Noteworthy News Articles on Mental Health Topics, March 22-31, 2001

Study: Russian Life Expectancy Linked to Alcohol Consumption
Andrew Chang, ABC News- 3/22/2001

The 1990s were a turbulent time for Russia, and there were large swings in life expectancy among its populace, as the Soviet Union broke up and its successor state changed from communism to democracy. But the swings in life expectancy may not be so closely related to the changes in Russia's political life, according to a study published today in the medical journal The Lancet. Instead, a group of Russian and British scientists say the changes in life expectancy during that time can be attributed to a more constant factor in Russian life: alcohol.
    Over the past 15 years, life expectancy in Russia has varied from roughly 58 years to 65 years for men, and roughly 71 to 74 years for women. Life expectancy in Russia was at its peak in the mid- to late-1980s, after the general secretary of the Communist Party, Mikhail Gorbachev, instituted an anti-drinking campaign in 1985. But in 1991, there was a steep decline when the Soviet Union collapsed. It has improved since 1994.
    The investigators say increase in life expectancy since has mainly been driven by a decrease in deaths from causes linked to heavy drinking, like acute alcohol poisoning, cirrhosis, suicide and homicide. Death rates among those aged 25-60 years decreased in this time, investigators said — but they remained high among young adults aged 15-24 because of to a high rate of violence in that age group. "This study provides further support for the view that alcohol has played an important part in the fluctuations in life expectancy in Russia in the 1990s," said Martin McKee, one of the researchers. He added, however, "There remains a need for a much better understanding of the factors underlying these continuing changes." The study was conducted by Vladimir Shkolnikov and colleagues from the Max Planck Institute for Demographic Research, Germany, and the London School of Hygiene and Tropical Medicine.

Health-Care Bloc Attacks Privacy Rules
Robert O'Harrow Jr.. Washington Post- 3/23/2001

The Bush administration, already under pressure from the health-care industry, heard new calls yesterday to weaken Clinton privacy regulations aimed at sharply restricting how hospitals, doctors and other providers use personal information in patients' medical files. The federal rules, released during President Bill Clinton's last month in office, require health-care providers to obtain consent before using patients' personal information and to limit the data that employers, drug makers and marketers can receive. Doctors, patients and privacy advocates generally praise the rules as overdue. But industry leaders complained again at a House hearing yesterday that they would hurt patient care and raise costs.
    The hearing came one month after Health and Human Services Secretary Tommy G. Thompson said he was delaying the effective date of the rules until April because they were not delivered to Congress on time. He reopened the comment period to give interested parties another chance to voice objections. The rules could be delayed further, he told Congress, "if we make some major changes." Seizing on the delay, Republican members of Congress and industry representatives urged just that yesterday. "Why in God's name put a rule in place we know is wrong?" Rep. Charles Whitlow Norwood Jr. (R-Ga.), a member of the House Energy and Commerce subcommittee on health, said at the hearing. "Let's just step back and give this new secretary, give us, some time." "This is a prescription for chaos," said Carlos Ortiz, director of government affairs for CVS Corp., calling the current version of the rules unworkable.
    Critics note the new administration has already made industry-friendly decisions to sign a bankruptcy bill and a resolution killing an ergonomics rule, and to reverse Clinton administration decisions on carbon dioxide emissions and arsenic levels in drinking water. They say the Bush team's second thoughts about medical privacy show it is bending to the wishes of industries that gave millions of dollars to Republican committees and candidates in recent years. The industry -- including hospitals, health insurers, medical equipment suppliers and drug makers -- gave more than $7.4 million to Bush and the Republicans in the past two years, according to the Center for Responsive Politics.
    "Some are saying that it needs some fine-tuning, or that some sections need to be fixed. Make no mistake -- that is not what the industry giants with money to burn are really trying to do," Sen. Patrick J. Leahy (D-Vt.) said this week. He is one of 60 Democrats who sent Bush and Thompson a letter Wednesday urging enactment of the rules as written. "They are trying to kill the medical privacy rule, and they are trying to get the new administration to pull the trigger," Leahy said. Robert Gellman, a lawyer and privacy consultant in the District, said the problem is that the health-care industry "has had the luxury of totally ignoring privacy for decades." "They just want this to go away," he said. The regulations are required by legislation Congress passed in 1996 to allow workers to change jobs without losing health insurance coverage. Under the law, Congress had to pass medical privacy legislation within three years or the responsibility fell to the Department of Health and Human Services. The deadline passed partly because senior Republicans could not agree on what to do.
    "I'm very worried a business climate is prevailing here," Mary Foley, president of the American Nurses Association, said after she testified yesterday in favor of moving ahead with the regulations. "I'm worried there is a real effort to find reason to delay or derail the regulations." Industry representatives met with committee officials to air their concerns before the hearing was scheduled, according to committee spokesman Ken Johnson. He said that played no role in the decision. "No one's leaning on us to hold a hearing," he said. "We're doing it because it's our responsibility." Members of the Healthcare Leadership Council -- a trade group that includes hospitals, drug makers and pharmacy chains -- said they support patient privacy. But they feel the Clinton regulations go too far and would be too costly to implement. The government estimated that it would cost industry $18 billion over 10 years to adopt the new rules, while one industry study put the cost at $40 billion over five years.
    In new comments on the regulation, the council said it wants to change the requirement that hospitals, pharmacies and doctors obtain consent before using patient information. Among other things, the group says, the requirement would "create chaos" at drugstores by forcing them to obtain permission from millions of customers. The group said it was surprised by the consent provision, which wasn't in the proposed rule, and recommends that the regulation allow patients' identifiable information to be "used and disclosed for treatment, payment and health-care operations without consent or authorization." It also wants the administration to remove a requirement that hospitals, pharmacies and other companies create contracts outlining limits on the use of patient records by their business associates.
    Consumer advocates say such complaints are intended to distract attention from the industry's real concern: Privacy regulations will cut into profits. They agree that the current document has flaws -- it allows marketers associated with health-care providers access to some patient records without consent, for instance. But they argue that it is an advance. "There are very few [special] interests in this town who want real privacy protections, because it's not in their interest," said Gary Claxton, a former senior Health and Human Services official who oversaw development of the regulations. "It's threatening."

Colombia Applauds 'Trafico' for Focusing on U.S. Role in Problem
T. Christian Miller, Los Angeles Times- 3/24/2001

BOGOTA, Colombia--There are plenty of ways to interpret "Traffic," the labyrinthine drug war docudrama with five Oscar nominations. But in Colombia, where the film was just released, one stands out: vindication. Few countries have done as much to fight drugs, with less recognition for the effort, than Colombia. Three presidential candidates, dozens of judges and hundreds of police officers have been killed in the largely U.S.-backed war on drugs. Nevertheless, Colombians complain that they are seen abroad as a nation of drug dealers, corrupt politicians and violent thugs.
    Thus, for many here, the most rewarding part of director Steven Soderbergh's film--which focuses on the U.S.-Mexico narcotics trade--is its emphasis on American demand as the other side of the drug problem, the evil twin to Colombia's production. "If you ask who is responsible for the problem with drugs, the answer is, 'The U.S.,' " said Ricardo Rincon, who watched the movie with his son at a mall in Bogota, the capital, on a recent weekday night. "Without demand, there is no production. Without demand, there wouldn't be a problem."
    Theaters have been packed since "Trafico" made its debut here this week. At a recent showing, the tense silence was broken only once, by scornful laughter, when several in the crowd laughed out loud at a character who dismissed the idea that addicts need treatment. Reviews have generally been positive, if somewhat befuddled. One critic wrote that he was "surprised" to finally see a film from the U.S. that portrayed the drug problem in all its complexity. That's because Colombians have long considered the United States blind to its own role in the narcotics trade, ready to deliver guns, money and lofty rhetoric but unwilling to confront the problem of drug consumption on its own turf.
    As a result, there is a lingering suspicion here that the U.S. doesn't take its obligations in the war on drugs very seriously and is content to let Colombia and other drug-producing countries do the dirty work. Former President Clinton's pardon of various drug traffickers was seen as the height of hypocrisy. Further proof came this week, when a poll by the Pew Research Center for the People and the Press found that 74% of Americans think the war on drugs is being lost. The poll found, however, that, rather than change strategies, 66% of respondents continued to back the same strategies now in place to stop importation. "I hope this film helps the U.S. recognize that it needs to do more to fight demand, and less to focus on the producers," said Edith Botero, a 44-year-old businesswoman who watched the film. "We Colombians don't need to be reminded of that. We live it every day."
    For many Colombians, the U.S.-backed "Plan Colombia" is the latest sign of this blind spot. The expensive effort to cut cocaine production in this country has generally been welcomed by Colombians, who believe that the $1.3 billion in aid will strengthen their police and army and help reestablish order within their borders. But few believe that the destruction of Colombia's vast coca plantations will result in the disappearance of America's vast numbers of drug users. "Colombia does not need more money to fight the war on drugs," said Juan Gabriel Tokatlian, an economist who spoke at a recent Berkeley conference on Colombia. "Use your money on yourselves."
    Besides putting the focus on demand, the film has struck a nerve here in another way. By tracing the lives of several characters touched by narcotics, the film personalizes the war on drugs. And many Colombians have direct experience with the violence and heartbreak of the drug trade. There is even a close parallel to the plot line involving Michael Douglas' character, the U.S. anti-drug czar whose daughter is addicted to heroin. In January, the son of the woman who heads Colombia's anti-drug cultivation program was sentenced to more than five years in prison for trying to smuggle heroin through the Miami airport. Marcel Borje, a 29-year-old who saw the film recently, said it did a good job of portraying the drug trade. But he said "Trafico" didn't teach him anything new. "For us, the things in the film are an everyday experience," he said. "It's part of the life of Colombia."

