Noteworthy News Articles on Mental Health Topics, September 18-23, 2001

Professionals Make the Case for Marriage Therapy
Fran Henry, Newhouse News Service- 9/18/2001

Divorce stinks. At least that's what divorced people told pollsters in several states. And marriage is wonderful, Linda Waite and Maggie Gallagher report in "The Case for Marriage: Why Married People Are Happier, Healthier, and Better Off Financially" (Doubleday, $24.95). It's the bible of the marriage movement, a loosely organized campaign to lower the divorce rate through education. Still, 43 percent of first marriages fail within 15 years and 39 percent of second marriages within 10 years, according to the National Center for Health Statistics.
    Can anything help these couples avoid divorce court? The answer, the experts say, is a qualified yes. When they study the facts yielded by clinical studies, they see hope. "There is evidence that marriage therapy works better than nothing at all," says Andrew Christensen, a psychology professor at the University of California at Los Angeles. He has a five-year, $3 million National Institute of Mental Health grant to study the effectiveness of marriage therapy. "But how much does it help, how long-lasting? Unfortunately, for a certain portion, there are only temporary gains, and some couples don't respond at all," adds Christensen. The irony, he says, is that few couples seek professional help before they divorce or separate.
    In a nutshell, marriage therapy--which is becoming known as couples therapy--focuses on the relationship, rather than on one individual or the other, explains David Yonas, president of the Ohio division of the American Association of Marriage and Family Therapy. "The relationship is seen as the client. You look at what each person brings to the relationship, what's working, what isn't, and you focus on problem-solving."
    Don't expect marriage therapy to include much talk about love. "Love can wax and wane," says William Doherty, director of the marriage and family therapy program at the University of Minnesota. It's a feeling that comes and goes, depending on how we're treated, says Diane Sollee, founder of the Coalition for Marriage, Family and Couples Education, torchbearer of the marriage movement. "When you're courting, you treat each other pretty nice, and the love feelings are there." But when the infatuation fades, she says, the considerate, loving behavior can disappear, giving live little reason to stay. "If you get couples to experiment with new behaviors, love comes back," she says.
    But nothing can save a marriage unless both parties want to save it, says Annabeth Benningfield, past president of the American Association of Marriage and Family Therapy and a marriage and family therapist in Dallas. "There can be reconnection for couples who have been distant and unhappy," she says, "but you can't make people want to stay married. If one person is saying, 'I don't want to be married,' I can say, 'let's take some time to think about this. Feelings change.' I can encourage them to not move hastily."
    Some divorces are justifiable, says Doherty. "There are things people shouldn't have to put up with: abuse, cruelty, chronic alcoholism or drug dependence that the partner won't work on, chronic irresponsibility and chronic affairs. I call these the hard reasons to get divorced." However, he says, "soft reasons" can catapult couples into divorce, too. "I'm not happy." "We don't communicate." "Our sex life is in the tank." "My husband is boring." "I deserve more out of life." "He doesn't understand my needs and feelings." "We've grown apart." "She's changed." By and large, people can work through soft reasons, says Doherty, "but you can take any of them, dwell on them and blow up your marriage." He advises that couples take the approach that part of the marriage commitment is to work through soft problems or else come to accept that the problems won't change.
    The problem is, America's consumer culture undermines commitment, he says. "We learn to approach marriage as a consumer choice to meet our immediate needs: 'If you're not happy, you're a chump for staying.' When we get into the consumer mentality, we can become more critical of the spouse and elicit more negativity from the spouse. Then over a period of a year or two, you have increasing polarization. You get depressed and your friends worry and you get more and more support to get out of the marriage."
    But, says Doherty, a determined couple can rise above the cultural climate that promotes divorce. It takes "rock-solid commitment and feelings of connection." While they are on their own in the commitment department, a couple can develop and nurture feelings of connection by cementing rituals into their daily lives, says Doherty, author of several self-help books including "Take Back Your Marriage" (Guilford Press, $21.95). "Couples need to carve out time together every day to talk," he says, to "take each other's emotional temperature. I tell a male (in therapy) that he may not need to share his day, but his wife needs to hear it anyway. Women want to be in the loop."
    Sollee, a former marriage and family therapist, advocates skipping therapy and going to a marriage education class or a marriage-saving weekend, such as Marriage Encounter or Retrouvaille. There is no hard data on the results of the weekend programs. "What happens in therapy is dismal and depressing," says Sollee, who left an executive position with the American Association of Marriage and Family Therapy to found the Coalition for Marriage, Couples and Family Education. "Therapy turns into divorce counseling," she says. "Look at the way marriage therapy works: Each tells how horrible and awful the other is. They blame each other. You'd pretty much convince any normal human being that the love was dead. "But get (a couple) into marriage education and they'll stand a chance. It happens all the time, every day….You can't help but change a little bit. You don't analyze anymore that you're wrong for each other, but that you're behaving badly. You're doing it wrong, but you can learn to do it right."

During Traumatic Times, Small Acts Can Bring a Measure of Comfort
Jane E. Brody, New York Times- 9/18/2001

On Wednesday, reeling from the unfathomable tragedy of the previous day, my husband baked bread, cooked comfort food and invited two single friends to dinner. We talked for hours about what had happened, and event that has shaken most Americans to the core, and about what further tragedies may unfold in the days ahead as the full extent of the disaster becomes known. Similar discussions have taken place during my morning walks and bike rides, in the Y.M.C.A. locker room, grocery store and playground, in the office and on the street.
   "We all have a natural reflex to huddle, and things like this can become occasions for reunion and healing," said Dr. Robert A. Rosenheck, a psychiatrist, affiliated with Yale. Now, a week later, conversation still comes back to these horrific acts of terrorism, acts that have undermined our basic assumption that in this country we are safe from war and external attacks, as Dr. Rosenheck put it. We are all trying to integrate what has happened, to assuage the pain and anxiety and find ways to get on with our lives, which we know will never be the same.
    "People should realize that responses of depression, grief, anxiety are to be expected and accepted," said Dr. Herbert Pardes, a psychiatrist and president of New York Presbyterian Hospital. "Our security has been penetrated and that is very threatening. A roster of concerns will come up: will I be able to get on a plane or walk near a famous landmark?"
    Whether it was a friend, relative, colleague, total stranger or the symbol of the twin towers that were the World Trade Center, we have all lost someone or something. Even for those not directly touched by the loss of a loved one in the events of September 11th, "The fallout can go on for months or years," said Dr. Fleming Graae, director of child and adolescent psychiatry at New York Presbyterian Hospital in White Plains. "Everyone is affected to some degree, responding with horror, anxiety and empathy. Especially for children, these events can leave a lasting imprint. They will reshape how we think about ourselves and the world, our community and our safety." And for some people, the traumatic events of September 11th will bring back memories of previous traumas that may have been buried for years and now must be relived, according to Dr. Rosenheck, who counsels veterans as director of the Veterans Affairs Northeast Program Evaluation Center in new Haven.

Talking Helps
Don't let anyone tell you to try to forget about it, to stop looking at the television, listening to the radio, reading the papers and talking about this disaster. Don't listen to people who say that thinking about it simply perpetuates the pain and insecurity. Psychiatrists and other counselors say otherwise. They have learned from the experience of Vietnam veterans that trying to suppress horrible memories only makes them worse; they eventually come back to haunt you in ways that are harder to recognize and treat. Rather, Dr. Rosenheck says, talking about the nightmare of September 11th is helpful, cathartic and healing. These events graphically tell us "not only that the world is not safe but that basic things are missing," Dr. Rosenheck said. "The mind now has to work hard to think about it and reconstruct the world with those pieces missing. People need to sit with their families and friends in front of the TV and talk and put the pieces together."
    It is also healing to do something to help those who have suffered the most from this tragedy, and that includes rescue workers as well as the families and friends of those who died. This kind of disaster makes people feel impotent, and finding ways to help others can restore a sense of competence and control. The very day of the disaster, many thousands of people lined up to give blood, so many that hospitals ran out of equipment. The Community Bookstore in my Brooklyn neighborhood began a drive for materials--from aspirin and alcohol to blankets and tents--needed by the rescue workers, the families of firefighters who died and the people who have been displaced from their homes. Scores of people responded.
    Even little gestures can bring solace to the givers as well as the recipients. One young mother rode her bicycle across the Brooklyn Bridge on Wednesday to bring food to police officers on rescue duty. My husband and I picked about 50 pounds of Concord grapes from our yard and put them out on the sidewalk, inviting people to "sweeten the sorrow." The grapes were gone in a few hours, and passers-by left notes of gratitude.
    It is also important to be a good listener to people who are suffering, said the Rev. Frank Geer, an Episcopal priest who is director of religious services at St. Luke's-Roosevelt Hospital and rector of St. Phillip's Church in Garrison, N.Y. Father Geer spent two days listening to the stories of rescue workers and medical personnel who were at the scene and needed to talk about what they had seen. "People need to tell their story over and over again, and every time they tell it, it brings further catharsis. So be a compassionate listener," he pleaded. "Even my wife and daughter wanted to hear what it was like for me. Sharing the burden is healing."
    President Bush, in his initial talk to the nation, expressed his desire that the country show the perpetrators that it cannot be brought down by terrorism. Psychological experts agree that it is important to resume normal life as soon as possible. "We should reinforce the aspects of daily life that help us feel safe and secure," said Dr. Graae of New York Presbyterian in White Plains. Adults should go to work and children should go to school, play dates and sports activities. At the same time, however, he said families must individually determine what is the right thing to do and when. Is this the time to take a long trip? Will flying cause undue anxiety? On the other hand, driving to the country, taking a hike in the woods, visiting the shore, going biking or fishing with the children and similar activities can be very restorative.

