Noteworthy News Articles on Mental Health Topics, August 7-12, 2001

E-Therapy's Risks and Limits Concern Experts
Detroit Free Press, 8/7/2001

According to the monitoring service ABC's of Internet Therapy at www.metanoia.org, what started in 1995 with 12 independent, fee-based sites grew in 2000 to include 300 independent e-therapy sites plus an additional three e-clinics with 700 additional e-therapists. Typically, they charge anywhere from $35 for one e-mail response to $100 for a monthly package, far less than a traditional office visit of $100 or more for an hour or less. (Keep in mind that most insurance companies cover at least a portion of traditional office visits, while few cover the expenses of online therapy.) Recognizing this growing trend, professional organizations, including the International Society for Mental Health Online, the American Counseling Association and the National Board for Certified Counselors, have created principles and guidelines that address everything from security and confidentiality to liability and appropriate counseling plans.

Approach with caution
If you are in a serious crisis situation -- such as feeling severely depressed or suicidal -- you should call a mental health hot line immediately, says Martha Ainsworth, Internet communications specialist and e-therapy consumer watchdog. In addition, she says, you must have the ability to express yourself well in writing. "E-therapy can be a viable alternative source of help when traditional psychotherapy is not accessible, if approached with appropriate caution," Ainsworth says. "It's not therapy, and it should not be compared with therapy." Ainsworth's New York-based Web site, ABC's of Internet Therapy, warns potential e-therapy clients to make sure they understand the limitations of the online relationship, the time line for responses and the privacy of the information they reveal. In addition, she says, they need to find out whether their e-therapist is for real.  Conveniently, her Web site offers a directory of e-therapists that includes ratings based on their credentials, fees, payment options and services offered.
    Perhaps most important, say both proponents and opponents of online counseling, is for consumers to recognize the risks of revealing details of yourself to strangers. For starters, says Hiten Patel, a psychiatrist in Novi, "You need to check references so you know you're not dealing with somebody who has just decided to become an e-therapist." Patel, who prefers meeting with clients face-to-face, says that although e-therapy offers some benefits, he's not ready to log on to the Internet. "I know there are people who are very comfortable striking up relationships in chat rooms ...but therapy is give and take, a dialogue between two people," he says. "With e-therapy, it becomes a series of monologues." Patel says that he doesn't discount the Internet as a therapy tool and sometimes uses it to converse with clients after a face-to-face session. "Occasionally, my patients will send me an e-mail after we meet for clarification on something," he says. "But we don't do actual therapy." Besides opening the door to "a lot of misuse by unscrupulous people," online communication lacks some key elements of good therapy, Patel says. "A lot of our work ...is an art, not a science," he says. "The way a person walks, what he dresses like, what kind of grooming he has, how he shakes hands and whether he makes eye contact are some of the subtle ways we communicate things about ourselves."
    Dr. Vic Strecher, professor at the University of Michigan's School of Public Health, says that study after study in the past decade has proved that people are more honest with a computer about their bad health habits than they are with a therapist. "People seem to be more comfortable in front of a computer," says Strecher, whose team has just applied for grant money to conduct a study on e-therapy versus tailored self-help programs on the Internet. "On average, they elicit more factual information." The U-M team has been studying the effect of new media and e-health to create software that mimics human therapy sessions for Web intervention, prevention and management of disease. Although it has had success dealing with issues like smoking and weight loss, therapy is a different challenge, Strecher says. "How do you replicate what great therapists ask into a software program?" Strecher asks, noting that one element surely missing will be the "emotional support and empathy" that only human beings can give.

Making it stick
E-therapy is not psychotherapy, and it isn't psychological counseling, says Dr. John M. Grohol, a Boston author and online expert. "Since it does not presume to diagnose or treat mental or medical disorders and because it does not limit who may be appropriate to provide e-therapy services, it would be inappropriate to compare it to traditional face-to-face psychotherapy, assessment or counseling services," he says. On his Web site, Dr. Grohol's Mental Health Page, www.psychcentral.com, he says that e-therapists do not diagnose disorders and do not treat diagnosed mental or medical disorders. Rather, they use their specific skills to provide coaching to help a person address specific concerns.
    On her Internet advocacy Web site, Ainsworth says e-therapy provides an outlet for people who are disabled or who live in rural areas as well as those who are not comfortable with the stigmas attached to therapy. But she also makes it clear that the client has to take some responsibility that includes doing a background check, asking a lot of questions and being honest. "Without being together in person, the patient doesn't automatically have information about the therapist, and the therapist doesn't automatically have information about the patient," she says. "Both of them need to take steps to gather enough information about the other to feel secure that the relationship is bona fide."
    Howard Wallman, psychotherapist with a private practice in Los Angeles, is among those who see the benefits of e-therapy for people who are isolated, but would not want it to replace face-to-face sessions. "It's good to have someone to talk to, but I don't think it's the best way to get psychotherapy," Wallman says. His advice for anyone considering e-therapy is to meet the therapist face-to-face first. Like Patel, however, Wallman is utilizing the Internet to help people. For those who are depressed, anxious or just looking for ways to uncover creative blocks, he has developed a self-help package in which the client pays a one-time fee of $39.95 to participate in a program called Free Yourself to Succeed, which includes 10 online lessons. "My hope was always to find a way to reach a lot of people with a lot of information that is not overwhelming," he says, explaining that the user is asked a series of questions, which are then interpreted by the computer program. He says the results focus on what's right and positive rather than what is wrong. "I do say on the site that if you have serious problems, please seek face-to-face therapy," Wallman says. Since the site at www.yourTherapist.com was launched last year, 150 people have bought the program. Another 2,000 have tried the free trial.
    Like self-help books, these programs also have their merit, Patel says, "as long as you are not out on the fringe." Joelle Lucido, a psychologist with a private practice in Clinton Township, says she began offering e-therapy to clients last year. "I started offering it because I had seen clients who were either moving or going away to college and wanted to continue therapy," she says. "Phone sessions were too expensive for them." So far, Lucido says, she has not had much online success. "Not many people are taking advantage of it," she says. "There is a component in the face-to-face therapy -- a connection between the therapist and the client that is missing when you are online." Not only does the therapist miss important nonverbal signals but clients also miss those facial expressions of empathy. "I've had a couple begin therapy with me in that manner, but it really didn't stick," she says. "I think the coldness of the computer doesn't provide that empathetic component that is so vital." Standard and online therapists alike doubt the Internet will ever replace traditional methods. But they do think that as technology continues to evolve, more online clinics will emerge. That's not all, Ainsworth predicted. "Many people will continue to prefer asynchronous, text-based communication, but video conferencing will open e-therapy for those who really want visual contact and talking as opposed to writing."

Research: Emotional Impact Can Be Key to Memory
Erin Hayes, ABC News- 8/7/2001

If you saw a tornado coming your way tomorrow morning, chances are you'd have a very accurate memory of it, for a very long time. So why can't you remember where you parked your car? One of the keys to locking in a memory is how much emotion is attached to it. "I think it's fascinating how some memories stick and others seem to disappear into thin air," says Stephan Hamann, an assistant psychology professor at Emory University who researches this very phenomenon.  Hamann uses functional magnetic resonance imaging, a technique that builds on standard MRI hardware, to chart activity in people's brains as they are shown different pictures and words. Half of the stimuli are meant to evoke emotion, while the other half are neutral. Examining the data, Hamann is then able to "see what areas are more active at that particular time" when a picture or word is shown.
    Results indicate that when items with high emotional content are shown, a specific area of the brain's temporal lobe called the amygdala lights up. The amygdala is the center of emotion in the brain and, it is becoming clear, a very strong tool for solidly hammering in a memory. "When the amygdala detects emotion, it essentially boosts activity in areas of the brain that form memories," says Hamann. "And that's how it makes a stronger memory and a more vivid memory." These can range from painful or fearful memories to ones that are slightly more pleasant, such as "the birth of a baby or a wedding." In Hamann's experiments, test subjects are able to remember twice as many emotional words and pictures as neutral ones.
    Although emotion can give weight to specific memories, it does not necessarily improve memory across the board. In fact, the very emotion that locks in one memory can often wash out others. University of South Florida neuroscientist David Diamond devised a simple experiment to demonstrate this behavior in a rat. First, the rodent swims its way through a water maze, searching for a safety platform. After a few tries, it remembers the location well. Then, emotion is introduced. For a rat, this entails the ultimate stress: close proximity to a cat. As stress hormones flood the rat's brain, its amygdala locks in a memory of the cat. But those same hormones also wash out the rat's other recent memories, stored in other parts of the brain. The next time it is placed in the maze, the rat is at a loss. Where is that platform? It has forgotten. So was what the rat learned before blasted out of its memory by the shock of seeing the cat?   "Exactly. It's completely gone," says Diamond. "What we can also say is that the rat probably remembers the cat very well."
    In this respect, he believes, rats and humans are very much alike. "It appears to be pre-wired that we remember important events very well, and in the process of remembering events extremely well, other memories basically get kicked out." Diamond offers this analogy: "After you see a bank robbery, you come back to the parking lot and you can't remember where your car is."  These studies take us a step closer to understanding the complexities of memory — an intricate process of brain biochemistry that affects us every day, at the most basic level. One day, they may also show us how to unlock its mysterious power. "We may be able to learn how to improve our memories if we study how extremely strong memories are formed," says Hamann

