Noteworthy News Articles on Mental Health Topics, May 27-31, 2001

Abuse More Common Than Most People Know
Crystal Harmon, Bay City Times- 5/27/2001

Narcotic drugs designed to soothe suffering have created an epidemic of despair and destruction in Bay City and across the nation. As police hinder the flow of illicit narcotics like heroin and cocaine, the abuse of prescription drugs fills the void. Proof of the devastation abounds.
    In March, a Bay City couple died after taking a toxic mixture including several different pain-killers doctors had prescribed to combat pain and depression. Last weekend, a Bay City woman with terminal cancer told police that her daughter, who is her caretaker, gave her enough medication to knock her out before fleeing with 51 Oxycontin tablets. The so-called "synthetic heroin" is one of the most sought-after pills, with tablets fetching up to $80 each on local streets. Last month, the Michigan Board of Pharmacy disciplined Kessel Pharmacy on Euclid Avenue for failing to report the disappearance of 25,000 pills of Vicodin - a highly addictive painkiller favored by abusers. And the Bay Area Narcotics Enforcement Team recently arrested a group of Bay City people who were scanning prescription forms into computers and writing their own tickets to potentially fatal doses of drugs.
    "Prescription drugs will become even more important as we are more successful in curtailing the supply of cocaine and marijuana," said Lt. John Card, commander of BAYANET. "Prescription drugs are much easier to obtain and much harder to scrutinize." Bay County Prosecutor Joseph K. Sheeran sees the trend, too. "From my perspective, we've seen an increase in cases involving the abuse of prescription drugs," Sheeran said, adding that his office doesn't keep track of the numbers of those cases.
    In 1999, an estimated 4 million people - 2 percent of the population age 12 and older - were abusing prescription drugs, according to the National Institute on Drug Abuse. The Drug Abuse Warning Network, which collects data on drug-related hospital emergency room episodes, reported that the number of patients visiting an emergency room for Vicodin overdose increased 37 percent nationally from 1997 to 1999. Locally, emergency room visits for drug abuse and drug overdose have actually declined steadily over the past five years, said hospital spokesman Kurt Miller. In 1997, 468 such admissions were reported. Last year, that number was 300. As of April 30 this year, 107 drug-related admissions were reported. The hospital doesn't differentiate between cases involving prescription drugs and those involving illegal drugs.
    While alcohol continues to be the abused substance of choice in the Bay City area, Margo Charlebois, executive director of Bay Area Social Intervention Services, said she's noticed an increase in prescription drugs as well as "club drugs" manufactured overseas, drugs like Ecstasy. Part of the problem, Charlebois said, is that some doctors are "unfortunately generous" in prescribing highly addictive drugs to people. Add that to the increasing prescription fraud and a lack of formal tracking of prescriptions for all but the deadliest medicines, and the supply has no trouble keeping up with demand. "It's difficult because people sometimes do have legitimate pain," Charlebois said. "They have an ongoing condition that needs treatment, and that can make it tricky sometimes."
    Lt. Card said, despite a formal tracking system for all but the most dangerous prescriptions, alert pharmacists and doctors are often the best defense against prescription abuse. Professionals report that patients have gone from doctor to doctor seeking narcotics, or are filling prescriptions out of town, or even have forged a prescription, and often alert law enforcement officers of suspicious activity. A week ago, state attorneys general met to discuss the possibility of a nationwide plan to combat prescription drug abuse. They're going to look at efforts that have shown promise in some states, such as computerized databases that allow doctors, pharmacists, police and prosecutors to see who's filling what prescriptions and who's writing them. People concerned that a friend or family member may be abusing drugs - prescription or otherwise - should watch for changes in sleeping patterns or behavior.
    But BASIS no longer offers residential treatment programs. No place in Bay County does. Sometimes such intense treatment is needed to kick drug addictions, especially when physical withdrawal kicks in. Meanwhile, Charlebois said, people should keep in mind that just because a drug is legal doesn't mean it's always safe. "Sometimes there's a mindset that, 'Hey, the doctor prescribes these, so they can't hurt me,' " she said. "That's not necessarily the case.

University of Houston's Program for Autistic Kids Put on Probation
Todd Ackerman, Houston Chronicle- 5/28/2001

Under fire from disgruntled parents paying its high fee to enroll their autistic children, a prized University of Houston project has been placed on de facto probation by the program's renowned national founder. The probation follows months of phone calls four families placed to Ivar Lovaas, a UCLA psychologist who created the program, which has mainstreamed many autistic children who began its nearly round-the-clock behavior-modification therapy at an early age. The parents complained they were paying for "the Rolls-Royce of autism programs" and not receiving it.
    "Parents have written and called me regarding their concerns about the treatment their children are receiving," Lovaas wrote Gerald Harris, director of the UH project, in a May 2 letter. "Their concerns are many and serious and reflect unfavorably on both" the UH project and the University of California at Los Angeles program. Lovaas listed 14 criteria for improvement and said the project will be evaluated after a six-month trial period "in regard to its adequacy as a UCLA-approved clinical site." The parents also took their concerns as high as UH's board of regents and general counsel and received a May 3 response from John Vincent, chairman of the psychology department, which houses the project. Vincent, out of town and unavailable for comment, said in the letter he was "very concerned" and will develop a plan to address the problems as quickly as possible.
    UH's Texas Young Autism Project, launched four years ago and modeled on Lovaas' program, represents a tiny battleground in the war against autism, a neurological disorder that impairs language development, communication and social interaction, locking victims (one of every 500 people) into an isolated world most never exit. So intensive it calls for eight to 10 therapists' giving each child 35 to 40 hours of one-on-one training a week, the project can enroll only a handful of children, whose parents pay a tuition of about $57,000 a year. (Lovaas said the fee is cheaper than the $650,000 to $1 million that society otherwise has to pay to institutionalize each autistic person over a lifetime. According to Lovaas' study, 47 percent of children who started his program at UCLA by age 3 achieved normal intellectual and educational functioning by first grade.)
    But the UH parents complained that, on average, their children receive closer to 30 hours of training a week and that student therapists who come to their homes to provide their children's treatment are unreliable, often late or no-shows, and uneven in quality. The parents also complained that they are receiving little training that would allow them to continue their children's treatment at times when no therapist was present and that their children are receiving no language and speech instruction.
    But first and foremost, some parents are angry that UH's project apparently lost its affiliation with Lovaas and didn't inform them. The project was terminated in December as an official Lovaas "replication site" -- one of 16 centers in the United States and around the world trying to show the same kind of results obtained at UCLA. Then, in May, Harris received the letter outlining the steps necessary to maintain any Lovaas affiliation. "We were willing to pay for the Rolls-Royce of autism programs," said Steven Minchen, who pulled his son from the project in April and is demanding reimbursement of $70,000. Another family removed its child from the program in the fall, and a third plans to pull its child in the summer and enroll him in a private center in Sacramento, Calif., even though the father will have to commute from Houston until he can find a new job. The mother, Melissa Bowden, accused UH of lying and said she is "appalled" that a university would act in such a way "when a child's life is in its hands."
    Harris played down the criticisms and said he feels good about the health of the project. He noted that its termination as a Lovaas replication site was wholly about its not enrolling enough children to meet the requirements of a research grant, an academic matter he didn't think parents would care about. He said the project continues to follow Lovaas' model and is directly supervised by a Lovaas-trained employee. "I didn't bring up the matter of the replication-site termination because it didn't impact the children's treatment," Harris said. "If someone had asked about it, I would have been glad to talk about it. As soon as I got a complaint that our Web site hadn't been updated to reflect the fact we are no longer a replication site, I took the Web site down."
    Harris said he is confused about the project's current affiliation with Lovaas because of seemingly contradictory statements from the UCLA psychologist. In his letter, Lovaas wrote that UCLA-approved clinical sites do not exist outside California, then enumerates the steps the UH project must take. Harris said it was his understanding the project was such a site, and parents said Lovaas told them the project was an approved clinical site on probation.
    In any event, Lovaas' 14 criteria included that Harris not claim the UH project is a UCLA-approved clinical site and that Harris not claim there are insignificant differences between replication sites and clinical sites. According to the letter, if the project is able to remedy the listed problems in the next six months, it can "claim to provide services consistent with the Lovaas/UCLA model." (Lovaas said in a phone interview that until he secures grant money to set up a national certification mechanism, the UH project's de facto probation represents his current unwillingness to give it his "blessing.")
    Harris said he had sought to implement the criteria Lovaas said the UH project needs to meet. The other criteria mainly concern better communication between project leaders and parents. They include ensuring that project leaders be present for the duration of weekly clinic meetings and thereafter; training parents to provide their children's treatment; forming a parent-advisory committee to meet with project leaders; and providing parents with informed consent and evaluation forms. They also include working to prevent student therapist no-shows or tardy arrivals and making calls to parents in advance of those occasions when schedule changes are unavoidable.  Harris disputed the parents' contention about hours. He said their contracts require that they must receive 35 hours of training a week and, though factors such as illness, vacation or finals may force a decrease in the number of a child's hours below 35 in a particular week, all have averaged at least 35 hours.
    Audri Villalon, a junior psychology student and former project therapist, said therapists often called superiors when they could not make a scheduled appointment, as is policy, but superiors didn't inform the families. Noting that policy calls for firing therapists who arrive late on three occasions, Harris said that would be a concern if true.  Villalon and other former therapists said an inordinate number of therapists have quit recently. Harris said he is not aware of more than the five or so he typically loses each year to graduation or better-paying jobs. He said he usually adds about 12 new therapists a year. The former therapists described an understaffed environment. The project consists of Harris and a second-in-command with a master's degree who trained under Lovaas; four supervisors (typically graduate students or graduates); and 38 undergraduate student therapists, who volunteer in their initial years and receive modest pay as senior therapists in later hears.
    Some parents are happy with the project. Mellody Panzer said her 9-year-old son -- once closed off to the outside world and now in a normal second-grade class -- would not have made such progress without the UH project. "I think UH will get its act together," Lovaas said. "They have issues to attend to in order to improve, but most sites stumble at the beginning -- that's how you learn. The big thing is, their problems are not the service they're providing. They're administering the project."