Avoiding Overreaction
Dr. Rosen heck warned against misplacing one's anger over this event. He said: "Trauma can elicit great rage. When we lose part of ourselves, there is a natural aggressive reaction. In Vietnam the trigger for atrocities against innocent civilians was not a hatred of the Vietnamese but the loss of comrades killed by an enemy that could not be seen and fought." In the aftermath of the current tragedy, "There is the danger of reaction in ways that will later be regretted," he said. "There is a call for vengeance, when what we need is to be led to react responsibly."

Ecstasy Conference Weighs Cause of Increased Club Drug Use
Corissa Jansen, Milwaukee Journal Sentinel, 9/19/2001

MILWAUKEE - Wisconsin law enforcement and health officials say they're struggling to keep up with trends involving club drugs, including the popular rave drug ecstasy. In particular, the use of the drug is on the rise among affluent suburban youths, more and more of whom are winding up in emergency rooms after overdosing. ''It's here, and it's big time,'' said Kathy Sorenson, program director of Project HUGS in Madison, an organization that works with the families of children with drug and alcohol problems.
    At a conference Friday at Waukesha Memorial Hospital titled ''Raves, Ravers, and Club Drugs,'' more than 100 social workers, health care professionals, and school and law enforcement officials gathered to discuss the rave subculture and club drugs scene in Wisconsin. ''Education is the key here,'' said Madison police Detective George Chavez. He said networking among law enforcement agencies, schools, parent advocates, and the medical community is the best way to stay abreast of the evolving trends. Chavez said the culture of all-night dance parties that are often heavily saturated with club drugs is spreading beyond Madison and Milwaukee. As the scene grows, with ravers from far-flung cities such as Atlanta and San Francisco making the trek to Madison, the Internet is a useful tool to find out what to watch for, whether you're a parent or a police officer, Chavez said. ''I tell you, I get on the Internet every day,'' said Chavez, a member of the Dane County Narcotics & Gang Task Force.
    On some Web sites, Milwaukee- and Madison-area users rate different types of ecstasy, including the orangish-pink ''Chanel,'' white ''Rocket,'' and ''Purple Motorola'' - describing the ''roll,'' or high, they get from the psychoactive stimulant and hallucinogenic drugs. ''It lasted a good three hours,'' a Madison resident using the handle ''djbuzz'' on one Web site said of the Rocket high. ''Started coming off, smoked a bowl [marijuana], and it hit me harder than b4 unreal Total Roll.''  Tickets to get into raves can cost $25 to $75. Hits of ecstasy, the psychoactive stimulant and hallucinogen known as the ''hug drug'' for its ability to enhance sensitivity to touch, go for $20 to $25 each. Ketamine, a veterinary drug that produces an almost instantaneous high, sells for about $20.
    Medical professionals say the popular practice of mixing several types of drugs in ''cocktails'' in order to achieve maximum, sustained highs presents a particular problem for doctors and nurses in emergency rooms who have to treat overdose victims quickly. ''It's backyard chemistry,'' said Michael J. Foley, a physician with St. Mary's Hospital Medical Center in Madison. ''And the result can be death.'' According to the US Drug Enforcement Administration, emergency room visits nationally related to ecstasy rose from 1,143 in 1998 to 2,850 in 1999.

Behavior Therapy Said to Help Treat Chronic Fatigue Syndrome
Lindsey Tanner, Associated Press, 9/19/2001

CHICAGO - Research on chronic fatigue syndrome indicates that behavior-based therapies, including exercise, may be among the most effective treatments, but data are deficient and scarce, a review suggests. While evidence on medications is less conclusive than behavioral approaches, research into treatments has been hampered by a lack of consensus on what causes the disease and even who is afflicted with it, according to the review.
    The review, which evaluated 44 studies from 1986 through last year, appears in today's Journal of the American Medical Association. A JAMA editorial said the review may be interpreted as confirming the bias that the syndrome is psychological. But Dr. Anthony Komaroff, a professor of medicine at Harvard University medical school, said behavioral therapy also has been used to treat heart disease and multiple sclerosis. ''It helps people cope with the illness, but it's not curative,'' said Komaroff, who was not involved in the review.
    Once given the misnomer ''yuppie flu,'' chronic fatigue syndrome is difficult to diagnose. It involves persistent, debilitating fatigue that renders many patients bedridden. About 800,000 adults in the United States are believed to have it.

Counselors Head to New York
Associated Press, 9/19/2001

BIDDEFORD, Maine -- Two counselors from Maine are heading to New York to serve on a specialized trauma-support team to help witnesses of the World Trade Center attacks. Cathy Lounsbury and Peggy Paine of Crisis Response Services, part of Counseling Services Inc., leave Wednesday to debrief witnesses of last week's terrorist attacks. Lounsbury, of Biddeford, is a licensed clinical professional counselor. Paine, also of Biddeford, is a licensed social worker.
    They are part of a group of 20 counselors selected by the Trauma Center in Brookline, Mass., to conduct what are known as ''critical-incident stress debriefings'' with hundreds of witnesses in New York City. ''It's designed to help reduce some of the long-term effects of the trauma they saw,'' Lounsbury said Tuesday. ''At the time of trauma, you go into survival mode and you aren't able to process all of the information,'' she said. ''Part of what we're doing is going back and helping folks process the information they've taken in and put words to it.''
    People who have witnessed traumatic events often carry around what they have seen for a long time without being able to ''unload'' the information, Lounsbury explained. So getting them to talk about it helps them understand the tragedy and not keep it bottled up inside them. ''We try to help people identify ways they can take care of themselves after something as traumatic as this,'' Lounsbury said. ''Our goal is getting people to find strength and meaning from what they've been through.'' Lounsbury and Paine expect to return to Maine next week.

Egypt Sentences Boy for Homosexuality
Associated Press, 9/19/2001

CAIRO -- A 15-year-old boy was sentenced Tuesday to three years in prison for practicing homosexuality, the first verdict in Egypt's mass gay trial that has drawn wide condemnation. The youth, who was found guilty of homosexuality and debauchery, will serve his sentence in a prison for young offenders, a juvenile court ordered.
    The youth screamed and sobbed as the verdict was read. The court said he underwent a medical examination that proved he had committed debauchery. Gasser Abdel Razek, an Egyptian human rights activist, said the ruling was "alarming [because] I believe it is based on what the judge thinks is socially acceptable or rejected, which ruins the whole concept of the rule of law."
    The teenager was arrested May 11 along with 51 other males aboard a Nile riverboat restaurant in Cairo. The trial of the 51 other defendants, which is being conducted in an emergency state security court, is expected to resume today. They have all pleaded not guilty. The court said it ordered the maximum penalty after the youth confessed to practicing homosexuality and being a member of a gay organization. Defense lawyers earlier disputed confessions of some of the defendants, saying they were made under duress during interrogation. Debauchery carries a maximum prison sentence of three years. The court said the 15-year-old will remain under police supervision for three years after his release from jail. International gay and human rights groups have condemned the charges. The case has rocked Egypt, a conservative, Islamic-oriented country.

