. But Mr. Kelly is an example of how the messenger has changed. Mr. Kelly, a roundish, bearded 45-year-old with a smiley face tie, is the founder and executive director of Dads and Daughters. His year-old organization is not only dedicated to enhancing fathers' relationships with their daughters but also, more specifically, to girls' relationships with their bodies. On this night, Mr. Kelly was speaking to six women and ten men at the Renfrew Center in Midtown Manhattan, one of nine treatment centers it runs for girls with eating disorders and psychological disturbances nationwide. The night's topic was "Raising Healthy, Confident Daughters in Today's World," and it focused on fathers helping their daughters deal with eating disorders.
    Traditionally, men have not been heralded for their sensitivity to women's body issues. But in therapy sessions, lectures and support groups around the United States, more men are trying to help their wives, girlfriends, sisters and daughters. Experts say such help may be critical to the women who need it. At the Hartford Hospital in Connecticut, Dr. Margo Maine, consulting director of eating disorders and the author of "Father Hunger: Fathers, Daughters and Food" (Gurze Books, 1991), says more men attend the support groups she runs. More men also show up at private therapy sessions to "understand what an eating disorder is all about," she said.
    Dr. Nancy Logue, a clinical psychologist and director of the Renfrew Center in Yardley, Pa., and an online consultant for Renfrew's Web site, said she receives hundreds of inquires from men concerned about a girlfriend, wife or daughter. So does Pam Guthrie, the administrative director at the American Anorexia Bulimia Association in New York. "A lot of fathers are much more supportive than mothers," she said. "Women get such pressure to look good, and a lot of mothers unwittingly pass those pressures on to their daughters."
    Mr. Kelly, a former journalist who along with his wife, Nancy Grufver, founded New Moon, a magazine for girls and edited by girls 8 to 14, became concerned with those issues while raising his twin daughters, who are now 19. Neither has had an eating disorder, but they have had their fair share of concern about physical appearance, leading Mr. Kelly to address how important a father is to a young woman's self-esteem. According to a 1997 study from the National Center for Education Statistics, girls with active, involved fathers are more successful in school and attend college more frequently. A study by the Melpomene Institute in St. Paul, Minn., which examines the relationship between sports and women's self-esteem, found that girls whose fathers encourage athletics are less likely to date or marry abusive partners. They are also less likely to have eating disorders, especially if the father is around during his daughters teenage years, a 1996 study from Loyola University of Chicago reported.
    Mr. Kelly started Dads and Daughters when a friend mentioned that his 9-year-old daughter had asked him if she looked fat. "We came to the idea that it was significant that she asked him and not her mother," Mr. Kelly said. "A girl is gong to want to know how to get the attention of members of the opposite sex. The first one she knows is Dad. How he responds to her and reflects back to her is incredibly important." His non-profit organization, based in Duluth, Minn., now has 1,600 members nationwide. Mr. Kelly lectures around the country and emails members a newsletter filled with tips, resources and calls to action. They have taken aim at Maidenform Bras for an ad featuring a naked woman and the headline "Inner beauty only goes so far." ("Outrageous!" Mr. Kelly exclaimed.) We ran the ad about two-and-a-half years ago," said Manette Scheininger, a senior vice president for marketing for Maidenform in Bayonne, N.J. "Our position is that we empower women to look better and feel better about themselves, and this ad was a return to that."
    They've protested jewelry.com for an ad that pictured a woman wearing only jewelry and a bra. She was embracing a man, and the accompanied slogan said, "Trust in us, a food processor won't get you there." Mr. Kelly and members of the group wrote letters to the chief executive, who apologized and pulled the ad. "Fathers need to know how important they are to their daughters," said Dr. Maine, whose latest book is "Body Wars: Making Peace With Women's Bodies" (Gurze Books, 2000). "they often feel that girls only need their moms, especially during adolescence. Yet this is the time when eating disorders are most likely to develop, so men must find positive ways to relate to their daughters."
    There's good reason for men to be concerned about their daughters. Studies from the American Anorexia Bulimia Association have found that one third of 12 to 13-year-old girls are actively trying to lose weight by dieting, vomiting, using laxatives or taking diet pills; the single largest group of high school students considering or attempting suicide are girls who think they're overweight. The Council on Size and Weight Discrimination reported in 1996 that half of all American women are dieting at any one time.
    But some feel that is another reason for men's increased interest in body issues. Bombarded with media messages about their own physical appearances, they can now empathize with women's experiences. "Boys are starting to have the same images as women foisted upon them at early ages," Dr. Maine said. Members of Dads and Daughters, like Bob Stien, a businessman in Upper Nyack, N.Y., and the father of two girls 9 and 13, are trying hard not to replicate their own fathers' behavior, claiming that they were often absent, unavailable or simply unable to connect with their daughters. When Mr. Stien's daughters make negative comments about their hair or bodies, he compliments them, a strategy taught in Dads and Daughters.
    Jeffrey Leder, another member, has had similar encounters with his 13-year-old daughter, who is 5 feet 8 and thinks she's too skinny. "She'd like to have curves, and she imagines her nose is big," said Mr. Leder, who owns a marketing design firm in New York. "I try to help her not judge herself against the prevailing criteria of how she's supposed to be. I tell her all this is meaningless, that it's created by people who are trying to move product."

