Noteworthy News Articles on Mental Health Topics, January 9-15, 2001

Too Many Children Obsessed by Weight, Studies Find
Lindsey Tanner, Associated Press- 1/9/2001

CHICAGO -- Influenced by their parents and the news media, a disturbing number of children and teenagers are worrying about their weight in hopes of looking model-thin or bodybuilder buff, a study says. A second study linked being overweight with low self-esteem in girls as young as 5, while a third suggests that watching TV at mealtime may contribute to children's unhealthy eating habits. A fourth study found that fewer than one-third of U.S. programs that train pediatricians teach about the effect of negative media messages on children's health. The reports, published in the January issue of the journal Pediatrics, come amid growing concern about the number of overweight youngsters -- 25 percent and rising by some estimates.
    The first study, from Brigham and Women's Hospital in Boston, is based on questionnaires given to 12,057 children ages 9 to 14 in 1996 and 1997. Weight concerns were found in children who weren't overweight. In the first year, 9 percent of the girls and 4 percent of the boys had extreme weight concerns, such as worries about gaining 2 pounds. Another 6 percent of girls and 2 percent of boys became highly weight-conscious during the study. Constant dieting was uncommon -- reported initially by 2 percent of the girls and 1 percent of boys -- but the numbers doubled in 1997.
    Girls have been encouraged "to form unrealistically thin body ideals" by the mass media, said Alison Field, who led the study. A similar message about sculpted male bodies "is taking its toll on boys, making them more susceptible to being overly concerned about weight," she said. The responses suggested that parents who were dieters or valued leanness strongly influenced their children. In addition, youngsters who reported spending lots of time trying to emulate popular media figures were more prone to chronic dieting and extreme weight concerns.
    Another study suggests that even very young children are aware of society's fixation on thinness. The study of 197 5-year-old girls included 48 who were overweight. Those who were overweight reported significantly lower body self-esteem than those of normal weight. Such girls may be prone to early dieting, which could impede their growth, said the study's authors, Kirsten Krahnstoever Davison and Leann Lipps Birch of Pennsylvania State University. While parents should not ignore a child's weight problem, they should avoid negative messages and seek constructive solutions, the authors said.
    One solution might be turning off the television during meals, suggests a third study, from the School of Nutrition, Science and Policy at Tufts University. It found that children whose families routinely watched TV at mealtime ate more salty snack foods and sodas, and fewer fruits and vegetables than those who turned the televisions off. The fourth study found that fewer than one-third of U.S. pediatric residency programs teach about the effect of media exposure on children's health. The results were based on responses from 204 of the 209 pediatric residency programs nationwide accredited for the academic year 1999-2000.

A Disturbed Man Set Adrift
David Snyder, Washington Post- 1/9/2001

The death of Christopher Lee Ausherman -- allegedly at the hands of a man with a history of sexual crimes -- has unleashed a torrent of anger that promises to reverberate through the Maryland General Assembly. State lawmakers have pledged to overhaul the system that returned Spencer to the streets. By piecing together court records and the accounts of police officers, corrections officials, family members and acquaintances who heard from Spencer during his six days of freedom, a picture emerges of a desperate and troubled man meagerly equipped for life beyond prison walls.A judge ruled that Elmer Spencer was insane in 1974, and therefore not guilty of attempting to strangle an 11-year-old boy with baling twine.  Three years later, he was convicted on another charge -- this time assault and battery -- and served three years in prison.
    Two years after his release, another 11-year-old fell victim. Spencer was convicted in 1982 in Carroll County Circuit Court of raping the boy behind a Mount Airy supermarket and then trying to strangle him with a shoelace. After serving 14 years of a 20-year-sentence, he was released again. Within a year he was arrested once more. An 8-year-old Howard County boy told police that Spencer had forced him to strip and jump into the Patapsco River. The case was dropped after prosecutors worried that the boy's account wouldn't hold up in court. Months later, when a 7-year-old Frederick girl told police that Spencer had fondled her, prosecutors dropped charges for the same reason: Small children can make poor witnesses. A stronger case came along later that year, when Spencer was charged with attempting to rape a Frederick woman and assaulting two police officers. He pleaded guilty to the assault charge and served 31/2 years of a 10-year sentence. Spencer, 45, was released for good behavior on Nov. 14. Six days later, he was jailed on a murder charge.
    The particularly ugly slaying of a 9-year-old boy, allegedly by a man with a long criminal history, has brought criticism and calls for reforms. Some want an end to the state's mandatory-release program, under which Spencer won an early exit from prison because he was able to apply good behavior points earned during a previous prison term to his latest sentence. State Del. Sue Hecht (D-Frederick) says she will propose legislation that would keep the most dangerous repeat sexual offenders, known as sexual predators, in state custody after their prison sentences have expired. Similar legislation failed to win passage in 1998, in part because of concerns that it amounted to forcing convicts to serve two sentences for one crime.
    After the U.S. Supreme Court upheld a similar law in Kansas in 1997, several states adopted sexual predator legislation. There are now 13 states with such laws, according to statistics compiled by the National Center for Prosecution of Child Abuse. "There's no doubt in my mind if we had passed this legislation, this little boy would be alive today," Hecht said. Other critics contend that the state does an inadequate job of dealing with inmates like Spencer. Maryland has no standard treatment for sex offenders. Inmates in need of counseling are sent to the Patuxent Institution, a psychiatric prison which has the state's lone program for sex offenders.
    During his nearly 20 years in prison, Spencer spent 16 months at Patuxent -- five months in the late 1970s after the first attempted strangling, and 11 months after his 1982 conviction for raping the Carroll County boy. A state psychologist who interviewed him in 1982 bemoaned that the state "has little to offer" severely mentally ill patients like Spencer. Phyllis A. Burke found that Spencer had an IQ of 63 and diagnosed him with mild mental retardation, paranoid schizophrenia (in partial remission) and pedophilia. "The potential for further sexual acting-out is present," she wrote. "Because Mr. Spencer feels so weak and inadequate, his victims are most likely to be children."
    He had a way of blending into the background. In prison, he barely made an impression on officers and fellow inmates. "He really never asked for much," said Ty Stepler, the corrections officer who oversaw the B Tier in housing unit No. 1, where Spencer finished his stay at the Maryland Correctional Training Center. "He was just quiet." And he was no bigger than the average 14-year-old, an unimposing, docile man who more easily made friends with children than adults. Aside from the cost of therapy, Spencer was required to pay a $40 monthly administrative fee to the state. Spencer's last job was in 1995, as a dishwasher at a Shoney's restaurant in Mount Airy. His relatives say he didn't attend school beyond the seventh grade.
    A well-qualified, well-educated convict often struggles to find work after being released, prison officials say. The state provides information about jobs and housing to those who ask for it, but the ex-inmate needs to find a paycheck and a bed on his own. When the screening officer asked for his new address, Spencer answered that he had none. "There's no way he could have provided for himself," said Spencer's sister, Rita Preston, 40, who now lives in Atlanta. "I don't condone my brother's behavior at all, but still I think the system failed him. . . . This was a time bomb waiting to explode. The system failed him and the family failed him." She declined to discuss his childhood.

Virginia Eyes Mental Health Overhaul
Steven Ginsberg, Washington Post- 1/9/2001

Virginia Gov. James S. Gilmore III announced plans yesterday to overhaul the state's mental health care system, proposing to move short-term patients from state-run facilities to community hospitals and other local health care providers. The changes would dramatically alter the focus of Fairfax County's embattled Northern Virginia Mental Health Institute, an acute care facility under investigation by the U.S. Justice Department for poor patient care. Within two years, under Gilmore's plan, most of the hospital's 127 beds would be reserved for long-term patients. Within six years, the changeover to long-term care would be complete. The plan drew criticism from some mental health advocates and state lawmakers, who will consider the governor's proposal during the session beginning tomorrow. "My first reaction is I don't think it will work," said Sen. Warren E. Barry (R-Fairfax), chairman of the Senate's Education and Health Committee. "There's a critical shortage of housing for those in need of mental health, and this will exacerbate that problem."
    Officials said the amount of money spent on mental health would remain the same, because the dollars would follow the acute care patients from state facilities to private ones. Funding to aid transition costs also will come from the sale of excess land and buildings at state facilities. The state's budget for the Department of Mental Health, Mental Retardation and Substance Abuse Services is about $750 million a year. Under the plan, community service boards would direct acute care patients to community hospitals. Health officials said the changes reflect a national trend toward subsidizing, rather than providing, acute care. Of the state's 1,800 mental health patients, 530 receive acute care, the most intensive and costly level of treatment.
    Acute care patients are treated in government facilities in Maryland and the District, though D.C. officials said they are considering a plan that would shift them to private hospitals. Officials said moving patients in need of less-extensive treatment into local facilities expedites care, reduces the stigma of going to a mental hospital and keeps long-term patients close to their families. For example, Northern Virginians in need of long-term treatment are sent to facilities in Petersburg or Staunton. "We believe each person with mental disability, to the extent possible, should be able to find fulfillment and live and function as a member of their community," said Arne Owens, deputy commissioner for public affairs and policy at the Department of Mental Health, Mental Retardation and Substance Abuse Services.
    The state operates nine mental health facilities, and the Republican governor's plan would shutter three of them -- in Danville, Burkeville and Salem -- over the next six years. The Falls Church facility has been under scrutiny since 1994 when the Justice Department launched an investigation following three deaths there within a year. Matters grew worse in 1998 when a 26-year-old patient died in the hospital's care. An internal investigation found that his death was a result of human error, partly due to lack of communication between staff members. That incident led to the resignation of the hospital's medical director and 11 psychiatrists and psychologists. Then the replacement director, hired to turn around the facility, abruptly resigned less than six months after taking the assignment.
    Mental health officials averted a similar crisis in December 1999 by promoting the hospital's chief medical officer, Mohamed El-Sabaawi, after he said he planned to leave. Thirty-nine physicians, psychologists and social workers threatened to resign if the director, the third in 14 months, was not retained. Several calls to El-Sabaawi's office yesterday were not returned, but state officials said Gilmore's plan would not affect the Justice Department investigation and expressed confidence in the facility. "It should not impact it at all," said Claude A. Allen, secretary of Health and Human Resources. "It may improve it, if anything, because it's moving its focus to long-term care needs."