Terror Attacks Spark A Pervasive Anxiety
William Booth and Ceci Connolly, Washington Post- 9/19/2001

She does not want to overreact, but a mother in Texas is standing in line to buy gas masks for her children. In Boston, panicky customers flee a shopping mall after fire alarms go off because of a burned pie in a pizza oven. And all day long, lawyer Monroe Whitesides looks out his window in Charlotte, N.C., at the towering Bank of America headquarters and just cannot stop himself. He imagines a jet airplane, a liquidy flash of orange flame, and then collapse.
    There are few reports of Americans becoming hysterical in the wake of the terrorist attacks. No stockpiling of canned goods; no rush on the banks. Yet there is a palpable change of mood. Outside the twin epicenters of New York and Washington, the feeling is perhaps not fear, but rather a draining, distracting anxiety, like a national case of the jitters. It is so pervasive that yesterday the Federal Communications Commission announced that radio and television stations could temporarily suspend their regular testing of the Emergency Alert System to avoid arousing needless fear that the United States is being attacked.
    "My heart keeps telling me something else is going to happen," said Roscoe Warren, mayor of Homestead, Fla., where Hurricane Andrew destroyed tens of thousands of homes in 1992. "I don't know if I'm paranoid, but I'm really worried for the average citizen of America." Warren remains at his post in city hall, and by and large Americans are back at work and school. The nation is anything but paralyzed. Still, people are more alert, more watchful. As one office worker in Los Angeles put it: "It's not normal to spend the day looking for suspicious packages."
    Paul Steiner, 52, marketing manager for a tourism company in Orlando, has been thinking a lot in the past week about the atom bomb drills of his childhood. "I think right now, we don't know where paranoia begins. Paranoia and rational thought kind of overlap," he said. "Our government is saying be alert, and nobody knows what that means. If you see something that is sort of unusual and it alarms you, it may be over the top, but everybody is so frightened." Americans are witnessing heightened security precautions all around them: at their office parks and manufacturing plants, at shopping centers, military bases, airports, power generators, schools and houses of worship.
    Chad Hartman, 36, lives a life on the road as the radio play-by-play announcer for the Minnesota Timberwolves basketball team. He'll be back in the air in a few weeks: "Will my head be on a swivel? No. Will I feel as comfortable as I would have a couple of weeks ago? No." While the residents of New York and Washington, especially, rightfully remain on edge, so do many people in cities with ties to the terrorist attacks, such as Boston and Los Angeles, where, respectively, two of the hijacked flights departed and three were headed. "The major components of stress and anxiety are unpredictability and loss of control," said Boston College psychology professor Joe Tecce. "Perception is more important than reality when it comes to being jittery."
    The John Hancock Tower, the tallest structure in Boston at 60 stories, has closed its observatory deck, and concrete barriers surround the building. "Part of me feels more secure and part of me is frightened," said Susan Boasi, a children's clothing designer who lives next door to the tower. "If the John Hancock is a secondary target and is hit, I'm dead." In the week since the hijackings, Boasi said she has been unable to do any creative work; for now, she refuses to fly or even take the train. "It's very unsettling to think these people were walking among us," she said. "Anytime I hear sirens I just think, 'Oh God, now what?' "
    Some people say they need to take active steps to protect themselves. In Spotsylvania, Va., police said a 3-year-old boy fatally shot himself with the handgun his father said he brought into the house for protection after the terrorist attacks. At a military surplus store in Austin, the Banana Bay Trading Company, the owner's father, Karl Nutting, said customers began a run on gas masks immediately after last week's attacks. The store sold out its stock of the $29.95 Israeli-made masks in a day or so. There's now a waiting list with about 200 names. "We're also getting a lot of calls for chemical warfare suits," Nutting said.
    One of those on the waiting list for gas masks is Jade Lindquist, 41, a computer programmer for Motorola in Austin. She wants four: one for herself; one for her husband, Estes, who works in hotel sales; and one each for their daughters, ages 2 and 4. Before the attack, she said, she could not have imagined buying gas masks. "I guess I feel kind of embarrassed for looking like a paranoid type," Lindquist said. "We're just normal kind of people. I mean, we don't keep guns in the house or anything like that." But on Sunday, Lindquist read a newspaper article that frightened her -- an article about Osama bin Laden possibly having access to chemical weapons. Since then, she has been haunted by thoughts of her daughters dying in a chemical attack. "I even sent a message to President Bush today, which I've never done before, saying, 'What kind of plan do you have for your citizens?' I told him not to do any attacking until he tells us his plan if there's retaliation. Make sure the people are equipped."
    Nancy Brumfield lives in a suburb of Seattle with her husband, and for the past seven months she has slipped into a comfortable routine of commuting to Salt Lake City weekly for her marketing job. Today, there is nothing comfortable or complacent about her routine -- or her life, she said. "I had tremendous anxiety Sunday night thinking about getting on that plane Monday morning," she said yesterday. "I knew that I needed to get on with my life, but I found myself reassessing if this is how I wanted to live. It was very hard." Brumfield eventually got on the plane -- but not before she ran back into her home at 5 a.m. to hug her husband goodbye one more time, and not before she steeled herself for the 90-minute flight. Once on the plane, she found herself nervously glancing around at her fellow travelers -- not necessarily looking for terrorists, but watching for "some sort of lunatic who might take advantage of situation." "Personally I am very worried right now," said Brumfield, 47, an executive vice president for marketing for Franklin Covey Co. "I'm worried for the safety of my family. I'm concerned that people are not really listening to what our leaders are saying. I'm worried that there will be another strike before we fully secure the nation."
    Francine Lovett confesses to feeling the same way. The 40-year-old dental hygienist in Birmingham says she has not had a full night's sleep in the week since the attacks. "Part of it is anxiety," Lovett said. "But the other part of it is something like guilt. I need to turn the TV on to see what is happening. I need to be informed, and find out that nothing else is going on while I'm taking the liberty of sleeping. Sleeping would be a luxury. How dare I sleep?" Lovett has also seriously questioned her faith. "I have always had a strong personal relationship with God," she said. "But I have even questioned that. I know when you're a faithful person, you have to put everything in God's hands. But I've even been second-guessing God. It's just my insecurity."

Jury Set for Competency Hearing
Carol Christian, Houston Chronicle- 9/19/2001

A jury was seated Tuesday to determine if Andrea Pia Yates is mentally fit to stand trial after nearly a third of the 120 prospective jurors were dismissed because they said they had already made up their minds about her competency. By a show of hands, all but a few of the prospective jurors said they had read or heard something about the Clear Lake mother who told police she drowned her five children in a bathtub June 20.  After questioning by state District Judge Belinda Hill and attorneys in the case, a jury of 11 women and one man was selected later Tuesday. Testimony in the hearing is scheduled to begin at 10 a.m. today.
    Thirty-five of the prospective jurors said during questioning that they already had made up their minds about Yates' competency and would not change their opinions after hearing evidence. They did not indicate whether they thought she was competent. Twenty-five -- including at least one woman chosen for the jury -- said somebody in their families had suffered from depressive disorders. Others later said they were surprised that mental illness is that prevalent.
    Yates has pleaded not guilty by reason of insanity to two charges of capital murder in the deaths of Noah, 7, John, 5, and Mary, 6 months. The mother called police to her southeast Houston home in the 900 block of Beachcomber and admitted drowning the children, along with their siblings Paul, 3, and Luke, 2. Harris County District Attorney Chuck Rosenthal has said he is seeking the death penalty to allow a full range of punishment options.
   On Tuesday, Yates, wearing orange jail clothing, sat nearly motionless at the side of the defense attorneys' table, facing the empty jury box. After the judge dismissed panel members who had not been selected, there were few people in the courtroom except for Yates' family members, including her husband, Russell Yates; her mother, Jutta Kennedy; her mother-in-law, Dora Yates; and her three brothers, Andrew, Brian and Patrick Kennedy. They were subpoenaed to testify at the competency hearing by prosecutors Joe Owmby and Kaylynn Williford. The 37-year-old defendant, who occasionally moved her swivel chair slightly back and forth, did not look at her family members and did not speak to her attorneys, George Parnham and Wendell Odom.
    Before the jury was selected, Hill told the group, which almost filled the courtroom, that competency to stand trial concerns a person's present mental state. Competency is based on the defendant's ability to consult with her attorney with a rational degree of understanding and to have a rational understanding of the court proceedings against her, the judge explained. Insanity pertains to the defendant's mental state at the time of the deaths. When there is a question about a person's competency to stand trial, a jury must be assembled to make the decision, Hill said. In this hearing, the defense has the burden of proving that Yates is incompetent. If Yates is found competent, a separate jury will be selected to hear evidence to determine whether she is guilty or innocent. If the jury decides Yates is incompetent, she will be sent to a state mental hospital with the possibility of being tried later. The hearing will probably end Friday but could continue Monday, Hill said.
    Meanwhile, about 30 people gathered across the street from the Harris County Sheriff's Department on Tuesday night to show support for Yates and her family. They held candles in memory of each of the Yates children.  "She'll be in a cell of her mind for the rest of her life, no matter the outcome," said Deborah Bell, president of the Texas National Organization for Women. "Her actions condemned her to that fate." Bell said there is no need to punish Yates further. Instead, she said she wants to bring attention to postpartum psychosis and its affects.

