Noteworthy News Articles on Mental Health Topics, March 11-15, 2001

More And More Children Are Facing The World With Two Moms Or Two Dads
ABC News, 3/11/2001

Danielle Silber says she has two mothers and two fathers. Sisters Emma and Camille Seitz-Cherner have two fathers, though right now, neither girl knows which of the two is her biological father. Danielle, Emma, and Camille are part of the "gaybe boom," a generation of kids raised by gay parents. The children are now old enough to voice their feelings about having two parents of the same sex. On 20/20, Barbara Walters talks with these children and their parents about their relationships and their experience in a world not always accepting of them.
    Twenty years ago, a wave of lesbian couples started reinventing the family by having children without dads, often through artificial insemination. Many gay men followed suit about a decade later starting families without mothers, usually through adoption. There are many unanswered questions about the long-term impact, if any, of growing up with gay parents. No matter how loving parents are, it is impossible to completely shield children from a sometimes-intolerant society. However, children who spoke with 20/20 seem to be just as well-adjusted and happy as any kids with mothers and fathers. And, there are some studies indicating that children of gays tend to be more tolerant of those often marginalized by society.

Two Moms With A Teen
Seventeen-year-old Danielle, of Takoma Park, Md., has two mothers, Susan and Dana. The couple fell in love more than 20 years ago and had Danielle through artificial insemination. She has two dads as well: Jacques, who is her biological father and his former partner Art, who has known Danielle since she was born. Though the dads have always played an active role in Danielle's life, Dana and Susan are her primary parents. In spite of her unusual family, Danielle has grown into a confident and popular teenager. She is even president of her senior class. As a young child she was essentially oblivious to the fact that many would judge her and her family harshly. Even her two mothers had few worries. But things changed when she reached middle school. "A lot of kids in my school would use gay slurs, such as 'faggot,' or, 'that's so gay,'" Danielle says, "I realized that having gay parents might not be acceptable to everybody. I had this fear kids would really hate me or start to hurt me because my parents were gay."

The Perils Of Middle School
Danielle slid into what she now calls her "paranoid period." She began to feel ashamed of her family and hid her lesbian moms from many of her classmates. "My parents were loving, they would do anything for me and I felt extremely guilty that I was acting ashamed of who they were," she says. Two years ago, she had a breakthrough when she reluctantly participated in a gathering of families in which one or both of the parents were gay. Connecting with kids like herself gave Danielle the courage to return home and "come out" to everyone about her lesbian moms. It was at that point that she was able to say to herself: "you know what? I need to stop, I need to stop being afraid. I need to stop worrying about ... how open other people are."
    Though she is now comfortable with her family, many argue it is unfair for gay people to have children and subject them to the likely ridicule and scorn from the world around them. As Danielle found out, during the middle school years the teasing can be particularly ruthless. But for her, the love and support she receives from her family far outweighs the intolerance she sometimes has to endure.
    She is dismayed by critics who say families like hers can be harmful. "My parents are extremely caring and supportive of me. I love my parents probably more than anything," she says. As far as Danielle's own sexuality, she is straight but she says having gay parents did cause her to question her sexual preference. Her mother, Dana, says she does not care whether her daughter is gay or straight, she just wants a lot of grandchildren.

Daddies' Little Girls
Emma, 10, and her seven-year-old sister Camille's parents are both gay men. There's Daddy Joe and Papa Laurent who have been together for almost 20 years. Joe and Laurent had their girls through a surrogate mother. Using a controversial approach to artificial insemination, they intentionally mixed their sperm together so they wouldn't know who the biological father would be. They did it to create family unity, and in spite of defying social convention, they do seem to be a close, happy family. As Emma puts it, "we love our dads as much as our friends like their mom and dad." Although they do not have a mom, Laurent says he plays the role of the stereotypical mom. He takes care of the house, does a lot of the cooking and usually is the one to help the girls get ready for school or to go out with their friends. One the neighbors even called him the best mother in the neighborhood.

Entering Womanhood Without A Woman
The two dads say they are not intimidated by the prospect of raising their daughters without a mom — not even by the sacred rights of passage into womanhood like buying the first bra or having their first period. "We've talked to Emma a lot about her first period because Emma's really tall for her age and she'll probably mature quickly. And we're going to go out to dinner and have a little bit of a celebration," say Joe. But like many gay parents, they've made sure that the girls have people of their own gender in their lives as well. A neighbor named Leanore acts as a female role model for the girls. Camille says, "She feels like our aunt because she's very close to us, and she comes up here practically every night." Though Joe and Laurent have certainly created a cozy, loving environment for their daughters, the two fathers have less control over how the girls fare when they leave the safety of home.
    While the girls do get exasperated trying to explain the complicated situation to their contemporaries, they say they've never been teased. This is perhaps because they live in a very liberal New York neighborhood and because they haven't reached middle school, where children can be especially cruel. Nevertheless, they have picked up on antigay prejudice. "When my friend was holding her friend's hand, they said, 'ooh, you're gay,' and I said, 'well, what's bad about that?'" says Emma. To those who say that girls will risk gender confusion and other setbacks by not having examples of a mother, Joe argues that lots of children don't have the benefit of a mother and a father. "Half of all marriages end in divorce, what kind of example of a mother and father do they have?" Joe asks.

Michigan's Celebrated Person-Centered Planning May Have Failed Patient
Wendy Wendland-Bowyer, Detroit Free Press- 3/12/2001

Stephen Boomer Jr. was a 48-year-old man with a low IQ, recurring seizures and a history of troubling behavior. He thought he could handle living on his own. His family thought otherwise. With the help of mental health officials in Livingston County, Boomer moved into his own apartment last year with minimal supervision. Within a month, he was dead. That's where the agreement ends and the accusations begin.
    Since 1996, Michigan has required community mental health boards to develop annual plans for clients that take into account their individual dreams and goals. Called person-centered planning, the system brought Michigan national recognition. It's supposed to help those in the system -- now numbering more than 200,000 statewide -- live in ways never imagined a few years ago. The problem, according to audits kept by the Michigan Department of Community Health, is that not one of the state's 49 community mental health boards has mastered it. A recent review by the U.S. Health Care Financing Administration, which oversees Medicaid-funded mental health programs, contends the boards need to improve and the state needs to be more aggressive in seeing that they do. Advocates for people with mental illnesses say clients sometimes receive excellent plans that properly spell out what services they need, but the plans are never followed. Other times, they say, plans are implemented, but because the agency that writes them also controls the purse strings, the plans save money at the client's expense. "People are not getting what they need," said Michelle Rumsas of the Arc of Northwest Wayne County, an advocate for people with developmental disabilities.
    Mark Cody, senior staff attorney for the Michigan Protection and Advocacy Service, which fights for the rights of disabled people, said the plans' effectiveness is crucial. "If you ignore the person-centered plan, you're ignoring the fundamental principles on which the mental health system should be founded," he said. Stephen Boomer's family says bad planning cost him his life. Those who drew up his plan say it gave him his best shot at having one.

Desires to live normally
As far back as Rob Boomer could remember, his older brother had talked about living on his own, getting married, having a family, driving a car. Stephen Boomer loved Elvis Presley, and he loved gabbing with people. "He knew what he wanted, and he wanted to be normal," Rob Boomer said.
    But in addition to a seizure disorder and mild-to-moderate retardation, Stephen Boomer's medical records show he had a long history of aggressive or destructive behavior, including setting fires. Institutionalized much of his life, he moved in the summer of 1998 to a duplex in Brighton, where he and his five housemates were monitored 24 hours a day, though less intensively than in the group homes he'd lived in before. It was a move the Livingston Community Mental Health Authority, which oversaw his care, hoped would give Boomer a chance to prove he could handle more freedom while quelling his family's fears about his safety.
    At first, Boomer seems to have done well. But within a year, his father, who served as his legal guardian, began to worry more about his son's welfare. In his annual report, filed in Livingston County Probate Court in the summer of 1999, Stephen Boomer Sr. said his son's living arrangement gave him too much responsibility. Other reports in the case file raised more concerns. That March, after the younger Boomer had been in the duplex for about eight months, he was kicked off a bus for playing with matches. In May, he set several objects on fire in his bedroom one night. Dr. Gary Ralph, his psychiatrist, wrote that in June, Boomer reported hearing voices of deceased relatives, telling him they would take him to heaven. He also said eyes were watching him from his TV set and window blinds. In July, Boomer smeared feces all over his room and refused to help clean it. He was argumentative and yelled at the staff at the duplex. Also that month, hygiene problems caused him to be banned from the kitchen. More than once, the staff found knives hidden in his room. But Boomer had no doubts about his capabilities.
    By July 29, 1999, when he sat down with his mental health team to write his plan for the year, he told everyone his goal was to move into his own apartment. The idea was shot down, the report shows, because of his lack of progress at the duplex. Instead, it was decided he should move back into a group home, where he could be more carefully watched. If the plan had been followed, his family says, Stephen Boomer Jr. might be alive today.