Even As Their Ranks Increase, Kids With Split Parents Still Feel Alone
Martha Irvine, Associated Press- 5/29/2001

TRAVERSE CITY, Mich.--Sometimes just one little comment triggers the sad, nervous feeling Lauren Recchia gets in her stomach when her parents' divorce comes up, even four years after the split. ''You have a dad?'' a fellow third-grader asked recently when 8-year-old Lauren produced a homework paper her father had helped her complete the night before. ''It doesn't seem like you do.'' Comments like those only deepen the feeling that Lauren and many other children from divorced families say they have: Even though new data indicates single-parent homes are more common than ever, many still feel like outsiders.
    The University of Chicago's biennial General Social Survey, taken last year, found that more than a fifth of children in surveyed households lived in single-parent homes a fourfold increase since the first survey in 1972. The 2000 Census found a similar trend. Lauren is one of those children. Most of the time, she lives with her mother just outside Traverse City, a Lake Michigan resort town that counting the outlying subdivisions among the region's corn fields, hardwood forests and cherry orchards is home to about 78,000 people. She's with her dad, a doctor who lives nearby, on Wednesday nights and many weekends. ''We both get a lot of special one-on-one time with her,'' says Lauren's mother, Kim Coleman, a pediatrician. ''So that's been one good thing to come out of a difficult situation.''  Still, in the last year, Coleman has noticed Lauren worrying more about what people think, setting off those familiar butterflies or a case of the ''angries'' when the divorce, or her father's more recent split from his second wife, come up. ''When it bothers you,'' Lauren says, sitting on her bed at her mom's house, ''it bothers you a lot.''
    There are those children who say divorce has actually improved their lives. ''At first, it was the most horrible thing,'' says 14-year-old Tori Schemelia, who lives in East Windsor, N.J., with her father and his new wife. Now, says her 10-year-old sister, Emily, ''there's no yelling at all.'' Others say they never really get over it, including Timothy Dickey, a writer from Los Angeles whose parents divorced each other twice in the 1970s. ''I could probably guess if someone's parents are divorced or not, just by talking to them for a few minutes,'' says Dickey, now 32. ''There's more cynicism.''
    Even with the growing number of children going through divorce today, experts say services for them are sorely lacking, especially in a legal system known for pitting parent vs. parent. Andrew Schepard, director of the Center for Children, Families and Law at Hofstra University on New York's Long Island, helped found a court-based program in his county that is one of a small but growing number that provide social workers and therapists specifically for children of divorcing parents.
    The many children from divorced families she was seeing in her medical practice and the lack of coordinated services also inspired Lauren's mom to help set up the Divorce Resource Center in Traverse City 18 months ago.  She hopes what's starting as an information hot line will grow into a nonprofit center with everything from neutral space for parents to exchange children to bus service to the local women's shelter. ''Divorce is a part of our culture,'' Coleman says. ''We can either pretend it isn't there, or we can provide resources for people who are trying to make that transition.'' Among other things, the center tracks services for children, including a support group at one elementary school for students whose parents have split. Students at Sabin Elementary call it the ''divorce club.''
    To get them talking, social worker Deb Newhouse sometimes hands students a backpack full of rocks painted with the names of feelings and emotions that may be weighing them down. She holds up a green rock with the word ''SHAME'' on it. ''I'm always amazed how much they know what that is,'' Newhouse says.  In the end, kids often find they share the same worries. ''They want their parents to get along. They want to know it's not their fault,'' she says. ''And they want to know that even though the family looks different, they'll be taken care of.''
    One of the big things on Lauren's mind lately is her mother's upcoming marriage in August. She admits that she's having trouble sharing her mom with her new boyfriend. And she says she's also trying to give up a longtime dream: that her parents will get back together. ''It's like wanting a doll that costs a billion dollars,'' Lauren says. Her mom is aware of Lauren's feeling and divorce statistics. A new federal study found that nearly 40 percent of second marriages for women end in separation or divorce within 10 years. But she's optimistic her new marriage will give Lauren the sense of family she's been craving. ''I used to feel so bad for Lauren. I mean, my dad used to come home and give my mom a hug and a kiss. They've always been so respectful of one another,'' Coleman says. ''I want Lauren to know what that's like. And I think she will I really do.''
   On the Net:
KidsPeace site with divorce info for teens: http://www.teencentral.net
Children and Divorce site: http://www.childrenanddivorce.com

Therapists Reveal Their New Obsession: 'The Sopranos'
Deborah Stead, New York Times- 5/29/2001