Ecstasy Creeps Into the Suburbs
ABC News, 8/7/2001

N E W Y O R K--"I think it makes me feel great, like I love everybody," Hilton Dufont said from his room at the Phoenix House, a New York drug treatment center. It used to be a drug reserved for club kids who raved all night long in the nation's big cities. These days Ecstasy use is spreading like a disease throughout the country. It's growing more than any other illegal drug in the United States and in the last year alone, the number of eighth-graders who used Ecstasy at least once jumped 82 percent. Dufont is one of many teens who got into big trouble with a substance he once thought of as a simple and safe love-drug. Doniel Goodstein, who is also battling his Ecstasy addiction at the Phoenix House, said he never thought the Ecstasy could be harmful.  "Everybody's having fun, everybody's dancing, it seems like everything's all right," Goodstein said.
    But the good times don't last for most Ecstasy users, and when the party is over they could end up with permanent brain damage and nerve damage. Research shows that Ecstasy can also cause liver, kidney and heart problems. Goodstein remembers the moment he realized that everything wasn't all right. "My legs started shaking, I couldn't stop shaking for like three days. I couldn't move for like three days," Goodstein said. Ecstasy, known scientifically as methylenedioxymethamphetamine, or MDM, is a synthetic, physchoactive pill that induces feelings of euphoria. It dramatically raises blood pressure, heart rate and body temperature. Dr. Terry Horton from the Phoenix House treatment center said Ecstasy use can have very severe consequences. "What we do know is this drug affects very sensitive parts of the brain that are involved with learning and memory," Horton said. "Eighth-graders are at a very special part of their lives when their brains are developing, and we can't even begin to guess what the damage will be 5, 10 or 20 years out."
    The U.S Customs Service has been tracking the flow of Ecstasy into the states since the drug first began appearing at its borders, in substantial quantities, during the late 1990s. In the last few years, Customs seizures of the drug have skyrocketed, from about 400,000 tablets four years ago to more than 9 million last year. The drug's compact size and shape make concealment options almost infinite, according to Customs. Ecstasy is easier to transport and hide than drugs that take up more space like marijuana or cocaine. The pills often cost $20 to $40 per tablet. Ecstasy dangers are becoming evident to politicians around the country.
    Just this week Illinois Governor George Ryan signed legislation that will seriously increase the penalty for selling Ecstasy. He said Ecstasy and other "club" drugs are growing more popular partly because teenagers don't think they are as dangerous as cocaine or LSD. And the reality of Ecstasy dangers may finally be getting through to some teens.
    Danya Moore, 16, was a successful student with a stable loving family who began taking Ecstasy at a friend's suggestion. At one point she was taking about 12 Ecstasy tablets a week. Moore testified about her ongoing climb out of Ecstasy's deep abyss at a Senate Government Affairs Committee last week. "I was once a normal kid and Ecstasy took me down a deadly, destructive path I could never have imagined," Moore testified. "Life is too precious. Ecstasy is not worth it."

Denver Orders Sex-Offender Group-Home Shutdowns
J. Sebastian Sinisi, Denver Post- 8/8/2001

Four group homes housing sex offenders in different parts of Denver were ordered on Tuesday to shut down within 60 days. In a 5-0 vote, the Denver Board of Adjustment for Zoning Appeals rejected an appeal by landlords and residents of those homes to remain open. The appeal argued that the homes are not group correctional facilities and therefore are not subject to a city ordinance barring them from residential neighborhoods. The city statute stipulates that group-home correctional facilities with three or more members are not permitted in single-family-home residential areas.
    "We still have lots more work to do," said resident Paula Hook, who organized an opposition group of Montbello neighbors. "Sex offenders shouldn't live in any neighborhood - not mine and not anyone else's." Hook said the safety of her 4-year-old daughter should supersede city zoning laws.
    "We're obviously disappointed," said Greig Veeder, who operates the group homes under a "Teaching Humane Existence" treatment program. The ruling, he said, "now increases community risk because the cornerstone of our program was a minimum of three people in one home. The idea is to deny sex offenders the anonymity and privacy that contributes to their behavior."  Tuesday's ruling came after more than four hours of deliberation that drew a standing-room-only crowd of more than 75 people.
    Hook organized homeowners after learning that four sex offenders had been living for 13 months in a group home near her while neighbors knew nothing of their presence. Although buoyed by the board's decision, some residents living close to the group homes were not completely satisfied. Montbello resident Daniel Johnson was more optimistic, saying "It should get better if group homes have to go from three to two people. The program in our neighborhood won't work with less than three." Johnson lives next door to the group homes on East 51st.
    Retired Denver police officer Robert Bogens, who has lived in Montbello for 26 years, said, "I remember when the neighborhood was called "Mont-ghetto.' Why, when the area has gotten better, do we want to bring in sex offenders?" Bogens added: "I'd rather deal with a thief. You can restore property. But when you steal a child's innocence, you never get it back."
    Assistant City Attorney Kerry Buckey and deputy planning director Kent Strapko argued that the homes in question were subject to the city ordinance. But attorney Mari Newman, who argued the appeal on a pro bono basis, said the city ordinance is so vague that it could be challenged in a federal court of appeals.
    The city and county of Denver isn't the first local municipality to curb sex-offender group homes. Lakewood altered city ordinances in the summer of 1999 to limit sex offenders in group homes. Aurora, Englewood, Thornton, Superior, Northglenn, Golden and Federal Heights followed suit by the following January. Arvada joined the fold in June 2000.

Guide Suggests Media Should Take Care Not to Glamorize Suicide
ABC News, 8/9/2001

Avoiding sensational coverage of suicides can prevent copycat suicides, a new federally endorsed guide for the media says. U.S. Surgeon General David Satcher, along with academics and suicide experts today issued recommendations calling on the media not to give graphic details about suicides, and not to portray them as heroic or romantic or present them as inexplicable acts of healthy people.
    The new guide, written by the Pennsylvania-based Annenberg Public Policy Center, calls on the media to report on suicide victims' problems — such as asking whether the victims ever had treatment for depression or problems with substance abuse. "The bottom line is we have an opportunity to prevent suicides," Satcher said. "The idea is to make clear that 90 percent of [people who commit] suicides are suffering from mental illness."
    Thirty thousand Americans kill themselves every year, and 760,000 attempt it, according to national statistics. "We're not saying don't cover it," Kathleen Hall Jamieson, director of the Annenberg Center, told The Associated Press. "But there are vulnerable individuals who read and watch news and might be affected by the way in which a suicide is covered."
    The researchers said the way the media reports on suicides can influence other vulnerable people to take their own lives — a phenomenon referred to as "contagion." The guide's authors studied hundreds of recent newspaper stories on suicide, and interviewed reporters and editors about the coverage. However, they found the reporters and editors to be generally skeptical about contagion, so they offered an example: In the mid-1980s, a series of people in Vienna committed suicide by jumping in front of subway trains. Media coverage was extensive and dramatic. After a campaign to educate reporters about copycat suicides, the number of subway deaths dropped by 80 percent, the authors said.
    The president of the American Society of Newspaper Editors welcomed the guide's recommendations, and told The Associated Press that they should be a part of training sessions for reporters and editors. "It's a classic case of attempting to put ethics to work in practical situations," said Oppel, who is also editor of the Austin (Texas) American-Statesman.
    Based on media coverage from prominent national newspapers, Jamieson gave another example of suicide coverage that might have been rethought. From The New York Times came the headline, "Eighth Grade Sweethearts In Suicide Pact." "Romantizing the act or making it a noble act increases the likelihood of imitation," Jamieson told ABCNEWS.

Virginia Officials Laud Work On Addiction Facility
Brooke A. Masters, Washington Post- 8/10/2001

A public and private effort to replace a deteriorating Arlington drug treatment facility puts Northern Virginia at the forefront of the battle to help addicts and cut drug-related law enforcement costs, national and local officials said as work on the center began yesterday. The $4.4 million project on Pollard Street in Ballston will expand to 160 beds and house the headquarters of Vanguard Services Unlimited, a nonprofit group that provides substance abuse treatment to adults and children in Northern Virginia, the District and suburban Maryland.
    Since its 1962 genesis in an Arlington church basement, Vanguard Services has treated more than 27,000 people and grown to 10 facilities. But the 80-bed Arlington building that houses its oldest and largest effort is dilapidated, with insufficient plumbing and troubled air conditioning. So the nonprofit turned to local foundations and government. Vanguard has already raised 79 percent of the $4.4 million needed, including grants from Arlington County and Virginia, said Debby Volz, president and CEO. The existing program will continue to operate until construction is complete on the new building next door.
    At the ceremony yesterday, former White House drug czar Barry R. McCaffrey told more than 50 guests that well-funded and well-run treatment programs such as the ones operated by Vanguard are crucial in tackling serious social problems. "If we don't fund and support science-based treatment, we'll pay for it in law enforcement, accidents, welfare and spouse abuse," he said. "There's probably 10 million of us abusing alcohol and 5 million using . . . drugs, but we've got a treatment capacity of 2 million." Former Vanguard client Chris Tucker echoed McCaffrey's praise, crediting Vanguard with helping him stay clean for more than 15 years. "It is extremely important that you give us a place to go," said Tucker, of Montgomery County. "We are not criminals. We are not bad people. . . . [Vanguard's counselors] were able to lift the pain and give me a new direction."
    The plan to expand Vanguard's Ballston presence has drawn little neighborhood opposition, said Chris Zimmerman (D), vice chairman of the Arlington County Board. "The fact that we can have a facility like this and not have controversy says a lot about the community and a lot about Vanguard . . . the skills and sensitivity they have shown in winning over the community." U.S. Rep. James P. Moran Jr. (D-Virginia) praised the public and private support for Vanguard's expansion. "Arlington is not only taking care of its own, it is showing the way to the rest of the country," he said. "If we can reduce the demand [for illegal drugs] through effective drug treatment . . . the supply will be less profitable and too risky for the growers to invest in."

