Noteworthy News Articles on Mental Health Topics, July 15-18, 2001

Psychiatric Hospital Still Has Sex Offenders Despite Year-Old Promise
Associated Press, 7/15/2001

PARSIPPANY, N.J. -- Judges are making it hard for state Human Services officials to make good on a pledge to move sex offenders from Greystone Park Psychiatric Hospital. A year after then-Human Services Commissioner Michele Guhl promised Morris County freeholders the sex offenders would be moved, 19 remain there.  They are there largely because of orders from judges. ''For those patients who had progressed in treatment, were approaching discharge, and/or judged not a potential security risk, or if the court did not agree with the proposed transfer, the person remained at the regional hospital,'' Human Services spokeswoman Pam Ronan said in a prepared statement.
    The issue of who is housed in the hospital which does not have prison-like security has been a hot one in the area for years. In October, 1999, a sex offender escaped and hid overnight in the woods near homes on the Morris Plains-Hanover boundary. Another was charged in January with raping another male prisoner in the hospital.    
    Last year's promise that offenders would be moved from Greystone within three weeks was welcomed. But it's proved hard to make good on. Civilly committed patients were to be moved to a new wing of the Anne Klein Forensic Center in Trenton. Those who had completed jail terms but were still considered dangerous would be sent to a Kearney facility run by the state corrections agency. Eleven such patients have been moved in the past year, Ronan told The Sunday Star-Ledger of Newark. The 19 remaining sex offenders are patients, not inmates. They have rights dictated by the courts. Some are allowed to travel unescorted to and from programs on the 671-acre hospital campus and get weekend passes to leave the hospital.
    ''It's disappointing that they have not lived up to their word to move these people out,'' Morris County Freeholder Director Douglas Cabana told the newspaper. ''They've had ample time to do it.'' Morris Plains Councilman Ralph Rotando, chairman of the Greystone Security Council, said he thinks the state has tried to move the offenders. ''No one's happy with Megan's Law patients here, but we're not happy with murderers either, and we have some of them,'' he said. ''As long as we keep on top of the situation and make sure incidents remain low, I think we're doing OK.''

Mentally Ill Inmates Lack Care, US Says
   Christopher Newton, Associated Press- 7/16/2001

WASHINGTON -- About one-fifth of the estimated 191,000 inmates in state prisons who were identified as mentally ill were not getting therapy or counseling, the Justice Department reported yesterday. A study based on 2000 data also showed that only 70 percent of state prison facilities screen inmates for mental illness as a matter of policy.   ''This is a modest survey,'' said lead researcher Alan Beck of the department's Bureau of Justice Statistics. ''We didn't assess what types of mental illness inmates were suffering from,'' he said. ''The numbers support that mental illness is a significant problem for state prisons. How inmates are diagnosed and how easily they can receive treatment is a subject worthy of attention.''
    Mentally ill inmates account for 16 percent of the state prison population, and 79 percent of those identified as mentally ill were receiving therapy or counseling, the report said. Female inmates are treated for mental illness at a higher rate than male prisoners. One in four women get therapy and one in five take medication for mental illness.  Only 10 percent of male inmates receive any treatment. ''There may be several factors, including that women may be more likely to admit or acknowledge mental illness than men,'' Beck said. ''There may also be an issue of how men perceive or understand mental illness.''
    Some mental health specialists said the statistics seemed too low to be accurate. ''There is no way to produce an accurate picture of mental illness in prisons,'' said Roger Paine, a psychologist at the University of New Mexico.  ''Asking the prisons results in numbers that are pure fiction. They don't have good measures for determining who has a mental illness or not. We need competent diagnosis as a first step to assessing the problem.''
    Three states - North Dakota, Rhode Island, and Wyoming - had no special psychiatric facilities for prisoners, the study showed. Those states put prisoners needing to be separated from the general population into state hospitals, prison infirmaries, or special-needs areas of the prison. About 66 percent of prisons help released prisoners obtain community mental health services, the study showed. States with the most inmates receiving psychiatric help were Louisiana, Maine, Nebraska, and Wyoming. In those states, at least one in four inmates were in therapy.

Class Tries to Help Drivers Shift From Angry to Amicable
Phuong Ly, Washington Post- 7/16/20001

Chris thinks he's a nice person, and most people who know him would agree. The 35-year-old business consultant is polite to strangers and speaks lovingly of his wife. He volunteers in his Arlington neighborhood, particularly on the traffic committee because he worries that speeding cars will hurt small children. But get him into his Honda Prelude -- especially when he's late for a meeting -- and watch out. His eyes narrow and his fists clench. Every car in front of him is an obstacle. Each narrow space is a way to slip through and speed ahead. Twice, police caught Chris, who didn't want his last name used because he didn't want to be associated with bad attitudes. Then an Arlington traffic judge ordered him to take an anger management class, the latest response to what has become a cause celebre of the past several years.
    The National Highway Traffic Safety Administration estimates that reckless driving causes about two-thirds of all fatal accidents. Warnings about aggressive driving blare on ads across the Washington region. Police agencies are stepping up enforcement. Nearly 42,000 citations were issued during two weeks of the region's Smooth Operator program in May and June. "We've got to look at changing their behavior and making the highways safer," said Deputy Chief John Haas, of the Arlington County police. And to do that, courts and safety advocates increasingly are turning to psychotherapy and awareness classes, though little data exists on their effectiveness.
    In June, Arlington judges began ordering people to pay $150 for a 12-hour anger management class run by psychologist Steven Stosny. In the fall, the Maryland Motor Vehicle Administration will refer to Stosny repeat offenders -- those with five points on their records -- from Prince George's and Montgomery counties. In the District, some drivers are sent to a class called "RoadRageous," which also is being used in other parts of the country.
    Behavioral psychologist Frederick A. Marsteller said he expects that the small percentage of people who come with antisocial or borderline behavior won't benefit much. But most people will change their attitudes at least a little, said Marsteller, who lives near Atlanta and has done research on the effectiveness of drunken-driving and addiction programs for state courts. "Most people aren't antisocial personalities and very commonly do things that they're just not paying attention to," Marsteller said. "If they realize the consequences, then they can change." He said changing aggressive drivers is probably easier than changing drunk drivers. Aggressive driving usually is a spontaneous reaction, whereas drunken driving involves more deep-seated problems such as alcoholism.

Learning to Soothe the Rage
Like Chris, the nine people attending a Stosny class recently had at least one form of reckless driving citation. They did not think of themselves as bad drivers, but they asked not to be identified publicly to protect their reputations. One man, 19, said other drivers were to blame for his on-the-road behavior. He wondered aloud: Why he can't just take down the tag numbers of people who tick him off and beat them up later? Another man, a cabdriver, asked, wouldn't you get frustrated if you spent 10 hours a day in traffic? "I guess they're trying to make everyone conform to slow driving," said Chris, a former New Yorker who talks as fast as he wants to drive. He said that he can look at maps and tune the radio while driving at or above the speed limit and that it's not his fault other people can't. "On the road, I look at things as obstacles. I'd like to be there in one second, but there are all these people in front of me and all these rules and the speed limit. You're just thinking that you're being attacked, like a squirrel in the corner."
    Deep in a church basement in Arlington, Stosny led the group in a chant. It was supposed to help them stay calm, even if another motorist drives like a jerk. "I forgive myself for feeling disregarded, unimportant, devalued and powerless when the driver cut me off," the seven men and two women repeated. "I forgive myself for feeling disregarded, unimportant, devalued and powerless when the driver tailgated me." One student lowered his head. Another barely moved his lips as he spoke. Stosny, in his even, lulling voice, asked for more conviction. By the time they got to the last chant -- "I forgive myself for feeling disregarded, unimportant, devalued and powerless when the driver gestured and yelled at me" -- a few were speaking loudly, though not everyone.