Expert Details Yates' Psychosis
Lisa Teachey, Houston Chronicle- 9/19/2001

Andrea Pia Yates wants to be executed so she and Satan will be destroyed, a psychologist testified Wednesday during a hearing to determine whether the mother accused of killing her five children is competent to stand trial. Gerald Harris, a psychologist at the University of Houston hired by the defense, visited Yates four times after she was jailed for drowning her five children in the family bathtub. The satanic delusions have begun to subside, but Yates still doesn't meet the threshold for the legal definition of competency, Harris told a jury of 11 women and one man. "She is rapidly getting better," Harris said under questioning by defense lawyer George Parnham. But Harris said he was concerned about Yates' delusions. "You're not going to defend yourself if you still believe your dying is going to get rid of Satan," Harris said of Yates' ability to help her lawyers.
    Jurors must decide if Yates, 37, has a rational understanding of the charges against her and can consult with her lawyers. Should they decide she is competent, Yates would go to trial on two charges of capital murder in the deaths of Noah, 7, John, 5, and Mary, 6 months. If the panel thinks she is not competent, they will have to decide whether she could become so with more treatment and medication or whether she is hopelessly incompetent. Competency deals only with Yates' state of mind today, not at the time of the deaths.
    Yates called police to her house in the 900 block of Beachcomber on June 20 and admitted to killing the children along with siblings Paul, 3, and Luke, 2. She has pleaded not guilty by reason of insanity. Harris County District Attorney Chuck Rosenthal is seeking the death penalty. He said the decision was made to allow for a full range of punishment options.
    Yates, wearing an orange jail uniform, sat virtually motionless during the first day of testimony. But periodically she appeared more animated than in previous court appearances. She sometimes looked at witnesses as they testified and a few times leaned over the desk to consult with lawyers when the jury was out of the courtroom. She never looked in the audience where her family was sitting on the first row. Her husband, Russell Yates, had to remain outside the court because he is scheduled to testify.
    Harris said Yates is being treated with anti-depressants and anti-psychotic drugs in the Harris County Jail and the medicines seem to be working. He predicted she would be fully competent within a month or two. During the first two visits within 10 days of the children's deaths, Harris said, Yates was psychotic and nearly catatonic when she spoke of her satanic delusions and hallucinations. Periodically during those visits Yates would look off as if she were listening or attending to someone else, Harris said. "She told me that Satan was talking to her," Harris said. "She said she had seen images of Satan in the walls (of the jail). "She said she should be punished and that the state would destroy her and Satan," Harris said later under cross-examination by the state.
    In a competency hearing, the defense has the burden of proof and calls witnesses first. During cross-examination, prosecutor Joe Owmby questioned whether it was possible Yates concocted the "complicated scheme with Satan" because she was facing the death penalty. "She lives in a state that has the death penalty," Owmby said. "You find it delusional that she thinks the state might execute her for killing five people?"
    Harris said Yates has an IQ of 113, meaning her cognitive ability is better than that of about 80 percent of the population. But he said a memory quotient test ranked her among the bottom 6 percent. Harris said Yates' long-term memory did not seem to be impaired. The memory test evaluated her ability to recall a string of numbers, sometimes immediately and other times after a 30-minute delay.
    "Could she have been distracted about being in jail for killing her five children?" Owmby asked. "Do you think that could have been more on her mind than telling you these numbers?" Harris said he did not get that sense. He also said Yates often denied she had a mental illness. After the last two visits with Yates, her social skills and emotions were returning, Harris said. But he warned the residual effects of her mental illness could cause her to deteriorate if she heard the details of her crime. "That level of stress would break her again," Harris said.
    Laura Marangell, a Baylor College of Medicine psychiatrist, said she had studied Yates' medical history, which included hospitalizations and outpatient treatment for major depression after the birth of her fourth and fifth children. If the jury should find Yates incompetent based on the progress she has made in the past with proper medication, she should be competent within a month, Marangell said.
    The medical records indicated Yates had attempted suicide twice, had homicidal thoughts and suffered from psychosis that seemed to improve only with medication. About a month before the children died, Yates had been hospitalized and received outpatient treatment. Her attending doctor discontinued a prescription for an anti-psychotic 16 days before the killings.
    Before the defense rested, Parnham was called to the stand by co-counsel Wendell Odom. Parnham said Yates could "reasonably" understand some of the issues he discussed with her. But she could not talk about others that he described as "fundamental" to her defense. He did not say specifically what those were because he did not want to violate the lawyer-client privilege.

Experts See Signs of Mental Distress as Americans Grieve
Pauline Arrillaga, Associated Press, 9/20/2001

PHOENIX --She's been cornered in the office elevator by perfect strangers who know only that she is a counselor. ''I'm feeling a little down,'' they begin, and Marlene Shiple does what she can to help. Her patients, recovering from their own traumatic experiences, relive them every day now. One was in a fire, and replays over and over again the fear of being trapped in a burning building. ''Everyone I saw mentioned it,'' says Shiple, a certified counselor in Phoenix. ''For someone not to have some feelings about it would be totally abnormal.'' ''It'' is the Sept. 11 terrorist attack an event so unprecedented, so overwhelming that it has left a nation struggling with depression, anxiety, anger and outright fear.
    For those already plagued by mental disorders, last week's assault may compound those problems, experts say. Panic attacks may be more severe, bouts of depression more frequent. Yet psychiatrists and counselors agree: Most Americans are experiencing some level of emotional distress following the attacks, which thrust an entire nation into grieving. ''It's not like this is a situation we were prepared to deal with or should've been prepared to deal with,'' Shiple says. ''It's something none of us have ever imagined.''
    The pain is felt far from New York and Washington and those directly involved. ''It's a national mourning,'' says Dr. Ken Duckworth, a psychiatrist and the medical director for the Massachusetts Department of Mental Health. ''This is a loss of individuals, but it's also a loss of our collective sense of invulnerability, and that's really hard for people.''
    Seven in 10 Americans say they have felt depressed since the terrorist attacks, nearly half report having trouble concentrating and a third said they have had trouble sleeping, according to a poll by the Pew Research Center for the People & the Press. Duckworth's agency established a mental health hot line and distributed an article to media outlets offering advice for those having trouble processing the events of last week. The key message: Whatever you're feeling is normal. ''There's a tremendous spectrum of human response to this, and there is no right way,'' Duckworth says. ''Most of us will have moments of anger, moments of feeling disturbed, moments of feeling unreal. Some of us will feel a profound sense of sadness.''
    Phoenix retiree Denny Bayers admits riding an emotional roller coaster since the attacks. His feelings have swung from compassion for those who died to frustration with the government ''for having let this happen'' to worry for the future of his 1- and 2-year-old granddaughters. ''It changed the way you have to look at the world,'' says Bayers, 50, who's been volunteering his time answering calls at the Red Cross. Last week, a number of people were in tears when Bayers picked up the phone. He explained how they might help, and by the end of the conversation both he and the caller felt better. ''I felt very good at the end of the day good that I did my thing,'' he said.
    Across the country, mental health agencies are reaching out. The Arizona Psychiatric Society has compiled a list of psychiatrists and psychologists offering free services. Others have volunteered as stress counselors at the Arizona chapter of the Red Cross, fanning out at airports over the weekend to talk with passengers and airline employees.
    In Connecticut, commuters shell-shocked by the attacks were greeted by crisis counselors last week as they arrived at local train stations. Counseling centers in Oklahoma received calls from hundreds of people reliving the terror of the 1995 bombing there. ''It's like a replay times tenfold of what we've been through,'' said Dr. R. Murali Krishna, a psychiatrist and president of Integris Mental Health in Oklahoma City. And in Boston, where two of the hijacked airlines involved in the attacks originated, the state Department of Mental Health dispatched counselors to several state agencies to talk with workers.
    ''We're just trying to remind people that you are fine. This is an over-the-top event; it isn't your response that's over-the-top,'' says Duckworth, who warns the emotions Americans are experiencing may linger. ''When Kennedy was assassinated, that was a loss and a tragedy, but everybody knew it was over,'' he says. ''This has an unsettling quality of not necessarily being done. It's more than you can bear.''
    On the Net: American Psychiatric Association: http://www.psych.org

Attacks Prompt Soul-Searching, Big Life Changes
David Foster, Associated Press, 9/20/2001

