Computer Training Helps Schizophrenics
Detroit Free Press, 1/1/2002

Computer training can help schizophrenic patients improve their mental functioning, according to a Yale University School of Medicine study. Computer training for things like attention, memory and executive function tasks, combined with work therapy, improved normal working memory performance by nearly 50 percent compared with patients who received only work therapy. Reporting in the December issue of the Archives of General Psychiatry, Morris Bell said computer training may work by stimulating mental activity, which can then enhance learning during work therapy.

Therapists Redraw Line on Self-Disclosure
Erica Goode, New York Times- 1/1/2002

For over a century, therapists have argued about how much of themselves they should reveal to their patients. Sigmund Freud, by all accounts quite chatty in his own consulting room, warned other psychoanalysts against self-disclosure. The analyst, he advised, should strive to remain anonymous, a blank slate upon which people could project their unconscious fantasies, conflicts and desires. "The doctor should be opaque to his patients," Freud wrote in 1912, "and, like a mirror, should show them nothing but what is shown to him."
    Other theorists, however, argued that sharing thoughts, feelings or personal details with patients could sometimes be helpful. Humanistic psychologists like Carl Rogers, for example, saw self-disclosure as a way of gaining trust and helping patients open up about themselves. And in recent years, even some psychoanalysts have asserted that the anonymity described by Freud was neither possible nor desirable.
    Now a new study has come down on the side of those who argue for self-disclosure. In the study, patients were randomly assigned to therapists-in-training at a counseling center at the University of Memphis. With one set of patients, the therapists refrained from disclosing personal information. With the other patients, the same therapists offered more personal information in response to comparable disclosures made by the patients than they normally would have.
    After four sessions, the patients were asked to rate their liking for the therapist and their level of emotional distress on a checklist of symptoms. The patients whose therapists were more revealing, the researchers found, both liked their therapists more and were less distressed than patients whose therapists limited their disclosures. A report of the study appeared in a recent issue of The Journal of Consulting and Clinical Psychology.
    Dr. Marna S. Barrett, a psychologist at the University of Pennsylvania's Center for Psychotherapy Research and the lead author on the report, said the results were unexpected. "I was of the school that no, you don't just share yourself," said Dr. Barrett, who conducted the research when she was a graduate student in Memphis. The study's findings, said Dr. Jeffrey S. Berman, Dr. Barrett's collaborator, suggested that revealing personal information was not harmful to patients. But it remained unclear, he added, whether increasing self-disclosure was helpful to the patients or whether restricting it was harmful. "One possibility," Dr. Berman said, "is that disclosure, at least at the level and of the type that was done in this study, serves to enhance the bond between therapist and client, and it's by enhancing that bond that provides the atmosphere where improvement can occur."
    Dr. Clara E Hill, a professor of psychology at the University of Maryland, praised the study as a rare attempt to compare different levels of self-disclosure in a systematic manner. Most previous work on the topic relied on case histories. Surveys or studies of simulated therapy situations in which observers offered their reactions to "disclosures" by therapists. Such studies have generally found that patients view self-disclosure as helpful, at least in the short run. In one study by Dr. Hill, for example, patients said that self-disclosures by their therapists, especially statements that were reassuring rather than challenging, were among the most helpful aspects of their time in therapy.
    For example, Dr. Hill and a colleague, Dr. Sarah Knox, write of a 44-year-old woman who described her early relationship with her male therapist, Dr. A.. as uncomfortable and filled with distrust. At one point, the woman brought to a session a song about a young man dying of AIDS and gave it to her therapist. He responded that one of his family members had died of AIDS. The woman, Dr. Hill and Dr. Knox wrote, "viewed the disclosure as a gift, which made her feel safer, closer and special that Dr. A. would share such a personal and emotional experience with her.
    Still, Dr. Hill and other experts have found, therapists are often less convinced that revealing themselves is beneficial, often rating self-disclosures as the least helpful thing they did during the treatment. "I think therapists have been told over and over that they are not supposed to self-disclose," Dr. Hill said, "so when they do, it feels like they're doing something they shouldn't. They feel vulnerable, and it changes the power balance."
    In their study, Dr. Barrett and Dr. Berman found that even when the therapists were instructed to reveal personal information in response to disclosures by patients, most did so only occasionally. In the group offering increased self-disclosure, for example, the therapists offered personal information an average of only three times per session, compared with an average of 60 self-disclosures per session by patients.
    Though the sharing of thoughts, feelings or opinions may often be helpful, Dr. Hill and other researchers said, some types of self-disclosure can clearly do more harm than good. Beginning therapists, Dr. Hill noted, often disclose far too much. And therapists who plunge into discussions of their own personal problems or reveal intimate details of their sex lives are certainly not acting in the patient's best interest. "There's a lot of different types of self-disclosure and they can have a lot of different impacts," Dr. Hill said. "If you're saying, 'Here's what I think, what do you think?' that's different from spilling your guts."
    But the anonymity that many analysts seek, said Dr. Owen Renik, a psychoanalyst in San Francisco and the former editor-in-chief of the journal Psychoanalytic Quarterly, is not a virtue either. The idea that an analyst can remain unknown to a patient is a fiction, Dr. Rekik said, one that "defies common sense" since everything the analyst does or does not do reveals information. When analysts withhold all reactions to what a patient is saying, Dr. Renik added, "the patient spends all his time focusing on the analyst and the analyst looms large as a figure of mystery." "It's all about 'guess what's in my head,'" he said.
    In contrast, self-disclosure, used judiciously, can help establish an atmosphere of authentic candor between analyst and patient, Dr. Renik contends. "When my patients experience me as saying what I really think--about them, myself, us--they respond in kind," he wrote in a 1995 paper. He gave as an example a session in which a patient was convinced that Dr. Renik had been especially gentle and careful with him during the previous hour in order not to hurt him. Dr. Renik replied that he was not aware of feeling any particularly concern about the patient, and that in his view, the patient had his own reasons for imagining that his analyst saw him as fragile. "I feel it is useful to make explicit my own perception of my emotional state," Dr. Renik wrote. In another session with the same patient, however, Dr. Renik declined to reveal his opinion of the patient's girlfriend, though the patient asked his impression. "I answer that whatever private opinions I may or may not be entertaining are not really relevant to our purposes," Dr. Renik said.
    Dr. Barry Farber, a professor of psychology at Columbia Teachers College, who has studied self-disclosure by patients and therapists, said that perhaps the hardest thing for therapists was to find a middle ground "between being too silent and too talkative." "On the one hand, you have the analytic cliché: Don't just say something, sit there," Dr. Farber said, "On the other hand, if you really do only sit there you are creating a rather sterile environment" that does not encourage patients to disclose themselves. His own research, Dr. Farber said, suggests that self-disclosure can be helpful when therapists apologize for their mistakes, share information about child rearing or offer feedback on their own emotional reactions to what the patient is saying. "The data we've collected suggest that sharing one's emotional reactions with the patient is potentially a very, very healing thing," Dr. Farber said.

Motion Seeks Gag Order Change in Yates Trial
Carol Christian, Houston Chronicle- 1/2/2002

A man claiming to be a former Texas prisoner now in Pittsburgh is the latest, and so far the most unlikely, source of a request to modify the gag order in the trial of Andrea Pia Yates. The man, who mentioned the Allegheny County Jail in Pittsburgh but didn't say he was an inmate there, has filed a motion asking state District Judge Belinda Hill in Houston to lift restrictions on coverage of the trial. Jury selection begins Monday and testimony is expected to start Feb. 11. Yates, 37, has admitted drowning her five children June 20 in the bathtub of the family's Clear Lake home. She has pleaded not guilty by reason of insanity to two charges of capital murder. If convicted, she could be sentenced to death.
    In a motion filed Dec. 19, the unnamed former inmate referred to himself as John Doe and signed it Pseudo Free Lance Scribe G-Force. He said he had spent 15 years in Texas prisons, from 1985 to 2000. No information was available on charges against him. In rambling sentences that warn of mass murders caused by "X-rayed hormones" dispersed through ventilation systems, the motion asks the judge to void the gag order. The same petition, however, describes the order as being "in good faith, with just cause."
    Hill imposed the order June 26, saying public comments would increase publicity about the case and could make it difficult to find an unbiased jury. The gag order apparently has done little to stem the flow of news about the case, considering that a computer search under the name "Andrea Yates" produced 29,900 hits.
    The former inmate claimed that he triggered the gag order by sending prosecutor Joe Owmby an unpublished article he had written. The article explains that altered hormones have caused mass murders, but according to the motion, this information has not been publicized. "Therefore, this evidence is very favorable to the defendant's case and requires evidence disclosure," the motion states. "Shortly upon the article being received by assistant prosecutor Mr. Joe Owmby, a gag order was imposed, barring further disclosure of facts regarding the case ... " The former inmate's claim is questionable. Hill imposed the order at the request of Bob Scott, the lawyer initially appointed to represent Yates. Her hired lawyers, George Parnham and Wendell Odom, protested the order, but Hill has declined to lift it.
    In a related matter, the judge is expected to conduct a hearing today on a request from the defense to respond to televised comments by Harris County District Attorney Chuck Rosenthal. In a Dec. 9 appearance on 60 Minutes, Rosenthal talked about why he was seeking the death penalty for Yates. Her husband, Russell Yates, also was interviewed on the program. Parnham and Odom did not say how they wanted to respond. Last month, Hill appointed George "Mac" Secrest, a defense lawyer and former prosecutor, to look into whether Rosenthal and Russell Yates violated the gag order. Secrest has not issued any findings. In August, the 14th Court of Appeals denied the Houston Chronicle's request for the court to remove the order.