Maxey Staffer Faces Drug, Soliciting Charges in Detroit
Susan L. Oppat, Ann Arbor News- 3/24/2001

Another staffer at the W.J. Maxey Boys Training School in Whitmore Lake has been arrested, this time on the west side of Detroit, for allegedly soliciting an undercover officer for sex then swallowing what police believe were several rocks of crack cocaine. The Family Independence Agency confirmed this week that Malloy Sanders, a youth specialist supervisor, has been on unpaid leave since the March 2 arrest.
    Detroit Police spokesman Claude Fox said officers also found what is believed to be a rock of crack in Sanders' car. Sanders, 42, was treated and released at Detroit Receiving Hospital after the arrest. He later posted bond and was released. Fox said Sanders was ticketed for a misdemeanor violation of the Detroit controlled substance act, and for "offering to engage." He faces a maximum one year in jail on each charge, and will have to pay $900 to get his car out of impound.
    Youth specialists are the workers who spend the most time with the youths sentenced to Maxey. The facility is licensed to house more than 400 boys ages 12-20, but currently houses a little more than 300. FIA spokeswoman Maureen Sorbet said Sanders has been a supervisor at Maxey since 1998. Prior to that, he worked in another state facility. He also worked at Maxey from 1988-94.
    Former Maxey youth specialist James Cotter, 49, of South Lyon, is scheduled for trial April 2 in Howell on charges of coercing a 15-year-old youth inmate into having sex in exchange for favors. Maxey social worker Blaine Burks, 45, is scheduled to stand trial in Pontiac on charges that the eight-time felon had a car full of marijuana, heroin, a gun and ammunition when police searched his car in front of a Southfield elementary school last September.
    Maxey remains under investigation by the FBI this month on allegations of civil rights violations. Teens have alleged they have been held in a restraint chair until their arms turn blue. Others complained that they were gang-raped or consented to sex with other teens as a way to gain entry into gangs inside Maxey.

Psychiatrist Now a Substitute Teacher Despite Felonies
Lynn Moore, Muskegon Chronicle- 3/25/2001

A former Muskegon psychiatrist who has 11 felony drug and fraud convictions is registered as a substitute school teacher in the Kalamazoo area. After being questioned by The Chronicle about James Dallman's inclusion on a substitute teacher list, a spokesman for the state Department of Education announced the state will conduct an investigation. Kalamazoo and state education officials have already conducted their standard background checks and have approved Dallman to teach in the county. Dallman filed papers saying he has been paid for teaching, but a county school official said he could not confirm that the ex-doctor who lost his license because he had sex with his patients has ever subbed there.
    State officials say it's possible for felons to teach in public schools. Except for specific convictions related to assault and battery and inappropriate behavior with children, state law essentially leaves it up to school districts to determine if a felony conviction precludes someone from teaching, said T. J. Bucholz, spokesman for the Michigan Department of Education. "It is a local district issue," he said. A teaching certificate cannot be denied based solely on a felony conviction, unless it involves "moral turpitude" or "adversely" affects the person's ability to teach, state law says.
    Dallman pled no contest in 1997 to the 11 felonies that included insurance and Medicaid fraud and delivery of drugs. Apparently the intermediate school district serving Kalamazoo County did not consider Dallman's convictions as meeting the definition of "moral turpitude."  He is on a list of substitute teachers developed by the Kalamazoo Regional Education Service Agency, the intermediate school district that serves Kalamazoo County, according to Tim Hofmeister, director of operations for the district. Hofmeister said Dallman was not on an "all-county" list that goes out to all school districts in the area, but rather for one or more specific districts. Hofmeister would not say for which district or districts Dallman was signed up to teach. Hofmeister said "to our knowledge (Dallman) hasn't subbed in our county." In a court document, Dallman said he was making $195 per week from the "Kalamazoo County regional school board," presumed to mean the intermediate school district. He said he had been employed there since October. Dallman included his earnings on an application to receive a public defender to represent him in a probation violation charge he is facing in Muskegon County.
    When asked by The Chronicle, Dallman declined to say where he is working. However, he did say he no longer works for a psychic hotline or as a photo finisher for Wal-Mart jobs he previously held. His application for publicly funded legal counsel was denied by 14th Circuit Judge William Marietti because, based on the earnings he reported from teaching, he earns too much money. Dallman's probation officer filed a probation violation petition against Dallman because of his failure to pay more than $86,000 in court costs, fines and restitution from his felony convictions. Dallman pleaded not guilty to the probation violation on March 12 and a hearing is scheduled Monday in Marietti's court. If he is found guilty, he could face up to four years in state prison.
    The Kalamazoo intermediate district conducts criminal and FBI background checks on potential substitute teachers and then compiles an annual list of those it deems suitable, Bucholz said. The department of education then reviews the list to be sure it complies with state law, he said. While the state already approved the list containing Dallman's name, officials will go back and review Dallman's application to be a substitute teacher. If he failed to inform the intermediate district of his felony convictions, the state could pull his name from the list, Bucholz said. Still, Bucholz said there is a lot of "gray area" when determining if a conviction excludes a person from a classroom. State law says that a teaching "certificate cannot be denied, suspended or revoked solely on the basis of a prior felony conviction."
    Dallman's insurance and Medicaid fraud convictions stem from his billing practices when he had a psychiatry practice at 1259 Peck in Muskegon. The drug charge, specifically delivery of a controlled substance, stemmed from an estimated two-year arrangement with a female patient who performed sex acts with Dallman in return for a sedative to which she was addicted, according to the Muskegon County prosecutor's office. When Dallman was out of jail on bond while awaiting trial, he was accused of raping a patient who was seven months pregnant. But the rape investigation against Dallman was dropped without any charges because of the reluctance of the alleged victim, the prosecutor's office said at the time.

Problem Gamblers Finding New Hope
Ryan Morgan, Denver Post- 3/25/2001

Twenty years ago, Steve realized compulsive gambling was destroying his life. But finding people who knew how to help him with his problem was very hard. "I went to a psychologist who told me just to stop gambling," he said. "She told me that if I couldn't do that, there wasn't anything she could do for me." But Steve, who participated in a Saturday conference on compulsive gambling held in Aurora, did find help through Gambler's Anonymous, an organization that helped him stop gambling, and do it confidentially. Because compulsive gamblers often steal, embezzle or otherwise break the law to pay their gaming debts, Steve said, it takes guaranteed confidentiality for compulsive gamblers to come forward. Steve and conference coordinators said things are changing, and for the better. Today, mental health professionals recognize gambling as a disease similar to alcoholism; compulsive gamblers can find hotline numbers posted in casinos and printed on the back of lottery tickets.

Casinos are cooperative
Reneée Rupe, president of the Colorado Council on Compulsive Gambling, the organization hosting the conference, said the purpose of the event was to increase awareness and to push for policy changes her group thinks will help diminish gambling addiction. "For the vast majority of people, gambling is just entertainment," she said. "But for the minority who can't stop, it's absolutely devastating."  A financial adviser, Rupe often sees the financial disaster that results from compulsive gambling: clients who max-out 30 credit cards, refinance their homes for more cash and often resort to theft.
    To keep gambling problems from escalating to those credit ruining heights in the first place, the Council on Compulsive Gambling works with casinos to help identify compulsive gamblers and stop them from going broke. The gaming industry, Rupe said, has been cooperative. "They've recognized from the very beginning that compulsive gamblers do not benefit them in any fashion," she said.  In fact, four casinos ponied up money for the conference, which Rupe said was an indication of their willingness to address the problem.

Tighter rein on cash
Louis Rice, executive director for the Casino Owner's Association of Colorado, said her organization's members, in addition to posting signs with compulsive gambling hotline numbers, are also trying to keep cash out of the hands of addicts. They're asking quick-cash operations inside casinos to adopt policies that will deny money to problem gamblers. "The real challenge is to make sure that if John Smith excludes himself from an Isle of Capri casino (in Black Hawk), he'll also be excluded from a Harrah's casino in Lake Tahoe," she said. In addition to asking for cooperation from casino owners, Rupe said her group needs more help from the state. The government now provides some money for help hotlines, but none for treatment. "We've gotten some great support from the industry," she said. "Now we just need help from the state for treatment."