'Compassion Power'
Stosny teaches what he calls "Compassion Power." He tells people that in getting angry, they're letting someone else control their emotions, that those who value themselves think their emotional well-being and safety are more important than tailgating the driver who just cut them off. Stosny tells his students that angry drivers develop health problems and lower their sex drive. (That usually gets people's attention.)
    Stosny, who also teaches domestic abusers ordered to attend his classes by some Maryland judges, said similar therapy methods work on both groups because both blame their behavior on others. But there can be a bit of aggressive driver in anyone on the highways, partly because driving itself is so impersonal. "You're never going to see those people again. You don't see a person; you are dealing with a machine. It's just like a video game," Stosny said.
    Social pressures through public ad campaigns also can help change attitudes, Marsteller said. Cases in point: anti-smoking and drunken-driving campaigns. "As fewer people smoke cigarettes or drive stupidly, the fewer will start to and the more will quit," Marsteller said. "Once people are given the information as to what's in their best interest, they will pursue it." Data on Stosny's classes are being collected, and Virginia and Maryland officials said the classes might be expanded.
    During the last class session, Stosny asked students to think of a recent scenario in which they tried to do things differently. Rumman, 20, said he was almost late to class because of a traffic jam caused by an accident -- the thing that upsets him most. But this time when he became angry, he started thinking, "I'm more powerful than this." He didn't speed up or try to change lanes repeatedly after the accident cleared. "You know what?" he said to his classmates. "It took about the same time to get here." Rumman drives a roaring red Ford Mustang, with the license plate "SPEEEED." He said he doesn't drive that fast, but the car makes other people assume he's a reckless driver.
    "I'm thinking about buying a smaller car," the drugstore manager said. "If I got another ticket, I don't know if I can afford this car." The youngest driver in the class stopped asking why he couldn't just seek revenge on other drivers. He still looked bored, though. "When you're younger, it's harder," Stosny said to him, sympathetically.
    Chris said that he is trying to slow down but that it's hard when he's running late. He said he's hired a therapist to work on time management and other issues. "I'm focusing on the fact that there are other people out there besides me," he said. Chris left at the end of class, but in just five minutes, he swung his car back into the church parking lot, cell phone in hand, headed to talk to Stosny. Chris's wife had just called. The court had sent him a notice saying that he was driving on a suspended license -- something that must be a mix-up because he was ordered to take the class. He was about to snap, but he took a deep breath and tried to calm down. "I'm practicing anger management, can't you tell?" he asked.

Drug Ads Hyping Anxiety Make Some Uneasy
Shankar Vedantam, Washington Post- 7/16/2001

About two years ago, newspaper, magazine and television news stories began popping up across the country about a little-known malady called social anxiety disorder. Psychiatrists and patient advocates appeared on television shows and in articles explaining that the debilitating form of bashfulness was extremely widespread but easily treatable. The stories and appearances were part of a campaign, coordinated by a New York public relations agency, that included pitches to newspapers, radio and TV, satellite and Internet communications, and testimonials from advocates and doctors who said social anxiety was America's third most common mental disorder with more than 10 million sufferers. So successful was the campaign that according to a marketing newsletter, media accounts of social anxiety rose from just 50 stories in 1997 and 1998 to more than 1 billion references in 1999 alone. And about 96 percent of the stories, said the report in PR News, "delivered the key message, 'Paxil is the first and only FDA-approved medication for the treatment of social anxiety disorder.' "
    The plug for a drug was no accident. Cohn & Wolfe, the public relations agency coordinating the campaign, did not serve at the pleasure of the doctors and patient advocates who participated in the education campaign. Instead, the agency worked at the behest of SmithKline Beecham, the pharmaceutical giant now known as Glaxo SmithKline, which makes the antidepressant Paxil. The campaign was supplemented by a multimillion-dollar marketing and advertising blitz that pitched the drug to doctors, audiences of television shows such as "Ally McBeal" and readers of magazines such as Rolling Stone. Sales of Paxil, which had been lagging those of Prozac and Zoloft, jumped, rising 18 percent last year alone.
    The education and advertising campaigns have raised concerns that pharmaceutical companies, traditionally in the business of finding new drugs for existing disorders, are increasingly in the business of seeking new disorders for existing drugs. Critics accuse the companies of recruiting patients by teaming up with doctors and patient advocates -- with all the attendant conflicts of agenda and conflicts of interest. "Pharmaceutical companies who are marketing psychopharmacological treatments have gotten into the business of selling psychiatric illness," said Carl Elliott, a bioethicist at the University of Minnesota, who studies the philosophy of psychiatry. "The way to sell drugs is to sell psychiatric illness. If you are Paxil and you are the only manufacturer who has the drug for social anxiety disorder, it's in your interest to broaden the category as far as possible and make the borders as fuzzy as possible."

Blurring the Lines
Blurring the line between normal personality variation and real psychiatric conditions can trivialize serious mental illness, some experts said. "Some marketing seems to imply that huge proportions of the population need pharmaceutical intervention for relatively common problems, and in the long run, I am concerned that that may undermine the credibility of the concept of serious mental illness," said Rex Cowdry, medical director of the National Alliance for the Mentally Ill, a patient advocacy group. Glaxo SmithKline did not make company officials available for comment, despite repeated requests. But doctors and advocates associated with the company's campaign defended the effort, saying it informed thousands of people who previously did not know they were suffering from the disorder, spurring many to seek needed help. "When I talk to family physicians, I don't hear them saying I have all these people who are asking for medicines they don't need," said Murray Stein, a psychiatry professor at the University of California in San Diego. "They say this patient said she had social anxiety and I've been treating her for years and I never thought to ask about it. What could be negative about that?"

Advocates Hail Attention
Although many of the participants said they served as paid consultants or scientific investigators for the company, they rejected any notion that they were manipulated by the pharmaceutical industry. Most said they had spent years toiling on social anxiety disorder and were delighted when SmithKline offered a way to get their message out. "I know there's lots of concern about, 'Are we medicalizing normative things and is the pharmaceutical industry trying to put SSRIs in the water,' " Stein said, referring to the class of drugs known as selective serotonin reuptake inhibitors, which includes Paxil. "The people I see talking about that have not seen these patients."
    Patients with social anxiety disorder aren't the shy people who hang out at the edges of parties. Those truly suffering from the condition are profoundly debilitated, refusing promotions or taking jobs as night guards because they can't stand to be around people. Some cannot open the door to a handyman because that would mean conversation. "Would somebody who is not having problems take a medicine that is costly and has side effects?" Stein asked. "I don't think too many people would do that. The idea that this is cosmetic psychopharmacology I find offensive."
    The advocacy organizations that participated in the campaign -- the American Psychiatric Association, the Anxiety Disorders Association of America and a Long Island-based group called Freedom From Fear -- said that the only way for nonprofit groups to get out a potent public health message is to team up with a pharmaceutical company with deep pockets. Moreover, the groups demanded and received full control over the editorial content of the education campaign, said John Blamthin, an APA spokesman. "We have never, ever promoted any drug," said Jerilyn Ross, the founder of the Anxiety Disorders Association of America. "If you look at our materials and on our Web site, we have never mentioned a drug." Ross said that she even got into "fights" with SmithKline because she frequently told the company's marketers, " 'We can't do this, we can't do that.' "
    But if the experts did not want to be boosters for Paxil, the arrangement with the public relations firm -- and the marketing campaign for Paxil, which offered journalists interviews with some of the same experts -- made that confusing. Cohn & Wolfe emphasized in its calls to the media that it spoke on behalf of doctors and nonprofits -- not the pharmaceutical company that was paying its bills. The Cohn & Wolfe Web site, however, made no secret of the fact that it is in the business of marketing, not public health: On a previous campaign to promote coverage about the 10th anniversary of Prozac's launch in Britain, the agency said it successfully helped drug maker Eli Lilly spin coverage. The strategy? Offer journalists interviews with "independent Key Opinion Leaders" -- doctors, advocacy groups and patients with "suitable debate." Cohn & Wolfe declined to talk about its role in the Paxil campaign, calling the information "proprietary and confidential."

Business of Educating
Marcia Angell, a former editor of the New England Journal of Medicine, said that pharmaceutical companies could not be expected to act solely in the interest of public health: "They are no more in the business of educating the public than a beer company is in the business of educating people about alcoholism." The expensive ad and education campaign paid off in the crowded antidepressant market: Glaxo SmithKline's 2000 annual report told shareholders the drug "became number one in the U.S. selective serotonin reuptake inhibitor market for new retail prescriptions in 2000." Barry Brand, Paxil's product director, told the journal Advertising Age, "Every marketer's dream is to find an unidentified or unknown market and develop it. That's what we were able to do with social anxiety disorder."
    Several experts, including some who treat social anxiety disorder, worried whether such marketing was in the public's best interest. "When the pharmaceutical companies focus on broadening the market, you miss out on the fact that there is a proportion of people for whom mental illnesses are truly disabling," said Cowdry, who formerly headed the National Institute of Mental Health. "I have the same reaction when I hear that one in three Americans have a mental illness. The problem with that kind of data is that it undermines credibility -- it doesn't pass the laugh test."