Colorado in Court Over Mental Care
Howard Pankratz, Denver Post- 9/19/2000

The state should pay a $1.7 million fine and its top human services officials should live in homeless shelters until Colorado takes better care of the chronically mentally ill, a lawyer argued Monday. Opening a scheduled five-day contempt-of-court hearing in Denver, lawyer Kathleen Mullen repeated her claim that the state has ignored a 1999 judicial order mandating improved care. As a result, Marva Hammons, executive director of Colorado's Department of Human Services, should "go to a shelter every night until there is compliance," Mullen said.
    "I don't mean to be mean," Mullen said. "(But) there has been little systematic effort to comply with the court's order. I don't want her placed in jail. But I ask that Mrs. Hammons or her administrators get in better touch with these people." Mullen represents about 1,600 of Denver's chronically mentally ill. She says the state has failed to get the mentally ill into group homes and other housing, keep track of the mentally ill and provide enough staffing - all required by Denver District Judge Morris Hoffman in an Oct. 20 ruling.
    But Wade Livingston, the assistant attorney general representing Hammons, said the state has poured millions of dollars into helping Denver's mentally ill and is in compliance with Hoffman's orders. The state has spent more than $30 million since 1994, officials have said. "We have seen outcomes we expected," Livingston told the judge Monday. "There are fewer hospitalizations, incarcerations" and more of the mentally ill holding jobs. "We have dramatically increased services," he said. He said that although available housing wasn't fully occupied in December 1999-- a situation caused, in part, by people who didn't want to be uprooted during the holiday season-- the housing is now completely full. As far as case managers and service teams, he said the required goals are being met.  The chronically mentally ill first sued the state and Denver in 1981, claiming their needs were being ignored by government agencies.
    Four years later, in a 43-page ruling, a Denver judge found that lack of state funding, as well as misdirected priorities by the city of Denver, had left thousands of Denver's mentally ill without adequate treatment and virtually abandoned. Nine years after that, in 1994, a settlement was reached and plans crafted to provide services for the mentally ill. Judge Hoffman has since dealt with ongoing allegations that the city and state were dragging their feet in implementing the plan. But Mullen said Denver had complied with the settlement by December 1998. She claimed, however, that the state had not. And in March, she said Hammons should be forced to live in a homeless shelter until the state comes into compliance.
    An angry Hoffman ordered the contempt hearing after Mullen said the state was gravely deficient in upholding its end of the settlement and ignoring the judge's explicit orders. Specifically, the state hadn't designed a "comprehensive plan to identify, track" and place on a priority housing list members of the 1,600 member class, the judge said. He said that instead of submitting the plan he ordered, the state gave him a two-page document that "did nothing more than parrot" back to him his conclusions in his Oct. 20, 1999, order. Hoffman ordered that during this week's hearing the state show why it should not be held in contempt for, among other things, failing to fill group homes and congregate apartments with the mentally ill by Dec. 15, 1999, and failing to design a comprehensive plan to identify and track the mentally ill. The $1.7 million request for punitive damages is based on a $5,000a-day fine figured from Dec. 15.

Insanity Plea Hearing Closed to Safeguard Man's Rights
Sam Skolnik, Seattle Post Intelligencer- 9/19/2000

A judge closed hearings to determine whether a Snoqualmie murder defendant is fit to stand trial yesterday, ruling that a public airing of the evidence would "totally jeopardize" the man's constitutional rights. Lawyers for Dayva Cross, who is charged with three murder counts and faces a possible death sentence, are using an insanity defense.  They claim mental illness caused Cross to attack his family with a knife in March 1999. His wife and two of her teenage daughters were killed.  The lawyers have also requested that the competency hearings in King County Superior Court be held secretly, for fear that public and press exposure to testimony on Cross' mental fitness would taint the jury pool. Judge Joan DuBuque ruled Friday that the record of initial closed competency hearings, held Sept. 7 and 8, would continue to be kept from public view.

Yesterday, news media representatives attempted to open the rest of the hearings, which should finish today.  Robert Mitchell, an attorney for the Seattle Post-Intelligencer, argued that competency hearings should be closed only in "exceptional cases" -- and then only in the least secretive manner. An attorney for The Seattle Times also testified in support of opening the hearing. DuBuque wasn't convinced. Cross, 40, has been charged with three counts of aggravated murder, and one count of kidnapping, involving his youngest step-daughter, who eventually escaped that day and called the police.

MIT Case Causes Repercussions Throughout Nation
Maria F. Durand, ABC News- 9/19/2000

In September 1997, Massachusetts Institute of Technology freshman Scott Krueger was found unconscious in the basement of a campus fraternity house with a blood alcohol level of .4. He died three days later, never emerging from a coma. Last week, after years of criticism from Scott’s parents for not taking responsibility for their son’s death, the prestigious university paid the family $6 million and admitted that "inadequate" alcohol and housing policies were partly to blame for the tragedy.
    Many are calling the admission a major turning point in how colleges and universities deal with alcohol on campus.
"This is a very important event," says Joel Epstein, a staff attorney for the Higher Education Center for Alcohol and Other Drug Prevention. "Increasingly, we are seeing a growing number of cases where courts, judges, lawyers and parents are saying this is absolutely outrageous we didn’t know that there was this level of drinking — that it was this dangerous," Epstein said.
    A recent survey of college students by the Harvard School of Public Health found 22.7 percent of the college student population engaged in frequent binge drinking in 1999, up from 20.9 percent in 1997. Binge drinking was defined as a man who drank five or more drinks, and a woman who drank four, in the three weeks before the survey.

Addressing Alcoholism
Some higher education experts say that despite initially denying responsibility, MIT’s example will do a lot to convince schools that they need to address alcoholism and binge drinking in their schools. "Some presidents don’t want to respond because it gives school bad press," says Helen Stubbs, a spokeswoman for the Higher Education Center, which is funded by the U.S. Department of Education.
    Last year, the center released a report on various approaches for curbing student substance abuse. The report titled "Be Vocal, Be Visible, Be Visionary," included a list of 13 suggestions for school presidents to follow. The authors of the report, which included six college presidents, proposed that school presidents open discussions about alcohol and other drug prevention among students, faculty and the community.
    That’s what is happening in New Hampshire, where a state commission has started looking at ways to make radical changes at the way students view drinking. "We can no longer say it is not our fault, not our responsibility," says Tom Horgan, executive director of the New Hampshire College and University Council. "It has a lot to do with us. There has to be a systematic attempt to changing the culture." The council, a group made up of university administrators from all 13 public and private schools in New Hampshire, is coming up with strategies to decrease drinking on campus. In a meeting last week, school officials met with law enforcement representatives, landlords, bar owners, to discuss strategies for responding to the problem. "This isn’t just a school problem we need to engage with the community to come up with the solutions." Horgan said.