Sex Offender First to Make Trips From Washington State Halfway House
Associated Press, 1/2/2002

TACOMA -- In the past three weeks, David Wrathall has visited his therapist, opened a checking account and made a shopping trip. Those all would be unremarkable accomplishments, except that Wrathall is the first convicted sex offender housed at the Special Commitment Center halfway house on McNeil Island, and the first making escorted trips to the mainland. "This is new ground for everyone," said Pierce County sheriff's detective Sgt. Keith Barnes. "The public has been against allowing these people off the island in the first place."
    Wrathall, 35, was convicted in 1995 of second-degree kidnapping in an incident involving a Snohomish County boy, and of indecent liberties in 1985 for assaulting two boys in Seattle. He is registered as a Level 3 sex offender, marking him as potentially violent and likely to reoffend. Since being placed at the facility in early December, Wrathall has made trips into the cities of Steilacoom, Lakewood and Tacoma. No incidents have been reported.
    The halfway house, officially called the Secure Community Transition Facility, eventually will house 19 convicted sex offenders. The facility is operated by the state Department of Social and Health Services. The halfway house is a compromise that springs from a long-running conflict over what to do with sex predators who have served their criminal sentences but are deemed likely to reoffend.
    A federal judge has ruled the state cannot simply warehouse such offenders in the civil commitment center but must provide a less restrictive alternative for those who make progress in treatment. The state tried to site smaller halfway houses around Washington, but strong opposition from locals prompted Gov. Gary Locke and the Legislature to opt for a single center on McNeil Island, which already holds a state prison and the special commitment center. DSHS and area law enforcement officials have developed a plan for off-island offender trips aimed at ensuring public safety and minimizing public worries. "I feel fairly comfortable that we are on the same sheet of music," Mark Davis, facility director for the halfway house, told The News-Tribune of Tacoma.
    Under the visiting guidelines:
* The public must be notified any time a sexual offender is released into the halfway house program.
*Any time sex offenders leave the island, they must be accompanied by a DSHS escort. Davis said the escorts will be trained in police response by the Lakewood sheriff's detachment.
*A weekly schedule of the residents' whereabouts will be given to local police departments. The schedule will contain all routes and stops as well as the name and phone number of the escort.
    "We have to know exactly where they're going and how they're going to get there," said Lakewood assistant chief Rick Adamson. Besides being escorted, halfway house travelers will be electronically monitored. Barnes said a global positioning system is in the works to help track movements. "There are always going to be safety concerns for us," he said. "The true test will come when we have more residents." Davis was optimistic that the strict monitoring guidelines would prevent any problems. "My hope is that in a year or so, people will have forgotten us," he said.

Study Finds Beating Cocaine Takes More Than Acupuncture
Erica Goode, New York Times- 1/3/2002

Acupuncture is widely used as a treatment for cocaine addiction. But the results of a large clinical trial suggest that when used alone without other treatments the therapy is not effective in reducing cocaine dependency, researchers report yesterday. Needles inserted into four acupuncture zones in the ear that are commonly used in treating addiction did no more to curtail cocaine use than relaxation exercises or a sham procedure in which needles were inserted into the rim of the ear. The study participants received the acupuncture or the other treatments five times a week for eight weeks.
    Dr. Arthur Margolin, a research scientist at Yale's School of Medicine and the main author of the study, said that based on the findings, "the recommendation would be that acupuncture not be used by itself as a treatment for addiction, or in a setting where there is only minimal counseling or therapy." But Dr. Margolin added, "I don't think this trial shows that acupuncture is ineffective across the board."
    Some practitioners who use acupuncture to treat cocaine addiction did not dispute the study's findings but said the technique was rarely used alone and was usually combined with other treatments. The way that acupuncture might work to treat addiction remains unclear. A report on the study appeared yesterday in the Journal of the American Medical Association. Earlier studies of acupuncture as a treatment for cocaine dependency, one of the most difficult forms of drug addiction to combat, have emerged with mixed results. A smaller trial at Yale last year found the therapy to be effective in helping some people reduce their reliance on the drug.
    Experts on addiction said the new trial--by Dr. Margolin, Dr. Herbert Kleber of Columbia University's National Center on Addiction and Substance Abuse, and more than a dozen collaborators at six community-based drug dependency clinics around the country--was the largest to test acupuncture's effectiveness for drug addiction and among the largest to examine the method's usefulness in any medical condition. The acupuncture procedure used in the trial followed guidelines developed at Lincoln Medical and Mental Health Center in the Bronx and adopted by the National Acupuncture Detoxification Association.
    Of the 620 adults who initially enrolled in the trial, 208 of whom regularly used heroin as well as cocaine, almost half dropped out before the study's completion, as is common in studies of addiction treatment. Those who remained showed a significant reduction in cocaine use, as measured by urine samples. But the extent of the reduction was the same no matter which treatment the subjects received. And while some experts have argued that acupuncture helps people with drug problems stay in treatment, the subjects who received acupuncture were no more likely to finish the trial or to attend the counseling sessions that were offered to participants.  Dr. Margolin said the findings were unexpected in light of the earlier, positive results from the smaller Yale trial. "It's not unusual when you have successive trials of similar treatments to have different findings, but to go from a fairly strong finding for acupuncture to no finding was surprising," he said.
    In their report, Dr. Margolin and his colleagues suggest that the difference may be explained by the fact that the subjects in the smaller study received more intensive individual counseling and weekly group therapy in addition to acupuncture. And unlike the subjects in the smaller study, the participants in the national trial were paid $2 per session and an additional $10 at the end of each week for their participation. Those who remained in the study until the end were the most severely addicted and the least motivated to conquer their dependency.
    Dr. Michael Smith, the director of the Lincoln Recovery Center, part of Lincoln Medical, where the acupuncture procedure employed in the trial was developed, said the technique was used by as many as 1,500 drug treatment clinics worldwide. But Dr. Smith, who served on an advisory committee for the trial, added that acupuncture was almost always combined with other treatments and that he was not surprised by the recent findings. "We never claimed nor does the study claim that acupuncture is a stand-alone treatment," Dr. Smith said. Still, Dr. Alan Trachtenberg of the federal Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment, who also served on the trial's advisory board, said that some drug treatment practitioners did offer acupuncture as a sole treatment. "One of the main concerns that people in the field have had is that acupuncture might be perceived as some kind of magic cure-all," Dr. Trachtenberg said, "and we can conclude from this study that that would not be appropriate."

Los Angeles Juvenile Mental Health Court Offers New Options
Greg Krikorian, Los Angeles Times- 1/4/2002

As judicial experiments go, it is modest in size, especially in California, where criminal justice measures can sweep up thousands of offenders virtually overnight. Still, a Los Angeles County attempt to rescue troubled teenagers from criminal activity has the potential to transform how the nation's largest juvenile justice system treats youths with mental illness.
    In a courtroom next to the crowded Eastlake Juvenile Hall, Superior Court Judge Clifford L. Klein presides over what is believed to be the first juvenile mental health court in the country. The brainchild of mental health advocates, the court is distinct from the dozens of others handling juvenile cases in Los Angeles County because it focuses only on youths with diagnosed mental health problems. The judge orders their treatment and monitoring to minimize their chances of additional run-ins with the law.
    "It is one thing to talk about guilt or innocence," said Deputy Public Defender Nancy Ramseyer. "Here we are looking at bigger issues, like why a kid got involved in the system and how we can prevent it from happening again." Like others assigned to the court, Ramseyer has years of experience in the field of juvenile delinquency. She began working with youths in the 1980s. "It is completely different now. We didn't have all these kids with mental health issues," she said. "Maybe it is better diagnosis. Maybe it is because so many kids were born to families who couldn't care for them and they wound up in the foster care system" without adequate mental health care.
    Whatever the reasons, Los Angeles County authorities say a Probation Department survey last year found that a staggering 40% of youths held at juvenile halls suffered significant mental health problems. Consider that the county's three high-security juvenile halls house about 2,000 youths, in addition to the thousands more held at camps or in other facilities, and one begins to see the scope of the problem.
    Addressing the problem begins with representatives from various agencies, including the district attorney's office. The group determines which youths might benefit from the court's intervention. Officials have decided that in the first year, they will limit the caseload to about three dozen youths. Eligibility is based on criteria that include a diagnosed mental disorder or developmental disability and the minor's competence to communicate with an attorney. Also, a youth's record cannot be too violent or the latest crime too serious.

