Noteworthy News Articles on Mental Health Topics, October 16-24, 2001

Study Shows Hypnosis, Relaxation Techniques Buoy Immune System
AScribe News, 10/16/2001

COLUMBUS, Ohio -- Researchers at Ohio State University have determined that hypnosis and related relaxation techniques can actually prevent the weakening of the immune response that often follows periods of acute stress. A new study suggests that hypnosis may even slightly enhance the immune status in some people compared with similar individuals who don't use these interventions. If true, the findings could have important health implications for patients facing surgeries.
    The research, reported in the Journal of Consulting and Clinical Psychology, is the latest to test whether people can protect themselves from immune-system changes that normally accompany increased stress. Lead author Janice Kiecolt-Glaser described using hypnosis in this research as something like "hitting a reset button" for the participants in the study. "We're really talking about being able to shut out a lot of distracting thoughts. And it varies according to how anxious a person is," said Kiecolt-Glaser, a professor of psychology and psychiatry at Ohio State University. "Our goal was to really get people to focus on the task at hand."

Study: Targeted Mental Training Helps Kids with Dyslexia
Lauran Neergaard, Associated Press- 10/16/2001

WASHINGTON -- Do genes determine your brain's abilities, or can you retrain the brain to overcome inherited problems, such as helping a learning-impaired child to read? Neuroscientist Michael Merzenich has proved that special training, targeting specific brain regions, can help some children with dyslexia and other language-related disabilities to learn. Sophisticated neural imaging shows the retraining, using computerized educational games, leads to physical changes in the brain.
    If it works for dyslexia, Merzenich reasons, why not for more profound neurological disorders like autism or schizophrenia? His theory: Such disorders aren't simply inherited illnesses. Instead, they're inherited brain weaknesses that turn into full-blown disorders only when the ever-changing brain essentially gets stuck in the wrong gear - and that might be possible to reverse. "There's a real prospect of understanding these conditions through understanding the brain as an operational machine that in a sense creates its own capacities," explains Merzenich, of the University of California, San Francisco.
    It sounds provocative. But as Merzenich discussed the latest research at a National Institutes of Health meeting last week, neuroscientists said recent years have brought widespread agreement that the brain's "plasticity" - continual changes that let us learn new things every day - sometimes veers out of control, causing developmental disorders once attributed solely to bad genes. The challenge now is to understand normal learning well enough to interfere when plasticity goes bad. Merzenich calls it "raising a brain."
    Think of the brain as an incredibly malleable computer. At birth, much of the hardware isn't hooked up and little software is running. But the brain physically changes as it learns, and each change enables new learning and more changes - constant evolution customized to experience. Take vision. Newborns see very little. Day by day, messages beamed from the eyes to a region in the back of the brain literally hook up neural vision circuitry until babies can see normally. But studies of monkeys show patching over one eye makes the brain rewire itself to see only through the eye without the patch. "It's a use-it-or-lose-it game during development," says Harvard Medical School's Carla Shatz.
    Change isn't limited to childhood. Other scientists have painstakingly counted how many new brain cells grow in adult rats - very few if they're kept in plain boring cages but lots if they learn to use exercise wheels. In humans, brain-scanning MRI machines show regions involved in playing music, for example, grow and become more intricately wired as musicians practice. But a genetic flaw can knock the whole cycle off kilter. Consider: Some people with dyslexia have problems reading not because of eye problems but because their brains don't properly process sounds, such as the difference between "duh" and "buh," that link to words.
    Merzenich's laboratory created computerized educational games to retrain sound-processing brain regions. The sounds may be drawn out until a child learns to recognize them and then gradually sped up to normal. Put children in MRI machines after about 60 hours of training, and the auditory cortex looks more normal. Tests show the children learn significantly better, too, Merzenich said. Merzenich co-founded a California company that now sells the retraining games, called Fast ForWord, to schools and speech therapists.
    More intriguing are severe disorders like autism or schizophrenia. Clearly genes alone don't determine who gets those diseases, because 15 percent of identical twins of autism patients escape the disorder, as do half of identical twins of schizophrenics. Merzenich thinks people who inherit a predisposition to those diseases actually get them when brain plasticity runs amok. How? He hasn't proved it yet, but his autism theory is that a brain region important for social development, the amygdala, gets bombarded with signals that it can't keep up with, and thus proper development is stymied. It's like a car getting stuck in the mud - the genetic predisposition - and revving the engine - the brain struggling to learn - just digs it in deeper. Redirect the stalled amygdala and maybe autism can be lessened if not prevented, he says.

Domestic Violence Restraining Order Is Reason to Restrict Gun Rights
Doug Simpson, Associated Press- 10/17/2001

NEW ORLEANS -- The government can restrict a person's Second Amendment right to bear arms when that person is subject to a domestic violence court order, a federal appeals court ruled. The 5th U.S. Circuit Court of Appeals on Tuesday overturned a district judge's decision that Timothy Emerson was wrongly prosecuted for buying a pistol while under a temporary restraining order meant to protect his wife and child. The appeals court sent the case back to Texas for trial. But in its ruling, the three-judge panel also took a step into a long-fought debate over the intent of the Second Amendment of the Constitution.
    The Second Amendment reads: ''A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.'' Gun-control advocates argue the wording should be taken literally to mean that only members of a ''well-regulated militia'' have the right to bear arms. Advocates for gun ownership say the amendment should be interpreted to mean almost all Americans have the right to own a gun.
    The appeals court wrote that the Second Amendment preserves Americans' ''right to keep and bear arms whether or not they are a member of a select militia or performing active military service or training.'' However, the court said, the restraining order against Emerson was sufficient ''to support the deprivation ... of the defendant's Second Amendment rights.''
    Although the Second Amendment protects an individual's right to bear arms, ''that does not mean that those rights may never be made subject to any limited, narrowly tailored ... exceptions or restrictions,'' 5th Circuit Judge William Garwood wrote for the panel. The court's ruling said the restrictions on Emerson's gun ownership were valid for as long as the restraining order was valid. ''Legally, it's a huge victory in the quest to prove that the Second Amendment is indeed an individual right,'' said David Guinn, Emerson's attorney. ''More importantly for Dr. Emerson, it's a very, very sad day. The consequences of fighting unsuccessfully with the federal government are usually pretty harsh.'' Guinn said he would request a hearing before the entire appeals court and might ask that the case be heard by the U.S. Supreme Court.
    The Supreme Court has ruled only once in 1939 directly on the scope of the Second Amendment. In that ruling, it said there is no right to own a sawed-off shotgun in the absence of ''some reasonable relationship to the preservation or efficiency of a well regulated militia.'' Assistant U.S. Attorney Bill Mateja said he was pleased with Tuesday's reversal but declined further comment until he could review the opinion.
    The ruling is a mixed bag for gun control advocates, said attorney Ruchi Bhowmik of the Brady Center to Prevent Gun Violence. ''Their decision on the constitutionality of the violence against women act is a victory for common sense gun safety measures,'' Bhowmik said. However, the Brady Center said the decision on the Second Amendment goes against established precedent. The National Rifle Association declined to comment Tuesday.
    The Texas case goes back to 1998 when Emerson's wife, Sacha, filed for divorce and was granted a temporary restraining order to prevent her husband from threatening or harming her or the couple's daughter. Emerson was arrested after he bought a pistol and was prosecuted on grounds that purchasing the gun was a violation of the order.  District Judge Sam Cummings of Lubbock, Texas, granted Emerson's motions to dismiss the indictment on both Second Amendment and Fifth Amendment grounds. The government appealed to the 5th Circuit, which heard arguments in the case last year.
    On the Net:
    http://caselaw.lp.findlaw.com/data/constitution/amendment02/
    United States vs. Emerson, Case 99-10331: http://www.ca5.uscourts.gov/opnew.cfm

Sept. 11 Led Many Americans to Alter Their Lives in Large & Small Ways
Geraldine Sealey, ABC News- 10/17/2001

Ty Gregory of Toledo, Ohio, has dated his girlfriend on and off for 15 years. He had long planned to propose marriage but never did. Then came Sept. 11. Through tears and anguish watching news reports of the terror attacks, it became clear that life could not wait, Gregory says. "It made me think, 'Man, we don't know how long we'll be here,'" said Gregory, 32, an information systems specialist. "I really felt like I wasted a lot of time in my life and there isn't a lot more to be wasted." He popped the question, she said yes, and the couple will marry early next year.
    Americans not even directly connected to the Sept. 11 suicide hijack attacks on New York and Washington that left more than 5,300 dead say they feel the ripple effects of terror, and some have already taken steps to change their lives. Although nationwide statistics on such change do not exist, ABCNEWS.com has read more than 1,000 emails from users who explained the impact that terrible day had on their lives. For some, change is tangible — a marriage proposal, a resignation letter, a postponement of parenthood. For many others who haven't reorganized their lives, Sept. 11 may have planted seeds of change to come. They are re-evaluating priorities, rediscovering faith and patriotism, reconnecting with family and friends, and confronting fear and depression. Although most ABCNEWS.com users said they were affected in some way by the attacks, some said they remain unchanged, adamant that terrorists not have the power to affect their lives.
    But it's not surprising that this crisis has led to contemplation and change for many, psychologists say. "Tragic events help people become more aware of their mortality and help them get in touch with things that are meaningful for them," said Richard Watts, a counseling professor at Baylor University. Experts worry about those who make "cold turkey" decisions in crisis, saying impulsive behavior can lead to bad choices. But for those who considered a change before Sept. 11, the tragedy may have clarified their thinking and helped them make a healthy move. "Sometimes a tragedy can spur one to an action that has been incubating within for some time prior to the tragedy," said Raleigh, N.C. family therapist Dianne Occhetti. "Whenever there is a crisis, be it in our nation or in ourselves, it is also an opportunity that opens other windows and doors."