Schools Cracking Down
And while student alcohol use remains high, there’s strong evidence that schools are cracking down. A recent survey by the Chronicle of Higher Education found that alcohol-related arrests on college campuses surged 24.3 percent in 1998, the largest jump in seven years. The increase was partly attributed to tougher enforcement.
    At MIT, all freshmen will be required to live in university dorms starting in 2002 and the school is moving toward more supervision of Greek houses by residence officials and police. That is a far cry from the attitude that began in the 1960s, when schools washed their hands of the responsibility of taking care of students in schools. "For 30 years, the college campus has been the de facto drinking zone, better than Bourbon Street or Amsterdam," says Peter Lake, a law professor at Stetson University of Law in St. Petersburg, Fla., who has followed the MIT and other similar cases.
    During and before the 1950s, colleges operating under the concept of loco parentis, became the caretakers to college age kids when parents were not around. But after the student movement of the 1960s, students asserted many of their adult rights by marching on campuses and going to war. This translated into an attitude that schools had no legal responsibilities Now schools are assuming liability. "What you see is a shift, … schools now function a lot like businesses do, they sponsor activities and courts see that," Lake said.
    Some see the change in public opinion much the same as attitude changes toward drinking and driving and the use of seat belts in cars. "Parents have much greater expectations of what the colleges’ role should be," says Lake. "Universities are very smart organizations. They have responded very quickly and have begun to manage the risks."

Home Visits Not Preventing Abuse
Lindsey Tanner, Associated Press- 9/20/2000

CHICAGO-- Regular visits by nurses to the homes of low-income, unmarried teen-age mothers may not be as effective at preventing child abuse as previously thought, new research suggests. The visits had little effect in homes where the mothers were routinely threatened or beaten by their partners -- and such domestic violence was present in one-fifth of the homes studied.    
    The report's authors initially studied home visits in Elmira, N.Y., more than 20 years ago, and those studies contributed to the development of similar experiments in other cities. While disappointing to social welfare activists who considered the Elmira program evidence of a promising solution to a troubling problem, the results may not necessarily apply to other programs, the authors said. Elmira is a semirural community in upstate New York and the participants were high-risk women who may have experienced more domestic violence than women in a more heterogenous population, the authors said in Wednesday's Journal of the American Medical Association. Still, they said their findings may help others develop more successful home-visit programs.     
    Researchers examined data on 324 Elmira mothers and their children who took part in the initial study between 1978 and 1980. A 15-year follow-up, previously reported, showed that women who received regular counseling-oriented visits from nurses during their pregnancies and first two years of their children's lives had reported substantially fewer instances of child maltreatment than women who had no visits.
    In their new analysis of the data, the authors found that nearly half of the women -- 48 percent -- reported some form of domestic violence during the follow-up, and the benefits of the home visits in preventing child abuse decreased as the frequency of domestic violence increased. The authors theorized that violent men in the battered women's lives might have also abused their children. They also suggested that batterings may have compromised the mothers' caregiving capacity. An editorial in the same periodical called the results significant given the increasing popularity of home-visit programs prompted in part by the Elmira experiment. The number of children served by home visits nationwide more than doubled in the 1990s, to at least 550,000 last year.

Wayne County Leads State in Number of Domestic Violence Victims
Detroit Free Press, 9/20/2000

FLINT, Mich. (AP) -- A Michigan State Police official expressed skepticism toward statistics showing a two-thirds decline in the number of domestic violence victims in Wayne County from 1998 to 1999. The state Uniform Crime Report listed 4,983 victims of domestic violence in Michigan's largest county in 1999, compared with more than 10,000 in 1998. The number of Wayne County deaths attributed to domestic violence fell from 21 in 1998 to two last year, the report showed.
    Amy Alderman, a state police crime analyst, told The Flint Journal in a report Tuesday that she suspected not all Wayne County municipalities reported their crime statistics. "It is correct what they report, but my very strong suspicion (says) it wouldn't drop that much. We're always at the mercy of what gets reported," Alderman said.
    Genesee County had 4,649 domestic violence victims in 1999, ranking just behind Wayne County but down from 5,052 in 1998. The county encompassing Flint also had four deaths related to domestic violence last year, more than any other county. A Genesee County activist said the statistics there, in contrast to Wayne County's, reflected more willingness to report domestic violence. "It truly is an epidemic," said Zoanne Saab, program director for Domestic Violence and Sexual Assault Services at the YWCA in Flint. "The reporting is much higher than ever before. People are more aware of the problem and the ripple effect it has in the community."
    Assistant Genesee County Prosecutor Daniel Stamos said his office handled 127 cases in which people were specifically charged with domestic violence. More serious charges also were filed in some cases, depending on the circumstances, he said. "Obviously it's no secret that there's a lot of violent crime in the county," Stamos said. "Domestic violence is a problem. If you come up here on the second floor where they issue PPOs (personal protection orders), they are lined up."

California Governor Signs Mental Health Services Bill
Miguel Bustillo, Los Angeles Times- 9/20/2000

SACRAMENTO--Multiple measures to improve treatment and care of the disabled and mentally ill were signed into law by Gov. Gray Davis on Tuesday, but the Democratic governor also vetoed some bills supported by mental health advocates. Perhaps most significant was Davis' support of legislation by Assemblyman Darrell Steinberg (D-Sacramento) that will expand funding for a community mental health outreach program created by lawmakers a year ago. The program, now operating in Los Angeles, Stanislaus and Sacramento counties, provides treatment to 900 severely mentally ill people. The bill, AB 2034, would allow other counties with independent public health programs to become eligible for funding. It was supported by dozens of health care, poverty and religious organizations and Davis had already placed money for it in the state budget. "We wanted to take it from a pilot program in a few counties to throughout the state," said Rusty Selix, director of the Mental Health Assn. in California, which sponsored the bill.
    Related bills garnering Davis' signature included a measure by Assemblyman Edward Vincent (D-Inglewood), to allow marriage and family therapy interns to provide mental health treatment services under supervision from more experienced superiors. The bill, AB 2161, allows the interns to obtain mental health patients' records. In addition, Davis signed bills by Assemblywoman Dion Aroner (D-Berkeley) to provide medical equipment under the Medi-Cal program for low-income parents of disabled children, and to allow community mental health centers to tap additional sources of state financing.
    But Davis vetoed some bills considered important by advocates for the mentally ill. They included a measure by Steinberg that would have required the state to publish on the Internet citations against nursing homes caring for severely mentally ill people. The bill, AB 1969, also would have required the Department of Mental Health to study ways to improve care of patients in such facilities. In his veto message, Davis said existing law already requires such a study.
    Davis refused to sign SB 1451 by Sen. Liz Figueroa (D-Fremont), which would have granted college graduates entering mental health care professions a break on repaying their student loans if they agreed to work in poor areas. California, Davis said in his veto message, has a greater need for primary care physicians and other health care workers in low-income areas.
    Davis also vetoed a bill directed against domestic violence. Legislation would have extended the time that a transitional housing program for victims of domestic violence could have provided services from 18 months to 24 months. Davis said in his veto message that the bill, while well intentioned, would cost too much, and indicated he would be open to extending services to some victims.

