Drunk Driving Laws: America the Irresponsible?
Oliver Libaw, ABC News- 12/19/2002

After a beer or two, you still might be legally cruising down U.S. Route 66. But in countries from Azerbaijan to Turkmenistan, you'd be driving drunk. As the Bush administration launches a new crackdown on the problem of driving while intoxicated, a new study reports the United States has one of the more lenient definitions of drunken driving in the world.
    "The U.S. is, in fact, one of the countries that has the highest blood-alcohol limits for drivers currently," says Marcus Grant, president of the International Center on Alcohol Policy, which conducted the study of different blood-alcohol standards around the world. The threshold for drunken driving varies in America from state to state — half have blood-alcohol limits of .10 percent, and half have stricter limits of .08 percent. People absorb alcohol differently, but a 200-pound male might have as many as six drinks over two hours and still be below the .10 limit.

Tougher in Thailand? Turkey?
That compares with .05 percent in most of Europe as well as countries such as Thailand and Turkey; .03 percent in Moldova and Turkmenistan; and .02 percent in Norway and Sweden. Eight countries do not allow any trace of alcohol in the blood, the researchers found.
    The legal definition of drunken driving is only one component in a country's efforts to combat the problem, of course. Many nations might have a much stricter drunken driving standard than America, but enforcement and punishment of offenders can vary tremendously from country to country. "Unless [drunken driving laws] are enforced and people understand them they're really not going to make any difference," Grant emphasizes. And because different countries calculate the number of drunken driving fatalities differently, it is hard to compare the effects of their various approaches.

Pushing for .08 Across the Country
Nevertheless, the different drunken driving definitions highlight the question of how best to combat the problem. Wendy Hamilton, the national president of Mothers Against Drunk Driving, says the blood-alcohol limits study shows the United States should be doing more. "It clearly tells us we've got a big problem in this country," she says.
    MADD advocates a .08 blood-alcohol limit nationwide, saying that research has not proven that a stricter threshold would decrease the number of drunken driving deaths in the United States. "We don't have enough research from those European countries to know whether a .5 percent limit is better," Hamilton says. Other enforcement elements are also key, Hamilton says, citing measures such as random driver checkpoints and strict penalties for repeat offenders.
    The Century Council, a liquor industry-funded nonprofit organization that combats drunken driving and underage drinking, notes the average drunken driver involved in a fatal accident has a blood-alcohol level of 1.6 percent — well above the legal limit anywhere in the country. "That's not, 'Gee, I had one drink too many,' that's 'Gee, I had seven drinks too many,' says the group's president, Ralph Blackman. The Century Council, which supports the stricter .08 blood-alcohol limit, stresses the importance of educating the public. The group's studies have shown that some 70 percent of Americans don't know the blood-alcohol limit in their state, and 80 percent don't know how many drinks will make them too drunk to drive legally.

Progress Has Stalled in Recent Years
With recent data showing the number of alcohol-related traffic deaths is creeping up, the National Highway Traffic Safety Administration said Wednesday it was beginning a new push to combat drunken driving. NHTSA estimates 17,448 people were killed in alcohol-related crashes last year — far fewer than 20 years ago, when more than 26,000 were killed, but the declines have stalled over the last three years.
    The government safety agency aims to lower the number of deaths by 2,000 next year. "We are not making sufficient progress," NHTSA head Jeffrey Runge said Wednesday. "There is no excuse for this." Over the holidays, when millions will hit the roads and drunken driving is a particular concern, the agency is spearheading an effort to establish more sobriety checkpoints around the country and increase police highway safety patrols.

Pennsylvania Lesbian Partner to Pay Child Support
George Strawley, Associated Press, 12/20/2002

HARRISBURG, Pa. -- The former lesbian partner of a woman who bore five children during their relationship must pay child support, a state Superior Court panel has ruled. The couple, identified only by initials in the three-judge panel's opinion, lived together in Carlisle from the mid-1980s until 1997 and agreed to have children together through artificial insemination. The partner, identified as H.A.N., stayed at home and cared for the children while the mother returned to work in a civilian job for the US Navy. H.A.N. did not legally adopt the children. After the couple split up, H.A.N. successfully sought custody of the children during summers and school breaks, but argued that she should not have to pay child support.
    A Cumberland County Common Pleas judge ordered her to pay back and current child support, and the Superior Court upheld the order Tuesday after she appealed. ''It is clear from the record that H.A.N. acted as a `co-parent' with mother in all areas concerning the children's conception, care, and support,'' Judge Joan Orie Melvin wrote for the court.
    A lawyer for the mother, who now lives in California, said the case is one of the first appellate-level decisions requiring a nonbiological parent to pay child support to her former lesbian partner. ''It puts lesbian and gay parents on notice that the courts will not tolerate blowing hot and cold when it comes to the assertion of parental rights and the assumption of parental duties,'' said the lawyer, Mark Momjian. ''Nonbiological parents who bring children into this world are going to be held financially accountable for their actions.''
    A lawyer for H.A.N. did not immediately return a telephone call seeking comment. The case marked the third time in less than a year that the Pennsylvania appellate courts ruled unanimously in cases involving gay and lesbian parents, Momjian said. One case granted standing to nonbiological mothers. In another, the state Supreme Court ruled that unmarried couples, including those in a same-sex relationship, can legally adopt children.

Anti-Psychotics Approved To Treat Suicidal Behavior
Erica Goode, New York Times- 12/20/2002

Clozapine, one of a new generation of anti-psychotic drugs, has become the first psychiatric medication to win federal approval as a treatment for suicidal behavior. The Food and Drug Administration announced yesterday that the agency had approved the drug for treating recurrent suicidal thoughts or suicide attempts in patients with schizophrenia, a devastating illness that afflicts 1 of 100 Americans. Clozapine was first marketed in 1989 by Novartis under the brand name Clozaril. But the company's exclusive rights to sell the drug expired in 1994, and the medication is also available in generic form. A clinical trial conducted by Novartis found that over two years, suicidal patients who took clozapine made fewer suicide attempts and required fewer hospitalizations to prevent suicide than similar patients taking olanzapine, another of the new generation drugs.
    The study involved 980 patients with schizophrenia, 490 taking each drug. Paulo Costa, the president and chief executive of Novartis, said, "For a long time, the incidence of suicide in schizophrenic patients has been of concern to caregivers and to patients themselves and to the psychiatric community." Dr. Herbert Y. Meltzer, a professor of psychiatry at the Vanderbilt University School of Medicine and the principal investigator for the clinical trial, said that about 1 in 10 patients with schizophrenia committed suicide. Many more try to kill themselves.
    Clozapine was the first of the so-called "atypicals," a class of antipsychotic drugs that had fewer side effects than their predecessors and that helped patients who did not respond to older drugs like thorazine or haloperidol. But clozapine has been less popular than its competitors because patients who take the medication must have frequent blood tests for agranulocytosis, a blood disorder that is an infrequent but potentially fatal side effect. One to two percent of people taking clozapine develop agranulocytosis and about 1 in 10,000 die from the disorder. But Dr. Meltzer said that given the far higher rate of suicide in schizophrenia, the drug might be lifesaving for patients at high risk.
    "There has always been a reluctance to use clozapine because of the side effects," he said. "This will be a major motivation for clinicians and patients to give clozapine a try." Dr. Jeffrey Lieberman, a professor of psychiatry and pharmacology at the University of North Carolina, said the study that led to th F.D.A.'s approval made clear "that clozapine has the ability to alleviate the symptoms which impel patients to suicidal behaviors."
    But Dr. Lieberman added that other newer anti-psychotics might also prove effective in reducing suicide. He said that the difference in suicide rates between the two groups in the study was statistically significant but small and that the clinical trial did not compare the newer drugs with older generation medications. "It's reasonable to think that this effect may be also shared by other clozapine-like drugs," Dr. Lieberman said.
    In a press release announcing the drug's approval for use in treating suicidal behavior, the food and drug agency said that clozapine might help patients "who are judged to be at chronic risk" for such behavior, based on a history of attempted suicide, hospitalization or suicidal thoughts. Dr. Lieberman and other researchers speculated that clozapine might help lessen suicidal behavior because it acted on serotonin, a messenger chemical in the brain. Studies have linked abnormalities in serotonin production to suicide.
    Dr. Meltzer said clozapine might turn out to be effective for suicidal patients with other illnesses like manic depression, now called bipolar disorder, or psychotic depression. He said the indicators of a high risk of suicide included feelings of hopelessness, depression, and a history of previous suicide attempts, and, in men, alcohol or drug abuse. Novartis said patients who take clozapine must be monitored by weekly blood tests for the first six months they are taking the drug and then every other week after that.