Focusing on strengths
Even several years after state law required person-centered planning for public mental health clients, county agencies are still learning how to do it and the state is still learning how to regulate it, said Glenn Stanton. "No one has mastered how to do this," said Stanton, who was director of quality management and service planning for the state Department of Community Mental Health until recently. Drawing up a plan is not a one-time event but a process, said Sally Burton-Hoyle, executive director of the Autism Society of Michigan, who trains mental health workers how to do it. Ideally, the client picks the time and place for the meeting and invites supportive people, such as friends and family. The conversation is supposed to center around the person's strengths, not weaknesses. Then the team maps out a plan geared toward the agreed-on goals, showing how everyone will work to make them happen while keeping the person healthy and safe, Burton-Hoyle said. Specific steps are to be written down. Sometimes more meetings are needed. Often, if the plan calls for a big move, it will specify extra support at the beginning, such as 24-hour supervision.
    In the two months after Boomer's plan was drawn up in July, his behavior grew worse, his family contends. Case file reports show he continued to verbally abuse the duplex staff. His hygiene problems continued. Once, he slathered cooking oil all over himself. But Livingston Community Mental Health saw a different Stephen Boomer. Angus (Mac) Miller, executive director of the Livingston CMH Authority, said Boomer did well in the duplex. "There were no serious incidents," Miller said. The fire-starting, hygiene issues, arguments and other troubling behavior were expressions of Boomer's frustration with his family's attempts to control his life, Miller said. "Steve felt very passionately. He said, 'My family treats me like a child and I'm not a child. My dad says he wishes I was normal because then he would not have to worry about me like this,' " Miller said.
    According to Boomer's plan, his father was supposed to find a group home that was suitable for his son. The family said several were found, but Boomer managed to block the move with something he'd tried unsuccessfully before -- having his father removed as his guardian. This time, the Livingston CMH helped Boomer fill out the court paperwork. CMH boards, under state law, have a legal duty to help clients live as independently and as safely possible, Miller said. "I think the family felt we put him up to it," Miller said. "That was not the case."

A powerless father
CMH psychologist Kimberly Richter evaluated Boomer for the probate court and recommended that his father be removed and a professional guardian be appointed to supervise Boomer's medical care and finances only. That would give Boomer the freedom to choose where he would live, assuming it was approved by CMH. Boomer's parents called the Michigan Protection and Advocacy Service for help. A staff member sent Boomer to an independent psychologist, Sandra McClennen, who also recommended removing Boomer's father because of the tension between the two. But she advised naming Boomer's younger brother Patrick as his guardian. The judge followed CMH's recommendation. Boomer's family was devastated. "This just crushed my dad. He just sat there, stunned," said Patrick Boomer, who accompanied his parents to court. "He got in the front yard of the courthouse, and he just lost it.... He was on the verge of tears and just beside himself with anger."
    CMH met again with Stephen Boomer to update his plan in November 1999. His family was not invited. Again, Boomer got what he wanted -- the go-ahead to move into an apartment. The CMH staff said it hoped his behavior would improve in the less-closely supervised setting. His family was incredulous. On Dec. 14, 1999, Boomer's father spoke by phone with his son. Stephen had big news: After the holidays, he would move to his own apartment. The conversation was short, said Patricia Boomer. Afterward, her husband started to pace. Then, she said, "all of a sudden he wanted to go to the hospital." A mile from their house in Howell, Stephen Boomer Sr. slumped over in the car. Panicked, Patricia Boomer pulled into a gas station and called 911. Within 40 minutes of the phone call, her husband was dead of a heart attack. Stephen Jr. came home to his parents' house to stay for the funeral. The day after, Patricia Boomer found several scorched funeral prayer cards in Stephen's bedroom. She said she told mental health workers about it, but it didn't seem to make a difference.

Challenges in Mental Health Care: Death Was Price of Freedom
Wendy Wendland-Bowyer, Detroit Free Press- 3/13/2001

Stephen Boomer Jr.'s heart was bursting. It was Feb. 14, 2000; moving day for the 48-year-old man with developmental disabilities who had yearned for years to leave group homes behind for a place of his own. To get to this point, he'd had his father, Stephen Boomer Sr., removed as his guardian and, with the backing of the Livingston Community Mental Health Authority, charted a course toward more independence. His new home was a one-bedroom apartment in a small, single-story complex near downtown Howell. But Boomer's enthusiasm didn't allay his family's fears. His father had collapsed and died of a heart attack, shortly after learning that his son would be moving out on his own. Other family members continued to fear the worst.
    The Livingston CMH, which had paid about $100 a day for Boomer's more-closely supervised care in group settings, now would get a break. It would cost the CMH board about $70 a day to send staff to check on Boomer at his apartment every day. Other government programs covered his rent, utilities and food. Despite the savings to the CMH, financial considerations played no role in the decision to let Boomer live more independently, said Angus (Mac) Miller, director of the Livingston CMH Authority. The goal was to give him the life he wanted. But Boomer's family, along with many advocates for the state's 200,000 mental health clients, say money can't help but play a role.
    Unfortunately, in many parts of our state, what we see is resource-centered rather than person-centered planning going on," said Eric Richardson, president of the Arc Michigan, a nonprofit advocacy group. No one disputes the fact that funding cutbacks or other administrative changes have affected Michigan's mental health system. Throughout the 1980s and 1990s, the state turned more and more of the responsibility over to a network of 49 community mental health boards. At the same time, state funding not only did not keep up with inflation, but has been further eroded, said David LaLumia, executive director of the Michigan Association of Community Mental Health Boards. "There are places around the state, like here in Lansing, Grand Rapids, northern Michigan, northeast Michigan, where boards are having to make very difficult and deep cuts in their program, including laying off of staff, to make ends meet," LaLumia said.
    Geralyn Lasher, spokeswoman for the Michigan Department of Community Health, stressed that Gov. John Engler's new budget calls for a 3-percent increase in Medicaid funding for mental health to make up for a recent 3-percent cut. It also includes a 2-percent increase in the general fund for mental health. CMH boards say that isn't enough. Advocates also are concerned about person-centered planning, the annual plans that are to be drawn up for each client. Built around the goals of a person who may have delusional or diminished thinking and written by the agency that controls the purse strings, advocates say the plans may not deal objectively with potential risks to the client. "In the Boomer case, it was pretty obvious to me that the people who wanted him to be independent did not want outside objective input because they removed his father as guardian and ...didn't substitute that with someone who did not have any financial position," said Fred Cummins, president of the Alliance of the Mentally Ill of Michigan.

Life on his own
Boomer was thrilled to be on his own. His family felt out of the loop. They wanted to know more about his care and say they repeatedly asked CMH for details but were never given any information. Director Miller and CMH documents say that Boomer didn't want the information released, but the family contends he did want them to know and blames the CMH board for not keeping them informed. A document provided to the Free Press by Miller shows an addition to Boomer's revised person-centered plan that called for a CMH worker to stop by at breakfast and dinner daily to check on him and help prepare meals. Someone also was to telephone at noon every Tuesday, Thursday, Saturday and Sunday and help once a week with grocery shopping and laundry. That was a big change from 24-hour supervision in the Brighton duplex where Boomer had been living. It also meant no one would be there to physically watch Boomer take his seizure and psychiatric medicines, though a CMH worker was to ask him about it in person or on the phone.
    Though Boomer usually smiled broadly when talking about his apartment, others began to see signs of trouble. "He would constantly call us. He was scared of being alone," said Mary Haney-Goulding, a caregiver at the duplex where Boomer lived before moving into the apartment. "He would tell us nobody had been here." Haney-Goulding said because Boomer no longer lived at the duplex, the staff couldn't help him. She said she told Boomer's new CMH workers of his calls. "He would call many times in the evening. He'd say, 'Could one of you come over here? I don't know if I took medication or not.' Or, 'I need something to eat and don't know what to do,' " Haney-Goulding said.
    Eileen Hogan also saw problems. She was Boomer's job coach at the McDonald's restaurant in Howell, where he had worked for several months before moving to the apartment. Boomer was proud of his job, which included mopping the floor and replenishing counter items. But after he moved, his personal habits deteriorated. "He wouldn't comb his hair. Sometimes his clothes were dirty," she said. "I told him about deodorants.... He would come in very disheveled, not shaved." Debbie Wilkinson of Commerce Township, who is Boomer's cousin, said she, her sister and mother were appalled when they came to take him out for lunch a couple of weeks after he moved into the apartment. A bottle of Pine-Sol was open on a bathroom counter, sitting like mouthwash amid shampoo containers and soap. Clothes, including some smeared with feces, were lying around and there was urine on the floor. Boomer smelled of body odor and urine. His bed was broken and he was sleeping on a sheetless mattress.  His freezer was full of hot dogs, and though there was plenty of cereal and milk in the fridge, there was little else. "It was very sad," Wilkinson said.