Is the Marketing Of Prescription Medicine Leading to
Overpriced, Overprescribed Drugs?
Melissa Schorr, ABC News- 9/20/2000

BOSTON— You can’t escape the television ads promising a cure for whatever ails ya: Paxil for the socially anxious. Xenical for the overweight. Claritin for the eternally stuffed up. And Propecia for the follicle-challenged. According to a new report, these ubiquitous commercials hawking a variety of prescription drugs to consumers have been wildly effective, helping drive the rise in sales of these medications. While pharmaceutical manufacturers say these ads are simply providing potential patients valuable medical information, insurance companies and some doctors believe the ads are creating an inappropriate demand for new, costlier and often unnecessary drugs.

Popular Drugs Heavily Advertised
In the report, released today by the National Institute for Health Care Management Foundation, a health care policy group based in Washington. D.C., researchers found an association between the advertising of drugs and their sales: 25 of the most heavily advertised drugs accounted for 40 percent of the rise in spending on drugs last year. The government and the Blue Cross/Blue Shield insurance company support the institute. Schering-Plough, manufacturers of the popular allergy medicine Claritin, for example, spent $185 million on ads in 1998, and saw a 20 percent rise in sales the following year, from $2.1 billion in 1998 to $2.6 billion in 1999, the report says. "Advertising is one piece of the puzzle why prescription drug sales are going up," says Steven Findlay,the institute’s research and policy director. "The fear here is whether this is driving people to get more expensive medicines they may not really need."
    Direct drug marketing to consumers has been controversial since the Food and Drug Administration relaxed rules in 1997 allowing the practice, ushering in an era of billboard, TV, magazine, and radio ads hawking the new "glam" drugs. High-profile spokesmen such as Joan Lunden for Claritin; Lauren Hutton for Premarin, a popular hormone replacement therapy, and Bob Dole for Viagra, the drug for "erectile dysfunction" famously promote the products. In 1995, before the relaxed rules, spending on mass media advertising was $375 million according to the report. After, ad spending rose from $1.3 billion in 1998 to $1.8 billion in 1999, while spending on prescription drugs rose correspondingly, from $93.4 billion to $111.1 billion. In that time, the report found, more consumers were visiting their doctors to ask for the marketed drugs and more prescriptions had been written for them. The findings are not surprising to some experts, seeing the increased sales as proof that advertising works.  "I would expect that the biggest profits in Hollywood came from the most advertised movies of 1999," says Tom Getzen, a professor of health insurance at Temple University in Philadelphia. "Drugs ought to be pretty much the same."

Rising Costs a Concern
But as the two presidential candidates battle over their competing plans to provide prescription drugs coverage for seniors, the projected rise in spending on drugs — $250 billion by the year 2005, the report estimates — could make such reimbursement extremely costly. "Higher drug costs from advertising could lead to a Medicare drug benefit which is unaffordable, no matter which plan is adopted," says Dr. Fred Hom, an internist and chairman of the pharmacy and therapeutics committee for Kaiser Permanente, a California HMO.
    Advertising costs may also be spurring an increase in drug prices, which then gets passed along to consumers and insurers. The price of a prescription rose 10 percent in 1999, the report says, partially because of the use of expensive new drugs, but also because of a rise in the price of drugs itself. Groups like Rx Health Value, a coalition of big business and non-profit HMOs including Kaiser Permanente, General Motors and the AFL-CIO and representing 83 million members, are striking back against the high drug prices they see being driven up by costly advertisements encouraging the use of these pricy drugs. The group has already called for stricter television ads, and will lobby doctors and Congress on whether cheaper drugs may be equally as effective. To cut cost, some managed care organizations remove heavily-marketed drugs from their formularies.
    Jim Carlson, assistant director of pharmacy administration at Group Health Cooperative in Seattle, Washington, says his group has specifically chosen to only cover medications that spend less on ads, such as Allegra rather than Claritin. Allegra spent $42 million last year, a third of what was spent promoting Claritin. But drug companies say prescription drugs are expensive not from advertising but because it costs $500 million to bring a new drug through the pipeline, and the companies need to make up for price controls set by other countries.

Ads Aid Consumers
Drug firms also defend the high amounts of advertising money being funneled towards consumers, saying that they educate people about diseases and encourage them to consult with their doctors. "Consumers are really hungry for health care information," says Jackie Cottrell, a spokeswoman for Pharmaceutical Research and Manufacturers of America, an industry group. "Patients want more information on the treatment options available to them." The insurance companies are complaining about the advertising expenditures because they don’t want to pay for the pricier drugs, Cottrell adds. "They want a "don’t tell, don’t ask" policy," she says. "If you don’t tell patients about these treatments, then they can’t ask for them." She cites a 1998 study done by Prevention magazine that found the ads prompted an estimated 21 million people to talk to their doctors about a medical condition they’d never mentioned before. Currently, the FDA requires that ads do four key things: provide an 800-number or a Web site consumers can call or visit, refer patients to a magazine ad for more information, and recommend a physician’s advice.