Heroin, An Old Nemesis, Makes An Encore
Evelyn Nieves, New York Times- 1/9/2001

SAN FRANCISCO- At 5 a.m. in San Francisco's seedy Tenderloin area, the drug addicts are just about the only ones out.  A young woman with matted blond hair stumbles down the street with her eyes closed; a man in a red spandex dress and silver pumps nods out against the door of a single-room-occupancy hotel; small clusters of hollow-eyed men and women hover on corners.  It is no wonder the police call this strip of the Tenderloin the heroin corridor.  Everyone on the street looks either high or hung over.
   Later in the day, Matt Dodman, a blond, angelic-looking 26-year-old, is sitting in a café in another, hipper neighborhood, the Mission. A heroin user for three years, he avoids the Tenderloin drug scene. "I'm not part of a hard-core drug clique," he said, taking a sip of mineral water. But down the block, a dozen of his friends and acquaintances--all heroin addicts in their teens and 20's, and all disheveled and homeless, as he is--sit on the sidewalk outside a community center and wait to be tested for hepatitis C. More than half will test positive, just as in the larger population of San Francisco heroin users who have been taking the drug at least five years.
    Heroin was supposed to be over, yesterday's drug. But almost 20 years after AIDS made injecting it deadlier than it had ever been, it is as common in some neighborhoods here as Starbucks. A draw for drug experimenters since the heyday of Haight-Asbury, the city remains a place where "old" heroin addicts--those who have been using the narcotic for 20 or 25 years--feed their habit. But more and more young people as well are using it.
    And not just here. Hospitals and treatment centers in other large cities, especially in the West, are seeing record numbers of heroin cases. Chicago officials attribute a surge in life-threatening cases of asthma to increased use of heroin among the young. And while HIV and AIDS are down among users, needles used to inject heroin are responsible for an increase in hepatitis C, which can cause liver failure. In fact, hepatitis C is growing across the United States and in Vancouver, British Columbia, a major trafficking point for a drug pipeline that extends from Canada to California.
    The estimated number of heroin users in the United States has risen to 980,000 from 600,000 at the beginning of the 1990's, while cocaine use has decreased 70 percent, according to the White House Office of National Drug Control Policy. The agency attributes the resurgence in heroin use to new forms of the drug, smokable and snortable alike; to a prevailing myth among the young that heroin is safer when not injected; and to the "heroin chic" look of models in the early 90's.
    Washington State, Oregon and California have the highest incidence of heroin abuse in the West. Elsewhere, New York, New Jersey, Michigan, Massachusetts and Delaware also have big problems with it, according to the Substance Abuse and mental Health Services Administration, an agency of the Department of Health and Human Services. Dr. H. Westley Clark, the agency's director, says its household surveys show that from 1996 to 1998, an estimated 471,000 people used heroin for the first time, with a quarter of the new users under 18 and 47 percent age 18 to 25.
    Heroin is not only cheaper than it once was, "it's cleaner, purer," said Joseph A. Califano, Jr., who was secretary of health, education and welfare in the Carter administration and now directs the Center for Addiction and Substance Abuse at Columbia University. "And too many young people think they can snort it and they won't get hooked." Eventually, Mr. Califano added, they do get hooked, and turn to needles to achieve a more potent high. "The next drug czar, in the Bush administration, is going to have to deal with heroin in a big way," he said.
    Public health experts see the big increase in heroin use as further evidence that the nation's 20-year-old war on drugs, with its emphasis on punishment rather than addiction treatment, needs a new approach. Here in Sand Francisco, heroin users, like homeless people (many are both), are part of the landscape. The city draws young people with troubled backgrounds from all over the country, even as it tries coping with inveterate users who have lived on the streets for years.
    The new people, like Matt Dodman, from Michigan, arrive with no money and no plans. Often they end up in loose-knit communities of homeless drug users, scorned by the rest of the city and consumed with a need to get their fixes. People cross the street to avoid them. "They look at us like dogs," Mr. Dodman said. To support his habit, which costs him $20 to $30 a day, Mr. Dodman steals. Or he "boosts"--steals an item from a store, then returns it for cash. He has panhandled, but says he does not "have the patience for it."
    Dr. David E. Smith, founder and president of the Haight-Ashbury Free Clinics, drug treatment centers here, has described the city's young addict population as people looking for "geographical cheer"--hope that life is going to be better in San Francisco than it was in Des Moines or wherever. Instead, they become alienated. The same is true of neighborhoods that attract young transients in Seattle and Portland. Officials in both cities consider heroin use at epidemic levels. In 1999, Portland had the nation's highest rate of death from heroin overdose. "You look back into the early 90's, and the heroin deaths are one to two dozen per year, and then in 1999 it was 111," said Gary Oxman, director of the Multnomah County Health Department in Portland. The department expects the final number for last year to drop to the low to middle 70's, he said, in part because of aggressive education programs.
    San Francisco has stepped up efforts in recent years to divert drug users to treatment. Such programs are making the city a model for California now that a statewide voter initiative, to take effect on July 1, makes first-time drug offenders eligible for treatment rather than jail. But more people keep coming to San Francisco than the city can help. Matt Dodman was one of several addicts, young and old alike, who said in interviews on the streets that they could not find a program that would accept them. Another was R.J., who said he had been using heroin for 40 of his 49 years and could not find a space in the city's detoxification centers.
    R.J., who would identify himself only by his initials, saying he wanted to spare his four children, is a walking sign of what heroin can cost. He has overdosed five times. He has been stabbed and raped while selling himself to support his habit. He has done time behind bars, almost nine years in all. And his inner forearms have so many needle tracks that they look striped. By selling his body, R.J. earns enough money to pay for his heroin, if nothing else. "When I see young people, I tell them, 'Don't end up like me,'" he said. "I tell them, 'Look at me.'"
    Gloria Clay, like R.J. a Tenderloin regular, is a little luckier. At 35, she is in a detoxification program and says she is on her way to kicking a heroin habit she picked up two years ago, after being addicted to crack. Her scars keep her motivated. While on drugs, she was kicked by her drug-addicted boyfriend, a beating that cost her an eye and permanently damaged her spine.
    Although infected sores in heroin addicts are the leading cause of admissions at San Francisco General Hospital, and while San Francisco consistently ranks among the worst metropolitan areas for emergency room visits related to heroin, health officials here are more worried about the drug's long-term effects. Experts compare heroin users to smokers, in that risk accumulates over time. Many people infected with the hepatitis C virus, for example, do not exhibit symptoms for many years, said Dr. Andrew Moss, professor in residence of epidemiology and biostatistics at the University of California at San Francisco. But, Dr. Moss said, a segment of those afflicted will develop liver disease, cancer or cirrhosis, and hepatitis C is very infectious.
    In San Francisco, where young users as well as old overdose routinely, the young are very difficult to reach, because their problems transcend drug use, Dr. Moss said. "they're America's damaged children," he said. Matt Dodman is not worried. He is sure he will not overdose, and certain he will remain free of disease. Why? "Because," he said, "I know so."