Relationships
"I broke up with someone I've lived with for many years. Although there were times when I was forgiving, this time I just thought about how precious life is, how precious we all are — and that I wanted to live that life with joy, with laughter," Cami Huk, Rutherford, N.J.
   Following the initial horror and shock of Sept. 11, the ensuing introspection led to some major decisions being made about relationships. For some, the terror attacks helped them realize they had found the right life partner. Amanda Claiborne, 45, of Sebastopol, Calif., said she is now rethinking separation from her longtime partner. She is less fixed on finding "perfection" in her relationship, and more inclined to appreciate her partner's good qualities, like being a good father to their son, she said. "What we learned above all is that we are each other's family," she said.
    "The attack brought out what people consider real and genuine and authentic in their relationships," Occhetti said.

For some distressed couples, though, the tragedy left them just as embattled — and in some cases, more so.  Sharyn Sooho, a Newton, Mass. divorce lawyer, says the phones in her firm went quiet for a few days after the attacks but soon rang again with a vengeance. Clients already embroiled in difficult divorces seemed even more belligerent, she said. "It's almost as though people were saying, 'If I can't defend the homeland, I can defend myself,'" Sooho said. In disaster and uncertainty, this kind of relationship dynamic is common, said Harrisburg, Pa. therapist Ed Beck. "If things are going well, things get better and stronger, but if the relationship is fragile and pathological, their symptoms will exacerbate because there is a perceived threat," he said.

Parenthood
"I have made a decision to wait to have another baby — I already have two children and my first thoughts were, 'How many more children would I have to worry about if this happens in my home town?'" Kelly Francl, Sparks, Nev.
    The impulse to protect and provide for one's family caused some Americans in the last month to rethink parenthood.  Sandra Turonis, a 32-year-old Pennsylvanian whose first husband died seven years ago, remarried last July and intended to have children. Now, she says, she's not so sure. "I am scared for myself, my husband, my 10-year-old step-daughter and my family," she said. "We recently bought a home and I wonder if we will keep our jobs and be able to maintain this home as this war continues."
    But we all react to tragedy and uncertainty in different ways — still other couples see, in this time of staggering loss and grief, an opportunity to affirm life by bringing a child into the world. Before Sept. 11, Titania Roberson, 28, of Durham, N.C. was still waiting to have children after four years of marriage. Now, she and her husband want to hurry their family along just in case one of their lives is cut short. "If one of us happen to be one of the innocent victims, then we want the other to have the child as a memory," she said.

Careers and Work
"I've stopped putting in so many crazy hours at the office and now try to leave at a reasonable time so I can enjoy family, friends, and life a little bit more," Natasha Wieschenberg, Bridgewater, N.J.
    `The more than 300,000 people laid off since Sept. 11 have been forced into job change. But many others who still have jobs say they are now questioning the work they do and the amount of time they spend doing it. Candace McCumbee, 32, of Rockville, Md., after being laid off from an informational technology engineering job in July, stopped looking for a similar position on Sept. 11. "I'll never forget that day," she said. McCumbee always had a natural writing ability, but never pursued writing as a career. Now, she is focused on writing short stories and poetry for children. "I'm going to give back to life and stop living in the future," McCumbee said.
    It's not uncommon during crisis for some people to reject unfulfilling jobs and look for their calling in life, says Dick Bolles, author of What Color is Your Parachute? "People suddenly realize they don't have much time to dilly-dally with their lives," Bolles said. For some who live and work far from relatives, the aftermath of Sept. 11 brought an intense desire to ditch work and move closer to home. "My current job is no longer important to me," said Vanna Lanh, 51, a construction project manager in Tampa, Fla. "I plan to relocate and settle my wife and child closer to my relatives and good friends" in West Palm Beach, Fla, he said.
    Of course, many don't have the economic wherewithal to quit their jobs. While that may make some discontented workers feel trapped, others may be happy just to have a job, says Bill Fenson, president of the National Employment Counseling Association. "These people know they have to subsist if they can't afford to make that move," said Fenson, a Binghamton, N.Y.-based counselor.

Rethinking Home and Hunkering Down
"I'm not so sure I feel safe where I work [in Silicon Valley]. I feel that any attacks here would cripple the United States. That is why I moved to a quiet area in the woods and five minutes from the beach," April Martin, Aptos, Calif.
    Exposed vulnerability of U.S. cities has led many to rethink where they live and work. Julia Duncan has lived 10 miles from the Pentagon in Northern Virginia for more than a decade. She never felt completely comfortable living there, she said, but the proverbial last straw came when a hijacked jet plunged into the nation's military headquarters, leaving 189 dead. Now, she's thinking of moving. "I don't know if anywhere is safe, of course, but my stomach goes hollow every time I remember waiting for my husband to get home on Tuesday, Sept. 11," she said.
    Some urban dwellers say they have reconsidered working in skyscrapers, while others have packed up and left cities altogether. Suburban New York real estate brokers have reported sharp jumps in interest since the Sept. 11 attacks. Even realtors in Vermont and Florida have found new homes for fleeing New Yorkers. Of course, escaping the city isn't realistic for everyone, and some experts wouldn't even advise it. "Don't rush into decisions without thinking about how others might be affected by your decisions," says Joseph Weintraub, an organizational psychologist in Wellesley, Mass. "Pulling your kids out of school and moving to the woods is not likely to give your family the sense of security that you hoped to accomplish."
    For urbanites who have decided to stay put, life in the city now means preparing for the worst. "My office is a stone's throw from the TransAmerica Building," says Ana Costa, 48, of San Francisco, who has discussed emergency supplies and evacuation plans with her court reporting agency staff. "I am aware that if a terrorist attack took place as I sat at my desk, I could be history."
    But even those who live outside city limits are rethinking how they live, if not where they live. Some say they're gathering personal papers, balancing accounts and paying off bills. Others are writing up wills, collecting survival gear and socking weapons away in drawers. On Saturdays, Cecilia Kruchko's family does drills at their home in the hills above Hollywood to make sure they can get their pets inside and close everything up in 15 seconds in case of germ warfare, she said. "I have put our valuable documents in a binder near the door in case of having to evacuate," said Kruchko, 49.

Praying, Volunteering and Finding True Value
"The attacks on Sept. 11 definitely make one realize what's really important in life … What's really important is people. What will tomorrow be like? Will I see this person tomorrow? How can I show my appreciation of them today?" Erin Manigault, San Francisco.
    For so many who said they had not adjusted their routines or relationships in recent weeks, change is less visible but just as real. Faith has been a great source of comfort for many in recent weeks, even those who say they had felt distant from their spiritual beliefs before Sept. 11. "I am going to church and praying a lot more. Before, it was rather hit and miss," said Marcia Lee of Tacoma, Wash.
    So many are finding more solace in their families, expressing appreciation and taking time to show love for family and friends. The horror of Sept. 11 reminded many that each day might be the last chance they get. "Since Sept. 11, I have realized that tomorrow is never guaranteed for any of us," said Kimberly Roelofs of Sandy, Utah. "This horror has made me appreciate everything precious in my life: freedom, education, good health, and especially family and friends."
    Danelle Carney, a mother of four from Marion, Iowa, says she never finds herself now being "so busy" that she can't take time to just sit with her children and play. "And I have never left my house since the attacks without giving my children a hug and kiss and telling them how much mommy loves them," she said.
    Community has become more important to many who are taking more time now to talk to neighbors and help the less fortunate. Helping others has psychological benefits in a time of uncertainty, says psychologist Weintraub. "This act of giving plays a very therapeutic role in dealing with our own decisions," he said. While many Americans would admit they placed too much value on material goods in the past, some say Sept. 11 changed their consumerist attitudes, a sure sign of shifting priorities in a society that in recent years has prided itself on unprecedented prosperity. "It has made me focus more on the 'little' things — hearing the birds sing, seeing the clouds, and being thankful for being able to see the sun rise," says Susan Tucker of Tennessee. "While I have always known it, it has made me more aware that material things are worthless."