As Backstreet Boy Leaves Rehab, His Mom Tells of His Emotional Struggle
ABC News, 8/10/2001

A month after Backstreet Boy A.J. McLean left his bandmates to undergo treatment for alcoholism and depression, his mother says he is still struggling to reconcile two conflicting sides of himself. Though the world knows A.J. as the tattooed, flirtatious bad boy of the hit-making heartthrobs, his mother tells Connie Chung on ABCNEWS’ 20/20 that she knows him as "gentle" and "insecure" Alex. As the Backstreet Boys achieved immense fame, Denise McLean says, Alex retreated into the A.J. persona, in part to escape his insecurities and emotional distress. Though it stunned fans, A.J.’s decision to enter treatment was a great relief for Denise. It was the beginning of what she hopes will be a homecoming for her son Alex. "’Mom, you’ve got your son back,’" Denise says her son recently told her.
    Alex was only 4 years old when his parents divorced. He and his mom lived with his grandparents in West Palm Beach, Fla., and his mother says there was a strong bond of friendship within the family. "We were inseparable, we were this mom-son buddy team," she says. He landed his first job in show business when he was 6 years old. It was a part in a play at the children’s theater where his mother worked. She says he was immediately hooked. "He walked on the stage that day when he was 6, that first show, and I don’t think he ever wanted to leave," says Denise. Alex continued acting as well as taking piano and dance lessons. By the time he was 8, he was spending his weekends in professional theater productions. "Everything that was involved around the theater, he wanted to learn. It was like he had this drive," says Denise.
    He dreamed of eventually going to Broadway but his plans took a turn when he answered an ad in a trade newspaper announcing auditions for a boy band, which would become known as the Backstreet Boys. The band spent two years in Europe, where they became a pop phenomenon, then they returned to the States, where they rocketed to stardom. Denise traveled with the boys, first as a guardian and later as part of their management team, but the mother-son team became increasingly difficult to maintain. "It wasn’t like you could just go somewhere as a mother and son anymore and enjoy the privacy, and the special moment of being with your child. There was no such thing. It was fading very quickly."
    Alex’s relationship with his mother was not his only relationship that was strained by his success. He seemed to attract people who were intoxicated by his fame and there was little substance to many of his new friendships, his mother says. "I think people started coming around that really were not interested in Alex anymore," Denise says. "They were interested in what the Backstreet Boy could do for them. ... It was not about him, it was about them."
    Instead of eschewing these people, her son would embrace the A.J. caricature, Denise says.  "He, wanting to please, would be the, the big guy … he would turn into A.J., and he would take them out, and he would pay for [them], and he would be the big shot." The private Alex was giving way to the public A.J., and he often went out drinking and carousing at night, she says.  "He wanted to sleep all day," his mother says. "He wanted to just go out and party at night."
    Denise says A.J. was hurt by his father, who had been out of his life for 15 years. A.J. had sought him out, hoping to build a meaningful relationship and find answers about his past. But like many of the other people coming into his life, Alex’s father seemed less interested in his son than he was in A.J. the pop star, Denise says. "He was interested in him because he was a Backstreet Boy," Denise says. "It wasn’t about Alex. … Alex had already seen so much of this in his friends happening that that must have been just devastating for him to see this in his father."  Alex’s father disputes that he was only interested in Alex because of his fame.Robert McLean says he was elated when his son first contacted him, and is now disappointed that Alex no longer returns his calls.   "I love my son Alex very much and would do anything I could to help him," says Robert. "It is my deepest desire for us to work together to resolve our past and to move forward." This year, Alex/A.J. took another emotional blows, which his mother believes contributed to his depression.
    His beloved grandmother, who helped raise him, died of heart failure. Denise says her son never had a chance to grieve. "He really didn’t have the coping mechanisms," she says. "And his lifestyle didn’t allow him the time to deal with it." Denise believes Alex’s way of shutting the door on his personal pain was to retreat further into his stage persona. "He found a back door he could go through, and that was A.J.," she says. "He just got lost in the hype, the drinking, the lifestyle, the fame. It just pushed Alex out."
    Last fall, when the Backstreet Boys launched their third album, Black & Blue, and began touring, A.J.’s bandmates became distressed by his self-destructive behavior. His voice was faltering, he lost energy on stage, and he wasn’t living up to his responsibilities in the group. It was clear to Denise that she was further losing touch with her son. A therapist began traveling with him. Denise says she tried repeatedly to get through to her son, but he wasn’t receptive. Then, one Sunday, he called his mother and asked for help. She says he was desperate and scared and told her, "I can’t stay out here … I can’t cope with it. I need help. I need to go somewhere." In July, his bandmates made the announcement on MTV that A.J. would be seeking treatment, and the support from the fans was overwhelming.
    Denise says she saw an immediate change in her son once he decided to seek treatment. "I was absolutely amazed at the calmness in his voice," she says. "I was so relieved that you could hear in his voice that he felt safe. He was where he needed to be." Denise says Alex has been out of residential treatment for six days, but remains under a doctor’s care in an outpatient program. She says her son now recognizes that he needs to learn to differentiate himself from the pop star persona. "He needs to learn that when he walks off that stage, he becomes Alex," his mom says. "He was capable of doing that. And he needs to regain that capability."

How TV Host Beat Depression
ABC News, 8/10/2001

N E W Y O R K— With her broad, smiling face, quick wit and infectious laugh, it’s hard to believe that Rosie O’Donnell even gets the blues. But, as the TV show hostess reveals in the latest issue of her magazine Rosie , she has struggled with depression her entire life. "I am one of the haunted," she wrote, saying she only freed herself of depression’s grip two years ago, at age 37, with the help of antidepressants. Depression is an illness that haunts many Americans, particularly women. In any given one-year period nearly 10 percent of the population — 19 million Americans, including 12 million women — suffer from depression. O’Donnell wrote about her own trials with depression in the September issue of her magazine, which launched this spring.
    "It is scary to read it back to myself … to let it go out there into the world, this dark piece of me," she wrote. O’Donnell decided to reveal her depression because she wanted to help others who suffer from it feel less alone. In an exclusive interview with ABCNEWS’ Good Morning America, O’Donnell said she went through 10 years of seeing different therapists before deciding to take medication for depression. "I would list all my complaints of my childhood and they would listen and nod and say ‘I think you need medication,’" O’Donnell said. "And after they said it two or three times I would get another shrink and change my number so they couldn’t call me back."
    Why talk about it now? She’s not sure. When she watches her performance in the 1992 movie A League of Her Own, O’Donnell says she can see her own depression coming through.  She said her emotional state was at its worst in her infamous television interview with Tom Selleck two years ago, when she blasted him for appearing in an ad for the National Rifle Association. Soon it was she who was being accused of hypocrisy. Her local paper reported that her son’s bodyguard had applied for a gun permit. At the time she defended herself by saying that she sometimes has security people who carry guns, and that they should be regulated, not banned. The Columbine High School massacre was what pushed her over the edge, O’Donnell said. She became obsessed with the idea that there was danger everywhere, and that no one was safe. She worried about her three adopted children. She would wake up in the middle of the night four or five times, gripped by fear. It got to the point that she considered leaving her talk show and checking into a hospital.
    O’Donnell says she was depressed even as a child, feeling that there was a darkness in her home but not knowing what it was. In fact, depression runs in her family, as does alcoholism "and an absurd ability to deny the obvious," she said. O’Donnell’s aunt was severely depressed and attempted suicide when she was a child. O’Donnell remembers watching her aunt at parties, sluggish from the lithium she was taking, unable to remember the names of her nieces and nephews. It scared her. Her aunt would likely have been helped by some of the new antidepressants, O’Donnell said. She herself resisted taking antidepressants, thinking it was cowardly, and a way not to really live. She also told herself that she was just sad or moody, not truly depressed.
    But that changed one day when she was lying in bed, feeling like the whole world was gray. Her son came in with a Rugrats video and said, "There are no guns in it. Do you want to watch it?"  She saw her own fear reflected in his eyes and thought of her aunt, who did not have the luxury of the medications she was refusing. The next day, O’Donnell took antidepressants. Even though the effect of the pills was supposed to take longer, her life began to change in about five days. Suddenly the world seemed brighter and she was able to forget some of the pain of her childhood, and the fears that kept her awake at night. There are side effects, including dry mouth and a disinterest in sex. But overall she is happy. "The gray has gone away. I am living in bright Technicolor," O’Donnell wrote.

Gay Teens Twice As Likely to Have Suicide Attempts
San Francisco Chronicle, 8/11/2001

SAN FRANCISCO—At 17, Tracy Peerson was a devout Christian struggling to come to terms with her attraction to other girls. She isolated herself from her classmates at her high school in Antioch, Calif., and didn’t talk with her family about her feelings. She became depressed and so despondent that she attempted suicide.
    Peerson was hardly alone when she tried to take her own life. A study published in August’s American Journal of Public Health shows teen-agers with same-sex attractions, or those in gay and lesbian relationships, are twice as likely as their heterosexual counterparts to attempt suicide.  "A lot of people knew I was lesbian, but they were silent about it," said Peerson, now 21 and in a relationship with another woman. "I think with a lot of gay teens, you almost feel rejected from your family, school, your religion. Some of the time, there might be support there, but there’s no dialogue."
    The gay teen suicide incidence rate in the newly published study is lower than previous research (an oft-cited figure has been that 30 percent of teens who attempt suicide are gay or lesbian), but it is the first study to look at national data. The report is based upon research gathered from the ongoing National Longitudinal Study of Adolescent Health. The questions about sexual orientation and suicide, asked in 1995, found that of the 458 youths who reported suicide attempts, 15 percent had a same-sex attraction. Only about 7 percent of the 12,000 adolescent girls and boys surveyed reported same-sex attraction.
    The study recommends improved prevention and intervention efforts that also take into consideration substance abuse, depression and family history of suicide—all of which researchers found are higher among gay teens. "It is our hope that this study can put to rest any doubt that while the majority of youth reporting same-sex sexual orientation make it through adolescence with no more problems than heterosexual youth, a significant number are at risk for suicide," said co-author Stephen Russell.
    The new data came as no surprise to Crystal Jang, who counsels gay, lesbian, bisexual and transgender youth through the San Francisco Unified School District’s Support Services for Sexual Minority Youth. Jang herself tried to commit suicide as a teen-ager because of her lesbian feelings. She thinks the number may be higher based on her conversations with teens and the fact that many don’t label themselves gay.
    Kim Westheimer, former director of the Massachusetts Safe Schools Program for Gay and Lesbian Students, said schools should look at ways to make students feel safe since research has shown that youths who are harassed less are also less likely to attempt suicide. "More needs to happen in schools, in communities to create safer and more welcoming environments for gay, lesbian and bisexual youth," said Westheimer, who co-wrote a book, When the Drama Club Is Not Enough, about the Massachusetts program. "They need to know they’re not alone. The more we can raise awareness about gay teen suicide, the more we can develop positive interventions."
    Russell, a professor of human development at the University of California at Davis, said that while the research delves into a somber area, he is optimistic the results offer a glimmer of hope. While gay teens are twice as likely to contemplate or attempt suicide as their straight counterparts, the study found that 85 percent of the same-sex oriented youth never contemplated taking their own lives, Russell said. "The next step is to look at the kids who are fine and ask what is it that promotes healthy development for gay and lesbian youth," he said.