In need of encouragement
On March 9, McDonald's fired Boomer because of his appearance. Patrick Boomer stopped by his brother's apartment that day. "The blinds were open and I could see Stephen sitting in his chair not moving," Patrick said. "I knocked on the door and came in." Stephen looked so distraught, Patrick thought he'd been hurt. "Steve, what's wrong? Are you OK?" he asked. "I lost my job today," Stephen replied. Patrick tried to cheer him up. He helped him warm up a frozen dinner and offered encouragement, telling him he could go to a Big Boy restaurant the next day to apply for a new job. After dinner, the two turned on "Dr. Dolittle," Stephen's favorite movie. He watched it so often he could say the lines before the actors did.  When Stephen's mood brightened, Patrick said good night.
    Records show a caseworker came by the next day -- March 10, a Friday. Stephen was clean, according to her report, and together they went to a Big Boy, where he put in his application. The caseworker also asked Stephen about his calls to the duplex. He denied being lonely. He said he didn't like mental health workers entering his apartment when he didn't answer the door. The two talked about how happy he was living on his own and how he wished his family would be happy for him. They also talked about getting together with the family to answer questions about his care.

A dreaded ending
On Monday morning, Patricia Boomer picked up the phone in Florida, where she was visiting her father. The caller identified herself as being from the Livingston CMH. "She said, 'You might want to sit down. I want to inform you your son Stephen was found dead this morning,' " said Patricia Boomer. "I said, 'What did he die of?' "She said, 'Natural causes.' "I said, 'No, you people killed him.' " Patricia Boomer hung up and burst into tears. Autopsy and police records show that Stephen Boomer had lain facedown on the floor beside his broken bed for 24 hours to 36 hours before he was found by a CMH worker Monday morning. Staff members had stopped by the apartment Sunday morning and evening but did not enter when he didn't answer, a CMH report noted. An autopsy report attributed his death to his seizure disorder.
    Sandra McClennan, the psychologist who had interviewed Boomer before his guardianship hearing, said it is common for parents to be concerned about their disabled adult children moving out on their own. In this case, she said, the concern was justified. "I think Stephen's death should not have happened.... I did not feel the move, as it was planned, simply putting him out there alone with very limited assistance, was in any way in his best interest," McClennan said.
    Miller said a division of his office reviewed every aspect of Boomer's death. Toxicology tests determined that the seizure medication in his body was below the recommended dose. His family took that as a sign that he was unable to properly take his medication, as they had feared, and contend it may have contributed to his death. But the CMH determined after speaking to Boomer's doctor and the CMH medical staff that the level was not a factor in his death. The CMH also rejected the argument that, had a staff member been present, Boomer's death might have been prevented. Miller said people with severe seizure disorders sometimes die, even with 24-hour supervision.
    Miller said he found solace in the words of a disabled woman who knew Boomer and serves on a CMH committee. "She said that Steve was so happy for that month that he lived on his own. He just had a special gleam in his eye. So hearing that from her, who had no particular reason to slant her answer one way or another, to me was some confirmation" that CMH had done the right thing, Miller said. Boomer's family derives no comfort from the way he died. Even a year later, Patrick Boomer can't hold back the tears. "In the end, what happened was what my dad feared," he said. "There had to be a way to give Stephen what he wanted without putting him in danger.... This was so preventable."

State Trying to Improve Its System
Wendy Wendland-Bowyer, Detroit Free Press- 3/13/2001

Just five to 10 years ago, Michigan's mental health services were built around professionals who told clients where they should live, who they should live with and how they should spend their time. Today, person-centered planning turns the tables, putting the emphasis on clients telling the professionals what they want and the professionals finding ways to make it happen. The new approach is credited with successfully helping people with disabilities live more independent lives. But too often, advocates say and state and federal records show, the planning is not properly done.
    The Michigan Department of Community Health is taking steps to improve the system. The state is revising and beefing up the standards community mental health boards must meet. Also, the state recently received federal approval to allow independent people not connected to CMH boards to help clients design their plans. That should start by fall 2002. The state hopes this will eliminate the potential conflict of having community mental health boards, which pay for the plans, also write them.
    Meanwhile, if you or your loved ones are unhappy with your plan, you do have options: If your mental health services are paid by Medicaid, you can request a hearing before an administrative law judge. Your CMH board must provide a request form. If your mental health services are not paid by Medicaid, you can file a grievance with your CMH board. Typically, grievances are reviewed by the CMH's Office of Recipient Rights. If your concern involves a possible violation of your rights, you can file a complaint with the CMH's Office of Recipient Rights. If you are still unsatisfied, write to the Michigan Department of Community Health, Lewis Cass Building, 320 S. Walnut St., Lansing 48913.

Other resources
*Nonprofit groups that advocate for people with mental disabilities also may help. Many of the groups have chapters throughout the state.
*The Michigan Protection and Advocacy Service defends the rights of people with disabilities and has lawyers to help with legal issues. Call 800-288-5923 or 800-414-3956, 8:30 a.m.-5 p.m. weekdays, or leave a message anytime.
*The Arc Michigan specializes in helping people with developmental disabilities. Call 800-292-7851, 8:30 a.m.-5 p.m. Monday-Thursday or until 4 p.m. Friday.
*The Alliance for the Mentally Ill of Michigan can be reached at 517-485-4049, 10 a.m.-2 p.m. weekdays, or leave a message anytime.
*The Mental Health Association in Michigan is an advocacy group. Call 248-557-6777, 8:15 a.m.-4:45 p.m. weekdays, or leave a message anytime. E-mail: mhamich@aol.com.
*The Michigan Association for Children with Emotional Disorders specializes in helping children with mental health issues. Call 248-552-0044, 9 a.m.-5 p.m. weekdays, or leave a message anytime.
*The Association for Children's Mental Health can be reached at 517-336-7222, 9 a.m.-3 p.m. weekdays, or leave a message anytime.

One in 10 Residents of Baltimore Is Addicted to Heroin
Carter M. Yang, ABC News- 3/14/2001

B A L T I M OR E — Baltimore is the heroin capital of the United States. Roughly 10 percent of the city's population — some 60,000 men and women — are addicted to the drug. Until this January, Wanda, 42, was one of them. "I did tricks, I stole, I robbed, I did whatever I had to do to get it," she says of her $50-a-day heroin habit. "The drug was taking control of my life." Wanda, who asked that her last name not be used, says she began using heroin at the age of 18. Now she is in a treatment program at the Center for Addiction Medicine in downtown Baltimore. She has been drug-free for more than two months.

'I Wanted to Die'
A 27-year-old woman who asked to be identified only as "T" is also undergoing treatment. She says her heroin addiction turned her from a ballet student into an exotic dancer. "I went from dancing at the Peabody [Institute] to dancing in a strip club — that's how I paid for that habit," she says. "[Heroin] will make you do things you wouldn't expect yourself to do."
    Jonathan, 18, says he contemplated suicide before he quit using the drug only last Friday. "I wanted to die," he explains. "I just wanted to shoot up until it killed me because I'd lost my feeling of self-worth." Jonathan, who says he spent as much as $140 per day on the drug, is being treated with buprenorphine — a prescribed "substitute drug."
    The problem in the city is so acute that the federal government has designated Baltimore part of what it calls a High Intensity Drug Trafficking Area, making it eligible for special federal assistance to local police. Tom Carr, the director of the Washington/Baltimore HIDTA program — a joint federal, state and local effort — says the heroin epidemic in Baltimore dates back to the 1950s and is now an engrained part of the city's culture. "It's an old 'heroin town,'" says Carr. "There is an appetite for heroin in Baltimore … It's accepted by all too many people down there as something that's normal behavior." "It's almost a rite of passage for some," he adds, noting that heroin habits are often passed down from generation to generation.