Doctors Disagree
But doctors say the ads are inducing inappropriate demand for the drugs — usually, the newest, most expensive ones and do not sufficiently address side effects. "The decision to allow direct to consumer advertising was a mistake," argues Bradford Kirkman-Liff, a professor of health policy at Arizona State University. "It put physicians in a difficult position of having to argue with their patients about the appropriateness of prescription drugs." Dr. Brian Strom, a professor of pharmacology at the University of Pennsylvania in Philadelphia, says the increased demand for these new drugs raises the chance of adverse reactions. "Physicians should be prescribing the oldest, best understood, cheapest and narrowest spectrum drug," he says, "These are exactly the opposite of that."
    The ads were initially approved with the goal of informing patients with a treatable illness that a new therapy had become available, explains Dr. Raymond Woosley, chairman of the pharmacology department at Georgetown University. "Instead," he says, "the drugs promote the brand name of the drugs, often over other products that are available with or without a prescription." "Health care is not a consumer good that should be advertised like pancakes," argues Dr. Alan Hillman, also of the University of Pennsylvania. "It’s just too complicated. Health care education must be performed by professionals — doctors, nurses — not by a professional spokesman who quickly mentions possible side effects under his breath." But others say the doctor-as-only-expert attitude is outdated. "It is too paternalistic to rely solely on the physician to provide information," says Dr. Richard Jackson of the Joslin Clinic in Boston. "I feel bringing information, of whatever form, directly to the patient, is essential."

Teen Court Give Youth Offenders Chance to be Sentenced by Peers
Detroit Free Press, 9/21/2000

LANSING, Mich. (AP) -- After three middle school students climbed atop a Lansing elementary school and broke out several lights, they were ordered to write letters of apology, attend counseling and pay for the damage. The sentence wasn't handed down by an adult judge, but by a new Teen Court. The program debuted Wednesday as part of a national trend to offer first-time youth offenders who commit minor crimes a chance to be sentenced by their peers -- and keep their records clean. Three area middle school students, ages 11, 12 and 13, were first up after damaging the lights at Kendon Elementary School in August. "They get a second chance," said Lori Gamet, whose nephew was among those sentenced Wednesday morning. "I hope they understand what they've been given here."
    Lansing's Teen Court is among about 675 across the country, the majority created during the last five years, according to the National Youth Court Center in Lexington, Ky. "There's a lot of movement in communities to become more involved in solving their problems locally and getting active citizen involvement," center manager Tracy Godwin told the Lansing State Journal for a story Thursday. "This is a program that does that." No national statistics exist yet on the success of Teen Courts, but a federally funded evaluation is under way, Godwin said.       
    Lansing's Teen Court was created through the efforts of Lansing Mayor David Hollister's Drug Free Youth Task Force, a group of organizations that represent areas including education, law and social services. The program puts city high school students in the jury box every month to listen to testimony and dole out punishments for misdemeanor crimes -- such as property damage -- committed by 11- to 16-year-olds. "It gives them a chance to learn lessons young," said junior Crystal Brown, one of six jurors excused from Sexton High School to decide the sentence. "We can pretty much understand them."
    To participate in Lansing's Teen Court, offenders must admit they committed the crime and their parents or guardians have to be involved and attend hearings. Jurors, supervised during the hearing by an Ingham County judge, listen to testimony and get 30 minutes to discuss the sentence. Options include community service, letters of apology and restitution. If Teen Court offenders successfully complete their sentences, the crime never goes on their record.
    Ingham County Probate Court Judge Richard Garcia said that can help prevent repeat offenses. "It gives them the sense they're not a juvenile criminal," Garcia said. "They don't have that label." Kendon Principal Minnie Wheeler-Thomas said she supports the program but prefers that offenders, including those who damaged her school, be required to perform community service. "When you do that, it helps you to remember what you did," Wheeler-Thomas said. "It has been said little kids turn out to be big criminals if something is not done."

Women Raging on Road, Too: Home, Work Stress Fuel Confrontations
Joey Ledford, Cox News Service- 9/21/2000

Not too many years ago, when somebody was so close to your back bumper that you could smell the garlic on their breath, you could almost guarantee it would be a young man. Back then, the drivers who would rip and snort their way though traffic, without regard for turn signals or leaving more than a few inches between cars, were almost always men. But times have changed. More and more women are dangerously aggressive drivers, and it is no longer unusual for a woman to take the next step from aggressive driving to road rage, committing acts of violence from behind the wheel.
    Barbara Curbow, an assistant professor of social and behavioral sciences at Johns Hopkins University in Baltimore, has looked into the driving behavior of some working women, and it's not a pretty picture. Curbow has found that when women face a demanding job in the workplace and are then confronted with the additional stress of trying to provide a good home life for their families, they often become Mad Maxine on the road. "Women are just feeling pressed by trying to fulfill both of these big roles," she said in a telephone interview.
    Curbow studied the driving habits of 218 female telecommunications workers. A majority, 56 percent, were married or living with a partner. Most, 67 percent, had more than a high school education and an even larger number, 76 percent, were parents. They averaged 42 years old and 18 years on the job. Her most shocking findings: 56.1 percent admitted they drove aggressively. A quarter confessed they "take my frustrations out from behind the wheel." Two in five admitted they yelled or gestured at other drivers. "I think there's just more anger in general in our society," Curbow said. "And I think there's a great sense of anonymity in our society." Instead of just swallowing these feelings, she contends women feel they can just let them out. Curbow said she found more correlation between home lives and road rage than job-related bad driving. "Road rage was highest for women with low home rewards and high home responsibilities," she said. It was "lowest for women with high home rewards and high home responsibilities."
    Now for some perspective. The best-known study on road rage, done by researcher Louis Mizell in 1997 for the AAA Foundation for Traffic Safety, examined 10,037 incidents classified as "road rage." Of those, only 413 involved female motorists. However, of those cases, 285 of the women used their car as a weapon and on 31 occasions, the victim was a police officer. Like men, women who engage in road rage "have used firearms, knives, baseball bats, defensive sprays and fists to settle arguments," Mizell wrote. "But the weapon of choice for most women who react aggressively to traffic disputes and traffic stops is the automobile."
    Cmdr. George Hatfield of the Cobb County, Ga., police said he sees plenty of aggressive female drivers these days, but most road ragers are still men. Hatfield said he's seeing more tickets being written to school bus drivers, who are predominately female. Women are more likely to be speeding and tailgating these days, two symptoms of aggressive driving. "We're seeing higher speeds by women that we formerly did not see," Hatfield said. Curbow said researchers need to examine the differences between offensive and defensive road rage. In other words, do women initiate conflicts or merely react to perceived slights on the highways?