Grappling with feelings of loss and abandonment now that "The Sopranos" has been snatched away from your Sunday nights? Nothing to be ashamed of here. Your therapist, should you consult one, may be enduring the same grief. Psychologists and psychiatrists around the country--especially the psychoanalytically inclined--have been watching the HBO series, which just ended its third season, with an almost cultish devotion. "So many therapists like the show," said Dr. Barbara Pizer, a psychologist who practices in Cambridge, Mass., and teaches at Harvard Medical School. "It's a heightened and condensed version of what goes on in real life."
    "The Sopranos" offers a refreshingly credible version of what happens in therapy, according to Dr. Pizer and other analysts. "It's the best representation of the work we do that has ever been in film or on television," said Dr. Phillip Ringstrom, an analyst at the Institute of Contemporary Psychoanalysis in Los Angeles. Last year, two of the show's writers Robin Green and Mitchell Burgess, got an award from the Western Regional Psychoanalytic Association for their portrayal of the therapy sessions of the show's main character, Tony Soprano, a New Jersey Mafia boss plagued by panic attacks.
    Last month, at a meeting of the psychoanalytic division of the American Psychological Association, Dr. Ringstrom packed the room with a presentation about the therapeutic effect of Tony's need to keep mob-related secrets from Jennifer Melfi, his psychiatrist. And during the show's past season, the online magazine Slate featured the running commentary of four psychoanlaysts, including Dr. Ringstrom, who traded insights after each episode. "We're obsessed with the show," said Dr. Glen O. Gabbard, another of the Slate commentators, speaking about colleagues on each coast and at the Menninger Clinic in Topeka, Kansas, where he is a professor of psychoanalysis. Dr. Gabbard, the author of "Psychiatry and the Cinema," said he was grateful, finally, to see "some semblance of real psychotherapy on television." Of the films that have psychotherapy as part of the plot, only a handful are real-life depictions, he said. "And 'The Sopranos' beats them all," he added.
    Part of the show's lure is the chance to indulge in armchair analysis. After all, Tony Soprano (a "sociopath," a "criminal, not a sociopath," a "psychologically complex psychopath" or a man with "a vertical split," depending on whom you ask) was raised by a rejecting mother and a mobster father. He picks dangerously needy women for his extramarital affairs. He is sexually attracted to Dr. Melfi. From time to time, he kills people. And he occasionally uncovers disturbing memories--his mother issuing horrifying threats or his father chopping a finger from the hand of a local butcher who wasn't paying up. All of this is presented in "sophisticated detail," said Dr. Emmanuel Kaftal, a psychologist in private practice in New York and New Jersey and a supervisor in the postdoctoral program in psychoanalysis at New York University. "The writers weave in things," he said. "It's like a gift."
    "The Sopranos" has become an endorsement of sorts for psychoanalysis at a time when the process is seen by many as outdated, given the current stress on biological theories and drug therapy. "I think we're being offered a new myth about ourselves," said Dr. Kaftal, adding that the show had upended the image in Freud's work of a male analyst working with hysterical female patients. The new image, coming at a time when women account for more than half of all psychotherapists, he said, "centers around the female and her relationship to an exaggerated male value system."
    Dr. Gabbard agreed that Dr. Melfi was something new in popular culture. Female therapists in American films, he said, are usually portrayed as being unable to resist "countertransference love," as he calls it. "Think about Ingrid Bergman in 'Spellbound' in love with Gregory Peck or, more recently, Barbara Streisand in 'Prince of Tides' falling for Nick Nolte," he said. "Most of my female colleagues are so delighted to see a professional, ethical psychiatrist that they are beside themselves." Indeed, Dr. Gabbard said, he has used taped episodes that show Dr. Melfi "masterfully" dealing with Tony's erotic transference to teach psychiatry residents at the Menninger Clinic.
    Not every therapist is delighted with "The Sopranos." Some psychoanalysts opposed the idea of giving an award to the show's writers last year, and organizer of the regional psychoanalytic conference said. But such analysts are difficult to find. Perhaps their patients have converted them by now. Dr. Ringstrom said all of the analysts at his presentation last month told him they had clients who watched "The Sopranos." And Dr. Pizer and Dr. Kaftal said the show surfaced in their sessions. Patients talk about all the characters, but typically bring up the show's therapy sessions first. Dr. Pizer says. "They ask, 'What do you think of Dr. Melfi?'" she said (Asked about her reply, she laughed: "You mean, after 'What do you think?'") A few of Dr. Kaftal's patients, meanwhile were riveted by the portrayal of the male psychiatrist who agrees to treat Tony's wife, Carmela, only if she leaves her husband and his life of crime. "They wanted to know why I didn't give more straightforward moral advice," he said. "I ducked it. I tried to get them to talk about it. But I really thought about it."
    It isn't just the therapy that draws therapists to "The Sopranos." Like other viewers, they say, they love the sharp writing, the plot twists, the humor. In fact, in some episodes the therapy isn't a draw at all. "Sometimes after a 'session,' I'm embarrassed to be identified with Dr. Melfi," said Dr. Pizer, the Cambridge psychologist. "I wish she were a little less uptight. And I would prefer that she not have such short skirts." Dr. Kaftal agreed that Dr. Melfi's manner seemed "stilted" at times. And Dr. Ringstrom said that occasionally he could "quibble with her technique." But the show is about something bigger, they said.
    "Mario Puzo gave us the mob as Greek tragedy," Dr. Kaftal said. "The Sopranos," he says, presents a version of bourgeois society. "It's the Mafia family as soccer mom, contending with suburban issues." It's a show in which little is spared, Dr. Ringstrom said. "Therapy is being challenged as an institution," he said. "The Mafia is, too. The Catholic Church is being questioned. The only social institution that survives the critique is Italian cooking."
    Now for the question of coping with void on Sunday night, Dr. Gabbard plans to co-commiserate. ("I'm getting emails from shrinks all over the country who are just as grief-stricken as I am.") Dr. Kaftal figures he'll watch reruns. ("Or I'll go to the show's website to get a hit.") Dr. Pizer said she would just deal with missing the show. And Dr. Ringstrom is at a loss. "I have no idea," he said. "Buy a lot of Italian wine. Probably be temporarily depressed."

Critics Claim That Youth Boot Camps Are Problematic
Lorna Collier, Chicago Tribune- 5/29/2001