U.S. Mental Health System 'In Shambles'
Newhouse Service, 12/20/2002

WASHINGTON -- On the morning last spring when President Bush gave Michael Hogan the Herculean task of fixing the nation's mental health system, the president told Hogan a story that gave him faith that the job can be done. Bush said he had always believed that "if you have personal problems, you suck them up and take care of them," Hogan recalls the president telling him. But after watching the decline and then recovery of a close friend who suffered from clinical depression, Bush continued: "It became clear to me that this is a medical illness. It is just not right to treat some illnesses well and neglect others."
    Decades after the nation stopped keeping the mentally ill in hospitals and released them into the streets without adequate provisions for their care, mental health providers, patients and their families are hoping that Bush -- with Hogan's 22-member commission -- will finally initiate long-needed fixes. But Hogan, director of the Ohio Department of Mental Health, cautions that the federal government's changes are unlikely to be sweeping.
    An interim report the commission delivered to Bush last month bluntly declared the system "is in shambles." It noted that mental illness is the top cause of disability in the United States and concluded that programs designed to help the mentally ill are scattered among too many agencies. People who need help are forced to navigate bureaucratic mazes at a time they are least able to do so, the report stated. Half of all Americans who need mental health treatment don't get it, the interim report noted, either because of barriers to getting treatment, such as a lack of insurance coverage, or because they fear being stigmatized. The report found problems are especially severe among members of minority groups and older Americans.
    It traced problems to a shift in the mental health care system that began in the 1950s. Before then, many people with serious mental illnesses were housed in government-run hospitals. Although hospital care was expensive, ineffective and often led to neglect, the report said patients at least were able to get all their services under one roof. As the system was disbanded and patients were released into their communities, a complicated maze of programs evolved to meet their needs. Many were fragmented across different levels of government and multiple agencies. For example, people who have a serious mental illness along with a substance abuse problem usually must go to separate programs for each.
    "Our nation needs to replace the institutions it began to empty 50 years ago with efficient and effective community services that people can count on," said the report, which singled out programs around the country that work, such as an Air Force initiative that cut the service's suicide rate in half. Mental health care experts and advocates say they agree with those conclusions. But some are skeptical any recommended improvements will take root.
    Although Bush announced his support for a bill requiring insurance companies to provide equal coverage for mental and physical maladies, the legislation has been mired in negotiations over which mental illnesses will be covered. Insurance companies say it is unfair to make them put minor problems like jet lag on equal footing with serious diseases like schizophrenia.

In Juvenile Hall, Most May Have Mental Disorders
Shari Roan, Los Angeles Times- 12/20/2002

Youths in juvenile detention centers were certain to have their share of mental illness, researchers thought. What they didn't expect was the size of the problem: More than two-thirds of detained youths have diagnosable psychiatric disorders, they found. Researchers from Northwestern University near Chicago found that nearly two-thirds of boys and three-quarters of girls, ages 10 to 18, had at least one psychiatric disorder. In the general population, about 15% of children have mental illnesses or substance abuse disorders.
    Previous studies on the rates of mental illness among detained youths ranged widely. The new study, in the December issue of the Archives of General Psychiatry, sampled 1,829 youths of various ethnicities, both boys and girls, upon admission to the Cook County Juvenile Temporary Detention Center. "In this, a random sample of kids in a typical detention center -- Cook County is typical; it's not a particularly bad or good center -- our findings were quite alarming. We anticipated high rates, but not this high," said Linda A. Teplin, a professor of psychiatry at Northwestern and lead author of the study. For example, she said, while researchers expected to find that many children used drugs and alcohol, they were surprised that about half of the detainees had diagnosable substance abuse disorders, which involve serious addiction or long-term abuse.
    The study also found that 20% of the females met the criteria for major depression. "We often think of kids in detention as being delinquent or bad. But depression is a very serious mental disorder with serious impairment in your day-to-day life," Teplin said. Although many youth offenders have conduct disorder, defined as a persistent pattern of aggressive and destructive behavior, the rates of psychiatric illness remained high even when that diagnosis was excluded; 60% of boys and two-thirds of girls still had a diagnosable disorder.
    The report is the first in what Teplin anticipates will be a series of studies aimed at understanding the mental health needs of youth who run afoul of the law. Her research group gained attention in the 1990s with the first detailed analyses showing high rates of mental illness among incarcerated adults. "We feel, in part because of our studies, that those populations received a lot more attention and resulted in jails nationwide being much more concerned about treatment of mentally ill detainees in their care," said Teplin. "We anticipate that this study will have a similar impact."
    In the paper, Teplin and her group hypothesize that more poor and disadvantaged children than ever are not receiving adequate mental health care. The shift to managed care, in which mental health care is often not covered by insurance, and the trend toward welfare-to-work programs may leave more children without services. For example, families on welfare can receive Medicaid benefits to obtain mental health services. But many parents leave welfare for jobs that do not supply insurance or offer affordable co-payments. "Because of cuts in the funding of children's mental health care ... there is concern that this problem is not going to get better; it's going to get worse," Teplin said.

Massachusetts Parents Sue Treatment Center
Associated Press, 12/20/2002

CHARLESTON, W.Va. -- The parents of a 14-year-old Massachusetts boy who killed himself at a wilderness treatment center are suing the center, alleging negligence and fraud. Ryan Lewis hanged himself from a tree with a tent cord on Feb. 13, 2001, a day after he told instructors that he had been trying to kill himself, according to the lawsuit. Alldredge Academy, renamed Ayne Institute in August, and the center's two founders, L. Jay Mitchell and Lance Wells, were named in the lawsuit filed Thursday in Kanawha Circuit Court. Lewis' parents, Diana and Paul Lewis of East Longmeadow, Mass., are asking for unspecified punitive damages.
    Ryan Lewis was brought by his parents to West Virginia to participate in a three-month program at the Tucker County center, which offered therapy through outdoor activities like hiking and camping. The lawsuit alleges that a short time into the boy's stay, he showed instructors a slash on his arm where he tried to kill himself. After promising that he would not hurt himself anymore, Ryan Lewis was handed back his program-supplied knife. The Lewises noted on their application that their son had attempted suicide twice before, according to the lawsuit, which was assigned to Circuit Judge Charles King.
    The facility entered into a court-approved agreement with the state Department of Health and Human Resources in August to rename itself, evaluate residents within 24 hours of arrival and hire experienced behavioral health staff. In June, the center was fined $5,000 after pleading no contest to charges of child neglect resulting in death.

Mental Health Center Seeks Community Financial Help
Associated Press, 12/21/2002

LACONIA, N.H. -- After losing $195,000 the last two years because clients couldn't pay, a mental health care center is seeking financial help from the communities whose residents it helps the most. ''When the phone rings and someone is standing on a bridge somewhere, we don't ask what their coverage is,'' said Michael Coughlin, the executive director of Genesis. Often, the group ends up not getting paid because patients don't have insurance coverage, or do not qualify for Medicaid, which supplies 82 percent of the group's funding. The last two years have built the deficit to more than $700,000. ''The agency had two really tough years,'' said Coughlin, who was hired in April. ''My task is to turn it around and balance the books.''
    Coughlin is asking 11 communities, whose residents it helps the most, to contribute to the nonprofit agency. For example, in Belmont, the organization provided 173 residents with care, and 43 couldn't pay. Coughlin has asked the town for $8,395; the selectmen said they would recommend $5,000. Coughlin has requested $1,245 from Center Harbor and $8,503 from Gilford. Meredith said it would recommend a warrant article for town meeting, but Gilmanton said its budget already has been sent to the budget committee, so Coughlin will have to wait until next year. Coughlin still plans to approach Alton, Bristol, Campton, Plymouth, Sanbornton and Tilton.
    ''This is the first time in history that we are asking the towns for help,'' Coughlin said. ''If residents aren't getting medications and treatment, there's potential for domestic violence or other types of crimes. I think it's in the interest of the towns to help.'' Genesis provides treatment plans, psychiatric services, medication, transitional housing, and group homes to adults and children who are chronically mentally ill in Belknap and southern Grafton counties. It also offers community education, working with police departments and schools to teach people how to handle the stress of having a person with significant mental illness in their lives.

Analyzing Freud: Letters of H.D., Bryher, and Their Circle
Edited by Susan Stanford Friedman
Robert Gottlieb, New York Times Book Review- 12/22/2002

