Noteworthy News Articles on Mental Health Topics, March 19-21, 2001

Stressed-Out Society Gives Birth to Rage
Lisa Anderson, Chicago Tribune- 3/19/2001

NEW YORK -- Road rage, desk rage, school rage, air rage, surfer rage and tennis rage--all manifestations of a growing category of American misbehavior that ranges from discourteous to deadly. A decade ago, they seemed like isolated incidents that made the headlines because of their bizarre nature. But experts fear that a growing number of violent incidents--children shooting classmates, workers attacking colleagues, airline passengers assaulting flight attendants--involve premeditated episodes of rage directed against societal forces rather than just individuals.
    "We are an enraged society, there is no question about it," said Dr. Arky Ciancutti, a physician and founder of The Learning Center, a Silicon Valley-based firm that researches and consults on promoting healthy work environments. "There's quite a range of rage. The most toxic ones, I think the psychologists would call infantile rage, helpless rage. . . . That's the rage that feels completely out of control and can get completely out of control." Moreover, said Ciancutti, "every person walking on the planet is susceptible to this phenomenon and it causes us to have some blind spots in whole categories of people and situations--women, men, supervisors, the other driver. There's a powder keg just waiting to happen."
    No government agency or official keeps statistics on all incidents of rage. But they account for hundreds of deaths every year, including 645 people slain on the job in 1999, the most recent year for which statistics are available. During the early 1990s, the average annual number of violent incidents reported between drivers in the U.S. increased 51 percent, to more than 2,000 in 1996, according to the AAA Foundation for Traffic Safety. Experts suspect that thousands more incidents go unreported. Though statistics indicate that violent incidents in schools and on the job are declining, experts say anger and incivility have increased in the past decade. The causes are myriad, including the round-the-clock, 365-day pace afforded by new communications technology; increased pressure for productivity; impatience; overburdened transportation systems; and the changing nature of such traditional rule-setting structures as home and church.

Unrealistic expectations
"We're more tired, stressed, hassled," said Jerry Deffenbacher, a psychology professor at Colorado State University and an expert on road rage. "We often are hurried. We have unrealistic expectations. We have, for example, a lot of travelers who think no flights they're on should be delayed or canceled. We should never be sick. Other people always should be considerate and polite. We've got more drivers on the road and the number of lanes has not kept up. "There are tremendous differences in how people deal with exactly those same conditions," he said. "Most people don't pull a gun at the airport or in the parking lot or on the road or anywhere else. Most people don't stand and scream at someone because their plane is canceled. Most people don't have guns, knives, clubs, etc. But you never know which one does."
    Nowhere is the expression of this anger more graphic than in the workplace and in the classroom. In 1992, when the Bureau of Labor Statistics created the Census of Fatal Occupational Injuries, homicides were the second-leading cause of deaths at work. In 1994, there were 1,080 such homicides. In 1999, the most recent year reported, workplace homicides dropped to 645, the lowest level since the bureau began counting them. Violent crimes against students age 12 to 18 are on the decline, but still 253,000 students fell victim to such crimes at school in 1998, according to a Justice Department report issued last year. Since then, fatal attacks have befallen a number of schools, notably Columbine High School in Littleton, Colo., in 1999 and Santana High School in Santee, Calif., early this month.

Survival mode
"Irrational behavior has become the norm in every aspect of our society, and that worries me," said Timothy Dimoff, president of Ohio-based SACS Consulting and Investigation Service Inc., a specialist in violence management. "Irrational behavior by kids at school, by sports stars, by mom and dad, by people at work, has become the norm. Basically, we've created a breeding ground for violence. "We're no longer in a community, negotiating mode," Dimoff said. "Adults are in a survival mode. We're doing it out of fear and we're doing it out of what's in it for me, me, me. Everything is focused on the `I' and the `me,' and it's surrounded by the pressure cooker."
    Incidents involving "unruly passengers" attacking flight attendants more than doubled between 1995 and 1999, to 310, though the figure dropped to 266 last year, according to the Federal Aviation Administration. Experts believe that many more incidents go unreported, perhaps as many as 5,000 a year. Increased awareness of the problem has led many airlines to impose new security features, including having crews carry handcuffs.
    Though homicides on the job are declining, the workplace remains a high-profile scene of rage. "When you go into a company, you're wearing 10 hats and you're doing 10 jobs and it's all, `Do it fast. Do it now.' There's no such thing as waiting," said Dimoff, one of many entrepreneurs in a burgeoning field built on rage, including anger management specialists, violence centers, screening tests, books, counselors, security specialists, Web sites and an array of academic researchers.
|    Businesses and other institutions typically seek help after high-profile incidents, such as the recent California school shooting or the office shooting in Wakefield, Mass., last December. Like others in his field, Dimoff said he has seen a steady rise in interest for his services. "Two and a half years ago, I got two to four workplace violence cases a month," he said. "Today, I average two to four phone calls a week, and an average six a week concerning altercations between employees, white collar and blue collar, anything from verbalization, pushing, shoving, spitting, intimidation and stalking."

Preventive measures
Measures that employers, schools and individuals can take to prevent outbursts of rage range from the physical, such as security systems, surveillance cameras and office and classroom doors that can be locked from the inside, to the psychological, such as screening and intervention. Michael McIntyre and Larry James, industrial psychologists and experts on aggression at the University of Tennessee at Knoxville, recently developed a test to help employers prevent workplace violence by identifying highly aggressive employees. The $5 Conditional Reasoning Test of Aggression, which can be administered and scored by the employer in 20 minutes, features a set of reasoning problems with multiple-choice answers. "Basically, you can tell if somebody tends to have a short fuse, some paranoia, some victim complex. That stuff comes out in the way that people solve problems," McIntyre said. "We're trying to enable employers to do their due diligence in hiring. If they get a high aggression score, we want them to dig deeper." Often such highly aggressive personalities are difficult to spot because their behavior may be fine until a conflict triggers their rage.  "My focus is that these people may ostensibly be normal, but they're not really just nice people who've been pushed to the edge," McIntyre said. "They're more likely to be ticking time bombs. They are aggressive personalities that haven't gone off the deep end yet.
    "The Navistar shooting, where the guy came in with like an AK-47, this is not somebody taking a swing at somebody in frustration. These are premeditated acts, for the most part," he added, referring to an incident six weeks ago when William Baker, a disgruntled former employee of the Navistar engine plant in west suburban Melrose Park, showed up at the plant the day before he was to go to jail for stealing from the company and murdered four people before killing himself.

Rage triggers
Whether at school, at work or on the road, often the most potent trigger of rage is a feeling of being disrespected or victimized, experts say. People who are hypersensitive to such feelings often are those who derive a disproportionate amount of their self-esteem from others, according to Paul Baard, a psychologist and professor of communications and management at New York's Fordham University. "If I haven't adequately defined myself, that I'm an OK guy, then I'm vulnerable to having other people define me," he said. "So, I become hypervigilant of my environment because, after all, what people think of me--or worse yet, what I think they think of me--can affect how I feel." To describe this condition, Baard coined the term "psychological fusion" in 1996. "Psychological fusion is that dynamic whereby I interpret events in my environment as reflecting of my self-worth. ... Psychological, because it's a trick of the mind. Fusion, because it's as though our brains were connected momentarily" to someone else's. "We can control this," said Ciancutti, who places the onus on the leadership of businesses, schools, hospitals and other institutions to build a culture that increases trust, clarifies rules and guidelines and reduces fear across the organization. Doing this, he said, makes not only for a safer and more pleasant workplace, but also a far more productive one. But, he said, "People are not motivated to look at this until there's more pain with the problem than there is with the solution."

Detroit Has Long Ties to Alcohol
Bill McGraw, Detroit Free Press- 3/19/2001

Detroiters are celebrating the tricentennial of their city this year and Catholics are observing the 300th anniversary of the church in Detroit. Few people realize that 2001 also marks three centuries for another local institution. Drinking. Name your poison -- booze, liquor, whiskey, John Barleycorn, beer, brewski, suds, stout, wine, vino, hootch, moonshine, firewater, rotgut -- drinking has played a huge role in Detroit's history, for better or for worse. Even before Detroit became a shot-and-a-beer factory town in the late 1800s, saloons and breweries were vital aspects of life in ways that are hard to imagine today. Saloons served as a combination library, hotel, restaurant, rec room and meeting hall throughout much of the 19th Century. The city's first election took place in a bar. Alcohol also fueled the economy. Brewing beer became a significant industry after 1850, and beer companies -- often run by immigrants -- created thousands of jobs. Detroiters also became known nationally as the inventor of drinks, such as sparkling cold duck and the Hummer, which members of the Bayview Yacht Club on the city's east side helped to popularize during their sailing trips around the world. "I never knew it would get this big," said Bayview bartender Jerome Adams, who combined rum, Kahlua, vanilla ice cream and crushed ice in 1968 for Hummer No. 1. In Germany, they honor the inventor by calling the drink a Sir Jerome.
    To put it mildly, drinking also has had a down side. Alcohol has ruined lives and destroyed families. Efforts by "drys" to ban drinking pitted neighbor against neighbor in the 19th Century in the way abortion would 100 years later. During Prohibition in the 1920s, the quest for illegal booze in Detroit sparked lawbreaking and violence that seems shocking even by today's standards. Even Detroit's two 20th-Century civil disturbances had their origins in bars: In 1943, a false rumor announced from the stage of a nightclub helped spread racial fighting that had begun on Belle Isle. Result: 34 dead. In 1967, a police raid on a blind pig ignited crowds on 12th Street. Result: 43 dead, 467 injured, 2,509 stores looted or burned and three decades of polarization.