Sizing Up the Problem
Two experts who were assembled by the American Psychiatric Association to write the definition of social anxiety disorder for the psychiatrist's manual said they admired the campaign for alerting patients suffering in silence. Still, they had concerns. "I don't think the ads make the distinction between social anxiety and shyness," said Edna Foa, a professor of psychology at the University of Pennsylvania who served on the APA committee. "One gets the impression from the ads that if you are shy and you have some difficulties and you want to be outgoing, then take Paxil. You are promoting medication when it is unnecessary."
    There were other instances where the social anxiety marketing campaign diverted from the message of medical experts -- including experts who were part of the education campaign -- or quoted the experts selectively. The campaign said that more than 10 million Americans suffered from social anxiety disorder, making it the most common mental disorder after depression and alcoholism -- and that 13 percent of Americans are affected by social anxiety disorder. But the National Institute of Mental Health says only about 3.7 percent of the U.S. population has social anxiety disorder. The American Psychiatric Association says rates vary between 3 percent and 13 percent. Stein of UCSD said he preferred the 3 percent to 4 percent estimate.
    Although Paxil has been specifically approved by the Food and Drug Administration for the disorder, many psychiatrists said there is probably little difference between Paxil and similar medicines such as Prozac or Zoloft in treating social anxiety. There are also other types of drugs available for treating other forms of anxiety. And although the campaign mentioned a psychological therapy called cognitive behavior therapy, it did not stress that the therapy is as effective as medication, has no side effects, such as sexual problems and fatigue, and does not require patients to stay on treatment indefinitely.
    "In my opinion, social anxiety is not a chemical problem with the brain," said Jonathan Abramowitz, a psychologist at the Mayo Clinic in Rochester, Minn., who worked on the psychiatrist's manual. "I see it as a problem with normal thinking and behaviors that have gone awry." Cognitive behavior therapy, he said, takes 14 weeks: "It's like learning to ride a bike. You are practicing these skills over and over. No one can take them away from you the rest of your life. The long-term benefits of cognitive therapy is better than medicine because with medicine, when you stop, the symptoms come back."

All About ADHD in Adults
Patricia Quinn, MD, Private Practice, Washington, DC Peter Jensen, MD, New York State Psychiatric Institute, Columbia University, ABC News- 7/17/2001

Most people assume that attention deficit hyperactivity disorder, or ADHD, is primarily a problem that affects children. Increasingly, however, ADHD is being recognized and treated in adults as well. Below, two medical experts discuss treatment options that can improve the quality of life for adult patients with this disorder.

How common is ADHD in the adult population?
DR. PATRICIA QUINN: Although no very good epidemiologic studies have been done, we know that it probably exists in about two to four percent of adults. We know that about fifty percent of children diagnosed with the disorder grow up to be adults who still have symptoms. So, it's still pretty common in the adult population.

Is it possible to develop ADHD later in life?
DR. PETER JENSEN: Well, we do know that some people develop secondary ADHD, for example, after a head trauma. We know that lead, at least in children, can precipitate ADHD symptoms and the syndrome. So we have to be open to that possibility. Certainly head trauma-from auto accidents, for example-are one clear cause. But we don't usually think of it as an adult onset or an adolescent onset disorder. We usually look for it starting in the early childhood years.

How do you diagnose ADHD in adults? What are you looking for?
DR. PATRICIA QUINN: First we get a historical diagnosis, which is based on the patient's personal history, just as we do with children. We need to ask the adults whether they have symptoms of the disorder: inattentiveness, difficulty getting work done, procrastination, or organization problems. But we also need to ask their spouses or significant others those questions, as well as their parents, if they're available. When I diagnose adults with ADD, I also ask for any report cards they might have from when they were children so I can study that documentation. We also look for job evaluations, if the person will share them with us. Their supervisors may have talked about the fact that they can't get anything handed in on time. Or they may have performance difficulties. We don't just take the adult's word for it. There are lots of clues that we can look for in the environment of the person that may lead us to believe that they do have problems in the spheres of attention, organization, distractibility, and hyperactivity, and that these problems are affecting their functioning.

What are the treatment options for adults with ADHD?
DR. PATRICIA QUINN: The treatment options are much the same as they are with children. Medication is very effective in adults with ADD. It used to be thought that you outgrew the medication at a certain age, but we now know that it's about seventy-five percent effective in adults. It's about ninety percent effective in children. There are some psychosocial changes that adults can make that can be very effective as well, such as counseling and career counseling. It is also helpful for adults with ADD to really create an ADD-friendly environment. Choose only friends who are willing to accept your condition. Work with your spouse and employers to get the accommodations you need. Choose the right career. There are lots of things adults can do. And I actually find adults are more hopeful after they get the diagnosis, because now they know there's something they can do about problems that they've been experiencing for a long time.

What's the drug of choice in adults?
DR. PATRICIA QUINN: Stimulants are still the treatment of choice in adults, as they are with children.
DR. PETER JENSEN: Sometimes with adults you find that they have additional problems. So the ADHD may have led to problems with anxiety or depression or even substance use. So sometimes you have to take those things into account, and then use other medicines as well, in addition to treating the ADHD. And that might create the illusion that adult ADHD has a different treatment, but it doesn't. It just has other problems that sometimes come along.

How would you suggest broaching the subject with a friend or relative who you feel might be suffering from ADHD?
DR. PETER JENSEN: Well, I think patience is essential. Plant a book in the right place, which might provide the person with good information. Bring trusted people into the discussion who might have information about the disorder. Self-disclosure on the part of other people who might be friends and might actually have similar problems is also very useful. I think there is fear about stigma, about being identified. And certainly no one wants to have something pushed at them. So I think the first principal is patience.

Any final thoughts on how adults should go about seeking treatment for themselves?
DR. PATRICIA QUINN: A lot of adult therapists aren't very well versed in treating this disorder. So I usually recommend that adults seek out child psychiatrists like Dr. Jensen, who are willing to treat adolescents, adults and young adults, because they are better educated in the ADHD field and the treatments available. It is crucial that they seek out someone who is experienced in this area. For example, women with ADHD tend to be misdiagnosed by adult therapists as having bipolar disorder rather than ADHD.

Mental Patients At Risk In Homes
David A. Fahrenthold, Washington Post- 7/17/2001

The District's system of group homes for the mentally ill is impaired by poor regulation and oversight, and includes unsafe or squalid homes that pose "significant health and safety risks" to patients, according to a new report by the D.C. Auditor. Concluding a year-long study, the auditor's report found that last fall, 107 of 147 group homes in the District were operating with expired licenses. An additional 131 homes were allowed by District law to operate with no license at all. City inspectors visited homes infrequently, the report found. The auditor's office found rats and insects infesting group homes, along with structural problems and fire hazards such as exposed wiring and broken smoke detectors. The report echoes accounts offered by Washington area mental health advocacy groups and seems to confirm their charges that the District leaves many group home residents vulnerable to abuse and neglect.
    "It's good to see the government recognizing that people are suffering and the system needs massive reformation," said Kelly Bagby, managing attorney of University Legal Services, which advocates for disabled people. If the mayor and the council "don't take notice of this, then we've got a big problem," Bagby said. The District's treatment system for the mentally ill is separate from its system for the mentally retarded, whose maltreatment in D.C. group homes was the subject of a series in The Washington Post in 1999.
    The District's mental health agencies have had their own problems. A lawsuit brought by patients in the 1970s cast a shadow for years and led to the system being placed in court-ordered receivership in 1997. This year, the system probably will return to District control under the newly established Department of Mental Health. The report, however, shows that serious flaws linger in "community-based residential facilities," which house more than 1,000 clients in homes operated by private contractors. Deputy Mayor Carolyn N. Graham said yesterday that the report illustrates the failure of court-ordered receivership to turn around the District's mental health system. "It's further indication that the receivership in mental health did not work," she said.
    D.C. Auditor Deborah K. Nichols's look into group homes for the mentally ill was prompted by a request by then-D.C. Council member Charlene Drew Jarvis in April 2000, according to a District government source. Nichols is charged with investigating various arms of the city government and reporting to the council. The report noted that District law allows many group homes to operate without licenses. District agencies delineate five categories of residences for the mentally ill. They range from a "supported residence," with intensive care for the most seriously symptomatic patients, to an "independent living" setting, for those who need minimal assistance. The District requires licenses for only three categories of homes. The two least restrictive types of housing are rooming houses or apartment buildings, which are excluded and are subject to less regulation. The report says that the unregulated nature of such homes allows hazards in many facilities to go undetected. They included rodent and insect infestations, as well as fire hazards such as missing and broken smoke detectors. To remedy the situation, the auditor's report recommends that all facilities housing District patients be licensed and regularly inspected.
    However, the auditor found that licenses were not a cure-all. In many cases, licenses were allowed to expire, with little consequences for the home's operator. The study examined 84 homes' records from 1998 to 2000. It found that 70 of those had operated with an expired license at some point from 1998 to 2000. The report says that as of October 2000, only 40 of the 147 licensed homes -- or 27 percent -- had current licenses. The report blames a shortage of city inspectors. From 1997 to 1998, the number of Department of Health inspectors was cut from eight to three, the report found. There are now five inspectors, but city figures show that about 15 percent of homes still have expired licenses. For patients, the expiration of a license had little effect, the report found. Most patients were allowed to remain in their group homes, despite evidence of unhealthy or unsafe conditions in some homes. The auditor's report also found problems with fire code inspections. In 2000, about half the homes whose files were reviewed by the auditor were not inspected.
    Martha B. Knisley, head of the Department of Mental Health Services, said she agreed with many of the auditor's conclusions. Among other reforms, she said her new department will centralize licensing procedures and create a staff of eight inspectors. The report's conclusions did not surprise Gora Bailey, who operates a group home on Mellon Street SE. In an interview this spring, Bailey showed off the neat rooms in which her 13 male clients lived.  Bailey said her home had operated for nearly four months this year with an expired license. But it was not much of a concern; her clients remained in the home. But University Legal Services staff say they toured the building recently and found several problems, including cramped conditions in patients' rooms. "They've been in there since 1988," Bailey said yesterday of the rooms. "[The city] gave us a license for this."