"The Lost Children of Wilder: The Epic Struggle to Change Foster Care" by Nina Bernstein
Tanya Luhrmann, The New York Times Book Review, 3/25/2001

One of President Bush's first official acts was to propose that religiously sponsored organizations should get public money to provide social services. In ways this is an admirable proposal. Religious organizations can count on motivated participants, and those in need of help often trust religious charities more than the agencies of the local government. But there is always the danger that the religious organizations will favor their own, or impose their own moral views on their clients. "The Lost Children of Wilder," is a brilliantly researched account of an attempt to make the New York City foster care system fair for all its children. Obviously Nina Bernstein's book was written before George W. Bush took office; but it provides a vivid argument against his plans.
    Since the 19th century, New York's foster care system had handled its needy children by contracting with private agencies to care for the children at public expense. Many, perhaps most, of the agencies were Jewish and Roman Catholic charities. The law allowed them to give preference to children of their own faith. In 1972, 90 percent of all foster beds were in the hands of these agencies, which could pick and choose among the children the city tried to place. Black children, of course, were mostly Protestant.
    That was the year Shirley Wilder entered the foster care system. She was 13. Her mother had died when she was 4, her grandmother when she was 11; when she turned to her father, whose name she did not bear, he threw her out. Over the next 10 months, every religiously sponsored foster agency the court approached turned her down. But her lawyer really liked her, and didn't want to send her to the Dickensian reformatory at Hudson, N.Y., for children convicted of criminal offenses, then the last resort for children rejected by foster care. The lawyer came back to the court 12 times, as Shirley shuttled among relatives, shelters and jail-like detention centers, to find some alternative. None were available.
    When Shirley arrived at Hudson she was raped by one of the girl gangs. She fought back, and the staff punished her for fighting by locking her in solitary confinement. When she was released, she ran away; she was caught, returned and placed in solitary confinement for three days. Then she was transferred to the Behavior Modification Unit, where the toilet paper was doled out one roll a month, the staff hit the kids, and to eat in the dining room you needed the tokens that were given out for good behavior. Shirley became rebellious and difficult. And yet a lawyer who visited her recalled: "She had the most beautiful smile, a smile that lit up her face. She was pretty and she was funny. She had this great sense of humor." She was the perfect test-case plaintiff.
    The lawyer was Marcia Lowry, a fierce Jewish misfit who for years kept a tattered poster quoting Eugene V. Debs on her office wall: "While there is a lower class / I am in it / While there is a criminal element / I am of it / and / while there is a soul in prison / I am not free." She had been hired by the New York Civil Liberties Union after working within the city's administration on foster-care issues; she was shocked by the fact that over half of the city's many thousands of wards were, like Shirley, black, but in the Catholic and Jewish agencies that received most of the public's dollars, fewer than a quarter were black. Bernstein, who wrote a series about the Wilder case while a reporter for Newsday and is now a reporter for the New York Times, tells us that in Lowry's view "the city had delegated the public good wholesale to a collection of sectarian agencies with a license to discriminate." When the Wilder suit was filed in federal court on July 14, 1973, it named as defendants six state and city officials and 77 voluntary agencies and their directors, and asked the courts to declare unconstitutional the entire statutory basis for the provision of child welfare services to New York City children.
    "The Lost Children of Wilder" describes the 26-year history of the case that was at last settled, more or less in Shirley Wilder's favor, in 1999. Its legal analysis is rich, but the drama is human. People who saw themselves as genuinely committed to these difficult kids suddenly found themselves attacked for racism and in effect asked to turn their services over to the forces who had created hellholes like Hudson. The judge who first heard Shirley Wilder's plea had struggled to make wise choices within limited options for decades, and had been denounced in tabloid headlines: "Daughter of Rabbi Wise gives child of Christ to Black Bearded Prophet of Mohammed." She came from an unbroken lineage of rabbis stretching back 19 generations, and when the American Civil Liberties Union was prepared to settle the lawsuit with the city--she fought against it with outrage and elegance. The man who became the city's corporation counsel was an heir to F.A.O. Schwartz, and yet somehow managed an austere authenticity sufficient to persuade opponents who hated each other to come to terms. And around these stories, bureaucracy becomes character, stage setting and plot, as the case drags through postponements, delay, appeal and absurdly irrelevant adjudications.
    Above all, "The Lost Children of Wilder" tells the story of these abandoned kids. At 14, Shirley Wilder had given birth to a son, Lamont. (She herself would die from AIDS at 39, three weeks before the lawsuit was finally over.) "It is almost boring to read her case record," one of her many caseworkers recalled, "because you have to read it so many times, in so many kids." While still in the maternity ward she was talked into signing her baby over to the state: she had no place to live, and she was too young for mother-child placement. She could visit him no more than once a month.
    Lamont was lucky at first. He was placed with a Hispanic family in the Bronx for his first five years. The father sexually fondled him, but the mother loved him--and then they were divorced, around the time that Shirley's parental rights were officially terminated, and, encouraged by caseworkers, his foster mother gave him back to the state. He was placed in a white family in another state, the only black child he knew. He didn't adjust. They gave him up within a year. Another white family took him on, but his behavior was worse. Transferred to a home for disturbed kids, he tried to make friends with various volunteers. They were kind for a while, and then moved on. He was classified as psychotic; he could have been going through normal but frustrated mourning for this losses. He entered the real world in his late teens without a high school diploma and with few skills.
    This book makes two things clear. First, it is foolish to separate parents from children with the ease that our current system encourages. Our policies assert that it should be less comfortable to be on welfare than to work, which is sensible. They also assert that a mother who cannot feed and house her child should not raise him, which also is sensible. The consequences are not. Lamont's care cost the city half a million dollars, far more than it would have cost to support his mother, and it repeatedly and traumatically severed him from an enduring human relationship, as crucial to a child's development as food and heat.
    Second, the problem is poverty. This is perhaps not a novel insight, but this history makes it sickeningly clear that the state cannot solve the problem of needy children without doing something about the conditions that produce them. There are so many children, so few resources--in this stunningly prosperous age--and, repeatedly, solutions born of crisis and good intention create disasters of their own. Children who enter the system tend to exit it as poor and unskilled as the parents who bore them, and the cycle grinds painfully on.
    Indeed, on January 22, 1999, the day the Wilder lawsuit finally ended, in the same courthouse a judge was deliberating over a class-action lawsuit brought by the Legal Aid Society, charging that new tough welfare practices endangered needy children. Unbeknown even to the Legal Aid lawyers, the child who stood at the center of the lawsuit was Shirley Wilder's grandson, Lamont's little boy.

Women Now 39% of Cigarette Deaths
Julie Deardorff, Chicago Tribune- 3/28/2001

Teenage girls are lighting up cigarettes in alarming numbers, a trend that over the last decade has threatened to wipe out progress made by anti-smoking campaigns during the 1970s and '80s, according to a U.S. surgeon general's report on women and smoking released Tuesday. If the backsliding continues, the consequences will be devastating to women, who as a group traditionally have smoked less than men, the report said. Women now account for 39 percent of smoking-related deaths, a proportion that has more than doubled since 1965.
    Kafi Jones, 16, is fully aware that cigarettes can kill her--so she tries to limit herself to five a day. That's five more than she wants to smoke, but Jones, a sophomore at Lincoln Park High School, says she is unlikely to stop. "I know how bad it is," said Jones, who started when she was 12. "I've seen photos of lung cancer and my grandfather died of it. But smoking is just something you do at coffee shops and concerts."
    The study--the first comprehensive summary on women and smoking in 20 years--charges that tobacco industry marketing and promotion unfairly targets teens, especially girls. Many of the ads feature slim and athletic models in outdoor settings--images that appeal to teens' desire to be independent and attractive. At the same time, spending for domestic cigarette advertising and promotion was $8.24 billion in 1999, it says--an increase of 22 percent from 1998. "Young kids will mimic the message their parents tell them and say `smoking is bad.' But as children get more into society, they are exposed to tactics of the advertising industry and it becomes too seductive," said Janet Williams of the Cook County Department of Public Health, a member of the Illinois Coalition Against Tobacco. "Tobacco industries prey on insecurities of young girls."
    About one in five women smokes--compared with one in four men--a rate that has stayed consistent in the last decade. But if teenage girls hang onto the habit, that gap will narrow. Last year, a government survey found that 30 percent of female high school seniors said they had smoked in the previous month, an increase from the early 1990s. Schools, grappling with the growing problem, have tried not only punishment but also treatment, like counseling. In Rolling Meadows an anti-tobacco group unsuccessfully urged a high school in Arlington Heights to consider providing nicotine patches to students. There are signs that public awareness of the dangers of smoking has improved. Teens who gathered Tuesday around "The Stage," an outdoor plaza littered with cigarette butts at Lincoln Park High School, said they knew the risks and believe smoking is unattractive and unhealthy. They also believe they are unswayed by tobacco ads.   But freshman Krista Anderson--who declined to say whether she smokes--said that even if the anti-smoking message is getting through, it's not making much difference. Smoking is "bad for your health but not bad enough for people not to do it," Anderson said.
    The grim statistics argue otherwise. Smoking has killed nearly 3 million women since the last surgeon general report in 1980, and lung cancer has been the most deadly female cancer since 1987, claiming 27,000 more lives than breast cancer. Smoking also can cause dangerous blood clots in women who use birth control pills, menstrual irregularities, earlier menopause, infertility, bone-thinning osteoporosis and cervical cancer, according to Surgeon General David Satcher. Smoking during pregnancy can result in low birth-weight babies, stillbirths and miscarriages. And smoking, of course, can cause wrinkles. "Smoking not only affects women directly but in many situations they are the caregivers and primary role models for children," Williams said. "The fallacy for many women who have small children is, `If I tell them it's bad and they know I'm unhappy with it, that is a strong enough message.' It's not."
    Williams is particularly concerned about advertising. In 1968, Phillip Morris marketed Virginia Slims cigarettes to women with the slogan, "You've Come a Long Way, Baby," stressing the importance of the emerging women's movement. That gave way to "It's a Woman Thing" in the mid-1990s and more recently the "Find Your Voice" campaign, which features women of diverse racial and ethnic backgrounds. The underlying message of these campaigns, according to the report, is that "smoking is related to women's freedom, emancipation and empowerment." "They're getting culturally sensitive in their pitches," said Williams. "The one that talks about finding your own voice is really insidious. They'll certainly have trouble finding their voice when they have cancer of the larynx."
    In light of the surgeon general's report, U.S. Sen. Dick Durbin (D-Ill.) introduced legislation Tuesday that would give recipients of Medicare, Medicaid and the Maternal and Child Health Program far greater access to therapies that help smokers quit. Curbs on tobacco marketing that encourages teens to smoke will be key because 80 percent of smokers start as teens, said Health and Human Services Secretary Tommy Thompson. "What starts out as a simple puff is turning into a death sentence," he said.
    Jones started because she had an older friend--14--who smoked. One day the friend handed her a cigarette, and Jones put it in her mouth. For two years, she said, she never inhaled, but she liked going through the motions of smoking--holding the cigarette, flicking the ash. "The cigarette is connected to hundreds of things smokers do," said Paul Palmer, who directs the Palmer Smoking Clinic in Palos Hills and treats smokers through hypnosis. "The behavioral part is the real culprit. Most start as social smokers to be cool." Jones said her smoking increased when she started going to concerts. "When you're moving and have that much adrenaline it calms you down," she said. "That's when I'll go through a whole pack." Normally though, she tries to stick to her limit: one cigarette in the morning, one at lunch, one after school, one before dinner and one before bed, while she's still chatting with friends online. "I tell my other friends not to start," she said. "I smoke now because it's a habit."