Meditation Holds Silent Promise for Prisoners
Vanessa Ho, Seattle Post-Intelligencer- 8/11/2001

Here, at the Northern Rehabilitation Facility, a minimum-security jail in Shoreline, Buddhist meditation—and its quest for freedom from suffering—is seemingly at odds with incarceration.  But as more jails and prisons search for better ways to rehabilitate lawbreakers, meditation has emerged as a cheap, innovative way to reduce drug and alcohol addiction and its associated crimes. At the forefront is NRF, the first jail in the country to offer inmates the rigorous course in Vipassana meditation, first taught by the Buddha more than 2,500 years ago. Today, Vipassana is considered non-sectarian and followed by many non-Buddhists.
    At first, the course sounds like cruel and unusual punishment. Ten days of isolating silence. Ten hours a day of meditation, beginning at 4:30 a.m. Very little food. No TV, no books, no mail, no exercise, no smokes, no meat. And no sleeping during meditation, which is no small feat for sleep-deprived neophytes propped on pillows in a darkened room. But officials say the program, which began four years ago, can transform even the most habitual offender. The early results have been so promising that the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, gave the University of Washington a grant to study the program last year. The research is expected to be completed in 2003. "It’s an extremely powerful journey in self-discovery and self-awareness," said Dave Murphy, the jail’s programs manager. Others are beginning to agree: Two jails, in California and Massachusetts, now offer meditation, and it’s piqued the interest of prison officials in New Mexico and Alabama.
    Most inmates at NRF, which is part of the county’s public health and jail departments, are petty criminals and traffic offenders. Many come in for drunken driving. The vast majority report some kind of drug or alcohol problem. And most reoffend. In a King County study, 75 percent of released inmates returned to jail within two years. But among Vipassana students, only half came back. The course is much shorter than other treatment programs, and costs taxpayers nothing, Murphy said. Courses are taught by Vipassana volunteers from around the country. The facility’s future, on the other hand, is less certain; it is being considered in a round of county budget cuts.
    As proof of success, officials point to Richard Jimerson, who by his own count has been in the King County Jail at least 45 times since 1986. An alcoholic with a bent for malt liquor, he racked up assaults, thefts, DUIs. He countered with detox stays, 12-step programs, church support groups. Nothing worked. But during a stint at NRF in 1997, he took the course, was released three months later and hasn’t been incarcerated since. "I’ll be realistic," said Jimerson, 36. "Everything didn’t stop at once. It’s not like you snap your fingers and you’re cured." Vipassana followers are supposed to meditate daily, but Jimerson quit and discovered heroin. Two years ago, he said he resumed the practice and has been sober since. "I was always bad for fightin’," said Jimerson, who now works for a Vipassana publishing company. "Stuff really became calmer." His mother delighted in her son’s newfound serenity so much that she, too, became an ardent meditator.
    The intensive courses are taught worldwide through an estimated 70 centers but were first taught in a prison setting in India, where a documentary captured hardened criminals weeping after a course. Adherents often say that results are "profound" and "life-changing," but struggle to articulate how. The literature offers vague nuggets about achieving the "highest happiness of full liberation," further prompting skeptics to wonder whether it’s all brainwashing. "Hmmm, it sounds like a rather new and unique alternative," said one veteran Seattle narcotics officer, snickering slightly. "But I would never argue with something that works."
    Lending credibility to Vipassana is the UW study at the Addictive Behaviors Research Clinic, where lead investigator Alan Marlatt just received another grant—from the Robert Wood Johnson Foundation—to study the meditation practice in a community setting. For the NRF study, psychologists will track meditators with a battery of questions both before the course and months after release. "Addicts lack self-regulation skills," said psychologist George Parks, the study’s research coordinator. "They’re impulsive. They’re pleasure-seeking. They want to get high; they get high. They want to drive drunk; they drive drunk."
    In contrast, Buddhist meditation trains people to simply be aware of impulses, thoughts and sensations—and to not react. It teaches a moral code, which forbids lying, stealing, doing drugs and killing, including even insects. At the root of Buddhism are the "Four Noble Truths," in which all life is suffering, and all suffering begins with craving. That’s something addicts already know well, Parks said. "It’s a theory that lends itself to understanding addictive behaviors," he said. The study of Vipassana, which means "to see clearly," is also part of two larger trends: More prisons are emphasizing offender rehabilitation, with understanding that drugs and alcohol fuel many crimes. And more scientists are studying the role of spirituality in treating addiction.
    Besides basic education and work skills, many prisons and jails now offer 12-step programs, cognitive-behavior therapy and even acupuncture. Yet, the idea of Vipassana wasn’t a big hit in the beginning at NRF, despite its reputation for innovation. When a staff member first introduced the idea, Administrator Lucia Meijer remembers dismissing it as some new-age "relaxation therapy." "I’m a bureaucrat," she said. "I like to think of myself as a pragmatic, practical, no-nonsense type." But after taking a course, she was sold. The next problem was logistical. Officials had to get creative to accommodate meditators in the jail’s crowded World War II-era barracks, which house nearly 300 inmates. Now, whenever they offer the course, which is five times a year, they have to clear out an entire wing of offices and classrooms, remove all clocks and drape the windows. The vegetarian diet also raised eyebrows. Initially, the jail chef, a retired military cook, wondered what to do with the "mye-so" (miso), "tah-fu" (tofu) and "brown stuff" (barley) on the Vipassana menu, Meijer joked. Soon, officials noticed meditating inmates were calmer and had fewer discipline problems. Staff members began taking courses at the Northwest Vipassana Center in Ethel in Southwest Washington. They became happier at work, more serene in traffic jams, more loving at home, they said. Some now meditate every day in the daily sessions offered to inmates.
    "If you can go through this, you can go through anything," said Steven Marcus, a 20-year-old former meth addict in for a DUI charge. He had struggled to finish the course in June. His body had hurt from sitting still for hours. But as his concentration deepened, he began to experience what teachers call "storms," in which the unconscious mind unleashes memories, emotions, traumas, songs and sometimes advertising jingles. Marcus thought of how he missed his aunt’s funeral because he was too high. How his grandmother was fed up with his addiction. How his mother and brother died violent deaths when he was 8 and 9. Heat rolled from his stomach to his head. "I had a lot of guilt. It was a way of letting go," he said. "I came to a resolution about the stuff I did to people through my addiction that I didn’t make right." He had dropped out of high school and got hooked on meth at age 15. He had stolen to support his habit and later lost his house in a meth lab raid. But in a few weeks, when he leaves jail, he hopes to emerge a new man, one breath at a time.