That first drink
It is the rare American city that can pinpoint the date when alcohol first appeared. In Detroit, it was July 24, 1701. That's the day 15 barrels of brandy arrived in canoes from Quebec, along with city founder Antoine de la Mothe Cadillac and about 100 Frenchmen, including two Catholic priests. The brandy touched off Detroit's first controversy, as Cadillac used it to win the Indians' loyalty -- and their fur pelts -- and the priests started complaining about how liquor was destroying the natives. The unsavory Cadillac was also Detroit's first rumrunner. He had standing orders that anyone in Quebec requesting permission to travel to his fort in Detroit had to bring along large quantities of brandy, which Cadillac would then sell at exorbitant prices.
    The French left in 1760, the British arrived, then the Americans took control of Detroit in 1796. The fur trade remained Michigan's leading industry, dictating liquor-control policy until trapping declined in the 1830s. The government looked the other way as traders provided booze to Indians.  Traders watered down the booze they sold the natives but boosted its kick by spiking it with tobacco or even sulfuric acid. Wayne State University historian Peter Slavcheff wrote a 383-page dissertation on liquor control in the state from 1800 to 1860. "Throughout the first three decades of the nineteenth century, alcohol played a key role in the economic and social development of Michigan territory," he wrote. Not surprisingly, after whites had plied several generations of Indians with liquor, Michigan by the 1800s was filled with Native Americans who had serious alcohol problems.
    Alcohol was becoming big business. Slavcheff reports that from 1820 to 1830, Wayne County's population grew by 84.2 percent, but the rate of increase for all places selling liquor by the glass was 200 percent. In addition, whiskey distilling accounted for about 40 percent of total manufacturing. One public figure who denounced the practice of supplying the tribes with alcohol was Lewis Cass, a Detroiter and the most important American official in dealing with the Indians during the treaty-making period of the 1820s and 1830s. But Cass was a hypocrite. Geographer Bernard Peters discovered that Cass was simultaneously using copious amounts of alcohol to help persuade Michigan Indians to give up their land. The Saginaw Chippewa, for example, turned over 6 million acres in 1819 after Cass had lubricated negotiations with 662 gallons of whiskey.

Beer and temperance
Coincidental with the demise of the fur trade and the beginning of increased immigration to Detroit, two things happened: Temperance societies began springing up across America to fight "King Alcohol," and British, Scottish and Irish Detroiters started brewing beer. In southeast Michigan, as Farmer's Brewery advertised that it was turning out porter and table ale, Isaac Stetson was railing against booze in a speech that was reported in the Detroit Journal and Michigan Advertiser in 1831. "Victorious Greece and Rome ...have been paralyzed, subverted and reduced to slavery and chains by the debilitating effects of luxury and intemperance," he thundered. Dry forces mounted a number of attacks against "groggeries," the "minions of Bacchus" and "rum-sucking judges," including an unsuccessful attempt to ban Detroit grocery stores from selling booze by the glass. Some towns voted to go dry, but not Detroit.
    In the 1850s, as German immigrants in Detroit such as Bernard Stroh began brewing their old-world lager, state residents voted overwhelmingly to shut saloons, and there were other legal moves to outlaw alcohol. Those attempts eventually fizzled, Slavcheff found, because of successful legal challenges and the realization by many Michigan residents that prohibition was, indeed, an abuse of governmental authority. After courts declared one such law unconstitutional in 1854, Detroit "wets" celebrated by firing a 100-gun salute from the foot of Randolph Street. By the Civil War, German-Americans had introduced beer gardens to Detroit. They came to dot the east side. In the 1870s, the issue of prohibition heated up again, just as saloons became a major political force in Detroit and breweries were multiplying. In 1870, Detroit had 105,000 residents and 29 breweries.
    In some years toward the end of the century, more than one-third of the 32-seat City Council were saloon owners or bartenders, and saloon interests controlled many voting districts. The saloon operatives stuffed ballot boxes, corrupted voting rolls and used alcohol in an attempt to sway foreign-born voters. Even Detroit's great reform mayor, Hazen Pingree, kicked off his 1889 campaign in Baltimore Red's bar to quell potentially damaging rumors that he was dry.
    Germans were Detroit's largest foreign-born group in the last half of the 19th Century, and they played a key role in fighting prohibition efforts. In March 1877, 1,200 mainly German people gathered at Arbeiter Hall for a rally againt an upcoming statewide vote to ban booze. "We don't fight prohibition as Germans, but as citizens, voters and freemen whose liberties are threatened," one speaker said, in German. Most blocks in Detroit had at least a couple of bars at the turn of the century. Entering many bars was to walk on the wild side. One of the most notorious was the Bucket O' Blood at Hastings and Clinton. The Bucket was an all-night joint with an integrated clientele, the scene of card games, crap games, dice games, open prostitution, so-called wild music and considerable knife fights and gunplay.

The Prohibition boon
Michigan drys failed to pass prohibition measures until 1916, when voters approved a statewide ban on alcohol that went into effect at midnight April 30, 1918. Two years later, the entire nation went dry. Thanks to its proximity to Canada, where a looser ban on booze was in effect, liquor poured into Detroit throughout the 1920s, during which the city was awash in wealth, growth and a party attitude, thanks to the booming auto industry.  Philip Mason, a Wayne State history professor who wrote a book on those years titled "Rumrunning and the Roaring Twenties," cites estimates that 75 percent of all illegal liquor smuggled into the United States during Prohibition came through Detroit. The illegal liquor touched off a crime wave.
    Today, Detroit police are under fire because they fatally shoot about 10 people a year. In 1926, police killed 44 residents and wounded 89 others. There were 225 homicides that year, by far the highest toll until 1967. Before Prohibition Detroit had 1,500 bars. By 1925, officials estimated the number of blind pigs at 5,000 to 25,000. The New York Times called rumrunning Detroit's second-biggest industry. Free Press Editor Malcolm Bingay wrote: "It was absolutely impossible to get a drink in Detroit unless you walked at least 10 feet and told a busy bartender what you wanted in a voice loud enough for him to hear you above the uproar."

Drugs Shatter Life of Former Detroit Pistons Player
Detroit News- 3/20/2001

TAYLOR, Mich. (AP) -- William Bedford was living the life dreamed of by every young basketball player until it was shattered by cocaine and marijuana addiction. Bedford, who helped lead his University of Memphis team to the 1985 NCAA Final Four, was a first-round pick in the 1986 NBA draft and later signed a five-year, $4.5 million contract with the Detroit Pistons. On Feb. 12, Bedford was arrested after Taylor police said they found 25 pounds of marijuana in his car. Bedford, 37, was not charged.  Wayne County Sheriff Robert Ficano, who is in charge of the case, said he was awaiting lab and fingerprint results.
    It has been a long and hard fall for the man former Pistons general manager Jack McCloskey said was "probably as talented as any player we ever had." "He could have had a great career and been financially secure all his life," said McCloskey, now a consultant for the Toronto Raptors. "But I've spoken to drug users in the past who told me how difficult it is to give it up, and obviously, William has never been able to do that." Bedford, who grew up in a middle-class neighborhood in a suburb of Memphis, earned a full scholarship to Memphis in 1983. He was a big man on campus driving around in a brand-new Corvette as a freshman, a new Lincoln and a year-old Jaguar as a sophomore. This drew an NCAA investigation, which ended with the university getting a two-year probation and a one-year ban on postseason play.
    Bedford left Memphis for the pros, and in 1986 became the first-round draft pick of the Phoenix Suns. With a four-year, $2.7-million contract, he lasted less than six months. In 1987, he was subpoenaed by a Maricopa County grand jury investigating drug use among Suns players, and testified against his teammates after receiving immunity. Bedford became a reviled figure in Phoenix, and was traded to the Pistons for a first-round draft choice. "I thought, here's a kid we'd really like to help -- not just to be a good basketball player, but so he'd have a good life," McCloskey told The Detroit News for a Tuesday story. "But he just didn't want to accept that responsibility."
    In March 1988, Bedford admitted he was addicted to cocaine and marijuana and was committed to the league's treatment facility in Van Nuys, Calif. He relapsed the following October and was readmitted to the clinic. When he returned, his behavior on and off the court grew more erratic. He received a dozen traffic tickets and 10 license suspensions in less than four years. Bedford's NBA career ended in 1992 after he was traded to the Los Angeles Clippers, who dealt him to the Washington Bullets in October. The Bullets dumped him before Thanksgiving after he missed three of his first four practices, and he was picked up by the San Antonio Spurs. Before Christmas, Spurs players asked coach John Lucas to fire Bedford, and Lucas complied.
    Bedford life continued spiraling downward. In September 1997, Bedford, who was on three years probation at the time, tested positive for cocaine and was sent to a Texas state jail for one year. Bedford admits his life has been tough, but does not blame the drugs. "Yeah, I went bust," he said recently from his home in Katy, Texas. "It was bad investments, mostly, plus I don't think the last few agents I had did things right. It's been tough, but all that's behind me now." For the moment Bedford is at his Texas home, with his common-law wife of eight years and their 3-year-old son, hoping he won't hear from U.S. marshals.