Complicated Problems Require Expertise
"The problems that cause these kids to behave the way they do are very complicated," said Michael Malkin, director of the Juvenile Court's mental health services. "And for anyone to have an impact on that behavior requires a lot of human effort by people who know what they are doing." Klein said many of the youths sent to his court have not done well at juvenile halls or other facilities.
    That was the case with a 14-year-old boy brought before the court recently. Hyperactive and diagnosed as mildly retarded, the teenager has long had problems in school, principally with reading. "He wasn't really doing as well as the other kids," said his mother, Gwen. His learning disabilities fueled the boy's frustration, his mother said, noting that in a pre-kindergarten class, he was suspended for misbehaving. On the streets, he has been arrested for property crimes such as stealing a bicycle. Then, in the early morning hours of Sept. 29, he was picked up joy riding not far from the family's South Bay apartment.
    Under routine circumstances, officials said, he probably would have been sent back to a juvenile hall without any individual focus on his disabilities. But on Oct. 30, about a month into the new juvenile mental health experiment, a judge in Inglewood referred the youth's case to Klein's courtroom. And in late December, after a series of evaluations, the teenager was released to the custody of his mother with an array of court-ordered services. Beginning this week, he will attend a small special education school that agreed to accept him after being impressed both by his interest in learning and his mother's commitment. For her son's interview appointment, Gwen, though sick with the flu, took three buses to get to and from the school. "We really admire that," Klein said. "That's quite a commitment." In addition to his specialized classroom instruction, the teenager will receive after-school supervision that includes homework and activities. Apart from schooling, he will undergo an evaluation at UCLA's Neuropsychiatric Institute and get regular counseling. His mother, meanwhile, will receive services including weekend respite care so she can shop or run errands.
    The county program also carries some restrictions. For example, from the time he returns home until he goes back to school, the teenager will be required to wear an electronic monitoring device that will alert authorities if he leaves the apartment. The judge also told the boy that he must not get into fights or hang out with old friends, many of whom are in gangs.

Doing Well Is the Best 'Thank You'
"We really don't want to put you back into juvenile hall," Klein told the youth. Before ordering the boy to return with his mother in 30 days for a status report, Klein made sure the youth understood the terms of his release and asked if he had anything to say. "Thank you," the boy said, breaking into a grin. "The best 'thank you,' " Klein responded, "is to do well out there."
    Outside court, with her son returned to her just days before Christmas, Gwen called the new court "a blessing." Given his history, she said, plenty of people over the years "knew my son had a problem, but nobody took the time to help." "But he came to this court and they have been great," she said. "It's like they are breaking their backs for him." No one involved in the program believes that every teenager who participates will never again get in trouble. "What I tell the kids when I first meet them is that this is a voluntary program, but if you work with me, we will make sure that this is the last time you are incarcerated," Ramseyer said. "I don't know if that is going to happen with every kid. But I think in most cases, we will make that happen."

No Place to House 13-Year-Old Washington State Sex Offender
David Fisher, Seattle Post-Intelligencer- 1/4/2002

OAK HARBOR -- Thirteen-year-old Nicholas Stroeder lives in an expensive netherworld. With his mother gone and his grandmother, the legal guardian, ailing, there's no family to care for him. And after accusations of sexual assaults on other children in foster homes, and a conviction for an attempted rape at a Lynnwood mall last year, the state can't find a foster family for him. So, since New Year's Eve, Stroeder, who is only a week past his 13th birthday, has spent his days in the Oak Harbor office of Child Protective Services (CPS). At night, armed Island County sheriff's deputies drive him 45 miles to a supervised juvenile respite home in Everett, and stand guard as he sleeps. The next day, they do it all over again. The cost: $40 an hour -- as much as $960 per day -- for the guards alone.
    But members of the public who walk into the CPS office, CPS staff members and the north Oak Harbor neighborhood that surrounds the CPS building may be in danger of attack from a youngster local law enforcement classifies as a Level III sex offender -- the most likely to reoffend, Island County Sheriff Mike Hawley said. "This is a huge lawsuit just waiting to happen," Hawley said yesterday. "And, unfortunately, someone is going to get hurt." The sheriff plans to distribute fliers with the youth's photo and history around Oak Harbor to warn people about him. He is also trying to dial up the pressure on state officials to do something about it. Officials at the Department of Social and Health Services say they don't know how long the situation will continue.  "We are working extremely hard to find him a permanent facility. We are looking into leads both in and out of state," one official told KOMO 4 News. As far as Hawley knows, the boy is getting no therapy or schooling while CPS conducts its search -- not an unusual predicament in Washington state.
    A study released last year by the Washington State Institute for Public Policy found that most of the 7,100 children in long-term foster care at any given time get no mental health treatment, although 40 percent are considered severely troubled. Although Washington has 6,284 foster parents, shortages of foster care are at times acute. A Seattle Post-Intelligencer investigation in 1999 documented a drop of nearly 30 percent in the number of foster parents in King County, forcing state workers to keep children as young as 2 in the Rainier Valley DSHS office for overnight stays. DSHS promised last year to team up with Casey Family Programs, a private foundation, and the Foster Parents Association of Washington State to recruit and train more foster families. But children's programs statewide face more than $46 million in proposed budget cuts, and old problems have not faded away. CPS staff members in Oak Harbor have told the sheriff that other juveniles have lived in the office for as long as two months at a time in recent months.
    Still, the expense of Stroeder's care and the extent of his background make the case stand out, and his story prompted the Post-Intelligencer to name him even though the newspaper seldom identifies juvenile offenders. Hawley said an angry Stroeder set fire to a mattress, which led to the destruction of his grandparents' home in 1998. In May 1999, the boy was accused of fondling and kissing an 8-year-old boy during a foster home commitment. A few months later, in another foster home, he was accused of trying to rape a 9-year-old housemate in her bed. Criminal charges were not filed in either case, partly because he was under the age of 12 and partly because CPS investigations were inconclusive.
    Last April, at age 12, the boy was on a field trip to Alderwood Mall with a juvenile group home when he asked to go to the bathroom, Hawley said. He sneaked into the women's bathroom and hid in a stall. When a 19-year-old woman, five months' pregnant, tried to use a stall next to him, the 5-foot-1, 152-pound boy crawled under the divider, choked her and tried to rape her. Another woman broke up the attack. For that, he was convicted of indecent liberties with forcible compulsion and sentenced to 15 to 36 weeks in the Echo Glen Children's Center. The Juvenile Rehabilitation Administration labeled him a less-serious Level II offender on release because his record showed only one conviction. Hawley upgraded the listing to Level III based on the youth's behavioral history.
    Since his release on New Year's Eve to Whidbey Island, where his grandmother lives, off-duty deputies have tried to keep him entertained as they while away the hours, Hawley said. On New Year's Day, his guard tried to take him to a movie, but he didn't want to go. So the deputy drove him around the island all day, showing him the sights, and then returned him to Everett. Compared with the estimated $28,800-a-month cost of guarding Stroeder, basic foster care costs $350 to $500 a month. Care in Level II "enhanced" homes runs $639 a month, and Level III therapeutic care in treatment homes or group homes can cost $3,417 a month.

Depression
Craig Stoltz, Washington Post- 1/4/2002

Clinical depression – usually characterized by extreme or lingering sadness that interferes with daily function and is different from normal feelings of sadness brought on by life events – is considered the leading cause of disability in America. It's twice as common in women as in men. During 2001, two long-standing forces continued to steer patients toward drug treatment: the marketing of a new generation of antidepressant medications such as Prozac, Zoloft and Paxil; and health insurers' policies that favor drug treatment over psychotherapy. The National Institute for Mental Health concludes that combination therapy, involving both drugs and talk therapy, is more effective for most patients. The agency singles out time-limited cognitive-behavioral and interpersonal therapies as particularly well-suited to depression.
    In August, the daily-dose version of market leader fluoxetine (Prozac) became available as a generic and more than 80 percent of users have switched to the lower-priced option. Prices of competing drugs are expected to be forced downward in 2002. While the current generation of antidepressant drugs acts on a single brain chemical, serotonin, drugs in development will target other so-called neurotransmitters as well. As science continues to explore the brain, researchers are learning more about – and discovering the limits of – neurotransmitters. They are exploring theories linking depression to cellular function, electrical pathways and bigger structures of the brain.
    A 2001 study funded by the makers of Zoloft concluded that the popular herb St. Johns Wort was ineffective against major depression. The study was widely considered irrelevant to the efficacy of the herb for mild depression, for which it is most commonly used. Other reports in 2001 did show that St. Johns Wort interferes with the body's ability to absorb some prescription drugs, underscoring the emerging consensus that most herbs should be used in consultation with a medical professional.