Kat darling, Love and barks, Fido." "Hallo Mog, Love, Rover." It's hard to follow at first, but you get used to it. Kat (also Mog, Hyacinth, Lynx, Dryad and just plain Cat) is Hilda Doolittle -- H. D. to you -- the celebrated Imagist poet (so christened by her onetime fiancé Ezra Pound) and, for a long stretch, Mrs. Richard Aldington. Fido (also Br, griffon, F.D., Dolly, small dog, Fitho and Chang) is the novelist Bryher, née Annie Winifred Ellerman, and also -- through a couple of odd marriages of convenience -- Mrs. Robert McAlmon and Mrs. Kenneth Macpherson. Rover (also Dog, Dawg, Kex, K., Kay, Bloodhound and Big Dog) is Macpherson himself, novelist and artist, who had an extended affair with H.D. and then married Bryher so that they could adopt the child H.D. had by Cecil Gray while she was married to Aldington. Rover himself was on the whole gay, but then so was Fido, and so was Kat once in a while. Got it?
    Around this core of unconventional and talented people circled a pack of other unconventional and talented people. There was Pound (H.D. got cross with him over his rabid anti-Semitism, but their friendship resumed after the war, when he was incarcerated at St. Elizabeths); D. H. Lawrence (he and H.D. were so close that they traded manuscripts until in 1918, shocked by her loose behavior, he decided never to see her again); the friends of her youth William Carlos Williams and Marianne Moore; and many more, whose once imposing names have receded into footnote material. And then there is Sigmund Freud -- "Papa" and "the Professor" in private correspondence, but never to his face.
    "Analyzing Freud," edited by Susan Stanford Friedman, presents the correspondence among H.D., Bryher and their circle during the two short periods, in 1933 and 1934, that Kat spent in Vienna, being analyzed by Papa with Fido paying the bills. It's a fascinating production. The letters reveal two complicated, appealing, highly intelligent women; give us a sense of Vienna at a time of great political upheaval and danger; and present Freud in close-up, as observed by the awed yet canny H.D. (Much later she was to write more formally about her experience with him in the moving "Tribute to Freud.")
    H.D.'s road to Vienna had been a rocky one. Raised in Pennsylvania by a severe astronomer father and a warm but repressed mother, she went to Bryn Mawr, then left for Europe in 1911. During World War I a beloved brother was killed, and her father died of the shock; she herself lost a baby and then almost died of double pneumonia. There were dangerous breakdowns. It was Bryher who rescued her, tenderly.. seeing her back to health. They are assumed to have had a brief affair, but that quickly turned into a loving domestic relationship that stretched out through the decades. The two women shared their lives, although each of them shared with others too. And they shared H.D.'s daughter, Perdita, who grew up with two mothers.
    By the 30's, H.D. had long since been established as a poet of consequence, but she was eager to break away from the "Imagist" label Pound had given her. She grew grander in her ambitions; invested herself in Greek drama, which she translated and recast; wrote overwrought autobiographical fiction. But her emotional condition was fragile, and Bryher -- who was obsessed with psychoanalysis, and indeed became something of a lay analyst herself -- was determined that she should be treated by Freud. Since Bryher was rich, she could afford to pay for the treatments and the expense of Vienna. (Her father, a shipping magnate, was one of the richest men in England.) late February 1933, H.D. left Perdita in Switzerland with Fido, Rover and Quex (Dorothy Hull, a semi-psychotic, housekeeper), and bravely set out for Vienna to expose herself to the implacable insights of the founder of psychoanalysis.
    Luckily for us, H.D. was a fluent, unguarded, honest -- you could say indiscreet -- letter writer. Her almost daily missives to Bryher reveal her in all her charm and impossibility. ("Do, do forgive me when I am a snarly cat. I will bite out the burrs and be a good cat-on-the-mat for ever and ever amen, after this.") She's funny and perceptive about her temporary new home. "I like this part of Vienna so much.... It's all artz, artz and student with smart university ladies in various degrees of having-arrived, and bows and scrapes and gnadidges." (You have to accustom yourself to her bizarre stabs at spelling and punctuation; these letters were written at top speed, meant only for her nearest and dearest.) She's endlessly gossipy, even bitchy, and Bryher matches her, gossip for gossip and bitch for bitch. And they're both good writers: one could argue that H.D. -- like Byron, like Wilde -- is at her freest and best in her letters. Wouldn't you rather overhear her giggling over Rebecca West or the Sitwells than, say, cope with a passage like this from her unpublished autobiographical novel, "The Gift": "Under every shrine to Zeus, to Jupiter, to Zeus-pater or Theus-pater or God-the-father, there is an earlier altar. There is, beneath the carved superstructure of every temple to God-the-father, the dark cave or grotto or inner hall or cellar to Mary, Mere, mut, mutter, pray for us."
    Besides the incidental pleasures -- the gossip (H.D. calls it "sending you the dirt"), the sense of a generously shared life, the up-close view of Europe possibly on the brink of war -- what makes the correspondence especially valuable is H.D.'s observation of Freud, both as a writer taking him in and as a patient grappling with him. From the first visit to the famous office in Freud's home at Berggasse 19, she is both overwhelmed and confrontational: the transference and the countertransference go into immediate high gear. For a while she reports to Bryher on the analysis itself, until Freud -- following standard analytic method -- warns her against talking about it. But there is no ban on talking about Freud himself: "He is like an old, old bird, he jerks out his arm, commandingly like a terrific old hibou sacré, it scared me to death. He is so old and so majic and so sweet." He's also a "little old mummy of an Oedipus-Rex" and "an exquisite old fish-papa" and an "old, old, old, thousand-year old Tom-cat."
    As the analysis takes hold, H.D. becomes more descriptive, more serious, more genuine. "He is a rare, exquisite being, small, very fragile looking but one does 'not notice his 'infirmity' as he calls it, the thing I much feared." (An allusion to the prosthesis in his mouth, which he wore as a result of his cancer of the jaw.) "He speaks such lovely English in a slightly timid manner with such a mellow Austrian intonation." "He has that wistful ghost look of someone who has been right past the door of the tomb, and such tenderness with such humor.... He is the real, the final healer." And, to Havelock Ellis, another close friend: "He is as always, fine, remote, spiritual yet so warm and near and sweet. He has of course a god-like, saint-like, imp-like quivering sense of humor, which alone should put him among the immortals."
    And we do get a sense of what the analysis was like, since on occasion H.D. breaks silence and recounts her dreams, and describes how she and Freud dealt with them. She also reveals the emotional texture of their relationship: on the one hand, "he has made me cry so terribly"; on the other, "we are terribly en rapport and happy together." There are also delicious bypaths down which the correspondence wanders. The constant concern for the well-being of Pussy (Perdita); the continuing melodrama of the housekeeper Quex, also known as Dragon and Queen, who, the analyst Hanns Sachs warned, was potentially dangerous; and Bryher's courtship of the famous actress (and tease) Elizabeth Bergner, who in 1933 fled Hitler for England. (You can experience her relentless charm in the 1936 film of "As You Like It," in which she is a simpering Rosalind to Laurence Olivier's Orlando) Bergner- led Bryher a merry chase. Loyal as always, H.D. finds a tacky little shop in Vienna where "an old bitch" sells her, at inflated prices, pictures of La Bergner that she sends on to Bryher. (Even Freud is impressed by the connection to this huge star of stage and screen. "He was simply floored," H.D. reports.)
    The most unlikely drama that unfolds in the letters might: be titled "A Comedy of Chows." At H.D.'s very first session with Freud, he warns that it would be unwise for her to approach his favorite, Yo-fi. H.D. knows better, and Yo-fi falls under her spell. Round 1 to H.D.! (Bryher is all ears: "What I must know is -- does the chow share the analysis hour".) Soon two puppies are born to Yo-fi, and on April 26,1933, H.D. writes: "Had a terrible 1/4 hour yesterday, as papa wants to get rid of two chows ... they have now 5 dogs.... He asked me most pointedly what kind of a garden we had, and how many dogs already.... I may be mewing up the wrong tree, but I have a vague hunch, he is sentimentally inclined to offer us the unwanted, male twin." And that very evening, in another letter, "The worst has happened. . . . I feel like the Virgin Mary at the entrance of the dove. Pa-pa offered us one of Yo-fi's pups. What will we do, about it?"
    H.D. and Bryher do not want this puppy, but they're too polite, or scared, to say so. What they do is stall. On May 3, Kat writes: "I think, Fido, the only thing to do ... is to hold it over very tentatively, as I am doing." It holds over (and over) until, in September, Anna Freud steps in, writing to Bryher about the dogs: "My father never wanted them to be a worry to you and you should have no feeling of obligation about them. They were just meant as a pleasure; there are too many worries around anyway, not counting the dogs."
    Before this welcome rescue, however, the comedy of manners has been punctuated by a scene of pure farce: "Had a terrible time yesterday. Yo-fi is back and doesn't like Lun, and flew at her in the room. We had been to the kitchen to see the pups. Freud ran like lightening and flung himself on the floor and pulled them apart, all his money fell out and Anna and the maid rushed in, Anna screaming in German of course, 'Pappachen beloved you shouldn't have done that,' and the maid taking off Yo-fi In her arms like Jesus with a lamb."
    But all was not fun and games in Vienna. e serious side of Bryher revealed itself in the financial help she funneled through Freud to endangered Jews, mostly from analytic circles. And we follow H.D.'s bold actions on a day when most of Vienna is shut down by demonstrations and fascist activities. (She's the only one of Freud's patients to turn up for her session that day, and she braves the troopers to go to the opera -- it's "Gotterdammerung.") We also begin to sense how deep her problems go. Freud recognizes, and she acknowledges, that she has a strong, almost megalomaniac impulse. Analyzing a dream about a baby in a basket in a river (linked to the Dore illustration of Moses in the bulrushes), she speculates (in "Tribute to Freud"), "Do I wish myself, in the deepest unconscious or subconscious layers of my being, to be the founder of a new religion?" And there are; delusions of grandeur: "My work is creative and reconstructive, war or no war, if I can get across the Greek spirit at its highest I am helping the world, and the future. It is the highest spiritual neutrality."
    Ironically, H.D. has indeed emerged as the founder of a new religion. Susan Stanford Friedman has been studying her, writing about her and, it would seem, attempting to canonize her for well over a quarter of a century. In "Analyzing Freud," she proves herself to be an excellent editor -- scrupulous and thorough -- but her convictions about H.D.'s importance as an artist and a thinker are so unmediated, so impervious to question, that, they distort her view of what was taking place between the poet and the analyst during those intense months in the early 30's. The very first lines of her introduction reveal her agenda: "Imagine the drama. The performance. The play of two great minds. Two supple phrasemakers in the wordshop of the dim Viennese study dotted with antiquities from around the . world." (To be fair, Friedman's prose calms down after a few pages.) Her view, in other words, is that Freud and H.D. are equal masters, equivalent geniuses, who are involved together not in therapy but in a "collaboration." I suspect that this reading of what took place in Freud's study would have come as a surprise to H.D. herself. She might frequently and forcefully disagree with the Master but, as she writes in "Tribute to Freud," "I was a student, working under the direction of the greatest mind of this and of perhaps many succeeding generations." And she quotes him as chastising her: "I keep an eye on the time.  I will tell you when the session is over. You need not keep looking at the time, as if you were in a hurry to get away." Does this have the ring of two geniuses engaged in a joint adventure?
    For Friedman, though, it is H.D., not Freud, who is the main event. In the past she has edited, with a colleague, a collection called "Signets: Reading MD.," which includes articles with titles like "Fishing the Murex Up: Sense and Resonance in H.D.'s 'Palimpsest"' She is also the author of the 1981 critical study "Psyche Reborn," in which she speaks of the poet's "lifelong revolt against a traditional feminine destiny," which. "set her apart from the literary mainstream and led her ultimately to a woman-centered mythmaking and radical revision of the patriarchal foundation of Western culture." This, then, is why H.D.'s proper place in the literary pantheon has-been denied her: it is the "distortions of a phallic criticism" that have insisted on seeing her as a "feminine" lyrical Imagist, dismissing her later "adaptation of the 'masculine' modes of epic quest and philosophic symbolism." I've tried to forget my own phallus while searching for signs of genius in H.D.'s immense body of published poetry and prose, but although I discern a large intelligence, a high level of craft and a vast ambition, I can identify only an intermittently interesting talent.
    Freud clearly admired and liked H.D., and he was polite and encouraging about her writing. But even in that area he is by any standard her superior. Consider a brief letter he wrote to her in May 1936, acknowledging a gift of flowers: "I had imagined I had become insensitive to praise and blame. Reading your kind lines and getting aware of how I enjoyed them I first thought I had been mistaken about my firmness. Yet on second thoughts I concluded I was not. What you gave me, was not praise, but affection and I need not be ashamed of my satisfaction. Life at my age is not easy, but spring is beautiful and so is love."