U.S. Panel Weighs Tougher Penalties for 'Ecstasy'
Peter Slevin, Washington Post- 3/20/2001

The U.S. Sentencing Commission is fashioning a significant increase in penalties for people who import or sell "ecstasy," a move that would elevate the party pill used by hundreds of thousands of adolescents into the upper echelons of illegal drugs. Responding to a command from Congress, the commission is considering proposals that would make trafficking in ecstasy a more serious offense than dealing powder cocaine.
    Medical researchers opposed the step yesterday, testifying that ecstasy – its purest form is known as MDMA – is not as dangerous as cocaine, heroin or methamphetamine. "MDMA is less likely to cause violence than alcohol, less addictive than cocaine or tobacco and less deadly than heroin," said New York University psychiatrist Julie Holland, who works in Bellevue Hospital's psychiatric emergency room. "I see alcoholics and crack addicts every time I go to work. I do not see people whose lives have been ruined by MDMA."
    Commissioners may vote as soon as today on new guidelines. Members, who set sentencing guidelines for federal judges, have been inundated with competing pleas in the months since Congress ordered stricter punishment to combat growing use of the "hug drug," a stimulant combined with a mild hallucinogen. Sometimes used in psychotherapy before the drug was outlawed in the 1980s, MDMA is especially popular at weekend rave parties, where a tablet can sell for $20 to $40.
    "The statistics have risen tremendously. You see it in cities, you see it in rural areas," Joseph Keefe, the Drug Enforcement Administration's operations director, said in an interview. "In 2000, Customs reported seizing 9.3 million MDMA tablets, compared with 400,000 in 1997." Ecstasy is "quickly becoming one of the most abused drugs in the United States," Robert S. Mueller, acting deputy attorney general, testified yesterday. "The damage this drug can produce is significant and long-term," said Mueller, once the District's chief homicide prosecutor. "We have an opportunity to stop this growing problem before it becomes an epidemic, and the proposal put forth by the commission would very much help."
    A proposal published for comment by the Sentencing Commission would make the penalty for selling 100 grams of ecstasy the same as the one for selling 100 grams of heroin. Each could draw a five-year prison term. Under a more recent, widely discussed option, the sale of 200 grams – or about 800 tablets – of ecstasy would be a crime punishable by five years in prison. Also possible is a slightly more lenient sentencing guideline that would resemble the penalty for selling powdered cocaine, which is five years for 500 grams.
    Today, only someone who imports or sells about 11,000 pills would be subject to five years behind bars under the sentencing guidelines. Diana Murphy, the commission chair and a U.S. appellate judge, said yesterday that the penalties must increase. One goal is to satisfy Congress and prevent lawmakers from creating new mandatory minimum sentences, which she described as "a very crude kind of thing that binds a judge." "If we don't follow that directive or satisfy Congress that we've done it in a reasoned way," Murphy said, "their remedy is a mandatory minimum."
    Ecstasy's clinical history and its relationship with other drugs occupied much of yesterday's public hearing. Researchers challenged assertions that MDMA poses long-term physiological risks and creates effects similar to hallucinogenic drugs such as mescaline. David E. Nichols, a Purdue University professor of molecular pharmacology, described MDMA's "low addiction potential" and reported that users typically do not ingest the drug daily. He said the pleasure reported by many users tends to disappear after two or three days of continuous use, making severe abuse of the drug less likely. Some studies have shown, however, that MDMA can inspire use of more than one session a week and more than one tablet a session, as the Federation of American Scientists put it. The organization, which does not favor increased penalties, also cited "growing laboratory evidence that MDMA is capable of causing lasting neurological changes."
    Opponents of stiff sentences argued that ecstasy's dangers and collateral damage do not merit prison terms more commonly associated with opiates and hallucinogens. Holland, who has worked weekends for five years in the Bellevue psychiatric trauma unit, said that less than 1 percent of the psychotic disorders triggered or deepened by substance abuse involved ecstasy. "Not only are MDMA-related cases a small percentage of all drug-related emergency room visits, but a large percentage of these cases are not life-threatening," Holland testified. "The most common adverse effects from acute MDMA intoxication are anxiety or panic reactions."

Criminal Penalties Proposed for All Drunken Drivers
Michael Mello, Associated Press- 3/20/2001

PROVIDENCE, R.I. (AP) Last year the argument for lowering the legal blood alcohol limit for drunken driving focused on saving lives. That battle won, debate this year has shifted to saving money. Rhode Island will lose millions of federal transportation dollars if it does not change its drunken driving law to ensure criminal penalties for all violators, state Transportation Director William Ankner said Tuesday. The General Assembly last year lowered the legal blood alcohol limit from 0.10 to 0.08, but required only a civil penalty for first offenders.
    A Senate bill requires criminal penalties for all violators of the law, including first offenders. The bill follows a new federal law that penalizes states for failing to make violating a 0.08 drunken driving law a criminal offense by 2004. Rhode Island stands to lose $4.5 million over two years and $16 million over four years if it doesn't comply, Ankner said. ''That's money that could be used to fix roads and bridges,'' Ankner told the Senate Judiciary panel this week.
    Besides the threat of lost funding, the state is already missing out on financial incentives. Ankner said the state would have received an additional $700,000 for this fiscal year if the current drunken driving law made all violations criminal. It will annually lose similar amounts in incentive transportation funding with the current law. ''Last year the debate wasn't about money, now we stand to lose significant amounts of federal dollars,'' he said.
    It took a decade for 0.08 drunken driving legislation to finally pass the General Assembly. Supporters successfully used radio, TV and billboard advertising last year and testimony from parents of children killed by drunken drivers. Requiring civil penalties for first offenders who register between 0.08 and 0.10 was the key to finally winning state lawmakers' support, said Rep. Peter Ginaitt, D-Warwick, the bill's House sponsor. ''I'll support the Senate bill but I don't see the urgency,'' he said. ''We always get this threat of lost federal dollars.''
    The Rhode Island Hospitality and Tourism Association fought against lowering the legal blood alcohol limit and opposes this year's Senate bill. The association claimed the lower limit would penalize social drinkers and hurt the restaurant and bar business.  ''We believe the way to combat drunk driving is to focus on repeat offenders and those who register 0.15 and above,'' association lobbyist Brian Goldman said.

Survey Connects Graphic TV Fare, Child Behavior
Richard Saltus, Boston Globe- 3/21/2001

Just as MTV said it would censor the new music video by Madonna, a sweeping new survey of research on media violence, sex, and risky behavior over the last 10 years concludes that what children watch can directly influence their behavior. The survey by a Johns Hopkins University psychiatrist, published yesterday, reflects the growing concern of mental health specialists about the impact on youngsters of the sexually suggestive, violent, and aggressive content that frequently permeates television today.
    The classic studies linking TV violence and aggression and youth behavior were done in the 1970s and '80s, ''with material that wasn't very violent'' by today's standards, said Dr. Susan Villani. But now, ''it's more violent and more graphic and more sexual,'' she said. ''Children are being exposed to more graphic content at younger and younger ages.'' Villani proposes that health care professionals treating disturbed children compile a ''media history'' of what they've watched, as well as the traditional medical history. Concerns about television sex and violence have led to a fierce debate about the government's role in regulating content, a voluntary ratings system to warn viewers about subject matter, and increasing sensitivity about content among some networks and producers. But for the most part, networks have been reluctant to concede that their shows can influence behavior.
    Yesterday, however, the popular music network MTV, which was embroiled in controversy over its animated series ''Beavis and Butt-head'' when several young viewers allegedly mimicked risky behavior depicted on the show, said it would broadcast the new music video by pop star Madonna only once, late at night, and would include a warning about its content. The video for ''What it Feels Like For a Girl'' shows the singer in a fantasy as an angry woman on a violent crime spree.
    Though anecdotal evidence abounds, the real link between televised sex and violence and actual behavior has been difficult to prove. Villani said the research in the past decade has strengthened previously reported links between television violence and increased aggressive behavior in preschoolers. Risky behavior depicted in entertainment media has been associated with increases in sexual activity, drinking, smoking, and drug use, she said. One major study cited by Villani showed that viewers of violent TV content learned aggressive behaviors and attitudes, became desensitized to violence, and became fearful of being victimized.
    Villani's review of a decade's worth of research on the media's impact on children and adolescence is published in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry. A number of researchers in the 1990s probed the impact of rock music and music videos, she finds. In one study, patients in a hospital for mentally ill offenders became less likely to get embroiled in assaults after a television showing MTV music videos was removed. Other research linked a preference for heavy metal music in the 1990s to reckless behaviors like stealing, driving fast, using drugs, and being sexually promiscuous, in adolescents. Again, cause and effect could not be proved.
    Even children's cartoons are becoming violent, said Kimberly Thompson of the Harvard School of Public Health. She studied G-rated animated films from 1937 to the recent past, and found that depictions of violence increased steadily - to the point that, Thompson says, children could be disturbed. Thompson said she is studying the content of video games. Villani, in her survey, said there's been little research on the impact of the games, but she did mention studies in Japan that found little support for the theory that video games cause aggressive behavior.
    Harvard researcher Jay Winsten, who heads the Center for Health Communication at the School of Public Health, cautioned that media exposure is only one factor shaping behavior, and that some children are more vulnerable because they live in an abusive or unsupportive family. ''We have to be cautious in interpreting these studies,'' he said. Winsten said his concerns are not so much about prime-time network television shows as about feature films shown on cable TV that contain a lot of violence. Winsten's center has developed ways to use the media to shape behavior positively.
    Villani believes parents should spend more time monitoring what children are watching. One trend she applauds is the development of ''media literacy'' programs in schools. Teachers highlight the messages that are being conveyed in movies and TV shows and music videos. In a study published in the journal Pediatrics this year and cited by Villani, researchers gave one group of California schoolchildren instruction in media literacy, and saw their violent behaviors decrease in comparison to a similar group that didn't receive the instruction.