Laura Martinez had tried everything from punishment to counseling in an attempt to straighten out her misbehaving 14-year-old son, Ariel, who was skipping school, disobeying and talking back to her. Nothing worked. Then Martinez saw a daytime TV talk show featuring a boot camp for teens. On the show, rebellious teens were transformed, seemingly overnight, by tough-talking, fatigue-clad drill instructors who shouted in the kids' faces, made them march like soldiers and taught them to respect their elders. Last December, Martinez, a Chicago saleswoman and married mother of three, sent Ariel to the About Face Boot Camp in rural North Carolina, at a cost of about $1,000 for two weeks' care. The camp, run by former Marine Raymond Moses, has been featured on the Jenny Jones talk show.
    "I was scared at first," said Ariel, who had to have his hair cut and was made to clean bathrooms, sweep floors, jog and march in military drills. "They would yell at you if you got them mad, if you didn't do what you're supposed to do." If you did what you were told, though, the instructors would be nice and tell jokes, said Ariel, who learned "not to take things for granted," especially TV, a luxury he especially missed while at the rustic camp. When Ariel came home, said Laura Martinez, "he was good for about two weeks." Then his old behaviors came back, leaving Martinez feeling that two weeks at boot camp was not enough time to change her son's ways. "It was a waste of money," she said, sighing, adding that she wishes instead that there were a boot camp or similar program closer to Chicago, where she could place Ariel for a longer period.
    Demand by parents for private boot camps for teens has soared in recent years, driven by daytime TV reality shows hosted by Maury Povich, Jenny Jones and others. Frustrated parents are encouraged to look upon such camps as a solution to problems with their teens--despite the fact that research has shown boot camps to be ineffective at best when it comes to changing teen behavior, critics say. "I disagree with the concept of boot camps," said Stacey Shapiro, director of juvenile justice for the National Mental Health Association in Virginia. "These `shock incarceration' programs have failed in the past for the majority of youth placed in them. The strict discipline and intense physical training, otherwise seen as punishment by youth, is not an effective deterrent and does not reduce recidivism." In addition, Shapiro warned, state boot camps have had a disturbing history of abuses, injuries and even deaths, causing many states to phase out or restructure such programs.
    Larry Brendtro, a professor emeritus of special education at Augustana College in South Dakota, has written several books about youth at risk and heads Reclaiming Youth, a training institute for professionals who work with delinquent children. Brendtro said that though some children "have received at least short-term benefits from the discipline and high expectations of boot camp," many other youths have had much less positive experiences.
    "The public popularity of a drill instructor in a Smokey the Bear hat compelling a smart-aleck teen to do push-ups obscures the system by which these programs run," Brendtro said. "A boot camp only functions as a bullying adult instills fear and then riles up the cadets to harass resistant peers. If these behaviors were used in any other normal community setting, they would be seen as assault and abuse." Brendtro, too, said that research has shown "no enduring crime-prevention benefits of boot camps." Yet parents continue to clamor for these programs.
    "A majority of our families come in first and foremost requesting information on boot camps," said Tessa Trass, who runs the not-for-profit Troubled Children Inc., based in Redmond, Ore., a service that helps parents find counseling or programs for their children. Troubled Children serves about 500 families per week, said Trass, and its Web site (www.troubledchildren.com) receives about 30,000 unique visitors each month. Trass said many parents, enthralled by sensational boot camp "quick fixes" on TV, think this is the only option for their child. Yet Trass said boot camps are not always the best choice. "A boot camp is just like basic training in the Army," Trass said. "You tear the person down and rebuild them. For some children, that's very successful--you need that discipline, that structure. But with children with self-confidence issues, who are already tearing themselves down internally, that's not going to be successful. "A lot of parents, because they are so frustrated, so angry and hurt, say this will be the `reality check' a child needs, but that's not necessarily true. It could be that's not going to be best for your child. Maybe there are some family issues going on that need to be looked at," Trass said.
    Raymond Moses, 33, founded About Face Boot Camp three years ago, after working in the corrections system, where he placed children in state-run boot camps. After receiving many requests from parents for a private camp they could place their children in, he started his Christian-oriented program as a weekend camp for local children. It quickly evolved and today the camp sees children from all across the United States and countries such as Canada, England and Russia, Moses said.
    Boys and girls ages 10 through 16 come to About Face during the summer months, for four-week sessions, as well as for shorter, one- to two-week camps, offered during school breaks. The cost is $500 per week. Moses also provides "home boot camps," at a price of $300 per day, in which he will come into a child's home, take away perks such as TV sets and video games, then make the child rise at the crack of dawn to begin exercising and chores.  Last year About Face was shut down briefly by North Carolina authorities when a camp resident complained of being handcuffed for three days, charges Moses disputed. Today the camp is back in business, and Moses is considering expanding it to include a school program so it can become a year-round military academy.   Though Moses claim an 80 percent to 85 percent success rate with children who have gone through his program, he agrees that boot camps are not going to work for every child. "We're a good tool to help motivate kids to make changes, but if the kid doesn't want to change, the program can't help them," said Moses, who also believes parents need to be willing to spend time with their children and change their home environment in order for permanent improvements to occur.
    Another voluntary boot camp, in which children can be placed without the order of a judge, is the Palm Beach County Sheriff's Office Youth Eagle Academy in Belle Glade, Fla., which is limited to residents of Palm Beach County. The camp is free; children, ages 13 to 16, must apply by writing an essay in their own handwriting, then meet with camp staffers before being accepted. "If they don't want to come, we don't take them," said Eagle Academy administrative lieutenant Bill Swain. The camp opened in 1997 and began accepting girls last fall. About 60 children (16 girls, 44 boys) attend each semester-long session, which includes school for most of the day, then chores, exercises and other activities. Parents are required to attend weekly meetings to learn parenting skills.
    Almost all other boot camps in the United States are state-run or require a judge to commit a child to their care. However, there are other teen programs that share many boot camp traits: physical exercise, labor and Spartan living in remote locations, where running away is difficult. Such programs are sometimes called "therapeutic boarding schools" or "wilderness camps"; some are marketed to U.S. parents but are in other countries, such as Jamaica or Mexico.
    Not all wilderness camps use the boot-camp model. Those that do, however, tend to be quite militaristic, with "an in-your-face, confrontational modality," said Mark Hobbins, senior vice president of Aspen Youth Services in Cerritos, Calif., which operates several youth outdoor programs that do not fall into the boot-camp category.  "Everybody can appreciate the value of living in a more primitive environment where you hope your child will begin to appreciate all that they have available to them," Hobbins said. "But we must be very cautious. That appeal has to be done in a very therapeutic and professional manner to produce proper results or you could end up harming a child."
    Unfortunately, some children have been injured or even died at wilderness camps in recent years. For example, Michelle Sutton died at age 15 in 1990 at Summit Quest, a camp in Utah, when she collapsed due to dehydration during a forced hike. Her mother, Cathy Sutton, has become an activist for camp safety, calling for federal regulation to correct the mishmash of state laws governing the industry.
    Pat, a teacher in New Mexico who asked that her last name not be used to protect her daughter's privacy, agreed to place her misbehaving 16-year-old daughter in a program in Idaho last year, at the urging of her ex-husband. Pat's daughter was taken from her high school in handcuffs by a professional "escort," then driven an hour away to the airport--still in handcuffs--where she was flown to Idaho. The program restricted contacts between Pat and her daughter, allowing only four visits per year, with no visits on Christmas Eve or Christmas Day, and only one phone call every two weeks. Phone calls and letters were monitored; Pat's daughter was told if she complained or asked to come home, she would lose mail or phone privileges. Pat pulled her daughter from the camp after about four months, over her ex-husband's objections. She said the program was characterized by emotional abuse, including intimidation, threats and sleep deprivation. Though the program cost about $30,000 for four months, her daughter received little in the way of education or individual therapy, said Pat, adding that her daughter spent "most of her time chopping firewood." "It's a profit-oriented racket," she said. "I'd advise parents never to resort to these facilities."
    Yet other parents say that residential teen programs in remote areas can work. John Freidheim, an Aurora minister, sent his daughter, Cara, then 15, to a therapeutic boarding school called Carolina Springs, in rural South Carolina, in mid-1999, after discovering she had become involved with drugs. Placing his daughter in the program "was the hardest thing I've ever done," Freidheim said, yet he credits the program with turning his daughter around. Cara stayed in the school for about 15 months, returning in the summer of 2000. Since then, Cara said, she has developed a closer relationship with her family, stayed away from drugs and is doing well in school. "It definitely was a life-changing experience," said Cara, now 17. "I know I wouldn't be where I am now if it weren't for [Carolina Springs], but it really is what you make of it." The program doesn't work for everybody, Cara pointed out.
    Cathy Sutton, who lost her daughter at a wilderness program, doesn't think all such teen programs should be banned.  "I believe in the concept," she said. What's needed, she added, is reform, to make sure that the problems are corrected. "The industry needs more regulation," Trass agreed. "Some states have already adopted standards, but [without national standards] you're going to have a lot of programs moving into states with lesser standards."
    Shapiro said that other types of programs can better serve children. "Teenagers respond best to positive reinforcement and encouragement," said Shapiro, who doesn't believe in taking a child out of his "natural setting." She recommends family counseling, in-home intervention, community activities and programs that emphasis treatment instead of punishment. But, Pat said, not all parents have access to counseling or local programs and services. "What's the alternative?" she said. "Where do frustrated parents go? There aren't many options. That's why businesses have stepped in to fill the void."
    The following advice is geared toward parents who are considering a boot camp or similar behavioral program for their teen. The advice is offered by Larry Brendtro, president of Reclaiming Youth; Tessa Trass, who runs Troubled Children Inc.; and Cathy Sutton, whose daughter died at a wilderness camp in 1990.
- Call state officials in the state in which the facility is located to find out if there have been previous complaints, if there are pending complaints and if the facility is properly licensed. Officials to contact include the state attorney general and social services department.
- Beware of any program that puts limits on parent contact. "Programs that try to insulate kids from parents are exceedingly suspect," Brendtro said.
- Ask your contact person at the facility whether the staff has been screened for drugs and what training they have, including CPR and first aid as well as educational credentials; what the facility's policy is concerning restraint methods; whether the program pays referral fees to parents; whether there is a doctor available or hospital nearby; what the student-to-staff ratio is.
- Visit the program or camp unannounced and ask to see every room or area.
- Be wary of programs that encourage the use of "paid escorts" to bring children to the facility.