Purer, Stronger, More Deadly
The narcotic white powder that, according to a February report by the HIDTA, one in every 10 residents of the city snorts, smokes or, more commonly, heats and then injects with needles is significantly more potent than the heroin sold in many other areas of the country. Smuggled into the United States from Colombia, the South American heroin is substantially purer than other varieties, a recent Drug Enforcement Agency study found, making it more addictive and more deadly. Last year, there were 304 fatal heroin-related overdoses in Baltimore and a similar number of heroin-related hospital emergencies. The higher purity, combined with an increased availability and a reduced street price — now pegged at $100 to $120 per gram — is fueling the city's scourge of addiction by helping to draw in new users. "People think because it's pure, you can smoke it, snort it — that it's safer," explains Drug Enforcement Administration Special Agent Bill Hocker.
    The recovering addicts who are doing better say anyone thinking about trying heroin should think again. "They might as well put a gun to their head and kill themselves," says Wanda, forming the shape of a gun with her fingers and pointing it at her forehead. "It's suicide." "I wouldn't let my worst enemy do it," adds "T." "Once you learn how it feels, you're on that track and there's not much that's gonna help you." The Washington/Baltimore HIDTA predicted in its February situation report, "The number of heroin addicts in [Baltimore] will continue to rise."

Study Showing High Relapse Rate Puts Spotlight on Electroshock Therapy
Lindsey Tanner, Associated Press- 3/14/2001

CHICAGO (AP) Patients who underwent electroshock therapy for depression had an unexpectedly high relapse rate in a study that has refocused attention on the procedure 25 years after ''One Flew Over the Cuckoo's Nest'' made it seem like torture. The treatment fell out of favor after that Oscar-winning movie, a satirical look at life in a mental hospital. But it has since made a comeback, with 100,000 Americans a year now getting it, according to the National Mental Health Association. Electroconvulsive therapy, or ECT, is most commonly used to treat severe depression that has not responded to medication or psychotherapy.
    A study of 84 patients in Wednesday's Journal of the American Medical Association found that without follow-up medication, depression returned in 84 percent of patients within six months. Among patients who received antidepressant and anti-psychotic medication after ECT, 39 percent relapsed. Previous research reported relapse rates of 20 percent with medication and 50 percent without.  The higher-than-expected relapse rates in the latest study reflect a debate over the procedure's benefits and risks. Columbia University psychiatry professor Harold Sackeim, who led the study and is one of ECT's most vocal supporters, said that it remains the most effective treatment for depression but that his findings illustrate the need for accompanying medication. Dr. Peter Breggin, a Bethesda, Md., psychiatrist, called the study ''an open admission that electrical shock is worthless.'' He said the high relapse rate supports critics' theory that ECT causes brain damage that for a few weeks prevents patients from expressing sadness or depression, while leading to possible long-term memory loss. Dr. Richard M. Glass, a deputy JAMA editor, said in an accompanying editorial that the study highlights the need ''to bring electroconvulsive therapy out of the shadows.''
    Major depression affects about 10 percent of Americans 18 and older yearly, or about 17 million adults, according to government estimates. It has a mortality rate as high as 15 percent, mostly from suicide, Glass said. ''The results of electroconvulsive therapy in treating severe depression are among the most positive treatment effects in all of medicine,'' relieving symptoms in 50 percent to 90 percent of cases, Glass said. Still, he wrote, ''on the face of it, producing convulsions with electric current seems like a strange way to treat illness.'' And more than 60 years after ECT was introduced, doctors still do not know exactly how it works.
    Patients typically receive three shocks weekly, under anesthesia, for up to a month, followed by medication. ECT is endorsed by the AMA, the National Mental Health Association and the American Psychiatric Association, which recently published a report that says there is no evidence ECT causes brain damage. Linda Andre, director of the anti-ECT group Committee for Truth in Psychiatry, criticized Sackeim for failing to investigate ECT's side effects and said it is because of his ties to the industry. The study was funded by the National Institute of Mental Health. Manufacturer MECTA Corp. donated the ECT equipment. Sackeim said he has worked for MECTA as an unpaid consultant but has no financial interest in the company. Most relapses in the study occurred soon after ECT, suggesting that drug treatment should perhaps begin during ECT instead of afterward, Sackeim said. ECT also could be gradually tapered off instead of abruptly stopped.
    Jerry Kirk said he has had ECT every three weeks since 1995 to control manic depression, even though he claims it has caused long-term memory loss and learning difficulties. Kirk did not want to reveal his location and employer because of the stigma of electroshock one so great it forced vice presidential candidate Thomas F. Eagleton off George McGovern's ticket in 1972.  ''It's a trade-off,'' said Kirk, an executive with a six-figure salary. ''Six, seven years ago, I couldn't work or hold down a job.''

In and Out of Hospitals, Woman Gave Warnings
Dennis Niemiec, Detroit Free Press- 3/14/2001

For more than 10 years, Cathy Cartwright has been crying for help. Cartwright, 39, threw rocks at cars on I-275, set her house in Detroit on fire three times without being criminally charged and threatened to kill herself and family members on several occasions, according to Wayne County Probate Court and police records. "If you leave me out here, I will hurt someone," Cartwright warned Detroit police outside her burning home in 1991. Cartwright had been in and out of mental hospitals at least nine times during the 1990s because of her threats or because of setting fires. And nobody stopped Cartwright from hurting someone. Until it was too late.
    Less than a week before Christmas, Cartwright, who said she was angry at her husband for being mean to her, lit newspapers on a living-room couch in the couple's two-bedroom apartment in Woodhaven, police said. She had threatened to set fire to the apartment two weeks earlier and also in September, according to police reports. With her husband, John Cartwright, and 15-year-old daughter asleep near the flames shortly after 7 a.m., Cartwright went to McDonald's for breakfast, Woodhaven Detective Sgt. John Boismier said. She left, and a scene of panic and chaos erupted, according to police reports obtained under the state Freedom of Information Act.
    Cathy Cartwright had awakened her daughter at 6:50 a.m. for school but the teen told her she had a headache and would stay home. About 15 minutes later, the daughter was awakened by an alarm in a smoke-filled apartment. The teen roused her sleeping father.  A couple living above the Cartwrights' burning apartment No. 107 also heard the fire alarm. Reports say one neighbor heard the Cartwright daughter scream to her dad, "Wake up, the apartment is on fire and it is too big to put out this time." Father and daughter would later tell police of previous fires. John Cartwright, who escaped without his shoes and glasses, didn't remember how he got his clothes on. He told police he was shocked; he said his wife had never before set a fire when anyone was home. The family's older daughter had spent the night with a friend.
    John Cartwright and his daughter escaped into the 8-degree morning of Dec. 20 without injury. But three neighbors were hurt in a blaze that destroyed eight apartments and caused $1.5 million in damage. One woman injured a knee and ankle while jumping from a second-floor apartment as firefighters from seven communities battled the fire. The other injuries were minor. About 11 renters at the Southpointe Square Apartments were temporarily left homeless. Most of the residents, including the Cartwrights, did not have their possessions insured. "Had it been 2 or 3 in the morning, there would have been multiple fatalities," Boismier said recently.
    About 9:40 a.m., police saw Cathy Cartwright walking near the fire scene. She told police she had set her husband on fire. En route to the police station, she said the many voices in her head told her to "burn the house down with everybody in it." Facing two charges of attempted murder and eight counts of arson, Cartwright is in jail today, familiar surroundings nationwide for thousands of mentally ill people. If she is found mentally competent to stand trial, a court hearing is scheduled for March 27 in Woodhaven District Court. Conviction of attempted murder carries up to life in prison; arson up to 20 years. She kept falling between the cracks: Detroit arson investigators had their hands tied because her husband wouldn't press charges; judges sent her to hospitals for only temporary mental health care; the state mental health system didn't make sure she took her much-needed medication, and her family didn't know how to control her.

'They knew she was a danger'
The handling of Cartwright's case shows how Michigan's mental health system is failing, said Fred Cummins, president of the nonprofit Alliance for Mentally Ill of Michigan. "The woman is clearly dangerous and the mental health system is not dealing with it," Cummins said. After hospitalization, Cartwright should have received monitoring at home, even daily if necessary, to make sure she took her medication, Cummins said. "The tendency is to dump on the family and walk away," Cummins said. "They knew she was a danger. It's unacceptable to hold the family accountable."
    More than 200,000 mentally ill people receive treatment in Michigan each year, said Geralyn Lasher, spokeswoman for the state Department of Community Health. Lasher said state officials could not comment on Cartwright because of privacy laws. It is unclear whether Cartwright received at-home visits. In September, Woodhaven police referred Cartwright for psychiatric evaluation after she threatened to burn down the family's apartment. Cartwright had rejoined the family in August after residing at a group home in Westland following release from the Northville Regional Psychiatric Hospital. Her family, meanwhile, had lived at the Woodhaven complex for four years. Following the threat in September, she was admitted into a Downriver hospital, released to a group home and finally taken by her husband back to the Northville hospital. She was released after a short stay, her husband told police.
    During her long history with the mental health system, probate court judges usually ordered Cathy Cartwright to spend up to 60 days in treatment, according to records. After being released, she often discontinued taking medication and lapsed into schizophrenic and paranoid behavior, court records say. Among those to petition the court for her hospitalization were her husband, Detroit police officers and a social worker. John and Cathy Cartwright have been married for 19 years, police said. John Cartwright, 70, is retired.  John Cartwright and other family members declined to comment for this article. He told police he hopes his wife is not sent to prison, but says she won't be allowed to move back in with the family.