New Trial Ordered in Recovered-Memory Case
John Ellement, Boston Globe, 3/21/2001

Signaling doubts about the validity of ''recovered memory,'' the state's highest court yesterday ordered a new trial for a Middlesex County man convicted of raping a teenager who did not recall most details of the assault until five years after it allegedly occurred.  In a unanimous ruling, the Supreme Judicial Court said William Frangipane is entitled to a new trial because the expert witness used by prosecutors to discuss the effects of trauma on memory strayed too far from her expertise. The court, in a 17-page ruling written by Justice John M. Greaney, said the prosecution's expert witness presented tainted evidence by testifying to the neurology of how trauma victims store memories in the brain. That evidence should have come from a medical doctor, not a psychotherapist, the court said.
    Frangipane was a school bus driver hired in 1991 to take a church youth group from the Wakefield-Melrose area to a nighttime Halloween hay ride in Tewksbury. While participants were gathering around a bonfire, the victim, who was 14 at the time, was allegedly grabbed on his way to the bathroom by a ''plump'' man, pushed to the ground, and raped. The youth returned to the bonfire but ''did not remember the rape and thought he had simply gone to the bathroom,'' according to court records. It wasn't until he was a freshman in college that he recalled the alleged rape and contacted Tewksbury police, the court said. The youth did tell his parents the next day about another incident that allegedly took place the same night. The youth said that Frangipane fondled him through his clothing seven or eight times while everyone was throwing hay around during the hayride, according to court papers. The family decided not to prosecute Frangipane.
    The concept of a ''recovered memory'' has been controversial for years in both medical and legal arenas, spawning fervent supporters and critics. Proponents believe physical and emotional trauma, such as being sexually assaulted as a child, causes victims to block out the events until years afterward. Often, the memories are ''recovered'' through therapy. Critics, however, say medical studies supporting the theory are flawed. They also contend that what some treat as actual memories are in fact imagined events planted in the minds of emotionally fragile people by therapists.
    The SJC ruled that there is enough disagreement on the issue among mental-health specialists that it would be appropriate for a judge to review the issue before allowing it to be used in a criminal case. The SJC's stance brings the court in line with appellate courts across the country, according to an article in last summer's Journal of Psychiatry and Law. Appellate courts in Rhode Island, Texas, California, Maryland and elsewhere have concluded that the science of recovered memories is too uncertain to be admissible in court, according to the article. Middlesex District Attorney Martha Coakley said yesterday that no decision has been made on whether to retry Frangipane.

Private Mental Hospitals In Dire Financial Straits
Matthew Mosk and Dana Hedgpeth, Washington Post- 3/21/2001

Without more financial help from the state, several of Maryland's most venerable private psychiatric hospitals could face financial ruin and the real possibility of shutting down, their directors said. The hospitals, including the largest provider of psychiatric care in Montgomery County, are struggling under expanding debt and have offered a grim prognosis to Gov. Parris N. Glendening about their future. It is a "true, looming financial crisis," the chief executives of five Maryland psychiatric hospitals recently told Glendening (D) in a joint letter. "The financial condition of the freestanding, private psychiatric hospitals is of such a serious nature that the continued viability of these institutions is in question."
    In recent months, state officials have faced numerous problems with mental health services. The department overseeing psychiatric care has accrued $42 million in debt, and one of the state's largest clinics, serving nearly 2,000 patients, recently closed. But the crisis facing Maryland's five privately owned psychiatric hospitals has taken on a new urgency in recent weeks because Chestnut Lodge Hospital in Montgomery County has begun turning away patients. Owners agree that it is likely that the bankrupt 91-year-old institution, whose leafy, 20-acre campus once offered refuge to ailing members of wealthy families, military generals and the children of Cabinet officers, will soon be forced to close. Although the origins of the financial crisis are complex, the hospital directors blame the rising number of patients who lack private insurance and an outdated state formula for funding. Under state funding rules, hospitals are paid roughly 80 percent of the total cost of care for each Medicaid patient. "In other words," said Bruce T. Taylor, chief executive of Taylor Health System, "we're losing money on every patient." For CPC Health, Montgomery County's largest provider of mental health services and the owner of Chestnut Lodge, that formula has resulted in an $11 million deficit, forcing it to file for federal bankruptcy protection in October. In recent weeks, it has begun taking offers for its assets and has scheduled an auction of hospital property for April 23.
    Government officials and the relatives of patients are preparing for the worst. Yesterday, the Montgomery County Council voted to lend the company $200,000 to help the hospital meet this month's payroll. And the county's legislative delegation asked the governor for $2 million to help relocate the remaining 30 patients, as well as 1,700 others who depend on the company's clinics for medication and regular care. The governor has pledged to help organize the effort to relocate Chestnut Lodge patients, but he does not believe the system faces consequences quite as dire as those foretold by hospital officials and echoed by lawmakers. "The whole situation . . . is being looked at," said Michael Morrill, the governor's spokesman. "But I don't think anybody has any expectation that all or most of these hospitals will actually close. That's the same picture everyone paints during budget times. Nobody comes to Annapolis and says, 'Please give us less money.' "
    Oscar Morgan, director of the state's Mental Hygiene Administration, said he "can't say whether there's a crisis right now," but he agreed that the funding formula needs to be overhauled to accommodate the rising number of patients who lack private insurance. "We really need to rethink this whole system," Morgan said, adding that any hospital closure would place substantial stress on the statewide system. Gundry Glass hospital in Baltimore has closed, and Potomac Ridge Behavioral Health went through bankruptcy. Taylor Manor in Ellicott City has reported severe financial trouble. And the state's largest mental health provider, Baltimore's Sheppard Pratt Health System, is eating into its endowment to keep its hospital running at full strength, according to Steven S. Sharfstein, the company's president. "These hospitals are not crying wolf," said Pegeen A. Townsend, a lobbyist for the Maryland Hospital Association. "It's a very unstable situation."
    For patients at Chestnut Lodge, evidence of this strain could not be more clear. Evelyn Saile, whose 40-year-old schizophrenic daughter has received both inpatient and outpatient treatment at the 130-bed hospital, said she has no idea where her daughter would go if it closed. Saile credits the hospital for dramatic changes in her daughter Deana's behavior since she arrived in 1996. "She would have these screaming fits and not come into the house," Saile said. "She would wander the streets. Imagine things. Hear voices. All of this stuff. She couldn't stand temperature changes. It could be zero degrees outside and she wouldn't put the heat on, or it could be 100 degrees and she wouldn't turn the air on. "She doesn't do that now," Saile said.
    Psychiatrists from the hospital predict that relocating patients would be more difficult than state officials anticipate. The typical Chestnut Lodge patient suffers from schizophrenia, severe borderline personality disorders and severe mood disorders. "Many of these are folks that cannot go a day without cutting or burning themselves or attempting suicide," said Nadia Krupnikova, a psychiatrist who resigned from the hospital this month. "The lodge has made its claim to fame treating these cases, treating them well. The idea that these patients will continue to find care in suitable facilities is a farce. For many, there are not suitable facilities."

Researchers Studying Possible Medical Use of LSD, Peyote, Psilocybin
Robin Eisner, ABC News- 3/22/2001

At Harvard, a psychiatrist is studying whether the hallucinogenic mushroom peyote creates any long-term memory or attention problems in the American Indians who take the drug as part of religious rituals. A University of Arizona psychiatrist is poised to begin researching whether taking the hallucinogen psilocybin under controlled circumstances may help people suffering with obsessive compulsive disorder. And another Harvard psychiatrist is in the beginning phases of designing a protocol that may employ LSD or another hallucinogen to see if it helps terminally ill people suffering from depression and pain. With some support from the private New Mexico-based Heffter Institute, these researchers, along with others in the United States and abroad, represent a small movement of scientists looking at the possible medical benefits of hallucinogens for some psychiatric conditions.