Connecticut To Stop Sending Mentally Ill Children Out of State for Treatment
Associated Press, 1/10/2001

HARTFORD, Conn.--The state will no longer send children with behavioral and mental health problems out of state for treatment and will return over 340 children now being treated elsewhere to Connecticut. The state Department of Children and Families announced the policy change Tuesday, as part of an effort to overhaul its mental health services. ''For me to continue to send kids out of state would be the easy answer,'' said DCF Commissioner Kristine Ragaglia. ''But it wouldn't be the right answer.''
    There are 457 children with behavioral and mental health problems living in out-of-state facilities, some as far away as Florida. They leave Connecticut at a rate of 14 to 30 children each month and return at essentially the same rate, Ragaglia said. The policy shift will result in the return of 347 children living in facilities out of state, and DCF will cancel contracts with those facilities, Ragaglia said.  About 110 other children are being treated in facilities that border Connecticut and, because of their proximity, won't be disturbed, she said. The state will also continue to send ''a few select cases'' to those facilities when warranted, Ragaglia said. ''This is a bold step that will benefit so many children, and a very positive decision by the commissioner,'' said state Child Advocate Jeanne Milstein. ''Now it is upon each of us to be committed to doing what it takes to care for our children here at home and in their communities.''
    The decision comes as the DCF launches a $33 million plan to improve the state's mental health system for children. The money will pay for the statewide expansion of DCF's community-based mental health program, as well as the creation of more than 200 sub-acute residential beds for children who, until now, couldn't be treated in Connecticut. Ragaglia said the department is poised to sign a contract with one of its private mental health providers that will create 75 new, sub-acute beds by the end of April. Another 46 beds will be created in the next six to nine months.

Colorado Attorney General: Toughen Sex-Offender Registry Law
Kirk Mitchell, Denver Post- 1/11/2001

Colorado Attorney General Ken Salazar proposed legislation Wednesday to beef up sex offender registry laws by adding more faces of child molesters and rapists to a state Web site and requiring offenders to report their addresses twice as often. Salazar also wants the Colorado Bureau of Investigation to keep a statewide sex offender registry. Data are now kept by law enforcement offices across the state. "The public safety of Colorado's citizens requires that attention be paid to this issue because over the next several years more than 1,600 sex offenders may be released from incarceration or parole without any supervision," he said.
    Last year, the Colorado Court of Appeals and the Colorado Supreme Court ruled that sex offenders who committed crimes between 1993 and 1998 weren't subject to the mandatory parole law. That means when they complete their prison sentences, they won't be required to serve any time on parole. Salazar has asked the Supreme Court to overturn those rulings, but he couldn't guarantee it would. All the more reason, he said, to pass his proposal. "Currently the sex offender program is essentially a hodgepodge of responsibility with a multitude of local governments," Salazar said, which doesn't allow good communication from one police department to the next. Because some counties don't have adequate resources, they've been unable to keep accurate or up-to-date registries of sex offenders in their areas, Salazar said. About 8,000 sex offenders are registered across Colorado. The CBI's Internet site only posts the names of violent sex offenders and should include many more sex offenders, Salazar said. Salazar also proposes requiring sex offenders to report twice a year instead of annually because of how frequently they move.

Talks Are Set on Mentally Ill
Alice Dembner, Boston Globe- 1/12/2001

The state is violating federal law by failing to provide care at home to hundreds, if not thousands, of mentally ill children, forcing them into unnecessary and lengthy hospital stays, lawyers for the children assert in a letter to state health officials. The lawyers say they are ready to file a federal lawsuit but suggest they would prefer to resolve the case without litigation. The letter, a copy of which was obtained by the Globe, presses the state to develop extensive one-on-one programs of therapy and recreation designed to keep troubled children at home, rather than to have them remain in hospitals or residential facilities. ''Despite some efforts by the administration, the crisis with kids has not abated; it's getting worse,'' said Steven J. Schwartz, an attorney with the Center for Public Representation, one of three groups that drafted the letter.
    The state has already invested millions of dollars to increase the number of psychiatric and residential beds, but yesterday, according to the state, 102 children on Medicaid remained hospitalized beyond medical necessity because appropriate, less restrictive care was not available. That number has risen steadily from 17 in May 1998. The letter, dated Jan. 4, is designed to prod the state into devising a different solution for children in the Medicaid program, which provided free mental health care to nearly 50,000 poor and disabled children last year. ''The model is to build on the strength of the family, to bring supports to the family, instead of taking the child out,'' Schwartz said. ''With this service, we can intervene early, before we have a full-blown crisis.''
    State Secretary of Health and Human Services William D. O'Leary said yesterday that the state had sent a response Wednesday, agreeing to meet with lawyers from the Center for Public Representation, the Mental Health Legal Advisors Committee, and the law firm of Hale and Dorr, which is preparing the suit. ''We are committed to dealing squarely with the issue of kids in the mental health system,'' O'Leary said. ''We've talked about how in the short run you expand the acute [hospital] capacity, but in the long run you might not need all those beds. This is an acute issue, an intermediate issue, and a community issue, and we're going to have to deal with all three.'' O'Leary said he expected the governor's budget proposal for next year to include additional money for community care, funding that was planned before the letter arrived. But he declined to provide specifics.
    Lisa Lambert, assistant director of the Parent-Professional Advocacy League, said additional services can't come soon enough for the families with mentally ill children for whom her group advocates. In the last month, she said, she helped three families on Medicaid whose children have been repeatedly hospitalized. One 10-year-old had been in the hospital 10 times, while a 6-year-old had been hospitalized three times and a 12-year-old seven times. ''If there was intensive support in the community, there would be fewer hospitalizations,'' she said.
    Schwartz said the proposals in the letter are modeled on other states, which have expanded services to meet children's needs and the provisions of Medicaid law, which entitle children to all medically necessary care. ''The few home-based services which do exist fall dramatically short'' of the need in Massachusetts, the letter asserts. What is needed, the letter says, is trained staff to provide individualized educational and recreational activities in the home to teach positive skills and help children adapt their behavior.  Meanwhile, discussions are ongoing between the state and the lawyers over demands in a similar letter sent in November regarding the provision of more group homes and community-based programs for adults.

Defendant's Psychiatric Records Sought
Farah Stockman, Boston Globe- 1/12/2001

Essex County prosectors asked a judge yesterday to unseal the psychiatric hospital records of Dr. Richard Sharpe, a Gloucester dermatologist charged with murdering his wife, Karen. The attempt by the prosecution comes nearly a decade after Sharpe fought a court battle to keep the records of his 1991 hospitalization secret. Citing The Boston Globe's successful suit to open the court records detailing how Sharpe was involuntarily admitted to The Arbour - and how he fought for three years to have the incident expunged - prosecutors asked a judge in Middlesex Superior Court to open two envelopes in the file that have remained secret: those that contain doctors' notes and his medical file. ''I think the Commonwealth should have access to the file as ... we will be putting his mental state at issue in this (murder) case,'' Assistant District Attorney Robert Weiner said. Defense lawyer Joseph Balliro objected, and told reporters after the hearing that the moves to pry into his client's medical records violated his privacy. The judge postponed a decision so as to give Balliro time to file a written objection.
    The tug of war over Sharpe's medical records reflects the increasing role that Sharpe's mental health has played in the run-up to the trial, scheduled to begin in June. Balliro yesterday formally notified the court that he planned to argue that Sharpe lacked criminal responsibility last July 14, when, authorities say, Sharpe showed up at his estranged wife's home and fatally shot her with a rifle in front of witnesses, ending 27 years of marriage and months of stormy divorce proceedings. ''One of my defenses will be that he was at least insane on the day this happened,'' Balliro said after the hearing.
    Since Sharpe's arrest, media outlets fought to gain access to Sharpe's divorce files, which chronicle allegations that he abused his wife throughout the marriage, abused prescription drugs, and dressed as a woman. Balliro said details of Sharpe's 1991 stay in a locked ward at The Arbour in Jamaica Plain could help prove that his client was not criminally responsible for his wife's murder. But the records could also highlight Sharpe's insistence in 1991 that he had no serious mental health problems, and that his admittance to the psychiatric facility was a mistake.
    Sharpe was admitted on April 27, 1991, to what was then called Cambridge City Hospital after his wife accused him of stabbing her with a fork and his psychiatrist became alarmed by his slurred speech and apparent disorientation. The psychiatrist, Dr. Margaret S. Ross, had earlier expressed concern that Sharpe suffered from major ''depression with features of anxiety and schizoid or other personality disorder,'' according to court documents. But when Sharpe was transferred to a locked ward at The Arbour he told doctors that his wife had ''attempted to frame'' him and had falsely accused him of attacking her. His wife soon recanted, and doctors at The Arbour declared him ''non-psychotic'' and released him.
    At the time, Sharpe said the hospital had treated him ''like a dangerous lunatic,'' and he sued The Arbour, the City of Cambridge, Waltham-Weston Hospital, and his health insurance company to erase the incident from his medical records. After Sharpe argued for three years that the hospitals should expunge what he called a ''false and extremely embarrassing medical record,'' a judge ruled against him but sealed the records from public view, and allowed him to add a written statement giving his explanation of events.