Ohio Social Worker Killed During Home Visit
Charley Gillespie, Associated Press, 10/17/2001

COLUMBUS, Ohio -- A caseworker who asked for assignments in the city's toughest neighborhoods was stabbed to death as she interviewed a couple whose seven children she had helped take away. The father was charged with murder in Tuesday's slaying of Nancy Fitzgivens. ''Her job was so important to her because she, too, was abused as a child,'' said Fitzgivens' husband, Clovis Dawson. ''As a caseworker she wanted to be on the front line fighting for the children.''
    Fitzgivens, 53, had spent 10 years earning her 1999 social work degree while working full time, and had worked for Franklin County Children Services for two years. Her husband said she knew the danger but logged long hours trying to stop family abuse. ''She would always look for the good in someone,'' he said. ''She would try to get abusers to get counseling so they could be reunited with their children.''
    On Tuesday, Fitzgivens went to the home of Gregory Pack, 38, and his common-law wife, Rosie Newkirk. Police said Fitzgivens was left alone with Pack, and when his wife returned a short time later, she discovered Fitzgivens' body. Police found Pack at a mental health center and arrested him. He was charged with aggravated murder. It was not immediately known whether he had lawyer. Six of the couple's children had been removed by July 2000. A seventh child, born in September 2000, was placed in foster care last March. According to court records, the children allegedly were neglected because of the couple's drug abuse. A court file also said Pack suffers from manic-depression and refused to stay on his medication. John Saros, director of the children's agency, said Fitzgivens had placed the children with relatives and ''had been making regular visits with the family trying to unify them.''  Dawson said his wife often talked about the seven children in the home but never said she feared going there. ''She carried a picture of one of the children a cute little girl standing with her arms crossed in her purse,'' he said.
    Saros said safety practices at the children's agency will be reviewed. Under a policy that was in place even before the slaying, caseworkers can ask for someone to accompany them or request that a family come to the office for interviews. ''We have always been aware that our workers are routinely threatened in writing, over the phone and face to face,'' Saros said. ''Whenever you are dealing with this level of family life you have the potential for danger.''
    Dawson hopes his wife's death will lead to a greater appreciation of the job caseworkers do throughout the country.  ''I hope people will support the good work that children services caseworkers across the country are doing,'' he said. ''They, like Nancy, break the cycle of abuse and stop future generations of violence and abuse.''

Social Worker Uses Woodworking to Help Troubled Students
Associated Press, 10/19/2001

ADRIAN, Mich. -- A social worker at Michener Elementary is using carpentry to help students who are dealing with troubling issues at home or at school. Joe Baker found that it is easier for some children to talk about their problems while being creative with wood. The idea for the woodshop came to him as he was looking for something to do other than just sitting and talking. "I think it's successful, " he told The Daily Telegram for a Thursday story. "It gives kids a sense of pride to make something."
    Baker said students can learn important lessons from woodworking. It provides an opportunity for him to encourage students to do their best, students learn it's OK to make mistakes and they make a connection between hard work and producing something useful. Baker said working on these projects introduces many of the children to delayed gratification by teaching them not to rush through an activity just so they can take it home. "I can help them raise their standards," he said. This is the second year the woodshop has been in use by students here. Another woodshop was started at Garfield Elementary School this year by Baker.

Promoting Suicide Prevention in Ann Arbor, MI
David Wahlberg, Ann Arbor News- 10/21/2001

David Stucki mentioned to co-worker Tammi Landry last spring that his brother had committed suicide. "I can't imagine that ever happening to me," Landry remembers thinking. Three days later, her father killed himself. Stucki and Landry have formed an Ann Arbor chapter of the American Foundation for Suicide Prevention to increase awareness about suicide and raise money for research on how to prevent it. "We're trying to focus on the root of the problem - depression," said Landry, 31, who lives in Berkley, north of Detroit. "We want to be more than just a support group," said Stucki, 36, from Chelsea.
    The two met while working in the marketing department of Logic Solutions, an Ann Arbor company from which they were laid off last month. The American Foundation for Suicide Prevention, founded in 1987, acts much like the American Heart Association with heart disease or the American Cancer Society with cancer. It organizes educational campaigns and allocates grants to researchers, such as University of Michigan psychiatrist Cheryl King, who has received $65,000 for studies on teen-agers and suicide.
    Detroit has a chapter of the group, but Stucki and Landry wanted one in Ann Arbor, partly because they found few resources here to help them deal with the deaths of their loved ones, they said. They plan to begin a support group soon and speak at schools, law enforcement agencies and other places interested in hearing about suicide and depression. A kick-off fund-raiser picnic in August generated $1,500. It is to be followed by a bowling event this winter and a walk next spring. Stucki and Landry also hope to work with the University of Michigan, which plans a new depression center within its health system. Given the Sept. 11 terrorist attacks and the American military response, Landry said she's concerned that many people will have a harder time dealing with depression. "It's going to cause problems long after (New York City) is rebuilt," she said.
    Stucki's brother, Curtis, had tried to commit suicide several years ago but failed. The 34-year-old seemed to have turned his life around after that, with a wife, a 2-year-old daughter and a steady job as an enrollment representative for the HMO Care Choices. But three years ago, Curtis' wife filed for divorce and he filed for personal bankruptcy. After not showing up for work for two weeks, he laid himself over a train track and let a railroad car run over him. "It's something I have to deal with every day," said Stucki, whose brother was best man at his wedding.
    Landry saw no signs forecasting her father's suicide. A 56-year-old detective with the Indiana State Police, he was preparing to retire on a scenic 13-acre plot when he walked outside one morning and shot himself with a revolver.  He had worried that his retirement fund was dwindling because of the downturn in the stock market. And Landry said he witnessed some terrible scenes in his work, such as car and plane crash victims. But he always seemed happy, she said. "There is no word in the English language to describe how you feel when someone you love takes their life," she said.

Shelters Have Empty Beds; Abused Women Stay Home
Tamra Lewin, New York Times- 10/21/2001

Refuge House, the battered women's shelter in Tallahassee, Fla. is usually full--so full that there are plans to replace the 28-bed facility with a 70-bed shelter. But since the Sept. 11 terror attacks, most of the beds at Refuge House have been empty. The day after the attacks, it was less than half full; by Sept. 24, it was less than a quarter full. "Women just stopped calling our hot line after the attacks," said Kelly Otte, the executive director. "One day, there were only two women in the whole shelter. Just as other people in relationships are pulled together in a tragedy, feeling that family's the most important thing, battered women feel that same pull. They're already very vulnerable, and they may feel they need to be with somebody, no matter what, so maybe the violence of the relationship is not such a big deal compared with a huge national crisis."
    After the terror attacks, many people are reviewing their priorities and clinging tighter to loved ones, psychologists say. More people are interested in writing wills; ARAG Group, which provides group legal insurance plans, has been getting 20 percent more calls about will preparation than usual since Sept 11--and its Web site offering legal forms has had a fifty-fold increase in the number of will documents purchased. Concerns about protecting family members have contributed to surging sales of life insurance, cell phones, gas masks and guns.
    But for some of the nation's most vulnerable people, including battered women and those who are chronically depressed or isolated, the crisis has had quite a different impact. In Cleveland, Paula Koos said that of 69 women at the Domestic Violence Center, at least eight left the shelter in the week after the attacks. "Women went back to their abusers, precipitated by a feeling that a bad home is better than no home at all," Ms. Koos said. "These are women who often feel overwhelmed, and not in control of their lives. So some of them feel that even if they're not returning to the best situation, at least they won't be solely responsible for taking care of themselves and their children."
    At Tallahassee's Refuge House, women were beginning to come back last week. But the attacks were still affecting victims of domestic violence, Ms. Otte said. "Some batterers have made the terrorism part of their repertoire of pain-invoking techniques," Ms. Otte said. "One woman got an email from her abuser, saying that it was a shame with all these buildings getting hit, that none had hit her building." She continued: "Our occupancy rate is still way down, but the staff tells me that they're again getting calls from women who want help. Last week, they held beds for three women and seven kids who had called, but they never came in. It's not normal for so many to call and not show up."
    While not all shelters reported so many empty beds--a few said they had more clients than ever, because of increasing domestic violence they linked to the declining economy--many, across the country, said the women they served had come under increased pressure to return to abusive relationships. "The batterers will say this is a time when we need to be together as a family, you need to be here where I can protect you," said Kristina Matkins, the director of community relations at Safehouse Denver Inc. "We had at least two women whose perpetrators used the terror attacks as an excuse to coerce them back into the relationships. The problem is that what we know about domestic violence is that it will happen again."
    At crisis hot lines, too, the terrorism, at least initially, brought an eerie lull. The usual calls from depressed people contemplating suicide all but ceased in those first few days, when much of the nation was watching television. "There was a huge silence on crisis hot lines right after Sept. 11," said Reese Butler of the National Hopeline Network, which connects 73 hot lines nationwide in its 1-800-SUICIDE line. "Calls dropped in half. Most people who call hot lines don't have anyone in their regular lives they can call and say, 'I hate my life.' But after a tragedy, things are different. People take care of each other more, check in, hug. So the chronic callers, the typical depressions, are less isolated, and they're not calling. Now, our callers are people trying to deal with the anxieties and the grief left in the aftermath of the tragedy."
    In Arlington, Va., Arlene Krohmal said that after an initial period of "deathly quiet," the call volume at the CrisisLink hot line had picked up, but more than a quarter of the calls were still about the Sept. 11 attacks. "We're hearing from a lot of the first responders, people who had to deal with the initial trauma," she said. "We know that after man-made disasters, suicide rates go up and stay up for several years. In Oklahoma City, it was still up five years later. So we're expecting that, but none of this is immediate. After a huge trauma, it can be a long time before you see all the effects."