Fewer Abused and Neglected Children Reunited with Parents
Heath Foster, Seattle Post-Intelligencer- 3/28/2001

Six months after Melody Dady first injected methamphetamine into her veins, she had lost everything she held dear -- her three children, lifetime partner, job and home. The meth high was so orgasmic that even when the custody of her youngest, a year-old baby daughter, hung in the balance, it took three tries at treatment for Melody to kick her habit.
    Child welfare workers say the drug's addictive hold on a growing group of parents like Dady is the biggest reason for a new trend: an increasing number of Washington children will never go back home. Over the last five years, the number of abused and neglected children reunited with their parents has plummeted 30 percent, from 8,495 to 5,908. That means thousands more children are staying permanently in foster or adoptive homes. At the same time, meth involvement in state dependency cases -- those in which children are in such imminent harm that they are taken from their parents, temporarily or forever -- has exploded around the state.
    In Pierce and Kitsap counties, where meth lab busts have been most concentrated, 65 percent of the dependency cases last year involved the inexpensive, easy-to-manufacture drug. In Clallam County, where Dady lives, 67 percent of the dependency cases in 1999 involved drug addiction, and three out of four times the drug was meth. While there's been no study of the drop in family reunification, "what regional administrators are telling us is, the biggest factor is the meth epidemic," said Peggy Brown, director of the management services division at the state Department of Social and Health Services.
    Mariann Whalen, a Clallam County-based state social worker serving on the Governor's Council on Substance Abuse, has no doubt that meth is behind the trend. "This drug takes over the whole being of a person in a way we just haven't seen with other drugs," said Whalen. "Parents absolutely forget that they have children when they are on this drug. One mom I had was so strung out she left her child in Seattle and couldn't remember where she left him."  Dady said meth's grasp upon her was so sinister that she eventually let her supplier move into her garage. At times, she forgot how much she loved her children. "This is a hard thing to admit and it still brings a lot of shame and guilt for me," the 29-year-old Port Angeles mother said. "I went against every moral and every belief I ever had when I was on that drug."
    A new federal law has made it especially hard for meth addicts to win back their kids. Before the implementation of the 1997 Adoption and Safe Families Act, the child protection system focused on doing everything possible to keep biological families together. But because children were getting trapped in foster care for as long as four years, the law gave priority to getting children into safe, permanent homes quickly -- if not with their own parents, then with relatives, guardians or adopted parents. The law placed tighter deadlines on judges and social workers, requiring that they make tough judgments early on about whether parents can change enough to regain their kids. And social workers say the shorter time frames are often too tight for meth-using parents, who can take years to overcome their addictions.
    In Washington, dependency workers must have a permanency plan in place within 60 days of removing a child, and must decide after a year's time whether the child can be reunited with the parents. Once a child has been in state care 15 of the previous 22 months, parental rights must be terminated unless social workers see "compelling reasons" to wait. "If parents don't get it together pretty quickly and get into treatment within a few months, they are not going to get their kids back," said Dee Wilson, a DSHS regional administrator in southwest Washington. "What used to be kind of an extreme position has become a normal position." The new federal rules have helped shorten the time Washington kids bounce around in foster care; since 1997, the median length of temporary care has dropped from about 21 months to 16 months.
    Meanwhile, the rules have been hard on meth-addicted parents. In a typical case, the mother's partner is manufacturing meth in the home, using cheap, over-the-counter ingredients and recipes that can be easily found over the Internet. Chris Robinson, regional administrator for child welfare cases in Pierce and Kitsap counties, said that because meth is highly toxic and explosive, when police bust the lab, the family usually loses its home and everything in it. "The kids often don't even have their favorite toy or blanket to take with them," she said. And a mother who loses her partner to jail, her children to foster care, and all her possessions has a far harder time than most picking up the pieces of her life, Robinson added.
    And then there's the drug's physical and psychological toll. Users become extremely paranoid and are given to hallucinations and sudden outbursts of violence. Meth addicts often cannot sleep and forget to eat. When Melody Dady finally went into treatment in 1997, she weighed 103 pounds. "You are often dealing with people who are literally falling apart," said Wilson. Whalen, the Port Angeles dependency caseworker, said that in her experience it takes a year and a half to two years for a meth-addicted parent to become clean and sober and win his or her children back. She has had the most success when she gets parents into treatment within 30 days of their children being taken away. "That's when they are feeling they will do whatever it takes to get their kids back," she said. "Some parents will walk away and say I'm done. The drugs are just too powerful."
    Whalen said treatment programs of less than six months aren't usually effective. She sees the most success when parents move from treatment into transitional housing programs that offer continuing counseling and support groups. That formula worked for Dady, who finally kicked the drug after she finished an intense residential program in Tacoma that allowed her to bring along her then year-old baby Suzanne. She eventually won all three of her children back. She reunited with and married their father, Michael. She is now attending community college, studying to become a child welfare caseworker like the one she credits with saving her life -- Whalen.  Whalen is considered a model caseworker. But some drug treatment counselors say that not all DSHS caseworkers are as aggressive about reuniting families as she is. Workers often seem resigned that parents won't be able to rebuild their lives in time to meet the new federal time frames, they say.
    The counselors note that the new federal law also created controversial cash bonuses for states that increase adoptions. Washington's adoption rate has jumped 83 percent over the last five years, to 1,164 cases in 2000. The success won the state a $620,000 bonus last year, and it used the money to speed adoptions for children permanently removed from parents. Wilson, the DSHS administrator, said caseworkers understand how deeply many children long to return to their parents, and genuinely make that their first priority. One challenge, especially in rural areas, is a shortage of substance abuse treatment and mental health treatment programs close to home.
    Like others in the DSHS system, Wilson cautions that meth use is probably not the only cause for the drop in family reunifications. One notable trend has been a dramatic decrease over the last five years in kids who are taken from their parents and then returned within two months, from 6,021 to 3,931. Both Wilson and Robinson believe that reduction reflects the fact that caseworkers have found ways to do effective social work without removing children from home, and so the least serious cases aren't entering the system in the first place. That means that the cases social workers are dealing with are more complex and harder to resolve, involving multiple issues such as drug addiction, mental health and family violence. So reunifications are becoming harder to achieve, they said.
    Because DSHS hasn't done a thorough study of the plummeting reunification rate, the state Office of Public Defense has asked the Legislature to pay for a study of the trend. "We have 2,000 kids less reunifying with their families than just four or five years ago, and we need to know why this is happening," said Joanne Moore, the office's director. Whalen hopes such a study will push lawmakers to spend more on drug treatment. Gov. Gary Locke's current budget proposal includes $5.1 million for meth treatment. "There's nothing more rewarding than seeing children with their parents again," Whalen said.

Drug Companies Push Antidepressants to Treat Severe PMS
Tara Parker-Pope, Wall Street Journal, 3/28/2001