A Rainbow of Differences in Gay's Children
Erica Goode, New York Times- 7/17/2001

Does growing up with parents who are gay or lesbian make a difference? A host of studies published over the last two decades would argue that it does not. These studies, cited in custody disputes and drawn upon by lawyers arguing for same-sex marriages or gay adoptions, have for the most part concluded that no important distinctions could be found between children raised by homosexual parents and those raised in more traditional homes, each with one mother and one father.
    But a paper that is stirring both interest and controversy, two sociologists dispute this view. After reviewing the research on the topic, they contend that social scientists have in fact found provocative differences but have played down those differences for fear that the findings will be misused. While there is no evidence that having gay or lesbian parents harms children, the sociologists say, the notion that it has no impact on a child's life is implausible at best. "There is suggestive evidence and good reason to believe that contemporary children and young adults with lesbian or gay parents do differ in modest and interesting ways from children with heterosexual parents," wrote the researchers, Dr. Judith Stacey and Dr. Timothy J. Biblarz, both of the University of Southern California. The paper appeared in the American Sociological Review.
    Dr. Stacey and Dr. Biblarz reviewed 21 studies of the children of gay or lesbian parents published from 1981 through 1998. They noted that the body of research on such children was still small and that many findings still needed to be confirmed. Nevertheless, in many studies, they said, there are suggestions that both the experience of having two parents of the same sex and growing up in a home where homosexuality is accepted influence children's behavior, self-image and life goals.
    Some of the distinctions noted by researchers, Dr. Stacey said, had to do with attitudes toward sexuality and sexual behavior. Others involved how flexibly children interpreted gender roles: several studies, for example, found that the sons and daughters of lesbian mothers were less likely to have stereotyped notions of masculine and feminine behavior and more likely to aspire to occupations that crossed traditional gender lines.
    Still other studies, Dr. Stacey and Dr. Biblarz found, charted differences in how children raised by gay or lesbian parents expressed themselves verbally, how close they were to their biological parents' partners and how equally their parents divided parenting duties and household chores. And while many researchers found that the children of homosexual parents often faced teasing and harassment from their peers, the sociologists wrote, the studies also showed that such children "seem to exhibit impressive psychological strength."
    Yet in spite of these findings, the sociologists said many researchers had virtually turned their backs on such results. In one study, for example, the sociologists said they had counted "at least 15 intriguing, statistically significant differences in gender behavior and preferences" between children raised by single lesbian mothers and those raised by single heterosexual mothers, though the authors of the study had emphasized in their summary abstract that few differences had been found.
    In another study, Dr. Stacey and Dr. Biblarz reviewed, they found that the researchers had reported a finding that the young adult children of lesbian mothers were more likely to have had, or to have considered having, a homosexual relationship than the children of heterosexual mothers. But the study's authors emphasized data showing that the children of the lesbian mothers were no more likely than other children to identify themselves as gay or lesbian. "We recognize the political dangers of pointing out that recent studies indicate that a higher proportion of children with lesbian/gay parents are themselves apt to engage in homosexual activity," Dr. Stacey and Dr. Biblarz wrote in their paper. "nonetheless, we believe that denying this probability is apt to prove counterproductive in the long run."
    In an interview, Dr. Stacey said she was not suggesting that the researchers were actively censoring their results. Rather, she said, "People are appropriately anxious when the consequences are so weighty, and when your research is going to be so instantly taken up and used in a variety of contexts. It's not so much political correctness but political anxiety."
    The sociologists' critique won praise from the representatives of several gay and lesbian organizations, who said its conclusions did not surprise them. "What I think it's done is, it's opened up a whole new area of inquiry about whether there's a positive lesson that anyone interested in parenting can learn from gay and lesbian parents," said Lisa Bennett, the deputy director of FamilyNet, a Web site for gay, lesbian and transgender families sponsored by the Human Rights Campaign, the nation's largest gay and lesbian advocacy group.
    But the article was also lauded by Lynn D. Wardle, a law professor at Brigham Young University, who has argued that the custody of children should be presumptively awarded to heterosexual parents. "I was quite pleased to see the writers actually saying, 'Yeah, the studies just don't show what they purport to show,'" Ms. Wardle said. "The science that has been done is simply unreliable."
    At the same time, the claim that researchers have played down differences when they have found them was greeted with some skepticism by Dr. Susan Golombok, whose 1996 study of the children of lesbian couples was among those mentioned in the review paper. Dr. Golombok, a professor of psychology at the City University in London, said she found the Stacey-Biblarz analysis of her work "a bit disingenuous." "The implication is that we have somehow distorted or misrepresented our findings, and I feel it's rather unfair," Dr. Golombok said. "We've always been very straightforward about our findings."
    Homosexual parenting remains a politically charged issue, even as the number of children with openly gay mothers or fathers has increased. The findings of researchers are often cited in custody disputes involving gay or lesbian parents and swept up into larger societal debates over a variety of gay rights issues, including same-sex marriages and gay adoptions. Most studies have focused almost exclusively on the question of whether homosexual parenting harms children, using a variety of methods including interviews with children, parents and teachers; batteries of psychological tests; and observation.
    A vast majority of these studies have concluded that the sons and daughters of gays and lesbians are no more anxious, depressed, insecure or prone to other emotional troubles than the children of heterosexuals. And most researchers, including Dr. Stacey and Dr. Biblarz, find these results convincing because they have remained consistent across studies carried out under a variety of conditions. But conservative critics, among them Ms. Wardle, have criticized the methods of many studies and charged that research on gay parenting is tainted by researchers' ideological bias in favor of gay rights. On the other side, many researchers assert that the critics are often themselves biased, and that they distort and misrepresent scientists' work.
    In this polarized climate, any finding of "difference" in the children of homosexual parents has often been equated with "deficit." And scientists who study sexual development in such children have found the path perilous. "The politics in this area are very paralyzing," said Dr. John Michael Bailey, an associate professor of psychology at Northwestern University, who studies sexual development. "Every camp wants to use the results to further the result they want."
    Dr. Bailey and other scientists said the field had also been plagued by a dearth of financing for studies of the children of gays and lesbians, a subject considered politically volatile by many agencies that award government grants. And only in the last tow decades, in part as a result of what has been called the "gayby boon," has it been possible to study children raised from birth by homosexual couples, as a result of artificial insemination or adoption. In earlier studies, the children were often born to couples who later divorced, clouding the picture for researchers. Still, even the small differences that scientists have reported are noteworthy, Dr. Stacey said. And in new studies, some researchers are beginning to emphasize the distinctions they find.
    In a recently completed study comparing 16 boys, ages 5 through 9, raised from birth by lesbian parents with 16 boys raised by heterosexual parents, for example, Dr. Peggy F. Drexler, a psychologist in San Francisco, found that the sons of the lesbian couples were more willing "to entertain discussion about a broader range of sexual orientation," and more "fluid" in their definition of masculine behavior. "They went outside and threw the ball around," Dr. Drexler said, "but they also did cooking with their mother. They were kind of redefining gender roles because they have to deal with the complexities of their own families." Still, she added: "These were very boyish boys. They were very confident about their boyishness. And the parents valued their maleness and encouraged it and admired it, which goes against the sort of myth that lesbians hate men and might undermine their sons' masculinity."
    One child who has grown up with gay parents, Jamie Bergeron, a high school student in Cortland, N.Y., says that growing up with tow mothers has clearly had an impact on her life. She believe, for example, that it has made her more independent and more apt to speak her mind than many of her classmates. And it has also made her more tolerant, no least because she herself has experienced taunting an ridicule from the outside world. In elementary school, Ms. Bergeron said, she learned to withstand the taunting of classmates, who called her "test-tube baby" and had referred insultingly to her parents. But ultimately, she added, the experience gave her a stronger sense of her own identity. "I've had to really identify who I was and what my opinions were," Ms. Bergeron said, "because I've had to do a lot of defending myself and defending my family." As for her sexuality, Ms. Bergeron said that she had questioned it earlier than many of her friends. She concluded that she was firmly heterosexual. But she would not be upset, she added, if she discovered that she liked women instead. "To me," she said, "love is love."