At the Top of My Game
Mark Helmke, Washington Post- 1/12/2001

The Monkey Demon delivered the blow with his ax. It sliced an arc several inches above and behind my left ear. No brain scan would reveal any marks, the doctors assured me. And yet I felt the wound vividly. It was electric. The slightest stressful incident -- an annoying telephone call, a barking dog, a doubting remark -- would send sparks jumping from the wound on the left side of my head to the right. "Brain volts," I called them. My right arm and leg jerked. This was how my mental illness felt last winter, about six months after my diagnosis. It would be another six months before I finally accepted this terrifying condition, labeled bipolar disorder but also known as manic-depressive illness, and began to learn how to live with it. Only recently have I felt more comfortable telling people I have a mental illness . . . that I had a mental breakdown . . . that I seriously contemplated suicide several times . . . that my earlier life as a power-Washington, corner-office high flier is over. And that this illness is now a part of my life, and that I must manage it appropriately.
    These were not easy conclusions to reach. There is no blood test, biopsy or X-ray that can identify bipolar disorder. And of course mental illness carries a stigma in our society, especially in this highly competitive city, where a person's brainpower often determines one's success, status and ultimate worth. The logic seems airtight: If it was my brain that made me a success; and if my brain has malfunctioned; I am therefore a failure. Back during the 1960s, I worked on an underground newspaper where my friends and I encountered the legend of the Monkey Demon in author Richard Farina's book "Been Down So Long It Looks Like Up to Me." Farina died shortly after publication of the book, in 1966, when he was thrown off the back of his motorcycle. We knew the Monkey Demon was responsible. We figured the Monkey Demon would attack with an ax from behind, when you weren't looking, when you least expected it. That's what happened to Farina, and that's what happened to me. Except the Monkey Demon didn't kill me. It was only a wound, that arc behind my left ear.

At the Top of My Game
At the beginning of 1999, I was at the top of my game. I had paid my dues, worked my way up, and I was in charge. I was doing what I had always wanted to do. After a stint in journalism in the 1970s, I had gone to work for Sen. Richard G. Lugar (R-Ind.). When Lugar was chairman of the Senate Foreign Relations Committee from 1985 to 1987, I gained recognition as a political player, a power broker, a commentator on international affairs. After the Reagan years ended, I was recruited by Reagan aide James H. Lake to help start a new K Street lobbying firm. I became president of the firm and helped build it, by 1995, into a big and influential company with more than 300 employees. I hired both Mike McCurry and Joe Lockhart before they were named White House press secretaries.
    Meanwhile, my wife, Sue, and I had three children, born in ordered intervals in 1980, 1985 and 1990. Our two daughters and son are bright and creative, though they have been diagnosed with various learning disabilities. Sue, who teaches preschool and has educational background in working with disabilities, helped our children to overcome their problems. I was too busy, too absorbed with being a "success," to focus much on their challenges. "Work through it. Try harder," I demanded of them, just as I had always demanded of myself. Now I know how counterproductive and dangerous those edicts can be. Back then I justified my minimal sensitivity to the needs of others as the flip side of my drive to provide for my family. We needed a big house, just like the one I grew up in, although at more than 10 times the cost. And private schools. And every other opportunity.
    And so I lived like the typical Washington workaholic. Up every morning at 5 to beat the rush downtown. By the time everyone else arrived in the office, I had consumed five or six newspapers. I obsessed about what was going on in the world, and fretted over the political nuances. Every day was handling hundreds of incoming business and political missiles. Work was war, and I saw my job as constantly taking and holding the next beachhead as we expanded the business. Whether in the office or traveling, I dealt with a ceaseless barrage of calls, challenges, conferences, meetings and management mediation. At night I was the last to leave the office. I would see the kids for an hour at most, then work at home until midnight, frustrated that I didn't have more time in the day. My travels were endless. I had a company apartment in New York, where I would spend two or three days a week. And as the Soviet Union collapsed in the early '90s I made trips to Ukraine and Russia, where I represented major international aeronautics and defense firms.
    But by 1995 the firm was breaking into competing factions and I went out on my own. I worked on Lugar's presidential campaign in 1996, built up a stable of clients and hired staff in an Old Town Alexandria office. I created a joint venture with a Miami company to work on Latin American issues. And I formed another joint venture with former Republican National Committee chairman Haley Barbour and former ambassador Richard Burt to develop international business. I was active on the boards of several start-up companies coming out of the former Soviet Union, and I managed my brother's 1998 U.S. Senate campaign in Indiana.
    Running around among all these offices and deals, I was depleting my physical energies. And now, for the first time in my career, something didn't feel right, like something very basic -- my motivation, my drive, my life itself -- was out of line. It was as if I had spent the past 30 years of my life working around the clock, denying everyone I loved and cared for, to woo the most beautiful prize in the world -- success -- and now, when I finally had her in my arms, I couldn't perform. Worse, I suddenly didn't care. In the spring of 1999, I realized I was using the word "depressed" more and more. Was this the malaise I felt? Depression? I had always been an optimist. In the competitive political world where every day, every issue, is like a kickoff return, I excelled at open-field running, taking advantage of the openings. Now all I saw were defenders ready to pounce, and an ever-shrinking field.
    I became fearful of marketing my business for fear I would fail. I stopped returning calls and scheduling meetings. I couldn't force myself to complete projects, because everything seemed so dull and useless. I hid in my office. I tried to bounce back by pushing myself harder and harder, as if I could somehow will myself back into the game. I tormented myself. The Bobby Knight implanted in my brain by long experience would not relent. When the going gets rough, the tough get going. Run through the pain. This is all about will, heart. But then my heart went into overdrive -- full-blown panic attacks for no apparent reason. I would be sitting in a business meeting when all of a sudden my heart started to pound. I had my heart checked by a doctor, and was told it was "just" a panic attack.
    But the word "just" did no justice to the fear and foreboding I experienced. When they hit me, I had to excuse myself from a meeting and hide in the bathroom until it passed. Later I would run away from meetings or receptions when the attacks came. And then I wouldn't go to them at all. For the first time in my life, I became afraid of heights. I was looking out the window of a Manhattan skyscraper before a meeting, and I started to swoon. I could see myself crashing through the glass and falling. I struggled to regain my composure and think straight. I made it through the meeting. I had the falling sensation again when I walked the corridors around the broad atrium of the Hart Senate Office Building, a place I knew well. I hugged the wall and couldn't cross over the walkways without getting dizzy.

Fear of Fraudulence
As my partners and clients complained about my loss of interest and failure to deliver, I began to act more erratically. I rearranged my office furniture on a weekly basis, thinking that would get me back on track. I bought new briefcases, believing they would help. I closed my Old Town office and moved everything downtown. But that didn't feel right, so I frantically moved rooms around in my house to create a different home office. One weekend, I decided to move everything to another office building downtown. And I suddenly decided I needed to take a 24-hour trip to the Philippines, 12 time zones away, to meet for eight hours with a business client I was already scheduled to see in another week, and then immediately fly home.
    Hard drinking goes with politics and journalism. I got my first newspaper job because I could drink the editor under the table. When I was working hard, a few stiff bourbons at night would quell my frustration that I didn't have more time. The drinks helped me downshift so I could get a few hours' sleep before the race restarted the next day. Now alcohol numbed my despair. But I didn't drink during the day. After Sue and children went to bed, I sat in my library, browsing through books, looking for some meaning to my malaise, but finding it in bourbon instead. In a stupor, I slept in a chair.

I Am Depressed
For months Sue, concerned about my deteriorating condition, urged me to see a psychiatrist. Not me, I said. Depression was all about will, I said. I could get out of this myself. In late August, with Sue contemplating divorce, I changed my mind. It was the time of year when the prospect of change fills the air. Summer is winding down and fall brings a new season and fresh hope. But I had no hope. I no longer liked myself. I was a failure at my job, and my family was on the verge of deserting me. I contemplated how I could smash my car into a tree along the George Washington Parkway. With my last ounce of energy, my last bit of faith, I admitted that I could no longer "snap out" of this funk. I told Sue I was ready to see a psychiatrist. I was ready to do anything to get my life back. But the night before the appointment, I broke down. My heart was beating so rapidly, I was afraid a major heart attack was on the way. Sue found me curled up in bed, sobbing uncontrollably. I held on to her.
    The next day, a Friday, with Sue at my side, I broke down crying again during my first meeting with the psychiatrist. All my fears and loathings burst out of me when the doctor asked what was wrong. In her quiet office, the psychiatrist calmly suggested that my condition was not the result of a personal failure, but a medical condition -- a brain disorder caused by a chemical imbalance. But to successfully begin treatment, the doctor said, I had to stop drinking. Self-medication through alcohol is common and corrosive in mental illness. I said I could stop. But she was concerned about alcohol withdrawal and urged me to begin the process of treatment in the controlled setting of a hospital or clinic where I could disengage from the alcohol and then get to the illness. We agreed I would enter Arlington Hospital's Center for Psychiatric and Addiction Treatment on the following Monday.
    I felt better after the meeting and spent the afternoon working in our vegetable garden, feeling safe and, for the moment, better. I was tending to my garden, tending to my life. But that afternoon the heart palpitations kicked in. The doctor had prescribed a tranquilizer called lorazepam if I started to feel panicky. I went into my bathroom and grabbed the bottle. I looked in the mirror and looked at the bottle in my hand. The floor seemed to open under my feet. I wanted to take the whole bottle and end this suffering forever. I blacked out and collapsed on the floor. Sue found me, got me to bed and took the bottle away. Lying in bed, sobbing, my body jerked, twitching like a broken electronic machine.