Is severe PMS a mental illness? Some pharmaceutical companies and psychiatrists are treating it as one. In television ads, drug maker Eli Lilly is promoting the drug Sarafem to treat the problem, now dubbed Premenstrual Dysphoric Disorder. But the pink and purple pills aren't a new drug--they are simply repackaged Prozac, the popular antidepressant. Makers of similar antidepressants, known as serotonin reuptake inhibitors, or SSRIs, also may follow suit. In January, Pfizer asked the FDA to approve Zoloft to treat PMDD. Forest Laboratories' Celexa and GlaxoSmithKline's Paxil also have been studied.
    The medical community, however, remains divided about whether PMDD is a real disorder or simply a way for drug companies to cast a wider net in search of new customers. Critics are particularly concerned about labeling women as mentally ill because of problems associated with menstrual cycles. "When you start calling what PMS is a psychiatric disorder, what are you saying about the women of this world?" says Nada Stotland, director of psychiatric education at the Advocate Illinois Masonic Medical Center in Chicago. "This lends itself to prejudices people already have about women being moody and unreliable."
    Although the FDA has approved Sarafem to treat PMDD, the psychiatric community is still debating the legitimacy of the disorder. The American Psychiatric Association includes PMDD in the appendix of its current Diagnostic and Statistical Manual of Mental Disorders, the part of the manual reserved for issues needing further research before being officially accepted as a mental illness. Fueling skepticism about PMDD and Sarafem is the fact that in August, Lilly, based in Indianapolis, loses patent protection on Prozac, a drug with $2.6 billion in sales last year, according to IMS Health. With Sarafem, the firm now has a separate patent to use the drug for PMDD through 2001, allowing it to partially offset loses in sales as rivals produce generic Prozac. Repackaging prescription drugs for other uses is becoming more common. Glaxo, for example, has repackaged its antidepressant Wellbutrin as the stop-smoking aid Zyban.
    Many physicians argue that PMDD is a legitimate mental illness triggered by normal hormonal fluctuations in a women's menstrual cycle. About 3 percent to 5 percent of menstruating women are affected. "This is a subset of women who have really, really severe mood changes and changes in their behavior," says Jean Endicott, professor of clinical psychology at Columbia University's College of Physicians and Surgeons. "It can be very debilitating." Unlike other mental illnesses that affect a patient on a daily basis, PMDD is said to affect women during the week to two weeks before their period. The symptoms include depression, anxiety, tension, anger , irritability and the feeling of being overwhelmed or out of control. Other symptoms also are typical of traditional PMS, such as breast tenderness, headache, bloating and weight gain. In order to be diagnosed with PMDD, a patient must have at least five symptoms, including one involving mood change and be markedly impaired as a result. Patients should track symptoms for two months before a diagnosis is made.
    About 60 percent of women who take Sarafem for PMDD will be helped, according to Endicott. Currently, the drug is taken every day, but researchers are studying dosing that would reduce the pills to several days a month, limiting side effects, which can include tiredness, upset stomach, nervousness, dizziness and difficulty concentrating.
    A 38-year-old Chicago flight attendant named Betsy, who didn't want her full name used, says the week before her period she felt like an "over-wound spring, getting wound tighter and tighter," and would often scream and lose control. "That's not my normal disposition," she says. "I knew something wasn't right." She noticed the correlation with her menstrual cycle and discussed her problems with her gynecologist, who prescribed Sarafem. "It has completely taken away the symptoms," she says.
    Stotland and other critics, however, worry that eager patients may push to be prescribed Sarafem as a quick fix, preventing doctors from diagnosing other serious health problems. Stotland says research has shown that more than half of the women who believe they have severe PMS actually suffer from other problems, such as depression, panic disorder or even domestic violence.
    Lilly's marketing of Sarafem also has sparked controversy. The first ads showed a frustrated woman wrestling with a shopping cart. "Think it's PMS? It could be PMDD," the ads said. But the FDA said the ads trivialized the seriousness of PMDD and the campaign was pulled. Newer ads show one woman arguing with her husband and another frustrated because she can't button her pants. Lilly spokeswoman Laura Miller says the ads attempt to show the full gamut of PMDD symptoms. "It's up to the doctor and the woman to determine whether she has PMDD and whether treatment is appropriate," she says.
    But Paula Caplan, a psychologist and affiliated scholar at Brown University's Pembroke Center for Research and Teaching on Women, says instead of labeling women as mentally ill, physicians should urge diet changes, exercise, less caffeine and even calcium supplements. "But nobody makes much money off calcium tablets." She adds.

Family Appeals Decision on Shock Treatments of Mental Patient
Pat Milton, Associated Press- 3/29/2001

NEW YORK (AP) The family of a former Hofstra University honor student asked an appeals court Thursday to stop a Long Island psychiatric hospital from giving the mentally ill man electric shock treatments. Adam Szyszko, 20, of Lindenhurst, was involuntarily committed to the Pilgrim State Psychiatric Hospital in Brentwood after he was diagnosed with schizophrenia. Attorneys for Szyszko appeared before the Appellate Division in Brooklyn, trying to reverse a Suffolk County State Supreme Court ruling from last year allowing Pilgrim State to proceed with the treatments. ''I think it's horrible they are holding my son prisoner,'' said Lucyna Szyszko, who immigrated from Poland 12 years ago with her son and daughter. ''I want the treatments stopped.'' But state Assistant Attorney General Thomas Litsky told the four-judge panel that Szyszko has been declared mentally incompetent and must receive the shock treatments because he is allergic to the medication used for his condition. Szyszko family attorney Kim Darrow argued the Supreme Court ruling should be overturned. Mrs. Szyszko, a pharmacist, fears that the shock treatments will cause memory loss and inhibit her son's ability to learn.
    The family became aware of Adam Szyszko's ailment about three years ago, when he became depressed and locked himself in his bedroom. His condition grew progressively worse, until he started wandering out of the house. He was later taken by police to Pilgrim State. Doctors there gave Szyszko medication to control the schizophrenia, but he suffered a severe allergic reaction, forcing them to transfer him to Southside Hospital in Bay Shore. ''If they had checked his medical records, they would have known he had a bad reaction to the medicine months before,'' Szyszko's sister, Anna Szyszko, said on the steps of the courthouse. A spokeswoman for the state Department of Mental Hygiene, Jill Daniels, declined to comment on the allegation, saying it concerned confidential patient information. Szyszko recovered after several weeks and was transferred back to Pilgrim State contrary to his and his family's wishes, his sister said. The family also objected to shock treatments, preferring that Szyszko be treated with psychotherapy.
    State mental health regulations require informed consent for major medical procedures, including shock treatment. Since Szyszko was found mentally incompetent, the hospital may seek permission from a parent, spouse, adult child or court. The hospital chose to seek a court order. Last November, after a hearing, Supreme Court Justice John Dunne authorized the hospital to administer up to 20 electroshock treatments, which involve running approximately 150 volts of electricity through the brain while the patient is under anesthesia. The family obtained a stay to the ruling but not before two shock treatments had been administered. Darrow, the family's lawyer, argued that the lower court lacked the authority to make such a ruling, since Szyszko's relatives were not brought in as parties to the action. A court decision is not expected for at least a month. ''These treatments are harming my son,'' Szyszko's mother said through tears outside the courtroom. ''He is such an intelligent boy. His life will be over.''

In Baltimore, a Victim Becomes a Criminal
Maureen O'Hagan, Washington Post- 3/30/2001

It started with a routine call to 911. "Can I have the police at 1525 Ramblewood, please?" the female caller said, trembling inside a Baltimore house. She had just broken up with her boyfriend, and she knew he was angry. "It's a gun involved, and a man has just assaulted me." The domestic assault case that began with that phone call has ended in outrage among victims' advocates, who say authorities abused their discretion, violated Justice Department standards and put the 911 caller in an impossible bind.
    Since the December 1999 call, Joann Laverne Gilliam has gone from being a victim seeking help to being the target of an investigation, and from prisoner of domestic abuse to prisoner of the federal government. Why? Like about half the victims of domestic violence, Gilliam tried to cover up her boyfriend's offense. She lied to a grand jury and tried to persuade a friend to do the same. At the time, he was out on bail, he was threatening her and she said she was scared for her life. Last week, Gilliam was sentenced to 30 months in prison on charges of perjury and obstruction of justice.
    "That is outrageous," Carole Alexander, executive director of the House of Ruth in Baltimore, said of Gilliam's prison sentence. "Nobody deserves this. . . . This woman calls police when he's pistol-whipping her. Now she's going to jail because she's scared to testify against him." Deborah Epstein, director of a domestic violence clinic at the Georgetown University Law Center, said, "The message that gets sent to victims is, 'Don't call police in the first place.' "
    The U.S. attorney's office in Maryland, which prosecuted Gilliam, 44, and her boyfriend, makes no apologies but said the case had its unfortunate aspects. "She's a victim, there's no question about that, and I don't think there was a question that she was afraid," said Marcy A. Murphy, a spokeswoman for the office. "But she lied in the grand jury. You cannot do that." Other prosecutors, however, say they see cases like Gilliam's all the time -- and they normally handle them much differently. "It is not our practice to sanction women with making false statements," said Videtta Brown, who is in charge of the domestic violence unit in the Baltimore state's attorney's office. U.S. Justice Department guidelines state that victims of domestic violence should be subpoenaed only to protect them from reprisals and only if the victim is willing to testify. Prosecutors are to "consider victim protection as the top priority in all decisions," according to the guidelines. Acting U.S. Attorney Stephen Schenning said, however: "These were affirmative actions on her part all aimed at trying to shipwreck a prosecution. Just because she's wearing the mantle of a victim, that doesn't give her a pass on breaking the law."
    Now, Gilliam, a Glen Burnie woman who dropped out of high school to raise the first of three children -- the youngest, now 16, lives with his father -- is preparing to be locked up. There is furniture to sell, knickknacks to divvy up and a car loan to deal with before she must report to prison May 22. "I didn't think it would turn out this way," she said. It started in 1999, when Gilliam, who ran a day-care center in her home, met Calvin Donnell Woodard Jr. at a Baltimore nightclub. "He knows how to charm a woman," she recalled.
    But soon she noticed changes: He followed her around; he checked her caller ID to see whom she was talking with; he looked in her closets and underwear drawer for signs of unfaithfulness, she said. Once, according to Gilliam, he kicked out the window of her car. Another time, he ruined a computer by dousing it with liquid. He also threatened her life, she said. "It got to the point where I thought, 'I've got to get out of this,' " she recalled. "I don't know how, but I knew I had to."
    On Dec. 5, 1999, Gilliam told Woodard it was over. After that, he allegedly fired shots out of the car window and hit her with the gun. She called 911 from his Baltimore home. Police arrested Woodard on assault and weapons charges, but he was soon released on $50,000 bail. "He would call me all day long," Gilliam said. "He would say, 'You know I didn't hit you, because if I would have hit you, I would have busted your head open.' He would come to this house and say, 'You better not send me to jail.'"Sometimes I would ignore it and say he's not going to do it. But then I thought, because of the way he is, I am afraid."
    That fear, coupled with a feeling that she didn't want Woodard's prison term on her conscience -- a common sentiment among domestic violence victims, experts say -- persuaded Gilliam not to help with the prosecution. In addition, Woodard, 36, who has been named in 17 other criminal cases, several related to domestic violence, had a history of getting out of jams with the law. However, he had been convicted of armed robbery and of battering another former girlfriend, which meant that the U.S. attorney could prosecute him as a "felon in possession of a firearm." The case was turned over to federal authorities, and the domestic assault case was put on the inactive docket.
    On May 3, 2000, Gilliam was subpoenaed to testify before a federal grand jury about the gun Woodard allegedly hit her with; she didn't show up. Two weeks later, she was arrested on a bench warrant, held overnight in jail, given immunity and ordered to testify before the grand jury. She went before the body and lied, a decision she said she will regret forever. Although she was instructed to tell the truth, Gilliam says she was less afraid of tangling with the law than of tangling with Woodard. "Whose gun was it?" the prosecutor asked her. "I don't know," Gilliam replied. "Have you seen Mr. Woodard with a weapon?" the prosecutor queried. "No," she answered. Then she made up a story about finding the gun under her car and said a friend could back up her story. Authorities tracked down the friend and recorded a phone call between her and Gilliam. "I need you to do something for me," Gilliam said in that call. "I need you to tell a big lie."
    Gilliam was charged with perjury obstruction of justice. Facing a significant prison term if convicted at trial -- and unable to afford the legal fees -- Gilliam pleaded guilty in July. On March 23, U.S. District Judge Marvin Garbis sentenced her to 30 months in prison. It was the shortest sentence he could give under federal law, which required him to consider Gilliam an accessory to Woodard's crime. "I lied to the grand jury; I'll admit that," Gilliam said. "But . . . I'm doing time for something he did." Even without Gilliam's testimony, the U.S. attorney's office was able to win a conviction against Woodard. He was sentenced to 10 years in prison and is facing a charge of manslaughter in the slaying of a man in jail. The woman who bought the gun for Woodard was not prosecuted. "It was a case that could have gone in the opposite direction," Gilliam's attorney, Russell Neverdon Sr., said of his client's sentencing.
    Bob Spagnoletti, who runs the domestic violence section of the U.S. attorney's office in the District, said, "We try one-half of our cases without ever having to call the victim to the stand or where she even testifies for the defense." On rare occasions, he said, his office will charge victims with perjury if their conduct is egregious. For example, he described a case involving sexual abuse of children in which the mother's lies would have let the perpetrator commit further abuse. Epstein, of the Georgetown law school, said: "This is an example of a relatively small group of cases in which a victim is prosecuted for perjury, but it will likely become a growing phenomenon. The pendulum has swung from never prosecuting to always prosecuting, even if it includes locking the victim up and forcing her to testify."