On an Expedition Through the Mind
Andy Meisler, New York Times- 8/12/2001

The Diagnostic and Statistical Manual of Mental Disorders, a standard reference work for mental health professionals, defines dysthymic disorder as "a chronically depressed mood that occurs for most of the day more days than not for at least two years." From his office on West 36th Street in Manhattan, Bill Lichtenstein, the creator and executive producer of the weekly public radio program "The Infinite Mind," got increasingly enthusiastic recently as he riffed on how the syndrome could be the perfect focus of an episode. "We'd want to know what it's like to live with dysthymia," he said. "Which brings up the question: What happens if we take all these people and treat them? Would you, if you were dysthymic, take a pill--or undergo a cognitive therapy or whatever--that would guarantee you'd be happy for the rest of your life?
    "So now you've got to get someone--a well-known observer of culture--to do an essay. To talk about this dialectic: How is it that some people feel that it's great to be happy all the time while some people seek the misery of life? So let's find a comedian who builds an act around being depressed all the time, and ask him or her: What's that all about? "And then there's the Anne Sexton thing. People say, 'If we'd had effective antidepressants in Anne Sexton's time, we wouldn't have had her great poetry.' The other side says, 'Yes, but she would have been alive and writing a lot longer.' So I say: Let's find some suffering poets! And ask them how they work and how they feel."
    In the media mainstream, explorations of human psychology tend toward relationship makeovers and journeys into the minds of serial killers. But "The Infinite Mind," a three-year-old program that focuses on the nature of thought, the science of the brain and mental health--and the subtle, often unfathomable interactions between them--is not afraid to probe deeper. And later this month an hour-long installment on dysthymia will join 117 previous shows on topics like habit, shyness, clutter and hoarding, the insanity defense, altruism, courage and post-traumatic stress disorder. "Sure, it's a complicated subject," Mr. Lichtenstein, 44, said, "but isn't it our job as journalists to take complicated subjects and make them understandable and interesting? That's the very reason we created the show."
    "The Infinite Mind" is broadcast on 168 public radio stations to an audience that averages around 500,000. Mr. Lichtenstein and his five-person staff--which includes his wife, June Peoples, as his senior producer and chief deputy--execute their idiosyncratic format on a budget of slightly more than $20,000 a show. The show's host is Dr. Fred Goodwin, 65, a former director of the National Institute of  Mental Health and a leading expert on manic depression, also known as bipolar disorder. Dr. Goodwin handles the show's in-studio interviews as well as all introductions and segues. Before he joined the show, he had no radio experience. "One of the reasons I took the job was to let the public listen to a psychiatrist who didn't fit the stereotype--who actually sounded like a normal person," he said.
    John Hockenberry, the writer and NBC correspondent who has contributed dozens of commentaries and essays for "The Infinite Mind," said: "Dr. Fred wouldn't pass an audition, wouldn't even get a callback, at any broadcast entity I've ever worked for. But on this show he does a tremendous job." Indeed, the soft-spoken, empathetic Dr. Goodwin--he often concludes his interviews with a therapeutic-sounding "I'm afraid we'll have to stop"--manages to keep himself and his interview subjects relatively jargon-free. "One of the interesting things we've learned doing the show," Mr. Lichtenstein said, "is that the top people in the field, including Nobel Prize winners, seem to have gotten where they are partly via their ability to explain their work effectively to the general public."
    In the hoarding and clutter episode, Dr. Goodwin intently questioned a clinician who treats patients with obsessive-compulsive disorder and a researcher examining the genetic and neurobiological underpinnings of the problem--after listeners heard from an elderly woman whose house had been taken over by decades of magazines and newspapers. There was also a segment about a successful advertising executive who had to face his fears and clear out his apartment before he brought his newly adopted child home. In the episode titled "Courage," a financial analyst related how he had reflexively risked his life to try to save a couple who had fallen into a nearly frozen lake: Dr. Goodwin talked to a Polish-born Jew who was hidden from the Nazis by a Catholic peasant woman and has become an authority on the sociology of courage and altruism and their siblings, sensation-seeking and criminal aggression. Mr. Hockenberry, a paraplegic since his teens, contributed an essay in which he bemoaned being congratulated for having the "courage" to proceed with life in a wheelchair.
    One of the themes that runs through "The Infinite Mind" is that those with mental illnesses and neurological disorders experience suffering and social stigma--and fascinating, often unexpectedly advantageous changes. This can be traced to Mr. Lichtenstein's own experience. Born and raised in the Boston area, he received a graduate degree from Columbia School of Journalism in 1979 and by his mid-20'sa was producing segments for "20/20." "Nightline" and other ABC news programs. In 1986, when Mr. Lichtenstein was working as a producer and director for a short-lived late-night television called "Jimmy Breslin's People," he began having paranoid thoughts and delusions, including the conviction that the FBI had him under surveillance and that he was receiving messages through his television set. Friends and co-workers convinced him that he needed to be hospitalized. After several incorrect diagnoses, he was identified as a manic depressive and placed on the proper medication.
    "So I said to myself, 'Well, now I can explain to my friends what was going on,' " Mr. Lichtenstein said. " 'That I have manic depression, but now I feel much better.' As if that would explain things. And then the phone just stopped ringing. I couldn't get a callback. People I'd worked with for six, seven years, with whom I'd been through war zones as a journalist, just stopped returning my calls." The strain of joblessness, Mr. Lichtenstein said, made his mood swings worse and complicated the task of getting his illness under control He was hospitalized several more times; by 1990 he was supporting himself as an office temp. With the help of a local support group for people with manic depression, he managed to regroup.
    Reviving a long held ambition, he formed an independent production company, Lichtenstein Creative Media. Working out of his apartment, he started raising money for a series of public radio documentaries on subjects he felt had received grossly inadequate coverage: manic depression, schizophrenia and depression. They were well received and won numerous awards; he met Dr. Goodwin while producing the program on manic depression. By 1998, with money from various private and corporate foundations--including several unrestricted grants from pharmaceutical companies--he was able to launch "The Infinite Mind."
    Although produced in association with WNYC, which contributes studio time and other services, "The Infinite Mind" is not affiliated with either National Public Radio or Public Radio International, the two major suppliers of public radio programming. The show is distributed free by satellite to any radio station that wants it. This means, Mr. Lichtenstein said, that he maintains editorial independence. It also means that "The Infinite Mind" receives far less promotion than programs like "Car Talk." "This American Life" or "Prairie Home Companion." Still, he said, the show is well enough established that he and his team are contemplating both TV and book versions. And he doesn't see the show running out of ideas anytime soon. "I don't see any sort of end game," he said, non-dysthymically. "The more subjects we do, the more subjects are revealed to us."

Teens Trek to City for Heroin
Jeff Coen, Chicago Tribune- 8/13/2001

The teenage experimenters from Chicago's western suburbs have never known the old heroin, the cooking spoons, the needles and the back rooms of drug houses. Theirs is the user-friendly version, a cheap but pure white powder inhaled with friends willing to make runs from suburbia to city neighborhoods where the new heroin can be bought on the street.
    Chicago tactical officers watch them from their surveillance posts in the tough Harrison District on the city's West Side. Teens park their Honda Civics or parents' SUVs and walk into busy open-air drug markets in a place they call "K-town," police say, so dubbed for Kostner and Keeler Avenues and other K-named streets that run through the sometimes troubled area. "These kids drive in and park the car and walk down blocks that I would be afraid to walk with my gun," Chicago Police Cmdr. Eugene Williams of the Narcotics and Gang Investigations Section said. Authorities say more and more teens are coming from across the area into the city to buy heroin, but most are from DuPage and Kane Counties. They are making the trek for the purer forms of the highly addictive drug--and more of them are turning up for treatment at emergency rooms back home.
    National statistics from the federal Department of Health and Human Services show heroin use among high school seniors last year reached its highest level since the agency began its annual survey more than two decades ago. Local experts said they fear teens in some suburbs are experimenting at a rate that outpaces even those figures. Although hard local numbers are difficult to come by, some suburban hospitals and treatment centers say they are now handling more overdose cases involving teens than ever before. The numbers began rising when high-purity heroin, most of it from South America and Mexico, became widely available in Chicago in the late 1990s, officials said.

Hospitals notice a change
Many west suburban hospitals report seeing several overdose cases a month so far this year, compared with only three or four a year in the mid-1990s. Most are described by hospitals as near-misses, but a handful of deaths have been recorded. Many teens believe the newer variety of heroin is safe, experts said, failing to recognize that what makes the drug effective when snorted is its dangerous purity level. Drug counselors said some youths don't expect the powerful cravings, crippling withdrawal symptoms and lifelong addiction that still come with its use.
    Although alcohol abuse still affects many times more teens in the area, heroin has extended its reach into some unlikely places, said Paul Teodo, administrator of behavioral health at Central DuPage Hospital in Winfield. "The shockers are the cases that are the type of thing you saw in the movie `Traffic,'" Teodo said. "Maybe dad's an executive and the mother is a stay-at-home mom or a schoolteacher. And they live in an area where you wouldn't expect heroin to be a problem." Young suburbanites have the money to experiment with the drug, which sell for about $10 a hit, police and experts say, and the Eisenhower Expressway offers a convenient way to get quickly into and out of city areas notorious for heroin dealings.
    For the most part, police said, neighborhood thugs know not to touch the teens or their cars. "They walk with impunity, because everyone knows why they're there and where they're going," Williams said. "The sellers protect them because they know these kids represent income, and they'll be back again and again."
    As the number of teens coming into the West Side became more noticeable, city police and the DuPage Metropolitan Enforcement Group, a collection of the top drug cops from county departments, occasionally began to run joint stings on the West Side. Mark Henry of the DuPage group said officers have seen teens make drug buys, traced the license plates of their cars and notified the registered owner, often a parent, where the vehicle has been. Williams said the teens who enter the drug markets are often are watched but not arrested because surveillance teams fear tipping off the sellers to busts like the one that resulted in more than a dozen arrests in North Lawndale in May.

Risky experimentation
An overdose of the powerful opiate can slow breathing to the point that it stops, and authorities said it's not difficult for teens new to the drug culture to take a dangerous amount. Dr. Jabeen Hussain, director of adolescent services at Glen Oaks Hospital in Glendale Heights, said as recently as a year or two ago her facility saw a few teenagers annually for heroin overdoses. The hospital now sees an average of one every week or two, Hussain said.
    One teen treated there this summer was the son of a Glendale Heights legal secretary who asked that her name not be used. Her 16-year-old's friends used heroin with the teen in her kitchen, and when he began losing consciousness, they called 911 and left. "I got home and my husband told me our son was in the ambulance, and that he overdosed on heroin," said the mother, whose son survived. "I don't even remember driving to the hospital after that."
    New federal data released in July through the Drug Abuse Warning Network shows a slight increase nationally in young teens treated for overdoses at emergency departments in between 1999 and 2000, but officials say the new figures are five times what they were in the early 1990s. National data from the federal Department of Health and Human Services released earlier this year showed that, among seniors in high school, heroin use rose to 1.5 percent last year from 1.1 percent in 1999. While a small jump, the increase resulted in what officials called the highest rate of heroin use among seniors since the 1970s.
    Don Mitckess, resource and referral coordinator for the Linden Oaks treatment center in Naperville, said his facility typically sees 10 teens a month seeking treatment for heroin addiction or counseling. The purer heroin available today is so addictive that some teens find themselves hooked after two or three uses, Mitckess said. Many turn to injecting the drug and spiral into $40-a-day habits simply to stave off withdrawal symptoms, which include severe flu-like symptoms and muscle pain, experts say.

`A socially acceptable drug'
"Heroin has become more of a socially acceptable drug in this age group," Mitckess said, "and because of the purity and the ability to inhale it, the stigma of the needle is no longer an issue." Many parents awaken to their teen's habit when valuables go missing. "It can be expensive, and to avoid withdrawal, life becomes a constant search to score," he said. "It's a daily hustle to get money, and their own stuff starts to disappear--CD players, the VCR, TVs. You ask, `Where'd it go?' and they say, `I don't know.'" Although the DuPage coroner's office could not provide a number of teen fatalities involving heroin, officials said cases involving accidental fatal overdoses of heroin are no longer viewed as uncommon.
    One such case involved Frank Mondia, 16, of unincorporated Wheaton. The teen's last conversation with his father, Frank G. Mondia, was not an extraordinary exchange. "He was coming in that night and he said, `Dad, I'm taking out the garbage,'" Mondia said recently sitting in the dining room of his home. "I said, `I'm going to bed, I love you,' and he said, `I love you too.' It was the last thing he ever said to me." Sometime that night, a few days after Christmas, Mondia's son sneaked out and joined a group of youths to cruise the streets of Chicago looking for heroin. They found it, and the teen, a popular sophomore football player at Wheaton North High School, died of an overdose. His stepmother found him the next morning in bed, and an autopsy revealed a lethal amount of heroin in his system along with cocaine and prescription drugs.
    Mondia said he had been trying to get his son help at a rehabilitation facility after finding syringes in his room. He was a good-natured, lovable kid who made some bad choices and didn't get the kind of help he needed quickly enough, Mondia said. "We talked about finding things to replace this: God, church, music, anything," he said of his son, who was Mondia's best man when he remarried three years ago. "He wanted to straighten his life out and break away, but he just got sucked back in."