Back-to-back blazes
In October 1990, police found Cathy Cartwright tossing rocks at cars on I-275 in Van Buren Township. Alternately crying and laughing, she told police she was suicidal and also would kill her father. While hospitalized, Cartwright was diagnosed with bipolar disorder, also known as manic depression, according to reports in her police file. There is no cure for the brain disorder, but it is usually treatable with medication. In 1991, a Detroit police officer saw Cartwright in front of a burned-out house in the 14000 block of Burt Road. Cartwright said she had set fire to her home and wanted to be put away or shot by police. John Cartwright lived in the home once it was rebuilt and her daughters went to live with an aunt for two years before the family was reunited. Cathy Cartwright also set fire to the house in July and November of 1994, according to police and court records. The July blaze caused $30,500 in damages; the November fire, $14,500, the state Fire Marshal's Office reported. At the fire in July, Cartwright fought with firefighters at the scene and told police she had tried to burn herself in the house. She kicked police at a medical facility in Westland and asked officers to kill her. She told a psychiatrist she burned part of the house because she didn't want children in the house, court records indicate. In November, Cartwright told a social worker she set fire to the house "to kill a mouse."
    After the fire at the Woodhaven complex, Cartwright's husband and daughters told police she had set previous fires, Woodhaven Sgt. Duane Ratliff said. John Tucker, chief of the Detroit arson squad, said John Cartwright, the home owner, did not want to press charges against his wife, so the fire department decided against further investigation. That was typical for incidents involving mentally ill patients and victims who did not want to prosecute, Tucker said. "If a person was committed for treatment, we'd just ignore" the case "and go on to bigger and better things," he said. But some of the arsonists "kept doing it."

Begging for attention
The department's policy has changed in recent years, he said. Officials seek criminal warrants even if the alleged perpetrator is receiving mental health care. The fire department is the complainant in cases where family members refuse to press charges.   Besides the fires, state mental health and police officials had frequent contact with Cathy Cartwright, according to court files. The incidents include:
March 1992: John Cartwright said his wife had shown great paranoia. Doctors said she was laughing frequently for no reason or hearing voices.
June 1993: John Cartwright said his wife was threatening to hurt everyone.
October 1995: A Detroit police officer said Cathy Cartwright said she wanted to kill herself and asked the officer to shoot her.
January 1996: A Detroit police officer responded to call about Cartwright with a gun threatening to shoot somebody in area of Greenview and Joy.
June 1996: John Cartwright said his wife stayed up half the night talking to herself and laughing. She constantly asked her husband and daughters to kill her. She constantly talked about actor Jerry Lewis.
    Sidney Barthwell, Cathy Cartwright's court-appointed attorney, said Cartwright can behave in a normal fashion when taking her medication. But family members told police that Cartwright had not been taking her medicine for months before the fire in Woodhaven. Family members "can beg and try until they're blue in the face but it's up to the person" to take the medication, Barthwell said. He said that with medication, Cathy Cartwright can live a fairly normal life, and in conversations with her lately, "she was clear and lucid."

Violent Man Wrongly Placed in Group Home, Advocates Say
David A. Fahrenthold, Washington Post- 3/14/2001

When D.C. police arrived at the house in the 2200 block of Naylor Road SE the morning of Nov. 11, Michael Hall had scratches on his arm. Paul Banks had voices in his head. Police soon figured out what was going on. The house is a group home for the mentally ill, and Banks -- a paranoid schizophrenic -- had assaulted Hall with a fork. Police took Banks, 41, to an emergency psychiatric center. In theory, he should have stayed away. The home had a city contract to house stable, low-risk patients. Hall, a mild man of 52 whose worst habit was asking questions over and over, seemed to fit in well there. Anyone with violent tendencies, like Banks, did not.
    For Paul Banks, a ward of the District of Columbia, the system rarely worked the way it was supposed to. He had been arrested five times in violent crimes just between 1998 and November, yet the U.S. attorney's office dropped charges in all but one case. He was convicted once, and court records show he was able to ignore his probation. Then, although Banks was accused of assaulting patients and doctors, the D.C. mental health system decided he could live in its least supervised type of group home. After the attack on Hall, Banks was returned to the home on Naylor Road in early February. Days later, Hall was dead. Police said Banks, now charged with second-degree murder, attacked his housemate with a fire extinguisher in a fight over cookies.
    A review of the Banks case, based on court records and interviews, shows that the system had ample chances to treat or institutionalize Banks. But despite his violent and documented outbursts, the District's criminal justice and mental health systems instead played roles in returning him to an unsupervised home where his behavior placed others at risk. Banks "had already demonstrated that his illness . . . was not in control," said Joan Bowser, president of the D.C. chapter of the National Association for the Mentally Ill. "Somebody should have seen this violence coming." The city's Commission on Mental Health Services is investigating Hall's death. Elizabeth Jones, the chief operating officer, said there are no signs that the agency acted inappropriately. "I'm not sure anything did go wrong," she said. Mental illness is cyclical, she added, and "you can't predict human behavior."
    Michael Hall's behavior -- though it had sometimes vexed his caseworkers and doctors -- was the subject of smiles at his funeral late last month. An audience of caseworkers, doctors and fellow mental patients recalled Hall as a forgetful man who was forever finding and losing watches and was constantly repeating questions and demands. "He was the kind of guy who would challenge you and [then] bond with you," a caseworker said from the pulpit. Hall loved living on Naylor Road, according to those at the funeral. Even when he had his own apartment -- in 1997 and 1998, according to a psychiatrist -- he would sometimes return to the group home for one-night "vacations." The home's operators sat in the front row at his funeral; police searched for days after his death, without success, for any relatives.
    The District's mental health commission is a separate agency from the one that handles mentally retarded people, though both have had problems with group homes in the recent past. A lawsuit over inadequate group homes put the mental health commission in court-ordered receivership in 1997. The Naylor Road home is classified by the commission as an "independent living" facility. Of the city's five types of group homes, independent living homes offer the least structure and the least supervision. Such group homes have no specially trained staff, and often no staff at night. Residents are expected to feed and clothe themselves and interact in the community without posing a danger.
    But Banks, who court records said also had an alcohol abuse problem, had been known to be dangerous. He spent the 1980s in prison on a burglary charge. After his parole in 1993, he spent much of his life at St. Elizabeth's Hospital or in the D.C. jail. From 1998 to last summer, Banks was arrested five times by D.C. police. He was charged with assault three times and with burglary and destruction of property once each. In four of those cases -- the assaults and burglary -- the U.S. attorney's office dropped charges before trial. Channing Phillips, a spokesman for the U.S. attorney's office, said records in two of the cases were unavailable. In one assault, the case was dropped the same day because there wasn't enough evidence to prosecute. The other case, an alleged assault last March, was dropped when the victims, two housemates in another group home, could not be found to testify. Banks was convicted in the destruction-of-property case and ordered to serve a year of probation. Court records indicate he showed up for only one meeting before his probation officer lost contact with him.
    Because of confidentiality rules, the mental health commission would not confirm when Banks was under its care or where he had lived. Although several of his alleged crimes involved patients, staff or property of the mental health system, court records show that by last year, Banks had been placed in the most lenient, unsupervised environment offered by the D.C. mental health system. A psychiatrist familiar with both men's treatment said Hall's mild demeanor and semi-independence made him a good candidate for the Naylor home. Banks, the psychiatrist said, did not belong in such a facility. "Somebody with Paul's problems should never be put in the same house as someone with Michael's problems," said the psychiatrist, who spoke on the condition that he not be named.
    In the predawn darkness of Nov. 11, police officers responding to the home found that Hall had been scratched on the arm with a fork. Banks was pacing around, talking about hearing voices. As officers watched, Banks picked up the dining room table and flipped it over. "That was enough for us," said Officer Frederick Wade, who responded to the call. The officers took Banks to the Comprehensive Psychiatric Emergency Program, a kind of mental health emergency room on the campus of D.C. General Hospital. There, according to police reports, Banks had another outburst. He threw a chair at a psychiatrist, pulled the fire alarm and sprayed a fire extinguisher on the floor and chairs.
    While he awaited trial in the assault on the psychiatrist (charges were never filed in the assault on Hall), Banks shuttled between familiar places: St. Elizabeth's Hospital and the D.C. jail. According to the D.C. Department of Corrections, Banks was housed in the jail's mental health wing, seen by doctors and given medication to control his schizophrenia. The case was dropped Jan. 30. Phillips, the U.S. attorney's spokesman, said the psychiatrist at the emergency psychiatric facility did not cooperate with prosecutors. When Banks walked out the door of the D.C. jail later that day, he had been arrested seven times and charged six times in about two years. The result was one year of probation and five dropped charges.
    Banks's release from jail set off a scramble to find him housing, according to Robert Keisling, a psychiatrist who once ran the District's psychiatric emergency room. He said a colleague on Banks's treatment team told him the team had sought a more structured group home, but that most homes refused Banks because of his history of violence. Officials with the Long Term Care Ombudsman's office, a city agency that handles complaints about such homes, said it is common for mental health clients to return to group homes after being removed for bad behavior. "Nine times out of 10, these people will go back to these houses," said Jerry Kasunic, of the ombudsman's office. Many who run group homes screen their clients to keep out those who have been violent at other homes.
    Within a week of his release from jail, Banks was back at the Naylor Road group home. On the morning of Feb. 5, Banks came downstairs from his bedroom and accused Hall of eating all the cookies, according to Detective Stephen McDonald. The two argued, as a staff member listened from upstairs, according to court documents. The staff member then heard a noise "like someone hitting something," according to court papers. Police say Banks had seized a fire extinguisher from the porch and bludgeoned Hall as he sat on the living room couch. Banks then fled on foot, police said. An hour and a half later, Banks called 911 from the Shaw-Howard University Metro stop, saying he had killed someone. Police said he gave them a detailed statement later that day.
    When contacted in the days after Hall's death, commission spokeswoman Linda Grant said the agency had not known of previous violence at the group home. The facility does not have a license -- city agencies disagree over whether it needs one -- but Grant and Jones said the Naylor Road home has a great reputation. It probably wouldn't have had to change much to get a license, they said. Banks is in the mental health unit of the D.C. jail. Through his attorney, he declined to comment. In the piles of court documents he has generated since 1993, his voice appears only once. At the bottom of a police report about the alleged assault at the psychiatric emergency room, there is a small space for the suspect's comments. "I told them," Banks is recorded as saying, "I was sick."