A Time for Americans to Redefine Their Closest Relationships
David Crary, Associated Press, 10/21/2001

A hard-charging investment banker, Debbie Young used to savor life as a single woman in downtown Chicago. Now, after restless nights contemplating terrorism and war, going solo has lost its allure. ''I'm an extremely independent person,'' she said. ''But you sit at home by yourself and watch the news on TV, and suddenly at 1 or 2 in the morning, you don't want to be alone. I'm scared.'' Using a matchmaking service, Young, 39, has intensified her search for a committed partner. She is one of countless Americans who have found an incentive to redefine their romantic relationships and revitalize family ties in the shadow of terrorism.
    Singles without a soul mate are seeking them. Parents without wills are writing them. Couples with conflicts are resolving them. Not all the changes fit into neat patterns, nor are they all about healing. While some spouses have abandoned divorce proceedings, new anxieties have hastened the breakups of other couples. But interviews with matchmaking consultants, marriage counselors, divorce lawyers and other experts make clear that the Sept. 11 attacks and the fears of more trouble have instilled a deeper appreciation for the importance of family and intimate bonds.
    ''People are seeking marriage counseling significantly more than they were prior to Sept. 11,'' said Enid Norris, a family therapist in Stamford, Conn. ''They're trying to work things out they're much more conscious of the value of relationships.'' Chicago divorce attorney Stephen Komie said business in September dropped by more than 50 percent compared to a year earlier. Connie Boysen, whose law firm in Overland Park, Kan., specializes in divorce, said even couples who are splitting up have become more civil. ''In fights over custody, you could tell parents were trying to pull together to calm kids,'' Boysen said. ''When something like this happens, it puts your own personal tragedies in a different perspective.''
    There also is a keener sense of mortality, and perhaps a stronger desire to make sure loved ones are cared for. Pamela Gorski, a family law attorney in suburban Cleveland, said her divorce caseload remains steady, but she reported a surging demand for wills, ''particularly for people who are traveling.'' Michael Yergin, director of the Premiere Connections matchmaking service in Chicago, said his business has jumped dramatically. ''Since Sept. 11, we've seen probably the largest increase since I've been in the industry,'' said Yergin, who entered the field in 1969.
    Young is one of Yergin's clients. She has enjoyed a successful career and freewheeling social life, but her outlook changed after the attacks. ''I still take my career very seriously,'' she said. ''But since the incident, I realize there's more to my life than being at the office every day. I'd rather be poor and in love; I want to be with somebody.'' Another of Yergin's clients, graphics artist Lisa Renee Cecala, said her previously low-gear search for a mate has taken on new urgency. ''I have to admit, after Sept. 11, I've been sitting on my sofa really wishing I had that special someone to hold me,'' said Cecala, 36. ''I wish I was married right now.'' Her girlfriends have reacted similarly, she said. One who had a multiyear engagement finally agreed with her fiance that the time to tie the knot had come.
    In some cases, the attacks have had the opposite effect. Dail Metzger, owner of the Singles Network dating service in southwestern Connecticut, said some clients have solidified relationships since Sept. 11, while others have broken them off. ''I guess they realized it wasn't right, that life is short,'' she said.
    Curtis McMillan, a professor of social work at Washington University in St. Louis, has studied the aftermath of previous disasters, including earthquakes and the Oklahoma City bombing. ''People report both positive and negative changes in their relationships,'' he said. ''With people who are not yet fully committed to each other, they look at how the other person responds to the crisis. You can get a sense of how compassionate they're going to be.'' Leslie Freedman, a psychologist with offices in Stamford, Conn., and New York City, has observed new concerns among suburbanites. ''People who commute to the city, leaving children in the suburbs, feel more anxious,'' Freedman said. ''People who have the option to telecommute, or are able to leave work earlier to go pick up their kids, are taking the opportunity.''
    As with previous major mobilizations, an upsurge of weddings has been reported near military bases. But Jean Dent, minister at The Wedding Chapel in Nitro, W. Va. said there's also has been more business from couples without a military connection. ''They are just waking up and deciding they are getting married today,'' said Dent, who has seen services jump from five a week to five a day. Phillip McGowan and Elza Chapa of Crystal City, Va., already had a wedding date set for December when the terrorists struck, killing Chapa's mother, Rosemary, at the Pentagon. Instead of postponing the long-planned wedding, the couple advanced the date to Sept. 20. The ceremony was attended by six guests instead of 125.
    Anecdotes abound of parents gaining new appreciation for their children, of young adults reconnecting with faraway parents, of children showing new interest in their grandparents' memories of World War II. Don Browning, director of the Religion, Culture and Family Project at the University of Chicago Divinity School, says the attacks have powerfully shown how people turn to their families in times of upheaval. ''This leaves us with a question,'' he wrote in a newsletter this month. ''Does it take disasters to remind us of the importance of good marriages and vital families? Do we have to be scared out of our wits to realize the essential value of these realities for our lives?''

New York State of Minds Now Emotionally Fragile
Geraldine Baum, Los Angeles Times- 10/22/2001

NEW YORK -- Ronnie Hirsh has absorbed so much anguish of so many New Yorkers, and yet he knows there is more to come--more pain, more nightmares, more fear, more flashbacks. A psychotherapist, Hirsh has counseled 50 groups of people who saw or experienced the Sept. 11 attacks. He has met with LaGuardia air traffic controllers who watched the hijacked planes blinking on their screens, with Starbucks employees who comforted victims escaping the inferno and with police who rushed to the scene, including one who made eye contact with a man as he tumbled to his death from a World Trade Center tower. "The people who are not talking about it--those who have it building inside of them, well, expect an explosion sometime this spring, probably in May," says Hirsh, a tired therapist who like many of his colleagues here is grateful when someone asks how he is doing. "Oh, I'm fine," he says flatly. "Just bracing for the next wave."
    In fact, in the days after the attack, New Yorkers also seemed "fine." They pulled together, grieved in public and held up and onto each other. They were numb. But almost six weeks later--with the Afghanistan war underway and new anthrax cases reported almost every day in New York--the effect on the mental health of the city is growing more apparent.
    From psychiatrists on Park Avenue to emergency room doctors in the Bronx, experts report that New Yorkers--already not the calmest 8 million Americans--are emotionally fragile. They are even edgier, prone to bouts of crying, clinically depressed, fighting off intrusive thoughts of new disasters and obsessing over every siren and rumor. Some started smoking again. But how long these troubles will last or how deep they run is unclear. No one is sure whether New York is facing a mass mental breakdown or a temporary neurotic jag. And now enough time has elapsed for experts to begin to diagnose how grave the situation is.
    "Right now people are responding normally to an abnormal situation," says Dr. Jack Saul, director of the international trauma studies program at New York University. "It's only a mental health crisis if it doesn't abate and people suffer further consequences." Saul goes down the list: suicide, alcoholism, family violence, depression and other acute disorders that lead people to lose their jobs and abandon their normal lives. "Those are mental problems that last," Saul said. "But they develop much later."
    Several official attempts have been made to tally the city's psychological toll. The New York State Office of Mental Health says 1.5 million people will need help; the Coalition of Voluntary Mental Health Agencies Inc. estimates 2.3 million. But this is trying to measure the unmeasurable, say other experts who wonder what it takes to consider someone to be in distress: Do only the 15,000 children who lost parents or the thousands who lost children count? Do the 25,000 people who fled the buildings qualify? And what about the Westchester matron who saw the whole thing on TV and now refuses to leave her house?
    The state came up with 1.5 million by using a complicated formula based on studies of past disasters and advice from those who managed the fallout from the Oklahoma City bombing, the Northridge earthquake and other traumatic events. "They advised us that it's not just the people who lost family who suffer but that we need to go door to door to find people who need help who might not find us," says Chip Felton of the New York Office of Mental Health. "We need resources to do that." So far the Federal Emergency Management Agency has sent $22.7 million here for mental health work in the first 60 days after the disaster, and more is expected. Private agencies also are providing services. But no one has a handle on how high the costs will rise. The FEMA money is paying for hotlines, media campaigns, classroom counselors, family centers and outreach for those who wouldn't normally call psychiatrists.
    For now, therapists report that they are getting dozens of new calls for their services, and in turn phoning in numerous new prescriptions for anxiety medications and increasing the dosage for those already taking them. And that familiar lyric about "the city that never sleeps" has never been truer: Pharmacists report selling out of over-the-counter sleeping pills. In recent days, after tests confirmed several anthrax cases in New York, a Park Avenue psychiatrist said he had more than a dozen patients on anti-anxiety pills begging him for another "anti," antibiotics for anthrax, even if they were nowhere near where the bacteria was found. "Frayed nerves are just that much worse," says the psychiatrist, who asked not to be named to protect his haute clientele.
    Emergency rooms and mental health hotlines are getting twice their usual volume from people complaining of all varieties of psychic pain. And the experts insist that, despite all the barbs about neurotic New Yorkers, this is not Woody Allen hand-wringing but genuine pain and suffering. "This is real to them," says Lydia Liness, a Brooklyn clinical psychologist. "Every time people hear a siren wail, they jump or start weeping. They weep reading the morning papers; their partners tell them they weep in their sleep." One of her patients was badly bruised when she got so distracted obsessing about where the terrorists might strike next that she wandered into traffic on packed West Broadway and got hit by a car last week. "This is a rather stable woman who was nowhere near the World Trade Center that day, but she has been seriously destabilized by what is going on around her," Liness says of her patient.
    Trauma experts estimate that 10% to 30% of those most endangered in the attack or who lost family will suffer post-traumatic stress disorder. That condition is usually associated with combat veterans or sexual assault victims. It is characterized by flashbacks and longer-lasting problems in eating, sleeping and focusing.
    Therapists like Hirsh worry most about those who do not shake the symptoms in three months to a year, which is why he targets May, the month in which most suicides occur. "Put an asterisk next to the names of those people," he says, "especially if they think they can handle this one themselves." Hirsh recently urged more counseling for a suicidal law firm secretary who was chased from the trade center area by a wall of black smoke. "She had huge preexisting problems, and this event was a trigger," Hirsh says, explaining that her father had died within the year, she was estranged from her mother and her dog was lost.
    Trauma also hits hard at those with problematic childhoods, whether prompted by parental divorce, physical or sexual abuse or major illness. Esther Perel, a psychologist who studied trauma, has seen patients whose vulnerabilities haunt them even more now. She mentions a woman patient who wasn't close to the events, though her husband--who is now fine--was. "She spent her growing-up years moving from country to country, and had no home in the sense of safety," said Perel. "She desperately is seeking a home, safety in a way she wasn't before." .
    In the long run, of course, the poor and already troubled may be the worst off. Mary Ann Carlino, a family and marriage therapist, says she is advising the 30 residents she supervises at the Bronx Veterans Hospital to check on the emotional health of patients in the emergency room and free clinic. "We have a population that is not aware of what to expect after trauma," she says. "So they come in thinking they're having a heart attack when it's really a panic attack. They're stressed to the max already. Now add this layer of grief and fear and they're over the top." Carlino sees a mental health crisis for the poor near her South Bronx hospital. "Our population does not have the luxury to ignore this," she says, adding her concern that many also do not have the insurance to pay for it.
    Then she describes the wounded in her emergency room recently:
* A middle-aged woman, who worked in offices three floors beneath the south tower, came into the hospital rolling a suitcase behind her and complaining of headaches. Carlino has counseled her three times since. She is back at work in midtown Manhattan but won't go anywhere without her essential belongings.
* A medical student made an excuse to stop by Carlino's office. Her boyfriend escaped the north tower's 97th floor and now won't leave their apartment. "He's lost his friends and colleagues, and now I've lost him," the student told Carlino.
* Another woman showed up with a routine medical problem and was sent home. When Carlino learned the patient had lost a brother, the therapist made sure she was brought back and treated for depression.
"We are going to lose these people who need us the most if primary-care doctors aren't trained to catch the mental as well as physical problems," Carlino says.
    So what's the long-term prognosis? "That is an existential question as much as a medical one," says Roberta Rinaldi, a Los Angeles therapist who has researched trauma. "A lot of people will need help, but the ones who will heal will do it through sheer force of will." Esther Perel and Jack Saul, both of whom studied terrorism in Bosnia-Herzegovina and Israel, believe that most New Yorkers will be best served seeking community. "It is a collective trauma and requires collective healing," says Perel. "You do community interventions, community meetings, family gatherings. You don't just stick people in individual offices with a shrink."
    Ronnie Hirsh advises people in pain to acknowledge their feelings as a demonstration of strength. He also gives the example of the policeman who saw the falling man and who told Hirsh he felt "useless." "I made the suggestion that he consider he was 'helpless,' not 'useless,' and remember all the people he did help that day," says Hirsh, adding, "The way that people say things to themselves is going to make all the difference in the world."