Welcome to the Monkey House
On Monday, in the Psychiatric and Addiction Treatment Center, the nurses took away my razor. There were no private rooms. Curtains around the beds provided the only privacy, but we weren't permitted to close them. The staff started me on a regime of tranquilizers and vitamins. Coffee was prohibited. I slept. My vital signs were taken every couple of hours. In between there were group meetings. We talked about addiction and mental illness. As I sat with alcoholics, drug addicts and others, I realized we all had brain disorders, all had demons taking swipes at our heads.
    I met some interesting and tragic people. There was a recovering alcoholic, her clothes decorated with Grateful Dead dancing bear designs. She said I was the first person ever to comment on them, probably the first to ever know what they are. At the common meals, I talked with a young African American woman addicted to heroin. She was desperately looking for a halfway house to take her in. And there was a young woman from a working-class family in a small town in the Shenandoah Valley. She was hooked on cocaine. She wanted to find a way home to see her little boy. These people were not criminals. Like me, they had brain disorders.
    After three days the doctors declared that I had no signs of alcohol withdrawal and my heart and blood were fine. I was given the antidepressant called sertraline, brand name Zoloft, and told to go home. My psychiatrist also prescribed mirtazapine, brand name Remeron. These are called selective serotonin reuptake inhibitors (SSRIs, antidepressant medications that influence the complicated chemical and electrical reactions in the brain. The medications began to stabilize my moods, but the doctor said it could take weeks or months for their full effect to kick in. I still felt depressed, but at least it was not the harrowing depression and despair.
    Every week I visited the psychiatrist to talk and review the effect of the medications. I tried to remain calm and not let anything upset me. I didn't want to go anywhere or see anybody. I read everything I could find on mental illness. I continued to struggle with an overwhelming sense of failure. I had to reconcile and overcome the most destructive feelings I'd ever had. All winter I continued the drugs and therapy and wrestled with the illness. My thoughts were disturbed. At times I felt a poison running out of my head, paralyzing my arms. I would lie in bed and couldn't move. This is when I started to dream about the Monkey Demon, and how his ax glanced off the left side of my brain. When something stressful happened to me, the brain volts from the Monkey Demon's wound fired. Sleep was the only relief. I felt like I slept for the next two months.

Drug Therapy
I stopped taking mirtazapine, which made me too sleepy. I tried bupropion, brand name Wellbutrin, but it made me hyper and anxious.  Experimenting with these new generations of medications is part of the contemporary process of dealing with depression. Because we know so little about how the brain works, some medications -- or doses or combinations -- work for some people and not others. There are no medical quick fixes to mental illness. I've learned that a holistic approach is required: a personalized mix of medication, therapy, exercise, nutrition and attitude. I took the controversial psychostimulant called methylphenidate, brand name Ritalin, often used for treating hyperactive children. It gave me focus and the ability to concentrate again. It removed the friction I had encountered in working and thinking.
    Although I started to feel better, the failure issue continued to stalk me like the Monkey Demon. The doctor argued that the breakdown wasn't my fault, wasn't my failure. It was a quirk of fate, of chemistry and genes and electrical impulse, that led my brain into trouble. She said I was like a round peg making itself fit into a square hole, always working overtime and stressing my brain and body to fill up the gaps. All this extra effort worked for a long time, but then I broke down, unable to handle the stress any longer. We talked about how my situation was like a star running back who breaks his leg on a fluke play. He can't play in the pros anymore, but he can still lead a happy and productive life.
    After all the years I'd spent on the fast track, it was hard for me to accept this fate. I went through the stages of death, mourning my old self. I was angry. I mulled every event in my past and my family's past that might have led to this, looking for someone or something to blame. Was it a mere genetic fluke? Was it because my grandfather was gassed during World War I? Was it the so-called "fake fallout" the government dumped over my home town in the 1950s to study wind patterns? Was it my visit to Chernobyl?
    By spring, the brain volts subsided. The medications, therapy and lifestyle changes were beginning to work. I could tell that my brain was beginning to recover. Science has not yet found a cure for mental illness, but the treatment of it is improving. I was learning to accept this illness, live with it, manage it in the hopes it would not get worse, which too often it can. I could concentrate on getting one thing done at a time, but if there were competing issues, I would fall apart. I had been a "big picture" person, but now my perspective was even more expansive. I lost all ability to attend to detail, unless one single, isolated issue came into focus. My short-term memory was sketchy, but my understanding of times past and even future seemed vast.
    I stayed at home living on disability insurance payments. I had no job to go back to. I told my Washington partners a medical condition prohibited me from working. My Miami partners were supportive at first, then turned the dissolution of the company into a contested issue for the lawyers. When old Washington friends and colleagues called after not hearing from me for some time, I didn't know what to say. I had to figure out what to tell people. "Well, I have this neurological condition," I explained. That seemed to worry people, like I might have a seizure right in front of them. So I tried something lighter. "Docs said I was under too much stress. Told me to back off." Back home in Indiana, people seemed to understand and sympathize. But here in Washington, the looks on their faces said to me: Loser. Couldn't cut it. With a select few, I acknowledged I had a mental illness. They looked at me curiously. A few said, "How can that be? You seem so articulate. So, why . . . ?" I wanted to complete their sentences: "You mean, why aren't I begging for quarters at the Farragut North Metro stop?"

Speaking Out
I'm different now, but I am alive. I can't do a lot of what I used to do. But there is still a lot I can do, and want to do. My marriage survived. My children feel like they have a father back. I can work again, provided I keep myself in a safe and secure environment and limit myself to one project at a time. I can write, I can speak, I can analyze things. I can't handle multiple stress hits. I can become very anxious at the smallest challenge, and have learned to either pace myself or even pull back. Eventually I might be able to do more, or may not. Mental illness is peculiar to all who have it. All illness makes us different, whether it's heart disease, cancer or a bum knee. Mental illness is no different, except for how our society thinks about it.
    Why was I afraid to seek treatment when I broke down? Why was I afraid to admit to myself I have a mental illness? It's partly because of the stigma it carries. With mental illness, the choices are stark. If what's wrong with me is a mental illness, then I'm sick and out of control and not to be trusted. If I'm not sick, I'm merely a fraud and a failure on his way to ruin. That's why suicide is a silent killer, especially among men. It pains me whenever there is a report in the papers about another successful person who kills himself. At times there are big stories, with hints of scandal, about presidential aides or top military officials. Then there are the disturbing reports of leading citizens of our communities who for some reason or another shoot themselves at a traffic light. My guess is most were tortured by the demons, but -- fearful of the consequences of admitting it and pursuing treatment -- ended their suffering their own way.
    Society has learned enough about the treatment of cancer to not be overly concerned about the late Paul Tsongas's running for president. And we accept that Richard Cheney's heart disease ought not to prohibit him from serving in the second most important executive position in the United States. But the admission of a mental illness, even for a minor player like me, comes with considerable risk. To "out" myself for having a mental illness is dangerous, especially in Washington. I've asked friends in confidence what my chances were. They said they would be reluctant to hire a consultant or a manager with a history of mental illness. While politicians and the media can all agree that mental illness is a serious issue, when it happens to one of us. . . . Well, that's another matter.
    When James Forrestal, the nation's first Secretary of Defense, had a mental breakdown, the Truman administration wanted to cover it up. They didn't want stories in the media about a "madman" with his finger on the nuclear button. So instead of helping him with proper treatment, Forrestal was sent to Bethesda Naval Hospital, where there were no provisions to stop him from jumping out the window to his death. As I grappled with my own illness, I wondered if the situation would be any different today. After all, Thomas Eagleton was a respected U.S. senator, but when the media revealed he had received electroshock treatment for depression, he was no longer considered qualified to serve as vice president. Even though the Eagleton affair was 28 years ago, I haven't found anyone today in politics and the media who disagrees with the premise that Eagleton today would still be kicked off the presidential ticket. It's now acceptable for a candidate's wife to talk in vague terms about depression and the need for mental health services and coverage. But for a person in a real leadership position, mental illness is still the kiss of death. Circumstances forced me to reconsider my ideas about mental illness. Society needs to do the same thing.

Confidential Mail for Domestic Victims Signed into Massachusetts Law
John Mcelhenny, Associated Press, 1/12/2001

BOSTON--The state will keep confidential mailing addresses for victims of domestic violence and will forward all first-class mail in order to keep their attackers from tracing them, according to a new law. Eligible victims, who will be identified through the courts, will be able to use an alternative address provided by the state on all public records, in order to further protect them. People often move to escape domestic violence, but until now, attackers could find the victims' addresses through government records or by such methods as asking utility companies or stores.
    ''This is one of the most significant advances in protection of victims since Chapter 209a,'' said Nancy Scannell, a spokeswoman for Jane Doe Inc., a coalition that fights sexual assault and domestic violence. Chapter 209a allows victims to take out restraining orders.  Under the new law, victims will be assigned addresses through one of the 16 branches of the Secretary of State's Office around the state. Similar programs already exist in Washington, California, New Jersey, Nevada and Florida. The proposal was one of several that Lt. Gov. Jane Swift signed into law by Friday, the last day to act on proposals passed during the 1999-2000 session.