Study Finds U.S. Children Fear Violence
ABC News, 5/29/2001

N E W Y O R K— American children ages 6 to 11 fret over guns, death, violence and the environment according to a new study by the creators of Sesame Street. The Sesame Workshop (formerly called the Children's Television Workshop) conducted the study to get a handle on the educational and developmental needs of children ages 6 to 11 and to come up with educational media content for that age group. In the pursuit of ideas about learning programs, researchers tapped into a surprising fear of violence in a majority of the kids interviewed. The qualitative study allowed 233 children of diverse ethnic backgrounds from across the country to use cameras, art work, collages from newspapers and magazines, and mini-essays to describe their lives — including their hopes and fears — in workbooks.
    Susan Royer, the vice president of research strategy at Sesame Workshop, says the kid's responses reveal that the "adult world" affects them very deeply. "We were surprised, I think, at the presence of the adult world so much in the child's world, kind of the sprawl of adulthood onto childhood," Royer told ABCNEWS' Good Morning America.  "Certainly that was evidenced in the kids' fears — not just of death, which might be considered normal at this age — but really, kind of the accompaniment of violence and more adult things as it relates to those issues."
    When asked to state their fears, nearly two-thirds of the children vividly depicted intense unsettling anxieties about guns, death and violence. Among the 9-to-11-year-olds, the proportion indicating such fears was three-fourths.  Asked what they were afraid of, Eric Najera, for instance, depicted his fears with a picture of a kidnapping.  "Lots of time, I'm like scared," he said. "There's people… there's people like gangsters, hanging around, marking their area."
    Robby Janeczek said he's worried about school shootings. To depict his fears, he had a workbook with the letters RIP on it. "I can picture it happening at any school," he said. "I feel safe, but there's still that one feeling that says that could happen. I don't want to die at a young age. I wanna die happy and old." Cherisse Olpin said she feels safe in her parents' bed, tucked in tightly. "No one can get me," she says, adding that it is safe from bad people, "like thieves or kidnappers."
    Though they were not asked expressly about the environment, it surfaced as a concern for many of the children who were part of the study. Children ages 9 to 11 said they are worried about environmental problems that could shrink their play areas and pollution. Nearly 65 percent expressed concerns that outdoor places could be lost to development or neglect. Media looms large in the lives of children, though its importance varied depending on sex, the study showed. Three-fourths of all the 9-to-11-year-olds interviewed cited the media room as the heart of their home, with 60 percent of boys saying the TV was the main attraction. Girls, however, emphasized family togetherness as the draw for the media room.
    Almost half of the boys said an electronic item such as a television or electronic game were their prized possessions, while girls valued dolls and toys. When asked about who they though of as heroes, magicians and wise ones in their lives, children consistently picked their parents and family members. Grandparents, aunts and uncles were also selected as people who played valuable roles in their lives.

Report: Abuse of Gay Students Rampant
Los Angeles Times, 5/30/2001

The United States gets a failing grade when it comes to protecting gay teens from harassment in school, according to a new report from the group Human Rights Watch. The study released today says gay teens often face so much bullying that it affects their emotional and physical health, not to mention their academic performance. It alleges that some teens are bullied so often that they are barely able to get an education.
    Sixteen-year-old Dominick Halse told ABCNEWS' Claire Shipman that he arrives at his school in Castleton on Hudson, N.Y., before all the other kids every day in order to avoid some of the torment he's faced over the years as a gay teen. "There were boys that said they would like to kill me and drag me behind a car, or take me to an island with all the other gays and shoot me," he says. "You don't need death threats as a child… it's hard."
    The HRW report suggests that high school can indeed be a terrifying experience for gay teens. Based on interviews with more than 250 students and teachers and parents in seven states, the study finds that treatment of gay students in American public schools constitutes a human rights issue. "You've got 2 million kids dealing with this," says Widney Brown of Human Rights Watch. "You've got their peers harassing them because they've gotten the message that it's OK. And you've got the adults in their lives — teachers, administrators, politicians and their communities — totally failing to protect them."
    As a result, gay teens may devise their own methods for avoiding such abuse. Halse says he's come up with different ways to protect himself against physical abuse from other students during the school day. "I cannot use the boys' restroom," he said. "I go to the bathroom in the nurse's office… or there's a single restroom in the cafeteria that I go to, because you live in fear." Though he is an excellent student and a talented musician, Halse spends as little time in school as possible. In fact, he plans to graduate a year early. At home, however, he says the taunts still ring in his ears. "'Are you too good for us? Are you too good for us, faggot?'" he recalls being asked. "And they would push me into a locker." His mother, Angela Halse, says she is frightened to send her son off to school every day. "He couldn't even walk down the hall," she says. "He came home one day and his flute was in pieces. There were times when he thought he just wanted to go home and hide." Halse says he sometimes did skip classes and hid out for the day. "It just gets to the point where you're afraid to even wake up, to open your eyes," he says.
    At one point three years ago, the taunting became too much to bear and Halse attempted to kill himself. "It just came to a breaking point and I could not take it anymore," he said. The suicide attempt proved to be a turning point for Halse: With the help of his parents and local gay support groups, he accepted his sexuality and confronted his school to demand better treatment. "I give him a lot of credit for opening up like that," says Ralph DiMarino, principal at Halse's High School "Letting us know, 'I have a problem. I need some help in dealing with this, and it's not just for me, it's for all students.'"
    According to the Human Rights Watch, abuse of gay teens is not regional or gender-based. It happens to young men and women from all over the country. Jesse Fuenes says when she attended a Los Angeles high school, she was forced to deal with the same kind of daily abuse described by Halse. "I had pebbles thrown at me for a week and a half," she says. "That ended up in rock throwing and I was bleeding." Fuenes said she is still angry with one teacher who ignored her suffering. "He saw the taunting, the teasing, the pushing, the shoving in the hallways, and never ever said anything," she says. "At the end, he would just laugh."
    One school singled out for praise by Human Rights Watch applauds is Fairfax High School in Los Angeles, which has counseling programs and education about tolerance from the top down. "I think that gay-bashing is probably the last bastion of intolerance that is still supported by society at large," says Fairfax Principal Heather Daims. "So it's difficult for people to come forward." Many gay students do manage to overcome the abuse with a little help.
    Halse is following his dreams and looking forward to graduating from high school. He plans to study social work in college. Though he is still scared at times, he hopes that his successes may help others win their battles for fair treatment. "All my pain and all my struggle will be worth it if it makes a difference for even one person," he says.

Statistics Say Child Sex Abuse Hits Close to Home
Jordana Hart, Boston Globe- 5/30/2001