Drug Firm Sued over Columbine Tragedy
Allison Sherry, Denver Post- 10/22/2001

Families of five Columbine High School shooting victims filed a suit Friday against the maker of an antidepressant drug Eric Harris was taking when he and Dylan Klebold opened fire in the school in April 1999. Jefferson County authorities found a "therapeutic" amount of Luvox in Harris' system after he died, according to a 1999 release by the coroner's office. Luvox is a psychotropic drug allowed only in the United States for obsessive-compulsive disorder, according to the website of its maker, Solvay Pharmaceuticals Inc.  Families believe officials at Solvay failed to warn Harris' doctor about side effects, saying the drug spurs "emotional blunting or disinhibition," according to the suit filed in U.S. District Court. "Such drugs caused Eric Harris to become manic and psychotic," the suit states.
    Solvay Pharmaceuticals has factories all over the world, with main offices in Switzerland. No one in its American office, based in Atlanta, could not be reached Saturday, but the company's website warns that side effects of Luvox include nausea and weight loss, and that it may impair judgment, thinking or motor skills. It is unclear in the suit or in Harris' autopsy what precise level of Luvox was in his blood when he died or how long he was taking the drug.
    The American Psychiatric Association defended Luvox in 1999, stating in a memo, "Despite a decade of research, there is little causal relationship between the use of antidepressant medications and destructive behavior." Hirsch Fishbein, an Aurora pharmacist not involved in the case, said Luvox is an uncommon drug. "It's not used very often at all," he said. "Most doctors use Paxil or Prozac."   Luvox is a serotonin uptake inhibitor, which means it keeps serotonin flowing through the body. Serotonin, produced naturally by the brain, counters psychotic tendencies. Filing the suit were families of students Mark Taylor, Evan Todd, Brian Anderson, Cory DePooter and teacher Dave Sanders. DePooter and Sanders were killed.   They are seeking damages in excess of $75,000 each.

Connecticut Man Accused of Killing Priest to Use Insanity Defense
Associated Press, 10/22/2001

BRISTOL, Conn. -- The man accused in the 1999 beating death of a Bristol priest is expected to use an insanity defense during his trial this week. Michael Ouellette, a homeless drifter diagnosed as a paranoid-schizophrenic, is accused of beating the Rev. Robert Lysz to death with an altar candlestick inside St. Matthew Church in June 1999.   Ouellette's attorney, Public Defender Kenneth Simon, is seeking to have him found not guilty by reason of insanity. A New Britain Superior Court judge ruled last year that Ouellette, now 34, is mentally competent to stand trial. The prosecution is expected to begin presenting evidence on Tuesday.
    According to an arrest affidavit, Ouellette told police he beat the priest after Lysz refused to let him sleep in the church. Police said Ouellette broke into the church parish house, accosted Lysz, bit his ear off and bludgeoned him to death. Police said Ouellette then changed into the dead priest's clothes, stole his wallet and dragged the body into a corner of the church, where he covered the bloodied corpse with a green cloth. The priest's body was found in the church sanctuary when worshippers arrived for an early morning service. Ouellette was discovered wandering inside the church by lay workers who called police.
    Ouellette was sent to the state psychiatric hospital in Middletown shortly after his arrest and has been under a suicide watch ever since. Officials have said the former U.S. Marine developed severe mental illness in his late 20s and wandered in and out of Bristol. Ouellette's family has said he suffers from manic depression and behaves erratically when he is not taking medication. Police said Ouellette stopped taking the drugs months before the murder. The killing led to a law that allows the state to force psychiatric patients with violent tendencies to take their medications.

For Low-Level Anxiety, Exercise May Provide Relief Without Pills
John Briley, Washington Post- 10/23/2001