Forcible Drugging Is Called Allowable
Patricia Davis, Washington Post- 3/30/2001

Alexandria's chief prosecutor filed court papers yesterday arguing that the Circuit Court judge overseeing the case against Gregory D. Murphy has the authority to allow doctors to forcibly medicate Murphy to make him competent to stand trial in the slaying of 8-year-old Kevin Shifflett. Commonwealth's Attorney S. Randolph Sengel said Murphy's attorneys, who are fighting efforts to forcibly medicate their client, are trying to confuse the issue by saying that state law does not permit the court to prescribe specific types of medical treatment. Sengel was responding to motions by Murphy's attorneys to block attempts to forcibly medicate their client.
    At a court hearing Tuesday, Sengel and Murphy's attorneys, Joseph N. Bowman and Joseph J. McCarthy, will have a showdown over the issue of whether Murphy, 30, who suffers from paranoid schizophrenia, should be forcibly medicated. Up to now, the fight has taken place only on paper. In yesterday's filing, Sengel noted that the psychiatrist treating Murphy at a state mental health facility in Hopewell, where he was sent to be restored to competency, has concluded that the administration of psychotropic drugs to Murphy is medically appropriate.
    Sengel called "bizarre" an attempt by Murphy's attorneys to undermine that conclusion by suggesting that testing and possible treatment for an advanced stage of syphilis are the medically appropriate course. "The purpose of this hearing is not to determine what illnesses the defendant has but whether he may be treated as professional physicians recommended," Sengel said. "The question for the court is whether to allow involuntary antipsychotic medication, not whether to order it."
    Doctors have concluded that Murphy does not exhibit any symptoms that warrant further testing for neurosyphilis, Sengel wrote. Murphy's attorneys believe their client may suffer from an advanced stage of syphilis, which could account for his psychotic behavior. In addition to establishing that medication is medically appropriate, prosecutors must show that such treatment is necessary for the safety of Murphy and others. Murphy's attorneys said that if their client, who has attacked other inmates at the facility, is a danger, then it is because he has been allowed to freely move about without restraints. Sengel said that more isolation and confinement do not address the government's interest in treating Murphy's illness.  Murphy was sent to the state facility after he assaulted one of his attorneys in court and was later found incompetent to stand trial in Kevin's slaying. Kevin was killed April 19 in an unprovoked knife attack while playing in a front yard in the Del Ray section of Alexandria. Murphy is charged with capital murder and with maliciously wounding two adults who tried to help Kevin.

Arabic Group Tackles Cultural Beliefs That Are Barriers to Treating Domestic Violence
Patricia Anstett, Detroit Free Press- 3/27/2001

The abuse started on her wedding night.  Her husband, nearly twice her age, slapped her when she told him she didn't want to have sex. She was a frightened 16-year-old who had never been intimate with a man. During the worst part of their marriage, he called her names, tore up her clothes and threw food in her face or on the floor, sometimes in front of their children, says the young mother, who asks not to be identified. Even after she divorced him, he stalked her and followed her when she took their children to school, she says.
    She credits her survival during "the most miserable years of my life" to the Dearborn-based Coalition on Domestic Violence and one of its key people, Hoda Amine, PhD, a mental health therapist with the Arab Community Center for Economic and Social Services (ACCESS). "Dr. Amine was there in the most broken time of my life," she says. "She believed in me, and that's what made me believe in myself. She would listen to me anytime. If I paged her, she called me right back. I told her, 'I wish that one day I can do for you what you do for me.' She told me, again and again, 'You must believe in yourself.' "
    Domestic violence coalitions can be found throughout the United States. Experts say these affiliations vastly improve the effectiveness of every part of the system, for victims, offenders, police gathering evidence and courts prosecuting the cases. What's unique about the effort in Dearborn, a city that has one of the nation's largest concentrations of immigrant and refugee families from the Middle East, is the focus on the Arabic community.  Domestic violence is not greater among Arabic people, coalition leaders say. But cultural issues, along with incorrect interpretations of religious tenets, have kept the problem unaddressed and misunderstood, they note. "This really was a taboo," says Diana Itawi, a Muslim woman hired by ACCESS to forge alliances with mosques and other community institutions. "No one wanted to talk about it." The coalition's work may help other regions develop culturally sensitive programs for religious and ethnic populations.
    Notably, too, many men have been involved in the Dearborn coalition. When it conducted a benefit banquet in October, men made up more than half of the 300 people assembled to hear domestic violence speaker Denise Brown. She has become a leading spokeswoman since the brutal slaying of her sister, Nicole Brown Simpson. "We have a successful model here," says Adnan Hammad, PhD, health director at ACCESS. "People need to understand that domestic violence is not only a problem of women, but of children, families and society. We need to make everybody realize that domestic violence is not the way to treat ourselves."

Two sisters make a difference
Anahid Kulwicki, PhD, an Oakland University professor of nursing, began thinking about solutions after receiving many calls from doctors saying, "I have an abused woman here." Several religious leaders encouraged her to do something. "Maybe it's time," she recalls one saying. With her sister, Hermine Dervatanian, a former ACCESS worker who headed the organization's domestic violence prevention program for 5 years, the two women searched professional journals for research about domestic violence in the Arab community. They found almost nothing. But Kulwicki knew there was a problem. In 1989, she conducted a study of 362 teens randomly selected from a teen clinic list at ACCESS. She found that 12 percent reported they had been physically abused in their homes.
    Kulwicki tapped foundations to help. The Kellogg Foundation gave $85,000 for a study to assess needs of Arabic women who had experienced partner abuse. The March of Dimes contributed $10,000 to create brochures in Arabic about abuse of pregnant women. Another $50,000 came from the Michigan Department of Community Health to develop an intervention plan and programs for victims. The Michigan Women's Foundation gave $35,000 to hire a staffer for outreach efforts. And last year, the Blue Cross Blue Shield of Michigan Foundation authorized $75,000 to assess barriers to domestic violence services among Arabic people.
    With the first grants, Kulwicki and Dervatanian focused on three goals: a study of attitudes among Arabic men and women about domestic violence, a mass media campaign with Arabic materials and a prevention program. Kulwicki surveyed 200 Arab clients randomly selected from a list of 4,000 clients seen at ACCESS centers. The results, published in the May-June 1999 Mental Health Nursing journal, found that a majority of Arabic men and women approved of physical abuse if a woman ignored what her partner told her, if she hit him first or if she was unfaithful to him. The findings shocked Kulwicki, as did reluctance to fix the problem. People said to her: "Why are you doing this? We don't have a problem," she recalls. Others cautioned, "If we say something negative about ourselves, it will make us look bad."
    The two sisters pressed on. Dervatanian developed news releases, three cable TV programs and public service announcements aired on local Arabic radio and TV shows. They held workshops -- first two for nurses, then nearly two dozen others attended by more than 500 people in the community. One held Sept. 12, 1997, is permanently etched in her memory. There were insults and yelling. Part of the problem was that Kulwicki is Christian, not Muslim, and people said, "How can you bring someone in here and tell us about our life and religion?" Diana Itawi says. The reaction was so bad that ACCESS nearly closed Kulwicki's program. She convinced ACCESS to resume the work and hired Itawi, a Muslim mother who worked as a secretary at one of the area's mosques. "I told her, 'I need a strong woman to get the message out to the mosques that this is important and that this is not what the Koran says.' "  Itawi led the next meeting, a panel discussion that included police, lawyers, health-care workers and social workers. Kulwicki sat in the audience.
    "Here was a group of people from the (Muslim) community saying what is going on is wrong, illegal and it must stop," Itawi says. The meeting was scheduled for 7:30 to 9:30 p.m, but it ran past 11 p.m. The meeting struck a chord with several religious leaders. Most were spending many hours counseling families with the problem. "If you ask some of the men why they hit their wives, they'll say, 'My religion allows me,' " says Imam Hassan Qazwini, with the Islamic Center of America in Detroit. He's one of several Muslim religious leaders instrumental in the effort. He tells couples flatly: "Islam does not condone beating women." After Qazwini appeared on a cable TV program to discuss the problem, some men called him and accused him of being biased, he says. "You're taking sides with women," he recalls the men saying to him. He responded: "I'm not taking sides with women. I'm taking sides with my religion." He helped write an explanation, since reprinted many times, that focuses on what Islam and Christianity say about family violence. It quotes from the Bible, the Koran and translated sayings of the Prophet Muhammad. Mostly, he says, men listen when he asks one question: "Twenty years from now, if your daughter shows bruises, how would you feel?"