Aaron Williams quit his job. Dan Saurino called military recruiters to ask about joining up. Kristin Wahrheit decided she wants to move to Ireland. Last week's terrorist attacks began a coast-to-coast wave of soul-searching, and now many Americans are making big changes in their personal lives, prodded by two lessons from the tragedy: Life is precious, and time is short. If ever there was a moment to seize the day be it by changing careers, dumping a boyfriend or joining the Army many people have decided this is it.
    ''Everything was made clearer this week,'' Aaron Williams said Wednesday. The Atlanta resident said he'd grown dissatisfied with his public relations job over the past year, ''but I never had the guts to do anything about it.'' Then the terrorists struck. Among the victims, Williams says, was an old family friend: Navy Cmdr. Dan Shanower, killed in the attack on the Pentagon. ''He reminded me a lot of myself,'' said Williams, age 28. ''He was a fun-loving guy, joked a lot, and all of a sudden he was dead.'' Williams spent last weekend huddled with his wife, Mary, reassessing their own lives. On Tuesday, Williams told his boss he was quitting so he could go to graduate school and return to his real passion: journalism. With no assurance of a paycheck, ''we may be eating ramen noodles for a few days a month,'' Williams said. But he's determined to make a change, and he said his wife supports him. ''She said, 'You gotta do what you gotta do.' Life is too short to be stuck in a cubicle all day, pushing papers.''
    It's common for disaster survivors to rearrange priorities, researchers say. Some people who narrowly escape death become more emotionally open, compassionate and spiritually minded, said Curtis McMillen, a professor of social work at Washington University in St. Louis. In his studies of survivors of a tornado, a plane crash and a mass shooting, McMillen found that big changes usually were reserved for those who personally experienced trauma. But last week's tragedy was different. ''We were all personally affected by this one,'' he said. ''We were all traumatized.''  Suddenly it seemed as if everyone was turning 40, a collective mid-life crisis that stirred smoldering dissatisfactions and awakened dormant dreams.
    In Los Angeles, calls flooded in this week after radio station KZLA invited listeners to offer stories of life changes they were making. One woman said she was trying to breach an old rift in her family. A man said he wanted to move from urban California to avoid future terrorism. In Seattle, high-tech professionals assessed their contribution to society and found it lacking. ''Many of my clients are questioning if the work they do really matters,'' said career counselor Janet Scarborough. ''They're asking, do I really care if Version 3.X ships on time?'' Stephanie Balzer, 30, of Phoenix, hit the Internet last weekend to research global politics. She's a financial reporter with the weekly Business Journal in Phoenix, but now what she really wants to be is a foreign correspondent. ''I did a lot of soul-searching,'' Balzer said. ''Although I love my job and I can't see myself doing anything other than writing, it makes me think maybe there's more out there.''
    A newly crystallized patriotism is moving many Americans to action. Recruiting stations and ROTC programs nationwide report increased interest. Some of that is mixed with practical concerns. In Raleigh, N.C., Dan Saurino visited military recruiters this week, saying finances figured as heavily as patriotism for him. He was a pilot with Midway Airlines until last week, when the airline announced that the terrorist attacks were forcing it out of business.  ''I've got a wife. I've got a young son,'' said Saurino, age 30. ''I'm worried more about job security with the recession coming, and people afraid to fly.''
    Others were less pragmatic. Kristin Wahrheit, 26, has a job she loves, as a health educator in Manhattan. But her priorities started changing after she looked out her train window on the way to work Sept. 11 and saw smoke billowing from the World Trade Center towers. Now she wants to move to Ireland, a country she has visited twice.   ''I think I would feel safer there than I feel here,'' she said. ''On Sept. 10, it was a lofty dream. As of Sept. 11, it's something I've been thinking about a lot more. ''I'm understanding how precious life is, and how I need to make goals happen. You never know when you won't get the opportunity anymore.''

Most Americans Feeling Depressed, Survey Finds
Los Angeles Times, 9/20/2001

The terrorist attacks have united the country in its backing for a strong military response but have left many Americans depressed, distracted and sleepless, a poll found. Seven in 10 said they have felt depressed since the attacks, nearly half report having trouble concentrating and a third said they have had trouble sleeping, according to the poll by the Pew Research Center for the People & the Press. Women were more likely to say they were feeling depressed about the attacks--4 in 5--than men--fewer than two-thirds. Parents were more likely than childless people to feel depressed. Residents of major cities along both coasts were more likely to say they were depressed by the attacks than were other Americans. Women also reported more problems sleeping than men.

Survey Says 60,000 In D.C. Are Addicts
David A. Fahrenthold, Washington Post- 9/20/2001

About 60,000 District residents -- more than one in 10 -- are addicted to illegal drugs or alcohol, D.C. health officials have concluded after a door-to-door survey. The survey of 15,035 households, conducted last December, is the most comprehensive snapshot of substance abuse ever taken in the city, D.C. government officials said. Mayor Anthony A. Williams (D) plans to release the study at a news conference today and announce a goal of reducing the number of addicts by 25,000 by 2005. Drug addiction "needs to be looked at as the 800-pound elephant in the room," said Larry Siegel, head of the District's Addiction Prevention and Recovery Administration. "The community needs to decide, once and for all, that this is intolerable."
    In the representative sample that was surveyed, about 8.9 percent said they were addicted to drugs or alcohol. Siegel's staff then added in estimates of the numbers of homeless and institutionalized people addicted to drugs or alcohol to come up with a final figure of roughly 10.5 percent of the city's population. The national rate of dependence, based on a 1999 house-to-house survey by the federal Department of Health and Human Services, is about 4.7 percent. In that study, federal officials estimated a 4.1 percent dependence rate in Virginia and a 4.7 percent rate in Maryland. A 1997 study by Maryland's state government estimated that 65,185 Baltimore residents were addicted to alcohol or drugs, or 10 percent of that city's 2000 population. The house-to-house survey was the first such study in the District. Local drug treatment experts said yesterday that the findings rang true. "We've always said there were about 60,000 people dependent," said Renee Lohman, of Washington Behavioral HealthCare, which helps coordinate local substance abuse and mental health care. "It's not getting better."
    The study found that marijuana was the most commonly used illegal drug in the District, with about 7 percent of those 12 and older having used it in the past month. Next came cocaine, which about 2 percent reported using in the last month. Less than 0.4 percent reported using heroin in the last month. District residents were far more likely to be addicted to alcohol than illegal drugs. Nearly 29,000 residents have an alcohol addiction, according to the survey, compared with the 10,400 dependent on marijuana. Among youth ages 12 to 17, one in six reported having had an alcoholic beverage in the month before the interview. Anita Bellamy Shelton, who heads the Hillcrest Children's Center in Northwest, said her experience suggests that youth drinking is on the rise. "The sleeper is the increase in alcohol among youth," said Bellamy Shelton, whose organization treats children for mental-health and substance-abuse problems. She said children progress from beer to hard liquor quickly. "It's like a social thing, and then it's every day," she said.
    The survey found that 11.5 percent of blacks had used an illegal drug within the past month, compared with 7.3 percent of Hispanics and 6.6 percent of non-Hispanic whites. The rate of drug use ranged from 14.1 percent in Ward 2, centered on Southwest and including neighborhoods such as Georgetown and Shaw, to 2.7 percent in Ward 3, in far Northwest. But whites were the racial group most likely to have used drugs at least once in their lifetime -- with 61 percent of white respondents answering "yes" to that question. The percentage was 41.1 percent for blacks and 16.9 percent for Hispanics. "For a while, we've been burying our heads in the sand about the [extension] of the problem across racial and ethnic lines," Bellamy Shelton said. "This is an equal-opportunity disease."
    Tackling the problem will be the work of a mayoral task force appointed in March and headed by Siegel and D.C. Police Chief Charles H. Ramsey. Today's news conference, at a new methadone clinic on N Street NE, will highlight one of the fields that Siegel says needs improvement: treatment for addicts hooked on heroin and other opiates.
    Siegel said he hopes to focus the District's anti-drug efforts on treatment, expanding beyond the city's 8,000 treatment beds for drug and alcohol abusers. "I consider the waiting list to be 52,000 people," Siegel said, referring to the rest of the 60,000 thought to be addicted. The study, conducted for the D.C. government by private contractor Westcon International, also found high rates of tobacco use in the District. About three in 10 District residents said they had smoked a cigarette in the last year, and about one-quarter had smoked in the last month.

Expert: Yates Contemplated Killing Children for Months
Lisa Teachey, Houston Chronicle- 9/21/2001

Andrea Pia Yates had been thinking for months about killing her five children but made the decision the night before she drowned them in the family bathtub, a psychologist testified Thursday. Testifying for the state at Yates' competency hearing, Steven Rubenzer, a psychologist with the Harris County Mental Health Mental Retardation Authority, said Yates made a chart showing the frequency of her "bad thoughts." "They (the thoughts) were clearly troubling for her," Rubenzer testified. But he said he was unable to determine whether what was troubling was based on visions or thoughts.
    Rubenzer said Yates told him that "it was time" for her to be punished, but he said she would not elaborate. "I wasn't a good mother. ... I neglected them. ... I guess I got overwhelmed," Yates told Rubenzer during one of eight interviews he conducted with her. The psychologist said he stopped her from saying more because he already had enough information to make his assessment on the competency issue and that he did not want her to jeopardize her case by confessing anything more to him.
    Yates, 37, is facing two charges of capital murder in the deaths of Noah, 7, John, 5, and Mary, 6 months. The mother called police to her home in the 900 block of Beachcomber on June 20 and admitted to drowning them along with siblings Paul, 3, and Luke, 2. Yates -- whose medical records indicate she had been treated off and on for severe depression with psychosis, suicide attempts and homicidal thoughts -- has pleaded not guilty by reason of insanity. Harris County District Attorney Chuck Rosenthal is seeking the death penalty. He said the decision was made to allow for a full range of punishment options.
    Insanity refers to whether a defendant will be held criminally responsible for his or her actions. The law says a jury can find someone legally insane only if that person had a severe mental disorder and could not tell right from wrong when the crime was committed. Rubenzer was ordered by state District Judge Belinda Hill to determine whether Yates is competent. His report, given to the court in early August, indicated that she was.
    Because of the discrepancies between Rubenzer's findings and those by defense psychologists, Hill ordered the hearing to allow a jury to decide whether Yates is competent. The panel of 11 women and one man will determine only what Yates' state of mind is now, not at the time of the crime. Under Texas law, defendants can stand trial only if they meet a legal definition of competency, meaning they understand the charges against them and can aid lawyers in their defense. If jurors find Yates is competent, her trial would progress. Should they find her incompetent, she could be remanded to a mental health facility. With the proper medication and therapy, she could, at a later date, be found competent.
    The defense, which has the burden of proving Yates is incompetent, rested Wednesday after its psychologist testified Yates wanted to be executed so she and Satan would be destroyed. The defense maintains Yates is getting better each day but is not fully competent yet. Rubenzer said Yates did not mention Satan to him unless he questioned her about it based on notations in her chart from the Harris County Jail. Yates is under the care of doctors in the psychiatric unit of the jail, where she has been under suicide watch since she was admitted. "I am Satan. ... George Bush will kill Satan," Yates told Rubenzer, apparently believing President Bush was still Texas governor. Prosecutor Kaylynn Williford countered that Yates could be using the satanic imagery to express the internal struggles of good and evil. Rubenzer agreed.
    When Rubenzer initially tested Yates using a standard interview technique to gauge how well she understood the legal system, she passed two parts of a three-part competency test, he said. Yates scored very low on the appreciation component of the test in July. She did score in the "acceptable range" on the other two parts -- understanding and reasoning. After later testing, Rubenzer said, her appreciation level had dramatically improved.
    Rubenzer's report to Hill classified Yates as depressed, mildly confused, slow and inefficient at processing some information, defense lawyer George Parnham said during his cross-examination of the psychologist. Parnham said Rubenzer had warned that putting Yates on the stand and submitting her to cross-examination, as well as the details of the crime, could send her back into a state of psychosis and render her incompetent. "The better she gets the more fully she will be able to appreciate what she did?" Parnham said. Rubenzer replied, "I believe so." "She's just not quite there, is she, doctor?" Parnham asked. Rubenzer said, "I don't think so."
    Earlier Thursday, a jail nurse testified that Yates is showing signs of improvement. John Bayliss said Yates was catatonic at first but now she talks to other inmates, cleans the common area and plays dominoes. Bayliss said Yates always smiles at him when he approaches her, but he said she has "a lack of luster in her eyes." The state is expected to rest today after calling one more witness.