While many people have sought pharmacological relief from the pall that has blanketed Washington since Sept. 11 – sales of anti-anxiety drugs are reported up as much as 30 percent in some areas since the terrorist attacks – many experts say physical exercise may be nearly as effective. And unlike pills, exercise has few nasty side effects, packs other benefits and is nearly free. It's certainly better than nothing. "Most Americans who are distressed by the current dramatic events may suffer from subclinical phenomena, for which a variety of self-help coping measures, such as physical exercise, can be very helpful," says Eli Somer, professor of social welfare and health studies at the University of Haifa, Israel. Somer has worked extensively with people suffering terror-related anxiety.
    Long before Sept. 11, a solid body of research showed the ability of exercise to improve mood and relieve subclinical cases of such mental conditions such as depression and stress. In a 1999 literature review in the journal Professional Psychology: Research and Practice, authors from the University of Manitoba note that more than 1,000 studies done before 1984 and hundreds done since "have endorsed the mental health benefits of regular aerobic exercise, usually for alleviating anxiety or depression."
    Beth Salcedo, medical director of the Ross Center for Anxiety and Related Disorders in Washington, agrees that "exercise can have antidepressant effects, anxiolytic or anti-anxiety effects." It can also improve immune function and "possibly provide some resistance to or attenuate the negative effects of stress." Salcedo says the research suggests these benefits are likely related to the effect exercise has on three key neurotransmitters, or chemical messengers, in the brain: serotonin, norepinephrine and dopamine.
    Somer cites a study by Mind, a leading mental health charity in Britain, that found 83 percent of people with various mental health problems looked to exercise to help lift their mood or reduce stress. Two-thirds said exercise helped relieve depression symptoms. More than half said it helped reduce stress and anxiety. He also cited research, published this year in the journal Perceptual and Motor Skills, showing that taekwondo participants, compared with a control group, had significantly lower tension, depression, anger, fatigue and confusion, and had more vigor. Study subjects also scored significantly better in total mood after a single bout of dynamic taekwondo.
    There are limits, however, to exercise's mood-altering power. A study published in 1998 in the American Journal of Psychiatry compared the effects on people suffering from panic disorder of aerobic exercise, the antidepressant drug clomipramine (brand name Anafranil) and a placebo over a 10-week period. The study showed that exercise and clomipramine separately were each superior to placebo, but that clomipramine produced better results than exercise alone. But Keith Valone, a Pasadena, Calif., psychologist and psychoanalyst, points out that panic disorder is more severe than the subclinical anxiety many people are suffering in the weeks after the terror attacks, so that 1998 study should not discourage those suffering from low-level anxiety from pursuing exercise as a low-risk form of self-treatment.
    While the ability of exercise to lift moods is widely acknowledged, how it does this – and what kind of exercise works best – is less clear. Somer and other experts concede that most studies on the subject are methodologically flawed, because they either lack adequate controls or fail to show the exact mechanism by which physical activity relieves anxiety. One theory is that exercise can simply dissipate muscle tension, a symptom of anxiety. Also, "it is believed that vigorous physical activity may release endogenous opioids [narcotic-like substances produced by the body] known to be involved in the reduction of fear," Somer says. In short, experts suspect that exercise affects the brain in much the same way as anti-anxiety drugs like alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium) do – by regulating neurotransmitter activity.
    Exercise may also provide useful distraction by letting the mind wander away from the things that are feeding the anxiety. Working out "helps the individual distract from unnecessary vigilant monitoring of the environment," Somer says, a key benefit now that anthrax news conferences are playing across the networks 24/7. The effect, Somer says, may be related to the concept of self-efficacy, a person's belief in his ability to deal with challenges. "Symptoms of anxiety typically represent doubts about one's capacity to handle the threats and challenges of life, a subjective sense of being out of control," he explains. "An exercising individual may reestablish his or her sense of mastery, accomplishment and self-esteem, thereby short-cutting the negative feedback loops that anxious worries often create."
    Mary Guardino, founder and executive director of Freedom From Fear in Staten Island, N.Y., has a simpler theory for how exercise relieves anxiety. Physical activity, she says, induces some of the same effects on the body as do panic and anxiety – racing heart and sweat – with one key difference: "Exercise allows the individual to control those events, Guardino asserts. "By purposefully causing those reactions, exercise teaches the body that they are okay and manageable, and that the individual is not going to die immediately because of them."
    As for the exercise itself, the research provides some guidance about the duration and frequency needed to alleviate anxiety. Workouts of anywhere from 20 to 60 minutes, three to four times a week – similar to the standards often used to describe a typical health and fitness regimen – were enough to produce measurable benefits. But what kind of exercise does the research endorse? Here, there's no single answer – and that's probably good news. While the bulk of the depression and exercise studies examined in the 1999 University of Manitoba literature review involved walking and running, many of the studies did not specify the form of exercise used – except to note it was, in most cases, aerobic.
    In their recommendations to "clinicians wishing to apply exercise therapy for psychological disorders," the literature review authors wrote, the choice of activity should be dependent on people's physical condition, their habits and experience. Activities easy to incorporate, the writers suggested, might be "functional" ones – those that accomplish some other task in addition to the exercise – like walking, jogging or cycling to work. Or, they proposed, people might get exercise from doing chores around the house, like raking leaves. (For other tips from experts on anti-anxiety exercise, see "Stepping Up the Pace is the Key to Calming Down," below.) Most of all, the authors suggest, people seeking to reduce their anxieties with exercise should be encouraged to choose the activities they like best and are most likely to continue. A workout regimen that's no fun and quickly abandoned, after all, isn't going to do much to reduce anyone's anxiety.

Second Opinion: On the Front Lines of Mental Health
Abigail Trafford, Washington Post- 10/23/2001

At a recent gala Washington dinner to celebrate advances in brain research, Lydia Lewis found herself at a table with the cream of the medical-political establishment – congressmen, health officials, university chairs. Lewis was in her element. As director of the National Depressive and Manic-Depressive Association, she bantered her way through an evening of fine food and important talk. But something was going on inside that no one could see. "I am having difficulty coping," says Lewis, who suffers from bouts of severe depression and a milder chronic depression. "I'm having a great deal of trouble focusing. I'm very fragmented. I'm feeling hopeless. I'm extremely tired. All I want to do is sleep." Although her passion is travel – she's been to Cambodia, the Sinai and New Zealand, and has plans for a trip to Malta – "I don't want to go. There's no energy to do anything," she says.
    These are the classic symptoms of depression, and Lewis knows that. She also knows where to go for help and how to take care of herself. After all, she drew up tips for the general public on how to cope in the wake of the terror attacks. With Americans under siege from threats of bioterrorism, people with psychiatric illness are on the front lines of what is now a national anxiety attack. For all the terror and confusion that has descended on the "normal majority," the assault is greater on those with mental illness. They already know what it's like to be afraid and despairing, bewildered and jumpy. That's the natural order when your mental Zip code includes schizophrenia, depression, anxiety or post-traumatic stress disorder. Not all the time, and not if you get proper care. But you've seen the dark side of the mind; stress is a constant companion.
    "I just basically lost it," says Brian Coopper, senior director of consumer advocacy at the National Mental Health Association in Alexandria. Right after the Sept. 11 attacks, he suffered a second blow. A close friend died of cardiac arrest. As he sat in the church at her funeral, he looked at her husband and children and grandchildren sitting in the front row. Then it hit him: 5,000 funerals going on for those killed in the attacks. All the loss, all the grieving. Then came the government warnings to expect another terrorist attack. That did it. He told the staff: "I'm taking some days off. I'm not sure when I'll be back." He describes it as "my own little Martin Sheen breakdown" after the scene in "Apocalypse Now."
    But Coopper, diagnosed years ago with depression, also knows how to take care of himself. He immediately contacted his psychopharmacologist to give him a prescription for sleep medication. He got on the phone with his support group of friends and colleagues. He started using the chain lock in addition to the deadbolt on his apartment door to give him "a tiny piece of security," he says. "We're all craving security right now." He stopped watching the news, stopped listening to National Public Radio while taking a shower. Instead he got out his folk-rock CDs, music he associated with better times. "I want to minimize my exposure. I'm already feeling it enough," he says. "I want to push myself into the ignorance zone." After a few days he went back to work.
    "I've had a couple of bad days," echoes Robin S. Cohen, a group leader at Peer Place, a drop-in counseling center run by the Mental Health Association of Palm Beach County, Fla. Cohen has manic-depressive illness with a secondary diagnosis of anxiety. The attacks of Sept. 11 left her nauseated. She couldn't swallow. She's lost 15 pounds and can only manage one meal a day. Her face broke out in pimples. She didn't want to get up in the morning. "I'd cry indiscriminately," she says; a burst of tears when she'd be driving on I-95 or shopping. She got a little paranoid, too. After all, she lives two towns away from the Florida man who died of anthrax. Right across the street is the airport where one of the terrorists took flying lessons. "I always think there are terrorists milling around," she says.
    "I became extremely manic along with anxiety. That's when your anger is at its peak," she continues. "Mania is a really tough part of my disease. You drive recklessly, you throw out unkind comments. You say: Why is this happening to me? Why not in South America? They deserve it more. Everything is everybody else's fault. The anxiety doubles when you're mad." One thought jumping to another and another, faster and faster. This is how the mind spins out of control. Cohen knew it was happening – and she dealt with it. She got a prescription for a tranquilizer in addition to the 18 pills she takes every day for her depression. She went to her therapist for counseling. She turned to her mom. She got help from her colleagues. Her supervisor gave her "a good talking to," she says, to help her get some perspective. Now she can say: "You can't always control everything. I could open an envelope of anthrax or I could get run over by a train."
    Lewis, Coopper and Cohen are the lucky ones. They have access to medical treatment and support services. They have jobs and safe places to live. They have social networks of friends, colleagues, family and peers. But many people with mental illness are not so lucky. The majority of people with schizophrenia, for example, do not receive the treatment and support they need, according to the 1999 Surgeon General's Report on Mental Health. Nearly 40 percent of those with bipolar depression go without treatment in a given year. There aren't enough child and adolescent psychiatrists to treat the estimated 5 percent of all children who experience "extreme functional impairment." The elderly are often forgotten, yet 20 percent of people over 55 have mental disorders that are not related to aging. The state of mental health care is "abysmal," says Coopper.
    It is almost a cruel joke that the 1996 Mental Health Parity Act expired on Oct. 1. A new and improved bill to make sure mental health coverage in group plans is on a par with medical and surgical benefits was unanimously passed by the Senate Committee on Health, Education, Labor and Pension before the terror attacks. The bill has 64 cosponsors and remains a high priority for Sen. Pete V. Domenici (R-N.M.), a long-time advocate of mental health services. But the only health programs that are getting congressional attention these days are those aimed at increasing stockpiles of Cipro or vaccines against smallpox. That leaves millions of Americans with mental illness without a safety net.
    Meanwhile, the suffering escalates among those most vulnerable. In Pittsburgh, an elderly woman with depression was so overwhelmed by television images, she thought firemen and the president were in her home. On an American Airlines flight to Chicago, a man stormed the cockpit because he thought the plane had been hijacked and was heading for the Sears Tower. He had been diagnosed with mental problems the week before and was not taking medication, according to news reports.
    In support groups across the country, attendance is up, mental health activists report. At meetings for people with depressive disorders in Boston, the number of newcomers doubled after Sept. 11. Those in treatment have experienced a worsening of symptoms. "People who have a delusional or paranoia aspect of their disease – it's been very difficult for them," says Everett Page, a group leader in Boston who has depression. In Iowa, about 10 people in a depressive and manic-depressive association checked into the hospital because they were cycling into a manic phase – a higher than usual number.
    Robin Cohen describes the mood in her Florida group. "People with paranoid schizophrenia think that the government is plotting against them anyway. They feel they are going to be targeted with anthrax, that the government is planting anthrax throughout the area." Those with depression have a different response. "They don't want to talk about it. They aren't ready to express how they feel. They want to go home and get into bed. They don't want to shop or shower," she says. "They are ready to get anthrax and die. It enables them to think that they don't have to do the job themselves."
    So much pain. September 11 has focused public attention on mental health. This is not to make a pathology out of the national mood of anxiety. Most people with the jitters will not develop post-traumatic stress disorder. But the line between normal and abnormal can get blurred in times of crisis. Those who were directly affected by the attacks – the thousands of children who lost a parent, for example – are at heightened risk. Without access to treatment and support, many Americans are in danger of a personal meltdown. Mental health services are a critical link in the public health chain of defense against terrorist attacks. People who are successfully coping with psychiatric disorders show us how to live with the demons of fear and despair – and live well. They also show us how much more needs to be done. "Now a whole nation knows what trauma is all about. It's a hard lesson. There's no simple medication that will make you not be fearful," says Coopper. "People need to feel safe and secure. People with serious mental illness haven't had that for a long time. Now the rest of society is joining us."