Hallucinogens Among Oldest Drugs
Hallucinogens are among the oldest known group of drugs that have been used for their ability to alter human perception and mood, according to the Drug Enforcement Agency. They have been used for medical, social and religious practices. More recently, synthetic hallucinogens have been used recreationally, with hippies from the '60s, such as the now deceased ex-Harvard psychology professor Timothy Leary, first promoting their use with the famous slogan, "Turn on, Tune in, Drop Out."
    Today, hallucinogens are deemed drugs of abuse by the DEA, with no known medical benefit. Approximately 8 percent to 10 percent of high school seniors tried a hallucinogen in the past year according to a University of Michigan study of drug use. It remains unclear how these drugs exert their action in the brain, but anecdotal evidence and some earlier studies indicate they may help a variety of psychiatric conditions, says David E. Nichols, founder of the Heffter Institute, in Santa Fe, and professor of medical chemistry and molecular pharmacology at Purdue School of Pharmacy in West Lafayette, Ind.
    Nichols says there is some indication these drugs work on the serotonin pathway in the brain, the same target of the selective serotonin reuptake inhibitor drugs Prozac, Paxil and Zoloft, used to treat depression, anxiety and obsessive compulsive disorder. He founded the institute in 1993 to help give scientific credibility to medical research on hallucinogens. After years of fund-raising, the institute now has enough money to help scientists do serious research.

Trials Must Be Rigorously Designed
"Since opinions are so strongly held about hallucinogens, it is essential that any studies in this area be performed with the most rigorous modern methods and great care to have an impartial approach," says Dr. Harrison Pope, professor of psychiatry at Harvard Medical School, who is leading the four-year peyote study in American Indians. Funded largely by the National Institute of Drug Abuse and Heffter, Pope’s group will be comparing three populations of American Indians — peyote users in religious ceremonies, alcoholics, and local tribespeople — to see if peyote use is associated with cognitive problems. Pope is also developing a trial to follow up on studies from the '60s and '70s suggesting that hallucinogens helped ease anxiety and depression in the terminally ill and also reduced their need for pain medication.
    "The challenge is to design the study in such a way that if the drug shows benefits, skeptics are convinced, and if it doesn’t help, proponents of hallucinogenic use don’t challenge the research as inadequate," Pope says. These studies take time to develop to get that scientific imprimatur. They also need to get review, by local medical institutions and governmental regulatory authorities. The DEA and the FDA is still reviewing a protocol by Dr. Francisco Moreno, an assistant professor of psychiatry at the University of Arizona in Tucson, hoping to study a chemically synthesized psilocybin for obsessive-compulsives. His hospital gave him permission to start the study. A protocol of psilocybin and depression in Switzerland also is undergoing revision before it is submitted to the government authorities there, Nichols says.

Critics: Risks Outweigh Benefits
Some scientists, however, question the potential risks of these studies. The problem with this kind of research is that when average people hear or read about them in this preliminary stage they might think these drugs could be good for them now, says Una McCann, associate professor of psychiatry at Johns Hopkins School of Medicine. "But it remains unknown until the studies are finished," McCann says. Dr. Gregory Collins the director of the Alcohol and Drug Recovery program at the Cleveland Clinic, in Cleveland, Ohio, believes the risks outweigh any benefits. "Some of these drugs have been shown to have long-term consequences in healthy people," Collins says. " I would be reluctant to try them in the mentally ill." Nichols, however, defends the research. "I think we will find some medical benefit of these drugs," Nichols says. "There is no other drug class that doesn’t have some medical utility."

Panel in U.S. Imposes Harsher Penalties for Possession of Ecstasy
Samantha Sommer, Cox News Service- 3/22/2001

WASHINGTON -- Lawmakers and drug experts are hailing new federal sentencing guidelines that impose tougher sentences for possession of the popular drug ecstasy. The guidelines, enacted Tuesday by the U.S. Sentencing Commission, mean longer prison stays for people caught with large quantities of ecstasy pills starting May 1. "These new guidelines are reflective of how seriously we view the threat to America's youth," said Sen. Bob Graham, D-Fla., Wednesday at a hearing of the U.S. Senate Drug Caucus on International Narcotics Control.
    The guidelines, a result of the Ecstasy Anti-Proliferation Act sponsored by Graham last year, increase sentences from less than two years to five years for someone caught with 800 pills, and from about three years to 10 years for someone with 8,000 pills or more. The hearing was the second the committee has held on ecstasy and similar so-called club drugs. Medical experts and former ecstasy users testified about the drug's hazards, along with officials from the Drug Enforcement Agency, U.S. Customs Service, the sentencing commission and police. Ecstasy, also known as MDMA, is an amphetamine and a hallucinogen popular with young people at raves and dance clubs. It often creates a feeling of euphoria and heightened senses, followed by a deep depression.
    The number of federal convictions for ecstasy trafficking has jumped from 20 in 1998 to 169 last year, said Diana Murphy, chairwoman of the sentencing commission. A White House drug-policy report said this week that the availability of ecstasy has increased dramatically and that more blacks and Hispanics are using the drug. Customs officials want to stop the flow of the drug into the United States from the Netherlands, the biggest producer of ecstasy, said Chuck Winwood, acting customs commissioner. "One of the added difficulties with ecstasy is that the drug's compact size and shape make concealment options almost infinite," he said.
    More than 9 million ecstasy tablets were seized by customs agents nationwide last year, Winwood said. The drug has spread from New York, Los Angeles and Miami to most of the country, largely because many young people mistakenly believe that it is not dangerous to use, said William Jacobs, a researcher at the University of Florida. "But I can find no data that convinces me that it is not a harmful drug," he said. Doctors still do not know many of the long-term effects of the drug, Jacobs said. Some known side effects include chest pain, liver damage, panic attacks, insomnia, seizures and depression.
    The rapid increase of the drug's use, especially by young people, prompted the second hearing. "We are talking about a very serious challenge at its early stage," Graham said. "We have the opportunity to combat, and hopefully reverse, this plague before it overwhelms us." Not all groups were pleased by the changes in the sentencing guidelines. The changes make ecstasy five times more serious to possess or sell than heroin on a per-dose basis, said the National Association of Criminal Defense Lawyers.

Maryland House Panel Kills Two DUI Bills
Daniel LeDuc, Washington Post- 3/22/2001

The Maryland House Judiciary Committee has killed two measures intended to toughen the state's laws against drunken driving, a move that could cost the state millions of dollars in federal aid. The bills, a priority of Gov. Parris N. Glendening, were part of a three-bill package tied to $140 million in federal highway aid over the next seven years. While most attention during the current General Assembly session has focused on efforts to lower the legal blood-alcohol limit for driving from 0.10 to 0.08, most of the federal money is linked to proposals to ban open containers of alcohol in vehicles and to stiffen sanctions for repeat offenders.
    The Judiciary Committee had already killed the open container legislation. In an unannounced voting session Tuesday, the committee also voted 11 to 8 to kill legislation to increase penalties for repeat drunk drivers. Those two bills account for $85 million of the $140 million in federal aid at stake, according to the Glendening administration. "The governor is very disappointed that two bills that would have saved lives and strengthened Maryland's drunken driving laws have not been approved," said Glendening spokeswoman Michelle Byrnie. "It will cost the state highway construction money and cost Marylanders in terms of lives lost." "It was an excellent piece of legislation. It's just plain stupid" to kill the bill, said Wendy Hamilton, public policy liaison for Mothers Against Drunk Driving in Maryland. "You can't just do 0.08 and expect to solve the problem."
    Among the legislation's provisions were a one-year license suspension, up to 30 days of community service and up to five days in jail after a second drunken driving offense. A third offense could be punished by 60 days of community service or 10 days in jail. Del. Joseph F. Vallario Jr. (D-Prince George's), the committee chairman, has called those penalties unduly harsh. Del. John A. Giannetti Jr. (D-Prince George's), who voted against the proposal, said he wasn't convinced that a habitual drunk driver would obey the one-year license suspension; such a driver, he said, would probably drive anyway. And he noted that the reduction in federal money for not passing tougher punishments for repeat offenders does not kick in for two years, unlike the 0.08 legislation that has more immediate consequences. "You'll see the committee pass it in the future," Giannetti said.
    This year, for the first time, Glendening (D) placed drunken driving legislation on his priority list for the General Assembly session. In meetings with legislative leaders, Glendening has pleaded that the measures are the right thing to do, that they are politically popular and that they will help the state receive significant federal money. The Judiciary Committee has been reluctant to pass proposals sought by MADD in recent years. But last year, Congress passed legislation that restricted federal highway funding unless states passed new drunken driving measures by 2003. With the money in the balance, advocates hoped this would be the year lawmakers would act.
    Last month, Vallario and Senate Judicial Proceedings Committee Chairman Walter M. Baker (D-Cecil) announced they had a deal on the 0.08 legislation. Both committees have also approved closing a loophole in Maryland law that had forbidden prosecutors from telling judges and juries that a drunken driving defendant had refused a breathalyzer test. That measure is not tied to federal funding. But the deal between the chairmen clearly didn't include the open container proposal. The same day the agreement on 0.08 was announced, the Judiciary Committee killed the open container bill. The Senate, which has stymied drunken driving legislation in the past, has tentatively approved the 0.08 and repeat offender bills this year. Prosecutors said yesterday that they were disappointed by the Judiciary Committee vote because of the danger that habitual offenders present. "So many of the fatalities are caused by repeat offenders," said Montgomery County State's Attorney Douglas F. Gansler. The legislation "shouldn't be offensive to anybody but drunk drivers or the lawyers who represent them."