Most Molested Boys Don't Molest Others as Adults
Reuters News Service, 1/4/2002

NEW YORK (Reuters Health) - A "cycle" of child sexual abuse seems to exist for only a minority of male victims, but not at all for female victims, British researchers report. Dr. I. Kolvin and colleagues from the Tavistock and Portman NHS Trust in London reviewed the cases of 843 people attending a psychotherapy clinic for sex offenders. Two women and 225 men were found to be child abusers, out of a total of 96 women and 747 men. Forty-one of the women were victims of sexual abuse, one of whom became a perpetrator, the investigators report in the British Journal of Psychiatry for December. Seventy-nine of 135 male victims became perpetrators.
    Homosexual men and transvestites were significantly less likely to be perpetrators than heterosexual men and men who were not transvestites. The authors observed no significant associations between status as a child molester and voyeurism, fetishism, obscene phone calls or other sexually deviant acts.
    Ten perpetrators and eight non-perpetrators used pornography compulsively, suggesting this as a possible risk factor. In addition, 19 of 24 men molested by a female became perpetrators, compared with 60 of 111 molested by males. Thus, Kolvin and colleagues note, victimization by a female may contribute more to a male becoming an abuser than victimization by a male. However, the authors caution that the numbers may be too small to establish causation.
    "Although the data do not provide strong support for a cycle of sexual abuse encompassing a substantial proportion of male perpetrators, prior victimisation may have some effect in a minority of perpetrators, and can be viewed as one mediating factor which enhances the probability of subsequent perpetrator behavior," the authors conclude.
    Two commentaries accompany the report by Kolvin's team. Dr. Mary Cannon of the Institute of Psychiatry in London cautions against blaming the victim, which could lead to further stigmatization and stress for individuals who have been molested in childhood. She does praise the study for exposing "psychoanalytic theory to epidemiological scrutiny."
    Dr. Susan Bailey of Mental Health Services of Salford in Manchester, UK, notes that "for each individual, dispositions conditioned by childhood abuse are subject to many different kinds of combinations of motivating and mediating factors that ultimately determine whether or not and in what circumstances being abused can lead on to abusing." She maintains that the real challenge for society is to develop treatment programs that are then evaluated by long-term follow-up.
    SOURCE: British Journal of Psychiatry 2001;179:482-494, 495-497.

OxyContin Lawsuit Is Withdrawn
Associated Press, 1/4/2002

PORTLAND, Maine -- A lawsuit that was the first in Maine to target the maker of OxyContin for someone's drug addiction has been dismissed. William Bushey's lawyer asked a judge to dismiss the lawsuit, and the request was granted by U.S. District Judge Gene Carter on Jan. 2. The order does not prevent Bushey from filing the lawsuit again at a later date.  The lawsuit in U.S. District Court had accused Purdue Pharma and Abbott Laboratories of marketing the drug aggressively even when they knew people were abusing the drug and becoming addicted in the late 1990s.
    Bushey, a guard at the Maine Correctional Center in Windham, contended he became addicted to OxyContin after it was prescribed for back pain. Chris Nyhan, a lawyer for Purdue Pharma, said the case was withdrawn because it had no merit. It was the first and only lawsuit against Purdue Pharma over OxyContin abuse in Maine, Nyhan said. But more than dozen have been filed in other states.
    Bushey's lawyer, John Hinck, said Friday that his client had personal reasons for dropping the suit and that the timing was not right. Hinck said he could file the lawsuit again before the six-year statute of limitations expires.  He also said he may bring lawsuits on behalf of other clients. His law firm, Lewis Saul & Associates, took out advertisements seeking people who abused OxyContin and was contacted more than 100 people. Bushey's lawsuit, which was filed on Aug. 14 in Portland, named Connecticut-based Purdue Pharma LP along with several subsidiaries and Abbott Laboratories, which is based primarily in Chicago. It sought compensatory damages and punitive damages, along with legal fees.
    OxyContin abuse first became widespread in Maine and in mountainous areas of Kentucky, West Virginia, Virginia and Tennessee. The drug is a slow-release narcotic painkiller. It is widely prescribed for victims of moderate to severe chronic pain resulting from such problems as arthritis, back trouble and cancer. One pill is designed to last 12 hours, but those who abuse OxyContin usually crush the medicine and then snort or inject it, producing a heroin-like high.

Michigan Parents Offered Drug Test for Kids
Sheri Hall, The Detroit News- 1/4/2002

PLYMOUTH TOWNSHIP, MI -- Tom Tiderington spent 20 years as a cop chasing drug dealers in Ft. Lauderdale, Fla. Now, as the new Plymouth Township police chief, he wants to help parents protect teens from the dangers of the drug trade. Tiderington kicked off a program this week to distribute free drug-screening tests to local parents in an effort to get help for teen drug-users. "This is just one more way that we can help parents become better parents," Tiderington said. "We're not saying parents should drug screen their kids. We're saying if you need answers, this is where you can turn. And it's up to the parents what they do with the information."
    Drug use among teens doesn't recognize geographic or economic boundaries. Forty percent of teens have used an illegal drug in the past year, according to a national survey by the University of Michigan. And 12 percent of eighth-graders had tried an illegal drug. The free kits are intended to help parents detect if their child has a drug problem.
    Courtney Suarez, a senior at Canton High School, said the program has its pros -- and cons. "If parents believe their kids are on drugs, it's a good idea," Suarez said. "But if parents want to randomly test kids, it could cause a lot of problems in the family. Then, the kids will think their parent doesn't trust them, and they won't want to take the test."
No evidence has been collected to show that teen drug testing prevents or reduces drug use. But Tiderington and others say knowing a child has used drugs is a start toward getting them help and steering them away for a life of drug abuse. "I'm convinced that parents can make a difference if they're aware of what their children are doing," Tiderington said. The free tests are meant for parents who suspect a problem, Tiderington said. Kids who test positive for drugs through the program will not be arrested, he said. If parents notify police of a positive drug test, officers will refer them to local treatment programs.
    Drug Free America Inc., a non-profit organization based in West Palm Beach, Fla., donated 40 screening kits to Plymouth Township. They cost $28 each, including the urine analysis and postage for the sample. The kits include a plastic container to hold a urine sample and packaging so parents can mail the sample to a Florida lab for analysis. They test for 10 types of controlled and banned substances, but do not measure levels of some designer drugs, such as GHB, Tiderington said.
    Caroline Reinke, a Plymouth Township resident, opposes parents testing children at home. "They should really take their kids to a doctor's or nurse's office so they can have some counseling," she said. While the program does not violate any rights, parents should know that such tests can produce false positive results, said Wendy Wagenheim, spokeswoman for the American Civil Liberties Union of Michigan.
    Drug Free America Inc. has distributed 14,000 drug screening kits to parents across the country since 1998, mostly in southern Florida. The tests are about 99 percent accurate. The organization funds the test through private donations and fund-raisers. And last year received its first government grant -- $40,000 from the State of Florida.
The name of the child being tested never leaves the home, assuming parents follow instructions. Before shipping, they are to affix a sticker with a numerical code on the container of urine. The child's name is not included. Two weeks after shipping, parents call a toll-free number to hear the test results associated with their child's number.
About 23 percent of Drug Free America Inc. tests come back positive, said Dr. Doug Smith, who founded the organization.
    Smith began raising money for the drug tests after treating hundreds of drug-addicted teens in Florida emergency rooms. He donates the tests to police departments, school districts and community organizations. Smith keeps a drug screening kit on top of his refrigerator at home, and said he wouldn't hesitate to use it on his 14-year-old son. "It's kind of like having a highway patrol man on the interstate," Smith said. "If you just see him, you slow down." The Plymouth Township Police Department has the drug test kit available at the front desk at the police station on Lilley Road. Although they're intended for township residents, Tiderington said he will not turn anyone away.

Prominent Expert to Testify in Yates Trial
Carol Christian, Houston Chronicle- 1/4/2002