Jury to Continue Deliberating in Yates Competency Trial
Lisa Teachey, Houston Chronicle- 9/22/2001

A jury deciding whether Andrea Pia Yates is competent to stand trial in the deaths of her children was sequestered Friday night after almost five hours of deliberations. The panel of 11 women and one man is expected to resume deliberations in state District Judge Belinda Hill's court at 8 a.m. today. Should the panel find Yates, 37, is competent, the mother accused of drowning her five children in the family bathtub would stand trial on two charges of capital murder. Yates, whose medical records show she had been treated for major depression with psychosis off and on over a two-year period leading up to the deaths, has pleaded not guilty by reason of insanity. The housewife summoned police to her home in the 900 block of Beachcomber on June 20 and admitted to drowning Noah, 7, John, 5, Paul, 3, Luke, 2, and Mary, 6 months. Harris County District Attorney Chuck Rosenthal is seeking the death penalty.
    If jurors in the competency hearing find that Yates is incompetent, they must decide whether she could become competent in the future. If they believe she can, Yates would likely be remanded to a state hospital for treatment and return to court at a later date to determine whether she has improved. Under Texas law, a defendant can stand trial only if she meets a legal definition of competency, meaning she understands the charges against her and can aid lawyers in her defense. The issue deals only with her state of mind now, not at the time of the crime.
    The defense, which has the burden of proving Yates is incompetent, rested Wednesday after its psychologist testified Yates wanted to be executed so she and Satan would be destroyed. The defense maintained Yates is getting better each day but is not fully competent yet. In closing arguments Friday, defense lawyers George Parnham and Wendell Odom pleaded with the panel to give Yates more time. "All we are really arguing is, `Do we do it (have a trial) now or do we do it later?' " Odom said. " ... The way you guarantee you do it one time is by getting the person where they need to be (mentally)." He added: "We are beyond the days, hopefully, when mental illness will be placed on trial. We have the facilities available to make people well ... to participate in the trial of their lives." How can a person stand trial for life "when you don't fully realize what's happened?" Odom asked the jury.
    Prosecutor Kaylynn Williford told the jury not to be "swayed" by the defense attorneys' argument that they needed more time for Yates to get better. "We're not disputing Mrs. Yates has a mental illness," Williford said. But she said Yates proved she understood the legal system when Steven Rubenzer, the court-ordered psychologist, pressed her on the details of the crime and she refused to answer without first talking to her attorney. "It doesn't matter if she's getting better or not," Williford said. "The fact is she is presently capable. ... She was able to coherently address those issues. That's what they (defense attorneys) are entitled to. Nothing more." Co-prosecutor Joe Owmby added that Yates can intelligently tell authorities about the crime.
    Before the state rested Friday, its final witness, Mary Alice Conroy, the director of forensic clinical psychology at Sam Houston State University, supported Rubenzer's findings that Yates is competent. But Conroy also said while depression does not affect competency, psychosis can. Rubenzer testified Wednesday that Yates' psychosis was in full remission.
    A rebuttal witness called by the defense Friday -- Dr. Melissa Ferguson, the psychiatrist who treated Yates in jail when she first arrived -- discredited that. Ferguson said full remission is defined by no signs of symptoms for two months, and said she would not classify Yates as in full remission. The day before, Rubenzer also said Yates was competent. But under cross examination he admitted her low scores on the appreciation aspect of a competency test meant she wasn't "quite there." She scored well on understanding and reasoning.

U.S. Mental Health Suffers a Major Blow
Maggie Farley & Charles Ornstein, Los Angeles Times- 9/22/2001

 NEW YORK -- In her mind, Arlene Charles can't stop hearing the walkie-talkie messages from a colleague, telling her to hurry out of the World Trade Center. She made it--carrying a severely burned co-worker down 78 flights of stairs--but the colleague on the radio is missing, and Charles feels guilty for having escaped. Three thousand miles away, in Los Angeles, Joan Smith keeps finding herself in tears, even though she didn't know anyone in the towers, in the Pentagon or on the planes. "I keep wondering what those people were thinking," she said. "I keep wondering whether I would have jumped."
    Never before has America seen a disaster so big, or been so widely affected by its trauma. Because of television, the terror's breadth and the sheer number of victims, this attack strikes right at the national psyche. Counselors from coast to coast are mobilizing to shore up the nation's mental health. But there is no systematic way to track and treat all those who might need help, experts say, leading some to fear a quiet national crisis of body and soul.
    "All of us in the whole country are survivors," said Robert Jay Lifton, a psychiatrist and expert on survivors of terrorism. "But because Americans, more than any other group in the world, tend to consider themselves invulnerable, we are having difficulty dealing with it. We have no psychological place to put this, and that absence contributes to our deep confusion and our pain."
    Disaster studies have shown that those closest to the epicenter experience the strongest and longest-term reactions. The effects diminish with distance, like ripples in a pond. But some experts say this disaster is different because it affects every American in some way. Though the epicenters were New York, Pennsylvania and Virginia, the victims in the buildings and the airplanes were from all over the world.
    And the weapons used were all the more terrifying in their familiarity: jumbo jets, not missiles or bombs. Box cutters, not machine guns or dynamite. The perpetrators were a small number of terrorists who had lived and studied among us, not uniformed soldiers in a formal war, and that pushes the terror into another dimension. "It's not the same kind of diminishing ripple," said John Schorr, director of the Institute for Social Research at Stetson University in Deland, Fla. "The ripple in New York is very high. But the rest of the nation is also deeply affected by this. . . . Out here in the hinterland, you really have the feeling that there's a tremendous sense of deep grieving for this. Also fear and trepidation about what's next."
    Not only are Americans and others dealing with their immediate shock and grief, but they are also grappling with multidimensional fears. "The scale and scope of this is unprecedented," said Charles Figley, a trauma expert and founder of the Green Cross. "We don't really know how to deal with it. We are going to do things that we know have worked and multiply it."
    After the Oklahoma City bombing in 1995, which claimed 168 lives, counseling teams targeted 9,369 rescue workers, survivors and the victims' family members for immediate debriefing and 10 regular sessions. They followed up on the bombing's anniversaries and during the trials. But how to handle even just those directly affected by the 6,000-plus deaths? "There are not enough traumatologists to help everybody," Figley said. "Just like with physical wounds, we are going to have to do triage in terms of the people who need it the most."
    Outside of New York, counselors are telling people they are entitled to feel anxious and depressed. At Los Angeles International Airport, therapists met with United Airlines flight attendants who were preparing to get back on airplanes. "They tend to minimize what they're going through, comparing it with what they think their colleagues back East are feeling," said John Sheehe, a psychiatric social worker with the Los Angeles County Department of Mental Health. "Then they walk in a room and see their crew all suited up and they lose it." For most, these are normal reactions to an abnormal event. But barring more attacks or a war, people will slowly slip from their grief into the grip of daily routines, bound mostly by a collective memory of "Where were you when?"