Lights Out for Troubled Youth Camps
Richard Stewart, Houston Chronicle- 8/13/2001

APPLE SPRINGS -- The teen-agers hiking up the eroded, sandy trail through the deep woods to the open-walled huts they called home knew nothing about tight state budgets and bureaucracies. They just knew that soon they and everyone else at the Bob Lanier Therapeutic Wilderness Program for Boys would soon have to be somewhere else. Soon they would have to leave the sense of structure and community they had learned at this 236-acre compound in the Davy Crockett National Forest. The camp and the Elizabeth G. Lanier Therapeutic Wilderness Program for Girls -- which were founded in 1972 by the future Houston mayor, his then-wife and others -- are closing this month. The nonprofit Hope Center for Youth and Family Services, which operated the camps, this year lost the $1.8 million in state funding it had received annually, and its officials say it must close.
    "I'm going to miss it here," said Chris, a round-faced 16-year-old with the wispy beginnings of a goatee. "I'm proud that I've been able to stick it out here." "I didn't think I could stand it when I was first here, but I've done real well," said Nick, 14, his dark eyes shining.  Both boys seemed to revel in the pure primitiveness of the place, which is precisely the point. The remoteness, the absence of television, radio or even electricity or flush toilets in the sleeping areas -- all seemed like an adventure to them.
    It's an adventure that has been undertaken by troubled teens for 29 years but is about to end. Hope Center President Hector Garcia said the center cannot make ends meet without the state money. "That was 60 percent of our annual budget," said Garcia, 65, who took over the Houston-based Hope Center several years ago after retiring as head of community relations for the Metropolitan Transit Authority. "Without that money, the board just found it impossible to go on." The Hope Center has strong ties to Houston. Its headquarters are on Richmond, and the organization once operated an alternative school on Yoakum. It owns an 18-unit apartment building on San Jacinto where troubled teens used to stay. Finances forced the Hope Center to discontinue the school and the residential center in recent years. Garcia said he doesn't know what's going to become of the campgrounds and buildings.
    Lanier was studying wilderness camps while seeking help for his son's drug problem when he decided Houston and East Texas needed the Hope Center. Lanier helped organize the private foundation and donated $1.5 million to build the camps. "I knew that a lot of young people could be helped in places like this, but many people didn't have the ability to pay for it," Lanier said. "We thought this could be a way to help some young people who needed it." The Hope Center camps serve 12- to 16-year-olds from all over the state and from all sorts of situations. Some are sent by county child probation departments, others from the Department of Protective and Regulatory Services. Some are enrolled by their parents. All have been in some sort of trouble and are in danger of getting into worse trouble in the future, Garcia said.
    The whole idea of a wilderness camp, Garcia said, "is to get these kids completely away from the environment they had been in."  "This is so different from where they came from that they can start all over again in a structured, secure environment," he said.  Their tent mates become their family, he said, and "all of the other campers become their community." Typically for 10 months, as many as 55 youths -- and their counselors -- sleep in tentlike huts with no electricity. At each campsite is a single cold-water spigot, a mess hall where campers cook their own meals on weekends over wood fires, a latrine and a central gathering spot. Campers sit on big peeled logs several times a day to talk over plans and hash out problems. Campers soon learn to "circle up," Garcia said. They talk out problems before they escalate into hard feelings or violence. Sometimes they just tell stories, sing songs, write poetry or relax. Campers spend most of every weekday at a central area where there are air-conditioned classrooms operated by local school districts, as well as a dining hall and offices for counselors and other support staff. There's no hazing or boot-camplike activities, Garcia said. "In boot camp, they tear them down to build them back up," he said. "Our kids come to us already torn down. We're here to build them up." Every year, the campers take down and rebuild some of their huts or other facilities. "This lets them know that they can accomplish things," Garcia said. The Spartan living conditions have drawn criticism from time to time. In 1996, some lawmakers questioned the DPRS for placing wards in the camps. Garcia and his staff insist that the campers were treated well.
    There have been success stories. The grandfather of Carey, a 16-year-old from Kirbyville who recently spent time at the boys camp, said he spent $20,000 for a month in a psychiatric facility for the troubled teen. But five months at the camp changed Carey's life, the grandfather said. "The boy got back and was completely different from the boy we sent them," he said. Carey said he hated the camp at first. But after making friends and realizing the key to success there was cooperation, he said, he changed his mind. "Even while you're working, it was fun," he said. Without television or video games to distract him, Carey said, he had time to think about his life. Now he plans to finish high school and go on to college to study parks and wildlife.
    Such stories did not come cheaply, Garcia said. The camp employed almost as many people -- 83 -- as it had campers. It cost the camp about $3,200 a month to house, feed and counsel a camper. Counties, other agencies and occasionally families paid for some of the campers, but by far the largest part of the operation's funding came from the state. "That is why the money from the state was so crucial," Garcia said. Garcia said the state appropriation -- administered by the DPRS -- covered the daily costs for counties that couldn't afford them. In exchange for the money, the Hope Center promised slots for 25 DPRS teen-agers. Some days there were fewer kids, sometimes more. Last year, there was an average of 26 a day, Garcia said.
    Some lawmakers were quick to point out the DPRS could have enrolled children in far less expensive programs. There are other youth camps with somewhat similar programs in Texas, but none is directly funded by the state like the Hope Center. "How fair is that to have, in effect, most-favored-agency status?" asked state Rep. Jim McReynolds, D-Lufkin. McReynolds said he is a longtime supporter of the camps but that the group's appropriation just stuck out as something different from similar agencies during every legislative session. State Rep. Garnet Coleman, D-Houston, agreed. He said he and other supporters of the Hope Center would often have to fight to keep the group included in the budget, but during the last legislative session the budget battle just got too tough.
    In the end, McReynolds said, there was just a general feeling in the Legislature that it was time for the center to lose its unusual funding and have to compete for state dollars just like other agencies. "There was no one leading a charge against it," he said.  Lanier said that for years the Hope Center had strong allies like former Lt. Govs. Bob Bullock and Bill Hobby. "But they're gone now," he said. "I should have seen it coming," Garcia said. Pay for the last of the staff members is scheduled to end in a few weeks. Still, Garcia said he isn't giving up hope that something can be done to keep the camps alive. "I'm spending all day, every day, talking with other groups trying to find a way to combine this with their programs. Anything to keep this place open," he said. After all, he noted, Hope is the name of his center.

California Drug Users Get Treatment, Not Jail
William Booth, Washington Post- 8/13/2001