To bolster their case that Andrea Pia Yates was sane when she drowned her children in the family bathtub, Harris County prosecutors have turned to one of the nation's most prominent, formidable and controversial forensic psychiatrists. Dr. Park Dietz, who earned a name for himself in high-profile cases such as those of would-be presidential assassin John Hinckley, Milwaukee serial killer Jeffrey Dahmer and Unabomber Theodore Kaczynski, is expected to testify in Yates' upcoming trial. Jury selection begins Monday.
    A professor of psychiatry at the University of California at Los Angeles School of Medicine and technical adviser to the television drama Law and Order, Dietz spent two days interviewing Yates in the Harris County Jail in November. At least part of the interview was videotaped. His testimony could be crucial as prosecutors rebut the claims of defense attorneys that the stay-at-home mom from Clear Lake should be found not guilty because she was insane at the time of the June 20 slayings. That could be a matter of life and death because the district attorney's office will seek lethal injection if Yates is convicted of capital murder. Dietz's detractors say he almost always concludes that defendants -- no matter how horrendous their crimes -- were sane when they committed them.
    Defense lawyer George Parnham said in a Dec. 3 hearing before state District Judge Belinda Hill that Dietz gave an oral opinion that Yates was sane on June 20 when she drowned her five children. Prosecutor Joe Owmby responded that he did not know how Parnham knew what Dietz had found, but the matter was not discussed further in the hearing.
    Based in Newport Beach, Calif., Dietz, 53, has interviewed hundreds of defendants of questionable sanity. His standard fee is $600 an hour, but he typically gives government agencies a discount, a spokeswoman said.  Because of the upcoming trial, Dietz declined to be interviewed for this story. Testimony is expected to start Feb. 11. Owmby said last week that the district attorney's office had paid Dietz $650 to date. That covered initial conversations and some review of records before the psychiatrist came to Houston. Owmby said he could not discuss Dietz's hourly rate or what his total bill might be, because that is expected to come up during the trial. Lawyers and witnesses are under order by Hill not to discuss the case.
    One of the cases that Dietz lists on his résumé is that of Susan Smith of Union, S.C., who killed her two young sons in October 1994. She sent her car rolling into a lake with the boys strapped in their car seats. Convicted in July 1995 at age 23, she could have received the death penalty but is serving a life prison sentence. Smith's defense attorney, David Bruck, recalled in a recent telephone interview that although Dietz did not testify at Smith's trial, he appeared to be working closely with prosecutors and even "orchestrating" some aspects of the prosecution.
    Bruck, an attorney in private practice in Columbia, S.C., who consults court-appointed attorneys in federal death penalty cases, said he disagreed with Dietz's approach. "He has a peculiar method, which is unfair and misleading but is extremely effective," said Bruck, who has specialized for 22 years in the defense of capital cases. "He makes an extremely detailed study of the defendant's actions surrounding the crime. "Then he emphasizes to the jury everything that the defendant did, while he minimizes what was going on in the defendant's mind. He tends to substitute one for the other."  For example, if a gun was the murder weapon, Dietz, a skilled marksman, will use it at a firing range.  "He knows exactly what it felt like to pull the trigger, how much force was used, what's required to cock it," Bruck said. "How many psychiatrists will do that? Juries eat that up." Dietz is the forensic psychiatrist for both the FBI's Profiling and Behavioral Assessment Unit and the New York State Police Forensic Sciences Unit. He was a consultant in the case against Kaczynski, who pleaded guilty before going to trial. To gather information, Dietz bought snowshoes and walked around in the snow by Kaczynski's cabin, Bruck said.
    Although Bruck has never heard Dietz testify in court, he said he has studied the psychiatrist's method as part of his work with a government-funded consulting service for court-appointed lawyers in federal death penalty cases.  In that role, Bruck said, he has seen videos of Dietz's testimony and has read portions of roughly a dozen of his trial transcripts. "I've made it my business to watch how he works," he said.  Dietz's "seductively simple" testimony, Bruck said, invites the jury to forget about the complexities of mental illness and the tremendous difficulty of understanding what it is like to be mentally ill. The jury that heard the evidence against Dahmer in 1992 agreed with Dietz that the sexual serial killer who ate some of his victims was sane. Even Dahmer's attorney, Gerald Boyle of Milwaukee, was impressed with Dietz. "He is an unbelievable expert, somebody whom I have a great deal of respect for, despite the fact he disagreed with our experts in Dahmer," Boyle said in a telephone interview. "I tell anybody who's going to be on the opposite side, they'd best be prepared."
    Dietz is such a formidable opponent because he is a skilled professional, Boyle said. Although Dietz usually testifies for the prosecution, it doesn't mean he's "bought and paid for," Boyle said. "Usually when there's an expert out there who's on one side to the exclusion of the other, it means they're pretty much nonobjective," Boyle said. "I don't think that could possibly be said of the doctors in our case."  A motion filed by Yates' husband, Russell Yates, derided Dietz as "the so-called state's expert" who is not a "treating physician." "He is a `testifying doctor' (and television personality), who lives in California," stated the Dec. 3 motion, in which Russell Yates asked to be released from Hill's order not to discuss the case. Among five concerns listed in the motion was the fact that the prosecution did not request a psychiatric evaluation of Yates until four months after the children died and three months after she was indicted. Hill denied the request.
    A native of Camp Hill, Pa., Dietz holds a medical degree, a doctorate in sociology and a master's degree in public health, all from Johns Hopkins University in Baltimore. A past president of the American Academy of Psychiatry and the Law, Dietz has taught at the University of Virginia and Harvard Medical School. He is the founder and head of Park Dietz & Associates, described as a "forensic litigation consulting firm," and Threat Assessment Group, a "violence-prevention consulting firm." Dietz has testified or consulted in all 50 states.
    He came to Houston 14 years ago to testify during the trial of a federal civil lawsuit against Soldier of Fortune magazine. Marjorie Eimann and her grandson, Gary Wayne Black, sued the magazine for $22.5 million in connection with the murder of Sandra Black of Bryan, Eimann's daughter and Gary Black's mother. Her husband, Robert V. Black Jr., had hired a hit man who advertised his services in the magazine. Before U.S. District Judge David Hittner, Dietz testified that Soldier of Fortune's classified ads catered to "lunatics" and "crackpots" and appealed to paranoid personalities, according to Chronicle reports. This should have been obvious to the publisher and made the magazine responsible for Black's death, Dietz said. The jury awarded $9.4 million, but the 5th U.S. Circuit Court of Appeals overturned the decision in 1989.
    Several months before he testified in February 1988, Dietz had gone to a Nevada convention of Soldier of Fortune subscribers to gather material for his testimony, according to a May 1994 article in the New Yorker magazine. He wore a camouflage suit so he could eavesdrop on conversations about the people "that are going to sue the magazine," the New Yorker reported. In the early days of the Branch Davidian siege, he was called to Waco and helped develop a profile of the group and its leader, David Koresh.
    Even with Dietz's credentials, he will have his work cut out for him in the Yates trial, Bruck said, because of the potential for the jury to empathize with a mother. "The overriding objective here is to rebut the notion that anyone who would do this must be crazy," Bruck said. "He's the man for the job."

Opposing Sides Seek Unalike Jurors
Lisa Teachey, Houston Chronicle- 1/4/2002

In picking a jury for Andrea Pia Yates' capital-murder trial, her defense attorneys and the prosecutors who want to send her to death row will be looking for certain traits. The Chronicle asked three jury experts -- local lawyer Stanley Schneider, jury consultant Robert Hirschhorn and psychologist Stacy Schreiber of the Institute of Trial Sciences Inc. -- to define some of the differences.
* Prosecutors do not want anyone who appears ambivalent about capital punishment. But they will have to overcome Yates' gender. Of the 455 people on Texas' death row, only eight are women. Only two women have been executed in Texas since the Civil War. They will want people who supported the 1998 execution of pick-ax murderer Karla Faye Tucker of Houston.
* Prosecutors also will seek people familiar with mental illness yet appalled that Yates' depression drove her to such extremes. They will be looking for people who say, "I have suffered a mental illness but I didn't kill anyone." Prosecutors will want parents, especially those with small children. They will want people who can distinguish between mental illness and the legal definition of insanity.
* The defense team's ideal jurors do not wholeheartedly support the death penalty but say they can follow the law to impose it if necessary. The defense will look for people who have had a difficult time with doctors and medical insurance companies. Russell Yates has indicated that his children would be alive today if his wife had received proper treatment. The defense will not want parents of small children. The defense will want people who believe mental illness can make a person do bad things out of their control. And they will look for people who are willing to consider the possibility that Yates suffers from a chemical imbalance. "I think they will be able to find them," Hirschhorn said. "But they will have to dig like they are searching for oil. All they need is one gusher, though."
* Neither side will want anyone who claims to want to be on the panel. The defense would be suspicious that the person is out simply to punish Yates. And the state would worry it was someone with a feminist agenda.

Lawyers to Interview Hundreds in Search for Jurors for Yates' Trial
Lisa Teachey, Houston Chronicle- 1/5/2002