Child Discipline: Crossing the Line
Dean Schabner, ABC News- 12/24/2002

New York City child welfare officials took the girl along with her two younger brothers from the parents, Jit Singh and Jaswant Kaur, who say the girl had a 25-year-old boyfriend who had convinced her to steal money from them. The 15-year-old, Pradhjit Kaur, was put in foster care and criminal charges of unlawful imprisonment were brought against her parents. Now the girl is missing, "fallen through the cracks of a city agency," the family's lawyer said. The boys are back with their parents, who never faced any physical abuse or neglect charges and will have their records cleared if there are no more problems for the next year. But the case is one that shows just how hard it can be for parents pushed to their wits' end trying to deal with a troubled child, as well as the potential perils of well-intended government intervention. "The parents did the best they could," their attorney, Alan Thau said. "The city took over, and now the girl's gone." The parents kept their daughter out of school beginning in April, though they said that they enrolled her in a home-schooling program and that she received her graduate equivalency diploma. "Whatever they did, they didn't expect all this," Thau added. "They didn't think they were doing anything wrong."

When Is Discipline Criminal?
The lawyer said there was no comparison between this case and others that have grabbed headlines, such as the 8-year-old girl in Texas whose stepfather is accused of locking her in a closet and starving her for months, an Iowa couple who are charged with chaining their two daughters in a closet, starving them and depriving them of health care, or an Iowa man accused of keeping his adopted sons locked in a dark basement without food.
    In some other cases, though, even the courts have not been so clear on where the line is crossed from discipline to abuse, which may reflect a growing confusion about the issue. "I think that until recent years there's been a trend towards being more protective of children," said Phyllis Miller, an Atlanta-area lawyer. "But also locally I've been seeing courts starting to allow parents a little more room, and I think that comes from a trend where we've gone from, 'Oh, no, don't touch little Johnny,' to 'Oh, no! Johnny's become a monster.'"
    In June 2001, a court in Hillsdale, Mich., accepted a plea of no contest to a misdemeanor child abuse charge from a husband and wife who originally had been charged with felony abuse admitted to chaining up their 16-year-old son to keep him from running away. Both the prosecutor and the parents said the reason for the plea deal was to leave open the possibility of the family being reunited. In Boston, in 1994, a nurse was charged with chaining her 15-year-old daughter to a radiator because she was afraid the girl would run away and become a prostitute, and the girl reportedly said that what her mother did the right thing. The teenager told The Associated Press that if her mother hadn't chained her up "it would have been worse. … She didn't want me to get hurt or run away."

Judge Orders Chains
In another case, it was a judge who ordered the chaining. A family court judge in Columbia, S.C., ordered a 15-year-old girl with a history of delinquency to be chained to her mother 24 hours a day for a month, and ordered that the mother could be punished if the teenager was found unshackled. At the time, the judge said he investigated state and federal laws before imposing the sentence and found no statute barring such a punishment. Like the Boston girl, the teenager in South Carolina reportedly said that being chained to her mother was good because it forced her to go to school and kept her out of trouble.
    In a current case in Santa Fe, Texas, a father is facing criminal charges after he put shackles on his 12-year-old daughter's ankles to keep her from running away and to make sure she went to school. He told the Houston Chronicle he took the drastic measure only after threats that he and his wife could be sent to jail if their daughter did not start attending school. He told the paper that his daughter was given the choice between having her ankles in shackles or having her wrist tied to her father's with a nylon rope and she chose the chain.

‘They Wanted to Rein Her In’
In the recent case in New York, there was no evidence that the girl was bound in anyway, and the lawyer said the parents were trying to keep her from going astray. "When you're 15, you shouldn't have a 25-year-old boyfriend," he said. "The daughter was hanging out with an older guy, and they wanted to rein her in a little." If the parents went too far in trying to keep the girl from getting into trouble, the city's efforts to protect her from them don't seem to have helped the situation, with the girl now unaccounted for.
    Some child psychologists and family rights advocates say this is too often the case when government agencies step in to protect children from parents whose idea of proper disciplinary methods do not conform to current standards. In the case of Singh and Kaur, immigrants from India who speak virtually no English, the issue may be cultural. There was a similar case in the same area of New York City, also involving an immigrant family from the same region of India, earlier this year.

‘Recipe for Disaster’
The question is not whether Singh and Kaur went too far, but whether government agencies go too far when they take children from parents who are trying to keep them out of trouble and teach them discipline, said Frank Furedi, a sociology professor and the author of Paranoid Parenting. "There are many parents out there who are desperately trying to maintain control," he said. "They feel that no one is really backing them up, so they feel that the world is a threat to them and their children.
    "Some parents look to government and government agencies, but their help is often kind of illusory," he added. "You end up in the situation where a child is taken to a foster home, where the situation is often far worse than anything would have been in the family home." Furedi said that taking children out of their home and putting them in foster care is a step that is taken far too often by child welfare agencies, and should only be done in extreme cases. "Taking a child away from the home is a high-risk strategy and really needs to be taken only when there is a real risk of physical harm or abuse," he said. "It's a recipe for disaster. Institutions like that foster care are not very effective for solving problems."

Out of Control
"We're reaping what we sow, in some sense," said Corinne Gregory, founder and director of PoliteChild, which addresses discipline problems by trying to teach manners to children. "We don't want to crush their self-esteem, so discipline is a bad word. We need to come back to the basics and say you need to discipline. You need to instill in a child a sense of moral responsibility." She said that in cases where families resort to such extreme measures as locking up children, it is because the family has not been taking the steps they should have all along. "They lost control of the child long ago," she said. "It didn't begin with this specific incident. These problems come when parents have failed to use good discipline with the child from early on."
    The question of what is discipline and what is abuse has changed over the years, family lawyers say, just as the sense of what are proper grounds for taking a child out of the home has changed. "The courts are being much more protective of children and much more limiting of what a parent can do," Florida family law attorney Mitch Karpf said. "Discipline is OK, abuse is not. Smacking a child in the face or something is not considered punishment, it's abuse. Spanking a kid on the rear end might be OK, but anything more than that is seen as wrong." But Miller said that she is seeing what could be the beginning of things going the other way, with parents being allowed more right to discipline their children. "I think it's part of our society struggling to understand what's going on with our children," she said.

The Happy Heretic
Cecilia Capuzzi Simon, Washington Post- 12/24/2002

Martin Seligman seems an unlikely man to lead the field of psychology, much less the rest of humanity, into the realm of human joy. The 60-year-old former president of the American Psychological Association and author of the bestselling "Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment" doesn't seem particularly, well . . . happy. He doesn't smile or laugh a lot; he's not especially warm or gregarious; his dress is subdued and professorial. Even his manner of speaking is quiet, monotone, often stern and blunt. But that, he says, is just the point. Seligman is a "born pessimist," he says, but that doesn't mean he is not happy. When it comes to this vital emotion, Americans have it "dead wrong."
    "You bought into Hollywood and Goldie Hawn and Debbie Reynolds, and you think the only form of happiness is pleasure, " he says, seated in a large, richly furnished conference room at the Gallup Organization's headquarters on F Street NW, where he hosted the First International Positive Psychology Summit in October. Americans, he says, generally pursue a media creation of happiness that is all about superficial trappings and transient pleasures. These may make us feel good temporarily, but they don't lead to true "gratification" -- the kind of happiness Thomas Jefferson or Aristotle wrote about and the sort Seligman believes we can all pursue. In reality, he says, many of us are just "fidgeting until we die." The antidote, says Seligman, is Positive Psychology, his effort to create a science of higher happiness and a program to help people achieve it. Positive Psychology corrects a long-standing imbalance in the profession, he says.
    Before World War II, psychology had three missions: cure mental illness, improve normal people's lives and identify and nurture high talent, he says. But with the return of so many emotionally traumatized soldiers after the war, the National Institute of Mental Health (NIMH) made available millions to help treat them. This push advanced our understanding and treatment of mental pathology, Seligman says, but in the process psychology abandoned its more positive missions. The time is right, says Seligman, to get the profession back on track.
    For one thing, the unprecedented material comfort of the 1990s has allowed people the luxury of looking beyond fulfilling basic needs and thinking instead about how to make life worthwhile. And, in Darwinian terms, Seligman and others believe that positive emotion serves an evolutionary function that can "broaden intellectual, physical and social resources." Humanity, he says, is now "on the threshold of an era of good feeling." Even Seligman wonders, in his book, if people will think he's been "smoking something."