As many see it, protecting children against sexual predators is primarily a matter of tightening the sex offender registry, educating children on ''stranger danger,'' and knowing when a convicted pedophile moves into the neighborhood. The problem, say law enforcement officials and doctors, is that these efforts fail to address one group that, statistically, poses the greatest threat to children: male relatives and family friends.
    According to State Police, county prosecutors, and child advocates, children under age 17 have made up more than half the reported rape victims in Massachusetts since 1997. At least a third of them said they were attacked by their fathers, stepfathers, other male relatives, or mother's boyfriends. Between 50 percent and 60 percent of the remainder were assaulted by someone familiar to them, such as a neighbor or family friend, according to those statistics. ''It's easier for the public to demonize offenders as another class of humanity and [to think] that all we have to do is figure out who they are,'' said Craig Latham, a psychologist in Natick who treats sex offenders and victims. ''Well, they are us, and that is the problem.''
    Warnings about strangers are the most frequent messages given to children, specialists say. They say that children as young as preschool age must instead be better trained to recognize ''good touches and bad touches'' from people they know, must learn not to keep secrets about ''bad touches,'' and be told to keep telling adults until someone listens.  That training ''is not intensive enough and not presented enough,'' said Dr. David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire. ''Kids are not given enough chances in school to practice what they have learned.'' What is also troubling, say those who run school programs, is that no one knows for sure how well those lessons are being reinforced by parents, whom specialists regard as a child's most vital source of information on preventing sexual abuse.
    In a 1998 survey of 1,535 Rhode Island middle-schoolers, 50 percent of boys and 37 percent of girls said their parents had not talked with them about sexual abuse and how to avoid it. Those who said that parents had talked to them indicated that the parent mostly mentioned stranger danger, according to the Sexual Assault and Trauma Research Center of Rhode Island. Experts say sexual abuse of children within the family is the most underreported of all crimes. When abuse does surface, relatives often try to downplay it by making excuses for the abuser, blaming someone else, or simply denying it.
    ''The gut-level response is, `That would never happen in my family,''' said Linda K. Cutting, a concert pianist in her 40s from Cambridge who has accused her father, a minister, of sexually abusing her until the age of 7. She is now a member of the board of directors of Massachusetts Citizens for Children, an advocacy group. In her 1997 memoir, ''Memory Slips,'' Cutting also wrote about the suicides of her two older brothers in the 1980s, who she said were both physically abused by their father. Therapists, prosecutors, and advocates for children say they understand why the public focuses on stranger attacks, instead of looking closer to home. ''A large number of abusers are in families, so you have to be willing to entertain the idea that good and evil can live in the same person,'' Cutting said in an interview. ''As long as people still look at abusers as purely evil, they will miss them right in their midst.''
    Despite headline-grabbing cases like that of defrocked Boston priest John Geoghan or the two Cambridge men accused in the 1997 murder and rape of Jeffrey Curley, sexual assaults by teachers, clergymen, and other unrelated adults make up less than 10 percent of the total, according to State Police and county data. Assaults by strangers make up between 4 percent and 6 percent of the reported assaults. In Suffolk County, for example, about 10 of 150 offenders arrested in attacks on children were not familiar to the victims. In 1999 in Middlesex County, 31 of 686 perpetrators were strangers, according to county prosecutors.
    Children must learn about avoiding strangers, Latham and others say, but, more important, they must be taught to reveal secrets about abuse that a relative or family friend might threaten or bribe them to keep and to understand that they don't have to share their bodies with anyone. Still, some specialists say that even the best programs are taught to children for only a few hours a year, at most.
    One well-regarded curriculum, the Child Assault Prevention Program, is taught in 66 Massachusetts elementary schools, but it lasts only one hour. In Arlington, 750 first- and third-graders spend a total of two hours in three years learning about abuse, and parents have a two-hour workshop on broaching the topic at home. Janice Pothier-Pac, coordinator of the Child Assault Prevention Program, said about 9,600 elementary pupils and about 700 preschoolers were taught in 1998.
    The Great Body Shop, a grade K-6 health curriculum in Arlington and 25 other districts, offers four classes a year on how to stay safe. The lessons ''hopefully empower kids to say no and be self-assertive,'' said Cindy Bouvier, health coordinator for the Arlington public schools. The Massachusetts Society for the Prevention of Cruelty to Children, which also offers a sexual-abuse prevention program, runs self-esteem classes through grade 12, a component of which is teaching children how to recognize trouble, said Karin Jeffers Ayre, western region clinic director for the society.
    In 42 preschool classes in Chicopee, for example, children are working with the ''Red Flag, Green Flag People'' coloring book, which mentions incest. The program, called ''Some Secrets Should Be Told,'' is taught in 90 schools statewide. ''We are touched by many people,'' the coloring book says, showing simple drawings of faces like those of a mother and a grandfather. ''This is a book about the sense of touch. Some touches feel good and loved. Other types of touch confuse, scare, and sometimes hurt us.'' Children need more information like that, Middlesex District Attorney Martha Coakley said.
    Coakley said that 17 percent of the 682 victims in sex-abuse cases her office handled last year were newborns to age 5, while 38 percent were ages 6 to 12. Almost 80 percent of the victims up to age 18 were girls, figures she said reflect the problem statewide. A study by the state Office of the Commissioner of Probation showed that 52 percent of reported rape victims were age 14 and younger, but that study only considered cases in which the suspect had been convicted, Coakley said. Her office prosecutes only about a third of substantiated child sex-abuse cases, often because the witnesses are too young or a parent decides not to go forward. ''This is very difficult, even for those of us in law enforcement,'' Coakley said. ''The last thing anyone wants to admit is that someone they love, someone they married or are dating [is molesting children]. There is more sex abuse in families than we want to admit.''

Explosive Children, Desperate Parents
Kathleen Megan, Hartford Courant- 5/31/2001

Much of the time, 12-year-old Todd Zavatsky seems like an ordinary kid. He likes to fiddle with gadgets, sports an earring for style and has a room crammed with fantasy books, including the entire Harry Potter series. But Todd's family has been struggling with a frightening side of his personality: a tendency from the time he was very young to explode fiercely and unpredictably. Last summer, when Todd's mother, Tracie, asked him to turn off the TV and go to bed, he pulled a knife on her. A month later, he confronted her with a knife in one hand and anxiety pills in the other and asked her to help him end it all. For years, Todd's mother has gone to experts seeking an explanation for his behavior. Was it attention deficit disorder? Hyperactivity? Oppositional defiance disorder? Or was it just a case of bad parenting? Finally a diagnosis was made: early-onset bipolar disorder.
    Once called manic depression, bipolar disorder is thought to be caused by chemical imbalances in certain brain cells, brought about by a combination of genetic and environmental factors. Only 10 years ago, it was generally believed not to exist in children. But in recent years, the disorder - which causes drastic mood swings - has become so widely diagnosed that some call it trendy. It has been featured on "Oprah" and "20-20" and is the subject of several well-received books, including "The Bipolar Child" by Westport authors Dr. Demitri Papolos and Janice Papolos.
    As is often the case with new medical territory, the childhood version of bipolar disorder also is the subject of growing controversy, dividing respected psychiatrists who disagree over its prevalence, its symptoms and even its existence. Often, parents are simply left confused about what is wrong with their child.  While psychiatrists such as Dr. Tim Wilens at Massachusetts General Hospital in Boston believe the condition is under-diagnosed, psychiatrists such as Dr. Joseph Woolston, director of the Children's Psychiatric Inpatient Services at Yale-New Haven Hospital, calls bipolar disorder "a huge fad," and a potentially detrimental one for kids. What's at stake in a diagnosis? Not only does a child's treatment depend upon it, but also his or her lifetime prognosis. "Once you get the diagnosis, you get a whole slew of drugs - big league drugs with big league side effects," Woolston said of the mood-stabilizing medications that include lithium, Depakote and Tegretol.  Woolston said parents desperate for treatment have pressured him to make the diagnosis because they are certain their child suffers from it. Because bipolar is a biochemical disorder, Woolston said, it is "completely blame-removing" for worried parents. "I try to convince them that it's better to have an unclear diagnosis than a clearly terrible diagnosis," Woolston said.
    At Massachusetts General, where 250 children with the disorder are in treatment and a long-term study of the childhood disorder is under way, Wilens said the clinic's staff members are confident when a child receives this diagnosis. "When you talk to parents, you would expect more resistance if it were an inappropriate label," Wilens said. "Instead they come back and say: `That's exactly it.' We have a long line of people trying to get into see us."
    Many experts believe that 1 percent to 2 percent of children - the same percentage as in the adult world - probably are bipolar. But the symptoms for adult bipolar disorder can be very different from those associated with the childhood version.   While adults with the disorder tend to alternate between elevated moods called mania and depressed moods -- both of which usually last weeks or months -- children with the disorder tend to have much more rapidly cycling moods. They can go from depressed to joyful and back again in a matter of minutes. Often, they are extremely irritable and have tantrums that go on for hours. Many experts also believe that from 10 percent to 30 percent of children with attention deficit disorder and hyperactivity actually are bipolar or have a combination of the two. While no one disputes that the number of children receiving the bipolar diagnosis is up, there is no certainty about whether the actual number of children with these troubling symptoms has increased. There are some experts who believe the numbers are higher and point to dietary deterioration, disintegration of the family and other reasons for the increase. But most say it is impossible to be sure because these children went unlabeled until relatively recently. Many suspect that these children were considered "bad kids" and wound up in juvenile jails.