LOS ANGELES -- In a dreary courtroom at the end of the hall, Crystal Davis shuffled her slippered feet, rearranged her shackles and mumbled to the judge, "Yes, your honor," as she pleaded guilty to possession of 0.02 grams -- a crumb -- of cocaine. In a few hours, Davis would be free from county jail. Whether she would be freed from the drugs that have brought havoc to her life is unknown. But instead of serving months or years behind bars, the 29-year-old crack cocaine user would be ordered to attend five to 10 hours a week of group therapy, individual counseling and 12-step study classes.
    California, known for its strict three-strikes penalties and its prison construction spree, has made a U-turn in the war on drugs. The felons are now patients. Despite widespread opposition by the state's political leadership, voters last year passed Proposition 36, and starting July 1, all people convicted of simple drug use or drug possession -- even for the hardest substances, such as heroin and cocaine -- were no longer sent to jail, but instead had to be released and offered drug treatment. It is estimated that 36,000 drug users a year -- and perhaps many, many more -- will be diverted from jail to treatment, enough to delay the construction of at least two new state prisons. The money saved on incarceration will be spent on rehabilitation, making dollars available for the first time for treatment on demand -- about $120 million a year.
    Although drugs have certainly not been legalized in California, drug users have essentially been decriminalized. With the exception of Arizona, which passed a similar measure requiring treatment instead of jail in 1998, no state has more lenient drug use and drug possession laws than California. While other states and cities have adopted "drug courts," where some drug offenders are diverted from jail to treatment, the California experiment is being played out on a grand scale. "It's a complete revolution," said Dave Fratello, one of the authors of Proposition 36. "We've changed the way drug abusers are seen by the system. Before, some people got some treatment. Now, everybody gets treatment, even the most hopeless cases." Los Angeles Superior Court Judge Michael Tynan agrees: The system has been profoundly altered. "People who went to jail or prison last month are now going back into the community and hopefully into drug treatment," he said in an interview in July. "The people have spoken. They wanted us to try something else."
    Outside a courtroom recently, a drug defendant who had just begun treatment under Proposition 36 and who asked that his name not be used, was enthusiastic about the new law, but also realistic. "For me? I've used on and off for 10 years," said the cocaine abuser in his thirties, who said he worked as a mechanic. "I've been sober and then I used again. I can stay clean. But some of these other people? They're junkies, man, and crack heads, they live on the streets, and nobody is going to take their drugs away." Then he hesitated. "But you know? Maybe they might clean up their act. They deserve a chance, and it's not any worse than sending them to prison."
    No one knows how successful Crystal Davis or any of the other tens of thousands of convicted drug users will be. Critics of Proposition 36 worry that the already overtaxed criminal justice system and community treatment centers will be overwhelmed, that committed addicts will resist help and abuse their freedom, and that not nearly enough money has been appropriated for such things as drug testing or residential treatment, which some hard-core users might need. The experiment will be closely watched, as the backers of Proposition 36 are currently polling and working to put similar proposals before the voters in Florida, Ohio, Michigan and Missouri. Support for the drug reform measures has come from three wealthy men: financier George Soros, University of Phoenix founder John Sperling and insurer Peter Lewis.
    An early examination of the implementation of Proposition 36 in Los Angeles, which has the largest addicted population in the state, is revealing. Crystal Davis was arrested for possessing cocaine while she was on probation for an earlier drug conviction, the possession of a crack pipe. A presentence report written by the probation office before Proposition 36 took effect recommended that Davis, who has a long criminal record of drug charges, be sent to state prison. Her attorney, public defender John Alan, assumed that before Proposition 36, his client would have been sentenced to a minimum of six months in county jail. "She probably would not have gotten the maximum, but you never know," Alan said.
    Los Angeles County Superior Court Commissioner Ronald Rose, who presided over her case, said later that a defendant such as Davis, with a long history of drug convictions and a demonstrated unwillingness to pursue treatment, would have definitely gotten county jail time, perhaps even a year or two in prison. "I believe you can stop using drugs," Rose told her at her hearing. "It's going to be a very, very difficult thing. But you can do it, and we are here to help you." Rose ordered Davis and two other drug defendants, who were all shackled together, to appear at the Homeless Health Care center near downtown Los Angeles within 24 hours to meet with their probation officer and undergo evaluation to decide the appropriate level of treatment. Davis will be on probation for three years and will likely be ordered, after evaluations, to undergo outpatient drug treatment for nine months. "All three of you are going to be released," Rose said. "The odds are that one of you isn't going to make it, and then you'll be going to state prison." And then they were led away by the bailiff, due back in court in three weeks to have their progress evaluated.
    A report done for the California legislature last year estimated that a total of 36,000 people would be diverted from jails to treatment each year under Proposition 36. But that number might prove to be conservative. In Los Angeles, a task force assembled to implement Proposition 36 estimated that 14,000 to 20,000 offenders in Los Angeles County alone would be eligible for treatment. To handle this volume, the county arranged for 18 judges to hear nothing but Proposition 36 cases. Defendants who are deemed eligible -- meaning they have not committed any violent crimes in the last five years -- and who plead guilty or are convicted of drug use or possession, are released and placed on probation, usually for three years.
    Their first step is to attend a Community Assessment Service Center, like Homeless Health Care or Tarzana Treatment Center. "I sit down with them, explain how it works and then off they go," said probation officer Ray Causly, who works at Tarzana. "After that, my contact with them is minimal." From there, they move down the hall into a treatment program. Before Proposition 36, Causly would meet with drug offenders on probation three or four times a month. "Now, that's all handled by counselors," he said. Asked whether he thought the new approach, described by a probation official as "kinder and gentler," would work, Causly said, "I give it a 50-50 chance. What we've done is decriminalize the individual, offer them help, and then step back and let treatment do its thing, and see if it works."
    In the past, some offenders were sent to drug courts, which offered treatment instead of jail time. The success rate was high in Los Angeles, with as many as seven of 10 abusers completing their programs and staying clean. But the number of people who went through drug court was small -- only about 5 percent of the eligible drug defendants in Los Angeles -- and preselected for potential success by judges and prosecutors. Now, everybody is offered treatment -- even users with dozens of drug arrests. Some judges and prosecutors worry that the toughest addicts will simply refuse treatment.
    At the Tarzana center, counselor Monica Weil is the first person the Proposition 36 clients see after the probation officer. She administers a standard test, the Addiction Severity Index, which measures how much treatment a client should have. An occasional cocaine user, who has a job and a supportive environment, would be classified as a Level One. Weil estimates that about 80 percent of the Proposition 36 clients would be Level Ones. A crack addict living on the streets, with multiple arrests and perhaps a psychiatric disorder as well, would be considered a Level Three. Treatment for a Level One would entail four or five one-hour meetings a week for three months, while treatment for Level Three addicts might include several days of detoxification, followed by a month of residential treatment and then 10 hours of meetings a week for nine months.
    There was widespread concern before Proposition 36 became law that the existing treatment centers would be overwhelmed, but that has not been the case in Los Angeles. The centers are busier, and they are scrambling to hire more counselors, but they are managing their growing caseload. If the convicted users fail to stay sober, and stumble in their recovery, the court gives them another chance. If they fail again? They are given yet another chance. On their third strike, they can be sent to jail or prison. "There is still a carrot and a stick," probation officer Causly said. "It just takes a lot longer before we pull out the stick." Crucial to the treatment, say the judges, probation officers and many counselors, is money for repeated, random drug testing -- funds that have not yet been appropriated.
    "Trust only takes you so far. Then you want to test them. A lot," said Ken Bachrach, clinical director at the Tarzana Treatment Center. "That is what this program is. Treatment. Treatment takes time. People screw up. They fail. They try again. The public should understand. They need to be patient. Because this is addiction we're talking about."

Mark Epstein Introduces Buddha to Sigmund Freud
Connie Lauerman, Chicago Tribune- 8/12/2001

Like most psychiatrists of a certain age, Dr. Mark Epstein was steeped in Freudian psychoanalytic theory during his residency training. But well before that, as a freshman at Harvard, he had encountered Buddhism in a course on world religions, and that was the major influence on the kind of therapist he would become. "What Buddhism actually did was give me courage in terms of being a therapist," said Epstein, who practices in New York. "For all the lip service they pay to it, [psychiatry programs] actually don't train you very well or very much in how to actually be with another person as a therapist. "All of a sudden you've got the doctor's coat on and you're the psychiatrist and they give you a patient and you take him in a room and you do therapy. You're alone. They never really tell you what to do."
    Epstein had studied Buddhism intensely, attending a sort of Buddhist summer school at Naropa Institute in Boulder, Colo., after his sophomore year. There he encountered Ram ("Be Here Now") Dass and later such influential Western teachers of Buddhism as Jack Kornfield and Joseph Goldstein. It made more sense to him, he said, than "the psychoanalytic stuff." Meditation, he said, during a visit to Chicago, "is so deceptively simple. You struggle just to keep your mind on your breath. And in trying to keep your mind on your breath, your world is intruding and you have to pay attention to that. So there's no room for pushing away parts of the self or trying to reinforce other parts of the self. It's just all there. Later, in therapy, I found the same kind of experience."
    Epstein, 47, a soft-spoken man with hair just going gray who dresses with tailored Zen simplicity, grew up in a suburb of New Haven, Conn. His father was a physician, an internist with a specialty in kidney disease, who taught at Yale and went on to become a chairman of the department of medicine at Harvard. "My family wanted me to be a doctor," Epstein said. "My father loved his work. He loved it the way my wife, an artist, loves art. I think he wanted me to be as happy as he was. He used to take me to the hospital with him." Growing up, Epstein, an introspective boy who liked reading, bicycle riding and sports, didn't know exactly what he wanted to do. In 7th grade he joined his classmates in forming "The Tuli Kupferberg Fan Club," named for a member of an East Village band, an outgrowth of the Beat literary movement, called the Fugs. He especially like the group's "nothing song," which was inspired by Zen Buddhism's' Heart Sutra. It had a chorus something like "Monday, nothing, Tuesday nothing, Wednesday, Thursday nothing. . . . "
    As a teenager, he was attracted to the writings of Eugene Ionesco and Samuel Beckett and the theater of the absurd. He said Paul Goodman's "Growing Up Absurd," a book that looked at the problems of youth in the "organized system" of modern American life, "really spoke to me. I didn't know Paul Goodman was a Gestalt therapist. I only knew he was a sociologist. "[At the time] I felt a psychological emptiness--some combination of personal unworthiness, yearning, lack of meaning and mostly insecurity over [my] ability to love. Goodman's book and the theater of the absurd gave me a frame."
    During that period, Epstein said, "I decided: `I know I'm a good listener. Maybe whatever being a therapist involves, maybe that's something I can do.'" He also wanted to figure himself out. It is a journey Epstein describes at length in his new book "Going on Being: Buddhism and the Way of Change" (Broadway Books, $23.95), his third and most personal book on the blending of psychotherapy and Eastern spirituality. The book amplifies the similarities Epstein finds between Buddhism and psychotherapy and how he fuses them in the way he works with his patients.
    In Buddha, Epstein said, he found "the first great psychologist," who put together a positive rather than a pathological approach. "He articulated a science of mind, a psychology before there was psychology. He found it in his own experience and then elaborated it conceptually as an explanation of anxiety, fear and where it comes from." Epstein likes to recount a story about the Buddha-to-be in his early days as a struggling ascetic, starving himself and trying to understand the nature of existence.
    "Then at the moment of maximum self-destruction," Epstein said, "the Buddha had a memory, the only reported childhood memory in Eastern thought. It was a memory of when he was a child, of spontaneously arising joy, while he was sitting under a tree watching his father work in the field. "It made him question his whole orientation. Where does pleasure come from? What he found is that it comes spontaneously on its own from within. That's the message of Buddhism, that there's some kind of latent capacity of joy that is inherent to who we are. That's not dependent on any kinds of outside stimulation."
    That view of humanity, so different from the psychoanalytic or psychiatric view of man as inherently flawed, is what drew Epstein to the ancient Eastern spiritual tradition. He is not alone. Other therapist-writers, including John Welwood, a San Francisco clinical psychologist, and Richard N. Wolman ("Thinking with Your Soul"), a clinical psychologist who has been on the faculty of Harvard Medical School for more than 25 years, also have explored the interface of spiritual traditions and the practice of psychology. While "there is still resistance on the part of a lot of therapists and psychiatrists," Wolman said, "many more are willing to deal with it. "[The establishment is] starting to open up. Research is being funded and people listening more carefully when we talk about it. People's lives cannot be thoroughly understood only in terms of the traditional psychodynamic language or theoretical framework."
    Still, Epstein, who once taught a course about Buddhism and psychotherapy at a New York University psychoanalytic institute, believes the founder of psychoanalysis, Sigmund Freud himself, had found meditation. "In his work as a psychoanalyst, from his writings, I think he was clearly putting himself in a meditative state, and that's where his insights would come from," Epstein said. "But he had trouble articulating what he was doing in that state and communicating it to his followers." Epstein also noted that Freud said very directly that therapists "have to give impartial attention to everything there is to observe, not to hold on and not to push away. It was completely a meditative state."
    As a therapist, Epstein said he found an approach that puts less emphasis on understanding and more of a focus on experiencing than he was ever taught in his formal education. He tries to get his patients "to be in the present moment with me. . . . I try as much as I can to put into practice what I've learned, which is to be present, as present as I am able. Then I look to see what's in the way here, what's keeping the person from meeting me in this moment." That is usually an issue that brought them to therapy in the first place, he said, and it's often the shadow of the past that's hanging over the present. "Change will happen naturally as we open to the truth," he writes. "Although terrible and traumatic things may have occurred, it is the individual's mind that perpetuates the suffering and that can be trained to change."
    As a psychotherapist, Epstein said, his approach requires making an effort to "undercut his professional stance," in a way, so as not to lose the person-to-person awareness that he said makes awareness so powerful. "A certain kind of expertise develops where people's problems start to fit into patterns, and I think I've seen it before," he said. "There's distancing in that kind of stance, and people are very sensitive to that. It's alienating and it detracts from the immediacy of the moment, which is where the healing comes from in therapy."