Depression Afflicts Millions, Costs Billions
Sarah A. Webster, The Detroit News- 7/15/2001

DETROIT -- Depression, which caused acclaimed local industrialist Heinz Prechter to take his life last week, is a far-reaching and destructive disorder that is still only partly understood by physicians and medical researchers.  The havoc-wreaking illness can cause mothers to drown babies, teen-agers to shoot classmates and man to turn against himself with self-mutilation or suicide, experts say. As many as 10 percent of depressed people may take their lives, though the actual number is not known because many suicides may be disguised as accidents. Most often, depression results in less dramatic but hurtful consequences: missed work days, disruption in marriages, poor parenting and substance abuse.
    About 10 percent of the U.S. population has one of several depressive disorders, and the illness is the single largest cause of absenteeism, according to the National Institute of Mental Health. The cost of depression to the nation in 1990 was as high as $44 billion, according to a study by the RAND Corp., an international nonprofit research organization. Absenteeism and lost productivity accounted for $24 billion, while suicides and medical care cost $8 billion and $12 billion, respectively.
    People expressed shock that Prechter, a German immigrant who popularized the sunroof in the United States and ran a successful global business, committed suicide. Yet the energetic Prechter, who raised millions of dollars for the Republican party and was active in revitalizing Downriver, suffered from the chronic mental illness for 30 years.
He was receiving treatment at the University of Michigan, which has a Depression Center in the planning phases.
While depressed people do go through unproductive periods, it is a misconception that they are not successful.
"There's some suggestion that people who may be predisposed to depression are in other ways extraordinarily functioning, like Heinz Prechter," said Dr. Sheila Marcus, clinical assistant professor and director of ambulatory psychiatry at the University of Michigan Health System.

Understanding disease
The understanding and treatment of depression has improved greatly in the past few decades, largely due to research by pharmaceutical companies who have brought an array of new antidepressants to the market, such as Prozac. "Within the last couple of decades, we increasingly understand that depression is an illness that changes both the structure of the brain and the function of the brain," Marcus said.
    Yet nearly one-fifth of depression sufferers do not benefit from today's therapies. So researchers are digging in deeper to understand the biochemistry and genetics. "What is going on in the brain? We don't fully understand that yet," said Dr. C. Edward Coffey, a neuropsychiatrist and the chair of the department of psychiatry at Henry Ford Health System in Detroit. He has been studying brains of aging and depressed patients for a decade. Many depression sufferers have a genetic predisposition to the mood disorder, studies of twins and families reveal. But researchers also know that environment and physiology plays a key role. Abuse, severe loss, pregnancy and stress can trigger the suffering for some. Even wintertime or a heart attack can spawn a depressive period.
"Most episodes result from interaction, from underlying predisposition coupled with some environmental stressor," Coffey said. Because genes and environment mix together to create our dark moods, investigation of the disorder is more difficult. Different types of depression may have unique biochemical dynamics.

Drug breakthrough?
Some of the many types of depressive disorders include: bipolar disorder, marked by cycles of highs and lows; seasonal affective disorder, which is marked by changes in weather; and postpartum depression, which is what mothers sometimes suffer after the birth of a child. Everyday blahs, which everyone experiences, are not considered depression. The distinction between a normal funk and depression has to do with the length of suffering and severity. Major depression usually lasts at least two weeks and is marked by lack of function, irregular sleep, fatigue, withdrawn behavior, hopelessness and crying.
    The suffering can range from full-blown major depression, where a person feels hopelessly down for most of the day, to mild depression, called dysthymia, where a person feels like a veil of sadness regularly clouds their life.
Left untreated, depression increases a person's risk of suicide and it can also cause wide-ranging physical damage. It can actually cause some illnesses, aggravate existing conditions or make other diseases, such as heart disease, more deadly. "There is a bona fide relationship between depressive illness and other medical illnesses that makes them more severe and difficult to manage," Marcus said. It may also cause more depression.
    "Once you've have an episode, your risk of having another one is significantly higher than if you've never had one at all," Coffey said. "With each episode, the symptoms tend to be a little bit worse, they tend to be a little bit harder to treat and the length of the interval between episodes tends to get shorter." This escalation may actually be rooted in damage to the brain. Coffey and others have found increased atrophy, or cell death, in the frontal region of the brain in people with depression. It is not clear whether the atrophy causes the depression or vice-versa.
    The cover story in this month's Discover magazine, called The Serotonin Surprise, suggests that popular antidepressants such as Prozac, Paxil and Zoloft may work by encouraging the growth of new brain cells. This process, called neurogenesis, may actually correct the atrophy. Harvard University psychiatrist Joe Glenmullen, who also authored the 2000 book Prozac Backlash, told the magazine that the drugs alter the brain in ways researchers had never imagined and that more study on the potential side effects is needed.

Lifestyle changes
Discovering how depression and its therapies work may be an increasingly important venture. That's because some experts believe depression is becoming more common. Other experts argue that diagnosis of the disease may simply be improving. However, there are clear lifestyle improvements that can protect against depression. Those include proper sleep, exercise and nutrition, as well as a strong support network of families or friends, Marcus said. In fact, exercise, which causes the release of endorphins, may be just as effective as antidepressants for some people, a study by Duke University revealed last year. Yet it is just those protective factors that are often being sidestepped in modern life. "People are not in the habit of taking care of themselves," Marcus said.

Shedding Light on the Day-Care Doom and Gloom
Meghan Mutchler Deerin, Chicago Tribune- 7/15/2001