Study: Doctors Miss Depression in Cancer Patients
Reuters News Service- 3/23/2001

LONDON (Reuters) - Doctors are failing to spot symptoms of stress and depression in cancer patients and are not referring them to experts for counseling, British researchers said on Friday. "Being diagnosed with cancer is often a traumatic experience and for many people it's a time when they need extra support," said Professor Lesley Fallowfield, of the University of Brighton. But a study of 2,300 people in 34 hospitals across Britain by Fallowfield and her colleagues showed many cancer patients are not receiving it. They found that more than one third of the people in the study could have benefited from some type of psychological help but the 143 specialists treating them only spotted the symptoms in a quarter of the patients. "If we can diagnose depression and anxiety more effectively then we can ensure that every patient gets the right treatment," Fallowfield added in a statement.
    The researchers, whose work is published in the British Journal of Oncology, called for doctors to be trained in communication skills to improve the care and treatments of cancer patients. They also suggested that patients fill out a questionnaire before seeing a doctor which may help to determine if they are depressed and need professional counseling. "We need to ensure that anybody experiencing mental health problems such as anxiety or depression is able to get the support they need -- whether this be medication, taking treatments or alternative or complementary therapies -- as soon as they first need it," said Ruth Lesirge, the chief executive of the Mental Health Foundation.

Maryland's Senate Passes 0.08 Limit, Breathalyzer Bill
Daniel LeDuc, Washington Post- 3/23/2001

Maryland's Senate voted yesterday to lower the blood-alcohol limit for drunken driving, all but assuring that the new standard will become law after years of opposition from many lawmakers. Senators also unanimously approved closing a loophole in the state law that prohibited prosecutors from telling judges and juries when people charged with drunken driving had refused a breathalyzer test. The House also has approved both measures, and Gov. Parris N. Glendening (D) said he will sign them. "It will save lives, that's the bottom line," said Sen. Ida G. Ruben (D-Montgomery), who sponsored the lower blood-alcohol limit legislation and has pushed drunken driving legislation for years.
    Closing the loophole on breathalyzer tests has been a goal of prosecutors. The House approved the proposal last year, but it died in the Senate. This year, the legislation sponsored by Sen. Jennie M. Forehand (D-Montgomery), got a major boost when the Senate Judicial Proceedings Committee chairman, Walter M. Baker (D-Cecil), said he would make drunken driving laws a priority. The 46 to 2 vote on Ruben's bill marked a major victory for Mothers Against Drunk Driving and other activists. They had been seeking to lower the level that defines a driver as drunk from 0.10 to 0.08 for the past five years. The proposals died in committee each year. The activists had argued that the lower limit, which is already in place in Virginia and the District, would deter drunk drivers and cut traffic fatalities. A federal study on Illinois drivers showed a 14 percent reduction in fatal crashes in 1998, the year after the state lowered its limit to 0.08.
    Maryland police officers stopped and tested about 17,000 people last year to see if they had been drinking and driving. About 1,500 of them registered 0.08 or 0.09 and nearly 7,770 showed a level of 0.10 or higher. Critics of lowering the blood level limit said those results showed there was a larger problem with heavier drinkers. But last year Congress tied federal highway aid to states passing 0.08. Maryland had $55 million at stake over the next seven years if it failed to lower its limit. In previous years, critics on the House Judiciary Committee argued that Maryland's current laws were actually tougher than federal requirements. Now, drivers can be charged with driving while intoxicated if blood alcohol level is 0.10 or with the lesser charge of driving under the influence if their level is 0.07. The critics in the legislature went along with the 0.08 standard because they said the did not want to jeopardize the federal aid. Drivers who measure 0.07 can still be charged with a lesser drunken driving offense under the new legislation. "We're very pleased," said Glendening, who this year for the first time put drunken driving laws on his list of priorities for the General Assembly. "It's the right thing to do. It will save lives. It protects a lot of our federal money."
    But Maryland is at risk of losing $85 million in federal funding over the next seven years because the Judiciary Committee has killed proposals to increase sanctions against repeat drunk drivers and to ban open containers of alcohol in vehicles. "It's bittersweet because it's not everything that's going to address the problem," Wendy Hamilton, of MADD of Maryland, said of yesterday's Senate vote. "It's unfortunate the House did what it did" with repeat offenders and open containers. Judiciary Committee members defended their actions, saying those proposals were overkill and that the penalties on federal aid would not kick in for two more years, giving them time to reconsider.
    Del. Dana Lee Dembrow (D-Montgomery) criticized the open container proposal because he said passengers should be able to drink as long as they didn't distract the driver. And Del. Donald E. Murphy (R-Baltimore County) said the legislation was so poorly written that a family with a half-empty bottle of alcohol in their minivan, where it might be accessible to the driver and passengers, could be prosecuted. Other Judiciary Committee members criticized the repeat offender sanctions, which among other things would have required a one-year driver's license suspension for a second drunken driving conviction.  Some committee members said it was not that more laws were necessary but that judges and prosecutors apply the tougher penalties currently available. "You can't pass anything just because it sounds good," said committee vice chairman Ann Marie Doory (D-Baltimore).

Still, the Stigma of Schizophrenia Remains
Linda Marsa, Los Angeles Times- 3/19/2001

Nina Wouk's early childhood was marked by trouble in school, anxiety attacks and hallucinations. Things got worse in her teens when she was diagnosed with schizophrenia and sent to mental hospitals, where she spent years "totally numb" from the effects of powerful drugs. Her symptoms gradually abated, and, with great difficulty, she weaned herself from medications. By her late 20s, Wouk began picking up the pieces of her life, though the label of ex-mental patient hampered her efforts: Employers were reluctant to give her a chance, and health insurance companies wouldn't offer coverage.
    Today she is a self-described "twitchy" person, with a nervousness that may have resulted from years of taking antipsychotic medications. But the 51-year-old Menlo Park, Calif., woman works in an occupation that is the very symbol of the clearheaded, organized personality that eluded her in her youth: She's an accountant. She also owns a home and has been in a stable relationship for 22 years. "I am not a crazed killer," she says. "In fact, I'm highly typical" of recovered schizophrenics.
    Extensive research conducted in this country and abroad indicates that Wouk's right: The stereotypical tortured souls who wander the streets responding to voices only they can hear are the exception, not the norm. With the right treatment, more than 75% of diagnosed schizophrenics have a complete or at least functional recovery, experts say. While they may suffer occasional symptoms, they "hold responsible jobs, have relationships and lead satisfying lives," says Dr. Raquel E. Gur, director of neuropsychiatry at the Schizophrenia Research Center at the University of Pennsylvania School of Medicine in Philadelphia.
    Today, an estimated 2.5 million Americans--roughly 1% of the population--are diagnosed with schizophrenia. The illness usually emerges between the ages of 13 and 25 and often appears earlier in males than females. Symptoms include disordered thinking, paranoid delusions, hallucinations, and extreme apathy and social withdrawal. The National Institutes of Health pegs the total costs of the disease, including long-term care, at more than $30 billion annually.
    Yet many experts say that our mental health system is ill-equipped to treat people with schizophrenia and that the psychiatric profession clings to outdated notions that patients deteriorate, not improve. It's no wonder, they say, that one of every 10 schizophrenics commits suicide within 10 years of diagnosis. Because the disease carries such a profound stigma, those who do recover often live secretive lives, revealing their psychiatric histories only to their closest intimates. So the public seldom hears about the thousands of success stories.
    Instead, we usually hear about headline-grabbing cases such as that of Michael Laudor, the charming Yale law graduate who was a poster boy for recovery from schizophrenia. With a movie deal based on his autobiography reportedly in the works, Laudor stabbed to death his 37-year-old pregnant girlfriend in 1998. According to reports, he had stopped taking his medication. The New York State Supreme Court later committed Laudor to a state mental institution for his crime. Although studies show that even severely mentally ill patients, if they receive treatment, are not any more violent than the average person, the negative image persists. "I spend so much of my time countering negative images; the label discredits and marginalizes people," says Dr. Dan Fisher, a psychiatrist and former schizophrenic who is co-director of the National Empowerment Center, a patients' rights organization in Lawrence, Mass.
    Indeed, some sufferers, like Wouk or Fisher, seem to go into full remission, meaning they have no symptoms and don't need to take medications. Others with residual symptoms learn to ignore them. I still hear voices, from the refrigerator, the television, the washing machine--all the major appliances," jokes Bill Compton, who takes medication to control the paranoid delusions that overtook his life when he was 42. Compton, 55, is director of Project Return: The Next Step, a self-help organization for people with mental illnesses.
Compton worked for theater companies in New York and Los Angeles before his psychotic break. He bounced around the mental health system for two years and lived on the street for nine months, convinced that he was waiting to be anointed as an archangel. He landed in a board-and-care home a decade ago, where he began his long climb out of the depths of madness.