True Happiness
Positive Psychology is built on the idea that to be truly happy, people must draw on what Seligman and his cadre call "signature strengths" -- such as integrity, critical thinking, street smarts, love of beauty, kindness, perseverance -- to re-craft their lives and become immersed in work, play, parenting, even acts of altruism. His book outlines the movement and his view of human potential, grounding his argument in research about optimism, longevity, hedonism and quality of life. Some of the work is new, but most has been around for years without being gathered and evaluated under one title. Mostly the book is a self-help manual meant, as Seligman says, to "give psychology away" so people can benefit from Positive Psychology themselves.
    The book provides self-evaluation tests for readers that aim to measure overall life satisfaction, motivation, optimism, gratitude and other personality traits. Most important, Positive Psychology measures the 24 signature strengths, which fall under one of six "virtues" that Seligman says are reflected in every major religious and cultural tradition: wisdom, courage, humanity, justice, temperance and spirituality. A 24-part test helps a person define his or her top five signature strengths. (Every test in the book can be taken free online at www.authentichappiness.org, though you must agree that your results can be used in the growing database of Positive Psychology research.)
    Evolution has provided humans with three roads to happiness, says Seligman: The Pleasant Life, The Good Life and The Meaningful Life. The Pleasant Life comes closest to what Americans typically mean when they think of finding happiness -- using the senses to experience pleasure. But the "pleasures," as Seligman calls them, have limitations. They gradually lose their power -- people need larger doses to get the original kick or find themselves on a treadmill moving from one to the next to keep feeling good. And a person's ability to experience them is constrained by genetics -- some just don't feel the "tingles," as Seligman says. As with a person's weight, research shows that an individual's happiness level usually centers on a set-point, so that even someone who wins the lottery and feels extreme joy, or a paraplegic at first devastated by his disability, will eventually move back close to his previous degree of happiness. (As for money's role in happiness -- we know you were about to ask -- Seligman and others suggest that once one's basic needs of food, shelter and safety are met, there is little correlation between money and happiness.)
    The higher forms of happiness -- achieving satisfaction and contentment -- require taking paths leading to The Good Life and The Meaningful Life. It is in these pursuits that one needs to use signature strengths. You don't have to be genetically predisposed to happiness to succeed on these paths, Seligman says. They are based in the experience of "gratification," which is what "arises when you use your strengths and virtues" in life's activities, whether they be working at a job, appreciating music or rock climbing. Gratification in turn results in "flow," the state of total absorption in an activity or intellectual endeavor when, as Seligman says, "time stops for you . . . and you are one with the music." The Good Life is achieved through obtaining flow in work, recreation or other activity; The Meaningful Life is achieved through service to others.

Let's Get Practical
The theory sounds good, but what does it mean in a practical sense? Positive Psychology, Seligman says, can have clinical applications and indeed he hopes that psychotherapists ultimately will use it as "another arrow in their quivers" when treating the mentally ill. But mostly Positive Psychology is for the "relatively untroubled" majority of people who want more from themselves and from life.
    Writing about Positive Psychology is only the "first tier" of his mission, Seligman says. The second is to devise ways to get people using it. Some 40,000 people have visited the Authentic Happiness Web site, for example, and Seligman has begun to target visitors with e-mails that offer advice on how to employ their signature strengths. For example, one mailing to those who scored high in appreciating beauty and striving for excellence suggested that they avoid stressful or mind-numbing commutes by driving more scenic routes. (Well, it's a start.)
    The third tier requires building a Positive Psychology "infrastructure," as Seligman calls it. He is consulting with "CEO types" about ways to profitably connect healthy people interested in Positive Psychology's benefits with credentialed life coaches -- perhaps they are psychotherapists who convert their practices into quests for happiness -- who can help those healthy people achieve their goals.
    Seligman and other psychologists who studied positive emotion and human strengths have been making some inroads by targeting children through character-education programs in schools and advice books for parents. Seligman just won a $2.8 million grant from the U.S. Department of Education to go into the Swarthmore-Wallingford school district in Pennsylvania and test a ninth-grade language arts program developed to promote the study of human virtues and strengths through classic literature.
    C. R. "Rick" Snyder of the University of Kansas, one of the founders of the movement, says positive traits can be taught. He, Scott Huebner of the University of South Carolina and others are working on implementing character education programs in schools, but hope that such techniques will go beyond teaching children how to capitalize on their strengths. "To me, Positive Psychology broadens the way we look at people," Huebner says. "The world is such a mess, we need to look at ways to strengthen people to prevent problems."
    Teaching these skills early is best, but Snyder, who has authored popular books for parents including "The Great Big Book of Hope" and "Hope for the Journey," says adults can learn how to manage emotion as well as children can. One way to reach everyone is to destigmatize and rethink psychotherapy. "As a field," says Huebner, "we can do a lot more for people if we stop looking for labels that explain how to fix them. People are more likely to work on psychological function and well-being if they don't have to be diagnosed with having something wrong in the first place."

A Man With a Mission
Many movements in psychology reflect the personal lives of the people behind them -- Freud, for example, famously had his issues with sex; Alfred Adler was short and saw the world as a struggle against inferiority. Martin Seligman, it seems, is no exception. He didn't always live life on the sunny side. Seligman earned his Ph.D. at the University of Pennsylvania and has been a professor there since 1972. He made his mark in psychology through groundbreaking studies on depression and what he called "learned helplessness," a theory that helplessness and depression can be learned states that grow out of repeated exposure to unavoidable unpleasant stimuli. In his experiments, Seligman gave electrical shocks to dogs and offered them no means of escape. What resulted was pathological helplessness so extreme that even when an escape route was provided, two-thirds of the dogs refused to take it.
    After working on helplessness for five years, Seligman says, he began to wonder why the other one-third didn't, as he says, "lie down and become victims." That, he says, led to the question of optimism and to "defining buffers against helplessness." The research helped earn him 31st place in the Review of General Psychology's list of the century's 100 most eminent psychologists. He has authored 20 books, including the popular "Learned Optimism" and "The Optimistic Child."
    The idea of positive psychology hit Seligman a few years ago, while gardening with his then 5-year-old daughter from his second marriage. He was hard at work; she was throwing weeds around and singing. He yelled at her. She called him a grouch. If she could learn to stop whining, she told him, he certainly could learn to stop being such a grump. At that moment, says Seligman -- who was also fishing around for a mandate to characterize his 1998-2000 tenure as APA president -- his psychological view "flip-flopped." "It was like a fork of lightning that took me out of the strange views that happiness is just the absence of sadness and that strength is just the absence of weakness," he says. "I saw I had a whole set of beliefs -- which came out of working on the worst side of life -- which were just unfounded."
    The recognition that he had spent 50 years as a "nimbus cloud" -- the last few in a house filled with his four young children and "radiant with sunshine" -- caused him to examine his own reference point. (Seligman has two older children from his first marriage.) He had succeeded in life, he determined, not because of his grouchiness, but in spite of it. And, in suddenly noticing his daughter's perspicacity, he realized that his role as a parent was not to correct her weaknesses, but to nurture her strengths -- in this case her "social intelligence" and ability to "see into his soul."
    That same logic, he decided, should be applied to psychological practice and research. Why, Seligman wondered, wasn't psychology paying attention to the 80 percent of the population that isn't depressed or suffering from mental illness? And for those who are depressed, why had psychology's goal been merely to get them to a neutral state? In the garden with his daughter that day, Seligman saw the light. And it made him happy.

The Sunnier Side
Seligman's idea to shift psychology's focus made many others happy, too. Given his stature and platform, he was able to gather some of the best minds in the field, including Mihaly Csikszentmihalyi, a professor at California's Claremont Graduate University who coined the term "flow" and authored a book on the subject with the same title; Ed Diener of the University of Illinois, who has spent 20 years studying subjective well-being (his term for happiness); Christopher Peterson, an expert on hope and optimism at the University of Michigan; and Rick Snyder. Seligman whisked them off to Akumel, Mexico, a cheerful spot in the Yucatan (the trip has been an annual event for the last four years), and there they developed a charter for the Positive Psychology movement.
    Seligman's efforts attracted money from enthusiastic, sympathetic parties, $25 million to date, to initiate research and spread the word. This includes grants from the Gallup Organization and the Department of Education and, especially, Sir John Templeton, an 88-year-old billionaire philanthropist concerned with questions of religion, humanity and the soul.
    With the Templeton money, Seligman established an annual $200,000 series of awards for young psychologists turning out the best research in Positive Psychology. It is an unprecedented sum in the field, and the prize is not without its critics, who question whether Templeton's preoccupation with exploring his Christian tradition and metaphysical doubts have any place in science.
    Some also wonder if the Templeton money and Seligman's lofty perch (not to mention psychologists' tendency, according to some in the field, to jump on bandwagons) are the engines driving Positive Psychology. But by pulling together the threads of compatible research, using his considerable skills at organizing and motivating the psychological community and acting on his savvy reading of the times, Seligman has managed in four years to create a substantial movement. He says the recent international summit in Washington had three times the applicants for its 280 spots. By one estimate, as many as 1,000 practitioners define themselves as Positive Psychologists. John Mayer, a professor of psychology at the University of New Hampshire and a noted researcher on emotional intelligence, adds another explanation: Positive Psychology appeals to the idealism of young people in the field.
    The Templeton Positive Psychology Prize is awarded annually to four researchers in the social sciences who are under 40 or who have spent less than 12 years in the field. The focus on young people is a conscious strategy to "change the establishment," says Jonathan Haidt, an associate professor of psychology at the University of Virginia and the first-place winner in 2001. The awards are divided into a personal stipend and a grant for further research. First-place winners, for example, receive a $100,000 prize, $30,000 of which is for personal use.
    Haidt's work is typical of other awarded research, and explores what happens to people physiologically when they perform acts of kindness. Haidt identified these feelings -- often felt in the chest or as chills, or as changes in patterns of heart rate and breathing -- and isolated them to the vagus nerve. He calls this phenomenon "elevation," a term that Jefferson -- who founded the university where Haidt conducts his research -- used to describe his version of happiness. Suzanne Segerstrom, assistant professor of psychology at the University of Kentucky, this year's first-place winner, also studies the mind-body connection and has determined that optimism has a positive effect on immune system function.
    With the Templeton awards, the Akumel summits, a Positive Psychology summer institute and now the first international summit, young psychologists say, Seligman has invigorated the field. "Marty needs to take the lion's share of the credit," says Michael McCullough of the University of Miami, a 2001 Templeton winner who studies what he calls "classical sources of human strength." "There have always been people studying pleasure, optimism and gratitude, but no one created the opportunities for these areas of research to influence each other. He's producing something bigger than the sum of its parts. We're thinking better together."