A recent study about the negative effects of day care on children may have panicked parents for no good reason, according to some of the study's own researchers. "The public was unnecessarily alarmed, but there's really no cause for concern," said Harvard Graduate School of Education professor Kathleen McCartney, one of the principal investigators of the ongoing 10-year child-care study funded by the National Institute of Child Health and Human Development.
    The study found that children who spend 30 or more hours a week in day care are more likely to be aggressive in kindergarten than those cared for primarily by their mothers. Panic ensued, according to some of the study's investigators, when fellow researcher Jay Belsky, a human-development expert at the University of London, presented preliminary findings to the press. "As time in care goes up, levels of aggression and disobedience go up, irrespective of the quality of care," Belsky said recently, reiterating his initial comments to reporters. "Any attempt to make light of this finding borders potentially on the irresponsible." It was Belsky who announced the study's finding that 17 percent of children who spent more than 30 hours a week in child care scored 60 percent or higher on a scale measuring aggressiveness. Comparatively, just 6 percent of children who spent less than 10 hours a week in child care rated 60 percent or higher on the same scale.
    Though none of the study's researchers disputes that the data showed a link between the number of hours spent in child care and aggression, many assert there is nothing strange about the fact that 17 percent of the children who spent most of their time in child care exhibit behavior problems in kindergarten. "When this measure has been administered to the population at large, 17 percent of all kindergartners" score in the aggressiveness range, McCartney said. "I'm not saying we should brush these findings away, but it's totally inaccurate to embrace them and say that child care poses anything of a risk."
    Meanwhile, Belsky defended the finding's significance, arguing that comparisons to the general public are irresponsible. "What you're presuming is that the sample we're studying is fully represented by the population of the United States," Belsky said. "We know that we don't have as many minorities, single parents or impoverished people in our study, the very groups that disproportionately make up that 17 percent in a national" survey. The study's 15 principal investigators followed 1,100 children in 10 cities nearly since birth in a variety of child-care settings.
    McCartney pointed out that the scale the researchers used to rate aggression includes some behaviors that many of us may not consider aggressive, such as bragging, talking excessively, acting jealous, showing off and being stubborn. "You could have just as easily called it self-assertion," McCartney said.
    Many child-care advocates and early childhood experts suggest that it's only reasonable to assume that children raised at home are less likely to be aggressive than those who spend extended periods in a group setting. "These kids are new to school and new to group settings, so they're very timid," said child-development expert Janellen Huttenlocher, a University of Chicago psychology professor. "Kids who've spent time in day care certainly learn how to cope socially, and they're certainly much more sturdy little interactors."
    Colleen Kramer, whose preschooler and kindergartner have spent 50 hours a week at a day-care center for the last two years, credits the program for her daughters' extraordinary self-confidence. "My kids are the first to raise their hands, the first to ask for help, and they want to be first in line," said Kramer, 34, of New Lenox. "They're assertive but not in a bad way."
    For day-care veteran Arielle Keuning, 15, a freshman student council representative at Oak Park-River Forest High School, the confidence she acquired as a toddler in child care has given her a leg up in life. "I think kids who go to day care when they're little have a really easy time interacting with other people when they're older," said Keuning, who described spending most of her young life quite happily at a home day care in Oak Park. "I've always been told I'm really good at sharing things, and I've never ever had a problem with making friends."
    But just as high-quality day care might foster assertiveness in children, lower-quality care could breed aggressiveness, said child psychiatrist and University of Chicago professor Alan Kravitz. "Depending on the specific group dynamics, sometimes all that's needed is assertiveness, but sometimes aggressiveness is all that works," Kravitz said. "If you're in a situation where you're with a lot of kids and there isn't adult supervision, a child has to learn to make his or her needs known."
    There are, unfortunately, an abundance of sub-par day-care centers. "We have far too many early childhood environments that are not of the quality they should be," said Mark Ginsburg, executive director of the National Association for the Education of Young Children, which accredits day-care programs throughout the United States.  About 57 percent of the children who participated in the NICHD study attended what researchers determined was low-quality child care, adding further fuel to the argument for high-quality day care, child-care advocates said.  "You can have a preschool version of `Lord of the Flies' if you don't have a quality center," said Bobbie Noonan, who founded Bobbie Noonan Child Care in Worth in 1963 and now operates 11 child-care centers in Illinois and Florida, as well as three elementary schools. "There are centers where you have large numbers of kids in the care of someone who has no experience, and like any unsupervised group of children, the kids become wild."
    But in day-care centers with well-educated staffs, low teacher-student ratios and stimulating and well-organized environments, future leaders are made, Noonan said. "What you end up with is children who are stronger leaders, more independent and more self-confident," Noonan said. And according to one recent study, less likely to become aggressive adults.
    A University of Wisconsin study released in May that followed disadvantaged children from the age of 3 to 20 found that the children who attended a high-quality day care center were 33 percent less likely to be arrested and 42 percent less likely to be arrested for a violent crime as adults. They were also more likely to finish high school.  "What you really want to know is over the long term, does day care place kids at risk of serious problem behavior, and there's been no study that's shown a long-term connection," said Arthur Reynolds, director of the recent University of Wisconsin study and professor of social work at the University of Wisconsin in Madison.
    During the next few years, NICHD researchers will attempt to uncover what this controversial correlation they have found between hours in day care and aggression really means, and if, perhaps, it fades as the children age. "Hours in care, itself, couldn't possibly explain it," Friedman said. "It's what happens in those hours, or perhaps, what happens at home at the end of the day."  In the meantime, Friedman hopes people take notice of study's more positive findings, which were obscured by the maelstrom over aggression. "The higher the quality of child care, the better the cognitive, language and academic skills of the children," Friedman said. "We found that more hours in center-based care is associated with better pre-academic skills and cognitive skills."  "Quality of care matters, and so does quantity," agreed Belsky. "The latter part seems to be an intolerable truth."
    Though many parents can't control the length of time their children spend in day care, they do have power over their own interactions with their kids. The study also showed that the parent-child relationship was most important determinant of behavior. "Maternal sensitivity is the strongest predictor of behavior problems in children," McCartney said. "This effect between hours in care and behavior problems is reduced when we control for maternal sensitivity." Therefore, the message parents take from the study should not be that "mothers should stay home," said Judsen Culbreth, editor-in-chief of Scholastic Parent and Child Magazine. "It should be that parents need to find quality care and parents need to find quality time to be with their kids."
    Though many child experts remain skeptical about the connection between day care and aggressiveness in children, most agree that the quality of the parent-child relationship is the most crucial influence on a child's behavior. "We need to ask ourselves, what happens at home at the end of the day?" said Sarah Friedman, a National Institutes of Child Health and Human Development psychologist and scientific coordinator of the recent NICHD early child-care study.
    Parents may need to set aside stress--and often, household chores--and spend quality time with their children.  "It doesn't bother me that my bed's not made because those few hours I have with my kids, I want to make those quality hours," said Colleen Kramer of New Lenox, whose 4- and 5-year-old daughters have attended a day-care center for the last two years. "I'm very conscious that I can only be tired after 8 p.m." Though many parents feel good about their child-care arrangements, others feel guilty about time spent away from their children and often allow that guilt to stand in the way of good parenting, University of Chicago child psychiatrist Alan Ravitz said.  "Some mothers who send their kids to day care tend to feel guilty that they're not taking care of those kids themselves," Ravitz said. "As a result, they are reluctant to set firm and consistent limits, and I guarantee you that by being inconsistent you grow aggressive kids."

The Highs and Lows of Ecstasy
Linda Marsa, Los Angeles Times- 7/16/2001

Sue Stevens was severely depressed after her young husband, Shane, succumbed to kidney cancer in 1999. She took large doses of numbing antidepressants to get through the day, and conventional therapy didn't help. Then, last fall, the 32-year-old Chicago woman chose a more radical approach. She traveled to the West to see a psychologist whom she had learned was using the illegal drug Ecstasy for a handful of patients suffering from severe trauma. In a single session, under the influence of Ecstasy--a drug that combines the effects of a psychedelic and an amphetamine--she said she was finally able to come to grips with her grief.
    "Somehow, I knew Shane was no longer hurting, which made it possible for me to let go," said Stevens, who hasn't taken any antidepressants since. "It was like a wire that was disconnected got reattached and jump-started the healing process. Even if this feeling was just an effect of the drug, it's what I needed to do to move forward." Anecdotal reports from other mental health professionals suggest similar results from Ecstasy, said Rick Doblin, president of the Multidisciplinary Association for Psychedelic Studies, a nonprofit group in Boston that funds psychedelic research. "There's a whole network of 30 to 40 people around the country--some are psychiatrists, some are psychologists--who risk their licenses to use MDMA [the chemical name for Ecstasy] with their patients," he said.
    Lester Grinspoon, a professor emeritus of psychiatry at Harvard Medical School who has studied psychedelics but is not among the therapists prescribing Ecstasy to patients, said the synthetic drug can "greatly accelerate" the therapeutic process. "It enhances one's capacity for insight and empathy, and melts away the layers of defensiveness and anxiety that impedes treatment," he said. "In one session, people can get past hang-ups that take six months of therapy to untangle."
    Other doctors, however, contend that MDMA is too dangerous to justify its use for any therapeutic purpose. "There's no scientific evidence that MDMA is beneficial; it's all anecdotal," said Dr. George Ricaurte, an associate professor of neurology at the Johns Hopkins School of Medicine in Baltimore. Giving patients even one dose of Ecstasy, he believes, is unethical because of its potential to harm.
    The intense but largely unknown scientific debate over MDMA's possible pyschotherapeutic use has been overshadowed by the recent storm of publicity about the health risks of the drug. The news is filled with horror stories of kids overdosing on Ecstasy at all-night parties, of machine-gun shootouts over Ecstasy deals gone bad and of disturbing surveys that show it is the fastest-growing illegal drug in America.
    Fueling concern over Ecstasy's safety has been a growing number of studies that suggest it may alter the brain, impair memory and concentration, dull one's intelligence, and cause chronic depression and anxiety. That has led Alan Leshner, director of the National Institute of Drug Abuse, to distribute thousands of postcards with images of brain scans labeled "Plain Brain/Brain After Ecstasy." Yet some credible researchers insist that Ecstasy may be a valuable therapeutic tool when used with professional oversight. They contend that critics have exaggerated the drug's dangers, using weak science to bolster their arguments.
    "The issue has become so politicized that it's impossible to get a fair, objective hearing," said Dr. Charles S. Grob, director of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center in Torrance. Grob helped conduct government-sanctioned tests of MDMA on humans in 1995.
    There is one thing, though, on which both supporters and critics of Ecstasy can agree: The recreational use of the drug is dangerous. Some people take multiple doses of Ecstasy, and the drug is often adulterated with other substances to create a potentially toxic mixture. And Ecstasy is often taken with other illegal drugs in crowded, overheated dance clubs, where users can become severely dehydrated.
    Some mental health professionals say that rampant street use of the drug has tainted the reputation of a potentially valuable tool for treating mental ills that are resistant to conventional therapy, including alcoholism, drug addiction and post-traumatic stress disorder. In addition, studying the parts of the brain stimulated by mind-altering compounds like MDMA gives scientists insights into brain chemistry. This understanding can assist them in formulating more effective medications for mental ills.
    The scientific community has long had an ambivalent attitude toward compounds like MDMA: tantalized by what they can teach us about brain circuitry and their therapeutic promise, but fearful of their possible adverse effects. The history of LSD is a case in point. Lysergic acid diethylamide was devised in 1943 by Swiss chemist Albert Hofmann. Apparently, some LSD seeped through his skin while Hofmann was working with the chemical in his lab. While bicycling home, the scientist experienced the first documented "acid trip." LSD's discovery fueled a flurry of research by scientists attempting to identify the brain regions stimulated by the drug. LSD also ignited interest in serotonin, a chemical messenger in the brain that we now know regulates mood, sleep, libido, impulses and body temperature.
    When serotonin was first isolated from blood cells in 1947, scientists thought it just constricted blood vessels. Then researchers noticed that serotonin and LSD had common chemical structures, which suggested the two compounds had a similar effect on the brain. Suddenly, serotonin became the subject of intense scientific scrutiny because it was believed to play a role in mental illness and schizophrenia. This research paved the way for the development of antidepressants such as Prozac, Zoloft and the class of antidepressants known as SSRIs, or selective serotonin reuptake inhibitors, which maintain high levels of serotonin the brain. "If LSD hadn't been discovered, it may have taken decades, not years, before we figured out what serotonin did," said David E. Nichols, a professor of medicinal chemistry and pharmacology at Purdue University in West Lafayette, Ind.