Disturbed Patients Were Deemed Hopeless
The public's pessimistic view of schizophrenia has its origins in the research of Swiss psychiatrist Eugene Bleuler, who coined the term schizophrenia in the early 1900s to describe the disordered thinking, suffocating anxiety, and vivid auditory and visual hallucinations his deeply disturbed patients exhibited. He thought such patients were hopeless. However, his son, Manfred, also a psychiatrist, realized there was a big piece missing from the picture: The patients his father studied remained hospitalized, which is why the disease seemed intractable. When the younger Bleuler tracked down those who had drifted way, he discovered they were leading relatively normal lives. "But he was dismissed as a cockeyed optimist and his findings discounted," says Sarnoff A. Mednick, a professor of psychology at USC who has studied schizophrenia.
    However, a landmark study that was launched nearly half a century ago confirmed Manfred Bleuler's observations. In the 1950s, Yale University researchers began following 269 chronic schizophrenics at Vermont State Hospital. The patients, most of whom were middle-aged, poorly educated and had little social support, participated in a comprehensive rehabilitation program. "The head of the hospital asked the patients what they needed to get out of the hospital, and they told him--jobs, friends and a decent place to live," recalled Courtenay M. Harding, a member of the Yale research team. Patients in the Yale study lived in a hospital ward designed to resemble a home-like setting. They received self-help therapy, vocational counseling and jobs, and were linked to family and friends to provide support. When researchers checked back with the patients 20 and 25 years later, they were astonished to find that one-half to two-thirds of the patients showed no signs of schizophrenia, though they may not have been working or were socially isolated. Slightly more than 25% were completely well and had jobs, families and friends. These were patients who had been considered hopeless, "who had been languishing in the back wards for years and couldn't dress themselves and had forgotten how to tell time," said Harding, who is now a professor at the Sargeant College of Health and Rehabilitation Sciences at Boston University.  For less severe patients who receive treatment, the recovery rates might be as high as 90%, Harding said. "But the belief that schizophrenia is incurable is so deeply embedded," she noted, "that no amount of facts seem to make a difference."
    Scientists don't know what causes schizophrenia, but the illness normally appears when the body undergoes hormonal and physical changes in late adolescence and young adulthood. Scientists speculate that people with schizophrenia may have an imbalance of dopamine and serotonin, two key brain chemical messengers that affect the way a person's brain reacts to sensory stimuli. Consequently, when these people face a crisis or are under stress, their senses become overloaded by sounds, sights, smells and tastes, which can spill over into hallucinations and delusions.
    Schizophrenia seems to run in families, too. Compton, for instance, had an uncle with schizophrenia. But genetics doesn't explain all of it. Scientists believe that disturbances in the creation of normal pathways in the brain--viral infections during pregnancy that can be toxic to the fetus, delivery complications that can deprive the newborn of oxygen--can push those with a genetic vulnerability over the edge. "Somehow, the wiring in the brain gets crossed, making people more prone to symptoms," said USC's Sarnoff Mednick.
The good news is that treatment has come a long way from the 1960s and early 1970s, said experts, when the severely mentally ill were written off, given debilitating medications and confined to locked wards.
    "I was forcibly drugged and placed in solitary confinement," said Fisher, who had his first psychotic episode in 1968, when he was a biochemist at the National Institute of Mental Health in Bethesda, Md. "I was so upset, frustrated and frightened," he recalled of the three times that he was hospitalized for treatment. "That's when I resolved to become a psychiatrist. I thought if I ever get out of this, I'm going to unlock these doors and provide help in a way that I wish someone had been there for me."
    Typical of that era was the experience of Pearl Johnson, a 71-year-old woman whose life started out with so much promise. An A student who played the saxophone and loved athletics, she ran away from home at age 16. Plagued by intense anxiety, paranoia and auditory hallucinations, she controlled her demons with heroin and other drugs. Johnson spent the next 45 years on the street or in prison, where she was kept in an isolation cell under heavy sedation and sometimes beaten if she complained. While she was in isolation, her only real companions were the voices in her head. In 1990, she ended up at Oasis House, a mental health program in South-Central. "Those people loved me to death, and that's where I began my road to recovery," said Johnson, now a community worker for the Los Angeles County Department of Mental Health.
    Despite the advances in treatment, nearly half of severely mentally ill patients in California avoid treatment, studies have found. For many, the fear of involuntary hospitalization has driven them underground. "Most people are poorly treated and slip through the cracks of the system," said Ronald F. Levant, dean of the Center for Psychological Studies at Nova Southeastern University in Ft. Lauderdale, Fla. "They self-medicate, become addicted to drugs or alcohol, and wind up on the streets, where they get beaten up and further traumatized."
    Research indicates that fewer than half of schizophrenics receive any kind of psychological help, only one in four gets vocational help and just 10% receive family therapy. Schizophrenia usually strikes in late adolescence as people are making the transition to adulthood and careers. The emotional damage can be severe as people see their dreams abruptly derailed. Consequently, they need to learn job and social skills, as well as how to manage their symptoms, to take their place in society. Rehab is not just window dressing, experts said; it's critical to a person's recovery. "The real tragedy is we knew in the 1950s what we needed to do to reclaim lives, yet it hasn't been applied," said Harding, the Boston University professor. "But there are pockets of excellence."
    The Mental Health Assn. in Los Angeles County, for instance, a private nonprofit agency, oversees a number of model programs that help people with mental illnesses become self-reliant. The MHA Village in Long Beach offers a comprehensive treatment program that includes counseling, substance abuse recovery, employment and even money management classes to its 500 participants, about half of whom are schizophrenics. Project Return: The Next Step, another MHA-funded program, is a network of 75 self-help clubs throughout Los Angeles that are operated by people with severe mental illness. The clubs offer peer support, social activities and part-time positions that provide a toehold into the work force for many of its member. "People need to have services they can connect to," said Project Return's Compton. "Once they do, they can turn their lives around."

Isolation. Paranoia. Despair.
Beth Baker, Washington Post- 3/20/2001

Judy Franz's life hit a huge pothole in 1998, when her employer began downsizing its staff. NovaCare Inc. provided occupational therapists, speech pathologists and physical therapists to nursing homes around the country, but cutbacks in Medicare coverage forced the company to scale back. Even though Franz kept her job and felt she was secure, she became clinically depressed as a result of the layoff's stress and turmoil. "Everybody was worried and scared," she recalls. "And we weren't able to treat patients who needed it."
    Over time, Franz, an occupational therapist who trained and supported other therapists in the field, grew increasingly sad and angry. "I didn't have the energy I had before. I don't think I slept as well," she says. "I wasn't as productive, work-wise, because I really was very depressed." For months, she and her remaining colleagues soldiered on. "The saddest of the sad days was when we heard that our leadership was throwing in the towel and closing the company," she says. Resources for patient care that had taken years to develop were thrown into a dumpster. Although she now has a good job as director of an assisted living facility in Silver Spring, Franz says, "I still get very sad when I think about it."