Psychoanalysts Use Films to Sharpen Interpretation Skills
Julia McNamee Neenan, Chicago Tribune-1/12/2001

It seems psychoanalysts may be honing their skills in an unlikely place -- a darkened theater. Watching a movie -- if it's stimulating enough -- can be a very familiar experience for a psychoanalyst, says Dr. Bruce Sklarew, co-founder and chairman of The Forum for the Psychoanalytic Study of Film. "It's like so much of what we're used to doing in dream interpretation." He headed several sessions on theories of film and psychoanalysis at the recent meeting of the American Psychoanalytic Association in New York.
    Literature is verbal, explains Dr. Francis D. Baudry, training and supervising analyst at the New York Psychoanalytic Society, who spoke on the film version of James Joyce's "The Dead." But if movies are good, they are like dreams; they are visual and communicate messages in oblique ways that must be interpreted. Like the analyst, the moviegoer must look for a number of cues such as lighting, shadows, tone of voice, posturing. For example, as if "The Dead" wasn't already focused on mortality, Baudry says, director John Huston was near death himself as he worked on the film. That lead to what Baudry describes as "a preoccupation with death as a subtheme" in the movie. In one dramatic scene, he says, Huston shows people leaving a party in a horse-drawn carriage, beside a river. Enter the symbol, Baudry says: "There's a long shadow behind it, presaging death."
    Analyzing film can be similar, Sklarew says, to analysis itself. So it comes as no surprise that many analysts relish movies. And the more complex, the better, he notes, citing a film of Bernardo Bertolucci or Ingmar Bergman as examples. For instance, Sklarew estimated he's seen Bertolucci's "The Conformist" 15 or 20 times. Dreamlike, it consists of multiple flashbacks that are not in chronological order. It's not an easy movie to watch, Sklarew says, "but it's the most wonderful work." Watching and discussing films with colleagues brings an additional benefit, Sklarew says. "With our patients, we have no chance to talk with our colleagues," he says, unless it's an extraordinary situation. Watching a film together means "we have the same clinical material on the screen, and we can discuss it."
    Three discussions at the conference examined the question of time. Kent Jarrett, with the Center for the Study of Anorexia and Bulimia in New York, spoke about the movie "Groundhog Day" and its main character's relationship with time. The character, Phil, sees time much as an alcoholic would, says Jarrett, who has worked extensively with alcoholics. As his life begins to repeat itself, he "binges" on time, repeatedly satisfying himself with shallow pleasures. Time is a commodity. "Often the analyst has one idea of time, which is to look at the past and help the patient move forward into time, and often the patient has another sense of time," Jarrett says. "What `Groundhog Day' did was make me think of this." In therapy, Jarrett says, analysts should provide the safe haven that lets the patient's sense of time change. "It's the analyst's job to give them a hopeful relationship," Jarrett says.

Boy's Murder Defense: Pro Wrestling Made Me Do It
By Terry Spencer, Associated Press, 1/13/2001

FORT LAUDERDALE, Fla.--One of the youngest defendants ever to face an adult murder trial in Florida has a novel defense in the beating death of a 6-year-old family friend: Pro wrestling made me do it. Nobody disputes that then-12-year-old Lionel Tate smashed in Tiffany Eunick's skull. But the boy's attorney contends it was an accident that resulted from an intellectually immature youth imitating the wrestlers he watched on television. The World Wrestling Federation is suing the lawyer for libel. Tiffany's death was one of at least four cases in 1999 in which pro wrestling was blamed when one child killed another.  Opening statements are scheduled Tuesday in Lionel's first-degree murder trial. If the boy, now 13, is convicted of first-degree murder he faces life behind bars without the possibility of parole until he is 38. Jurors also could convict him on a lesser homicide charge.  Prosecutors offered a plea deal that would have sent Lionel to a juvenile facility for three years followed by 10 years' probation. But he rejected it on the advice of his attorney, Jim Lewis, who said his client isn't guilty of any crime. ''This was a horrible accident,'' Lewis said.
    Lionel, who despite his age weighed 170 pounds when Tiffany died, has the intelligence of an 8-year-old, Lewis said. He says the boy didn't understand that professional wrestling is staged, and thought that if he body-slammed someone they would walk away unhurt, just like on TV. The lawyer plans to call psychologists to testify about Lionel's intelligence. Lewis tried to force such wrestling stars as Dwayne ''The Rock'' Johnson, Terry ''Hulk Hogan'' Bollea and Steve ''Sting'' Borden to testify about how their moves are staged, but Judge Joel Lazarus quashed their subpoenas. The judge also rejected Lewis' request to have psychologists testify about the effect of pro wrestling on children.
    Prosecutor Ked Padowitz wrote in court documents that Lionel never told anyone he was imitating wrestlers until a month after the girl's death. Instead, Lionel originally told detectives in a recorded interview that will be played for jurors that he and Tiffany were playing tag and watching cartoons at his home in suburban Pembroke Park. He said he picked her up and accidentally hit her head on a coffee table. Lionel's mother, a Florida Highway Patrol trooper, was upstairs taking a nap at the time of the death in the summer of 1999, police said. She and Tiffany's mother were longtime friends and often babysat for each other. No charges were filed against her.
    Jerry McDevitt, an attorney for the WWF, said the wrestling defense is Lewis' fabrication. The Connecticut-based federation, the nation's top pro wrestling organization, has filed a libel suit against Lewis, saying comments he made on national television and elsewhere defending Lionel have been false and defamatory. ''This defense would be just a joke but for the tragic consequences of his client's actions,'' McDevitt said. ''It's regrettable that when some juvenile delinquent commits a homicide that his attorney would try to make a television program the fall guy.'' The WWF consistently has some of the top cable television ratings.
    There have been no studies specifically on the impact of pro wrestling on children, said Dr. Howard Spivak, a Boston pediatrician who chaired an American Academy of Pediatrics task force on violence. But he said there have been more than 1,000 studies on how televised violence affects children, and most show that children who watch the most violence are the most violent. ''There is reason to be seriously concerned,'' Spivak said. ''Proponents of wrestling say that kids can differentiate between reality and fantasy, but we know that children are actually fairly old before they do that in any consistent way.''
    Laurence DeGaris, a former Washington State University education professor who moonlights as a professional wrestler, believes it is wrong to blame pro wrestling for the actions of children. Most children can tell professional wrestling is fake, DeGaris said. If they can't, he said, it's up to their parents to keep them from watching. DeGaris, who studies the sociology of sports and now works for a Denver sports marketing company, said children have always played at wrestling but most know not to hurt the other person. Those who don't know have other psychological or anti-social problems, he said. ''By the time children are 2 or 3 they know not to hurt other people,'' DeGaris said. ''I certainly think a 12-year-old should know the difference between play fighting and hurting someone.''

New Michigan Law Keeps Divorced Parents Within 100 Miles of Home
Sara Scott, Ann Arbor News- 1/14/2001

LANSING--Most divorced parents in Michigan will now need permission from their ex-spouses or judges if they intend to pack up and move their families more than 100 miles. Legislators approved a bill in the final days of 2000 that prohibits parents from moving more than 100 miles from the home where their child was living at the time of the custody order. "It's our goal to encourage parents to stay closer together and work together, so that each parent can have a relationship with the child," said the bill's sponsor Sen. Bill Bullard Jr., R-Highland.
    The law applies to parents who have joint legal custody or who share in the decision-making of health, educational and other issues relating to children. It does not apply to parents who have sole legal custody. Signed by Gov. John Engler Tuesday, it took effect immediately. The bill also was intended to address some inequities in the old law, which required court permission only if a parent wanted to move out of state. "Basically, you had to go to court if you were going to move 15 miles from Monroe to Toledo . . . But you didn't, if you wanted to move 600 miles away to Ironwood, Michigan," Bullard said.
    Seen by many as a pro-father bill, proponents say it will help even the playing field. "This is a huge issue for a lot of parents," said Murray Davis, the executive director and founder of DADS of Michigan, a fathers' rights organization. "If a custodial parent wanted to move, they could, and suddenly, the noncustodial parent is out of the picture."
    However, critics say it places unfair restrictions on custodial parents who may need to move for a new job or educational opportunity. It is likely the law will be challenged in court as an unconstitutional restriction on the rights of the custodial parent, said Margaret Nichols, an Ann Arbor attorney and member of the State Bar Family Law Section. "These are painful situations," Nichols said. "This will only make it more difficult." Nichols also said the new law could bog down an already overloaded court system. "I think we're going to see a lot more people contesting these moves," Nichols added. "From what I've heard, these are the cases judges hate the most."
    Under the new law, parents who want to move beyond the 100 mile barrier must first get permission from the other parent. If permission is denied, a judge is asked to render a ruling. The judge is required by the new law to consider several factors: parental motives, how the move will affect quality of life for the child, domestic violence and whether a new, reasonable parenting time schedule can be worked out.
    Lawmakers approved the bill during the lame duck session last month, despite concerns from women's organizations that it unfairly penalized custodial parents, who are mostly women. Specifically, they argued the bill could create difficulties for women in domestic violence situations. In an attempt to address those concerns, legislators added a clause allowing women who are abused to temporarily move without a court order. Opponents, however, felt it failed to address the issue. They argue that any restriction on relocation makes it more difficult for women to leave abusive situations.
    Meanwhile, the other side believes lawmakers went too far. "We're simply concerned that this will be abused, that custodial parents may make false allegations of domestic violence," Davis said. "We do not disagree with the intent of the clause, we just don't think this was the best answer." Still, Davis called the new legislation a "limited victory." Genesee County Friend of the Court Director Jennie Barkey agreed. "I see more and more of this all of the time," Barkey said. "A lot of these noncustodial parents really get pushed out of these kids' lives."