Study: Walking Works on Elderly Depression
Ephrat Livni, ABC News- 9/22/2000

NEW YORK--Exercising three times a week could be more effective than medication in relieving the symptoms of major depression in elderly people and may also decrease the chances that the depression will return over time.  Researchers at Duke University Medical Center, in Durham N.C., studied 156 majorly depressed patients 50 and older and found that after 16 weeks, those who exercised showed significant improvement compared to those who either took medication alone or those who combined the therapies. In a six-month follow-up study, Duke psychologists found that depression returned in only 8 percent of the patients in the exercise group, versus 38 percent for the drug-only group and 31 percent for the drug and exercise combined group.
    Study participants in the exercise group engaged in one half-hour of brisk walking three times a week.
"The main conclusion is that maintaining an exercise program can significantly help in reducing depression," says the study’s lead researcher, Duke psychologist James Blumenthal, whose work is published in the current issue of the journal Psychosomatic Medicine. He believes this is the first study that actually looks at exercise as a treatment for depression for any age group, but says the results, "just confirm what a lot of people think exercise can do anyway."

Number One Anti-Aging Medicine
"If exercise could be put in a pill it would be the number one anti-aging medicine and the number one anti-depression medicine," agrees Dr. Robert N. Butler, President of the International Longevity Center, at Mount Sinai Medical School in New York City. "It’s also cheap, and it avoids problems such as the side-effects of medication."
Depression is prevalent for the elderly. A recent report by the National Institute of Mental Health called depression in the elderly "widespread" and "a serious public health concern." Surveys suggest more than 15 percent of the elderly population experiences depression at some point, while an additional 25 percent of elderly individuals have periods of persistent sadness that last two weeks or longer.
    Contributing to depression in the elderly are medication side effects; the onset of Alzheimer’s disease and other ailments and a sense of loss that is perhaps different from depression younger people may experience. The elderly are more subject to depression because they tend to experience more loss and they "no longer get the income of self-esteem" that comes with working, says Norman Abeles, professor of psychology at Michigan State University in East Lansing.
    Abeles, who is the former president of the American Psychological Association, called the Duke finding "interesting" and added that exercise could serve as an adjunct to the counseling often recommended for the elderly because antidepressants may adversely interact with the other medications the elderly take. "If you bring up medication, often people don’t want to take it," says Dr. Joseph Gallo, assistant professor of Family Practice and Community Medicine at the University of Pennsylvania in Philadelphia. He says that elderly patients often deny depressive symptoms, and that using exercise to treat those symptoms could be effective because exercise builds on "self-efficacy and self-confidence." But not everyone will benefit from exercise, cautions Gallo. Because depression plays a role in how people take care of themselves, he points out it’s unlikely all depressed people will be motivated to start or keep exercising. Additionally, older adults may have medical complications that prohibit them from being active. The disability can contribute to their depression, he says, but also makes movement an impossible treatment for them.
    Study leader Blumenthal says it’s still unclear how exercise affects depression. Further studies will examine whether the improvements experienced in the exercising group actually came from the social support of exercising with others. He plans to look at a home-based exercise versus group-exercise group to establish what impact the exercise is actually having.

Woodbridge the Official New Jersey Choice for Unpopular Sex Offender Prison
John P. Mcalpin, Associated Press- 9/22/2000

TRENTON, N.J.--Despite public opposition, the Whitman administration will build a new facility for sex offenders in Woodbridge, home to the state's only dedicated prison for molesters and pedophiles. The decision is based on public safety, Gov. Christie Whitman said Friday, especially since she supports the law that requires the state to confine certain offenders after they have served a criminal sentence. Woodbridge officials and residents have fought the plan in court and will continue their protest, Mayor Jim McGreevey said.
    Township lawyers obtained documents showing the state considered Woodbridge as its sole option and disregarded rules requiring it to review three sites, McGreevey said. ''As a mayor, as an elected official, it is very disheartening to see, that in America in the year 2000, a governor of a state deliberately sidestep legal requirements,'' McGreevey said. Whitman and her administrators Friday denounced such claims. Woodbridge will be home to the new facility because it is the most secure site, they said. ''The bottom line here is the safety of the public,'' Whitman said.     
    The sex offenders who will live there are those ordered by a judge to be committed for treatment. That comes after they have served prison sentences for sex crimes. ''We should find a place to house them,'' Whitman said, since the state requires that they be confined. New Jersey now houses most of its sex offenders at the Adult Diagnostic and Treatment Center in Avenel, a section of Woodbridge. Inmates already destined for the new facility are now lodged in temporary facilities in Kearney and Woodbridge. The $43 million new jail will hold 300 of these inmates, and state officials claim that will not increase the total prison population of Woodbridge. Avenel's prison population will be reduced by the same number of new inmates going to the facility, according to Corrections Department Commissioner Jack Terhune.
    When Woodbridge opposed the plan, New Jersey officials looked to Maurice River Township and even agreed to pay that town $200,000 a year while the prison is being built and $825,000 once it begins to operate. The Maurice River proposal was to put the new prison on the grounds of Bayside State Prison. In addition to Bayside, a medium-security facility housing almost 2,400 inmates, Maurice River Township is the site of Southern State Correctional Facility, a medium-security prison with about 1,650 inmates. But that location would cost taxpayers $5 million more in construction costs, officials said.
    The Avenel site offers prison administrators advantages besides security, Terhune said. ''We are very familiar with these individuals in terms of their behavior characteristics, their treatment compliance, security risk and assaultive behavior,'' Terhune said. ''It's crucial this will be a satellite to ADTC for managerial purposes for the Department of Corrections.'' While these inmates might have more personal privileges than they enjoyed while in a state prison, the new facility will be surrounded by two fences with 13 rows of razor ribbon. The perimeter will be protected with electronic detection systems and lights, officials said.
    Both Whitman and McGreevey said politics and political aspirations played no part in their positions. McGreevey, a Democrat, lost to Whitman in 1997 and again is running for governor. ''I think all the individuals involved recognize this is a matter of public policy and not a matter of politics,'' Whitman spokesman Pete McDonough said.