Negative Thoughts
Some aren't so sure. Critics worry that Positive Psychology's momentum has resulted in faddish hype. The most vocal had been Richard Lazarus, an emeritus professor at University of California at Berkeley noted for his work on coping (and Number 81 on the most-eminent psychologists' list). Until his death in November at age 80, he conducted a not-so-positive exchange with Positive Psychologists in a scholarly journal called Psychological Inquiry. In an interview for this article a month before he died, he dismissed the research supporting it as not rigorous enough, and he derided the movement as "happiology," led by "zealots and simplistic thinking."
    Academic researchers' rush to publish, he said, inflamed by the Templeton money and prize, may be driving the enthusiasm to explore the field. The danger is akin to the debacle created when the medical community prescribed hormone replacement regimens to menopausal women before they had adequate longitudinal research that evaluated its effects. In that case, "optimism preceded the science," Lazarus said. Diener says there is room for criticism of the movement. And he is aware that "we have to be critical and stay based in science and not rush out into a Pollyanna world."
    Others worry that Positive Psychology plays to Americans' cultural emphasis on happiness, entitlement and self-actualization, and could become just another temporary salve, like antidepressant medication, in our efforts to "sweep depression under the rug." Ilene Serlin, a humanistic psychotherapist who treats a lot of unhappy young Silicon Valley executives in her private practice in San Francisco, agrees: "The rush to normalize people in a dysfunctional culture is a problem. You should be depressed by what you see. It's only when you don't numb yourself that you feel outrage." Julie K. Norem, a professor of psychology at Wellesley College in Massachusetts and author of "The Positive Power of Negative Thinking," says Seligman has a "pull-yourself-up-by-the bootstraps" message that she finds troubling. "I don't know what his book has to say to the mother pushed off welfare, and then to the society who thinks that all she has to do to be happy is to think in the right way."
    Seligman, who has studied suicide and other aspects of death in Africa, says he is not unaware of suffering. But there is an "ahistoric reality" at play in modern culture, he says. The Washington area sniper attacks may have made us unhappy and nervous, but they are not in the same ballpark as Stalin, he says. The stock market isn't at 150, it's at 8,500. "Every statistic measuring well-being in the last 50 years has gone north," he says. "But measurements of morale have gone south." The reason, he says, is because people focus too much on a mood system based on daily hassles. "So if you've got a hole in your swimming pool liner, you'll be just as troubled as if you're worried that the Nazis are going to come and take your child away."
    When you feel depressed and anxious, he says, "you can function in spite of it" by drawing on your strengths. He points to historical figures he admires -- Abraham Lincoln, Winston Churchill, Eleanor Roosevelt -- known to have had problems with depression but who lived great lives of meaning anyway. And so Seligman plods positively onward, despite the criticism in the field. "I think this mission I'm on is working," he says. "I think the world will be better for it."•

Lab Monkeys May Reveal Secrets of Childhood Depression
Mary Duenwald, New York Times- 12/24/2002

A rhesus monkey, only 4 months old, has been pried from the shoulders of its sedated mother and let into a small steel cage. Within minutes the fright in its little brown eyes softens into curiosity, and stepping tentatively, the monkey makes its way across the cage. But when a man with a white hood over his head strides in and stops two feet away, the baby freezes. It pulls its body close to the bars and quietly looks the other way, appearing to ignore the man until, two minutes later, he leaves "This is a very inhibited response," says Dr. Judy Cameron, a neurobiologist and the director of the University of Pittsburgh's primate laboratory, watching the monkey through an opening in a curtain. "Obviously, the intruder caused this animal a great deal of anxiety."
    Other young monkeys, placed in the same situation, act braver, Dr. Cameron knows from having observed more than 150 of them. Some at least exhibit their fear by grimacing with bared teeth. Others smack their lips in a gesture of submission. The bravest open their mouths wide, a threatening expression for a monkey, and may even lunge toward the intruder. That this little female would be so utterly passive makes her typical of a small subset of Dr. Cameron's laboratory population -- 8 percent to 10 percent -- that show high anxiety.
    More important, for Dr. Cameron's purposes, the baby monkey can be compared to a highly anxious or depressed human child. Monkeys as fearful as this one produce less growth hormone than the average monkey does when injected with substances that bring on the hormone's release, Dr. Cameron has found by testing blood samples.
    Though scientists do not believe that the growth hormone causes depression, it seems to be a marker. The same blunted response has been found in depressed adolescents. This means not only that rhesus monkeys provide a good model for studying depression in children but also that some biological underpinnings of the disorder may be in place years before adolescence.. Though scientists have long suspected this, finding the early signs of depression in human children has been difficult because they do not seek treatment until symptoms arise, like lack of motivation, lethargy, concentration problems and irritability.
    Adolescent depression was long disregarded by scientists because dark moods and dreary thoughts were assumed to be natural parts of being a teenager. But in the last 25 years, scientists have come to realize that some 14- to 18-year-olds -- about 8 percent -- suffer from clinical depression. Their symptoms can be different; young people are likely to exhibit very low energy or a lack of enthusiasm rather than outright sadness. Still, adolescent depression has come to be seen as essentially the same disorder as adult depression.
    Now researchers are putting a spotlight on teenage depression, hoping that by learning how the disorder takes root, they can find ways to keep it from growing into a debilitating and lifelong problem for 9.5 percent of adults. The monkey studies, it is hoped, will add to the effort to discern which aspects of brain function are involved in adolescent depression. In monkeys, depression is difficult to diagnose because, obviously, the animals cannot talk about feelings. Anxiety, though, is fairly easy to measure by observing behavior.   
    The kinds of anxious behavior the monkeys demonstrate -- not only inhibition when facing a stranger but also increased fearfulness and vigilance -- are like the actions of children with anxiety, Dr. Cameron said. In children, anxiety and depression are closely related and are thought to arise from the same biological mechanisms. "Now, we can do all sorts of studies with the anxious monkeys that are harder to do in humans," Dr. Cameron said. "We can observe their behavior every day. We can take blood samples and .look at their hormones. We can assess how they respond to stress. We can ask what's different about their brains. And ultimately, we can search for genes that underlie their anxiety."
    Dr. Cameron and her colleagues are careful to say they do not believe adolescent depression is strictly a biological disorder. "It may begin with a genetic liability, but when the early episodes of depression happen, it probably has to do with psychosocial stressors," said Dr. Neal D. Ryan, a psychiatrist and a leader of a 20-year study of adolescent depression at the University of Pittsburgh.
    The kinds of stress that can bring about depression in adolescence, psychiatrists have found, can include both negative experiences and the lack of positive experiences -- the death of a family member, for example, and perhaps a dearth of love, warth or support from others. "We'd like to understand the biological piece not because we think it's all of the story or even most of the story," said Dr. Ronald E. Dahl, a psychiatrist and an investigator for the Pittsburgh study. "It's because there probably is this interaction between biological systems and stress; we'd like to get insights into the brain systems involved." The ultimate goal is to find ways to nip depression in the bud. "Our hypothesis is that there is some degree of plasticity in these brain systems, and that to intervene early in anxiety and depression may have greater potential than intervening late," Dr. Dahl said.
    Only about 2 percent of children under the age of 12 suffer from depression. "Childhood, it seems, is relatively protective," Dr. Ryan said."And then there's a clear increase in depression at puberty. Then, once you've had one episode, there is sort of a kindling effect. It makes the next depression even easier to get, and that continues through adulthood." About 70 percent of adolescents with depression go on to have recurring episodes, he said.
    Vulnerability to depression mushrooms when children begin producing significant amounts of reproductive hormones. At puberty, too, suddenly twice as many girls as boys have the problem. The same female-to-male ratio holds through adulthood. "This interaction with maturation may offer clues to depression," Dr. Ryan said. "It suggests that one of the things you're going to look at is the effects of steroids on the brain." But, he added: "The social roles of sexually mature females are different from the social roles of immature females. There's lots more interesting stuff going on than just estrogen causing depression.'' Although growth hormone is a marker for depression, it is probably not directly involved in the disorder, Dr. Ryan said. Rather, the growth hormone seems to be under the control of certain neurotransmitters -- substances released by brain cells -- that also affect behavior.
    Cortisol is also regulated differently in adolescents who have depression. This hormone probably has a more direct effect, Dr. Ryan said. The body releases cortisol in varying amounts throughout the day to help provide energy. Cortisol levels in the blood are typically high in the morning, but wane toward evening. The adrenal glands will secrete extra cortisol if needed for more energy and in response to stress.  Dr. Ryan and others have found that in depressed teenagers, in the late afternoon, cortisol levels do not regularly drop as low as they do in other teenagers. "This may not be just an empty phenomenon," Dr. Ryan said. "The regulation of cortisol is certainly one of the important aspects of how we control stress," he said, adding that it is related to developing other psychiatric disorders.
    In the last five years, with the advent of functional magnetic resonance imaging, researchers have also been able to look at brain differences in depressed adolescents. Recently, for instance, Dr. Wayne Drevets, the laboratory chief of neuroimaging and mood and anxiety disorders at the National Institute of Mental Health in Bethesda, Md., has found that a part of the brain's prefrontal cortex just behind the forehead is smaller than average and abnormally structured in mothers with depression, as well as in their children and adolescents. "It may be that the children have inherited some biological vulnerability to having these structural and functional differences in the brain," Dr. Drevets said.
    The amygdala, deep in the middle of the brain, is another area that is smaller and functions differently in people with depression. This part of the brain is involved in regulation of emotion, response to stress and recognition of fear. In a study conducted by Dr. Drevets, Dr. Dahl and others, children with both anxiety and depression demonstrated normal activity in the amygdala when they were shown pictures of people with fearful expressions on their faces.
    The hippocampus, another part of the midbrain, also looks somewhat different in people with depression. Both the hippocampus and parts of the prefrontal cortex seem to be involved in thought processes having to do with rewards -- anticipating, striving for and feeling satisfaction about earning rewards. Scientists would like to understand how operations in both these brain areas might correlate with the abnormal way in which depressed adolescents often think about rewards.
    Depressed adolescents typically lose their motivation to seek rewards, Dr. Dahl said. They may, for example, feel no desire to attend a party. Yet if they are given rewards anyway, they enjoy them. "If you take them to the party, they'll have a pretty good time," Dr. Dahl said. Depressed adults, in contrast, lose both the motivation to seek rewards and any feeling of satisfaction upon receiving them. "I think that's actually a hint about one part of depression," Dr. Dahl said. "The capacity to enjoy rewards probably is intact at least early in the course. Kids are still able to brighten up quickly."
    Perhaps, Dr. Dahl said, it may be possible to minimize adolescent depression by helping teenagers avoid the "downward spiral" of negative experiences, bad feelings about themselves and lost motivation. "If you could get them out there and doing things and feeling good about themselves, it may be easier to rescue the system," Dr. Dahl said. "Rather than think of adolescence as only a period of vulnerability, it may also be a period of opportunity."
    An important next step in the research is to look for genes that underlie anxiety and depression. Dr. Cameron has just received a five-year grant from the National Institutes of Health that will enable her to examine the genes of the baby monkeys who exhibit anxiety in response to the human intruder as well as other stressful situations in the laboratory. Already, Dr. Cameron has seen that the trait can be inherited and passed on; it clearly runs in monkey families.
    Because her monkeys -- 400 of them in Pittsburgh and 3,500 at the Oregon National Primate Research Center in Beaverton, Ore. -- are part of research colonies that have existed since the 1960's, Dr. Cameron knows which monkeys are related, making it easier to trace the traits and ultimately to home in on genes that are inherited. Along with other scientists, she will look for places on the monkey genome where the anxious animals appear to have patterns in common. If genes that correlate with anxiety can be identified, researchers can look for them in human adolescents with depression.
    Finding genes and ultimately figuring out what those genes do could provide a much more detailed understanding of the biological mechanisms of depression. But it is likely that a dozen or more genes are involved in depression, scientists say, because the disease is complex and varies in appearance and intensity among the people who suffer from it. "The model that makes sense," said Dr. Ryan, "is that there are genetic variations in how you handle stress or how you react to this or that. Some combination of those genes makes you more liable for getting depression or anxiety."
    Why would such genes evolve in the first place? Dr. Ryan suspects that the biological roots of depression may have evolved simply as a propensity to be inhibited or anxious. "There are probably plenty of circumstances In which being more inhibited or anxious could protect people," he said. Viewing depression as a disorder that arises from adaptive characteristics makes it seem like less of a stigma, Dr. Cameron said. "When it interferes with your life, we are going to call it a problem and find ways to treat it," she said. "But there's nothing inherently bad or wrong with you for being a little anxious or inhibited. I think that's actually a very accepting perspective."