The first act in what promises to be an unusually long and difficult legal drama opens in a Harris County courtroom Monday as lawyers begin the arduous task of picking a jury in the capital murder trial of the Clear Lake mother who drowned her children in the family bathtub. Prosecutors and defense lawyers will interview prospective jurors from what could be a pool of several hundred candidates in an effort to pick the 12 people who must evaluate the various, sometimes conflicting issues involved in the case of Andrea Pia Yates. That jury must rule whether Yates was legally insane, as she claims, or whether she is guilty of capital murder. If jurors agree to the latter, they then must decide if she should spend the rest of her life in prison or be put to death.  The weeks-long process to find a jury is expected to be even more tedious than in most death-penalty cases. Not only will each juror have to be open to the possibility of death as a punishment, each also will be scrutinized almost as much as Yates will be during the trial. Given the anticipated length of the exercise, testimony is not expected to begin until Feb. 11.
    In picking a jury, lawyers on both sides will want to know specifics about each candidate's life, moral beliefs and ability to follow the law. Prosecutors and defense attorneys are prohibited from discussing the case by order of the presiding judge. But experts in jury selection say other issues involved -- including relentless media coverage of the crimes, the public debate over whether husband Russell Yates should have done more to protect his children, the possibility of sending a woman to death row, the nuances of mental illness spurred by the birth of a child, the complexities of an insanity defense, and the societal pressure to avenge the deaths of five small children -- will make finding a dozen jurors plus alternates even more difficult.
    "Nothing is going to be easy for either side," said Stanley Schneider, a lawyer not connected with the case. "Both the state and defense are going to have a real tough time getting a jury. Everyone's going to have an opinion. Everyone's going to know things about this case." In addition, most people have had some experience with mental illness, whether they have suffered depression themselves or know someone undergoing therapy or being treated for alcohol abuse, Schneider said. Many parents have children on medication for hyperactivity or attention disorders. "The issues are universal," Schneider said. "People have been debating them since the day it happened." The lawyers must ferret out what opinions have already been formed and how those opinions affect where people fall on the emotional spectrum. Schneider described the two biggest emotional issues as competing factors: the loss of five children and sympathy for the distraught mother. "Which side controls the courtroom will be the key to this case," he said. "The prosecution wants the first. The defense wants the second."
    Robert Hirschhorn, a jury consultant who has advised defense attorneys for Terry Nichols in the Oklahoma City bombing case, lawyers for the Branch Davidians and prosecutors during the Whitewater investigation, said it is likely that jury selection could easily weed through as many as 500 people. Seating a jury in a potential death-penalty case is a long process that usually involves questioning dozens of candidates before each side agrees upon the final panel. State law mandates that it be that way because the stakes are so high. Each potential juror must be questioned individually to allow prosecutors, defense lawyers and the judge to determine if that person can follow the law, even if that means sending someone to death row. It also helps make the candidate comfortable answering such difficult questions.  For that reason, the pool called in for death-penalty cases is larger than for other felonies. "This one's going to be bigger than (normal)," Hirschhorn said. "They will probably (have to excuse) much of the pool because of the publicity factor alone. Then they'll lose another portion of those who do not believe in the death penalty."
    How exactly the Yates jury selection process will work has not been made public. In most death-penalty cases, though, the judge will call in about 60 to 80 people the first day and more afterward as needed. The judge will reiterate that defendants are presumed innocent and that the state has the burden of proving otherwise. She will explain that a capital murder case is conducted in two phases: the first to determine if the defendant is guilty and a second phase, if necessary, to set the punishment. In this case, the judge also must explain what an insanity defense means. If anyone in the group is adamant about not being able to understand or follow the law on any of those issues, the judge will dismiss him or her.
    Under Texas law, a jury can find Yates legally insane only if they believe she had a severe mental disorder and could not tell right from wrong at the time she killed the children. The law forbids the judge from telling jurors what will happen to Yates if she is found to have been insane. That issue has been a point of concern for Yates' lawyers, George Parnham and Wendell Odom. State District Judge Belinda Hill has denied their motions that sought to inform jurors that in some cases a person found to have been insane was confined in an institution for years.
    State District Judge Bill Harmon, who oversaw the death-penalty conviction of serial killer Angel Maturino Resendiz, said the law "could not be more clear" about withholding such information from the jury. Harmon said he had no difficulty explaining the law to jurors. Maturino Resendiz, who has admitted to at least 19 slayings in Texas and across the country, was sentenced to death despite his insanity defense for the 1998 murder of West University Place physician Claudia Benton. "Most people know it is fundamentally unfair to find a person guilty of capital murder -- even though they think the person is insane -- just because they don't know what was going to happen," Harmon said. "A few will not understand, but we can usually identify them and excuse them."
    The lawyers for both sides select which ones they want to talk to individually. That selection is determined from answers to a questionnaire compiled by the prosecution and defense. The questionnaire asks not only about a person's vital statistics and prior jury service but also about whether one has been a victim of crime or knows someone who has, whether one has had a bad experience with the criminal-justice system and how one feels about the death penalty, mental illness and other issues. The questions do not refer to the current case specifically.
    Harmon said, in his experience, the lawyers usually agree to talk to about a dozen from the original group and probably only those who stated on the questionnaires that they were neither generally opposed to nor in favor of the death penalty and could consider all the penalties provided by law and the facts of the case. But claiming to be against the death penalty under any circumstance will not be an easy ticket out of the courtroom.
    Hirschhorn said the process is structured that way because a person may tell the judge one thing during the group discussion yet give a different answer to the same question rephrased by a lawyer. It is the judge's job to sort out what the person is really saying. Each side will have unlimited chances to ask the judge to eliminate candidates "for cause," because their answers appear to be in conflict with the law or their opinions would make them unable to be fair. Hirschhorn said some judges may try to straighten out the discrepancies, while others simply excuse the candidates.
    Because there has been so much publicity about the Yates case, everyone in the pool of potential jurors will have heard something about the case, Hirschhorn said. "The ones who have read everything should be excused," Hirschhorn said. "But many will have just heard things and won't know all the details. That's who is going to end up on the panel." By the same token, Hirschhorn said, neither side will necessarily be able to dismiss anyone who watched a CBS-TV 60 Minutes broadcast last month that aired interviews with Russell Yates and Harris County District Attorney Chuck Rosenthal and prompted Hill to appoint a special prosecutor to determine whether her gag order was violated. "If they formed an opinion after watching it, then they should be excused," Hirschhorn said. "Whether people will admit to that in front of a judge is another question." Likewise, just because someone has suffered a mental illness, or knows someone who has, also will not lead to automatic dismissal. Hirschhorn said it depends on how that person has been affected. The lawyers must try to ascertain if the person is answering truthfully.
    Each side will be allowed to summarily disqualify up to 15 people for any reason other than race or gender. For example, if the judge refuses to dismiss a juror who is hesitant about the death penalty but says he could vote for it if he had to, prosecutors could use one of their discretionary strikes to eliminate him. A defense attorney could do the same with a juror who seems pro-police. But lawyers on both sides will have to go with their instinct as well, Hirschhorn said. That is because even though people say they can follow the law and be fair, they probably have some sort of opinion formed already.
    Prosecutors Joe Owmby and Kaylynn Williford have at least one advantage: Everyone who makes the final cut must be willing to at least consider the death penalty. Schneider said those people tend to see things as black and white and are less likely to be swayed by an insanity claim. The defense team's main objective will be to educate the jury on what mental illness is and how it affects people, Hirschhorn said.   "Most people, especially a death-qualified jury, think the insanity defense is a bunch of hooey. The defense will have to focus on what insanity is. Was it a crime at that moment?" Hirschhorn said. "Everyone's had experiences where they just snapped, then came back. The defense should get the potential jurors to talk about that. That will get the jurors on the road to an insanity defense. If the defense can get jurors thinking like that, they will be on the way to getting a verdict that will save their client's life."
    Each side is looking for something totally different in a juror. The trick will be finding someone who is middle-of-the-road and then swaying that juror during the trial itself. "But both sides are in a Catch-22," said Stacy Schreiber, a psychologist who heads the Institute of Trial Sciences, which specializes in litigation psychology. During jury selection, the defense needs to convince the anti-death-penalty juror that he really could consider it for certain cases, Schreiber said. "That will seem like the defense is arguing against its own case, but they will want that juror because that juror will be more willing to consider mental illness and less likely to eventually assess the death penalty," Schreiber said.
    Conversely, although the state doesn't really want someone on the panel who has suffered a mental illness, during jury selection prosecutors may look like that is exactly who they are after, Schreiber said. "Hopefully what you end up with is a jury that can really give full consideration to the guilt-innocence phase and the punishment phase as well," Hirschhorn said. "But the emotional nature of the case will extract a heavy toll on the panel. I do not envy this jury."
    Complete List of Houston Chronicle Articles on the Yates' Trial:    
     www.chron.com/content/chronicle/special/01/drownings/index.html

Seattle Home Offers to Take Teen Sex Offender
Seattle Post-Intellingencer, 1/5/2002

A 13-year-old sex offender who spends his days in a Child Protective Services office and his nights guarded by Island County sheriff's deputies could find a home and mental health care in Seattle. The Seattle Children's Home is willing to accept Nicholas Stroeder for treatment at its McGraw Center, which provides 24-hour care for severely disturbed adolescents. The offer was made under two conditions: The teen would need one-on-one staffing around the clock, and the center would need to receive the standard state reimbursement rate for that care.
    Children's Home President R. David Cousineau made the written offer to the state Department of Social and Health Services yesterday, and expects the agency to consider it over the weekend, as well as other options such as sending Stroeder out of state. DSHS officials couldn't be reached for comment.
    Stroeder was convicted of attempted rape at a Lynnwood mall last year, and has been accused of sexual assaults on children in foster homes. The state has been unable to find a foster family for him, and his legal guardian is ill.  Island County sheriff's deputies guard him at night at a juvenile respite home in Everett, and he spends his days in the Oak Harbor CPS office, a situation that Island County Sheriff Mike Hawley said is a community danger. Hawley classified Stroeder as a Level III sex offender, the most likely to re-offend.
    Guarding Stroeder now costs an estimated $28,800 per month. Cousineau did not have precise estimates for his costs at the Children's Home, but said it would likely be between $350 and $425 per day, including psychiatric treatment. Cousineau said yesterday that the home's two psychiatrists have treated Stroeder in the past, and his staff is "very willing" to establish a long-term treatment plan for him. Stroeder is "a difficult kid who has done bad things, and he is a danger," Cousineau said yesterday. But he needs professional help, not just baby sitters, Cousineau said.