Home for Autistic Kids Stirs Furor
Carolyn Starks, Chicago Tribune- 9/23/2001

With a lush lawn and a back-yard patio, the house on West Main Street in Cary has barely raised an eyebrow since it was built in 1978. Three families have come and gone. Then this summer, neighbors started whispering about a new owner. This time, it wasn't a family moving in, but an agency with plans to turn the split-level into a group home for six young autistic children. Providers say the children need to live in a neighborhood to help them blend more easily into mainstream society. But some of their prospective neighbors already are singling them out and asking that they go somewhere else.
    The proposal became so emotionally charged that village meetings became shouting matches, with several neighbors complaining that their property values would decrease and traffic would increase. Other neighbors preached empathy, saying they would welcome the children on their placid residential street. The Village Board is scheduled to vote on the issue in early October. Whatever the outcome, it is testing the compassion of a neighborhood and has raised questions about how society should handle children who need special care they cannot get in their family homes.
    "We're hearing from the ones who don't want us there and then there are people who have a burning desire to help humankind," said Shawna Egan, executive director of the Children's Center for Autism, the agency planning the group home. "One [neighbor] said, `Gosh. What's the big deal? Why are we afraid of six kids?'" The trend across the country has been to scale down or close state-operated institutions and move disabled adults and children into community-based settings where they can receive better care and closer attention. "We are encouraging providers of institutions to downsize and develop smaller settings for children" to improve the ratio of staff to kids and to help them better integrate into society, said Melissa Wright, associate director of the office of developmental disabilities for the state Department of Human Services. There are only two children's group homes in Illinois--in Elmwood Park and Carol Stream--that specialize in autism for children under the age of 13, Egan said.
    Egan, who has a 7-year-old autistic daughter, wants to use the five-bedroom house in Cary as a licensed group home for six autistic children, ages 6 to 12. The village's Zoning Board this month recommended approval of a conditional-use permit for the property. "We want to put something in the community where the parents can still be a part of their lives," Egan said.
    Autism is a neurological disorder that first appears in very early childhood, affecting about 1 in 400 children, most of them boys. Autism can overtake a child's ability to communicate, control emotions or relate to people. At the group home in Cary, the children would spend their days like other children in the neighborhood, Egan said. "They'll get up in the morning, catch the school bus, come home, do homework, play, have dinner, take a bath, play some more, get up the next day," she said, adding that there will be four staff members in the home. "It will really be a home for them." The home will be equipped with a 5-foot-tall fence so the children can play outside, and alarms on the doors so staff members are alerted if a child leaves the house without a staff member.
    Dennis Oltz, a resident who lives near the home, is concerned about the effect on his property value. "The reality is, nobody seeks out a home next to a group home," Oltz said during a Zoning Board meeting. "A fence around the place and alarms? I'm the one who will be living with this decision. I strongly oppose it." Other neighbors said they had safety concerns for the children, citing a pond next door to the house, drainage ditches with a concrete wall, and back-yard pools. Gary Verdung, a member of the village's Zoning Board who voted against issuing the permit, said putting a business, albeit a not-for-profit business, into a residential neighborhood would set a precedent. "I live next to a funeral home and I have found that it does limit the market," Verdung said.
    Although there is little or no research published regarding children's group homes, the vast majority of studies on the effects of adult group homes have concluded that they do not adversely affect the property values of nearby homes. However, a team of Illinois researchers in 1999 studied the effect of adult group homes in DuPage County and found a significant decline in surrounding property values, especially if there was a protest against the home. "Our research went against the common grain--that group homes don't have impact at all," said Nicholas Lash, professor of finance at Loyola University, one of the researchers. "When we looked at it, we found evidence of some fall in price."
    "Where would you rather see these kids go?" asked Eileen Foreman, a Crystal Lake mother of two children, one of whom is autistic. "Should we ship these kids away to some institution?" Some autistic children who cannot live at home are housed in large, state-operated institutions. Other options include private child-care institutions or small group homes. Although 48 disabled children from Illinois are boarded in out-of-state institutions, the state initiated a policy two years ago to stop that practice.
    Egan's fight is familiar to Terry Herbstritt, an Oak Park parent of a 16-year-old autistic boy. Realizing that his son needed to live outside his parents' home, Herbstritt headed efforts to open a five-bedroom group home in Oak Park in March 1999, then another one in Elmwood Park in 2000. "There were no obstacles in Oak Park," he said. "Elmwood Park was a different story," he said. "Some people thought there were places for kids like this--just not in their neighborhood."

Sleepless Nights, Shattered Psyches
Donna St. George and Avram Goldstein, Washington Post- 9/23/2001

His red-brick town house is draped with an American flag. Inside, the sofa is a soft shade of Army green, and the room is fragrant with roses. Two dozen in one vase, two dozen in another. Maj. John Thurman, still recovering from the Pentagon attack, has found new comfort in all of these things. At night, it is harder. In his dreams, Thurman sees the two colleagues he was with the day the Pentagon exploded, fellow workers who succumbed to the heat and smoke as he tried to lead them toward an escape route. In his dream, his office mates are not missing or dead. They are unscathed, talking, sitting cross-legged on the floor. "How was your weekend?" the conversation starts. "How about those Dallas Cowboys?" someone says, laughing.
    The dream is a soothing wish for the life John Thurman left behind, the way the world looked before Sept. 11, before he crawled on his elbows in utter darkness, choking on a dense, unbreathable smoke that ultimately claimed many lives. But not his. That was the day that America watched the unthinkable unfold -- mass violence from abroad descending on U.S. cities. More than 6,000 people dead or missing. Two American icons up in flames. And now, the specter of a protracted, vexing war.
    It remains so great a trauma to the national psyche that experts say it is not just injured survivors such as Thurman who struggle with the implications. It is the country at large -- anyone who can imagine being seated on one of the hijacked planes, trapped inside a burning office, bidding goodbye by cell phone in the face of imminent death. It is not only those who empathize or grieve but also those who in small moments -- dropping a child at school, leaving a friend, boarding a jet -- find their confidence shaken. The ordinary is not as predictable as it was.
    "We're all changed by this," said psychologist Ronald D. Wynne, president of Washington Assessment and Therapy Services, which has gone to 20 Washington area businesses to assist workers struggling with the emotional fallout. In Washington, members of the clergy have become so overwhelmed by questions and anxiety that crisis training is planned for about 200 of them and a comparable number of mental health professionals, said Renee Lohman, executive director of Washington Behavioral HealthCare. "Everyone is feeling inundated and not adequately prepared to deal with the questions they are getting," Lohman said.
    These are questions that arise from shattered expectations, uncertain futures, amorphous fear, anxiety and anger. As so many people have observed, America will never feel as safe as it did before Sept. 11. The illusion of homeland safety is gone. Perhaps no one knows this better than survivors of the terrorist attacks -- those who got away. Many are only now being released from hospitals, going home. Like the rest of America, they struggle to move on, but many find themselves captive to the power of human memory and to the enormity of what has happened in the past 12 days.
    Thurman, 35, does not shy away from the details. They are hard, and some, he says, still hurt. The Army major was at his computer in the office of the deputy chief of staff of personnel at 9:38 a.m., when he felt a percussive WHOOSH, then a blast. Almost immediately the blaze was so intense that the only available air was at floor level. At first, two colleagues crawled behind him in search of an exit. But when Thurman found a door, it was intensely hot -- fire on the other side. By the time he made his way to an opposite exit, one co-worker had fallen silent. Then the other did. He pulled on his colleagues. They did not respond. He was gasping for air, knowing he was about to collapse. He staggered out the exit and pleaded for help. "They're in there. They're in there. You've got to go get them." But by then, the fire and smoke made it too dangerous.
    "I feel I should have been able to do something," he recalls telling one friend in recent days. "Had you done any more, you would've been among the missing," the buddy reassured. At his home in the District, Thurman reflects on this: "That's hard to get to. Objectively, you can. But emotionally . . . I'm going to think about these people for the rest of my life."