Problem Gamblers Prefer State Lottery
Gene Schabath, The Detroit News- 3/14/2001

DETROIT -- Some 185,000 Metro Detroit adults have serious gambling problems, with wagering on the Michigan lottery and gaming at casinos the main culprits, according to results of a study released Tuesday. The United Way Community Service's study quantifies for the first time the level of gambling addiction in Metro Detroit.  "We have numbers ... and these are significant numbers," said Virg H. Carr, United Way president and chief operations officer, at a news conference in the agency's headquarters on Griswold, six blocks from the MGM Grand casino.
The number of problem gamblers was calculated from a random survey of 1,200 residents in Detroit and Wayne, Oakland and Macomb counties, Carr said. The study had a margin of error of 2 percentage points, and was based on a population of 2.9 million adults over the age of 18.
    The survey showed that 85 percent of Metro Detroit adults have gambled at some time. The state lottery was the most favorite form of gambling, with 76 percent saying they participated in state-run games. Casino gambling was second at 61 percent.   Statewide, an estimated 84.5 percent of Michigan residents have gambled, according to the Michigan Department of Mental Health. About 5 percent of gamblers ultimately become addicted. In Michigan, that translates to about 350,000 compulsive gamblers.  The percentage of problem gamblers in Metro Detroit is slightly higher, at about 6.4 percent, according to the United Way survey. National studies have shown the percentage of compulsive gamblers at between 6 percent and 10 percent.  The study showed that many of the problem gamblers are in the 18-25 age range.
    "I don't agree with the study," said Christopher Kelly, 35, of Utica. He had just bought $20 worth of scratch off lottery tickets at Mike's Party Store in Mt. Clemens.  "If you're spending more than you can afford, it's a problem," said Kelly, a real estate agent who spends as much as $100 a week on lottery tickets. "I make good money and can afford it."
    Carr said the $37,000 study was commissioned after agencies that United Way deals with began noticing problems associated with compulsive gambling during the last few years.  "They were very concerned about the problems they were seeing with families," Carr said. "There were areas that were very targeted to problem gaming -- suicides, threatened suicides, depression, use of emergency public assistance and bankruptcy."  Carr said he hopes the study will inspire a statewide forum on problem gambling with emphasis on educating people about the dangers of gambling and more money to treat addicts.  Carr said he would like to see schools have courses on the evils of gambling.
    "The problem with gambling is in a way kind of like alcoholism in the 1960s ... when it was recognized as a mental health problem, a community problem," said Paul Wong, dean of the college of arts, sciences and letters at the University of Michigan-Dearborn. Wong supervised the study.  "If you look at gambling nationwide and in Metro Detroit, we are at a critical point in terms of seeing it as a community problem and a mental health problem in terms of those impacted by it."   Wong said the study showed there also was a high percentage of illegal gambling, such as poker and dice games.
    The problem has become so acute that therapists at the Catholic Social Services in Oakland County cannot treat all of the gambling addict who call for help, said Deborah Bergenson, director of professional services for the agency.  "In one month's time we turned away 22 people," Bergenson said. "We treated 40 people."  Bergenson said that some of the gambling addicts were professionals with salaries of more than $100,000.

How to get the report
* The Survey of Problem Gambling in the Metropolitan Detroit Area can be obtained for $5.30 by calling the University of Michigan-Dearborn at (313) 593-5490.
* For a summary of findings from the survey, call United Way Community Services at (313) 226-9411.

Study highlights
* 85 percent of Metro Detroit residents have gambled at some time, 79 percent in the past year.
* Detroit residents are less likely to gamble than their suburban neighbors, but Detroit residents who do gamble are more likely to become problem gamblers. About 5.7 percent of Detroiters are problem gamblers, compared to 3.7 percent of those in the suburbs.
* Metro Detroiters ages 18 to 25 are thought to be most at risk of becoming problem gamblers. They gamble more often and lose more money than older groups.
* African Americans and other nonwhite respondents are less likely to have ever gambled than are whites, but are more likely to become problem gamblers if they do gamble.
Source: United Way Community Services

Eating Disorders: Not for Women Only
Carol Ann Campbell, Newhouse News Service- 3/14/2001