Boy With Mental Illness Record Not Liable in Suicide Pact
Darragh Johnson, Washington Post- 9/22/2000

A Crofton teenager who gave his girlfriend the gun she used to kill herself in October effectively assisted her suicide but is not legally responsible because of his mental health problems, a judge ruled yesterday. The 16-year-old, the first person tried under Maryland's new assisted-suicide law, "did knowingly [help] another person to commit suicide, and he knowingly provided the physical means by which another person committed suicide," Anne Arundel Circuit Judge Pamela North said, quoting from the 1999 statute drafted to protect the elderly and people with chronic diseases.
    The testimony of two psychiatrists convinced the judge that the defendant, whom The Washington Post will not identify because he is a juvenile, could not be found criminally responsible. The defendant has a history of major depression--including numerous psychiatric hospitalizations and evaluations by psychiatrists, psychologists, psychiatric nurses and social workers, said forensic neuropsychiatrist David Williamson. And last August--two months before the defendant and his girlfriend, 15-year-old Jennifer Garvey, made the suicide pact that led to her death--the defendant spent time in a psychiatric hospital under suicide watch, according to testimony yesterday.
    "He was voicing thoughts of killing himself," Williamson told the court, and the hospital considered those thoughts to be "a significant risk." They assigned a staff member to watch him constantly, and they suggested that he continue with treatment and medication after his discharge. Yet he was not medicated, Williamson told the court: "There was a disagreement between his mom and the hospital. And because his mother would not permit him to be medicated, a referral was made to Child Protective Services." Over the next month, Williamson added, the youth continued to exhibit signs of major depression, and finally, an appointment was made with a mental health professional in Annapolis. But because of a backlog in appointments, Williamson said, the defendant did not see someone before the Oct. 18 shooting.
    That day, the youth and his girlfriend stayed home from school and hung out at his house in Crofton, a community across the Anne Arundel County line from Bowie. He found the key to his stepfather's gun cabinet in his mother's jewelry box, and before the teenagers left the house that afternoon, they packed five bullets, two knives and a bag of potato chips into his backpack, according to his testimony last month. They also took a gun and walked to a storm drain off Route 3 in Crofton, where they lighted candles and talked about things that depressed them. The defendant then gave the gun to Garvey--they decided she would kill herself first because they worried she would not be strong enough to pry the gun from the defendant's hand if he died first--and walked around the corner to avoid watching her shoot herself. He later told police that he would have killed himself, too, but he could not find the gun.
    "His actions were a direct result of his major depression," Williamson said. "Major depression . . . is a brain-based illness. It's a physical abnormality. People think with their brains, and when their brains are functioning abnormally, they think abnormally. . . . This disease makes people do things they wouldn't normally do." The judge said she would reconvene the case Friday, after the defendant had undergone another evaluation at Crownsville State Hospital, which should recommend a treatment plan. He is currently being monitored electronically.
    Defense attorney Bill Davis said after the hearing that he disagreed with the judge's decision to apply the suicide law to this case. The law, he said, was intended to prosecute health care providers or family members who help terminally ill people end their lives. But North said the General Assembly had a chance to limit the scope of the legislation when it reconsidered the measure in its 2000 session. The law took effect three weeks before Garvey died.

New Study Suggests Depression Is Genetic
Detroit Free Press- 9/22/2000

Hiccups in the growth hormone pathway may herald major depression in children and adolescents at high risk for the mood disorder, new research says. Pittsburgh scientists have found that children with a strong family history of serious depression don't respond normally to a substance that spurs production of growth hormone. Although the study doesn't suggest that depressed kids won't grow properly, the researchers say, it does offer hints about the causes and deep workings of depression.
    "This is more evidence that (depression) is a genetic, biological illness," says Dr. Boris Birmaher, a psychiatrist at the University of Pittsburgh and author of the study, which appears in the latest issue of Archives of General Psychiatry. The connection should prompt schools and insurance companies to think about children who are depressed as they do those who have asthma, diabetes and other physical conditions, Birmaher says.
    Studies have shown that children in the midst of a major depression or recovering from one have a dulled response to growth hormone stimulation. No one knows why that is, experts say. Although these children have normal levels of growth hormone, depressed adults often have lower-than-expected concentrations. In the latest study, Birmaher looked for differences in growth hormone in 119 children, ages 8 to 16, 64 of whom had a family history of depression. The children received regular injections of growth hormone releasing hormone (GHRH), which makes the brain's pituitary gland produce growth hormone. They were monitored for fluctuations in their growth hormone levels. Children at high risk for major depression had, on average, a much weaker response to GHRH than those who didn't have a family history of mood problems, the researchers found. Emotional disorders on top of depression didn't seem to make the response to GHRH any worse.

Former Child Advocate Says Governor's Office Tried to Silence Her
Matthew Daly, Associated Press- 9/22/2000

HARTFORD, Conn. (AP) - Former Child Advocate Linda Pearce Prestley said Friday that high-ranking officials on Gov. John G. Rowland's staff interfered with her work so often and with such intensity that she feared she would be fired merely for doing her job. Appearing under subpoena at a legislative hearing, Prestley said Rowland's co-chief of staff, Peter Ellef, repeatedly chastised her for critical comments she made about the Department of Children and Families. At one point, Ellef warned Prestley in writing, ''Don't let it happen again.'' Another time, at a meeting at the governor's mansion in Hartford, Ellef asked her bluntly, ''Who do you think you are?'' Prestley testified. Her first thought in that ''awkward personal moment'' - which occurred just after Rowland was re-elected in 1998 - was that, ''I'm not getting invited to the inaugural ball,'' Prestley joked. She wasn't. A more serious concern was that her job was in jeopardy, Prestley said. ''I'd been put on notice,'' she said. ''I was stunned. I felt I was having to compromise my standards on the welfare of children in the state.''
    Ellef, appearing later at the same hearing, denied trying to intimidate or silence Prestley, although he acknowledged he may have overstepped his bounds in dealing with the child advocate, an independent agency created as a watchdog on behalf of children. ''While I believe my goals were correct it's obvious I pushed too hard,'' Ellef said. ''There's a fine line between interaction with the child advocate and interference. My actions sent the wrong signal and for that I apologize. It will not happen again.'' A spokesman for Rowland said Ellef has been chastised by the governor. Ellef, testifying before the legislature's judiciary committee, admitted he had a ''less than perfect'' relationship with Prestley, who is now a Superior Court judge. But Ellef blamed the rift on the fact that both were ''strong-willed people'' who did not back down from a fight.
    Prestley served as child advocate from December 1997 until March, when she accepted Rowland's appointment to the bench. Ellef and other administration officials said Rowland respects the independence of the child advocate's office, having played a key role in its creation in 1995. ''It has never been the policy of the governor's office to interfere with, direct or influence the office of child advocate,'' Ellef said. A trail of memos from Ellef to Prestley told a different story, however. The memos, copies of which were distributed at Friday's hearing, showed Ellef repeatedly expressing irritation with Prestley over comments she made in the news media. In memos and handwritten comments on the side of newspaper stories, Ellef urged Prestley not to make recommendations without cost estimates and repeatedly chastised her for failing to give the governor's office advance notice.
    By law, the child advocate is required to be independent of all state agencies charged with protecting and serving children, including DCF. Advocates say that no one - including the governor - can demand that the child advocate follow a set of rules for speaking publicly about systemic problems, even if those comments reflect badly on DCF or the administration. Prestley, who testified for nearly four hours Friday, said the legislature should clarify how - or if- the child advocate can be fired and what its relationship with the governor's office should be. ''I worried for 2 1/2 years that I'd be fired,'' she said, adding that by the nature of the job, the child advocate will inevitably say things that make the administration unhappy or even angry. No legislation came out of Friday's hearing, but lawmakers said bills related to the child advocate's office would be submitted next year.