Living With A Bipolar Child
A ring of experts is gathered at Lorie MacDougall's Norwich home for a monthly meeting about Stephen, her 9-year-old son who has been diagnosed with early-onset bipolar disorder. In the circle is a person who coordinates all of his services; a Department of Children and Families' staff member who assists families that are under stress and voluntarily ask for help; a counselor who provides therapy to the entire family; and several others. When a small boy in a red fleece jacket bounces into the room after school, his mother tells him, "We're all here for you Stephen!"  He smiles - happy for the attention - but sinks behind the couch, only to jump up moments later to ask his mother, "What's for snack?"
    As a single mother with three children, MacDougall has assembled the group at her house to help her with getting the right services for Stephen and her family. Like most bipolar children, Stephen, who until very recently was taking the mood stabilizer Tegretol along with an anti-psychotic, Seroquel, can be a happy and engaging child.  He is proud to show you how he can "bunny hop" his new scooter, lifting it off the ground and landing with a broad smile in a snow bank.
    But since his infancy, his mother said, she knew he was different. His tantrums would come from nowhere and last for hours. By the time he was 4, he was ejected from three day-care centers for throwing chairs, and for other aggressive behavior. At the age of 5, he tried to leap from a moving car. His mother nailed the lock shut, but he pried out the nails and tried again.  Stephen's anger can flash suddenly. On a recent afternoon in the midst of a counseling session at home with his family and a therapist, Stephen went from mildly bored to wildly angry in a matter of a few seconds. Saying, "I'm tired of no one talking about me," he swiped several trophies off a nearby table and lunged menacingly toward his mother. MacDougall fended him off with the help of a counselor, and together they held him tightly while he screamed, yelled and kicked. Stephen himself seems to know that his moods are more intense than others'. Asked how he feels when he's angry, Stephen said, "I get burned and I go all wild. I get hot inside and then I get wild."  His mother says, "He's like a volcano erupting on impulse."
    When Stephen was 3, Lorie MacDougall sought help for him. The doctors talked about hyperactivity and attention deficit disorder and his defiant behavior. Her parenting skills were called into question. When he was 5, a doctor said it was bipolar disorder and put him on Depakote. That seemed to help, but the next doctor thought it was depression and put him on an antidepressant. That caused Stephen to have a manic episode.
    Like many mothers of bipolar children, MacDougall functions as a sort of super social worker, overseeing the details of his medical and educational program. She has to watch carefully to assess how various medications affect her son. Stephen is no longer taking Tegretol and Seroquel because MacDougall feared they were actually making him more explosive. Although MacDougall has found some help for Stephen, she feels she needs much more. Fighting depression herself, she often feels overwhelmed by his needs and thinks Stephen might be better off in a residential program. At the very least, she knows she needs more help for Stephen, herself and her family. "I feel I've given all I can give," MacDougall said. "What people don't understand about the bipolar child is how difficult it is ... It's a living hell." This past fall, a counselor who had blamed MacDougall's parenting skills apologized.

Not Wanting to Diagnose
Historically, psychiatrists have been loath to diagnose children with major mental illnesses such as bipolar disorder, and for good reason. As one of Todd Zavatsky's Connecticut psychiatrists once told his mother, Tracie, "I'm very reluctant to make that diagnosis in a child because it's a death sentence." Indeed, the outlook for those with bipolar disorder is bleak. They are more likely to abuse drugs or alcohol, have troubled relationships and have difficulty holding jobs. A quarter, if untreated, commit suicide.
    The mood-stabilizing medications also pose their own dangers. The side effects of mood stabilizers such as lithium, Tegretol, and Depakote can range from weight gain to fatigue to nausea and headache. Often, these drugs are paired with an anti-psychotic such as Risperdal or Zyprexa, which have their own possible side effects, including weight gain and fatigue. All such drugs have to be carefully monitored or else worse - in rare cases potentially lethal - side effects may occur. Almost all of the medications taken by Todd caused him to become either super-charged or lethargic. While on Tegretol, he was not well enough monitored and was hospitalized with liver problems that took months to resolve. High levels of Neurontin, a newer mood stabilizer, upset Todd's endocrine system. Stephen was hospitalized last summer when Topomax, another mood stabilizer, turned him into a zombie. One of Woolston's concerns about diagnosing a child with bipolar disorder is that "people may stop thinking creatively about who this child is, a unique person, and become more and more narrowly focused on the meds as the sole way of treating this child."
    Another hesitation for doctors considering a bipolar diagnosis is that the symptoms can be confusing, sometimes mimicking other disorders. Often, too, a child may have several disorders at once. The differences between adult bipolar disorder and the childhood version also raise questions in some experts' minds about whether the disorders are the same. "There is the possibility that we are talking about two different things," said Dr. Lisa Namerow a child psychiatrist with Connecticut Children's Medical Center. The research has not yet been done that shows whether children diagnosed with this disorder grow up to have the adult version. Besides the rapidly cycling moods, irritability and prolonged tantrums, other symptoms associated with the childhood disorder include feelings of grandiosity, difficulties with friends, separation anxiety, night terrors and a craving for carbohydrates.
    But, at this point, there still are no definite criteria for bipolar children in the psychiatrist's bible, "The Diagnostic and Statistical Manual of Mental Disorders." "We're being told grandiosity and irritability, but those two symptoms can be very difficult to clinically differentiate from what might be normal thoughts of a 7-, 8-, 9-year-old," Namerow said. She said she often tries to focus on simply treating the symptoms and finding out what works rather than getting hung up with trying to make an definitive diagnosis.

Not A Bad Parent
Since Todd was 3, Tracie Zavatsky of West Hartford has listened as doctors rattled off possible diagnoses, ranging from attention deficit disorder to oppositional behavior to, simply, poor parenting. But none of those seemed to explain Todd's seesawing moods - from happy and enthusiastic to dangerously angry. Todd tried to describe the feeling to his mother, saying: "You know those cartoons where the angel is always saying, `Don't do it,' but the devil is always saying, `Just kill yourself and get it over with'? The devil's voice is much louder."  In school, Todd was always frustrated. Although an excellent reader with high intellectual capabilities, he couldn't sit still and do his work the way the other children seemed to do so easily. "I was always on the edge of my seat, all the time," Todd said. He also had trouble making friends. "He was never accepted in any arena," his mother said.
    Finally, last year, Zavatsky and Todd went to Massachusetts General, where doctors said it was bipolar disorder.  At the time, Zavatsky was relieved to have a diagnosis. She wanted to call the doctors who had talked about parenting problems and say, "Ha, ha, see, it's not me. It's nothing that I did." But when she returned to Connecticut, she found one doctor who believed it wasn't bipolar, though he wouldn't rule it out, and another who thought it was. Zavatsky is convinced her son has both bipolar disorder and an anxiety disorder. He is now responding well to an anxiety medication.
    Todd, himself, is confused about his diagnosis. "I don't know if I have [attention deficit and hyperactivity disorder]. I don't know if I have bipolar disorder. I don't know if I have anything," he said. "There are so many things to choose from and most of the doctors think I have symptoms of all of them."   Although Zavatsky hoped to keep Todd at home, she recently made the decision to place him at a private residential school in Connecticut. "Either he was going to kill me or I was going to kill him in self-defense,'' she said. "It wasn't safe.'' She hopes he will eventually be able to return home and attend public school.