A New Dimension in Snapshot of Gay Teenagers
David Tuller, New York Times- 12/24/2002

In 1989, when a government report suggested that gay teenagers were at high risk for suicide attempts, lesbian and gay rights advocates welcomed the finding as long overdue. They said the report, one of the first to address the health of gay youth, offered compelling evidence of` what they had maintained for years -- that prejudice had damaged gay adolescents' psychological well-being.
    Indeed, dozens of studies in the past several years have strengthened that conviction. Gay teenagers, researchers say, are much more likely than their heterosexual peers not only to attempt suicide but to suffer from depression, eating disorders, alcohol and drug abuse, violence-related injuries; and infection with H.I.V. and other sexually transmitted diseases. Advocates for gay youth routinely cite the statistics to argue that schools and health care providers must do a better job of protecting and counseling lesbian, gay, bisexual and transgender teenagers.
    A growing number of schools and school districts have adopted policies forbidding anti-gay harassment. According to the Gay, Lesbian and Straight Education Network, an organization fighting anti-gay bias, more than 1,000 schools now have "gay-straight alliances" that provide forums for support and discussion among teenagers.
    But some experts are now saying that the research is incomplete and has created a distorted picture of what it is. like to be a gay teenager. Dr. Ritch C. Savin-Williams, a professor of developmental and clinical psychology at Cornell, says many of the studies are "horribly flawed" and significantly overstate the degree of self-destructive behavior. Moreover, he says, by focusing so much attention on those who are at risk rather than on the large majority of gay and lesbian teenagers who appear to be doing well, the research is "pathologizing" gay youth and handing conservative groups ammunition to argue that being gay is inherently unhealthy.
    "Most of this research was done essentially to try to gain resources and services for these youth by demonstrating to the outside world how poorly they have been treated," said Dr. Savin-Williams, an expert on adolescent sexual identity issues. "But the research is delivering what I call 'the suffering suicide script' which essentially tells them 'Hey, look how horrible it is to be gay.'
    Some of the statistics that have been gathered are certainly grim. The Seattle-based Safe Schools Coalition, one of many groups founded in recent years to improve the educational environment for gay youth has compiled a review of eight large-scale government-financed surveys of students. In Minnesota according to the coalition's report 31 percent of gay lesbian and bisexual students had attempted suicide; in Massachusetts, 33 percent had tried cocaine compared with 7 percent of other students; and in Seattle 9.2 percent had vomited or taken laxatives to lose weight in the previous 30 days compared with 2.8 percent of students who were not gay.
    Many gay and lesbian teenagers like 18-year-old Rebecca Fureigh, say the gloomy portrait painted by the research is consistent with their experience. Ms. Fureigh, who graduated from high school this year in the San Francisco Bay area left her own family two years ago in the face of persistent problems and went to live with a friend's family. "All of my friends who were gay or bisexual were self-mutilating, cutting themselves with safety pins or razors or burning themselves," Ms. Fureigh said. "All of them were doing drugs and alcohol. Some of them tried to commit suicide. I certainly thought about suicide."
    Many others, however, say they are doing just fine. Saira Qureshi, a graduate student at San Francisco State University, said she had felt little connection as a teenager to the news media's portrayals of tormented gay youth. "None of the stereotypes applied to me;" said Ms. Qureshi, 24, whose parents were born in India, but who grew up in Arizona. "I wasn't butch, I wasn't an alcoholic, I didn't feel empty inside, I wasn't abused. I was just a normal kid."
    Dr. Savin-Williams does not dispute that some gay youth engage in harmful behavior. But a major drawback of much research, he said, is that the studies include only those willing to identify themselves as gay or at least acknowledge same-sex attraction. That sample, he argued, is significantly smaller than the total number who will eventually turn out to be gay, lesbian, bisexual or transgendered. Many teenagers in the larger group may be adjusting very well but simply prefer to keep their sexual orientations to themselves even on anonymous surveys, he added.
    Dr. Savin-Williams said that although researchers often discussed these limits, they generally highlighted only the alarming statistics when presenting the results. "That's great for headlines, but I'm saying let's look at the kids who are doing extraordinarily well and see how they got that way," he said. Others share Dr. Savin-Williams's concerns. "The studies are starting to become very two-dimensional," said Dr. John D'Emilio, a gay historian and the director of gender and women's studies at the University of Illinois at Chicago. "'Very often people who confront social hostility develop incredible strength and resilience. If you emphasize where the strengths are instead of what's bad, it helps you figure out, for example, what kind of environment you want to create in schools."
    Beth Reis, co-chairwoman of the Safe Schools Coalition, acknowledged that there might be some merit to the argument that the studies undercount gay youth who are adjusting well. "We may be identifying a slightly more at-risk group than if we were surveying the population at large in their 20's, but I don't think it invalidates what these studies have found," she said.
    Several factors have fueled the gay youth research boom. Some government-sponsored surveys of teenagers have begun to include questions about sexual orientation, for example, enabling researchers to get more data. Researchers also say gay youth are easier to study now because they are acknowledging their sexual orientation sooner, with many coming out publicly as young as 14 or 15 - a rare phenomenon 10 or more years ago.
    Moreover, an interest in studying sexual minority youth is less likely to raise eyebrows in academic circles than it was a decade ago, said Dr. Stephen T. Russell, director of the 4-H Center for Youth Development at the University of California at Davis, a research center. "The area of adolescent sexual orientation was marginalized, and that prevented research for a long time," said Dr. Russell, a sociologist and a prominent researcher in the field.
    Whatever the risks associated with being young and gay, researchers have started to explore in more depth the factors that may help gay teenagers adjust. For example, Caitlin Ryan, director of policy studies at San Francisco State University's Institute on Sexuality, Inequality and Health, recently began a study to examine families in which a gay, lesbian or bisexual child has felt able to come out to relatives. "We need to understand why some youth struggle and others thrive," she said, "so we can put more effective programs in place."