Down the Road, Ecstasy May Still Do Harm
New York Times, 10/23/2001

People who use the drug Ecstasy appear to suffer long-term memory damage even after they give it up, a new study from the Netherlands concludes. The study, published last week in The Archives of General Psychiatry, compared 22 recent Ecstasy users, 18 people who said they had used the drug but not for at least a year, and 13 people who had never taken it.
    Another part of the study gave some clue about why. Ecstasy appears to act on the parts of the brain that regulate the production of serotonin, a brain chemical linked to mood and emotions. Earlier research had found that the drug appeared to cause a surge of serotonin. Brain scans in recent users showed signs of damage to mechanisms associated with serotonin, particularly in an area of the brain linked to memory. That damage was not found in those who had quit.
    Taken together, the finding suggest that while the mechanisms regulating the brain's chemistry may recover, the disruption appears to cause permanent damage in cognitive function. The researchers suggested that longer studies might find even larger problems.

British to Give 12-Year-Olds Nicotine Patches As Therapy
Reuters, 10/23/2001

LONDON -- Children as young as 12 in Britain will be given nicotine-replacement therapy in a new drive to help them quit smoking, according to cancer charities. Although the therapy, called NRT, is not recommended for children under 16 and has not been tested on young smokers, government experts believe there is no good reason why it should not be given to youngsters. More than 400 children in Britain begin smoking every day. By the time they reach 15, one in four youths is a smoker and addicted to the habit.
    "At the moment we have the absurd situation that kids can easily get hold of cigarettes but can't obtain the NRT that might help them give up," said professor John Britton of the Cancer Research Campaign. "We hope that our study will show that, as expected, NRT is just as effective in teenagers as adults in helping them to quit," he added in a statement. Britton and his colleagues will test NRT on child smokers from a deprived area in the central English city of Nottingham. Children will be questioned about their smoking habits and what they would like to help them quit. If they want to stop and are deemed appropriate for the study, they will be given a nicotine patch or placebo for as long as six weeks. All the children will be monitored to see if they abstain from cigarettes and will be offered psychological counseling for help.

More Men Have Eating Disorders, Bad Body Image
Lisa Liddane, Houston Chronicle- 10/23/2001

The secret signs of bulimia and anorexia are familiar. Looking in the mirror and always seeing an unfit, unattractive, fat person -- even when the real reflection isn't. Purging in the restroom after eating dinner with friends. Starving oneself by eating only one meal a day. Thinking constantly about one's body. But the person in the mirror is not familiar. It's a man. His name is Dick. The 32-year-old sales associate from Anaheim asked that his last name not be used. None of his family members, friends and co-workers knows that he has been struggling for more than a decade with a distorted body image.
    Dick is among a growing number of men -- about 1 million in the United States, by most estimates -- who battle with what is still largely perceived as a woman's mental health condition. The numbers of men with eating disorders may be greater -- from 3 million to 5 million, said Roberto Olivardia, clinical psychologist at McLean Hospital in Belmont, Mass. Olivardia is co-author of The Adonis Complex: The Secret Crisis of Male Body Obsession (Free Press, $25). Male eating disorders are underdiagnosed because society lacks awareness of them and men are less likely to admit they have this medical problem and seek help, Olivardia said. That's changing slowly, he said.
    Knowing who might be at risk may help prevent eating disorders from developing, say body-image researchers. Understanding the nature of male body obsession and eating disorders may help men recognize that they have these conditions and seek treatment. Doctors and psychologists do not know the exact causes of distorted body images and eating disorders in men because research in these areas is in the infancy stages. But more studies on men and boys are emerging in medical publications such as the International Journal of Eating Disorders Research.
    One in six men may have anorexia and bulimia, according to a 1999 study in Psychiatric Annals, by Dr. Arnold E. Andersen, an eating-disorder researcher at University of Iowa. Andersen classifies at-risk men into four groups:
* Men in sports and athletic activities who need to control weight for performance. This is the most prevalent group.
* Men who were overweight or obese and had negative, sometimes traumatic experiences related to their weight.
* Men whose fathers had ill health, possibly weight-related, or may have died because of it.
* Men who want to improve their body image. This includes gay and straight men.
    Researchers have coined a term for one type of male body obsession: body dysmorphia disorder (BDD). An example is of BDD is muscle dysmorphia, sometimes called "reverse anorexia" or "biggerexia." This disorder occurs when normal-size or big, muscular men think of themselves as thin and scrawny. Some men with muscle dysmorphia may be workout-aholics, or users of steroids or muscle-enhancing supplements. Researchers also know that the effects of eating disorders on men are similar to those on women: weakened, fragile bones, elevated risk for heart attacks because of electrolyte imbalance, tooth decay, gastrointestinal problems and damage to the esophagus.
    One theory in research that is gaining ground is the genetic link. Scientists suspect that the predisposition to an eating disorder may run in some families and in both sexes. But genes aren't the only factors to blame. In the past decade, magazines such as Men's Health have perpetuated the myth that the look of male health is lean, low in fat, with Michelangelo-chiseled musculature, said Lynne Luciano, author of Looking Good: Male Body Image in America. Luciano is assistant professor of history at University of California, Dominguez Hills. Lean and muscular physiques also are glorified in sports, TV, movies, music videos, advertising. They're even in toys. If GI Joe Extreme -- the enhanced version -- had been life-size, Luciano said, he would have a 32-inch waist, 44-inch chest and impossible 32-inch biceps.
    The danger of these images, Olivardia said, is they create a blueprint for the masculine man that is difficult for most men to follow without resorting to drastic, unhealthy measures, such as taking steroids, muscle-enhancing supplements, using laxatives, working out obsessively, becoming anorexic and/or bulimic. Distorted body images and eating disorders are often the manifestation of other problems, Olivardia said. Low self-esteem in childhood, adolescence and adulthood, psychological, emotional and mental issues can drive men to focus on their body or specific parts such as the midsection and see themselves as incredibly physically flawed.
    Some people with a history of obsessive behaviors carry these over into their eating habits as a form of control, said Sarah Steinmeyer, psychologist at South Coast Medical Center Eating Disorders Program in Laguna Beach.  "Eating disorders are rarely about food," she said. "Food is a metaphor for other aspects of life. A man with an eating disorder and body obsession sometimes thinks he can control food, but food actually controls him."
    South County resident Terry Murphy, 53, loathes what he sees when he looks in the mirror -- an out-of-shape, overweight man. At 6 feet and 210 pounds, the management consultant said he feels he has no control over his body and is depressed about it. "I can't get it out of mind," Murphy said. "I think about it at least a dozen times a day." Murphy, who said he never had weight issues before, put on pounds over the years when a heart condition prevented him from maintaining six-day-a-week, one-and-a-half-hour intense workouts. Murphy continues to exercise most days of the week, but has reduced the intensity for the sake of his heart. So he diets. His breakfast: a regular-size beef patty and cottage cheese. Lunch consists of a protein drink and a banana or an apple. Dinner is a low-calorie salad with chicken, half a glass of milk and the occasional small cookie.
    Dick, like Murphy, feels frustrated and alone. "Ever since I can remember, my physical appearance has been a way of gauging my self-worth," Dick said. Dick's weight for most of his teens was normal, but when he turned 19, he gained weight. At 5 feet, 6 inches, he weighed 195 pounds. After a routine physical exam, the doctor told him he was obese. To lose weight, Dick did several things. He starved himself in private. And when he ate out with friends, he consumed a normal amount of food. But shortly after, he would excuse himself from the table, go to the public restroom and make himself vomit. "The sooner I could purge, the easier it would be to get the food out," he said.   He exercised relentlessly most days of the week, sometimes more than once a day. Within a year, he lost 40 pounds.  Dick knew what he was doing was not healthy. But he kept it a secret. He was ashamed to talk about it with anyone. "It's a girl's disease," he said.
    In 1989, a roommate caught him purging. At the friend's urging, he found a doctor who treated eating disorders. "The doctor tried to scare me with statistics and stories of girls who had died because of ruptures to their esophagus. I went three times for regular counseling. And then, I stopped. I thought I could do this on my own." And he stopped bulimic behavior for six years. His weight stabilized at about 155 pounds. But his esophagus had been damaged from years of regurgitating food. After a painful divorce several years ago, Dick returned to some unhealthy behaviors. He takes nothing but coffee throughout the day. His only meal is at night. "I don't know that I'm over it," he said. Dick has tried to look for local men's support groups -- to no avail. He does not feel comfortable attending women's anorexia and bulimia support groups. "That happens fairly often to men who are trying to get help," Steinmeyer said. "And that's terrible because the lack of support groups for men only perpetuates the myth that this is only a woman's disease."
    When men seek help, they are in the advanced stages of their eating disorders because it takes them a long time to recognize and admit that they have a serious health problem and to develop the courage to communicate their need for help, said Jane Supino, executive director for the Center for the Study of Anorexia and Bulimia in New York.  Treatments for men are the same as women's -- they are tailored to the individual. They vary from outpatient visits to hospital confinement for days, weeks or months. They may include intense nutritional intervention, such as intravenous feeding, if needed. Olivardia said treatment programs that target the problems from many angles with a team approach -- involving the primary doctor, a psychologist or psychiatrist, a nutritionist and support groups -- are likely to have best results.