One survivor's story
The campaign successfully reached more than 100 Arab women. ACCESS asked Dervatanian to head a support program for victims, a job she held for 5 years until last fall, when money ran out. She now works for a law firm. There are no new funds forthcoming to resume her work. Help also came when the Oakwood Healthcare System took on the campaign and tapped Lisa Rutledge, a woman with the title system facilitator, to print $25,000 worth of posters in English and Arabic with small cards telling women how to get help. More than 100 hospital volunteers regularly check pockets with pullout cards on the posters to see that they never are empty. Now, Rutledge says, "when I go somewhere, they say, 'There's the domestic violence lady.' I've been working in the health field for 20 years, and it's the thing I'm most proud of."
    One of the women to respond to the campaign was Heidi, a name she chose to use to protect her identity. She, too, worries about rekindling abuse from her ex-husband. She was 16 when she married an older man. He was overprotective and even refused to let her finish high school, as he had promised, she says. If he didn't like what she said, he embarrassed her, she says. If he thought a meal was too salty, he would turn over the table and yell. When she persisted with her school plans, and later a job, he ridiculed her. Once, when he couldn't find money that he had stashed inside furniture so she couldn't find it, he threatened her with a knife, she says. He told her that he planned to take their three children back to the Middle East, where she'd never see them again. Outwardly, she tried to hide the abuse and her depression. Inside, she wanted to kill herself. "No one knew I spent so many nights crying by myself," she says.
    She grew, with a new job and counseling from Dervatanian. "Every time I accomplished something good, I gained confidence," she says. In all, she and her husband divorced three times. She attributes the two reconciliations to her desire to keep the family together. These days, she is in a new job, living with her children miles from Dearborn, happy to have her life moving in a new direction. "I feel like it's time for me to succeed," she says. "My kids are happy for me. "I want to send a message to women. They should know that you need to love yourself so others can love you. I want to tell them: 'I know you are suffering. If I can make it, anybody can.'"

Batterers learn a few lessons
Ever since she started as a mental health therapist at ACCESS in 1988, Hoda Amine has received calls from women needing help. Some Arabic women told her that local domestic violence shelters didn't seem to understand them. The biggest issue was that no one at the shelters spoke Arabic. Now, many bring in Arabic women to help. Amine counseled many women. And she started the Arab Stop Abuse Program in November 1999. The 26-week, court-ordered program offers anger management and behavioral modification techniques for offenders. Men found guilty of domestic violence either have to go to jail or enter the program, which requires them to pay $25 a session.
    "There are no funds really," she says. "I do this on my own." One tedious task is translating domestic violence materials into Arabic. "We need funds just for translation," she says. For the legal assistance her clients need, Amine has coaxed lawyers into taking some cases free. One attorney she enlisted, Carlo Martina, grew up in southwest Detroit. Eighteen of his 23 years as a lawyer have involved representing women and men in domestic violence cases. He says: "I've seen auto executives, physicians, lawyers and others. Domestic violence really affects all segments of society. I give this community so much credit for taking on this issue."
    Nine men began the most recent course Amine is conducting. If a man misses three sessions, "he's out of the program," she says, and referred to court authorities for failure to comply with the order. On a recent Wednesday morning, four men show up. All are in their 20s and wearing casual work clothes. All have separated from their partners. The most articulate man pokes at the frayed hems of his jeans and talks about his own shame for abusing his wife. When Amine asks how he feels, he acknowledges: "Not good. I'd rather be liked than feared." A second man tells of feelings of low self-esteem because his American partner ridiculed him and did things behind his back like using drugs. "What happened to me, I can't forget," he says. "I feel stupid. "I've learned from this class how to use my mind. I've learned how to stop a problem before it gets worse."

A team of advocates, cops, imams
   Julie Valicenti begins each workday by checking the detectives' case book for domestic violence cases involving Arabic families. There usually are one or two among the six or so cases detectives began the night before. Men who have been arrested the night before face morning court hearings.  Her job entails representing the victims in court, all the way through the usually months-long process. From a small office in the Dearborn Police Department's detective bureau, she offers whatever help a woman needs. "I'm part social worker here," she says. She also helps with immigration, transportation, child care, finances, housing and welfare issues. She arranges police escorts for women coming to court to testify against their partners and finds a safe spot for them if necessary inside the courthouse. She has written embassies to help women who were forced to return to their native countries when they divorced their spouses -- a problem since resolved by the passing of a federal law last year. "A large part of what Julie does is make connections," says Barbara Glasson, the community-based program supervisor who oversees eight other victim advocates.
    Dearborn police and court officials say they have benefited from having a victims advocate in the building. "We were able to take a giant step forward because of her," says inspector Michael Strum. The department has formalized the way it handles domestic violence cases and works hard to bring in translators. There are many obstacles, including a victim's reluctance to press charges and the tendency in the Muslim community to avoid contacting the police initially. "We prefer not to call police the first time," says Imam Qazwini. "It goes out of control." He prefers that couples seek counseling with an imam. After three calls and no resolution, he gives couples a chance to obtain a religious divorce, a process distinct from a civil divorce through the courts.
    Cpl. Jimmy Ferris, who is involved with the coalition, says the police better understand these kinds of objections. "Our goal is not to break up the family, but to bring peace to it," he says. "Police have to act. We are in the business to protect lives. We wish if there's a problem in a household that they seek help early, through family, church and friends. But if the problem is to the point where it's endangering them, they should call the police."  With 8,000 to 10,000 new Arab immigrants moving each year to metro Detroit, "our job has just started," he says. Still, the last 5 years have proved that the community supports the issue, says Adnan Hammad, ACCESS health director. "This has been a very positive response," he says. "The community can be proud of what it has accomplished."
    For more information about the Coalition on Domestic Violence, contact: ACCESS, 2651 Saulino Court, Dearborn 48120; 313-843-2844, 9-5 weekdays. The ACCESS Web site is www.accesscommunity.org.

Home Detox: Mom's Lockdown Helps Daughter Kick Habit
ABC News, 3/30/2001

March 30 — In November 1998, Desirée Danner was passed out in her expensive Houston home when her mom, dad and brother, converged on her house like a SWAT team. She opened the door and they burst in and grabbed her. Her mother pinned her down, and her father dragged her outside to the car. After the "kidnapping," they sped away to her parents' home, 35 miles away. Once there, Danner, a 28-year-old woman who had a six-figure salaried job and a beautiful home, was basically in lockdown. Her family tapped the phones and bolted the windows so that she couldn't call anyone or escape to buy cocaine, a habit that she had been spending $800 a day on. Danner told ABC News' Good Morning America that her cocaine addiction was so bad at one point that her nostrils gave out on her. Once she couldn't snort the cocaine anymore she turned to crack, until her mom stepped in.

Mom's Lockdown
For two weeks, Brenda Romero, watched her daughter's every move with the scrutiny of a prison guard. Romero had cleared the house of anything that contained the least bit of alcohol: mouthwash, vanilla extract, Italian dressing with wine in it, and cough syrup were all gone, because alcohol could trigger a craving for drugs. "It was either let her do what she was doing, let her die or save her," said Romero on ABCNEWS' Good Morning America. Her mother fed Danner vitamins, herbs, fresh fruits and vegetables, watching as she chewed and swallowed. She had read that detox took 7 days, but she decided to keep watch over her daughter for 21 days " and really get it out of her system," Romero said.

Sweating it Out
That intervention was what it took for Danner to finally get control of herself. She then went to Narconon, a rehab facility in Newkirk, Okla., for 100 days. There she shook off the addiction, sweated out the drug toxins in a sauna, exercised, and attended classes on addiction. Danner is part of an upward trend of powder cocaine use among young people. A University of Michigan study shows that powder cocaine use by those between the ages of 19 and 28 jumped 33 percent between 1993 and 1999. Americans spend $39 billion per year on cocaine, with 5.2 million users of cocaine and its derivatives, and 3.3 million addicts, the President's Office of National Drug Control Policy estimates.
    By the time her parents intervened, Danner had lost 30 pounds, much of her hair had fallen out from malnutrition, and powder coke had eaten a hole in the cartilage of her sinus cavity. Her addiction caused Danner to lose her job as the top sales executive at a country music station in Houston. There, she considered cocaine use with clients as "just part of the job," and over four years, she rose to the top of the sales staff. But as her addiction grew, her boss got suspicious about her unhealthy appearance and slipping sales figures and figured out that she was on drugs. Danner and her then-boyfriend were each spending $800 a day to get high.