Researcher Looks at Treatment for Early Onset of Bulimia
Meghan Mutchler Deerin, Chicago Tribune- 8/12/2001

In her quest for beauty titles, Miss Lake Cook has been sharing an ugly secret. Lest anyone get the idea that looks are everything, every aspiring beauty queen needs a platform, but while Gina Coconato's competitors have been expounding on politically correct causes from AIDS awareness to drunken-driving prevention, the young woman from Schaumburg has been tackling a very personal issue: bulimia.
    "I was bulimic from the time I was 13 till I was 16," said Coconato, now a 20-year-old senior at Roosevelt University's Theater Conservatory of Chicago and second runner-up in the Miss Illinois Pageant this summer. "I hid stashes of food. I'd eat whole pizzas." At her lowest point, Coconato was throwing up five times a day, bingeing as many as four times daily and regularly abusing diet pills and laxatives. Her parents never had a clue-until she told them. "They had no reason to suspect anything," Coconato said. "My grades were good, and I didn't look sick."
    Eating-disorder specialists suspect that many young bulimics are disguising the illness into adulthood. "An awful lot are not telling you that they really have had this eating disorder from a very early age, earlier than anyone assumed," said Vivian Hanson Meehan, executive director of the National Association of Anorexia Nervosa and Associated Disorders, based in Highland Park.
    Bulimia is two to four times more common than anorexia but much easier to hide because unlike anorexics, bulimics seldom become alarmingly thin, said psychologist Daniel le Grange, director of the University of Chicago's eating-disorder program and assistant psychiatry professor. Whereas an anorexic may be avoiding food to stay abnormally thin, a bulimic may be bingeing on food, even in secret.
    "So you have to be a bit of a detective," explained le Grange, who recently launched one of the first and largest treatment studies of adolescent bulimia. He faces the daunting task of recruiting 90 young bulimics to participate in the five-year, $668,000 study funded by the National Institute of Mental Health. "We need to make people more aware that bulimia is not just a late adolescent or early adulthood illness," le Grange said. "If you catch someone soon after the onset, the outcome is likely to be much better."
    Bulimia nervosa was defined as a separate disease from anorexia nervosa in 1979. Like anorexia, bulimia is largely a female disease. The illness is characterized by frequent episodes of binge eating that are almost always followed by purging. Purging can include vomiting, abusing laxatives and diuretics, exercising compulsively and fasting. Often it starts the way Coconato's did, with a failed diet. Girls attempt to adhere to a very strict diet, but the deprivation leads to intense physical cravings for food, and they find themselves bingeing. Disgusted, they purge, vow once again to stick to the diet, and the cycle repeats.
    Coconato ended up going to her parents about it. "She had read about it, so she knew what was going on," said her mother, Linda. "She did come to us, and I was devastated to find out. We got involved, and she started working with the different groups. Really that's how she got the majority of her help. I have to give credit to the groups that are out there."
    "We are dealing with a very scary illness, which, sadly, many people view as self-inflicted or just as a fad, something you can get over yourself," le Grange explained. Instead, bulimia is a chronic and complex disorder. "There's a great deal of damage," le Grange said. "Patients can lose their teeth, rupture their esophagus. I've known patients who've died from [internal bleeding] when they've ruptured their esophagus." Bulimia also can cause dehydration and damage to the bowels, liver and kidney. It can induce electrolyte imbalance, which can result in irregular heartbeat and sometimes cardiac arrest. "Compared to other eating disorders, adolescent bulimics are typically more depressed, have lower self-esteem" and are more likely to be suicidal, le Grange said.
    Most studies indicate that 2 percent to 5 percent of 15- to 19-year-old girls are bulimic. About to .5 to 1 percent of girls in the same age group are anorexic. But while the anorexics are likely to get treatment when they're young, most bulimics struggle with the disease for six years before seeking treatment. "The mean age of onset for bulimia is 18, but a lot of the cases clearly have an adolescent onset," said Jim Mitchell, president of the Academy for Eating Disorders, the largest international organization of eating-disorders professionals.
    In the absence of a national study, no one has a clear idea of how many younger teens and even preteens are bulimic, Mitchell said, but there is anecdotal evidence that it's striking girls earlier. "Most of us think it's happening earlier," said Mitchell, who also is a professor and chairman of the neuroscience department at the University of North Dakota Medical School. "We know that by the time kids start school, there's already a strong bias against obesity, and it could be that these sorts of cultural messages are just reaching girls at younger ages." But because bulimics typically wait years before getting treated, little is known about how to treat adolescent bulimics.
    Le Grange's study will examine the effectiveness of family therapy in treating adolescent bulimia, because some studies suggest that the method is more effective than individual therapy for treating adolescent anorexics. Family therapy reverses starvation in 60-70 percent of adolescent anorexics, said le Grange, who co-authored, "A Treatment Manual for Anorexia Nervosa, A Family-based Approach." "That's pretty good outcome data given the seriousness of the illness," le Grange said, adding that an estimated 18-20 percent of anorexics ultimately die of the disease.    
    Family therapy emerged in adolescent anorexia treatment in the 1980s, when most hospitals closed their inpatient eating-disorder units, le Grange said. "Once health-management organizations decided [inpatient] treatment was too expensive, there was quite a dilemma of how to treat anorexics," le Grange said. "Family therapy became a very viable alternative."  In family therapy, parents are coached to do exactly what nurses at inpatient clinics once did. "Mom and Dad will make the choices about the type of food, the time to eat, and they don't engage in debate and don't discuss with the anorexic the merits of what's on the plate," le Grange said.
    When family therapy is applied to bulimics, a little more vigilance may be required, le Grange said. At first, the child may be very resistant and extremely angry but is likely to be relieved. "I feel a lot better and a lot more confident," said 13-year-old Elizabeth Hanke, of Michigan City, Ind., whose family began seeing le Grange after she was diagnosed with anorexia in the 7th grade. "I'm scared sometimes that I think it's going to happen again, but then, I know it can't happen again because my parents won't let it. They'll know what to do."
    For help and information
- For information on participating in the University of Chicago Adolescent Bulimia Treatment Study, call773-702-9277,orvisit http://psychiatry.uchicago.edu/research/volunteers/bulimia.html
- Other bulimia resources include The National Association of Anorexia Nervosa and Associated Disorders (ANAD), Box 7, Highland Park, IL 60035. Call the hot line, 847-831-3438, or log on to the Web site, www.anad.org for a listing of support groups and referrals in your area.
- Anorexia Nervosa and Related Eating Disorders Inc. can be contacted through www.anred.com

Study: Kids Show Effects Before the Divorce
Ascribe News Service- 8/12/2001

COLUMBUS, Ohio -- Many of the problems seen in adolescents of divorced parents are evident before the divorce is final, according to a new nationwide study. The study showed that even about a year before the divorce, children of divorced parents showed more academic, psychological and behavioral problems than children whose parents remained married. Moreover, many of these problems were not much worse after the divorce than they were a year before the breakup, results showed.  "Divorce is a process, not just a single incident in these children's lives," said Yongmin Sun, author of the study and assistant professor of sociology at Ohio State University's Mansfield campus. "The negative effects that we associate with divorce are actually evident in teens at least one year before the marriage has ended."
    The study appeared in a recent issue of the Journal of Marriage and Family. Data for this study came from the National Education Longitudinal Study, which surveyed thousands of students beginning in 8th grade in 1988. Sun's study involved 10,088 students who were surveyed in 1990 and again in 1992. Between these two waves of data collection, 798 of the children experienced the divorce of their parents. Sun examined how the children fared before and after the divorce in four broad areas: academic progress, psychological well-being, school behavior and substance abuse. In addition, the study looked at the extent of family dysfunction both before and after divorce. The results showed that in every indicator of academic progress, psychological well-being and behavior problems, children showed maladjustment even before the divorce of their parents. This was true even after various demographic controls were taken into consideration. For example, on average, students whose parents would later divorce scored lower on both math and reading tests than did students whose parents would stay together. They also showed more behavior problems in school and a less-positive self-concept.
    "It's not accurate to say divorce doesn't matter at all, but it is true that much of the damage to adolescents has already occurred before the divorce," Sun said. Sun said that many of the problems children of divorce face may be caused by the poor family environment that existed before the parents split up. For example, children of pre-divorced parents were less likely to report having a good relationship with their parents than did children whose parents would stay together. Parents who would later divorce also attended fewer school events and were less likely to do things or discuss school-related issues with their children. All of these factors were associated with lower well-being in their children, Sun said.
    In addition, while several previous studies concluded that divorce affects boys more than girls, Sun said these results suggest girls are equally vulnerable. One reason may be that most previous studies have focused on younger children, while this study involved children with an average age of 16 at the time of the divorce. "Adolescents may react differently to divorce than do younger children," Sun said.  Sun cautioned that the results of the study don't mean that the actual divorce itself does not affect adolescents. This study only looked at teens about one year before and one year after divorce. Sun is working with a collaborator on a study that will examine children both further before and further after the divorce of their parents to see if more effects become evident.