ADD Children Need Positive After-School Activities and Supervision
Susan DeBow, Chicago Tribune- 10/23/2001

The bewitching hours may no longer fall in the middle of the night. Instead, they may be those hours between 3 and 6 p.m. when many kids are left home alone. According to an article titled "Asking for Trouble, ADD and Alone After School," by Beth Gilbert in the October issue of ADDitude magazine, a lack of supervision and a child with attention-deficit disorder may not be a good mix. Such children--and teens similarly afflicted--tend to be more impulsive than others. "They often don't stop to think before they act," says Dr. Larry B. Silver, a child-adolescent psychiatrist in Washington, D.C.
    Suggestions for keeping your kids out of trouble after school include having your child give back to your community by volunteering. Such work promotes self-worth, and there is usually supervision. Also, consider lessons and classes. Many public schools and community centers offer after-school learning programs. Or consider hiring a college student or high school senior to "mentor" your child after school. ADDitude is the "Happy, Healthy Lifestyle Magazine for People With ADD"; check out www.additudemag.com.

Back off from bribery
Most parents, at one time or another, have resorted to that master of all manipulators, the bribe. It could have been a sucker, a new sweater or a trip to see Mickey Mouse, but according to an article called "Bad Mistakes Even Good Parents Make," by Lawrence Kutner in the October issue of Parenting magazine, bribing your child is a no-no. Also included in the list of behaviors that can get a parent sent to his or her room are criticizing, yelling and nagging, which can reduce parent/child communication to nil. Kutner says that although bribery, which originates from a weak position, might appear to work in the short run, chances are it will create a bigger problem. Kids, intelligent little beings that they are, learn the name of that game and if given the opportunity will use that power to get what they want. Kutner says that instead of offering a prize for poor behavior, ignoring the child might be a better idea, unless the child is doing something dangerous. And as important as it is to ignore misbehavior, it is important to compliment good behavior. Check out www.parenting.com.

Weaving a happy spell
Magic doesn't have to wait for big events to make an appearance. In the October issue of Family Fun magazine (www.familyfun.com) read about traditions that can make every day special. "Everyday Magic," by Catherine Newman, will show you how. Make mealtime special by choosing a day to eat routine macaroni and cheese off the good china, or plan a Friday family night. Making magic is easier than you think.

British Say Medical Unit Failed to Treat Schizophrenic
Beth Gardiner, Associated Press, 10/24/2001

LONDON - Health officials apologized yesterday to former Beatle George Harrison and the schizophrenic man who stabbed him as a new report disclosed major lapses in the attacker's treatment before he broke into Harrison's home.  The sharply critical report said workers at the British hospitals and clinics that saw Michael Abram failed to assess and treat him properly. It criticized staff who discharged him from one hospital about a month before the December 1999 attack, leaving him to walk home alone early in the morning, and said he should have been put in a treatment program 18 months earlier.
    ''We wish to make a full and formal apology to George Harrison and his family and to Michael Abram and his family for the failures in Mr. Abram's care and treatment prior to the appalling events of December 1999,'' said the statement by the St. Helens and Knowsley Health Authority and Hospitals National Health Service Trust.   ''We wish to reassure the Harrison and Abram families that lessons have been learned,'' it added. The report was commissioned by the St. Helens and Knowsley Health Authority, which oversees health services in an area northwest of London.  ''There is no doubt, with hindsight, that there were shortcomings in the mental health services we provided,'' said Ken Sanderson, chief executive of the St. Helens and Knowsley Hospitals National Health Service Trust. ''Michael Abram had complex mental health problems which we failed to comprehensively assess and manage.''
    Abram, 35, now detained indefinitely in a psychiatric hospital, welcomed the report's condemnation of the care system, but said it should have specifically identified the workers who failed to treat him properly. ''Unless they're put on the spot, how can we be sure they won't make the same mistakes again?'' his statement said. He also apologized to Harrison, now 58, saying he was ''deeply embarrassed and ashamed about the terrible thing that I did.''  ''I feel very guilty about it, but I can't turn back time and all I can say is that I am very sorry,'' he said. ''But I hope people may understand what happened to me and appreciate that it was not my fault. Physically I did it, but I was not in control of my own mind at the time.''
    Abram was accused by prosecutors of breaking into Harrison's home in Henley-on-Thames, west of London, and stabbing him repeatedly, puncturing a lung. He also was charged with attacking Harrison's wife, Olivia, when she came to her husband's defense. A judge last year ordered jurors hearing the case to find Abram not guilty by reason of insanity after three psychiatrists testified he had been a paranoid schizophrenic since 1990. He told psychiatrists he was on a ''mission from God'' and believed he was possessed by the former Beatle when he rampaged through the Harrisons' 120-room mansion. Abram had been in and out of psychiatric facilities for years and sought help shortly before the Dec. 30, 1999, attack. The report said the health service's failings were ''unacceptable,'' but added that none of the staff who treated Abram could have predicted the attack.

Drug-Penalty Bill Would Fund Therapy
Julia C. Martinez, Denver Post- 10/24/2001

Criminal prosecutors took a controversial step Tuesday to free up money for drug-abuse treatment by reducing the penalty for addicts caught with a tiny amount of illegal drugs. The state's district attorneys, led by Denver's Bill Ritter and Adams County's Bob Grant, won bipartisan support for the plan from a panel of lawmakers who will introduce the measure in the coming legislative session.
    "It hasn't been an easy sell to prosecutors across the state, and it won't be an easy sell to the (full) legislature," Grant told the committee of lawmakers working to streamline Colorado's sentencing laws. "But it's the correct thing to do. And if it's done right, it will in fact impact for many, many years the population of our prisons and the numbers of people addicted to drugs who will not come before the courts," Grant said.
    If the bill passes, Colorado would join a national trend of keeping nonviolent offenders out of prison, thus freeing millions of tax dollars for treatment aimed at lowering overall crime. At a minimum, prosecutors figure, 100 fewer drug offenders might be sentenced to prison under the plan, which would involve possession of 1 gram or less of a controlled substance. It costs the state $26,000 per year for one prison bed. Freeing up 100 beds would save $2.6 million that could be used to treat several hundred drug addicts.
    District Attorney Grant had initially opposed the idea but said he now agrees that it's necessary to stem the flow of drug offenders in and out of the state's prisons. The bipartisan panel of lawmakers voted 7-3 to introduce a bill in the coming session. The bill will be sponsored by Republican Rep. Lynn Hefley of Colorado Springs and Democratic Sen. Ken Gordon of Denver. "Through treatment, if we can cause people to get off drugs, that will improve public safety, and that's what we're trying to do," Gordon said.
    But Republican Sen. Ken Arnold of Westminster objected.   "What we're doing is not realizing that people who are being sentenced on these lower drug charges have already had their chance," he said. Republican Shawn Mitchell of Broomfield, who also voted against the plan, along with Rep. Richard Decker of Fountain, might vote in favor of the proposal during the regular session. "One of the arguments that might persuade me to support it is that people who would get helped the most from this would be the families of the drug users," Mitchell said. "They would have a ray of hope because their loved one would be getting treatment instead of a long prison sentence."