'I'm Still Torn Up'
In her gracious colonial in Mitchellville, Lt. Col. Marilyn Wills is resting reluctantly, two days out of the hospital. Her skin is bruised. She has burns on her shoulder, and her left arm is injured. But Wills wants to be back at the Pentagon. For days, she has been focused on the work she did not complete Sept. 11, when a staff meeting that dragged on too long probably saved her life. Her close friend, a co-worker whose desk was so close the two could almost whisper, is missing. Her tortured push to get out of the building, head-to-toe in a human chain of fleeing colleagues, is still vivid in her mind. She very nearly died.
    Still, the unfinished work is nagging at her. "Don't worry about that stuff," colleagues have insisted. But the work, the job, is a stretch for the old normalcy. The experts say that this is healthy. They say that when crisis strikes as intensely as it did Sept. 11, there are some predictable patterns of human behavior, in spite of many personal differences. That goes for survivors such as Wills and for the country as a whole.
    Once the initial state of emergency is over, many people grow numb, the trauma being too much to process. How do you understand what was once unimaginable? Often a little later, emotional realities bear down -- feelings of sadness, rage, fear, horror, confusion. "I call this the world of terrible knowledge," said psychologist Jeffrey Jay, director of the Center for Post-Traumatic Study in Washington. The rhythms of ordinary life, he said, are shocked by "a sense of vulnerability of oneself and everyone else." But Jay and other experts say that connecting to others, by volunteering or attending vigils, for example, can help. So can returning to exercise and other everyday routines.
    For Wills, 40, normalcy means the Pentagon. It means family -- her "rock" of a husband, Kirk, and daughters, 7-year-old Percilla and 13-year-old Portia. It means her Baptist church, where she teaches Sunday school and volunteers in the physical fitness ministry. "God didn't bring me out of that building to be afraid to go back in the Pentagon, to be afraid to go out of the house," Wills said. Still, she knows she and others have a long way to go. Reminders of Sept. 11 almost involuntarily produce panic. Darkness is one -- she sleeps with a night light in her bedroom now -- and smoke is another.
    On the day Wills learned of co-workers who were missing, she was crushed, asking: "Why me? . . . Why did I get out and she didn't?" She said solace finally came from her pastor, who said: "God has a plan for you. . . . Your life is predetermined." "Physically I'm healing," Wills said. "Emotionally I'm still torn up." But with a master's degree in counseling psychology -- having chosen "resilience" as her thesis topic -- Wills probably has more information than most about processing the ordeal. Like many Pentagon survivors, she was visited by hospital psychologists. "You've got to talk about it," she said. "Tell the story again and again." She knows this, too: The country shares her anguish. Neighbors she hardly knows tell her they weep for no reason. They have been pulled into the larger American trauma.

'Angry at a Lot of People'
Twelve days after the Pentagon attack, Michael Petrovich, 32, is out of the hospital, his body healing well from first- and second-degree burns on his face and ears. But he finds it hard to get over his anger. "I'm getting very argumentative with my wife, my friends, everyone -- and that's not healthy," he said.
    An Army specialist who lives at Fort Belvoir, Petrovich works in the Pentagon's office of personnel, which was particularly hard hit. He joined the chain of workers trying to escape through the suffocating smoke and approaching flames. The dead included his car-pool buddy. "I'm angry at myself for not getting this guy out I drive to work with every day. I'm angry at him for not getting out. I'm angry at the terrorists, for sure. And I'm angry at the people who don't fund our intelligence community enough." He reflected, "I'm very angry at a lot of people -- and some of them for totally irrational reasons." His brittle emotions are more common than not -- among survivors and much of the nation.
    "People are just so raw right now," said Patricia D. Hawkins, a psychologist at the Whitman-Walker Clinic who said the issue has come up in therapy sessions. "People are in a state of shock and disbelief." Experts say trauma may be more difficult when it is caused deliberately. It is often especially intense for people in the throes of other life difficulties -- a divorce, a recent death, unemployment -- or who have recently endured violence in another country, as many immigrants have.
    Now the anxiety triggered by the events of Sept. 11 may be flowing into new anxiety as the country prepares for war. In his speech Thursday night, President Bush described a global fight against terrorism, "a lengthy campaign unlike any we've ever seen." He pledged to give law enforcement the tools it needs "to track down terror here at home." The very idea of homeland terror may be especially unnerving for Washington, the symbol of American government. "People are feeling that if there are any reprisals . . . they're going to come here," Hawkins said.

'Grateful to God'
Another attack in Washington is about the worst of possibilities for Racquel Kelley, 32, a mother of four in Northeast Washington who works as a civilian computer technician in the Army's Information Management Support Center. When American Airlines Flight 77 slammed into the Pentagon, the impact knocked the shoes off Kelley's feet. As she and two office mates held each other tightly and tried to flee, she cut her feet badly. She was burned, too -- on one hand, her ears and a lip.
    As she passed nearly a week in the burn unit of Washington Hospital Center, relatives, friends, neighbors and even strangers showered Kelley with love and support, which has helped, she said. "I'm just grateful to God to be given this second chance," she said. Still, as glad as she is to be alive, living itself is sometimes hard. "At night I just sit up in the bed with my husband," Kelley said. "I'm just terrified. There's not much he can do but hold me and tell me it's going to be okay. He's been very supportive, but he can't make the dreams or the thoughts of the terrorists go away." She worries that this may not be the end. "It's not over. There's going to be a lot more killing before this is over, and there are going to be innocent victims," she said. "I can try and hope, but I don't think I'll ever be normal again."

'Good Wins in the End'
Lt. Col. Marion Ward is still on crutches. As he escaped from the Pentagon, in the human chain of workers crawling out of the personnel office, he finally was so overcome by smoke inhalation that he jumped to safety from a second-story window. His left knee, shin and ankle were severely strained.
    Now home in Springfield with his wife and three children, Ward cannot help but dwell on those who did not make it. He was at the staff meeting that Lt. Col. Marilyn Wills attended. Three of their colleagues, he said, are unaccounted for. "I still wake up and try to remember where those three people were and why they weren't in the chain," he said. He knows others who didn't make it. "It keeps you awake at night, and when you open your eyes, there's invariably another question on your mind."
    The way Ward comes to terms with the heartache, he said, is through his larger religious faith. It is what kept him going when he thought he might die. "I have a simple prayer," he said, reciting its words: "Father, increase my territory, let your hand be with me, protect me from evildoers and keep me from pain." But after reflecting more, Ward offered his own belief: "There are two things to take out of this: Good wins in the end, and love is stronger than hate. We haven't seen the end yet, but good will win."
 

D.C. Sex Offender Law Struck Down
Spencer S. Hsu, Washington Post- 9/23/2001

A federal judge has ruled that the District's method of classifying sex offenders under "Megan's Law" is unconstitutional and has told police to stop releasing detailed information about 279 sex offenders and cease registering certain sex offenders who committed crimes while younger than 22. The law, similar to those passed in all 50 states, is named for Megan Kanka, a 7-year-old New Jersey girl who was raped and strangled in 1994 by a twice-convicted sex offender in her neighborhood. It requires that the public be notified when sex offenders are released into the community.
    But U.S. District Judge Ellen Segal Huvelle said the District's method of deciding how widely to publicize the names, photographs and home and work addresses of offenders -- sorting them into three classes of offenses -- violates their due process rights because they are not granted court hearings or the opportunity to argue whether notification is necessary to protect the public.
    Laws in other states assess offenders individually, rather than by the type of sex crimes they committed. Huvelle's ruling, released Wednesday, still requires sex offenders who are released from prison to register with the District's parole agency for 10 years to life, depending on the severity of their crimes. But the judge enjoined the District from publicizing that information, whether by answering inquiries, releasing registration lists at police stations, posting names on the Internet or notifying schools, day-care centers, victims or other vulnerable populations.
    "While the government unquestionably has a valid and laudable interest in protecting the public, and in particular our youth, from being victimized," Huvelle wrote, "the beneficence of its aims [does] not excuse it from according to the offenders subject to the statute the due process protections to which they are entitled under the constitution."
    Huvelle's ruling applies to at least 279 offenders who lived in the District as of March 27. Under the District law, three classes of sex offenders existed: 119 offenders were classified as Class A, 149 were Class B and 11 were Class C. All were listed on a police registry available to the public. Class A offenders committed sex abuse, rape or murder or were determined to be sexual psychopaths. They were subject to the most widespread public notice, including notification to neighborhood schools and vulnerable groups and publication on the Internet. Class B offenders committed offenses against minors, wards, patients or clients, and their names were published on the Internet before Huvelle issued a temporary restraining order to the city in February to halt that practice. Class C offenders committed other sex offenses and were deemed less likely to commit future offenses.
    Despite the Wednesday order, the D.C. police sex offender registry, at www.mpdc.dc.gov/serv/sor/sexoffender.shtm, still showed the names and addresses of 146 offenders yesterday. Arabella W. Teal, principal deputy corporation counsel for the District, said yesterday that the office was aware of the ruling but was not prepared to comment on it. A spokesman for the office said that an appeal was possible.
    The case was filed on behalf of five offenders by the D.C. public defender's office, which argued that the plaintiffs were subject to stigma, legal burdens and loss of privacy and employment prospects disproportionate to the likelihood that they would commit a new offense. "The judge ruled that the District cannot cut corners and deem all offenders dangerous without individual assessment and giving people hearings," said Robert L. Wilkins, formerly with the public defender's office and now in private practice. "We had offenders who had been deemed rehabilitated by the system, yet they were still being labeled dangerous by the statute."
    The judge also said that under sentencing reforms passed last year, people with convictions for sex offenses committed before Aug. 5, 2000, and set aside by the D.C. Youth Rehabilitation Act -- which permits some people younger than 22 to have convictions set aside once they complete their sentences -- do not fall under the city's Megan's Law. That ruling applied to two of the plaintiffs in the case. Two were found not guilty by reason of insanity for separate assaults in 1969 and 1982 and were sent to St. Elizabeths Hospital. The fifth plaintiff pleaded guilty last year to lewd acts with a 15-year-old boy. His term of five years of supervised probation was terminated early after he received treatment, Wilkins said.