LSD Effective for Some Addictions
LSD also proved effective in treating alcoholism and heroin addiction in studies conducted in the 1960s in Canada and Europe, chalking up recovery rates in the 40% to 50% range--much higher than traditional treatments. But research abruptly ceased in the United States in 1966 when the federal government banned LSD.
    Despite scientists' efforts to maintain secrecy, MDMA met a similar fate. First synthesized in 1912 by German chemists at Merck Pharmaceuticals, the compound is both a stimulant like cocaine, which means it can raise a person's body temperature, blood pressure and heart rate, and a hallucinogen. In 1976, after publication of the first scientific paper on MDMA's psychoactive effects on humans, psychotherapists quietly began experimenting with it. One estimate suggests that perhaps 500,000 doses of MDMA were dispensed by therapists during the late 1970s and early 1980s, said Doblin, of the Boston psychedelic research group. MDMA was hailed by these therapists as a "penicillin for the soul." "It augmented therapy by enhancing communication and intimacy, and allowed people to access repressed feelings and memories in a nonthreatening atmosphere," said Grinspoon, who has taken MDMA and said it led him to "extraordinary" personal insights.
    Psychiatrist George Greer, for instance, conducted more than 100 therapeutic sessions with MDMA in San Francisco and Sante Fe, N.M. According to Greer, use of MDMA helped ease the pain of a cancer patient and assisted the daughter of a Holocaust survivor to rid herself of "the concentration camp consciousness that had colored her entire life." Greer also used the drug in couples therapy. "Virtually every couple said their intimacy and communication was greatly improved," he recalled. "They were able to bring all the skeletons out of the closet without being afraid their partner would reject them or feel betrayed."
    MDMA's development as a therapeutic aid was derailed in the early 1980s by one enterprising patient, who recognized its lucrative potential as a party drug. He renamed it Ecstasy, and the so-called "love drug" became popular on the college party scene. In 1985, the Drug Enforcement Administration banned the use, possession and manufacture of MDMA, and therapeutic research in the U.S. came to a halt. Soon, reports about MDMA's dark side surfaced. University of Chicago researchers reported that people taking MDMA were sensitive to even minor changes in ambient room temperature and could easily get overheated, possibly resulting in severe dehydration and even death. Other experiments in laboratory animals indicated even one dose of the drug damaged the ends of serotonin neurons, though scientists still aren't sure if that's necessarily detrimental.
    In studies involving primates, exposure to MDMA caused brain damage that was evident six to seven years later. In humans, the toll from chronic use seems even more disturbing. Tests done at Johns Hopkins University in Baltimore revealed that frequent MDMA users had subtle deficits in memory and concentration. Other studies suggested that habitual Ecstasy users didn't do as well on standard intelligence tests. "The evidence is extremely compelling that MDMA is harmful," said Johns Hopkins' Ricaurte, who conducted many of these studies.
    Other scientists, however, think the jury is still out. Part of the problem is that most experiments showing MDMA's deleterious effects have been done on habitual users who mix it with other illegal drugs. Or the research subjects have taken Ecstasy laced with other drugs. So identifying the actual source of the trouble can be tricky.
    An autopsy of a 26-year-old chronic Ecstasy user who died of a drug overdose is a good example. His family donated his brain to scientific research in hopes of learning about how Ecstasy alters the brain. Scans of slices of his brain revealed that serotonin levels were reduced by 50% to 75% of normal levels. Critics have used this information to argue that Ecstasy leaves the brain practically moth-eaten--a fact that is not yet supported by research. Scientists do know that Ecstasy triggers the release of massive amounts of serotonin from its storage sites, which is why users experience a feeling of euphoria. Artificially flushing the brain with so much serotonin eventually depletes reserves of this crucial brain chemical. Consequently, after weekend drug binges, people often experience a profound emotional letdown--a condition known in the Ecstasy-drenched Rave scene as "the terrible Tuesdays." However, the individual whose brain was autopsied used many other drugs and may have had an underlying psychiatric disorder, said Stephen Kish, a University of Toronto pharmacologist who conducted the autopsy.
    Kish speculated that the severe serotonin depletion might have been a symptom of depression. Or it might have been due to the cumulative effects of the combination of drugs that he habitually ingested. Or perhaps it was simply a reaction to taking six to eight times the normal dose of Ecstasy, as he had done just before he died. "There was an extraordinary amount of Ecstasy in his bloodstream so we really don't know whether the damage was permanent or reversible," said Kish. "Still, the available evidence is pointing in the same direction. The question is: Do you want to play Russian roulette with your future?"
    Swiss researchers, however, found that there was no apparent brain damage in people who used chemically pure Ecstasy only a few times. In a study done last year of people who had never taken the drug, 10 subjects were given a single dose of MDMA while an equal number received a placebo. A month later, researchers used a PET scan to take snapshots of participants' brain activity. The images revealed there were no changes in the serotonin neurons. "It was a small sample, so I can't say with total certainty that MDMA isn't harmful," said Dr. Franc X. Vollenweider, a psychiatrist at the Psychiatric University Hospital of Zurich who led this study. "But what I can say is that if you use it a few times in a clinical setting, it won't do brain damage."
    There also may be some hard data soon on MDMA's ability to enhance conventional psychotherapy. Two studies are exploring whether Ecstasy can help people recover from traumatic events, such as rape, incest or physical abuse. Scientists in Madrid have begun prescribing MDMA for rape victims who haven't responded to conventional counseling. Researchers believe the drug will reduce these patients' intense fears so they won't feel emotionally threatened in therapy sessions. In South Carolina, scientists are seeking government approval to test the drug's effects on victims of rape and other assaults and who have been diagnosed with post-traumatic stress disorder. They believe MDMA may help to overcome the key stumbling blocks in treating these victims.
    "People who have been abused have trouble trusting others, which is a real impediment to establishing a therapeutic relationship, and reliving traumatic incidents can provoke incredible anxiety," said Dr. Michael C. Mithoefer, a clinical assistant professor at the Medical University of South Carolina in Charleston. "We believe that using MDMA will make it possible for them to work through their trauma without feeling their fears, and to trust their therapists." Still, experts sound a cautionary note. "I'm not saying this type of research shouldn't be done," said Johns Hopkins' Ricaurte. "But this is a drug that has documented potential for abuse. So human experiments must be done in the most careful and clear-minded of circumstances."