Word quickly spread through the eating disorder center: Another man was checking in. That meant that Dave Scala, a Rutgers University researcher with anorexia, was getting a roommate, Rick DiSalvo, a carpenter with bulimia. The two men, both fathers of young children, both in despair after years of illness, were trying to get well -- and in the process challenge notions that only women get eating disorders. The two men were admitted last fall to the eating disorders program at Somerset Medical Center in Somerville, N.J., one of the few in-patient centers that takes men. Today, they continue to recover from illnesses they never knew men could develop. Scala was in denial even as his weight dipped below 110 pounds. "I thought this was a disease for teen-age ballerinas," said Scala, who lives in Clinton Township, N.J. "To think that I was a 34-year-old guy with anorexia seemed preposterous."
    Researchers are just beginning to understand the role eating disorders play in men, who may exercise relentlessly, binge and purge, or simply starve themselves. A decade ago experts suspected that one of every 10 people with an eating disorder was male. More recent studies say the figure is higher, perhaps one in six, or even one in four, according to several experts. Little data exist since men rarely come forward seeking help for a so-called "women's disease." Yet several experts said they believe eating disorders among men are on the rise, and blame the same kind of body-image pressures long put on women. Men's magazines, movies and even toys promote a muscular and rarely attainable male physique.
    "If you look at the G.I. Joe dolls today, they don't look like the dolls of 20 years ago. They are disproportionately muscular," said Joseph Donnellan, medical director of the eating disorders program at Somerset Medical Center. Men's magazines, he said, help develop an unrealistic view of what a normal man looks like. The irony, though, is that some men who start out trying to look "buff" focus so much on losing fat that they end up becoming ultra-thin. The fat-fighting behavior becomes obsessive.
    "Men want to bulk up. But the image gets distorted. One man told me, `I wanted to look like Michelangelo and I ended up looking like Picasso,"' said Ellen Pederson, who runs the men's eating disorder program at Rogers Memorial Hospital in Oconomowoc, Wis. The program has admitted boys as young as 13. "An eating disorder gives a person the illusion that they have control over life," Pederson said.
    Anorexics starve themselves, and 10 percent will die, either of starvation or heart attacks related to malnutrition.
Bulimics sometimes will eat enormous quantities -- like pizzas and gallons of ice cream -- and then vomit. Some will exercise hours each day, or use laxatives to purge their bodies. They can die of a heart attack or a ruptured esophagus.
    Scala's compulsion was to barely eat at all. The 35-year-old lives with his wife and two small daughters in a rural subdivision. He was doing post-doctoral research in microbiology at Rutgers University, surrounded by young associates, when he began to feel fat. His thoughts became obsessive, even though he was trim. "First I wouldn't eat meat. Then I wouldn't eat fish," he said. "I said I was becoming a vegetarian, but this was really a way to eliminate entire food groups." He would do aerobics, and then hundreds of sit-ups and push-ups each day. His weight dropped from 155 to 125, and, when people remarked on his disturbing weight loss, he would tell them he was a vegetarian. He is 5 feet 7 inches tall. "I wanted the washboard abs," Scala said. "But I thought they were covered with fat. I became obsessed with fat, and with the numbers. First I wanted to be 124 pounds. Then 118. Then 115. It was getting harder to hide. I would tell my wife I was having `dinner' at the lab. If we went to someone's house I would say, `Oh, I don't eat red meat.' I would push the food around the plate and hide stuff in napkins." Some days, Scala ate just carrots and seltzer. His hair began to fall out and he became dizzy and shaky. A turning point came when he passed out holding his new baby. He was 107 pounds and went into the hospital, afraid, at first, that therapists would laugh at him -- a man with anorexia. Instead he found a connection with the women patients. "We really had a lot of the same issues," Scala said.
    DiSalvo, 38, of Newton, N.J., still remembers when he weighed 250 pounds and co-workers at a factory jokingly put him on a diet. They weighed him each day. He felt ridiculed. One day he went into the bathroom, locked the door and vomited his lunch. The next day he did the same thing. And the next. The weight began to fall off. He was in his mid-20s when he lost 100 pounds in 10 months. "Then the name-calling stopped and the compliments started," DiSalvo said. He became so fearful of getting fat again that he began purging almost every meal -- a compulsion he followed for more than a decade. "I couldn't stop," said DiSalvo, who has worked as a plumber and carpenter. "I would eat a bowl of chicken broth and feel I should purge. I was weight-lifting three or four hours a day, running at night, doing sit-ups. As soon as I started cooking a meal I would think, `How can I get to the bathroom and purge this meal without anyone seeing me?"' DiSalvo's teeth began to rot from his own stomach acids. He snapped at his wife of 16 years if she said anything. "One day I was walking to the bathroom and I heard my daughter say, `Daddy's going to throw up.' That really hurt," he said. "I didn't want to die."
    Experts say men with eating disorders frequently were chubby children, and often the target of jokes. Others were athletes, such as wrestlers or jockeys, who had to "make weight." Scala and DiSalvo, both still battling their illnesses, said they want other men with eating disorders to know they can get help. Scala is now up to 133 pounds. DiSalvo rarely vomits his meals now. They are still working on their problems, but both feel more at peace -- and they've both banned men's magazines from their homes.

Emotional Turmoil Prompts Self-Injury
Teresa Novellino, ABC News- 3/14/2001

Lisa Bayens was only 12 when she started cutting her own arms and stomach with a razor. Now 20, she is finishing therapy, where she confronts the inner demons that first drove her to cut herself. "I felt so much anger inside and I was so upset that I wanted to have my feelings expressed," she said. "I couldn't discuss them with somebody, so I felt like I had to put a mark on my body. I felt so relieved afterwards that I continued the behavior every time I was sad or angry, upset or depressed." 
    Bayens' behavior may seem bizarre, but it's not unusual. Researchers say 2 to 3 million Americans — and more worldwide — cut themselves on purpose. Those who cut themselves are often turning their anger on themselves because they are afraid to let their feelings out, says Good Morning America parenting expert Ann Pleshette Murphy. "This can be a way to express painful feelings and avoiding having to express them out loud," says Murphy. "The philosophy behind it is not very different from girls who starve themselves."

'Physical Expression of Anger'
In recent years, the secret impulse has gone public. Princess Diana admitted in a 1995 BBC interview that she cut her legs and arms because she was unhappy about her marriage, for example. Experts say cutters inflict pain on themselves to deal with worthlessness and self-hatred. Most of these self-injurers are female, 50 percent were sexually abused and many also have eating disorders. "It's a physical expression of anger," says author and clinical psychologist Wendy Lader, co-founder of the Self-Abuse Finally Ends (S.A.F.E) program. "You might see guys who are angry hit a wall, or kick something and they feel better. For these girls, they hurt themselves."
    Journalist Marilee Strong interviewed more than 50 "cutters" for her book, A Bright Red Scream. The group included foster children, prisoners, doctors, lawyers, nurses and Sunday-school teachers. "Self-injurers," ," she says, "are often bright, talented, creative achievers-perfectionists who push themselves beyond all human bounds, people-pleasers who cover their pain with a happy face."  Often the cutting episode begins on impulse: A cutter grabs a sharp object to cut themselves, or they nick themselves shaving their legs and just keep cutting. Many cutters describe relief and solace in watching themselves bleed, as though their pain and fear is seeping away. "Basically there's a belief that when one cuts," says Lader, "there may be naturally occurring opiates that produce an analgesic effect."

The First Cut
Doctors often misdiagnose cutting as attempts to commit suicide. Self-injurers, however, view the behavior as a way to survive, to show themselves they are still alive and capable of feeling pain. Bayens says she cut herself as an angry reaction to a neighbor who had abused her since she was 5 years old — something she never revealed to her parents. "I did not want them to know about the past sexual abuse… so I could not bring the self-injury up to them," says Bayens. "I did not want to hurt them." Instead, she went to S.A.F.E., a 30-day inpatient treatment program at MacNeal Hospital in Berwyn, Ill. The program accepts 10 patients at a time. Almost all of them end up being white females; many are adolescents.
    When Lader and Karen Conterio co-launched S.A.F.E. in 1984, they received 1,250 letters a year from those seeking help. Today they get 5,000 letters each month. They have seen girls who have amputated parts of their body, girls who have cut themselves to the point where they require hundreds of stitches to re-seal their flesh, girls who have carved words like "fat" or "ugly" into their skin. The therapy that S.A.F.E. patients go through emphasizes that they alone can help themselves. "Our program puts the responsibility squarely with the client," says Lader. "To recognize that they do have control. That this is a choice."

A No-Harm Contract
S.A.F.E. patients sign a contract promising not to hurt themselves during their 30-day stay. There are no restraints to keep the girls from hurting themselves and they are not kept away from potentially self-injurious weapons such as scissors. Instead the focus is on new behaviors: group therapy to discuss feelings, not their injuries, taking anti-depressants if needed, and writing in impulse control logs to help them pinpoint the emotions that lead to the cutting. "The self-injury isn't the problem," says Lader. "It's the feelings that lead to it, the anger and the abandonment." And addressing those feelings appears to help, at least in Bayens' case. "The jump is so frightening between where I am and where I want to be," she says. "I am learning to live a full life."

Signs of Cutting and Getting Help
Even parents and family members may be unaware that a loved one is hurting themselves in private. The signs of cutting are obvious, but often the cutters try to hide their slashed skin and their bruises. Good Morning America's Parenting Contributor Ann Pleshette Murphy says parents should be wary of unexplained bruises or cuts that a girl may say she got while shaving, for example — especially if they are paired with other indications that she is troubled. "Look for any depression or low self-esteem," says Murphy. A teen might also describe herself as bored or unable to express emotions. A teen may also wear long, baggy clothes in the summer to cover up her body. Note signs of an unusual desire for privacy — reluctance to change clothes in gym class, for instance. When seeking help, be sure to check out therapists carefully, since many are not experienced in this type of behavior.