Suddenly, No Waits For Detox In District of Columbia
Avram Goldstein, Washington Post- 1/15/2001

These days, uninsured District residents seeking detox are being admitted to city facilities without a wait -- a dramatic change from the years when people queued up before dawn to improve their chances of getting a bed. Officials throughout the D.C. Health Department, private agencies and the criminal justice system say the waiting list for patients needing detoxification treatment for drug or alcohol abuse simply evaporated several months ago, when the District added beds and contracted with a private group to take overflow cases." We are very pleased," said Susan Shaffer, director of the D.C. Pretrial Services Agency, which refers many criminal defendants to detox. "We used to direct people to go there at 5:30 in the morning to get priority in getting in. Now we can send clients over at any time of day, and we get them in."
    The main facility for detox services is Building 12 on the campus of D.C. General Hospital at 19th Street and Massachusetts Avenue SE. About 80 beds are available in the 24-hour facility, operated by the D.C. Addiction Prevention and Recovery Administration. The hospital also operates a small inpatient detox unit, and some city-sponsored patients are sent to the Psychiatric Institute of Washington in Tenleytown, a private facility with a contract to take patients. A detox stay can last a week, during which a drug or alcohol abuser goes through withdrawal and considers long-term treatment options to attack the cause of the addiction. Long-term plans are often complicated by the fact that many patients use multiple drugs and alcohol, and they might be diagnosed with mental illnesses, including schizophrenia and bipolar disorder.
    No one involved in treating the District's estimated 60,000 drug addicts thinks improved access to detox is a panacea in a city plagued by substance abuse problems. Experts agree that many addicts do not seek treatment, though they differ over why. But private agencies say the District's response to the problem -- an APRA budget of about $32 million this year -- might be inadequate when compared with the estimated $1.2 billion that drug abuse costs the city directly and indirectly, such as through crime, the courts and jails.
    District health officials, such as Health Department Director Ivan C.A. Walks, acknowledge that uncertainty about funding makes it more difficult to expand treatment. Nonetheless, a variety of officials hailed the progress. Walks said clearing the path to detox allows counselors to command the addict's complete attention at a pivotal moment. "Detox is real treatment at the most critical time, when you have a combination of physical illness and psychological addiction," Walks said. "Getting people when they are at that crisis is critical."
    In recent years, D.C. Council members have harshly criticized the D.C. Addiction Prevention and Recovery Administration, which they said turned away people seeking detox even when beds were available because of mismanagement. "Now we can look at building a continuum of services beyond detox," said Renee Lohman, executive director of Washington Behavioral HealthCare, a private provider of detox and treatment services. "We don't want people to leave the short-term stabilization of detox and go back to their old neighborhood and be back at detox two weeks later," she said. "We want them to have a whole treatment plan in the detox unit, with a follow-up plan and someone they are accountable to." D.C. Council member Jim Graham (D-Ward 1), a frequent critic of APRA, said he was unaware of the elimination of the detox waiting list. "It's a long overdue step," Graham said. Before, admission was a test of clout, he said. Drug addicts say APRA used to block immediate care.
    A 35-year-old uninsured woman who has been addicted to crack said she has been through detox 14 times since 1985 and has always found the experience maddening. "You've got to go in at 4 o'clock in the morning to get seen at 7 in the evening," said the woman, who spoke on condition of anonymity. "It would be crowded and overloaded. And a lot of time, you would ask for inpatient care, but they would put you in outpatient care. I'm not good at outpatient." A few weeks ago, a psychiatrist effortlessly referred her to the Psychiatric Institute of Washington. After detox was completed, she continued on there in a privately funded 14-day transition program. "It's essential to have immediate access," Shaffer said. "If a person is drug addicted, you don't want to have to tell them to come back two days from now."
    The city's next challenge is to draw more addicts into long-term treatment, said APRA Director Larry Siegel. The city can now put most addicts into treatment with little or no wait, Siegel and Walks said, though private agencies say the city's success in that area is not as clear as it is with detox. Siegel said the city funds 4,000 treatment slots, far fewer than the number of addicts but adequate to care for most who seek treatment. Many of them also have access to treatment through private groups. As part of its effort to track the many disparate groups offering drug treatment, APRA is inspecting and certifying drug treatment agencies to ensure that standards of care are met. "We don't yet have any way of assuring that every provider is qualified," Siegel said.

Healing the Body and Spirit of Rape Victims
Jane E. Allen, Los Angeles Times- 1/15/2001

After she was raped in her bed by a man with a knife, Patti Lancaster felt paralyzed by fear, unsure how she'd make it through each day. "I felt everything I had been was gone," she recalls. "I wanted out of my life." She found refuge a few miles away at the Rape Treatment Center at Santa Monica-UCLA Medical Center. From the moment she entered the center's private waiting room, far from the chaos of emergency patients, she felt protected. No one rushed her. A doctor specially trained in treating rape victims took the time to explain each part of the medical examination before touching her. Lancaster said she felt "really comfortable" with him and the therapists who helped her over time see "the things that were important to me were still there and I could rebuild." Looking back, she says, "they truly saved my life."
    Lancaster, a 46-year-old producer of television commercials, was fortunate. After her May 1992 attack, she landed at the Santa Monica center, which is considered a national model program for comprehensive rape treatment. Most U.S. communities provide advocacy and referrals through rape crisis centers and hotlines, many of them founded during the women's movement in the 1970s. The vast majority, however, are not equipped or licensed to furnish medical care. That means that rape victims are directed to often-chaotic hospital emergency rooms, where they can languish for hours while busy doctors attend first to the critically ill and wounded. Some women walk away in frustration. Emergency room exams are often hurried, with little if any counseling, and perhaps some advice about possible pregnancy or sexually transmitted diseases, experts say. Women are typically left to their own devices to cobble together follow-up medical care and counseling services.
    The Rape Treatment Center is different. It delivers free, comprehensive services to meet the woman's physical and emotional needs in an atmosphere of safety, privacy and calm. It's one of the few facilities in the country that takes into account that a fragile rape victim is unlikely to want to travel to several locations or chase down prescriptions in the middle of the night. It is also a leader in the training of advanced-practice nurses in how to collect evidence after a rape and in working with the police to help them deal more effectively with rape victims. The clinic offers rape survivors immediate and follow-up treatment based on the latest advances in medicine and technology. This kind of attention to a rape victim's needs reflects a major shift in how the aftermath of sexual violence is dealt with. Rape is now viewed as more than just a crime; researchers and doctors increasingly have come to view rape as a health issue, with not just physical injuries but also long-term mental-health consequences.
    Research during the last decade has shown that the sooner a rape survivor gets help, the better her emotional and physical recovery. (The studies have focused on adult women, but men and children are victims as well.) Rape victims suffer more from chronic pain, headaches, stomachaches and sexual difficulties, and they seek more medical services over the years than other women. Women who suffer silently, without counseling, develop more stress-related mental health problems. Although an estimated one in six U.S. women is a victim of rape or attempted rape--the majority committed by an acquaintance-- only about a third of adult women report it. Because the costs of forensic exams typically are borne by police agencies, women are often required to file a report to ensure payment of their exams.
    Comprehensive rape counseling and medical service programs, such as that of the Santa Monica clinic, are rare throughout the country. Moreover, rape treatment services vary widely, depending on local financing and community attitudes. "There's no broad universal standard of care and services for victims of sexual violence," said Ann Burdges, executive director of the sexual assault center in Gwinnett County, Ga., near Atlanta, which is also cited by experts as one of the nation's best facilities. "It's just a roll of the dice where you happen to be."