Traumatic Times
Among Washington area jurisdictions, Virginia has been hit hardest by layoffs in recent months. According to December statistics from the U.S. Bureau of Labor Statistics, Virginia had 59 "mass layoff events" (in which 50 or more people from the same company file for unemployment and remain laid off for more than 30 days), which affected 8,561 workers. Maryland had nine such events that month, affecting 709 people, while there were three in the District, with 265 people losing their jobs. In January, the pace of layoffs in Virginia continued to run far ahead of the rates in the District and Maryland.
    It's no surprise that downsizing can be traumatic: Workers who lose their jobs are vulnerable to depression, anxiety, social isolation and stress-related illness. But as Franz's case shows, layoffs can also injure those who remain at work. A growing body of research finds that these surviving employees often suffer some of the same symptoms as their laid-off colleagues. There's even a new label -- "layoff-survivor sickness" or "survivor syndrome" -- to describe the ailments observed in many employees who work for companies that are going through downsizing.
    Employers would do well to understand the human toll of layoffs, says Elizabeth Wolfe Morrison, associate professor of management and organizational behavior at New York University's Stern School of Business. "If [surviving employees] are demoralized, if they are no longer trusting their employer, these have ripple effects that are lasting for the company," she says.
    Indeed, companies often find they have to address a growing volume of worker problems after a downsizing, even though there are fewer employees. A 1997 survey conducted by the American Management Association found that 70 percent of downsized companies had experienced a substantial increase in disability claims, particularly in categories that most directly reflect stress: mental illness, substance abuse, hypertension and the broader cardiovascular disease category. One reason for these ills is that the work itself can be more demanding and less rewarding. A downsized work force typically means longer hours, demands for higher productivity and fewer opportunities for advancement.
    Another factor is the chronic worry that you might be next to lose your job. "Insecurity is one pathway that produces the bad health outcomes. Living in a state of high anticipation that your job is at risk is obviously extremely stressful," says Leon Grunberg, professor of comparative sociology at the University of Puget Sound in Tacoma, Wash. In his study of a large corporation in Seattle, published in the Journal of Occupational Health Psychology, Grunberg found that personal contact with layoffs was associated "with more symptoms of poor health, depression and eating changes." Women in particular were found to gain weight as a result of layoff concerns, he says. Grunberg and others speculate that the disruption in social relationships caused by layoffs may also contribute to poorer health. He found that 43 percent of survivors said their social relationships had been "significantly disrupted" and 38 percent had experienced increased tension in their home life.
    Employees can be rattled seriously by mere rumors of a layoff. "Does that create behaviors that you don't normally see? Absolutely," says China Gorman, chief operating officer of a career transition and management consulting firm in Woodcliff Lake, N.J. "Shorter tempers, communication faux pas, missed deadlines, perhaps increases in stress-related medical situations or increased sick days." "When the downsizing begins, nobody knows where it's going to end -- that in itself creates stress," says Mike Luther, a deputy associate administrator at NASA, recalling his agency's major cutbacks in the '90s. "Then, as it's nearing completion, you're quite frankly doing more work with fewer people. This puts excessive hours on people's schedules and stress in their lives. It takes its toll on people's health and work habits." To make matters worse, the remaining workers may start to bail out. "You can go into free fall," Luther says. "People see downsizing coming and they start leaving. It's not just a numbers problem. You lose intellectual capacity and experience. All that combines to put additional workload and pressure on everybody." "It certainly affects your sleeping and your mental focus. You're dealing with it on a personal plane: 'What's happening to me? Am I going to be downsized? Am I going to have the job that I've got now? How is it going to affect my long-term career?' " Even after he learned his job was not in jeopardy, Luther worried about his co-workers. "Morale was affected," he says. "I had many people come into my office who were very, very upset and were trying to figure out where their career was going. You do your best to advise and encourage them."

Shock, Denial, Anger
"People experience all kinds of stages of loss," says Joan Simon, a clinical psychologist at Matrix Integrated Psychological Services/Employee Assistance Programs in Columbus, Ohio, who has counseled hundreds of layoff survivors. "They go through anger, distrust, guilt, anxiety. It's kind of a workplace divorce."
    For Nancy Marucci, of Silver Spring, going through a layoff was like watching old friends die. For years, her large software company had experienced rapid growth -- too rapid, as it turned out. Two years ago, her employer began to reorganize. Hundreds lost their jobs. "I equate it to grief," says Marucci. "You're in shock, you're in denial, you're angry, you start making bargains in your mind." But she slowly came to a level of acceptance. What once felt like the dissolution of a family now seems like a necessary business move. "You begin to live and grow again and come to the next stage," she says. "Now we're a thriving company again." Marucci's survival skills are better than some other people's. Research shows that the severity of a layoff's health effects on survivors is related to several factors:
• How the company carries out the layoff. (Is it perceived as being a reasonably fair and justifiable process?)
• How close the individual survivor is to the laid-off workers. (Do they have a similar job? Are they friends? Do they share office space?)
• How the survivor copes with change. (Does the person tend to be negative, fearful and cynical or positive, flexible and willing to take risks?)
    Jon Leca, a Web architect at the Federal Aviation Administration, survived several layoffs at his former employer, a trade association in the District. "The first one came suddenly and hurt some really nice people," he says. "It left [surviving employees] in a bad mental space. I felt anger and disappointment." But a later layoff that was handled more fairly hurt survivors less, Leca says.
    Employers can mitigate the distress of layoffs. Helen Drinan helped manage a major downsizing at BankBoston, a large financial institution in Massachusetts. By being honest and providing generous outplacement services to all 2,000 people who lost their jobs, the company was able to accomplish two goals, she says: treating the departing employees with dignity and respect and keeping morale high among the remaining employees. "It had the effect for people who remained of actually making them proud of their employer, in spite of the fact that their friends were losing their jobs," says Drinan, who is now chief executive officer and president of the Society for Human Resource Management, a professional organization based in Alexandria. Others point out that if companies focus totally on those who are laid off, negative feelings can arise among the survivors. "They think, 'I got to keep my job, so how come I don't feel like the lucky one here?' " says Gorman.
    Gorman's firm recently surveyed 450 human resource executives at downsized companies and found that 63 percent reported declines in employee morale, 50 percent said employees had lost trust in management and 32 percent felt employees were less able than before to cope with stress. Although these numbers were better than those found in previous surveys, Gorman says there's still a long way to go. Employers need to train managers to listen to the surviving employees, to acknowledge their feelings of loss and anxiety and to help them figure out how to cope with the changed workplace.
    For their part, surviving employees need to acknowledge how a layoff may be affecting their emotional health. Layoff survivors need to guard against self-blame, fault-finding, the impulse to take revenge against the company and other negative feelings that can exacerbate the stress they're under. Instead, advises Simon, "You have to develop a whole range of social skills. You have to promote teamwork, de-escalate disagreements and point yourself toward resolution and conflict management." Protecting your self-esteem is key to emotional well-being, she adds. You must strive to maintain your "personal integrity and deal with others fairly and benevolently -- even when you feel the company has not."

Researchers Find Gene Linked to Schizophrenia
ABC News, 3/21/2001

WASHINGTON (Reuters) - A team of scientists on Monday announced the discovery of a gene associated with a form of schizophrenia in a breakthrough that may shed new light on a devastating mental malady that leaves people divorced from reality and inhabiting a world of delusions. Researchers at the Julius Maximilians University in Wuerzburg, Germany examined a family of about 35 people over three generations in which eight members suffered from catatonic schizophrenia. They found evidence that a gene of so-far unknown function carried a mutation on human chromosome 22 associated with the disorder. All eight schizophrenics had the mutation, said Dr. Klaus-Peter Lesch, who led the study. Catatonic schizophrenia is dominated by physical symptoms -- such as immobility, the assumption of bizarre physical postures and excessive motor activity -- as well as hallucinations and delusions.
    "The genetics of mental disorder and schizophrenia particularly -- it's very complex," Lesch said in a telephone interview. "And we expect to have at least 10 to 20 more genes out there related to schizophrenia, if not more. And, therefore, it's just one small step on a long and winding road toward the goal of elucidating the biology of schizophrenia and developing better treatments." Schizophrenia is associated with psychosis (a loss of contact with reality), hallucinations, delusions (false beliefs), as well as a general decline in the ability to function in the world, experts said. It affects about one person in every hundred around the world, usually striking between the ages of 15 and 30. While an exact definition evades medical researchers, the evidence points to a severe disturbance of the brain's functioning.
    The study could lead to a better understanding of the physiological mechanisms underlying the development and long-term outcome of schizophrenia, researchers said. It also may represent an important step in the process of sorting out how much of the disorder is inherited and how much is a response to the environment or upbringing.

Genes may be just part of the story
"We have very complex biology in these disorders and genes might be only a part of the whole story. But I still think that some of the forms of schizophrenia are influenced by genes," Lesch said. "We are confident that at least in this family we have found the major sector which influences the disease process." There are many kinds of schizophrenia besides the catatonic form. Paranoid schizophrenics are preoccupied with delusions and hearing voices. Hebephrenic schizophrenics exhibit disorganized speech and inappropriate emotions. And undifferentiated schizophrenics display symptoms from all the types.
    The German researchers have not been able to ascertain what exactly the role is of the gene they have identified. "The gene function is not known, but it's a brain specific gene -- it's exclusively expressed in the brain and apparently is associated with neurons," Lesch said. "It's probably influencing neural activity, which would fit very well with a disorder like schizophrenia, which is a brain disorder."  The protein encoded by the gene shares some features with certain proteins that assist in the transportation of electric currents along neurons. Similar mutations cause episodic ataxia, a rare movement disorder lacking psychotic episodes.

A breakthrough
The study, published in the journal Molecular Psychiatry, represented the first report of a mutation identified through genetic linkage studies in psychiatry. Lesch said there have been claims in the past that other researchers had found genes related to mental disorder, particularly schizophrenia, but none has been replicated. But the German team's findings appear to be a breakthrough. "So far the evidence is the strongest as yet," he said. "Nobody has gotten closer to a gene with regard to scientific evidence. ... (But) this might just be one gene in this family. And in another family with a heavy load of mental disorder, it might be a completely different gene."
    The finding eventually may contribute to new treatments for schizophrenia, but Lesch said that was "several steps ahead." Regarding the potential promise of new treatment, he said: "You have to be modest now and careful -- not raising premature hopes because it's just a small, small step, hopefully in the right direction."