Connecticut Law Says Only Doctors Can Recommend Ritalin for Youngsters
Matthew Daly, Associated Press- 7/17/2001

HARTFORD, Conn. -- When Sheila Matthews' son was in first grade, a school psychologist diagnosed him with attention deficit/hyperactivity disorder and gave his parents information on Ritalin. Matthews refused to put him on the drug. She believed the boy was energetic and outgoing but not disruptive, and she suspected the school system was trying to medicate him just to make it easier for the teachers. Now the state of Connecticut has weighed in on the side of parents like Matthews with a first-in-the-nation law that reflects a growing backlash against what some see as overuse of Ritalin and other behavioral drugs.
    The law approved unanimously by the Legislature and signed by Gov. John G. Rowland last month prohibits teachers, counselors and other school officials from recommending psychiatric drugs for any child. The measure does not prevent school officials from recommending that a child be evaluated by a medical doctor. But the law is intended to make sure the first mention of drugs for a behavior or learning problem comes from a doctor.
    The chief sponsor, state Rep. Lenny Winkler, is an emergency room nurse. ''I cannot believe how many young kids are on Prozac, Thorazine, Haldol you name it,'' Winkler said. ''It blows my mind.'' While she has no problem with the use of Ritalin under a doctor's care, Winkler said a teacher's recommendation is often enough to persuade parents to seek drug treatment for their child's behavior problems. ''It's easier to give somebody a pill than to get to the bottom of the problem,'' she said.
    Nationally, nearly 20 million prescriptions for Ritalin, Adderall and other stimulants used to treat ADHD were written last year a 35 percent increase over 1996, according to IMS Health, a health care information company. Most of those prescriptions were for boys under 12, IMS Health said. In some elementary and middle schools, as many as 6 percent of all students take Ritalin or other psychiatric drugs, according to the federal Drug Enforcement Administration.   
    Dr. Andres Martin, a child psychiatrist at the Yale University Child Study Center, said schools have no business practicing psychiatry. ''We've all heard these horror stories of parents who are told, `If you don't medicate your child, he can't be in the classroom,''' he said. ''You never hear the school say, `If you don't take the damn appendix out, this kid has a bad outcome.' You say, `Your kid has a stomach ache. Take him to the doctor.'''
    The Connecticut Association of Boards of Education has taken no position on the bill. Nor has the Connecticut Education Association, the state's largest teachers union. But union President Rosemary Coyle said the she believes the problem is overstated. 'I really believe teachers do not practice medicine,'' Coyle said. ''We don't recommend kids get on drugs.''
    Concern about Ritalin and other drugs is widespread. The Texas Board of Education adopted a resolution last year recommending that schools consider non-medical solutions to behavior problems. The Colorado school board approved a similar resolution in 1999, and legislation regarding psychiatric drugs in school has been proposed in nearly a dozen states.
    In the New Canaan school district, Matthews and her husband took their son, now 8, to a private psychologist, who said the boy has trouble with reasoning. He now receives special education from the school system. ''I was able to get, for $2,000, a different label that has an educational connotation, rather than medical,'' said Matthews, who did not want her son's name used.  Barbara Lombardo, the district's director of special education, said she supports the new law, but rejected the suggestion that school officials promote behavioral drugs or other medication. ''I can state to you unequivocally that we do not in the public school system profile children'' for behavior problems, she said. ''Every decision we make to assess a child is made'' by a team of staffers.
    Matthews said she has resolved many of her differences with the school system, which did not threaten to remove her son from class. ''I'm really thrilled'' about the law, she said, ''because it gives parents an awareness that there should be a clear difference between education and medication. Our schools are now getting into the field of mental health. That's not what we send our children to school for.''

Mental Health Authorities Say Rage Is a Matter of Accumulation
Lee Dye, ABC News- 7/18/2001

A good friend with a mellow personality was in an elevator awhile back when the door opened and a burly chap stepped inside. "Good morning," my friend said, smiling broadly. The other guy belted my friend in the face, shattering his jaw. It turned out that it hadn't been such a good morning for the assailant. He had just been fired. My friend just happened to be in the wrong place at the wrong time, falling victim to anger that pushed a stranger over the edge. Why do these things happen? Why do we see frequent outbursts ranging from an impolite gesture from another motorist to road rage that can lead, quite literally, to death?

More People, More Conflict
What's intriguing about so many cases of uncontrolled anger is that they often result from such trivial encounters. It's easier to see why a jealous spouse might take a shot at a mate found in a compromising position than it is to understand why road rage would compel someone to yank a small dog from another motorist's car and fling it into the path of oncoming traffic. Why do we get so mad over things that don't really matter, like getting cut off in traffic by someone who's in too much of a hurry?
    To find out I turned to Redford B. Williams, a psychiatrist at Duke University Medical Center, who has spent years studying anger and what we can do about it. It's a pressing issue these days because more and more research shows that if you can't keep your anger under control, it can kill you. Heart disease and strokes have been repeatedly linked to anger. Anger results from our inability to deal with stress. "It's more apt to happen in the world we live in today" because there are so many opportunities for conflict in an increasingly complex, crowded, and busy society, he says.
    But why do we spend so much of our time angry over minor incidents? Some people are just more hostile than others, and anger is often the result of cumulative insults, not a single event.  It's doubtful the kind of road rage that drives one person to the brink of killing another human being is the direct result of getting cut off in traffic, Williams says. More likely, it resulted from a whole series of events that, taken together, pushed someone just a bit too far. The traffic incident served as a trigger, releasing hostility that had been building up for some time. In other words, someone reached a threshold and flipped out.

The Anger Sack
It's as though each of us carries a burlap bag around, storing the insults that have been hurled at us. "You keep stuffing things into that gunny sack you've got on your back," and you get home and find that your mate didn't carry out an assigned chore, Williams says. "You try to put that in the gunny sack, metaphorically speaking, and the damn thing just completely bursts open and it all comes spilling out. It's not that particular thing, but the built up load of all the stuff you've been trying to get out from under." Maybe the mate will understand, bring you your slippers, prop your feet up and tell you everything is OK. But it's quite likely he or she will react unpleasantly because these days, both marriage partners usually work, blurring the roles each is to play and introducing additional stresses.
    And chances are one of you is more hostile than the other.   "My wife and I can be riding in the same car, and I'm sitting there going bonkers [over a traffic incident] and she's sitting there thinking what a nice opportunity we have to talk," Williams says. If you tend to overreact while driving a car, he adds, perhaps you are a bit more hostile than you think you are. Maybe underneath it all, you're seething a good part of the time, and it has little to do with the jerk that just cut you off.
    That's significant because uncontrolled anger can double your risk of having a stroke, according to a recent study by the University of Michigan School of Medicine. Researchers looked at 2,110 middle-aged men and found that those who were better at diffusing their anger had half the number of strokes over a seven-year period as those who were constantly "blowing off steam," according to psychologist Susan A. Everson. "Losing your cool can be very hazardous to your health," she says. Another study found that "hostility reduction training" among patients who had suffered a heart attack lowered their blood pressure almost as effectively as drugs.

Taking Control
Of course, none of this means anger is always bad. Sometimes, anger is a signal that we need to do something about a situation. "If people in the past had not acted on their anger, black people in this country would still be riding in the back of the bus," Williams says. So the key is not to eliminate anger, but to manage it. Williams and his wife, Virginia, have a counseling program in Durham, N.C., working chiefly with companies and governmental agencies, to help people take control of their anger. The first thing to do when conflict arises is make sure you've got your facts straight, Williams says. Once you know what's going on, he says, ask yourself four questions.
1) Is this important to me?
2) Are the thoughts and feelings I'm having appropriate to the facts?
3) Is this situation modifiable? In other words, is there anything I can do about it?
4) Would it be worth it to do what I have to do to change the situation?
    "If you get a no to any one of those questions, you need to change your angry reaction rather than change the situation," Williams says. But if you get a yes to each question, you need to take some action. "That doesn't mean blowing up or screaming or hollering or cutting somebody else off," he adds. What it means, he says, is "engaging in problem solving behavior." If you can remember those four questions, Williams says, it will help you get a grip on your anger. At the very least, you will have time to cool off while you're asking them.

N.J. Sex Offender Law Eased for Teens
Ralph Siegel, Associated Press- 7/18/2001

TRENTON, N.J. - The state Supreme Court ruled yesterday that juveniles who commit sex offenses before age 14 should have the chance to clear their records by their 18th birthdays to avoid the stigma of being listed as sex offenders. A New Jersey law, known as Megan's Law, requires many sex offenders to register with police so the communities they live in can be notified of their offenses.
    In its ruling yesterday, the Supreme Court said juveniles convicted of sex offenses should be given a second chance if they complied with court-ordered treatments and could prove they had been rehabilitated at age 18. The law was challenged by a 17-year-old who argued that he shouldn't be labeled a sex offender for his entire life because of something he did when he was 10. ''This ended up being a life sentence, or a potential life sentence,'' said Craig Hubert, a lawyer representing the boy. Emily Hornaday, a spokeswoman for the attorney general's office, said the agency was pleased that despite the ruling the court affirmed the basic notion that sex-offender laws can be applied to juveniles. She said lawyers had been seeking to have the law nullified for all minors.
    The boy had pleaded guilty to a sexual assault charge involving genital penetration without injury. Hubert said the boy admitted rubbing against an 8-year-old girl in his home when he was 10 but denied there was penetration.  Authorities had classified the boy as a moderate-risk sex offender and sought to notify officials at his high school and other schools. The Supreme Court said yesterday that was unwarranted. Megan's Law was named for a New Jersey girl who was raped and killed in 1994 by a released convict in her neighborhood.