When Bipolar Is Overlooked
While there are many reasons not to rush into a diagnosis of bipolar disorder, there also is a real danger in overlooking the disorder. A child with the disorder who goes undiagnosed may be thought of as simply a "bad kid" and won't get needed help. Without it, that child is more likely to drop out of school, to self-medicate with drugs or alcohol or turn to crime.
    In addition, a misdiagnosed child may be given the wrong medication. As experienced by Stephen, typical antidepressant medication can cause a manic episode in children who actually are bipolar. Medication given for attentional disorders also can have negative effects on a bipolar child. Janice Papolos, the Westport author, said it is important for psychiatrists to first rule out bipolar disorder before treating a child with stimulants or antidepressants. She urges a careful examination of a child's genetic history, looking not only for those with mental illness, but also for relatives who may have covered up their troubles by drinking or taking drugs.  The odds of having the disorder rise from 1 percent in the general population to 15 percent to 30 percent if a parent has the disorder. Both MacDougall and Zavatsky say their children have one or more relatives with bipolar disorder.
    Experts also say doctors might want to keep watch for the possibility of bipolar disorder when a child is diagnosed with attention deficit disorder with hyperactivity or with depression. Estimates are that nearly half the children diagnosed with severe depression before puberty will eventually develop bipolar disorder. Among the subjects Wilens and his group are studying is whether children with bipolar disorder continue to have it as grown-ups. The hospital is also looking at whether early treatment for the disorder improves the child's prognosis.
    Wilens is confident that, in the coming years, the percentage of children identified with bipolar disorder will increase and the condition will become more accepted. "Twenty five years ago, nobody thought kids were depressed," said Wilens. Woolston, on the other hand, believes that while bipolar disorder was likely "under-diagnosed in the past, I think it is unlikely that it is nearly as common as some so-called experts are saying today."

Researchers Develop Liquid Nicotine
Doug Johnson, Associated Press- 5/31/2001

RALEIGH, N.C. –– Smokers who've tried the patch, gum, inhalers or other products to give them that nicotine fix may have another tool to help them kick the habit – one they can drink. A nicotine solution that can be mixed with drinks has been patented and tested by researchers at Duke University in a small study. The school is now looking for a pharmaceutical company to help it conduct larger clinical trials. "You can put this stuff in your coffee, your peach Snapple ice tea or soda, whatever you like to drink," Eric C. Westman, an assistant professor at the Duke University Medical Center who has headed the study, said Tuesday.
    In 1998, the nicotine patch accounted for 49 percent of the drug-assisted attempts to quit, nicotine gum 28 percent and Zyban – a prescription drug – 21 percent. The nicotine inhaler and nasal spray accounted for less than 3 percent. The Centers for Disease Control and Prevention says attempts to quit have increased nearly every time a new product has been made available.
    But Jed Rose, co-inventor of the nicotine patch who is now working on the liquid solution, said some forms of nicotine replacement aren't always user-friendly. "Nicotine gum is often hard to chew or tastes bad, the inhalers are difficult to use and the patch doesn't always provide the hand-to-mouth action that smokers crave," he said. The liquid solution tastes "a bit like an ash tray" on its own, Westman said. When diluted with another beverage, it becomes tasteless, he said.
    Study participants consumed anywhere from 2.5 milligrams to 10 milligrams of the solution per drink. Three milligrams of solution is close to the one milligram of nicotine typically acquired by smoking a cigarette, Westman said. The only participant to drop out of the study complained of a burning sensation at the site of dental work. Otherwise there were few side effects reported.

Should Extreme Racism Be Considered a Mental Illness?
Michel Martin, ABC News- 5/31/2001

When Buford O. Furrow Jr. turned himself in after shooting up a Jewish community center in Los Angeles two years ago, he explained his actions as a "wake-up call to America to kill Jews." Furrow was a member of a white supremacist group and an avowed racist. But he had also had mental problems: a year earlier, he had tried to commit himself to a psychiatric hospital, saying he wanted to shoot people and kill himself. Furrow's case— and other recent incidents of "extreme racism" — have reopened debate about whether racism should be considered a mental illness. Advocates say psychological treatment could prevent some people from committing violent acts. But opponents say it would open the way for violent racists to plead insanity to avoid punishment for their crimes.
    The American Psychiatric Association (APA) does not list racism in its Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of psychiatrists worldwide. Most psychiatrists believe that racism is a cultural and social problem, not a matter of individual pathology. Harvard University psychiatrist, Alvin Poussaint, thinks that's a mistake. "Extreme racism is treatable, and sometimes even lesser forms of racism are treatable because they have psychodynamics to them," he told Nightline. "They don't exist as a social problem, they … exist as psychological problems inside the individual." Poussaint, who is black, believes that racism — like other human behaviors — exists on a continuum, and that racism's extreme forms, in which a person has racist delusions that can lead to violence, should be considered a serious mental illness and be listed in the DSM.
    The association's officials disagree: "Brutal, violent hate crimes are usually committed by mean, not sick, individuals and groups. We must not provide the convenient excuse of mental illness for those who are not genuinely ill," APA President Daniel Borenstein wrote in the association's newsletter last September. Borenstein also wrote that an APA work group had considered including racism in the DSM, but declined because there was not sufficient scientific research on the issue to meet the manual's strict criteria. He said that some racists might have psychological illnesses which are in the DSM, but that racism is too broad a phenomenon to label as a single mental illness. Poussaint and other critics of the APA's position say that Borenstein and the APA have shown no willingness to devote funding to research on racism.
    The federal prosecutor in Furrow's case, Michael Gennaco, doubts that classifying racism as a mental disorder would allow racist defendants to escape punishment. "I think that the federal definition of insanity would not include extreme racism as a defense because in order to be insane under the federal system, you have to not be able to know the difference between right and wrong," says Gennaco, who has handled hate crime cases for 15 years in more than 20 states. "The impact would be rather slight with regard to the cases in which I have been involved in."   Furrow, who wounded five people at the Jewish center and killed a Filipino-American a few miles away, pleaded guilty in the case and faced the death penalty. Gennaco declined to seek the death penalty, because of his history of mental illness.

Report: Single Cocaine Dose Has Big Impact on Brain
Mike Collett-White, Reuters News Service- 5/31/2001

LONDON -- A single 'snort' of cocaine has a bigger and more lasting effect on the brain than previously thought, scientists said on Wednesday. Researchers at the University of California, San Francisco found that the illegal drug can change the way nerve connections transmit signals in the part of the brain crucially involved in addiction. From the very first contact with the drug, interlinked neurons become more strongly connected -- a process known as potentiation. Because the process occurs in the part of the brain involved in increased craving, cocaine users are vulnerable to addictive urges for a sustained period of time. "You think you are getting two hours of pleasure but for one week you are vulnerable to wanting more cocaine," researcher Antonello Bonci told Reuters. "So the hypothesis is: think twice about using cocaine." Drug users normally take 'coke' in powder form nasally.
    According to the research, published in the Nature journal, potentiation is still observed up to one week after cocaine exposure. "The incredible thing is that cocaine is producing a change in the activity in the brain that basically uses the same mechanism as normal learning and memory processes but in a different region," Bonci said. "The normal capacity for strengthening links between cells is usurped by the drugs. This is the first demonstration that direct functional change is happening as a consequence of exposure to drug abuse."
    Co-researcher Mark Ungless said the findings went further than previous investigations into the impact of drug use and abuse on the brain. "There was no evidence before that a single dose of cocaine was having such a large effect on the brain and in such an important area," he said. "Most people using cocaine may be surprised to know that the effect is so long lasting." He also said that the extent of changes was far greater than expected. "It is sometimes difficult to show any connections getting stronger (after drug dosage), but in this case the effect was very large," he said. "Cocaine was shown to be changing all the connections. It is surprising to see such a big effect."
    Scientists believe that the research provides clues about why people become hooked on addictive drugs. It may also provide a more "subtle" message to drug users, giving them more informed warnings of the risks posed rather than focusing simply on how damaging banned substances can be. The experiment involved analysis of behavior in mice after they had been injected with a dose of cocaine. In some cases the animals were then tested for electrical activity in the brain.