A Troubled Youth
In high school, Danner had been a cheerleader and overachiever, but she had some secrets. As a girl she had been molested. And at 15, she had cancer and had to have both ovaries removed. The operation made her look pregnant, and rumors spread around school. To fit in, she hung out with a more accepting crowd, and started using pot and cocaine. Romero never suspected her daughter's drug use, though she was concerned about Danner's sales job, because it required her to do so much entertaining, and drinking. The first time Romero tried to get her daughter into an addiction program, the doctor diagnosed Danner with bipolar disorder and gave her antidepressants. Four days later, he discharged her as cured, and within days she was back on drugs. That was when her mother executed the kidnapping. And that's what put her on track for recovery, Danner said. She is now a counselor at Narcanon, and has been clean for two years. She is married to another counselor, and they live in Oklahoma.

Revisiting Electroshock Therapy
Benedict Carey, Los Angeles Times- 3/30/2001

"It was a brilliant cure, but we lost the patient," Ernest Hemingway remarked famously after receiving electroshock therapy for depression in 1961. Forty years later, a new study finds that the cure rate for the controversial treatment is far from brilliant, even when combined with drug therapy. In a six-month study of 84 severely depressed adults, psychiatrists in New York found a relapse rate of almost 40% among those who had the electroconvulsive therapy, or ECT, followed by an antidepressant drug regimen. Almost 90% of those who had only ECT plunged back into depression. Some consider electric shocks to be worthless and gruesome, as it was portrayed in the 1975 movie "One Flew Over the Cuckoo's Nest." But many psychiatrists insist the treatment is extremely effective as a last resort for people who don't respond to drugs. Major depression strikes about 10% of American adults, or about 17 million people, according to most estimates, and many of them simply don't do well with counseling, drugs or a combination. In Hemingway's time, when ECT was used more often as a first choice, psychiatrists boasted a cure rate of about 50%, six months after the treatment was stopped. This study, write the authors, "suggests that the prognosis following ECT is more guarded today."

Reports Show Inmate's Emotional Ups and Downs
John McCarthy, Associated Press- 3/31/2001

COLUMBUS, Ohio (AP) -- Death row inmate J.D. Scott suffers from mental illness to the point that he hallucinates that he is hearing voices and has had bouts of psychotic behavior when he is not under medication, according to documents his lawyer provided on Thursday. Scott, convicted of aggravated murder for the slaying of a Cleveland delicatessen owner during a 1983 robbery, is scheduled to be executed on April 17. Scott, 48, has appealed to Gov. Bob Taft to reduce his sentence to life in prison without the possibility of parole. A clemency hearing before the Ohio Parole Board is set for Tuesday. The board then will make a nonbinding recommendation to Taft on whether to spare Scott's life.
    On May 6, 1983, Scott and an accomplice entered the V&E Delicatessen in Cleveland and ordered something to eat from owner Vinnie Prince. After Prince prepared their food, the 74-year-old woman was shot in the chest at near point-blank range during an attempted robbery. Sentenced to death for the crime in 1984, Scott is close to becoming the first Ohio death-row inmate to be put to death against his will since 1963. His lawyers on Thursday provided scores of documents to Taft's office, Attorney General Betty Montgomery and others questioning Scott's mental state and whether jurors were aware of his background.
    The release of the documents was an attempt at delaying Scott's execution, Montgomery spokesman Joe Case said. ``Scott's attorneys are following the strategy they telegraphed back in February. We tried to expedite the whole issue of his competency,'' Case said.  Scott is a schizophrenic whose life should be spared because of his illness and other factors, his attorney, Timothy F. Sweeney said. Before Scott was sentenced, the jury never heard about his illness or upbringing because his then-attorneys never introduced it into evidence during the mitigation phase of the trial, said Sweeney, who does not question Scott's guilt.
    Scott is one of 11 children, whose parents both were alcoholics. One of is brothers was shot to death, another was paralyzed by gunfire and a third also suffers schizophrenia, Sweeney said. The jury never learned about it because the defense lawyers ``evidently believed'' that disclosures about Scott's past, including criminal behavior, would have swayed the jury toward the death penalty. ``In order to put the jury into a position to where they can begin weighing mitigating evidence, you've got to put something in front of them,'' Sweeney said.
    Sweeney, who was appointed with another lawyer to take over Scott's defense in 1996, won a reversal on the sentence in federal court but then had the reversal overturned in the 6th U.S. Circuit Court of Appeals. The U.S. Supreme Court declined to hear Scott's appeal and the Ohio Supreme Court set Scott's execution date on Jan. 31. Evidence that Sweeney has sent to Taft and to the parole board includes medical evaluations of Scott from defense consultants, and staff at Mansfield Correctional Institution, where he is currently housed, and the Southern Ohio Correctional Facility, where he began his wait on death row.
    Dr. Margarette B. Rogler, a psychiatric consultant at Mansfield, evaluated Scott on April 10, 1996. She found he had stopped taking medication for his schizophrenia. ``He was actively hallucinating and the voices were telling him to harm himself. I checked throughout his chart and I really don't understand how this patient stopped having medication. He was taking his medication faithfully through January 30th when it expired,'' Rogler wrote in her report. ``He was setting a fire, flooding toilets, etc. He once again flared up and I don't know what is going on that he exacerbates in this manner. ... There is a possibility of some substance or alcohol abuse but I don't know.'' On March 9, 1995, Rogler wrote that Scott was displaying paranoid behavior, though she had doubts about his motive. ``At this time, there is a clear indication of strong paranoid ideation. He felt that they were southern people who didn't like black people and 'treated people like they were picking cotton,''' she wrote, but added, ``The possibility of malingering for goal oriented aim of removing himself from SOCF is strongly suggested.''
    Taft's lawyers are studying the documents and will consider them after the parole board makes its recommendation, said Kevin Kellems, the governor's spokesman. ``The governor takes very seriously this responsibility. Assuming he receives a report and recommendation from the parole board at some point, he will take great care and spend a significant amount of time and attention studying the case and reviewing the request,'' Kellems said. Taft allowed the execution of Wilford Berry, who killed his boss during a robbery, to proceed in February 1999. Berry, known as ``The Volunteer,'' had dropped his appeals in the case and became the first person executed in Ohio in 36 years.

Recent Studies Expose Dangers in Chronic Sleep Deprivation
ABC News, 3/31/2001

Tens of millions of Americans suffer from a condition that until recently, most health professionals did not take seriously. It can accelerate the aging process, lead to obesity and increase the risk of some diseases. It's garden-variety sleep deprivation and it might be more of a problem than you think. For the first time, scientists are looking seriously at what happens to our bodies when we live on five, six or seven hours of sleep a night and what they're finding is shocking.

Upsets Blood Sugar
Dr. Eve Van Cauter is a sleep science trailblazer whose research team at the University of Chicago recently published the first study to specifically examine the physical health impact of ordinary sleep deprivation. She calls the impact of sleep debt on the body, "astonishing." After four hours of sleep for six consecutive nights, healthy young men had blood test results that nearly matched those of diabetics. Their ability to process blood sugar was reduced by 30 percent, they had a huge drop in their insulin response, and they had elevated levels of a stress hormone called cortisol, which can lead to hypertension and memory impairment. "We had results that were more compatible with individuals 60-years-old than with young, fit men in their early '20s," Van Cauter explains.
    Perhaps equally incredible is that until Van Cauter's study, most scientists believed that sleep debt did not cause any significant physical problems. "The concept that sleep is for the mind not the body prevailed and so no one was really looking at the possibility that sleep loss has an impact on health," Van Cauter says. Though subjects in the study slept only four hours a night, Van Cauter says sleeping six or seven hours might be just as dangerous. "Six hours instead of four hours, would have a similar impact but would just take a longer period of time," she says.
    After the experiment, the six men could make up for their sleep debt. It is unclear, however, how sleep debt affects the body over long periods of time. Van Cauter's early findings suggest that chronic short sleepers have a hard time keeping their blood sugars stable, which makes them prone to insulin resistance and obesity. Experts are now speculating that lack of sleep could be the missing link in understanding America's obesity epidemic.

Slows the Mind
The military's leading sleep expert, Colonel Gregory Belenky has long been concerned about the effect of sleep deprivation on America's hi-tech warriors. Now he is looking beyond safety and performance to uncover the biological damage that might result from sleep deprivation. His research shows that "brain function is degraded by prolonged waking." Belenky's high-tech brain images show that sleep debt decreases the entire brain's ability to function — most significantly impairing the areas of the brain responsible for attention, complex planning, complex mental operations, and judgement. What most surprised Belenky, however, is the difficulty with which the brain recovers from sleep deprivation. Even after four eight-hour recovery nights of sleep, Belenky's subjects were still making more errors than when they started.

Trying to Cheat Nature
The United States is becoming a nation of chronic short sleepers. In 1910, most Americans slept nine hours per night. Now, the average night's sleep is seven and a half hours and the trend shows no signs of flattening. Though millions of Americans routinely get fewer than six hours, the vast majority needs at least 8 hours per night. Dr. David Dinges, chief of the Division of Sleep and Chronobiology at the University of Pennsylvania, estimates that only 10 percent of Americans can consistently sleep fewer than eight hours per night without harmful effects on one's health. Many people, he says, need as many as 10. "If you're a nine or a nine and a half-hour need, and you're sleeping eight, you're developing a sleep debt — there's no way to cheat Mother Nature," says Dingis.

Fighting Fatigue
Though you cannot cheat Mother Nature, many people try by guzzling cup after cup of coffee. Dingis explains that the lift a cup of coffee gives is in fact an extra boost of stress. "When you use caffeine heavily during sleep deprivation, you have an elevated level of stress hormones occurring in the body and that's not particularly good," Dingis says. Other people who suffer from sleep debt blame their environment, saying that their meeting or lecture is too boring to keep them awake. Dinges says this is denial: "If you're bored, you're awake, you're just bored. If you're bored and you fall asleep, you've got a sleep debt."