Adolescent Anger or a Deeper Disorder?
Jane E. Brody, New York Times- 12/24/2002

Teenagers -- one minute they're on top of the world, the next they're down in the dumps. One minute you're the best dad or mom there ever was. The next you're the world's worst, and they're threatening to leave home. As their lives, bodies and hormones change, teenagers can find themselves on an emotional seesaw with no way off. Not all teenagers, of course. Some are rather even-tempered, always up or always down or somewhere in between.
    So what's normal? And how can you tell if an adolescent is just momentarily unhappy or truly depressed and in need of professional help? These are questions that troubled teenagers and every parent of a child from, say 10 to 18, should seriously consider. Depression, which affects as many as one in five adolescents by age 18, is not readily recognized in adolescents because its manifestations usually differ from those in depressed adults. Someone looking for traditional signs of adult depression -- lethargy, weepiness and overt expressions of sadness -- may be misled by the irritable or angry adolescent.

Causes and Consequences
Many environmental factors can bring on depression in young people: parents' divorce, family poverty, experiencing a natural disaster, being subjected to physical or sexual abuse or witnessing it, or having a parent who is addicted to alcohol or drugs. Some children become depressed because they fail to achieve particular academic or extracurricular goals or because they have trouble making friends, are snubbed or are relentlessly ridiculed by peers or rejected by special friends.
    Then there are internal factors: underlying feelings of inadequacy or unattractiveness, depression that runs in the family, or confusion or distress about sexual identity. Unrecognized and untreated, teenage depression can have long-lasting consequences that affect a child's future, at school and at work.
    A national study assessing levels of teenage depression involving 4,648 boys and girls ages 10 to 18 was published this fall in The Archives of Pediatric and Adolescent Medicine. The authors, Dr. Sherry Glied of Columbia University's Mailman School of Public Health and Dr. Daniel S. Pine of the National Institute of Mental Health, found higher rates of absenteeism, smoking and binge-eating among those with depressive symptoms, even after taking into account factors like poverty and traumatic events.
    In the worst situation, depressed teenagers may take their own lives. Since 1995, the number of suicides among teenagers is estimated to have tripled, to as many as 2,500 each year. Suicide is the third-leading cause of death among people 15 to 24, behind accidents and homicides. In the 1999 Youth Risk Behavior Surveillance Survey, nearly one student in five of high school age had seriously considered suicide in the previous year.

Recognizing Trouble
It is easy to dismiss the signs of teenage depression as merely a phase or the mood swings of adolescence. And teenagers may be reluctant to admit they're depressed, seeing the disorder as a sign of weakness, notes Dr, Alice R. McCarthy in her excellent book," Healthy Teens: Facing the Challenges of Young Lives" (Bridge Communications, $14.95). Even their closest friends may fail to notice the subtle or masked signs of serious teenage depression, or, if they do notice, they find other explanations, like having a bad teacher or losing a boyfriend.
    Depression can cause fatigue or interfere with the ability to concentrate. Or the teenagers may become irritable, angry, bored, excessively guilty or anxious. There may be frequent outbursts of shouting, complaining or crying, and talk of leaving home. In some depressed adolescents, the emotional turmoil shows up in physical complaints like chronic or frequent headaches, muscle pains, tiredness or stomachaches. Sometimes a teenager may exhibit more classical signs of depression, like a significant change in eating habits, appetite or body weight, difficulty sleeping or oversleeping (12 to 14 hours a day), a persistent sad mood, loss of energy, feelings of worthlessness, withdrawal from friends and previously enjoyed activities, or thoughts or talk of death or suicide. If five or more of these symptoms persist for two weeks, professional attention is warranted. Such attention is mandatory for anyone who attempts or threatens suicide.
    Sometimes generalized anxiety precedes the onset of depression in teenagers and persists even after the depression lifts. Also, a milder chronic form of depression, dysthymic disorder, can cause persistent symptoms that may be wrongly dismissed for more than a year as the teenager's natural personality. These symptoms may include low self-esteem, feelings of hopelessness, low levels of energy, difficulty concentrating or making decisions, and significant social difficulties. One long-term study found that 70 percent of adolescents with dysthymic disorder eventually developed an episode of major depression. In most, dysthymia preceded the depressive disorder by three years.

Treatment
Only one in five depressed adolescents receives treatment, which can involve a combination of short-term psychotherapy, medication and changes at home or school. Psychotherapy, either traditional talk therapy or more focused cognitive behavioral therapy, may be all that a moderately depressed teenager needs to recover fully. But when depression is more severe, chronic or recurrent, or when psychotherapy is refused, medication is strongly recommended. Medication can also enhance the effectiveness of psychotherapy when depression is severe.
    Antidepressant drugs in the Prozac family -- selective serotonin reuptake inhibitors, or S.S.R.I.'s -- are the first choice for adolescents. Several studies have shown them to be safe and effective against persistent adolescent depression. But tricyclic antidepressants have not proved to be any more helpful than dummy medication for depressed teenagers.
    Proper use of antidepressant medication is essential for it to be effective. Experts suggest a low starting dose taken daily for four weeks, with an increase in dosage if no improvement is noted by then. If the child improves even minimally, the current dose should be continued for another two weeks.
    But after six weeks of drug therapy, if the adolescent is still depressed, alternative therapy is needed, like switching to another drug or combining the first drug with a second one. For example, a depressed teenager may have a more complicated problem known as a bipolar disorder. With it, depressed episodes are interspersed by manic periods. Or the depression may be mixed with an anxiety disorder. Different drugs are needed in these cases.
    Since depression is often a recurrent problem, experts suggest continuing drug therapy for 6 to 12 months, even if the teenager feels fine long before then. For adolescents who have had two or more episodes of serious depression, maintenance drug therapy for one to three years is recommended. Then, the drug should be gradually reduced over six weeks.

Recovering Addicts Help Educate Future Doctors
Linda Villarosa, New York Times- 12/24/2002

Jillian Polis, a second-year medical student at the Weill Medical College of Cornell University, admits that she had little if any experience with substance abuse. Raised in a suburb of Denver, she learned about drugs from popular culture. "I thought the only people who got addicted were those who were wealthy with nothing to do or the urban poor," said Ms. Polis, 23. "I got those images from movies like 'Traffic' since there was little or no addiction that I knew of growing up.'"
    Jonathan Austrian, Ms. Polls's classmate at Cornell, said that he thought people used drugs simply to have a good time, and that he didn't know anyone who had been addicted. "My only experience with drugs and alcohol was in the party setting," said Mr. Austrian, 24, who grew up in Baltimore and attended the University of Pennsylvania. "Coming from the middle-class college scene, people took drugs to enhance the party experience; they were for a good time."
    Both of these students, who now admit to being naive, got an eye-opening look at addiction this fall, during a field trip to Phoenix House, a drug treatment center in Queens. These students and several others took part in an informal but intense session in which the medical students and some residents of Phoenix House engaged in a morning of free-flowing discussion.
    This monthly session, part of a class called "Medicines, Patients and Society," is designed to help students better understand addiction and develop empathy for the addicted patients they will inevitably face once they begin practicing medicine: "Medical students often have misconceptions about people who are addicted or in recovery," said Dr. Terry Horton, medical director of the program, which began eight years ago. "Students and interns often only see addicts as the guy in the E.R. who ripped out his IV or the street person who is uncooperative. But in an urban setting, an estimated one-third of patients are going to be addicted. A medical student who becomes a physician in the community who hasn't learned that addiction is a brain disease is not going to be effective."
    In a recent discussion with medical students, Roy Jackson, who has been a resident at Phoenix House for 18 months; described the harrowing years of physical and sexual abuse that he said led to drug use at age 16. He became addicted to heroin, attempted suicide twice and was arrested for selling crack. "I'll be getting out soon, and I'm scared," said Mr. Jackson, 36. "I'm scared of getting high again. I used drugs to cover up the feelings that I had that no one loved me. I have to fight the urges and stay away from people and place and things, so I can stay on my recovery."
    After hearing Mr. Jackson's story and those of others, Ms. Polls said experience helped her see those addicted to drugs as real people. "What I heard were people who were using drugs to make the suffering go away, to get lost in the world of drugs," she said. "This experience will stick with me for a long time."
    Keisha Badger, 32, tearfully told the medical students that she, too, started using drugs as a way to numb the pain brought on by sexual abuse. She started smoking crack when she was 16. After the session, she said she shared her story with the students because she wanted to change doctors' attitudes about addicts. "It's important for them to know who we are, that we are more than just the drugs," said Ms. Badger, who has been at Phoenix House for 13 months. "I want to be clean. I don't want to use anymore. I am not just a crackhead."
    Jana Dickson, 29, a fourth-year student at Meharry Medical College in Nashville, visited Phoenix House in September on a scholarship to study substance abuse in New York. She admitted to the group of residents that she felt uncomfortable asking about substance abuse during intake interviews with patients. "Could you give us some feedback about the best way to ask about drug use?" she asked the group. "You have to ask the question honestly," said Darone Green, 43, who is recovering from crack addiction. "But you also have to understand that you might not get an answer, or you might get a totally different answer an hour later. As an addict, I may not be in a clear state to understand your question. Or your question may be totally irrelevant to me because I am trying to figure out how, to get the next hit. I've been an addict for 29 years, and there is a lot of shame, denial and guilt in the life style, so I might lie to you." Ms. Dickson said the session helped further her understanding of addiction. "The residents described how out of their minds they were, how precious the drugs were, how nothing else mattered," she said. "That was important for me to hear. Before, if a patient wouldn't talk to me, I took it personally. Now I see it's not about me, it's about the drugs. In order to help someone who is addicted, I have to be vigilant about finding out what they are using."
    Mr. Austrian said his morning at Phoenix House changed the way he thought about addiction and substance abusers. "I volunteered in the E.R., and I saw drunks who came in who were unmanageable and unruly, out of control," he said. "My initial instinct was that this is their own fault and people like this create long lines and prevent other patients from receiving care. But after hearing the stories, I am much more empathetic because I understand how fragile these people are, even those in recovery. One false step, one taste of crack, they could be thrust back into the depths of their hell. This was a powerful lesion."