Vermont Cities Drop Plans for Methadone Clinics
Associated Press, 1/6/2002

MONTPELIER, Vt. -- Rutland and Brattleboro have dropped plans to set up methadone clinics to treat heroin addicts because of a lack of funding. Representatives from Rutland Regional Medical Center and the Brattleboro Retreat said they had abandoned bids to establish methadone maintenance programs after the state lowered the rate it would reimburse the hospitals for the service. ''It can't be done for the amount of money they're offering,'' said Rutland hospital president Thomas Huebner.
    For months, the two hospitals have been negotiating with the Vermont Health Department for an acceptable rate at which the state would fund the them for hosting the programs. The negotiations collapsed in recent months when the state lowered the amount it was willing to pay, hospital officials said. ''The rates that the state proposed over the summer the rates we accepted were the same that the state pays to treat people who are addicted to alcohol or other drugs,'' said Jerry Caltrider, vice president of patient care at the Retreat. ''I don't understand how anyone can effectively treat people addicted to heroin and opiates for less.'' The state offered a rate of $25 per dose or $175 a week in the summer, according to the department's application for opiate treatment sent to interested hospitals. That rate abruptly changed to $135 per week in the fall, officials said.
    The news that the programs were dropped was welcome in some corners of the state and a dreaded in others.  Melissa Hayden of Rutland First, a local group that launched an opposition campaign against a methadone maintenance program in the Rutland community, celebrated the decision. ''That's great. That was the goal,'' said Hayden, who is chairwoman of the group. ''Rutland First is looking at the whole community, people who live here and work here who aren't addicted. There are more of them than there are heroin addicts. There are heroin addicts that need help, but not at the expense of the whole community.'' One of the chief concerns of the group was that the program would compromise the quality of life in the area by attracting addicts and dealers.   Meanwhile, Alice Diorio, an advocate of using methadone maintenance treatment to ease the withdrawal symptoms from heroin, described the news as a setback that compromised the health of a growing number of Vermont addicts.  ''I'm just so disappointed,'' she said. ''This is medication that works. What is it going to take? How many people have to die? What kind of leadership does it take?''
    The creation of methadone maintenance programs in Vermont has been controversial since the beginning. In 2000, the Legislature passed a law allowing the synthetic narcotic to be used to wean addicts off heroin and other opiates. That law passed despite Governor Dean's opposition to the practice. Dean relented as long as the programs were housed in hospitals. Shortly thereafter, the heroin problem in Vermont developed into a pressing political issue with teen-agers dying from the drug and more crime attributed to it. Dean eventually approved language in the budget last year that permitted hospitals to locate the programs off-campus as long as the state approved of the location and allowed the state to negotiate a reimbursement rate to the hospitals. Fletcher Allen Health Care in Burlington is still working with the Howard Center for Human Services on a proposal to host a methadone clinic, said Fletcher Allen spokesman Mike Noble.

Kentucky Domestic Abuse Ruling Stuns Advocates
Francis X. Clines, New York Times- 1/7/2002

LEXINGTON, Ky. -- The violent arena of domestic abuse litigation has grown a bit more volatile after a judge placed two women in contempt of court for having contact with their partners. Some advocates for battered women are surprised by the decision. "You can't have it both ways," Judge Megan Lake Thornton of Fayette District Court said in her ruling. She has levied fines of $100 and $200 in recent weeks against the two women, who had obtained emergency protection orders forbidding future contact with their partners. However, they later contacted the men. Thornton also cited the men for contempt. "It drives me nuts when people just decide to do whatever they want," said the judge, who is experienced in Kentucky's thick domestic abuse docket, which produces nearly 30,000 emergency protection orders a year.
    State officials call the situation a virtual epidemic of abusive relationships in the state. Thornton's ruling has alarmed advocates for battered women, who plan to appeal it. The advocates say that the finding goes beyond existing law and is unrealistic because some renewed contacts often prove unavoidable in domestic abuse cases, which involve economic and family dependencies among the issues.

State backs advocates
The state office on domestic violence agrees with them, warning that the ruling could cause abused women to hesitate in bringing their plight before the courts for fear of being chastised for their trouble. "The reality is it's easy to say they should never have contact," said Sherry Currens, executive director of the Kentucky Domestic Violence Association, an advocacy and legal protection group. "But we're talking about people in long-term relationships. They may have children in common," she said. "It's pretty hard to say, `Never speak again.' People have financial difficulties. They may love the partner. It's not an easy thing."
    But Thornton declared in court: "When these orders are entered, you don't just do whatever you damn well please and ignore them." The ruling stunned Cindra Walker, the two women's lawyer at the Central Kentucky Legal Services, which represents many indigent women caught in abusive relationships. "For over five years, I've been in court practically every day on these abuse cases, and I've never before had a victim threatened with contempt," Walker said. "The domestic violence law is a tool for victims to use to be safe," not a device to punish them, she said. Thornton's office said the judge could not comment on the pending cases under judicial rules. But her two rulings made clear that she expected the original protection orders against all contact to apply equally to the person suspected of abuse and the abused.
    Carol Jordan, director of the Governor's Office of Child Abuse and Domestic Violence, said she disagrees with the ruling even though she sympathized with the professionals overseeing violent domestic situations. "These are tough cases for judges," she said. "They are dealing with complex human emotions. They are dealing with danger." If the ruling stands, Jordan warned, some abused women might conclude that they would not be treated fairly if they ever gain the courage to seek refuge in the courts. This sort of ruling "absolutely increases abused women's level of risk" by seemingly encouraging their abusers, she noted.
    In Kentucky, as in most of the United States, abuse victims have increasingly turned to the courts as protection orders have become more accepted, said Billie Lee Dunford-Jackson of the National Council of Juvenile and Family Court Judges. Most judges "have been making clear to the batterers that the issue is between the state courts and them," rather than a domestic issue between two parties, said Dunford-Jackson, assistant director of family violence law and policy. A "sizable minority" of judges may still equate the conflicting parties in their rulings, she added, but recent state laws have put the focus on violent abuse as the main problem requiring protection for victims. Walker's two clients declined to be interviewed.

`Chilling effect' is a concern
"Our big concern now is the chilling effect this will have," said Walker, one of two legal service lawyers handling hundreds of abuse cases in 17 counties in Kentucky. The state Legislature considered a proposal in 2000 that would have specified that the orders of protection applied equally to the person accused of abuse as well as the victim, Jordan noted. But it never passed. The notion of mutual protection equating the two parties is not part of Kentucky law, Jordan said. Thornton's ruling, she added, if extended in that direction, would "establish a barrier that stops abused women from seeking protection of the courts."

Illinois Divorce Court Aims to Keep Cost Down
Kevin Lynch, Chicago Tribune- 1/7/2002

As an assistant at a Wheaton law firm, Debra Barnel is well aware of the going rates for legal advice, which explains why she jumped at the chance to represent herself in a Kane County night court set aside for divorce cases. The sessions, which began in November, are for people who want to handle their divorce cases without attorneys. They were established to make divorce more affordable and convenient, judges said. "Lawyers around here generally get around $200 an hour. Then you've got to come up with a retainer. If they're coming from DuPage County, you're going to get charged for travel time," said Barnel, who recently appeared in night court seeking an order to lower her former husband's child-support payments. "Here I am trying to give him a break so he can keep making his payments, and I would have ended up paying $600 or $700 in legal fees just to get an order that we've both agreed to," said Barnel. Instead she had only to leave work an hour early to keep her court date. Sessions begin at 4:30 p.m. every Wednesday in the Kane County Judicial Center in St. Charles.
    The divorce court was designed to address common complaints about the high cost of hiring a lawyer and the difficulty of getting time off work, said Judge F. Keith Brown, who presides over Kane County's family law division. "A lot of people get so focused on divorce issues, they find they can't concentrate at work. But if you have to take time off, that puts even more pressure on the employee. ... I've seen people lose jobs because they came to court," Brown said.
    But attorney Steven Peskind, chairman of the Kane County Bar Association's family law committee, said handling a divorce without an attorney can be "legal suicide." "There are some things you can do on your own, but it's really a terrible idea if you have any children or assets," Peskind said. Brown agreed contentious divorces are best left to lawyers but noted that many people can't afford representation. "I'm not here to discourage people from hiring attorneys, but sometimes it's just not practical. These cases can go on until the kids are out of college, and some of these people get wiped out by big legal bills," Brown said.
    Kane County's night court divorce cases are heard on a rotating basis by Judges Brown, Karen Simpson and Steven Sullivan. Other Kane County judges also hold special Wednesday night sessions for child support cases and therapeutic drug court. DuPage County holds an afternoon bond court, and Cook County has three night courts to handle criminal drug cases. But court officials in several circuits said they have nothing like Kane County's divorce night.
    A benefit of the nighttime, lawyer-free atmosphere of the court, Brown said, is judges can take more time to explain procedure to the non-lawyers who appear before them. Former spouses, in turn, are grateful for the chance to talk directly to the judge and tell their stories in their own words, Brown said. "It's like `The People's Court.' The rules of evidence are still in effect, but we loosen it up a little bit," Brown said.
    In a typical night court session, the judge will hear about 15 divorce cases in three to four hours. Most of the hearings are for undisputed minor adjustments to existing divorce agreements. During an unusually light session recently, Simpson heard seven cases in a little more than two hours. One man who had just lost his job asked Simpson to reduce his child-support payments. His ex-wife was not present, but he assured the judge she had agreed to the change. Simpson reluctantly ordered the change with the understanding the man would provide documentation of his ex-wife's consent later. "I'm going to lower the child-support order temporarily," Simpson told the man, but I'm also going to enter an order that says you have to look for a job."
    In another case Nancy and Gerardo Martinez agreed that he would begin paying $30 a week more to support their 13-year-old son. "Before night court you had to take a vacation day or a personal day to get off work," said Nancy Martinez of Aurora, a collections agent for a medical supplies distributor. "I'd rather spend that time with my son."