Homes Overuse Drugs, Study Says
Lena H. Sun, Washington Post- 9/23/2000

The most comprehensive review of mentally retarded adults in the District's care has found that nearly 40 percent of those assessed are at risk because providers are overusing psychotropic drugs, improperly monitoring medication or failing to deliver routine health care. In addition, 5 percent of those reviewed had been assaulted, according to a draft report provided to The Washington Post. The city is planning to release a final report by Monday. The preliminary report by a team of consultants is the first systematic, independent assessment of those in the District's troubled system of care for the mentally retarded. City officials ordered the review in the spring after stories published in The Post last year detailed numerous instances of abuse, neglect and uninvestigated deaths among mentally retarded adults.
    From April through August, the Delmarva Foundation for Medical Care Inc. and the William H. Mercer Group sent nurses, doctors and other specialists to review the health and safety of 1,155 mentally retarded individuals. Most live in group homes in the District. "Although we knew things were bad, it's somewhat staggering to see the data laid out like this," said Kelly Bagby, managing lawyer at University Legal Services, a watchdog group charged with protecting the city's disabled population. Among the cases reviewed by the consultants was that of Curtis Suggs, a 67-year-old man who died June 30. Suggs, according to city records, was not fed properly at his group home, repeatedly developed bedsores and was forced to have his right leg amputated because of gangrene.
    More than a year ago, Mayor Anthony A. Williams (D) vowed to reform the network of agencies and providers caring for mentally retarded adults. But the key city division overseeing this population, the Mental Retardation and Developmental Disabilities Administration, has lost several senior staff members in recent months, and a federal review released last week found that the system still is plagued by basic management problems. The D.C. Council's Human Services Committee has scheduled a hearing Monday on agency management and general conditions in the group homes.
    In response to the new study, Deputy Mayor Carolyn N. Graham said she welcomed the review and pledged to "make the reforms that are necessary to make sure that [these individuals] are kept out of harm's way." She said the city would hire more case managers and is hoping to turn case management over to private contractors. The 1,155 people who were assessed represent about 80 percent of those in the District's care. City officials asked consultants to focus the review on those requiring more intensive services. The remaining 300 adults will be assessed later, Graham said.
    Among those who were reviewed, the report found:
* 36.8 percent, or 425 people, face some degree of risk of injury or illness because of their care.
* 13 percent have been injured in the past year, not including those who were assaulted.
* 48 percent are receiving psychotropic medications. Nearly two-thirds of this group had not gone through the required review and documentation to justify use of the drugs.
    Graham called the overuse of medications the "weakest dimension in the system," noting that one-third of the providers "rely on drugs to manage behavior." The city plans to offer on-site training and is setting up a "psychotropic review team"--headed by two doctors--to focus on people most at risk of over-medication. The report also found that a "significant number" of people were hepatitis B carriers but that staff members were unaware of their status and "did not practice infection control techniques." In addition, reviewers observed that providers had not documented, diagnosed or treated problems with swallowing or breathing.
    Among those identified as at risk was a 22-year-old woman who was receiving an antipsychotic drug even after her doctor ordered that the medication be stopped. The consultants also found no record that the woman had been taken for a follow-up medical exam nearly a year after a test showed she could be at increased risk for cervical cancer. Nor was there any documented follow-up after her knee was injured when she was hit by a car nine months ago. The cases of two others were so serious that reviewers alerted city officials that they should intervene immediately. Each case involved a woman who was hospitalized more than once in a short period of time for pneumonia or unexplained fractures.
    In the case of Suggs, others had warned the city that he was at risk. In the months before he died, the U.S. Department of Justice, advocates for the disabled and his court-appointed attorney repeatedly told officials that his group home in Northwest Washington was not providing the proper care for his bedsores and other problems. "If his skilled-care needs are not immediately met, his health may deteriorate to the point of being fatal," wrote his court-appointed attorney, Jennie Shamey, in a March letter to city lawyers and officials. The city began an investigation. At one point in the spring, the health department recommended that the provider, the Symbral Foundation, lose its federal funding because conditions at Suggs's group home jeopardized his health and safety. But the department rescinded that decision after the group home promised to monitor Suggs more carefully. In the weeks before he died, Suggs was hospitalized twice for breathing difficulties, and each time, he had new bedsores and was poorly nourished and dehydrated, according to family attorney Harvey Williams, who reviewed Suggs's hospital records.
    The Justice Department also had warned the city about another man in its care, Major Brewster. He died Aug. 23 after suffering a seizure on his way from his residential group home to a day program. Brewster, 47, was taken to D.C. General Hospital, where he was found to have internal bleeding, according to his brother, Warren Brewster. Graham said she could not comment on either case because the medical examiner had not yet determined the causes of death.