New York Senate Plan Would Boost ''Coercive'' Drug Treatment
Lynn Brezosky, Associated Press- 3/14/2001

ALBANY, N.Y.-- Drug addiction recovery programs that include the threat of prison time are succeeding, Senate Majority Leader Joseph Bruno said Wednesday in a pitch to increase funding for such programs by $20 million. The funding would go to existing programs as well as new programs modeled on the Drug Treatment Alternative to Prison program operated by d Educational Assistance Program on Long Island with area prosecutors. The 18-month to 24-month program oversees drug addicts through detoxification and rehabilitation centers and then through halfway houses and finally into jobs or training programs. District attorneys, judges and defenders decide who to offer the alternative. In Brooklyn, the recidivism rate of the program's participants was 23 percent compared to 46 percent for others. The program and Treatment Alternatives to Street Crimes primarily draw second-time nonviolent felony drug offenders, as first-time offenders are rarely sentenced to prison time. Relapse or other violation of the program's rules means automatic incarceration.
    ''By dangling the promise of 'no prison' but always keeping that option open, coerced drug treatment programs have proven to be a cost effective and successful way of ending dependency,'' said Sen. Michael Nozzolio, R-Seneca, chairman of the Senate's Crime Victims, Crime and Correction Committee. ''Felons eligible for treatment alternative programs are faced with the choice to use it or lose it.''
    Courts upstate have few options for addicted persons whose only crimes are committed to feed their habits, and Schenectady County District Attorney Robert Carney said he and other district attorneys would welcome such choices. He said the savings alone treatment is less expensive than incarceration make the proposal appealing to small counties such as Schenectady. The $20 million would also pay for more treatment beds for incarcerated felons, higher funding for treatment services before and after prison release, and job placement assistance for addicts who have finished their programs. It would initially fund treatment for an additional 800 offenders.  Caroline Quartararo, spokeswoman for the state Division of Criminal Justice Services, said the governor's office would take a look at it. ''The state now spends in excess of $35 million on drug treatment in prison,'' she reminded.  Assembly Democrat Jeffrion Aubry of Queens, chairman of the Assembly's Committee on Corrections, said the Senate appeared to be taking a step in the right direction. ''I disagree with the amount of money they commit,'' he said. ''But I think it's important they have recognized that you have to have treatment.''

Experiment Supports Freud's Theory of Repression
Alex Dominguez, Associated Press- 3/15/2001

An experiment found that people can push an unwanted memory out of their minds, lending credence to Sigmund Freud's theory of repression. In the study, college students who had memorized pairs of words were later shown half of the pair and were asked to either say the corresponding word or try to forget the second word. The more the participants were asked to put words out of their minds, the less likely they were to recall the word later, even when paid to remember the word.
    The University of Oregon study is one of two on memory appearing in Thursday's issue of the journal Nature. In the second study, which was conducted on rats, researchers found that the growth of new neurons in a part of the brains known as the hippocampus is necessary to form memories relating two events separated over time. Martin Conway, a psychologist at the University of Bristol in England, said in an accompanying commentary that the Oregon research supports Freud's theory about the mind's ability to repress thoughts, especially painful or disturbing ones. ''Even more surprising is that this occurs for unrelated pairs of words,'' Conway said. ''How much stronger must this inhibition be for objects central to our thoughts and emotions.'' Michael Anderson, who led the study of 32 students, said the participants were about 10 percent less likely to remember the second word after 16 attempts to repress the memory, a figure he said he expected would climb if repression continued.
    The work supports the findings of a colleague who found that children were less likely to remember abuse at the hands of a parent or guardian than a stranger, possibly because they had to forget in order to be able to cope with their daily routine, Anderson said.  However, the researcher admitted that memorizing word pairs is far from the type of memory associated with painful events such as child abuse. ''What we really need to do is see if the same effect occurs for emotionally more significant material,'' Anderson said. ''That's a very important step we have to take. I wouldn't really say we've solved the repression problem here. It's just a good start.''
    In the rat study, Tracey Shors of Rutgers University said rats were not as likely remember the connection between two events separated by time if given a drug that cuts the production of neurons in the hippocampus, an area of the brain used in the formation of some types of memory. Eighteen rats were given the drug. The brains of both rats and humans have a hippocampus, and the study is the first to show in mammals that new neurons are used in memory formation, though previous work has shown the connection in birds, Shors said. Shors said previous work has shown that the learning of certain tasks made cells in the hippocampus live longer. The current work found that these cells are needed for some types of memory. Jeffrey Mackliss, a neurobiologist at Harvard Medical School, said the experiment supports both the concept that the production of neurons is necessary for some types of memory formation and the idea that it may one day be possible to treat some diseases of the nervous system with neurons.

Poll Questions Students on School Violence
Gary Langer, ABC News- 3/15/2001

N E W Y O R K, March 13 — A third of high school students can think of a classmate who may be troubled enough to stage a violent attack in their school — yet fewer than half have ever had a special class or discussion group that told them how to report a threat of school violence. More than a third also say they've heard a classmate threaten to kill someone — but most of them didn't take it seriously or report it to an adult, according to a new ABCNEWS/Good Morning America poll. One in eight say they personally know a student who's brought a gun to school, and one in 10 say they've heard of a plan by one or more students at their school to shoot or kill classmates.  At the same time, just a little more than half, 54 percent, say they've had a class, special program or group discussion on the subject of school violence. And just 46 percent have been taught in such a class what to do if they hear a threat or think another student is armed.  On the positive side, the poll found that most students feel safe, and that their concerns are no worse — and in some cases better — than they were after the April 1999 shootings at Columbine High School in Littleton, Colo. At that time, for instance, 40 percent saw some likelihood of a violent attack at their own school; now it's 29 percent.

The Bullying Factor
Charles Andrew Williams, who is accused of killing two students and wounding 13 last week in Santee, Calif., reportedly had been a target of bullying at his school. And this poll finds that when students think of a potentially violent classmate, it's generally a boy who comes to mind, and one who's been bullied by others, rather than a bully himself. Thirty-three percent say they can think of a fellow student "who may be troubled enough to try something like this." That's down a bit from 40 percent in 1999. Seven in 10 say the potential attacker they can think of is a boy, and 29 percent think of both boys and girls; just 2 percent have only a girl in mind. Three-quarters say it's more likely to be a person who gets picked on than one who picks on others. Relatively few students, 13 percent, say they personally are picked on at school.

Safety Concerns
Despite the Santee shooting and another two days later in Williamsport, Pa., students are taking the issue in stride. Now as in 1999, nine in 10 say they feel personally safe at their school, and more than three-quarters say violence is not a serious problem there.   There's evidence, moreover, of fewer guns in school, and less access to guns. While 13 percent of students personally know a student who's brought a gun to school, it was 20 percent two years ago. And while 44 percent say it would be easy for them personally to get a gun, that's down from 54 percent in 1999.
    Risk, of course, never reaches zero. Among the vast majority of students who haven't seen a gun in school, nine in 10 say they'd report it if it happened. But a few — 7 percent —say they would not report it. Similarly, just 5 percent call violence a "very serious" problem at their school (another 16 percent call it "somewhat serious") and just 7 percent feel personally unsafe at school. But while small percentages, these represent hundreds of thousands of students. Most students say there are security measures in place at their schools, and nearly two-thirds think their schools are doing enough to try to prevent violence there. On one hand, that's up from 57 percent in 1999; on the other, it leaves a third of high schoolers who think their schools still aren't doing enough to protect them.
    Counseling for troubled students is said to be the most prevalent line of deterrence; 87 percent say their school offers it. Sixty-seven percent say there are police officers or armed security guards at their school, and 63 percent say the school tries to identify troubled students who may be prone to violence. About half report random searches of lockers; four in 10, security cameras in the hallways; three in 10, random searches of students. Seven percent report metal detectors at school entrances.

Students at Smaller Schools Feel Safer
Two factors seem to influence students' perceptions of threat at their schools: The size of the school, and the age of the student. Older students, and those in smaller schools, are less apt to feel threatened. Fifty-eight percent of teenagers attending small high schools feel "very safe" from violence, compared to 46 percent of those attending large schools. Similarly, in small schools just 12 percent call violence a serious problem; in larger schools it's 23 percent. Interestingly, while students in larger schools are less apt to feel safe, these are the same schools that are more likely to have police or armed security guards on patrol. Among students in larger schools, 84 percent say they have guards; in small schools it's just 43 percent. Larger schools — and the presence of guards — are more prevalent in the West.
    In rural schools, which tend to be smaller, 54 percent of students feel very safe, compared to 49 percent in suburban schools and 41 percent in city schools. While rural schools are less likely to have guards, they're more likely to conduct random searches of student lockers. Sixty-one percent in rural schools say this happens, compared to fewer than half in city or suburban schools. Girls are more likely than boys to think their schools should be doing more to deter violence; 41 percent of girls think so, compared to 28 percent of boys. But in other gauges, including personal feelings of safety, there's no real difference between the sexes.
    This ABCNEWS poll was conducted by telephone March 8-11 among a random national sample of 500 high school students. The results have a 4.5-point error margin. Field work was done by ICR- International Communications Research of Media, Pa.