Study Finds Wide Geographic Variations in Prescription Drug Use
Associated Press, 1/7/2002

ST. LOUIS -- A study released Monday by a drug-benefit management company found wide geographic variations in the use of prescription drugs in 2000, raising questions about access to drugs and whether their use in some cases may be unnecessary. The study, conducted by St. Louis-based drug-benefit manager Express Scripts Inc., looked at more than 720,000 prescription-drug claims made to the company, as well as among separate classes of drugs, such as antibiotics and estrogen.
    It found that adults in Kentucky who had health insurance plans with a drug benefit managed by Express Scripts led the nation in prescription drug use in 2000, at 12.2 average prescriptions per adult. New York, with 8.3 average prescriptions per adult, filled the least. More than 40 million Americans are members of a benefit plan managed by Express Scripts. The study also found that 70.6 percent of adults in Kansas received at least one prescription in 2000, the nation's highest rate, compared to the national low in California of 57.9 percent.
    Brenda Motheral, one of the study's authors, said the results demand further research into who or what is driving prescription drug use. "Are (patients) actually being fully informed and this variation reflects preferences across the country, or does it more reflect the preference of physicians?" she said while discussing variation in estrogen use.  The study is believed to be the first to research geographic variation in prescriptions so extensively. Long-standing research into the use of surgical procedures has found similar geographic variations.
    The data is based on Express Scripts prescription claims, limiting it to children (up to age 17) and adults (18-64) who receive prescription drug coverage through a plan administered by the company. It does not consider the drug-use trends of seniors, who usually receive health benefits through Medicare and Medicaid. "That is a larger database than anyone has ever had to do this kind of work," said Deborah A. Freund, vice chancellor for academic affairs and provost of Syracuse University and an expert on prescription drugs. "This is a very significant study in that regard."
    The study found:
--Among adults, prescription drug use is generally highest in the south and midwest, led by Kansas (70.6 percent with at least one prescription), Michigan (70.2), Utah (69.6), Kentucky (69) and Louisiana (69). It was lowest in New York (58.9), Arizona (58.7), Wisconsin (58.7), Oregon (58.4) and California (57.9).
-- Among children, use was highest in Louisiana (64.5), Kentucky (64.3), Kansas (63.2), Missouri (63.1), and Michigan (62.8); use was lowest in Wisconsin (52.4), Colorado (51.9), Washington (51.2), California (50.6) and Arizona (48.5).
--Variation in cough/cold/allergy prescriptions ranged from highest in Louisiana (23.2 percent of adults with at least one prescription) to Maine (7.8) and Vermont (7.5). In calcium-channel blockers, use was spread from a high of 5.3 percent in South Carolina to a low of 1.3 percent in Oregon.
    "If this actually means that there is overuse in some regions and underuse in other regions on average, then I would be alarmed for people living in those regions," Freund said. "Some people may not be getting the drug that would do them the best for the condition they would have, while, of course, over-treatment comes with side effects," she said.
    The study does not provide any specific explanations for the variations, something Motheral said would require further investigation. But some explanations appear obvious, she said. "When we looked at risk of heart disease, it was highly correlated with cardiovascular drug use," Motheral said. "In the south, where we saw much higher use of these medications, we also know there is a higher risk of heart disease."
    Freund suggested the way in which health-insurance providers manage their prescription-drug benefits, such as whether to cover certain drugs, especially newer and more expensive medications, could also contribute to the variations. The cost of co-payments or full charges for drugs that are not covered could also affect a patient's decision to fill a prescription, she said. "I would want to do more studies to find out if this is an access problem," Freund said, "if this has to due with the nature of the benefits package and how it is administered, or whether it simply has to do with physicians choosing to use different drugs in different ways."

Experts Say Bishop Case May Help Them Understand Teen Suicide
Jeff Carpenter, ABC News- 1/7/2002

What drove 15-year-old Charles Bishop to crash a plane into a Florida high-rise may never be known, but experts say there's much that can be learned about his likely state of mind, and those insights may shed light on the broader problems of teen violence and suicide. Bishop died Saturday when he slammed a stolen airplane into an office building in downtown Tampa. A suicide note he left behind expressed sympathy for Osama bin Laden, law enforcement officials said.
    Police have called Bishop a troubled young man, but one of his teachers, Gabriella Terry, described him as "very sociable, very active in class." Dr. David Shaffer, a child psychiatrist at Columbia University in New York, believes it may be possible to diagnose any problems Bishop had. "You can patch together the kind of psychiatric diagnosis the kid had, usually without any difficulty," said Shaffer. "What you normally do, in the case of a 15-year-old, is you interview both parents separately, and you would also interview some teenagers — either a sibling or a friend who knew them well — and you would ask in a lot of detail about individual symptoms." Shaffer refers to this technique as a psychological autopsy, or a way to piece together the clues to a person's psyche after his death. "The context of the way he killed himself had to do with what was going on in the news. So in a way it's a little bit of a copycat," said Elaine Leader, a psychotherapist at Cedars-Sinai Medical Center in Los Angeles.

Identifying the Symptoms
Many experts believe the problem of teen suicide stems from mood disorders, such as depression. "Two-thirds of the kids who commit suicide have a mood disorder, primarily bipolar disorder or depression," said Dr. Eric Benjamin, a child psychiatrist at Phoenix Children's Hospital in Arizona. "There is that quiet small group of 10 to 20 percent of kids who everybody thought was a perfect student; they were quiet; they never said anything. A lot of these kids will get obsessed with perceived role models or heroes, and start living in their own world," he said. Psychiatrists estimate that as many as 8 percent of teenagers experience some form of depression. "[Depression] is not difficult to diagnose, but it typically goes unrecognized, because people chalk up most of this as just a phase of teenage behavior," said Dr. Robert Findling, the director of child and adolescent psychiatry at University Hospitals of Cleveland.
    Experts say that the warning signs of depression include: lack of energy, not enjoying things that used to be pleasurable, disturbed sleep patterns, loss of confidence, irritability and a tendency to be critical of self. "One by one, they may actually be fairly common, but when you get them all occurring at the same time, that would be less common and indicative of a depressed period," said Shaffer. One of the predictors of emotional problems is believed to be genetic, and can be traced back to other family members with psychological problems. "There is almost invariably a family history either in a first- or second-degree relative of some type of emotional problem," said Benjamin. Findling said that since depression goes undiagnosed in many adults, it is likely that most teenagers don't know there is a family history.

Yates Trial Gets Under Way
Carol Christian, Houston Chronicle- 1/7/2002

Eight of the first 60 potential jurors in the Andrea Pia Yates' trial said Monday they had so firmly made up their minds that they would not be swayed by evidence. State District Judge Belinda Hill asked who had formed an opinion about the Clear Lake mother accused of capital murder in connection with the drowning of her five children.
    When a woman in the front row raised her hand, Hill asked if it would influence her decision about the verdict. "I'm afraid it would," the woman said. "There's nothing that could be presented by way of evidence that could change your opinion?" Hill probed. "No, I'm sorry," the woman answered. "You don't need to apologize," Hill said. "Am I correct that you have formed an opinion about the guilt or innocence of Mrs. Yates and it would influence your verdict?" "Yes," the woman responded.
    Despite these opinions, no one was eliminated Monday from the jury pool. All 60 will now be questioned individually by prosecutors Joe Owmby and Kaylynn Williford and defense lawyers George Parnham and Wendell Odom. The individual interviews are required because Yates could receive a death sentence if convicted. Yates was in the courtroom dressed in a dark jumper and white top. In earlier court appearances, she wore orange jail clothes.
    When the judge introduced the defendant to potential jurors, Yates stood and smiled faintly. She was seated between her lawyers at a table shared by the prosecutors, facing the jury panel. Although somber and subdued, Yates appeared to follow the proceedings, turning her head in the direction of potential jurors as Hill questioned them.
    Nine of the 60 people are scheduled for individual interviews today. Between eight and 11 potential jurors are scheduled to be questioned individually each day through Jan. 15. If 12 jurors and an alternate are not selected by that date, another group will be assembled and additional jurors will be impaneled. Hill said she could "only guess" how long the jury selection would take but estimated that testimony might not start until Feb. 18 or 25. That schedule would include a week's break after the jury is seated to allow the lawyers time to prepare for the trial, she said.
    Monday's jury panel was seated in the courtroom at 301 San Jacinto after members had spent most of the morning filling out a lengthy questionnaire compiled by prosecutors and defense lawyers. While potential jurors filled out questionnaires, Hill took up motions that Parnham and Odom had filed last month. She denied their motions to suppress the grand jury indictment and to be allowed to tell potential jurors why the death penalty is inappropriate in Yates' case. Hill said she would rule this morning on a defense request for a chance to respond to comments made by Harris County District Attorney Chuck Rosenthal last month on a 60 Minutes broadcast.