Cooperation Can Lead to Better Care
New federal laws, though, have provided more money for improving the forensic medical care that victims receive. And rape kits are becoming standard equipment at most medical centers. Services improve, said Liz Flowers, national spokeswoman for the Rape Abuse and Incest National Network, when doctors, prosecutors, advocates and law enforcement cooperate. In rural Georgia, for example, advocates from several counties lobbied successfully for federal funds to purchase sophisticated instruments called colposcopes, which improve the ability of health professionals to detect genital injuries, Burdges said. Colposcopes, she points out, are not yet available for rape exams in Atlanta, where nearly a third of the state's rapes and sexual assaults occur.
    Rape treatment centers are designed to help women regain control after a degrading crime has rendered them powerless. Many victims aren't even sure what constitutes rape, in legal terms beyond sexual intercourse to which they did not consent. Under most definitions, rape involves forced vaginal, anal or oral sex. California law also includes penetration with fingers or other objects. Although many victims are wary of reporting sodomy or oral sex, experts say, the information guides their physical exams. That's where the clinic staff's skill and ability to engender trust come in. "A lot of times, they disclose things during the exam they didn't feel comfortable telling law enforcement," said Tish Tighe, a nurse practitioner at the Santa Monica center.
    When the nurse knows where to look for injuries, she can provide a better examination and utilize advanced technology, such as video colposcopes with monitors that let the victim see her injuries and watch how they heal. When women can see proof of the force used against them, it often helps to validate the experience for them, making them more likely to file a police report, experts said. Light-staining microscopes may be used to pick up traces of semen--the sperm cells appear yellow on a blue background--and provide DNA evidence that also helps make a criminal case. Knowledge of which sexual acts occurred can help the nurse assess potential exposure to sexually transmitted diseases and to recommend preventive medications.  Sometimes, the victim may not know or recall what was done to her. In those cases, collection of urine samples within the first three days of the rape can detect whether she's been drugged with the so-called date-rape drugs, Rohypnol or GHB. (Many experts disdain the term "date-rape drugs," noting that many women are drugged not by their dates but often by strangers or acquaintances at bars or parties.)

A Closer Look at Rape's Lasting Effects
In recent years, more attention has been focused on the long-term mental health consequences of rape. It wasn't until 1994 that the widely used manual of psychiatric diagnoses, known as the DSM-IV, listed rape as a source of post-traumatic stress disorder.
Psychological trauma in most cases "is more severe than any physical injuries," said social worker Gail Abarbanel, founder of the Rape Treatment Center. Counseling can stave off post-traumatic stress disorder, major depression, suicidal thoughts, substance abuse, sexual problems and social withdrawal.
    Although rape victims often received supportive therapy in the past, research has found that the most effective psychotherapy focuses on the trauma, said psychologist Naomi Himmelfarb, clinical director of the Rape Treatment Center. One successful form of therapy stresses exposure by encouraging the victim to imagine, write or talk about the trauma rather than avoid it. "When you avoid something," Himmelfarb said, "your anxiety grows and grows."
    Therapists use another technique called "processing" to help victims reexamine their worldview. Many women assume the world is a safe place as long as they do everything "right." But after a rape they blame themselves for doing something "wrong." Said Himmelfarb: "Processing is about trying to help people get away from these distortions."
    The trauma can be made worse when those who are supposed to help, instead make things worse--often unknowingly. So Abarbanel and other advocates train police and prosecutors in responding to victims' reactions. Donna, a radio producer attacked by two men in March 1985 when she was 24, went into a tailspin spurred in part by the behavior of untrained police officers. After a rape that left her battered, bloodied and disoriented, police officers arrived on the scene. She expected protection. Instead, "They asked if I had been drinking," she recalled. "And they sniffed at me." The officers' words and actions, she said, felt like another assault. She was not offered medical attention. Donna, who later was found to have suffered hairline skull fractures, loss of smell, and hearing damage, spent the next few weeks in her childhood bedroom. Eventually Donna resumed her usual routines, but her anger couldn't stay buried. In 1998, she came to the Rape Treatment Center looking for "emancipation from the rape." Retelling the rape and reviewing the attendant emotions reduced it to a "small part" of her past. Therapy, while "not a miracle . . . gives you back your wholeness," she says today.

First Response Has a Profound Effect
Although Donna's recovery demonstrates "it's never too late" to get help, Abarbanel said healing could have begun right away "if she had a different response from police officers." Swift intervention helped Anna, a former massage therapist. She was robbed and raped at gunpoint in May 1999 en route to treat a client in an industrial area of the San Fernando Valley. During the rape, Anna, a Quaker, remembers praying: "Let him take my body, not my soul." After she drove home, her boyfriend took her to the Rape Treatment Center's Verna Harrah Clinic, which had just opened in a new space at Santa Monica-UCLA Medical Center, where nurse practitioners had taken over the task from ER staff of examining patients. Anna met immediately with a female psychologist, who "sat with me and talked to me, getting the facts and also [asking], 'How did it feel?' " Anna recalled. The clinic, she said, "was like being in someone's living room. There was a couch, a lamp, there were no fluorescent lights, there was no one screaming. I felt I had entered a safe place. I was surrounded by extremely compassionate women. A lot of my questions got answered quickly. At every step of the way, I was given options." Within a week, she began individual counseling, which gave her a chance "to weep and be insecure. I needed to have a place where I could go and get messy." What a difference between her experience and that of a friend raped in college, who "drove herself to the ER of a hospital and waited four hours. When she was dealt with, she was treated like another medical emergency."
    Anna was lucky to go to a center that provided comprehensive services at no charge. But until the 1994 Violence Against Women Act, victims like her often had to pay for their own rape exams, which can cost as much as $700, Flowers said. Under federal and most state laws, a victim isn't charged for a forensic medical exam if she reports the crime. She may be charged for treatment of injuries and prevention of sexually transmitted diseases and pregnancy. The laws can deter poor women who fear retaliation or being stigmatized, said Dean Kilpatrick, director of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston. Both the 1994 law and the Victims of Crime Act provide money to help pay for exams. However, Aileen Adams, formerly director of the Justice Department's Office of Victims of Crime, bemoaned federal legislation that this year capped VOCA funds to victim programs. "Because of the cap, California lost millions of dollars," said Adams, now secretary of the State and Consumer Services Agency in Sacramento. However, she said, the state's victim compensation program limits rose on Jan. 1 from $46,000 to $70,000, which can help victims of reported crimes obtain counseling and medical care. "It's still hard to get the kind of comprehensive care the Rape Treatment Center provides," said Adams, "but we're light-years ahead of where we were a decade ago."

Health Risks
* Physical injuries, including cuts, abrasions, bruises, trauma to the genital areas.
* Sexually transmitted diseases, including chlamydia, gonorrhea, herpes simplex virus, syphilis, hepatitis B and HIV.
* Unwanted pregnancy.
* Psychological trauma, including shock, feeling of numbness and symptoms of acute stress disorder such as detachment, flashbacks, nightmares, avoiding reminders of the trauma, irritability, problems concentrating.
* Long-term medical problems, including stress, anxiety, tension headaches, stomachaches, nausea, back pain, allergies, skin disorders, chronic pain, menstrual and other gynecological complaints.
* Long-term emotional problems, including depression, sexual problems, social withdrawal, suicidal feelings, diminished self-confidence and loss of self-esteem; post-traumatic stress disorder symptoms such as flashbacks, sleep disturbances, difficulty concentrating.

What to Do if You Are Raped
1. Go to a safe place.
2. If you want to report the crime, immediately notify the police, who will help you get a medical forensic examination to collect evidence. A friend, family member or rape crisis center worker may accompany you during a police interview. Reporting the crime can help you regain a sense of control and ensure the safety of other potential victims. It is never too late to make a police report.
3. Ask a friend, family member or someone else you trust to stay with you.
4. Preserve all physical evidence of the assault. Do not shower, bathe, douche or brush your teeth. Do not eat or drink anything. Save the clothing you were wearing at the time of the assault, placing each item in a paper--not plastic--bag. Do not disturb anything where the assault occurred.
5. Seek medical care at a hospital emergency department or a specialized rape treatment clinic. Local rape crisis centers or police departments can refer you to providers with sexual assault expertise. Even if you have no apparent physical trauma or are unsure about reporting the crime, you should have a medical examination. You may have internal or other injuries.
A health-care worker can explain the risks of sexually transmitted diseases and pregnancy and provide preventive medications that must be taken within 72 hours of the assault. If you suspect you've been given a "date rape" drug, such as Rohypnol or GHB, ask your medical provider to take a urine sample for evidence. These drugs are more likely to be detected in urine than blood.
6. Consent to collection of forensic evidence during the medical exam, regardless of whether you're making a police report, because physical evidence deteriorates rapidly. Sometimes the evidence can be preserved in case it is needed if a criminal case is brought later. In California, you have the right to be accompanied during your exam by a rape counselor and another support person.
If you report the rape, law enforcement will pay for the evidence-collection portion of your examination. If you decide not to report the incident, you can contact a rape crisis center about financial aid to pay for your medical care.
7. Talk with a trained counselor. To find one, contact a hotline, rape crisis center or counseling agency. The Rape Abuse and Incest National Network hotline at (800) 656-4673 will connect you to a rape crisis center in your area.
8. Every state has a victim compensation program that provides financial help with medical care and counseling, usually contingent upon cooperation with law enforcement. Contact the district attorney's office or the state victim compensation program. In California, call (800) 777-9229.

Counseling, Care and Legal Resources for Coping After a Rape
You can get information about your legal rights, medical and counseling services and other assistance by contacting a local rape crisis center or a national referral service. For a national organization, you can contact the Rape Abuse and Incest National Network, which operates a hotline at (800) 656-4673 for rape crisis centers nationwide. The group's Web site is http://www.rainn.org.